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    Old 01-06-2011, 09:28 PM   #1
    brandonn
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    need guidance, no end in sight

    Hello,

    Please Read

    I feel like this post is going to be too long and I fear that will deter people from reading it. If you are knowledgeable on the subject, I can only plead for your patience and hope you will read it. I feel like I need answers because I've about given up hope. This post will lead you to beleive I am posting in the wrong forum at times but please bare with me and get through the whole thing before you decide.

    I just turned 24 last month.

    Some Problems

    The more I goto the doctor, the more questions I seem to have. Don't get me wrong either my two doctor's I do see do answer quite a bit of my questions. But by the next day or two I seem to have built up a whole new list.

    That is mostly the reason for my signing up to this forum and posting this. It is because I build up a list of questions and notes of my reaction to anything that could possibly help figure out what is not right about me. And then when I goto my doctor I seem to fall flat on my face when trying to describe things.

    And to get information I purposely try to be indirect because I for some reason beleive this will help me to not be biased to any thinking or feeling I have about what might be my problem. I try to communicate my problems by describing events that I think could possibly contribute to said problems.

    Another problem I have is when I read or am asked a list of "Does this apply to you? Do you feel this? Have you had that?" I tend to find ways to relate. This is not helpful to the cause of diagnosis.

    I think I let the "placebo effect" work on me as a direct result of me always being so hopeful when I learn something new. I always feel like something new I try (lifestyle, meds, routine, etc) works wonders for the first few days and then it all goes back to the way it was. This causes problems because then it becomes hard for me to distinguish what was a placebo effect, and what truly wasn't. - Huge issue.

    And finally, I'm hugely objective. I base my learning ability on facts and being able to connect facts, processes, events, and more together. This is probably what made me so reluctant to go see a doctor for the longest time. I want to know everything about anything I find interest in. This translates poorly since doctor's don't have the time to explain everything biological to me. However, as time unfolds I began to let go of the need to know every detail and just -trust- the doctor.

    My Story

    The string of events that landed me to this writing is a large mess for the most part (I'll try to be breif, if you'd like anymore info I will be more than happy to oblige):

    It began nearly two years ago when I went to the doctor about being so tired all the time. For a year or two by this time I was having much difficulty feeling good during the day. I was always tired for some reason or another. I largely beleived this was the consequence of the fact I spent a large amount of time "partying" during these years. Never any illicit drugs or abuse of pills, only alot of alcohol and staying up well into the morning; work or no work the next day. I always stayed on top of my responsibilities (or at least made it look like it) though, even if barely. I went through a large amount of time (year or two) where I'd mostly only drink hard liqour (vodka was the weapon of choice). Unfortunately I can't seem to be certain if this decline happened before or after alcohol had entered my life (around age 18) but I feel it's quite necessary to mention it. Sometime when I was 22 I decided I needed to grow up and start treating my body better. I cut alcohol out of my life almost right out for 8 months. Coming from a line of severe alcoholics, I was intimidated, but sure enough I did it without much problem. Nowadays, I'll have a beer every now and then. Maybe 3 a month on average, though not a drop in the last two months.

    So getting back to the story, I visit the doctor about the issue for the first time. I am immediately treated for insomnia and depression. I was not happy about the depression diagnosis for too many reasons to list. I strongly felt I was not depressed. But going against my own opinion and letting myself trust the doctor I went with it. Ambien and Lexapro are given to me. This is the first time in my life I've been "on" medication and I hated it.

    Only a few nights of Ambien convinced me that not all meds are bad.

    At first I thought it was awesome because I was finally falling asleep when I needed to and for the most part, staying asleep. My mind was always racing at night and I couldn't ever seem to "turn it off". If I hear a single noise (as small as a pencil dropping on the floor) while trying to fall asleep I will go wide awake and have to begin the long drawn out process of falling asleep all over again.

    For the first week I convinced myself I was rapidly feeling better. But quickly I recognized I was feeling no different (except the fact that I was happy that I could at least sleep).

    So while the sleep was good, I still feel completely unrested in the morning. I feel obliterated when I wake up. I have to fight the alarm clock to unreasonable end. I am generally very late for work.

    After a couple weeks I guess the Lexapro was starting to kick in- and I felt absolutely miserable on it. I felt more tired during the day than ever, completely emotionless, and more unmotivated to do anything. I refused to take it by then and in only a few days I was feeling back to where I was without it.

    Months went by and I was just making due with sleep pills.

