10/4/06
There's a line in the "Pink House" script that was meant to describe Chapel Hill post-grads, but was actually about me: "suffering from A.D.D., but ironically, too distracted to go the doctor for a prescription." I wrote that in 1999, and finally got to the attention-deficit psychiatrist yesterday. Seven years... hey, that's no so bad!
Psychopharmacologists are weird lot; they have the black socks and demeanor of therapists, thus tempting you to talk about your problems, but they really just want the facts. I tried to tell my guy about Sept. 11 and being traumatized as a kid, but he was only really interested in how I felt now and take it from there. I was more than happy to oblige. I told him that I've always had incredible swings in concentration and that I haven't had any energy since I was about thirteen. He promptly put me on Speed.
Actually, he gave me several options - I could gradually switch from Celexa to Effexor (which is better for concentration issues) but there was no guarantee it would work, and to be honest, Celexa is truly doing its job in the anxiety and depression department.
He also mentioned Cymbalta and/or Strattera, but I could tell he meant those drugs as Plan B. The solution that appealed to me most was the direct targeting of energy and attention, which happens to be Dexedrine. When I got home and told Tessa, she was like, "oh, you mean Mother's Little Helper." When I told Sean, he said, "oh, like a housewife from 1959." To which I say "fuck yes!"
I don't know if any of you have tried Dexedrine, which is basically an early form of Ritalin and Adderall, but I'll be starting a small dose tomorrow to see if I can start having wide-awake days and less fitful sleep. I'm not a big fan of taking any more drugs, but I'm already taking an anti-depressant, so drawing an arbitrary line in the sand seems pretty stupid at this point. I could easily smash the two drugs together with a spoon and call it Celexadrine if I wanted to fool myself into thinking I was anywhere close to low-maintenance.
You just have to look at this stuff like dentistry. When your teeth get rotten, you have them filled or pulled. If you don't, your mouth hurts for fifty years. I once read that one of the leading causes of suicide in the 18th century was tooth pain. I look upon my psychopharmacology with the same phlegmatic acquiescence: there has always been a terrible cavity in my mood, and I'm going to use modern tools to fix it.
LOVE that beautiful turn of phrase, "terrible cavity in my mood."
There's also a fabulous "speed-type" drug called Provigil. If the Dexedrine doesn't work--ha!--ask for that.Bon Chance!
Wellbuturin is also an amphedamine (works on dopamine receptors). The difference between the 1960s version and today's is they now make it time-released so you get a steady stream of the juice. Results in a vastly reduced incidence of shooting the TV in the middle of the night.
Good luck finding a stimulant that works for you!
You know that I am completely in favor of drugs that mend the mind. Best of luck! Cheers to improved mental health!
About a year ago I went to see a band that I knew from 15 years ago. 15 years ago backstage the conversation tended towards what kind of illegal drugs everybody was on and what everyone liked to do. Last year it was still what kind of drugs we were on, but they were all prescription anti-depressants and the like and which ones were effective. Kind of strange.
Been on Effexor for about 6 weeks now myself - very low dose, but it has been very helpful for me - especially in keeping my focus and desire to get projects done.
Can I have one? Just kidding, sorta.
I like Adderall XR (extended release) the best. Out of all that I tried it felt the least like doing Real Drugs (cocaine) and more like an all-over brain wake-up call without being jittery.
ian are you still running? don't mean to knock the drugs at all or be an exercise nerd, but running (or swimming or whatever)regularly is such a great mood/energy regulator.
Are you worried it might hamper your creativity? Look at the blog entries you produce every day even with your ADD.
I think Dexy's Midnight Runners are named after Dexedrine (the wikipedia entry on them is very enlightening, btw...I looked them up a few months ago because I never knew what "It's a loo-roy-ay" meant.)
It's funny that Tessa & Sean had the same reaction.
I myself have wondered whether I have attention def - ooh, my watch is reflecting a little spot of light on my wall!
Don't forget the morning multivitamin, Ian. Might as well mush that one in too.
Hey Ian,
Thanks for this post. I've been tired since I was about thirteen too. No amount of sleep ever seems enough. I hadn't thought about the Dexedrine/legal speed route. I am going to find a psychopharmacologist here in the great Midwest and see what s/he recommends.
By the way, just seeing the word Effexor sends chills up my spine. I got a prescription for it in 1993. I took my first pill and got in my car to drive from Durham to Raleigh. My body was so allergic to the stuff that I went into whatever form of shock it is that paralyzes your arms and hands. Not good when driving a stick shift. After an evening in the hospital, I was fine. I'd have to say it was Ineffexor for me.
Thanks again for the info,
Grib
Wow, I took Dex (illegally) in college a few times. I guess I'm very sensitive to stimulants -- for example, I still don't drink caffeinated coffee or tea, to avoid "the jitters" -- because I felt amazing while it was working, then went into the worst downer as it wore off. I was practically moaning on my bed, convinced my personal world was ending, trapped in some bleak black place that I couldn't crawl out of.
Well, that was just my own little pharmaceutical psychodrama. I'm sure you're going to take some very reasonable dose, Ian. Let us know what you think. I, like you, have always had a distractable mind and label myself as "lazy" when it comes to focusing on work. BTW, I am taking both Lexapro and Wellbutrin, which my psychiatrist added last spring to wake me up a little and address a creeping recurrence of the depression. It really energized me for the first 3 months or so; now, not so much. I'm pretty happy, though! 8-)
Read the label very carefully.
