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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 KaraS on October 28, 2003, at 1:05:42
I just started on Ritalin at 5 mg. for anergic depression. It's supposed to give me energy, motivation and focus but instead it puts me to sleep. I don't have ADHD (at least not that I know of) so this reaction has been a surprise to me. My doctor said to increase the dosage to 10 mg. and then to 15 mg. as I might find larger amounts stimulating rather than sedating. The trouble is that I'm afraid to take anymore of it. The 5 mg. knocks me out so much and there is no guarantee that those larger dosages won't put me to sleep also. My fear is that they will put me out too much - like taking too large a dose of sleeping pills. Am I being ridiculous or is this a legitimate concern? Has anyone else dealt with this?
Posted by Ame Sans Vie on October 28, 2003, at 7:01:51
In reply to Does Ritalin make you drowsy?, posted by KaraS on October 28, 2003, at 1:05:42
I have a mild case of ADD w/o hyperactivity (though I was a terror-child with full-blown ADHD growing up; a very high-achiever in school though). The symptoms of ADD may not be obvious, but they may be there -- Ritalin does the same thing to me. 5mg makes me want to curl up and take a nap, but 10mg is a bit over-stimulating to my heart. It does not, however, put me to sleep -- just gives me added drive and focus. If I were you I would give 7.5mg a try just to see what the deal is. Just one slightly higher dose should be enough to judge, and at least it only lasts 3-4 hours (I presume you're taking immediate-release Ritalin).
Failing that, perhaps a trial of an amphetamine or Provigil is in order? The amphetamines are every bit as stimulating as Ritalin for most people, not to mention less cardiotoxic and may provide more energy (especially Adderall, since the racemic amphetamine in it seems to provide added physical energy). Provigil, at higher doses usually (i.e. 300-400mg), may be an even more benign way to decrease anergia.
It seems a lot of people find Ritalin to be "zombifying", so I wouldn't discount that you're just one of the many people who react to it that way and need another type of stimulant.
Posted by KaraS on October 28, 2003, at 13:16:57
In reply to Re: Does Ritalin make you drowsy? » KaraS, posted by Ame Sans Vie on October 28, 2003, at 7:01:51
Thanks so much for your very helpful, informative response. I wouldn't be surprised if I have a mild case of ADD or it might be, as you said, that I am just one of the people who react to Ritalin by becoming sleepy. I have tried Provigil but unfortunately it makes me feel like I have concrete limbs. I think that I will try to take 7.5 mg. of Ritalin, as you have suggested, and see what happens. I wasn't aware that Ritalin could be cardiotoxic. I'd always thought of Ritalin as "safer" than the amphetamines. I may eventually try Adderall as I could definitely use the physical energy. I am afraid of tolerance, addiction and rebound effect with the amphetamines though. Has any of that been a problem for you ... or do you take something like Acamprosate or Memantine along with the Adderall?
> I have a mild case of ADD w/o hyperactivity (though I was a terror-child with full-blown ADHD growing up; a very high-achiever in school though). The symptoms of ADD may not be obvious, but they may be there -- Ritalin does the same thing to me. 5mg makes me want to curl up and take a nap, but 10mg is a bit over-stimulating to my heart. It does not, however, put me to sleep -- just gives me added drive and focus. If I were you I would give 7.5mg a try just to see what the deal is. Just one slightly higher dose should be enough to judge, and at least it only lasts 3-4 hours (I presume you're taking immediate-release Ritalin).
>
> Failing that, perhaps a trial of an amphetamine or Provigil is in order? The amphetamines are every bit as stimulating as Ritalin for most people, not to mention less cardiotoxic and may provide more energy (especially Adderall, since the racemic amphetamine in it seems to provide added physical energy). Provigil, at higher doses usually (i.e. 300-400mg), may be an even more benign way to decrease anergia.
>
> It seems a lot of people find Ritalin to be "zombifying", so I wouldn't discount that you're just one of the many people who react to it that way and need another type of stimulant.
Posted by Bill LL on October 28, 2003, at 14:44:19
In reply to Re: Does Ritalin make you drowsy?, posted by KaraS on October 28, 2003, at 13:16:57
I never heard of Ritalin being cardiotoxic. Is that true? On the dosage issue, you should try a higher dose since it might give you energy.
Posted by Ame Sans Vie on October 28, 2003, at 17:45:10
In reply to Re: Does Ritalin make you drowsy?, posted by KaraS on October 28, 2003, at 13:16:57
> Thanks so much for your very helpful, informative response.
