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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by jazzaholic on July 5, 2002, at 18:49:27
Hi,
I have been treated many years for depression and ended up doing pretty well with Prozac 20 mg and 10 mg of Klonopin. So well I quit smoking and drinking! When I recently started to feel some depression again, I described a lack of concentration, weariness, and also asked about something my daughter had responded well to - Adderall.
He gave it to me for a month, 20 mg and when I went back I told him how I was focused at work again, getting things done, feeling confident and how it seemed to offer a renewed outlook with vigor and determination. He therfore prescribed 5 months worth and I see him again later this month.
The problem was the good effect did not last. I began taking the Adderall a bit later in the day as I was starting to feel like i was falling asleep again after lunch and driving home.
Bottom line is, i think the dose is not working anymore. I tried 2 one day and the benefits returned.
Since I was prescribed a certain amount, I knew that wouldn't work however. I then experimented with medicines similar. Namely Didrex and Phentermine which were available online. This helped allot, but there was no question the Adderall felt healthy and right while these misxtures could make me nervous. I also knew self medicating was bad for me.Well, I want to work with my doctor. When i see him, i am afraid of mentioning the experiments as he may give me nothing. What I want is advice as to how to get the benefits of Adderall without it becoming less effective. I think a greater dose might help, but if that just happens again, then what?
In other words I had a glimpse of productivity and being able to focus again, and now I don't know what to tell him. I was going to just say it helped for awhile and the benfits became less.
Any thoughts on getting the right help from your doctor without being branded as an addict and left with nothing? Why did the Adderall have to start failing? Would an increase dose help? IS there a group of medicines you rotate through.
By the Way, he diagnosed ADD when giving it to me in the first place. he cautioned about addictiveness.
Any insight is most welcom.
J
Posted by katekite on July 6, 2002, at 18:10:57
In reply to How to Work With Psychiatrist on Dosage, posted by jazzaholic on July 5, 2002, at 18:49:27
At the beginning of dosing stimulants it is normal to have to play around with it, and it is normal to have to increase the dose some.
One option would be to call and leave a message saying that it just doesn't seem like the 20 is as effective as it was, and ask if it's ok to take more, 30 or 40. He will most likely call back and say fine. Then you can honestly talk to him about what dose was best and what he thinks in the next appointment, without squirming around looking guilty.
Having to increase the dose once does not necessarily mean you will find you have to keep upping it to get an effect, but some people do find that, and in that situation you would risk addiction.
One way to combat having to increase the dose is to take frequent holidays from it, if you can function without it. For example weekends off.
There is usually a minimum effective dose and an optimal dose. The optimal dose will work even when you haven't slept well, for example. So it does take some experimentation at the beginning.
If your doc is not comfortable with the higher end doses of adderall you could potentially try dexedrine spansules or one of the ritalin-type formulas: different people need different amounts of the different stimulants.
So there are many options: the key is to get on the level with your doc as quick as possible. You will want to make sure you are clear with him in the future on whether you should call for permission to play around with doses or whether that is something he feels comfortable letting you do on your own. It is hard enough to get medicated for ADD as an adult that you don't want to get him worried about you. Although it does seem that he trusts you quite a bit if he's giving you 5 months of prescriptions.
Good luck,
kate
Posted by fachad on July 7, 2002, at 9:56:18
In reply to How to Work With Psychiatrist on Dosage, posted by jazzaholic on July 5, 2002, at 18:49:27
Hi again jazzaholic,
I just wanted to add another suggestion about your situation and your asking for a dosage adjustment.
If you were to switch to Adderall XR, or Dex, or Ritalin, you would once again be in the "initial period" when dosage adjustments are considered standard practice.
You could then see (or phone conference with) your pdoc every month and adjust the doseage up or down as needed until you and your pdoc decide on a "final" effective and optimal dose.
Thinking back on my med history, I was taking 30 mg Ritalin immediate release for years, but when I changed to Concerta (a long acting form), my doc and I changed to dose to 54 mg Concerta. It seemed like the 34 mg Concerta was not as effective as 30 mg of Ritalin, and the next incriment in Concerta pill was 54 mg.
> Hi,
>
> I have been treated many years for depression and ended up doing pretty well with Prozac 20 mg and 10 mg of Klonopin. So well I quit smoking and drinking! When I recently started to feel some depression again, I described a lack of concentration, weariness, and also asked about something my daughter had responded well to - Adderall.
>
> He gave it to me for a month, 20 mg and when I went back I told him how I was focused at work again, getting things done, feeling confident and how it seemed to offer a renewed outlook with vigor and determination. He therfore prescribed 5 months worth and I see him again later this month.
>
> The problem was the good effect did not last. I began taking the Adderall a bit later in the day as I was starting to feel like i was falling asleep again after lunch and driving home.
>
> Bottom line is, i think the dose is not working anymore. I tried 2 one day and the benefits returned.
> Since I was prescribed a certain amount, I knew that wouldn't work however. I then experimented with medicines similar. Namely Didrex and Phentermine which were available online. This helped allot, but there was no question the Adderall felt healthy and right while these misxtures could make me nervous. I also knew self medicating was bad for me.
>
> Well, I want to work with my doctor. When i see him, i am afraid of mentioning the experiments as he may give me nothing. What I want is advice as to how to get the benefits of Adderall without it becoming less effective. I think a greater dose might help, but if that just happens again, then what?
>
> In other words I had a glimpse of productivity and being able to focus again, and now I don't know what to tell him. I was going to just say it helped for awhile and the benfits became less.
>
> Any thoughts on getting the right help from your doctor without being branded as an addict and left with nothing? Why did the Adderall have to start failing? Would an increase dose help? IS there a group of medicines you rotate through.
>
> By the Way, he diagnosed ADD when giving it to me in the first place. he cautioned about addictiveness.
>
> Any insight is most welcom.
>
> J
This is the end of the thread.
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