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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by sedona on July 28, 2004, at 15:57:47
I have been having no luck with Wellbutrin, SSRI's, or Lamictal. My doctor added a small dose of Klonopin to help with anxiety and Ritalin to help with concentration and energy. The antidepresants have not helped my depression nor has the Lamictal. My doctor suggested trying an MAOI or a tricyclic, but I am not very enthusiastic about them since many of them have the side-effects of weight gain and fatigue. Both of which have been the side-effects I have had the most problems with. The only drugs that have helped me at all are Klonopin and Ritalin. So, my question would be to others out there who have had little success with AD's: Has anyone used a stimulant as their main AD and if so which ones have helped?
Thank you
Posted by zeugma on July 28, 2004, at 16:11:59
In reply to Stimulants as an Antidepressant, posted by sedona on July 28, 2004, at 15:57:47
Not to discourage you from stimulants, but tricyclics don't cause the same kind of fatigue as SSRI's or Effexor do (from disruption of sleep architecture). Most are sedating, which is very different, and helpful if you have sleep problems.
Posted by sedona on July 28, 2004, at 16:30:14
In reply to Re: Stimulants as an Antidepressant, posted by zeugma on July 28, 2004, at 16:11:59
> Not to discourage you from stimulants, but tricyclics don't cause the same kind of fatigue as SSRI's or Effexor do (from disruption of sleep architecture). Most are sedating, which is very different, and helpful if you have sleep problems.
Thank you for the information, if you have had a good expreience with tricyclics I would love to hear more about it. Unfortunately, my problem with sleep is that I sleep too much and it is hard to get up
Posted by King Vultan on July 28, 2004, at 17:41:31
In reply to Stimulants as an Antidepressant, posted by sedona on July 28, 2004, at 15:57:47
The tricyclics desipramine and protriptyline (Vivactil) are both relatively activating and may be worth trying; although, I always caution people that Vivactil has rather severe anticholinergic effects. Both of these are selective norepinephrine reuptake inhibitors, which, in my experience, do tend to reduce the need for sleep, as do the MAO inhibitors.
As for the MAO inhibitors, Nardil is neutral/sedating, while Parnate has a direct stimulant effect and lacks the weight gain side effects that many people have reported for Nardil. I am in the process of tapering off Nardil and will be going on Parnate myself in late August; although, it took a bit of convincing to talk my pdoc into it.
My own particular bias is that I tend to look very much askance at amphetamines because of the tolerance/abuse potential, but I know that they are widely used and do not present a problem for many people. On my last visit with my pdoc a couple days ago, the issue of substance abuse came up (in regard to Parnate, which does have a slight abuse potential), and I was surprised to hear him say that my personality was of a type that he doesn't generally associate with abusing substances. He feels that there is a strong element of control in my personality, which I suppose I have to agree with (at least from his perspective) because I am so heavily involved in my own treatment. In fact, it winds up being almost self directed, with his experience and wisdom as a safety net. He said that abusers, OTOH, don't have such a priority with control and are more comfortable with giving that up and going for a ride on whatever substance of abuse is their preference, and in essence, letting the substance control them. I must say I had no comprehension of this line of thinking, and there is apparently a great deal about psychology I do not have a clue about.
Todd
Posted by zeugma on July 28, 2004, at 17:45:02
In reply to Stimulants as an Antidepressant » zeugma, posted by sedona on July 28, 2004, at 16:30:14
I've had reasonable success with nortriptyline, and that is the only AD that has done anything at all for me- I've tried less than some here, but more than I wish I had. I do have a sleep disorder of some kind, but I tend more to insomnia, with bouts of compensating hypersomnia. I have serious fatigue issues as well as pretty drastic ADD issues. The TCA's generally work more for insomnia-predominant depression, but there is some evidence that they can regulate sleep cycles- I was never able to either fall asleep or wake up at a predictable time before I got to a therapeutic dosage of nortriptyline. Some find nortriptyline stimulating. Desipramine would be the most stimulating TCA with a good side effect profile (protriptyline is more stimulating still but is supposed to have some nasty side effects).
I'm trying a stimulant myself: as you can see from the thread immediately below. My dilemma is that I either feel half-asleep while awake, or I can't sleep at all, while remaining completely fatigued. Nortriptyline makes my sleep feel more 'normal', and it is easier to wake up these days.
Posted by appadoo on July 28, 2004, at 18:55:13
In reply to Stimulants as an Antidepressant, posted by sedona on July 28, 2004, at 15:57:47
Try dexemphatamine or one of the long actin amphatamine be it Ritalin or Adderall.I found that the ir stimulates gives me a rebound effect and I have a hard time geeting up in the morning.
wheras the LA formulas have a smother action and there is little if any rebound effect.
I think that any drug that effects the CNS will cause fatigue.Its a matter of degree I am taking prozac now since its suppose to be the most activating SSRI and I experience some fatigue especially in the morning if I decrease the dosage I'm less tired however the therautic effect is somewhat compromised.
Bottom line is the no medication otherwise you have to put up with the side effects if you take any antideppresant.
