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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by Peter on November 3, 2001, at 13:57:19
Hello all:
I've been diagnosed over the years with mild bipolar/SP. I've been on many mood stabilizers, finally settling on depakote, and have tried many SSRI's, which resulted in problems. I'm also on daily klonopin for SP/panic. It wasn't until I decreased the depakote as a test over a few months (my pdoc monitered me closely) that alot of other things about my mood rose to the surface (I think the years of depakote might have masked these new mood tendencies instead of targeting them). All of these newly apparent mood problems fall under the catagory of ADD, especially since I began to remember I had the same tendencies when I was a little kid. So, my pdoc told me at our last session that I have a combo bipolar/SP/ possible ADD diagnosis, and he just prescribed Adderall. I just took my first 2.5mg dose about 4 hours ago, and I noticed that I started feeling pretty good when it kicked in. I was calmer, more focused, and mildly euphoric. But I've also experienced a bit of nausea and spaciness. Now I feel sort of 'crashy' - low energy, low mood, and I feel like taking my second dose. My questions are: 1) Anyone experience these feelings (both the good and the side-effects)? 2) I don't want to be on this drug if I don't have ADD, especially since I had a past drug abuse problem. Are the effects the same for someone who has ADD and for someone who doesn't? I mean, I would think that either way anyone would feel good on it. Is it possible to tell if you have ADD by how you respond to the first few doses? I'd really like some input. Thanks.
Posted by JohnX2 on November 3, 2001, at 15:53:23
In reply to Adderall help, posted by Peter on November 3, 2001, at 13:57:19
Let's see.
The 1st time I took Adderall it made me severly
manic and I was nauseaus as all heck. This was
before I got a bipolar diagnosis. On Subsequent
dosing, the Adderall had less of an effect on
me (the nausea and spaciness went away). After
3 days, it had no effect. It just sounds like
on your 1st experience it went a little
balistic on you, which seems reasonable given
you lowered your depakote, and Adderall can be
pretty powerful for a bipolar. My dosing was
in the 20-40mg range when it stabilized, and
I only got a smooth Adderall response while
also taking klonopin.I was depressed when I took the adderall so when
it wore off i just returned to being about the
same depressed.Suppose you took your standard dose of depakote
with the adderall? I found that klonopin
substantially smoothed out my adderall response
and others have reported success with neurontin.
Both are anti-convulsants. Maybe the older dose
of depakote + the adderall would work out?
You are already familiar with depakote so
raising the dose a little to counter the adderall
may balance things out and would be a quicky
experiment.Just a suggestion.
BTW, if you don't want to take an addictive
med for ADD, then Wellbutrin is the obvious
choice to augment your depakote (if you
haven't already tried). Effexor would be 2nd.
Plus if they worked they would have the same
mood elevating effect. I'm guessing you've
maybe tried these meds in the past though,
because usually the doctor would give wellbutrin
before trying adderall for the obvious
addiction concern.-john
> Hello all:
> I've been diagnosed over the years with mild bipolar/SP. I've been on many mood stabilizers, finally settling on depakote, and have tried many SSRI's, which resulted in problems. I'm also on daily klonopin for SP/panic. It wasn't until I decreased the depakote as a test over a few months (my pdoc monitered me closely) that alot of other things about my mood rose to the surface (I think the years of depakote might have masked these new mood tendencies instead of targeting them). All of these newly apparent mood problems fall under the catagory of ADD, especially since I began to remember I had the same tendencies when I was a little kid. So, my pdoc told me at our last session that I have a combo bipolar/SP/ possible ADD diagnosis, and he just prescribed Adderall. I just took my first 2.5mg dose about 4 hours ago, and I noticed that I started feeling pretty good when it kicked in. I was calmer, more focused, and mildly euphoric. But I've also experienced a bit of nausea and spaciness. Now I feel sort of 'crashy' - low energy, low mood, and I feel like taking my second dose. My questions are: 1) Anyone experience these feelings (both the good and the side-effects)? 2) I don't want to be on this drug if I don't have ADD, especially since I had a past drug abuse problem. Are the effects the same for someone who has ADD and for someone who doesn't? I mean, I would think that either way anyone would feel good on it. Is it possible to tell if you have ADD by how you respond to the first few doses? I'd really like some input. Thanks.
Posted by Peter on November 3, 2001, at 16:31:31
In reply to Re: Adderall help » Peter, posted by JohnX2 on November 3, 2001, at 15:53:23
> Thanks for the input, John. As a matter of fact, raising the depakote back up to my normal level (750mg) is exactly what my pdoc had me do for a few days before I even started the Adderall, so I would be as calm as possible. I'm sure the klonopin is taking the edge off; I just don't like the depressed, 'crash' feeling when the Adderall wears off, 'cause it reminds me off my former days with drug abuse. Oh, and yes, my doctor did try me on Wellbutrin first, but I had bad side-effects. I guess it's sort of a psychological thing; I have to remind myself that I'm not ravaging my body with illicit drugs, but that I'm taking a prescribed drug for a corresponding diagnosis. Besides, when the Adderall is working, and I'm not crashing, it's fine - it does the job; and I know it's only been one day and it takes a while to find the right dosing for each individual. Thanks alot for your feedback, though, it encouraged me to know I'm on the right track (I hope).
Peter
> Let's see.
> The 1st time I took Adderall it made me severly
> manic and I was nauseaus as all heck. This was
> before I got a bipolar diagnosis. On Subsequent
> dosing, the Adderall had less of an effect on
> me (the nausea and spaciness went away). After
> 3 days, it had no effect. It just sounds like
> on your 1st experience it went a little
> balistic on you, which seems reasonable given
> you lowered your depakote, and Adderall can be
> pretty powerful for a bipolar. My dosing was
> in the 20-40mg range when it stabilized, and
> I only got a smooth Adderall response while
> also taking klonopin.
>
> I was depressed when I took the adderall so when
> it wore off i just returned to being about the
> same depressed.
>
> Suppose you took your standard dose of depakote
> with the adderall? I found that klonopin
> substantially smoothed out my adderall response
> and others have reported success with neurontin.
> Both are anti-convulsants. Maybe the older dose
> of depakote + the adderall would work out?
> You are already familiar with depakote so
> raising the dose a little to counter the adderall
> may balance things out and would be a quicky
> experiment.
>
> Just a suggestion.
>
> BTW, if you don't want to take an addictive
> med for ADD, then Wellbutrin is the obvious
> choice to augment your depakote (if you
> haven't already tried). Effexor would be 2nd.
> Plus if they worked they would have the same
> mood elevating effect. I'm guessing you've
> maybe tried these meds in the past though,
> because usually the doctor would give wellbutrin
> before trying adderall for the obvious
> addiction concern.
>
> -john
>
>
> > Hello all:
> > I've been diagnosed over the years with mild bipolar/SP. I've been on many mood stabilizers, finally settling on depakote, and have tried many SSRI's, which resulted in problems. I'm also on daily klonopin for SP/panic. It wasn't until I decreased the depakote as a test over a few months (my pdoc monitered me closely) that alot of other things about my mood rose to the surface (I think the years of depakote might have masked these new mood tendencies instead of targeting them). All of these newly apparent mood problems fall under the catagory of ADD, especially since I began to remember I had the same tendencies when I was a little kid. So, my pdoc told me at our last session that I have a combo bipolar/SP/ possible ADD diagnosis, and he just prescribed Adderall. I just took my first 2.5mg dose about 4 hours ago, and I noticed that I started feeling pretty good when it kicked in. I was calmer, more focused, and mildly euphoric. But I've also experienced a bit of nausea and spaciness. Now I feel sort of 'crashy' - low energy, low mood, and I feel like taking my second dose. My questions are: 1) Anyone experience these feelings (both the good and the side-effects)? 2) I don't want to be on this drug if I don't have ADD, especially since I had a past drug abuse problem. Are the effects the same for someone who has ADD and for someone who doesn't? I mean, I would think that either way anyone would feel good on it. Is it possible to tell if you have ADD by how you respond to the first few doses? I'd really like some input. Thanks.
