![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by KaraS on July 19, 2005, at 18:21:51
Those of you who have taken dexedrine, have you found the generic to work as well? What about the spansules? I think I remember reading here that most folks haven't like the spansules. Am I remembering that correctly? Also, are the spansules the only extended release form of the drug?
Posted by Sarah T. on July 19, 2005, at 19:52:20
In reply to Dexedrine questions, posted by KaraS on July 19, 2005, at 18:21:51
Hi, Kara!
I've taken Dexedrine immediate release tablets, Dexedrine Spansules and generic dextroamphetamine tablets. For ME, the name-brand Dexedrine tablets were the best. I didn't think the generic tablets lasted as long, and they didn't feel the same. In my experience, the Spansules were unpredictable and inconsistent; unfortunately, Glaxo Smith Kline (formerly called Smith, Kline and French; then Smith, Kline Beecham or Beckham -- or whatever!) never "upgraded" the Spansules' release mechanism to the level of either Adderall-XR or Concerta. I don't know why. I think it would sell well, but I'm sure their marketing division knows much more about that than I do.
Posted by Sarah T. on July 19, 2005, at 20:02:09
In reply to Dexedrine questions, posted by KaraS on July 19, 2005, at 18:21:51
Kara, since I posted my first response, I started thinking that it might be worth trying the Spansules to see how you do on them. I have met several people here and elsewhere who have done well on them and I think, in theory at least, sustained release meds are a better idea, as long as you take them early enough in the day.
Posted by KaraS on July 19, 2005, at 22:12:50
In reply to On second thought. . . » KaraS, posted by Sarah T. on July 19, 2005, at 20:02:09
So basically they may have something of a consistency problem but that's the best and only choice there is if you want sustained release, eh?
How often did you take it and how late in the day would your last time be? I imagine that you conk out after it wears off, right? That might even solve my getting to bed early problem. I forgot, why did you stop taking it?
Thanks for your help.
Kara
Posted by KaraS on July 20, 2005, at 16:48:29
In reply to On second thought. . . » KaraS, posted by Sarah T. on July 19, 2005, at 20:02:09
> Kara, since I posted my first response, I started thinking that it might be worth trying the Spansules to see how you do on them. I have met several people here and elsewhere who have done well on them and I think, in theory at least, sustained release meds are a better idea, as long as you take them early enough in the day.
I just spoke to a couple of pharmacists and then did some more research on-line and there ARE sustained release generic versions of the dexedrine spansules. My doctor wrote "d/-amphetamine" on the prescription but then he wrote "spansules" after that. I think he intended the generic for me. If the spansules themselves aren't all that great, then I shouldn't be sacrificing much in the way of quality to go for the generic, right?
Posted by Sarah T. on July 20, 2005, at 19:04:39
In reply to Re: On second thought. . . » Sarah T., posted by KaraS on July 19, 2005, at 22:12:50
Hi Kara,
I prefer the name-brand for most drugs. In most cases, I do think it makes a difference, but I know others would disagree with me. Is it possible to go back to the doctor and ask him for an rx for the name brand? The trouble is, it might be a lot more expensive; however, it's an old drug, so I would think it wouldn't be nearly as expensive as Adderall XR or Concerta.
As far as the timing of the Spansules, well, I can't remember what the PDR says, but I think the drug lasts anywhere from 5 or 6 to 9 hours. I don't think it ever lasted 12 hours for me, but since this med is so new for you and you haven't developed any tolerance, you might be very sensitive at first. I suggest taking it as early in the day as possible.
Try not to take very acidic food or fluids with it. I took my vitamin C and juice at night before bed. Acidic products hasten the urinary excretion of amphetamines, and that, in turn, might hasten the development of tolerance, which you want to stave off as long as possible. Also, try to take days off from the med whenever you can, like on the weekends. Another thing that helped for me was to take it an hour before or two hours after meals. Food does seem to weaken the effects of the drug, but DON'T starve yourself, and don't try to go without food for too many hours because, in addition to the importance of maintaining good nutrition, ketosis (which happens when you don't eat) creates an acidic environment which, again, hastens the excretion of the drug and hastens tolerance.
I thought it was the only med that has ever really helped me, but I developed a tolerance to it, so I'm trying to build up more sensitivity to it again by staying off it as long as possible. I would like to go back on it at some point. I doubt it will ever be as effective as it once was, but I do think it will be somewhat helpful again.
