Questions about medications

[CarlaMarie]

I have some questions. I need some answers so I so I can think about my options before making any decisions about what to do. My diagnois's are ADHD, Chronic PTSD, Alcoholism and drug addiction, Fibro-myalgia. I take Effexor, Stratera, Topamax as a preventative for migraines, Zanaflex, and Trazadone. My internist wants me on Crestor for high colesteral but it irritates my fibro.

I have been seeing the same psychyatrist since I struggled to get clean 5 years ago. I was on Aderall XR at that time. I found it very effective for my ADHD but I still struggled with other issues needless to say. I did something really stupid by failing to get a script filled for Aderall within the 7 days necessary with an controlled substance. I changed the date on the script. That is illegal you know. I don't know what was thinking. I got caught but managed to get to my psychyatrist so she could help me.
Our deal no more controlled substances. Now I would not want to jeopardize my sobriety I am an addict at heart and I love the effect of mood altering chemicals but I did not abuse aderall I found it very effective with managing my ADD Symptoms.

Stratera may help me concentrare but I have found my life still unmanageable after all these years with the diagnosis.pp

The other question I have is with an antidepressant loosing it's effectiveness after years of use. I have been on Effexor for probably about 10 years now. I am 42 and feel like I am definitely hormonal, moody and emotional. I have mentioned switching antidepressants to my psychiatrist her response was that I would have to withdraw from Effexor completely before begining another antidepressant. I am aware of some of the negative press Effexor has received regarding withdrawal. I am curious about what a plan of action would look like. I like to be an educated consumer.

 

[Dragonfly]

Wow. The pieces of your story really talk about the trials and tribulations that you have been through. Your courage speaks volumes. There are many, many different approaches that any one provider might take with someone who has the history that you gave ..... it seems like one plan of action might be for you to develop a list of questions that you would like to discuss with your psychiatrist. (some of them might be: Are there alternatives for the treatment of ADHD that don't involve stimulants? Can I expect to have to fine tune my meds every decade or so? How do I know if a dose of a particular med is at its max? ) Please understand that these are just some examples of things that might help you get some of the education that your seek. It might be that rather than one specific approach or medication, you seek a more collaborative approach with her. She has some specific knowledge about meds and physiology, and you are the expert on you. Approaching this as a collaboration might get you further ahead.

 

[Retired]

I am aware of some of the negative press Effexor has received regarding withdrawal.

Negative lay press tends to dramatize and sesationalize issues to make them appear everyone might be susceptible. The reality of what happens when Effexor (venlafaxine) is discontinued is usually quite different.

If you and your physician conclude that Effexor is no longer required to control symptoms, and no other similar medication (SSRI or SNRI) will be replacing it, then the physician should provide you with a very specific plan for tapering the dose over an extended period of time to where Effexor would no longer be taken. The tapering schedule depends on the dose and length of time the medicationhas been taken. Tapering can take afrom a few weeks to several weeks, but the schedule must be adhered to in order to minimize discontinuation symptoms.

The reason for tapering is that this medication's pharmacological profile has a relatively short metabolic half life, and it achieves a rapid steady state in the bloodstream when therapy is initiated. Your physsician is therefore able to monitor your response to the medication and make necessary adjustments if necessary. When the medication is withdrawn, without a replacement being prescribed, that rapid steady state works in revers, so blood levels drop rapidy, sometimes causing withdrawl symptoms.

This is not an uncommon situation with some types of medications, and is clearly understood by physicians, so the doctor has strategies in place to deal with these situations...in the case of Effexor discontinuation whrn there is no replacement, tapering is initiated.

When another SNRI or SSRI replaces another medication within the same class, regardless of the pharmacokinetics of the previous medications, the new medication is usually started when the discontinued med is stopped.

 

[CarlaMarie]

I have to be honest. I have issues that scare me about myself. They have to do with MD's. I don't trust the Doc's and I don't trust myself. I am a prescription med junkie with a pain condition. There are so many well meaning Doc's out there who love to make me feel better. They don't understand that I can't just have one. I love the effect and will take the pills till I hit a brick wall.
I'm afraid of my ability to "work" my Doc's. I'm good at it. I'm afraid to go to an ob/gym. I'm afraid to tell my psychiatrist the truth about what is really going on. I just can't seem to build a bridge over it. It is like I have to figure it all out first so I know if I can trust.

I'm a little nutty. I don't know if I am making any sense.

 

[Retired]

I don't trust the Doc's and I don't trust myself

Do you see that the only thing this behaviour accomplishes is to sabotage your own health? It's like ignoring that your car needs an oil change, or telling the mecahnic there's nothing wrong with the car, but then having no brakes when you reach the edge of a cliff!

Do you have any desire to get your healthcare under control?

 

[Dragonfly]

I don't trust the Doc's and I don't trust myself.

CarlaMarie, I suspect this is going to sound odd .... but I am not sure that at this point, your goal can realistically be "trusting" yourself or your Docs. There are probably very good reasons why you don't trust yourself or your Docs (you actually mention a few of them). Ironically, it may be that for the time-being, you need reinforcement around not trusting. That for you, maybe it is a good idea, right now to not be trusting. It seems instead of learning to trust, a more immediate, reachable goal might be to stretch yourself and just talk. Maybe even begin the conversation with something like: "I don't really trust you. And I don't trust me ...." I imagine that a start like that might both empower you and would likely get their attention (in a positive way). Just an idea. Best wishes. I know it is hard.

 

[CarlaMarie]

I like that approach. I have to get my butt in an office. First thing to do is to find the courage to make the appointment.

