Posted by Ktemene on August 4, 2004, at 16:04:48
In reply to Ritalin's Diminishing Returns, posted by University on August 3, 2004, at 23:18:34
Do you have ADD/ADHD as well as depression? My pdoc told me that your reaction to
Ritalin, being able to fall asleep after you have taken it, is typical of people who have ADD. I have ADD, and can take 10 mg Adderall and fall asleep if I want to. Doses of Adderall over 20 mg don't make me feel euphoric and wired, they just make me feel irritated.My experience was that amphetamine did not help much at all with drowsiness, although it does help with focus and concentration. Provigil on the other hand did help make me less drowsy, and improved my concentration as well, but even at the 400 mg maximum dosage of Provigil I was still struggling with excessive daytime sleepiness. You mentioned that you tried Provigil but did not continue it, so I guess that it did not work for you. The meds that helped me most with drowsiness are Wellbutrin and Selegiline. You did not say how much Prozac you are taking. If it is a high dose you might try lowering the Prozac dose and adding Wellbutrin. Strattera is another med that can be added to Prozac and can increase wakefulness in some people (although it can also make some people even more drowsy). If you have already tried Wellbutrin, and it did not help, you might try quitting Prozac altogether and starting on an activating TCA like Desipramine or Protriptyline.
The med that has helped me the most with drowsiness and anhedonia is Selegiline. I only take 5 mg, but my body is so sensitive to Selegiline that even 5 mg is vastly more activating than the 450 mg Wellbutrin + 80 mg Strattera + 400 mg Provigil + 20 mg Adderall that I used to take. I mention this last because I gather that most people who have atypical depression do not have this response to low dose Selegiline. But a few people do- in fact it was by reading posters on Psycho-Babble who had had success with Selegiline that I got the idea to try it. My pdoc was a little dubious, but it has worked much better for me than the ten medications I tried before. But Selegiline probably shouldn't be your first choice. Your chances are better with Wellbutrin or a TCA. Good luck!
> I have been VERY lucky to be free from depression for over six years now--via Prozac with occasional Klonopin for anxiety. Nevertheless, I began taking Ritalin a couple of years ago, after trying Provigil, for Prozac-related daytime sleepiness.
>
> It really helps with my motivation, concentration, and mental energy. But I can take a 10mg tablet and fall asleep no problem. :(
>
> Interestingly, the only drug I have found that keeps me from drowsiness--and the desire to sleep--ironically, is hydrocodone.
>
> ANYWAY, as I knew it would, methylphenidate is not working as well. Even increasing the dose hasn't really made it as effective as before. But it does make me more jittery, and makes me have "nervous stomach."
>
> I've tried Adderall and straight dexedrine AND normethylphenidate (or whatever the other methylphenidate without one isomer is). None of these has worked.
>
> I think the onlly solution for me is frequent vacations from ritalin. Any advice?
poster:Ktemene
thread:373827
URL: http://www.dr-bob.org/babble/20040730/msgs/374085.html