Opinions - Doc giving choice of drugs

[dark12]

Hey all,
SWIM's psychiatrist says swim is displaying signs of ADHD, but she doesn't want to prescribe a stimulant because SWIM also has anxiety issues. SWIM's psychiatrist seems a bit cautious of potential recreational use. SWIM doesn't doesn't show any signs of drug abuse other than shaggy hair .
So SWIM's shrink gave SWIM a stack of reading material on both Concerta(methylphenidate) and Strattera(atomoxetine) and told me to come back in a week with my thoughts. She put more emphasis on the Strattera it isn't a stimulant. By the way, SWIM is also taking Wellbutrin XL for depression.
SWIM would clearly prefer the Concerta prescription, but SWIM doesn't know how he should approach this issue. SWIM's shrink repeatedly mentioned how stimulants are used by cramming college students and SWIM is a college student so he is obviously weary of that reference. She also said it was obvious that SWIM knew what he was talking about when it came to the choices. SWIM is not comfortable with this situation.
When SWIM returns to the doc in a week how should he approach this issue?

[Lobsang]

Well first of all. WTF? Why would the shrink be so stupid as to even consider Wellbutrin with Cocerta?. That could result in seizures or overstimulation. And as far as the other choice. I have no idea. Maybe...Just maybe the shrink is testing SWIy to see if SWIy will go for the speed. Thus deciding that he has potential as a drug abuser. I just have to say that combining Wellbutrin with Concerta is a misjudgement. And it may be a misjudgement to combine it with the other drug. But if SWIy wants to take the risk that is up to SWIy. So if SWIy really wants the Concerta maybe SWIY should ask for the other drug first and then come back and say it does not help. Then try the Concerta. You have to treat these psychiatrists like children.

[dark12]

SWIM is aware of a possible interaction, but SWIM hasn't heard much about enough of a seizure threshold change to warrant such a negative reaction.

[mickenator]

Seen as how swim has had 2 seizures in the past due to badly perscribed medication swim would urge caution as seizures are horrible things to go through. Maybe if swiy needs the stimulant then swiy could try and reduce or even come off the anti-depressant. Think carefully when swiy is asked to make there decision as to what they want.

[staples]

I can't imagine a doctor prescribing Bupropion and Methylphenidate at the same time, ADHD often causes the symptoms of depression, so if not for the drug interaction the doctor should discontinue Bupropion before starting Methylphenidate and pay attention to the depression symptoms; it might cure both for the patient.

Atomoxetine (Strattera) was originally developed as an antidepressant, but failed to show enough clinical evidence for actually helping with depression. Eli Lilly noticed that it showed enough efficacy to be labeled an ADHD medication, but it seems unanimously understood to be extremely crummy at addressing ADHD. There are a few threads around here that discuss Strattera, this post, in particular, seems on par with most of what I've read. I'd steer clear of this option.

[GForce]

I'm a student at a very competitive University and my ADHD manifsted itself once I got to school since High School was a breeze in comparison. I never had a doctor that thought I might be trying to get a prescription for an academic steroid. This includes three psychiatrists; my original one in town that had his own private practice, my temp in Manhattan while I interned there, and now one that works at my University's Health Service (so I don't pay a dime). If you have legitimate problems a doctor will take you seriously. After all, it is their job to listen to your symptoms and make a diagnosis. It isn't their job to assume you're lying just because they profile you as a college student.

That being said, I was perscribed Adderall because it was what my brother took and benefited from. Personally I find concerta and ritalin useless, but most people at least feel something from them, if not relief for their ADHD all together. I'm not familiar with the other medication though. Either way, you should try and get Adderall. Granted medications work different for different people, but it is pretty unanmously considered the best ADHD relief, at least among the people I know.

[dark12]

Thank you for the responses.
SWIM's psychiatrist stated from the start that she "doesn't like prescribing amphetamines." so Adderall seems to be out of the picture. SWIM knows atomoxetine(Strattera) has been proven ineffective in many instances so he thinks he will address that in his next visit.
SWIM is a bit hesitant on the ween off of bupropian because it has really helped him with his depression.
SWIM knows many will suggest looking for another psychiatrist, but SWIM's father is urging him to stick with this one due to insurance reasons.

[Lobsang]

Well just remember that Wellbutrin in terms of molecular structure is very similar to an amphetamine. So that is part of the reason one might consider not combining them.

[staples]

Originally Posted by dark12

Thank you for the responses.
SWIM's psychiatrist stated from the start that she "doesn't like prescribing amphetamines." so Adderall seems to be out of the picture. SWIM knows atomoxetine(Strattera) has been proven ineffective in many instances so he thinks he will address that in his next visit.
SWIM is a bit hesitant on the ween off of bupropian because it has really helped him with his depression.
SWIM knows many will suggest looking for another psychiatrist, but SWIM's father is urging him to stick with this one due to insurance reasons.

Even moreso, I don't imagine a doctor prescribing any of the Amphetamine-based medications alongside Bupropion; it seems to be limiting SWIY's options when it comes to treating ADHD, and since these chemicals mostly work on the same neurotransmitters, I would trust a doctor to try switching off of it, if things don't work out SWIY can always tell the doc that he wants to go back to Bupropion.

[dark12]

Interesting,
SWIM didn't even consider this since Wellbutrin has never made him feel any different aside from alleviating his life of rare episodes of massive depression.

dark12 added 4 Minutes and 38 Seconds later...

