The doctor I was seeing, who tried me on 18mg and 27mg concerta, decided to refer me to a psychiatrist. I thought that would be ok, I would have more time to talk and explain how I'm feeling and all that.

I don't like the guy I got.

He prescribed wellbutrin 100mg/day and Risperidal (also called Risperidone, an antipsychotic) 0.25mg/day. Why? Because he "doesn't believe in stimulants, because they have abuse potential and street value."

Every one of you already know exactly what I think of that statement. It's disrespectful to me, regardless of the fact that he blindly applies it to everyone, and, oh yeah, most of the psychiatric and medical community would disagree with him, which is why stimulants are actually indicated for AD/HD, and wellbutrin is not officially.

As an aside, he told me some worthless story about how wellbutrin + risperidal cured this girl, it was great. He explained what she was like. She was nothing like me. My ex, who was bipolar, ended up with this guy. He prescribed the exact same thing to her. And other things. Nothing he ever gave her helped, most made things worse, and she felt like he didn't listen to a word she said.

Not that I don't think that wellbutrin can be the best choice for some people, maybe it just works for some where stimulants don't. But I can't, first of all, find one shred of evidence online that this combination makes sense or is ever used for anyone short of schizophrenics. When I finally convinced him that I'm not ignorant like he assumes everyone is, and that I spend hours a day reading about brain chemistry, he gave his reason for the Risperidone being that it blocks dopamine in parts of the brain and helps direct it to the frontal cortex. That sounds reasonable to me but the drugs and the timing do not.

I'm generally very happy with my moods and my emotions. Yes, wellbutrin is a dopamine reuptake inhibitor, and yes, I have a dopamine deficiency. But it does a lot of other stuff too. Stuff that even the people who invented don't fully understand. Nobody fully understands the action of antidepressants. And sure as hell NO one understands fully the action of antipsychotics. They do brain scans and see yes, there's more dopamine here, or less there, but dopamine has a thousand functions in the brain, not all applicable to my lack of focus. I don't want something to mess with my emotions, flatten my emotions, cause weight gain and drowsiness, and so on. I'm aware that these are small doses for both, but that just makes me think I'll get to week 4 or 5 before I finally decide they do nothing, and by that point any unfortunate changes will be done and I'll have to recover from that. That, and I don't feel like I can handle waiting weeks right now.

Anyway, I'm not comfortable with the idea of either of these drugs at this point. Any references or informed suggestions for wellbutrin is for those who have a history of abusing amphetamines, and those for which at least 2 different stimulants don't work (some suggest it as even a fourth-line attempt, after a SNRI like Straterra). A relatively low dose of concerta not working that well for me is no indicator that I should give up on stimulants, because as I see on these boards, a lot of people do find something that works and they don't mind the side effects, even if just for a while. And I'm rather comfortable with the idea of what stimulants are up to in my brain.

(Note this whole post is in no way saying that wellbutrin is flat wrong, or that people are wrong for taking it. I hope that's clear)

Maybe my current situation, where I'm looking so forward to ANYTHING at all that will help that I'm maybe even depending on the idea to get me out of the mess I feel I'm in, is the reason I feel so bad about this. I feel like the slim chance that I was getting help finally and getting help soon has just suddenly been taken away from me, and I have nothing but a psyc who won't listen and believes that the full gamut of approved ADD medications "don't exist".

So I'm going to take this prescription to my old doctor, say I'm not comfortable with it at this point, and hope that he understands and doesn't take the psyc's side. All I want is a doctor who will let me try things on my own. It's up to me to report back on how it feels anyway. The main thing that I've learned from here is that you don't know anything until you try it for yourself. And that's what I want to do... I just want to be able to go to a doctor, tell him how I'm informing myself on the subject, say, I want to maybe try an amphetamine-based med instead of MPH, or, I want to try d-MPH, maybe it will be better. I hope that this is the right decision. I feel better having ranted about it a bit.

