Seeking advice on medication and more concrete solutions to address symptoms. In 2006 I was diagnosed with depression, in 2013 I was diagnosed with ADHD:Inattentive. Figuring out the complex blend of symptoms between depression and ADD has been frustrating, and I don't conveniently fit into either box. I need to get more pro-active in developing a comprehensive treatment plan. Currently the only thing I'm taking is fish oil, multivitamins, and a vitamin D supplement. Exercise seems to help my mood significantly, but I've fallen out of the habit in recent months.
I've been on Vyvance, Adderall, and Ritalin at normative, standard doses and felt essentially nothing. No jitters, no side effects, just nothing. It is entirely possible that the dosages were just not high enough. I'm 6'4" and all kinds of drugs really don't impact me strongly unless I take a bit more than indicated.
I was on Wellbutrin for a long time with positive impact, but now that my lifestyle habits (sleep, work, family) are more robust I honestly can't tell you what good it did. Wellbutrin had a marked impact when I had essentially no sleep schedule and really toxic habits (pre-marriage/relationship, pre-family).
Aside from therapy in the 2006-era for about a year, I have only been in talk therapy addressing ADHD in the past year and a half or so. It has been a while since my last session with my psychologist. Talk therapy is fine, but I feel like we get nothing done and don't work towards any kind of direction. By my very nature I do not set goals well, and follow through is not reliable. Remaining mindful of all of this is extremely difficult. Since my life is more or less functional and my unhappy marriage is not in any kind of crisis, it is hard to see how any amount individual therapy in the generic sense could help. Prescribing physicians have essentially just thrown pills at me, and I'm more or less out of the main categories of stimulants to try. I feel like I need to start from scratch, and am weary of indifferent trial and error.
The main thing I wanted to ask was: Have people here gone into the Amen Clinics and done SPECT? I have read Dr. Amen's book and am pretty well versed on his approach. I seem to be a combination of his Inattentive and Limbic sub-types. My psychologist follows his work with interest. I have also seen a lot of criticism of his methods from other professionals and the psychiatric community at large. Opinions?
I was sick of not doing
Submitted by jackrungh on
I was sick of not doing anything to start addressing these issues. Right now I am hyper-focusing on the problem of my symptoms and especially the problems in my marriage. I am not naturally someone who makes a lot of friends, and for this relationship to be so disconnected is really not an OK thing. My wife's next round of ordering from Amazon will include Driven to Distraction, which is one of the works I've seen recommended frequently that I have not yet read. At any rate I feel like I need to use this hyper-focus to make ground while it lasts.
To that end I started this morning by adding a stimulant to my usual round of vitamins and fish oil. I have a bunch left over from trial and error many months ago. I was prescribed 30mg Adderall 3x daily, and I felt nothing. This morning I took two, and I feel... extroverted.
My ADHD seems to be co-morbid with depression, and there never is any hyperactivity or anger. Perhaps a little bit of impulsivity, but usually in the hyper-focus sense, and never in the sense of "impulsive behavior" that leads to rashness or tactlessness. I don't feel like the Adderall is making me any less distractible for forgetful. I'm jumping from thing to thing in the usual way. However, what is changed is the energy required to launch into something and be productive. I'm having a much easier time of committing to things and getting work done.
I feel like 60mg is probably too much, as I do feel a bit of a buzz. I wonder if this is really a solution since it doesn't address the really problematic symptoms. Not setting goals, not keeping things in mind, and staying on track. Still, as someone who has recently been totally shutting down; less and less able to embark upon anything; it is a change. I still think my mental issues are more complex than just standard ADHD, and the only other medication with any impact has been BupropionXL. At lunch I will try 1 1/2 (45mg).
A couple of quick comments
Submitted by sunlight on
Re SPECT: my husband hasn't done either SPECT scans or MRIs (both suggestions from the psychiatrist, the MRIs to check for head injuries). The psychiatrist originated the suggestion (i.e., we did not put the SPECT idea in his head). We haven't decided not to do them so much as not got around to deciding whether the results might make a difference to the actual treatment.
Re Adderall etc: My husband only responds to Adderall and takes 30mg x 4. For comparison, he's 5'8 compared to your 6'4. I've suggested more but the psych is a little resistant to go there. His (husband's) response is definitely suboptimal - 20mg doesn't do anything for him at all, neither does dex or ritalin (apart from ritalin making him very abrasive and angry, certainly no good effect) or any of the other common variants. This suboptimal response seems to be, in his case, pretty much due to genetics. Your description of the effect of Adderall is similar to his although he has the H in ADHD and the Adderall also has the effect of allowing him to be much more coherent in conversation and less impulsively angry. He does not do 'talk therapy' since he prefers to make his own mistakes (my words!) and the meds are allowing him to be much more aware of what is going on around him, so we leave him to it.
Have you tried adding a mood modifier? My husband also takes gabapentin, it works well and he doesn't have any of the (very bad) effects he experienced from SSRIs.
That's interesting that the
Submitted by jackrungh on
That's interesting that the psychiatrist originated. All I've ever gotten from prescribing physicians (well.. mostly just from one guy) is mild disapproval. The wavering on my part has more to do with the expense. At $3+K and mostly outside insurance we could probably swing it, but it isn't a casual decision, and I'm pretty sure what the sub-type outcome is going to be anyway. What I would mostly be looking to pay for is not diagnosis but rather: "Take these pills; take those supplements; eat this; don't eat that; work out this much; here is the after-scan showing that treatment is A)actually working B)not just a figment of your hopes for yourself, and C)not part of some massive rationalization about how everything is cool now." I live just a few miles from one of his main clinics.
