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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by zonked on March 18, 2016, at 17:43:33
Hi: SLS and everyone else,
Graduated from the dual diagnosis rehab with flying colors. I don't even smoke cigarettes anymore. Today's my last 7mg patch!
My ADHD symptoms:
That is....:
disorganization, inattentiveness, impulsiveness, washing the same dish over and over, taking 3 hours to unpack my stuff which would take most people an hour, losing things/leaving things lying around, fidgeting/trouble staying still, overfocus on things of interest, "spacing out", putting milk in a cupboard instead of the refrigerator, unconsciously/unintentionally provoking arguments/drama to get my adrenaline up (low baseline level of arousal), clutter/hoarding, caffeine cravings, mental disorganization (i.e. not knowing instinctively how much time to devote to a given activity and thus wasting time), very low working memory (like low RAM in a computer), etc etc....
Whew. Are unresolved without my Focalin XR. In fact I think after my insurance changed after moving, not finding a doctor to prescribe Focalin XR concurrently with Nardil was one of the factors which drove me to choose methamphetamine - it was unconscious, of course. (I since have the same insurance I had when I was on Focalin XR before, and my old pdoc retired but the new one is the house expert on MAOIS).
Anyway, should I just say this to my new pdoc next month? I really do better on Focalin XR and can present all of the data I need to make a case for a stimulant with MAOIs being safe. I am worried about being branded a "drug addict"; I have several things I could tell the new doc, if the coadministration of a MAOI and Focalin XR is not a concern but abuse is:
1. Ask to be offered weekly prescriptions
2.Make the case that I am less likely to use street drugs again if properly medicated.
3. Approximately 1/4 of dual diagnosis patients according to one source have ADHD, and untreated ADHD complicates treatment - being treated improves outcomes.
4. ADHD patients are unlikely to abuse their prescription stimulants (I haven't, except for taking an extra Adderall or two in college during finals)...Anything else? SLS what would *you* do? Anyone been in this situation?
If that fails, I am thinking of (very carefully) purchasing and dosing with pure PEA powder. There are posts about this, I think.Not interested in Strattera or Wellbutrin... Have had the best results with Focalin XR , second best with Dexedrine Spansules (extended release).
Thanks as always--
-z
Posted by rjlockhart37 on March 18, 2016, at 18:17:07
In reply to SLS/others: Dual diagnosis, but need ADHD meds, posted by zonked on March 18, 2016, at 17:43:33
when i was on dexedrine spansules i asked about desoxyn extened release, there's not really a big diffrence in dextroamphetamine and methamphetamine, but yes methamphetamine does release more dopamine and serotonin but it also can deplete the stores of it, so usally if ever chose to go on desoxyn keep it at at least 25-30mg a day, it comes in 5mg tablets, nothing else because of it's abuse potential
i read on bluelight that dexedrine sometimes has better psychostimulant effects than desoxyn, i read somewhere desosyn is methamphetamine but people take it and feel lazy.....like that feeling your stimulate and feel good but you don't want to work
dexedrine is good choice, it's the cleaner version of amphetamine just like focalin is the clean version of ritilin, only the right isomer
usally a doctor will think of person when they drug seek about certain drugs, or are implusive to be prescibed, but there's some doctors that will give it to you freely, but the thing about a drug addict is you want more and more, increased dose, add more drugs
dextroamphetamine is similar to methamphetamine but methamphetamine has more a chance to be abused more, it works more on serotonin than dextroamphetamine at higher doses......
i think you should ask about dexedrine and that's it, forget desoxyn it's too hard to convince a doctor, dexedrine is good for attention and getting things done
r
Posted by baseball55 on March 18, 2016, at 19:13:08
In reply to SLS/others: Dual diagnosis, but need ADHD meds, posted by zonked on March 18, 2016, at 17:43:33
While lying to doctors is not something I feel good about (I never did, but my p-doc was also my therapist, so I could talk things out),a lot of docs, if they know you're using street drugs, will refuse to prescribe any DEA scheduled drugs.
Posted by SLS on March 18, 2016, at 19:48:12
In reply to SLS/others: Dual diagnosis, but need ADHD meds, posted by zonked on March 18, 2016, at 17:43:33
> Hi: SLS and everyone else,
>
> Graduated from the dual diagnosis rehab with flying colors. I don't even smoke cigarettes anymore. Today's my last 7mg patch!Holy crap! That's awesome!
> My ADHD symptoms:
>
> That is....:
>
> disorganization, inattentiveness, impulsiveness, washing the same dish over and over, taking 3 hours to unpack my stuff which would take most people an hour, losing things/leaving things lying around, fidgeting/trouble staying still, overfocus on things of interest, "spacing out", putting milk in a cupboard instead of the refrigerator, unconsciously/unintentionally provoking arguments/drama to get my adrenaline up (low baseline level of arousal), clutter/hoarding, caffeine cravings, mental disorganization (i.e. not knowing instinctively how much time to devote to a given activity and thus wasting time), very low working memory (like low RAM in a computer), etc etc....I am appreciative of your providing such a detailed description. It helps me to understand what it's like to experience ADHD.