This issue is triggering for me. I react like a child. Everytime I write about it, talk about it, I cry like a baby. I want to solve this problem myself. It hurts so bad. I am not afraid of a negative response. I am terrified of being cared for. It hurts really bad. Taking care of me hurts. I don't know if you all can comprehend that?

I don't want to make the appointment. I want to hide under my bed embarassed and ashamed. That is how I feel. I also know it is the right thing to do.

I know... I have been taught to do it anyway. Take the action. I can not rely on myself to solve to this problem I need help.

I will make appointments tomorrow. One with an ob/gyn and one with my psychiatrist even though I don't want to do it and it hurts. :dramaqueen:

 

[Dragonfly]

Yeah CarlaMarie. I am very sure that I am not the only one who believes that I know how frightening and bewildering taking care of self can be. Good for you! Please let us know when your appts are, and how you manage anxiety as the appts approach. After reading many of your posts, I firmly believe that you can do this!

 

[CarlaMarie]

I did it. I am proud of myself and so sad all at the same time. How can that be? I am crying. I made three appointments. I see the ob/gym one week from today at 11:30 am, I see my psychiatrist on that Thursday and I see a dermatologist this Friday for my psoriasis. Wow, it is done. I closed my eyes and jumped.:yahoo:

 

[CarlaMarie]

I went to the dermatologist on Friday. I thought this would be the easy one. It was terrible but at the same time a great big learning lesson. I was in a panic before during and after. My thoughts raced. It wasn't until after that I put it all together with what I was feeling. What it was that was triggering. I guess I am growing up and taking care of me. I felt like a child. I argued with myself before about deserving to go. I went to the dermatologist once to get diagnoised as a child. Care of my psyoriasis over my lifetime has been getting the medication I can from who ever I can and scrubbing and cutting the scales off my body (I am vain). I thought it was mild. I found out it is moderate and 5% of my body. Wow! Now I have use the medication with strick instructions and go back in 6 weeks. He is militant! And he is making me use coupons for the medication and telling me what to do. It's cheaper than my insurance. Yes, sir!

 

[Dragonfly]

Good for you! Taking care of yourself - both by yourself, and for the wisdom of knowing when it is good to follow the care offered / provided by someone else!! Outstanding!! :2thumbs:

 

[CarlaMarie]

I am catching my breath. I had my appointment with my new ob/gym. I got it done. Ah! It's over till next year unless of course there is a problem with all the tests. I was completely honest for the first time ever with an ob/gym. It was terrifying for me. She even asked me my drug of choice. She assured me she was not one of those Doctor's who likes to give pain pills. I liked her. We agree that hormone therapy would not be the right option for me. So to the psychiatrist I go. My blood pressure was high so she wants me back to my internist. I wonder if my blood pressure had anything to do with the anxiety it took to get me there. I ought to take her direction, right?

 

[David Baxter PhD]

Right.

 

[Retired]

I had my appointment with my new ob/gym

I noticed this abbreviation repeated, so I thought I would mention the abbreviation should be Ob/Gyn for Obstetrician/Gynecologist

 

[CarlaMarie]

You know what I think is happening. I hit the m instead of then n. They sit next to each other. I do depend on spell check. Too bad gym it a word too. Hate it when that happens!

 

[rdw]

On the other hand when your feet are in those stirrups it is worse than the gym....:lol:

 

[CarlaMarie]

Got a good chuckle out of that one, RDW.

 

[CarlaMarie]

It is done. The decision is made. Now I am thinking "what have I gotten myself into". I am scared. We decided since she doesn't want me on a lot of medications adding an antidepressant like Abilify for long term would not be a good option for me unless I went off my migraine preventive. So we are switching my antidepressant from Effexor to Cipralex. She was upfront with me. She said it was a difficult transition to make. She asked me if I was sure this was the right time. I could end up very depressed. Would I be willing go into a hospital? This will take four-six weeks. I start tomorrow. I go down from 300 to 180mg. She gave me a script for 37 mg to take if I absolutely need to and some clonazepam. Now I haven't looked up clonazepam but I believe those are happy pills. I'm on the fence about them. I know my Doc wouldn't prescribe if she didn't think it was necessary. She knows about my addiction. I am nervous.

I am going to write this now while I am thinking clearly about hospitalization. I don't mind going I find them to be a safe place. I will prepare my husband, and my therapists that this will be an option. I can tell you right now guilt and shame will stop me for asking for what I need. I may not be able to know it is time if there will come a time. just in case anyone wanted to know. My psychiatrist plans to see my in 5 days.

It is a cost benefit ratio to me. I may be down for a month but on the right medication It could be possible for all the therapy I have had to work. I notice I think better I just don't feel better. I want my life back. This is a step in that direction.

FYI I popped in on my internist with high blood pressure. He gave me meds back in two weeks.

 

[David Baxter PhD]

Edited your post above to avoid confusion about your medications:

• Cipralex, an SSRI antidepressant, not Celebrex which is for arthritis
• clonazepam, a mild tranquilizer, not clozapine which is an antipsychotic

 

[Dragonfly]

I am going to write this now while I am thinking clearly about hospitalization. I don't mind going I find them to be a safe place. I will prepare my husband, and my therapists that this will be an option. I can tell you right now guilt and shame will stop me for asking for what I need. I may not be able to know it is time if there will come a time. just in case anyone wanted to know.

CarlaMarie, you are doing a great job of taking care of yourself and anticipating where you might need some additional help or backup. .... Texas is one of the states that recognizes Advance Mental Health Directives - essentially documents where you write down your wishes for mental health treatment before you actually need it - because many, many factors can impede accessing help when someone actually needs it. Have you looked into this? Publications (DADS)

The only reason I am asking about this - not giving you more to do - is because it might help to increase your sense of control and autonomy and reduce some of your anxiety. Just an idea. All the best.