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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by zeugma on January 27, 2005, at 4:17:35
I am being pulled off Ritalin because it is wasting me away to a skeleton and causing terrible jitteriness and anxiety. It also forced me, because of cardiovascular effects, to lower my dosage of nortriptyline to 50 mg/day, and this has worsened the jitteriness immeasurably and brought back my cataplectic synptoms with terrible force (hallucinations, sleep paralysis- last Sunday when I fell asleep I felt like I was literally being mummified- i cannot describe how AWFUL this was-). I don't see how I can take adderall if I experienced extreme anorexia on ritalin, and correct me if I am wrong, but I believe the cardiovascular s/e of amphetamines are greater then those of ritalin. On 100 mg nortriptyline I have no hallucinations and less jitteriness. But the fatigue, the f*king fatigue. eighteen cups of coffee a day. the caffeine does nothing for my ADD, but it keeps me awake. Awake, but not really functional.
-z
Posted by zeugma on January 27, 2005, at 4:35:51
In reply to Ritalin trial ends, posted by zeugma on January 27, 2005, at 4:17:35
I can't take provigil or cylert either. maybe my pdoc will put me back on a therapeutic dose of nortrip and call it a day. maybe desipramine. i wish i could take strattera, maybe he will try strat with dexedrine, but if he does, I am going to need close monitoring, and someone is going to have to put me on an IV for nutritional purposes. and then God knows what will control the IBS. or effexor or cymbalta. maybe selegilene, but I am going to need AD dosages to control cataplexy (MAO-A regulates norepinephrine, which keeps a lid on the paralysis and REM hallucinations). Also going down to 50 mg nortrip has brought back depression- there does seem to be a therapeutic window with this drug.
-z
Posted by awatts on January 27, 2005, at 6:40:08
In reply to Re: Ritalin trial ends, posted by zeugma on January 27, 2005, at 4:35:51
> I can't take provigil or cylert either. maybe my pdoc will put me back on a therapeutic dose of nortrip and call it a day. maybe desipramine. i wish i could take strattera, maybe he will try strat with dexedrine, but if he does, I am going to need close monitoring, and someone is going to have to put me on an IV for nutritional purposes. and then God knows what will control the IBS. or effexor or cymbalta. maybe selegilene, but I am going to need AD dosages to control cataplexy (MAO-A regulates norepinephrine, which keeps a lid on the paralysis and REM hallucinations). Also going down to 50 mg nortrip has brought back depression- there does seem to be a therapeutic window with this drug.
>
> -zMy doc is going to start me on Provigil and I'm trying to learn more about it. You said that you can't take Provigil. Could you tell about your experience with Provigil, and why you can't take it?
Posted by Kenny Koala on January 27, 2005, at 7:19:42
In reply to Re: Ritalin trial ends, posted by zeugma on January 27, 2005, at 4:35:51
What kind of IBS do you have? Perhaps Amitriptyline would be useful to you, it should boost your appetite, give you great sleep, is a moderate SRI & then it turns into Nortriptyline.
Have you tried Desipramine? Nortriptyline is a mild 5-HT2A antagonist while Desipramine isn't, perhaps too much 5-HT2A blockade is giving you tiredness.
Posted by zeugma on January 27, 2005, at 7:39:54
In reply to Re: Ritalin trial ends, posted by awatts on January 27, 2005, at 6:40:08
Provigil: better stimulant than ritalin, not anxiogenic, in fact i found it calming after a while.
why i can't take it: bizarre side effects, my brain would sometimes feel frozen while my body went into a violent sweat, my lymph nodes became swollen and this was not due to infection since the swelling stopped when the P was stopped and came back whenever i restarted. i felt, to put it simply, ill on the drug, from day one and at every dose, and the feeling of illness weas constant and intolerable.
-z
Posted by zeugma on January 27, 2005, at 7:47:07
In reply to Re: Ritalin trial ends, posted by Kenny Koala on January 27, 2005, at 7:19:42
> What kind of IBS do you have? Perhaps Amitriptyline would be useful to you, it should boost your appetite, give you great sleep, is a moderate SRI & then it turns into Nortriptyline.
>
> Have you tried Desipramine? Nortriptyline is a mild 5-HT2A antagonist while Desipramine isn't, perhaps too much 5-HT2A blockade is giving you tiredness.I know AMI would be useful. unfortunately the tiredness is due to narcolepsy, not nortriptyline. It is an effort to stay awake, and this has been true for more than a decade and has nothing to do with med s/e.
-z
>
Posted by zeugma on January 27, 2005, at 7:58:07
In reply to Re: Ritalin trial ends » Kenny Koala, posted by zeugma on January 27, 2005, at 7:47:07
and by the way, I think you see my dillema. I have mixed type IBS, but mostly pain and nausea, and SSRI's intensify the nausea to unbearable levels, and do nothing for the pain. Effexor and cymbalta would probably kill my appetite, and TCA's work because they give me a LITTLE appetite while helping my IBS and cataplexy. My doctors have preferred nortriptyline for me over AMI because I have always been overtly fatigued on a constant basis even before someone realized it was probably narcolepsy. I'm also anxious, severely so, and nortriptyline is a better anxiolytic than desipramine. I am on 1.5 mg clonazepam but that merely reduces the anxiety, and it adds to the drowsiness which is the last thing I need.
