![[dr. bob]](/dr-bob-sm.gif)
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 Maxime on February 5, 2005, at 22:26:39
Right now I take:
Klonopin 4mg
Trileptal 450 mg
Synthroid 175 mcg
Adderall XR 30 mgWas - Parnate @ 80-100 mg
Then (Jan 25 to Feb 4) Nardil @60 mg
Now (today) Stopped Nardil and deciding what to doSymptoms:
Cold, always cold. Tingling in hands and feet. Hands go snow white after feeling too cold for too long (honestly nothing has ever freaked me out as much as seeing my fingers look as though they are dead.) Okay, sounds like poor circulation. Would any of my meds cause this?Maxime
Posted by anastasia56 on February 6, 2005, at 0:13:34
In reply to Would any of my meds cause these symptoms?, posted by Maxime on February 5, 2005, at 22:26:39
i believe synthroid would do that at the incorrect dosage. hopefully someone here with more experience with this could tell you more.
Posted by Ritch on February 6, 2005, at 10:22:37
In reply to Would any of my meds cause these symptoms?, posted by Maxime on February 5, 2005, at 22:26:39
> Right now I take:
>
> Klonopin 4mg
> Trileptal 450 mg
> Synthroid 175 mcg
> Adderall XR 30 mg
>
> Was - Parnate @ 80-100 mg
> Then (Jan 25 to Feb 4) Nardil @60 mg
> Now (today) Stopped Nardil and deciding what to do
>
> Symptoms:
> Cold, always cold. Tingling in hands and feet. Hands go snow white after feeling too cold for too long (honestly nothing has ever freaked me out as much as seeing my fingers look as though they are dead.) Okay, sounds like poor circulation. Would any of my meds cause this?
>
> MaximeSince you have just recently stopped taking MAOI's, you might be experiencing symptoms of withdrawing them.
Posted by Maxime on February 6, 2005, at 11:21:36
In reply to Re: Would any of my meds cause these symptoms? » Maxime, posted by Ritch on February 6, 2005, at 10:22:37
It is has been going on for several months now. I think this is a discussion I should ask on a thyroid board. I have asked my endocrinologist if it is possible that I am still hypothyroid despite the test results. I have asked him to do other tests ... but he won't. Dammit!!!!
I am so frustrated with doctors and health care systems. I don't want to be taking psych meds for a metabolic problem/disorder. However, now that I have been labelled with a psych problem I find that no doctor takes me seriously. That I am seen as a hypochondriac. But it's my body and I KNOW when something is wrong and there is something wrong.
Crap .... now I am in tears again. I have to think of an original way to deal with this.
Maxime
> > Right now I take:
> >
> > Klonopin 4mg
> > Trileptal 450 mg
> > Synthroid 175 mcg
> > Adderall XR 30 mg
> >
> > Was - Parnate @ 80-100 mg
> > Then (Jan 25 to Feb 4) Nardil @60 mg
> > Now (today) Stopped Nardil and deciding what to do
> >
> > Symptoms:
> > Cold, always cold. Tingling in hands and feet. Hands go snow white after feeling too cold for too long (honestly nothing has ever freaked me out as much as seeing my fingers look as though they are dead.) Okay, sounds like poor circulation. Would any of my meds cause this?
> >
> > Maxime
>
> Since you have just recently stopped taking MAOI's, you might be experiencing symptoms of withdrawing them.
Posted by Larry Hoover on February 6, 2005, at 11:22:13
In reply to Would any of my meds cause these symptoms?, posted by Maxime on February 5, 2005, at 22:26:39
> Right now I take:
>
> Klonopin 4mg
> Trileptal 450 mg
> Synthroid 175 mcg
> Adderall XR 30 mg
>
> Was - Parnate @ 80-100 mg
> Then (Jan 25 to Feb 4) Nardil @60 mg
> Now (today) Stopped Nardil and deciding what to do
>
> Symptoms:
> Cold, always cold. Tingling in hands and feet. Hands go snow white after feeling too cold for too long (honestly nothing has ever freaked me out as much as seeing my fingers look as though they are dead.) Okay, sounds like poor circulation. Would any of my meds cause this?
