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Dr. Bob is Robert Hsiung, MD,
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Posted by CareBear04 on February 3, 2005, at 13:18:59
In reply to Re: Stimulant withdrawal » ed_uk, posted by zeugma on February 2, 2005, at 15:51:05
zeugma-- i hope you're feeling better! i think i remember reading in your posts awhile ago that you have problems eating on stimulants and that you've been experimenting to try to find one that doesn't speed you up too much? is that accurate or am i mixing you up with someone else?
what i've experienced and heard about strattera from my later pdoc is that it tends to work best for children and less well for adults. it didn't do much of anything for me. i went up to 80mg a day in split doses, then added provigil. i liked the provigil and it definitely helped me focus without ruining my sleep. however, with provigil and strattera together, i could take the strattera or not and couldn't feel any difference. have you tried provigil? it did make me a bit of a zombie as far as repetetive tasks or doing one thing for hours on end when i was alone in my dorm room. a good thing is that it suppressed my appetite, but when i made myself remember to eat, even setting alarms if necessary, i had no problem with working up an appetite to eat.
about your sleep-- do you think it's related to your meds or psych condition or related to a pulmonary problem? my sister is a few months from graduating from med school, and i actually had a conversation with her about sleep medicine yesterday. i was surprised when i learned recently that most sleep doctors are pulmonary specialists and not pdocs like i had previously thought. i guess the "true" sleep disorders originate in the lungs and breathing, while insomnia and restlessness of a psychiatric or medicine origin are best dealt with in therapy or with a pdoc. i don't know if this is relevant or not.
going from 60 to 0 cold turkey from any stim sounds like torture to me. i know that i should take vacations from my adderall and ritalin to make it more effective because i've worked up quite a tolerance to them. but the thought of being off them, being so sluggish and cranky, scares me and prevents me from taking even weekend breaks. how are you doing with this?
what other stims have you tried and what experiences have you had? i've tried high-dose wellbutrin, strattera, provigil, regular adderall and xr, regular ritalin and concerta. i once asked about focalin, but hardly any pharmacies around me carry it or can even order it for some reason. my pdoc had never heard of it either. i don't know what other options are. some people mentioned tricyclics to augment, but my drs won't prescribe them because of some heart abnormalities.
i'd like to hear more about your experience if you get a chance. thanks!
Posted by zeugma on February 3, 2005, at 17:06:18
In reply to Re: Stimulant withdrawal » zeugma, posted by ed_uk on February 3, 2005, at 8:29:41
hi Ed, just to let you know, I've been feeling better now that the nortriptyline has kicked in again. I've had this experience before: going below 75 mg plunges me into misery.
My blood levels were taken a couple of years ago when I was on 60 mg nortrip and experiencing a suboptimal response. My pdoc didn't tell me the exact level but said it was 'low' so I moved up to 75 mg and started feeling better. So I'm assuming 75 mg is the bottom threshold for therapeutic response.
I suppose I'll try 25 mg Strattera again tomorrow. I don't know if my current pdoc will see me any more, though. I didn't call the sleep doctor today but will have more time tomorrow (less full work schedule).
It's been really, really crazy lately with all the med changes and trying desperately to hang on to my job. I suppose I need to get used to the anxiety, or think about something like Seroquel. I just worry about movement disorders (I have a tic from the Ritalin) and I experienced a neuroleptic-like effect from >30 mg buspirone, and buspirone is a very weak D2 antagonist.
So yes, I'm feeling better, but I don't know if I currently have a pdoc, because the way I left it with him was that I would see a sleep doc instead. (I'm putting it mildly, of course. I was yelling at him on the phone, and this is not very cool behavior. this is part of why the Ritalin had such a bad effect on me. Instead of calming me down as is apparently the norm with ADHD patients it hyped me up.)
-z
Posted by zeugma on February 3, 2005, at 17:12:07
In reply to Re: Stimulant withdrawal » zeugma, posted by CareBear04 on February 3, 2005, at 13:18:59
hi carebear. I've tried wellbutrin, provigil, cylert, ritalin. I can't take any of them.
The Provigil was actually the best from the appetite point of view because I actually only lost a pound on it after a couple of months on it. It also seemed to be the opposite of Ritalin in that it slowed down my thought process and was anxiolytic, which were VERY good things. but unfortunately the sweating, feeling simultaneously hot and cold, queasy, and generally sick made it impossible for me to stick it out.
Right now I'm relying on caffeine pills to keep me alert. I suppose I've imbibed so much caffeine over the years that I've built up a tolerance to its anxiogenicity.