When I took 60mg this morning it was definitely too much. It crossed the border between experimentation with neurological pharmaceuticals and getting high. They are simply amphetamine salts, after all. 45mg was better. A good bit of drive to action, but not so much... that tingle. 60 felt like I had had maybe two alcoholic drinks (it takes me 4ish to get "tipsy"). Perhaps I should take 30mg tomorrow and see if the impact was as negligible as I remember. It sure as hell won't come as a surprise to anyone here that the memory of an ADHD spouse isn't all that trustworthy. At that time I was also on Wellbutrin, and this time I'm not combining non-OTC meds.
I like talk therapy but I tend to woo my therapists. Not literally. In saying that I mean that without realizing it, without really wanting to, I tell them the best version of events and lull them into a false perception of the nature of my progress. Who the hell should care about their therapist feeling good about the way things are going? Why would you want them to be approving of you when it is false and when it derails progress?
I don't understand it, and I'm the one doing it. I don't even realize I'm doing it until I return to earth, get home, and there is some glaring inconsistency there in reality that disproves the sweet, sweet story I've spun. If I'm really in a bad, symptomatic stretch of time that inconsistency gets discarded as soon as possible, and if anything lingers the 30 minute drive to the next appointment is certainly long enough to reboot all the rationalization computers in my brain. The most honest, productive sessions are typically the first few that I have. The last bout of regularly-scheduled sessions I started by warning my psychologist to be on her guard against me. Not sure she is willing to be brutal enough or necessarily has the type of character to draw the most honest version of myself out. My wife should be my therapist. She can read me like a book and understands passages I can't fathom.
Trying perhaps some new meds, getting a new prescribing physician ( and maybe even a new therapist ) in this new area we have moved to is the next thing, but no I haven't even heard of gabapentin. I'm pretty sure I've never been on an SSRI either. Adderall, Ritalin, Vyvance, WellbutrinXL, Abilify, and Cymbalta. It was either Abilify or Cymbalta that had the only side-effects. Pretty sure it was Cymbalta. Felt like my skin was too tight for my body, I constantly felt like... something was wrong?, and there was a sexual side-effect. The two drugs were adjacent trials and were both very quickly discarded. Waiting on depression meds to kick in and --in Cymbalta's case: go the hell away-- is exhausting. I don't have to conjure up too much effort to procrastinate on that effort.
Thanks for the reply.
Worrysome
Submitted by jackrungh on
Calling it quits on Adderall at least until this subsides. I just feel extremely out of sorts. I had an evening implementation for work last night and got to bed after midnight, which is unusually late these days. I should have fallen asleep handily but just stared at the ceiling with my mind churning intensively. I tried several times to clear my head and get some rest but could not. It should be noted that I have never strongly identified with the ADHD characteristic of racing thoughts. There are isolated times when I'm busy on a task, but I've never resonated with any of those hyperactive metaphors such as all the TV channels being on at once.
The bizarre part is last night I felt tingly and had this sleeplessness many many hours after the last dosage should have worn off. Yesterday was the first time trying it. At 08:00 I took 60mg and at lunch I took 45mg. I've already said 60mg seemed to be too much and went down to 45mg, but from what I know past dinner there should have been nothing left influencing my system. All yesterday and today I have had essentially zero appetite and have made myself eat a smallish helping at meals with absolutely no desire. This is a radical change in appetite.
The only thing I can think is that 60mg may have been a bigger shock to my body than it seemed. Today any complaints I have are likely the result of getting about 30-60 minutes of sleep the entire night. Laying low and hoping for things to level out.
I gave my system some time to
Submitted by jackrungh on
I gave my system some time to level out and began to feel the way I did before taking the Adderall.
So this morning I took the regular dose, 30mg. I feel flustered, on-edge, and not at all well. It is as if it is enough stimulant to get me out of depression-induced non-thought and lethargy, but not enough to get me active on anything.
Just about all it seems to be good at doing is making me extremely unable to ignore the death-spiral of dysfunction that is happening all around me. I can't focus, I don't seem to be able to work, my daily life is just careening out of control and I can't seem to feel much of anything but dread. How much of that has to do with the medication and how much had to do with the fact that I have a looming deadline tonight is an assessment I can't make my mind up on. I've procrastinated for weeks on this thing I have to do for work and every time I try to make some headway the admittedly technically-complex task produces another hurdle. It isn't working like it is supposed to and I seem to be unable to summon the will to drive through it. The only reason I'm even stressing about it enough to feel this need to vent is due to the approaching deadline.
This isn't working, and I need to get in treatment. My wife left to take the kids to therapy and left me with the youngest two boys. One played IPad in my home office while the other slept. The baby woke up and wouldn't stop crying, so I went up and got him and rocked him in my desk chair in the office. Then I wept. I'm barely holding on over here, and there is no great trial or tribulation before me. It is just the daily stuff of work and family life. I came to these forums again because the void in my relationship with my wife was no longer bearable to internalize. Now I feel like everything is coming to a screeching halt, and I am unable to endure much of anything in silence any longer. Might just be the frenzied mental state caused by this terrible drug. I feel like such a weak person.