>
> MaximeSounds more like Raynaud's syndrome, not a drug problem. See: http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10964.html
Lar
Posted by Optimist on February 6, 2005, at 11:23:02
In reply to Would any of my meds cause these symptoms?, posted by Maxime on February 5, 2005, at 22:26:39
Perhaps it's the Adderall. They're supposed to act as vasoconstrictors I believe so it may be decreasing the blood to your periphery leading to decreased circulation. How long has it been going on for?
Brian
Posted by Ritch on February 6, 2005, at 12:28:24
In reply to Re: Would any of my meds cause these symptoms?, posted by Maxime on February 6, 2005, at 11:21:36
I'm sorry, I didn't know this had been going on for so long. Just an opinion, but I think that bipolar II essentially is just a neuroendocrine disturbance. I only have 1/3 of my thyroid now after surgery. Just prior to my thyroid tumor being found I was on Adderall and was experiencing a spate of panic attacks. I went to my PCP complaining about the panic and he done an exam of my neck and felt an enlargement. The nurse told me she thought the Adderall could have contributed. Anyhow, my pdoc put me on higher dose clonazepam and pulled the Adderall. The tumor grew really fast and after the surgery things seemed to settle down. BUT, every so often I get feelings of panic and changes in sensation in temperature.. feeling really COLD for no reason, then sometimes feeling really WARM. I attribute most of that to my meds. My endocrinologist doesn't want to explore some "hidden" possible root of my life-long bipolar. YES, once you get stuck with a psychiatric diagnosis, all the other practitioners didn't want to touch me with a ten foot pole. The endo just looks at TSH, etc. feels my neck, if that's OK, then that's all he'll do. My PCP wouldn't treat the panic symptoms.. "need to see your pdoc". It's a hassle because I really think there is a metabolic connection. Just before I go into a general hypomanic phase my skin gets real oily, get acne, need to shave twice as often, etc. and WHAM I'm high. Along with these changes are changes in appetite, sleep, temperature sense, you name it. I had considered getting a new PCP, pretend I don't have a psych dx, don't list an psych meds and complain and let them refer me to another endo! OH well, sorry for the rant, but I do understand your frustration.
> It is has been going on for several months now. I think this is a discussion I should ask on a thyroid board. I have asked my endocrinologist if it is possible that I am still hypothyroid despite the test results. I have asked him to do other tests ... but he won't. Dammit!!!!
>
> I am so frustrated with doctors and health care systems. I don't want to be taking psych meds for a metabolic problem/disorder. However, now that I have been labelled with a psych problem I find that no doctor takes me seriously. That I am seen as a hypochondriac. But it's my body and I KNOW when something is wrong and there is something wrong.
>
> Crap .... now I am in tears again. I have to think of an original way to deal with this.
>
> Maxime
>
>
> > > Right now I take:
> > >
> > > Klonopin 4mg
> > > Trileptal 450 mg
> > > Synthroid 175 mcg
> > > Adderall XR 30 mg
> > >
> > > Was - Parnate @ 80-100 mg
> > > Then (Jan 25 to Feb 4) Nardil @60 mg
> > > Now (today) Stopped Nardil and deciding what to do
> > >
> > > Symptoms:
> > > Cold, always cold. Tingling in hands and feet. Hands go snow white after feeling too cold for too long (honestly nothing has ever freaked me out as much as seeing my fingers look as though they are dead.) Okay, sounds like poor circulation. Would any of my meds cause this?
> > >
> > > Maxime
> >
> > Since you have just recently stopped taking MAOI's, you might be experiencing symptoms of withdrawing them.
