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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 bulldog2 on October 31, 2009, at 12:21:43
Some seem to think they cancel each other out. Some think there is a synergy with them. Are there any studies showing a benefit to using them together? Also how about tcas with stimulants?
Posted by Phillipa on October 31, 2009, at 12:31:49
In reply to Studies Of Using SSRIs With Stimulants, posted by bulldog2 on October 31, 2009, at 12:21:43
Good question. Phillipa
Posted by manic666 on October 31, 2009, at 14:34:55
In reply to Studies Of Using SSRIs With Stimulants, posted by bulldog2 on October 31, 2009, at 12:21:43
i dont no about stimulants , but benzo,s thats how i got hooked on them.Whenever i tried a new ssri,med i would use ativan to calm anxierty.the trouble was when the test failed an i started another ad, i was already hooked on ativan.if the p docs had used cross taper maby i would have been cool. but in england its still rare for a p.doc to gross taper, crazy sure but thats there way
Posted by Maxime on October 31, 2009, at 15:15:48
In reply to Studies Of Using SSRIs With Stimulants, posted by bulldog2 on October 31, 2009, at 12:21:43
I don't see how a stim could cancel an SSRI. Something to research perhaps.
Posted by bulldog2 on October 31, 2009, at 15:41:27
In reply to Re: Studies Of Using SSRIs With Stimulants » bulldog2, posted by Maxime on October 31, 2009, at 15:15:48
> I don't see how a stim could cancel an SSRI. Something to research perhaps.
Just anecdotal reports of those that had tried such combos.
Posted by Phidippus on October 31, 2009, at 18:16:01
In reply to Studies Of Using SSRIs With Stimulants, posted by bulldog2 on October 31, 2009, at 12:21:43
There are no indications that stimulants cross interact with SSRIs in any other way than to, on rare occasion, cause seratonin syndrome, but this is very rare as stimulants have little potentiating effect on seratonin.
There are concerns that SSRIs worsen ADHD, which complicates treating comorbid ADHD and depression, but there's not a lot of literature on it.
I have ADHD and OCD and I use Lexapro and Dexedrine to treat both conditions.
P
Dexedrin 45 mg
Geodon 80 mg
Keppra 1000 mg
Lexapro 20 mg
Gabitril prn
Tramadol prn
Posted by bulldog2 on October 31, 2009, at 18:27:55
In reply to Re: Studies Of Using SSRIs With Stimulants » bulldog2, posted by Phidippus on October 31, 2009, at 18:16:01
> There are no indications that stimulants cross interact with SSRIs in any other way than to, on rare occasion, cause seratonin syndrome, but this is very rare as stimulants have little potentiating effect on seratonin.
>
> There are concerns that SSRIs worsen ADHD, which complicates treating comorbid ADHD and depression, but there's not a lot of literature on it.
>
> I have ADHD and OCD and I use Lexapro and Dexedrine to treat both conditions.
>
> P
>
> Dexedrin 45 mg
> Geodon 80 mg
> Keppra 1000 mg
> Lexapro 20 mg
> Gabitril prn
> Tramadol prnQuite a combo...Would you mind telling me what each one is for?
Posted by Phidippus on October 31, 2009, at 18:39:22
In reply to Re: Studies Of Using SSRIs With Stimulants, posted by bulldog2 on October 31, 2009, at 18:27:55
> > Dexedrin 45 mg
> > Geodon 80 mg
> > Keppra 1000 mg
> > Lexapro 20 mg
> > Gabitril prn
> > Tramadol prn> Quite a combo...Would you mind telling me what each one is for?
Dexedrin - ADHD and OCD
Geodon - OCD and ictal/interictal psychosis
Keppra - Epilepsy
Lexapro - OCD and depression
Gabirtil - Anxiety
Tramadol - Pain and OCDI have ADHD, OCD, Occipital Lobe Epilepsy and depression with psychotic features.
