Posted by SLS on February 20, 2001, at 10:56:09
In reply to Re: Adderall Dosage--Update, posted by Noa on February 14, 2001, at 11:37:05
> > I was reading archives, and came across a suggestion to stop Adderalll for a while and restart, in order to get back some effectiveness. Does this really work? How long of a "vacation" do you need from the med to make it work better upon resumption?> ---This is exactly what I do; I have to, as Adderalll loses effectivness for me after 3-5 days. I usually find that 24-48 hours without it is long enough, but that I'm not good for very much during that time. I don't really get back full effectiveness in that time, but that's about as long as I can stand being without.
Hi guys.This is a pretty frustrating and discouraging position to be in.
The following is just a bunch of stuff that crossed my mind. It may not have a single thing right with it. Any hypothetical scenario is something that I haven't taken the time to substantiate any further than using the stuff currently floating around between my ears:
All appropriate caveats...
Going on and off Adderall is not only a difficult roller-coaster to ride, but it might be counterproductive. Regular usage might foster dopamine depletion and change receptor sensitivities. Such could at best mask, and at worst prevent, an antidepressant response to other drugs. One example of Adderall-induced systemic changes is represented by the appearance of irritability and possibly a *worsened* depression immediately after the Adderall is withdrawn. Perhaps you "lower" the starting point from which an antidepressant must work. "Pulsing" true antidepressants on and off in the manner that you are currently using Adderall seems to promote treatment-resistance, and can also induce mania. But you gotta' do what you gotta' do. If I were in your shoes, I would probably join your club. All of this being said, I don't think you are taking much of a risk by continuing to pulse Adderall. However, it is something to think about based upon your current situation. It is my gut feeling that the system would be much happier establishing a homeostasis to create a stable milieu within which the antidepressants can work.
Noa, I think you may want to try high dosages of T4 if you haven't already. I don't remember if you ever tried T4 or if you have taken T3 exclusively.
DaL, are you bipolar? Perhaps you should take note of the many stories, especially the older ones, that you can follow the history of that's case profile closely matches your own. Perhaps you will find someone else's subsequent successful medication regimen equally effective for you and give you some alternative directions to head in. It might be interesting to give Mirapex, a dopamine drug, a trial to see what it does. It might be a better way to stimulate the same system that Adderall does. It works using a completely different mechanism, and might afford you a more persistent improvement. Even if it doesn't, pay particular attention to and record your response to it as it might lend clues as to what to try next. I am guessing that there is a lot of stuff you haven't tried yet. For every drug or drug combination you try, much can be gleaned as relevant information how you respond to them. Make three lists:
1. Drugs that are partially effective.
2. Drugs that are neutral.
3. Drugs that make your depression worse.You gotta' start somewhere, Sherlock Holmes.
? What has been your experience with tricyclic antidepressants?
Without knowing your history, the first aggressive approach that popped into my head based on your responsiveness to Adderall is to use an MAOI as the core treatment. If you have had absolutely no partial responses to any medication other than Adderall, AND you have been properly diagnosed as having an axis I affective disorder without comorbitity, these are aggressive alternatives, but doable:
The choice of which MAOI to try first is difficult. There is trend to prescribe Parnate for someone who is anergic (low energy) or has bipolar depression. If there are anxiety or OCD tendencies (GAD generalized anxiety disorder, social phobia, social anxiety, panic attacks), Nardil seems to be superior. Sometime you just have to flip a coin. Parnate is usually the milder of the two in terms of side effects, which might be important when adding drugs that exert the same type of side effects. For me, I like the way I feel on Nardil better, even though I fit the "Parnate profile". I am partially responsive to both.
Unless you have already tried both Parnate and Nardil and are able to make a comparison, it seems reasonable to determine which of the two, if either, gives you some partial relief. You could perform 4-week trials of each to compare them and choose which to use as the core of treatment of any algorithm. Who knows? Maybe one of them will work great by simply adding it to Adderall.
* I would try throwing in low dosages (300mg-600mg) of lithium at some point. You'll know within a week if it yields any improvement. If it is not producing any side effects, you might as well keep it until you find something that works, and try removing it later to see if it is necessary. People seem to have particular success adding lithium to Parnate.
----------------------------------------------------------------------General format:
MAOI + Wellbutrin + tricyclic + stimulant + DA agonist + neuroleptic + thyroid + opioid antagonist + lithium
* You must take the (Adderall, Ritalin) continuously - no holidays.
** Consider Lamictal if bipolar
Example:(Parnate, Nardil) + Wellbutrin + (desipramine, nortriptyline) + (Adderall, Ritalin) + Mirapex (Risperdal, Zyprexa, ziprasidone, amisulpride) + (T3, T4) + naltrexone
* ALL of these drugs can be taken at the same time. However, this stuff is meant to represent "cocktail" destinations rather initial trials. Drugs are to be added methodically around the MAOI core.
** You should probably exclude any drug to which you have experienced a negative reaction.
Algorithm Summary: Mix and match. Pray. Get well. Smile. Help me get well.:-)
If something like this works, you can later try to remove the (Adderall, Ritalin) slowly to see if you really need it.There is so much more. I discover more and more viable and optimistic treatments the longer I participate on Psycho-Babble. There is quite a bit of data and logic supporting the idea that you will find something that works *well* for you.
My one request of you is that you occasionally remind me of what I wrote in the preceding paragraph. :-)
This is just one direction that I thought might be worth considering. I would love to hear from AndrewB regarding this approach as he has a much wider knowledge base to work with than I do. I would like to know from him if he thinks selegiline (Eldepryl) or adrafinil would have a place here. He will also help find a place for Buspar and/or pindolol as augmenters. However, if ziprasidone (neuroleptic) becomes available, it might already have a stronger Buspar "built-in".
Sincerely,
Scott
poster:SLS
thread:53526
URL: http://www.dr-bob.org/babble/20010212/msgs/54468.html