Posted by Peter on August 5, 2003, at 9:55:41
Hello all:
It's been quite a while since I've posted here.
Quick background: I was diagnosed in 1996, after a few years of drug abuse (pot then cocaine & heroin), with a comorbid disorder of bipolar (mild, but I fall somewhere along the bp spectrum), adult ADHD, social anxiety, depressive anxiety. I've been seeing the same pdoc since '96, when he literally had me start up depakote right after I quit heroin. Since then, he has had me on every combination of just about every med I can think of - anticonvulsant mood-stabilizers (depakote, neurontin, lamictal), SSRI's (all of 'em), benzos (klonopin, restoril), other AD's (effexor, wellbutrin, moclocbemide, trazadone), beta blockers (inderal, tenorman, etc.) dopamine agonists (permax, mirapex, etc.), stimulants (adderal xr + IR, dex spansules, concerta), strattera, ambien, and the list goes on.
I went through periods over the years of becoming rather upset at my pdoc for constantly changing my med regime, even at times when I thought I was settled and doing well. BTW, my pdoc has stated to me numerous times that my disorder is not severe at all, but just 'difficult to pinpoint and treat." I've gone to numerous other pdocs for consultations, and each one has told me something different; one said I don't have BP but I do have ADD, another said the complete opposite, and a 3rd said I have none of the above, and only some depressive anxiety.
My most recent combo, which I had been taking since late winter/early spring, was adderall 35mg, prozac 5-10mg, lamictal 50-100mg, strattera 25mg, klonopin 2-3mg, temazepam 15mg, trazadone 25mg. Of course, I had to titrate the lamictal over months, and the doses of all the other meds were constantly in flux over the months).
In mid-June, my doc decided to begin the shuffle again; this time I think it was because I was experiencing some agitation. He first had me stop the prozac; seeing that my agitation was still there, he had me stop the lamictal (which never really did anyything for me anyway). As both of these meds have long half-lives, he had me stop them 'cold,' stating they would 'wean themselves out of my bloodstream.' And they did - no severe withdrawal (nothing like zoloft!).
I went on a trip to Europe late June, and I'm still there now. During my stay, I again became a bit more agitated than usual, and my pdoc took that as an opportunity to taper (5mg - a -day) off the 35mg adderall. I reluctantly followed his instructions; out of all the meds I've taken, I've found the adderall to most accurately target and treat whatever comorbid disorder I actually have. I was markedly less symptomatic on adderall (more focused, productive, calmer, social, etc.). But, at moderate-high doses, it did sometimes cause me to isolate and avoid people more, and it gave me 'dips' in my mood when it wore off. But still, the anticonvulsants did nothing but put a 'heavy blanket' damper on my mood; the SSRI's would help only temporarily (a few months) and didn't seem to target whatever my 'core' disorder is; the klonopin is ok, and now I just use it at night for sleep 'cause it makes me too drowsy during the day. Everything else was obviously ultimately unsuccesful, as I'm not on any of it anymore.
Anyway, I tapered and stopped the adderall; the first few days I experienced intense fatigue, but then I began to experience complete restlesness, fidgetiness, irritability, impulsiveness, racing thoughts, etc. Now, this is after I'd been off of the lamictal and any other 'mood stabilizer' for months. But right after stopping the adderall, this began. It got worse the more time elapsed since having stopped the adderall. I've even begun drinking at night to ease the restlesness - when I took adderall, I was calm and had no desire to drink alcohol or take street drugs.
I told my pdoc that this is the first time since I was 11 or 12 that I'm on such a small amount of 'substances' (prescribed or not). I've always taken combinations of meds and this has really just made it more difficult to pinpoint my diagnosis; that's why he had to eliminate each med this last time one-by-one so he could see more clearly what was going on with me; each cocktail produces more synergistic effects which further confuse the whole situation.
So finally, I'm on only 25mg strattera during the day and 2mg klonopin + 15mg temazepam at night. But I'm still experiencing these typical ADHD symptoms. Isn't it logical to assume that ADHD is in fact the core of my disorder and that the adderall ALONE, not combined in yet another cocktail, would be a wise choice at this point?
The anticonvulsants might very well have 'calmed' me to a certain extent in the past, but in an indirect way, dampening my mood as I mentioned, thereby 'masking' but not treating my seemingly evident ADHD.
BUT, my pdoc said starting up the stim now isn't a prudent move, and instead he's taking me off strattera! I agree with coming off strattera - any acute side-effects would have abated by now, but I still get so restless and agitated even on such a low dose.
But why wouldn't he allow me, for the sake of simple relief, to resume the adderall?
It seems like it's just one huge guessing game for him and I'm the gineau pig. He loads me down with tons of meds and then, when I eact badly, he has no idea which out of all of them works and which causes the problems, so he takes me off each one. But it's obvious from taking adderall on and off for years, that it is the most effective med, as it renders me least symptomatic out of the billions my doc has put me on.
He claims that my restlesness/irritability/mood lability, etc. is not signs are ADHD because ADHD 'sufferers don't experience such intensity of discomfort.' Is that true? Why do ADD'ers seak treatment then? Also, he's not the one feeling these symptoms, I am. He's even admitted to not really understanding my condition and how to treat it. That's very comforting!
I'm so sorry for being so long-winded. Thanks to anyone bore with me up to this point,
My basic questions are:
1) As, he's having me now stop Strattera, he said I should skip a day of my 25mg, and then resume with 10mg caps (I have 15 of the 10mg's with me). Does Strattera taper produce withdrawal symptoms? If so, what? How long does it take to get off it?
2) I'd appreciate any advice and opinions about what I'm experiencing and the resulting frustration of my pdoc not agreeing to place me back on adderall, though I've experienced that it is on-the-whole more effective for me than any other med I've taken. I'd appreciate it; I've been bottling this all up inside for months, even years.
thank you so much,
Peter
poster:Peter
thread:248228
URL: http://www.dr-bob.org/babble/20030802/msgs/248228.html