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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by colin wallace on August 1, 2003, at 15:15:02
Hi guys,
Today, I asked my GP about the possibility of adding Atomoxetine to my Lamictal/Prozac combination,in order to address some severe inattention symptoms which remain unresolved, even though my depression is almost in remission.
He'd never heard of it, and couldn't even find it in his 'little black bible' of alchemy.
After some quick thinking, I pushed for a small dose of Lofepramine, knowing that this TCA is metabolized to desipramine, which has also shown some efficacy in treating ADHD symptoms.
As a bonus, I thought, it may also help my residual depressive symptoms and anerga, and I can get away with taking a much smaller dose due to Prozacs drastic effects on the clearance of TCA's.
Two questions.First, has anyone here benefited directly from a noradrenergic TCA for inattention issues, motivation etc.
Secondly, say for example the starting dose of Lofepramine is 70mg twice daily(up to 210mg I believe), how d'ya think 70mg would actually translate into, considering the Prozac/TCA reduced clearance??
I'm staying at 70mg for a while, to be safe.Whaddaya think, you TCA/SSRI combination veterans??
Col.
Posted by zeugma on August 1, 2003, at 20:10:43
In reply to Lofepramine/Prozac, posted by colin wallace on August 1, 2003, at 15:15:02
Hi Colin
I haven't taken an SSRI long enough for it to have featured in any combinations, but I do take a noradrenergic TCA, and I do have severe inattentive ADD (plus depression, and a few other things) and I can say that TCA's do work for motivation, and they can improve attention as well. But the TCA I am on (nortriptyline) is somewhat sedating, and I find this limits the help I can get for the general 'drifting off' feeling. So I have recently added Strattera, which has really woken me up! I'm planning to taper off nortriptyline in the next month, or maybe cross-taper to a low dose of amitriptyline; I don;t feel like I should stay indefinitely on therapeutic doses of TWO noradrenergic antidepressants.
From what I understand, lofepramine is one of the less sedating TCA's. It might well be as beneficial for ADD as Strattera.
Posted by colin wallace on August 2, 2003, at 9:37:55
In reply to Re: Lofepramine/Prozac » colin wallace, posted by zeugma on August 1, 2003, at 20:10:43
> Hi Colin
>
> I haven't taken an SSRI long enough for it to have featured in any combinations, but I do take a noradrenergic TCA, and I do have severe inattentive ADD (plus depression, and a few other things) and I can say that TCA's do work for motivation, and they can improve attention as well. But the TCA I am on (nortriptyline) is somewhat sedating, and I find this limits the help I can get for the general 'drifting off' feeling. So I have recently added Strattera, which has really woken me up! I'm planning to taper off nortriptyline in the next month, or maybe cross-taper to a low dose of amitriptyline; I don;t feel like I should stay indefinitely on therapeutic doses of TWO noradrenergic antidepressants.
>
> From what I understand, lofepramine is one of the less sedating TCA's. It might well be as beneficial for ADD as Strattera.Hi there,
Your reasoning for switching to Straterra seems very sound.It's also reasurring to hear that noradrenergic TCA's do actually exert a beneficial effect on inattention issues.
Straterra was actually my first choice as I mentioned, but not having it available, I realized it had to be either Lofepramine(can't get desipramine here either),or Reboxetine.Interestingly,although Reboxetine and Atomoxetine are structurally very similar, the former didn't show much benefit for ADD at all.
Wonder why?....
Let me know how you get on with Straterra,'cos I'm trying to overcome that 'drifting off' feeling too.Also,it would be nice to be able to read a page of a book in under five minutes again!!!Col.
Ps. Any sexual side effects on Straterra???
Posted by zeugma on August 2, 2003, at 16:50:18
In reply to Re: Lofepramine/Prozac » zeugma, posted by colin wallace on August 2, 2003, at 9:37:55
If you take lofepramine with Prozac you should think about getting a blood level done at some point, because you have to be careful with TCA levels (although lofepramine seems to be the least cardiotoxic of the bunch).
Neither Strattera nor nortriptyline has caused any kind of sexual side effect.
Posted by Ron Hill on August 2, 2003, at 22:49:47
In reply to Lofepramine/Prozac, posted by colin wallace on August 1, 2003, at 15:15:02
Kernel Colin,
> As a bonus, I thought, it may also help my residual depressive symptoms and anerga,
Did ENADA NADH help with your anerga? Did it help your inattentiveness? What's your assessment of the OTC based on your trial a few months back? How long did you take it and at what dosage? Did you get irritable?
