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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 Comp on August 26, 1998, at 18:07:52
Hello to everyone..A special thank you to Dr. Bob.
I am glad that we have this type of fourum in wich
we can discuss our feelings and at the same time get
some help. My questions are, I am a 28 yr old male
5'9 and 160 lbs. I am taking 2 tablets of Zoloft 25mg
for mild depression. At the time when I was given
these pills my my family doctor, I was not diagnosed
with ADD. I because of my mild depression or, my ADD,
I was not able to make many friends or develop
relationships. Since then, I went to a pyschiatrist
where he diagnosed me with ADD. My social attitude
changed a little as I was able to meet this wonderful
girl. When we decited to "be together", I could not
get an errection and when I did, it would not last.
More than embarrased about the situation, I was worried
nothing like this had happened to me before. Is this
the result of taking Zoloft or Addrenoll? If it is
Zoloft, is it permanent? And should I ask my doctor
to take me off imediately since my mild deppression
is not worth the side effects?My other question
I started taking 2 tablets of Adderoll in the morning
and two in the evening aprox 5pm. After 3 weeks,
I have yet to notice a big difference in myself.
I still daydream alot, even when I am performing
a task. Do you think that it is too soon to give up?
I got immediate effects on Ritalin but soon wore off
and with Adderall, the same thing. It is like they
work, and then they stop working.. I wonder why?
If you have the answers or have any imformation that
you could share, I would appreciate it very much..
Thank you all again in advance.
Posted by Toby on August 27, 1998, at 9:33:46
In reply to Zoloft side effects... also, does Adderoll work?, posted by Comp on August 26, 1998, at 18:07:52
There are three or four things to consider when figuring out what caused the difficulty with erection. One, depression itself can lead to decreased libido, arousal and erection. Two, antidepressants can cause this difficulty in about 15-20% of people. Three, anxiety about a new relationship can cause this difficulty (the way the human nervous system works, you have to be relaxed to be excited). Four, are you taking any other medications or have any other health problems (like diabetes) that could be the cause?
If you can get an erection during sleep or when masturbating, the medication is probably not the cause and it's probably early relationship jitters. If not, or if you've attempted intercourse another time or two with the same results, then it may be the medication. Of course, you still want to see your doctor who can quickly find any possible physical causes.
If you and your doctor determine it is the Zoloft, there are options to help without discontinuing the Zoloft. These include L-arginine 2000 mg on an empty stomach, 1-2 hours prior to intercourse, adding Buspar or Wellbutrin to the Zoloft, or even replacing Zoloft with Wellbutrin (which has been shown to also be effective for ADD). There are also Cyproheptadine and Yohimbine but the one makes you drowsy and the other can give insomnia, so I don't like them. The best options are adding Buspar or switching to Wellbutrin.
In regard to the ADD: Do you really think you have this? I mean, has the doctor discussed the symptoms with you and you can see that they apply to you? The reason I question this is that anyone may feel sharper and more attentive during the first little while on a stimulant medication, but the effect soon wears off. If a person really has ADD, generally the effect does NOT wear off like you describe. Perhaps some of the attention and concentration troubles are due to the mild depression that is not fully treated. I can't be sure since I can't talk to you directly, but you may want to explore this further with your doctor since it is useless to take medication that doesn't treat what you've got. If it turns out that the depression is the true culprit, increasing the Zoloft is an option, but that also puts your sex drive at more risk, so switching to one without those side effects would be more reasonable (these include Wellbutrin, Serzone and Remeron).
Posted by Comp on August 29, 1998, at 16:16:01
In reply to Re: Zoloft side effects... also, does Adderoll work?, posted by Toby on August 27, 1998, at 9:33:46
Thank you Toby for your help in giving me peace
of mind about my errection problem. You brought
several points that were exactly what was going
on with me. I never have problems problems
masturbating and have always been errect in
the morning since I reached puberty. Since this
was the first time that I had a sexual
relationship in a long time, I may have had the
jitters. I failed to mention that we did have
intimate relations the next day as normal.As for ADD, I was diagnosed by my school counsleor
at the Universtity in which I attend. He referred
me to a psychiatrist which quickly labeled me as
ADD. I believe that my school counsleor took
more time in diagnosing this than my psychiatrist.
