If I need meds because I have focus problems, how can I focus on ... what, um, hmm, where was I going with that?
March 26, 2010 12:36 PM   Subscribe

HeadMedFilter: How to keep track of effectiveness of ADHD/anti-anxiety/anti-depression meds. Working with a therapist and a dr to find the right meds, but I can't seem to quantify how anything effects me. I want to help them help me.

I can try keeping a little journal or something but I can't seem to do it with any consistency. It's not like I have had a broken arm and each day I can measure how much more or less I can move the arm from the day it came out of the cast.

Everything seems so subjective with the ADHD (inattentive type) and the anxiety/depression that is either in addition to or caused by the ADHD being undiagnosed until last year.

When I had been seeing a psychiatrist before I had an insurance lapse, he had tried me on everything from Lexapro to Trileptal and all kinds of Ambien, Lunesta, etc. All of those things made me feel like crap. (before the ADHD diagnosis, this came when the therapist and pdoc at that time thought i was just depressed and had GAD)

The only time I have ever felt "normal" (e.g., the chatter in my head from my 8 million different stations stopped or dulled), was the several weeks that Adderall seemed to work. I had a few days of the euphoria feeling, but then there were about 3-4 weeks of just awesome "oh, i see, here is how i can plan and do things, in a timely manner. la la la!" it was great. then it stopped working so great and i started getting anxious a lot. Zoloft was added to the mix and that was awful (massive side effects and couldn't sleep, had absolutely no appetite, was a zombie). But I gave it a good try, I would wait out the 4-6 weeks to see if I felt less anxious.

I did, but it completely canceled out any good from the Adderall. So now I'm on Vyvanase. And just tapered off the Zoloft (all under dr supervision). The Vyvanase does nothing as far as I can tell except make me sleepy, which is how I feel in general when I was not medicated.

I don't know how to explain to my dr and my therapist what I am feeling or how the drugs seems to be effective or not. And the head meds seem to be so hit or miss for everyone that it's hard to do anything than just keep trying different meds and hope this one works.

tl;dr: How can I keep track of (seemingly) subjective responses to medication when I don't even feel the same way or do the same things every day? I need to be able to present this succinctly and clearly to a doctor.

bonus question: why, oh why, does it seem like this is just dart-throwing? the psychiatrist just seemed to follow a flow chart of meds ,much like my dr is doing now. Or I say that I read about something (Vyvanase) and that it seems to help people who have anxiety and ADHD, and the dr says "sure, let's see what happens." this is so incredibly frustrating for me and BF, not to mention that my work suffers when I'm having 3 weeks of productivity followed by 6 weeks of "oh sorry i'm a spaz" (which I don't say of course, but YKWIM).

posted by sio42 to Health & Fitness (11 answers total) 10 users marked this as a favorite
This is where a good titration methodology would come in handy. You go to a titration specialist (they're out there), you get Medicine X. The doctor also gives you a handy form to fill out, taking away at least part of the subjectivity. You report back to the doctor after the recommended period of time and repeat with Medicine Y. The number of medicines for you to try will be based on self-reports of what's worked before and what the doctor thinks might work based on your history.

As your psychiatrist/GP if he/she can help you find a titration clinic. You may have better luck contacting the local children's hospital ADHD clinic, if they have one. [this assumes you're in the US. I have no idea how these things work elsewhere.]
posted by cooker girl at 12:44 PM on March 26, 2010 [1 favorite]

oh holy hell. that sounds AWESOME. i was not expecting such a rational solution so soon!

i go to a university teaching hospital physician's group for my primary care. so i'm sure that somewhere at the main facility is a titration specialist.

i cannot believe i never heard of such a person on the addforums. i really hate all this shooting in the dark trial and error for things messing with my neurotransmitters. ick.

to tag on to my OP, if anyone has an experience with a titration specialist, did it help?
posted by sio42 at 12:48 PM on March 26, 2010

I have a lot of friends that swear by moodtracker. They say it helps them *a lot* when it comes to talking with their therapist and psychiatrists about meds. It will print out a mood chart based on your every day moods and what meds you're taking. Give it a try and see how it works for you.
posted by patheral at 12:48 PM on March 26, 2010

Why, oh why, does it seem like this is just dart-throwing?