> Whew. Are unresolved without my Focalin XR.
I found Focalin to be more helpful for depression than Ritalin. They feel like different drugs to me.
> In fact I think after my insurance changed after moving, not finding a doctor to prescribe Focalin XR concurrently with Nardil was one of the factors which drove me to choose methamphetamine...
Were you taking Nardil with methamphetamine at the same time?
> Anything else? SLS what would *you* do? Anyone been in this situation?
I have never been in your situation, so my advice kinda sucks.
Can you provide the medical records from your old doctor's practice?
> Not interested in Strattera or Wellbutrin...
Getting Focalin would be ideal, of course. However, if the PEA doesn't work out, and you have no other alternatives, adding desipramine to Nardil might produce a significant improvement in ADHD along with residual depression. Side effects can be problematic, but I found them to be tolerable.
- Scott
Posted by J Kelly on March 18, 2016, at 20:38:08
In reply to SLS/others: Dual diagnosis, but need ADHD meds, posted by zonked on March 18, 2016, at 17:43:33
> Hi: SLS and everyone else,
haha "and everyone else" I'm sure you meant that in the most endearing way but I had to lol :)
>
> Graduated from the dual diagnosis rehab with flying colors. I don't even smoke cigarettes anymore. Today's my last 7mg patch!This is awesome zonked! Yay for you!!!
>
> My ADHD symptoms:
>
> That is....:
>
> disorganization, inattentiveness, impulsiveness, washing the same dish over and over, taking 3 hours to unpack my stuff which would take most people an hour, losing things/leaving things lying around, fidgeting/trouble staying still, overfocus on things of interest, "spacing out", putting milk in a cupboard instead of the refrigerator, unconsciously/unintentionally provoking arguments/drama to get my adrenaline up (low baseline level of arousal), clutter/hoarding, caffeine cravings, mental disorganization (i.e. not knowing instinctively how much time to devote to a given activity and thus wasting time), very low working memory (like low RAM in a computer), etc etc....I have ADD, so much of that sounds familiar.
>
> Whew. Are unresolved without my Focalin XR. In fact I think after my insurance changed after moving, not finding a doctor to prescribe Focalin XR concurrently with Nardil was one of the factors which drove me to choose methamphetamine - it was unconscious, of course. (I since have the same insurance I had when I was on Focalin XR before, and my old pdoc retired but the new one is the house expert on MAOIS).I totally rely on Ritalin. I doubt much would get done here without it.
>
> Anyway, should I just say this to my new pdoc next month? I really do better on Focalin XR and can present all of the data I need to make a case for a stimulant with MAOIs being safe. I am worried about being branded a "drug addict"; I have several things I could tell the new doc, if the coadministration of a MAOI and Focalin XR is not a concern but abuse is:
>
> 1. Ask to be offered weekly prescriptions
> 2.Make the case that I am less likely to use street drugs again if properly medicated.
> 3. Approximately 1/4 of dual diagnosis patients according to one source have ADHD, and untreated ADHD complicates treatment - being treated improves outcomes.
> 4. ADHD patients are unlikely to abuse their prescription stimulants (I haven't, except for taking an extra Adderall or two in college during finals)...That's all you can really do, right? Show him you are prepared and make the case for treating your ADHD with what has worked for you in the past.
>
> Anything else? SLS what would *you* do? Anyone been in this situation?Yes. Not the history of abuse. But at one point I actually switched pdocs cause mine simply wouldn't combine anything with Parnate. If your pdoc wont give you what you want it could be a matter of treatment preferences.
> If that fails, I am thinking of (very carefully) purchasing and dosing with pure PEA powder. There are posts about this, I think.
>
> Not interested in Strattera or Wellbutrin...Me either. Been there both were disappointments.
> Have had the best results with Focalin XR , second best with Dexedrine Spansules (extended release).
My T swears by Focalin, I'm thinking of asking my pdoc to let me try it in place of the Ritalin.
Good luck with all that :)
Jade
>
> Thanks as always--
> -z
Posted by Horse on March 19, 2016, at 2:17:44
In reply to SLS/others: Dual diagnosis, but need ADHD meds, posted by zonked on March 18, 2016, at 17:43:33
Your ADHD deserves to be treated. Personally, I feel fine, (though a little anxious since I don't like lying by omission), about not fully disclosing my past if I am honest with myself.
The case you make is good. Much depends on your relationship with your doctor and their attitude about stimulants. I don't have much advice other than to include your intution regarding your approach.
