Posted by dennison on April 1, 2002, at 22:28:04
In reply to dexedrine augmentation of ssri's - dennison , posted by Bekka H. on April 1, 2002, at 19:35:15
Hi Bekka - Hope Dr. kramer ventures down and takes alook at my post!!! :):).............................Bekka yes I have plenty studies showing psychostimulants being used to help augment ssri's or help alleviate anergic "lack of energy", hypersomnolence "daytime drowsiness" , apathy "frontal apathy--:) lol" ,all serious impediments to adequate restoring functional status,lethargy etc. etc........................................The response was dramatic and sustained,whereas before the addition of the psychostimulant functional status was essentially non-existent,thus any significant degree of recovery was severely hamperred. Psychostimulants also showed basic mood augmenting effects to the previous refractory ssri clients, thus as I stated earlier these reports, although not actual double blind studies -the improvement was definitely significant and was sustained, ritalin and dexedrine were both used in these situations. Some cases were followed for many months without loss of effect or tolerance,thus this strategy certainly merits at the very least a good honest consideration as a valid treatment ""ssri + psychostimulant" -- These were small groups of patients however nonetheless you can't argue with success..............................................................................................................................................Now as I stated previously laboratory studies have indeed shown ssri drugs, in these studies at least, to have the capability to totally block the psychomotor aspect of subsequent psychostimulant addition, though in some cases dopamine release into the critical areas(((((((((((( "nucleus accumbens" , of course being most important producing the "psychomotor-effect")))))))))))) was still just as significant and some times above psychostimulant alone.........................However, as earlier stated the subsequent stimulatory effect on psychomotor activity was totally abolished, thus implying a down stream effect of the actual dopamine receptors in the "nucleus accumbens" . Postulated theory was that some how the ssri enhanced neural functionality was reciprocally diminishing the dopamine effect, which of course we know happens with ssri's "sexual diminution" , "increase in extrapyramidal effects from neuroleptics" , ssri extrapyramidal effects from ssri's alone occassionally as well disinhibition of modualatory dopamine effects on skeletal musculature "" resulting in spasms, twitching and myoclonus". ................................................I've kinda just rehashed my previous post haven't I, rambling on again I guess, but In this little tiny text box lol - I kinda get stir crazy--, plus I'm doing this straight out of on spot thinking no preparation or outline.......................Anyway the issue of the studies. .......................................................Here's one #1 Methylphenidate Augmentation of Serotonin Selective Reuptake Inhibitors: A Case Series J Clinical Psychiatry 57:2, February 1996 ""AndrewL. Stroll, M.D., Srinivasan S. PIllay, M.D., Lisa Diamond, Susan B. workum, M.D., and Jonathan O.Cole, M.D. """ whew --take was kinda long - no cut n paste there :) !!!! I have several more similar to that but my typing is so atrocious I'm getting A bit fatiqued here. .............................................Ok another study of interest , more of theoretical nature,though demonstrating deleterious effect ssri's can have on dopamine function though!!!!! ""Flouxetine and Extrapyramidal Side Effects""" Am J psychiatry 146:10, October 1989 ---Roch Bouchard M.D., Emmanuelle Pourcher M. D., Pierre Vincent M.D..........................................................................................................................The main study which specifically showed ssri negation of psychomotor aspect of psychostimulants I have, but I'll need to dig it up - I remember it in detail though since the implication was very significant. I presume you only have pubmed abstract access, and not full medline access priviledges, I have the full reports but the abstracts sometimes aren't all that bad, though I definitely prefer the full complete full text article, perhaps if you could access a medical school library they of course would have all the journals. Bekka I'll supplement with more citations to literature, in near future, simply need to dig them up -- I have literally piles and piles---will take awhile. ..................................btw methylphenidate augmentation of desimpramine has been extensively studied and shown efficacy -- without inherent serotonin over-ride that ssri's potentially exhibit!!!!!!!
poster:dennison
thread:101313
URL: http://www.dr-bob.org/babble/20020327/msgs/101388.html