-z
Posted by CareBear04 on February 3, 2005, at 19:36:55
In reply to Re: Stimulant withdrawal » CareBear04, posted by zeugma on February 3, 2005, at 17:12:07
hey zeugma, i hear you on the caffeine. last year, i went for about a month and a half without any caffeine, and when i had coffee ice cream at the end of that time, i couldn't sleep all night! that was before i was on prescription stimulants. i also drink a lot of coffee. i think the tolerance to caffeine plus the heavy duty prescription stims have caused me to be immune to caffeine. i used to take the caffeine pills a few years ago, and i could take, like, 4 or more and fall asleep right away with all that in my stomach. i think it caused some ulceration.
i think the provigil slowed my thoughts down, too. adderall and ritalin calm me down, too, but in a different way. provigil slowed me down enough that i could sit in the same position forever and focus on one thing. but like you, it was pretty weight neutral as long as i remembered to eat.
do you know if caffeine has the same side effects as the schedule II stims? high blood pressure and pulse, headaches, strokes and heart attacks in overdose? also, do you know if your weight loss on stims is due to suppression of your appetite or possibly the speeding up of your metabolism? mostly, i hear about their killing appetite, but i think i read once about amphetamines speeding everything up, including metabolism. maybe when the heart works harder and beats faster, you need more fuel to feed the process? have your docs every talked about anything like this?
hope you're well.
Posted by ed_uk on February 4, 2005, at 6:29:47
In reply to Re: Stimulant withdrawal, posted by zeugma on February 3, 2005, at 17:06:18
Hi Z!
Glad to hear you're feeling better :-) I hope the Strattera helps. If not, will you try 100mg nort?
>I suppose I need to get used to the anxiety, or think about something like Seroquel. I just worry about movement disorders (I have a tic from the Ritalin) and I experienced a neuroleptic-like effect from >30 mg buspirone, and buspirone is a very weak D2 antagonist.
Seroquel *might* reduce your anxiety but on the other hand it might just knock you out! Perhaps a small dose in the evening would be enough. What happened when you took buspirone?
>I was yelling at him on the phone, and this is not very cool behavior.
He's probably used to being shouted at! Call him, I'm sure he'll understand :-)
>Instead of calming me down as is apparently the norm with ADHD patients it hyped me up.
It often hypes up ADHD patients as well!
Ed.
Posted by zeugma on February 4, 2005, at 19:22:37
In reply to Re: Stimulants » zeugma, posted by ed_uk on February 4, 2005, at 6:29:47
> Hi Z!
>
> Glad to hear you're feeling better :-) I hope the Strattera helps. If not, will you try 100mg nort?Of course. My script is for 100 mg. 100 mg worked fine until I had the Ritalin problem.
>
> >I suppose I need to get used to the anxiety, or think about something like Seroquel. I just worry about movement disorders (I have a tic from the Ritalin) and I experienced a neuroleptic-like effect from >30 mg buspirone, and buspirone is a very weak D2 antagonist.
>
> Seroquel *might* reduce your anxiety but on the other hand it might just knock you out! Perhaps a small dose in the evening would be enough. What happened when you took buspirone?
>
I felt *knocked out*! Severely. I felt like I did on Trialfon, an old typical AP- seriously wiped out, and I wasn't exactly a ball of energy to begin with. That was every time I went over 30 mg buspirone. At that dose or lower, no probs. I take 15 mg at night to help me with the hypnagogic hallucinations. It has an anti-cataplectic action, and is absorbed much faster than nortriptyline. it is also an AD, though maybe a weak one- but I'll take all the mood elevation I can get.
> >I was yelling at him on the phone, and this is not very cool behavior.
>
> He's probably used to being shouted at! Call him, I'm sure he'll understand :-)
>
Ah, he's understood before, if you know what I mean. I fear I am a difficult patient.
> >Instead of calming me down as is apparently the norm with ADHD patients it hyped me up.
>
> It often hypes up ADHD patients as well!
>I suppose that famous 'paradoxical' calming effect isn't all it's cracked up to be, then? Yet another urban folktale circulating in the realm of psych disorders :-)
By the way, how are you doing off the TCA?
-z
-z
> Ed.
Posted by ed_uk on February 5, 2005, at 10:44:08
In reply to Re: Stimulants » ed_uk, posted by zeugma on February 4, 2005, at 19:22:37
Hi Z!
>I suppose that famous 'paradoxical' calming effect isn't all it's cracked up to be, then?