Dexedrine has been around for years (over 50 years, I think), and there has been a lot of research on it, so it's not like taking a new SSRI or SNRI which might result in a lot of unpleasant "surprises" a few months or years down the line. It's a shame that there is such a stigma attached to amphetamines. If used carefully, conservatively, and judiciously, Dexedrine is an excellent medicine.
Posted by Sarah T. on July 20, 2005, at 19:17:44
In reply to Re: There is generic dexedrine sustained-release » Sarah T., posted by KaraS on July 20, 2005, at 16:48:29
Kara, I just read a few more of your rEEG posts above, and I see that you've also been rx'd Klonopin. I forgot to ask you how many milligrams of Dexedrine you're starting with, and how many mg Klonopin?
Posted by KaraS on July 21, 2005, at 19:24:10
In reply to Kara, a question. . . » KaraS, posted by Sarah T. on July 20, 2005, at 19:17:44
> Kara, I just read a few more of your rEEG posts above, and I see that you've also been rx'd Klonopin. I forgot to ask you how many milligrams of Dexedrine you're starting with, and how many mg Klonopin?
Hi Sarah,Thanks so much for all of your valuable information. It's so HELPFUL!! In my relief to get diagnosed and prescribed, I hadn't even thought of the poop-out factor of the dexedrine. My starting dosage on the Klonopin is either 2.5 or 5.0 (if I feel I need it) twice a day while I decrease the doxepin. I can gradually decrease it as I get comfortable enough on the Klonopin. The dexedrine dosage is 5 mg. to be used once a day initially but I can quickly go to twice a day on that as well.
I really wish I could start on a lower dosage of dexedrine to try it out - to make sure that it doesn't send my heart into a tailspin and make my anxiety a hundred times worse. (I also wish I weren't such a wimp.) One of the generic sustained release forms come in capsules. The pellets are usually enterically coated so I would be able to try smaller amounts first. I know that you advise against generics but I'd like to try both of them and see how they work. Money is a big issue since I don't have any insurance coverage and the spansules aren't supposed to be that great to begin with...
Do you think that 5 mg. could really be very stressful for me or just provide a mild stimulation?
Do you mind if I ask you how long you took the Dex? Do you have any attentional deficit issues that have been diagnosed or that you just suspect you have? Did you also not use it on weekends to help prevent the tolerance? If so, were you a complete sloth on the weekends? I am that way now all of the time so if it were just on weekends it would be an improvement. How long did it take for it to stop working for you? Have you tried Adderall or Ritalin? Would either of those work after Dex fails or are they too similar?
I am wondering if maybe we don't have similar brain chemistries. I know we've talked before about TCAs but I don't remember what your experience has been on them. Have you tried desipramine? Dr. E. mentioned that Wellbutrin, and possibly desipramine, would be the only antidepressants he'd recommend for me. I don't like thinking how few options I have if/when the Dex stops working.
I am going to bring up the tolerance issue with Dr. E. soon. He gave me his cell phone number in case I have any questions. That's something I like about him - but for what he's charging, he should be available 24/7. In fact, for what he's charging he ought to provide sexual favors as well. :-)
Take care,
Kara
Posted by Sarah T. on July 21, 2005, at 22:44:35
In reply to Re: Kara, a question. . . » Sarah T., posted by KaraS on July 21, 2005, at 19:24:10
Hi Kara,
I will try to respond more fully later tonight or tomorrow, but I just wanted to say something quickly right now. I am a bit worried about your combining Dexedrine with Doxepin. I'm sorry to be an alarmist, and I know that you may not necessarily be nearly as bad a metabolizer as I am, but I've had a lot of difficulty when trying to combine TCA's with stimulants. The PDR does have a warning about such a combination. I do know a few people who've successfully combined TCA's with stimulants, but if you're very sensitive, you can get rather dramatic spikes in blood pressure and/or heart rate. If it were me, I'd wait to get off of Doxepin before getting on Dexedrine. It may not be a problem for you, and since you have Klonopin on hand, that will probably help to lower heart rate and BP. Of course, it's best for you to work that out with your doctor.
I do have to mention that in the distant past, I did successfully combine an MAOI with Ritalin, but that's a different sort of interaction altogether. I never had any BP problems on those two meds. In fact, on the MAOI alone, my BP was so low that the Ritalin helped to bring my BP up to normal (110/70). I've also read of some interesting combinations using other MAOI's and stimulants and even MAOI's plus TCA's plus stimulants, but I never tried those.
