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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64410
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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I am a 74 year old woman who for as long as I can remember

Resolved Question:

I am a 74 year old woman who for as long as I can remember has had difficulty just getting through each day and actually accomplishing what I needed to do and I was always tired. I used to just say that my brain was wired wrong - that was even back in the days before so much brain research was being done. A few years ago I ran across an article on adult ADHD. As I went down the list of behaviors, I was saying yes that's it - that's why I did these things and didn't do those things. I felt that I was a walking text book case. It was so obvious to me and yet it was nearly impossible to get anyone to listen to me. I do have a medical background as an RN with a BS degree. I have a history of anxiety depression and have been on an antidepressant for over 25 yrs and on Alprazolam o.5mg tid as needed and have never abused it - it has been my saving grace. About 2 yrs ago my primary doctor agreed after a thyroid test, to put me on a dose of Ritalin 10mg every morning and I could tell the difference right away. My sister who has lived with me for 20yrs. said she could tell the difference also. I was more focused and started doing things that before I would just look at and wasn't able to work up the energy to do. My doctor retired and I started seeing a CNP who when she saw the Ritalin on my chart, commented that that was really a low dose and increased it to 20mg. She had no problem with it. I am in good health with no heart problems - I know that because I did go to the ER one night with chest and back pain with no atypical beats, normal Sinus rhythm and normal enzymes. We pretty much agreed it was probably caused by muscle spasms from Fibromyalgia. I had a stress test a few days later that was normal. I have some hypertension and elevated cholesterol which are both well controlled. Now to get to my question - I started getting my medications through the mail but needed to have the Cymbalta and Alprazolam prescriptions from a Mental health provider. I saw a Mental Health CNP who did not really ask any questions and within about 20 minutes when I mentioned ADHD, she said, "You don't have ADHD. You are depressed." She increased my Cymbalta from 60mg to twice a day - which has been good, but she discontinued the Ritalin and prescribed Provigil 200mg instead. She did not taper the Ritalin. I did have some Ritalin left and with the increased Cymbalta I felt so great - I was ready to take on the world, but that lasted only 3 days until I used up the Ritalin and I crashed. The Provigil may give a boost but not in the right area of my 'wrongly wired brain'. I did go through a few days of withdrawal. I called her a couple of times and talked to her nurse, asked if she would restart the Ritalin The nurse said that "She emphatically said NO!" I asked why and the nurse was fumbling for some excuse about me having sleep apnea and something about the vascular system. My primary CNP really did not see anything that would cause any problem, but said she could not go over the mental health CNP's head. They made an appointment with a Psychiatrist but not until May 1st. So here I am again struggling (word used in connection with what I have read in researching ADHD) through each day. Now my big question: Is there legitimate reason I should not take Ritalin? I would really choose to feel alive again........................
Submitted: 3 years ago.
Category: Medical
Expert:  DrRussMD replied 3 years ago.

Hello

I see nothing in your story that says provigil is better in this situation than Ritalin.

 

 

The problem here is no actual diagnosis from a psychiatrist.

 

If you get the diagnosis, Ritalin is more indicated.

 

Use reply to let me know if you have further questions. [click reply to expert]. Please do not forget a positive rating.

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Customer: replied 3 years ago.

I had been seeing a psychiatrist for several years who then moved. He said in 2006 that it was very probable that I did have ADHD and prescribed Straterra which was not very effective and stopped at that time. It is difficult in this area to find a Psychiatrist and my primary doctor said he would continue my antidepressant and antianxiety prescriptions.
I do not understand the mental health CNP's emphatic, strong objection to prescribing Ritalin when no one else has a problem. It hasn't been thrown out of the computers at the Pharmacy..........................