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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Ezekiel on June 18, 2008, at 19:36:19
Greetings All,
Allow me to begin by providing a little background, I have suffered from dysthymia most of my adult life (I'm now 35) interspersed with periodic moderate-major depressive episodes (lasting from several months to several years when it hits) during the past 14 years. Back in the mid 1990s when my depression first began, I went to see a physician about for help and he began prescribing me numerous SSRI drugs one right after the other as soon as the previous one failed to help me. Well, I eventually became greatly disillusioned with pharmacotherapy when nothing helped, and determined to never go down that road again using psychiatric drugs to treat my mood issues after that pharmaceutical debacle (oh what sheer joy it was to withdraw from effexor, NOT!)
Now fast forward to the present - recently (3 months ago) I began to experience mild-moderate depressed YET AGAIN. Presently I'm a graduate student working towards a master's degree in a rigorous academic health care program and I'm nearly finished with my first year (I'm running on nothing but fumes at this point). I've literally gotten eaten alive this year by the furious demands of the curriculum, and my stress/anxiety level have been SKY HIGH for the last 9 months straight (I decided quit caffeine from any source & that helped a little with reducing anxiety). My grades dropped lower than is acceptable by my university last term, and so I was placed on academic probation and offered only 1 TERM to get my GPA up (to at least a 3.0 solid B average) or I will be dismissed from the program - well, I worked extremely hard to even get to this point, so I cannot allow academic failure to be an option! Talk about pressure & stress!!!! I've studied various depression treatements for many years (undergone treatments like cognitive therapy, naturopathic remedies, etc.) all with minimal-moderate success but never long lasting, and my dysthymia has always been lurking around the corner meanwhile, ready to pounce on me just at the point when I'm not looking - man, depression is such an EVIL BEAST!!!
Alright I'm getting wordy so let me get to the reason for this post - scientifically it is well known that there exists a strong relationship between extreme stress and the onset of a depressive episode (perhaps what triggered my latest episode), so I went to see a psychiatrist 6 weeks ago to see if the new frontier of anti-depression drugs I've been researching might succeed where the SSRIs failed me (e.g. EMSASM, tineptine, etc) because a lot has changed since the mid-90s when the SSRI's were as good as it got back then, unless you were willing to take on the risks of the older MAOIs.
The psychiatrist I'm seeing diagnosed me with ADD after our first 90 minute session, and said I most likely needed a stimulant and that that may solve much of my mood problems, needless to say I was completely shocked by his analysis (btw, he's involved in cutting edge depression research at a world eminent hospital in Boston where I live, so I have to at least consider the merit of his diagnosis, although I'm not 100% convinced YET).
The ADD thing had NEVER even gotten into my radar as playing a role in my depression, so I've never looked into it. Well I was desperate so I agreed to give stimulants a shot and see what happened. He told me we could add an AD if it was warranted down the road. So I started off with Ritalin for a few weeks but it made me tense (but did act as a mild anti-depressant & gave me focus). So our next meeting he prescribed me Adderall to for a trial run, and so I've been on it the last 7 days. It was astounding the soothing euphoria it provided the first 2 days, but that quickly subsided and now I get just extra concentration and energy (good thing it went away or I may never have wanted to stop this drug!). My side-effects have been a fast heart rate which has gone over 100 bpm at times, and also I've felt my heart contracting with greater force (evidently from the extra norepinephrine at sympathetic nerve synapses which adderall causes to be released). These adverse effects have improved the last couple days, and man, it is certainly no fun feeling fluttering/pounding sensations in your chest throughout the day as I'm sure some of you reading have also experienced!
So, FINALLY to the reason for posting (sorry I can be verbose at times), I am receiving some MUCH NEEDED motivation from Adderall, it's not a perfect drug, meaning it's not magically solving my study habit/time management difficulties or grander ones like revealing me the purpose why the universe exists, but it is helping me organize myself better (which was virtually non-existent before) and is also helping me to prioritize academic tasks and actually begin to work on them along with an improved ability to concentrate for longer spans of time (but only a modest AD effect, and that at the higher doses).
