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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by phillipa on October 6, 2012, at 19:07:35
In reply to Re: Ritalin while on an maoi » enndub, posted by ChicagoKat on October 6, 2012, at 14:36:30
Weekends Murphy's Law. Phillipa
Posted by ChicagoKat on October 6, 2012, at 19:55:24
In reply to Re: Ritalin while on an maoi, posted by jono_in_adelaide on October 6, 2012, at 18:54:58
> Kat, have you dumped the nortriptyline?
For the nonce I have switched back to Elavil, and yes, dumped the Nortryp, b/c I just have to sleep. I'm keeping it to 50mg/night, and I definitely plan to talk to my pdoc about switching permanently, or switching to some other sleep aid and keeping the Nortryp. But as I've said, I've been on every sleep aid known to man...and ones that once worked don't anymore. My pdoc was cool about upping my ambien dose to 20mg qhs when 10mg pooped out on me, but it now takes 30mg for it to work, and i'm not even gonna ask him about that one.
Posted by ChicagoKat on October 6, 2012, at 19:56:15
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by phillipa on October 6, 2012, at 19:07:35
> Weekends Murphy's Law. Phillipa
lol Phillipa, how right you are!
Kat
Posted by AlexCanada on October 7, 2012, at 0:19:36
In reply to Ritalin while on an maoi, posted by ChicagoKat on October 6, 2012, at 13:24:15
I have taken Parnate + ritalin without any problems. No interaction that I could notice. That's my experience at least. I been on as high as 30mg parnate + 2.5mg x6 times a day. And I am the type who is very sensitive to meds.
> Hi, does anyone know how low the dose of ritalin needs to be to take safely when on nardil. oh, aand i'm on a low dose of a tca too. does that rule the possibility of low dose ritalin completely out? doses are: 30mg/day of nardil and 50mg/day of elavil.
> Thanks,
> Kat
Posted by jono_in_adelaide on October 7, 2012, at 5:21:29
In reply to Re: Ritalin while on an maoi » jono_in_adelaide, posted by ChicagoKat on October 6, 2012, at 19:55:24
I think you'd be ok taking the nardil and nortriptyline for depression, and (say) 25mg of doxepin for sleep
50mg of amitriptyline isnt enough to produce an antidepressant effect
Posted by SLS on October 7, 2012, at 7:06:56
In reply to Ritalin while on an maoi, posted by ChicagoKat on October 6, 2012, at 13:24:15
Why a stimulant?
Why Ritalin?Nardil + Ritalin?
Ritalin does not inhibit the reuptake of serotonin. It does not bind to the transporter. However, there is a study of rats reporting that adding Ritalin to Celexa can produce a greater increase in serotonin levels in the hippocampus compared to Celexa alone. No such effect was reported in the cortex.
http://www.sciencedirect.com/science/article/pii/S0924977X07000508
I don't know about Nardil, but I have added Ritalin to Parnate + desipramine. In fact, some doctors have done this as a way to remedy Parnate-induced hypotension. I have also added Dexedrine and Adderall to Parnate. I cannot remember adding a stimulant to Nardil.
I can't find on Medline/Pubmed an abstract regarding Nardil and Ritalin used in combination. There is only a letter reporting a case study, but without the abstract.
http://www.ncbi.nlm.nih.gov/pubmed/14970373
If it were me, I would try amphetamine first. However, I would not exclude Ritalin from consideration.
- Scott
Posted by ChicagoKat on October 7, 2012, at 8:00:59
In reply to Re: Ritalin while on an maoi, posted by AlexCanada on October 7, 2012, at 0:19:36
> I have taken Parnate + ritalin without any problems. No interaction that I could notice. That's my experience at least. I been on as high as 30mg parnate + 2.5mg x6 times a day. And I am the type who is very sensitive to meds.
>
> > Hi, does anyone know how low the dose of ritalin needs to be to take safely when on nardil. oh, aand i'm on a low dose of a tca too. does that rule the possibility of low dose ritalin completely out? doses are: 30mg/day of nardil and 50mg/day of elavil.
> > Thanks,
> > Kat
>
>
Thanks for yet more encouraging info Alex :) I hope you are well
Kat
Posted by ChicagoKat on October 7, 2012, at 8:03:05
In reply to Re: Ritalin while on an maoi, posted by jono_in_adelaide on October 7, 2012, at 5:21:29
> I think you'd be ok taking the nardil and nortriptyline for depression, and (say) 25mg of doxepin for sleep
>
> 50mg of amitriptyline isnt enough to produce an antidepressant effectYes, I know 50mg is not enough to produce an antidepressant effect, but I'm supposed to be slowly titrating....at this point I'm supposed to only be on 25mg of Nortryptiline.