Posted by zeugma on July 28, 2004, at 20:27:26
In reply to Re: Stimulants as an Antidepressant, posted by appadoo on July 28, 2004, at 18:55:13
Prozac may be 'activating', but its deleterious effects on sleep cause it to be fatiguing in the long run. I'm a little peevish on this issue, because I suffered from terrible fatigue (over and above my usual levels, which is bad enough) and my pdoc, in trying to determine which med was causing it, had me decrease or stop several medications, with disastrous results, until the one he thought least likely, the recently released and 'selective' Strattera, turned out to be the culprit. Lowering the dose of the tricyclic only made me more fatigued and depressed. Yes, I'm peevish on this issue.... one of the early observations of Roland Kuhn, discoverer of the AD properties of imipramine, was that the drug appeared to restore the sleep of depressives to a normal, restful manner. This is in stark contrast to the drugs that have been developed more recently. Knowledge can be lost as well as gained, and I think this is what has happened in the last decade and a half. It frustrates me tremendously.
Posted by fayeroe on July 28, 2004, at 21:09:03
In reply to Re: Stimulants as an Antidepressant » sedona, posted by King Vultan on July 28, 2004, at 17:41:31
I'm jumping in here because I'm taking elavil and prozac and am gaining weight as I type. It's unreal, how much weight I've gained. I lost on EffexorXR and almost died.....what to do, what to do? Tell me more about Parnate, please
Posted by King Vultan on July 29, 2004, at 9:28:44
In reply to Re: Stimulants as an Antidepressant, posted by fayeroe on July 28, 2004, at 21:09:03
> I'm jumping in here because I'm taking elavil and prozac and am gaining weight as I type. It's unreal, how much weight I've gained. I lost on EffexorXR and almost died.....what to do, what to do? Tell me more about Parnate, please
I'm curious as to the dosages of Elavil and Proxac you are taking. This can be a very dangerous combination if your doctor doesn't know what he's doing.As for Parnate, this is an MAOI that is quite stimulating, as it has an amphetamine-like structure. It and Wellbutrin are the only two drugs in the antidepressant class that have a strong effect on dopamine. As such, they tend to lack sexual side effects and are even pro-sexual in some cases. Neither one is noted for weight gain, and it is not uncommon for people to find that they act as appetite suppressants. Parnate is a superior antidepressant to Wellbutrin, but it has the dietary and OTC drug restrictions that go along with being an MAOI.
Todd
Posted by fayeroe on July 29, 2004, at 9:42:52
In reply to Re: Stimulants as an Antidepressant » fayeroe, posted by King Vultan on July 29, 2004, at 9:28:44
20mg of prozac and 50mg of elavil. prozac in the a.m. and elavil at night. all i think about is eating. i've never, ever been like this. i'm just five feet tall and i'm miserable with the extra pounds...both meds are the generic variety because they are so much cheaper than the originals. any info is much, much appreciated, Todd.....thanks, pat
Posted by King Vultan on July 29, 2004, at 12:53:26
In reply to Re: Stimulants as an Antidepressant » King Vultan, posted by fayeroe on July 29, 2004, at 9:42:52
> 20mg of prozac and 50mg of elavil. prozac in the a.m. and elavil at night. all i think about is eating. i've never, ever been like this. i'm just five feet tall and i'm miserable with the extra pounds...both meds are the generic variety because they are so much cheaper than the originals. any info is much, much appreciated, Todd.....thanks, pat
My opinion is that this particular combination is not likely to be all that dangerous, but if I were the doctor, I would be checking your blood plasma level of the amitriptyline just to be certain of where you're at. What has likely happened, however, is that the blood plasma level of the amitriptyline has been boosted to a level similar to what you would see if you were taking 100-300 mg of this drug by itself. In other words, you are probably somewhere around a full therapeutic dose, with the associated side effects.Amitriptyline is a relatively powerful antihistamine, which is associated with appetite increase and weight gain. If it were me, I would ask the doctor to alter the drug combo to one that would tend to cause less weight gain. It's surprising how many doctors are not sensitive to the distress this side effect can cause their patients.
Todd
Posted by fayeroe on July 29, 2004, at 13:40:28
In reply to Re: Stimulants as an Antidepressant » fayeroe, posted by King Vultan on July 29, 2004, at 12:53:26
thanks...i am going to make an appointment to see if we can change things.
Posted by fayeroe on July 31, 2004, at 22:16:04
In reply to Re: Stimulants as an Antidepressant » fayeroe, posted by King Vultan on July 29, 2004, at 12:53:26
Todd, the elavil keeps my panic attacks at bay. Would it help any to drop the prozac? I understood your post, but after taking the elavil, I quit waking up totally panicked. Thanks a big bunch!! pat
Posted by King Vultan on August 1, 2004, at 10:20:45
In reply to Re: Stimulants as an Antidepressant » King Vultan, posted by fayeroe on July 31, 2004, at 22:16:04
> Todd, the elavil keeps my panic attacks at bay. Would it help any to drop the prozac? I understood your post, but after taking the elavil, I quit waking up totally panicked. Thanks a big bunch!! pat
Well, it's up to you, as this is one of those cases where it appears you are taking the bad (weight gain) with the good (anxiolytic properties)--both of these almost certainly coming from the Elavil (amitriptyline). If you dropped the Prozac, I believe you would still be left with the weight gain problems from the amitriptyline. These are some possibilities for what you could do:
Replace the amitriptyline with
Nortriptyline: This has less of a weight gain tendency than amitriptyline and is not as sedating, but apparently, it is too stimulating for some people. I found it intolerably sedating myself, but I think I'm an exception.