I don't understand why he'd prescribe an antipsychotic for ADD. *confused look*

Unless you have a reason to get Risperdal (which you forgot to mention), it sounds weird.

NB If you want to try 'stimulants', I guess get your TESTING done.

Most Docs seem to Rx once they see a proper LD/ADD/Neuropsych Testing Report.

There's no other reason to justify the risperidone. The reason he gave sounded somewhat sensible, and it is a low dose, but it has other effects. I want to the first line of action before I try something that could potentially mess with my emotions and my state of mind.

I was already tried on stimulants, as a trial to see if it helped. It helped a bit but not enough, that's what I said. I can recognize that it might be something that helps me. I absolutely cannot afford the official test, and honestly I can't justify spending nearly a thousand (after insurance) for someone to tell me I have this.

(Yes, I know you never know until you're really tested, that there's a possibility however slim that it's something else, and that there are other benefits... but I can't justify the cost right now. I can't handle my money well enough to ever be able to afford it, and I need something that will help me before that will ever be an option.)

The thing about this guy is he doesn't care if I'm officially tested. He doesn't believe in stimulants. He actually said, "as far as I'm concerned, Ritalin doesn't exist". Great, way to completely blow off tons of medical knowledge based on a personal opinion on stimulants and an assumption that you apply to everyone that they're going to abuse it and get addicted. He has no idea.

I might as well go to a dsffdsafding scientologist for ADD treatment.

I just want that "let's hook you up with a psyc, oh look he's free tonight" to not have happened, because I felt like I was finally getting somewhere, and now I feel screwed.

I use to take risperidone but not for adhd. It can be used to calm the anxiety and tension that people can get from wellbutrin. It did good for my anxiety but gave me heart palpitations.

Being focused on prevention of drug abuse and ignoring the fact that schedule II controls substances are available for legitimate reasons amounts to malpractice. I think I broke my ribs several months ago when I fell face forwarded into the pavement while running with my dogs in the rain. It was very painful for a few months if I took a big breath or moved the wrong way(ironically I could still run fine). My web searching said treatment options for broken ribs is basically limited to pain management. I did not want to face a similar situation as you being made to feel I was a drug addict or dealer so I just suffered.


Been looking on the net a little for the logic in combining a dopamine antagonist with a dopamine re-uptake inhibitor. If I find anything thing interesting I will post it.

1: Biol Psychiatry. 2003 Jun 1;53(11):978-84.
Links
Combination pharmacotherapy in children and adolescents with bipolar disorder.
Kowatch RA, Sethuraman G, Hume JH, Kromelis M, Weinberg WA.

Department of Psychiatry, Cincinnati Children's Hospital Medical Center and the University of Cincinnati Medical Center, Cincinnati, Ohio 45267, USA.

BACKGROUND: The purpose of this study was to develop prospective data on the effectiveness of combination pharmacotherapy of children and adolescents with bipolar disorder during a 6-month period of prospective, semi-naturalistic treatment. METHODS: Thirty-five subjects, with a mean age of 11 years, were treated in the extension phase of this study after having received 6-8 weeks of acute treatment with a single mood stabilizer. The extension phase of this study lasted for another 16 weeks, for a total of 24 weeks of prospective treatment. During this study phase, subjects were openly treated, and they could have their acute-phase mood stabilizer switched or augmented with another mood stabilizer, a stimulant, an antidepressant agent, or antipsychotic agent, if they were assessed to be a nonresponder to monotherapy with their initial mood stabilizer. RESULTS: During the extension phase of treatment, 20 of 35 subjects (58%) required treatment with one or two mood stabilizers and either a stimulant, an atypical antipsychotic agent, or an antidepressant agent. The response rate to combination therapy was very good, with 80% of subjects treated responding to combination therapy with two mood stabilizers after not responding to monotherapy with a mood stabilizer. CONCLUSIONS: This study suggests that children and adolescents with bipolar disorder are similar to adults with bipolar disorder, who also frequently require combination therapy.

