More threads by nphelps

nphelps

Member
Before I ask my questions, I'd like to give a little information about my situation and some of the steps I took before they gave me a diagnosis. Some of the posts on this forum have alleviated some of my personal concerns, but I still would like to be certain before taking the medications given to me. It's not that I don't trust medical professionals, but their time is limited, and it's hard to ask them a lot of questions in one sitting. I am hoping someone with a medical background, or someone with a similar situation can help me out a little. I would be very grateful for any assistance.

My problems started long (early teens) ago, although I mostly ignored them and managed to get by (details of which I can elaborate later). However, they seemed to get worse and worse the past 5 years rather than getting better on their own, and so I went to a doctor with my sleeping problems. I was given melatonin, propranol HCl, Trazodone HCl, and Zopiclone (all at various doses), and they all made me sleepy/groggy, but I would still wake up in the morning feeling like hell and would fall asleep throughout the day like before. The doctor was going to give me something that he said would completely zonk me out, but I refused as the idea scared me far too much.

I never told the doctor at the time that I was having problems during the day and that I woke up a dozen times at night, but rather that my sleep problem was that I just couldn't sleep at night. I figured, that if I got sound sleep at night, it would take care of the rest during the day. Guess I was wrong about that. I went and got blood tests done, as well as an ECG, and everything showed up normal. I then went to see a clinical psychologist, to whom I opened up about the details of my problems, we had two one hour sessions, and he also referred me to a psychiatrist that spent an hour with me.

They both realized that I have several problems, but the main one is narcolepsy (without cataplexy, meaning I won't fall on my face while doing things, I can endure it somewhat). My sleep is irregular, in that I wake up at the very least every 2 hours on good days, and about every 30 min to 1 hour on average. I apparently also have ADD, anxiety, depression, and OCD.

They made me feel like a bit of a nut case, but at this point, I think if I can feel a little normal with my sleep condition, the rest should go away, or so I hope. I am also going to be scheduled for some overnighter sleep lab tests, but apparently it takes a long time to get in.

I was prescribed an SSRI called Cipralex, and a stimulant called Adderall. We're currently testing the dosage (the pharmacist called it "titration"), and was supposed to start taking it a couple of days ago, but after having read some of the posts online I've gotten really worried about it. Mostly because I was told one thing by the psychiatrist, and another from the pharmacist, and from the posts I've read, I need to be sure not to mix certain vitamins/minerals or I could potentially do something bad to myself. I'm not sure if I am mistaken about this, but again my reading has been limited to what I can find online.

The psychiatrist told me to take Adderall in the morning, and Cipralex at night. Whereas the pharmacist told me to take it during the morning, both. Although, she did mention I could take the Cipralex at night. Not sure what difference it makes or what's really better.

Secondly, I do like to supplement my diet with a protein shake during the day, an amino acid tablet, a multi-vitamin, including two extra B-complex, and vitamin D tablets. There problem here is that the protein shake and amino acid has things like L-tyrosine, and the multi-vitamins has good dose of magnesium, potasium, and choline.

So my questions are:

1. Should I be taking the two prescriptions at the same time? or like it was recommended initially? I already have a feeling I will be told to follow the doctor's orders, but I would like to know the difference if someone can help with that.

2. Should I be worried about my protein/amino acids/vitamins in the mornings? If there is some concern, how should I try to time it?

3. I also read about something called Modafinil for narcolepsy, and is not a stimulant or has as drastic side effects as Adderall. Any advice/suggestions on this?

I know it sounds like I am being overly cautious, but these are medications that affect brain function, and so I want to proceed with caution (maybe that's part of my OCD side). I also don't want to avoid dealing with my problems.
 

Retired

Member
It's not that I don't trust medical professionals, but their time is limited, and it's hard to ask them a lot of questions in one sitting

Instructions for taking medications are critical and need to be understood, so any concerns should be discussed until you are satisfied with the answers. It's up to you to advocate for the time you need with your doctor and not be rushed.

That being said, now that you have concerns, they should be followed up with the doctor. If your pharmacist has concerns about the doctor's instructions, the pharmacist should contact the doctor for clarification, rather than confuse the issue by giving you alternate instructions.

Though there may be concerns about a form of interaction between Cipralex and Adderall, your doctor is likely measuring the benefits of the therapeutic plan for you against any potential concerns, which is why you were instructed to divide the doses morning and night, likely because of the biologic half life of Adderall.

By titration, do you mean the dose is gradually being increased over a period of time? If so, the reason is to acclimate your body's systems to the new neurochemical balance, and to minimize side effects.

During this period of adjustment, you should report any adverse reactions to your doctor, so modifications, if necessary can be made.

The bottom line is that your doctor has to be the final authority in the way you take your prescribed medications, and consulted before any changes are made. Your pharmacist can help, and make suggestions, but the pharmacist should not implement any changes without first consulting your prescribing doctor.


Perhaps others will have comments to offer on your questions #2 & 3.
 

nphelps

Member
Thank you Steve. I will follow what the doctor recommended, and ask further questions and concerns during my next appointment. I should mention that I am hesitant to ask them too many questions as I always get the feeling I annoy or anger people when I take up their time. I know it's not really the case, it's just how I feel when there's that kind of direct attention on me.

Questions #2 and #3 are important as I want to be careful with my diet to avoid problems, and I want to take the safest route and possibly ask my doctor about valid alternatives.
 

Retired

Member
I should mention that I am hesitant to ask them too many questions as I always get the feeling I annoy or anger people when I take up their time

I would propose you re-orient your thinking so you see yourself as your doctor's partner in your health care. By being a partner, you now become empowered to participate in the discussion, to ask questions and be certain you both have a clear understanding of your health goals, and your treatment plans.

By doing your research, and making notes prior to your appointment, you can be prepared to ask all your questions and make all your points.

My doctor often takes my written notes and addresses each issue by reading my notes himself.

By being an empowered patient and a partner in your healthcare means providing your doctor with the information s/he needs to make the best possible diagnosis so that you are provided the best treatment options. It also means asking informed questions to maximize the effectiveness of your treatment plan.
 

nphelps

Member
That's fair, and I agree. I'll get over those obstacles, and I have a good circle of support around me. The written notes is a good suggestion, I think I'll do just that.
 
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