>
>
Posted by Phillipa on February 6, 2005, at 17:58:21
In reply to Re: Would any of my meds cause these symptoms? » Maxime, posted by Ritch on February 6, 2005, at 12:28:24
Maxime; I'm so sorry. I believe you are right about it maybe being your thyroid. Before I was dx'd with Hashimotos Thyroiditis {auto-immune type}, I really was not on any meds except .125mg of xanax. When the thyroid quit, it presented as a 2 day episode of extreme fatigue, then went to panic 24 hours a day. They told me I would need more or less of above when it was corrected. I now take .125mg of synthroid, and you know the rest. I think the thyroid causes a lot more problems than the docs admitt. I noticed when I worked in psych that more of the pts had thyroid problems than those who did not. Fondly, Phillipa
Posted by Maxime on February 6, 2005, at 19:42:21
In reply to Re: Would any of my meds cause these symptoms?, posted by Phillipa on February 6, 2005, at 17:58:21
At the same time I was a depressed child and teenager and attempted suicide at the age of 13. I was in a "happy" home but so unhappy inside. My parents wouldn't acknowledge my problems even though the doctor told them I suffered from depression.
Chicken and the egg situation.
Thanks for all your responses and suggestion. I am so grateful to all of you for taking the time to respond.
Maxime
Posted by Maxime on February 6, 2005, at 19:50:29
In reply to Re: Would any of my meds cause these symptoms? » Maxime, posted by Ritch on February 6, 2005, at 12:28:24
I often feel like doing the same. Not mentioning the psych portion of my life. But I feel it's necessary because of the medications I am on. UGH! I mean it would not cause my endocrinologist any extra work to order the extra tests to see if the Synthroid is being absorbed, yet he won't do it!
Maxime
> I'm sorry, I didn't know this had been going on for so long. Just an opinion, but I think that bipolar II essentially is just a neuroendocrine disturbance. I only have 1/3 of my thyroid now after surgery. Just prior to my thyroid tumor being found I was on Adderall and was experiencing a spate of panic attacks. I went to my PCP complaining about the panic and he done an exam of my neck and felt an enlargement. The nurse told me she thought the Adderall could have contributed. Anyhow, my pdoc put me on higher dose clonazepam and pulled the Adderall. The tumor grew really fast and after the surgery things seemed to settle down. BUT, every so often I get feelings of panic and changes in sensation in temperature.. feeling really COLD for no reason, then sometimes feeling really WARM. I attribute most of that to my meds. My endocrinologist doesn't want to explore some "hidden" possible root of my life-long bipolar. YES, once you get stuck with a psychiatric diagnosis, all the other practitioners didn't want to touch me with a ten foot pole. The endo just looks at TSH, etc. feels my neck, if that's OK, then that's all he'll do. My PCP wouldn't treat the panic symptoms.. "need to see your pdoc". It's a hassle because I really think there is a metabolic connection. Just before I go into a general hypomanic phase my skin gets real oily, get acne, need to shave twice as often, etc. and WHAM I'm high. Along with these changes are changes in appetite, sleep, temperature sense, you name it. I had considered getting a new PCP, pretend I don't have a psych dx, don't list an psych meds and complain and let them refer me to another endo! OH well, sorry for the rant, but I do understand your frustration.
>
> > It is has been going on for several months now. I think this is a discussion I should ask on a thyroid board. I have asked my endocrinologist if it is possible that I am still hypothyroid despite the test results. I have asked him to do other tests ... but he won't. Dammit!!!!
> >
> > I am so frustrated with doctors and health care systems. I don't want to be taking psych meds for a metabolic problem/disorder. However, now that I have been labelled with a psych problem I find that no doctor takes me seriously. That I am seen as a hypochondriac. But it's my body and I KNOW when something is wrong and there is something wrong.
> >
> > Crap .... now I am in tears again. I have to think of an original way to deal with this.
> >
> > Maxime
> >
> >
> > > > Right now I take:
> > > >
> > > > Klonopin 4mg
> > > > Trileptal 450 mg
> > > > Synthroid 175 mcg
> > > > Adderall XR 30 mg
> > > >
> > > > Was - Parnate @ 80-100 mg
> > > > Then (Jan 25 to Feb 4) Nardil @60 mg
> > > > Now (today) Stopped Nardil and deciding what to do
> > > >
> > > > Symptoms:
> > > > Cold, always cold. Tingling in hands and feet. Hands go snow white after feeling too cold for too long (honestly nothing has ever freaked me out as much as seeing my fingers look as though they are dead.) Okay, sounds like poor circulation. Would any of my meds cause this?
