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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by CindyB on December 14, 2004, at 22:17:33
I have been taking various SSRI's for Premenstral depression for over a decade now. Fatigue related to the SSRI's was becoming intolerable over the last few years. My doc tried different SSRI's and eventually added Wellbutrin. The Wellbutrin did help with the fatigue and had a side benefit of making me feel more "focused" mentally. I later read that Wellbutrin could help with ADD which lead me to think that I might have some form of AADD. Unfortunately Wellbutrin bothered my stomach “a lot”. I thought that an ADD medication might be a possible alternative and asked my doctor about it. She gave me an Rx for 20 mg Adderall-XR taken once per day in the AM with 2 refills to try. I've only taken it for a few days and feel pretty good on it. It gives me energy, a fairly dramatic improvement in my mental focus and makes me feel generally happier. Although I pretty much crash from it by late afternoon.
What is bothering me is that when I went to fill the Rx the pharmacist said she needed the docs DEA # as this drug is an amphetamine. Hearing this was a bit upsetting as I guess I associate amphetamines with dangerous, addictive, unhealthy “drugs”. Later I noticed that my Rx bottle had no refills despite my doc writing 2 refills on the script. When I called the pharmacist about it she said that refills are not “allowed” for this drug because of its DEA “classification”. I need a hand written script every time I fill it. It can’t even be phoned in as they need the doctors signature for every refill. How scary is that? I’m worried that I might be getting myself on something “dangerous”. If it didn’t work so well I would definitely be scared away from this by now. I guess I’m hoping to get assurances that this is not a dangerous, addictive unhealthy drug to be putting into my body.
Posted by King Vultan on December 14, 2004, at 23:31:16
In reply to Adderall, posted by CindyB on December 14, 2004, at 22:17:33
Well, it's hard to believe your doctor would be so ignorant as to give you refills on a Schedule II med. Refills can be prescribed for Schedule IV meds, such as the benzos, but you need a separate prescription for each time you wish to get more of a Schedule II drug. Adderall is a mixture of amphetamines that is very commonly used for ADD/ADHD. However, just giving you a prescription for Adderall without doing some testing and diagnosis for ADD is highly reckless and imprudent IMO. You may wish to consider finding a different doctor who is somewhat more conservative and knowledgeable. From what you've described of your doctor, I don't think this would prove to be terribly difficult.
In response to your concerns, the amphetamines do have a certain abuse and dependency potential, which is why they are classified as DEA Schedule II drugs. For people with ADD/ADHD, they can be very beneficial, and the abuse and dependency potential really is not particularly large for this group. Obviously, amphetamines can be very problematic when used by individuals who are deliberately looking for their more notorious and detrimental effects. You sound like a concerned and conscientious person, however, and someone who certainly does not appear to fit the profile of a drug abuser. As I alluded to above, I really think you should get a second opinion on this. If you're looking for a drug to cut down on your fatigue that is not nearly as problematic, Provigil might be a good choice. This is a very safe drug that is only a Schedule IV med--this is the same class that contains Xanax and the relatively innocuous sleep med Ambien. Provigil is approved for certain sleep disorders but is also used off-label sometimes for treating ADD and augmenting antidepressants.
Todd
Posted by SDW on December 15, 2004, at 1:05:03
In reply to Re: Adderall, posted by King Vultan on December 14, 2004, at 23:31:16
Your concern with all the regulations surrounding psychostimulants is very understandable. I agree with King Vultan's point that some doctors presribe these without much thought to their potency and the patient's diagnosis...I obviously can't make a call in your particular case. But, for certain people with unrelenting fatigue, stimulants like Adderall can be very helpful and relatively safe. They are controlled because they can be abused easily. If you stick to a standard pharmacological dose and don't take them chronically over a period of years you should not have problems. I have used Adderall for fatigue(DXs: dysthymic disorder w/ anhedonia/apathy/fatigue) for the last year or more. They allow me to work and keep up a minimal level of functioning. They do not do much for the depressive symptoms however. In a few days I will be starting trials of new meds and hope to go off the Amphetamines within a few months.
It might be useful to search on this site for posts on Amphetamine/stimulants to get a sense of other people's experiences - if you haven't already.
Good Luck ..Keep us Posted...