PMID: 12788243 [PubMed - indexed for MEDLINE]
(Bupropion shows up in a keyword search)

Its possible he might think you could have bipolar disorder. In that case it make sense to treat that as the first priority and then address the ADHD later. And since there is some efficacy of using welbutrin
for ADHD.

1: Postgrad Med. 2000 Apr;Spec No:1-104.
Links
The Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder 2000.
Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP.

Partners Bipolar Treatment Center, Massachusetts General Hospital, USA.

OBJECTIVES: New treatments for bipolar disorder have been reported since we first published survey-based expert consensus guidelines in 1996. The evidence for these treatments varies widely; data are especially limited regarding comparisons between treatments and how to sequence them. We therefore undertook a new survey of expert opinion in order to bridge gaps between the research evidence and key clinical decisions. METHOD: Based on a literature review, a written survey was prepared which asked about 1,276 options for psychopharmacologic interventions in 48 specific clinical situations. Most options were scored using a modified version of the RAND Corporation 9-point scale for rating appropriateness of medical decisions. We contacted 65 national experts, 58 of whom (89%) completed the survey. Consensus on each option was defined as a non-random distribution of scores by chi-square test. We assigned a categorical rank (first-line/preferred choice, second-line/alternate choice, third-line/usually inappropriate) to each option based on the confidence interval of its mean rating. Guideline tables indicating preferred treatment strategies were then developed for key clinical situations. RESULTS: The expert panel reached consensus on many key strategies, including acute and preventive treatment for mania (euphoric, mixed, and dysphoric subtypes), depression, and rapid cycling, and approaches to managing the complications of treatment resistance and comorbidity. Use of a mood stabilizer is recommended in all phases of treatment. Divalproex (especially for mixed or dysphoric subtypes) and lithium are the cornerstone choices among this class for both acute and preventive treatment of mania. Regardless of which is selected first, if monotherapy fails, the next recommended intervention is to use these agents in combination. The combination can then serve as the foundation on which other medications are added, if needed. Carbamazepine is the leading alternative mood stabilizer for mania. Expert opinion regards other new anticonvulsants as second-line options (e.g., if the previously mentioned mood stabilizers fail or are contraindicated). For milder depression, a mood stabilizer, especially lithium, may be used as monotherapy. Divalproex and lamotrigine are other first-line choices. For more severe depression, a standard antidepressant should be combined with lithium or divalproex. Bupropion, selective serotonin reuptake inhibitors (SSRIs), and venlafaxine are preferred antidepressants, and should be tapered 2 to 6 months after remission. Divalproex monotherapy is recommended for initial treatment of either depression or mania with rapid cycling. Antipsychotics are recommended for use with the above regimens for mania or depression with psychosis, and as potential adjuncts in non-psychotic episodes. Atypical antipsychotics, especially olanzapine and risperidone, were generally preferred over conventional antipsychotics. Recommendations are also given concerning the use of electroconvulsive therapy (ECT), clozapine, thyroid hormone, stimulants, and various novel agents for patients with treatment-refractory illness. CONCLUSIONS: The experts reached high levels of consensus on key steps in treating bipolar disorder despite obvious gaps in high-quality data. To evaluate many of the treatment options in this survey, the experts had to extrapolate beyond controlled data; however, their recommendations are generally conservative. Experts reserve strongest support for initial strategies and individual medications for which there are high-quality research data, or for which there are longstanding patterns of clinical usage. Within the limits of expert opinion and with the understanding that new research data may take precedence, these guidelines provide clear pathways for addressing common clinical questions in a manner that can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions.

PMID: 10895797 [PubMed - indexed for MEDLINE]

It's not any sort of drug protocol I've ever heard of, or read in the common ADD books on the market.

Ask the Pharmacist?

Hey okok!

Dang! I totally hear ya on how darned frustrating your situation is. And I totally understand where you're coming from with regard to not wanting to start on his odd choices of combo meds.

