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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Benzylboy on February 18, 2004, at 1:21:39
We know it true that tolerance slowly builds to Adderall, and I have noticed this just in the three months I've been taking Adderall.
As far as I can tell by various posts, Adderall and Ritalin have a minimal cross tolerance, so I hope to propose the following cycle to my P-doc:
3 months on Adderall
1 month on Ritalin
3 months on Adderall... etc.Essentially, I am searching for some kind of medication equilibrium - peace of mind knowing that I need not worry about ever-increasing tolerances.
This Adderall/Ritalin cycle would, in theory, circumvent taking unpleasant "drug holidays" as well.
Will it work? Will it fry my brain? Any ideas?
Posted by PsychoSage on February 18, 2004, at 4:54:20
In reply to Adderall-Ritalin-Adderall, posted by Benzylboy on February 18, 2004, at 1:21:39
i am so skeptical of amphets/methylphenidate for this reason. I never took these over time or by prescription, but I was experienced with illicit stimulants to be knowledgeable about how they affect the brain. I did have a short period with ritalin use in school, so I know what a less euphoric stimulant is like in terms of onset, effects and crashing down. These stimulants are like drugs of abuse in that people become used to the effects, and it takes more to achieve the same subjective effect as first noted and experienced. It's a simple rule.
I just started on provigil and for the reason of potential tolerance and psychotic symptoms, I am starting at 50mg and will try to take as needed or at least take days off here and there. I just know though that my relationship to the drug will change, and i will have to think about moving to what I was prescribed which is 100mg in the morning.
It's good that there are dopamine agonists and aricept and other drugs to examine for attention/energy/concentration symptoms. I am obviously precluded from amphet and ritalin because I am in recovery. Naturally, I have to be very careful on provigil, and I can see myself getting used to it eventually. therefore, I would want to increase the dose which if I did it a few more times would send me into the madhouse if the psychotic symptoms come first or leave me searching for the perfect level of arousal in vain because that is so difficult to maintain.
I definitely believe rit and amphets can leave you depressed or cause mood disturbance in more sensitive folks who also have major depressive or bipolar disorders like myself.
My friend just sufferred a horrible depression, and she had been on ritalin for some time {not more than a year I think}. She is bipolar, and I have no doubt the ritalin probably burned her brain out because even though it brings you up and makes you productive {it was for her depression I think, since she has tried many and few ADs work but no doubt it helped her work 50 hour work weeks while taking very tiring anticonvulsants and lithium and remeron} it doesn't allow you to be too flexible with your emotions. In a depression I think the ritalin jolted her up when she was really down at her baseline. That probably tired her out and sent her into a suicidal funk, since she was trying to work hard at her job and deal with other normal issues but she had little time to work things out in the right mood.
Good luck, and just be pragmatic. I am not familiar with your plan, but just be ready to form a new one after a year or whenever you need to.
Posted by Kacy on February 19, 2004, at 8:29:58
In reply to Re: Adderall-Ritalin-Adderall, posted by PsychoSage on February 18, 2004, at 4:54:20
My advice is to switch brands. That seems to be helping me avoid tolerance. They are all different though, and you will get different responses to each one. From my experience, you should avoid Eon Labs. It doesn't seem to be even close to the effectiveness of Barr, Shire, and Ranbaxy. (If I hadn't had some Barr pills left to try, I would have thought I had reached tolerance. No–it's Eon.) When one weakens, if I switch, the next brand works. I've never heard of anyone else doing it, but it seems to be effective. It's still relatively new to me, though.
My doctor is telling me Dexedrine is more robust and suggesting I try it. Have you tried it?
