Can I just ask my psychiatrist for meds?

[Fuzzy12]

I guess, I know the answer to this one.

I've got my final appointment with the psychiatrist tomorrow, where he is going to put together a treatment plan for me.

He thinks all my problems are due to depression. I think, I might have ADHD. Either way, he thinks even if I do have ADHD, the best treatment option for me would be CBT. I've tried CBT (just 2 sessions, then the therapist dismissed me because I couldn't keep up the appointments regularly ) and I'm not too hopeful this time round either.

Can I ask him if I can just try stimulant meds to see if they help? I'm guessing not because even if they should help but I actually don't have ADHD, I probably shouldn't be taking them. The problem is I don't trust his diagnosis (he seems pretty ignorant about ADHD) and I don't know what else to do to help myself (assuming that CBT won't help). I guess, I've got nothing to lose by asking, but I'm still hesitant about it.

Sigh and please don't flame me for being a performance enhancing stimulants seeking junkie.

Any inputs?

[Lisa_Mac]

I think it would be perfectly acceptable for you to ask him to put you on a trial of Concerta or Ritalin for a period of time. (10 days perhaps). That is what they do when ADHD is suspected in children.

I really can't see why he should have any problem agreeing to that. It can't do any harm.

L

[Abi]

When a mood disorder is suspected along with ADHD, standard practice is to treat the mood disorder first, and to delay treatment of the ADHD.

I suggest you request an antidepressant that inhibits noradrenalic reuptake.

Go for Wellbutrin as a first choice.

Failing that, Cymbalta / Effexor / Pristiq. I've heard they have some nasty side effects tho.

Good Luck.

[avjgirsijdhtjhs]

Symptom:

Fuzzy12 is upset about her lack of performing in life (write down on a sheet of paper that you'll bring to the appointment some notes to jog your memory during the appointment on things to elaborate on to him as far as how you aren't performing).

Problem:

Fuzzy12 isn't performing in life.

Treatment option 1:

Treat the symptom directly - Give high dose SSRI's to induce a "don't give a ****" attitude (which also happens to make the actual problem (the lack of performance) worse ).

Treatment option 2:

Treat the problem directly - Give stim with the option of Bupropion also, to treat the problem (and symptom indirectly).

Moral - Treat the problem.

Originally Posted by avjgirsijdhtjhs

"Most psychotropics ameliorate component psychological functions that are misfunctioning rather than “cure” specific syndromes at the etiological level."
-----------------------
"it is argued that pharmacological agents may be viewed as inducing particular psychological states which though not specifically related to diagnosis, are nonetheless the basis for the usefulness of the medication."

Originally Posted by avjgirsijdhtjhs

"The most frequent description of the effects of SSRIs that I have heard from my patients are “It doesn’t matter.” or “Don’t sweat the small stuff.” or “What’s the big deal?” It is this “Don’t sweat the small stuff” perspective that I believe is SSRIs unique blessing and curse."

Originally Posted by avjgirsijdhtjhs

I don't claim to know very much about the brain. In fact, I'll go ahead and make a claim about what I do know about the brain: I know VERY little about the brain.

One thing I do know though is that dopamine is not rewarding. As far as rewards go, dopamine causes you to seek what would otherwise just be pleasurable sensory experiences. Without the motivating effects of dopamine, rewards will still be satisfying, they just won't be sought out.

Check this out:

