Posted by Sarah T. on July 22, 2005, at 1:40:17
In reply to Re: Kara, a question. . . » Sarah T., posted by KaraS on July 21, 2005, at 19:24:10
KS: > > > Hi Sarah,> > Thanks so much for all of your valuable information. It's so HELPFUL!! In my relief to get diagnosed and prescribed, I hadn't even thought of the poop-out factor of the dexedrine. My starting dosage on the Klonopin is either 2.5 or 5.0 (if I feel I need it) twice a day while I decrease the doxepin.
ST: Regarding Klonopin, do you mean 0.25 and 0.5?
KS:> I really wish I could start on a lower dosage of dexedrine to try it out - to make sure that it doesn't send my heart into a tailspin and make my anxiety a hundred times worse. (I also wish I weren't such a wimp.)
ST: I don't think you're being a wimp at all. I think you're just being careful and a bit apprehensive. I'm that way whenever I try a new medicine. If you really want to try Dexedrine at a lower dose, why don't you ask your doctor for the Dexedrine 5 mg tablets? They are scored, so you can cut them in half. I've even cut them in quarters. The name-brand tablets cut and break fairly well without too much crumbling. If I remember correctly, when I tried to cut the generic version, it created too many crumbs and dust, so a lot was wasted. That was another reason I didn't like the generic.
KS:> > Do you think that 5 mg. could really be very stressful for me or just provide a mild stimulation?
ST: I don't think 5 mg should be that stressful, but as I said earlier, I'd be very careful about combining it with Doxepin. I feel I have to say that, but at the same time, I realize that I'm projecting my own problems and fears onto you. I have extreme difficulty with medication combinations, and I've learned through much trial and error (mostly error) to start medication combinations very slowly at low doses. One thing I've done occasionally when I've been worried about a potential problem with a drug combo is to take the meds on alternate days. I'm a very slow metabolizer, so I figure that if I can't tolerate them on alternate days, then I won't be able to tolerate them on the same day.
KS:> Do you mind if I ask you how long you took the Dex?ST: Well, I took it on and off for four to five years. There were several long stretches when I didn't take any medications at all, or I tried other medicines (instead of Dex). A couple of times, I had to prepare for a SPECT or PET scan or other medical testing, and I was advised to get off all meds for those. For the SPECT, I was off all meds for over a month, I think, and then I stayed off all meds for another few weeks, just to see how long I could go without anything (masochist that I am).
KS:Do you have any attentional deficit issues that have been diagnosed or that you just suspect you have?
ST: Yes, and these were confirmed on SPECT and PET and through neuropsychological testing. I also have another medical condition that contributes to my depression and cognitive problems.
KS: Did you also not use it on weekends to help prevent the tolerance? If so, were you a complete sloth on the weekends? I am that way now all of the time so if it were just on weekends it would be an improvement.
ST: I tried not to use it on as many weekends as possible, but it wasn't always possible. Also, as I said above, I went for several long stretches when I took no meds or I took an AD instead. I was a complete sloth on the weekends when I took drug holidays from stimulants for just a day or two, but when I took weeks or months off, I found that I started to function after about five days. The first few days were very difficult and, in addition to not getting anything accomplished, I got horribly constipated. During one of those long stretches when I got off Dex and took no meds, I felt as if I had severe PMS every single minute of every single day for eight weeks. That made me wonder whether, for some women, PMS is similar to drug withdrawal as far as low levels and/or depletion of certain neurotransmitters.
KS: How long did it take for it to stop working for you? Have you tried Adderall or Ritalin? Would either of those work after Dex fails or are they too similar?
ST: I have to think more about this one. It didn't stop abruptly. I'd say the only abrupt change was when I made the terrible mistake of adding Celexa to the Dexedrine. Within a few weeks of adding Celexa, I had to DOUBLE the Dexedrine dose in a futile attempt to counteract the fatigue and apathy caused by Celexa. I do know a few people who've successfully combined stimulants and SSRI's, and they've been maintained on that combo for years. In fact, recently, I communicated on this board with Gabbii, who has had a long, successful run on that exact same combo (Celexa plus Dexedrine). For me, that combo was not good. As I said, I had to double the Dex, and it was never quite the same after that, even after I got off of Celexa. I did stay on Dex for a long time after that, even though I didn't benefit from it as much as I had before the Celexa.
