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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by MB on February 22, 2002, at 18:47:30
OK, when I take my Adderall, I definitely feel that at different times during its activity, there are different sensations. I wish I knew how the salt-time-release thing really worked (I mean, I know that the different salts are assimilated at different rates), but could the different sensations I'm feeling at different times be tied to the times when the pure dextroamphetamine is high in my blood as opposed to when the racemic amphetamine (including the levo-isomer) is peaking? There are times when I feel sharp and "with-it"; times when I feel "dull and dumb", yet speedy in the body; times when I am breathless and have tachycardia; times when I am more depressed than I have ever been in my life; and times when the peripheral side effects are the strongest (similar to ephedrine: chills, goosebumps, creeping scalp, vasoconstriction, etc.). The doctor mentioned a sustained release form of desoxyn. Would that be more centrally and less peripherally active? I've searched the net far and wide and have yet to find individual pharmacokinetic information on each individual salt: d,l-amphetamine aspartate; d,l-amphetamine sulfate; d-amphetamine sulfate or d-amphetamine saccharate. It would help me figure out if it is the timing of the t-maxs of the Adderall's various salts, or the other drugs that are causing the wide range of feelings throughout the day.
schedule:
8am (400mg Neurontin, .5mg Klonopin, 20mg Adderall, 50 mg Serzone)(+food)
Noon (400mg Neurontin, 10 mg Adderall)(+food)
3:00 (10mg Adderall, 400mg Neurontin)
6:30 (5mg Adderall, 400mg Neurontin)(+food)
Bedtime (275mg Serzone, 2mg Klonopin, 400mg Neurontin)
Does anybody have any ideas why the swings throughout the day: Happy & social, but some slurry, cognitive dulling from about 8:30-11:00....then an anxious, choppy, motivated phase from 11:00 until about 2 or 3.....then I settle into almost the worst depression/dysphoria I've ever felt (lasting until about 5:00), and then I just feel dysthymic and hopeless for the rest of the night. I've tried playing with doses and times (keeping schedule relatively the same) and it always turns out this way. Life seems worth living until 2:30, then I just want to die.MB
Posted by TSA West on February 23, 2002, at 3:21:57
In reply to Adderall: 4 salts, but how are they released?, posted by MB on February 22, 2002, at 18:47:30
Dear friend,
The swingy activity of your moods and the nature of the medications in your regimen (none lasts an entire day), leads me to recommend agents with long half-lives such as:
1. venlafaxine XR - mentioned in the Tips as being very beneficial in those with cyclic disorders (http://www.dr-bob.org/tips/split/Possible-indications-of-bi.html). Venlafaxine might provide needed hypnotic, anxiolytic, or stimulating effect.
2. Mirtazapine or any tricylic antidepressant (most namely, the tolerable(s) desipramine or nortriptyline)
3. An atypical neuroleptic with mood elevating properties (olanzapine).
This way a medication would fill in the gaps where the other medications seem to fail for a few hours.
Wishing you the best that psychiatry has to offer,
-------TSA West: Self-Denial----------------
Posted by Ritch on February 23, 2002, at 9:41:50
In reply to Adderall: 4 salts, but how are they released?, posted by MB on February 22, 2002, at 18:47:30
> OK, when I take my Adderall, I definitely feel that at different times during its activity, there are different sensations. I wish I knew how the salt-time-release thing really worked (I mean, I know that the different salts are assimilated at different rates), but could the different sensations I'm feeling at different times be tied to the times when the pure dextroamphetamine is high in my blood as opposed to when the racemic amphetamine (including the levo-isomer) is peaking? There are times when I feel sharp and "with-it"; times when I feel "dull and dumb", yet speedy in the body; times when I am breathless and have tachycardia; times when I am more depressed than I have ever been in my life; and times when the peripheral side effects are the strongest (similar to ephedrine: chills, goosebumps, creeping scalp, vasoconstriction, etc.). The doctor mentioned a sustained release form of desoxyn. Would that be more centrally and less peripherally active? I've searched the net far and wide and have yet to find individual pharmacokinetic information on each individual salt: d,l-amphetamine aspartate; d,l-amphetamine sulfate; d-amphetamine sulfate or d-amphetamine saccharate. It would help me figure out if it is the timing of the t-maxs of the Adderall's various salts, or the other drugs that are causing the wide range of feelings throughout the day.