Helen Phillips
The pleasure seekers
New Scientist, 11 October 2003
"At first glance, the "reward centre" idea seems hard to fault. The self-stimulation experiments, beginning with rats in the 1950s and followed by the human experiments in the 1960s, seemed perfectly clear. Modern brain-imaging studies have confirmed that the centre works overtime whenever you're enjoying something, whether it's sex or chocolate, drugs or music. And chemical analysis shows that, whatever your pleasure, dopamine fuels the circuit. "Dopamine was the pleasure transmitter," says Berridge. "The evidence seemed so strong. If you shut down dopamine signalling by giving a drug that blocks dopamine receptors, you dilute the reward value of everything." So why did he and others begin to question the status quo?
Berridge reckons that his doubts began to creep in around the late 1980s, with a few surprise results. He'd found that he could watch rats' facial expressions to judge their reactions to certain tastes. Believe it or not, rats actually look pleased when given sweet things to taste, and produce the rat equivalent of a disgusted look in response to bitterness. The assumption was that these expressions were of pleasure or displeasure, mediated by the reward centre. The surprise came when Berridge blocked the dopamine signal with drugs. In theory, with dopamine knocked out there was now no way for the rats to sense the reward value of the sweetness, so he was expecting not to see any "pleased" expressions. But the rats seemed just as expressive as ever.
Putting it down to experimental error, Berridge tried a more foolproof test. He used rats in which dopamine-producing cells had been wiped out with a neurotoxin. It was already known that these animals simply stopped eating. "They would voluntarily starve to death if the experimenter didn't intervene and feed them," says Berridge. Researchers had always thought that the rats' lack of dopamine meant they didn't like food. But when Berridge force-fed them with sweet and bitter liquids, their facial reactions were normal. "They still showed the proper positive face to sugar and the proper negative face to quinine," he says. "It looked like their reaction to pleasure was normal even though their dopamine was gone."
What was going on? The experiments prompted Berridge to look back at Heath's brain electrode results. He was struck this time by what feelings the subjects reported. They all said they felt good, and always pleaded for more when the controls were taken away. But was it pleasure? The reports mentioned feelings of alertness, warmth and goodwill, arousal, a desire to masturbate, or to drink even though they weren't thirsty. It sounded more like desire than pleasure. This fitted perfectly with Berridge's rats. Even with no activity in the reward area, they seemed to "like" the taste of sweet food. They just didn't "want" it. Could the dopamine system be a desire circuit that mediates our feelings of wanting something, rather than a pleasure centre that supplies our feelings of liking?
Although it was Berridge who drew attention to the distinction between wanting and liking, he is by no means the only researcher to realise that "pleasure" is not quite the right term to attach to activity in the dopamine system. If people are given drugs that block or stimulate dopamine release, it doesn't alter how much they report liking certain tastes. What that suggests is that the dopamine system itself doesn't produce feelings of pleasure, says Panksepp. "The dopamine system is about motivation and seeking. It gives a generalised desire or urge, an eagerness to engage with the world."

Originally Posted by Calm & focused

As i stated in this thread:ADD: "Disorder" or "Trait"? (...and does the distinction really matter?) ...

http://www.addforums.com/forums/showthread.php?t=82007

...people don't have ADD or anxiety disorder in the same way that you have a disease like cancer or a physical defect. With ADD you can't just point to a part of the brain that's entirely missing, or pinpoint a neurotransmitter that's entirely missing, etc. There is science behind ADD, but it's a matter of placing people on a continuum, and that is by necessity a largely subjective endeavor. If medication makes your life better overall, then don't worry about whether you're breaking some sort of rule about only taking the med if you "have" ADD. Do what's best for you. Look at it this way, a lot of drugs are used for mainly off-label applications (for example, it is technically off-label to prescribe a lot of these ADD meds to adults). So maybe you don't have ADD...then maybe you've discovered that Ritalin is a great off-label treatment for "K-Funk Syndrome."


The questions that matter for you are:
1) Do i have an issue (whatever its cause may be) that was sufficiently problematic to seek treatment?
2) Is Adderall, Ritalin, Concerta, Zoloft, Lexapro, Wellbutrin, or some combination thereof the most effective treatment? And...
3) Do the benefits outweight the costs?

[T-Rex65]

It is perfectly OK to ask.

[Twiggy]

I usually get options from my doctor and can pick/choose what medication(s) I'd like to try out for each condition.
I don't like when doctors pick for you. The freedom to choose gives me a great feeling.

[Fuzzy12]

Originally Posted by Abi

When a mood disorder is suspected along with ADHD, standard practice is to treat the mood disorder first, and to delay treatment of the ADHD.

I suggest you request an antidepressant that inhibits noradrenalic reuptake.

Go for Wellbutrin as a first choice.

Failing that, Cymbalta / Effexor / Pristiq. I've heard they have some nasty side effects tho.

Good Luck.

Well, I've been taking Sertraline for 5 months now and it has made a huge difference in terms of depression but not really with any of my ADHD-like symptoms. Sertraline is supposed to have an effect on dopamine uptake so I thought it might help at least a little bit, but it hasn't.

