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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by florence on August 24, 2005, at 21:18:29
I can't take the pain any more..I am so sick of this.
Why do I get tight sinus pain in my face that eventually causes pressure pain in my ears whenever I wean off of Ritalin, Adderall, Wellbutrin and now PROVIGIL???? (Actually, I am still taking Provigil)
I hate it: as if I don't have enough medical bills; I have to pay for antibiotics-then of course being female the yeast infection follows.What might Provigil and the other stimulants have in common? Are they vaso constricters? I already have a migraine "problem". And Hashimoto's thyroid disease so my mouth and eyes are already dry as heck.
Decongestants don't help prevent this.
Can someone please offer an educated guess or theory? ...Maybe that substance P -that I have read about here on the boards.
Please refrain from telling me to drink lots of water..or steam my face or stay away from dairy.
Florence
Posted by gromit on August 24, 2005, at 22:33:27
In reply to Provigil, Ritalin sinus infections HELP!, posted by florence on August 24, 2005, at 21:18:29
I have no idea why this happens, I'll just say that the steroid nasal sprays like nasonex are a good prophylactic. I've had sinus problems from several medications including ritalin (but not provigil) and using the spray regularly keeps it from becoming a problem that needs antibiotics.
Rick
Posted by theo on August 24, 2005, at 23:05:37
In reply to Provigil, Ritalin sinus infections HELP!, posted by florence on August 24, 2005, at 21:18:29
> I can't take the pain any more..I am so sick of this.
> Why do I get tight sinus pain in my face that eventually causes pressure pain in my ears whenever I wean off of Ritalin, Adderall, Wellbutrin and now PROVIGIL???? (Actually, I am still taking Provigil)
> I hate it: as if I don't have enough medical bills; I have to pay for antibiotics-then of course being female the yeast infection follows.
>
> What might Provigil and the other stimulants have in common? Are they vaso constricters? I already have a migraine "problem". And Hashimoto's thyroid disease so my mouth and eyes are already dry as heck.
> Decongestants don't help prevent this.
> Can someone please offer an educated guess or theory? ...Maybe that substance P -that I have read about here on the boards.
> Please refrain from telling me to drink lots of water..or steam my face or stay away from dairy.
> FlorenceI have the same damn problem, also with anticonvulsants especially.
Posted by Declan on August 25, 2005, at 0:33:17
In reply to Re: Provigil, Ritalin sinus infections HELP! » florence, posted by theo on August 24, 2005, at 23:05:37
Florence, wouldn't pseudoephedrine have similar decongestant properties to amphetamine compounds and therefore be a useful stopgap measure while your system gets over the lack of stimulants? I thought they were all vasoconstrictors, dunno about Ritalin.
If my sinuses etc block up I more or less have to clear them a bit to prevent infection from stagnant phlegm (yuck). You don't want to dry your sinuses out anymore than they already are, anyway.
Declan
Posted by Leonard Peabody on August 27, 2005, at 21:17:01
In reply to Provigil, Ritalin sinus infections HELP!, posted by florence on August 24, 2005, at 21:18:29
> I can't take the pain any more..I am so sick of this.
> Why do I get tight sinus pain in my face that eventually causes pressure pain in my ears whenever I wean off of Ritalin, Adderall, Wellbutrin and now PROVIGIL???? (Actually, I am still taking Provigil)
> I hate it: as if I don't have enough medical bills; I have to pay for antibiotics-then of course being female the yeast infection follows.
>
> What might Provigil and the other stimulants have in common? Are they vaso constricters? I already have a migraine "problem". And Hashimoto's thyroid disease so my mouth and eyes are already dry as heck.
> Decongestants don't help prevent this.
> Can someone please offer an educated guess or theory? ...Maybe that substance P -that I have read about here on the boards.
> Please refrain from telling me to drink lots of water..or steam my face or stay away from dairy.
> FlorenceI don't know if your problem is my problem, but it sounds like it might be. (I get nasal congestion and pressure and pain in my face, inside my ears (which can cause them to pop), and various other places. One of my tonsils even swells up occasionally.) If so, I doubt the antibiotics are going to help you, since I doubt you're having infections. I originally assumed I had sinusitus--in fact, I got sinus surgery because of it, but it did nothing. I tried a decongestant, which worked for a while and then stopped working.
Then, after realizing that there was a correlation between the pressure and stress, I went to get treatment for anxiety, which led to a diagnosis of GAD and ADD. Since then, I've tried a number of drugs, and the only ones that helped with the pressure were Adderall, Ritalin, Strattera, and desipramine--in other words, the ones that increase norepinephrine. (Wellbutrin and Provigil never did anything for me, but that you had rebound effects when you got off them would at least be consistent with the NE theory). I think at least part of the reason is that NE's a vasoconstrictor, but there may be other reasons. Incidentally, nasal congestion is symptomatic of cluster headaches (since it involves vascular inflammation), and I've read that Ritalin has been used a treatment for cluster headaches. Maybe for migraines too, since it's also a vascular headache, but I don't know.
