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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 MightyKondrian on July 23, 2018, at 17:31:36
Well, not been this bad for, well forever. Had to stop quetiapin as I refuse to put on any more weight. And my mood has gone seriously down hill. Cant remember what my signature says but All I'm on not is clonazepam, amitriptyline, phenelzine, bupropion & acamprosate. This quetiapine withdrawal is hell. I was only taking 250mg.
Anyhow, I now have a script for methylphenadate. Post dated so I have 2 weeks worth ending when I see my doc next.
I turned down D-amphetamine coz of past addiction issues.
I know 5mg day is tiny but I never thought my doc would prescribe a stim at all!
I've 'used' 30mg slow release Ritalin before. Loved it! Alot smoother then amphetamine.
Its funny. 2 weeks ago I reach my docs office, lunged myself onto the chair and said out loud "methylphenidate!" It was actually a joke! Just kinda saying how hot it was and how little energy I had. I told the doc I had dumped the quetiapine (has made me fat!). Before I knew it he was asking about my experiences with stims and my experiences when I've taken it on myself to take stims while on an MAOI. Theres not much I haven't taken with an MAOI lol.
So I walk out with a post dated script for Ritalin. Immediate release. Only 5mg day. I know that wouldn't make a nat high let alone be any medical use for a human. But all that dont matter. He prescribed a stim! Even easier than getting a script for Parnate (coz theres far too much paperwork, aparently.Anyway, all helpfull comment wellcome. Negative comments? You know what you can do with them!
I'm seriously depressed right now. Not much I can do.
Posted by linkadge on July 23, 2018, at 17:59:05
In reply to MAOI + ritalin, posted by MightyKondrian on July 23, 2018, at 17:31:36
Not sure. You might notice some overstimulation. There is some overlap with the Wellbutrin (norepinephrine / dopamine reuptake).
I took Ritalin with amitriptyline (worked fairly well).
How long have you been taking Wellbutrin? What dose currently?
Linkadge
Posted by MightyKondrian on July 23, 2018, at 18:32:47
In reply to Re: MAOI + ritalin, posted by linkadge on July 23, 2018, at 17:59:05
> Not sure. You might notice some overstimulation. There is some overlap with the Wellbutrin (norepinephrine / dopamine reuptake).
>
> I took Ritalin with amitriptyline (worked fairly well).
>
> How long have you been taking Wellbutrin? What dose currently?
>
> LinkadgeHi mate. Been on Wellbutrin like forever. With Nardil the Marplan and now with Nardil again. 120mg Nardil. Nothings working. I'm in a real bad state. Wellbutrin 450mg many times. My doc agreed with me that I'm at less risk of fits as the 4mg Klonopin should take care of it as its anticonvulsant. Most benzos are.
I might move my amitriptyline to 150mg. Whats there to loose, right?
Posted by MightyKondrian on July 23, 2018, at 18:34:59
In reply to Re: MAOI + ritalin » linkadge, posted by MightyKondrian on July 23, 2018, at 18:32:47
I'm sleeping 16-20hrs a day too. Lifes like an egg timer right now.
Posted by beckett2 on July 23, 2018, at 19:04:49
In reply to MAOI + ritalin, posted by MightyKondrian on July 23, 2018, at 17:31:36
Have you started the Ritalin yet? I imagine 5 mg will seem stronger with the Nardil. When I was on emsam, I had to watch coffee because it was potentiated. I also recall at higher doses, the emsam made me sleepy rather than stimulated.
None of this is news, but I wanted to chime in. Would you be better off with parnate despite the paperwork?
I wish you best of luck. So seroquel is tough to kick? Bloody sorry :(
Posted by MightyKondrian on July 23, 2018, at 19:46:17
In reply to Re: MAOI + ritalin » MightyKondrian, posted by beckett2 on July 23, 2018, at 19:04:49
>So seroquel is tough to kick? Bloody sorry :(
It is if you're like me and just stop it without tapering. Its coz I know why I feel so sh*t (the way I stoped seroquel) that keeps me going.
