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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by g_g_g_unit on April 9, 2011, at 0:59:17
I've been curious about the interaction between stimulants and mood disorders, given my not-so-favorable reaction to first Dexedrine and now Strattera ..
On 5mg Dexedrine, I noticed an increase in anxiety and OCD ruminations, in addition to a general speeding up of my thought processes (albeit not to the point where my mind was overwhelmed or concentration became impossible). I was also more hyper-focused and irritable.
On 2.5mg of Dexedrine, sometimes I noticed an improvement in focus, sometimes I just wanted to fall asleep.
Strattera was similar, although at 40mg I noticed that my thoughts became a kind of blur - as if they were moving at warp-speed. They were also restricted to the back of my mind and did not completely hijack my consciousness. Like Dexedrine, these effects seemed dose-dependent and I think I may have seen the best results on just 10mg.
My psychiatrist has said that racing thoughts + irritability on a stimulant isn't diagnostic of Bipolar, though I've been diagnosed atypical depression in the past and know there is some overlap between the two disorders, which is why I'm now curious ..
I should note that I've only really experienced racing thoughts in relation to OCD. My current state is one of depression and mental/physical inertia - yet I find that whenever I take something to 'wake up', I end up swung too far the other end, feeling more mentally racy and wound-up inside. Even caffeine's been causing this reaction in me. My concentration problems predate any anxiety/depression issues, so I'm quite convinced I do have ADHD.
So is it possible to a) just be highly sensitive to stimulants, b) be more susceptible to overstimulation due to high baseline anxiety, or c) does what I describe point more towards a mood disorder on the BP spectrum?
Posted by Christ_empowered on April 9, 2011, at 3:40:27
In reply to stimulants and mood disorders, posted by g_g_g_unit on April 9, 2011, at 0:59:17
The "bipolar spectrum" can both expand and contract, depending on the psychiatrist you're talking to. Euphoric response to stimulants+amphetamine psychosis are more common in bipolar (according to my ex-shrink), although they can happen to people who aren't bipolar and they don't happen to all bipolar people (some people w/ bipolar take amphetamines for depression w/o any problems). I don't think your response to stimulants is necessarily indicative of a mild bipolar disorder; it probably means you just need to be more cautious in using "uppers" than your average joe/jane.
What else leads you to think you might have a mild bipolar disorder? Do you think you'd benefit from lithium, an anticonvulsant, or a neuroleptic?
Posted by bleauberry on April 9, 2011, at 4:37:34
In reply to stimulants and mood disorders, posted by g_g_g_unit on April 9, 2011, at 0:59:17
>
> So is it possible to a) just be highly sensitive to stimulants, b) be more susceptible to overstimulation due to high baseline anxiety, or c) does what I describe point more towards a mood disorder on the BP spectrum?Well, yes, I think all the above are possible, but there are other factors as well. For example, the meds themselves are well known for producing the kinds of negative effects you describe even in perfectly healthy normal people. Of all the stimulants, the one in my experience least likely to overspeed things and most likely to help is Ritalin.
No matter which med though, I think you have already discovered an important clue....low doses for you are the way to go.
I hated Dexedrine, Strattera, Reboxetine, but I like Ritalin. All made me overhyped, on edge, irritable, and generally dysphoric, though I could concentrate better. Even at low doses they felt wrong to me. Ritalin however is a different breed. Weird, but I found the immediate release generic to feel a lot better than the extended release brand, which felt bad like dexedrine. The one downfall with any of them is wear-off period, which I think many people become accustomed to longterm but is uncomfortable in the early going.
Some herbs to consider in accomplishing stimulant results except in a smoother more natural biological manner are Eleuthero (Siberian Ginseng) or Corcyceps. Rhodiola Rosea is another one to consider. Unlike stimulants which hit immediately, these take weeks or months to bring on their healing and good effects, though you will feel something almost immediately. Unlike stimulants, they work on anxiety at the same time. They provide wide spectrum biological benefits throughout the body, glands, nervous system, and immune system, which of course stimulant meds do not do. As with the stimulants, starting with very low doses and gradually increasing if necessary is the way to go, because the same kind of overstimulation can happen if too aggressive too soon.