    Finally, I had broken again and had to go see the doctor. I was completely lethargic, couldn't focus on anything long enough, and can't concentrate enough to read thoroughly. Obivously these would be bad for most any job, especially mine as an IT professional. This time he referred me to a sleep disorder specialist.

    Immediately the sleep specialist drops the depression bomb on me and I tell him my story about Lexapro. He is still adament about it and has me go on Nortriptyline. He had explained that feeling the way I did on Lexapro just means I truly was depressed and that I needed to fight through the initial first weeks of feeling worse. This did not make any sense to me, but I was willing to try anything. I gave it 3 or 4 solid weeks and it was agonizing. I called the doc and said I'm not taking this stuff anymore, I can't... I never got a call back and so I gave him up. During this time I had two sleep studies done. One of them barely put me in the "sleep apnea" category, in fact I think the numbers were smudged a bit to qualify me. I tried the CPAP machine, but as an extremely light sleeper, having something strapped to my face was horrible! But I put much effort into it and eventually was falling asleep with it on. Almost two months of dealing with this horrible device and I felt no better... I gave it up. Also to note: It was said I don't hit a certain stage of sleep for very long, stage 3 or 4, can't remember which.

    Again I was just dealing with my problems, only using sleeping pills, until once again I couldn't take it anymore. I asked my general doctor to give me a new sleep disorder doctor and he kindly did. I tried my best at explaining everything to my new doc and he had me try "Trazadone" that, as he described, was an anti-depressant that was never really good at being an anti-depressant- for my sleep after I described how Lunesta doesn't do much for me, Ambien has all but quit working for me, and the rest on my list just give me horrible hangovers into the next day. The Trazadone did work enough that I stayed on it for a few weeks, and eventually I added Clanzopan to the top of it, and I was sleeping well enough. Still though, not feeling better during the days.

    My second visit, my new doctor's response was something to the extent of "It sounds like you've beaten down the insomnia path too long, it's time to look in a new direction". Thank God... He ordered another sleep study and a narclepsy study. I quickly questioned the narclepsy and he said alot of what I've been saying indicates it. So I went with it. I won't have the results of these tests (already did the tests) until the end of February. This doctor is unfortunately packed full.

    And here is the interesting development that began only a mere 4 weeks ago...

    During the second visit he gave me Ritalin SR 20. I didn't know very much about it other then hyper kids take it to chill out. I left the office only knowing it should help me feel more alert. I felt the less I knew, the more chance I had to be completely objective about it.

    It was around 11am I left the office and got the script filled. I took one to see what it did for me. 20 minutes later I didn't feel tired. Instead I felt, calm and centered... Something I havn't felt in a very long time. I thought this was a godsend! I did not take my sleep med this night (Trazadone).

    I fell asleep that night so easily and woke up earlier than my alarm clock feeling fine. I havn't experienced anything close to this in 5 years at least... I couldn't beleive it. So I started that day with a Ritalin and went to work. I proceeded to get more things done on that day and the two days after that day then I have in a long time. I used to be super efficient and get things done left and right. That feeling and production was back!

    The next day things were just as good. That night, however I felt like I wasn't going to be able to sleep very well so I took a Trazadone to help me sleep. I felt a little wierd shortly after, but fell asleep quickly and woke up fine the next morning.

    That day I didn't feel as great as the previous, but I was still leaps and bounds better than I was. That focused and centered feeling was still there and I getting my work done. That night I again took my Trazadone.... About 30 minutes after I had a very wierd and scarily intense sensation that I was going to pass out. It felt like my world was just crushing in on itself, things went blurry and I got very dizzy. My heart started to race, but I'm pretty sure that was just fear. That all happened and ended in about 5-10 seconds. I unsmartly just went to bed.

    I woke up the next day feeling okay. Took my Ritalin and went to work. I started reading up on Ritalin intensely and eventually found "If you feel like you're going to pass out, this is a serious medical problem get help immediately" That scared me badly, because I had taken my Ritalin that morning! I was thinking, great, I could die at any moment... I immediately called the doctor and went in. I didn't get either of my normal doctor's, none of them were available. So I explained my history and my problems I was dealing with and what had happened that night. I made special note of how the faintness only occured after I took Trazadone. The doc was sure there couldn't have been an interaction there but did beleive there was something bad going on with the Ritalin. She asked me a series of questions and said "...and you've never been diagnosed with ADD?" I said no. My mom was there (she took me there to be safe that I wouldn't pass out while driving). My mom replied and said that several people said that I could have had it but my mom never wanted to medicate me.