P
Dexedrin 45 mg
Geodon 80 mg
Keppra 1000 mg
Lexapro 20 mg
Gabitril prn
Tramadol prn
Posted by 10derHeart on November 1, 2009, at 1:07:48
In reply to Re: Studies Of Using SSRIs With Stimulants » bulldog2, posted by Phidippus on October 31, 2009, at 18:16:01
I took Prozac 20 mg and IR methylphenidate (anywhere from 20-80 mg daily, prn) for comorbid ADD and depression for about 18 months. Worked pretty well for me. The addition of really good psychotherapy did the rest. Due to issues with Ritalin and hypertension, and the fact my pdoc and I were both really intrigued when Strattera became available, I switched to that alone. Been on it for 6 years straight with excellent control of most ADD symptoms.
I think my ADD (inattentive-type) really was/is the main issue and precipitated the depression (not hard to become depressed when your scattered brain and racing thoughts make every little and big task in life seem confusing and *impossible* to organize/prioritize, and you slowly become a royal sc***up...exhausting, too!!)
Just anecdotal, I know, but I gotta find some reason to post with you super-brains on this board once in a while!! ;-)
Posted by floatingbridge on November 1, 2009, at 11:02:23
In reply to Re: Studies Of Using SSRIs With Stimulants, posted by 10derHeart on November 1, 2009, at 1:07:48
10derHeart,
Hmmm. So Strattera alone? That's what my pdoc wants me to try, augmented w/ dexedrine.
Right now, I am on pristiq and dexedrine. And yes, the ever-tag-along daily benzo. (oh well.)
Addressing the thread, I don't know of any (or have heard of any
detrimental effects of ssri, snri & stims. But, I'm no science-head.) The stim is what turned the lights on for me. Never had experienced anything close to remission before.)
fb(I notice no icons in your post--let's see when I post this...)
Posted by floatingbridge on November 1, 2009, at 11:06:54
In reply to Re: Studies Of Using SSRIs With Stimulants » bulldog2, posted by Phidippus on October 31, 2009, at 18:39:22
Hi Phidippus,
Did it take you some time to get your cocktail working and identify / address your issues? I would think it would have taken much work on your part--kudos!
I take 45 d-amp per day. I am currently taking barr spansules. May I ask you what form / brand and how you dose? (I'm trying to keep my dosage down and steady. I'm also switching to brand dexedrine for my next script.)
fb
Posted by bulldog2 on November 1, 2009, at 12:21:33
In reply to Re: Studies Of Using SSRIs With Stimulants » 10derHeart, posted by floatingbridge on November 1, 2009, at 11:02:23
> 10derHeart,
>
> Hmmm. So Strattera alone? That's what my pdoc wants me to try, augmented w/ dexedrine.
>
> Right now, I am on pristiq and dexedrine. And yes, the ever-tag-along daily benzo. (oh well.)
>
> Addressing the thread, I don't know of any (or have heard of any
> detrimental effects of ssri, snri & stims. But, I'm no science-head.) The stim is what turned the lights on for me. Never had experienced anything close to remission before.)
>
>
> fb
>
> (I notice no icons in your post--let's see when I post this...)What do you think of your pristiq + dexedrine combo. Are they synergistic? What dose of pristiq?
I tried strattera and did not like it. It's feel's like mostly norepinephrine to me. I got a two hour boost and than a crash.I do enjoy a dopamine boost which ritalin and the amphetamines provide.
My one month free trial with vyvanse was a success. The 30 mg pill which is on 8.9 d-amphetamine felt smooth but was not enough. I will ask the p-doc for 40 mg which I guess is about 12 milligrams of d-amphetamine. Hopefully this novel method of delivery will help prevent tolerance which has been a problem of mine in the past with stims.
Posted by Phidippus on November 1, 2009, at 14:10:05
In reply to Re: Studies Of Using SSRIs With Stimulants » Phidippus, posted by floatingbridge on November 1, 2009, at 11:06:54
> Did it take you some time to get your cocktail working and identify / address your issues?