Steve
Posted by anxiety_free on December 15, 2004, at 1:05:39
In reply to Re: Adderall, posted by King Vultan on December 14, 2004, at 23:31:16
hey! Your doc does sound ignorant, but my guess would be that s/he just gave you refills without thinking; my doc, i know, will occasionally make little errors like that b/c of overwork. Anyway, don't fret about the DEA classification thing. Here's the deal with adderall and other amphetamines: for a long time, they were MUCH more available and used for add, depression, lethargy, weight loss, and just about anything else where a stimulant might help. They were also used in combo drugs such as Dexamyl (sedative+amphetamine combo). Problem is, there were addiction problems, diversion of the drugs, abuse of the drugs, deaths, etc. Then came along the speed freaks of the late 60s and BAM! the amphetamines were restricted to class II to prevent over-use and diversion. In terms of safety...just take as directed. Used properly, amphetamines can be great, and I personally think your doc was right in giving you an rx for adderall (20mgs is a low dose, BTW). If you like it, all you'll probably have to do is call your doc a few days before you run out and remind him/her to give you a new script...that's how my adderall is handled. If your doc is nice, s/he might give you several scripts at once, each one dated a month after the other...this makes life easier for everyone.
Posted by Bill LL on December 15, 2004, at 9:23:38
In reply to Adderall, posted by CindyB on December 14, 2004, at 22:17:33
If you live in the United States, it's true that you need to visit the doc's office once a month to pick up a new prescription for Adderall (also for Ritalin). I don't know the rules in other countries. But Adderall has proven to be a very safe drug so don't worry about it.
Your doctor did the right thing in giving you Adderall since the Wellbutrin was bothering your stomach. While it is possible to give a test for ADD, it's definitely not necessary to do so.
Three years a go I spoke with a well respected pdoc who sees a lot of children in his practice. He thinks that tests for ADD are not necessary. He thinks that if a child seems to have ADD, it's ok to just give him Ritalin or Adderall and see whether or not it helps.
Posted by banga on December 15, 2004, at 18:23:39
In reply to Re: Adderall, posted by Bill LL on December 15, 2004, at 9:23:38
I have understood that although Adderall can have addictive potential, it is in fact a very very low dose of amphetamines--using the street drug version is a different ballgame.
As always, I feel the truth lies somewhere in between RE: assessment and diagosis of ADHD. It is prudent to do a general assessment and history-taking to get an idea whether ADHD is a plausible diagnosis. BUT there are several problems--not everyone has the classical ADHD symptoms (bad grades, etc). And if you are of average or above average IQ, you learn to compensate quite well--thus the use of testing for adult ADD may not be reliable.
I would say that if the doctor is mindful of the drug's usual uses and risks; and if the patient is mindful in taking it as prescribed and notes any inclinations to abuse the drug, it should be OK.
I myself am in the midst of now considering a diagnosis of ADHD (inattentive type) for the first time of my life---and may be trying Adderall as early as next week. I am scheduled for assessment and testing in several months, but waiting so long for something that may help is not logical. And testing may be compromised for me due to apparent compensation and having administered various IQ and other tests myself (I am almost a psychologist), the reuslts would be of questionable validity.
I have a make it or break it situation with a dissertation--if I dont finish it in the next months, goodbye PhD and goodbye ten years of investment to get to this point.
Posted by Bill LL on December 16, 2004, at 14:14:40
In reply to Re: Adderall, posted by banga on December 15, 2004, at 18:23:39
I hope your doctor will write the prescription without you being tested. My internist did write my prescription for Strattera without me being tested.
> I have understood that although Adderall can have addictive potential, it is in fact a very very low dose of amphetamines--using the street drug version is a different ballgame.
> As always, I feel the truth lies somewhere in between RE: assessment and diagosis of ADHD. It is prudent to do a general assessment and history-taking to get an idea whether ADHD is a plausible diagnosis. BUT there are several problems--not everyone has the classical ADHD symptoms (bad grades, etc). And if you are of average or above average IQ, you learn to compensate quite well--thus the use of testing for adult ADD may not be reliable.
> I would say that if the doctor is mindful of the drug's usual uses and risks; and if the patient is mindful in taking it as prescribed and notes any inclinations to abuse the drug, it should be OK.
> I myself am in the midst of now considering a diagnosis of ADHD (inattentive type) for the first time of my life---and may be trying Adderall as early as next week. I am scheduled for assessment and testing in several months, but waiting so long for something that may help is not logical. And testing may be compromised for me due to apparent compensation and having administered various IQ and other tests myself (I am almost a psychologist), the reuslts would be of questionable validity.