> > > >
> > > > Maxime
> > >
> > > Since you have just recently stopped taking MAOI's, you might be experiencing symptoms of withdrawing them.
> >
> >
>
>
Posted by Maxime on February 6, 2005, at 19:53:34
In reply to Re: Would any of my meds cause these symptoms?, posted by Phillipa on February 6, 2005, at 17:58:21
One interesting factor (well IMHO) is that I have never suffered from anxiety or panic. Never. You would think that a thyroid problem would cause this to occur at times (panic or anxiety).
Maxime
Posted by gardenergirl on February 6, 2005, at 19:56:31
In reply to Re: Would any of my meds cause these - Ritch, posted by Maxime on February 6, 2005, at 19:53:34
Maxime,
Are you taking the Synthroid on an empty stomach and waiting an hour before eating? I know that can affect absorption.Sorry you are struggling right now. I am actually considering switching from Nardil to Parnate, but your experience is making me think twice.
Take care,
gg
Posted by Maxime on February 6, 2005, at 21:59:05
In reply to Re: Would any of my meds cause these - » Maxime, posted by gardenergirl on February 6, 2005, at 19:56:31
Thanks GG. I do take it on an empty stomach and wait an hour before eating. Also, did you know that iron can prevent it's absorption?
Re. Nardil versus Parnate.
Do NOT let my experience with MAOIs have any bearing on your decision. Everyone is different. I haven't followed any posts re. your Nardil experience (sorry). Why do you want to switch?Maxime
> Maxime,
> Are you taking the Synthroid on an empty stomach and waiting an hour before eating? I know that can affect absorption.
>
> Sorry you are struggling right now. I am actually considering switching from Nardil to Parnate, but your experience is making me think twice.
>
> Take care,
> gg
Posted by gardenergirl on February 7, 2005, at 10:56:58
In reply to Re: Would any of my meds cause these - » gardenergirl, posted by Maxime on February 6, 2005, at 21:59:05
Thanks for the tip about iron. I actually have to plan out when I take my meds, supps, and vitamins to get the optimum absorption, since I take a pre-natal vitamin with Iron and also calcium and magnesium. It's really annoying how I have to impose such structure on my routine. But I suppose it helps me remember.
I am thinking of switching primarily because of weight gain on Nardil. Also, at my usual dose, I've been sleeping more and more. I didn't think you could augment an MAOI with a stimulant. Everything I've read suggests they are contraindicated, although I suppose with careful monitoring it would be okay. I'm not sure what my pdoc will say, at any rate.
But I was hoping that Parnate would stop the weight gain (actually I hope it will help me lose) and also be a touch more stimulating since I have been sleeping so much.
My alternative is to go up on the Nardil dose to 67.5 mg. But then the weight gain continues, and I start getting edema. Ugh.
Still thinking about this, and actually, I'm pretty sure my pdoc will not jump at the idea.
gg
Posted by Maxime on February 7, 2005, at 18:35:44
In reply to Re: Would any of my meds cause these - » Maxime, posted by gardenergirl on February 7, 2005, at 10:56:58
> Thanks for the tip about iron. I actually have to plan out when I take my meds, supps, and vitamins to get the optimum absorption, since I take a pre-natal vitamin with Iron and also calcium and magnesium. It's really annoying how I have to impose such structure on my routine. But I suppose it helps me remember.
>
> I am thinking of switching primarily because of weight gain on Nardil. Also, at my usual dose, I've been sleeping more and more. I didn't think you could augment an MAOI with a stimulant. Everything I've read suggests they are contraindicated, although I suppose with careful monitoring it would be okay. I'm not sure what my pdoc will say, at any rate.
>
> But I was hoping that Parnate would stop the weight gain (actually I hope it will help me lose) and also be a touch more stimulating since I have been sleeping so much.
>
> My alternative is to go up on the Nardil dose to 67.5 mg. But then the weight gain continues, and I start getting edema. Ugh.
>
> Still thinking about this, and actually, I'm pretty sure my pdoc will not jump at the idea.