Have you tried provigil or nuvigil? Nuvigil is helping with my ADD, and I like that I don't crave it.
Best to you, and congratulations on your sobriety. If you have a sponser (if you do AA or another program), I'd get them to have your back.
Posted by zonked on March 19, 2016, at 16:49:06
In reply to Re: SLS/others: Dual diagnosis, but need ADHD meds » zonked, posted by SLS on March 18, 2016, at 19:48:12
Scott: Thanks for the reply. Yup, used meth with Nardil many times. No incidence of hypertensive crisis or serotonin toxicity even at high, recreational doses.. Snorted, smoked, and once, IV.
Does a lot to dispel the stimulant MAOI interaction myth.I did it roughly once a month with some months off for about a year.
Yup, I can produce those records.
Interestingly enough I can't tolerate regular Ritalin, it gives me palpitations on Nardil and makes me anxious. Focalin XR is the best ADHD drug I've taken.
How are you doing /what are you taking btw?
Your friend,
Z
> > Hi: SLS and everyone else,
> >
> > Graduated from the dual diagnosis rehab with flying colors. I don't even smoke cigarettes anymore. Today's my last 7mg patch!
>
> Holy crap! That's awesome!
>
> > My ADHD symptoms:
> >
> > That is....:
> >
> > disorganization, inattentiveness, impulsiveness, washing the same dish over and over, taking 3 hours to unpack my stuff which would take most people an hour, losing things/leaving things lying around, fidgeting/trouble staying still, overfocus on things of interest, "spacing out", putting milk in a cupboard instead of the refrigerator, unconsciously/unintentionally provoking arguments/drama to get my adrenaline up (low baseline level of arousal), clutter/hoarding, caffeine cravings, mental disorganization (i.e. not knowing instinctively how much time to devote to a given activity and thus wasting time), very low working memory (like low RAM in a computer), etc etc....
>
> I am appreciative of your providing such a detailed description. It helps me to understand what it's like to experience ADHD.
>
> > Whew. Are unresolved without my Focalin XR.
>
> I found Focalin to be more helpful for depression than Ritalin. They feel like different drugs to me.
>
> > In fact I think after my insurance changed after moving, not finding a doctor to prescribe Focalin XR concurrently with Nardil was one of the factors which drove me to choose methamphetamine...
>
> Were you taking Nardil with methamphetamine at the same time?
>
> > Anything else? SLS what would *you* do? Anyone been in this situation?
>
> I have never been in your situation, so my advice kinda sucks.
>
> Can you provide the medical records from your old doctor's practice?
>
> > Not interested in Strattera or Wellbutrin...
>
> Getting Focalin would be ideal, of course. However, if the PEA doesn't work out, and you have no other alternatives, adding desipramine to Nardil might produce a significant improvement in ADHD along with residual depression. Side effects can be problematic, but I found them to be tolerable.
>
>
> - Scott
Posted by SLS on March 19, 2016, at 18:15:24
In reply to Re: SLS/others: Dual diagnosis, but need ADHD meds » SLS, posted by zonked on March 19, 2016, at 16:49:06
Hi Zonked.
I appreciate your asking me how I'm doing.
I am neither good nor bad.
Prior to contracting a nasty upper respiratory infection a month ago, I was doing significantly better. I actually thought that I was headed towards a true remission. I was getting better day by day. However, it is likely that brain inflammation resulted from the infection. Brain inflammation and depression seem to be associated.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919277/
I am currently taking:
Parnate 80 mg/day
desipramine 300 mg/day
Lamictal 300 mg/day
Lithium 300 mg/day
Abilify 10 mg/day
- Scott
Posted by zonked on March 20, 2016, at 9:10:20
In reply to SLS/others: Dual diagnosis, but need ADHD meds, posted by zonked on March 18, 2016, at 17:43:33
Thanks everyone for your feedback!
I forgot, a doctor (who wasn't my permanent doctor) once had a patient who abused meth ask for Adderall so he wouldn't resort to street meth -- apparently, that patient never abused nor sold it.
So what I'm asking is not impossible. One hurdle (dispelling the myth that MAOIs and stimulants are medically dangerous) is easy to overcome, the other (making the case that I won't abuse my stimulant) should be pretty easy, as well, as long as I'm patient.
I do attend 12-step meetings although I don't buy into all of the steps or the culture, and am looking for a new sponsor (the one I have now objects to me going to non-12 step, evidence-based addiction day treatment classes provided by my insurance... he thinks 12-step and ONLY 12-step works for addiction), so it'll be good to look for one who supports my ADHD. Thanks for the tip!!!)
Thanks all,
-z> Hi: SLS and everyone else,
>
> Graduated from the dual diagnosis rehab with flying colors. I don't even smoke cigarettes anymore. Today's my last 7mg patch!