I seem to get all the *****ho!e shrinks myself. I've NEVER met one that that helped me. And I have met some that bordered on harming me.

I'm so sorry you're going through this!

Sue

Thanks Theta for the information. I hate that feeling, I know what I want to do and what I want to try and going in to literally ask for stimulants, for geniune reasons, makes me feel like I'm going to come off as a druggie.

The quotes are good. The basic reasoning he gave was that the risperidone, as a dopamine antagonist, blocks dopamine in some areas and that somehow promotes it in others (the prefrontal cortex, or where there's likely a deficiency with ADD). On the surface it sounds reasonable and I'm sure he has more understanding and has helped people this way, my main issue is timing, and his complete denial of stimulants as a possible approach, when they are the suggested FIRST approach, and probably second or third, too.

Yeah, I could only find articles relating it to bipolar and schizotypical conditions, too (the combo, that is). If this doesn't work for me I might try this, though. I just want to try something that feels "safer" to me.



Good news though. I went back to the doctor who referred me to him to explain how I was uncomfortable with this, and gave him my reasons clearly, and he was very understanding. I mainly said that I might try this, but I would rather try a different stimulant, because if a stimulant is the wrong choice, it only takes a day or two to notice, and a day or two to feel normal again, at most. With antidepressants it takes weeks and can have some lasting effects.

He prescribed me Adderall XR even though he wasn't extremely familiar with it, because he knew that I was. (He looked it up while I was there, we talked about reasons it might be a good thing to try first.) He told me to keep my script for wellbutrin and respirdone, in case I want to try it, or even just the wellbutrin alone. I get the feeling the psyc. would disagree with this, but it comes down to what I'm comfortable with. I'm very very happy to be seeing a doctor this understanding.

Sue, thanks for the empathy. :) I hope that you find a doctor or shrink that will listen to you, because it needs to be something you feel comfortable with, and you need to have some level of control. I think it's important to be very clear and direct with your doctor, and ask for what you want, and if you're well informed you should be able to try it. If asking for a stimulant makes you get treated like a druggie, walk out (I was prepared to, today), and find a new doc.

:)

Sounds similar to experiences I've had with past doctors, and as frustrating as it was to begin the whole routine with another doc 3 times over within the last 1 1/2 years, I've finally found a MD and counselor pair who has a good balance of making recommendations based on their experience, but also ensuring that I as the patient have full involvement in decision making process on treatment.

So my first word of advice that I'm sure you'll see everywhere else here - get a doctor you're comfortable with...there's no rule saying you need to stick it out with a current one if you don't feel he or she is right for you. For me, it was a MASSIVE roadblock removed when I could finally see eye to eye with my doctors. Not that I'm running the show solo.....but neither are they. ;-)

As for Risperdal, I've been on it for just over 2 weeks - they added .5mg of it to my 20mg Lexapro and 40mg Adderall XR in AM/20mg in PM. So far my own experience is that it's done things that I honestly would have expected the Adderall or Lexapro to do (but never did):

Mood/anxiety significantly improved.
OCD traits (many which are confused w/ ADD traits) that kept me from focusing are now controllable.
Efficiency/productivity have improved.And I have absolutely NO side effects from it (likely due to low dose I guess), which was not the case with Strattera and Wellbutrin.

Best of luck with the adderall!!!

GOOD FOR YOU, okok!!! I'm so pleased and relieved for you! That was GREAT NEWS and has lifted my spirits!!! (And I appreciate your sharing stratdude! Everyone's input here really boosts my confidence to assert myself.)

Sue

Thanks stratdude, that's somewhat comforting. If stimulants really don't work for me then something like what that psyc prescribed will seem more realistic and worth a shot, and if that's the case, I hope that I have similar luck with it.

I don't tend to have much anxiety... I wonder about OCD traits, I don't feel like I have any, based on the fact that I don't feel that there are certain things that if I don't do them, I'd get anxious or uncomfortable (that's my understanding of OCD, but I haven't researched a lot into it).