> I have a make it or break it situation with a dissertation--if I dont finish it in the next months, goodbye PhD and goodbye ten years of investment to get to this point.
Posted by pablo1 on December 18, 2004, at 19:18:27
In reply to Adderall, posted by CindyB on December 14, 2004, at 22:17:33
It's unlikely you would have any problem if you are responsible. It's quite safe for most people at therapeutic doses. Feeling good on stimulants does not mean you have ADD though, it used to be prescribed for depression & is effective for that. Even perfectly normal people like the feeling & feel smarter, more alert, etc. So it's good to get tested for ADD if you suspect that, and as long as you stay at low doses enjoy the prescription but don't take it as evidence of having ADD.
Posted by CindyB on December 30, 2004, at 22:13:25
In reply to Re: Adderall, posted by pablo1 on December 18, 2004, at 19:18:27
Thanks for all your advice and info. I have a feeling I wont be staying on Adderall afterall. I'm thinking of trying a provigil/strattera combo as Adderall seems to"burn me out". I'm either over stimulated or spent with not much in between. As time passes the ratio of over stimulated/spent is leaning more towards being spent. I'm going to try 10mg 2x a day first first to try to even things out a bit but I likely will be looking for a change at my next Dr's apt.
Posted by Festus on December 31, 2004, at 1:06:14
In reply to Re: Adderall, posted by pablo1 on December 18, 2004, at 19:18:27
I went through a trial of Adderrall for ADHD/Fatigue and it did a burn-out job on me,too.This drug is originally from the early 60,s used for weight control.It was marketed as Obitrol,then re-marketed years later as an ADD med.What makes it so harsh is the mixture of Amphetamine salts cause more CNS stimulation than Ritalin or Dexedrine.Ritalin made me feel sick and really depressed as it wore off.Dexedrine turned out to be the best for my case,less harsh side-effects.It,s been around longer than the others.Provigil has had some good results for many who don,t like the Amphetamines,but you better have insurance if you do get it,it is costly.I would at least give the Dexedrine a try(do the time-release spansule caps,maybe a 15mg. to start,or a 30mg. if you need more)If that,s too strong,try the Provigil.These can be very good and very helpful meds to people that really need them,the trick is getting the right med and dosage that,s best for YOU,and it can take time,but it can make all the difference in the world.Festus
Posted by Dave001 on December 31, 2004, at 21:35:18
In reply to Re: Adderall, posted by anxiety_free on December 15, 2004, at 1:05:39
> hey! Your doc does sound ignorant, but my guess would be that s/he just gave you refills without thinking; my doc, i know, will occasionally make little errors like that b/c of overwork. Anyway, don't fret about the DEA classification thing. Here's the deal with adderall and other amphetamines: for a long time, they were MUCH more available and used for add, depression, lethargy, weight loss, and just about anything else where a stimulant might help. They were also used in combo drugs such as Dexamyl (sedative+amphetamine combo). Problem is, there were addiction problems, diversion of the drugs, abuse of the drugs, deaths, etc. Then came along the speed freaks of the late 60s and BAM! the amphetamines were restricted to class II to prevent over-use and diversion. In terms of safety...just take as directed. Used properly, amphetamines can be great, and I personally think your doc was right in giving you an rx for adderall (20mgs is a low dose, BTW). If you like it, all you'll probably have to do is call your doc a few days before you run out and remind him/her to give you a new script...that's how my adderall is handled. If your doc is nice, s/he might give you several scripts at once, each one dated a month after the other...this makes life easier for everyone.
Some states in the U.S. allow prescriptions of more than one month for schedule II substances. I think it is 3 months here in MA.
Posted by Dave001 on December 31, 2004, at 22:01:01
In reply to Re: Adderall, posted by Festus on December 31, 2004, at 1:06:14
> I went through a trial of Adderrall for ADHD/Fatigue and it did a burn-out job on me,too.This drug is originally from the early 60,s used for weight control.It was marketed as Obitrol,then re-marketed years later as an ADD med.What makes it so harsh is the mixture of Amphetamine salts cause more CNS stimulation than Ritalin or Dexedrine.Ritalin made me feel sick and
I think what you mean to say is that it tends to cause more peripheral stimulation (e.g., tachycardia, hypertension, etc.), not CNS. This is not related to the acid used to form the amphetamine salt. The reason Adderall tends to produce more peripheral stimulation is because about 1/4 (if memory serves) of the preparation consists of the levo isomer of amphetamine.
This is the end of the thread.
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