    So- I was told to stop the Ritalin and try this Dexedrine. That night I did not take Trazadone just to be safe.

    The next day I didn't take anything on advice of the doctor. And the NEXT day, I took the Dexedrine. I had the similar experience of my first few days on Ritalin with the Dexedrine. Felt much better, was focused, and productive. The second day on Dexedrine, I took a Trazadone that night... AGAIN that pass out feeling happened!

    So that was the last day I took the Trazadone and I havn't come close to having that feeling again.

    But continueing on with the Dexedrine, the first 3 or 4 days felt good. But by the 5th day I started to feel like a zombie! I felt like I was on Lexapro without the super-tiredness. Simply, emotionless, zombie like... I hated it! After my 10 day supply of Dexedrine ran out, I didn't bother getting more. I gave Ritalin another shot because I was sure it was the Trazadone by then.

    And now I'm about 4 weeks into Ritalin. My focus and centeredness seems to be maintained, however, my tiredness will kick in. Some days I get through the day feeling very good and very productive. Other days I feel too tired to do anything! The worst part is, it's completely random! I cannot predict how the next day will go until a few hours of being awake. I still feel obliterated in the morning trying to wake up but eventually force myself into the shower. I'll take a Ritalin and eventually feel close to normal for an hour or two. At this point I go down either 1 of 2 paths. 1) I will continue feeling fairly well, and make it through the work day with little to complain about. But by the end of work or by the time I get home I generally get really tired; or 2) I start to get super tired and it's hard to keep going. The other day I had to leave work early because I was feeling too tired to press on.


    Since I didn't explain much of my symptoms here's two generalized lists, one before ritalin and one with it.

    Before Ritalin:
    -Tired always
    -Hard to sleep
    -Never rested sleep
    -Can't keep my attention on anything for too long
    -Impossible to wake up easily
    -Never do anything after work
    -Rarely do anything on the weekends
    -I tend to think about several things at once which clouds my mind like noise...
    -I cannot focus on two things at once. Example If someone tries to talk to me while i'm reading, my mind snaps

    to them uncontrollably

    Now, on Ritalin:
    -Tiredness always hits near 4PM
    -Tiredness CAN come in the morning and obliterate me all day
    -Much easier to sleep, don't always need sleep pills
    -Still no rested sleep
    -Much better at focusing on things
    -Productivity at work has climbed greatly
    -Getting things done after work
    -Going out again on weekends
    -I can keep on track with thoughts
    -I still cannot focus on two things at once. Example If someone tries to talk to me while i'm reading, my mind

    snaps to them uncontrollably


    So I guess that's it, for anyone that made it this far, what do you think? What should I bring up with my

    doctor? What should I look into? Does Ritalin seem to be needed or is it masking something else entirely?

    Anyone have any similar experience?

    Last edited by brandonn; 01-06-2011 at 09:34 PM.

     
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    Old 01-06-2011, 11:08 PM   #2
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    Re: need guidance, no end in sight

    brandonn,

    You got a couple good things going for you. Ritalin helps. Dexedrine doesn't. Trazadone is poison for you.

    Some type of sleep disorder will come back with sleep study results in February.

    I don't think ADD is the cause of your problems. Your before Ritalin symptom list doesn't describe ADD. It looks like a list of chronic mental fatigue symptoms that comes from prolonged sleep deprivation.

    IMO, Ritalin is suppressing your mental fatigue symptoms not ADD symptoms. Ritalin is putting you back into functional range on some days. So, yes, Ritalin is needed because it is "masking" (suppressing) symptoms that will put you out of a job otherwise.

    You do need a diagnosis that positively identifies the failing system function causing your symptoms. The problem must be defined before an effective solution can be prescribed.

    Do your homework. Research every possibility. Learn as much as you can. Stop worrying about biasing your feelings about the possible causes. You should want to discover possible causes. Your doctors to date haven't been diagnosing you none to well. Indirect? Did I read correctly, you are in IT? Indirection does not get you answers, it gets everyone including your doctor confused.

    Spend your next 100 yours researching what could be ailing you. It will enable you to give more precise, more accurate, more detailed descriptions of your symptoms to your doctor that will help him do his diagnostic job.