I think this is something that often causes confusion! When parents say that Ritalin 'calms' their child they generally mean that it reduces hyperactivity ie. not that it 'calms' anxiety. As you know all too well, Ritalin often makes anxiety worse- although a few people do seem to find it anxiolytic. The fact that it can reduce hyperactivity is not really paradoxical at all! Because Ritalin often makes boring repetitive tasks seem interesting, and because it generally improves concentration, Ritalin can often reduce boredom and 'fidgety restlessness', even on people who have not been diagnosed with ADHD. This effect is certainly not unique to children ...nor is it unique to ADHD patients, as has often been claimed. Because Ritalin is commonly refered to as a stimulant, people find it very hard to understand how it can reduce hyperactivity. Perhaps it would be better just to refer to it as methylphenidate! Because it called a stimulant, people often think that it effects will be the opposite of a sedative such as Xanax. Pharmacologically, the effects of Ritalin are in no way 'opposite' to the effects of Xanax. Classifying drugs as being either stimulants or sedatives is really very crude!! After all, some people get hyped-up on benzos!
Whether or not Ritalin makes a person 'hyper' is very individual, it is not simply a function of their age or whether or not they have been diagnosed with ADHD. Some ADHD children get much worse on Ritalin, whereas other improve greatly. This also applies to ADHD adults. Similarly, some non-ADHD adults get very 'hyped-up' on Ritalin, whereas others find that it helps them sit still and complete masses of paperwork. As ever, drug response is very individual... and very difficult to predict. Response to Ritalin also depends on dose, most people would feel hyped-up if they took too much. The doses which are effective for hyperactive children are generally quite low. There is so much trial and error in psycho-pharmacology, much more that most pdocs would be willing to admit!
Ed.
Posted by ed_uk on February 5, 2005, at 10:46:42
In reply to Re: Stimulants » ed_uk, posted by zeugma on February 4, 2005, at 19:22:37
PS. Sorry about the rant!!! I got a bit carried away!!
I restarted the lofepramine last week. I think I felt a bit more fatigued without it, it might have just been a withdrawal symptom though- or perhaps it was a figment of my imagination.
I'm really pleased that you're feeling a bit better :-D
Ed.
Posted by CareBear04 on February 5, 2005, at 12:47:48
In reply to Re: Stimulants » zeugma, posted by ed_uk on February 5, 2005, at 10:44:08
ed-- thanks for the info.
here's a question i've wondered about-- my friend who has a little brother with ADHD talked about how he went in for teeth extraction or something. they tried to give him sedatives, but he kept getting more and more hyped up. accoreding to this friend, sedatives have the opposite effect on ADD kids. is this true?
for me, benzos make me calm; stimulants maybe a bit calmer.
Posted by ed_uk on February 5, 2005, at 13:46:31
In reply to Re: Stimulants » ed_uk, posted by CareBear04 on February 5, 2005, at 12:47:48
Hi,
>but he kept getting more and more hyped up. accoreding to this friend, sedatives have the opposite effect on ADD kids. is this true?
Sedatives such as benzodiazepines do sometimes increase hyperactivity in children with ADHD. This is not inevitable though, and they can still be effective in reducing anxiety. In general, unusual reactions to sedatives seem to be significantly more common in children than in adults.
Ed.
Posted by zeugma on February 7, 2005, at 10:43:11
In reply to Re: Stimulants » CareBear04, posted by ed_uk on February 5, 2005, at 13:46:31
I can't take even 25 mg strattera, as it is making me uncontrollably depressed. I don't know if it's causing it, actually, but it certainly isn't helping it and I continue to feel like I am breaking down. My current pdoc can do no more for me, and I am scheduling an appt. with a sleep doc. unfortunately this will not save my current job. And it depresses me to not work. But I am falllng apart.
-z
Posted by CareBear04 on February 7, 2005, at 11:05:01
In reply to No more strattera, posted by zeugma on February 7, 2005, at 10:43:11
dear zeugma,
i know what it feels like to not be able to work like before and to feel depressed about it. there's no doubt about it-- i'm a bum now-- but somehow, in the past week or two, i've started to be at peace about it. my drs don't understand; they think i'm giving me. still, whether or not you're a religious person, maybe you can agree that sometimes we just need to rest to find direction for the future and to rejuvenate ourselves. i've spent the past two years frustrated since, of that time, i've only been back to school one semester. i've been on about three dozen medications, most of them duds. i know the stimulant path is maybe most frustrating of all because it deals with your livelihood, your ability to function, and your energy. i don't know what to say except that i feel with you, and i wish you the best.
Posted by ed_uk on February 7, 2005, at 11:15:04
In reply to No more strattera, posted by zeugma on February 7, 2005, at 10:43:11
Hello,
>I can't take even 25 mg strattera, as it is making me uncontrollably depressed. I don't know if it's causing it, actually, but it certainly isn't helping it and I continue to feel like I am breaking down.