I wish strattera were nortriptyline without cardiotoxicity. Then i would try that with dexedrine.
-z
Posted by zeugma on January 27, 2005, at 8:05:30
In reply to Re: Ritalin trial ends » zeugma, posted by zeugma on January 27, 2005, at 7:58:07
Maybe I could retry strattera and add periactin for appetite/anxiolysis/possible IBS help (does anyone know if periactin helps IBS?) and add a little dexedrine. Of course I am going to have to find out if periactin has cardiac toxicity potential. I felt like I was going to have a heart attack on 75 mg nortriptyline and 60 mg ritalin. Less than 60 mg ritalin was totally ineffective.
-z
Posted by alohashirt on January 27, 2005, at 8:08:41
In reply to Ritalin trial ends, posted by zeugma on January 27, 2005, at 4:17:35
My experience is ritalin (concerta) caused no effect on blood pressure but Aderall and dexedrine caused big effect.
Can you treat the BP effects?If anything, my appetite is greater on Aderall / dexedrine, especially for sweets. (Half a tub of Ben & Jerry whilst working on my PC at 11.00pm when I thought I was having a mouthful.)
With Concerta I would sometime forget to eat
but find that staying focused requires food + meds.Do you exercise? My best days are those that
begin with early breakfast, then gym, then breakfast #2, then work. Breakfast #2 is the most satisfying meal ever.Re: depression - there are many references to Wellbutrin as a unique antidepressant that helps
some people with ADHD. Is that a possibility?Good luck.
Posted by zeugma on January 27, 2005, at 8:16:28
In reply to Re: Ritalin trial ends, posted by alohashirt on January 27, 2005, at 8:08:41
> My experience is ritalin (concerta) caused no effect on blood pressure but Aderall and dexedrine caused big effect.
> Can you treat the BP effects?That sounds bad. I suppose I could treat the BP effects but my pdoc already said to me that he doesn't think that would be a good idea, and I think he had good reason to say that.
>
> If anything, my appetite is greater on Aderall / dexedrine, especially for sweets. (Half a tub of Ben & Jerry whilst working on my PC at 11.00pm when I thought I was having a mouthful.)
> With Concerta I would sometime forget to eat
> but find that staying focused requires food + meds.
>
> Do you exercise? My best days are those that
> begin with early breakfast, then gym, then breakfast #2, then work. Breakfast #2 is the most satisfying meal ever.
>
I could not exercise on ritalin because of the cardiac effects. The slightest exertion and I was seeing stars, getting headaches, etc.> Re: depression - there are many references to Wellbutrin as a unique antidepressant that helps
> some people with ADHD. Is that a possibility?
>I can't take Wellbutrin. It seemed to unhinge my entire nervous system. I couldn't focus my eyes, and I spent my week and a half on the starter pack walking into walls and sitting in dark rooms wearing sunglasses.
> Good luck.thanks.
-z
Posted by Kenny Koala on January 27, 2005, at 8:33:30
In reply to idea-what do you think?, posted by zeugma on January 27, 2005, at 8:05:30
Would you have tried taking a Beta Blocker with Nortriptyline?
Periactin is a powerful 5-HT2A antagonist, but I doubt that it has any M1 blocking properties to assist with IBS.
Posted by zeugma on January 27, 2005, at 8:41:48
In reply to Re: idea-what do you think? » zeugma, posted by Kenny Koala on January 27, 2005, at 8:33:30
> Would you have tried taking a Beta Blocker with Nortriptyline?
I had no cardiac problems from 100 mg nortriptyline. It was only when the ritalin dose became effective (60 mg) that I started having problems. Do you think a beta blocker, 100 mg nortriptyline, and dexedrine would be a viable option?
>
> Periactin is a powerful 5-HT2A antagonist, but I doubt that it has any M1 blocking properties to assist with IBS.Thanks for the info. I have a feeling my pdoc is going to want to start from scratch anyway.
-z
Posted by jujube on January 27, 2005, at 9:28:30
In reply to Ritalin trial ends, posted by zeugma on January 27, 2005, at 4:17:35
The only thing I can think of is making a drastic switch to Parnate. But, I don't know what effect Parnate would have on your narcolepsy and cataplexy and you may likely need at least a small dose of a stimulant. And, you would have to go through a complete washout, which would no doubt be difficult and trying. Anyway, that is all I have to offer - sorry.
I am so very sorry you are going through this. My thoughts are with you.
