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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by tensor on August 24, 2010, at 8:07:13
Hi,
I'm on combo of 30mg Remeron and 150mg Anafranil for depression and anxiety. It worked well for a month or so, then I felt I needed a little more energy so I started modafinil 250mg/day which has helped about a month. I'm starting to recognize this pattern where I don't do much, don't go outside, no desire to do anything.
MAOIs are not used here. Any ideas what to do? Why do I get tired from dopaminergic drugs like bupropion and modafinil?Thanks,
Mattias
Posted by weatherfreak on August 24, 2010, at 9:03:53
In reply to Need advice, posted by tensor on August 24, 2010, at 8:07:13
Any ideas what to do? Why do I get tired from dopaminergic drugs like bupropion and modafinil?
>
> Thanks,
> MattiasHi, now that last sentence grabbed my attention. Have you been tested for ADHD or ADD. Dopaminerigic drugs CAN make people with ADHD and ADD tired.
Modafinil never did it to me but Ritalin does sometimes. Ritalin can put me to sleep. I don't know how it's going to affect me somedays so I really want to try bupropion.
Posted by tensor on August 24, 2010, at 9:13:05
In reply to Re: Need advice » tensor, posted by weatherfreak on August 24, 2010, at 9:03:53
> Hi, now that last sentence grabbed my attention. Have you been tested for ADHD or ADD. Dopaminerigic drugs CAN make people with ADHD and ADD tired.
>
> Modafinil never did it to me but Ritalin does sometimes. Ritalin can put me to sleep. I don't know how it's going to affect me somedays so I really want to try bupropion.I know I have ADD of some form but not ADHD.
/Mattias
Posted by weatherfreak on August 24, 2010, at 9:22:17
In reply to Re: Need advice » weatherfreak, posted by tensor on August 24, 2010, at 9:13:05
Same here Mattias, I know I have some form of ADD but not ADHD and other various bizarre things :)
good luck
Posted by tensor on August 24, 2010, at 9:25:08
In reply to Re: Need advice » tensor, posted by weatherfreak on August 24, 2010, at 9:22:17
> Same here Mattias, I know I have some form of ADD but not ADHD and other various bizarre things :)
>
> good luckEver tried APs like Abilify and Seroquel?
Posted by weatherfreak on August 24, 2010, at 9:54:21
In reply to Re: Need advice » weatherfreak, posted by tensor on August 24, 2010, at 9:25:08
> > Same here Mattias, I know I have some form of ADD but not ADHD and other various bizarre things :)
> >
> > good luck
>
> Ever tried APs like Abilify and Seroquel?Not Abilify but the AP's I have tried were awful for me, Seroquel, Zyprexa and Zeldox. I don't know how I functioned, actually I don't remember to be honest. Drugs like that mess me up.
Posted by Phillipa on August 24, 2010, at 10:35:14
In reply to Re: Need advice » tensor, posted by weatherfreak on August 24, 2010, at 9:54:21
I've read if you were not add or adhd as a child you don't become one as an adult. Anyone know anthing about this as seems so many adults are now add or adhd. Phillipa
Posted by ed_uk2010 on August 24, 2010, at 16:28:23
In reply to Re: Need advice » weatherfreak, posted by Phillipa on August 24, 2010, at 10:35:14
>Anyone know anthing about this as seems so many adults are now add or adhd.
ADD has turned into a catch-all diagnosis for people who can't concentrate for as long as they would like to be able to concentrate for ie. most people.
Posted by sigismund on August 24, 2010, at 17:41:05
In reply to Re: Need advice, posted by ed_uk2010 on August 24, 2010, at 16:28:23
>ADD has turned into a catch-all diagnosis for people who can't concentrate for as long as they would like to be able to concentrate for ie. most people.
There's not much of that here. At least I feel it's too shameless to bodgie up the diagnosis.
But then I hear that some people in Australia are prescribed Dexedrine for depression.
