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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 Peter on August 28, 2003, at 9:57:11
I've added 20mg adderall (10mg bid) daily to my 3.25mg klonopin regime. My pdoc had me raise my klonopin dose 1.5 weeks ago due to heightened anxiety, but he said I could add the adderall if I had difficulties with the increased lethargy and dullness as a result of the higher klonopin dose.
I've taken the adderall EVERY OTHER DAY for about a week, and then, in addition, I've taken it for 3 days in a row to try to more easily adjust to the undesirable SE's of the adderall.
The adderall has been helping my drive and alertness that the higher-dose klonopin took away, but I find that it (adderall) also might be exacerbating my anxieties - especially those of an anticipatory nature.
I have pretty severe social and general anxieties. I just did all this research to plan a trip to go with my brother somewhere over the weekend; I found the cheapest fares, etc., and got him all psyched about it, and, now, as the time of the flight is getting closer (tonight), my anxiety is getting higher.
While the adderall has been helping me in relaxed, stressed-free environments, I think that, if anything, it could make my anxiety worse if I go on this trip. I don't want to dissapoint my brother (as I have so many people so many other times by opting out at the last minute due to anxiety).
The only thing I can think of doing with such short notice is to DROP the stimulant for the next 3 days that I will be away on this trip. Can I just drop it cold trukey tonight (considering I've been taking it only a few days), or do I have to worry about tapering it?
The way I see it, if I go, it might actually be a good thing for me (like being thrown into deep water and forced to learn to swim). I'll still be taking my klonopin.
Man, I'm anxious.
What do you think (I have to tell my bro within like a 1/2 hour!).
Posted by blondegirl47 on August 28, 2003, at 12:40:38
In reply to HELP-NEED QUICK ADVICE!!, posted by Peter on August 28, 2003, at 9:57:11
tapering is alway better with adderall so you don't crash so hard. I would lower the dose and see how your anxiety goes. You aren't drinking any caffiene are you? That will make it much worse.
Blondegirl
Posted by Ame Sans Vie on August 28, 2003, at 12:48:00
In reply to Re: HELP-NEED QUICK ADVICE!! » Peter , posted by blondegirl47 on August 28, 2003, at 12:40:38
Three days on 20mg? Nah, no need to taper. That's a pretty low dose and it takes much longer than three days to become dependent.
Posted by blondegirl47 on August 28, 2003, at 13:22:44
In reply to Re: HELP-NEED QUICK ADVICE!!, posted by Ame Sans Vie on August 28, 2003, at 12:48:00
I agree with Ame Sans Vie, I didn't read very well that you were only taking it for 3 days. For me going cold turkey means sleeping most of the day. sorry
Blondegirl
Posted by Peter on August 28, 2003, at 14:43:19
In reply to Re: HELP-NEED QUICK ADVICE!! » Ame Sans Vie, posted by blondegirl47 on August 28, 2003, at 13:22:44
> I agree with Ame Sans Vie, I didn't read very well that you were only taking it for 3 days. For me going cold turkey means sleeping most of the day. sorry
> Blondegirl
>>Well I had to taper off my 40mg dose when I used to take adderall continually for almost a year. But this time, when my pdoc said I could resume it, I took it every other day for a week, and THEN 3 days in a row (once I decided to stick with it).
>>But, anyway, it didn't work out. I ended up planning the whole trip, and then the sudden onset of anticipatory anxieties overwhelmed me and, as usual, I ended up having to say 'no' and didn't go on the trip. I afterwards reverted to lying on my bed in a deep depression. I was so deperate to get out of that state that I took an extra 5mg adderal, making 25mg total for the day). It lifted my mood enough above my depression that I was able to get out of bed and occupy myself for a bit. But then I went out to dinner and ended up sitting there staring out into space, not talking to anyone. It really sucked. I guess as the adderall dose wore off my depression came back, OR the extra 5mg made me too spaced-out (I doubt the latter, since I used to take much more adderall daily). I can't wait for my pdoc to return from vacation. This whole tapering off of all those drugs followed by having me double my klonopin and add a small dose of adderall just hasn't seemed to help my core symptoms, which seem now to be anxiety and depression. Maybe there's also an underlying bipolar element that's shining through now too - like cyclothymia and even some mixed moods. I haven't been on a mood stabilizer since I tapered off lamictal 2 months ago, and ever other one I've been on felt like a heavy wet blancket. I don't know what my pdoc will suggest this time (He's had me try just about everything over the years except for MAOI's). But I'm really desperate now. I definitely need help.