Anyway, I think the most important thing is to find one drug and stick with it, so you don't have the weaning/rebound problems. I personally found that when I got off Strattera the pressure became much worse. The stimulants have the problem of wearing off at the end of the day, which potentially creates a rebound problem on a daily basis. I'm not sure why you stopped the other drugs, but you might want to consider trying Strattera. I've found that taking 40 mg--which is lower than the recommended ADD dose--helps with the head pressure. In fact, I've found that it only takes a couple hours to kick in (unlike the couple weeks or so they say it takes to help with ADD). The lowest dose they make is 10 mg, and I plan to try that dose and work up from there to see if I can get benefits without the side effects (drowsiness if I take it in the morning, insomnia if I take it at bedtime).
By the way, do you find that the pressure is sensitive to temperature? I find that I feel much better when I am breathing moderately cold air. Also, alcohol makes it a lot worse, especially wine and beer.
Posted by florence on September 14, 2005, at 19:50:15
In reply to Provigil, Ritalin sinus infections HELP!, posted by florence on August 24, 2005, at 21:18:29
Thanks to you all for taking the time to offer some help/suggestions.........
I am almost certain that it is the Provigil-since I weaned off of it slowly then took one today and the ear pain that never totally went away has come back rather intensely.Does anyone know where I can find information that states NE is a vasoconstrictor? Thanks again.
Back to square one: trying to get rid of the pain by taking the least amount of other drugs. Florence
Posted by florence on September 14, 2005, at 20:01:01
In reply to Re: Provigil, Ritalin sinus infections HELP!, posted by Leonard Peabody on August 27, 2005, at 21:17:01
> > I can't take the pain any more..I am so sick of this.
> > Why do I get tight sinus pain in my face that eventually causes pressure pain in my ears whenever I wean off of Ritalin, Adderall, Wellbutrin and now PROVIGIL???? (Actually, I am still taking Provigil)
> > I hate it: as if I don't have enough medical bills; I have to pay for antibiotics-then of course being female the yeast infection follows.
> >
> > What might Provigil and the other stimulants have in common? Are they vaso constricters? I already have a migraine "problem". And Hashimoto's thyroid disease so my mouth and eyes are already dry as heck.
> > Decongestants don't help prevent this.
> > Can someone please offer an educated guess or theory? ...Maybe that substance P -that I have read about here on the boards.
> > Please refrain from telling me to drink lots of water..or steam my face or stay away from dairy.
> > Florence
>
> I don't know if your problem is my problem, but it sounds like it might be. (I get nasal congestion and pressure and pain in my face, inside my ears (which can cause them to pop), and various other places. One of my tonsils even swells up occasionally.) If so, I doubt the antibiotics are going to help you, since I doubt you're having infections. I originally assumed I had sinusitus--in fact, I got sinus surgery because of it, but it did nothing. I tried a decongestant, which worked for a while and then stopped working.
>
> Then, after realizing that there was a correlation between the pressure and stress, I went to get treatment for anxiety, which led to a diagnosis of GAD and ADD. Since then, I've tried a number of drugs, and the only ones that helped with the pressure were Adderall, Ritalin, Strattera, and desipramine--in other words, the ones that increase norepinephrine. (Wellbutrin and Provigil never did anything for me, but that you had rebound effects when you got off them would at least be consistent with the NE theory). I think at least part of the reason is that NE's a vasoconstrictor, but there may be other reasons. Incidentally, nasal congestion is symptomatic of cluster headaches (since it involves vascular inflammation), and I've read that Ritalin has been used a treatment for cluster headaches. Maybe for migraines too, since it's also a vascular headache, but I don't know.
>
> Anyway, I think the most important thing is to find one drug and stick with it, so you don't have the weaning/rebound problems. I personally found that when I got off Strattera the pressure became much worse. The stimulants have the problem of wearing off at the end of the day, which potentially creates a rebound problem on a daily basis. I'm not sure why you stopped the other drugs, but you might want to consider trying Strattera. I've found that taking 40 mg--which is lower than the recommended ADD dose--helps with the head pressure. In fact, I've found that it only takes a couple hours to kick in (unlike the couple weeks or so they say it takes to help with ADD). The lowest dose they make is 10 mg, and I plan to try that dose and work up from there to see if I can get benefits without the side effects (drowsiness if I take it in the morning, insomnia if I take it at bedtime).