Its been taking a little over a year too get my cocktail in order. The biggest changes have come with the Lexapro and the Keppra. I'va had a lot of neurological issues entangled with the psychiatric and no firm diagnosis of epilepsy, however I am responding strongly to anticonvulsants. Mostly I get these headaches all the time and serious derealization and depersonalization and have had two seizures over the past year. I have been trialing seizure meds all year and most have had serious psychiatric side effects, however Keppra along with my other current medications really seems to cool things down. Gabitril and Zonegran have also been helpful.
>May I ask you what form / brand and how you >dose?
I take Dexedrine spansules and dose 15 mg, 15 mg and 10 mg 3 times a day.
P
Posted by Phidippus on November 1, 2009, at 14:28:02
In reply to Re: Studies Of Using SSRIs With Stimulants » 10derHeart, posted by floatingbridge on November 1, 2009, at 11:02:23
>(or have heard of any
> detrimental effects of ssri, snri & stims. But, I'm no science-head.) The stim is what turned the lights on for me.There are no interactions between ssris, snris and stims except for the remote chance of seratonin syndrome.
Have you ever been diagnosed with ADHD?
P
Posted by floatingbridge on November 1, 2009, at 17:36:01
In reply to Re: Studies Of Using SSRIs With Stimulants » floatingbridge, posted by bulldog2 on November 1, 2009, at 12:21:33
Hey bulldog,
> What do you think of your pristiq + dexedrine combo. Are they synergistic? What dose of pristiq?
I'm not sure. I think if I were less neurotic, it might be really good. The pristiq at 50 is transparent, though I do take it at night. At 100 pristiq, I sank quickly. I'm looking at something with more glue--like emsam. if I can convince my doc to add a small amount of dex. (I do not like provigil!)
> I tried strattera and did not like it. It's feel's like mostly norepinephrine to me. I got a two hour boost and than a crash.I do enjoy a dopamine boost which ritalin and the amphetamines provide.Well, I did not like Wellbutrin--I was up to 450 per day. Didn't feel good, and did not 'turn on the lights', though, in all fairness, I did not combine it at the time with d-amp.
> My one month free trial with vyvanse was a success. The 30 mg pill which is on 8.9 d-amphetamine felt smooth but was not enough. I will ask the p-doc for 40 mg which I guess is about 12 milligrams of d-amphetamine. Hopefully this novel method of delivery will help prevent tolerance which has been a problem of mine in the past with stims.
>Bulldog, so you take one pill per day? I take more than that. I'm trying to keep it at 45 d-amp. For some reason, my doc has not mentioned vyvanse. Some other babblers really like it. Maybe if it's a better quality than the barr spansules, I could do less. So it really lasts the day for you?
fb
Posted by floatingbridge on November 1, 2009, at 17:44:01
In reply to Re: Studies Of Using SSRIs With Stimulants » floatingbridge, posted by Phidippus on November 1, 2009, at 14:28:02
Hi Phidippus,
You must really know what you are doing and have some good doctors on board. I'm really impressed you've identified and addressed so many issues. Wow.
>
> Have you ever been diagnosed with ADHD?
>
> PYes, ADD inattentive (I am a woman). As an adult, by my current pdoc. I had suspected it as I looked back on my childhood behavior--pretty classic. My pdoc did not put me through a battery of tests, so maybe some could contest his diagnosis. For me, it fits. And the d-amp put my world into focus, and action (I have fatigue issues) AND dealt w/ crippling social anxiety. I'm working my bottom off in therapy, but it wasn't until the d-amp that I gained some real traction.
Are you new here? I've been meaning to ask. I haven't seen your posts until lately. I've been here since early last spring.
best,
fb
Posted by bulldog2 on November 1, 2009, at 17:59:11
In reply to Re: Studies Of Using SSRIs With Stimulants » bulldog2, posted by floatingbridge on November 1, 2009, at 17:36:01
> Hey bulldog,
>
> > What do you think of your pristiq + dexedrine combo. Are they synergistic? What dose of pristiq?