The problem though is that I'm TERRIFIED of getting physically addicted (we'll leave psychological addiction out of this, one issue at a time!) to Adderall, because this is an inevitable consequence of taking a pharmaceutical stimulant daily for extended periods of time - I believe it probably takes somewhere between 3-4 weeks of daily use until this physical dependency occurs (that may not be an exact timetable, but I'm pretty sure it's approximately correct) and whenever you do cross that threshold, you must then resign yourself to the inevitability of going through some potentially very uncomfortable withdrawal effects for a while depending on how much you were taking & for how long (as you guys already know, this phenomenon is well documented).
So then, if someone is reading this post and has already gone down this road of becoming physically dependent on Adderall, and then at some point decided to get off of Adderall, then will you please be a good samaritan and share your experience in some detail? I know that depression and lethargy are some of the possible symptoms, but how long do the withdrawal symptoms last generally speaking? How exactly did you go about getting off of Adderall? Did you carefully taper down over time, and if so did that method lessen the severity/intensity of your withdrawal symtoms? And honestly, how miserable of an experience is it getting off of Adderall when one decides too, is it within the range of tolerability? Is there something a person can take to help get them through the withdrawal period, e.g., briefly using an opiate or benzodiazapine (or some other pharmaceutical) to help offset the worst of the withdrawal period?
I'm finding that I only respond to higher doses of Adderall, and this is maybe the case with with any stimulant because I required higher doses of Ritalin as well. I've titrated up to 50mg (instant release) twice daily with my psychiatrist's approval, and at this dosage schedule I'm functioning ok, but it still takes a good deal of effort to do the things my classmates do (study for long stretches and retain everything) seemingly with minimal effort. If taking a drug like Adderall to enable me to function "somewhat" like other people do normally, then it may be a necessary and acceptable trade off to stay on it for a year or so until I have sufficient time to research a more long-term solution that will not potentially harm my cardiovascular system down the road arising from a constantly elevated pulse pressure (this results in all you major organs aging faster over the long-term).
Ok I'm done droning on, if you've read this far I thank you for doing so, and it's my hope that a kind soul (or 2 or 3 . . .) will share some insight into the above concerns I shared, because at some point VERY SOON (I've been on it daily 7 days) I'm going to have to decide to stop Adderall or continue with daily use past the point where my body/brain becomes dependent, and just have to accept the fact that somewhere down the line I'm going to have to go through the experience of withdrawing from Adderall. Taking days off was tried and is not really an option because I revert to a slugs pace with everything and will surely be dismissed from my school due to sub-standard grades if this pattern continues.
Anyways, again thank you for reading and a HUGE thank you in advance to anyone who will take the time to share their Adderall story!!
Robert
Posted by dbc on June 18, 2008, at 21:42:49
In reply to Struggling graduate student needs Adderall advice!, posted by Ezekiel on June 18, 2008, at 19:36:19
A very very simple answer.
No matter what substances you ingest you eventually have to stop taking them.
Posted by elbee on June 18, 2008, at 23:04:03
In reply to Struggling graduate student needs Adderall advice!, posted by Ezekiel on June 18, 2008, at 19:36:19
Hi,
Sorry I can't offer any advice as I haven't taken Adderall but I hope you find a solution that works out. Are you sleeping OK and everything else going OK? Your posting reminded me a little of the type of posting I might make if I was hypomanic and I was a little concerned upon reading it. I'm not saying that's what's going on with you though. It could just be me reading my experience into someone else's post...Take care of yourself though during this difficult time. I was in grad school a few years ago and it can be tough. Best,
L.
Posted by ezekiel on June 19, 2008, at 0:26:27
In reply to Re: Struggling graduate student needs Adderall advice!, posted by elbee on June 18, 2008, at 23:04:03
Hi elbee,
Thanks for the concern, no I'm not hypomanic (yet!) lol - I'm just feeling apprehensive because I've never been physiologically dependent on a powerful psychoactive compound - ok I once smoked for several years and got off caffeine a while ago, but I don't count those :=)
I'm just concerned because I've read in numerous places that extreme lethargy & intense depression can characterize the experience of coming off pharm stimulants (same goes forthe illicit stims). So, the fact that I already have a propensity to various depression manifestations, i.e., sometimes it's dysthymia predominating my mood, then other times it's more troublesome like moderate depression.
This fact makes me a little wary of a powerful psychoactive compound that can help me like Adderall is at the moment, but in the back of my mind is the thought that the day of reckoning must inevitably come and you must pay the mental/emotional toll price for all the chemical assistance you've received from the drug, namely, a vicious withdrawal depression. That's why I posted here hoping that someone has traversed this road before me and can share their experience of how bad withdrawals can be (keeping in mind though everyone is obviously different in their response) and if there exists devised methods people have used to reduce the intensity of the stim withdrawal experience.
