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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Jay2112 on February 14, 2022, at 17:31:28
Looking at clinical studies, many people seem to respond to either Ritalin, or Dexedrine (or Vyvanse, the twin of Dexedrine except for delivery systems) but not both. I have a preference for Dexedrine (amphetamine), and it has been described as being 'smoother' then Ritalin. But, some find Ritalin much more effective. (I also have had a good response to Aderall, which is mixed amphetamine salts). Ritalin just seemed way to strong for me, even at smaller doses. Dexedrine, and then Vyvanse, has worked awesome for me, without dose escalation, for over 15 years. In fact, I have even come down on the dose. Yes, it has induced a happy hypomania (I am Bipolar II), but it subsides quickly.
I am now trying another antidepressant (I am on a small dose of Effexor) to boost the amphetamine effect, for the cognitive dulling effect of my carbamazepine and lamotragine. I tried desipramine, but it is way, way too strong, with numerous stomach, back ache, and headache side effects, even at miniscule doses. So, yet another trial of nortriptylne is in place, as it feels, once again, much 'smoother' than desipramine.
I am very, very comfortable with polypharmacy, as it has been the only solution for my bipolar. Really, bipolar is all about balance, so it is balancing each med to a mental 'harmony'. I think that is whar all of us are trying to achieve...
Posted by undopaminergic on February 15, 2022, at 5:35:27
In reply to The Ritalin Vs. Dexedrine debate, and more..., posted by Jay2112 on February 14, 2022, at 17:31:28
> Ritalin just seemed way to strong for me, even at smaller doses.
>That is peculiar, because Dexedrine is (dose-dependently) much stronger than Ritalin. Ritalin is just a reuptake inhibitor, while Dexedrine is a releaser. If I recall correctly, a reuptake inhibitor (in the studies I read it was cocaine) can increase synaptic dopamine up to 175% or so of baseline in the nucleus accumbens, whereas amphetamines can achieve several hundred percent.
While I have forgotten the precise figures, the point remains that amphetamines elevate dopamine more than reuptake inhibitors.
Of course, it is still true that you feel a stronger effect, but it is likely not due to higher dopamine elevation.
-undopaminergic
Posted by Jay2112 on February 15, 2022, at 15:30:59
In reply to Re: The Ritalin Vs. Dexedrine debate, and more..., posted by undopaminergic on February 15, 2022, at 5:35:27
> > Ritalin just seemed way to strong for me, even at smaller doses.
> >
>
> That is peculiar, because Dexedrine is (dose-dependently) much stronger than Ritalin. Ritalin is just a reuptake inhibitor, while Dexedrine is a releaser. If I recall correctly, a reuptake inhibitor (in the studies I read it was cocaine) can increase synaptic dopamine up to 175% or so of baseline in the nucleus accumbens, whereas amphetamines can achieve several hundred percent.
>
> While I have forgotten the precise figures, the point remains that amphetamines elevate dopamine more than reuptake inhibitors.
>
> Of course, it is still true that you feel a stronger effect, but it is likely not due to higher dopamine elevation.
>
> -undopaminergic
>I did not know that about Ritalin (it being less stronger than Dexedrine). I was just going by from various comments on different websites. I just found Ritalin turned my anger up by about 300 percent..it was horrible feeling that way...I was ready to kill! uggh. Dexedrine (and it's twin, Vyvanse) just feels so smooth, a tad bit artificial, but like my brain is functioning at a really comfortable speed. I find myself, sometimes, rushing through the day to get my tasks done before it's effects start to wear off. And, 'coming down' off it is very gentle, and doesn't make me 'crave' more of it.
From what I understand, it kind of 'bursts' dopamine from the receptor..as well as, less so, serotonin and norepinephrine. I also seem to respond well to psuedophedrine, which I understand does a similar action but to just norepinephrine. I take the extended release almost daily. But, this may explain why/that I don't respond to reuptake inhibitors well...at all, really. In fact, I have quite an adverse reaction to reuptake inhibitors. Forcing that neurotransmitter to stay in the synapse is a no-go for me, and I think may be part of the reuptake inhibitor's failure for many...and their failure in many. Ironically, though, when I am feeling really, really anxious and depressed, one single, very high dose of an SSRI dissipates the bad feelings, at least for a day or so, at the most. I find that quite peculiar.
