2011-03-08

Ritalin III

My doctor refused to consider Ritalin. She said that I could continue self-medicating, it was my body, and I could certainly get a second opinion. She pointed out that, of course, I feel better! I am taking a stimulant, but as a doctor she has sworn to do no harm and Ritalin could cause a lot of harm.

I was crushed. There is a really no other way to put it. I spent some time bawling helplessly and hopelessly in the restroom over my stolen happiness.

On my way home, via SMS, several friends raised concerns about addiction and habituation. It was infuriating to be condescended to like that. Neither my doctor, nor my friends, have any comprehension of what it's like to live under a smothering blanket, having it removed for a moment, and then being told it's your lot in life to be struggling to breathe. Try telling someone with hearing loss that's it's cheating to use a hearing aid and see how that works out.

I popped into Whole Foods, bought 1500 calories worth of gummy candy and ate it all when I got home. Nasty.

Then I started doing some research on Ritalin. I had hoped that even if my doc refused to prescribe it, at least she'd give me some advice for semi-safe usage, but she completely washed her hands of the situation. She suggested she'd adjust my "real" medications, possibly replace the Effexor with something else, reduce the amount of Lithium because it's been known to make people tired. I kind of laughed at that. It really makes no difference if I take the Lithium or not.

So, since she wouldn't help, I decided I should figure out how to reduce the risk of stroke and heart attack, addiction and ever increasing dosages myself. As I was reading along I came across some odd discrepancies: the doses of Ritalin varies from 10mg to 60mg and it's given a number of times a day because it's a very short acting drug. That hasn't been my experience at all, in addition I knew that my pills say 200mg.

Upon examining the bubble packs I discovered that it says Modafinil. That's the generic for Provigil. It's an analeptic as apposed to a psycho-stimulant, and is not as heavily regulated as Ritalin (schedule IV versus schedule II). It's commonly used to help people with sleep apnea and other sleep related problems. My therapist even suggested I ask about Provigil, and warned me that the doctors at the center don't prescribe Ritalin on principle.

You may ask, what the hell happened? How did i come to think I was taking Ritalin and don't I read the labels when I buy drugs illegally off the Internet? Well, err, I don't know.
I did bring up Provigil during my appointment, but my doc refused to consider that too. She referred me to my sleep doctor; suggested I ask the sleep doc to have it prescribed as a complimentary treatment to the CPAP machine for my sleep apnea.

I wish doctors took a more hollistic approach. My psychiatrist is just the last of many, many doctors who are simply not impressed by me suggesting treatments. They want to try other things first because somehow, my explaining that I have tried any number of anti-depressants in different dosages and combinations and been medicated for more than 8 years is not enough to convince them that maybe it's time for a new approach.
I don't relish going to my sleep doctor and explaining that I want Provigil and why. The last time I talked about my chronic depression with her she suggested I read The Cognitive Behavioral Workbook for Depression, which is a self-help book for mild depression describing techniques similar to those I was tought during PHP and in DBT. It wasn't helpful.

It is hard for me to communicate to people that they are underestimating how poorly I actually feel. While they don't quite accuse me of exaggerating I can hear the doubt in their voices. So, yeah, it's totally realistic that I'll go through this again and ask my sleep doctor for a legitimate prescription for Provigil.

Maybe if any of my many psychiatrists had ever suggested that sleep apnea might be causing my depression and had referred me to a sleep expert, I would been more inclined to trust my doc's opinion, but it was Ted that discovered something was wrong. He told me I stop breathing when I sleep, that he'd lie there, heart pounding, waiting for me to start breathing again.

If upon diagnosis of sleep apnea, my sleep doctor and my psychiatrist had conferred a little and combined their efforts maybe Provigil would have come up by now, but no, it's I the patient, the person with no authority or credibility who is charged with communicating between doctors.

That as an aside, I was deliriously happy when i realized I have been taking Provigil not Ritalin. Provigil is not considered a highly addictive drug and its interactions with my current medications are not as severe, and I do have a completely legitimate reason to take it. I am not just a junkie anymore. I ordered another 200 pills to celebrate.

1 comment:

  1. Did you stop taking Ritialin because of the hollowness? In what way did it deplete your system? What specifically made you decide to stop taking it?

    You know I had another thought about doctors when I read your comment; when I'd go to a psychiatrist when I was younger I'd feel momentarily cheered up just from the attention and novelty. That elevated mood would last for a little while after and then I'd slide right back into my hole.

    That experience can't be specific to me. I think most people will feel a bit better under someone's interested gaze, and thereby screwing themselves over diagnostically so to speak, because they're not their depressed selves when examined.

    The digestive issues suck. Not helpful. It's really hard to complete the food sensitivity tests too (at least for me), especially if they don't seem to make much difference.

    But as you say, maybe there is room for hope there, if eating the wrong things can make you feel worse then perhaps removing the right things will have positive effect. There is certainly a lot of anecdotal evidence that cutting out simple carbohydrates, stimulants such a coffee, chocolate, tea, heavy processed food with preservatives can have quite a dramatic effect on health and mood.

    Personally though, any experiments I have done have not had any obvious effect. And I have no idea how long you have to keep it up to notice anything.

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