Posted by ChicagoKat on October 7, 2012, at 8:16:45
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by SLS on October 7, 2012, at 7:06:56
> Why a stimulant?
> Why Ritalin?
>
> Nardil + Ritalin?
>
> Ritalin does not inhibit the reuptake of serotonin. It does not bind to the transporter. However, there is a study of rats reporting that adding Ritalin to Celexa can produce a greater increase in serotonin levels in the hippocampus compared to Celexa alone. No such effect was reported in the cortex.
>
> http://www.sciencedirect.com/science/article/pii/S0924977X07000508
>
> I don't know about Nardil, but I have added Ritalin to Parnate + desipramine. In fact, some doctors have done this as a way to remedy Parnate-induced hypotension. I have also added Dexedrine and Adderall to Parnate. I cannot remember adding a stimulant to Nardil.
>
> I can't find on Medline/Pubmed an abstract regarding Nardil and Ritalin used in combination. There is only a letter reporting a case study, but without the abstract.
>
> http://www.ncbi.nlm.nih.gov/pubmed/14970373
>
> If it were me, I would try amphetamine first. However, I would not exclude Ritalin from consideration.
>
>
> - Scott
>
>
>
>Scott,
A stimulant b/c I am going out of my mind with depression. The blip, as you say, is over. It was just an idea to temporarily keep me halfway sane until the Nardil finally truly kicks in. And when Ritalin works in me, which it is much more likely to do since I've had none for 2 wks, it makes me feel 100% better. Adderall never worked so well for me.
And Ritalin b/c I much prefer it to amphetamines. Biggest reason is b/c of shorter half-life, thus shorter duration of crash when it comes, or anxiety if I should get that. I found a couple of studies on the combo, and they all had positive results.
All I'm asking for is a potential dose that you think may be safe. If you truly think amphetamines are the better way to go, I would consider them, I have some IR adderall. But I'd need dosage rec, and if things go negatively, as is always a possibility, I will have like 10hrs of anxiety to face. If you don't think I should try this combo feel free to say so. I'm waiting to talk to my doc tomorrow first anyways.
Kat
Posted by ChicagoKat on October 7, 2012, at 12:00:17
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by SLS on October 7, 2012, at 7:06:56
> Why a stimulant?
> Why Ritalin?
>
> Nardil + Ritalin?
>
> Ritalin does not inhibit the reuptake of serotonin. It does not bind to the transporter. However, there is a study of rats reporting that adding Ritalin to Celexa can produce a greater increase in serotonin levels in the hippocampus compared to Celexa alone. No such effect was reported in the cortex.
>
> http://www.sciencedirect.com/science/article/pii/S0924977X07000508
>
> I don't know about Nardil, but I have added Ritalin to Parnate + desipramine. In fact, some doctors have done this as a way to remedy Parnate-induced hypotension. I have also added Dexedrine and Adderall to Parnate. I cannot remember adding a stimulant to Nardil.
>
> I can't find on Medline/Pubmed an abstract regarding Nardil and Ritalin used in combination. There is only a letter reporting a case study, but without the abstract.
>
> http://www.ncbi.nlm.nih.gov/pubmed/14970373
>
> If it were me, I would try amphetamine first. However, I would not exclude Ritalin from consideration.
>
>
> - Scott
>
>
>
>ps I looked it up. Half-life of IR Ritalin is 2-4hrs. As far as IR Adderall goes, half-life of d-amphetamine is 10hrs, for l-amphetamine it is 13hrs. It is Ritalin's considerably shorter half-life and thus doa that makes me prefer it, in case anything should go awry.
Kat
Posted by phidippus on October 7, 2012, at 14:31:23
In reply to Ritalin while on an maoi, posted by ChicagoKat on October 6, 2012, at 13:24:15
Why the TCA?
You'll be fine taking the Ritalin at your regular dose.
Eric
Posted by ChicagoKat on October 7, 2012, at 15:54:50
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by phidippus on October 7, 2012, at 14:31:23
> Why the TCA?
>
> You'll be fine taking the Ritalin at your regular dose.
>
> EricHi Eric,
Thanks for the info on the Ritalin, it is much appreciated.