But I have read many books and taken home tests
that clearly show that I have ADD. My inability
to FOCUS, my constant Daydreaming while I am
performing my tasks. My multitasking and never
finishing anything. My impatience anywhere,
traffic, checkout stands. Sometimes, I start
reading a book and 5 pages later, I do not know
what I was reading. I will start reading a book
and my mind will wonder about thinking of many
things that have nothing to do with what is at
task. When I was in Junior Highschool and
Highschool, my teachers used to get mad because
I would blurt out the answers before they were
finished with the questions. More often than not,
my answers were not correct. I pay attention to
the things that interest me and little to the
ones that I may not be interested in reguardless
of their importance. Many times, when I am talkin
to someone, I cannot pay attention to them because
I click them off of focus. Which makes them upset
because they have to give me instructions over and
over again. I almost always, interrupt people
while they are speaking because to me, I already
know what they are going to say. I am a very
impatient guy.Well, Thank you again Toby for your help and I
would apreciate your continued help. Please
imform me, if to you these are the signs of a
ADD. And what is the normal working dose for
ADDERALL or what is the most effective drug I can
take if I indeed have ADD. My psyc has already
made his label. Do you think that I should get
and oustside second oppinion??Thanks again.
Posted by Toby on August 31, 1998, at 8:56:09
In reply to Re:Thanks for your help Toby, here is my ADD inf , posted by Comp on August 29, 1998, at 16:23:49
The extra info was very helpful. Sounds like ADD for sure. Let me give you some basic info about the medication treatments.
About 85-90% of people respond to stimulants. Ritalin and Dextroamphetamine are the first choices. If one of these drugs fail, there is a 25% chance the other drug will work. If a short-acting stimulant lasts only 3-4 hours with abrupt return of symptoms, consider the sustained-release form, or Cylert. Dextroamphetamine spansules (long-acting) can have uneven effects with early intense activity and a significant decline thereafter; the long action form of Ritalin works well. When a stimulant works, it works within 2-3 days, the effects persist and there is little to no tolerance over months to years. When a stimulant works, 30% of patients get marked improvement, 40% get some benefit and 10-30% are refractory. **** If the drug is tolerated well (no side effects) but gets only minimal or partial improvement, higher doses are likely to increase improvement.**** That sounds like what has happened for you. A simple increase may do the trick. The usual maximum dose for Adderal is 40-60 mg per day and about 80 mg per day for Ritalin. Different problems related to ADHD may respond at different doses so you have to keep track of what's happening with you, balance benefits with side effects, and decide whether you feel comfortable with your daily functioning at a certain dose, even if every single symptom isn't completely gone.
If the stimulants end up not helping even at the maximum dose, there are some other meds to try. Cylert is good because it has once a day dosing. A drawback is that you have to get blood drawn every 6 months or so to keep a check on your liver because it can (uncommonly) cause some elevation in the enzymes in the liver (catch it early and stop the Cylert and the liver does OK). Wellbutrin is an antidepressant that has been shown to work in some unknown way to improve ADD and the dose is 150-300 mg per day (good for depression, no sexual side effects and well tolerated but you can't take it if you have a history of seizures). Tricyclic antidepressants like imipramine, desipramine and nortriptyline have also been used for years for ADD with good effect (these work best on impulsivity and attention problems and I personally like nortriptyline best because it has fewest side effects). Side effects include some weight gain, and have to get EKG's once a year to monitor the heart. Clonidine and guanfacine are blood pressure medications that are usually used to augment other medications (works only so-so alone). Most common side effect is sedation that goes away in 2-4 weeks. Guanfacine better tolerated than clonidine (less effect on blood pressure, less sedation) and works well on hyperactivity, inattention and immaturity but doesn't do much for mood or aggression.