>
> My ADHD symptoms:
>
> That is....:
>
> disorganization, inattentiveness, impulsiveness, washing the same dish over and over, taking 3 hours to unpack my stuff which would take most people an hour, losing things/leaving things lying around, fidgeting/trouble staying still, overfocus on things of interest, "spacing out", putting milk in a cupboard instead of the refrigerator, unconsciously/unintentionally provoking arguments/drama to get my adrenaline up (low baseline level of arousal), clutter/hoarding, caffeine cravings, mental disorganization (i.e. not knowing instinctively how much time to devote to a given activity and thus wasting time), very low working memory (like low RAM in a computer), etc etc....
>
> Whew. Are unresolved without my Focalin XR. In fact I think after my insurance changed after moving, not finding a doctor to prescribe Focalin XR concurrently with Nardil was one of the factors which drove me to choose methamphetamine - it was unconscious, of course. (I since have the same insurance I had when I was on Focalin XR before, and my old pdoc retired but the new one is the house expert on MAOIS).
>
> Anyway, should I just say this to my new pdoc next month? I really do better on Focalin XR and can present all of the data I need to make a case for a stimulant with MAOIs being safe. I am worried about being branded a "drug addict"; I have several things I could tell the new doc, if the coadministration of a MAOI and Focalin XR is not a concern but abuse is:
>
> 1. Ask to be offered weekly prescriptions
> 2.Make the case that I am less likely to use street drugs again if properly medicated.
> 3. Approximately 1/4 of dual diagnosis patients according to one source have ADHD, and untreated ADHD complicates treatment - being treated improves outcomes.
> 4. ADHD patients are unlikely to abuse their prescription stimulants (I haven't, except for taking an extra Adderall or two in college during finals)...
>
> Anything else? SLS what would *you* do? Anyone been in this situation?
> If that fails, I am thinking of (very carefully) purchasing and dosing with pure PEA powder. There are posts about this, I think.
>
> Not interested in Strattera or Wellbutrin... Have had the best results with Focalin XR , second best with Dexedrine Spansules (extended release).
>
> Thanks as always--
> -z
Posted by tom2228 on March 26, 2016, at 21:21:08
In reply to Re: SLS/others: Dual diagnosis, but need ADHD meds, posted by zonked on March 20, 2016, at 9:10:20
I'm a recovering meth addict and I too have used meth on MAOIs (Marplan) + desipramine .. No *physical* problems (other consequences that come along with an addiction, yes of course). My brain seems to be completely tolerant to this combo. Makes me shirk when certain docs are too afraid to prescribe low dose stimulants with my MAOI and desipramine... But that's lack of experience/ knowledge and another rant.
I've also been on Desoxyn as part of the combo for the past 6 years, and I can truly and honestly say that I am highly satisfied with my ADHD treatment. Nothing has given me close to the relief and focus I have taking this med in combination with desipramine. I am completely honest with my doctors and while they're hard to find, they've understood that having my ADHD treated is a significant relief to the stresses in my life that often manifest as mood episodes or trigger drug use. I've explained to them that I've used meth while medicated and while off Desoxyn and notice that if I'm not treated I use much harder, more dangerously, find it much harder to control myself or my behavior on or to get the drug and that the rewards of drug use are fueled by an unmedicated state.
I've also been sober on Desoxyn and off Desoxyn and struggle a whole lot more off the medication ... Things like feeling ineffective as a person , unable to control myself or regulate my actions or affect, or focus enough to tune into my relationships.. Is a huge trigger for my self-destructive tendencies.
Last year I truly tested it out trying to get by on Nuvigil, then retrying Vyvanse and finally back on Desoxyn at half a year sober. Once I got back on my career took off, I developed a set of skills that I have achieved the feint of self-support, and I've been able to do what I set my mind to. It is not a catch-all or magic pill that I pep myself up on. It just allows me to not be held back if I decide I want to embark on something that requires my attention or personal growth.
I am taking 20mg daily, 5mg 4 times a day on a strict every-4-hours schedule, sometimes only 3 times a day if I sleep in. I never abuse it, barely ever feel tempted to take more. It is a blessing to have at least one of my psychiatric diagnoses in check and why abuse 5mg pills when if I'm going to destroy my life I'll just buy a 1.8grams for 80 bucks and go from there until I'm destitute again.
It definitely takes self-discipline. At the end of the day you must ask yourself what you really want in your life and wherther your decisions support or oppose that goal... Surrounding ADHD meds + dual Dx , or otherwise.
I have found several several doctors who are support this, or me being on Stimulants, even Desoxyn, as a meth addict in recovery. It's just getting that plus the Marplan AND desipramine prescribed that's a real pain in the *ss.
Let me know if you have any questions and good luck!
Tom
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In reply to SLS/others: Dual diagnosis, but need ADHD meds, posted by zonked on March 18, 2016, at 17:43:33
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