Posted by Phillipa on August 24, 2010, at 21:03:08
In reply to Re: Need advice, posted by sigismund on August 24, 2010, at 17:41:05
Epidemic here for sure!!!!! PJxxx
Posted by weatherfreak on August 24, 2010, at 22:49:05
In reply to Re: Need advice, posted by ed_uk2010 on August 24, 2010, at 16:28:23
ADD has turned into a catch-all diagnosis for people who can't concentrate for as long as they would like to be able to concentrate for ie. most people.
>
>
LOL Ed, I wish that was the case but I really think it rings true for me. I struggled big time as a child and managed to get through high school somehow. The diagnosis was only just being used for extreme cases when I was a child.
Posted by ed_uk2010 on August 25, 2010, at 14:12:33
In reply to Re: Need advice, posted by sigismund on August 24, 2010, at 17:41:05
>There's not much of that here.
It doesn't happen here either, stimulants aren't generally used in adults.
Posted by ed_uk2010 on August 25, 2010, at 14:15:36
In reply to Re: Need advice » ed_uk2010, posted by weatherfreak on August 24, 2010, at 22:49:05
>LOL Ed, I wish that was the case but I really think it rings true for me.
I wasn't referring to you :)
It seems to me that the ADHD diagnosis is profoundly overused in the US. Symptoms such at 'difficulty concentrating on schoolwork' are essentially normal behaviour. A lot of kids don't like schoolwork, why should they like it? Not everyone was designed to be academic!
Posted by ed_uk2010 on August 25, 2010, at 15:39:54
In reply to Need advice, posted by tensor on August 24, 2010, at 8:07:13
>Why do I get tired from dopaminergic drugs like bupropion and modafinil?
Hi Mattias,
I'm not sure that bupropion *is* dopaminergic, or modafinil for that matter. The mechanism of action of bupropion isn't really understood - it is an extremely weak dopamine reuptake inhibitor but that may not account for much. Hmmm.
Have you ever taken a stimulant such as methylphenidate?
Posted by emmanuel98 on August 25, 2010, at 19:25:11
In reply to Re: Need advice » weatherfreak, posted by ed_uk2010 on August 25, 2010, at 14:15:36
I think the issue is that, back in the bad old days before medication, children who couldn't sit still and concentrate on school work -- i.e, high-energy, boisterous children not academically inclined, were whipped, beaten with rulers, set to work in factories. The energy was basically beaten out of them. Now we are more humane and have outlawed child labor, corporal punishment in schools and frown upon child abuse in the home. So we medicate these children instead.
Posted by chujoe on August 25, 2010, at 19:46:01
In reply to Re: Need advice, posted by emmanuel98 on August 25, 2010, at 19:25:11
I have no doubt that ADHD is over-diagnosed among children in the US & I don't disagree with the idea that stimulants are the "more humane" way of beating the energy out of some youngsters. As an educator myself, I honor and value that energy and even occasional craziness. BUT I'm also an ADD sufferer who might well have been a happier kid if I had had some really humane intervention and understanding and perhaps medication. I'm nearly 60 years old now & I take 30 mg of ritalin every day. It has made me more productive, happier, and has allowed me to put some of the energy that flies around in my brain to creative -- as opposed to distracting -- use.
Posted by violette on August 25, 2010, at 22:08:51
In reply to Re: Need advice, posted by emmanuel98 on August 25, 2010, at 19:25:11
I don't agree with the lack of disclipline.
Some of you might be interested in this historical narrative outlining ADD within a social/political context:
https://facultystaff.richmond.edu/~bmayes/ADHD_Mayes_Rafalovich_HistoryofPsychiatry.pdf
I have mixed feelings about prescribing potent drugs to children whose brains are not fully developed (front lobe not fully developed until about age 20)...In addition to growth defects associated with use of those drugs. If such growth problems are obvious-what is not seen?
My psychiatrist said parents, not doctors, gave their children pure amphetamine salts at the turn of the century for children with these traits (this article does not mention that).
It would be ideal if schools would design programs to harness the positive traits of ADD type thinkers; but schools are not individualized, most are designed for the most common cognitive 'types'.
While they do have special ed programs, they are nowhere near the quality of programs for gifted children, and ADD children with above-average intelligence, in those special ed programs, do very remedial-level work. They surely do not reap the benefits from the special ed as gifted children-those who are already at an advantage yet are placed in intensive special programs designed to bring out their full potential.
