Posted by KaraS on July 22, 2005, at 14:15:21
In reply to Re: Kara, . . . » KaraS, posted by Sarah T. on July 22, 2005, at 1:40:17
> ST: Regarding Klonopin, do you mean 0.25 and 0.5?
KS: Probably.
> 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: But you can't really judge from the immediate release how strongly a dose of sustained release will be for you, can you?
> 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: Makes sense. In this case, I'd need the Klonopin daily though.
> 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: 4-5 years isn't a long time especially when you consider that you took long drug holidays in between. Makes me wonder if you hadn't done that how little time you would have gotten out of the Dex.
> 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: The reason I asked is that I have a feeling when I ask Dr. E. about the tolerance issue, that he will say something about my needing the drug so it won't happen. I may be wrong but he tends to have this view that when you get on the right meds, that they don't poop-out. But that obviously isn't the case here. I'll have to talk to him about it. (Also, I have CFS (episodic) which also contributes to my cognitive problems.)
>
> 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: I'm a complete sloth on weekends as it is so it couldn't be much worse but this isn't a great solution for me to still have so much dysfunctional time.
> 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.KS: According to Dr. E and from my experience, SSRIs haven't done much for me. Effexor helped with mood somewhat. I'm wondering if I could take it with a stimulant. I'd stay at 150 mg. or lower so the amount of NE would be minimal. Can they be safely combined? I doubt Dr. E. would even give me a script for Effexor based on my test results. I'm just thinking out loud here. I don't have any serious thoughts about restarting on that yet. I'll have to look for your conversation with Gabbii and do more searching for info on this topic in the archives.
> 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: Isn't that strange how you could react so differently to the Adderall? Maybe it's just not a good match for you.
> 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.
KS: I wonder why you didn't have that much trouble stopping Dex most times but that one time it took 8 weeks and it was total hell. How would I be able to hold down a job while going through that kind of a withdrawal? I wonder what AD I could take that would help me enough with withdrawal given that they haven't helped me much in the past anyway...
> 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: Interesting. I couldn't tolerate Celexa, Prozac may have given me a good month or so and nort. gave me tachycardia. When I started on the nort, probaby because of the tachycardia, I had a lot of energy. It felt great. I went off of it because I wasn't on a large enough dose and yet my pulse rate was about 100 bpm. I wonder if I had taken a beta blocker whether I would still have had that energy and drive. Have you ever tried Wellbutrin? That can't be combined with stimulants, can it? I know you've taken at least one MAOI and weren't that thrilled with it. Did it or they not help enough with depression or were you just not able to stand the side effects? What are you taking now?
> 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.
KS: I do think he's good in many ways but I think that one of his failings is that he's too optimistic. I think he should have spoken to me about tolerance and trying to prevent it.
> 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.KS: Thanks again. Right now I'm feeling discouraged. I think this medication is probably going to be a good match for me but it's such a limited solution. I'll definitely keep you posted.
Kara
poster:KaraS
thread:530246
URL: http://www.dr-bob.org/babble/20050718/msgs/531621.html