Posted by kingcolon on May 17, 2010, at 13:39:29
In reply to Re: Need strongest stimulant suggestions » hrguru, posted by juanantoniod on May 13, 2010, at 16:22:35
I am using buprenorphine (Subutex) for TRD, but I also had a history of opiate abuse many years ago. I believe many opiate addicts self-medicate depression with opioids. Buprenorphine provides the unique benefit of an antidepressant effect without the abuse potential of opiates. I experience no euphoria whatsoever and use small doses, eg, 2 mg daily. This is the only med that has helped me and I'm now continuously euthymic for over 2 years. I suffer from fatigue for a number of reasons, among which may be that I'm taking some meds that can cause this (buprenorphine, Lyrica (for anxiety), Zoloft) but I also have always had a lethargic type of depression and it is known that some people remit from their depressions psychically, but still have residual fatigue or apathy. Recently, I have tried several stimulants. Provigil and Nuvigil weren't very helpful. Ritalin made me irritable and anxious. Adderall made me tired!! But now, finally, I'm on dextroamphetamine, 10 mg twice a day, and have experienced significant relief of the fatigue as well as some mood improvements. I've done a lot of research on tolerance to stimulants. There is evidence that NMDA inhibitors such as memantine, dextromethorphan (as in cough syrup), and magnesium reduce tolerance to opioids as well as stimulants. There is a lot of info on this site about these agents if you search for reducing tolerance to stimulants. I myself am using memantine, 20 mg daily as "prophylaxis" against development of tolerance, as I have a history of high tolerance to both opiates and stimulants from years ago. Interestingly, I seem to have a high tolerance for Adderall, but not for dextroamphetamine sulfate as a single agent. So far, the 20 mg daily of dex seems to be continuing to work and I'm very happy with the improvement in my fatigue. I hope it continues. In any event, I'm never going to take any more than 40 mg of dextroamphetamine a day as I think the higher you push the dose, the worse the side effects (like anxiety)and the more likely risk of dependency, and I don't intend to revisit my past indiscretions. Also, I am finding that dex seems to last longer than methylphenidate and I've not needed extended release as yet. If Adderall doesn't work out for you, you should consider trying plain dextroamphetamine.
poster:kingcolon
thread:947032
URL: http://www.dr-bob.org/babble/20100514/msgs/947683.html