Posted by Ritch on January 19, 2005, at 13:44:51
In reply to Re: Adderall tx for Atypical Depression » Ritch, posted by Ron Hill on January 19, 2005, at 10:55:55
> Mitch,
...
> Unfortunately, the Adderall caused severe insomnia (2 hr sleep per night)immediately, and within four days I was in a full-blown mania. The cause of the mania was two fold: 1) the Adderall induced insomnia and; 2) The amphetamine directly.Wow! you really had a serious spinout there! Yeah, 10mg is too high too start off with a potentially serious risk of inducing mania from the getgo. It is tough to tell what that stuff will do (at least you can find out relatively quickly!).
I started at 5mg first thing in the AM and I was only taking some Neurontin with it.. that's it. No Depakote, lithium, anything that is supposed to be an "antimanic" med. I *was* beginning the usual seasonal depressive thing, so I wasn't taking it at a time where manic sx tend to predominate anyhow. I slept like a ROCK.
When I was taking Ritalin (10mg/day) or Dexedrine (5mg/day) I never had any sleep trouble. To me stims seemed to work out my brain and tire it and when bedtime came I SLEPT. When I took dexedrine I actaully felt somewhat tired and drowsy feeling and my forehead seemed as hot as an iron.
When I want to get "high" on something, all I have to do is take an extra pinch of an SSRI! That's the stuff that sets *me* off. Just like weed.
The negative effects that I got from pstims were: 1) sometimes overfocused and aloof, cold personality, 2) occasionally an exaggerated sense of interest in something... REALLY!, that's INTERESTING!, 3) A worsening anxiety scene over time (without a pinch of SSRI/Eff. +a little clon). I kinda think that I truly have a comorbid ADHD condition. I felt just a slight bit of euphoria a day or two starting up any stim, but very quickly there was zero euphoria from them. I could get "excitable" on them, but NOT euphoric... OK that's the distinction with me. It is difficult to explain, I was *interested* in stuff and worked one thing at a time, but wasn't HIGH. Very strange.
...
> Don't get me wrong, I have a very good pdoc. He just made a couple bad calls. The other bad call was to start me out on 10 mg/day when we should have started with 5 mg/day. We all make mistakes, and I can forgive. I just wish that these pdoc's would listen to us patients a little better.
>
> To bring you up to date with regard to my Adderall trial, two weeks into the trial the pstim caused burnout. My symptoms of burnout are physically drained, increasing amounts of sleep required to recover physically, aches and pains (flue-like without the runny nose and/or cough), etc.
IMO, I think you should have just just halved the Adderall on the second day and checked what happened. If you had trouble after a couple of days on the lower dosage I would have dx'ed it. I've been hounded for self-discontinuing as well. But, I can TELL when something is going seriously awry.. especially if it is immediately triggering hostile/mixed/manic symptoms.
>
> These symptoms are distinctly different from the atypical depression symptoms of increased sleep, low energy, etc. I'm not able to articulate the symptoms of burnout very well, but trust me it's very different from the simillar words that I use to describe atypical depression.I think it triggered a mixed state. Or what many folks would call an agitated depression. I have two different "flavors" of depression.. the 'atypical' one where I sleep and eat too much and the other where the anxiety is like an air-raid and I have sleep disruption and am agitated/angry as hell, no appetite.
> So back to the story at hand. One week ago I discontinued the 5 mg/day of Adderall and I left a v-mail for the nurse asking her to tell (not ask) the pdoc that I had to discontinue the Adderall trial due to burnout. I didn't hear back from his office, but I'll talk to him at my next appointment next week.
>
> I was deeply regreting that I had to discontinue the Adderall because it had helped me so much initially and because I expected a huge rebound depression from the discontinuation. But to my suprise, the antidepressive effects are continuing even still, one week later. No hint of depression. Some hypomania, but I can chase it down with extra Trileptal.If something is irritating or agitating you and you stop it you can get an antidepressive effect by stopping the offending substance. Your reaction to stopping Adderall is the reaction I've gotten (for a few days or so) after stopping Wellbutrin when it gets too agitating.
>
> From a pyschopharmacological standpoint, it makes no sense at all to me that the antidepressant effect continues for me after discontinuation. The half-life of Adderall is 13 hours, so it's gone by now! So my plan at this point is to use Adderall on a prn basis and to take it as infrequently as possible and for short durations. Time will tell.Yep, it's gone by now, but your receptors are re-regulating from stopping it.. I'm wondering whether ever using Adderall might be a good thing for you. I would suggest trying 5mg dexedrine (cut it in half take it twice a day) instead if you want to pursue stims again. That way you can get a definite crash after six hours or so.. you shouldn't be staying up on that one... if you do.. WARNING.
>
> > Yes, there is something weird about Depakote that I don't like regards sleep. It seems to *aggravate* sleep maintenance troubles I have. ... I liked Trileptal or lithium because I could take a dose at bedtime and it would put me out right.
> Mitch, do you take magnesium at bedtime? I take 750 mg of magnesium malate every night at bedtime. It really helps my sleep (going to sleep, staying asleep, and sleeping sound. Along with it, I also take 10 mg of P-5-P (co-enzyme B6) to help the magnesium do its thing, and I take 1/2 tablet of a B-100 (B-complex) so that the Bee's don't get out of balance by taking the P-5-P. The Bee's can get angry if they get outta balance. :-)Ron, I've been down the B'vits, etc. route and did try magnesium and it simply upset my stomach. It seems that MEDS are causing a circadian sleep disruption of some kind.. I'm trying to mitigate the source of the disruption instead of trying to treat it as much.. haven't found much that really helps to treat it. The only supps I've found to be helpful is folic acid (I stopped losing hair on Depakote!), a little fish oil (and I'm even a little doubtful on that one).
>
> > I get clearly depressed on Depakote if I take it during a depressive episode in doses exceeding 250mg/day. You know, here's something I've been wondering about a little: Effective antimanics are associated with effective PKC inhibition, but I think brain norepinephrine levels are reduced as some downstream consequence of this...and if they aren't corrected during a BP depression an antimanic might actually worsen it.. SO I've found that a low dose of a stim or a little Strattera or nortript. whatever seems to be the right thing to counteract the antimanic's depressogenic tendencies.. just thinking out loud a little.... Mitch
>
> Exactly!! I don't know about the mechanism, but that's why I like to decrease my Lithobid and Trileptal dosages when I cycle into a depressed phase because I'm convinced that these moodstabilizers make the depression worse. Of course, when the depression abates, I have to increase these dosages to keep my hypomania in check. But this dosage adjustment is what my pdoc is complaining about. Go figure.
Yeah the conventional wisdom with antimanics is to maintain the dose all the time at the level that is effective for the worst manic sx and then just toss plenty of antidepressants onto the smoldering bonfire when the flames are about to go completely out :) I understand the reasoning, I just don't think all the truth is known just yet about how they effect the depressive phases.... Mitch
poster:Ritch
thread:441138
URL: http://www.dr-bob.org/babble/20050119/msgs/444244.html