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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by CarolAnn on April 11, 2000, at 18:18:09
I've been on 10 mgs. Adderall 3x per day since before christmas, and for the last couple months, the effect has been really minimal and lately nonexistant. My Pdoc has already negated the idea of increasing the Adderall dose. The problem is that I *really* need a stimulant with my AD's, for my extreme fatigue(which, without stimulants, makes the depression worse). I've read a few threads involving switching stimulants back and forth to deal with the poop-out thing. I know I can't take Ritalin, anyone have other suggestions? Also, could use advise on the best way to approach my Pdoc with this suggestion. Thanks for the help! CarolAnn
Posted by DC on April 11, 2000, at 19:03:51
In reply to Adderall poop-out, posted by CarolAnn on April 11, 2000, at 18:18:09
Dear CarolAnn,
I've been taking adderal for a couple of weeks now in combination with neurontin and klonipan and it seems to help quit a bit with energy, focus, and it allows me to work at tasks for longer periods of time. In one of the "Tips" posts, I read something about how in children the morning dose of ritalin is often much more effective than the afternoon and evening doses. The reason is because the first dose is taken after a a good night sleep, during which certain neurochemicals have a chance to replenish themselves. Apparently for stims to work best these neurochemicals have to have a chance to build up again, and they can't do that when the drug is in the system. I'm not certain about this, but you might end up getting more energy from the Adderal if you went off it for a few days or else lowered the dose. This would give your brain some time to replenish those adrenergic receptors or whatever. The other thing to consider is that sometimes stims actually become SEDATING at higher levels. This so-called paradoxical effect of stims is well known. If you take too much, you can become sort of listless and catatonic, staring off into space for long periods of time. This happened to me and I found that when I reduced the dose I actually felt more energized. But you'll probably just have to experiment to see what works best--maybe you would do better on a higher dose. But if the stims still don't work, you might try one of the more energizing antidepressants like wellbutrin, prozac, effexor, and (when it comes out) reboxetine. There is also the drug Cylert (sp?) which is used for ADD but doesn't work the same way the stimulants do.
> I've been on 10 mgs. Adderall 3x per day since before christmas, and for the last couple months, the effect has been really minimal and lately nonexistant. My Pdoc has already negated the idea of increasing the Adderall dose. The problem is that I *really* need a stimulant with my AD's, for my extreme fatigue(which, without stimulants, makes the depression worse). I've read a few threads involving switching stimulants back and forth to deal with the poop-out thing. I know I can't take Ritalin, anyone have other suggestions? Also, could use advise on the best way to approach my Pdoc with this suggestion. Thanks for the help! CarolAnn
Posted by kazoo on April 12, 2000, at 2:23:23
In reply to Adderall poop-out, posted by CarolAnn on April 11, 2000, at 18:18:09
> ... anyone have other suggestions? Also, could use advise on the best way to approach my Pdoc with this suggestion.
^^^^^^^^^^
Hit 'em up for some DESOXYN (15 mgs Gradumet tabs), and after they stop laughing, ask for
DEXEDRINE TIMED-RELEASE SPANSULES (SKB) 15 mgs, or the 5 mgs tabs. Either one will keep your
lights on nicely bright.Greetings to CarolAnn.
I remain,
kazoo
Posted by liz on April 12, 2000, at 9:27:22
In reply to Re: Adderall poop-out, posted by kazoo on April 12, 2000, at 2:23:23
Hi. This is an interesting topic to me. I've recently begun Adderall, in addition to Celexa. (It was prescribed for ADD, not to combat any effects of Celexa). I started on 10mgs 2x a day, then after 3 days, went to 15mgs. Since my pdoc requires that one check in with him after starting a new drug or increasing the dosage, I am to call him every three days when on a new dose or new regimen. I had little or no effect on 10mgs. I could stay on task, focus better, but was not "energized" in the least. When I went to 15mgs, the doctor thought I might be having some sort of bipolar or hypomanic episode as I suddenly was hyper, euphoric, with racing thoughts, big plans, etc. I thought the response was due to something besides Adderall because the smaller dose had a minimum effect. Well, I did go off the Adderall for a few days, but really hated taking Celexa by itself; I was just exhausted during the day and then had trouble sleeping at night. So I crept back on the Adderall to counter the fatigue. (I know, I'm non-compliant!) I went from 10, to 15, then 20mgs as often as 3x a day. The thing is, it finally dawned on me that it was not giving me any kind of energy boost; I was still really