Posted by Cressida on November 4, 2001, at 19:52:25
In reply to Re: Adderall help » Peter, posted by JohnX2 on November 3, 2001, at 15:53:23
Hey Peter, I was diagnosed with ADD at a very young age. I'm 24 and currently in college. I've tried all of the available stimulants: Ritalin/Concerta, Dexedrine and Adderall. I've been taking 20mg Adderall twice a day since mid-summer; over a year ago I tried 10mg Adderall, but it made me drowsy and spacey. I still frequently feel that way, but to a lesser degree.
I can relate to your "crashy" feeling. The initial stimulation is often accompanied by feelings of anhedonia. Adderall is an amphetamine mixture, so it is a powerful CNS stimulant. Something to remember is that it's supposedly "smoother" in action and lasts longer (4-6 hours) than regular methylphenidate.
The following is an excerpt from manufacturer's official prescribing information on Adderall:
"ADVERSE REACTIONS:
Cardiovascular: Palpitations, tachycardia, elevation of blood pressure. There have been isolated reports of cardiomyopathy
associated with chronic amphetamine use.Central Nervous System: Psychotic episodes at recommended doses (rare), overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia, dysphoria, tremor, headache, exacerbation of motor and phonic tics and Tourette’s syndrome.
Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances.
Anorexia and weight loss may occur as undesirable effects when amphetamines are used for other than the anorectic effect.Allergic: Urticaria.
Endocrine: Impotence, changes in libido.
DRUG ABUSE AND DEPENDENCE: Dextroamphetamine sulfate is a Schedule II controlled substance.
Amphetamines have been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred. There are reports of patients who have increased the dosage to many times that recommended.
Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with amphetamines include severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia. This is rare with oral amphetamines.OVERDOSAGE: Individual patient response to amphetamines varies widely. While toxic symptoms occasionally occur as an idiosyncrasy at doses as low as 2 mg, they are rare with doses of less than 15 mg; 30 mg can produce severe reactions, yet doses of 400 to 500 mg are not necessarily fatal.
Symptoms: Manifestations of acute overdosage with amphetamines include restlessness, tremor, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations, panic states, hyperpyrexia and rhabdomyolysis.
Fatigue and depression usually follow the central stimulation.
Cardiovascular effects include arrhythmias, hypertension or hypotension and circulatory collapse.
Gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Fatal poisoning is usually preceded
by convulsions and coma."So, the side-effects you're experiencing are common. If you're afraid of abusing Adderall or want something with less ups and downs, try Adderall XR or Concerta or Metadate CD. They're all once-a-day 12-hour extended-release forms of Adderall amd Ritalin; search for them on the web to get specific information. Adderall XR was approved by the FDA just last month.
I know someone in my major who was misdiagnosed with ADHD before he was properly diagnosed with bipolar disorder. According to him, if I remember correctly, stimulant medication didn't help much. If I were you, I'd give myself more time for my body to adjust to the drug, such as 1-3 weeks of taking it exactly as directed. If it works, it obviously works as it does for me. If it doesn't, then at least you gave it a shot, and hopefully learned something.
Posted by Peter on November 5, 2001, at 1:50:23
In reply to My Adderall info and experience, posted by Cressida on November 4, 2001, at 19:52:25
> Thanks for the great info, Cressida. I'm interested about this Adderall XR. Does it work as well as normal Adderall? Have you tried it? Since I've already started normal adderall, though, I'm wondering if the ups and downs smooth out over time, once you figure out the right dosing, etc. But is there a corellation between the dose and the duration? In other words, does a larger dose actually last longer or does it just increase effects? The reason I ask is because I'm wondering how my daily, active lifestyle can be managed with Adderall. I'm a musician so my schedule is very erratic; sometimes I'll have a gig or rehearsal late at night, and I wouldn't want to be feeling like crap and crashing during this time. Likewise I often have obligations early in the morning in addition to stuff late at night (I'm not a 9 to 5 guy). This makes my adderall dosing schedule confusing. If a larger dose means a longer duration, then maybe as my dose increases, I will get to a point where I'll be covered the whole morning, afternoon, and night on just those 2 doses (1 in morning and 1 in afternoon). Does this make sense? What do you think? I'm just trying to figure out if this is all manageable. Oh - and one last thing - does a higher dose mean a worse 'crash'?
Peter
> So, the side-effects you're experiencing are common. If you're afraid of abusing Adderall or want something with less ups and downs, try Adderall XR or Concerta or Metadate CD. They're all once-a-day 12-hour extended-release forms of Adderall amd Ritalin; search for them on the web to get specific information. Adderall XR was approved by the FDA just last month.
>
> I know someone in my major who was misdiagnosed with ADHD before he was properly diagnosed with bipolar disorder. According to him, if I remember correctly, stimulant medication didn't help much. If I were you, I'd give myself more time for my body to adjust to the drug, such as 1-3 weeks of taking it exactly as directed. If it works, it obviously works as it does for me. If it doesn't, then at least you gave it a shot, and hopefully learned something.
Posted by Peter on November 5, 2001, at 2:25:26
In reply to My Adderall info and experience, posted by Cressida on November 4, 2001, at 19:52:25
> Hey Peter, I was diagnosed with ADD at a very young age. I'm 24 and currently in college. I've tried all of the available stimulants: Ritalin/Concerta, Dexedrine and Adderall. I've been taking 20mg Adderall twice a day since mid-summer; over a year ago I tried 10mg Adderall, but it made me drowsy and spacey. I still frequently feel that way, but to a lesser degree.
> Also Cressida: do u ever feel a dull feeling on adderall (almost like being burnt out on alot of pot use) where you're a little spacey and free of worry, but your mind can concentrate and focus well on single things? This is what I've been experiencing and I'm wondering if it's normal-if, perhaps this is how an ADD person responds to it as opposed to a non-ADD person?
Peter
Posted by Cressida on November 5, 2001, at 15:24:26
In reply to Re: My Adderall info and experience, posted by Peter on November 5, 2001, at 1:50:23
I have not tried Adderall XR. It was approved for use by the FDA only a month ago. It is no less effective than plain Adderall. It's convenient because it's taken once a day.
Based on my experience with regular Adderall at 10mg and 20mg a higher dose doesn't correlate to a longer duration of action. One does at any strength will last between 4-6 hours. Of course that range isn't fixed in stone, as it can be affected by diet and metabolism, among others. A larger dose will often increase the chance of experiencing adverse reactions - that goes for a lot of drugs. I realize a more beneficial response at 20mg than at 10mg; FYI the next and highest dosage is a 30mg tablet. I can focus better, feel more lucid mentally, and feel calmer, which is strange since it's a stimulant. Most people with ADD/ADHD have that paradoxical reaction to CNS stimulants. The only downside to the higher dose is that I experience a deeper "crash" SOMETIMES when the medication begins to wear off. This is completely normal, and it's usually transient. I had steeper "crashes" that lasted longer when I was taking Concerta and Ritalin. In my experience Adderall is very smooth from beginning to end; a "softer" drug that's just as smooth is Dexedrine. Any "ups and downs" do diminish or smooth out over time as your body adjusts or once you find the appropriate dose and schedule that works.