One drug I am experimenting with is desipramine. It is, mostly, a norepinephrine reabsorption blocker. It has a much, much smaller anticholinergic effect than nortriptyline. As well, it has been shown to slightly extend and enhance the effects of amphetamine. (https://pubmed.ncbi.nlm.nih.gov/2065713/) Besides being bipolar (with having very, very few "switches" with amphetamine), I have extreme asthenia, and SRI/SNRI's cause switching to major dysphoric mania. (I feel like the most intense piece of sh*t and get extremely angry..to an extreme point of intense distress, with murderous and suicidal throughts. Only high dose antipsychotics bring me down).
Even high, or regular, doses of desipramine make me feel like the above, and I take a very miniscule dose, along with high dose carbamazepine, clonazepam, and Lyrica (pregablin).
So, I really think the mechanism of SRI/SNRI's is greatly flawed. I tried Nardil four times, and was blasted into dysphoric mania, as well as having the "cheese" reaction after less than a week of use. (And had strongly stuck to the low tyramine diet.) My psychiatrist said that some people that he has seen, and read about in the literature, seem to be wired chemically to not be able to tolerate MAOI's, even though that is rare. He tries MAOI's with almost every patient he has, usually with success. His father was also a psychiatrist, and ironically, I had him as my first psychiatrist. But, the problem was he (father) diagnosed me as unipolar, depressive. But, I am lucky to have such an open-minded shrink.
Jay
Posted by beckett2 on February 15, 2022, at 23:34:42
In reply to The Ritalin Vs. Dexedrine debate, and more..., posted by Jay2112 on February 14, 2022, at 17:31:28
> Looking at clinical studies, many people seem to respond to either Ritalin, or Dexedrine (or Vyvanse, the twin of Dexedrine except for delivery systems) but not both. I have a preference for Dexedrine (amphetamine), and it has been described as being 'smoother' then Ritalin. But, some find Ritalin much more effective. (I also have had a good response to Aderall, which is mixed amphetamine salts). Ritalin just seemed way to strong for me, even at smaller doses. Dexedrine, and then Vyvanse, has worked awesome for me, without dose escalation, for over 15 years. In fact, I have even come down on the dose. Yes, it has induced a happy hypomania (I am Bipolar II), but it subsides quickly.
>
> I am now trying another antidepressant (I am on a small dose of Effexor) to boost the amphetamine effect, for the cognitive dulling effect of my carbamazepine and lamotragine. I tried desipramine, but it is way, way too strong, with numerous stomach, back ache, and headache side effects, even at miniscule doses. So, yet another trial of nortriptylne is in place, as it feels, once again, much 'smoother' than desipramine.
>
> I am very, very comfortable with polypharmacy, as it has been the only solution for my bipolar. Really, bipolar is all about balance, so it is balancing each med to a mental 'harmony'. I think that is what all of us are trying to achieve...I like Adderall because I respond to Dexedrine, but for some reason, Dexedrine creates strong ups followed by significant comedowns. I seem to burn it up too quickly (?)
A genetic test showed Ritalin as less compatible. It also felt much more of a body thing. Undopaminergic (I think) explained why this would happen. Anyways, it did feel stronger as in it felt more like effexor.
Posted by Christ_empowered on February 16, 2022, at 7:44:55
In reply to Re: The Ritalin Vs. Dexedrine debate, and more... » Jay2112, posted by beckett2 on February 15, 2022, at 23:34:42
the amphetamine preparations are generally stronger than the Ritalin compounds. I -think- Focalin may be something of an exception (?), because each mg of Focalin is supposed to be 2x potent as equivalent dosages of ritalin or...something like that, anyway.