No problem. :-)
>I wouldn't be surprised if I have a mild case of ADD or it might be, as you said, that I am just one of the people who react to Ritalin by becoming sleepy.
Yeah, who knows, lol.
>I have tried Provigil but unfortunately it makes me feel like I have concrete limbs. I think that I will try to take 7.5 mg. of Ritalin, as you have suggested, and see what happens. I wasn't aware that Ritalin could be cardiotoxic. I'd always thought of Ritalin as "safer" than the amphetamines. I may eventually try Adderall as I could definitely use the physical energy. I am afraid of tolerance, addiction and rebound effect with the amphetamines though. Has any of that been a problem for you ... or do you take something like Acamprosate or Memantine along with the Adderall?
Well, first of all, Ritalin is every bit as much a risk as amphetamines as far as tolerance, rebound effect, etc. go -- if not more so (it is incredibly similar to cocaine). I wouldn't worry about giving amphetamines a shot. I don't take Adderall currently, but I take DextroStat (dextroamphetamine) and haven't developed a tolerance after months of daily use at 30mg/day, and sometimes up to 120mg/day. I don't take memantine or acamprosate, but I recommend dextromethorphan (found in OTC cough syrups) which is also an NMDA antagonist, and a cheaper one at that. 15mg four times daily and I never even developed a tolerance of any sort to the Ultram I used to take, which is a narcotic analgesic. And now, with Robitussin CoughCaps having just been released, you don't have to drink that disgusting syrup, lol.
The trick to avoiding rebound effect, by the way, is to take your next dose about 45 minutes to an hour before the first wears off (unless you take an extended-release form, like Adderall XR or Dexedrine Spansules, which will eliminate daytime rebound). That way it will be kicking in as the first dose declines in activity. At night before bed, when you obviously won't want to be taking stimulants, perhaps a bit of Ambien or something similar could be of assistance.
Posted by Ame Sans Vie on October 28, 2003, at 17:46:59
In reply to Re: Does Ritalin make you drowsy?, posted by Bill LL on October 28, 2003, at 14:44:19
> I never heard of Ritalin being cardiotoxic. Is that true?
Actually, there have been many deaths (mostly children) due to cardiotoxicity from methylphenidate when taken at a standard prescribed dose without a pre-existing heart condition. Granted, this occurs sometimes with amphetamines, but is not as common.
Posted by KaraS on October 29, 2003, at 1:08:28
In reply to Re: Does Ritalin make you drowsy? » KaraS, posted by Ame Sans Vie on October 28, 2003, at 17:45:10
Thanks again for all of the info. That's very encouraging that you haven't developed any tolerance/addiction problems with the amphetamines. (I knew that dextromethorphan was an NMDA antagonist but for some reason had never heard or read, even on this site, about anyone using it to prevent tolerance.) Getting back to the safety issue though - don't you consider amphetamines more dangerous than methylphenidate in terms of neurotoxicity? Do you take NAC, selegiline or anything else for that?
> > Thanks so much for your very helpful, informative response.
>
> No problem. :-)
>
> >I wouldn't be surprised if I have a mild case of ADD or it might be, as you said, that I am just one of the people who react to Ritalin by becoming sleepy.
>
> Yeah, who knows, lol.
>
> >I have tried Provigil but unfortunately it makes me feel like I have concrete limbs. I think that I will try to take 7.5 mg. of Ritalin, as you have suggested, and see what happens. I wasn't aware that Ritalin could be cardiotoxic. I'd always thought of Ritalin as "safer" than the amphetamines. I may eventually try Adderall as I could definitely use the physical energy. I am afraid of tolerance, addiction and rebound effect with the amphetamines though. Has any of that been a problem for you ... or do you take something like Acamprosate or Memantine along with the Adderall?
>
> Well, first of all, Ritalin is every bit as much a risk as amphetamines as far as tolerance, rebound effect, etc. go -- if not more so (it is incredibly similar to cocaine). I wouldn't worry about giving amphetamines a shot. I don't take Adderall currently, but I take DextroStat (dextroamphetamine) and haven't developed a tolerance after months of daily use at 30mg/day, and sometimes up to 120mg/day. I don't take memantine or acamprosate, but I recommend dextromethorphan (found in OTC cough syrups) which is also an NMDA antagonist, and a cheaper one at that. 15mg four times daily and I never even developed a tolerance of any sort to the Ultram I used to take, which is a narcotic analgesic. And now, with Robitussin CoughCaps having just been released, you don't have to drink that disgusting syrup, lol.
