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30 August 2005 @ 04:21 pm
Oh, for crying out LOUD. !&!%%)*#!!: a PSA  
I was going to friends-lock this, but then I decided no, I want anyone to be able to see it--anyone who's interested, anyway--because maybe it could be helpful. It's probably only of special interest to people who are taking various combos of prescription meds, or thinking of taking antidepressants, etc.


So for a few years now, I've taken a medication to lower my blood pressure. A year ago, I began to try and find a better antidepressant, because a longstanding prescription of Wellbutrin wasn't doing much for me.

The sequence of my recent attempts at better living through chemistry:
  1. I start visits with a psychiatrist who was recommended by my general practitioner and seconded by my therapist. (My therapist can't prescribe medications.)
  2. The psychiatrist prescribes Prozac, then adds in Lamictal. Together, no trouble.
  3. When adding in an ADD/ADHD medication, he prescribes Adderall.
  4. At this point, I'm taking Prozac, Lamictal, and Adderall.
  5. New side effects: sharp rise in blood pressure; tachycardia (100-130+ pulse).
  6. Recommendation of my general practitioner: stop the Adderall.
  7. Recommendation of my psychiatrist: keep Adderall, and bump up the blood-pressure meds to compensate.
  8. I decide to go off Adderall, which sucks, because it's effective. I start Ritalin, which doesn't work and also has many negative side-effects.
  9. I quickly abandon the Ritalin, and at my psychiatrist's recommendation start taking Strattera instead, which is a different drug type (not an amphetamine like Adderall or Ritalin). It's only at this point that the psychiatrist says, "You'll need to stop taking the Prozac, because it has an interaction with Strattera."
  10. I go off Prozac--without tapering off, so that I can start Strattera--and my mood and energy plummet noticeably. Maybe related to cutting out the Prozac, maybe not.
  11. So now I'm off Prozac, off Adderall, and on Strattera. Note: I've been told that it takes several weeks for the effects of Strattera to be felt. So at this point it's safe to say that it doesn't factor in to any moods or issues of focus that I'm having. Anyway, with this combo, I'm feeling pretty crappy. And because I'm desperate to keep doing well at work, I've been "cheating" by taking Adderall now and then. It works well, and whenever I take it I'm reminded of how much I'd like to continue on it. So today I decide to research drug interactions a bit more and find out that:
    • Though there's a general warning that Adderall can inhibit effectiveness of blood-pressure medication, it doesn't have a specific interaction with the kind I'm taking.
    • None of the other drugs I've been taking have interactions, but
    • "FLUOXETINE may interact with AMPHETAMINES"
HELLO? So, Prozac (fluoxetine) interacts negatively with Adderall (amphetamine). This next quote is from a site I've found to be reliable:
Although the cause of this potential interaction is not clearly understood, fluoxetine may increase the effects of amphetamine. This could cause an increase in side effects including irritability and depression, restlessness, and anxiety. Other more serious side effects include an increase in blood pressure, a rapid heart beat, and an abnormal heart rhythm.

If fluoxetine and amphetamine are used together, your doctor may want to monitor you closely for side effects and adjust the dose of either drug if needed. Ask your healthcare provider about these drugs and this potential interaction as soon as possible.

This interaction is poorly documented and is considered major in severity.
Lesson? Do all the research yourself. Don't assume the doctor knows what the fuck he's doing.

And the thing is, I'd been saving all the documentation I got with each prescription, and had been asking all the right questions. I just hadn't paid close *enough* attention.

Of course, now that I've cut the Prozac, I want to see whether I can take the Adderall without any negative effects on my blood pressure, etc.

And now I'm returning to the work that I get paid to do. Later I think I may remedy my frustration by stuffing big wads of chocolate in my mouth and reading gay porn.
 
 
 
Alizarin_NYC: gunn don't mess withalizarin_nyc on August 30th, 2005 11:37 pm (UTC)
Oh GEEZ. **head spins**

I wish I was surprised by this, but I am not. I have to keep reminding myself that antidepressants are pretty new and so you are not going to have any doctor that has studied them and their effects all HIS/HER life, most likely. And that even though my psychiatrist is considered one of the top of his kind in the entire U.S., he will still answer my questions with, "well there's no way to really know that. What do YOU think?" *headdesk*

And I certainly have my own story of how a doctor said one thing and research said another, and then the doctor admitted a year later, "well sure, in some cases." And if she had just said that in the beginning, we could have saved a lot of grief. That grief being MINE.

Good luck, Eliade. You are doing the wise thing. Doctors are only one piece of the solution puzzle.
Moral Whiplashbkwyrm on August 30th, 2005 11:38 pm (UTC)
I am with you on this completely. May your prescription woes abate.
Jonquil Serpyllumjonquil on August 30th, 2005 11:45 pm (UTC)
This drives me nuts, too. I have chronic depression and chronic migraine and my two specialists WILL NOT TALK to each other, and the migraine specialist doesn't even believe I have depression.
Whitwhitsun on September 1st, 2005 04:07 pm (UTC)
depression and migraine
I have chronic depression and chronic migraine and my two specialists WILL NOT TALK to each other, and the migraine specialist doesn't even believe I have depression.