Sorry staples, posted same time as you.
SWIM is just very very afraid of his life returning to how it was a year and a half ago like it was before bupropion. On the other hand, SWIM feels a need to address this problem before the start of his next year of college.
I guess SWIM needs to decide whether or not to risk taking both at the same time or maybe lowering his bupropion dosage to a single 150SR a day? SWIM let his doctor know quite clearly that he wants to stray from other anti-depressants like SSRI's because of the side effects(mostly sexual).

[thenightwatch]

From the Wikipedia article:

"Although the drug can be "felt" right away, it does not start "working properly" for 3-4 weeks time. Users should expect to feel tired and groggy for a few weeks."

"A significant minority of adult male patients taking Strattera suffer minor to severe sexual side effects, including erectile dysfunction, retrograde ejaculation, painful orgasm, and the decoupling of orgasm from ejaculation, wherein ejaculation takes place up to ten seconds before or after orgasm."


Just mention your concerns over these two things, it should help the case for choosing Concerta.

[dark12]

Originally Posted by thenightwatch

From the Wikipedia article:

"Although the drug can be "felt" right away, it does not start "working properly" for 3-4 weeks time. Users should expect to feel tired and groggy for a few weeks."

"A significant minority of adult male patients taking Strattera suffer minor to severe sexual side effects, including erectile dysfunction, retrograde ejaculation, painful orgasm, and the decoupling of orgasm from ejaculation, wherein ejaculation takes place up to ten seconds before or after orgasm."


Just mention your concerns over these two things, it should help the case for choosing Concerta.

Thanks so much!
That works perfectly because SWIM mentioned that he demanded Wellbutrin over SSRI's and other options because of the lack of sexual side effects.
SWIM will also mention the fact that concerta takes effect that very day.

[HorseBucket]

A word of advise. DONT TAKE STRATTERA!!! Its complete shit. It makes swim angry and drowsy all day and everyone pisses him off now. He has no patience for anyone at the moment especially kids who seem to piss him off even more because they have high pitch voices and ask too many questions. It takes weeks to accumulate in your system before it helps you concentrate but you have to deal with all those shit side effects in the meantime.

[Dr. Awesome]

Originally Posted by HorseBucket

It makes swim angry and drowsy all day and everyone pisses him off now. He has no patience for anyone at the moment especially kids who seem to piss him off even more because they have high pitch voices and ask too many questions

Sounds like swiy should talk to his doctor about switching, this doesnt sound good at all! These are definitely side effects that would constitute a prescription change.

I did lol at high pitch voices part though

[Hinty]

SWIM's doctor has him on all three of these medications actually. Concerta Strattera and Welbutrin. Strattera provides a basline and takes several weeks to build up in ones system. It also burns when Swim snorts it. Swim snorts concerta and it definitely provides a kick as well as works fairly well when taken orally. Try getting both, the strattera to keep about a 70% baseline and the concerta when important exams or work comes up. Or when SWIY just wants a little boost to have fun with.

Hinty added 4 Minutes and 31 Seconds later...

Also, Concerta nor any form of methylphenidate (ritalin) is an amphetamine so there really isn't a problem about combining it with things anyone wouldn't want to combine with an amphetamine. Unless someone is worried about getting hyped up too much.

[Boca Bitch]

Originally Posted by dark12

Thank you for the responses.
SWIM's psychiatrist stated from the start that she "doesn't like prescribing amphetamines." so Adderall seems to be out of the picture. SWIM knows atomoxetine(Strattera) has been proven ineffective in many instances so he thinks he will address that in his next visit.
SWIM is a bit hesitant on the ween off of bupropian because it has really helped him with his depression.
SWIM knows many will suggest looking for another psychiatrist, but SWIM's father is urging him to stick with this one due to insurance reasons.

I'd like to know where your psychiatrist graduated from.. as it's been mentioned, she's lining up two medications known to have interaction potential. Methylphenidate acts primarily on the exact same neurotransmitters that bupropion does: norepinephrine and dopamine. This sounds like a seizure waiting to happen. AND she said she doesn't like to prescribe amphetamines!?! Yet she's willing to prescribe methylphenidate.... which has even greater abuse potential because of a higher euphoric state than amp could ever offer, when used recreationally.

And the idea that she left the choice for medication up to the patient screams "I don't know what to do."

My suggestion: don't opt for the stimulant unless you're going to stop taking the anti-depressant.

[dark12]

hehe SWIM says thanks for the responses.

He ended up trying Focalin XR(dexmethylphenidate) for a while, then he somehow got his doc to switch him to Adderall XR(mixed amphetamine salts), now he is content with Dexedrine(dextroamphetamine).

SWIM thinks his doc changed her mind about amphetamines because she began to trust SWIM more when she found out he was a pharmacy student.

[eche05]

Originally Posted by dark12

hehe SWIM says thanks for the responses.

He ended up trying Focalin XR(dexmethylphenidate) for a while, then he somehow got his doc to switch him to Adderall XR(mixed amphetamine salts), now he is content with Dexedrine(dextroamphetamine).

SWIM thinks his doc changed her mind about amphetamines because she began to trust SWIM more when she found out he was a pharmacy student.

Methylphenidate, dextromethylphenidate, and dextromethorphan are all suitable, however be warned in combination with SSRI or tri. anti depressents. Serotonnin syndrome, etc.

[dark12]

hehe DXM for ADD??

I didn't know serotonin syndrome was really a risk with pharm stims... I thought most of their affinity was geared toward dopamine rather than serotonin.

Either way, the big decision was taken care of. SWIM thanks everyone for the responses.

[toe]

Combinations of bupropion with stimulant meds (esp in cases of co-morbid BP and ADD) are not at all unheard of. There's a site all about "crazy meds" where you can read all about it. (Of course, these are people on minimal doses of stims, 10-15mg MPH or 30mg lisdexamfetamine per day.)