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Therapy

Insurance coverage kicked in on the 1st. Had my first session this morning. We pretty much picked up where we left off, and anyone reading my posts here will have a fairly good outline of the discussion. She thought my reconnection with messy feelings regarding my symptoms and their consequences was really healthy. She agreed that I was looking at it from a clinical, philosophical perspective when we did sessions a few months ago, and that more productive progress can be made when I'm (as she said) "in the muck."

Tomorrow I have an appointment with the MD to review medication. Vyvance did nothing noticable at 30mg or 40mg. Hoping something else will make this a bit easier.

Comments

I'm glad you're able to see a

I'm glad you're able to see a therapist again.  But I have some advice.  Don't get stuck (on purpose) in talking about your feelings.  Changing your behavior is the most important thing you can do at this point to help your relationship.    

Adderall?

carathrace's picture

I agree with Rosered, not that your feelings aren't important, but that will just bog down your progress.  Concrete behavior changes, that's what will make the most difference.

Also, I wondered if you've ever been prescribed Adderall?  My h's doctor believes it is the most effective, and H proved that it is more effective than the ritalin family for him, by trying both.  Absolutely no effect from ritalin, so he went back to Adderall.  Not great results from adderall either, but at least he has more energy to attempt to change his behavior.

Trial Error

jackrungh's picture

I agree that focusing on feelings and doing endless talk therapy can be a crutch. We've had three sessions now, and in the last one we talked about dietary changes that might be made, and even perhaps getting a SPECT. Started reading up on Daniel Amen at her suggestion.

http://www.amenclinics.com/clinic/anxiety-issues-atlanta/type-7-lights-a...
http://www.amenclinics.com/clinic/adhd-add-atlanta/type-5-limbic-add

I have not been prescribed Adderall before. The only stimulant I've ever tried is this Vyvance. I went to see the M.D and they prescribed 50mg this time. I guess the idea is if there are no negative side-effects then up the dose until you see something. I actually do notice some impact for the first time with this drug. It feels like a bit of an energy boost, somewhat akin to having a coffee, but nothing huge. It has absolutely no impact on inattentiveness or prioritization of tasks. I have more energy to do things, and I think it helps launching into tasks, but there is no improvement in the portions that really cause problems. I've always been able to get a certain amount of things accomplished; the trouble was always doing the right thing at the right time, and planning out how it all might get done.

I am really not hopeful about the impact of amphetamine-based medications. I'd trade the high for a dopamine IV. I really want to try a different tack if there is one. Still, this appears to be better than nothing. Since these medications are pretty instant, and do not take 3 weeks to set in like anti-depressants, wouldn't it make sense to give you sort of a combo-pack for experimentation? I'd like to get a weeks worth of Ritalin, Adderall, Vyvance, and whatever else instead of wasting all this time mucking around. They gave me three months worth of prescriptions, which is not going to fly. I'll be setting up another appointment after a month at the latest.

In Theory

In theory, would be great if u could trial these meds in sequence.  No practitioner would be willing to risk her/his license to let you do that.  It might be that you "system needs time to adjust" before you can appreciate or reject this med.   If it doesn't work for you in the (longer) term, try other meds.  But give Adderall a bit of time.  I think the one month follow up is a good idea.  Can you take your pulse and blood pressure at home?  I worry about the side affects of Adderall but that doesn't mean it is not usefull.

 

                                L

Leonardis

I really don't feel jittery

jackrungh's picture

I really don't feel jittery or over-energized at all, it is almost exactly like normative doses of caffeine. It seems like this line of medications is much more successful in hyperactive types, and that isn't me. I've been on Wellbutrin for 8 years, and have had significant improvement due to it. The two or three times I have attempted to wean off of it have been very noticeable. I think the only reason I have a mate, children, and a successful career is because it made pulling myself together easier. Unfortunately it doesn't go far enough to stop me from often driving the people I love crazy.

Because of the success of Wellbutrin my thinking is that dopamine deficiency is central to my brain chemistry. The stimulants are supposed to go in that same direction so maybe I just haven't found the right type, or the dose of Vyvance is just not high enough. My therapist was telling me about one patient she had who could only take 1/8th a pill of Prozac, and another who was at three times the recommended dose. Everyone is different. All this guesswork and subjective assessment is frustrating though. I think it is rather expensive to do the full SPECT workup. Roughly $3,500 I believe, but I think you can do select portions of it and skip other parts that may not be so relevant. The muddled history of Major Depression and ADHD really makes me want to get some kind of clear picture of just exactly how my brain functions.

Meds

jackrungh,

Keep working on this. What you have with your family is worth it, and you have much to teach the rest of us as well.

L

Leonardis

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