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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 Calis on May 2, 2008, at 13:17:14
I was prescribed ritalin for inattentive ADD 6 weeks ago and while it really improved my attentional difficulties I am finding the sympathetic nervous system stimulation to be too great. My heart rate tends to go up quite a bit on it, once to the point that I had a very uncomfortable feeling of tension in my chest running up my throat.
I'm also finding that it makes me feel like crap once it wears off, like I've been totally burnt out - very lethargic possibly even mild depression. I have low levels of androgens and adrenal hormones anyway (which I'm also receiving treatment for) and ritalin seems to be making things worse, it has totally destroyed my exercise performance and libido. I found a study somewhere mentioning that it decreases LH and FSH and I'm sure it probably causes even more stress for my already overworked adrenals.
On the positive side it has allowed me to work effectively for the first time in my life, I finally feel like I may be able to fulfill my potential at university (which up until this point I have been on the verge of failing despite having a high iq and finding the material very easy). I also have pretty bad social anxiety which it has helped quite a bit. I have tried SSRIs and GABAergic drugs for this in the past but found them dulling and counterproductive. It seems that mentally I respond very well to stimulants just not physically.
I'm trying to get myself a prescription for dexedrine as I've heard that it can be better for some of these side effects, but, living in the UK, finding a doctor willing to prescribe dex is proving problematic.
Can anyone suggest any alternatives to ritalin that may be beneficial in my situation, or anything that I could try taking with it in order to help calm some of the physical sides?
I would really appreciate any help.
Calis
Posted by undopaminergic on May 2, 2008, at 18:52:16
In reply to Ritalin - alternative/avoiding side effects, posted by Calis on May 2, 2008, at 13:17:14
Guanfacine lowers heart rate and blood pressure, and has also proven effective against ADD. I've personally found it quite useful in combination with stimulants.
A cardioselective beta-blocker, such as atenolol, is another option for reducing heart rate (and blood pressure).
Other than Dexedrine, modafinil, low doses of sulpiride or amisulpride, selegiline or rasagiline, can be useful agents on their own or in addition to Ritalin.
Posted by Phillipa on May 2, 2008, at 23:27:38
In reply to Ritalin - alternative/avoiding side effects, posted by Calis on May 2, 2008, at 13:17:14
Calis see your new to babble wanted to welcome you and there is a wealth of information on this board and the ones listed below. I have heard that vyvanase is good too. Does the UK have this med? Again welcome. Love Phillipa
Posted by Molybdenum on May 3, 2008, at 1:27:51
In reply to Ritalin - alternative/avoiding side effects, posted by Calis on May 2, 2008, at 13:17:14
Dear Cialis, (?) ;)
OK - I have had a lot of methylphenidate (Ritalin) for tiredness re sleep apnoea. I hate it but it's so cheap here (Aust.). Now that I have found (thanks to people in this forum) that modafinil is available cheaply from India & Bosnia, etc I am going to swap over & never look back..! It hasn't arrived in the mail yet... :(
So at the moment I take about 50-80mg of Ritalin per day in 10mg doses separated evenly between 7am & 3pm. I am fond of saying that Ritalin gives me 2 hours of "up" for 4 hours of "down". And some of the "up" time spikes a bit & I feel "speedy". A very bumpy ride it is for me. Not very conducive for work or study. And a crap day will be had by all.....IMHO.
Then every 2 weeks I take none of it on the weekend so as to reduce the likelihood of building up a tolerance. I sleep 14hrs Sat & Sun and feel like crap regardless. Some of that is due to the sleep apnoea, but I think most is rebound from the Ritalin for sure.
Although it should be noted that there are a few people here who combine the two drugs. I have been meaning to ask them why & how. I shall post!
Will it help with your ADD? I don't know but if the doc agrees, I really suggest trying it.
Good Luck :)
If you've not heard of modafinil, see: http://en.wikipedia.org/wiki/Modafinil
Posted by cumulative on May 3, 2008, at 4:53:21
In reply to Re: Ritalin - alternative/avoiding side effects, posted by Molybdenum on May 3, 2008, at 1:27:51
Molybdenum: Have you done anything to address the sleep apnea? Besides that, you might look into the methylphenidate patch (if it's available for you) which might take care of the bumpiness.
undopaminergic: What was the guanfacine like? I've thought about trying this. Optimally, it would encourage a more relaxed focus ...
Posted by Molybdenum on May 3, 2008, at 5:24:45
In reply to Re: re:, posted by cumulative on May 3, 2008, at 4:53:21
> Molybdenum: Have you done anything to address the sleep apnea? Besides that, you might look into the methylphenidate patch (if it's available for you) which might take care of the bumpiness.
>Thanks cumulative,
the sleep apnoea is central type, most often seen in cases of head injury or congestive heart failure - neither of which I have. CPAP makes CSA worse. There's a pseudo-respirator on the market but I just cannot tolerate it. Hence all I can do is try to survive on less quality sleep & boost my days with stims.