Posted by rjlockhart37 on July 23, 2018, at 21:56:21
In reply to Re: MAOI + ritalin » beckett2, posted by MightyKondrian on July 23, 2018, at 19:46:17
i've taken wellbutrin at 450mg XL with dexamphetamine, in 2004....but it was after failed attempts, so wellbutrin was added during the summer for depression, then when school started again, i started dexamph ... it just enhanced, but also wellbutrin made me irritable, i used to think wellbutrin would help if dexamphetamine washed out, i was still tired. It just lightly keeps your dopamine levels up. Ik now some people who take Selegiline and stimulants for ADD
dexamphetamine always worked well with me, it was the first stimulant i was prescribed, it just helps activation and being able to think properly, and clearly. Methylphenidate was very mellow, in a way smoother, but either way dexamphetamine has always worked well with me, but your more washed out after it wears off
Posted by linkadge on July 24, 2018, at 8:30:28
In reply to Re: MAOI + ritalin » linkadge, posted by MightyKondrian on July 23, 2018, at 18:32:47
Amitriptyline could cause more oversleeping than other TCAs (more antihistamine effect).
Not sure what to recomend. Have you tried nortriptyline? (would be less sedating than amitriptyline). Trimipramine may produce deeper sleep than amitriptyline.
The problem with sedating antidepressants is that they can induce sleep, but often not restorative sleep. Amitriptyline and clonazepam could both do this to some extent. The upper / downer combos can take their toll.
Nardil can (unfortunately) also mess up sleep (reduce deep / REM sleep), leading to fatigue. You may notice that lower doses of nardil help relieve the somnolence.
You are on a lot of meds. Sometimes for TRD, more is not necessarily better. Also, when I have bouts of deep fatigue, sometimes supplements help a bit better with that. Here are a couple of supplements that may help depression and fatigue:
methylfolate (activated folic acid), methlycobalamine (activated b12)
niacin
vitamin d
phenylethylamine (PEA) (start very low with maoi)
tyrosine (start very low with an maoi)
co-q10A couple of suggestions:
Reduce the nardil
Switch amitriptyline to trimipramine or cyproheptadine + melatonin 1mg
Lower clonazepam a bit (add niacin + magnesium)
Vitamin d, b12, folic acid, q10 in morning
Tyrosine (start LOW) in morning)
Coffee in morning (if agrees with you)
Ritalin / Wellbutrin in morningLinkadge
-----------
Posted by MightyKondrian on July 24, 2018, at 14:37:44
In reply to Re: MAOI + ritalin, posted by linkadge on July 24, 2018, at 8:30:28
> Amitriptyline could cause more oversleeping than other TCAs (more antihistamine effect).
>
> Not sure what to recomend. Have you tried nortriptyline? (would be less sedating than amitriptyline). Trimipramine may produce deeper sleep than amitriptyline.
>
> The problem with sedating antidepressants is that they can induce sleep, but often not restorative sleep. Amitriptyline and clonazepam could both do this to some extent. The upper / downer combos can take their toll.
>
> Nardil can (unfortunately) also mess up sleep (reduce deep / REM sleep), leading to fatigue. You may notice that lower doses of nardil help relieve the somnolence.
>
> You are on a lot of meds. Sometimes for TRD, more is not necessarily better. Also, when I have bouts of deep fatigue, sometimes supplements help a bit better with that. Here are a couple of supplements that may help depression and fatigue:
>
> methylfolate (activated folic acid), methlycobalamine (activated b12)
> niacin
> vitamin d
> phenylethylamine (PEA) (start very low with maoi)
> tyrosine (start very low with an maoi)
> co-q10
>
>
>
> A couple of suggestions:
>
> Reduce the nardil
> Switch amitriptyline to trimipramine or cyproheptadine + melatonin 1mg
> Lower clonazepam a bit (add niacin + magnesium)
> Vitamin d, b12, folic acid, q10 in morning
> Tyrosine (start LOW) in morning)
> Coffee in morning (if agrees with you)
> Ritalin / Wellbutrin in morning
>
> Linkadge
>
>
I'm well used to amitriptyline. The antihistamine effect has long gone in the morning.
(the reason I sleep so much is cos I dont wann face the world, not coz I'm overly tired.
I'm lucky if it puts me to sleep within the hr like it used to. I think 150mg amitriptyline might be worth a try, just for a week see what happens. Trimipramine gives me dreams that are far too lucid and usually disturbing.
I have lots of melatonin to try (backup). Mybe I should pop one at night and maybe I wont feel so doomed when I wake up. Get my sleep sorted.Tried PEA with MAOI before. Not for me.
I have l-tryptophan too. Aparently I'm to slowly work up from a small dose of 250mg up to 3g pm.