>
> gg
It's hard to know what to do. I know that some people gain weight on Parnate. And Parnate made me sleepy.But here are some articles about adding stimulants to MAOIs. I used to have the link for them (they came from this board, but I can't find it). Anyhow, you can add stimulants to MAOIs even though it is contraindicated. I am lucky to have a pdoc who knows which contraindications to ignore!
Maxime
: J Clin Psychopharmacol. 1991 Apr;11(2):127-32.CNS stimulant potentiation of monoamine oxidase inhibitors in
treatment-refractory depression.Fawcett J, Kravitz HM, Zajecka JM, Schaff MR.
Department of Psychiatry, Rush-Presbyterian-St. Luke's Medical Center,
Chicago,
Illinois.We report on our clinical experience with a combination of a CNS stimulant (either pemoline or dextroamphetamine) and a monoamine oxidase inhibitor (MAOI) for treating 32 depressed patients (mainly outpatients) refractory to standard
antidepressant pharmacotherapy. This combination, though not approved by the FDA, appears to be safe and effective. Twenty-five (78%) of these patients experienced at least 6 months of symptom remission with a stimulant + MAOI combination. Many patients required adjunctive antidepressant treatment, including tricyclics and lithium. Side effects were not excessive, though 6 patients (3 unipolar and 3 bipolar) cycled to mania (N = 1) or hypomania (N = 5). None developed hypertensive crises. With properly motivated and complaint patients and careful clinical monitoring by the prescribing psychiatrist, stimulant potentiation of MAOIs may be a viable option for treatment-resistant depressed patients.PMID: 2056139 [PubMed - indexed for MEDLINE]
2: J Clin Psychiatry. 1985 Jun;46(6):206-9.Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.
Feighner JP, Herbstein J, Damlouji N.
Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a moral and legitimate right to innovative
therapy. Combined treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and stimulants has been resisted by practitioners because of hypertensive and hyperthermic crises noted in certain cases. This paper reports a case series demonstrating the safety and efficacy of adding a stimulant to an MAOI or to a combination of TCA and MAOI in the treatment of intractable depression.PMID: 3997787 [PubMed - indexed for MEDLINE]
MAOIs in high doses and with stimulantsDate: Sat, 1 Apr 1995 13:33:03 -0800 (PST)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Non-response to tranylcypromineThe commonest reason people do not respond to tranylcypromine (Parnate) is an inadequate dose. When using an MAOI I follow platelet MAO levels and keep increasing the dose is sufficient to reduce those levels almost to zero. This often takes > 60 mg/day of tranylcypromine.
If a month or so on 80 mg/day or so does not lead to a significant improvement, the next thing I usually do is to add a psychostimulant such as methylphenidate or dextroamphetamine to the cocktail. Starting with small doses, the dose is gradually increased until the patient is taking about 30 mg/day of dextroamphetamine, or twice as much methylphenidate.
Date: Fri, 14 Apr 1995 15:06:15 -0700 (PDT)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: MAOIs in high doses and with stimulantsThere are recently been a number of warnings posted there that MAOIs should not be prescribed together with psychostimulants. While that is the conventional wisdom, if universally implemented, it would deprive many severely and intractably depressed people from relief.
In the olden days, the early 1960s, we used to treat some patients with resistant depressions with up to 200 mg/day of tranylcypromine and if that was not effective potentiate it with dextroamphetamine, starting with 2.5 mg once a day and gradually increasing to 15 or 20 mg/day.
Until it was recently withdrawn, a 60ish year old patient of mine was only able to continue in his professional work by taking 170 mg/day of isocarboxazid + 5 mg of dextroamphetamine t.i.d. Since the isocarboxazid became unavailable, he has been doing almost as well on phenelzine 135 mg/day + the dextroamphetamine.
When treating patients with unusually hard to treat syndromes it is often necessary to use combinations [and doses] of medication that are conventionally considered to be contraindicated.