Because it almost is. Except it is dart throwing with a lot more information than your average guy in a bar has about the environment. It's like dart throwing knowing the wind resistance, relative weight of the dart, &c &c. In the end, however, your mental condition is unique and will require a unique treatment and will not always react the expected way.

I know it is frustrating, but please keep trying and communicate, communicate, communicate. With your doctors, with your boyfriend and, to a more abstract degree, with you coworkers/professors. Remember: you have a disability and you are legally entitled to proper accommodation from the latter.
posted by griphus at 1:08 PM on March 26, 2010 [1 favorite]

*ahem* Yes! My very good friend did titration with her son and it worked so well we're about to start it with our son (both diagnosed with ADHD). That's how I know about it.
posted by cooker girl at 1:09 PM on March 26, 2010

I went through the antidepressant dartboard toss for a while and had many of of the same frustrations you describe.

I started out trying to take control of the process by recording all kinds of data that seemed like it might be relevant -- this was overwhelming and impossible to keep up with and not all that useful anyway. Gradually I pared that down to something very simple: every morning, midday, and night, I'd rate my current mood on a scale of one to ten. Period. Nothing more than that.

And it turned out that this was actually really useful. Yes, there was a lot of variance from day to day depending on what else happened to be going on, but the overall trend showed a measurable difference from one drug to the next.

Plus it let me spend a lot of time making pretty line graphs in Excel, which I found relaxing.
posted by ook at 2:55 PM on March 26, 2010

After reading a thread that came up recently on ADD, I started to look into it myself.

The office I inquired at has a policy of doing computer based testing (they may have called it "assessment") for it, evidently it takes about 2 hours at the outset, with a redo of the testing after drug regimes are changed.
posted by yohko at 3:08 PM on March 26, 2010

If you use a pill dispenser, it might be helpful if you put a little note sheet in with it, to update at each time you take meds. Note the time you took the meds, any food/drink you've had in the last hour, and a 2 to 5 word comment about your state of mind. Having the note sheet there, with the meds, automatically reminds you to update the sheet when you take meds, and you or your doc may see a pattern of time, or with foods that you're eating, which are affecting the meds, in terms of uptake by your system.

A pill dispenser also allows you to count out and "pre-dispense" your meds, when you're in a low stress situation, to subsequently re-verify your original counts, and to automatically track missed or late dosages. Meds can't work if you don't take them, or take them willy nilly.
posted by paulsc at 3:18 PM on March 26, 2010

The book Feeling Good has depression and anxiety checklists that I found very useful. It's an easy way to put a numerical score on how you're doing that I personally found accurate.
posted by callmejay at 3:44 PM on March 26, 2010

There is also the PHQ-9 [PDF unfortunately] which you can use to track your symptoms and improvement or lack thereof. If you don't see a reduction of 50% in key symptoms by 6 weeks for most antidepressants, they're not likely to work for you.

IANAD but if Adderall worked and then "pooped out" you may want to either try a higher dose of that or a cousin drug like Ritalin or possibly the novel stimulant modafinil (Provigil). Provigil has the advantage of having little abuse potential and therefore not being a controlled substance. Bupropion (Wellbutrin) is also one of the more 'stimulating" antidepressants, as it acts on dopamine, like the traditional stimulants, though, again, it's not a controlled substance and doesn't produce any "high."

But yeah, the reason it's trial and error is because of vast human genetic variance as well as variance due to environmental exposures (child trauma, etc). This is also why the antidepressant trials make it look like the drugs are no better than placebo. If you've got 40 subjects and in the drug group, 10 have amazing positive effects and 10 have horrible negative effects and placebo helps 50%, it will look like your drug did nothing. Meanwhile, people will go around talking about the miraculous "cure" and the "evil devil drug" and they will be talking about exactly the same thing! And the only way to figure out which group you will be in for any particular drug right now is to try it...
posted by Maias at 5:58 PM on March 26, 2010

thanks for the link Maias - i think that form would help a great deal. i probably could have made that myself, but then i would just keep trying to tweak it. ha.
posted by sio42 at 7:53 AM on March 28, 2010

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