> I am being pulled off Ritalin because it is wasting me away to a skeleton and causing terrible jitteriness and anxiety. It also forced me, because of cardiovascular effects, to lower my dosage of nortriptyline to 50 mg/day, and this has worsened the jitteriness immeasurably and brought back my cataplectic synptoms with terrible force (hallucinations, sleep paralysis- last Sunday when I fell asleep I felt like I was literally being mummified- i cannot describe how AWFUL this was-). I don't see how I can take adderall if I experienced extreme anorexia on ritalin, and correct me if I am wrong, but I believe the cardiovascular s/e of amphetamines are greater then those of ritalin. On 100 mg nortriptyline I have no hallucinations and less jitteriness. But the fatigue, the f*king fatigue. eighteen cups of coffee a day. the caffeine does nothing for my ADD, but it keeps me awake. Awake, but not really functional.
>
> -z
Posted by KaraS on January 27, 2005, at 11:53:29
In reply to Ritalin trial ends, posted by zeugma on January 27, 2005, at 4:17:35
> I am being pulled off Ritalin because it is wasting me away to a skeleton and causing terrible jitteriness and anxiety. It also forced me, because of cardiovascular effects, to lower my dosage of nortriptyline to 50 mg/day, and this has worsened the jitteriness immeasurably and brought back my cataplectic synptoms with terrible force (hallucinations, sleep paralysis- last Sunday when I fell asleep I felt like I was literally being mummified- i cannot describe how AWFUL this was-). I don't see how I can take adderall if I experienced extreme anorexia on ritalin, and correct me if I am wrong, but I believe the cardiovascular s/e of amphetamines are greater then those of ritalin. On 100 mg nortriptyline I have no hallucinations and less jitteriness. But the fatigue, the f*king fatigue. eighteen cups of coffee a day. the caffeine does nothing for my ADD, but it keeps me awake. Awake, but not really functional.
>
> -zz,
I'm so sorry to hear that. Wish I could give you the magic formula.
K
Posted by zeugma on January 27, 2005, at 12:17:32
In reply to Re: Ritalin trial ends » zeugma, posted by KaraS on January 27, 2005, at 11:53:29
thanks for your thoughts :)
I've been falling asleep all day. I have only half-caffeinated coffee here, b/c the Ritalin was doing a good job of keeping me up. I've had two pots already and it is doing nothing. I can't get myself to leave here because I am so uncontrollably tired. I'm going to make another pot and see if I can force myself into the arctic weather to get some food.
-zzzzzz
Posted by zeugma on January 27, 2005, at 13:09:50
In reply to falling asleep off ritalin » KaraS, posted by zeugma on January 27, 2005, at 12:17:32
I have a feeling my pdoc is going to try strattera with dexedrine. I suppose it will put my theory to the test, that Strattera's 4-hydroxy metabolite is depressogenic. Or maybe he will surprise me- I admit, I am at a total loss.
-z (trying desperately to wake himself up and get out of the house)
Posted by Cairo on January 28, 2005, at 7:29:12
In reply to falling asleep off ritalin » KaraS, posted by zeugma on January 27, 2005, at 12:17:32
Have you had a sleep study?
Cairo
> I've been falling asleep all day. I have only half-caffeinated coffee here, b/c the Ritalin was doing a good job of keeping me up. I've had two pots already and it is doing nothing. I can't get myself to leave here because I am so uncontrollably tired. I'm going to make another pot and see if I can force myself into the arctic weather to get some food.
>
> -zzzzzz
Posted by zeugma on January 28, 2005, at 13:36:10
In reply to Re: Sleep study » zeugma, posted by Cairo on January 28, 2005, at 7:29:12
yes I did. I have always had a sleep disorder of some kind. Unfortunately what I had until the age of 23 was insomnia, severe, intractable insomnia, and that's what I went to the study for- and couldn't sleep. Then a couple of months later I developed the hypnagogic hallucinations and other symptoms that I think are narcolepsy. unfortunately I was seeing idiot psychotherapists and psychiatrists who dismissed these as 'anxiety.'
If the change in meds (no more ritalin- I'm fine at peak plasma concetrations, awful when on the up or down slope) doesn't help, then I will go back to a sleep clinic and get a formal diagnosis.
-z
Posted by Chairman_MAO on January 28, 2005, at 15:54:34
In reply to Ritalin trial ends, posted by zeugma on January 27, 2005, at 4:17:35
You really should try combining an MAOI + low dose d-amphetamine. Don't take anything with the l- isomer in it (like Adderall), as that's what causes most of the jitters.
Posted by zeugma on January 28, 2005, at 17:07:15
In reply to Re: Ritalin trial ends, posted by Chairman_MAO on January 28, 2005, at 15:54:34
> You really should try combining an MAOI + low dose d-amphetamine. Don't take anything with the l- isomer in it (like Adderall), as that's what causes most of the jitters.
ed_uk had a similar suggestion, and so did tamara (jujube). it sounds like it makes a lot of sense, and the MAOI should be anxiolytic enough to overcome whatever jitters d-amphetamine causes. If I do wind up going for that sleep study, it will be one of the proposals I will make to the sleep docs, who will no doubt have experience with this sort of combination.
-z
This is the end of the thread.
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