Peter
Posted by blondegirl47 on August 28, 2003, at 15:01:42
In reply to Re: HELP-NEED QUICK ADVICE!!, posted by Peter on August 28, 2003, at 14:43:19
I seem to be more social on dexedrine sr than on adderall. I noticed something strange this morning. For breakfast about 2 hours after taking my dexedrine sr, I ate a couple tablespoons of peanut butter. It seemed to kill my dexedrine sr and I have been bingeing and yawning the whole day. I need to take my short acting adderall, but I haven't stopped eating long enough to take it.
Hopefully tomorrow will be better
Blondegirl
Posted by Questionmark on August 29, 2003, at 0:38:59
In reply to HELP-NEED QUICK ADVICE!!, posted by Peter on August 28, 2003, at 9:57:11
> I've added 20mg adderall (10mg bid) daily to my 3.25mg klonopin regime. My pdoc had me raise my klonopin dose 1.5 weeks ago due to heightened anxiety, but he said I could add the adderall if I had difficulties with the increased lethargy and dullness as a result of the higher klonopin dose.
> I've taken the adderall EVERY OTHER DAY for about a week, and then, in addition, I've taken it for 3 days in a row to try to more easily adjust to the undesirable SE's of the adderall.
> The adderall has been helping my drive and alertness that the higher-dose klonopin took away, but I find that it (adderall) also might be exacerbating my anxieties - especially those of an anticipatory nature.
> I have pretty severe social and general anxieties. I just did all this research to plan a trip to go with my brother somewhere over the weekend; I found the cheapest fares, etc., and got him all psyched about it, and, now, as the time of the flight is getting closer (tonight), my anxiety is getting higher.
> While the adderall has been helping me in relaxed, stressed-free environments, I think that, if anything, it could make my anxiety worse if I go on this trip. I don't want to dissapoint my brother (as I have so many people so many other times by opting out at the last minute due to anxiety).
> The only thing I can think of doing with such short notice is to DROP the stimulant for the next 3 days that I will be away on this trip. Can I just drop it cold trukey tonight (considering I've been taking it only a few days), or do I have to worry about tapering it?
> The way I see it, if I go, it might actually be a good thing for me (like being thrown into deep water and forced to learn to swim). I'll still be taking my klonopin.
> Man, I'm anxious.
> What do you think (I have to tell my bro within like a 1/2 hour!).hope u get this in time..
Dropping adderall after just a few days should be no problem. i would almost definitely not take it while youre on the trip-- it can dEFinitely exacerbate anxiety a good deal, plus its not like youll be needing to study or anything right? Yeah go on the trip, dont take the Adderall, and then decide about whether u need it or not when u get back. Good luck, & have peaceful fun.
Posted by Budgie on August 29, 2003, at 0:58:08
In reply to HELP-NEED QUICK ADVICE!!, posted by Peter on August 28, 2003, at 9:57:11
Hi Peter,
I guess you won't get this in time, and it's not med help anyway. But we just learned in my Intro Psych class today that the relief you get by turning back at the last moment is actually a positive reinforcer- it keeps you engaging in that behavior. Not to make you feel worse, really ('cause I've definitely been there with you many times!), it's just something that I've been thinking about all day. It's why I *forced* myself to raise my hand and talk in all my classes today, despite the panic.
Of course, as I write this, it occurs to me that the knowledge of the depression that would surely follow an experience like yours should act as the opposite of a reinforcer, right? (Don't know the technical word for that yet.)
Keep trying, Peter. Keep talking to us, too- maybe over on the psychological babble board?
Best,
Budgie
Posted by Peter on August 29, 2003, at 11:48:08
In reply to Re: » Peter , posted by Questionmark on August 29, 2003, at 0:38:59
I'm really sick of this. This adderall+klonopin combo is turning out to be a weak 'bandaid' for my disorder and it's not targeting the larger, overarching, more problematic symptoms.