For a while, Ritalin was preferred for the younger set and treatment of some forms of depression and also off setting sedation from other treatments (Ritalin for stable people with Schizoprenia-spectrum disorders, for instance, was apparently a somewhat common practice, for a season). Many nations do not allow amphetamine products, at all, so Ritalin is -the- primary option, mostly for attention disorders and I think also narcolepsy.
I dunno. A former acquaintance was on a moderate dosage of long acting Ritalin because the amphetamines she'd tried caused too much anxiety. Other insist that the amphetamines cause less anxiety and are more effective for their concerns.
Personally...for me, Ritalin was better once I needed an "atypical" in my life, but Adderall was (is?) very much the market leader, so...good luck with that, lol. The Ritalin helped concentration and mood without the "wow. I'm both tranquilized and stimulated, all at the same time" feeling. The Adderall was OK, except I think it may have triggered or exacerbated EPS.
The information I've skimmed on uppers for depression is surprisingly scant and unimpressive, considering that various flavors of uppers have been used for depression since the 1930s or so. It seems that some prescribers use Ritalin in older people and/or people with serious health concerns. Low to moderate doses of amphetamine have some data indicating good effects on some aspects of depression in carefully selected patients, but...
yeah, considering the decades upon decades of both official and off label usage, surprisingly little solid, real data to help people/patients or prescribers. what fun.
I think the amphetamine products are regarded as more potentially addictive and likely to induce mood changes and/or psychosis, but I also seem to recall reading that long term Ritalin treatment in places that can track patients (nationalized health care, diagnoses available to researchers) indicated that a somewhat disturbingly high % of children and adolescents given Ritalin developed psychotic symptoms and of those an unusually high % went on to be labeled with and treated for a Schizophrenia-spectrum diagnosis. so...there's that, of course.
ugh. hope this helps :-)
Posted by undopaminergic on February 16, 2022, at 8:23:11
In reply to Re: The Ritalin Vs. Dexedrine debate, and more..., posted by Christ_empowered on February 16, 2022, at 7:44:55
>
> The information I've skimmed on uppers for depression is surprisingly scant and unimpressive, considering that various flavors of uppers have been used for depression since the 1930s or so.
>Freud used cocaine before that, and he was probably not the first.
-undopaminergic
Posted by beckett2 on February 16, 2022, at 17:16:36
In reply to Re: The Ritalin Vs. Dexedrine debate, and more..., posted by undopaminergic on February 16, 2022, at 8:23:11
Don't forget WWll German forces.
Posted by Jay2112 on February 16, 2022, at 18:45:33
In reply to Re: The Ritalin Vs. Dexedrine debate, and more..., posted by Christ_empowered on February 16, 2022, at 7:44:55
Hi C_E:
I will admit, there are times when my Vyvanse (reformulated amphetamine) overstimulates me way too much. I have standby risperidone, propranolol and clonazapam for that. I was diagnosed in the 70's (I am old..lol) as a kid with a learning disorder, and later with ADD (no H). Even though I accomplished a degree in political science, with honours, my brain still tends to be way too understimulated. I was formerly diagnosed by a psychologist with ADD, but being bipolar, my emotions are either too sped up (anxiety bordering sometimes on psychosis), or too down in the dumps. (I get in the pits of Hell and see no way out.) Finding a middle ground has only been brought around by large doses of carbamazepine (Tegretol) and Lyrica. So, I don't just take amphetamine for depression, but for my ADD, and that 'learning disability' had from childhood. (My left/right hand were all mixed up, as I was left handed but forced to be right handed. My co-ordination all messed up...reading comprehension (although now I read big, big time..usually textbooks) and math problems (never fixed..lol). Practical things like organization, 'handyman' stuff....I suck at big time!! lol.
I personally like the 'lift' from amphetamine, which no antidepressant has *ever* been able to provide me. (one exception...nefadezone..but that was completely taken off the market here in Canada :( ) High dose Buspirone has, at times, worked like risperidone. And I have read on many Schizophrenia boards of people safely using different stimulants, to help with the cognitive and emotional negative symptoms not helped by AP's, with prudence, of course.