Posted by blondegirl47 on February 19, 2004, at 13:00:42
In reply to Re: Adderall-Ritalin-Adderall, posted by Kacy on February 19, 2004, at 8:29:58
I take dexedrine spansules...actually they are called dexedrine sr now. The generic seems to work as well as name brand. Dextrostat is pretty good too, all though I didn't care for generic dexedrine tablets. Be sure to take medication on an empty stomach and with a full glass of water for best effects. :) hope this helps
Blondegirl
Posted by Benzylboy on February 23, 2004, at 17:27:40
In reply to Re: Adderall-Ritalin-Adderall, posted by Kacy on February 19, 2004, at 8:29:58
I know that dexedrine is one of the "ingredients" of Adderall, so it doesn't seem like it would help too much with the tolerance issues, but I'll certainly look into it. Perhaps just switching from Adderall to dexedrine from time to time would do the trick.
> My advice is to switch brands. That seems to be helping me avoid tolerance. They are all different though, and you will get different responses to each one. From my experience, you should avoid Eon Labs. It doesn't seem to be even close to the effectiveness of Barr, Shire, and Ranbaxy. (If I hadn't had some Barr pills left to try, I would have thought I had reached tolerance. No–it's Eon.) When one weakens, if I switch, the next brand works. I've never heard of anyone else doing it, but it seems to be effective. It's still relatively new to me, though.
>
> My doctor is telling me Dexedrine is more robust and suggesting I try it. Have you tried it?
Posted by Kacy on February 25, 2004, at 14:21:53
In reply to Re: Adderall-Ritalin-Adderall, posted by PsychoSage on February 18, 2004, at 4:54:20
> "i am so skeptical of amphets/methylphenidate for this reason. I never took these over time or by prescription, but I was experienced with illicit stimulants to be knowledgeable about how they affect the brain. I did have a short period with ritalin use in school, so I know what a less euphoric stimulant is like in terms of onset, effects and crashing down.
>…because even though it brings you up and makes you productive
>…it doesn't allow you to be too flexible with your emotions.
>…she had little time to work things out in the right mood."
Pschycosage: I appreciate your concern about what could be happening to people who are taking stimulants. Just know that none of the above applies to me or others like me. I wouldn't mind a little euphoria, but it just isn't a state I'm likely to ever see from a drug or from anything in life. I'm not using speed. I'm taking a hormone.The drug doesn't make me productive. Yes, I can be more productive with it, but it's actually helping me by making me more effective as I keep working at doing the things I have always worked at. I have tried all my life and I keep trying.
The right stimulants do allow me to be more flexible with my emotions. As a matter of fact, I experienced more emotions and a lot better thought, the type of thinking I've always been capable of of but was too blanked out to follow. I didn't even care when my emotions were negative because I actually had some feelings to go with them. (I never expected a happy pill.) And I started to remember my life. That was amazing.
On the last note, I'm with you. I have little time to work things out in the right mood—but that's because the time I have is limited to when the stimulants work, and that time is limited to when I am allowed to have them at effective doses.
Last month was lost to a brand that didn't work. That was four weeks of zero help after two and a half months of progress. Well, I know I have to try them. This month, I finally conceded to try dexedrine instead of Adderall. Contrary to what the doctor had said before, he started me on a lower dose. Now it will be five weeks of what for someone like me is a starter dose. "Fail on this and then we'll try more." At that point, he wouldn't let me out of it, meaning he wouldn't write a prescription for Adderall. Three months titrating up on Ritalin. Three months titrating up on Adderall. Can we learn from the past here? Have we learned nothing? Try to be sincere. Thank you, Doctor. (I don't think I got it out.) Power, opportunity and corruption: it applies everywhere, doesn't it?
Some of the most depressing times I have are after seeing the doctor, and this guy's probably better than most. I get tired of paying the price for all the people who abuse drugs, the price exacted by the right in their war on people.
Posted by Benzylboy on February 25, 2004, at 14:49:55
In reply to Re: Adderall-Ritalin-Adderall, posted by Kacy on February 25, 2004, at 14:21:53
That must be unbearably frustrating - the potential of 5 more weeks of downtime. I have learned that there is a phonebook full of psyc-docs, all competing for my business. I hate to say it, but if one doctor doesn't agree with what I feel I should be prescribed, another doctor will.
