Starting Adderal XR, learning more about drugs

After having my psychiatrist once again go over my chart and test results showing indications of attention deficit disorder and prefrontal cortical dysfunction, he still wanted to postpone putting me on Adderal, an amphetamine stimulant indicated for ADHD. He was glad that we were finally getting some improvement in my mood stability and my anxiety symptoms, and he stresses that stimulants, like Adderal, can worsen symptoms of panic attacks, anxiety, and mood swings. I acknowledge this and explained that if the symptoms got worse, I could likely handle it long enough to know to stop the medication and give him a call. I used the line of reasoning my therapist recommended I use, basically that, why don't we just give it a try and see what happens?

I've only taken my first daily dose this morning. I had a good day, got up early to see my cousin in the hospital, was fairly attentive and engaged in my class, and was able to come home and study for a good 2 hours, and then again in the evening for another hour.

I'll have a better idea of how this medicine effects me within a few days, since it isn't supposed to require a long time to build up in the system. I see my therapist again on Friday, I'll bet he'll want to do a follow up ADD test to compare results. I forget the name of the test, but it is done by me sitting at a computer and responding to things on the screen. It could be letters flashing and I have to press a certain key when a certain letter appears, or having a shape flash on the screen and then try to duplicate it, or read a short story and then later answer questions about it, things like that. I'm making an early prediction that we'll have to increase the dosage to notice a significant positive effect.

In any case, I'm really enjoying my class, I'm developing a much deeper understanding of how drugs, especially psychotropics (both illicit and licit) work in the brain and with individual neurons and their receptors, how the drugs get metabolized in the body, how they are removed from the body, how tolerances are formed, etc.

And thank God for lower Fall temperatures! Reminds me more of home, and makes the bike ride to school that much more relaxing.

Return to college

Well, I'm officially back in college now to hopefully finish my Bachelor's in Psychology. Yesterday was my first class, called Psychopharmacology, about drug interactions, specifically psychotropics. I'm only taking one class this semester to see if I can handle it. Baby steps. Long term goal is to go all the way to a Doctorate and in the process pull myself out of enough of the disabling effects of my co-morbid disorders to move on in life and start pulling my own weight again. But first things first.

I was really anxious during the orientation period last Friday at the university, but yesterday at class I felt at ease and enjoyed it. I even rode my bicycle there, so I got some good exercise! (didn't have much of a choice though, since the battery in my truck is dead).

Big problem I'm having now is that I am so tired all the time, which I attribute to all the drugs. I'm on Seroquel again, an atypical antipsychotic (tranquilizer). So it's real hard to stay awake at all. I'm still trying to get my psychiatrist to try me out on Adderal, a stimulant, which is what the plan we had worked up called for, and is what me and my therapist have been thinking for quite some time should be a real help for me.

Better eat and drink properly and regularly

Well, I learned the hard way how important it is to eat and drink properly and consistently, especially while on meds like lithium. I ran into a problem were the Lamictal I'm on was causing me to not want to eat or drink, and after a couple of weeks of hardly eating or drinking at all, my lithium levels became toxic for a while and my electrolytes got off balance and I became VERY sick. I really thought I was going to die it hurt so bad. I ended up spending 3 days at the hospital hooked up to an IV to bring my electrolytes back into balance and to nurse me back to where I could start to eat and drink again. I'm still recovering from it, I still have the shakes, a little dizzy, and a very mild pain in my abdomen, but over the next week I should be back to normal and be able to go back on the lithium.

So, my advice to others in a similar situation: even if you feel you can't eat or drink, force it down. Otherwise call your doctor and tell them the meds are causing you to not be able to eat or drink, and they can adjust the meds before you get sick enough to go to the hospital like I did.

Lesson learned!

But, on a positive note, this mishap seemed to improve my attitude and I feel a little more motivation to once again put effort into getting on with life as best I can, both with the small things like helping out around the house more and the bigger things like going back to school.

anxiety and trance-like states

Wow, my internet connection is actually up at the moment, hope it stays up long enough for me to type in this entry and get it posted.

I've noticed my anxiety slowly increasing in intesity over the past two weeks or so. My guess is that I'm again growing tolerant of the Xanax. But, no panic attacks yet.

Over the past couple days, and especially yesterday and today, the conversations that I have in my head have been increasing in length, but also in terms of how much they take over the focus of my thoughts. Today it's occured to me to describe it as a trance-like state. I've snapped out of it enough at least for a while to be able to look back and think about it.

