Psycho-Babble Medication Thread 859329

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Ritalin for depression?

Posted by valiente on October 26, 2008, at 10:52:11

I suffer from treatment resistant depression. I currently take 20 mg. of Prozac on Monday, Wednesday and Friday (none of weekends), Zyprexa, 5 mg. and Xanax, 1 mg., for severe morning anxiety and 1 mg. at bedtime. Recently my doctor determined that I also have ADD. He prescribed Ritalin for the ADD and says that it is also helpful for depression. I take 10 mg. in the morning and 10 mg. at noon. Has anyone been prescribed Ritalin for depression and if so, has it helped?

He also said that next time I have an appointment he wants to add a small dose
(200 mg) of Lithium. I wasn't clear on what this would do. Any ideas?

 

Re: Ritalin for depression? » valiente

Posted by Phillipa on October 26, 2008, at 11:10:28

In reply to Ritalin for depression?, posted by valiente on October 26, 2008, at 10:52:11

Just that the lithium could act as a mood stabalizer or boost an antidepressant? Phillipa

 

Re: Ritalin for depression? » valiente

Posted by azalea on October 26, 2008, at 11:20:53

In reply to Ritalin for depression?, posted by valiente on October 26, 2008, at 10:52:11

Are you being treated by a psychiatrist or general practitioner?

It seems counterintuitive to combine Zyprexa and Ritalin. While both are used to augment response to SSRIs like Prozac, they have opposing mechanisms of action. Zyprexa blocks dopamine, while Ritalin increases dopamine. Theoretically, it seems like the effects would cancel out each other.

In addition, it's a bit unusual to add additional agents before maximizing the dose of your current meds. 20mg if Prozac 3 days per week is a very low dose. I'm curious what the reasoning is behind this.

However, if what you're doing is working, no reason to change.

> I suffer from treatment resistant depression. I currently take 20 mg. of Prozac on Monday, Wednesday and Friday (none of weekends), Zyprexa, 5 mg. and Xanax, 1 mg., for severe morning anxiety and 1 mg. at bedtime. Recently my doctor determined that I also have ADD. He prescribed Ritalin for the ADD and says that it is also helpful for depression. I take 10 mg. in the morning and 10 mg. at noon. Has anyone been prescribed Ritalin for depression and if so, has it helped?
>
> He also said that next time I have an appointment he wants to add a small dose
> (200 mg) of Lithium. I wasn't clear on what this would do. Any ideas?

 

Ritalin + Zyprexa » valiente

Posted by azalea on October 26, 2008, at 15:14:02

In reply to Ritalin for depression?, posted by valiente on October 26, 2008, at 10:52:11

In my previous post, I mentioned concern about the canceling out effect of combining an atypical antipsychotic (Zyprexa) with a stimulant (Ritalin). While doing some reading, I came across some additional information. Stahl's Essential Psychopharmacology notes that "in heroic cases, stimulants can be combined with atypical antipsychotics . . . Such as approach is controversial and best left to experts for patients who fail to improve adequately on monotherapies."

> I suffer from treatment resistant depression. I currently take 20 mg. of Prozac on Monday, Wednesday and Friday (none of weekends), Zyprexa, 5 mg. and Xanax, 1 mg., for severe morning anxiety and 1 mg. at bedtime. Recently my doctor determined that I also have ADD. He prescribed Ritalin for the ADD and says that it is also helpful for depression. I take 10 mg. in the morning and 10 mg. at noon. Has anyone been prescribed Ritalin for depression and if so, has it helped?
>
> He also said that next time I have an appointment he wants to add a small dose
> (200 mg) of Lithium. I wasn't clear on what this would do. Any ideas?

 

Re: Ritalin for depression?

Posted by bleauberry on October 26, 2008, at 18:53:11

In reply to Ritalin for depression?, posted by valiente on October 26, 2008, at 10:52:11

Just wanted to share a few thoughts.

While anything could be suspect in your symptoms, I am trying to see what is the highest suspect. In my opinion that is dosing prozac 3 times per week. Before being labeled treatment resistant, you would have had to have been on 80mg every day for a couple months, as well as max doses of a couple other ADs from other classes failed. 20mg three times a week is not enough. We give prozac credit for a long halflife, but in my experience it really does take daily dosing to keep some mysterious aspect of it working. I say that from my own experience, not theory. While stable on 20mg per day, if I did 10mg one day or skipped a day, I could definitely tell. Immediate symptoms were morning anxiety and feeling blue. The long halflife should have prevented that, theoretically, but didn't in the real world.

20mg every day should be tried. For me, the prozac jitters side effect was most prominent at the lower doses, nearly nonexistent at 20mg daily.

Another thing to consider is that the prozac/zyprexa combo could be causing a form of akathisia, easily misinterpreted as anxiety. Not pure akathisia, but something in that family. I say this, again, from personal experience. It took a few years, but after being on 20mg prozac and 5mg zyprexa for a long time, I began to wake each morning with horrible anxiety. I had never had anxiety before and didn't know what it was. Until I found out I had been calling in the "morning butterflies". Butterflies in the stomach at waking. It was horrible. I discovered that dose increases did not help and maybe made it worse. It was maybe two months after I had weaned off both drugs that those butterflies mostly went away, but still plague me somewhat at a mild level.

Low dose klonopin was an immediate cure.

I wouldn't do it again, but my doc added st johns wort to my prozac/zyprexa mix, and that cured the morning anxiety and I felt great. Until serotonin syndrome hit at about the 4 week mark.

As for ritalin, yeah, it can help. It helped me a lot with prozac and zyprexa combo. Zyprexa softened the ritalin jitters but certainly the meds did not in any way cancel each other out. But ritalin only increased my anxiety when it wore off. It was good for mood and energy, bad for anxiety.

I don't see why you are having meds piled on top of each other when you haven't even gotten to a normal dose yet. Should at least be 20mg prozac daily before making any other moves.

Lithium I also tried with prozac zyprexa combo. It was 100mg and felt like a massive adrenaline rush, like a whole lot of coffee. Mood immediately improved, but anxiety went through the roof.

Ya know, all this stuff is so complicated that it makes sense to keep things as simple and basic as possible, and then, and only then, embark on outside experiments when mainstream approaches have failed at therapeutic doses. Your current combo of prozac and zyprexa could actually be a fantastic one if at the right doses, which could involve prozac at anything from 20mg to 40mg per day, and zyprexa at 5mg to 10mg per night.

Just my own longtime experience with these two meds, their magic really doesn't kick in until a 20mg/5mg mix has been attained. And from my own experience, a real good add-on at that time, better than ritalin or lithiu, good for mood, interest, and non-anxiety provoking, is provigil.

Just my experience.

 

Re: Ritalin + Zyprexa

Posted by valiente on October 26, 2008, at 20:31:07

In reply to Ritalin + Zyprexa » valiente, posted by azalea on October 26, 2008, at 15:14:02

Thanks for the information azalea. I feel better now that this combination is noted somewhere. I am fairly new to my Pdoc so am still a bit insecure about what he's doing.


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