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Creek Running North

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December 09, 2005

Too Much Information update

I had an interesting meeting yesterday with a psychiatrist-neurologist to talk about my self-diagnosed ADD. He confirmed that I may indeed have either a mild case, or a more serious case with some symptoms masked by other behavioral issues. (Is my lack of nervous fidgeting an indication of not really having full-blown ADD, or of just being too unmotivated to fidget? It is to puzzle.)

His recommendation kind of surprised me. We agreed that stimulants were not a good idea right off the bat, and then he turned around and suggested that we totally fuck with my norepinephrine reuptake by way of experiment.

And so against the fervent advice of my brother Craig, who's had some bad experiences with such things, I am starting to eat about a tenth of a gram of Bupropion HCl daily.

It is thought that one organic cause of attention deficit problems may be a deficiency in norepinephrine, a hormone and neurotransmitter involved in the cascade of neurobiological responses we routinely experience in stressful situations. There's a little piece of blue tissue on your brainstem - the "locus ceruleus" - that secretes norepinephrine. The locus ceruleus is connected to many other parts of the brain: the cerebral cortex, the cerebellum, the medulla oblongata, and in my case the sleeping hamster in the little rusty exercise wheel to whom I have traditionally outsourced my higher intellectual functions. Norepinephrine is closely related, chemically, to adrenaline, and that's not a bad mnemonic for its effect on the brain. It enables the kinds of mental faculties you'd want if you were, say, attacked by a bear: heightened alertness, focus, determination to complete a task. These faculties, interestingly, are also useful in getting the goddamn Earth Island Journal to the printer on time.

With ADD, one instead goes through a mental process best described thusly:

"Yikes! A bear, and it's coming this way! I'd better...
"Hey, cool. A fossil! Looks like a trilobite. Craig would really like...

Which explains why I still don't have my Note From The Editor written for next week's printer date.

Bupropion, trade name Wellbutrin, is one of a class of drugs that interferes with the reuptake of norepinephrin by neurons in the brain, increasing the level of ambient norepinephrine, and at least theoretically alleviating the symptoms of Attention Deficit Disorder. This is not one of the applications of the drug listed on the bottle: Wellbutrin is sold as an anti-depressant. I am chronically depressed, more or less, though I wonder more and more whether that's in response to the ADD, so it's not like alleviating depression will be an unwanted side effect.

In deciding to cooperate with my pshrink I wasn't all that concerned about side effects - once we ruled out the fatal ones - so much as withdrawal. What if I didn't like it? Would I be trapped? Turns out there are withdrawal effects, but nowhere near those that other anti-depressants might have, certainly less than coffee. I can handle that.

I did do some research on side effects, to be sure. Seizures would be a possibility - 4 in 1000 - if I was binge drinking. There are some potential cardio effects that I'll monitor, as bupropion does have a mild stimulant effect, and the doctor has recommended cutting down on the caffeine.

The most troubling potential side effects:
- elevated mood
- general stimulated feeling
- weight loss
- possible increased libido
and I only hope they don't all hit at once. That would suck.

Of course, there's the marked possibility that the stuff won't help. That would be disappointing. But at least the science experiment is a rather diverting way of passing the next month. I do feel some trepidation about the prospect of mucking with my brain chemistry, but then I remember that it's my brain that's causing that fear, and it's not exactly unbiased in the matter. Best to take its blandishments with a grain of salt.

I do wonder about the effect on my writing. I asked the doctor whether any of his patients reported effects on their creativity as a result of taking such drugs, and he assured me that rather than experiencing what he called "emotional dampening" - which sounds to me like what happens to theater kleenexes at the Terms of Endearment marathon - I'm much more likely to feel more elevated, that if anything I will find myself being more effectively created when freed of some of the burden of depression.

That was reassuring. It's not like I want to suffer so that I can sing the blues, but I've often thought that pain I've felt has offered my writing a resonance that's potentially compelling. It'll be interesting to see how that writing changes as I start taking the drugs. I'm picking up my prescription after I walk the dog. Let me know if I get too shallow and goopy over the next month, will you?