I've heard that wellbutrin can help with ADHD as well. I can ask if I can try that, but I doubt they'll let me choose.

Originally Posted by avjgirsijdhtjhs

Symptom:

Fuzzy12 is upset about her lack of performing in life (write down on a sheet of paper that you'll bring to the appointment some notes to jog your memory during the appointment on things to elaborate on to him as far as how you aren't performing).

Problem:

Fuzzy12 isn't performing in life.

Treatment option 1:

Treat the symptom directly - Give high dose SSRI's to induce a "don't give a ****" attitude (which also happens to make the actual problem (the lack of performance) worse ).

Treatment option 2:

Treat the problem directly - Give stim with the option of Bupropion also, to treat the problem (and symptom indirectly).

Moral - Treat the problem.

Thanks for putting all that together. The exerpt about human and rat studies about the difference between feeling pleasure and seeking pleasure was fascinating. That is so applicable to me too. I know what's good for me and I do feel good when I've achieved something (and feel bad when I've messed up, etc.) but that doesn't translate into premeditated action.

Originally Posted by Twiggy

I usually get options from my doctor and can pick/choose what medication I'd like to try out.
I don't like when doctors pick for you. The freedom to choose gives me a great feeling.

He doesn't want to prescribe any meds. He thinks, all I need is CBT (Cognitive behaviour therapy).

I did makea note of all my impairments and problems substantiated with examples from my life. We talked at length (3-4hours) about my history. He says my struggles are valid but since I've got 2 degrees, a shelter above my head and I've managed to stay married for quite a few years, he thinks it's impossible that I could have ADHD.

[Twiggy]

Originally Posted by Fuzzy12

He doesn't want to prescribe any meds. He thinks, all I need is CBT (Cognitive behaviour therapy).

I did makea note of all my impairments and problems substantiated with examples from my life. We talked at length (3-4hours) about my history. He says my struggles are valid but since I've got 2 degrees, a shelter above my head and I've managed to stay married for quite a few years, he thinks it's impossible that I could have ADHD.

If you're struggling and feel you need medication to help then you should go to another psychiatrist that knows more about Adhd.

I tried CBT, and let me tell you:
It's a waste of time and money, unless you like getting common sense answers to your problems that you already know about. All it felt like was a tutoring session for a Psychology class at college.

[gatorADDe]

Originally Posted by avjgirsijdhtjhs

Symptom:

Fuzzy12 is upset about her lack of performing in life (write down on a sheet of paper that you'll bring to the appointment some notes to jog your memory during the appointment on things to elaborate on to him as far as how you aren't performing).

Problem:

Fuzzy12 isn't performing in life.

Treatment option 1:

Treat the symptom directly - Give high dose SSRI's to induce a "don't give a ****" attitude (which also happens to make the actual problem (the lack of performance) worse ).

Treatment option 2:

Treat the problem directly - Give stim with the option of Bupropion also, to treat the problem (and symptom indirectly).

Moral - Treat the problem.

Good post. This is why I hate antidepressants. They don't treat the problem directly. I don't think there is anything "drug seeking" about wanting to explore treatment options. It's one thing to go into a doctors office and say, "I want adderall" - that's drug seeking. Allow the doctor to be the doctor. If you've discussed with your doctor that you think that something more "stimulating" sounds like a more appealing treatment than the numbing effects of antidepressants they may listen to you. If not then your doc is incompetent. Stimulants, although not FDA approved to treat depression in the USA, have some documented antidepressant properties. If you had a good doc that knows what they're doing they should be aware of this.

[avjgirsijdhtjhs]

Originally Posted by Fuzzy12

He doesn't want to prescribe any meds. He thinks, all I need is CBT (Cognitive behaviour therapy).

Originally Posted by salleh

Near as I can figure, Dr. Barkley, ( acknowledged as the top man in ADD today) .........says that ADD is something that basically can only be helped by medication.....training and diet and all the other methods people have tried, are limited in the success you can get using them .....


....it is a PHYSICAL problem .......not a behavioral one....... you can compensate for it up to a point, but to truely alleviate the problem, you have to find the correct medication, and dosage for your brain.......