The special ed programs for those with ADD who perform poorly in classes might even bring out the worst. The kid is singled out in a negative way; secondly the kid is bored with remedial work, and those programs are not designed with any creativity in mind. (Only my experience at my school district-and this was an upper-middle class school).
And it is rather sexist that those with borderline personality organizations-mostly women-are often not afforded treatment payments by insurance companies; "borderline" is very much related to neurological problems (temperment) much like ADHD-overactive nervous system/hyperarousal, emotional dysregulation, impulse control issues, etc. They share very similar traits. Much like those from orphanages who end up with PTSD. The majority of those diagnosed with ADD are males.
"Very hyperactive, restless, and inattentive children have been identified by clinicians and
medical researchers dating back to at least 1902. Since then, upwards of 20 different diagnostic
labels have been used to categorize children who exhibit these problematic behaviors."
Posted by sigismund on August 25, 2010, at 22:24:03
In reply to Re: Need advice » emmanuel98, posted by violette on August 25, 2010, at 22:08:51
Kids probably shouldn't be in the schools we have.
Something medieval would be better....apprenticeships in the right field.
It's no wonder that they react to the destruction of promise in the way they do. They should be helping sail boats around the world. They get to be 20 and know bugger all, largely because of the way it is presented.
Posted by tensor on August 26, 2010, at 2:07:16
In reply to Re: Need advice, posted by ed_uk2010 on August 25, 2010, at 15:39:54
> I'm not sure that bupropion *is* dopaminergic, or modafinil for that matter. The mechanism of action of bupropion isn't really understood - it is an extremely weak dopamine reuptake inhibitor but that may not account for much. Hmmm.
>
> Have you ever taken a stimulant such as methylphenidate?Hi Ed!
No, I have never tried stimulants. Although modafinil works great most of the times it almost always make me yawn. It's like I'm tired and alert at the same time.
Regards,
Mattias
Posted by ed_uk2010 on August 26, 2010, at 13:42:28
In reply to Re: Need advice » ed_uk2010, posted by tensor on August 26, 2010, at 2:07:16
> > I'm not sure that bupropion *is* dopaminergic, or modafinil for that matter. The mechanism of action of bupropion isn't really understood - it is an extremely weak dopamine reuptake inhibitor but that may not account for much. Hmmm.
> >
> > Have you ever taken a stimulant such as methylphenidate?
>
> Hi Ed!
>
> No, I have never tried stimulants. Although modafinil works great most of the times it almost always make me yawn. It's like I'm tired and alert at the same time.
>
> Regards,
> MattiasDo you have Concerta in Finland?
Posted by ed_uk2010 on August 26, 2010, at 14:56:47
In reply to Re: Need advice, posted by emmanuel98 on August 25, 2010, at 19:25:11
>I think the issue is that, back in the bad old days before medication, children who couldn't sit still and concentrate on school work -- i.e, high-energy, boisterous children not academically inclined, were whipped, beaten with rulers, set to work in factories. The energy was basically beaten out of them. Now we are more humane and have outlawed child labor, corporal punishment in schools and frown upon child abuse in the home. So we medicate these children instead.
I don't think the demise of corporal punishment is in any way related to the increased use of medication :)
Corporal punishment has been banned because it is thought to be wrong, not because children are now on meds. Here in England, only a small minority of children are medicated, but this doesn't mean that we need to use corporal punishment.
In my opinion, a large proportion of children are not academically enclined. They don't like school work. It bores them to tears. They find it difficult to concentrate and so they feel restless. This shouldn't lead to a diagnosis of ADHD. This is not a mental health problem, it is normal behaviour. We need to accept that school is not actually a suitable place for many older children. Rather than prescribing drugs and encouraging such children into further education, we should allow children to leave school faily early (eg. at 14) and get them into work. Apprenticeships would be fantastic for a lot of young people. Some kids are practical, not academic. If they were able to do something useful instead of messing about at the back of the classroom, this would surely be beneficial to everyone.