Well, I hope this dialogue was helpful. If you want additional information, type Adderall or Adderall XR in Google's search engine. You might also visit Web sites about ADD/ADHD. They carry a lot of useful and random info on stimulant medication.
Posted by Cressida on November 5, 2001, at 15:51:42
In reply to Re: My Adderall info and experience, posted by Peter on November 5, 2001, at 2:25:26
It seems a coincidence that you mention feeling burned out and dulled by Adderall. I've been feeling a little burned out lately. I've always felt dulled or vegetative on stimulants. Like I wrote in the previous posting, Adderall and friends frequently have a calming effect on ADDers. If it's uncomfortable, then maybe you're on too much. If the lowest dosage strengh is making you feel that way, that probably indicates a need for a different med; such as Dexedrine which has been touted as "softer", or a low dose of Ritalin. Talk with your doctor. Another thing to consider is that you could be over-analyzing yourself and your reaction. Sometimes I'm unfair to myself by being hyper-acute to every little change or discomfort. Have you honestly given yourelf time to settle into the new medication? Can you say that you're not worrying needlessly? No person nor any drug is perfect.
Posted by Peter on November 6, 2001, at 10:53:41
In reply to Re: My Adderall info and experience, posted by Cressida on November 5, 2001, at 15:51:42
> You got it; my mind races around and I do worry needlessly about everything, including the very medication I'm taking to try to calm the endless worrying down. Ironic, huh? Thanks for your advice. It's been very helpful, and I'm just going to cool it, follow doctor's orders, and try to not be so hyper-sensitive about every little thing (story of my life).
>It seems a coincidence that you mention feeling burned out and dulled by Adderall. I've been feeling a little burned out lately. I've always felt dulled or vegetative on stimulants. Like I wrote in the previous posting, Adderall and friends frequently have a calming effect on ADDers. If it's uncomfortable, then maybe you're on too much. If the lowest dosage strengh is making you feel that way, that probably indicates a need for a different med; such as Dexedrine which has been touted as "softer", or a low dose of Ritalin. Talk with your doctor. Another thing to consider is that you could be over-analyzing yourself and your reaction. Sometimes I'm unfair to myself by being hyper-acute to every little change or discomfort. Have you honestly given yourelf time to settle into the new medication? Can you say that you're not worrying needlessly? No person nor any drug is perfect.
Posted by Mitch on November 6, 2001, at 13:29:29
In reply to Adderall help, posted by Peter on November 3, 2001, at 13:57:19
> Hello all:
> I've been diagnosed over the years with mild bipolar/SP. I've been on many mood stabilizers, finally settling on depakote, and have tried many SSRI's, which resulted in problems. I'm also on daily klonopin for SP/panic. It wasn't until I decreased the depakote as a test over a few months (my pdoc monitered me closely) that alot of other things about my mood rose to the surface (I think the years of depakote might have masked these new mood tendencies instead of targeting them). All of these newly apparent mood problems fall under the catagory of ADD, especially since I began to remember I had the same tendencies when I was a little kid. So, my pdoc told me at our last session that I have a combo bipolar/SP/ possible ADD diagnosis, and he just prescribed Adderall. I just took my first 2.5mg dose about 4 hours ago, and I noticed that I started feeling pretty good when it kicked in. I was calmer, more focused, and mildly euphoric. But I've also experienced a bit of nausea and spaciness. Now I feel sort of 'crashy' - low energy, low mood, and I feel like taking my second dose. My questions are: 1) Anyone experience these feelings (both the good and the side-effects)? 2) I don't want to be on this drug if I don't have ADD, especially since I had a past drug abuse problem. Are the effects the same for someone who has ADD and for someone who doesn't? I mean, I would think that either way anyone would feel good on it. Is it possible to tell if you have ADD by how you respond to the first few doses? I'd really like some input. Thanks.I have been dx'ed in the past two years with BPII, SP, Panic, and ADD. The Adderall worked for me quite well and it actually had an anti-cycling effect and improved my sleep/wake architecture. I was taking Neurontin instead of Depakote with it however. I have trouble with SSRI's too, but if I don't take a serotonergic med, I tend to get panicky. I had to stop it because of panic that developed-although I wasn't taking a Benzo or antidepressant with it at the time.
The best way you can tell if it is really making a difference is at work and when you are listening to music (just my opinion). I found that I could be busy on the computer doing something very complex and there could be a group of people standing nearby busily talking and if they wanted to talk to me or ask a question about something they had to *get my attention*. Whereas before I got so distracted by their conversation I had to STOP what I was doing and wait for them to go away so I could concentrate on my work! As far as the music goes-there are scores of CD's I own that I have only faint clues what the lyrics are in the songs or even what the CD (as a whole) is about. When I was taking Adderall I could actually hear the words in the song and more importantly *understand contextually* what the song was about! Otherwise lyrics just seem like a lot of sounds with no meaning to them.
I also had some mild euphoria and insomnia the first couple of days I took it as well, and then that disappeared and I just felt focused. Another thing: Ordinary mundane tasks didn't seem so dreadfuly *boring*. They just became tasks with lots of little discrete steps to them that you do one after the other. Another thing: Games. I NEVER could follow the rules on how to play most card games. Someone would tell me a bunch of stuff that I would half-ass understand, the game would start, and then I would be asking everybody what I was supposed to do. I couldn't keep track of who had what, what cards they just discarded, etc. It was just another big blur. On the Adderall (5mg/day), it was like another world. When someone wanted to do something that I previously considered boring, my attitude was just "sure-why not?", and I would go through the motions and not feel bored/agitated/restless/need to escape!
As far as the effects on SP went it was kind of mixed. I felt more interested in being around people and doing more ordinary things, but I really picked up any negativity from people a lot easier than before, and that would make me more anxious and edgy. But on the other hand, I didn't feel the pressure to talk as much, and I generally was a lot more quieter.
Hope this helps,
Mitch
Posted by Peter on November 6, 2001, at 14:09:47
In reply to Re: Adderall help » Peter, posted by Mitch on November 6, 2001, at 13:29:29
> > Hey Mitch. I'm completely with you on all you've said. Now that I'm getting more used to the adderall, I'm realizing that it really does calm me down and help me to hyperfocus on important things without being as easily distracted. The music thing is interesting. I'm a musician - a jazz pianist - even off of medication I can get very involved in creating music because I love it. But now that I think of it, I always had trouble following lyrics and the spoken meaning of certain compositions. Since I was very young, it always seemed like my friends would be able to recite lyrics and I'd just be in the dark. I'll see as the days go by how adderall helps me with that. As far as the SP, you really hit the nail right on the head; I'm more willing to go out, be with groups, less nervous and chronically worrisome about engaging in new activities, and less restless and agitated when I do engage in them. But I gotta say there is something wierd that accompanies the benefits - maybe a subtle paranoia or oversensitivity to people around me, like you touched on. Also, I gotta get used to the "crash" element of the adderall - when it wears off, I sort of feel crappy. Oh well, I guess finding the right doses of the combined adderall, depakote, and kolonopin can smoothen the problems out. BTW, did you take 5mg 2x each day or 5mg total? Starting tomorrow I'm going from 2.5mgx2 to 5mg+2.5mg, and eventually up to 5mgx2 by the end of the week. Just curious. Anyway, thanks alot for your input; it's been really helpful and encouraging.