From: "Steven L. Dubovsky" <Steven.Dubovsky@UCHSC.edu>
Date: 15 Apr 95 08:47:17 MST-0700
Subject: MAOIs in high doses and with stimulantsIt is common practice where I come from to combine MAOIs and stimulants for MAOI-induced hypotension and treatment resistance. This is also mentioned in Jan Fawcett's book of a number of years ago. Also, remember Feighner's report of MAOI + TCA + stimulant in ECT-resistant depression. I have tried this a number of times and found it helpful. Since half the caucasian population are (is?) rapid acetylators, higher doses of Parnate are frequently necessary. Other patients are rapid metabolizers of hydrazide MAOIs and need high doses of those. The PDR is a legal, not a medical, document, so I don't think their doses are always reliable.
From: Donald Franklin Klein <dfk2@columbia.edu>
Date: Sun, 16 Apr 1995 23:44:11 -0400
Subject: MAOIs with stimulantsMAOIs plus methylphenidate (Ritalin) has not been a problem in my hands although theoretical risk requires discussion with patient, consent, and available nifedipine . Very useful for orthostatic hypotension.
Date: 06 Sep 95 11:38:03 EDT
From: Troy Caldwell <75112.1676@compuserve.com>
Subject: MAOIs with stimulantsNone other than my teacher, John Rush, some years ago referred just such a refractory person to me specifically to try adding a stimulant to her MAOI. This was in the days when doctors could still hospitalize and had authority to do things. Apparently, we private practitioners had a bit more autonomy than the university MDs at that time, so I got the referral.
Social commentary aside, I put the pt in the ICU and added very slowly Dexedrine or Desoxyn to the patient's regimen. It was wonderful -- a grand remission occurred -- and complications were zero. I've tried it since a few times, starting a low doses and titrating gradually upward, and each time no complications arose. Like all treatment efforts, it has been variably effective, but definitely worth trying. Of course, give them nifedipine as an antidote to carry.
Date: Fri, 09 Feb 1996 10:57:43 -0600
From: Kevin Miller <MillerKB@wpogate.slu.edu>
Subject: MAOIs with stimulantsHypotension is a frequent side-effect of MAOIs. If hypotension limits appropriate dosage increases, either based on clinical response, or on not reaching the target dose of about 1 mg/kg in the case of phenelzine (Robinson and Nies), the slow and careful addition of stimulants while monitoring BP makes wonderful sense. The hypotension is treated, the antidepressant effect is augmented, and, if methylphenidate is used, there may be pharmacokinetic effects as well. This is riskier with tranylcypromine given that spontaneous elevations of BP have been noted with this MAOI despite strict dietary adherence. It's also easier to do safely on an inpatient basis.
From: JoelSHoffm@aol.com (Joel S Hoffman)
Date: Sun, 18 Feb 1996 21:43:52 -0500
Subject: MAOIs with stimulantsThere is fortunately a small literature on combining MAOI and stimulant medication: Fawcett, J Clin Psychopharm 1991, 127-132; Feighner, J Clin Psych 1985, 206-209. Also, Clary, J Clin Psych 1990, 226-231, reported in a survey of prescribing habits of Pennsylvania psychiatrists that among those who prescribed MAOIs, use of high doses and combined use of MAOIs with stimulant meds were not unusual.
I have used this combination for the treatment of refractory depression and have at times have found it a great help and at other times useless. I do not remember it being helpful when a patient was not at least partially responsive to either the stimulant or the MAOI alone. However if there is a partial response to one of those meds, then when the two are combined, there can be either an additive or synergistic effect.
I have never had a problem with elevated BP, however I most often add the MAOI to the stimulant rather than the reverse... If I do add a stimulant to an MAOI, I start with 1.25 mg d-amphetamine or equivalent, the idea being that it probably takes at least 5 mg tyramine to precipitate a hypertensive crisis, and since the molecular weights are about the same 1.25 mg amphetamine would be sub-threshold. Starting at that level has not caused any reactions, but I still prefer to start with the stimulant and add the MAOI later.
I find that with time, as more treatment options are available, I use this combination less but there are still some patients for whom nothing else seems to work. The side effects that do cause problems include activation sometimes resembling or identical to dysphoric mania. Stereotypy and choreiform movements including bucco-facial dyskinesia can also occur. These side effects have to watched for closely. If it is essential to continue the regimen, pimozide can usually alleviate the movement disorder.