I will try to write more in a while. If I can't, I promise to write tomorrow. Also, I hope I haven't caused any unnecessary anxiety, but I just want you to proceed with caution on Dexedrine if you are still taking Doxepin.
Posted by KaraS on July 22, 2005, at 0:24:29
In reply to Re: Kara, » KaraS, posted by Sarah T. on July 21, 2005, at 22:44:35
Hi,
I'm only taking 12.5 mg. of doxepin right now but I have been concerned about mixing them as well. I think I'll go off of the doxepin and start on the Klonopin first. Then I'll make sure the doxepin is out of my system for a couple of weeks before I start on the Dexedrine. I'm not much of a risk taker. I'd much rather be safe than sorry.
Thanks for your concern. Talk to you later.
Kara
Posted by Sarah T. on July 22, 2005, at 1:40:17
In reply to Re: Kara, a question. . . » Sarah T., posted by KaraS on July 21, 2005, at 19:24:10
KS: > > > Hi Sarah,> > Thanks so much for all of your valuable information. It's so HELPFUL!! In my relief to get diagnosed and prescribed, I hadn't even thought of the poop-out factor of the dexedrine. My starting dosage on the Klonopin is either 2.5 or 5.0 (if I feel I need it) twice a day while I decrease the doxepin.
ST: Regarding Klonopin, do you mean 0.25 and 0.5?
KS:> I really wish I could start on a lower dosage of dexedrine to try it out - to make sure that it doesn't send my heart into a tailspin and make my anxiety a hundred times worse. (I also wish I weren't such a wimp.)
ST: I don't think you're being a wimp at all. I think you're just being careful and a bit apprehensive. I'm that way whenever I try a new medicine. If you really want to try Dexedrine at a lower dose, why don't you ask your doctor for the Dexedrine 5 mg tablets? They are scored, so you can cut them in half. I've even cut them in quarters. The name-brand tablets cut and break fairly well without too much crumbling. If I remember correctly, when I tried to cut the generic version, it created too many crumbs and dust, so a lot was wasted. That was another reason I didn't like the generic.
KS:> > Do you think that 5 mg. could really be very stressful for me or just provide a mild stimulation?
ST: I don't think 5 mg should be that stressful, but as I said earlier, I'd be very careful about combining it with Doxepin. I feel I have to say that, but at the same time, I realize that I'm projecting my own problems and fears onto you. I have extreme difficulty with medication combinations, and I've learned through much trial and error (mostly error) to start medication combinations very slowly at low doses. One thing I've done occasionally when I've been worried about a potential problem with a drug combo is to take the meds on alternate days. I'm a very slow metabolizer, so I figure that if I can't tolerate them on alternate days, then I won't be able to tolerate them on the same day.
KS:> Do you mind if I ask you how long you took the Dex?ST: Well, I took it on and off for four to five years. There were several long stretches when I didn't take any medications at all, or I tried other medicines (instead of Dex). A couple of times, I had to prepare for a SPECT or PET scan or other medical testing, and I was advised to get off all meds for those. For the SPECT, I was off all meds for over a month, I think, and then I stayed off all meds for another few weeks, just to see how long I could go without anything (masochist that I am).
KS:Do you have any attentional deficit issues that have been diagnosed or that you just suspect you have?
ST: Yes, and these were confirmed on SPECT and PET and through neuropsychological testing. I also have another medical condition that contributes to my depression and cognitive problems.
KS: Did you also not use it on weekends to help prevent the tolerance? If so, were you a complete sloth on the weekends? I am that way now all of the time so if it were just on weekends it would be an improvement.
ST: I tried not to use it on as many weekends as possible, but it wasn't always possible. Also, as I said above, I went for several long stretches when I took no meds or I took an AD instead. I was a complete sloth on the weekends when I took drug holidays from stimulants for just a day or two, but when I took weeks or months off, I found that I started to function after about five days. The first few days were very difficult and, in addition to not getting anything accomplished, I got horribly constipated. During one of those long stretches when I got off Dex and took no meds, I felt as if I had severe PMS every single minute of every single day for eight weeks. That made me wonder whether, for some women, PMS is similar to drug withdrawal as far as low levels and/or depletion of certain neurotransmitters.