It would be comforting to know if there exists a way to withdraw from ADD stimulants that would lead to the least punishment on one's mind & body, e.g., a really slow tapering down approach, that would in effect minimize the depression withdrawal symptom. This was how I kicked a 16 year heavy caffeine use addiction, by slowly tapering down, and it worked very well. I just don't know if that approach would be successful with a far more powerful stimulant like Adderall.
Thanks for the feedback though - please keep them coming!!
ezekiel
Posted by dbc on June 19, 2008, at 4:18:28
In reply to Re: Struggling graduate student needs Adderall advice!, posted by ezekiel on June 19, 2008, at 0:26:27
Amphetamine is not forgiving when its abused but is more so when simply used long term. I know this from a year of dexedrine use and the only answer is to live through it. I have no idea who you are and where you've been so i cant speak for you but a weeks worth of lethargy and some depression doesnt sound like a bad trade off that amphetamine gives especially in comparison to other stimulants.
I've had much more trouble over therapeutic use of sedatives/benzos (valium, klonopin, ativan, xanax)as far as withdrawal than amphetamine. Chances are if you have a doctors over 50 they ate hand fulls of dexedrine during med school (mine did and told me so).
This drugs been around 100 years and i dont think theres more we can say that hasnt been said about amphetamine. Its a personal choice.
Posted by wdh on November 14, 2008, at 11:51:07
In reply to Re: Struggling graduate student needs Adderall adv, posted by dbc on June 19, 2008, at 4:18:28
I've been on 30mg of Adderall XR, once a day, for about two months now. Over the Halloween weekend I was busy enough to not make it home and take my daily dose. I spent two full days off the medication and one of these was a work day. I felt no withdrawl symptoms, I simply reverted back to my normal distractable self, though my ADD symptoms were less severe than before I started the Adderall two months ago. By the end of the second day I did notice a desire to get back to the structured routine that I had built for myself over the last two months. Also recently I went off the Adderall for about three days while I was sick with the flu. I never felt any withdrawl symtoms during this time either. I'm not sure if this is a normal response. I enjoy taking Adderall, it has helped me so much in gaining focus and perspective in my life, but at the same time, if I feel like I don't need it for a day or two I seem to have little issue with skipping a day or two. Try skipping a day or two and see how you feel, maybe it's not as addicting as you think.
Posted by JadeKelly on November 14, 2008, at 12:59:08
In reply to Re: Struggling graduate student needs Adderall adv, posted by dbc on June 19, 2008, at 4:18:28
OK, just lost my post. I'll try again. I tried Adderall for a couple days, not for me. My fears same as yours. What DID work for me, and I know you've tried this, was Ritalin 5mg tabs 3-5x day, depending on what I was doing at the time. I also happened to be taking Klonopin for nerve pain in my neck/headaches. This combo turned out to excellent for me. Ritalin, not the XR, I found to be just right as I could take as needed.
After many years of use, I abruptly stopped to try A/D that was contraindicated. No W/D at all except small amount of fatigue for few days. (Now Klonopin, that would be a different story!) You may want to revisit Ritalin as I feel it is much easier on your system and won't cause the depression I suspect Adderall causes upon D/C. All just MHO! I think you are right to be hesitant about Adderall.
Good Luck!
~Jade
Posted by JadeKelly on November 14, 2008, at 23:52:29
In reply to Struggling graduate student needs Adderall advice!, posted by Ezekiel on June 18, 2008, at 19:36:19
Hi Robert,
Had chance to read other posts. Being in health care, I'm sure you know the risks of long term amphetamine use, and use of mixed amphetamines. I geuss I'm surprised you would consider it at all, with the access you have to detailed drug information!!! Of couse, PDocs prescribe them every day, so I just don't know. Are they not as risky as I thought? In addition, I feel its possible you would be looking at a depression upon D/C that could be intense, and certainly last longer than a week. Not to beat this to death, but if another try on Ritalin IR would offer alternative, I'd certainly give it another try. Have you tried Strattera? Also, if you do have information re: risk vs.benefit using amphetamines long term I'd love to hear it if you don't mind!