I was worried that you might not be well since you haven't posted for a few days. I'm so sorry that you're feeling bad. I'm sure that you'll fell better once the Strattera is out of your system, it seems like a very bad drug for you. Are you taking 100mg of nort?
>My current pdoc can do no more for me, and I am scheduling an appt. with a sleep doc.
Do you know when you'll be able to see him/her? I'm sure they'll be able to help you :-)
>unfortunately this will not save my current job. And it depresses me to not work. But I am falllng apart.
Can you take a break from work until your better? Won't they let you go back after taking a break? I know what it feels like to have nothing to do, it can be depressing.
Best,
Ed.
Posted by zeugma on February 7, 2005, at 11:24:49
In reply to Re: To Zeugma » zeugma, posted by ed_uk on February 7, 2005, at 11:15:04
thanks care bear and ed for your support. I am going to take 100 mg nortriptyline tonight and wait for the Strattera to clear out of my system. I am also waiting for the sleep doc to call me back. I wanted to limp through these problems without changing pdocs etc. but that is no longer possible. I have never had this problem (drug-induced depression) with anything but Strattera and I consider it very irresponsible of my pdoc to represecribe it when I had a similar reaction to it last year. I hope I feel better soon.
-z
Posted by ed_uk on February 7, 2005, at 11:38:05
In reply to Re: To Zeugma, posted by zeugma on February 7, 2005, at 11:24:49
Hi Zeugma!
>I am going to take 100 mg nortriptyline tonight and wait for the Strattera to clear out of my system.
Good idea :-) Keep thinking about how much better you felt before you took the Strattera- you'll soon feel like that again.
>I have never had this problem (drug-induced depression) with anything but Strattera and I consider it very irresponsible of my pdoc to represecribe it when I had a similar reaction to it last year.
My already low opinion of Strattera just went down a notch!
>I hope I feel better soon.
I know you will :-) I hope you can go back to work when you're better.
Ed.
Posted by zeugma on February 7, 2005, at 11:39:36
In reply to Re: To Zeugma, posted by zeugma on February 7, 2005, at 11:24:49
it is doubly irresponsible of him to retry it when this was not merely the 2nd time I had done so. I had used it in Oct. or Nov. when on a subtherapeutic dose of Ritalin and it induced dysphoria then, too, which was why I stopped it (I can deal with stomach pain, but not sustained dysphoria and increased fatigue). It was notable that this time when I retried it it was purely out of trust in him, as there is no pharmacological evidence that it is superior to TCA's in terms of efficacy or tolerability (I had brought up desipramine and he maintained Strattera was better for ADD. I do not believe Lilly has conducted trials against desipramine so how could he say this? Also I am sure desipramine would not induce this kind of dysphoric reaction.)
-z
Posted by zeugma on February 7, 2005, at 11:46:44
In reply to Re: Strattera » zeugma, posted by ed_uk on February 7, 2005, at 11:38:05
Posted by ed_uk on February 7, 2005, at 11:52:18
In reply to one more thing, posted by zeugma on February 7, 2005, at 11:39:36
Hello,
>I do not believe Lilly has conducted trials against desipramine so how could he say this?
Some doctors have a habit of thinking that new drugs are always better, they are very susceptible to Big Pharma's propaganda! I very much doubt that Lilly would dare to conduct such a trial. In one of my lectures the other day we got taught 'New drugs are only approved after it has been demonstrated that they are clearly superior to existing drugs.' (I do pharmacy btw). Our minds are being filled with bulls**t!
Ed.
Posted by zeugma on February 7, 2005, at 12:45:55
In reply to Re: one more thing » zeugma, posted by ed_uk on February 7, 2005, at 11:52:18
Our minds are being filled with bulls**t!
Yes, only too literally in this case.I became sick of arguing with my pdoc about this last year, as he was neither going to produce evidence nor budge. I also became sick of arguing it with my therapist, who took the line that 'newer is better' (well, this is america after all). I should have dumped them both, unfortunately one tries to play along with mental health professionals for as long as possible in the hope of getting relief despite atavistic attitudes (and in my case, it is hard for me to function, period, without chemical help).
