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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by psycho-explorer on May 31, 2002, at 10:59:07
Hi. This is my first post on this board. Iīm argentinian, so my english may not be accurate.
I was recently diagnosed ADD. However, previous to that confirmation, I had already made a highly extensive trial of meds. Good attentional response was fully achieved only with amphetamine-type stimulants. Despite their great efficacy, therapeutic effectiveness was systematically shadowed by increased anxiety on social interactions. So was forced to deal also with this fact.
I have been on the following meds (I mention if they worked or not for the ADD symptoms):
* venlafaxine (slight response)
* selegiline + phenylalanine (fairly good response)
* bupropion (good response, but made me manic)
* fluoxetine (null response)
* pemoline (fairly good response)
* desipramine (null response)
* aniracetam (useless against ADD symptoms, though appeared to increase memory/recall/creativity)
* DMAE (slight response; though, its effect seem as ephemeral as that of coffee. therefore, therapeutic use of this supplement is unfeasible.)also tried street metamphetamine and cocaine, several times. the latter being a great mental brightener but clearly inconvivient for long-term use, due to the short half-life, current legal status and side effects profile of this substance, which purity may be, furthermore, umpredictable.
on the other hand, meth allowed myself to perform much better than usual, but led to marked tolerance and dependence, and was hardly impossible for me to dosify it correctly. Decided to leave meth but had to pay the price of an onerous withdrawal syndrome.
I clearly find my current combo more effective than speed. Also cheaper and healthier, and free of the pavorous tolerance developement inherent to meth, which forces dose-escalation and worsens side effects profile.Nowadays, I take the following combo (4 weeks on it):
* sertraline (100 mg; started with 50 mg).
* methylphenidate (45 mg, divided in 4 doses).I honestly suggest giving this combo a try, specially to those whose problem is similar. I would describe results as: I feel my CNS optimized in its functioning: fully operating, both in cognitive and emotional performance.
I must add that I also take:
* 130 mg of caffeine, 3 times a day.
And donīt have insomnia, but get net beneffit from
* 0,5-1 mg clonazepam before bed (no more than 3 or 4 times a week).
The search is over and I could find the KEY. No tolerance symptoms yet. Finally, some additional notes. Canīt smoke tobacco on this combo, because it strangely shoots anxiety and nervousness; the same for marihuana, which actually impairs cognition more than usual. Alcohol also shares this ansiogenic potential while you are running on this combo. Of course, further details should be taken into account: eg. hydration is a basic task. Also, an adequate nutrition is a relevant factor: try to reach the optimal amounts of vitamins/minerals/aminoacids, which are active precursors of our neurochemistry.
Posted by katekite on May 31, 2002, at 12:49:31
In reply to sertraline + methylphenidate = MY KEY, posted by psycho-explorer on May 31, 2002, at 10:59:07
What about side effects with the sertraline? Did the stimulant stop the sexual side effects from occurring or are you one of the lucky ones that is unaffected by ssris?
I had a similar experience with bupropion to yours, although I like to call it 'agitation'.
I found prozac the best of the ssris for my ADD (though sertraline was second), and both adderall and methylphenidate are very good.
I am currently on Adderall and also take 0.25 mg of klonopin a day (but am trying to wean down).
Can you say more about selegiline side effects and aniracetam effects? I have been considering both. Do you think you could take methylphenidate or another stimulant, and aniracetam together?
What have you found the most helpful for sleep and general calmness, other than benzodiazepines?
Thanks for sharing your experiences.
kate
Posted by geno on May 31, 2002, at 14:58:51
In reply to Re: sertraline + methylphenidate = MY KEY, posted by katekite on May 31, 2002, at 12:49:31
I totally agree with pyscho explorer, nice name too, i feel like pscho explorer guiny pig! LOL
Zoloft 100mg
Ritalin 10mg every 4 hrs.
Klonopin .1mg 2x a day to combat ritalin.zoloft anixety.
Remeron 30mg Sleep. Cannot fall asleep in any way with out remeron. Ambien helps too.
Desipramine 25mg at bed. Boost norepinephrine.This above combo is absolutely the best for depression, lethargy, concentration, anxiety , social phobia and sleep! Ill break it down again:
Zoloft( depression)
Ritalin (uplift,concentration, energy without panic like ephedra causes or welbutrin.
Klonopin ( anxiety)
Remeron ( sleep)
Desipramine ( causes a nice tingly feeling and a bit of mood improvement augmented with ssri)Also i beleive ritalin and desipramine counteract zolofts sexual side effects due to increases dopamine and norepinephrine. Also Ritalin/desipramine counteract remeron/klonopin sedation, yet remeron/klopin counteract ritalin/desipramine and zoloft anxiety.
good luck. Thanx physcoeplorer.
Posted by psycho-explorer on June 10, 2002, at 0:27:43
In reply to Re: sertraline + methylphenidate = MY KEY, posted by katekite on May 31, 2002, at 12:49:31
Much stuff to talk about:
1. Side Effects from sertraline
* No sexual-related side-effects. (Probably, is Ritalin what counteracts them).