Regards,
~Jade
Posted by Ezekiel on November 16, 2008, at 4:15:54
In reply to Re: Struggling graduate student needs Adderall advice! » Ezekiel, posted by JadeKelly on November 14, 2008, at 23:52:29
Hello Jade,
I'm ezekiel aka Robert - thank you immensely for caring enough to share your experience with ritalin! I'll have to give that idea some consideration, I'm still going back and forth with several options to treat my emotional/mental difficulties, e.g., I may try naturopathic approaches such as omega 3 fish oil & the like - I've read many clinical trials concerning its efficacy for treating depression an adult ADD.
Presently, I'm still taking adderall and have really refined my therapeutic use of it (5 months or so now) to a science. BUT, I have since my first post experienced withdrawal from it twice, and it wasn't as catastrophic of an experience as I anticipated it would be - but don't get me wrong here, I still went through several days of morbid depression (not suicidal but vicious pessimism about the world & intense sadness). It seems to begin lifting around day 3, and each day after that I've always experienced dramatic improvement wih each subsequent day off adderall.
Also, I've since learned that adderall is a "profoundly addictive" drug with respect to psychological dependency - this drug has provided me extraordinary assistance academically (usually, not always!), but at a cost - what I mean is this - once you achieve what formally seemed to be unattainable goals "after" beginning adderall, you then become completely uncertain if it was really "YOU" or the drug that produced the success.
This is a huge bioethical debate, and I don't claim to have an answer, but I can say this much, for most people (encountered through via internet forums) this confusion about which "cause & effect" relationship (you or adderall) is the real one, is no easy task to determine if you attain your goals post-adderall use.
So, I've thus far arrived at some less than glowing conclusions with respect to adderall, but also positive - here's just a few:
1) adderall does not create increased intelligence that did not exist already for those of you who believe the drug will sky rocket you to the top of the dean's list - it certainly can increase the "rate" of one's thoughts & inferences concerning ideas, but only to the complexity that one was already capable of engaging in in the first place (i.e., you won't all of the sudden grasp the nuances of Isaac Newton's laws of planetary motion, when prior to adderall you could not get past intermediate algebra!). Hey, don't laugh, I've interacted with many adults who had such outlandish expectations of what adderall would do for them, like going from a general manager position to a top executive in 6 months!
2) one can quickly & easily come to believe that they cannot sufficiently function in novel, or even familiar social settings w/o a dose of adderall taken beforehand - it develops into quite an insidious belief which is often completely erroneous, but this false belief quickly can become a self-fulfilling prophecy - this may be the case because social settings become much less strenuous on the mind & emotions when you actually find yourself having a "genuine interest" in other people's lives, rather than feigning interest because depression or acute anxiety have made you entirely self-absorbed - depression almost never allowed gratifying social experiences due to my melancholic propensity to engage in perpetual & severe morbid introspection about the wretchedness of this life, along with shameful levels of self-centeredness, which nearly always prevented me from ever even getting to a social event in the first place!
3) at least a full 24-48 hr break from adderall a week MUST be done for most people it seems, or tolerance will rapidly spiral out of control and can drive many good people to serious abuse of adderall to avoid the inevitable crash & withdrawal symptoms.
Ok, I would love to provide more of my experiences, but I have 3 more weeks until I graduate, this assuming I exceed a 3.0 GPA, which it actually looks as if I will! I should be overjoyed about finally reaching graduation (I am excited, no mistaking that!), but here's the downside, for the rest of my life I will never know with ABSOLUTE CERTAINTY if it was I myself who persevered, or a powerful stimulatory compound named adderall that enabled me to achieve what I could never have achieved naturally - just a thought.
Furthermore, wondering which came first "the chicken or the egg" can potentially have long-lasting detrimental effects on one's sense of self-efficacy - but honestly, what can you do really do when you feel you have run out of recourses?? You can either refuse the chemical help and risk failure, or accept the help and raise your chances to succeed - I chose the latter, and now I will have to live with that decision - but heck, you know what, life could have turned out far worse for me, so I really am not apt to complain at the present moment, but rather be thankful that I found a way (just in time) to help myself persevere through my long pursued goal of graduating from grad school - but I also don't believe it was just "I" who did it - please allow me to briefly elucidate what I mean.
I don't wish to bore people, but I believe that my faith in God ultimately made the final difference.
