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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by jealibeanz on February 27, 2007, at 14:29:42
OK, so I've been taking Xanax, 4 mg, q.i.d. for quite some time. Today, out of nowhere, my doctor has this wonderful idea to switch me to 3mg Xanax XR.
I've been taking Ritalin LA, 30mg, b.i.d., with no luck. It just doesn't seem to last very long. So my doc wanted to add Provigil in the middle of the day.
I wanted to ask him about switching to IR Ritalin or to another stimulant. I didn't want to try Xanax XR. I like to have the control that the IR Xanax gives me. Plus, I've never tried the XR version, so I don't know what I'm in for.
I don't think I'm metabolising the extended release drugs properly. I'm not sure why he's not coming to this conclusion on his own. However, I could suggest this because I am sick with a sinus infection and laryngitis. So I just don't have the energy or the literal voice to speak more than a few words, nor did I really care, because I just wanted to go home and lie down.
Sorry, just venting. I have recheck on March 15th, so I'll hopefully go back then with some feedback on his current treatment regime and my own ideas when I feel better.
Ughh... and to top it off, I think he was sort of hinting at the fact that I've gained a lot of weight by asking if I work out, since I used to be really thin. The stress eating has done me in. Yuck. :(
Posted by dbc on February 27, 2007, at 14:54:36
In reply to My latest cocktail..., posted by jealibeanz on February 27, 2007, at 14:29:42
Ritalin schmitalin, stop being a sissy and ask him for dexedrine. Its cheap, it has a better safety record and is a more potent CNS.
Posted by jealibeanz on February 27, 2007, at 15:08:18
In reply to Re: My latest cocktail..., posted by dbc on February 27, 2007, at 14:54:36
> Ritalin schmitalin, stop being a sissy and ask him for dexedrine. Its cheap, it has a better safety record and is a more potent CNS.
>Concerta and Ritalin LA seem to be my docs favorites! I guess they all have them, especially GP's.
I hate to "name drop", as if I'm drug-seeking and love to look up medical things (although he knows I'm getting a medical education, so wouldn't be surprised that I would be moderately aware of options and know enough to research a bit).
I'll ask about IR or switching stimulants. Make it known that I like real stimulants (lovvve coffee), not just wimpy ones like Provigil or Strattera, even though I've had mild success with both.
I'll mention to him again that I thought Adderall was the most stimulating. It just made me soo up and down and eventually depressed. I don't know if I was on XR or IR. I should actually ask that. Then ask if he thinks trying that again would be a good idea or if there are any other stimulants that people have success with.
I think he switched me to Xanax XR because he thought he was doing me a favor, since some people don't like to "pop pills" every few hours. That's not a problem with me right now. I'm a student. If I were working a full-time job with limited breaks it might be, but that's in the future. Hopefully by the wonder drugs will be out (laughs!).
I'm normally reallly good at collaborating with my doctor and getting what I want. I'm just so sick right now, I didn't have the ability.
Posted by laima on February 27, 2007, at 15:33:59
In reply to Re: My latest cocktail..., posted by jealibeanz on February 27, 2007, at 15:08:18
A few thoughts- you know, provigel can really last a very long time- why take it in the middle of the day?Also- I agree- ritalin and adderall and dex- all kind of different.
I found ritalin choppier than adderall, but more likely to induce activity. Also most likely to induce fixation if dose is too high. I've found Shire's adderall to be very smooth, calm, and even. No crash for me on this one. It also lasts longer than ritalin. I've tried a generic dexedrine (can't remember the brand), but what sticks in my mind about it was even the prescribed doses induced spells of near-euphoria. It was almost like an anti-anxiety med, in my case.
And don't even get me started on generic variations...so many versions!
Sorry your doctor seems so keen on the XR versions- I never cared for those myself- I never felt I got the full effect intended from any of them.
Posted by jealibeanz on February 27, 2007, at 15:48:44
In reply to Re: My latest cocktail..., posted by laima on February 27, 2007, at 15:33:59
I'm not sure he's terribly fixated on the Xanax XR. I've been taking daily Xanax since last May. I see him almost every month. This is the first time he ever thought of it. It actually would have been someone thing I would have considered initially and thought about it, just never did get the guts to ask him about it.