>
> I'm not sure. I think if I were less neurotic, it might be really good. The pristiq at 50 is transparent, though I do take it at night. At 100 pristiq, I sank quickly. I'm looking at something with more glue--like emsam. if I can convince my doc to add a small amount of dex. (I do not like provigil!)
>
>
> > I tried strattera and did not like it. It's feel's like mostly norepinephrine to me. I got a two hour boost and than a crash.I do enjoy a dopamine boost which ritalin and the amphetamines provide.
>
> Well, I did not like Wellbutrin--I was up to 450 per day. Didn't feel good, and did not 'turn on the lights', though, in all fairness, I did not combine it at the time with d-amp.
>
>
> > My one month free trial with vyvanse was a success. The 30 mg pill which is on 8.9 d-amphetamine felt smooth but was not enough. I will ask the p-doc for 40 mg which I guess is about 12 milligrams of d-amphetamine. Hopefully this novel method of delivery will help prevent tolerance which has been a problem of mine in the past with stims.
> >
>
> Bulldog, so you take one pill per day? I take more than that. I'm trying to keep it at 45 d-amp. For some reason, my doc has not mentioned vyvanse. Some other babblers really like it. Maybe if it's a better quality than the barr spansules, I could do less. So it really lasts the day for you?
>
> fb
>
>One pill is supposed to last 12 hours. It is called a prodrug which is a novel method of delivery. Here is an explanation of this med.
Posted by floatingbridge on November 1, 2009, at 18:09:09
In reply to Re: Studies Of Using SSRIs With Stimulants » floatingbridge, posted by bulldog2 on November 1, 2009, at 17:59:11
Bulldog, Thanks for the link. This is something to discuss with my doctor. Does it last you 12 hours? Even 10 would be great. I dose three times per day and can feel the barr spansule wearing off (though it is smother than the awful ir tabs).
So tell me about your experience of it's staying power.
fb
Posted by bulldog2 on November 1, 2009, at 18:36:48
In reply to Re: Studies Of Using SSRIs With Stimulants » bulldog2, posted by floatingbridge on November 1, 2009, at 18:09:09
> Bulldog, Thanks for the link. This is something to discuss with my doctor. Does it last you 12 hours? Even 10 would be great. I dose three times per day and can feel the barr spansule wearing off (though it is smother than the awful ir tabs).
>
> So tell me about your experience of it's staying power.
>
> fbYes it seems to last 10 to 12 hours..sometimes longer...the way the body uses it there is just a very gradual taper...so there it doesn't feel like a crash..I just want to feel alert not drugged and euphoric which leads to problems...I think with adhd I think the stimulant can end up having ad properties...I've heard that with add and later adhd it is like the trunk of the tree..all other mental disorders can spring from that primary disorder. Seems to make sense to me..
Posted by Phidippus on November 1, 2009, at 22:52:49
In reply to Re: Studies Of Using SSRIs With Stimulants » Phidippus, posted by floatingbridge on November 1, 2009, at 17:44:01
> You must really know what you are doing and have some good doctors on board.
I know too much-it feeds my OCD and that gets me in trouble, but I love my docs-therapist, psychiatrist, neurologist and neuropsychiatrist. My psychiatrist gets to deal with most of the sh*t. They all keep me out of trouble
>I'm really impressed you've identified and addressed so many issues. Wow.
Not having a clear diagnosis of Epilepsy but having had seizures and very strong reactions to anticonvulsants is aggravating. Its like shooting in the dark trying to treat my phantom ailment.
> Yes, ADD inattentive (I am a woman).
I'm combined, but if I have Epilepsy, the attention problems may be more owing to it. I also got diagnosed with conduct disorder as a kid and have had trouble with the law and such.
> Are you new here?
Yes, I am. Nice to meet you. How do you Babblemail?
P
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