Posted by katekite on June 27, 2002, at 18:54:26
In reply to Katekite, posted by rainbowlight on June 26, 2002, at 18:01:21
> Thanks for answering my other post. I have a question for ya. That short of breath feeling/like breathing hurts/chest seems to hurt (oh, and if I exercise at all feels like my heart is going to pound out of my chest) thing we were discussing in the other post. Is there a name for those symptoms? I keep trying to describe it to my pdoc and she looks at me like I'm nuts. Is it a blood pressure problem? Today I had a cup of tea with my Zoloft and WOW! the short of breath thing started happening right away and is still there, hours later. It's a horrible feeling, feels like my hearts gonna stop. I want to be able to tell pdoc what I am feeling but don't know how to express it. Any ideas on how to describe it to her?
It sounds like the negative effect of tea on top of zoloft is similar to the negative effect of adderall. You seem really good at describing it, I wouldn't worry about that. I would guess your pdoc is looking at you funny because they are trying to figure out whether you are having an anxious reaction to stimulants or whether you have a weird medical reaction like high blood pressure or increased pulse (a pressor response).
The anxiety cause: caffeine and stimulants can increase anxiety and jitteriness and generally make you feel yucky and some people who feel jittery start being able to really feel their heart, feel like their chest is tight, may breath heavier or be tense and their muscles or chest may even hurt. These people are sensitive to their bodies and can really tell when things are a little bit off, and know that its not a good thing and can be really concerned about it. It can be a vicious circle because if you worry then your pulse etc goes up and that just confirms things are not good. However, pulse and blood pressure would go back to normal as soon as you are distracted or with a relaxation technique and wouldn't stay high for hours on end. Usually it would also not go up real high, but just up a little. The best thing to do, if it were this, would be to avoid caffeine and adderall and hope that a different stimulant won't be as bad that way.
The pressor response: if your circulatory system (heart and blood vessels) is sensitive to stimulants and over-reacts, that's called a pressor response. To see if this is it, you would take your pulse and blood pressure in the morning while resting (after sitting for 5 minutes) and then while resting after taking a low dose (say 2.5 mg) of adderall. Most people would not have much of a difference. A few of us (me included) are ridiculously sensitive to stimulants and have a big difference in at least one of those measures that stays up high until the stimulant wears off.
There would usually be a medical reason for this and it would be important to make sure the cause of it is not serious (some people are just born this way and it can be normal for them). Heart problems are really rare (even though it feels like its the heart's fault) but many many things can affect the heart's sensitivity to drugs. For example with me it has turned out I have high cortisol, and am seeing an endocrinologist monday to figure it out.
Stimulants most always cause a small pressor response (like pulse goes from 65 to 70) but usually that's it unless people take a high dose. Anxiety is more common a cause for feeling like the heart is pounding, than a big pressor response. I don't know what the cut off would be for when someone would be considered medically over-sensitive to stimulants in a way that needs to be looked into... Sometimes it could be a combination of anxiety and a true pressor response. The symptoms of anxiety overlap with the physical responses to stimulants which makes it confusing to all.
Since your appointment is tomorrow its a bit late today to figure it all out.
You could do this: carry a 2.5 mg (or whatever is the smallest size adderall that makes you feel yucky) with you to the appointment tomorrow. Find out if they are equipped at the office to measure blood pressure and ask to have it and your pulse measured (to get a baseline).... then take the pill at the office and wait until it takes effect... have them remeasure. Then your psychiatrist should be able to say whether the difference is an important one or not and whether you need to get a physical check-up.
Many pharmacies also have blood pressure machines so you could do it on your own, instead. If it seemed much different you would then make an appointment with your regular general doctor to look into it.
I ended up buying a home blood pressure monitor since I was having so much trouble with ritalin(they have them at pharmacies for about $60) and still wanted to try more stimulants. I found it was better to do it at home because I have social anxiety which complicates everything (is my pulse up because because ritalin gives me anxiety, because ritalin gives me a pressor response, or because I'm staring at a white coat???).
>I am going to ask her if I can try Ritalin on Friday (instead of the Adderall). Should I ask for the regular type or Concerta?
The lowest dose of Concerta that the drug company makes is 18 mg which is the same as 5 mg ritalin three times a day. Concerta can not be broken into smaller doses. I think that dose of Concerta would be a lot for you to experiment with since you are so sensitive to adderall and caffeine. It might be better to try the short acting ritalin(even though eventually you wouldn't want to deal with the peaks and valleys). The short acting ritalin can be broken into as little as you want, although the starting dose for a toddler is 2.5 mg (half a pill).
Then if you found you were able to take 5 mg of ritalin 3 times a day and it helped with no heart things, you could switch to concerta for simplicity, later.
Since there is a chance your blood pressure is going high, be cautious and don't overdo exercise until you are sure all is well.
Whew, long complicated message.
Good luck tomorrow. Hope your blood pressure etc is ok.
kate
poster:katekite
thread:110851
URL: http://www.dr-bob.org/babble/20020617/msgs/110946.html