Posted by g_g_g_unit on April 9, 2011, at 5:58:49
In reply to Re: stimulants and mood disorders, posted by Christ_empowered on April 9, 2011, at 3:40:27
> The "bipolar spectrum" can both expand and contract, depending on the psychiatrist you're talking to. Euphoric response to stimulants+amphetamine psychosis are more common in bipolar (according to my ex-shrink), although they can happen to people who aren't bipolar and they don't happen to all bipolar people (some people w/ bipolar take amphetamines for depression w/o any problems). I don't think your response to stimulants is necessarily indicative of a mild bipolar disorder; it probably means you just need to be more cautious in using "uppers" than your average joe/jane.
>Thanks for responding. I did experience some mild euphoria on Dexedrine, though it typically accompanied my morning dose, and the effect completely vanished after a week.
I did have two other unusual experiences on Dexedrine: 1) formication (i.e. the sensation of bugs crawling on my skin), though I was never under the impression that bugs actually *were* crawling on my skin, so I don't believe that constitutes psychosis.
2) I was initially instructed to take 5mg 4x a day, including 5mg at bedtime. Not surprisingly, I couldn't sleep at all the first night, so ended up taking an Ambien. The next day, I noticed that if I stared at the clouds for a while, they started to flicker or seemed animated, but once I refrained from dosing at night, I never noticed anything like that again . .
> What else leads you to think you might have a mild bipolar disorder? Do you think you'd benefit from lithium, an anticonvulsant, or a neuroleptic?
I have no idea. That's why I was putting my reaction out there, i.e. I wasn't sure if racing thoughts in anxiety or stimulant overdoses differed from those in bipolar (for example, do they tend to overwhelm your consciousness in Bipolar, or will they sometimes remain at the back of your mind?) and if the experience I described sounded more like one or the other etc.
Posted by g_g_g_unit on April 9, 2011, at 7:31:56
In reply to Re: stimulants and mood disorders, posted by bleauberry on April 9, 2011, at 4:37:34
Thanks for your reply bleauberry.
Interestingly enough, IR Ritalin is the one stimulant I've yet to try (I had a bad reaction to the LA). What bothers me is that, like you, I tend to experience anxiety, dysphoria, irritability, etc., but still reap no concentration benefits due to the speedier thoughts - just a general increase in motivation and mental vigilance.
I've heard the amphetamine analogues agree the most with OCD (while Ritalin tends to exacerbate it), so may try Dexedrine again first in conjunction with an anxiolytic, but if things don't work out, I'll give Ritalin a shot.
>
> Well, yes, I think all the above are possible, but there are other factors as well. For example, the meds themselves are well known for producing the kinds of negative effects you describe even in perfectly healthy normal people. Of all the stimulants, the one in my experience least likely to overspeed things and most likely to help is Ritalin.
>
> No matter which med though, I think you have already discovered an important clue....low doses for you are the way to go.
>
> I hated Dexedrine, Strattera, Reboxetine, but I like Ritalin. All made me overhyped, on edge, irritable, and generally dysphoric, though I could concentrate better. Even at low doses they felt wrong to me. Ritalin however is a different breed. Weird, but I found the immediate release generic to feel a lot better than the extended release brand, which felt bad like dexedrine. The one downfall with any of them is wear-off period, which I think many people become accustomed to longterm but is uncomfortable in the early going.
>
> Some herbs to consider in accomplishing stimulant results except in a smoother more natural biological manner are Eleuthero (Siberian Ginseng) or Corcyceps. Rhodiola Rosea is another one to consider. Unlike stimulants which hit immediately, these take weeks or months to bring on their healing and good effects, though you will feel something almost immediately. Unlike stimulants, they work on anxiety at the same time. They provide wide spectrum biological benefits throughout the body, glands, nervous system, and immune system, which of course stimulant meds do not do. As with the stimulants, starting with very low doses and gradually increasing if necessary is the way to go, because the same kind of overstimulation can happen if too aggressive too soon.