Peter
> I have been dx'ed in the past two years with BPII, SP, Panic, and ADD. The Adderall worked for me quite well and it actually had an anti-cycling effect and improved my sleep/wake architecture. I was taking Neurontin instead of Depakote with it however. I have trouble with SSRI's too, but if I don't take a serotonergic med, I tend to get panicky. I had to stop it because of panic that developed-although I wasn't taking a Benzo or antidepressant with it at the time.
>
> The best way you can tell if it is really making a difference is at work and when you are listening to music (just my opinion). I found that I could be busy on the computer doing something very complex and there could be a group of people standing nearby busily talking and if they wanted to talk to me or ask a question about something they had to *get my attention*. Whereas before I got so distracted by their conversation I had to STOP what I was doing and wait for them to go away so I could concentrate on my work! As far as the music goes-there are scores of CD's I own that I have only faint clues what the lyrics are in the songs or even what the CD (as a whole) is about. When I was taking Adderall I could actually hear the words in the song and more importantly *understand contextually* what the song was about! Otherwise lyrics just seem like a lot of sounds with no meaning to them.
>
> I also had some mild euphoria and insomnia the first couple of days I took it as well, and then that disappeared and I just felt focused. Another thing: Ordinary mundane tasks didn't seem so dreadfuly *boring*. They just became tasks with lots of little discrete steps to them that you do one after the other. Another thing: Games. I NEVER could follow the rules on how to play most card games. Someone would tell me a bunch of stuff that I would half-ass understand, the game would start, and then I would be asking everybody what I was supposed to do. I couldn't keep track of who had what, what cards they just discarded, etc. It was just another big blur. On the Adderall (5mg/day), it was like another world. When someone wanted to do something that I previously considered boring, my attitude was just "sure-why not?", and I would go through the motions and not feel bored/agitated/restless/need to escape!
>
> As far as the effects on SP went it was kind of mixed. I felt more interested in being around people and doing more ordinary things, but I really picked up any negativity from people a lot easier than before, and that would make me more anxious and edgy. But on the other hand, I didn't feel the pressure to talk as much, and I generally was a lot more quieter.
>
> Hope this helps,
>
> Mitch
Posted by benzapp on November 6, 2001, at 19:19:19
In reply to Adderall help, posted by Peter on November 3, 2001, at 13:57:19
I have had my drug abuse problems as well. Nothing makes me as calm, focused, an happy as do opiates, but Adderall is a good alternative. I have the same reactions to Adderall, it can be a little variable, and the effects diminish over time making you want to take more, more frequently. Not to the extreme, but now I take 10mg 4x a day, instead of 3x.
All i can say is Adderall withdrawl is not heroin withdrawl, in some ways its worse. As crazy as you feel from opiate withdrawl, you can still THINK, especially if you take some valium. But Adderall withdrawl, you can't think at all, and nothing helps, except of course Adderall. but it goes away, I wouldn't worry. As far as the negative effects, like feeling more spacey, sugar helps, as well as taking hefty doses of B vitamins and the amino acid Tyrosine. I am in graduate school now, and its amazing what a snickers bar can do. Just remember Adderall really boosts your metabolism, so eating more in general will make a big difference. Alcohol and Tobacco also really precipitates the spacey feeling. If I have just two drinks or smoke some cigarettes, the next day studying is not possible. The mild euphoric effect is also very transient, so if you are looking for Adderall to boost your mood.. Its a bad choice. Until opiates are easily prescribed, I don't think positive moods will ever be possible for most people. As far as I can tell, morphine is far superior to anything else for immediately reversing and preventing depression.
> Hello all:
> I've been diagnosed over the years with mild bipolar/SP. I've been on many mood stabilizers, finally settling on depakote, and have tried many SSRI's, which resulted in problems. I'm also on daily klonopin for SP/panic. It wasn't until I decreased the depakote as a test over a few months (my pdoc monitered me closely) that alot of other things about my mood rose to the surface (I think the years of depakote might have masked these new mood tendencies instead of targeting them). All of these newly apparent mood problems fall under the catagory of ADD, especially since I began to remember I had the same tendencies when I was a little kid. So, my pdoc told me at our last session that I have a combo bipolar/SP/ possible ADD diagnosis, and he just prescribed Adderall. I just took my first 2.5mg dose about 4 hours ago, and I noticed that I started feeling pretty good when it kicked in. I was calmer, more focused, and mildly euphoric. But I've also experienced a bit of nausea and spaciness. Now I feel sort of 'crashy' - low energy, low mood, and I feel like taking my second dose. My questions are: 1) Anyone experience these feelings (both the good and the side-effects)? 2) I don't want to be on this drug if I don't have ADD, especially since I had a past drug abuse problem. Are the effects the same for someone who has ADD and for someone who doesn't? I mean, I would think that either way anyone would feel good on it. Is it possible to tell if you have ADD by how you respond to the first few doses? I'd really like some input. Thanks.
Posted by Mitch on November 7, 2001, at 0:18:06
In reply to Re: Adderall help, posted by Peter on November 6, 2001, at 14:09:47
> > > Hey Mitch. I'm completely with you on all you've said. Now that I'm getting more used to the adderall, I'm realizing that it really does calm me down and help me to hyperfocus on important things without being as easily distracted. The music thing is interesting. I'm a musician - a jazz pianist - even off of medication I can get very involved in creating music because I love it. But now that I think of it, I always had trouble following lyrics and the spoken meaning of certain compositions. Since I was very young, it always seemed like my friends would be able to recite lyrics and I'd just be in the dark. I'll see as the days go by how adderall helps me with that. As far as the SP, you really hit the nail right on the head; I'm more willing to go out, be with groups, less nervous and chronically worrisome about engaging in new activities, and less restless and agitated when I do engage in them. But I gotta say there is something wierd that accompanies the benefits - maybe a subtle paranoia or oversensitivity to people around me, like you touched on. Also, I gotta get used to the "crash" element of the adderall - when it wears off, I sort of feel crappy. Oh well, I guess finding the right doses of the combined adderall, depakote, and kolonopin can smoothen the problems out. BTW, did you take 5mg 2x each day or 5mg total? Starting tomorrow I'm going from 2.5mgx2 to 5mg+2.5mg, and eventually up to 5mgx2 by the end of the week. Just curious. Anyway, thanks alot for your input; it's been really helpful and encouraging.
> Peter
Hey, no problem! I have only rapped with a few folks here with this odd combo of troubles. I have been through some docs over the last few years (including a neuro that did some brain mapping that said I had some asymetrical hypofunction in my frontal lobes-whatever!). Have had the BPII dx around my neck for over 20 years, but interestingly with no hospitalizations or relatives/friends dragging me to see a doctor!As far as music goes-I have to have it around me constantly. Also I am always listening to my own CD's and stuff, not the radio with all the commercials-need to have that control. Yes, *creating* something is one hell of a lot easier than *analyzing* stuff- though my job involves a lot of analysis it is *graphical* in nature.