>
> schedule:
>
> 8am (400mg Neurontin, .5mg Klonopin, 20mg Adderall, 50 mg Serzone)(+food)
>
> Noon (400mg Neurontin, 10 mg Adderall)(+food)
>
> 3:00 (10mg Adderall, 400mg Neurontin)
>
> 6:30 (5mg Adderall, 400mg Neurontin)(+food)
>
> Bedtime (275mg Serzone, 2mg Klonopin, 400mg Neurontin)
>
>
> Does anybody have any ideas why the swings throughout the day: Happy & social, but some slurry, cognitive dulling from about 8:30-11:00....then an anxious, choppy, motivated phase from 11:00 until about 2 or 3.....then I settle into almost the worst depression/dysphoria I've ever felt (lasting until about 5:00), and then I just feel dysthymic and hopeless for the rest of the night. I've tried playing with doses and times (keeping schedule relatively the same) and it always turns out this way. Life seems worth living until 2:30, then I just want to die.
>
> MBHi MB,
Wow, you are definitely on a *regimen*! Adderall always made me feel kind of kicked back and mellow the first two hours and then got buzzy and made me anxious and then I would feel the flipping back and forth during the day. But, you are complaining about the "feel good the first half of the day-feel like hell the last half". It seems your doc is convinced it is the psychostimulant. I wonder if it is really the Serzone. I am looking at your dosing and the Neurontin and Adderall seem spread out fairly even IMO. The Serzone is pretty lopsided. Also, the primary first pass nefazodone is short-lived and then you get metabolites-one of which is mCPP which has been found to be anxiogenic in a lot of people. When I tried nefazodone I would feel "ok" and calmed after I took it, but it seemed to have this rebound of sorts with it that was kind of unpleasant. That's why I switched back to a low-dose standard SSRI. You said you played around with the doses/timings, etc. Could you sleep OK if you just took 50mg of Serzone 5x daily along with your Neurontin?? That way you might have more nefazodone relative to its metabolites at any given time and might feel better, just a hunch.
Mitch
Posted by MB on February 24, 2002, at 17:53:27
In reply to Re: Adderall: 4 salts, but how are they released?, posted by Ritch on February 23, 2002, at 9:41:50
> > OK, when I take my Adderall, I definitely feel that at different times during its activity, there are different sensations. I wish I knew how the salt-time-release thing really worked (I mean, I know that the different salts are assimilated at different rates), but could the different sensations I'm feeling at different times be tied to the times when the pure dextroamphetamine is high in my blood as opposed to when the racemic amphetamine (including the levo-isomer) is peaking? There are times when I feel sharp and "with-it"; times when I feel "dull and dumb", yet speedy in the body; times when I am breathless and have tachycardia; times when I am more depressed than I have ever been in my life; and times when the peripheral side effects are the strongest (similar to ephedrine: chills, goosebumps, creeping scalp, vasoconstriction, etc.). The doctor mentioned a sustained release form of desoxyn. Would that be more centrally and less peripherally active? I've searched the net far and wide and have yet to find individual pharmacokinetic information on each individual salt: d,l-amphetamine aspartate; d,l-amphetamine sulfate; d-amphetamine sulfate or d-amphetamine saccharate. It would help me figure out if it is the timing of the t-maxs of the Adderall's various salts, or the other drugs that are causing the wide range of feelings throughout the day.
> >
> > schedule:
> >
> > 8am (400mg Neurontin, .5mg Klonopin, 20mg Adderall, 50 mg Serzone)(+food)
> >
> > Noon (400mg Neurontin, 10 mg Adderall)(+food)
> >
> > 3:00 (10mg Adderall, 400mg Neurontin)
> >
> > 6:30 (5mg Adderall, 400mg Neurontin)(+food)
> >
> > Bedtime (275mg Serzone, 2mg Klonopin, 400mg Neurontin)
> >
> >
> > Does anybody have any ideas why the swings throughout the day: Happy & social, but some slurry, cognitive dulling from about 8:30-11:00....then an anxious, choppy, motivated phase from 11:00 until about 2 or 3.....then I settle into almost the worst depression/dysphoria I've ever felt (lasting until about 5:00), and then I just feel dysthymic and hopeless for the rest of the night. I've tried playing with doses and times (keeping schedule relatively the same) and it always turns out this way. Life seems worth living until 2:30, then I just want to die.