>
>
Posted by Phillipa on April 9, 2011, at 12:53:39
In reply to stimulants and mood disorders, posted by g_g_g_unit on April 9, 2011, at 0:59:17
Haven't read other responses but asked my pdoc exactly same thing and in response to my question about something to wake up and focus she said it's the anxiety that makes me tired. I wear myself out with anxiety. Definitely no to any stimulants for me she said. Phillipa
Posted by floatingbridge on April 9, 2011, at 13:34:20
In reply to stimulants and mood disorders, posted by g_g_g_unit on April 9, 2011, at 0:59:17
Hey ggg,
Provigil for concentration? Can't remember if you tried it. Think you're on a current nuvigil thread, but risking repitiion....
I responded well to dex (you probably remember) but not at all to provigil. Dysphoric. However, wears off fairly quickly.
I could fall alseep most times on dex :(
In fact, it helped regulate my schedule, albeit harshly. I would just tank by 8:00 and be asleep most nights during my good run with it.
Oh boy. Best to you. Sorry I'm unable to address your questions.fb
Posted by mtdewcmu on April 12, 2011, at 22:41:53
In reply to Re: stimulants and mood disorders » g_g_g_unit, posted by floatingbridge on April 9, 2011, at 13:34:20
> I could fall alseep most times on dex :(
>
> In fact, it helped regulate my schedule, albeit harshly. I would just tank by 8:00 and be asleep most nights during my good run with it.Did you ever try Adderall? The added side effects of Adderall might actually keep you awake.
If being sleepy on Dexedrine was your biggest problem with it, I'm not sure that's a problem. If it's for ADD, then its purpose is not to keep you awake. You could always add caffeine or some other stimulant for that.
Posted by mtdewcmu on April 12, 2011, at 22:46:28
In reply to Re: stimulants and mood disorders » Christ_empowered, posted by g_g_g_unit on April 9, 2011, at 5:58:49
>
> Thanks for responding. I did experience some mild euphoria on Dexedrine, though it typically accompanied my morning dose, and the effect completely vanished after a week.
>I think it's normal to experience euphoria on Dexedrine. That's why it's so tightly controlled.
> I did have two other unusual experiences on Dexedrine: 1) formication (i.e. the sensation of bugs crawling on my skin), though I was never under the impression that bugs actually *were* crawling on my skin, so I don't believe that constitutes psychosis.
>
> 2) I was initially instructed to take 5mg 4x a day, including 5mg at bedtime. Not surprisingly, I couldn't sleep at all the first night, so ended up taking an Ambien. The next day, I noticed that if I stared at the clouds for a while, they started to flicker or seemed animated, but once I refrained from dosing at night, I never noticed anything like that again . .
>That was more likely due to the Ambien. Or perhaps due to disturbed sleep.
Posted by mtdewcmu on April 12, 2011, at 22:51:23
In reply to Re: stimulants and mood disorders » bleauberry, posted by g_g_g_unit on April 9, 2011, at 7:31:56
> Interestingly enough, IR Ritalin is the one stimulant I've yet to try (I had a bad reaction to the LA). What bothers me is that, like you, I tend to experience anxiety, dysphoria, irritability, etc., but still reap no concentration benefits due to the speedier thoughts - just a general increase in motivation and mental vigilance.
>That sounds like my experience of Ritalin IR. Except my motivation and mental vigilance weren't really improved. That's why it went on the junk heap.
If you still have any Ritalin LA, you could probably get the same effect as IR by crushing the tablet.
Posted by mtdewcmu on April 12, 2011, at 22:54:03
In reply to Re: stimulants and mood disorders » bleauberry, posted by g_g_g_unit on April 9, 2011, at 7:31:56
Sorry. Ritalin LA isn't a tablet. You could probably open up the capsule and crush whatever is inside.
This is the end of the thread.
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