What OCD traits would you say could be confused with ADD traits? I'm interested to know.

Thanks Sue. :) The positivity around here can be really uplifting. I think I've learned that asserting myself is very important, and my doc was more understanding even than I thought he'd be. I told him how I was afraid of being seen or being treated by saying directly what I wanted to try, and he said based on what I told him and how informed I'm making myself on the subject that it's understandable and that he agreed. Sometimes you just have to say what you're thinking. I think the main thing was being prepared to search for a different doctor if I had to. Without your direct, honest input, all a doctor can do is guess.

I'm glad you're finding a dr. that's listening to you and sorry you had a crappy psychiatrist that "didn't believe in stimulants." I had a horrible psychiatrist before finding my current one. I had neuropsych testing done and was diagnosed with Bipolar in addition to ADHD. Well, my crappy psychiatrist never read the full report-- so he didn't notice the bipolar part and went ahead and prescribed me Strattera in addition to the adderall I was already taking even though it should not be used in people with a mood disorder (made me homicidal at a tiny dose). Anyhow, he refused to listen to me and told me to keep taking the Strattera even though I told him it was giving me rage attacks. To make a long story short, I found a new psychiatrist who specializes in ADHD and Bipolar and actually listens to me.

As for wellbutrin and risperidal-- I was prescribed wellbutrin years ago before my formal diagnosis and it sure did make me productive. Really productive, it actually made me manic but it helped a lot with the ADHD and I got a whole lot done. I can see that it would help with ADHD, but I think most drs. would try a stimulant first.

I was prescribed risperidal just last week. Unfortunately, I had a horrible reaction to it from just one dose. I took .25 mg. and proceeded to suffer from bradykinesia (extremely slowed movement) for 24 hrs. It was horrible, I had to get a friend to walk all the dogs for me because I couldn't walk. Just a word of advise, I would be very careful about taking atypical antipsychotics-- they can have a lot of very serious side effects and unless someone is schizophrenic or bipolar, there's really no reason to take them. I take Seroquel which helps me calm down, organize my thinking, and be rational; however, a lot of my confusion/disorganization comes from my bipolar, not the ADHD. If ADHD is your only diagnosis, then I see little reason to treat it with an antipsychotic.

Good luck with the stimulants and I hope you find something that works for you.

Wow. I was prescribed .50mg of risperidone. I'm not bipolar, or schizophrenic, etc. Just ADD. I knew .50 wasn't even the smallest dose and that worried me. I'm glad I didn't take it.

Btw, the Adderall is much more effective than the concerta was for me. I'm glad I stuck to my guns, otherwise I'd still be waiting for a few weeks to see if wellbutrin was even going to help, or not taking anything at all.

What OCD traits would you say could be confused with ADD traits? I'm interested to know.

One major one was inability to focus....but counselor realized over time that this was due to constant worrying/obsessing that was distracting me. For example a simple elevator conversation about the weather - I'd obsess about and review over and over again in my head for an hour about what I said, what the other person's physical/verbal responses were....etc., etc. And I guess the key factor here is the inability to shut that sorta stuff off....or at least calm it down.

As I understand it, OCD doesn't necessarily have to be touching, counting, or other physical repetitive actions. In my case, it was inability to remove myself from certain tasks or attention to unnecessary detail even though I was aware they weren't a priority or in some cases needed.

And re: the Risperdal - take positive feedback AND negative with a grain of salt. There's definitive a laundry list of side effects and cautions. However this doesn't necessarily mean immediately dismiss it if it's reintroduced as an option....the key is to ensure A) a competent doctor is the one making the recommendation, and B) they'll want to monitor your progress closely to watch for those side effects. Oddly with me, Straterra, Wellbutrin, and even my current Lexapro have side effects where I have no noticeable ones from the .5mg of Risperdal.