>
> The trick to avoiding rebound effect, by the way, is to take your next dose about 45 minutes to an hour before the first wears off (unless you take an extended-release form, like Adderall XR or Dexedrine Spansules, which will eliminate daytime rebound). That way it will be kicking in as the first dose declines in activity. At night before bed, when you obviously won't want to be taking stimulants, perhaps a bit of Ambien or something similar could be of assistance.
Posted by Ame Sans Vie on October 29, 2003, at 6:06:29
In reply to Re: Does Ritalin make you drowsy? » Ame Sans Vie, posted by KaraS on October 29, 2003, at 1:08:28
Amphetamine neurotoxicity was something I was concerned about a while back... I posted here to ask about it. From the responses I received, I gather that amphetamines are perfectly safe when used at medically therapeutic doses, orally, even for very extended periods of time. It's when you start smoking them or mainlining 50cc's of meth a day that you run into trouble. :-) This can be evidenced by their wonderful track record of safety for so, so many years.
I do take ALC though, by the way, as well as DLPA (to keep my catecholamines and endorphins up to par).
Michael
Posted by femlite on October 29, 2003, at 14:07:45
In reply to Re: Does Ritalin make you drowsy? » KaraS, posted by Ame Sans Vie on October 28, 2003, at 17:45:10
Hey Ame Sans Vie,
I would like to jump in here to ask you ...I took my first dose of adderall 20mg.xr today. I was good for a bout 5 hours then I imploded, sobbing, ideation, definate crash.. 5 hours...? I was told peak time was 8.
What do you think?
Am I a fast metabolizer, is it a bad fit. Could another med, cause this
thank you
Posted by Ame Sans Vie on October 29, 2003, at 14:26:25
In reply to Re: Does Ritalin make you drowsy? » Ame Sans Vie, posted by femlite on October 29, 2003, at 14:07:45
You know, sometimes it's just as simple as the drugs not working as long as they're supposed to. <shrug> I know many people who find sustained-release forms of many drugs (esp. Inderal, Dexedrine, and MS Contin) to last a fraction of the time they're supposed to. But, Adderall XR does work a full eight-ten hours for me... perhaps your metabolism is a bit fast. You didn't take it with grapefruit or orange juice, did you? Which other medications are you taking? Many meds can hasten the metabolism and excretion of amphetamines.
Posted by femlite on October 29, 2003, at 14:43:45
In reply to Re: Does Ritalin make you drowsy? » femlite, posted by Ame Sans Vie on October 29, 2003, at 14:26:25
Thanks for getting back,
I know about the citrus issue, no problem there.
Im prescribed to take it with 450 mg. Lithium am and pm. I took my first am Lith today, but I only took half.
I also took 2 ativan each 5 hours apart, at the same time as the adderall and then right before the crash. Any problem there?The last few days Ive been so unstable with out any AD (to clean me up for my new cocktail) I took 1-3mg. percocet each day just to stop from climbing the walls and screaming at my kids.
I felt like jekyl and hyde today, all sweetness from 7am till noon when the beast returned. What a let down. The docs office says "They dont consider me in any danger, so unless i want to be committed Ill have to wait till my next visit to discuss my meds" What a crime. My computer has better tech support..
thanks
Posted by srd1074 on November 3, 2003, at 19:06:59
In reply to Re: Does Ritalin make you drowsy? » Bill LL, posted by Ame Sans Vie on October 28, 2003, at 17:46:59
Okay, let's clarify a couple of things. Amphetamines are more neurotoxic than methamphetamines. In fact, more neuronal damage is found laboratory studies on short term use with amphetamines than methas. As far as cardio-toxicity levels are concerned, if implications were found with low dosages, it sounds more like anaphylactic shock than cardiotoxicity. Methylphenidate is a derivative of a methamphetamine and is considered to be a "mild CNS stimulant." As someone who takes it for its stimulant effects, I can tell you that with an extended release, it is more subtle than a cup or two of coffee. If it is making you drowsy, then what is causing your "depression" is not related to your dopamine levels. If you are feeling a constant state of fatigue, I recommend you check a few things on sleep disorders - your internist is not likely to be educated on them. You also may want to look into drugs that do not affect your dopamine levels - such as amphetamines, methamphetamines, caffeine, ephedras (or pseudos), methylphenidate - or any other drug used to treat ADD. You might want to look into medications that affect epinephrine/norepinephrine. There are some new re-uptake inhibitors on the market that primarily affect these chemicals - ask your pharmacist, not your doctor, about them before discussing with your physician. Doctors don't go to school to specialize in pharmacology, they specialize in anatomy and physiology. Your pharmacist does knows the drugs and their pros and cons a little better.
S.
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