Posted by Ame Sans Vie on March 28, 2004, at 19:19:04
In reply to Re: Xanax XR vs Klonopin, posted by utopizen on March 27, 2004, at 17:49:33
> Not to dwell on your very determined regimen of taking amphetamines at 20mg/day beyond the PDR daily dose that is recommended,....
60mg is the max dose recommended by the FDA when amphetamine is used to treat narcolepsy. And it is pretty widely agreed upon by psychiatrists who prescribe stimulants that the important thing is, once you find a pstim that provides some benefit, you should push the dose to achieve maximum benefit from it while still lacking significant side effects. Also, there's the body weight factor -- 60mg is technically a rather small dose for someone my size.
> ...or that many of the symptoms you describe are potentially "negative symptoms" associated with a state of schitzophrenia, a very severe disorder that you may or may not have yet could receive benefit through a trial of Abilify over--
The symptoms more perfectly match a profile for atypical depression, several anxiety disorders, and mild-moderate ADD. I've never experienced episodes of strangely altered thought process, flat affect, etc. Antipsychotics just don't agree with me, and in my opinion, should never be taken unless a psychotic/manic condition is apparent. You know what they say -- if it ain't broke...
And I can quite honestly say that it hasn't been "broke" ever since the switch from DextroStat to Adderall XR.
> Kava is extremely toxic on the liver. My p-doc was the one who came out with this FYI to the new media in 2000. Please be careful, and let your doctor know of everything you're taking.
My doctor is very aware of all remedies I take --he and my nutritionist work in tandem in that regard. Regarding the kava, I suppose I should have specified that I only drink it occasionally, as a substitute for alcohol, along with a blend of well-established potent liver tonic herbals. I definitely wouldn't drink it everyday.
> And given your hyptensive condition, I would be concerned to take as many herbals as you list, if you were me, IMHO. Simple flowers have magical powers.
Well, one other thing I should have made clearer is that the long list of herbs I posted is just what I currently have in my cabinet. Naturally I don't take them on a regular basis -- they're simply alternative treatments that, for example, can act as external or internal antibiotics/antivirals, laxatives, metabolic stimulants, nervous system tonics for extreme stress or anger, etc. And many of them have at least a mild antihypertensive property to boot. I've been monitoring my B/P five times daily, and it seems to do just fine. In fact, my doctor advised me just today, after hearing my recent readings, to begin taking only a half-tablet of Avapro daily. My hypertension was only mild to begin with.
> But taking 60mg of Adderall when you have a hypertensive condition, then combining that with an urinary alkanizer?
Apparently it's the Adderall that's causing the mild hypertension. I never had it before. I figure so what if I have to take an additional medication to combat that side effect so long as I am actually a fully-functional human being.
>Besides the fact that some Xantac is far more hi-tech at doing this than some Alka-Selzter,
Ranitidine is an H2-blocker... it alkalinizes the gastrointestinal tract, but not the urine. I've looked into this. Same goes for Tagamet (cimetidine) and Pepcid (famotidine).
>and that I do it now and then, um, have you tried switching to a different stim, like Desoxyn, instead of trying to possibly go all-for-nothing on a stimulant that might not be the best choice for you, hence the need for you to take 60mg?
I gave Desoxyn a try, but Medicaid will only pay for 100 immediate-release amphetamines per month. In my case, that pays for 11 days worth of the amount of Desoxyn that truly helps, and paying such an ungodly amount for the rest is just financially out of the question at the moment. Perhaps if Able Labs' methamphetamine HCl is affordable, I'll switch, but that's still up in the air as I feel Desoxyn and Adderall are both very helpful to me in somewhat different ways. I think my body's grown used to the Adderall and I don't know if it makes sense to rock the boat at this point.
While on the subject of finances and meds, I just want to say real quick that the Medicaid limits on amphetamines are what prompted my doctor to finally endorse the urinary alkalinization thing so as to keep my dose affordable (Medicaid covers 30 extended-release amphetamines monthly, so I still have to pay for half the prescription out-of-pocket).
> The fact that you're on Adderall for a host of issues concerns me. I started Adderall two years ago at 40mg/day in two divided doses. Now I don't respond to it like I use to, and I barely respond to the Desoxyn I get prescribed at 50mg/day, and use to fare quite well if not better at just 20mg/day last spring to it. I of course take it for sleepiness, but I'm suspecting I've actually got depression. And let me tell you, after awhile, it stops working for depression, fancy NMDA modulating augmentations or not.
Well, poop-out is a phenomenon seen with many psychotropic drugs -- it doesn't necessarily indicate a buildup of tolerance to the amphetamine effect. NMDA-antagonists *are* extremely effective in combatting tolerance -- so much, in fact, that several new narcotic/dextromethorphan preparations are about to hit the market (e.g. MorphiDex [morphine/DXM]). But not everyone responds to everything, and I'll just stick with what works and keep my fingers crossed that things continue on the path they have the past six or so months.
> Treat your underlying issues while you still can with a light antidepressant+some Abilify at a low dose for a couple of months, maybe with or without Straterra, perhaps Provigil as well.... if you want to.
The vast majority of antidepressants are all an absolute no-no for me, except for Prozac which really didn't seem to do a whole lot of anything at all; I already gave my opinion of unnecessary neuroleptic administration above. Provigil is something that I just gave another shot and it didn't do a thing for me this time around... Strattera is still an option, as are Edronax, Aurorix, and Stablon. But once again, I'm just not comfortably putting yet more drugs into my body at this point when I seem to have achieved a sort of homeostasis.
>You've been on the benzos for awhile, that's not an atypical thing. But even at 8mg, how cool and collected can you possibly be if you feel the need to augment it with Kava, or have insomnia?
Well I already explained my kava use above; as for insomnia, it's a distinct disorder, separate from my anxiety/phobic issues. The Klonopin simply doesn't address it, and lately since I've been in ketosis I've rarely felt the need to take Seconal or Somnote.
>I'm not judging, but do you exercise? I don't, but I'm about to next week. It's not like these don't have side-effects--if you can do something for your depression and insomnia through exercise, I'd take that idea seriously, but it's up to you. Remember, walking just 20-25 minutes 3x/day is just as helpful to your stress as running, so don't get intimidated. And if you exercise, insomnia may be treatable easier with less powerful agents.
I just started exercising again last week when my nutritionist and I decided it was time to really restrict the carbs down to zero for a bit. I just wake up with so much *physical* energy that I have to go for a quick jog at 5:00AM and then perhaps lift some weights in the afternoons. Believe it or not, I really *am* hoping (and quite confident, I might add) that this healthy lifestyle will allow me to decrease dosage and/or eradicate certain medications from my regimen completely.
> Are you combining this with CBT? I'm concerned, you sound like me a year ago.
Well, I've failed many forms of talk therapy before (CBT included -- several times), but my psychiatrist himself is making me sort of a "special case" and providing CBT for me during my regular appointments.
poster:Ame Sans Vie
thread:328918
URL: http://www.dr-bob.org/babble/20040325/msgs/329581.html