This is the specialist you are seeing now, right? Does the specialist give you a dx of BP II? Any comorbid ADHD?
Good to see ya back Colin. Where the heck did ya disappear to?
-- Ron
Posted by colin wallace on August 3, 2003, at 4:53:50
In reply to Re: We missed ya. Where the heck were you? » colin wallace, posted by Ron Hill on August 2, 2003, at 22:49:47
> Kernel Colin,
>
> > As a bonus, I thought, it may also help my residual depressive symptoms and anerga,
>
> Did ENADA NADH help with your anerga? Did it help your inattentiveness? What's your assessment of the OTC based on your trial a few months back? How long did you take it and at what dosage? Did you get irritable?
>
> This is the specialist you are seeing now, right? Does the specialist give you a dx of BP II? Any comorbid ADHD?
>
> Good to see ya back Colin. Where the heck did ya disappear to?
>
> -- RonHowdy Gringo,
How was the vacation Ronald ol' chap?? Any mischief to report? I'd sloped off for a bit of a break to, with much happening in the way of...generally fiendish misbehaviour...*_-
Anyway, the NADH and I didn't really hit it off;
I developed a tolerance to it fairly quickly, and although it didn't make me irritable, I found that(although it helped initially) I'd wake up in the morning and actually feel a bit more depressed than usual.Strange.I cut back on the 5mg alternate days dosage to just twice a week, but still felt a bit off the next day.
So I bade it a sad farewell.
As for my BP specialist consultation, well, one of the ceaseless joys of the NHS is the prolongation of waiting lists and deferred appointments.Ain't happened yet.
I was about to stump up £160 for a private appointment with a very reputable psych. who treats BP disorders and other 'oddities' (!)
but my GP has been so impressed with my self-help and accuracy in appraising and targeting my own symptoms, that he'll basically accept and run with my ideas.(partly because he knows I'll just go ahead and do it alone anyhow!!)
I've tackled my stability issues(and to a large degree, the depression) with Lamictal, smoothed out my temper spells and zapped the remaining depression with Prozac, and now I've just started on Lofepramine in the hope of tackling the inattention issues I have to deal with.
And yes, you're absolutely right in your thinking;My GP and I both believe I'm BP11(without doubt) and very probably adult ADD aswell-it seems to account neatly for everything.
Third day now on 70mg Lofepramine-no side effects other that a very shaky and weak day on the bike yesterday.In fact, a guy of around 70 past me on the road, and asked if I was okay, as I looked and felt awful.I said,"yeah, don't worry I'm fine-I always look like this when I'm on drugs...."Keep us posted.
Col.
Posted by Ron Hill on August 3, 2003, at 22:00:59
In reply to Re: Ronaldo » Ron Hill, posted by colin wallace on August 3, 2003, at 4:53:50
Colin my Friend,
> How was the vacation Ronald ol' chap??
So you do read the board even when you're not posting. Our vacation was good; thanks for asking.
> Any mischief to report?
Nope, I'm too old for mischief. I'll leave the mischief for the young bucks like you.
> I've tackled my stability issues(and to a large degree, the depression) with Lamictal, smoothed out my temper spells and zapped the remaining depression with Prozac, and now I've just started on Lofepramine in the hope of tackling the inattention issues I have to deal with.
Yes, I know. The Lamictal and Prozac are old news and I read about the TCA addition in your recent posts.
Have you ever considered a trial of Provigil to treat your inattentive symptoms? As you know, it's expensive. Do you pay for meds out of your pocket? If so, it's probably cost prohibitive. As I recall, a typical dosage of Provigil costs about $300 (US) per month. You'd know better than I regarding the conversion rate into pounds (hey when the heck are you Brits going to start using Euros instead of pounds?).
I don't recall that you have ever tried a pstim like Ritalin, Adderall, or Dexedrine. Have you? A pstim will help you focus like crazy and give you energy and motivation. They're great but, as you know, they are notorious for reducing mood stability in bipolar patients.
How ‘bout Armstrong? Incredible human being!