I never tried to learn to play music until I was seeing a shrink. My first therapist (of about 18 years) played lead guitar in a roaming bar band in the midwest and sold me his 1967 Gibson "f-hole" dual accoustic/electric for $600 so I could try to learn. He bought it right back when I got frustrated with trying to play it-I really..really.. wished I would have kept that and plowed on!As far as lyrics go-throw something lyrically complex in the CD player (it may take some extensive thought to even come up with a lyrically complex example!) in the morning an hour of two after the Adderall and a cup of coffee and see what happens.?? I found listening to some Van Morrison or older Dylan lyrics were especially enlightening (don't ask me any specifics about those now-because I won't be able to remember).
As far as the "hypersensitivity" goes-I have seen a couple of posts here about this. Even my pdoc mentioned this also. When you become more "attuned" to the CONTEXTS around you (all sorts of contexts), you are going to experience a lot of stuff that you MISSED before-and that may freak you out somewhat. IF you grow up as a child (without ADHD), you "pick up" on these social cues and ADAPT over time. When you start taking meds now that flood you with NEW information that you "tuned out" due to inattentiveness you may get panicky and experience worsening of pre-existing anxiety disorders.
Oh, as far as dosage goes-I started off with 2.5mg in the morning like you did. I also noticed a "crashing" effect later in the evening before bedtime accompanied by some irritability. I then just increased it to 5.0mg in the morning and I was fine. I "crashed" just an hour or two before I would normally go to sleep. I slept like a rock without any disturbances and woke up about 7-8hrs later within minutes (+/-) for days. In hindsight, it might have worked better for me to take 2.5mg/twice daily (say 2nd dosing in the afternoon).
I really think that just plain Dexedrine would have worked better for me also somehow. The "L"-amphetamine that is mixed up in Adderall is supposed to cause more anxiety then the "D"-amphetmaine(dexedrine). I did notice that within about an hour of dosing in the morning I would have this almost *sleepy* phase where I could go and lay in the sunshine coming through the windows and nearly nap for an hour. But, I got these *waves* of anxiety that would ebb and flow during the day. I wonder if it was the "mixed-salts" peculiarities of the med.
Keep us posted,
Mitch
Posted by DiscoPuppy on May 14, 2002, at 18:16:05
In reply to Re: Adderall help » Peter, posted by Mitch on November 7, 2001, at 0:18:06
What type of doctor have you guys been seeing? A GP, psychiatrist, etc.? Adderall should never have been prescribed to someone who had a previous drug abuse problem.
Posted by katekite on May 16, 2002, at 10:24:56
In reply to Re: Adderall help, posted by DiscoPuppy on May 14, 2002, at 18:16:05
While I agree it sounds risky to prescribe drugs to previous drug abusers, many people abuse drugs for a reason. (depression, anxiety, ADD)
For example, 15% of cocaine users are reported to experience a slowing calming effect from it, not the energizing effect most people are seeking. The theory is maybe these 15% have ADD and are self medicating. If one took a sample of the general population and gave them coke, far less than 15% would be calmed, most would get speedy...so this translates that people with ADD are more likely to chronically use cocaine. (The issue is a little hard to research since you can't just experiment with cocaine, but that's the theory).
Think, if you can get that 15% on a safer alternative like adderall you would be actually treating them -- and removing 15% of the druggie population.
Another study has shown that kids medicated for their ADD with a prescription stimulant are actually less likely to abuse drugs or alcohol later in life, than those who were identified at the same age but never medicated..... the theory there is maybe the frustration and secondary problems that go along with untreated ADD lead to self medication.
I take ritalin for ADD and had never tried coke, am not an addict in any way. However, had I known coke might calm me down instead of speed me up I might well have tried it had ritalin not been available!
I think its a mistake to label people abusers and therefore deny them medication that might help them.
kate
Posted by 3 Beer Effect on May 17, 2002, at 13:43:50
In reply to drugs for previous drug abusers, posted by katekite on May 16, 2002, at 10:24:56
Katekite,
If I were a psychiatrist or doctor I don't think I would prescribe Ritalin, Adderall, Focalin, or Dexedrine/Dextrostat to a previous Cocaine, Speed/Crystal Methamphetamine, or multiple-drug abuser.From personal experience, the temptation to abuse these drugs for former drug abusers & sometimes even plain old alcoholics is great.
A big problem is that all of the Schedule II ADD stimulants are very easy to abuse & they are very powerful drugs.
All one has to do is save up a few days worth of medication (40+ mg Adderall, or 60+ mg Ritalin), crush them up with a credit card or better yet the available everywhere otc "pill pulverizer" and snort them in a manner similar to powder Cocaine hcl with a dollar bill (dirty) or as a cleaner method they use a shortened unused Slurpee straw, empty pen tube, or even a rolled up post-it note.I think the street name for Ritalin is "West Coast", while College Kids call it "Vitamin R" or "Rit". Oddly enough, on the 'street', intranasal Ritalin with either oral Zoloft (Zoomers) or pentazocine (T's & Rits/Poor Man's Heroin) are sometimes (though rarely) used combinations. Generally, ADD stimulants (with the exception of Desoxyn) are derided as "kiddy drugs" in the ghetto & aren't being sold by/diverted to traditional drug dealers. The people doing the dealing are children or college kids with ADD prescriptions who obviously dislike (children are said to experience dysphoria on Ritalin/Adderall) or don't need/have too much of the medication in the case of college kids.
Granted, these medicines do not offer anywhere near the euphoria of crack cocaine or crystal methamphetamine.
BUT, the major draw & temptation to misuse/abuse these ADD stims is that they are easily available, & pharmaceutically pure so you know what you are getting, while street drugs like Cocaine & Speed are adulterated/cut with all sorts of things from Ephedrine, Caffeine, Procaine, Benzocaine, Vitamin b-12, laxatives, baking soda, & even strychnine (a very dangerous stimulant also used as a rat poison!).Also, business professionals & college students can abuse these stims (intranasally or orally) to gain a competitive work/academic edge without any obvious external symptoms of drug abuse & without the danger/risk of arrest that comes with going to the ghetto to buy street drugs out in public from armed & very paranoid drug dealers.
From personal experience, Ritalin & Adderall in adequate dosages intranasally produce an much longer lasting "high" that roughly parallels the "high" from the "cut/highly diluted" poor quality 'powder' Cocaine hcl available in most areas of the US (excluding of course areas close to Mexico with higher quality cocaine especially Southern California, & also AZ, NM, Texas-south of San Antonio, & the port cities of Houston & Miami, FL).
Adderall in high enough doses causes mild visual hallucinations, & Adderall combined with Ritalin intranasally produces a double whammy effect of extensive dopamine release & blocking of its reuputake causing a "high" with euphoric & somewhat hallucinogenic properties that is very close or equal to the powerful street drugs intranasal methamphetamine hcl or relatively 'uncut' powder cocaine hcl like that available in Mexico border cities, but thankfully, no one has seemed to figure this out yet. But I would guess the risk of adverse (hypertensive) effects of this combination is great- much greater than Adderall or Ritalin alone.
The new ADD stimulant, Focalin, eliminates half of Ritalin-all of which is the inactive isomer & so is basically useless/filler, retaining only the active d-isomer, & has no color additives & a limited amounts of dilutents/inactive ingredients & if abused intranasally would probably be much more potent in its effects than Ritalin.