Now that I have been stable to brand name IR Xanax (yeah, I hate the variations in generics too!), I'm not eager to switch. I wasn't even going in complaining about anxiety or problems with Xanax and its coverage. He switched me to 4 times daily this fall. That would have been the time to think about XR, not now.
Anyway... yeah still need to think a bit more about my ADHD/fatigue meds.
I actually remember vaguely that Adderall made my anxiety worse, so I'm not sure it's a good option for me, plus it is what induced my worst depression of my life (in conjunction with Klonopin).
Posted by laima on February 27, 2007, at 16:16:58
In reply to Re: My latest cocktail..., posted by jealibeanz on February 27, 2007, at 15:48:44
Oh- sorry to hear adderall didn't work well for you. I did discover that the generic and brand versions acted very differently for me, very different effects, but I can understand your not wanting to go there again, anyway.Well- sounds like there are a few new ADD/stim meds coming along- what's that new vyvanase, for example?
I have an idea regarding your XR-enthused doctor though. I had some success deflecting XR suggestions by explaining how I prefer the shorter acting versions because I feel more in control of them, and because they seem to last longer than expected. This sort of reasoning might work especially well with stims, as you can explain you fear insomnia. Just a patient's strategy scheme I thought to toss out-
> I'm not sure he's terribly fixated on the Xanax XR. I've been taking daily Xanax since last May. I see him almost every month. This is the first time he ever thought of it. It actually would have been someone thing I would have considered initially and thought about it, just never did get the guts to ask him about it.
>
> Now that I have been stable to brand name IR Xanax (yeah, I hate the variations in generics too!), I'm not eager to switch. I wasn't even going in complaining about anxiety or problems with Xanax and its coverage. He switched me to 4 times daily this fall. That would have been the time to think about XR, not now.
>
> Anyway... yeah still need to think a bit more about my ADHD/fatigue meds.
>
> I actually remember vaguely that Adderall made my anxiety worse, so I'm not sure it's a good option for me, plus it is what induced my worst depression of my life (in conjunction with Klonopin).
Posted by jealibeanz on February 27, 2007, at 17:03:44
In reply to Re: My latest cocktail... » jealibeanz, posted by laima on February 27, 2007, at 16:16:58
>
> Oh- sorry to hear adderall didn't work well for you. I did discover that the generic and brand versions acted very differently for me, very different effects, but I can understand your not wanting to go there again, anyway.
>
> Well- sounds like there are a few new ADD/stim meds coming along- what's that new vyvanase, for example?
>
> I have an idea regarding your XR-enthused doctor though. I had some success deflecting XR suggestions by explaining how I prefer the shorter acting versions because I feel more in control of them, and because they seem to last longer than expected. This sort of reasoning might work especially well with stims, as you can explain you fear insomnia. Just a patient's strategy scheme I thought to toss out-
>
>
>
>
> > I'm not sure he's terribly fixated on the Xanax XR. I've been taking daily Xanax since last May. I see him almost every month. This is the first time he ever thought of it. It actually would have been someone thing I would have considered initially and thought about it, just never did get the guts to ask him about it.
> >
> > Now that I have been stable to brand name IR Xanax (yeah, I hate the variations in generics too!), I'm not eager to switch. I wasn't even going in complaining about anxiety or problems with Xanax and its coverage. He switched me to 4 times daily this fall. That would have been the time to think about XR, not now.
> >
> > Anyway... yeah still need to think a bit more about my ADHD/fatigue meds.
> >
> > I actually remember vaguely that Adderall made my anxiety worse, so I'm not sure it's a good option for me, plus it is what induced my worst depression of my life (in conjunction with Klonopin).
>
>That's a good idea. I do like control. The same way I like control with my Xanax. I no longer take it at specified times of the day, I take it when I need it. Some days I end up using more than others, but in the end it works out to the prescribed amount. He actually doesn't know that.
And to make matters worse... my Xanax XR is not brand name! Maybe he didn't know they came out with generic because once I asked him specifically for brand Xanax, he's been very careful to check DAW. Ughhh... oh well, oh 3 weeks til I go back.
Posted by Phillipa on February 27, 2007, at 21:17:14
In reply to Re: My latest cocktail..., posted by jealibeanz on February 27, 2007, at 17:03:44
I heard the long acting xanax doesn't release properly from my pdoc and she has to let people take the regular xanax in between doses. Doesn't make sense does it. But how does an ADD med and A downer like xanax work? Don't they counter each other? Love Phillipa I just don't understand the psychopharcology of these meds together.