KS: How long did it take for it to stop working for you? Have you tried Adderall or Ritalin? Would either of those work after Dex fails or are they too similar?
ST: I have to think more about this one. It didn't stop abruptly. I'd say the only abrupt change was when I made the terrible mistake of adding Celexa to the Dexedrine. Within a few weeks of adding Celexa, I had to DOUBLE the Dexedrine dose in a futile attempt to counteract the fatigue and apathy caused by Celexa. I do know a few people who've successfully combined stimulants and SSRI's, and they've been maintained on that combo for years. In fact, recently, I communicated on this board with Gabbii, who has had a long, successful run on that exact same combo (Celexa plus Dexedrine). For me, that combo was not good. As I said, I had to double the Dex, and it was never quite the same after that, even after I got off of Celexa. I did stay on Dex for a long time after that, even though I didn't benefit from it as much as I had before the Celexa.
I've tried both Adderall and various forms of methylphenidate/Ritalin. I think Dexedrine is better, but you'll find some people here who like Adderall better. I don't think I could take Ritalin as monotherapy. I'd have to find a darn good antidepressant to combine with it. I felt kind of depressed on it. I am very quiet and focused on it, but my mood is terrible. As for Adderall, I wish I could get that to work for me. Perhaps I didn't dose it properly. Some people say the dosing is the same as Dexedrine dosing; others say that you have to take a bit more Adderall than Dexedrine. I found Adderall's peripheral effects to be very troublesome (tremors, palpitations, more anxiety and fear). Another thing that bothered me about Adderall is that, ordinarily, whether I'm on a medication or not, I don't care that much about what other people think of me. I don't worry about it, but when I was on Adderall, I was VERY self-conscious and overly concerned with being accepted by others, pleasing others. Not only does this seem anti-therapeutic, but it's contrary to what we often hear about amphetamines. Amphetamines may give some people a false sense of confidence, but on Adderall, I had no confidence. I became withdrawn and fearful. It's possible I took too much. I just don't know. I might try it again someday.
KS:> I am wondering if maybe we don't have similar brain chemistries. I know we've talked before about TCAs but I don't remember what your experience has been on them. Have you tried desipramine? Dr. E. mentioned that Wellbutrin, and possibly desipramine, would be the only antidepressants he'd recommend for me. I don't like thinking how few options I have if/when the Dex stops working.ST: I don't think Dexedrine will stop working completely for you. It may lose some of its effects, but since you know now, at the beginning, how to combat some of the poop-out, you are in a good position to try to counteract that as much as possible. I do think it's good to take both short and long drug holidays. I will say that not taking any meds for more than a couple of days is tough and probably a bad idea UNLESS you HAVE to get off of everything for a SPECT scan or for surgery or something like that. If you want to get off of Dexedrine for a while (more than a few days), then it's probably best to take an AD.
Yes, I have taken desipramine. I took it a long time ago, and I thought it was OK, but imipramine was probably better for my mood, although it had more annoying side effects. As for Nortriptyline, I could never get the dosing right, probably because of that "therapeutic window." Physically, I felt better on Nort. than on Imipramine, but I didn't do ANYTHING while I was on it. I also didn't do anything for the eight weeks I was on Prozac. I know we're not discussing Prozac, but I just thought I'd mention that because the effects on me were similar to Nortriptyline's effects. In fact, I would say I was more of a slug on Prozac, Celexa and Nortriptyline than when I took drug holidays from Dexedrine!
KS:> I am going to bring up the tolerance issue with Dr. E. soon. He gave me his cell phone number in case I have any questions. That's something I like about him - but for what he's charging, he should be available 24/7. Take care, Kara >>
ST: Your doctor does sound good. I have to say that I didn't get much help regarding tolerance from my regular pdoc. Actually, I got more help from Psychobabble and from a few other boards and from my own reading. Unfortunately, I had already developed some tolerance by the time I got around to doing my "homework" on this issue. I really wish I'd been helped more by my pdoc.
I think you'll do well on Dexedrine. It may take a few days or weeks of experimenting to find the right dose and to decide on generic vs. name-brand and tablets vs. Spansules. Some doctors will prescribe both the Spansules and the tablets to their patients so they can have the option of taking one or the other. Some people take both. For example, some people take the immediate release tablet in the morning and then take the sustained release a few hours later. Some take the SR first, and then take the tablet later in the day. Eventually, you'll get to know what's best for you. Please let us know how you're doing.