I've tried both Adderall and various forms of methylphenidate/Ritalin. I think Dexedrine is better, but you'll find some people here who like Adderall better. I don't think I could take Ritalin as monotherapy. I'd have to find a darn good antidepressant to combine with it. I felt kind of depressed on it. I am very quiet and focused on it, but my mood is terrible. As for Adderall, I wish I could get that to work for me. Perhaps I didn't dose it properly. Some people say the dosing is the same as Dexedrine dosing; others say that you have to take a bit more Adderall than Dexedrine. I found Adderall's peripheral effects to be very troublesome (tremors, palpitations, more anxiety and fear). Another thing that bothered me about Adderall is that, ordinarily, whether I'm on a medication or not, I don't care that much about what other people think of me. I don't worry about it, but when I was on Adderall, I was VERY self-conscious and overly concerned with being accepted by others, pleasing others. Not only does this seem anti-therapeutic, but it's contrary to what we often hear about amphetamines. Amphetamines may give some people a false sense of confidence, but on Adderall, I had no confidence. I became withdrawn and fearful. It's possible I took too much. I just don't know. I might try it again someday.
KS:> I am wondering if maybe we don't have similar brain chemistries. I know we've talked before about TCAs but I don't remember what your experience has been on them. Have you tried desipramine? Dr. E. mentioned that Wellbutrin, and possibly desipramine, would be the only antidepressants he'd recommend for me. I don't like thinking how few options I have if/when the Dex stops working.ST: I don't think Dexedrine will stop working completely for you. It may lose some of its effects, but since you know now, at the beginning, how to combat some of the poop-out, you are in a good position to try to counteract that as much as possible. I do think it's good to take both short and long drug holidays. I will say that not taking any meds for more than a couple of days is tough and probably a bad idea UNLESS you HAVE to get off of everything for a SPECT scan or for surgery or something like that. If you want to get off of Dexedrine for a while (more than a few days), then it's probably best to take an AD.
Yes, I have taken desipramine. I took it a long time ago, and I thought it was OK, but imipramine was probably better for my mood, although it had more annoying side effects. As for Nortriptyline, I could never get the dosing right, probably because of that "therapeutic window." Physically, I felt better on Nort. than on Imipramine, but I didn't do ANYTHING while I was on it. I also didn't do anything for the eight weeks I was on Prozac. I know we're not discussing Prozac, but I just thought I'd mention that because the effects on me were similar to Nortriptyline's effects. In fact, I would say I was more of a slug on Prozac, Celexa and Nortriptyline than when I took drug holidays from Dexedrine!
KS:> I am going to bring up the tolerance issue with Dr. E. soon. He gave me his cell phone number in case I have any questions. That's something I like about him - but for what he's charging, he should be available 24/7. Take care, Kara >>
ST: Your doctor does sound good. I have to say that I didn't get much help regarding tolerance from my regular pdoc. Actually, I got more help from Psychobabble and from a few other boards and from my own reading. Unfortunately, I had already developed some tolerance by the time I got around to doing my "homework" on this issue. I really wish I'd been helped more by my pdoc.
I think you'll do well on Dexedrine. It may take a few days or weeks of experimenting to find the right dose and to decide on generic vs. name-brand and tablets vs. Spansules. Some doctors will prescribe both the Spansules and the tablets to their patients so they can have the option of taking one or the other. Some people take both. For example, some people take the immediate release tablet in the morning and then take the sustained release a few hours later. Some take the SR first, and then take the tablet later in the day. Eventually, you'll get to know what's best for you. Please let us know how you're doing.
poster:Sarah T.
thread:530246
URL: http://www.dr-bob.org/babble/20050718/msgs/531386.html