Posted by Chris Clarke at December 9, 2005 07:32 AM TrackBack URL for this entry:

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I'm with Craig.

But I don't have those initials after my name, so I don't know anything, right?

Posted by: Carrie at December 9, 2005 08:44 AM
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I'm not going to a chiropractor for ADD, Carrie.

Posted by: Chris Clarke at December 9, 2005 08:47 AM
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I've been reading you for several months now. I, too, recently started taking Wellbutrin. For depression, though. It took about a week to start working for me, but the results have been good. I still get melancholy, but now without the self-defeating despair. With me, the biggest side-effect is occasional insomnia, and that is happening with less frequency as I adapt to the new internal chemistry. As for creativity, I create languages (kinda like Tolkien, but without the novel.) I find I do have more time and inclination for this now. Before I would spend my free time playing solitaire and castigating myself for doing something so useless when I still had to write up how aspect markers interacted with various tenses and such. Nowadays, I still play solitaire, but I also get the other stuff done, too.

So, anyway, Wellbutrin is working for me. If it works for you, too, great. If it doesn't, go back to the pshrink and try something else. But you already know that.


Posted by: Sylvia at December 9, 2005 09:08 AM
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Will do. Shallow and goopy sensors set on high.

Posted by: Rana at December 9, 2005 09:32 AM
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As a now-veteran of messing w/ brain chemistry, I say don't worry about it. If it doesn't work, you'll know. If it sorta kinda works but maybe not all that well, then it doesn't work, and you'll know. If it works, you'll know. And ime, if it works, you won't get goopy and your writing won't get worse; you'll just stop feeling crappy / distractable / whatever, and your writing will stay pretty much the same, only get easier. IME.

Bon chance.

Posted by: bitchphd at December 9, 2005 09:55 AM
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Who said anything about a chiropractor?

Posted by: Carrie at December 9, 2005 09:56 AM
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I am deathly afraid to take drugs (well, the pharmaceutical kind anyway) but know that they are a necessity for some...but I wish you much success and hope it works for you...but if ANYTHING goes wrong, get off quick! After the disturbing news about Paxil this morning, and the propensity for these drugs to cause suicidal tendencies, I am very afraid.

Posted by: TMJ at December 9, 2005 09:57 AM
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My mother died of bipolar disorder. She refused treatment for her diagnosis because she thought it would interfere dull her artistic edge, muffle that resonance you describe above.

She was a very good artist. She was a very good mother when she wasn't sick, and a wonderful friend. I've got a portfolio full of beautiful paintings and no mom. Guess which one I'd rather have.

Good for you for having the courage to try something new.

Posted by: Sara at December 9, 2005 10:45 AM
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"Yikes! A bear, and it's coming this way! I'd better...
"Hey, cool. A fossil! Looks like a trilobite. Craig would really like...

Stephen Colbert is right. Bears are a menace.

Posted by: eRobin at December 9, 2005 11:12 AM
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Good luck. It sounds like a sensible course of action.

But jeez, Chris, I am sitting here praying that you have good medical insurance with prescription coverage, because if you have to pay full price, you are gonna be so profoundly depressed....

*crosses fingers*

Posted by: larkspur at December 9, 2005 11:30 AM
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larkspur, I had a ten dollar co-pay for 200 tabs. I feel better already.

Posted by: Chris Clarke at December 9, 2005 11:57 AM
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I've also been reading your blog pretty regularly for a couple of months now.

I'll skip the concern part. I know you've got loved ones reading who'd show far more genuine concern than some random stranger on the internet.

Your writing often reminds me of Pirsig. The meditative melancholy. The dexterity with language. In fact, I'm surprised about the ADD. My mental image of you was that of a careful craftsman, with lots of patience and focus.

I'd really be interested to see if there will be a qualitative difference in your writing style (more precisely, the style that I discern here, not that that is your entire repertoire).