tired! Anyway, your discussions in this thread have been enlightening. Were you diagnosed with ADD or ADHD? Or are you taking it for some other reason? I have two boys on stimulant medication; one is on dexedrine and the other on Ritalin and both have ADD. Both have "smoothed out" on the drugs considerably, though the younger one has responded best (using Ritalin), I think due to diagnosis and treatment at a much younger age. My point is that I feel "smoothed out" too, which makes me wonder if people with ADD/ADHD have a different response to these drugs than those that don't have ADD. Well, thats probably a given now that I think about it. I guess what I'm reading from your posts is that Adderall is not necessarily an energizing drug for some of us - perhaps for no one. I was interested in the suggestion that some of the other antidepressants are more energizing...would you still recommend Dexedrine with one of those ADs? (The Wellbutrin, Prozac, Effexor list?) The reason all this has come to mind, other than my own reaction, was well put in an article I read from a link off Dr. Bob's site. Ivan Goldberg, I think it was he, wrote a few notes that intrigued me. He said that if one's whole basis for achievement has been fear driven (fear of failure, fear of inadequacy, etc.) then taking an SSRI can remove the fear and also one's motivation. That can be pretty depressing in itself! Sorry to be rambling so much to get to this point, but thats where I think I'm at. I'm curious to know if you all feel or once felt that way; that the medicine was not the right mix for the depression/motivation issue and then, what did you do about it? In other words, were you still depressed and on top of that, unmotivated? If you took a stimulant like Adderall, did it not energize you as you had hoped? (I did decide to drop back on the Adderall dose as one of you suggested; the "give the brain a rest" idea seems to have merit.) Thanks all, Liz
**************************************************
> ... anyone have other suggestions? Also, could use advise on the best way to approach my Pdoc with this suggestion.
>
> ^^^^^^^^^^
> Hit 'em up for some DESOXYN (15 mgs Gradumet tabs), and after they stop laughing, ask for
> DEXEDRINE TIMED-RELEASE SPANSULES (SKB) 15 mgs, or the 5 mgs tabs. Either one will keep your
> lights on nicely bright.
>
> Greetings to CarolAnn.
>
> I remain,
> kazoo
Posted by dove on April 12, 2000, at 9:29:45
In reply to Re: Adderall poop-out, posted by kazoo on April 12, 2000, at 2:23:23
I have also experienced an eventual weaker effect from Adderall. I do not switch meds, nor do I pump the dose up a notch. The one thing that actually seems to work is temporarily going off it. The first time I did it, I skipped two days worth, and upon return, found the Adderall much more effective. After a few trial and error sessions, I found that I can skip one of my three daily doses and get the responsive return. Skipping the morning dose has never helped, but skipping the noon and early evening dose does.
Leave out one dosage and see how you feel the next day. I have been doing this every other weekend, skipping the third dose on Saturday and Sunday, and getting a good response during the week. Nothing else I have tried works as well, or as easily. In addition to being very benign.
dove
Posted by DC on April 12, 2000, at 13:20:18
In reply to Re: Adderall poop-out, posted by dove on April 12, 2000, at 9:29:45
Point one: raising the dose on Stims will not necessary give you a more energizing effect. IN FACT, it often does the OPPOSITE!
Point two: your body has to have a recovery time when the meds are not in your system for them to work properly. For most people the ten hours or so during the night when the drug is not in their system is enough. But for others it may be necessary to stop the drug altogether on ocassion.
Posted by liz on April 12, 2000, at 13:51:10
In reply to Re: Adderall--doesn't anybody listen to me?!, posted by DC on April 12, 2000, at 13:20:18
DC: I finally get the message! Thank you! Its just that I had the impression, I guess, that it WOULD be more energizing the more one took. Obviously, I was wrong and due to your input, I cut down on it today and will go off this weekend altogether to get the "rest" you refer to. Thanks again. Listening but lame, Liz
Point one: raising the dose on Stims will not necessary give you a more energizing effect. IN FACT, it often does the OPPOSITE!
>
> Point two: your body has to have a recovery time when the meds are not in your system for them to work properly. For most people the ten hours or so during the night when the drug is not in their system is enough. But for others it may be necessary to stop the drug altogether on ocassion.
Posted by saint james on April 12, 2000, at 17:50:54
In reply to Re: Adderall--doesn't anybody listen to me?!, posted by DC on April 12, 2000, at 13:20:18
> Point one: raising the dose on Stims will not necessary give you a more energizing effect. IN FACT, it often does the OPPOSITE!