> >
> > MB
>
> Hi MB,
>
> Wow, you are definitely on a *regimen*! Adderall always made me feel kind of kicked back and mellow the first two hours and then got buzzy and made me anxious and then I would feel the flipping back and forth during the day. But, you are complaining about the "feel good the first half of the day-feel like hell the last half". It seems your doc is convinced it is the psychostimulant. I wonder if it is really the Serzone. I am looking at your dosing and the Neurontin and Adderall seem spread out fairly even IMO. The Serzone is pretty lopsided. Also, the primary first pass nefazodone is short-lived and then you get metabolites-one of which is mCPP which has been found to be anxiogenic in a lot of people. When I tried nefazodone I would feel "ok" and calmed after I took it, but it seemed to have this rebound of sorts with it that was kind of unpleasant. That's why I switched back to a low-dose standard SSRI. You said you played around with the doses/timings, etc. Could you sleep OK if you just took 50mg of Serzone 5x daily along with your Neurontin?? That way you might have more nefazodone relative to its metabolites at any given time and might feel better, just a hunch.
>
> Mitch
I've been trying to find out as much about the pharmacokinetics of these four meds, that i came across an interesting tidbit about Serzone: multiple dosing causes AUC (area under the curve) to rise disproportionately with the dose...or something like that: with single dosing, difference in AUC between 200mg and 400mg was about double, where with BID dosing difference in AUC between 200mg and 400mg was 4-fold. The warning, I guess, was that the spreading out of the same daily dose in smaller doses increases blood levels in an unexpected non-linear way. That's my interpretation...I would be scared of a 5 x day dosing of Serzone. I wondered, for a while, if the 20mg Adderall in the morning "used up" all my "feel good" brain chemicals early in the day, leaving me with low levels later on. I've also considered the fact that the Klonopin in the morning, with its long t-max and 1/2 life, might be bringing me down in the afternoon (2-3pm lately)--it has been known to cause depression, right? Except I feel better awakening 6 hrs after my nightly 2mg Klonopin dose than I do during my afternoon crash, which is only six hours after a ,5mg dose of K. I've tried not taking the Klonopin in the morning and the crash still occurs.Anyway, a side note: the restless leg problem is getting really bad again (doc calls it "akithisia")..."feels" like its intinsity is coinciding with the dose increases of the Serzone. I've always had this problem with SSRIs (even though Serzone is a little different than a true SSRI). Effexor was worse for me than any SSRI, and I just learned that Serzone increases norepinephrine as does Effexor. What does a person with depression do when they just can't tolorate antidepressants?
I took Prozac for two weeks (I think) then switched immediately to Serzone (climbing slowly from 100mg a day to 375mg a day), I wonder how sick I would get quitting the antidepressant cold turkey.
My doc I can only talk to once a month over the phone. It is ridiculous. Thursday, I am talking to a local psychopharmacologist who might be able to do more than hand me four bottles of pills and say "have a go at it, call me in a month."
MB
Posted by Ritch on February 24, 2002, at 22:57:50
In reply to Re: Adderall: 4 salts, but how are they released?, posted by MB on February 24, 2002, at 17:53:27
> Anyway, a side note: the restless leg problem is getting really bad again (doc calls it "akithisia")..."feels" like its intinsity is coinciding with the dose increases of the Serzone. I've always had this problem with SSRIs (even though Serzone is a little different than a true SSRI). Effexor was worse for me than any SSRI, and I just learned that Serzone increases norepinephrine as does Effexor. What does a person with depression do when they just can't tolorate antidepressants?
Hi MB,If you could answer that question accurately you might find the answer many of us would like to know as well.
>
> I took Prozac for two weeks (I think) then switched immediately to Serzone (climbing slowly from 100mg a day to 375mg a day), I wonder how sick I would get quitting the antidepressant cold turkey.
>
> My doc I can only talk to once a month over the phone. It is ridiculous. Thursday, I am talking to a local psychopharmacologist who might be able to do more than hand me four bottles of pills and say "have a go at it, call me in a month."
>
> MB
This is my idea of what's happening. You are on *too high* a dosage of Serzone. It seems that all of your troubles seem to coincide with dose increases of antidepressants. It also seems like you are *chasing* the dose of pstim to keep up with the Serzone fogginess, etc. ALL SSRi cause akathisia with me, but they do have anxiolytic effects, but only at very low doses. What about this: 1) Keep your mood stabilizer(s) dosage(s) the same (Neurontin-Klonopin), 2) Decrease incrementally first the Serzone in steps. 3) If you find you are getting too anxious from reducing the Serzone-reduce the pstim (Adderall) incrementally as well. 4) Wait a while after you make any significant reduction.Maybe if you get your mood stabilizer/AD+pstim dose ratio a little higher you might find yourself cooling out.
keep us posted,
Mitch
This is the end of the thread.
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