Posted by sb417 on February 4, 2004, at 5:24:10
In reply to Struggling with Dexedrine Use Abuse, posted by Incorrect Chemistry on February 3, 2004, at 17:46:47
Hello Incorrect Chemistry.
First, congratulations to you on overcoming your difficult past. That is a remarkable feat, and you should be very proud of yourself. Your present accomplishments in biochemistry are even more commendable.
As far as your medication problems are concerned, how long have you been on Dexedrine? How long have you been on Paxil? Perhaps you need to try a different stimulant to prevent further tolerance. Perhaps you could try Adderall or some form of Methylphenidate (Ritalin, Concerta) for a while, and you might be able to go back to Dexedrine at a later date. You refer to your need to take more Dexedrine as an "addiction." I don't know whether it's an addiction. Perhaps you just require a higher dose? It is also possible that the Paxil is counteracting the dexedrine. Have you tried lowering the Paxil a bit? A long time ago, I took an SSRI with a stimulant, and I found that the SSRI completely wiped out the benefits of the stimulant. I had to keep on raising the stimulant dose until I got off of the SSRI. SSRI's (like Paxil, Zoloft, Celexa) are known to deplete dopamine in certain parts of the brain. When the dexedrine wears off, it also depletes dopamine somewhat, so you've got a double whammy! No wonder you feel you need more dexedrine! Do you think the Paxil is helping you? Is it possible to switch to another antidepressant that doesn't deplete dopamine? I know that's easier said than done, and if you're doing well on Paxil, then you probably shouldn't try to "fix what ain't broke."
Although I've never tried it, I've read a number of threads on PB about methods to prevent amphetamine tolerance. Several people here have suggested magnesium. Others use dextromethorphan, an ingredient found in cough syrup. I'm awfully wary of that because I don't think it's a good idea to chronically impair the coughing reflex. We have the coughing reflex for a reason, and it shouldn't be suppressed if you need to cough. Nevertheless, several posters here have found it helpful in preventing amphetamine poop-out. If I were going to go that route, I think it would be safer to try magnesium supplements.
I think you should speak with your doctor honestly about your situation, but don't refer to yourself as an "addict." Frankly, I don't think you are an "addict," and I think labels are damaging, at best. As you know from your biochemistry studies, psychopharmacology is very complicated and cannot be reduced to something as simple as "addiction." People who self-medicate are trying to help themselves. They are trying to make themselves feel better, even if they do it in a misguided fashion. Quite frankly, some of the self-medicating I've seen here is a lot more creative than most of the drug regimens I've seen doctors prescribe.
Based on my past experience with ssri + stimulant combinations, I would put a lot of the "blame" on Paxil. The trouble is, you probably shouldn't drop Paxil if it's helping you, and there are very few people who do well over the long term on stimulants alone, so being on an antidepressant is probably a good idea, but you may want to look for an antidepressant that doesn't cause dopamine depletion to the extent that ssri's cause it. Have you ever tried Trazodone? Although it's very sedating, it does increase serotonin by a completely different mechanism than ssri's so you don't end up with the dopamine depletion that medicines like paxil and celexa can cause.
Going back to you and your doctor. . . if it's possible, I think you should talk to your doctor, but avoid the use of any negative terms like "addict" or "addiction." You have ADHD and SAD, and you need the medicines you're taking. Tell him you feel that they have helped you tremendously, but it seems as if the Paxil might be counteracting some of the benefits of the dexedrine. Or, you could say you think you might need more dexedrine or perhaps a different stimulant for a few months to prevent "Poop-out." You can do a little bit of research on ssri depletion of dopamine and present the information to your pdoc, who should know that anyway. Stop thinking of yourself as an addict, either by yourself or in front of others. You don't need to apologize for your "incorrect chemistry."
Try to think positively. Remind yourself of how far you've come through your own valiant efforts. Stop the negative thinking and don't fall into the trap of using those damaging diagnostic labels. Diagnostic labels are for the imbeciles who work at health insurance companies. They are for people who are incapable of "thinking outside the box" or incapable of thinking at all. You have a bright future. You might have to try some new antidepressants and spend some "drug holidays" away from dexedrine, by trying other stimulants or taking days or weekends off from dexedrine. You are obviously a very resourceful person, and you will find a solution to this problem.
poster:sb417
thread:309006
URL: http://www.dr-bob.org/babble/20040204/msgs/309193.html