Were there a large number of anorexic and wired looking model types in the waiting room while you were there? Is this guy a "doctor to the stars"? Sorry to be a smart ass but I'm a bit skeptical of a psychiatrist who would choose dexedrine first. That seems a bit extreme especially with all the new, "cleaner" and less addictive drugs out there now. Have you seen Walk the Line? Cash liked dexedrine too.
Sorry to be a downer (instead of an upper like you prefer? - couldn't help myself there!) but I have never seen dexedrine used first line - that doesn't mean it can't be of course.
I am suprised he didn't discuss Wellbutrin. That seems like the logical addition since it is used as an adjunct to SSRIs often and is used off label for ADD as well.
Here's my other unsolicited advice - like Eric above I would not recommend Effexor before trying other stuff. It can be very difficult to stop. The withdrawl symptoms are very uncomfortable and sometimes dangerous. I have also seen some bad reactions to cymbalta and one psychatrist I refer to has stopped using it.
Let us know how you're doing today please.
Effexor is lovely, especially when you are stuck in the middle of a bleak Iowa February.
I know I don't have to tell you this, but there will be a backlash to any kind of medication you use. For some reason, people feel like it's okay to eat a sandwich when you're hungry, but it's crappy to take medication when you're suffering.
I'm on a cocktail of things to deal with my many maladies, but it doesn't mean that a) I don't take responsibility *personally* for the many ways I'm not living my life the way I want to and b) that the medication changes my personality.
My meds have made me capable of being productive and happy, and making those around me productive and happy. Ian, before celexa you had a hard time keeping the wolves at bay, and you've been that way since you were an *infant*. You have medical problems quite beyond what one normally gets in their first four decades, and you are now as happy and as well-adjusted as I've ever seen you. Ever.
Pop 'em if you got 'em. Let everyone else drink coffee and scotch to get 'em up and down.
Has anyone heard of/used Concerta? I think this is a very similar (perhaps safer?) ADD drug. I have heard of it used along with Effexor with good results. Never used it myself. I wonder if this is one of the drugs Neva was talking about...
Sean has a good point. I think many people who have never experienced the true suffering of depression, etc. tend to see medications for such as unnecessary crutches. I believe depression and anxiety are as serious as a heart attack (to coin a phrase) and are probably more easily treated! I strongly encourage people to use meds if they need them. I do believe that some are safer than others and that as consumers we need to realize that any chemical you put in your body can have negative as well as positive effects. Remember the recent discussion by the FDA of Adderall having a "black box warning" for several cases of sudden death in people beginning this drug. There are many arguments to make that this black box business is unnecessary and reactionary and based on questionable science, however, the controversy is there and those people are still dead.
To answer Annie, Concerta is a longer acting ritalin drug. That has been the newest addition to ADD therapy - the long acting versions of the older short acting drugs - ie adderall XR lasts about twice as long as regular adderall. That has advantages for once a day dosing (less drugs at school) and perhaps other advantages but they are more expensive because they aren't generic yet.
I mentioned Wellbutrin because it's not a stimulant but more of an antidepressant that is used for focus and energy in folks with depression issues. Stimulants do make me a bit nervous due to the cardiac effects and addiction and abuse potential but I still prescribe them when warranted and necessary and see them benefit people. I do think, however, that the treatment of ADD is a bit more hazy than depression because the symptoms are less "serious". People don't generally commit suicide because they are distracted and unfocused so taking a risky medicine seems less warranted. There are people who believe that ADD does lead many people to a life of drug and alcohol abuse and general dissatifaction and maybe that's the reason to treat folks. I have seen many children who could not succeed in school suddenly thrive but I often wonder why adults who seem to be doing fine really need that "extra edge" that stimulants give. I see lots of college students who take it before exams. Maybe we all need it? I usually insist people get good psychological testing to ensure the diagnosis is correct before I prescribe stimulants to protect myself and them.
serious as a heart attack (to coin a phrase)
That's "borrowing a phrase." Borrowers credit coiners, or they declare they're borrowing. To avoid looking like a plagiarist or illiterate, I guess.
BTW them's wise words from Sean, I'd say. I'd quibble about "personality" not changing, but that's because it's such a broad term. I'd say it does change, just as your vision changes when you wear glasses. But glasses only give you use of such a retina and cortical wiring as is yours innately. If you end up better than 20/20 and fit for the air force, still that's "all you"...by convention
Meanwhile, the southern Californians who steal our water to wet their deserts and call themselves "farmers" are just a bunch of self-deceiving sinners.
I have to say that I find it funny that Oliver insinuates that Neva is illiterate and then he uses the word “them’s”. Neva is a Morehead Scholar with the letters M.D. behind her name!
However, I agree with Oliver about the water situation. I live in SoCal and the hills outside of my gated community are covered with cactus, and yet we all have lush, green lawns. It’s sickening how much water is wasted here to keep the grass green.
Wait, wait, I come back from an anniversary dinner at the Carolina Inn (our ninth by the way!) to find I've been declared a Morehead once again. It's not true! A finalist only. Thanks for the kind thoughts however! It was a beautiful night to be out in Chapel Hill by the way..
I insinuated no such thing, but I'm sorry I created the impression I was denigrating Neva rather than myself. That's just one of the ways I try not to seem full of myself, despite my obvious brilliance .
You might want to read one of Diana Schwarzbein's books. They are a little hokey, but she has some interesting opinions on the interrelationship between insulin and seratonin.