Very surprisingly, Dexedrine & Dextrostat are arguably stronger than Adderall when taken orally, but intranasally are less effective probably because they are much more diluted with inactive ingredients (A 5 mg Dexedrine pill contains 13.8 mg of sucrose along with 4 other inactive ingredients/dilutents, & a 10 mg Dextrostat pill is about equal to the size of a 30 mg Adderall pill indicating that it contains a large amount of inactive ingredients/dilutents. I don't know if these (50+ year old pills) have always contained so many inactive ingredients- I do know that many years ago Dexedrine was once available in 10 mg pills & in an elixir form that was discontinued a few years back. Perhaps the makers of Dexedrine & Dextrostat learned from the speed epidemic of the late 1960s & diluted the pills enough so that when an attempt at intranasal abuse is made, the bulky inactive ingredients greatly slow the absorption into the bloodstream, thus greatly reducing the high & making intransal abuse almost pointless.
I think the best choice for a former stimulant drug addict would be Wellbutrin SR since street drug use is self-medication often for both depression & adult add, & Wellbutrin SR often clears up both, but its risk of abuse is low.
Another good choice, would be Concerta. Concerta cannot really be abused intranasally, & there have been reports of failed attempts at this by adolescents.
Other possible choices would include Adderall XR or Dexedrine Spansules, but only assuming that the pellets inside the capsules cannot be grinded up into a dry powder (which I don't know the answer to & haven't read anything on this).
Perhaps, the best thing would be to educate the former drug abuser on the futility on intranasal abuse. For example, the intranasal abuse of Ritalin by college kids in order to study & focus better is self-defeating, because Ritalin only lasts for one hour intranasally, while if swallowed on an empty stomach provides about 3.5 hours of efficacy. Tolerance to Ritalin skyrockets when used intranasally at a ridiculous rate. But with a proper oral regimen, tolerance to Ritalin (or Adderall) is a slow process easily fixed by taking stimulant breaks on weekends or stimulant holidays.
But remember, drugs like Ritalin & Adderall can be abused orally, so everyone should be careful when taking ADD stimulants. Anytime you are "saving up", or "taking double doses" it often begins a viscious circle of last minute procrastination of work/study/deadlines that you often meet successfully for the first few times (by escalating the dosage), but eventually this sporadic dosage escalation induces 'pyschological dependence' & tolerance- you find that your prescribed dose no longer works as well as it used to & you begin to believe that you won't be able to work or study even normally, without the x dose of Ritalin/Adderall that helped you meet that deadline/cram/stay up all night in the past.
So remember that even though Ritalin/Adderall/Dexedrine etc are not "physically" addictive, they are still powerful DEA Schedule II Drugs [the same class as prescription Cocaine, Desoxyn (methamphetamine hcl), Seconal, Oxycontin, Dilaudid ("drugstore heroin"), Percocet, Morphine etc.] that some, especially adults, can become "psychologically" addicted to resulting in dose escalation & abuse. So remember to periodically take weekend breaks (Ask yourself if really need that Ritalin on a Friday afternoon/night) & when tolerance builds take a week off "a stimulant holiday".
3 Beers.....
Posted by Elizabeth on May 17, 2002, at 17:07:50
In reply to ADD stimulants similarities to Cocaine Meth. » katekite, posted by 3 Beer Effect on May 17, 2002, at 13:43:50
I think it's important to recognize that the reason some people like drugs such as cocaine and meth is that these drugs are actually treating symptoms of a mental disorder such as ADD or depression. The problem is that stimulants can cause euphoria (and people usually become tolerant to this effect after a short time), so if there isn't a doctor monitoring you, then you risk becoming dependent on them. Still, I don't think that people who have ADD should be denied effective treatment simply because they abused stimulants at some point in the past. This is the kind of decision that has to be made on an individual basis, IMO. (Same with opioids or benzos.)
Of course, there are some people who will just be toooooo tempted if you hand them a script for a bottle of Adderall. It's hard to predict, but I'm sure there are cases where it would be better to try milder stimulants (Cylert, Provigil, phentermine, etc.) and see if they work. But remember that different people have different experiences; not all who use stimulants recreationally become addicts, and there are lots of people who once abused stimulants who nonetheless can use them responsibly as medications.
> A big problem is that all of the Schedule II ADD stimulants are very easy to abuse & they are very powerful drugs.
I have to disagree with that in regard to Ritalin. Some high school and college kids seem to get a kick out of it, but I think that most people who'd previously been taking amphetamine or cocaine would not be impressed by Ritalin.
> All one has to do is save up a few days worth of medication (40+ mg Adderall, or 60+ mg Ritalin), crush them up with a credit card or better yet the available everywhere otc "pill pulverizer" and snort them in a manner similar to powder Cocaine hcl with a dollar bill (dirty) or as a cleaner method they use a shortened unused Slurpee straw, empty pen tube, or even a rolled up post-it note.
You know you're cheap when...!
> I think the street name for Ritalin is "West Coast", while College Kids call it "Vitamin R" or "Rit".
"Ritalin" was what I always heard. And the people who used it when I was in college were mainly looking for a way to pull an all-nighter -- it wasn't considered a party drug. (And yes, some folks did snort it.)
> Oddly enough, on the 'street', intranasal Ritalin with either oral Zoloft (Zoomers) or pentazocine (T's & Rits/Poor Man's Heroin) are sometimes (though rarely) used combinations.
Pentazocine (Talwin) is *nothing* like heroin. It's a kappa agonist/mu antagonist. If a heroin addict takes it, it will trigger withdrawal symptoms. And as for Zoloft...well, we all know how absurd that one is.
Kids these days have pretty low standards when it comes to getting high. I mean, some people will take *anything*. Ahh, the power of the placebo effect!
> But I would guess the risk of adverse (hypertensive) effects of this combination is great- much greater than Adderall or Ritalin alone.
The most serious risk of stimulant overdose is probably paranoid psychosis, actually.
> I think the best choice for a former stimulant drug addict would be Wellbutrin SR since street drug use is self-medication often for both depression & adult add, & Wellbutrin SR often clears up both, but its risk of abuse is low.
Unfortunately, a lot of people find that Wellbutrin isn't very effective for ADD.
> So remember that even though Ritalin/Adderall/Dexedrine etc are not "physically" addictive ...
I think I disagree with this. Stimulant withdrawal is real and definitely sucks, although it doesn't make you downright sick (like opioid withdrawal) or cause seizures (like benzo or barb withdrawal). And of course, people who abuse stimulants almost always develop tolerance (the other definitive characteristic of addiction). There's more to stimulant dependence than just nonspecific psychological "cravings."
> ... they are still powerful DEA Schedule II Drugs ...
The FDA is the regulatory agency that does the scheduling (the DEA is a law enforcement agency). But anyway, the FDA has often made poor decisions. The Schedule in which the FDA places a drug should not be considered proof of the drug's abuse potential. (Remember, these are the guys who made Meridia a controlled substance while the almost-identical Effexor is not. I could list dozens of other silly things the FDA has done, but you get the point.)
> So remember to periodically take weekend breaks (Ask yourself if really need that Ritalin on a Friday afternoon/night) & when tolerance builds take a week off "a stimulant holiday".
I don't think that people using stimulants for ADD or narcolepsy typically become tolerant. As for skipping a couple days, I'd expect that to result in withdrawal symptoms (once again, there *is* a specific and well-defined stimulant withdrawal syndrome). It might be something good to try, but I don't think it's necessary for everyone.