I'm really sick of MP though. Taking 10mg every 60-90 mins is the same as a patch or the other pricey slow release forms. I always preferred the modafinil but the cost made it prohibitive for me.
Re Calis's ADD, I don't know whether there's any advantage of MP over modafinil for this particular disorder. If they'll both work, then my suggestion is to ditch the MP. I think the dexamphetamine is good too but more rarely prescribed due to it's perceived increased potential for dependence.
;)
Posted by Calis on May 3, 2008, at 5:37:03
In reply to Ritalin - alternative/avoiding side effects, posted by Calis on May 2, 2008, at 13:17:14
Thanks for the welcome and advice everyone.
Guanfacine does sound like a good option other than the fact that it lowers blood pressure. I'm already on the borderline of hypotension and had fainting episodes as a teenager because of low blood pressure so I think that would rule it out for me.
Unfortunately Vyvanse is not available in the UK yet. We're very behind with the treatment of ADD in general here, and especially in adults. At the moment just getting ritalin is hard never mind anything else.
I actually once tried modafinil that a friend takes for narcolepsy along with my morning dose of ritalin. I'm not sure it had any added benefit for my ADD, but it was great for social anxiety. It might be worth experimenting with a bit more, but again I think it may be hard to get a prescription for it here.
I like the sound of your dosing protocol Molybdenum. I think smaller, more regular doses may help me a bit so I'll give that a shot and report back.
I was also thinking maybe some sort of adaptogenic herb such as rhodiola or ashwagandha along with the ritalin may help a bit, while also being a fairly healthy option. Does anyone have any thoughts on that?
Posted by Calis on May 3, 2008, at 5:46:05
In reply to Re: re: » cumulative, posted by Molybdenum on May 3, 2008, at 5:24:45
> Re Calis's ADD, I don't know whether there's any advantage of MP over modafinil for this particular disorder. If they'll both work, then my suggestion is to ditch the MP. I think the dexamphetamine is good too but more rarely prescribed due to it's perceived increased potential for dependence.
>
> ;)
>From the one experience I have with modafinil it definitely is of some benefit to me for social anxiety and energy in general. However it didn't seem to do anything for attention, from my limited experience I think I need something with an effect on dopamine. Maybe a combination of modafinil and amisulpride would be a possible ritalin alternative? I think the motivational aspect of amisulpride would be particularly useful in my case, although I have heard that it has a high poop out rate.
Posted by Molybdenum on May 3, 2008, at 6:02:21
In reply to Re: re:, posted by Calis on May 3, 2008, at 5:46:05
>
> From the one experience I have with modafinil it definitely is of some benefit to me for social anxiety and energy in general. However it didn't seem to do anything for attention, from my limited experience I think I need something with an effect on dopamine. Maybe a combination of modafinil and amisulpride would be a possible ritalin alternative? I think the motivational aspect of amisulpride would be particularly useful in my case, although I have heard that it has a high poop out rate.
>
>
>
I can't comment on the amisulpride - never used it but I do believe the modafinil is a very subtle yet effective animal. It can also take a couple of weeks for your body to become attuned to it.As to the difficulty of getting it in the UK, you've just got the script problem. But modafinil is supposed to have much less potential for abuse than other stims - you're not supposed to be able to "get high" from it. It's not soluble in water - you may as well try dissolving fibreglass in a spoon..! Hence junkie's can't shoot it. I'd definitely try the doc for sure. Tell him/her that you find the Ritalin "too strong" and have heard that modafinil is "gentler" and "less addictive".
Hmm....mentat calculation gives this course of action a 70% chance of success... ;)
Unfortunately for our American comrades, their FDA has classified modafinil as a controlled substance which makes it a prohibited import. I get the impression it's a bit of a fcukup & hopefully for them, the FDA will reverse the decision soon.
What I mean is that with a script, you should be able to legally import 3 months worth from India or Bosnia VERY CHEAPLY. Americans trying this risk the goods being seized by customs, etc on entry.
Dear USA-ians, is my take on this correct?
:)
Posted by undopaminergic on May 3, 2008, at 12:04:15
In reply to Re: re:, posted by cumulative on May 3, 2008, at 4:53:21
> undopaminergic: What was the guanfacine like? I've thought about trying this. Optimally, it would encourage a more relaxed focus ...
>Since I'm so lethargic without stimulants, I haven't found guanfacine particularly useful on its own. However, on top of methylphenidate, it improves certain aspects of cognition, executive function and working memory. As noted elsewhere in this thread, it reduces heart rate and blood pressure; fortunately, it does not interfere with the baroreflex, so there is no orthostatic hypotension except if you take an excessively large dose which also results in dry mouth. I also have the impression that it reduces dopamine beta-hydroxylase activity, thus reducing excessive conversion of dopamine to noradrenaline; this is noticeable, for example, as a reduced cardiovascular response to L-dopa (LD) and an increase in LD-evoked nausea.
This is the end of the thread.
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