When I took the 'higher-dose' klonopin that my pdoc told me to take for my acute anxities alone WITHOUT the adderall, I felt socially detached, dulled (like I was underwater), and 'down,' which caused some irritability and depression.
So, since my pdoc told me to resume adderall 10mg bid IF the higher-dose klonopin didn't help me feel at least 80% better after 4 days, I DID resume the adderall.
But now, with the adderall added, I feel that, while it seems to give me an initial boost for only 1 hour after each dose, I then become withdrawn, more irritable, and socially avoidant; within the next hour (I guess about 2 hours after each dose), II become very detached from my surroundings and comatose. zombie-like, slow reflexes, and numb and even more antisocial. And I thought 1-2 hours after each dose is when the med is at its 'peak' levels.
I didn't use to experience these phenomena when I took adderall 35-40mg for many months, but maybe that's because I was also taking lamictal, prozac, strattera, and a lower dose of klonopin at the same time. Maybe the synergies of everything benefitted me.
Also, perhaps now I am having some real chronic depression or bipolar mood switches going on beneath the adderall+klonopin.
My pdoc gets back from vacation this coming Tuesday. I don't really know what to do until then. Even though I hated tapering off my 40mg adderall last month after almost a year of taking it, it might be best if I did come off the adderall again so that, when I talk to my doc, I will only be taking the higher-dose klonopin and won't therefore hav e to start tapering the adderall then and thereby have to go through more days before he finally (hopefully) agrees to put me on something that will target my main symptoms more effectively.
On the other hand, I'm in a really isolated, low-stress place on vacation, and maybe using the adderall until he returns will at least give me some periods of feeling a little better (even though these periods of relief are few and far between) so I could get through the weekend.
But still, as I've mentioned, I took the adderall Monday, Wednesday, and Friday of LAST week, then took the weekend off completely from it and then resumed it on Tuesday and took it everyday from then on through today. So if I stop it 'cold,' espcially considering I'm still takig the higher-dose klonopin, I might get even more depressed; though some of you said that 3 days last week+4 days in a row this week of adderall is not enough to necessitate a taper so that I could just stop it with no problems?
If I do taper it, i guess I would chop off 5mg a day starting tomorrow, so, since I'm taking 20mg total, it'll take 4 days to come off completely - but that's almost as much as I've been taking the med! It's confusing.
Why do you think the adderall is having this effect on me? it's combination with the higher klonopin? some sort of underlying depressive episode or mixed moods going on? Am I taking too much of it? Too little of it?
This sucks. And I just know that if he ends up putting me on another AD, it'll take forever to start working and then it'll only work for a short time. I say this 'cause I've tried pretty much every one and that was the case. Another wierd thing is that he initially diagnosed me with bipolar as well as 'possible' ADD and SA, yet he doesn't seem to care anymore that I'm not taking a mood stabilizer (even though he always insisted that I be on an MS before adding any other meds). And other docs I went to for 2nd opinions all had different diagnoses for me - some said NO bipolar, others said NO ADD. I don't know if my own pdoc knows what my diagnosis is anymore. I sure don't.
Whatever, I'm rambling. I feel like taking another adderall just for that initial lift out of the zombie zone, but I think I'm not thinking straight. What do you think I should do about this adderall conundrum?
thanks-and sorry for the rambling,
Peter
Posted by blondegirl47 on August 29, 2003, at 11:58:57
In reply to FEEL COMATOSE, posted by Peter on August 29, 2003, at 11:48:08
I wish I could feel something on such a low dose of adderall. I have to take 25 mg at a time. Maybe when your pdoc comes back he can write you a script for a different stimulant...everyone reactive diffently to different stimulants.
I too get a little bummed on adderall, sometimes you have to try to lift yourself out of. This is going to sound trite, but try listening to some uplifting music, watch a movie that will make you laugh...even better watch it with friends who will laugh with you. You don't have to be real social when your watching a movie together. :)
Anyway, hope this helps some...