-elizabeth
Posted by katekite on May 17, 2002, at 22:22:05
In reply to Re: psychostimulant treatment for former abusers » 3 Beer Effect, posted by Elizabeth on May 17, 2002, at 17:07:50
Apparently Wellbutrin is only effective for about 30% of adult ADDers, whereas the stimulants work for 80-90 % depending on the reference.
It would be a shame to keep someone with ADD from functioning because of concern over addiction. Yes addiction is real. Yes people with ADD can abuse their medication. But will they? Who is to say that? That's extremely individual and the decision should be up to the doctor and the patient and the patient's family.
I'm off of ritalin for a week right now for a medical test. I hate it. My functional status just sucks. I don't think I should take weekends off... maybe a week once a year, but not every weekend. ADD is a pervasive condition that affects all of life, it is not a work-disorder. I barely can organize myself to pee before I burst -- pretty basic issue that doesn't go away at night or on weekends.
Yes, people with ADD who are past drug users should try Wellbutrin first. But not only Wellbutrin, if it doesn't work.
The new non-stimulant atmoxetine should be out this year as an alternative for past addicts. No one will know until its been out for a while whether it actually works.... but the option is good to have.
kate
Posted by Zo on May 18, 2002, at 3:31:16
In reply to Re: psychostimulant treatment for former abusers, posted by katekite on May 17, 2002, at 22:22:05
Okay, it's not a pstim. . .but it has an amazing effect, opening up and organizing a part of my brain that Dexedrine (and Adderall) never touched. When added to Dex, I should say. . . for me.I keep seeing this argument over and over again, on the board. . .Who IS it that is getting high off Dexedrine? In these teeny-tiny ADD amounts? Certainly not anybody *with* ADD, certainly not anyone in *need* of dopamine, it's just bringing us up to normal! Organizing. Giving that Executive Function a little kick so it can *try* and keep up with that racing, funny, non-linear space cadet of a Right Brain.. . .You get my point. I hope. ..
Zo
Posted by MomO3 on May 21, 2002, at 16:23:58
In reply to Re: Adderall help, posted by DiscoPuppy on May 14, 2002, at 18:16:05
I know a couple people with current drug problems that have been prescribed adderall... for the one guy I am thinking of, his wife is upset because he won't party with her anymore. Adderall has taken away his DESIRE to do coke.
Posted by Phil on May 21, 2002, at 19:34:08
In reply to Re: Adderall help, posted by MomO3 on May 21, 2002, at 16:23:58
Boy, they are a high functioning couple. 8^D
I used to abuse coke and meth years ago and agree w/ the self-medicating idea. My pdoc, when I told him I did coke in my younger years and it helped me focus, etc. He used that as a reason to put me on Ritalin. I have never abused any psych med and don't think it's a problem for ex abusers. There will be exceptions but a sharp doc will know it.
I wouldn't prescribe stims to anyone who is actively doing coke, obviously. But, the guy probably forgot to mention it. My .02.
Posted by Christina on May 22, 2002, at 12:30:06
In reply to Re: Adderall help, posted by MomO3 on May 21, 2002, at 16:23:58
His wife needs to get a real life.
I can understand that... Adderall has almost wiped out my obsession with over-eating.
It has been wonderful.
Posted by Elizabeth on May 22, 2002, at 13:56:30
In reply to Re: psychostimulant treatment for former abusers, posted by katekite on May 17, 2002, at 22:22:05
> Apparently Wellbutrin is only effective for about 30% of adult ADDers, whereas the stimulants work for 80-90 % depending on the reference.
That's interesting, although it comes as no surprise that WB doesn't work. (What's the placebo response rate?) Can you provide sources for me to look at? Also, do you happen to know what the stats are for kids?
Lately Effexor has been pushed for ADD. I doubt it's any better than WB, but who knows? Imipramine and other TCAs used to be considered options as well, but I'd hesitate very much to give those to kids (plus I'm skeptical as to whether they even work).
> I'm off of ritalin for a week right now for a medical test. I hate it. My functional status just sucks. I don't think I should take weekends off... maybe a week once a year, but not every weekend. ADD is a pervasive condition that affects all of life, it is not a work-disorder.
For a long time ADD was considered a childhood disorder, and lately stimulants have been thrown at any kid who's "difficult" for teachers. Because of the "treatment first, diagnosis second" methodology that has become so common lately (especially in amateur psychiatric diagnosis!), the assumption is that if stimulants help, then ADD must be the cause of their bad behavior. Stimulants do sometimes decrease the behavior, but I don't think that childhood violence and other serious misbehavior are necessarily (or even usually) indicative of ADD.
Anyway, that was a sidetrack, but the point I was going to make was that a lot of these kids who are a handful in school are fine when they're at home, which is a clear sign that they probably *don't* have ADD -- the problem, whatever it is, only manifests in one area of their lives, not in a variety of settings. It's more likely that this school-limited mishbehavior is related to a difficulty adapting to the requirements of a school environment, I would guess.
> I barely can organize myself to pee before I burst -- pretty basic issue that doesn't go away at night or on weekends.
Well, *that's* something that imipramine could help with, at least!
> Yes, people with ADD who are past drug users should try Wellbutrin first. But not only Wellbutrin, if it doesn't work.
There are other options, too, such as clonidine (and of course the TCAs and Effexor). I don't know if they've ever been studied, but I'd expect MAOIs to be very effective in ADD, more so than the TCAs and the newer ADs. And as Zo points out, modafinil is an option...if you have good insurance!
(Zo: why do you not consider Provigil to be a "pstim?" It's not a phenethylamine, but I'd call it a psychostimulant. And no, I don't know who is getting high on Dexedrine etc. A sometime-professor of mine said that when he tried amphetamine as a med student, he became "quasi-psychotic," although others used it for staying-awake purposes.)
> The new non-stimulant atmoxetine should be out this year as an alternative for past addicts. No one will know until its been out for a while whether it actually works.... but the option is good to have.
Do you mean atomoxetine? AFAIK, it's just another monoamine (NE) reuptake inhibitor. I know that it's been found effective for ADD in several studies -- we'll see if that result is borne out in "real life." :-)
-elizabeth
Posted by katekite on May 22, 2002, at 17:15:12
In reply to Re: psychostimulant treatment for former abusers, posted by Elizabeth on May 22, 2002, at 13:56:30
Yes sorry atomoxetine. I agree too, that there are lots of alternatives to stimulants.
That 30% figure came directly from the mouth of my nerdy psychiatrist.... so I don't have a reference, although with him I'm sure there is one somewhere. He said, and I have seen too, most journal articles quoting a much higher success. He says that is often transient or just not tolerated in the dose needed.
I agree kids are overmedicated. One really needs to adhere to diagnosing it only when the attentional and impulse problems are pervasive throughout life.
I also have read about really really little kids getting the diagnosis, say, at 2 or 3. That's pretty crazy.
kate
Posted by azurebay on May 22, 2002, at 18:35:43
In reply to ADD stimulants similarities to Cocaine Meth. » katekite, posted by 3 Beer Effect on May 17, 2002, at 13:43:50
> Katekite,
> If I were a psychiatrist or doctor I don't think I would prescribe Ritalin, Adderall, Focalin, or Dexedrine/Dextrostat to a previous Cocaine, Speed/Crystal Methamphetamine, or multiple-drug abuser.Love the name 3Beers (and hi Ketekite):
However I disagree with you regarding former substance abusers and the prescribing of ADD/ADHD medications. Granted, it may be questionable in some situations, even this one. But you must know the research behind ADD/ADHD(?)