>
James here....Actually the more you take (in normals) the faster you go, till you become a speed freak. Catonic state is seen in normals at very high doses. It is with ADD persons that you see this paradoxical effect, usually normal doses puting people to sleep. As the poster was no ADD, I think, there is usually not a "paradoxical effect"
I would try Dexadrine.
james
Posted by liz on April 12, 2000, at 20:55:32
In reply to Re: Adderall--doesn't anybody listen to me?!, posted by saint james on April 12, 2000, at 17:50:54
Saint James: I do have ADD and Adderall has had no effect on energy for me at any dose. I would appreciate it if you would explain your point VERY slowly for me. Are you saying that Dexedrine is more energizing and might be more appropriate than Adderall for that effect in people that do have ADD? The focus and concentration aspect is welcome, but not necessarily my goal. I would appreciate a more detailed explanation of your post because I wasn't sure to whom it was directed. Thanks, Liz
*************************************************Point one: raising the dose on Stims will not necessary give you a more energizing effect. IN FACT, it often does the OPPOSITE!
> >
>
>
> James here....
>
> Actually the more you take (in normals) the faster you go, till you become a speed freak. Catonic state is seen in normals at very high doses. It is with ADD persons that you see this paradoxical effect, usually normal doses puting people to sleep. As the poster was no ADD, I think, there is usually not a "paradoxical effect"
>
> I would try Dexadrine.
>
> james
Posted by saint james on April 13, 2000, at 11:03:28
In reply to Re: Adderall/saint james, posted by liz on April 12, 2000, at 20:55:32
> Saint James: I do have ADD and Adderall has had no effect on energy for me at any dose. I would appreciate it if you would explain your point VERY slowly for me.
> > I would try Dexadrine.
> >
> > jamesJames here....
I was speaking about carolann (the original poster) she is getting used to Adderal and often switching to another stim will allow for a lower dose. There is no evidence that Adderal is more stimulating than dexadrine.
james
Posted by AndrewB on April 14, 2000, at 11:08:04
In reply to Adderall poop-out, posted by CarolAnn on April 11, 2000, at 18:18:09
One poster one the web said they were able to keep their dexadrine from pooping out with tyrosine supplements. The theory is that dexadrine depletes dopamine and tyrosine is a dopamine precursor. Dose is variable, but try 3,000 mg half an hour b4 breakfast or 1,000mg half an hour before each meal. Also take a multivitamin and a magnesium supplement.
AndrewB
Posted by Nigel on April 14, 2000, at 12:14:45
In reply to Re: Adderall/saint james, posted by saint james on April 13, 2000, at 11:03:28
> > Saint James: I do have ADD and Adderall has had no effect on energy for me at any dose. I would appreciate it if you would explain your point VERY slowly for me.
> > > I would try Dexadrine.
> > >
> > > james
>
> James here....
>
> I was speaking about carolann (the original poster) she is getting used to Adderal and often switching to another stim will allow for a lower dose. There is no evidence that Adderal is more stimulating than dexadrine.
>
> james
Did you know that Adderall contains Dexadrine? Here is the composition:EACH TABLET CONTAINS
Dose 5mg 10mg 20mg 30mg
Dextroamphetamine Saccharate 1.25 mg 2.5 mg 5 mg 7.5 mg
Amphetamine Aspartate 1.25 mg 2.5 mg 5 mg 7.5 mg
Dextroamphetamine Sulfate 1.25 mg 2.5 mg 5 mg 7.5 mg
USP
Amphetamine Sulfate USP 1.25 mg 2.5 mg 5 mg 7.5 mg
Total amphetamin base 3.13 mg 6.3 mg 12.6 mg 18.8 mg
equivalence
Posted by leslye on April 19, 2000, at 11:51:58
In reply to Adderall poop-out, posted by CarolAnn on April 11, 2000, at 18:18:09
> Carol Anne, have you asked your pdoc if there is another AD you may switch to that is not so sedating? Many people are exquisitely sensitive to the sedating SE's - some of these people turn out to be ADD folks, but others have various other types of brains that make them sensitive. It is also common for stims to become relatively ineffective in 2-3 months of treatment - this is tolerance, and it is the healthy brain's way of regaining equilibrium. This is often treated by either rotating stims ( 2 months on one, 2 on another) or by taking 2 week drug holidays (which seems to be the amount of time the brain needs to reset the receptors fully). Many people feel they need to "chase" the stim effect, but the brain just goes right on adjusting! So, you may see an initial improvement, but poop out returning fairly fast. The body doesn't tolerate to the effects quite as fast, so dose escalation can also lead to increased heart rates and higher bloodpressuree, too. Other stims, including dexidrine, ritalin, are worth trying, but they may poop out too if you don't rotate. There are some new forms of these meds on the market too - I hear there will be an extended release adderal, and a time release ritalin ( rumor has it much more effective than the ritalin sr). Good luck, Leslye
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