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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by alchemy on March 11, 2010, at 18:19:44
Of course I'm treatment resistant, aren't most of us here? So my psych dr. is having me try dexadrine with my other meds (including lamictal as a stabilizer). It doesn't really do anything! I was thinking I would at least get some kind of boost.
At first it seemed to help with tedious tasks. Don't know if it does anymore. I just took it here & there for a month and then my dr. said that sometimes the continuation/cumulative effect can be helpful and thought I should try them every day. Has anyone heard of this?
Posted by West on March 12, 2010, at 8:04:48
In reply to Stimulants helping more over time?, posted by alchemy on March 11, 2010, at 18:19:44
Concerta has helped my depression longer term.
Posted by linkadge on March 13, 2010, at 8:03:11
In reply to Re: Stimulants helping more over time?, posted by West on March 12, 2010, at 8:04:48
There is some research to suggest that longer term stimulant use can strengthen and develop dopaminergic circuitry in the prefrontal cortex, especially in animal models of hyperactivity.
Linkadge
Posted by linkadge on March 13, 2010, at 8:04:23
In reply to Stimulants helping more over time?, posted by alchemy on March 11, 2010, at 18:19:44
When I first took ritalin, it actually depressed me, then eventually that dissipated and it seems to work as a mood stabilizer. My thinking has become much more linear. This is something that the SSRI's screw up - linear thinking.
Linkadge
Posted by alchemy on March 13, 2010, at 15:54:50
In reply to Re: Stimulants helping more over time?, posted by linkadge on March 13, 2010, at 8:03:11
Thanks linkadge & West! You only hear about the crashes.
West, how long did it take before you noticed improvement?
Posted by West on March 14, 2010, at 10:35:53
In reply to Re: Stimulants helping more over time?, posted by alchemy on March 13, 2010, at 15:54:50
I would echo what linkage pointed out about depressive reactions and would personally not do well on any stimulant if not already stabilised on an antidepressant.
Immediate release ritalin and dex are not worth the hassle imo. Concerta is different. I don't notice it wearing off anymore. Dex-amp degrades mood whereas mph supports it. D-threo-mph, it's metabolite shows clinically relevant agonism of 5-Ht(1a) in guinea pigs, useful if taken with SSRis.
Add a 5ht(2c) antagonist and you're increasing NA/DA firing.
Posted by West on March 14, 2010, at 10:38:57
In reply to Re: Stimulants helping more over time?, posted by West on March 14, 2010, at 10:35:53
Noticed increased attention immediately. It probably takes a little longer for adaptive changes...
Posted by linkadge on March 14, 2010, at 11:20:27
In reply to Re: Stimulants helping more over time?, posted by West on March 14, 2010, at 10:35:53
Yeah, I would think d-methyphenidate would make a good antidepresant. It is more selective towards the norepinephrine transporter and the added 5-ht1a agonism. Something like norquetiapine the metabolite of seroquel (is has the same two properties) probably why seroquel helped my attention somewhat.
Linkadge
Posted by linkadge on March 14, 2010, at 11:22:29
In reply to Re: Stimulants helping more over time?, posted by West on March 14, 2010, at 10:38:57
The effects of 5-ht1a agonism and norepinephrine reuptake are likely convergent / synergistic.
5-ht1a agonists have procognative effects by releasing prefrontal dopamine. The norepinephrine transporter inhibition will prolong the activity of that dopamine (at least in the prefrontal cortex).
Linkadge
Posted by West on March 15, 2010, at 9:36:51
In reply to Re: Stimulants helping more over time?, posted by linkadge on March 14, 2010, at 11:22:29
I just wanted to say how lucky we all are to have such a mine of invaluable knowledge in you linkadge. It was you who I got the 5-ht1a action of mph from and will hopefully continue to learn from your wisodom + research. Thanks.
> The effects of 5-ht1a agonism and norepinephrine reuptake are likely convergent / synergistic.
>
> 5-ht1a agonists have procognative effects by releasing prefrontal dopamine. The norepinephrine transporter inhibition will prolong the activity of that dopamine (at least in the prefrontal cortex).
