From Wellbutrin to Ritalin: good idea?

About three years ago when I had my first appointment with a psychiatrist, I was struggling really hard with college (my graduation was already long overdue by then) and all I wanted out of the psychiatrist was really just a prescription for Ritalin/methylphenidate. He said "yes, you do have ADHD", but for some reason he didn't want to prescribe me any stimulants, and prescribed me Zoloft/sertraline instead. No good. At all. I don't know if I would have ever graduated otherwise, but sertraline was the final nail on the coffin. I pretended to remain in college for about a year after my bad experience with it, but I didn't pass a single class that year, and decided it was about time to give up. Good riddance, college.

Anyway, after some other bad experiences with pharmaceuticals in the meantime (still no stimulants, though), this year I decided to try Wellbutrin/bupropion, as I had heard good things about it, including effectiveness in the treatment of ADHD. Surprisingly, it worked! I felt motivated with no reason to be motivated, and I stopped procrastinating (well, I didn't suddenly become a master planner and organizer, but I did at least do something quite effortlessly, instead of doing nothing most of the time). I also found it a lot easier to switch from one activity to another.

Unfortunately, after a while the meds started to feel like a coach who wouldn't ever leave me alone, night and day. It kept on building slowly, but I was on my way to zombiedom. I kept sleeping light and little, and doing things at the same pace as in the beginning. I would feel like doing vigorous exercise, for example, but it would leave me exhausted for a full week afterwards. The medication gave me the consistent "willpower" that I lacked, but left me with even less actual energy than usual. I was already taking a low dose (150mg/day), so there didn't seem to be much of a point in trying to lower it even more, and I stopped taking it altogether.

What I noticed is that it effectively acted as a long-lasting stimulant. But since it is supposed to be maintained continuously running in your blood, it never offers you (or at least never offered me) time to rest properly. It would seem logical to me, then, that despite my first shrink's opinion, a regular, short-acting stimulant would actually be suitable as a drug to help me cope with daily activities.

Any thoughts?...

This seems a rather difficult situation. What reason did your psychiatrist give you for choosing to go the antidepressant route vs stimulants? As you stated that,

anagram wrote: despite my first shrink's opinion, a regular, short-acting stimulant would actually be suitable as a drug to help me cope with daily activities.

I can gather that the psychiatrist who prescribed the wellbutrin was a new one. What was his reasoning for also choosing an antidepressant vs a short acting stimulant? Would this new one be more open to a discussion about a new medication?

Cheze2 wrote:What reason did your psychiatrist give you for choosing to go the antidepressant route vs stimulants?

If you mean the first psychiatrist, no clear reason other than "stimulants are strong drugs you know, they're almost like street drugs". I don't know if he was afraid of liability, or if he thought that my primary problem was anxiety, or something else; either way, he was wrong.

I have seen two other psychiatrists before my current one (a very expensive one, and then one from the public system). Both seemed too quick to label me as schizophrenic and to prescribe me antipsychotics, which I did take for a short while, and were even worse (a lot worse) than the SSRIs.

My current psychiatrist seems to be willing to prescribe any medication that I tell him to. Every time I have a new appointment with him, he asks my name as if it were my first appointment, and then calls me by the wrong name anyway. And then he asks me what I have been taking, and as soon as I tell him, he starts writing down prescriptions for refills. I'm honestly amazed that he hasn't had his license revoked yet. But he's the only psychiatrist in my area covered by my health insurance.

Considering the available options and my previous experience with them (also, even my therapist kept telling it was frustrating that there was no psychiatrist in the area who he felt comfortable enough recommending), it seems to me that I'm basically on my own when it comes to decisions about medication.

anagram wrote:If you mean the first psychiatrist, no clear reason other than "stimulants are strong drugs you know, they're almost like street drugs". I don't know if he was afraid of liability

A lot of psychiatrists are trying to steer clear of stimulants as many people do sell them, or abuse them. I know that this is difficult for people who would benefit from them. It's similar to people who have substance addiction histories even if that was over 20 years ago and psychiatrists won't prescribe them benzos for fear that they will become addicted even if they have extreme anxiety. Some doctors won't prescribe benzos at all for the same fear that it will make someone become an addict. I'm not saying that you have an addiction history, just that many psychiatrists don't like to prescribe certain medications out of fear vs looking at the whole person and what might benefit them. I know you stated that you were on 150mg of wellbutrin and that seemed too much. They do make a 75mg tablet, and it's not the SR version (which is extended release) so there is room to lower the dosage, and perhaps have it not affect you all day and night if you were interested in talking to your non-psychiatrist about that. (I say that as since he isn't really doing his job properly)

anagram wrote: it seems to me that I'm basically on my own when it comes to decisions about medication.

This is a really tough position to be in, especially when the point of seeing a psychiatrist is for them to provide you with professional advice. That's terrible that there's not even one decent psychiatrist in your area that your therapist feels comfortable suggesting.

Cheze2 wrote:Some doctors won't prescribe benzos at all for the same fear that it will make someone become an addict.

Ironically, the shrink who wouldn't prescribe me stimulants did prescribe me benzos (Xanax/alprazolam, more specifically), which I have been taking daily ever since. I probably have developed some chemical dependence by now, but not to a dangerous level, I think. I wouldn't say I'm addicted either, since I do forget to take it sometimes, and I also haven't changed my dose since I first started taking it (0.5mg/night — it doesn't work as well as it did at first, but it still works).

I know you stated that you were on 150mg of wellbutrin and that seemed too much. They do make a 75mg tablet, and it's not the SR version (which is extended release) so there is room to lower the dosage, and perhaps have it not affect you all day and night if you were interested in talking to your non-psychiatrist about that.

I don't know if the 75mg tablets are available in my country (the 150mg generic ones that I bought were already marketed exclusively for smoking cessation — the leaflet stated: "this medication has been prescribed to you by your doctor to help you quit smoking"). I'll keep it in mind anyway. Thanks for the advice.

What I wonder, though, is, since the 150mg pills took a few days to reach the first desired effects, wouldn't any dosage or tablet format that allowed me to have a good restful sleep at night fail to offer me noticeable benefits enough to justify taking the drug to begin with?

(I say that as since he isn't really doing his job properly)

Yes, he really isn't. But as unprofessional as he is, and despite my total lack of respect for him, at least I don't have to argue with him for nothing, unlike the other ones. The other ones would only listen to what they wanted to. This one simply doesn't care, period...

This is a really tough position to be in, especially when the point of seeing a psychiatrist is for them to provide you with professional advice.

Yes, this is why I want to be extra careful with my own research, especially since I have never taken stimulants so I don't really know what to expect (and I certainly can't count on my current shrink or any of the previous ones to provide me with accurate and relevant information). But from what I've read about these meds so far, none of their most important contraindications seem to apply to me. Particularly:

• My blood pressure has always been remarkably stable at ideal levels.
  
  
• My latest check-up results indicate no warning signs at all regarding cardiac activity.
  
  
• My mood fluctuations don't seem to be consistent with bipolar disorder (both in timing and intensity).
  
  
• Despite having been given a formal schizophrenia-related diagnosis (ICD-F21, which is pretty much a catch-all code for anything in between schizoid personality disorder and overt schizophrenia), I don't seem to be particularly prone to psychosis. Moreover, I don't even have some of the hallmark traits of schizotypal personality disorder as defined by the DSM.

As far as I'm aware, this short list covers all the most important things to be careful with as far as stimulants are concerned. But if anyone has any other advice to offer, it would be very welcome. Or, more specifically, if anyone can describe some type of comparison between bupropion and any other drug used to treat ADHD, I'd be very interested to hear it.