Since you are currently taking a stimulant, it's best to stick with it until the dose is maxed out. You will need to talk with your psychiatrist about this at length, because many docs are hesitant to prescribe higher doses because of potential abuse. I'm assuming you don't have a history of any major drug abuse since the doctor likely wouldn't have even started a stimulant in that case, so have a good talk with him about carefully increasing the dose and mention the fact that partial responders often get better effect with an increase in dose (dazzling him with your research) and discuss what his plan will be if you don't get any real long-lasting benefit from the stimulants. If he doesn't have any options except Cylert (i.e., doesn't know about Wellbutrin, the tricyclics, or clonidine), time to look for a second opinion.
Posted by Comp on September 3, 1998, at 17:50:01
In reply to Re:Thanks for your help Toby, here is my ADD inf , posted by Toby on August 31, 1998, at 8:56:09
Toby, thanks again for your help.. it is honestly
appreciated. As I told you before, I am a male
28 5'9 and weigh 160 lbs. I am taking 40 mgs of
Adderoll for 3 weeks with minimal help.
I can notice that the speed of my voice
has decreased as well as my thought process.
Yet my concentration is not that good.
I do not know if all people with ADD are
the same, I am sure they are not,
but without any medication(Adderoll or Ritalin
the only drugs that I have taken so far)
my mentality and comprehension are very good.
But most of the time, my mentality, concentration
and comprehension are not good. I know how it
feels to be ADD free (without the medicine)
but most of the time, that is not the case. I
feel like I have a BIG Block of Cast Iron on
my forehead preventing me from thinking and or
learning. I feel so defeated sometimes, I know
what my potential is and although sometimes I
reach it, most of the time no matter how hard
I try, I cannot meet it. I would appreciate
your help again Toby.PS My pysc (the one able to use medicine)
only prescribes medicine but does not use
therapy ( does not help out with the emotional
aspect. Is that the way it is supposed to be?
Posted by alan on September 6, 1998, at 0:55:28
In reply to Re:Toby, I have these side effects.. , posted by Comp on September 3, 1998, at 17:50:01
> Toby, thanks again for your help.. it is
honestly
> appreciated. As I told you before, I am a male
> 28 5'9 and weigh 160 lbs. I am taking 40 mgs of
> Adderoll for 3 weeks with minimal help.
> I can notice that the speed of my voice
> has decreased as well as my thought process.
> Yet my concentration is not that good.
> I do not know if all people with ADD are
> the same, I am sure they are not,
> but without any medication(Adderoll or Ritalin
> the only drugs that I have taken so far)
> my mentality and comprehension are very good.
> But most of the time, my mentality,
concentration
> and comprehension are not good. I know how it
> feels to be ADD free (without the medicine)
> but most of the time, that is not the case. I
> feel like I have a BIG Block of Cast Iron on
> my forehead preventing me from thinking and or
> learning. I feel so defeated sometimes, I know
> what my potential is and although sometimes I
> reach it, most of the time no matter how hard
> I try, I cannot meet it. I would appreciate
> your help again Toby.> PS My pysc (the one able to use medicine)
> only prescribes medicine but does not use
> therapy ( does not help out with the emotional
> aspect. Is that the way it is supposed to be?
>I'm taking pemoline 112.5/day--it wa added to
proac and lithium--and it seems to me that it is
making me very sleepy, not what I'd want or expect
of a stimulant. This intense sleepinees did seeem
to start witth the pemoline being added. Any
helpful or edifying comments. I havee always had
extreme difficulty concentrating and wa hopin for
a miracle.