I think it may have been in one of the www.CADDAC.ca videos (click the "Parents", "Educators", and "Teens & Adults" links at the bottom of the page in the link, for more vids) where Russell Barkley said stims were a form of either genetic therapy or neuro-genetic therapy or however he worded it.

Originally Posted by Fuzzy12

I did makea note of all my impairments and problems substantiated with examples from my life. We talked at length (3-4hours) about my history. He says my struggles are valid but since I've got 2 degrees, a shelter above my head and I've managed to stay married for quite a few years, he thinks it's impossible that I could have ADHD.

You've got OCD, right (Paul Cooijmans quote - "Also, conscientiousness itself, if driven too far, may lead to disorders that reduce creative output. This concerns primarily disorders of the neurotic kind, involving obsessions, compulsions, anxiety, depression, and more.")? Looks like you're high in some of this conscientiousness stuff.

Conscientiousness is the only aspect of creativity that can be improved significantly, permanently, safely and purposely in an adult. This is probably so because conscientiousness is not a unitary trait, but comprises various traits, some of which are independent, and not per se correlated with each of the other traits that make up conscientiousness. Conscientiousness is a kaleidoscope of good features, and it is possible to possess different combinations thereof, and to gain or lose some of them without affecting the rest...

...Conscientiousness, when exceeding a threshold, leads to obsessions and compulsions (which in turn cause anxiety and depression) and thus destroys creativity (through neurosis rather than psychosis), be it less drastically. This is part of regular psychiatric knowledge. For genius, one needs to be close to that threshold.

I wish treatment was more like what's in these two quotes (actually, all drugs should be legal since making drugs illegal violates your right to your body, and your taking drugs doesn't violate anyone else's rights):

Originally Posted by Calm & focused

If medication makes your life better overall, then don't worry about whether you're breaking some sort of rule about only taking the med if you "have" ADD. Do what's best for you. Look at it this way, a lot of drugs are used for mainly off-label applications (for example, it is technically off-label to prescribe a lot of these ADD meds to adults). So maybe you don't have ADD...then maybe you've discovered that Ritalin is a great off-label treatment for "K-Funk Syndrome."


The questions that matter for you are:
1) Do i have an issue (whatever its cause may be) that was sufficiently problematic to seek treatment?
2) Is Adderall, Ritalin, Concerta, Zoloft, Lexapro, Wellbutrin, or some combination thereof the most effective treatment? And...
3) Do the benefits outweight the costs?

Originally Posted by Calm & focused

There's a pill that fixes that. I've gone to a doctor who thinks taking it will be beneficial and safe, and I agree. Is ADD a "real" disease? I don't care!

[Abi]

Originally Posted by Fuzzy12

Sertraline is supposed to have an effect on dopamine uptake

Minimal.

--------

CBT is okay for situational depression, simple phobias and very mild chronic conditions.

For chronic depression or other mood disorders or anxiety spectrum disorders, CBT, s stated by another poster, is a waste of time.

I really think a change of psychs. is indicated.

[avjgirsijdhtjhs]

Can anybody answer me this:

What is wrong with drug seeking?

----------------------------------------------------------



Hmmm. I wonder what class of drug might work best for the apathetic type of depression? That's a toughie.

[avjgirsijdhtjhs]

Originally Posted by Abi

I really think a change of psychs. is indicated.

Seconded.

The two I went to were VERY easy, but I've heard it's a lot more difficult in the UK or England or whatever...

[Abi]

Originally Posted by Abi

For chronic depression or other mood disorders or anxiety spectrum disorders, CBT, s stated by another poster, is a waste of time.

This should have read:

For MODERATE TO SEVERE MANIFESTATIONS OFchronic depression or other mood disorders or anxiety spectrum disorders, CBT, as stated by another poster, is a waste of time.

[plank80]

Originally Posted by Twiggy

I usually get options from my doctor and can pick/choose what medication(s) I'd like to try out for each condition.
I don't like when doctors pick for you. The freedom to choose gives me a great feeling.

You've obviously never lived in the UK then. Doctors here act like they are above you.

I dont go to my GP for **** all cos you leave feeling like a hypochondriac.

At the minute Im having to live with severe vertigo cos trying to get proper treatment for anything is near impossible. In this country you just have to live with it.