From: "David A. Kahn" <kahndav@cpmc3.cpmc.columbia.edu>
Date: Wed, 21 Feb 1996 10:31:11 EDT
Subject: MAOIs with stimulantsI'm always in the position of trying to augment an existing MAOI regimen, so it's never seemed feasible to stop the MAOI, start the stimulant, and then restart the MAOI. I just add the stimulant. The only adverse reaction I've encountered is an odd lability of blood pressure on two occasions, where supine blood pressure was somewhat elevated on a tonic basis, together with a worsening of orthostatic hypotension. The supine elevation made it impossible to think of Florinef, etc., so we had to stop the combination. Interestingly, both of these individuals had prior histories of intermittent bordereline essential hypertension which had resolved on the MAOI alone.
From: JoelSHoffm@aol.com (Joel S Hoffman)
Date: Wed, 21 Feb 1996 08:29:48 -0500
Subject: MAOIs with stimulantsBy the way, I do not get signed consent. I do not think that that holds up very well anyway. Well documented clear chart notes indicating the clinical rationale and including what is told to the patient should always be standard practice and especially with atypical treatment modalities such as this.
Posted by gardenergirl on February 7, 2005, at 23:05:06
In reply to Re: Would any of my meds cause these -, posted by Maxime on February 7, 2005, at 18:35:44
Posted by Ron Hill on February 8, 2005, at 21:45:07
In reply to Re: Would any of my meds cause these symptoms? » Maxime, posted by Ritch on February 6, 2005, at 12:28:24
> Just prior to my thyroid tumor being found I was on Adderall and was experiencing a spate of panic attacks.
> The nurse told me she thought the Adderall could have contributed.
Ritch, do you think the nurse was right? In other words, is it your opinion that the Adderall contributed to your thyroid tumor?
-- Ron
Posted by Ritch on February 8, 2005, at 23:33:23
In reply to Re: Adderall Effects on the Thyroid » Ritch, posted by Ron Hill on February 8, 2005, at 21:45:07
> > Just prior to my thyroid tumor being found I was on Adderall and was experiencing a spate of panic attacks.
>
> > The nurse told me she thought the Adderall could have contributed.
>
> Ritch, do you think the nurse was right? In other words, is it your opinion that the Adderall contributed to your thyroid tumor?
>
> -- Ron
Ron, it is possible, but I am not convinced. I've got a family history of thyroid/metabolic disorders (more so than psych disorders BTW). My Mom had three interventions for thyroid problems. The first was solved by simply taking T4 (when she was young). The next was surgery to remove a benign tumor. The next was surgery to remove most of her thyroid after it was found to contain a cancerous tumor. Her first surgery ocurred at the exact same age that my first surgery occurred (for a benign tumor). My surgeon reasoned it would be best that most of my thyroid be removed because of my Mom's later cancer experience (ten years later). The thing that does spook me about dopaminergic meds (antipsychotics/stimulants) is their effects on hormones (prolactin, etc.) So, the stim thing might have impacted the growth, but I think it was probably more genetic... BUT I would welcome any comment from anyone about this issue. Adrenal functioning.. I think that's what the nurse was linking with stim usage and the tumor growth thing... just guessing here.. Not to say that I wouldn't try pstims again in the future if they prove helpful. I just need to check thyroid hormones, etc. and make sure things aren't going awry... I've also had potential *para*thyroid problems from lithium usage over many years (clinical hypercalcemia in the past resulting in dx of lithium). I'm starting to think that my extreme med sensitivities may be related to a screwed up neuroendocrine system (from the genetic getgo), and that certain med changes that get made have to be followed up with relatively frequent serum electrolytes, TSH, etc.
Posted by Ron Hill on February 9, 2005, at 11:25:31
In reply to Re: Adderall Effects on the Thyroid » Ron Hill, posted by Ritch on February 8, 2005, at 23:33:23
Mitch,
Adderall greatly worsens my hypoglycemia. Does this make any sense to you?
-- Ron
---------------------> > > Just prior to my thyroid tumor being found I was on Adderall and was experiencing a spate of panic attacks.
> >
> > > The nurse told me she thought the Adderall could have contributed.
