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pdoc left it up to me..not sure what to do:


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hey all,

I just got back from my follow-up appointment with the hyperactive-pdoc (I swear he dips into his Adderall samples!) for $100 I was in and out in 20minutes, he sits down with you, fires off prescriptions and walks you out..good thing I did my research and was able to steer him in the direction I needed...but I'm still a bit stumped now that I've gotten back from the pharmacy on what I should do with all this:

  • Old Rx: Wellbutrin XL 450mg (maxed out), finished tapering off of Zoloft 100mg yesterday (and noticed no difference what-so-ever...I was on it for 6months and it never did a thing) and Adderall XR 20mg (new a week ago)
  • Today's Rx: Wellbutrin XL 450mg, Adderall (IR) 20mg up to 3x a day, and Effexor XR (start at 37.5mg, then go up to 75mg, then go up to 150mg)

    • Wellbutrin: I'm fine with leaving this as-is, adds stability but not totally kicking the depression
    • Adderall: He was about to put me on 40mg XR per day and I asked him about the IR so I could have more control over my dosage and timing options and he was happy to oblige, but I'm still not sure how far apart I should take them to avoid crashes? He pretty much told me to experiment, so any suggestions?
    • Effexor: HEREIN lies the main issue. He was about to kick me out with the Adderall prescription in my hand but still depressed and I wouldn't let him. I asked what my other 'long-term' options would be AD-wise since the Adderall is helping and all, but I don't want to have to rely on it to get out of bed in the morning--I'd rather just have it help normalize me during the day and reign in my thoughts. He then got himself hooked on the Effexor idea and took off to get me samples. I asked if it would really help that much since SSRIs haven't done anything for me in the past (Lexapro or Zoloft) and doesn't it work on Seratonin? him: "It's not an SSRI, it's an SNRI" and that was that.

      • (I'm now reading online that it doesn't kick in on the 'N' part until you hit 200something milligrams? Should I just try it anyway? Maybe seratonin will help me and I just had the wrong two SSRIs in the past? Any guidance or kicks in the pants would be helpful here)

meg

ps- before you all say it: I AM getting new pdoc--my appointment is mid-June and she sounds great and is covered by insurance. I'm pretty much done with this guy above but he's all I have right now :-P

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Adderall: He was about to put me on 40mg XR per day and I asked him about the IR so I could have more control over my dosage and timing options and he was happy to oblige, but I'm still not sure how far apart I should take them to avoid crashes? He pretty much told me to experiment, so any suggestions?

Maybe it's a function of being a mixture of amphetamine salts; maybe it's just me, but I generally don't crash out from Adderall. Even the very few times I've taken the non-prescription variety it tapered out more than crashed. Granted, this sets one up for "wasn't I supposed to have done something a couple of hours ago?"

MY preference is to take it about an hour before commuting to/from work. Usually though, mid-afternoon helps get my brain back to work.

Effexor: HEREIN lies the main issue. He was about to kick me out with the Adderall prescription in my hand but still depressed and I wouldn't let him. I asked what my other 'long-term' options would be AD-wise since the Adderall is helping and all, but I don't want to have to rely on it to get out of bed in the morning--I'd rather just have it help normalize me during the day and reign in my thoughts. He then got himself hooked on the Effexor idea and took off to get me samples. I asked if it would really help that much since SSRIs haven't done anything for me in the past (Lexapro or Zoloft) and doesn't it work on Seratonin? him: "It's not an SSRI, it's an SNRI" and that was that.

(I'm now reading online that it doesn't kick in on the 'N' part until you hit 200something milligrams? Should I just try it anyway? Maybe seratonin will help me and I just had the wrong two SSRIs in the past? Any guidance or kicks in the pants would be helpful here)

Whether Effexor is the best choice for you, I don't know. It doesn't sound like it will do much for you before you see your new pdoc, but ... it might. Incidentally there are more-noradrenergic medications on the market - Straterra and Cymbalta come to mind.

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thanks null0trooper

I was crashing with the 20mg adderall xr so I thought it would definetly happen when I started the shorter-acting ones but it hasn't been the case so far...I've been doing 20mg at 7:30am and then at about 1 or 2pm I take the other dose (I took 20mg yesterday for the second dose but I'm trying 10mg today to see if it'll work just as well)..no crashes that I've noticed (but it is only day three!)...thanks for the experience, I guess I really do need to just try different things until it fits.

started the effexor--just sucked it up and decided to go for it. nothiing bad so far at all, but it is the lowest dosage possible, lol.

I probably *should* wait until mid-june when I see my new pdoc for the first time to start taking it...but I don't want to waste this time, you know? I want to be trying something so if it doesn't work, then I won't waste my whole summer with the pdoc messing around with it, just to try something else at the beginning of the next school year---but if it does work, then we can spend the summer tweaking dosage and getting it just right so I'm stable and (possibly?happy??) then she'll know more about me if we have to change the dosage over the phone during the year. guess I'm just working things out in writing...if anyone has any comments or suggestions if they happen to read this, then don't hesitate to post!

whoo-- I'm wordy ;)

meg

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I don't blame you for not wanting to waste time. Between titrating and the time it takes to kick in, a few months can be an eternity depending on how severe your depression/bp is.

I've also got to add that your doc still cracks me up.

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I don't blame you for not wanting to waste time. Between titrating and the time it takes to kick in, a few months can be an eternity depending on how severe your depression/bp is.

I've also got to add that your doc still cracks me up.

he'd crack me up too if he wasn't trying to crack me up.

(different meanings of 'crack' there, clever, eh?)

annnnway, I'm done with him soon so he can just be 'oh that crazy pill-popper-pusher-pdoc that I had once' and then it'll be quite good for stories, lol, but he has been useful for what I needed him for. I'm actually glad that I didn't get stuck with a really conservative doctor because I doubt they would have let me try the adderall which is almost like a miracle for me sometimes. I can SLOOWWWWwwww down my brain for three seconds, it's beyond amazing..I can't get over it! I'm still using my own motivation and energy but now I'm able to get somewhere with it instead of summing it up, just to get distracted and lose it.

glad to be starting the effexor...nothing bad so far ((knock on wood)) but even if it doesn't work, I think I'll be glad that I wasn't just wasting this time and not trying anything, if I start being passive about all of this and sitting back waiting for it to go away on it's own again I think I'll get stuck and that would suck.

man am I on top of the puns, rhymes and alliteration today...gotta get to class to LEARN now (yay!)

meg

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