Have you looked at Topamax? It's used for migraines and at one point a psychiatrist used it as a mood stabilizer with me. In conjunction with anti-depressants, but still. Two-in-one, maybe.
Re: depression and migraine - jonquil on September 1st, 2005 05:08 pm (UTC) (Expand)
WesleysGirlwesleysgirl on August 30th, 2005 11:52 pm (UTC)
I've been told that a good pharmacist is the best person to talk to about your prescriptions and possible interactions.

*Hugs you*
julia_herejulia_here on August 30th, 2005 11:52 pm (UTC)
YOW.

Had no idea about Prozac/Adderall interaction, mostly because Prozac was an excessively unfriendly drug for me, and it's been more than ten years since I've taken it.

But, good, though that you found out, because all of the downside of taking Adderall could be explained by the drug interaction.

Julia, thinking of someone I need to tell, fast-ish
The Spikespike21 on August 30th, 2005 11:55 pm (UTC)
For those very reasons I do all my own research on any drugs given to me and Mr. Spike. It's saved us much pain and suffering and after 20 years or so my doctors have come to trust me a little. For references I like: the Blue Book at the pharmacy, the pharmacist and the internet in that order.
rachelrachelmap on August 30th, 2005 11:55 pm (UTC)
Do all the research yourself? Oh, HELL yeah!

There are so many drugs out there, and new ones are coming out all the time. Spock himself would have a hard time staying on top of them all--not that I'm excusing them.
Mayhem Parvaraincitygirl on August 31st, 2005 12:14 am (UTC)
Ouch! Damn good thing you're Research Girl. You know what, I recently started taking new medications, and now that I've read this, I'm going to research them myself. I shouldn't assume that my doctor and my pharmacist are infallible.
The Alpha Beta: Drugs don't work - suzvoydiluvian on August 31st, 2005 12:15 am (UTC)
Yet another confirmation that doctors are not gods -- they are body mechanics, and frequently they think they're working on a domestic and what they've got is an import. And are using metric wrenches when they should use standard. Grrr...
Kreskres on August 31st, 2005 12:17 am (UTC)
Later I think I may remedy my frustration by stuffing big wads of chocolate in my mouth and reading gay porn.

There is, apparently, a solution to everything. And it's called fandom :)=

Very good bit of research. *congratulates and hopes this time it will work*
_: TVMAvalerie_z on August 31st, 2005 12:45 am (UTC)
Wow, I'm glad you're okay. About six years ago I had a doctor prescribe me Neurontin for depression, and then I found out Neurontin isn't even FDA-approved for depression. I'm still pissed off about that.
velvet_viragovelvet_virago on August 31st, 2005 01:08 am (UTC)
Yeah, I was on a prescription for some years of one of those "-xentine" type meds, and the doctor assured me that it was non-addictive.

Uh huh. Non-addictive, but the Big Pharma company later described there bieng something like "cessation issues"? No no no, not addictive, so not "withdrawal". But it so was. And it was so hard to get off. It almost seemed preferable to stay on it for life- not because I needed it anymore, but because I couldn't face a month of hell to get off the drug. (Off it now.)

And that's just *one* med, not a handful of them. Thank god you informed yourself.. hate to think of what might have happened.

(and they wonder why their malpractice premiums are so high...)
ex_niciasus652 on August 31st, 2005 01:33 am (UTC)
Between your post and Te's on Splenda, I'm sitting up taking notice. My doctor wanted to increase my diabetic and high-blood pressure medicines. I accepted the increase in BP because it has been steadily increasing over the past couple of years. I refused to accept the increase in the diabetic medicines. I spent about ten minutes explaining to my doctor why. Just because there was a high reading, I had eaten lunch before seeing him, was not a good reason to do so without taking a fasting test. Around noon-time my blood sugar drops so fast I break out into sweats with the beginnings of body tremors. That's not good for the heart!

This thing on Splenda has me worried and wondering could it cause an increase in BP.

It's a good thing you're doing research. I think everyone should be informed of the pros and cons on the medicines they take.
KayJay: KJ sweet!Deppfiresignwriter on August 31st, 2005 01:41 am (UTC)
Have you tried an extended trial (more than two weeks) of St. John's Wort for an antidepressant? My pop's a doc, and one who's generally highly skeptical of herbal remedies, but he's grudgingly come to admit that SJW appears to have genuine demonstrated worth in treating depression.

I used to be on Adderall. More to the point, I used to be fairly well addicted to it. It was a wonderdrug for, I dunno, a year or two? But there were eventually side effects for me -- mainly irritability and, much more importantly, an inability to write anything worth a damn while it was in my system -- so I got off of it and started looking for herbal stuff that would reproduce some of the better effects. ... So far not much luck there. Ginseng (Siberian seems to work best for me) for energy, Green Tea or some blend that includes it for appetite control, but something for the actual ADHD? Nope. Ah well.

But god, yes, be careful with mixing meds. Pop's told me some serious horror stories about doctors who were ignorant or careless, and how the patients paid for it. Kudos for having the sense to do your own research.
Barbrahirah on August 31st, 2005 01:47 am (UTC)
Argh. That is all.