* But, when I discontinue ritalin, then sertraline seems to cause slight (but odd) tremors (pseudoparkinsonian-type). I think that this is due to the lowered dopamine release, indirectly induced by 5-HT2 targeting.
this fact, combined with moderate tolerance to ritalin, are a feasible explanation. I avoid this side-effect taking each dosage of ritalin as scheduled. But I think clonazepam has also something to do with it, because I have been taking it for months and much tolerance may has developed. so, those tremors could be intensified by the fact I am trying to lower its dosage last days. I strongly believe that clonazepam should not be used for more than 4 weeks. but, how to initiate clonazepam withdrawal? any idea?
* Also I have read that 75 mg is the minimmum effective dosage of sertraline for social phobia or related symptoms, so may try lowering the dose from 100 mg to 75 mg expecting to mantain desired results.
* In the long term, when sertraline has definitely kicked-in, may sustitute clonazepam
with another substance, any one with benign cognitive-impairment effects. Probably, GABA + GABOB will be enough for go to sleep and long-term SNC modulation. But difenhidramine, which has a shorter-half life, could be useful for sleep, too. even prometazine could be a suitable option. zolpidem is also in the list.2. Prozac
I tried prozac but was not on ritalin then. it worsen the syndrome, but, honestly, it did feel great! it simply made me happy, but absolutely improductive. but I consider it a wonder antidepressant. Then tried to
combine it with ritalin but it produced a bupropion-like agitation. Thatīs why I chose the second most activating SSRI, sertraline, which nicely interacts with ritalin and has additional benefits. For instance, it produces less inhibition of the cytoprome P-450 enzyme, reducing the risk of toxic interactions. Also, it has a weak activity as dopamine-reauptake inhibitor, which may be appreciated for ADDers (but i donīt consider that it is really relevant). To be honest, I must mention that its shorter half-life is relevant for me, cause I esporadically enjoy the empathogenic propperties of ecstasy (on prozac, a previous week of abstinence is required for X to work...).
Finally, sertraline doesnīt provoke the nervousness/anxiety offen associated with prozac, specially when combined with Ritalin. It is less activanting that prozac, but definitively, it is not sedative. so sinergy with amphetamine-type stimulants seems to be clear.
Something I consider important: those who are chronically taking prozac + ritalin + clonazepam,
usually add the clonazepam to counteract anxiety/nervousness from the other substances... then, it would be worth for them trying another SSRI instead of prozac, which is the most likely to reforce those reactions. I mean... clonazepam could be avoid.4. Stimulant + Nootropics
I tried pemoline with aniracetam, but results were definitiley BAD. aniracetam, when taken alone, is a memory booster, but it seems to promote excesive inter-hemispheric activity in the brain, and (in my case) doesnīt enhance ability to synthezise information in the frontal lobe, causing great mental- connections but dirty planification performance. And great ideas are not enoough. But it is an issue for further reserach.
5. Selegiline
Took it with dl-phenylalanine. It is effective. but it is not a comfortable med. I consider it too strong. and its activation of peripherical dopamine is excessive for people who actually donīt have parkinson disease, causing rigidity and being very intrusive for relax purposes.
> What about side effects with the sertraline? Did the stimulant stop the sexual side effects from occurring or are you one of the lucky ones that is unaffected by ssris?
>
> I had a similar experience with bupropion to yours, although I like to call it 'agitation'.
>
> I found prozac the best of the ssris for my ADD (though sertraline was second), and both adderall and methylphenidate are very good.
>
> I am currently on Adderall and also take 0.25 mg of klonopin a day (but am trying to wean down).
>
> Can you say more about selegiline side effects and aniracetam effects? I have been considering both. Do you think you could take methylphenidate or another stimulant, and aniracetam together?
>
> What have you found the most helpful for sleep and general calmness, other than benzodiazepines?
>
> Thanks for sharing your experiences.
>
> kate
Posted by katekite on June 10, 2002, at 7:04:00
In reply to sertraline + methylphenidate (+clonazepam) ŧ katekite, posted by psycho-explorer on June 10, 2002, at 0:27:43
Posted by 3 Beer Effect on June 13, 2002, at 8:29:15
In reply to sertraline + methylphenidate (+clonazepam) ŧ katekite, posted by psycho-explorer on June 10, 2002, at 0:27:43
If you are having agitation or anxiety with an SSRI + Ritalin combo you might want to switch over to Dexedrine/Dextrostat.
I took Ritalin for a long time & when I added Zoloft 100 mg to it, the Ritalin stopped working. In stead of making me focused, with Zoloft it made me numb, euphoric & dumb.
I think I read somewhere that Ritalin affects the blood levels of certain antidepressants such as Prozac or it might be the other way around.
I've also tried Adderall 10 & 20 mgs. I personally didn't like it because it takes too long to start working, seems to cause more anxiety than dexedrine/dextrostat, & seems to cause more distractibility than Ritalin or dexedrine/dextrostat.
