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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by tendency on April 18, 2005, at 11:20:00
hi. i just cannot tolerate side effect wise the stimulant meds but really need something for my add. any ideas out there? im currently on 20mg celexa for depression, anxiety, irritability and it's working wonders.
until emsam arrives (come on god damm!t bristol ;-)) maybe selegiline would be worth a try? any other ideas? thanks.
Posted by med_empowered on April 18, 2005, at 20:03:47
In reply to need replacement for stimulants, posted by tendency on April 18, 2005, at 11:20:00
hey! For ADD/ADHD, you can do a few things w/o a true stimulant. Obviously, there's Provigil, which doesn't have nearly as many side-effects as the "classic" stimulants, the amphetamines and ritalin. Its also only a schedule IV substance, not a schedule II like the older drugs, so you can get refills and things of that nature. Then there's straterra, but that apparently has occasional ill-effects on the liver that haven't been fully researched yet, so I personally wouldn't try that one until research on that problem is better. The more old-school remedy would be a tricyclic, with or without an add-on stimulant and/or provigil. Pamelor is popular. Cymbalta, according to my shrink, should be good for ADD, but I haven't seen any great research to that effect. Whatever. The dosing is easy (60mgs flat for most people; if your doc is adventurous, like mine, you might end up more in the 90-120mgs range). Effexor has been used for ADD/ADHD, but its definitely an off-label use of the drug. If your doc tries this, you'll probably end up at the upper-end (200s-300s, maybe more) of the Effexor dosage spectrum. Supposedly, cymbalta is a lot like effexor but seems (note: **seems**) to have a better side-effect profile. There's also Wellbutrin. Wellbutrin is chemically similar to the oldish appetite supressant *Tenuate* and has some stimulant-ish effects (loss of appetite, nervousness, etc.) Usually its used as an add-on for depression, but can be used alone or in combo with other medications for things like ADD/ADHD. There is an elevated seizure risk compared to other anti-depressants (.4% vs .1%, so its low, but still 4X that of the other ADs). If you're brain damaged or have a seizure disorder, please don't take this. Also avoid Effexor, Wellbutrin, and probably cymbalta (its new, so who knows) if you've had any eating disorder, especially anorexia. Backing up to the tricyclics...Tofranil, the first tricyclic, is now available as Tofranil-PM...its basically the same drug, but it comes in an ugly brown capsule and you can take it all at nite, instead of spacing it throughout the day. Woohoo! Not really exciting, I know, but it does allow you to avoid the sedation and confusion sometimes associated with tricyclics by taking all your dose at nite. I used it, it was great until I started seeing spots and gaining weight. As they say, your mileage may vary. If you've got anxiety issues and ADD, (I do, so I know the tough spot it puts you in), its a good idea to cover your bases for both **before** you start taking any ADD drugs, because while the meds I mentioned aren't stimulants (except provigil), they do have some of the side-effects of stimulants, epsecially at the high doses sometimes used for add and especially if they are combined with other meds. So, I'd recommend going ahead and adding on an anti-anxiety med...personally, I've come to love my buspar. Its generic, so its got a low copay, and it doesn't sedate very much after a few days. Supposedly, it works best when you're already taking a serotonin-boosting AD that's working. It, in turn, seems to improve anti-depressants' efficacy (when and if it works). Just like with the stimulants, I'd also recommend asking the prescribing doc for a short-term RX for a sleep med (anything from hydroxyzine to Sonata to Ambien should work) and something to kill off what are **usually** short-lived, early-onset side effects, like racing heart, sweating, etc. I personally like propranolol for this kind of thing, but thats me...your doc should have his/her own ideas. The point of the preventive meds isn't to load up on meds so much as it is a recognition that these meds can and do have side-effects, but they can usually be managed until they go away. If you're any kind of bipolar or have cyclothymia or are prone to hardcore repeated bouts of depression, you might want to try a mood-stabilizer before, during, or after you medicate for ADD. For some people, this helps with focus. Good luck!
Posted by tendency on April 19, 2005, at 10:56:05
In reply to Re: need replacement for stimulants, posted by med_empowered on April 18, 2005, at 20:03:47
> hey! For ADD/ADHD, you can do a few things w/o a true stimulant. <snip>
wow, thanks for all the great advice. im not familiar with provigil so ill have to research that one.
im currently taking celexa for depression, anxiety and irritability and it seems to be working well though it makes my mood unstable (bp II) so im going back to doc on thursday to get on a mood stabilizer as well.
been reading good things on wellbutrin. ill check out buspar too.
Posted by jparsell82 on April 20, 2005, at 21:23:28
In reply to need replacement for stimulants, posted by tendency on April 18, 2005, at 11:20:00
> hi. i just cannot tolerate side effect wise the stimulant meds but really need something for my add. any ideas out there? im currently on 20mg celexa for depression, anxiety, irritability and it's working wonders.
>
> until emsam arrives (come on god damm!t bristol ;-)) maybe selegiline would be worth a try? any other ideas? thanks.Provigil is a possibility, though I didn't get much help from it. Strattera I haven't tried, though it likely has a similar side-effect profile as stimulants. I would not recommend Selegilene for ADD. If anything, I had a harder time focusing with Selegilene. DMAE or even better, Centrophenoxine, is helpful to some extent with ADD. Also, Pyritinol may be of some help. If you're not already taking Fish Oil(EPA&DHA), you should definitely be taking that for your ADD.
Posted by tendency on April 22, 2005, at 10:56:32
In reply to Re: need replacement for stimulants, posted by med_empowered on April 18, 2005, at 20:03:47
hey med, thanks for the great info. im starting wellbutrin along with my celexa and will see if that does the trick. take care
Posted by tendency on April 22, 2005, at 10:57:49
In reply to Re: need replacement for stimulants » tendency, posted by jparsell82 on April 20, 2005, at 21:23:28
> Provigil is a possibility, though I didn't get much help from it. Strattera I haven't tried, though it likely has a similar side-effect profile as stimulants. I would not recommend Selegilene for ADD. If anything, I had a harder time focusing with Selegilene. DMAE or even better, Centrophenoxine, is helpful to some extent with ADD. Also, Pyritinol may be of some help. If you're not already taking Fish Oil(EPA&DHA), you should definitely be taking that for your ADD.
thanks for the tips. ive tried dmae, fish oil and probably 200 other supplements having worked extensively with several naturopaths and 'alternative' practioners. ive found none of them to do much.
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