    Bob

     
    Old 01-07-2011, 12:18 AM   #3
    brandonn
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    Re: need guidance, no end in sight

    Thank you for the response. It is good to hear that I don't have to append ADD to my already piling list of possibilities, but at the same time not good to see I'm no closer to figuring all this stuff out. Seems I made the wrong decision about putting this post in the ADD forum- I guess I was just hoping that maybe I found what my problem was.

     
    Old 01-07-2011, 01:15 AM   #4
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    Re: need guidance, no end in sight

    Well, you're dealing with Ritalin, so an ADHD forum isn't a bad place to start. You'll also find that, as a group, we have extensive experience with sleep disruption.

    I agree with Bob, I don't think ADHD is your issue. Ritalin is a stimulant and is doing for you what coffee does for people who get better sleep, waking you up. I think your sleep disorder should continue to be your primary focus, as your symptoms clearly seem centered around sleep deprivation.

    Continuing with the Ritalin is certainly an option for the time being, as stimulants go, it's extremely well tested, and safe when taken in anything resembling reasonable doses. In the long term, however, you're going to have to deal with the underlying issue, as you will very likely develop tolerance to the drug, and will find the effects abate.

    A quick side note: My experiences with doctors were very similar to your own. Beware the quick and dirty 'depression' diagnosis, I've found it's a catch all for pretty much anything, especially when the doctor doesn't want to bother looking for the real problem. Beware, too, the 30 second interview ADHD diagnosis, where depression fails, docs these days seem to love slapping an ADHD label on people, knowing that they'll feel somewhat better on stimulant meds.

    Best of luck.

     
    Old 01-07-2011, 10:50 AM   #5
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    Re: need guidance, no end in sight

    Thanks again for the response.

    Now that I've had some time between posting this and now, I've realized I've missed a lot of what I originally wanted to ask. I do this a lot, I will go off on a tangent and never return to whatever I started on.
    1. As I do tasks, I find that I often need to replay in my head what I've done already to catch up to where I was, to continue.
    2. When reading (even stuff I'm highly interested in) I will "zone out" but still somehow be reading... meaning I will still be saying the words in my head but they don't register or something. Sometimes I catch myself doing this by the end of the sentence, sometimes I go a few paragraphs. Then I have to go all the way back and re-read everything.
    3. If anything happens around me while I'm trying to do anything, my mind will snap uncontrollably to whatever it was. I can be working on something at the computer intensely and if I hear someone talk, I cannot take my mind off them talking. This pattern is sometimes gets out of hand, another event can happen and i'll snap to THAT. on and on and on. When this happens I HAVE to put headphones on and play music WITHOUT lyrics (so I can't focus on words). I think this is the reason I can't sleep.
    4. If I want something I want it now or never. This is incredibly annoying and manifests itself in both good and bad ways. The good being, I can acheive some goals very fast. The bad being, if I want something that costs money, I don't think about the money and just go get it.
    5. I can't seem to finish anything I start anymore. As a programmer I will get these great ideas and present them to like minded friends. Before you know it we have a team established to get a project up and running. And as quickly as I get things rolling, I'm even faster on disengaging the whole thing.
    6. When I lock onto something I want to do, I will do it so much that I burn myself out on it and don't enjoy it anymore. I go through hobbies way to fast. This combined with number 4 becomes very expensive. Last summer I dropped over a grand on remote control car stuff on a 5 minute whim that it might be fun to race them. I did it for a month tops and havn't touched it since. I do this kind of thing all too often.

    Those are some symptoms I can come up with my own right now. I hope I explained them clearly. I have also asked a select few of my closest friends to throw some quick things they notice about me together in hopes that perhaps an outside view in would be helpful and here's what I got back:

    -your attention span is very short
    -your easily distracted
    -you get frustrated easily when conversing
    -you seem like nothing is steady in your life, like you're still trying to figure out what you want to do with your life
    -it's hard for you to focus on one thing
    -I feel you have nothing that a doctor should be able to diagnose as depression
    -I see you as an achiever, and when you are not constantly acheiving you are lethargic and unhappy
    -You are more focused when you have a goal
    -when you get tired, you REALLY get tired and you don't want to do anything until you get out of it
    -You're very complacent. It's something you want to work so much and once it's working and you have it. It's not a goal for you any more. You then go back to your routine.
    -Goal oreiented
    -highly competetive, Must-win attitude
    -Explorative hobbist
    -requires center of attention
    -Un-yeilding to other's perspectives

    Wow. That's alot. I hope someone read all this.