Blondegirl
Posted by Jasmine Neroli on August 30, 2003, at 0:12:28
In reply to FEEL COMATOSE, posted by Peter on August 29, 2003, at 11:48:08
Peter, I'm concerned!! OK, here's a radical question: Why can't you, for the next 3 -4 days, try to tolerate that low underwater feeling. Like "go with it". Be numb. Be anxiety free. Feel little. Have no expectations. Do not concern yourself about "performance".Give up 4 days and be zoned-out.Rest your emotions????Huh?? Huh??? What would be the big deal about being low and lethargic for a short while?Ask yourself why it is such a big deal? Is there something that scares you here?? Are you afraid of falling into a big dangerous depression? Do you feel something comng on?
Why I'm asking, is that I'm wondering if you should ditch Adderall until you talk to your Doc. (Maybe the Klonipin dose is a bit too high, and you could get the necessary anti-anxiety effect with a little less??? Talk to your Doc maybe).
I can't help thinking that Adderall and you sound like a dependency thing. I remember calling it a "love/hate relationship" before!
This sounds like a bit of a challenge, but it's really meant as support:)
Blondegirl's advice sounds good, I know you have a sense of humour :), so a funny movie with friends might really help, right about now.
You just have to be there, that's all, the movie does all the performing!!
Keep posting..we want to know that you are ok right up until you get on that plane to NY!!!!
Jas
Posted by Peter on August 30, 2003, at 5:22:34
In reply to Re: FEEL COMATOSE, posted by Jasmine Neroli on August 30, 2003, at 0:12:28
Hi Jasmine:
You're ccompletely right. There probably is an element of dependency with me on the the ole' adderall. I guess I am scared of destabilizing myself further by constantly switching dosing (takingh adderall, not taking it) and falling into a pit of depression, since, as you know, those are horrendous. In fact, when I DID fall into deep depression after I gave into my anxieties and cancelled the trip, I took an extra 1/2 pill of adderall to try to help me somewhat feel a little better. What differentiates this from true addiction, though (since I am very familiar with that - cocaine, heroine,->rehab, etc.), is that I am not 'craving' the adderall; at the time it seemed to be my only choice to get me out of my deep depression and help me function instead of lying in bed the rest of the day. I'm much more 'looking forward' to taking something that will help me function, like an SSRI, than continuing adderall. But I still am wary of stopping it cold turkey for the next 3 days - I'm still unsure as to whether taking it Monday, Wednesday, and Friday the week before last followed by Tuesday-Friday this past week is enough to warrant a taper off of it or if I would be able to stop it cold. There's also the issue that I have a history with this med - I used to take it for 6months or more in a row, and I don't know if my neurotransmitters are sensitized to it or something - i.e. I'd have withdrawal even if on it for a shorter time like I've been?
Regardless, the extra 5mg that I took on Thursday in my deep depressive episode did nothing but make me more exhausted. This is the first time I've taken adderall without a mood stabilizer or antidepressant, and it seems as though my reactions to it are very indicative to an ADDers reaction to a stimulant - it calms me. I have a feeling that, even though many (including myself) consider 20mg to be a small dose, it is effecting me in the opposite way a stimulant should - sometimes it gives me a bit of energy, but most of the time it calms me and makes me withdrawn and numb. Who knows, maybe without all the other meds to buffer it, this might be too HIGH a dose of adderall this time around; or it might be the fact that it's combined with high-dose klonopin' or it might have something to do with the fact that every since I was a little kid medications would have the exact OPPOSITE effect on me than they were supposed to. (in terms of sedation/stimulation) Dramamine or something if I was given when ill on a plane would make me yell and scream and run around. I don't know if that kinda stuff stays with you thru adulthood, but I sure am experiencing a non-stimulating effect from a stimulant. On the other hand, it calms me down unlike a sedative like klonopin. The feeling I;ve been getting from adderall is one of apathy and numbness - like I just don't care, which in turn takes a way my self-consciousness - this is all sort of a nice break from overthinking everything and driving myself nuts. But I'm quite sure nonethless that it isn't a good med for me - when vacation's over and I begin to deal with responsibilities, etc., I'm gonna need to feel and react, etc. True my pdoc gets back on the 2nd, but I wasn't able to get a session with him until the 11th. Maybe I can geta sort of 'emergency' 5 minute conversation with him on the 2nd, because if he decides on any larger treatment moves (AD, mood stabilizer), then I'd have to have scripts shipped to me here and THEN once I begin whatever it is, it'll take ages from THAT point to start working. And you know I've been holding on to a thread these past few weeks. So the real immediate decision is whether to stay on the adderall until I talk to him, and, if not, whether to just stop it cold or taper it. See? I'm oerthinking everything again. At least the adderall would make me nice and empty-headed and boring(-:
I should have just gone on that trip with my brother, and I actually found another cheap flight (like $59!) if I left with him tonight (though I didn't tell him because I'm afraid to get him psyched and then have my anxiety kick in and ditch the whole thing again). But the reason I was thinking of going is just to have 2 days (especially appropriate before in these last few days before my pdoc gets back) of having my mind directed 'outside' of myself.