I've come to expect a certain lack of reason from people in mental health professions. I'll derive what grim amusement I can from today from pondering that one :)
-z
Posted by zeugma on February 7, 2005, at 18:05:34
In reply to Re: one more thing » ed_uk, posted by zeugma on February 7, 2005, at 12:45:55
I'm still going thru stim withdrawal, and now that I'm going to be d/c'ing Strattera, I decided to stay at 75 nortrip for the time being because I am so d*mmed anxious about the effect these drugs are having on me that I want to make as few changes as possible in the space of 24 hours. The strattera dysphoria is a peculiar, anhedonic feeling that should dissipate within a day or two independently of any antidepressant effect of other drugs. (I suppose that Ki of 95 nM is low enough in my case...) I wonder why the TCA's are so much more reliable than these new drugs. My own theory is that since we don't have a clue about the brain yet, relatively speaking, it is the serendipitious discoveries that yield better meds, because we literally don't know what we're aiming at and are more likely to produce favorable results by pure chance than by 'designing' a drug 'rationally.'
-z
Posted by ed_uk on February 8, 2005, at 10:08:07
In reply to still going thru stim w/d, posted by zeugma on February 7, 2005, at 18:05:34
Hi Z!
>I've come to expect a certain lack of reason from people in mental health professions. I'll derive what grim amusement I can from today from pondering that one :)
Lol :-)
>I wonder why the TCA's are so much more reliable than these new drugs. My own theory is that since we don't have a clue about the brain yet, relatively speaking, it is the serendipitious discoveries that yield better meds, because we literally don't know what we're aiming at and are more likely to produce favorable results by pure chance than by 'designing' a drug 'rationally.'
Perhaps Strattera and/or desipramine bind to numerous receptors that haven't even been discovered yet, that might explain some of the apparant differences between them. What do you think? New receptors are being discovered all the time. Most drugs won't have even been tested to find out whether they bind to these 'new' receptors. Anyway, the function of recently discovered receptors is generally poorly understood.
Ed.
Posted by banga on February 8, 2005, at 11:18:51
In reply to Re: still going thru stim w/d » zeugma, posted by ed_uk on February 8, 2005, at 10:08:07
RE Why tricyclics may be better:
I think the newer drugs are almost overengineered...they are SO specific that they initially right the problem--the imbalance--but then go too far and disrupt the imbalance because they act so powerfully on the target but not on anything else. Like letting in cold water in the bath to cool off the bathwater...but if you overdo it it all swings to the other extreme. People talk about brain fog and apathy etc. The older "dirtier"drugs may act more broadly and not overpush the whole system.
Posted by SLS on February 9, 2005, at 20:19:11
In reply to still going thru stim w/d, posted by zeugma on February 7, 2005, at 18:05:34
> I'm still going thru stim withdrawal, and now that I'm going to be d/c'ing Strattera, I decided to stay at 75 nortrip for the time being because I am so d*mmed anxious about the effect these drugs are having on me that I want to make as few changes as possible in the space of 24 hours. The strattera dysphoria is a peculiar, anhedonic feeling that should dissipate within a day or two independently of any antidepressant effect of other drugs. (I suppose that Ki of 95 nM is low enough in my case...) I wonder why the TCA's are so much more reliable than these new drugs. My own theory is that since we don't have a clue about the brain yet, relatively speaking, it is the serendipitious discoveries that yield better meds, because we literally don't know what we're aiming at and are more likely to produce favorable results by pure chance than by 'designing' a drug 'rationally.'
>
> -z
I wonder what would happen if you were to take an anticholinergic like Akineton...
- Scott
Posted by zeugma on February 10, 2005, at 16:30:00
In reply to Re: still going thru stim w/d, posted by SLS on February 9, 2005, at 20:19:11
I wonder what would happen if you were to take an anticholinergic like Akineton...
It seems like you're thinking what I'm thinking... that the cholinergic-aminergic imbalance is so pronounced that it produces movement-disorder- and akathasia- type symptoms (and it does, though my docs son't take these seriously- when younger I used to pace incessantly, now I can barely get myself out of my chair, though I am so tense that I would love to pace if given the energy...) I'm also thinking that a stim is out of the question, for several reasons. I wonder if protriptyline might be the answer.
-z
Posted by ed_uk on February 11, 2005, at 6:42:03
In reply to Re: still going thru stim w/d » SLS, posted by zeugma on February 10, 2005, at 16:30:00
Hi Z,
>I wonder if protriptyline might be the answer.
Protriptyline tends to cause a lot of side effects. Anyway, it doesn't have any clear advantages over desipramine. It is sometimes claimed that protriptyline is 'stimulating' in a way that desipramine is not- I am convinced that this is a myth. Protriptyline is potently anticholinergic, cardiovascular side effects such as hypotension are common and it sometimes causes a rash. Basically, I'd stay away from it!! There are better drugs available!
Best Regards,
Ed.
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