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Ralph

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I am not okay. I don't know where else I can say that so I'm putting it here. I'm thinking more about suicide lately. I'll go for a few hours thinking it's the only way out, and the obvious solution, then I'll switch and think that was crazy, how could I be considering suicide. It's like Dr. Jekyll and Mr. Hyde are playing tug of war with my head.

Triggering event was visit with pdoc to discuss ADHD meds. This did not go well and I left feeling insulted, berated, and hopeless about getting effective treatment for my condition.

I now believe my ADHD is the cause of my depression and anxiety. This would explain why my depression was "treatment resistant" since we were never getting at the root cause and only dealing with the after effects of the real problem.

I left pdoc's office with some Strattera samples. Great, something that costs me $5/pill and takes six weeks to start working. Six weeks of dealing with side effects just to find out if it's going to help enough to be worth it. Hope I still have my job by then. I'm so frustrated.

Obviously I can try another doc, and that was my therapist's recommendation. I'm going to do that, and maybe get a 3rd or even 4th opinion. Heck maybe Strattera will be fine for me and this will all become a moot point, except for how will I afford it? I'm tired of living like this though. I am running out of ways to compensate for my symptoms. If I don't get some relief soon, I am going to get my affairs in order and say goodbye. Wonder if it's too late to buy life insurance?

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Oh Ralph, this sounds awful. :( I hate it when a pdoc appointment goes badly - it really affects you; it's an important event with a lot of significance for your life. What did he say that left you feeling insulted and hopeless?

Does Strattera really take 6 weeks to work? I thought it was just the anti-depressants that took that long. I have heard good things about it though, from people who say it has really helped their ADHD. Bummer about the cost.

Unfortunately, I think life insurances have exclusionary clauses for suicide... :(

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It wasn't so much what he said as how he said it. He said I couldn't try a stimulant for ADD because I had struggled with alcohol in the past. This was done with no investigation as to the severity of my problem, only the fact that I am "in recovery" was used to cut off an entire class of medication, which happens to be the best evidence based treatment for my symptoms. The subtext here was that I am a worthless addict who has no say in my own care because I cannot be trusted not to abuse the meds. This offends me because I have done a lot of work to achieve and maintain sobriety, yet all of that counts for nothing. The impact my symptoms are having on my life count for nothing. All that matters is making sure I don't accidentally catch a buzz somehow, regardless of the risk of losing my job and failing in personal areas of my life.

Strattera is in the same chemical class as Prozac. It is an antidepressant, but in trials it was found to have effects on ADD symptoms. It's the only non stimulant medication approved for ADD.

I have heard that the suicide exclusion runs out after two years. I could easily hold a policy for two years before exiting, but the ethics of this are still a sticking point for me.

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That's rough, sorry to hear that. :(

CrazyMeds's Strattera page says that if it is going to work for you it will probably do so quickly, like within 3-4 days to two weeks. Might be some cause for hope? What dose has he started you on?

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I've been on 18mg for a week, tomorrow I go up to 25mg for a week and then 40mg after that. So far I've noticed a lot of side effects but no improvement in my symptoms.

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I'm sorry, Ralph, that you was treated so badly and that nothing got better since :(.

I certainly encourage you to seek some other opinions and also to explain to those other docs the reasons why you need another opinion - including your feelings about that lack of trust and the "implicit messages" of this doc who refused to give you an appropriate stimulant. (Maybe you could somehow try to be engaged in a study of the effects of those meds on somebody with a history of alcohol abuse - they probably never tried, just assume it would be "bad", but... Yes; sorry; I know it's very naive. Just an idea :o. Maybe you could at least try to present it this way - as your volunteering for trying a new approach (?)... It's your life, your decisions... and they may control you anyway - and how could you start to misuse it (-the stimulant) under medical control?)

I hope so much that you'll stay able to work and to take care about and for yourself :(. You may be very angry at a doc, you may feel frustrated by his approach, but... you should never let him to influence negatively your decision about life and suicide... :o

Take care!

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He is titrating you appropriately, but you may only hit your "sweet spot" on a higher dose (25 or 40) and then you may need a week or so at that dose before things start to clear. But it doesn't sound like it will take 6 weeks, unlike the AD I am currently titrating up on. Like you, I wish it was faster.

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You may be very angry at a doc, you may feel frustrated by his approach, but... you should never let him to influence negatively your decision about life and suicide.

My reason is not specifically this incident, but this incident points to the reason. I have a lot of reasons not to commit suicide, but I've felt consistently bad for a long time now. I know life isn't all sunshine and roses, but is life worth living if one never feels good? If I can't get help for my symptoms, I am not sure I will ever feel good again, and treatment like what happened with my pdoc gives fuel to the despair that I feel over not getting appropriate treatment.

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Luna, I hope it works faster, but the strattera website (strattera.com) says it may take 4-6 weeks after reaching the target dose. So that's three weeks for titration up to the target dose, plus another 4-6 weeks at the target dose just to find out if it's going to work. I'm sure my pdoc will want to give it that long. The frustrating thing is that the first line meds for this condition work instantly, no titrating required.

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Ralph, Life is worth changing if one never feels good.

Dying kinda guarantees the "nevers" that depression wants us to believe.

There aren't that many situations where dying is truly an improvement.

You probably know that stimulants do increase the likelihood of impulsive behavior, which would include binge drinking. Perhaps that's made even more difficult because no titrating required also means no titrating possible. There would be no way to increase you gradually to see if you tolerate the stimulants without undesirable behavioral changes. That's probably his concern, but I agree that there ought to be mitigations possible.

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I am doing my best to change, but it feels like I finally figured out what is wrong and the only treatment available is an antidepressant that happens to sometimes help with ADD symptoms, instead of the first line treatment that is known to work from multiple studies and years of prescribing experience.

I don't think stimulants increase impulsivity at the doses prescribed for ADHD. Otherwise nobody would ever be prescribed them, as impulsivity is a symptom of hyperactive type ADHD. They're supposed to reduce impulsivity when taken as prescribed. And the stimulants clear the system quickly, so if for any reason I didn't tolerate them, I would simply not take it again and be done with it. That's in my eyes a reason to try stimulants first, they are out of the system so fast that side effects don't really have a chance to build up.

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I talked with my partner about what I am going through. We now have a plan for what to do if the worst case scenario happens. Therefore I don't feel like I'm backed into a corner regarding suicide. I'm still going through suicidal thoughts, but I'm back to challenging them. When I spend time with my partner I don't seem to have them at all. Sadly he goes back across the ocean soon so I am trying my best to plan for dealing with this on my own.

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It's a good point about impulsivity ... still, you have suicidal thoughts as well as the addiction difficulties. I know that there were times when all it would have taken for me to do something stupid would have been a strong enough impulse ... and my trip to the hospital probably was just such an impulse. Of course, my experience doesn't bear directly on yours ...

Have you given any more thought to trying a different prescriber?

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