>
> By the way, do you find that the pressure is sensitive to temperature? I find that I feel much better when I am breathing moderately cold air. Also, alcohol makes it a lot worse, especially wine and beer.
>
>Do u know where I can find info/link to where it states that NE is a vasoconstrictor? thanks..still in pain but thanks for your long post. i appreciate it. Florence
Posted by neuroman on September 15, 2005, at 21:10:13
In reply to Re: Provigil, Ritalin sinus infections HELP! » Leonard Peabody, posted by florence on September 14, 2005, at 20:01:01
Hi,
This is an interesting thread. I've suffered with chronic nasal congestion for so long I had forgotten it was a problem. While i haven't had ear pain, i often get a staticy buzzing sound in my left ear. I have anhedonia and dysthimia and some anxiety. I also have chronic neuropathic pain. I figured i'd give bupropion SR a try because i'm certain low dopamine and/or norepinephrine is at the root of my problem. SSRI's haven't helped me. Anyway, with the first dose i found the bupSR relieved a lot of pain. Then over the course of the next few days i felt something going on with my sinuses and ears. They felt like they were clearing up. I actually found that i could sing along with the car radio without my nose getting stuffed up as it usually does. Unfortunately, the bupropion starting knocking me out for some reason so after a couple of weeks i stopped. I still have a bunch and plan on giving it another shot. I found out that besides being an NRI and mild DRI bupropion is also an alpha-2 agonist. Before i try it again i'd like to give a specific alpha-2 agonist like clonidine or guanfacine a try. They have also shown promise as treatments for ADD/ADHD so they must have some type of dopaminergic effect. I may give Ritalin a try also. Anyway, here are a couple of interesting norepinephrine links.
http://www.answers.com/topic/norepinephrine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7507588&query_hl=7
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12387934&query_hl=16
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11777250&query_hl=16I've also read about people who have a deficiency of dopamine beta hydoxylase. This is the enzyme that converts dopamine into norepinephrine. These people have high plasma dopamine levels and virtually zero norepinephrine. The sypmtom complex consists of ptosis(droopy eyelids), orthostatic hypotension, low body temperature, a few other things and of course...chronic nasal congestion! I guess a similar symptom complex could occur if you don't have enough dopamine to convert to norepinephrine regardless of the amount of converting enzyme. I think this might be my problem. I hope this was of some help to you. Good luck...
Paul
Posted by florence on September 20, 2005, at 23:49:13
In reply to Re: Provigil, Ritalin sinus infections HELP! » florence, posted by neuroman on September 15, 2005, at 21:10:13
> Hi,
>
> This is an interesting thread. I've suffered with chronic nasal congestion for so long I had forgotten it was a problem. While i haven't had ear pain, i often get a staticy buzzing sound in my left ear. I have anhedonia and dysthimia and some anxiety. I also have chronic neuropathic pain. I figured i'd give bupropion SR a try because i'm certain low dopamine and/or norepinephrine is at the root of my problem. SSRI's haven't helped me. Anyway, with the first dose i found the bupSR relieved a lot of pain. Then over the course of the next few days i felt something going on with my sinuses and ears. They felt like they were clearing up. I actually found that i could sing along with the car radio without my nose getting stuffed up as it usually does. Unfortunately, the bupropion starting knocking me out for some reason so after a couple of weeks i stopped. I still have a bunch and plan on giving it another shot. I found out that besides being an NRI and mild DRI bupropion is also an alpha-2 agonist. Before i try it again i'd like to give a specific alpha-2 agonist like clonidine or guanfacine a try. They have also shown promise as treatments for ADD/ADHD so they must have some type of dopaminergic effect. I may give Ritalin a try also. Anyway, here are a couple of interesting norepinephrine links.
>
> http://www.answers.com/topic/norepinephrine
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7507588&query_hl=7
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12387934&query_hl=16
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11777250&query_hl=16
>
> I've also read about people who have a deficiency of dopamine beta hydoxylase. This is the enzyme that converts dopamine into norepinephrine. These people have high plasma dopamine levels and virtually zero norepinephrine. The sypmtom complex consists of ptosis(droopy eyelids), orthostatic hypotension, low body temperature, a few other things and of course...chronic nasal congestion! I guess a similar symptom complex could occur if you don't have enough dopamine to convert to norepinephrine regardless of the amount of converting enzyme. I think this might be my problem. I hope this was of some help to you. Good luck...
>
> PaulThanks for all your links; I like to have documentation of the info I come across on line to print out to take to the dr whom I pay to treat me after I teach him/her about the mechanism of actions, etc. of these things. Sorry, I am not usually so sarcastic.