Lot's to talk about on this topic...of course.
Jay
Posted by Jay2112 on February 16, 2022, at 18:51:35
In reply to Re: The Ritalin Vs. Dexedrine debate, and more..., posted by beckett2 on February 16, 2022, at 17:16:36
> Don't forget WWll German forces.
Dexedrine was the go-to pill for the 24hr pilots that fly the zones doing nuclear launch watch patrols, but has now been replaced by modafinil.
Posted by linkadge on February 16, 2022, at 19:07:26
In reply to Re: The Ritalin Vs. Dexedrine debate, and more..., posted by Jay2112 on February 16, 2022, at 18:51:35
A number of childhood mental illnesses initially present as attention / concentration or hyperactivity problems. I do believe that stimulants can cause psychosis in and of themselves (in certain individuals at certain doses), but in other cases, they may simply be unmasking a bipolar spectrum, or psychotic disorder. I remember reading a study where psychotic symptoms were not uncommon in children with ADHD, regardless of medication status.
As others have mentioned, amphetamine is generally though to cause more psychotic reactions than ritalin. For some children, stimulants can cause significant tachycardia, for others, the pulse barely budges. A lot of the response is likely genetically determined. There are plenty of kids that do just fine on either drug.
This is not to dismiss the side effects, or safety concerns. Most mental illness is poorly understood, and there is a lot of comorbidity.
Linkadge
Posted by rjlockhart37 on February 17, 2022, at 15:40:35
In reply to Re: The Ritalin Vs. Dexedrine debate, and more..., posted by linkadge on February 16, 2022, at 19:07:26
dexedrine is more like pep pill, ritilin is less potent but still gives the focus effect.
Posted by Jay2112 on February 21, 2022, at 14:44:33
In reply to Re: The Ritalin Vs. Dexedrine debate, and more..., posted by linkadge on February 16, 2022, at 19:07:26
> A number of childhood mental illnesses initially present as attention / concentration or hyperactivity problems. I do believe that stimulants can cause psychosis in and of themselves (in certain individuals at certain doses), but in other cases, they may simply be unmasking a bipolar spectrum, or psychotic disorder. I remember reading a study where psychotic symptoms were not uncommon in children with ADHD, regardless of medication status.
>
> As others have mentioned, amphetamine is generally though to cause more psychotic reactions than ritalin. For some children, stimulants can cause significant tachycardia, for others, the pulse barely budges. A lot of the response is likely genetically determined. There are plenty of kids that do just fine on either drug.
>
> This is not to dismiss the side effects, or safety concerns. Most mental illness is poorly understood, and there is a lot of comorbidity.
>
> Linkadge
>
>
>Thinking back, I am sort-of happy my parents didn't medicate me, which really still wasn't popular back in the early 70's. Quite simply, some of my problems with math and reading comprehension were treated by my deeply loving parent's patience and major involvement in doing all sorts of after-school exercises with me. I do have some concern that today's parents (some) reach way too quickly for the medication bottle instead of spending an extra few hours with their child after school. I can understand parental stress these days, but if you don't have the time, don't have kids. IMHO..anyways.
Jay
Posted by linkadge on February 24, 2022, at 15:42:17
In reply to Re: The Ritalin Vs. Dexedrine debate, and more... » linkadge, posted by Jay2112 on February 21, 2022, at 14:44:33
I agree completely. I don't have kids because I don't have the emotional capacity to deal with them. I know this, and act accordingly.
Stimulants are overused. That being said, there are cases where stimulants can really help and can put a child on a better path.
I know ADD students who are incredibly bright but underachieve because of motivational and attention issues. Some of them were my brightest students and now work for minimum wage. This can create all sorts of financial problems and the associated stress and increased risk for future depression.
My $25 ritalin prescription easily pays for itself each month in terms of its ability to stop me from impulse shopping on Amazon. I can think things through and do the math before clicking buy.
Linkadge
This is the end of the thread.
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