I currently take Dextrostat (the only "name brand" Dexedrine available in 10 mg tablets, but is only a few cents more than the generic dextroamphetamine which is supposed to be worthless)- For ADD I take 20 mg 2 x per day. It works great, it is very nearly as good as Ritalin 20 mg 2x per day for 'focus' but has way less anxiety & seems to me to work great for social phobia (better disinhibitor than clonazepam/Klonopin, also increases confidence, talkitiveness). Lower doses such as 5-10 mg seem to help more with social phobia while higher doses 10-20 mg seem to help the most with ADD. But the Klonopin/Dextrostat combo is probably the best social phobia regimen out there especially if you combined/could tolerate it with Zoloft 100mg or perhaps 75 mgs. Klonopin seems to work best for daytime social phobia if you take it at breakfast & lunch (& late afternoon or 1 hr prior to bedtime if necessary) instead of all at once.
Also taking stimulants Monday-Friday (morning), & then take a break each weekend will pretty much prevent tolerance.
3 Beers..........
Posted by psycho-explorer on June 13, 2002, at 17:24:29
In reply to Re: sertraline + methylphenidate = MY KEY, posted by geno on May 31, 2002, at 14:58:51
geno:
I had read many of your posts and found them useful. The same with 3 beersī and many othersī stuff.
Diverse experience reports are a mighty tool for people like me, I mean: people who live in
societies with old-fashioned psycho-pharmacological paradigms. I much appreciate this site. Self-experiences
are a valuable contribution, specially when go along with refined background in technical issues.Your combo seems very attractive! But canīt make any comment on it, cause, due to brands diversity in different countries, Iīm not sure about remeron... is It paroxetine?
Thanks in advance.
> I totally agree with pyscho explorer, nice name too, i feel like pscho explorer guiny pig! LOL
> Zoloft 100mg
> Ritalin 10mg every 4 hrs.
> Klonopin .1mg 2x a day to combat ritalin.zoloft anixety.
> Remeron 30mg Sleep. Cannot fall asleep in any way with out remeron. Ambien helps too.
> Desipramine 25mg at bed. Boost norepinephrine.
>
> This above combo is absolutely the best for depression, lethargy, concentration, anxiety , social phobia and sleep! Ill break it down again:
>
> Zoloft( depression)
> Ritalin (uplift,concentration, energy without panic like ephedra causes or welbutrin.
> Klonopin ( anxiety)
> Remeron ( sleep)
> Desipramine ( causes a nice tingly feeling and a bit of mood improvement augmented with ssri)
>
> Also i beleive ritalin and desipramine counteract zolofts sexual side effects due to increases dopamine and norepinephrine. Also Ritalin/desipramine counteract remeron/klonopin sedation, yet remeron/klopin counteract ritalin/desipramine and zoloft anxiety.
>
> good luck. Thanx physcoeplorer.
Posted by psycho-explorer on June 15, 2002, at 0:17:07
In reply to have you tried Dexedrine/Dextrostat=less anxiety , posted by 3 Beer Effect on June 13, 2002, at 8:29:15
3 beers:
sadly, dextroamphetamine and "adderal" arenīt available here, in Argentina.
current treatment for ADD is methylphenidate, pemoline or bupropion...
yet, iīm going to follow your advise and take a break each weekend to avoid tolerance.Thanks.
> If you are having agitation or anxiety with an SSRI + Ritalin combo you might want to switch over to Dexedrine/Dextrostat.
>
> I took Ritalin for a long time & when I added Zoloft 100 mg to it, the Ritalin stopped working. In stead of making me focused, with Zoloft it made me numb, euphoric & dumb.
>
> I think I read somewhere that Ritalin affects the blood levels of certain antidepressants such as Prozac or it might be the other way around.
>
> I've also tried Adderall 10 & 20 mgs. I personally didn't like it because it takes too long to start working, seems to cause more anxiety than dexedrine/dextrostat, & seems to cause more distractibility than Ritalin or dexedrine/dextrostat.
>
> I currently take Dextrostat (the only "name brand" Dexedrine available in 10 mg tablets, but is only a few cents more than the generic dextroamphetamine which is supposed to be worthless)- For ADD I take 20 mg 2 x per day. It works great, it is very nearly as good as Ritalin 20 mg 2x per day for 'focus' but has way less anxiety & seems to me to work great for social phobia (better disinhibitor than clonazepam/Klonopin, also increases confidence, talkitiveness). Lower doses such as 5-10 mg seem to help more with social phobia while higher doses 10-20 mg seem to help the most with ADD. But the Klonopin/Dextrostat combo is probably the best social phobia regimen out there especially if you combined/could tolerate it with Zoloft 100mg or perhaps 75 mgs. Klonopin seems to work best for daytime social phobia if you take it at breakfast & lunch (& late afternoon or 1 hr prior to bedtime if necessary) instead of all at once.
>
> Also taking stimulants Monday-Friday (morning), & then take a break each weekend will pretty much prevent tolerance.
>
> 3 Beers..........
This is the end of the thread.
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