Intersting that I noticed the ear pain when I stopped Wellbutrin many yrs back. I had been on it for 6-8 wks and she told me to hang in there. Well, my only complaint then was fatigue not depression.
I had menstual migraines for over 20 yrs and antidepressants were handed out like candy --with no knowledge of the major problems with side effects and weaning off of them..I learned everything the hard way.
Wellbutrin knocked me out too. I went from being fatigued to being bedridden and having crying spells and agitation..It works for my sister though..But she has no motivation and has been trying to find an SSRI to conteract this.SSRIs never worked for me. Ten yrs later I know why, thanks to this board. If u have a thyroid disease the ADs won't usually work until the thyroid problem is corrected. And mine was not even discovered for over ten yrs.
If u think of it, let me know how the other drug works. Do you use Scott's Pschiatric & Associated drug list? According to his list, buproprion has the property of being a ACh(n) antagonist-Is that the same thing as the NE alpha2 agonist in clonidine? ..I don't believe so.
Do u know how many types of NE receptors there are? alpha? beta? ...I think I have anhedonia and dsythmia too as a result of my Hashimoto's thyroid disease. Depression and Fatigue are the hallmarks of this disease. It never lets up. The Provigil gets me out of bed but then I need to take Xanax or Klonopin to deal with the depression/anxiety 6-7 hrs later when the Provigil wears off.....It never gave me ear pressure before- just the Wellbutrin, Adderall, and Ritalin..
I am trying so hard to find something to supplement the provigil with so I don't get the tightness in the face and throbbing pressure in the ears........Thanks again for taking the time to answer to cry for help. I really appreciate it. I just haven't felt well enough to check my email every day lately. Bye for now, Florence
Posted by neuroman on September 22, 2005, at 12:35:33
In reply to Re: Provigil, Ritalin sinus infections HELP!, posted by florence on September 20, 2005, at 23:49:13
> I like to have documentation of the info I come across on line to print out to take to the dr whom I pay to treat me after I teach him/her about the mechanism of actions, etc. of these things. Sorry, I am not usually so sarcastic.
Believe me I know how you feel. Unfortunately, most doctors are clueless. Once they get their medical license they figure they know everything and that there's nothing left to learn. I better stop here because I'm about to go off on a tirade...
> SSRIs never worked for me. Ten yrs later I know why, thanks to this board. If u have a thyroid disease the ADs won't usually work until the thyroid problem is corrected. And mine was not even discovered for over ten yrs.
I've had a lot of the symptoms of low thyroid for many years along with a borderline high TSH, but was ignored until a thyroid antibody test was done about 9 months ago and I came back postive. I've been on 1/2 grain of mixed T3 T4 formula for about six months. Unfortunately it hasn't helped all that much.
> Do you use Scott's Pschiatric & Associated drug list?
Yes, it's an excellent reference.
> According to his list, buproprion has the property of being a ACh(n) antagonist-Is that the same thing as the NE alpha2 agonist in clonidine? ..I don't believe so.
According to my copy of "Essential Psychophamacology", bupropion (unlike the tricyclics) is not a direct Ach antagonist. However, since NE generally stimulates the sympathic nervous system and Ach is a major (if not the major) parasympathetic neurotransmitter, it may indirectly antagonize it. Scott (SLS) probably knows more about this than I do.
> Do u know how many types of NE receptors there are? alpha? beta?
Unless they've discovered some new ones, here they are (there may be beta subtypes too):
Alpha 1a, 1b, 1d, 2a, 2b, 2c, 2d and Beta 1 and 2.I'm still looking for a website or book that concisely describes the major functions of each of these receptors. Unfortunately, I get the impression that even the researchers aren't totally sure.
> I think I have anhedonia and dsythmia too as a result of my Hashimoto's thyroid disease. Depression and Fatigue are the hallmarks of this disease.
These can also be a sign of low dopamine. Especially the anhedonia. I know this is my main problem. Which would most likely also mean low norepinephrine levels. It's not a simple problem to address because generally in the face of chronically low neurotransmitter levels some of the receptors become sensitized.
> I am trying so hard to find something to supplement the provigil with so I don't get the tightness in the face and throbbing pressure in the ears...
Is this happening as it's wearing off?
By the way which wellbutrin were you on, regular, SR or XR? And for how long? I took a 100mg SR the day before yesterday. It didn't wipe me out. I had some of the sympathetic effects like piloerection (hair standing on end) and I have to say I felt really good yesterday. Maybe I'm a slow metabolizer and should take it every other day. We shall see...
Have you ever tried the amino acids phenylalanine or tyrosine? They are the dopamine and norepinephrine precursers. I take them everyday. They're no cure all but they help.
Keep me posted,
Paul
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