> >
> > Ritch, do you think the nurse was right? In other words, is it your opinion that the Adderall contributed to your thyroid tumor?
> >
> > -- Ron
>
>
> Ron, it is possible, but I am not convinced. I've got a family history of thyroid/metabolic disorders (more so than psych disorders BTW). My Mom had three interventions for thyroid problems. The first was solved by simply taking T4 (when she was young). The next was surgery to remove a benign tumor. The next was surgery to remove most of her thyroid after it was found to contain a cancerous tumor. Her first surgery ocurred at the exact same age that my first surgery occurred (for a benign tumor). My surgeon reasoned it would be best that most of my thyroid be removed because of my Mom's later cancer experience (ten years later). The thing that does spook me about dopaminergic meds (antipsychotics/stimulants) is their effects on hormones (prolactin, etc.) So, the stim thing might have impacted the growth, but I think it was probably more genetic... BUT I would welcome any comment from anyone about this issue. Adrenal functioning.. I think that's what the nurse was linking with stim usage and the tumor growth thing... just guessing here.. Not to say that I wouldn't try pstims again in the future if they prove helpful. I just need to check thyroid hormones, etc. and make sure things aren't going awry... I've also had potential *para*thyroid problems from lithium usage over many years (clinical hypercalcemia in the past resulting in dx of lithium). I'm starting to think that my extreme med sensitivities may be related to a screwed up neuroendocrine system (from the genetic getgo), and that certain med changes that get made have to be followed up with relatively frequent serum electrolytes, TSH, etc.
Posted by Ritch on February 9, 2005, at 12:47:48
In reply to Re: Adderall Worsens My Hypoglycemia » Ritch, posted by Ron Hill on February 9, 2005, at 11:25:31
Ron, are you checking your blood sugar with one of those portable devices (like diabetics use) during the course of the day? I tried that once when I was having really bad periodic daytime drowsiness that I couldn't seem to figure out (it was normal the whole day). I can't remember the exact MOA that sitmulants have (other than being NE/DA reuptake inhibitors/releasers), so I can't really answer your question. From what I recall it does initially raise your blood sugar when it kicks in.. so perhaps the crashing effect is aggravating things. Maybe there is something you can do with meal timings, etc.??
> Mitch,
>
> Adderall greatly worsens my hypoglycemia. Does this make any sense to you?
>
> -- Ron
> ---------------------
>
> > > > Just prior to my thyroid tumor being found I was on Adderall and was experiencing a spate of panic attacks.
> > >
> > > > The nurse told me she thought the Adderall could have contributed.
> > >
> > > Ritch, do you think the nurse was right? In other words, is it your opinion that the Adderall contributed to your thyroid tumor?
> > >
> > > -- Ron
> >
> >
> > Ron, it is possible, but I am not convinced. I've got a family history of thyroid/metabolic disorders (more so than psych disorders BTW). My Mom had three interventions for thyroid problems. The first was solved by simply taking T4 (when she was young). The next was surgery to remove a benign tumor. The next was surgery to remove most of her thyroid after it was found to contain a cancerous tumor. Her first surgery ocurred at the exact same age that my first surgery occurred (for a benign tumor). My surgeon reasoned it would be best that most of my thyroid be removed because of my Mom's later cancer experience (ten years later). The thing that does spook me about dopaminergic meds (antipsychotics/stimulants) is their effects on hormones (prolactin, etc.) So, the stim thing might have impacted the growth, but I think it was probably more genetic... BUT I would welcome any comment from anyone about this issue. Adrenal functioning.. I think that's what the nurse was linking with stim usage and the tumor growth thing... just guessing here.. Not to say that I wouldn't try pstims again in the future if they prove helpful. I just need to check thyroid hormones, etc. and make sure things aren't going awry... I've also had potential *para*thyroid problems from lithium usage over many years (clinical hypercalcemia in the past resulting in dx of lithium). I'm starting to think that my extreme med sensitivities may be related to a screwed up neuroendocrine system (from the genetic getgo), and that certain med changes that get made have to be followed up with relatively frequent serum electrolytes, TSH, etc.
>
>
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.