-- Ron
Posted by colin wallace on August 6, 2003, at 11:02:52
In reply to Re: Treating Inattentiveness » colin wallace, posted by Ron Hill on August 3, 2003, at 22:00:59
Hey there Ron,
So you do read the board even when you're not posting. Our vacation was good; thanks for asking.
>>Glad you had a good break.
Actually, I'm away from home a lot these days, and tend to look in now and then from an internet cafe...I'm likely to miss a few posts!Yes, I know. The Lamictal and Prozac are old news and I read about the TCA addition in your recent posts.
>>Yup, well, as with most of us posters who get some respite..no news is generally good news as you know!!The TCA is very unobtrusive, and I must say I feel feel less of my usual(longstanding) lassitusde already.Slightly more inclined towards effort in my approach to daily tasks.
I don't recall that you have ever tried a pstim like Ritalin, Adderall, or Dexedrine. Have you? A pstim will help you focus like crazy and give you energy and motivation. They're great but, as you know, they are notorious for reducing mood stability in bipolar patients.Yes, the quandry that afflicts us merry band of fortunates with both BP and ADD symptoms.The fine contradictions involved in both maintaining stability whist 'speeding' up those fuzzy and sluggish thought patterns!
It's an unenviable balance to strike, eh??
That's why I chose a bog-standard TCA in preference to a stim.,etc.(I remember what stims did to you, and let's not forget even benign ol' Sam-E pushed us both over the edge eventually!!)
It has to be Straterra next, as stims are really a weapon of last resort for me.> How ‘bout Armstrong? Incredible human being!
>
Is he ever!I was leaping into the air and yelling as he put Ulrich in his place.Take care Ron,
Col.
>
>
Posted by Ron Hill on August 7, 2003, at 10:35:35
In reply to Re: Treating Inattentiveness » Ron Hill, posted by colin wallace on August 6, 2003, at 11:02:52
Colin Farrell,
> The TCA is very unobtrusive, and I must say I feel feel less of my usual(longstanding) lassitusde already.Slightly more inclined towards effort in my approach to daily tasks.
Please let us know periodically how the TCA add-on is working for you. I hope Lamictal provides enough mood stabilizing power to hold in check the potentially destabilizing influences of the SSRI and the TCA.
Check out my line of sports wear apparel at the link below. I opened this business on your side of the pond to tap into the Brit runners market. Let me know if you see anything you want and I'll send you a "friends and family discount coupon".
http://sport.kelkoo.co.uk/b/a/sbs/uk/sport/manufacturer/Ron_Hill/sport/Running/163601.html
-- Ron Hill
Posted by fluffy on August 7, 2003, at 10:44:54
In reply to Re: Treating Inattentiveness with a TCA » colin wallace, posted by Ron Hill on August 7, 2003, at 10:35:35
Hey Colin--
Are you still taking Li? Just curious how it's working out for you (or not working out as the case may be).
Best to you,
Katy
Posted by Dr. Bob on August 7, 2003, at 10:56:56
In reply to Re: Treating Inattentiveness with a TCA » colin wallace, posted by Ron Hill on August 7, 2003, at 10:35:35
> Check out my line of sports wear apparel...
Thanks for the discount, but let's stick to medication issues here, OK?
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by cybercafe on August 7, 2003, at 18:36:11
In reply to Re: Treating Inattentiveness with a TCA » colin wallace, posted by Ron Hill on August 7, 2003, at 10:35:35
> Colin Farrell,
>
> > The TCA is very unobtrusive, and I must say I feel feel less of my usual(longstanding) lassitusde already.Slightly more inclined towards effort in my approach to daily tasks.
>
> Please let us know periodically how the TCA add-on is working for you. I hope Lamictal provides enough mood stabilizing power to hold in check the potentially destabilizing influences of the SSRI and the TCA.
>
> Check out my line of sports wear apparel at the link below. I opened this business on your side of the pond to tap into the Brit runners market. Let me know if you see anything you want and I'll send you a "friends and family discount coupon".
>
> http://sport.kelkoo.co.uk/b/a/sbs/uk/sport/manufacturer/Ron_Hill/sport/Running/163601.html
>
> -- Ron Hill
>hey guys sorry to jump in but have you ever thought of trying abilify for mood stability + ADD?
does anyone know if its out in the UK yet or when it will be available?
(... im my experience ritalin doesnt seem to destabilize me )
This is the end of the thread.
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