Lastly, I wish all of you out there true peace in this crazy life - never stop seeking for it, because you truly never know when it may find you, just as you were about to lose all hope - I eventually found the elusive peace of mind I had searched for every day of my life, it finally happened through faith in the God of the Christian scriptures - I believe God honored my faith in Him and used various means to keep me going in life & enabled me to not give up when most days I just wanted it all to end. I tried reading western philosophers, comparative religion texts, majored in psychology, and on & on, BUT FOR ME, reading the ancient and holy scriptures was the only experience that ever provided me "tangible relief" from my anguish in life that I could actually "feel". So as previously said, NEVER give up on life, because if you can find a reason OUTSIDE OF YOURSELF to justify goig on, then you will appreciate this brief life FAR MORE than someone who has never suffered from a disturbed mind - I gambled and acted in faith that my existence was not in vain and lept across the chasm and unable to see the other side, not knowing if I would land safely or continue falling forever - BUT, we must all be sure of this fact - each one of us must ONE DAY make the leap (for some on their death bed) - I chose to jump even though I could not see if their was anything on the other side, and for me there was, and I have never been the same - take the chance and jump into the unknown, you just may land safely on the other side as I did - peace & joy to all of you . . .
Robert
Posted by JadeKelly on November 16, 2008, at 16:46:15
In reply to Re: Struggling graduate student needs Adderall advice!, posted by Ezekiel on November 16, 2008, at 4:15:54
Robert,
So glad you are at peace (I think?) with your decision, and from what I read, it was a good one! You were very careful not to abuse, or become addicted to a med that for most, is hard not to do. I'm sure you are aware that many grad/medical students get a little help along the way. Be proud you used a med as it was intended. Nothing wrong with that. I envy you your intelligence. You are right, all the adderall, or Ritalin in the world isn't going to change our I.Q.s. However, when I needed it, Ritalin made it possible for me to accomplish what I NEEDED to, taking good care of my small kids (at the time) working a stressful job, building a house. I never did become addicted to Ritalin, which is what I like about it. But to each his own!
Your post will be very helpful to any out there considering Adderall and I will always recommend they read it! Thanks for sharing your experience.
~Jade
Posted by PollyFarm on December 10, 2008, at 3:46:41
In reply to Struggling graduate student needs Adderall advice!, posted by Ezekiel on June 18, 2008, at 19:36:19
So, Zeke, did you graduate yet? I am rooting for you!
I have only had recent experience with Adderall to treat possible ADD (a very recent and surprising diagnosis considering that I did well in school, though have been known to be impulsive at times) and found that it worked on my depression and enabled me to accomplish tasks that would otherwise overwhelm and continue the cycle of depression...something as simple as cleaning out a closet. I had to get my house ready to put on the market and I DID it...amazing, for me! But I don't question whether it is the Adderall or my own self accomplishing small and large tasks and tolerating the nitty-gritty of raising 3 kids under 5 (two yr old twins, yikes!)...whatever you accomplish, whatever is in you, is in you...a pill can't put it there. It just gives you access to it, a conduit throught which to express it. Hallucinogenic drugs, for example, create an amazing spectrum of images conjured up from the depths of our subconscious...I haven't experiemented much, but one time I saw dragons, the "evolution" of religious structures from temples to pagaodas, etc...was that all there in my brain? Of course! The shrooms just created a pathway for me to experience them (I hope I don't get kicked out for this reference). But many cultures use hallucinogens to "see God" in their own cultural context...I am straying, but I just want to reassure you that your accomplishments while taking Adderall are all you, probably MORE you than w/out the Adderall, b/c it allowed you to access the parts of your brain that you needed.
I am currently taking 20mg of Adderall in the a.m. and a 10 mg dose around 2 p.m...I've been having some crashing and crying and desperation, but I'm on lots of other meds, so trying to parse it out. I've gone off the Adderall when sick w/no ill effects (depression-wise)...today didn't take the first dose until the 2:30 p.m. and consequently crashed on the couch amid three children (and my mom, thankfully) and that didn't seem to make any sense. Later in the evening had a baby shower to go to that I left feeling incredibly anxious and sobbed on the way home...maybe my withdrawal is coming daily?
Anyway, I'm interested in hearing how things go for you. Probably once you graduate you will be out in the field and not needing to continually focus on lectures and texts, and maybe that will keep you adequately focused.
Sorry for the lengthy post...keep us all posted on your success!
This is the end of the thread.
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