The TCA has been added to contribute to my AD therapy, especially since I cannot take more than 45mg/day of nardil, secondary to the fact that I develop ataxia and suffer falls at higher doses. This is what happened the first time I tried Nardil, and the drug was stopped b/c of the falls. And it absolutely was NOT orthostatic hypotension that caused the falls. I know the difference, and besides, I was noticing problems with my gait whenever I walked as well. We tried absolutely everything else we could think of after that, but nothing else worked, or it had intolerable side effects. Ritalin worked for a while, but after a few months it led to incredible anxiety in me. I believe I could take it with Nardil now, b/c Nardil completely wipes out any anxiety in me, almost from the time I take the very first tablet, and the effect does not go away, no matter the dose. Anyways, the TCAs were meant to supplement the Nardil. But I was put on Nortryptiline, which unfortunately does not help me sleep. I had previously been taking Elavil to help me sleep. Trust me, I have tried every other sleep aid known to man and nothing works anymore except for Elavil. I am switching back to Elavil so I can sleep, and tbh, I'm thinking I'll just stick with the low dose of 50mg qhs that I need to sleep and ask my doc about supplementing the Nardil with Ritalin instead.
Sorry for the long post, but that's all the info.
How are you?
Kat
Posted by jono_in_adelaide on October 7, 2012, at 18:08:42
In reply to Re: Ritalin while on an maoi » phidippus, posted by ChicagoKat on October 7, 2012, at 15:54:50
My Suggestion:
Nardil 45mg/day (for anti anxiety effect)
Nortriptyline 50-75mg at night (for antidepressant effect)
Amitriptyline or Doxepin 25-50mg at night (as a sleep aid)
And if your doc agrees, Ritalin at your previous dose as a short term measure till the antidepressants kick in
Posted by phidippus on October 7, 2012, at 20:35:54
In reply to Re: Ritalin while on an maoi » phidippus, posted by ChicagoKat on October 7, 2012, at 15:54:50
Bored. I need school, bad.
Eric
Posted by ChicagoKat on October 8, 2012, at 9:23:27
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by phidippus on October 7, 2012, at 20:35:54
> Bored. I need school, bad.
>
> EricDid you decide on a school then? If so, when do you start?
Kat
Posted by phidippus on October 8, 2012, at 18:34:07
In reply to Re: Ritalin while on an maoi » phidippus, posted by ChicagoKat on October 8, 2012, at 9:23:27
I'm hallucinating. Its the weirdest thing n the world. With the meds I'm on it makes no sense. I started Wellbutrin 2 weeks ago...?
Yes, I applied to DU and the University of Pheonix. We shall see who wants me.
Eric
Posted by ChicagoKat on October 8, 2012, at 20:41:04
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by phidippus on October 8, 2012, at 18:34:07
> I'm hallucinating. Its the weirdest thing n the world. With the meds I'm on it makes no sense. I started Wellbutrin 2 weeks ago...?
>
> Yes, I applied to DU and the University of Pheonix. We shall see who wants me.
>
> EricActually, Wellbutrin can cause hallucinations. It's rare, but it can happen. What else are you on? I mean, I'd put my money on the Wellbutrin, but I'm still curious to know about your other meds. And you probably told me before; if so I apologize that I've forgotten.
Good luck with your apps to schools - keep me posted.
Kat
Posted by phidippus on October 8, 2012, at 21:12:02
In reply to Re: Ritalin while on an maoi » phidippus, posted by ChicagoKat on October 8, 2012, at 20:41:04
Wellbutrin is causing some strange and fascinating visuals. Thanks for letting me know that.
I'm also on:
Lithium 1200 mg
Abilify 10 mg
Viibryd 60 mg
Vyvanse 70 mg
Bupropion 150 mgEric
Posted by ChicagoKat on October 9, 2012, at 12:04:03
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by phidippus on October 8, 2012, at 21:12:02
> Wellbutrin is causing some strange and fascinating visuals. Thanks for letting me know that.
>
> I'm also on:
>
> Lithium 1200 mg
> Abilify 10 mg
> Viibryd 60 mg
> Vyvanse 70 mg
> Bupropion 150 mg
>
> Eric
>
>Yeah, I'd put my money on the Wellbutrin, especially since you just started it. Let your pdoc know, if you haven't already. Or maybe you are enjoying the visuals and don't want to let you pdoc know? lol
What's your official diagnosis? Again, I'm sorry, I'm sure you've told me in the past, but my memory is just sh*t ever since ect. I see Lithium there, so it must be more than simple depression...oh wait! I remember you mentioned OCD too. But do you suffer from bipolar disease or anything that would cause psychosis? Aside from your current visuals, of course; I'm sure they are secondary to the Wellbutrin. And I know you have suicidal ideation.
