Posted by KaraS on July 25, 2005, at 14:51:13
In reply to Re: Dexedrine questions » KaraS, posted by Sarah T. on July 25, 2005, at 2:30:31
KS: Sarah, please don't feel you need to respond to this right away. Days or even weeks is fine.
> 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: To be fair, I'm not certain that Dr. E. feels that meds won't poop out if they're the right ones. I'm getting the impression he may feel that way based on other things he has said. That's interesting about estrogen influencing stimulant response. How does a lack of estrogen factor in here?
> 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: The trouble is that most ADs do very little for me. The SSRIs controlled my anxiety well but didn't do much for mood. Effexor was best for mood. It helped maybe 50% but I'm not sure it would work again. Also, since going off of it, I am now ultra sensitive to starting on SSRIs. I used to have no problem with that but now even little amounts feel like akathisia. Plus Dr. E thinks the SSRIs aren't good for me. Going on a TCA is contraindicated so that doesn't leave much. MAOIs are tricky with stimulants too.
> 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: Of course it's nice to understand why but the bottom line is that it doesn't work for you.
> 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.KS: Exercise works for me in the short-run but it doesn't last long. I'm glad that exercise helps you and that you're able to motivate yourself to do it.
> 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: I agree. The dangers or side effects of the SSRIs are downplayed too much and those of amphetamines and benzos are over-emphasized. Is it possible with the Zoloft, that by the time you went off of it, your hormone levels were a lot lower and could account for at least part of your decreased sex drive?> 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.
KS: Some people seem to react a lot less to stimulants and Wellbutrin - to NE/DA in general. It doesn't take much to shoot my pulse way up and keep it there so I'm quite certain I wouldn't be one of the ones who could tolerate Wellbutrin plus a stimulant.
> 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: That is really strange. How unfortunate for you. Dr. E. said that he didn't think I would be a good candidate for an MAOI because it increases voltage and I am already too high voltage in some parts of my brain. I wonder what increasing the voltage does to someone like me. Could it possibly produce the kind of weird thoughts you're referring to? I'll have to ask the doctor. I always wondered if an MAOI would actually correct my circadian rhythms. What a disappointment to know that it actually made yours worse. You've never tried Nardil though, right? Perhaps after your Parnate experience you have no desire to take another MAOI.
> 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.KS: Yes, but this is what they get paid good money to know!!! They have seen others go through using stimulants and they have studied it in medical school so it's not enough to let them off of the hook because they may not have used it regularly themselves.
> 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. That's extremely helpful to know!!!
I don't drink nearly enough water. I'll have to work on that. I'm sure I need to get plenty of protein too. The vitamin C I take is in ester form so maybe that wouldn't be too detrimental. I'll take them separately to be careful though. I wonder if taking l-tyrosine to provide the building blocks would be a good idea. I've taken huge doses of it before and it didn't give me a racing heart or any noticeable effect. Given my sensitivity to NE, I wonder if something wasn't working along that pathway (other than the rate-limiting enzyme). So I don't think taking l-tyrosine would be a dangerous combo for me but it probably wouldn't do any good either. I'm assuming it won't be a problem to take my thyroxine along with the dexedrine? It's so hard to find time when I have 3 hours without eating any food. :-)> 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.
KS: Very true.
I hope you're feeling better and less stressed soon. Take care of yourself and, seriously, there's no rush in responding - esp. since you've already given me the all of the critical information on the dexedrine.Kara
poster:KaraS
thread:530246
URL: http://www.dr-bob.org/babble/20050723/msgs/533277.html