Posted by Sarah T. on July 25, 2005, at 2:30:31
In reply to Re: Dexedrine questions » Sarah T., posted by KaraS on July 22, 2005, at 14:15:21
> >> > > 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: Hi Kara. I'm sorry it's taken me so long to respond. I've been very busy and very tired lately. Among other things, this weather is really getting to me. Anyway, I think that the immediate release dosing can probably help approximate the dosage for sustained release, but I don't think you can judge exactly. Like almost all of these psychiatric meds, I think you just have to start at the LOWEST dose possible and slowly work up to a dose that feels right for YOU.
> 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: Oh, yes, I've had doctors like that. They seem to have these standard lines, which may have some element of truth. I don't agree that if you're on the right meds, they won't poop out on you. I think nearly all psychotropic meds, not just stimulants, poop out eventually for most people. I have met a few people here and on other boards who've managed to stay on stimulants many years without pooping out. If I remember correctly (and I apologize if I'm wrong), I think Fachad and possibly Viridis have been on some stimulant for many years without any poop out. I don't think they had to raise the dose much at all. But I think Fachad and Viridis are men (again, I apologize if I'm wrong about that). The reason I mention their gender is that, as long as they're not abusing stimulants and/or as long as they're being really careful about trying to stave off poop-out, men seem to be able to get more months or years out of stimulants, especially when compared with women of a certain age. I believe that estrogen and its effects on neurotransmitters greatly influences how women respond to stimulants.
> > > 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: If you are able to combine stimulants with an antidepressant, I think that would be the best solution. Unfortunately, due to my inability to tolerate polypharmacy, I've been unable to find a good AD + stimulant combo, but that doesn't mean you can't find one. Although you and I seem to have many similar reactions to medications and our diurnal rhythms are similar, we are still different. So, please don't assume that you can't tolerate something just because I couldn't.
>> > > 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?ST: I'm almost certain that they can be combined. Do you know Noa? She has posted here for years, but I haven't seen her around much lately. I know that she was on Effexor + Serzone + Adderall for a very long time. Prior to taking Adderall, I think she was on another stimulant, possibly some form of methylphenidate. I think she gained a lot of weight from Effexor, but I do believe it helped her mood and life in other ways so much that she decided to stay on it. I shouldn't be speaking for her, so I hope I haven't misinformed you. I'm just relaying the impression I've gotten from many of her posts. Oh, she also took some thyroid meds.
> 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 still haven't figured that out yet. It's so odd because about 69 or 70% of Adderall is dextroamphetamine. Only a small portion is dextroamphetamine sulphate, which is the same as Dexedrine. There are a few other dextroamphetamine salts in Adderall (dextroamphetamine combined with counter-ions other than the sulfate ion), but it's still dextroamphetamine. Then there's some levoamphetamine and some of the racemic mixture. I believe that the reason I have difficulty with it is either due to the levoamphetamine, which is known to have more peripheral effects (tremors, palpitations, etc.) and/or the dextroamphetamine salts other than dextroamphetmaine sulfate are too insoluble for me, so they don't dissolve thoroughly in my body, or perhaps they dissolve too slowly.
> > 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...
ST: There may have been several reasons for the extreme difficulty I had that one time. There were a lot of other stressors in my life at the time and, probably more important, I wasn't able to exercise as often as I usually do during that 8-week stretch. Exercise is a very important component of my antidepressant regimen. In fact,in many ways, I believe it's been the best and most reliable AD I've even "taken." It's just not enough. I'd say that exercise is a critical adjunct or augmentor of other antidepressants and, for me, the exercise has to be fairly rigorous in order to work as an AD. I have to swim or run and get my breathing and heart rate up. Although walking is an excellent exercise, it just doesn't do anything for my mood.
As I said the other day, if you're going to go off stimulants for more than a few days, I really think it's best to take an AD during that time. And if you're going to get off of stimulants for more than a few days, whether you take an AD or not, it's probably best to start the withdrawal when you are on vacation so that the worst part of the withdrawal (the first few days to a week) can coincide with when you don't have to be at work or school anyway. I know this all sounds very complicated, but, you know, I think it's pretty much the same for any psychiatric med withdrawal or start-up. I have to say that I get a bit impatient with people who stigmatize stimulants, stimulant withdrawal and stimulant neurotoxicity. Look what Paxil does to many people. I know people who got off of Paxil months or years ago, and they're still having brain zaps and all sorts of other horrid problems. Look what Zoloft does to so many of us. Before I started Zoloft, in spite of my depression, I had a healthy sex drive and ability, and I never chewed my cud/cheek. I was on Zoloft for 1.5 years, and I've been off of it for about six years. After six years, I still don't have the sex drive I had before Zoloft, and it wasn't until this year that my cheek chewing finally subsided. I had to spend $600.00 on a dental mouth guard because of what Zoloft did to me. Amphetamines never did that to me. SSRI's did.
>>> >> KS: 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?ST: I took Wellbutrin for a long time (years), and then I took it again during one of those two-month stretches when I got off of Dexedrine. The first time I took it, I thought it was the "least of the evils," but when I tried it again, I found it very agitating. It always gave me a lot of insomnia, both times. I am unable to combine stimulants with Wellbutrin, although I did try. For the first day, I felt OK, but after that one day, I started to feel horribly ill. I had high blood pressure, but I also felt ill in a way I've never felt before. It is difficult to describe how sick I felt on that combination, and I was scared enough that I never tried it again. I have come across several people on this board and on other boards who've successfully combined Wellbutrin and Dexedrine and Wellbutrin and Adderall! That always amazes me that ANYONE could tolerate that combo. I'm also stunned when I meet people who take stimulants plus Provigil.
Regarding MAOI's, I tried Parnate a few times. The only times I've ever exhibited any psychotic thoughts were on Parnate. I've met a few others here who've also had "weird" or bizarre thoughts on Parnate. I won't take it again. Oh, Parnate also made my circadian rhythms even whackier than they already are. That problem was helped when Ritalin was added, but the "weird" thoughts were an unacceptable side effect.
> 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.ST: I know what you mean, and I'm angry that my pdoc didn't help me try to prevent tolerance, but it may be because he has never been through that himself; I don't know. I think some of these guys may have taken stimulants in college or medical school to get through a rough stretch, and then they probably got off the meds and "crashed" for a weekend and never took the stuff again. They probably don't have the personal experience of taking it for months or years, so they have no idea what that's like.
Oh, that reminds me. . . Another way to stave off tolerance is: DON'T use the medicine to mask fatigue. DON'T use it to cram for exams without sleeping, and DON'T use it drive across the country in a couple of days. Use it as you would an antidepressant. Make sure you get PLENTY of rest and eat really healthfully. I wouldn't use it to lose weight either, although I know there are a number of people who want it primarily for that purpose. Dexedrine never suppressed my appetite much, although Adderall did. That's another reason I don't like Adderall. I don't think it's healthy to have my appetite suppressed to that degree. I can't stress enough how important it is to eat healthfully, get lots of rest, stay well-hydrated primarily with water, and take days off from the meds whenever you can. Take the medicine one hour before, or two hours after, meals, and if you're going to have very acidic foods, orange juice or vitamin C, take them at night before bed, when you want the dexedrine to wash out anyway.
>> >> 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. > >
ST: I'm sorry to say that I think ALL of the currently available antidepressants and stimulants are limited solutions, but it's all we have right now.
poster:Sarah T.
thread:530246
URL: http://www.dr-bob.org/babble/20050723/msgs/533141.html