I like to think of the doctor as a teammate. I'm a responsible adult, I've read heaps on medicating a.d.d., and my intention is to go on X medication at Y dose. My doctor agrees, I give him $65, and I'm on my way with the Rx. I guess my point is that one needs to feel that one's happiness, stability, functionality, etc. is in his or her own hands, not the doctor's. I'm not out to get high; I'm out to control my a.d.d. with minimal drug dependence and avoid drug holidays at the same time - I just hope the doctor sees it the same way!
> On the last note, I'm with you. I have little time to work things out in the right mood—but that's because the time I have is limited to when the stimulants work, and that time is limited to when I am allowed to have them at effective doses.
>
> Last month was lost to a brand that didn't work. That was four weeks of zero help after two and a half months of progress. Well, I know I have to try them. This month, I finally conceded to try dexedrine instead of Adderall. Contrary to what the doctor had said before, he started me on a lower dose. Now it will be five weeks of what for someone like me is a starter dose. "Fail on this and then we'll try more." At that point, he wouldn't let me out of it, meaning he wouldn't write a prescription for Adderall. Three months titrating up on Ritalin. Three months titrating up on Adderall. Can we learn from the past here? Have we learned nothing? Try to be sincere. Thank you, Doctor. (I don't think I got it out.) Power, opportunity and corruption: it applies everywhere, doesn't it?
>
> Some of the most depressing times I have are after seeing the doctor, and this guy's probably better than most. I get tired of paying the price for all the people who abuse drugs, the price exacted by the right in their war on people.
>
Posted by Festus on February 27, 2004, at 22:05:58
In reply to Adderall-Ritalin-Adderall, posted by Benzylboy on February 18, 2004, at 1:21:39
The world of getting proper medicating while dealing with ADD and Chronic Pain,has near driven some of us off the deep end.I.ve fought the tolerance issue two-fold(Opiates and Stimulants)for several years and I,m seriously thinking of throwing in the towel on both of them,just to see what happens.Tolerance IS a big issue,I don,t care who says that folks with true CP don,t get tolerance to Opiates,or true ADD folks don,t get it with Stims.HOGWASH!!After years of Morphine and Ritalin,Oxycontin and Provigil,Methadone and Adderrall,AAAHHHGGGG!!!Anyway,I,ve just settled into a regular schedule of Methadone,Dexedrine,Prozac,and Xanax,opting to go with a 3 week on,1 week off schedule with the Dex,simply to ward off tolerance to it.I am glad there are Dr.,s out there,although not many,who see the relief of patient symptomatic discomfort and dysfunction first,instead of fear of the DEA.Help as they do,I would trade almost anything to be able to not have to take ANY pills at all.Does anybody else get just plain ,old sick-and-tired of enduring the effects of meds,day in and day out?Sorry if I,m whining,don,t mean to,just wondering how others deal with this feeling.Festus
Posted by benzylboy on April 5, 2004, at 3:03:35
In reply to Adderall-Ritalin-Adderall, posted by Benzylboy on February 18, 2004, at 1:21:39
Follow up:
So I tried my little plan to go on Ritalin as an attempt to reduce Adderall tolerance. I'm sure there are worse experiences in life - like being forced from the womb - but they are few and far apart.
I switched from 15mg Adderall 2x daily to 20mg Ritalin 2x daily. I did not decrease the Adderall dosage slowly either, an agonizing mistake. The first three days felt like someone had jabbed a stick through my brain, and in addition, I was speedy and moody from the Ritalin.
After a week, I felt better, but my ADD symptoms were all back; the Ritalin made me plenty speedy but no less spacey. Within another week I was back on Adderall, same dose, with no noticeable reduced tolerance.
Conclusions:
I've learned from my experiment that if Adderall tolerance is indeed a concern, substituting Ritalin is not an advisable way to approach the problem. Maybe a complete "drug holiday" is better, but I certainly never want to stop using Adderall "cold turkey" again and will step down my dose in stages next time.
Also, when the P-doc says, "That's really not a good idea, but if you really want to...," that should send up a warning flag to reconsider.
This is the end of the thread.
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