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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by John Q P on October 5, 2013, at 14:49:57
Diagnoses: Atypical Depression (hypersomnia, hyperphagia), ADHD-PI, "numerous traits associated with Aspergers" (neuropsych eval)
Essentially the only things that work are stimulants... And Vyvanse > Adderall. While scaling up doses... no matter the dose, the effects were the same... Just the duration was longer. At 70mg Vyvanse, that window is about 6 hours.
During those 6 hours I'm myself and it's great... Around 6 hours my cognitive functioning declines and shortly thereafter so too does my mood, followed by return to my baseline drowsiness/fatigue/brain fog/sleepiness.
After many failed attempts at augmentation my psych and I are now trying Vyvanse 70 with Emsam 6mg/24. The biggest benefit: I can finally wake up in the morning and go to sleep at normal times. Downsides? It somehow worsened my baseline mood (almost sorrow or dysphoric) and Vyvanse no longer does anything.
So I tried lowering the Vyvanse dose to see if I was overdosing. Nope, nothing. The[n] I tried carefully increasing Vyvanse dose (while checking BP). My internal "lightswitch" turned back on and it was effective again.So wtf? Anyone with MAOI experience able to decipher what is going on?
Posted by Dr. Bob on October 7, 2013, at 0:56:37
In reply to MAOI is diminishing stimulant effectiveness?, posted by John Q P on October 5, 2013, at 14:49:57
Posted by SLS on October 7, 2013, at 1:28:06
In reply to MAOI is diminishing stimulant effectiveness?, posted by John Q P on October 5, 2013, at 14:49:57
Are you looking for some sort of pharmacological explanation for your response pattern?
In the absence of such an explanation, perhaps it is best to continue a safe trial-and-error protocol and draw conclusions based upon empirical observations.
How do you respond to Parnate?
What about increasing your dosage of Emsam? For me, dietary restrictions are well worth the resolution of severe depression.
How do you respond to methylphenidate - Focalin in particular?
I am not familiar enough with Asperger's to be able to help incorporate its treatment in your regime.
- Scott
Posted by former poster on October 17, 2013, at 0:23:37
In reply to MAOI is diminishing stimulant effectiveness?, posted by John Q P on October 5, 2013, at 14:49:57
6 hours was about all I ever got with Vyvanse too. I took as much as 18mg Emsam patch with the Vyvanse. No hypertensive crisis, but stimulation was unbearable. I don't think the 6mg Emsam patch is good for depression. You need to get the Emsam dose up to 12-15mg/day and reduce the Vyvanse to 35mg or less. Good luck.
Posted by John Q P on October 18, 2013, at 22:19:11
In reply to Re: MAOI is diminishing stimulant effectiveness? » John Q P, posted by former poster on October 17, 2013, at 0:23:37
> 6 hours was about all I ever got with Vyvanse too. I took as much as 18mg Emsam patch with the Vyvanse. No hypertensive crisis, but stimulation was unbearable. I don't think the 6mg Emsam patch is good for depression. You need to get the Emsam dose up to 12-15mg/day and reduce the Vyvanse to 35mg or less. Good luck.
This is exactly what happened and it has been working out very well so far.
This is the end of the thread.
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