Posted by Sarah T. on July 22, 2005, at 1:50:50
In reply to Re: Kara, » Sarah T., posted by KaraS on July 22, 2005, at 0:24:29
Hi. What is the half life of Doxepin? Is it that long that you'd need to stay off of it for a few weeks? The last time I tried a TCA, it FELT as if it was out of my system after about 4-5 days. I took a teensy, tiny dose, and it still took 4-5 days to get back to my old self. Unless Doxepin's half-life is really long like Prozac's, I doubt you'd need to wait several weeks.
Posted by KaraS on July 22, 2005, at 14:15:21
In reply to Re: Kara, . . . » KaraS, posted by Sarah T. on July 22, 2005, at 1:40:17
> ST: Regarding Klonopin, do you mean 0.25 and 0.5?
KS: Probably.
> ST: I don't think you're being a wimp at all. I think you're just being careful and a bit apprehensive. I'm that way whenever I try a new medicine. If you really want to try Dexedrine at a lower dose, why don't you ask your doctor for the Dexedrine 5 mg tablets? They are scored, so you can cut them in half. I've even cut them in quarters. The name-brand tablets cut and break fairly well without too much crumbling. If I remember correctly, when I tried to cut the generic version, it created too many crumbs and dust, so a lot was wasted. That was another reason I didn't like the generic.
KS: But you can't really judge from the immediate release how strongly a dose of sustained release will be for you, can you?
> ST: I don't think 5 mg should be that stressful, but as I said earlier, I'd be very careful about combining it with Doxepin. I feel I have to say that, but at the same time, I realize that I'm projecting my own problems and fears onto you. I have extreme difficulty with medication combinations, and I've learned through much trial and error (mostly error) to start medication combinations very slowly at low doses. One thing I've done occasionally when I've been worried about a potential problem with a drug combo is to take the meds on alternate days. I'm a very slow metabolizer, so I figure that if I can't tolerate them on alternate days, then I won't be able to tolerate them on the same day.
KS: Makes sense. In this case, I'd need the Klonopin daily though.
> ST: Well, I took it on and off for four to five years. There were several long stretches when I didn't take any medications at all, or I tried other medicines (instead of Dex). A couple of times, I had to prepare for a SPECT or PET scan or other medical testing, and I was advised to get off all meds for those. For the SPECT, I was off all meds for over a month, I think, and then I stayed off all meds for another few weeks, just to see how long I could go without anything (masochist that I am).KS: 4-5 years isn't a long time especially when you consider that you took long drug holidays in between. Makes me wonder if you hadn't done that how little time you would have gotten out of the Dex.
> ST: Yes, and these were confirmed on SPECT and PET and through neuropsychological testing. I also have another medical condition that contributes to my depression and cognitive problems.
KS: The reason I asked is that I have a feeling when I ask Dr. E. about the tolerance issue, that he will say something about my needing the drug so it won't happen. I may be wrong but he tends to have this view that when you get on the right meds, that they don't poop-out. But that obviously isn't the case here. I'll have to talk to him about it. (Also, I have CFS (episodic) which also contributes to my cognitive problems.)
>
> ST: I tried not to use it on as many weekends as possible, but it wasn't always possible. Also, as I said above, I went for several long stretches when I took no meds or I took an AD instead. I was a complete sloth on the weekends when I took drug holidays from stimulants for just a day or two, but when I took weeks or months off, I found that I started to function after about five days. The first few days were very difficult and, in addition to not getting anything accomplished, I got horribly constipated. During one of those long stretches when I got off Dex and took no meds, I felt as if I had severe PMS every single minute of every single day for eight weeks. That made me wonder whether, for some women, PMS is similar to drug withdrawal as far as low levels and/or depletion of certain neurotransmitters.KS: I'm a complete sloth on weekends as it is so it couldn't be much worse but this isn't a great solution for me to still have so much dysfunctional time.