Take yesterday, for example. I got home from my visit with my therapist a little after 4pm. I immediately began to have a hypothetical conversation in my head describing in detail my entire life's story. Pretty much next thing I knew it was about 6:30 am and I fell asleep even though I wasn't tired. I was basically unaware of the passage of time, of the sun going down, getting dark, and the sun coming back up. I was only vaguely aware of the fact that I was moving from room to room in the house. Basically only vaguely aware that I was in a different room sitting in a different chair, not aware of actually moving between the rooms. Thankfully the cat knew when I'm supposed to take my medications, he would meow and distract me enough to know to take my meds and give him his food and his antibiotics.

My guess is that the Provigil may be causing these conversations to expand in length. I've had complex conversations constantly going on my head pretty much all the time, but I usually don't go into a trance like state, I have, but not all that often, usually just the hour after I get out of bed, and these states, in the past as far as I can recall, have never laster longer than an hour or two.

I also feel compelled, when I do snap out of it, to return to that state to finish the conversation, because in that state I can focus on it. Whereas when I'm not in this state, and going about my day, I'm dealing with various intrusive memories and still having conversations with hypothetical people, it's just that it's usually more in the background, and the intrusive memories are pretty much all negative, like a crowded noisy bar where everyone is criticizing me or calling me names or something.

Anyway, it's always been difficult for me to describe just what it's like, but I've made another attempt here, wanting to note the dramatic change, it seems, that has started to occur.

not a new doctor, please!

Well, I went to see my psychiatrist today, but instead of the same psychiatrist I've been seeing for a good year and a half, some new psychiatrist walks into the lobby and calls me back. Doesn't seem like much of a nice guy or very compassionate. First asks me the exact date, including what year it is. Then he asks me what meds I'm on. So, I'm a little miffed, here I am with a new doctor, when I've been working with my real psychiatrist on a long-term plan and we had planned on introducing a new drug this session.

When I tell this new guy I'm on 8mg of Xanax, he says that is too much, he refuses to have any of his patients on that much, and I must instantly lower my dosage to 4mg. I put the brakes on hard then. I've never heard anybody even vaguely suggest that a person should drop 4mg of Xanax in one day. Even lowering by 1mg a week is crazy. When I had to lower my Xanax for the purpose of getting brain scans before, we did one mg a week down to 6, then half a mg a week down to 4mg, where we stopped. Even tapering at that rate, the withdrawals gave me near psychotic episodes. He also flatly refused to put me on a stimulant, which was the plan that the Amen clinic and my real psychiatrist (as well as my therapist) were planning to do. And he wanted to jump from 100 to 200mg of Lamictal. A pretty high jump at once, especially since my moods seem stable, not sure why he would want to do that. He also said the reason my hands shake is because of the Xanax. He wouldn't listen to me when I said my hands have been shaky my whole life (they always called my klutz in school since I always dropped things), long, long before I started any kind of benzos.

Anyway, trying my best to be polite, I insisted that I see my real psychiatrist. Eventually this new doctor said he would try to see if my psychiatrist was available. While he did that, I went back to the front desk and asked why I was seeing this new guy when I was scheduled for my real doctor, and they said that my real doctor was trying to help out the new guy by giving him some new business.

When I finally got to see my real doctor, he mentioned that he kind of wanted to have this new guy give a fresh perspective on things. Well, this new guy sure doesn't act like a fresh thinker.

Anyway, before I complain more, I'm now on Provigil, which is a stimulant, but not an amphetamine like Ritalin or Adderal (Adderal was what we were originally planning on trying). I'll start my first dose in the morning. Provigil, from what I've read, is used more for people who have narcolepsy to wake them up, and in general to allow people to be awake and alert for longer periods of time. Not many side effects from the sounds of it, but it's still a fairly new drug. Hopefully it should be good for me, since I've been really groggy lately, even more so than normal.

We're also still increasing my dosage of Lamictal. Not really sure we have to do that, since my moods have been pretty stable.

In any case, my therapist and my real doctor have been gradually telling me I should think about cutting down on the Xanax. I told them I don't mind that, as long as we do it very, very slowly. In some of my correspondences with other people who have been on high dosages of Xanax, it's been suggested to go as slowly as one quarter miligram a month. Granted at that rate it would take me 32 months to get completely off of it. My other argument is that we'll need some anti-anxiety medication to take its place. And there aren't many anti-anxiety medications we haven't already tried without success.

So, I hope I can continue with my real psychiatrist and not this new guy.

Anyway, on to other things, I've got a stray cat living in my bedroom now, one of the strays we take care of outside the apartment, he got into a fight and got a nasty infection, so he's living in my room until he's done with his regimen of antibiotics. It's nice to have a cat, I miss the cats I used to have back home. It'll be tough putting him back outside to live.