The reason I'm asking all these questtions is b/c you are on quite a cocktail of drugs and yet you are still suffering from constant suicidal ideation. And the Wellbutrin is out now; I was kidding before you really should stop it and call your pdoc.
I'm just thinking that maybe your depression is worse than you think, b/c of all the suicidal ideation, and you are on so many drugs and yet, they are not helping to stop those thoughts. So I was really wondering if you might not benefit from an MAOI, b/c they help more than all the drugs you're taking combined. Which of course you are taking all of them combined lol
Just a thought; and it really depends on your diagnosis, your pdoc's opinion, and of course, your opinion.No matter what, keep me posted on the hallucinations and the Wellbutrin, which, again, I really do think needs to be stopped. If you stopped it and the hallucinations stopped, at least you'd know for sure it was the Wellbutrin that caused them. And be sure to call your pdoc too.
Sorry for the long post!
Stay well, and write if you need support, have questions, or just want to talk.
Kat
Posted by phidippus on October 9, 2012, at 14:54:48
In reply to Re: Ritalin while on an maoi » phidippus, posted by ChicagoKat on October 9, 2012, at 12:04:03
>Let your pdoc know, if you haven't already. Or maybe you are enjoying the visuals and don't want to let you pdoc know?
I did let my pdoc know about it. He just wanted me to lower the dose.
>What's your official diagnosis?
ADHD, Bipolar I and OCD
>you are on so many drugs and yet, they are not helping to stop those thoughts.
I know. I've tried everything to end the thoughts.
>I was really wondering if you might not benefit from an MAOI
MAOIs are lousy when it comes to treating OCD. I also find them scary.
Thanks,
Eric
Posted by SLS on October 9, 2012, at 15:03:35
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by phidippus on October 8, 2012, at 21:12:02
What about increasing your dosage of Abilify? If things actually get worse instead of better, then you might need to switch APs - perhaps to Latuda - so that you can retain the Wellbutrin. Abilify + Wellbutrin might be exerting too much dopaminergic activation.
- Scott
Posted by phidippus on October 9, 2012, at 15:54:09
In reply to Re: Ritalin while on an maoi » phidippus, posted by SLS on October 9, 2012, at 15:03:35
I could increase my Abilify. I'm stuck with it though as I've been on all the atypicals except for Fanapt. I liked Latuda, but in the end Abilify treats my OCD more effectively. I could push it up to 20 mg. I've been working on music today and haven't had a hallucination
What a weird problem to be saddled with.
Eric
Posted by ChicagoKat on October 9, 2012, at 17:37:12
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by phidippus on October 9, 2012, at 14:54:48
> >Let your pdoc know, if you haven't already. Or maybe you are enjoying the visuals and don't want to let you pdoc know?
>
> I did let my pdoc know about it. He just wanted me to lower the dose.
>
> >What's your official diagnosis?
>
> ADHD, Bipolar I and OCD
>
> >you are on so many drugs and yet, they are not helping to stop those thoughts.
>
> I know. I've tried everything to end the thoughts.
>
> >I was really wondering if you might not benefit from an MAOI
>
> MAOIs are lousy when it comes to treating OCD. I also find them scary.
>
> Thanks,
>
> EricI'm glad you called your pdoc :) And I'm glad that since the Wellbutrin seemed to be helping he didn't just d/c it, that he had you lower the dose. Let us know if/when the hallucinations stop.
I understand that MAOIs can be scary. But I have to say I just love my Nardil, cos it has saved my life, and more...I mean I was smiling with joy at several points today, enjoying life as I have not done in years, if not decades. :D
I just worry that you are on so many damn drugs!
Hope you feel better,
Kat
Posted by phidippus on October 9, 2012, at 17:54:34
In reply to Re: Ritalin while on an maoi » phidippus, posted by ChicagoKat on October 9, 2012, at 17:37:12
>I just worry that you are on so many damn drugs!
I'm a tank.
Eric
Posted by ChicagoKat on October 9, 2012, at 21:19:23
In reply to Re: Ritalin while on an maoi » ChicagoKat, posted by phidippus on October 9, 2012, at 17:54:34
> >I just worry that you are on so many damn drugs!
>
> I'm a tank.
>
> Ericlol, I won't worry then ;)
And btw, I want to thank you Eric, for all your help when I felt like crap. Your advice did a lot to help me get better.
Kat
This is the end of the thread.
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