>
> Linkadge
Posted by floatingbridge on March 15, 2010, at 23:30:14
In reply to Re: Stimulants helping more over time?, posted by West on March 14, 2010, at 10:35:53
West, are you saying that ritalin is similar to concerta? I thought concerta was like strattera?
Dex broke my depression--however there is the cyclic low mood as it wears off. Is that what you refer to as 'mood-degrading'?
And it certainly doesn't work like it used to. Have you had diminished effectiveness with concerta?
> I would echo what linkage pointed out about depressive reactions and would personally not do well on any stimulant if not already stabilised on an antidepressant.
>
> Immediate release ritalin and dex are not worth the hassle imo. Concerta is different. I don't notice it wearing off anymore. Dex-amp degrades mood whereas mph supports it. D-threo-mph,
it's metabolite shows clinically relevant agonism of 5-Ht(1a) in guinea pigs, useful if taken with SSRis.
>
> Add a 5ht(2c) antagonist and you're increasing NA/DA firing.
Posted by West on March 16, 2010, at 5:49:57
In reply to Re: Stimulants helping more over time?, posted by floatingbridge on March 15, 2010, at 23:30:14
They are the same drug. Concerta is an extended release formulation with a laser drilled hole on one side which works through an 'osmotic release' system, slowly feeding the drug into the gut allowing active drug levels for a period of about 12 hours.
Strattera is actually an NRI and a failed antidepressant. Some people actually find it worsens mood. I've never tried it.
I've had no tolerance to MPH. I could see immediate problems occuring with that and desire to re-dose with d-amp as the pleasant feelings wore off after 30 mins or so. It felt recreational.But i've found the right dose of concerta has given me opportunities i never had before, now i just need to get off my *rs* and do something about it.
Posted by g_g_g_unit on March 16, 2010, at 20:53:49
In reply to Re: Stimulants helping more over time?, posted by West on March 16, 2010, at 5:49:57
> I've had no tolerance to MPH. I could see immediate problems occuring with that and desire to re-dose with d-amp as the pleasant feelings wore off after 30 mins or so. It felt recreational.But i've found the right dose of concerta has given me opportunities i never had before, now i just need to get off my *rs* and do something about it.
>yeah, the lack of peripheral side-effects made redosing with dex past my prescribed limit far too tempting. in that sense, i actually find the 'abrasiveness' of ritalin therapeutic, as i have no desire to indulge; it strictly makes me more productive, which is good for someone with an addictive personality.
granted i never stayed on either stim very long. i'd like to try concerta, but wonder if it might agree less with my OCD. do you find it superior to ritalin?
Posted by West on March 17, 2010, at 6:37:49
In reply to Re: Stimulants helping more over time? » West, posted by g_g_g_unit on March 16, 2010, at 20:53:49
Hi, I think you'd probably find concerta superior if you found crashes to be a problem before on ritalin.
I actually think this an inherent problem with short-acting stimulants: an innate mammalian compulsion to push the reward buttons in the brain.
But yes, if a lack of peripheral side effects are an attractive characterisic of dex, then as somebody with compulsive behaviour, and i had to make a choice between the two, i would probably plump for ritalin.
Concerta in my experience is a more suitable treatment than, and preferable to, either dex or ritalin as its smoother, less distracting (without the peaks and troughs of t.i.d dosing), less prominent rebound, mood supporting etc.
> > I've had no tolerance to MPH. I could see immediate problems occuring with that and desire to re-dose with d-amp as the pleasant feelings wore off after 30 mins or so. It felt recreational.But i've found the right dose of concerta has given me opportunities i never had before, now i just need to get off my *rs* and do something about it.
> >
>
> yeah, the lack of peripheral side-effects made redosing with dex past my prescribed limit far too tempting. in that sense, i actually find the 'abrasiveness' of ritalin therapeutic, as i have no desire to indulge; it strictly makes me more productive, which is good for someone with an addictive personality.
>
> granted i never stayed on either stim very long. i'd like to try concerta, but wonder if it might agree less with my OCD. do you find it superior to ritalin?
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