Episode 383: Alternatives to Adderall & My Therapist Talks Too Much!

Hello friends!

In today’s episode, we delve into two compelling listener questions that I’m sure many of you will find relatable and insightful.

Navigating Therapy with a Talkative Therapist: One listener shares their experience with a therapist who often overshadows the session with personal stories, leaving them feeling unheard. This is particularly challenging as the listener is dealing with a controlling spouse with dementia. We explore the importance of feeling heard in therapy, the role of therapist’s self-disclosure, and the value of assertiveness in therapeutic relationships. We also discuss the concept of transference and how it can impact therapy sessions.

Considering Alternatives to Adderall: Another listener seeks advice about a close relative looking to taper off Adderall, which they’ve been dependent on for managing ADHD. We discuss the complexities of ADHD diagnosis and treatment, delve into the pharmacology of Adderall, and explore its side effects and potential for psychological dependence. Additionally, we examine Provigil (Modafinil) as an alternative, highlighting the differences in abuse potential and side effects. We also touch upon other medication options like Strattera, Intunive, Clonidine, and Wellbutrin, and emphasize the role of therapy and coaching in managing ADHD.

As always, your questions and stories bring a depth of understanding to our discussions. If there’s something on your mind, don’t hesitate to reach out at duffthepsych@gmail.com. For full show notes, please visit http://duffthepsych.com/episode375.

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Question:

Hi! I have a close relative in their early 30s that has been taking adderall for three years. It was prescribed by their GP and they have reached a point where they feel as though they cannot taper off as they now depend on it to function (their words not mine). I saw something in a textbook about Provigil being a possible alternative to adderall. Have you heard anything about this or do you have any suggestions on how to proceed with trying to safely taper off? I understand that they need to see someone and are seeing a psychiatrist as well as undergoing talk therapy and transcranial magnetic stimulation, I’m just searching for information from a trusted source.  Thank you for your time!!

Response:

Navigating the complexities of ADHD medication, particularly in the context of tapering off Adderall, is a multifaceted issue. It’s crucial to understand the role of ADHD medication and to approach any changes in treatment with careful consideration and professional guidance.

Adderall, a mixture of amphetamine salts, works by increasing dopamine and norepinephrine levels in the brain, aiding individuals with ADHD to achieve better focus and alertness. Despite its efficacy, concerns about dependence and side effects, such as tolerance, cardiovascular impact, and sleep disturbances, may arise. When contemplating tapering off Adderall, it’s essential to delve into the reasons behind this decision and to evaluate the benefits versus the potential drawbacks of continued use.

Psychological dependence, characterized by a belief in the necessity of the drug for daily functioning, can occur even when Adderall is used as prescribed. It’s important to distinguish between dependence and the effective management of symptoms with the right medication. If tapering off is considered, a gradual approach is recommended, ideally during less stressful times. Possible withdrawal symptoms include fatigue, mood swings, and decreased concentration, among others. Awareness of these symptoms can help in managing them effectively.

Provigil (modafinil), a non-amphetamine stimulant, presents an alternative to Adderall. It’s used off-label for ADHD treatment, although its efficacy in adults with ADHD has shown mixed results. Modafinil is considered to have a lower potential for abuse and milder withdrawal symptoms compared to Adderall.

Other medication options include Strattera (atomoxetine), an SNRI, and blood pressure medications like Intunive (guanfacine) and Clonidine, which can help manage impulsivity and hyperactivity. Additionally, Wellbutrin (Bupropion) may be suitable for some individuals. Beyond pharmacological treatments, therapy and coaching offer valuable support in developing coping strategies, organizational skills, and managing ADHD’s impact, especially given its frequent comorbidity with anxiety and depression.

Ultimately, the decision to taper off Adderall should be made with a full understanding of the alternatives and in close consultation with healthcare providers. It’s essential to remember that needing medication is not a personal failure – just as with medications for physical health conditions, treatment for mental health should be approached with the same acceptance and understanding.

Question:

My therapist talks too much! I like him and his insight into my life. But I wish he would be paying more attention to me and asking me MY questions.

But he interrupts me and tells me stories about his cats and dogs or how he crocheted his sweater. He talks about how my situation fits into a movie he’s seen and then proceeds to tell me about the whole movie.

I am seeing him for issues related to my marriage. My husband has dementia and other issues and is controlling of me.

I feel like the time we spend together is short. I want to leave there feeling like he was listening to me. I want him to challenge me and help me make plans for my future.  I went to him because I have a controlling husband who never listens to me, and he is sort of doing the same thing.

What do I do?

Response:

It’s essential to feel heard and supported in therapy, especially when managing challenging personal situations like a controlling spouse with dementia. Different therapists have unique approaches, influenced by their theoretical orientation, experience, and personality. It’s not uncommon for therapists to self-disclose, but this should be done sparingly and with a clear therapeutic purpose.

Your experience with your therapist, who often talks about personal anecdotes and deviates from focusing on your issues, is understandably frustrating. This might be due to various factors, such as the therapist’s personality or lack of experience. It’s crucial to assess whether these are minor issues that can be adjusted or fundamental mismatches in therapy style.

Asserting your needs in therapy can be a constructive step. If you feel comfortable, addressing this concern directly with your therapist could be beneficial. For instance, you could express your feelings about feeling overlooked and your need for a more focused approach. Alternatively, humor can be a tool to steer the conversation back to your needs, depending on the nature of your relationship with the therapist.

If the current setup doesn’t seem to improve, seeking a different therapist might be the right choice. Therapy is a personal journey, and finding the right match is crucial for effective treatment. Exploring the possibility of transference – where your feelings towards your husband might be influencing your therapy sessions – could also be an insightful angle to consider.

Regardless of the path you choose, remember that your feelings and needs in therapy are valid. If you decide to continue with your current therapist, addressing these issues directly could lead to more effective sessions. Additionally, seeking out resources for caregivers of dementia patients might provide you with additional support and coping strategies.

In conclusion, trust your instincts about what feels right in therapy. It’s your journey, and finding a therapist who can provide the support and guidance you need is paramount. Remember, it’s okay to seek a change if your current therapy situation isn’t meeting your needs.

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