Posted by ed_uk2010 on August 26, 2010, at 15:21:15
In reply to Re: Need advice, posted by sigismund on August 25, 2010, at 22:24:03
>They get to be 20 and know bugger all, largely because of the way it is presented.
Well yeah, school is great for those who are interested in academic subjects. I did well at school. I'm not a practical person, but I was quite good at school subjects.
At the moment, we force all children through the same education system regardless of whether they are suited to such an environment. The result of this is that a lot of kids are reaching the age of 18....and they haven't learnt anything or done anything useful. For those who prefer physical and practical activities to reading and studying, school is bound to be a waste of time (beyond the age of say, 14). If a child prefers manual work, there's not a lot of point forcing them to study French. Why not get them into an environment where they can learn to be a builder, or something similar?
America is essentially diagnosing kids who are not suited to school as suffering from a mental health problem. A problem which is treated with amphetamines and similar controlled drugs. I do not understand how we have reached this situation. If school had been physical and practical, *I* would have found it a nightmare. Does this mean that I have a mental health problem? No, of course not, it simply means that the environment would not have been suitable.
I'm not saying that the ADHD diagnosis shouldn't be used - but any diagnosis which is used so frequently is suspect IMO.
Let's look at a few of the diagnostic criteria from ADHD.......· often fails to give close attention to details or makes careless mistakes in schoolwork,
work, or other activities;· often does not follow through on instructions and fails to finish school work, chores, or
duties in the work place (this failure is not due deliberately refusing to do it or not
understanding instructions);· often avoids or is reluctant to engage in tasks that require sustained mental effort;
· often loses things necessary for tasks or activities;
Hyperactive/Impulsive Symptoms· often fidgets with hands or squirms in seat;
· often leaves seat in classroom or in other situations in which remaining seated is expected;
· often talks excessively;
· often blurts out answers before questions have been completed;
· often has difficulty awaiting turn;
· often interrupts or intrudes on others (e.g. butts into conversations or games)
Are these not 'symptoms' of a child who is not suited to academic study? A large number of the symptoms are directly related to the school environment.
Posted by sigismund on August 26, 2010, at 16:30:31
In reply to Inappropriate ADHD diagnosis » sigismund, posted by ed_uk2010 on August 26, 2010, at 15:21:15
School is glorified child minding, isn't it?
I remember reading about an educative proposal. The idea was that kids doing the 2 years before university could investigate 4 areas, from a variety of angles. Of the 4 suggestions I've forgotten two, but the other 2 were The Marriage of Figaro and the Holocaust. Kids are most able to learn young. It's a great pity their lives are filled with such crap. Useless stuff about the Journey and the Destination in English. Mind numbingly boring. I did English, French, Chemistry, Physics, MathsI and MathsII, simply to be in a class I felt I would be left alone in. I had no idea what I was interested in and everyone else cared even less.
Posted by simcha on August 26, 2010, at 16:31:24
In reply to Inappropriate ADHD diagnosis » sigismund, posted by ed_uk2010 on August 26, 2010, at 15:21:15
Yeah, sometimes the ADHD diagnosis is over-used. However, in my job I have and still do encounter children and adults with genuine ADHD.
One diagnosis that I think is bogus is Oppositional Defiant Disorder. Basically it sounds like your average elementary school boy who just doesn't want to do as he is told. Is that really a disorder or is it annoying for the teachers/parents/administrators and that's why they have classified that as a disorder?
Posted by sigismund on August 26, 2010, at 18:51:17
In reply to Re: Inappropriate ADHD diagnosis, posted by simcha on August 26, 2010, at 16:31:24
>One diagnosis that I think is bogus is Oppositional Defiant Disorder. Basically it sounds like your average elementary school boy who just doesn't want to do as he is told. Is that really a disorder or is it annoying for the teachers/parents/administrators and that's why they have classified that as a disorder?
I was told that in the state system in Vietnam, kids who are overactive and badly behaved are required to kneel in, I suppose, front of the class.
In the private language schools they seemed remarkably well behaved for kids who are, after all, the children of the elites.
If you asked one of them to 'stand over there' they would do it without question.
This is during a language class after school.
When you walk in the room they all say 'Good afternoon teacher'.
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