Each time I go from 3-4mg clonazepam I end up back on 4mg. I would rather add/exchange meds for supps once I'm more steady but thanks for all the suggestions.My doc said that back to pre-SSRIs the norm for stubborn depression was Nardil + lithium + L-tryptophan. An idea for the future.
From his point of view mostly only sedating TCAs should be combined with MAOIs. He's already said no to nortrptyline. I'm not to bothered about. He allows bupropion only coz I had a history of MAOI + bupropion before from a Prof of Neoro-psychiaty (well known). Guess that made him comfortable with it up to 450mg.
I already take a whole heap of supps inc activated b2,b6, b12 & folate. Plenty of D3. And high doses of most of the rest. I think I will up my vit C back to 3-5g daily. In fact they are tucked away so I keep forgetting they're there duh!
Another excellent nootropic oxiracetam + CDP coline is also tucked away forgot about. Out of site out of mind huh
I thank you for your post and I've saved it for future reference ;)
I'll keep this thread updated coz things are desperate now and If I find something that does the job I want you all to know about it!
I've also been thinking of an implant which my doc Dr Malizia pioneered & help design. It really is getting to that point :(https://www.bbc.co.uk/news/av/health-12285852/deep-brain-stimulation-hope-for-depression
Posted by MightyKondrian on July 24, 2018, at 14:48:12
In reply to Re: MAOI + ritalin » linkadge, posted by MightyKondrian on July 24, 2018, at 14:37:44
Need Flash player to play vid in previous. Otherwise another similar vid:
Posted by linkadge on July 24, 2018, at 16:29:48
In reply to Re: MAOI + ritalin » linkadge, posted by MightyKondrian on July 24, 2018, at 14:37:44
Hey,
It seems like you have a good handle on your body. The amitriptyline actually metabolizes to nortriptyline, meaning you actually have nortriptyline in your system by taking amitriptyline. So, not sure why he would say no to nortriptyline as technically you are already taking it (i.e. you would be on less drug).
I'm not sure if you have had a sleep study done. The deeper sleep stages can be more restorative and give you a feeling of power / efficacy the next day. Too many meds can actually gum up the system and leave you feeling ineffectual. Of course, it can be the depression too.
See what the ritalin does for you.
Linkadge
Posted by MightyKondrian on July 24, 2018, at 18:27:30
In reply to Re: MAOI + ritalin » MightyKondrian, posted by beckett2 on July 23, 2018, at 19:04:49
Thanks.
No, the script has been postdated 15 Aug. What a tease! He just want that quetiapine totaly out of me, That includes any after effect.
And I'm impatient. get them in 3 weeks I think. It would be great if he went back to working privately as money talks lol.
Parnate? Yeah I really gotta courage up and say "not good enough". It needs to be an option. I'll do the darn paperwork ffs! ;)
Posted by bleauberry on July 26, 2018, at 14:49:39
In reply to MAOI + ritalin, posted by MightyKondrian on July 23, 2018, at 17:31:36
One of my doctors said that Ritalin is the most common medicine she prescribes because it helps to improve the quality of life for more people and more symptoms, diseases and syndromes, than any other medicine on the market.
I agree. I think Ritalin is an unsung hero and under-utilized.
My personal experience - Ritalin is the best med I ever took. Adderall was the opposite - it sent me into a dark anxious dungeon.
I have been on every SSRI, 4 TCA's, an MAOI, antipsychotics, benzodiazepines, mood stabilizers, and boatloads of supplements and herbs. And I failed 12 sessions of bilateral E.C.T. Out of all that, Ritalin was the best of them all.
I found it moderately helpful with depression, majorly helpful with anhedonia, majorly helpful with executive function such as planning and executing, multitasking, social engagement, and on top of all that I slept the best of my life. On a stimulant! I could handle the world with Ritalin.
I may be back on it someday. Stopped for a surgery and since it costs $120 month more than I could afford I didn't do it.
Great med. I am perplexed why it is not maybe the most popular med out there in the world of psychiatry.
Posted by MightyKondrian on August 10, 2018, at 19:08:47
In reply to Re: MAOI + ritalin » MightyKondrian, posted by bleauberry on July 26, 2018, at 14:49:39
Thanks. Thats exactly the words I was looking for ;)
I'mm sorry you had to come off it and the cost is criminal!
This is the end of the thread.
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