Posted by Toby on September 8, 1998, at 14:01:54
In reply to Re:Toby, I have these side effects.. , posted by alan on September 6, 1998, at 0:55:28
In answer to Comp: You still have a ways to go with the Adderall, up to 60 mg per day or so to see if the concentration will improve. Also, two stimulants can be used together, but whether your doc will take that risk or not is a matter you will have to discuss at length. The risk is mainly one of state licensure since prescribing two stimulants to one adult is not too common and could draw the state board's attention (docs don't like that). Another option is adding Clonidine to the Adderall. Don't forget the other options listed in a previous posting. Regarding the "meds only" psychiatrist, that is getting to be far too common unfortunately due to managed care and rationing resources. Managed care cuts the number of visits per patient, the reimbursement to docs, increases the number of patients the managed care company wants seen per day, prevents the doctor from being able to do real therapy with patients and lets them just be a walking prescription pad (and how can the doc get to know you in only 15 minutes much less address all your concerns and side effects and new difficulties? Let me know if you figure it out; we complain but nobody listens). If you have the inclination, you might want to write to your congressmen and representatives both at the state and national levels to complain and get them to pass the parity laws for mental health. That may help docs get more time with their patients and get the insurance companies to cover more visits, medications and services. But enough soap box. There are some great books on ADD at the bookstore and in the library that give clear simple ways to control the residual symptoms that the medication doesn't take care of. Use these if you can't get access to a therapist.
Answer to Alan: People that have ADD can get sleepy on stimulants if the dose is too high. That does indicate, however, that you are probably on the right track of finding something that works. Generally, if a patient gets sleepy on Cylert (or any of the others) I will decrease the dose gradually and try to find a happy medium of effectiveness vs. sleepiness. If you have found that a lower dose didn't help, you still might want to try to lower the dose anyway because this high dose may have "reset the thermostat" and you might respond now, whereas you didn't before. Also, something to talk about with your doc: Do you have Bipolar disorder or are you taking the Lithium to boost the antidepressant effect of Prozac? And is that why the Cylert was added, too? You will want to be sure of your diagnosis, because if you really only have ADD and have depressed mood due to the perhaps poor self esteem from the ADD, perhaps you could come off the lithium and prozac. If depression is a separate issue, then of course don't mess with the Prozac. There is no data available that I could find on the interaction of Cylert and Lithium -- I wonder if there could be an interaction that causes the sleepiness you have, especially if very low doses of the Cylert caused sleepiness right away. Check with the doctor.
Posted by alan on September 8, 1998, at 20:45:11
In reply to Re:Toby, I have these side effects.. , posted by Toby on September 8, 1998, at 14:01:54
> In answer to Comp: You still have a ways to go with the Adderall, up to 60 mg per day or so to see if the concentration will improve. Also, two stimulants can be used together, but whether your doc will take that risk or not is a matter you will have to discuss at length. The risk is mainly one of state licensure since prescribing two stimulants to one adult is not too common and could draw the state board's attention (docs don't like that). Another option is adding Clonidine to the Adderall. Don't forget the other options listed in a previous posting. Regarding the "meds only" psychiatrist, that is getting to be far too common unfortunately due to managed care and rationing resources. Managed care cuts the number of visits per patient, the reimbursement to docs, increases the number of patients the managed care company wants seen per day, prevents the doctor from being able to do real therapy with patients and lets them just be a walking prescription pad (and how can the doc get to know you in only 15 minutes much less address all your concerns and side effects and new difficulties? Let me know if you figure it out; we complain but nobody listens). If you have the inclination, you might want to write to your congressmen and representatives both at the state and national levels to complain and get them to pass the parity laws for mental health. That may help docs get more time with their patients and get the insurance companies to cover more visits, medications and services. But enough soap box. There are some great books on ADD at the bookstore and in the library that give clear simple ways to control the residual symptoms that the medication doesn't take care of. Use these if you can't get access to a therapist.> Answer to Alan: People that have ADD can get sleepy on stimulants if the dose is too high. That does indicate, however, that you are probably on the right track of finding something that works. Generally, if a patient gets sleepy on Cylert (or any of the others) I will decrease the dose gradually and try to find a happy medium of effectiveness vs. sleepiness. If you have found that a lower dose didn't help, you still might want to try to lower the dose anyway because this high dose may have "reset the thermostat" and you might respond now, whereas you didn't before. Also, something to talk about with your doc: Do you have Bipolar disorder or are you taking the Lithium to boost the antidepressant effect of Prozac? And is that why the Cylert was added, too? You will want to be sure of your diagnosis, because if you really only have ADD and have depressed mood due to the perhaps poor self esteem from the ADD, perhaps you could come off the lithium and prozac. If depression is a separate issue, then of course don't mess with the Prozac. There is no data available that I could find on the interaction of Cylert and Lithium -- I wonder if there could be an interaction that causes the sleepiness you have, especially if very low doses of the Cylert caused sleepiness right away. Check with the doctor.