     
    Old 01-07-2011, 03:16 PM   #6
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    Re: need guidance, no end in sight

    brandonn,

    Just who are you describing? You OR Me?

    You just changed my perspective - tain't easy to do. You as ADD as HELL.

    Later, maybe tommorrow.

    Bob

     
    Old 01-07-2011, 03:40 PM   #7
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    Re: need guidance, no end in sight

    Bob, thanks so much for reading through my hours of typing. Hopefully others will chime in here sometime with their 2 cents.

    I am particularly curious about these two traits as I have not read about them being a symptom of ADD nor can I find exactly what they could be symptoms of:

    2. When reading (even stuff I'm highly interested in) I will "zone out" but still somehow be reading... meaning I will still be saying the words in my head but they don't register or something. Sometimes I catch myself doing this by the end of the sentence, sometimes I go a few paragraphs. Then I have to go all the way back and re-read everything.

    3. If anything happens around me while I'm trying to do anything, my mind will snap uncontrollably to whatever it was. I can be working on something at the computer intensely and if I hear someone talk, I cannot take my mind off them talking. This pattern is sometimes gets out of hand, another event can happen and i'll snap to THAT. on and on and on. When this happens I HAVE to put headphones on and play music WITHOUT lyrics (so I can't focus on words). I think this is the reason I can't sleep.


    I hate these two symptoms very much.

     
    Old 01-07-2011, 06:57 PM   #8
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    Re: need guidance, no end in sight

    Both of those sometimes happen to me. Luckily, I've learned to hyperfocus on reading, so I can usually avoid the first one, but I definitely have that experience with people talking to me. I hear every word, I'm deliberately listening, but nothing locks.

    I can't stand to have a TV on unless I'm watching the show, because it reaches out and grabs me even if I think the program is boring and stupid. There is no such thing as TV background noise, unless it's the Yule Log Show or something.

     
    Old 01-07-2011, 08:31 PM   #9
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    Re: need guidance, no end in sight

    Oh wow, you definitely nailed that example... One of the reasons I used to HATE having a roommate. If he was watching TV I could not do ANYTHING to stop myself from listening to it if I was trying to do anything else.

    How have you trained yourself to hyperfocus on reading?

     
    Old 01-07-2011, 09:05 PM   #10
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    Re: need guidance, no end in sight

    Wish I could tell you. I learned it quite early, definitely by 10, possibly by 7. (I was reading children's books on my own by the time I turned 5.)

    I think it's just the way it grabs all of my attention. I read as fast as I can read, and I read faster than anyone I know. When someone's talking, I sometimes get bored waiting for the next sentence and space out. If I space out, I've missed something important, and the only way to get it is to ask, which is sometimes practical and sometimes not practical. I spent most of elementary school literally bored stupid, and books were the one thing that really interested me. When I was unhappy, books would take it away.

    What do you hyperfocus on?

     
    Old 01-08-2011, 12:52 AM   #11
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    Re: need guidance, no end in sight

    Unfortunately, and I hate to admit it, video games. When I was younger it was programming, but it eventually turned into video games.

     
    Old 01-08-2011, 07:51 PM   #12
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    Re: need guidance, no end in sight

    Yeah.... I had you pegged for ADD from your first post. You really described a lot of what I went through back in the day. I was diagnosed with ADD in my early 20's, and started taking adderall for it. I took 20 mgs twice a day (once at 7am-ish, and again at 2pm-ish), and it was amazing the difference it made! If ritalin and dexedrine haven't helped you, adderall might be something worth looking in to. Good luck....

     
    Old 01-08-2011, 10:55 PM   #13
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    Re: need guidance, no end in sight

    marisuela, thanks for the reply. Was sleep a big issue for you as well? If so, have you gotten any better? Any advice that seemed to make big changes for you?

     
    Old 01-09-2011, 08:43 AM   #14
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    Re: need guidance, no end in sight

    Sleep's been an issue for me basically since birth. I was about 14 when I realized that most people did not spend an hour trying to fall asleep every single night.

    Solutions, well.

    I do sleep better since I started taking a low dose of nortriptyline, a tricyclic antidepressant. It also allows me to go back to sleep if I wake up too early.

     
    Old 01-09-2011, 09:09 AM   #15
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    Re: need guidance, no end in sight

    branndon,

    Our top-shelf members covered it all. No need for me to chime >>dong to the <<dings.

    YOU==ADD. Get a good shrink to help you with debugging.

    Bob

     
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