Imipramine: This ancient drug might not actually be a bad choice. If you can tolerate amitriptyline, you can probably tolerate imipramine, which is not as sedating and prone to induce weight gain as amitriptyline but is anxiolytic. This was the standard drug in the psychiatric field for years.
Trazodone: A drug that is similar in sedation level to amitriptyline but regarded as not as bad on weight gain. It should be relatively anxiolytic.
You might also look at replacing the Prozac, which has the least tendency of the SSRIs to induce weight gain but is also the most stimulating. A good rule is to replace only one thing at a time, though. If it were me, I guess I would talk to my doctor about imipramine.
Todd
Posted by Viridis on August 1, 2004, at 18:48:16
In reply to Stimulants as an Antidepressant, posted by sedona on July 28, 2004, at 15:57:47
I do well with Adderall + Klonopin (plus occasional Xanax), and can't tolerate SSRIs or Wellbutrin at all, even at the smallest doses. Adderall is a powerful AD, and my pdoc acknowledges this, although he's cautious. I take very little per day and have no trouble going on and off it, although of course others will react differently. Klonopin is great, but if you've been taking it for long you do have to go off it gradually. But for me at least, Adderall seems to a safe and benign med that causes me no problems and improves my mood.
Posted by sedona on August 3, 2004, at 12:42:03
In reply to Re: Stimulants as an Antidepressant » sedona, posted by Viridis on August 1, 2004, at 18:48:16
> I do well with Adderall + Klonopin (plus occasional Xanax), and can't tolerate SSRIs or Wellbutrin at all, even at the smallest doses. Adderall is a powerful AD, and my pdoc acknowledges this, although he's cautious. I take very little per day and have no trouble going on and off it, although of course others will react differently. Klonopin is great, but if you've been taking it for long you do have to go off it gradually. But for me at least, Adderall seems to a safe and benign med that causes me no problems and improves my mood.
Thanks for your response. I have been taking Klonopin 1 mg/day and Ritalin SR along with Lexapro and Lamictal. I have had days in which I did not take Ritalin or Klonopin and have not noticed withdrawal effects. However, I am trying to wean myself off the Lexapro and am finding I need more Klonopin for the anxiety. But, so far my experiences with the SSRI's (over 4 years)have left me feeling lifeless. And I have only recently realized that this is probably just how I react to SSRI's. May I ask if you have tried Ritalin and how it compares to Adderall. Also, how much Klonopin do you have to take for anxiety?
Thanks again
Posted by Viridis on August 4, 2004, at 1:38:22
In reply to Re: Stimulants as an Antidepressant, posted by sedona on August 3, 2004, at 12:42:03
Hi Sedona,
I haven't tried Ritalin -- my pdoc mentioned it as a possibility (for ADD), but felt that Adderall was likely to be "gentler" so we went with that, and it's worked well. According to him, some patients find Ritalin too "up and down" and harsh, although he was quite willing to try it if necessary.
I should add that I tried Provigil (modafinil) for a while first, and although it was somewhat stimulating without causing anxiety, it just didn't help a lot with concentration, nor did it improve my mood the way that Adderall does. I had no problems with it, and my pdoc says it seems very safe, but kind of hit or miss, depending on the patient.
I 've taken 1 mg of Klonopin/day (in the morning) for almost four years, and that generally works well. Very rarely, I'll take another mg in the evening if I'm really stressed, or 0.5-1.0 mg of Xanax, but this is just for special situations. I haven't noticed any tolerance or craving for Klonopin, although I do seem to become quite anxious if I go off it for more than about a day. So, apparently I have become dependent on it and recognize that if I decide to quit I'll have to do so gradually. But I don't see any particular reason to stop using it, since it helps and causes me no side effects.
BTW, I do take 150 mg of Lamictal/day as well. It's subtle, but seems to help smooth things out. I find it very subtle, but effective. If I take more than this it makes me feel a bit restless, but nothing really unpleasant.
Good luck!
Posted by Laree on August 4, 2004, at 7:43:13
In reply to Stimulants as an Antidepressant, posted by sedona on July 28, 2004, at 15:57:47
I definitely would not recommend going it alone with a stimulant solely for treatment of depression. It may provide some short-term relief (I'm talking like a few hours here), but the 'crash' when it wears off may be worse than the initial depression you felt before taking it. This can make for a nasty habit of abusing the stimulant in attempts to avoid the depressing crashes.
I'd recommend at least augmenting with an SSRI, in combination one may be of help to you.
This is the end of the thread.
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