First, thank you. And I'll mention: tthe lithium is to augment prozac. The Cylert for ADD and hyperomnia; both of latter before latest depresive episode. Again, thanks.
Posted by Barbara on September 15, 1998, at 11:23:52
In reply to Re:Toby, I have these side effects.. , posted by Toby on September 8, 1998, at 14:01:54
> For those of you who have ADD, which I do and was just daignosed with, there is a very informative message board for those of us who are new and need to be informed and to discuss this with others. Only someone with ADD really knows what it is like. The address is AADD-FOCUSED@MailList.Net. I almost forgot it.Hope to see you there.
B.
Posted by Comp on September 15, 1998, at 20:26:12
In reply to Re:Toby, I have these side effects.. , posted by Barbara on September 15, 1998, at 11:23:52
Hi Barbara... I tried the address but perhaps I do
not know how to get to the message board... please
inform.
Posted by Barbara on September 15, 1998, at 22:42:46
In reply to Re:Barbara Message Boards?? Where... Plese help?, posted by Comp on September 15, 1998, at 20:26:12
> Hi Barbara... I tried the address but perhaps I do
> not know how to get to the message board... please
> inform.I'm happy to let everyone know - go to http://www.MailList.Net - the message board is called AADD-FOCUSED and is one of the first on the list - can't miss it - type in AADD-FOCUSED in the subject line and then write subscribe in the body of the message and give them your e-mail address,
I hope that you join us. It is very interesting and informative.
Barbara
Posted by l. on December 9, 1999, at 12:08:02
In reply to Zoloft side effects... also, does Adderoll work?, posted by Comp on August 26, 1998, at 18:07:52
> Hello to everyone..A special thank you to Dr. Bob.
> I am glad that we have this type of fourum in wich
> we can discuss our feelings and at the same time get
> some help. My questions are, I am a 28 yr old male
> 5'9 and 160 lbs. I am taking 2 tablets of Zoloft 25mg
> for mild depression. At the time when I was given
> these pills my my family doctor, I was not diagnosed
> with ADD. I because of my mild depression or, my ADD,
> I was not able to make many friends or develop
> relationships. Since then, I went to a pyschiatrist
> where he diagnosed me with ADD. My social attitude
> changed a little as I was able to meet this wonderful
> girl. When we decited to "be together", I could not
> get an errection and when I did, it would not last.
> More than embarrased about the situation, I was worried
> nothing like this had happened to me before. Is this
> the result of taking Zoloft or Addrenoll? If it is
> Zoloft, is it permanent? And should I ask my doctor
> to take me off imediately since my mild deppression
> is not worth the side effects?> My other question
> I started taking 2 tablets of Adderoll in the morning
> and two in the evening aprox 5pm. After 3 weeks,
> I have yet to notice a big difference in myself.
> I still daydream alot, even when I am performing
> a task. Do you think that it is too soon to give up?
> I got immediate effects on Ritalin but soon wore off
> and with Adderall, the same thing. It is like they
> work, and then they stop working.. I wonder why?
> If you have the answers or have any imformation that
> you could share, I would appreciate it very much..
> Thank you all again in advance.
Look up Social phobia. John Marshall has a good book on it . Maybe talk with your girl about it too.
This is the end of the thread.
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