An extremely high percentage (depending on which study you read, but in almost every single one where substance abuse is related to ADD...), the person has little if ANY desire to abuse the neurostimulant. In fact, it is quite the opposite response.
The bottom-line question of importance, yet again, is getting THE correct diagnosis by a psychiatrist, not a GP or any other doc.
I can tell you with absolute, one-hundred-percent certainty that I, as a former substance abuser, did not in the least manner have any tendiency to abuse neurostimulant medication. And I never have, in going on three-something years. It was like a feeling of, "Finally... wow I can function half-normal!"
Ya, I certainly discovered other comorbid problems underneath the ADD, but with the right psychiatrist they, too, are now like night and day compared to even two years ago.
So, I totally challenge the idea that substance abusers will abuse psychostimulant medications, assuming they are properly diagnosed with true ADD/ADHD. And I believe the vast majority of research confirms that point.
Smiles Always,
Azure
>
> From personal experience, the temptation to abuse these drugs for former drug abusers & sometimes even plain old alcoholics is great.
>
> A big problem is that all of the Schedule II ADD stimulants are very easy to abuse & they are very powerful drugs.
> All one has to do is save up a few days worth of medication (40+ mg Adderall, or 60+ mg Ritalin), crush them up with a credit card or better yet the available everywhere otc "pill pulverizer" and snort them in a manner similar to powder Cocaine hcl with a dollar bill (dirty) or as a cleaner method they use a shortened unused Slurpee straw, empty pen tube, or even a rolled up post-it note.
>
> I think the street name for Ritalin is "West Coast", while College Kids call it "Vitamin R" or "Rit". Oddly enough, on the 'street', intranasal Ritalin with either oral Zoloft (Zoomers) or pentazocine (T's & Rits/Poor Man's Heroin) are sometimes (though rarely) used combinations. Generally, ADD stimulants (with the exception of Desoxyn) are derided as "kiddy drugs" in the ghetto & aren't being sold by/diverted to traditional drug dealers. The people doing the dealing are children or college kids with ADD prescriptions who obviously dislike (children are said to experience dysphoria on Ritalin/Adderall) or don't need/have too much of the medication in the case of college kids.
>
> Granted, these medicines do not offer anywhere near the euphoria of crack cocaine or crystal methamphetamine.
> BUT, the major draw & temptation to misuse/abuse these ADD stims is that they are easily available, & pharmaceutically pure so you know what you are getting, while street drugs like Cocaine & Speed are adulterated/cut with all sorts of things from Ephedrine, Caffeine, Procaine, Benzocaine, Vitamin b-12, laxatives, baking soda, & even strychnine (a very dangerous stimulant also used as a rat poison!).
>
> Also, business professionals & college students can abuse these stims (intranasally or orally) to gain a competitive work/academic edge without any obvious external symptoms of drug abuse & without the danger/risk of arrest that comes with going to the ghetto to buy street drugs out in public from armed & very paranoid drug dealers.
>
> From personal experience, Ritalin & Adderall in adequate dosages intranasally produce an much longer lasting "high" that roughly parallels the "high" from the "cut/highly diluted" poor quality 'powder' Cocaine hcl available in most areas of the US (excluding of course areas close to Mexico with higher quality cocaine especially Southern California, & also AZ, NM, Texas-south of San Antonio, & the port cities of Houston & Miami, FL).
>
> Adderall in high enough doses causes mild visual hallucinations, & Adderall combined with Ritalin intranasally produces a double whammy effect of extensive dopamine release & blocking of its reuputake causing a "high" with euphoric & somewhat hallucinogenic properties that is very close or equal to the powerful street drugs intranasal methamphetamine hcl or relatively 'uncut' powder cocaine hcl like that available in Mexico border cities, but thankfully, no one has seemed to figure this out yet. But I would guess the risk of adverse (hypertensive) effects of this combination is great- much greater than Adderall or Ritalin alone.
>
> The new ADD stimulant, Focalin, eliminates half of Ritalin-all of which is the inactive isomer & so is basically useless/filler, retaining only the active d-isomer, & has no color additives & a limited amounts of dilutents/inactive ingredients & if abused intranasally would probably be much more potent in its effects than Ritalin.
>
> Very surprisingly, Dexedrine & Dextrostat are arguably stronger than Adderall when taken orally, but intranasally are less effective probably because they are much more diluted with inactive ingredients (A 5 mg Dexedrine pill contains 13.8 mg of sucrose along with 4 other inactive ingredients/dilutents, & a 10 mg Dextrostat pill is about equal to the size of a 30 mg Adderall pill indicating that it contains a large amount of inactive ingredients/dilutents. I don't know if these (50+ year old pills) have always contained so many inactive ingredients- I do know that many years ago Dexedrine was once available in 10 mg pills & in an elixir form that was discontinued a few years back. Perhaps the makers of Dexedrine & Dextrostat learned from the speed epidemic of the late 1960s & diluted the pills enough so that when an attempt at intranasal abuse is made, the bulky inactive ingredients greatly slow the absorption into the bloodstream, thus greatly reducing the high & making intransal abuse almost pointless.
>
> I think the best choice for a former stimulant drug addict would be Wellbutrin SR since street drug use is self-medication often for both depression & adult add, & Wellbutrin SR often clears up both, but its risk of abuse is low.
>
> Another good choice, would be Concerta. Concerta cannot really be abused intranasally, & there have been reports of failed attempts at this by adolescents.
>
> Other possible choices would include Adderall XR or Dexedrine Spansules, but only assuming that the pellets inside the capsules cannot be grinded up into a dry powder (which I don't know the answer to & haven't read anything on this).
>
> Perhaps, the best thing would be to educate the former drug abuser on the futility on intranasal abuse. For example, the intranasal abuse of Ritalin by college kids in order to study & focus better is self-defeating, because Ritalin only lasts for one hour intranasally, while if swallowed on an empty stomach provides about 3.5 hours of efficacy. Tolerance to Ritalin skyrockets when used intranasally at a ridiculous rate. But with a proper oral regimen, tolerance to Ritalin (or Adderall) is a slow process easily fixed by taking stimulant breaks on weekends or stimulant holidays.
>
> But remember, drugs like Ritalin & Adderall can be abused orally, so everyone should be careful when taking ADD stimulants. Anytime you are "saving up", or "taking double doses" it often begins a viscious circle of last minute procrastination of work/study/deadlines that you often meet successfully for the first few times (by escalating the dosage), but eventually this sporadic dosage escalation induces 'pyschological dependence' & tolerance- you find that your prescribed dose no longer works as well as it used to & you begin to believe that you won't be able to work or study even normally, without the x dose of Ritalin/Adderall that helped you meet that deadline/cram/stay up all night in the past.
>
> So remember that even though Ritalin/Adderall/Dexedrine etc are not "physically" addictive, they are still powerful DEA Schedule II Drugs [the same class as prescription Cocaine, Desoxyn (methamphetamine hcl), Seconal, Oxycontin, Dilaudid ("drugstore heroin"), Percocet, Morphine etc.] that some, especially adults, can become "psychologically" addicted to resulting in dose escalation & abuse. So remember to periodically take weekend breaks (Ask yourself if really need that Ritalin on a Friday afternoon/night) & when tolerance builds take a week off "a stimulant holiday".
>
> 3 Beers.....
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Dr. Bob is Robert Hsiung, MD,
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