The only potential problem, which I didn't mention, and which I'm sure increased my struggle decided whether to go a few days ago, is where we'd be going: guess? Amsterdam! My brother happens to be a huge pot head, and I even used to enjoy going there with him. But is it worth my smoking myself silly to the point where I'll be all burnt out and it will be more confusing for my pdoc to assess the next move? Also, there was the anxiety factor - of having a panick attack while there, etc. What's better? staying here, isolated, comatose but comfortably numb on adderall or stopping the adderall completely and going to Amsterdam and smoking and exploring with my brother. Or, thirdly, staying here, dropping the adderall, feeling exhausted, uncreative, and preoccupied with treatment until I speak to my pdoc? Haha! These seem to be my options(-: And on top of all this is the creepy thought that I have an underlying bipolar disorder that is really getting worked up beneath everything; for instance, maybe the reason the adderall has been effecting me so inconsistently is because I am having bipolar cycles beneath the adderall 'band-aid,' and I'm blaming the adderall itself. Does that make any sense? In which case, if all my 'peripheral' syndromes are driven and exacerbated by my bipolar syndrome, I dont want to end up in Amsterdam freaking out (in a bad way). Whatever, I sense a return of good old generalized anxiety. Perhaps I should just play it safe and stay here until I talk to Dr. Richard Dreyfuss.
Peter
p.s-I compose jazz and modern chamber music, and I play jazz and classical piano (but am more adept at jazz piano, as that's what I record on albums, etc.).
Posted by Jasmine Neroli on August 30, 2003, at 22:52:34
In reply to Re: FEEL COMATOSE » Jasmine Neroli, posted by Peter on August 30, 2003, at 5:22:34
Yeah, I really see your dilemma Peter. It certainly looks like Adderall is having an ADD- like "non-stimulant" effect on you, which adds to the relaxing (& sedating, at your dose)effect of Klonipin. And, as such, I'm inclined to agree that a few days in zombie-land at "home" would be better for you....if a little dull! If you're at all doubtful of any kind of withdrawal effects on tapering off Adderall, perhaps you should keep on with that low dose for the next few days.
BTW, when I said 'dependency' before, I didn't mean in an addict- kinda way, I meant it exactly how you described it!
I can well understand your fear of something "cycling" underneath it all and being trepidacious about making the wrong move with meds. It could set something bigger off ..and as you say...you are hangin' by a thread right now.
I was reading something interesting from an old thread about Klonipin. Apparently GABA (since it has an inhibitory affect on neurotransmitters and firing), is neuro-protective, so Klonipin can actually protect neurons (keeping them from firing inappropriately),reduce over-excitory reponses and neurotoxicity. Kind of healing!!!
The doctor who wrote the piece (Dr. Cheney), says there's nothing wrong with letting your "brain shut down for a while" on a higher dosage of Klonipin!! Maybe that's what your Pdoc had in mind! This Cheney guy also recommends taking a very low dose of Klonipin (e.g. .25mg) in the am and mid-afternoon, but quadrupling it before bedtime.(e.g. 1mg, if your daily total is 2mg) According to him, taking the daily Klonipin dose in this ratio gives the patient more energy and cognitive function during the day. Maybe re-structuring the dosage amounts/times could lessen your lethargy lows?Hey, I'm so envious of your musical talent/creativity!!! Ever written any lyrics? Poetry? A lot of the kids I deal with, write fabulous poetry and express their pain that way (mostly the 15 year old boys as a matter of fact!).
Jasmine
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