Posted by med_empowered on February 28, 2007, at 3:13:28
In reply to Re: My latest cocktail..., posted by jealibeanz on February 27, 2007, at 17:03:44
With xanax, I imagine that you might be able to prevent tolerance/dose increase and reduce inter-dose anxiety if you went xr--then again, you could just switch to something else that lasted longer. So...maybe the xr will be OK. Have you tried a longer-acting benzo, w/ xanax as-needed?
I dont get the whole provigil in the middle of the day thing. It seems like it should be the other way around--start off w/ provigil+ stim, add in stim as needed. But...maybe it works? Provigil does have a long half-life, so one would think midday dosing could be problematic.
Posted by jealibeanz on February 28, 2007, at 4:36:06
In reply to Re: My latest cocktail... » jealibeanz, posted by Phillipa on February 27, 2007, at 21:17:14
> I heard the long acting xanax doesn't release properly from my pdoc and she has to let people take the regular xanax in between doses. Doesn't make sense does it. But how does an ADD med and A downer like xanax work? Don't they counter each other? Love Phillipa I just don't understand the psychopharcology of these meds together.
Good question. I have seen a few doctors who thought it was ridiculous for my to be taking a stimulant (Provigil and Straterra), a benzo (Klonopin... yuck!), and a sleep aid (Lunesta). If you're a doc who actually treats ADHD patients, you wouldn't be shocked to hear this or to prescribe the medications.In actuality, it's quite common. I had a classmate with ADHD. Anxiety and insomnia are very common comorbities with adults.
The medications work on different parts of the brains. For some people, these combs would be ridiculous and "cancel each other out", for others they work like a charm.
ADHD meds are stimulating. The amphetemine-like stims tend stimulate dopamine from the frontal cortex, some work in other areas. Straterra also is a norepinephrine reuptake inhibitor. Provigil is one of those "unknown mechanism" drugs. At one point that came out saying they had a theory, then retracted it. It does however promote wakefulness (and in my case, it increased anxiety, and I increased Xanax!).
But the fact that the ADHD meds may cause an increase in anxiety doesn't mean that they cancel out in meds, in just means that it's a side effect or that they are possibly uncovering an unlying anxiety disorder.
Benzo's, as I'm sure you know cause more GABA to stick around in the brain. They are anxiolytic and I believe target all regions of the brain.
In some very anxious people they may help concentration because the patient is no longer focusing on the nervous/racing thoughts. In others they may be counter-productive. I think Klonopin would be counter productive with me, because it just knocks me out cold, no matter the dose, and I feel "dumb".
Also, stimulants don't always last long enough for the to effect sleep. In my case, and in the case of many others, we "crash" in the late afternoon/evening when the stim wears off. Sleep aids are common because the patient suffers from anxiety-related insomnia and racing thoughts (probably for that unorganized ADHD brain that bolts around from idea to idea). But in my opinion, the insomnia is rarely caused by the stimulant.
Does this make sense and help?!
Posted by jealibeanz on February 28, 2007, at 4:59:12
In reply to Re: My latest cocktail..., posted by med_empowered on February 28, 2007, at 3:13:28
K, I'm starting a new thread about my Xanax issues!
Posted by laima on February 28, 2007, at 8:41:23
In reply to Re: My latest cocktail..., posted by jealibeanz on February 28, 2007, at 4:36:06
As for how long stims last, you know, provigel lasts a LOOOOOOONG time. Like AAAAAALLLLL day.
Posted by jealibeanz on February 28, 2007, at 14:41:40
In reply to Re: My latest cocktail... » jealibeanz, posted by laima on February 28, 2007, at 8:41:23
>
> As for how long stims last, you know, provigel lasts a LOOOOOOONG time. Like AAAAAALLLLL day.Yes, Provigil does work for a long time. I have it prescribed currently as 200mg, b.i.d. Right now I feel great. However, after a few months, it tends to lose its efficacy. I guess I'm someone who has to play the med switch-up game constantly.
Posted by laima on March 1, 2007, at 9:31:08
In reply to Re: My latest cocktail..., posted by jealibeanz on February 28, 2007, at 14:41:40
Or maybe rotate?> Yes, Provigil does work for a long time. I have it prescribed currently as 200mg, b.i.d. Right now I feel great. However, after a few months, it tends to lose its efficacy. I guess I'm someone who has to play the med switch-up game constantly.