Posted by: buck at December 9, 2005 11:59 AM
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I've gone through several drugs and combinations of drugs to help with my motivation and depression. I didn't fair too well with Wellbutrin myself. A week into taking it, I broke into hives, which led to a severe panic attack. I don't mean to scare you off or anything; I just wanted to share my own experiences. My doctor says that my reaction is rare, more a product of my own unique make-up than the drug itself. Like BPhD says, you'll know if it's working or not.

I too was worried about the effects on my creativity messing with my brain chemistry would have. I can safely say that I have had none. In fact, rather than moping around with good ideas in my head and no motivation to follow through with them, I actually get more work done.

I think you're doing the right thing. Good luck.

Posted by: Kevin Andre Elliott at December 9, 2005 12:03 PM
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Just a note from a (non ADD) fellow sufferer and depressed insomniac, I don't medicate for it, but I don't have any deadlines hanging over my head, so I feel free to wallow. I sincerely hope you find relief and maintain your creativity. I'll keep checking back to see if there's any shallow goopiness here.
Good luck, my friend.

Posted by: Rexroth's Daughter at December 9, 2005 07:11 PM
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Humans are fiendishly individual when reacting to psychotropic drugs. It's better to try, watch the results, and back off if it isn't working. With Wellbutrin, do make sure you're taking the XL version,since it has the lowest seizure rate.

Posted by: Karen at December 9, 2005 08:16 PM
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good luck chris. the potential side effects sound like good things to me, maybe especially all at once. anticipation certainly hasn't made your writing shallow or goopy.

Posted by: dread pirate roberts at December 10, 2005 09:21 AM
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I'm not sure how much anecdotal experience will help here - reactions to medications are highly individual things. That being said, my 150mg daily dose of Wellbutrin has lifted a fog of depression I've carried around for much of my life. It's not cured by any means, but the clarity I've found has helped me take advantage of other forms of treatment as well. (therapy, exercise, positive life changes)

You'll know whether it's working or not, and you'll do what's best for you. Good for you for taking steps to deal with it - that's often the hardest part.


Posted by: Space Kitty at December 10, 2005 10:58 AM
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My doctor prescribed Wellbutrin for me a year ago, when I was diagnosed as bipolar. It very well may have saved my life... it helped the lengthiest and most crushing depression I'd ever experienced become managable, and like Space Kitty I found that I was able to get a lot more out of therapy when I was in a better frame of mind.

I found that it was difficult getting adjusted to the medicine. For the first week or so I was very irritable, almost to the point of rage... I spent my days at work thisgoddamnedclose to just tearing into my students over little behavioral issues that wouldn't even have fazed me normally. But once that period of time had elapsed, I was thinking more clearly than I had in years.

Posted by: the_bone at December 10, 2005 05:33 PM
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From what you've written, wellbutrin sounds like a good idea to me. I've been taking it for years for depression and ADD - I also take ritalin.

If it doesn't help or you're just not crazy about taking drugs, you might want to look into biofeedback. I've read some good things about it.

Posted by: Mary Ann at December 10, 2005 06:07 PM
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Greetings from Planet Effexor, and thanks to Michael Berube for that phrase! I'm in the camp that says give it a try; you'll soon know if it's helpful or not. I'm not out of my own metaphorical woods but E has been a tremendous help in balancing my humours. I have found that, contrary to experiencing emotional dampening, I feel things more. This is both good and bad, as I was raised in the most Stoic tradition of Polish Buffalonian Catholicism. I shouldn't be crying about my cat who died a few days ago, should I? Or having that little death trigger memories of other losses of friends and family. But I never want to go back to that damp, black morass of numbness I spent all of my first 50 years in.

Take care of yourself.

Posted by: Buffalo Gal at December 11, 2005 11:36 AM
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Buffalo Gal, I'm sorry to hear about your kitty.

Posted by: Chris Clarke at December 12, 2005 11:09 PM
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Today is my third day on Wellbutrin xl 300mg in the am. I have always thought of me as a veryu happy person and have always self medicated and used drugs,sex,music to fill me needs. Im hoping that wellbutrin will help me get happy and get off wellbutrin and ejoy life. These perscribed drugs are scary it's almost like just before you trip.


Posted by: John Smith at December 25, 2005 08:40 PM
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