Posted by jealibeanz on March 2, 2007, at 5:35:12
In reply to Re: My latest cocktail... » jealibeanz, posted by laima on March 1, 2007, at 9:31:08
>
> Or maybe rotate?
>
> > Yes, Provigil does work for a long time. I have it prescribed currently as 200mg, b.i.d. Right now I feel great. However, after a few months, it tends to lose its efficacy. I guess I'm someone who has to play the med switch-up game constantly.
>
>Rotate? You mean daily? That might cause some major mood changes. I don't know.
I think I'll have to ask him about switching the Ritalin LA to some other stimulant. I'll stress the fact that the Provigil is keeping me awake right now, but the Ritalin seems worthless and doesn't help with concentration and studying. I suppose this is where an immediate-release drug might help. Adderall did, but also made me crazy. Strattera helped with overall organization and structure in my daily life, but also did not help with me sitting down to study and read my text books (even when motivated).
Posted by laima on March 2, 2007, at 12:46:52
In reply to Re: My latest cocktail..., posted by jealibeanz on March 2, 2007, at 5:35:12
Gosh no, not daily! I meant it as a possibility, if doctor thinks it's a good idea, after a year or two-whenever it just plain doesn't work anymore. No, don't think sudden and frequent med changes are great idea. Sorry to be confusing.
>
>
> Rotate? You mean daily? That might cause some major mood changes. I don't know.
>
> I think I'll have to ask him about switching the Ritalin LA to some other stimulant. I'll stress the fact that the Provigil is keeping me awake right now, but the Ritalin seems worthless and doesn't help with concentration and studying. I suppose this is where an immediate-release drug might help. Adderall did, but also made me crazy. Strattera helped with overall organization and structure in my daily life, but also did not help with me sitting down to study and read my text books (even when motivated).
>
Posted by jealibeanz on March 4, 2007, at 6:49:55
In reply to Re: My latest cocktail... » jealibeanz, posted by laima on March 2, 2007, at 12:46:52
>
> Gosh no, not daily! I meant it as a possibility, if doctor thinks it's a good idea, after a year or two-whenever it just plain doesn't work anymore. No, don't think sudden and frequent med changes are great idea. Sorry to be confusing.
>
>
> >
> >
> > Rotate? You mean daily? That might cause some major mood changes. I don't know.
> >
> > I think I'll have to ask him about switching the Ritalin LA to some other stimulant. I'll stress the fact that the Provigil is keeping me awake right now, but the Ritalin seems worthless and doesn't help with concentration and studying. I suppose this is where an immediate-release drug might help. Adderall did, but also made me crazy. Strattera helped with overall organization and structure in my daily life, but also did not help with me sitting down to study and read my text books (even when motivated).
> >
>
>Haha! OK, I thought that you were going a little med-crazy there! Of course daily switching would make me unstable!
The last time I took this dose of Provigil was beginning in September and ended in November. It just suddenly lost its effectiveness after 3 months. It was great at first. It's great now.
It's too bad I can't find something I can stick with. I feel like a freak or an annoyance sometimes when I have to go to my doctor (a GP) at least once a month to make constant changes. Even when I think something is going well and I'm getting close to finding a med-cocktail that works OK for me, I end up having some problem and we end up making adjustments and switching.
It sucks, haha.
At least my doc is very kind and caring and patient. I don't know what I would do without him... probably give up and live an even lower-quality life. I know he and all family docs have such limited time and can be frustrated when something doesn't work.
I think I, along with the others on this message board, are patients who demand and expect optimal treatment. A lot of people who just keep taking meds, without much question, but I don't.
I suppose there's hope with future drugs. My problem is that I may need to switch things up, but I seem to be running out of options. There isn't really any equivalent of Provigil availble right now. There are other stims though, and a few new ones being released.
Stupid comorbidities... it would be easier if I didn't have ADHD, extreme fatigue, GAD, insomnia, depression, allergies, acne... haha all difficult to treat on their own in a 10 minute appointment. Together, it's a lot to handle. I think right now I have 9 monthly scripts... thank god for good health and insurance and very low co-pays (which I will lose this December... off my parents plan... I'm screwed!)
I think I'm lucky though... my doc spends a few more minutes than he should with me because we talk too much!
This is the end of the thread.
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