> ST: I have to think more about this one. It didn't stop abruptly. I'd say the only abrupt change was when I made the terrible mistake of adding Celexa to the Dexedrine. Within a few weeks of adding Celexa, I had to DOUBLE the Dexedrine dose in a futile attempt to counteract the fatigue and apathy caused by Celexa. I do know a few people who've successfully combined stimulants and SSRI's, and they've been maintained on that combo for years. In fact, recently, I communicated on this board with Gabbii, who has had a long, successful run on that exact same combo (Celexa plus Dexedrine). For me, that combo was not good. As I said, I had to double the Dex, and it was never quite the same after that, even after I got off of Celexa. I did stay on Dex for a long time after that, even though I didn't benefit from it as much as I had before the Celexa.KS: According to Dr. E and from my experience, SSRIs haven't done much for me. Effexor helped with mood somewhat. I'm wondering if I could take it with a stimulant. I'd stay at 150 mg. or lower so the amount of NE would be minimal. Can they be safely combined? I doubt Dr. E. would even give me a script for Effexor based on my test results. I'm just thinking out loud here. I don't have any serious thoughts about restarting on that yet. I'll have to look for your conversation with Gabbii and do more searching for info on this topic in the archives.
> I've tried both Adderall and various forms of methylphenidate/Ritalin. I think Dexedrine is better, but you'll find some people here who like Adderall better. I don't think I could take Ritalin as monotherapy. I'd have to find a darn good antidepressant to combine with it. I felt kind of depressed on it. I am very quiet and focused on it, but my mood is terrible. As for Adderall, I wish I could get that to work for me. Perhaps I didn't dose it properly. Some people say the dosing is the same as Dexedrine dosing; others say that you have to take a bit more Adderall than Dexedrine. I found Adderall's peripheral effects to be very troublesome (tremors, palpitations, more anxiety and fear). Another thing that bothered me about Adderall is that, ordinarily, whether I'm on a medication or not, I don't care that much about what other people think of me. I don't worry about it, but when I was on Adderall, I was VERY self-conscious and overly concerned with being accepted by others, pleasing others. Not only does this seem anti-therapeutic, but it's contrary to what we often hear about amphetamines. Amphetamines may give some people a false sense of confidence, but on Adderall, I had no confidence. I became withdrawn and fearful. It's possible I took too much. I just don't know. I might try it again someday.
>KS: Isn't that strange how you could react so differently to the Adderall? Maybe it's just not a good match for you.
> ST: I don't think Dexedrine will stop working completely for you. It may lose some of its effects, but since you know now, at the beginning, how to combat some of the poop-out, you are in a good position to try to counteract that as much as possible. I do think it's good to take both short and long drug holidays. I will say that not taking any meds for more than a couple of days is tough and probably a bad idea UNLESS you HAVE to get off of everything for a SPECT scan or for surgery or something like that. If you want to get off of Dexedrine for a while (more than a few days), then it's probably best to take an AD.
KS: I wonder why you didn't have that much trouble stopping Dex most times but that one time it took 8 weeks and it was total hell. How would I be able to hold down a job while going through that kind of a withdrawal? I wonder what AD I could take that would help me enough with withdrawal given that they haven't helped me much in the past anyway...
> Yes, I have taken desipramine. I took it a long time ago, and I thought it was OK, but imipramine was probably better for my mood, although it had more annoying side effects. As for Nortriptyline, I could never get the dosing right, probably because of that "therapeutic window." Physically, I felt better on Nort. than on Imipramine, but I didn't do ANYTHING while I was on it. I also didn't do anything for the eight weeks I was on Prozac. I know we're not discussing Prozac, but I just thought I'd mention that because the effects on me were similar to Nortriptyline's effects. In fact, I would say I was more of a slug on Prozac, Celexa and Nortriptyline than when I took drug holidays from Dexedrine!KS: Interesting. I couldn't tolerate Celexa, Prozac may have given me a good month or so and nort. gave me tachycardia. When I started on the nort, probaby because of the tachycardia, I had a lot of energy. It felt great. I went off of it because I wasn't on a large enough dose and yet my pulse rate was about 100 bpm. I wonder if I had taken a beta blocker whether I would still have had that energy and drive. Have you ever tried Wellbutrin? That can't be combined with stimulants, can it? I know you've taken at least one MAOI and weren't that thrilled with it. Did it or they not help enough with depression or were you just not able to stand the side effects? What are you taking now?
> ST: Your doctor does sound good. I have to say that I didn't get much help regarding tolerance from my regular pdoc. Actually, I got more help from Psychobabble and from a few other boards and from my own reading. Unfortunately, I had already developed some tolerance by the time I got around to doing my "homework" on this issue. I really wish I'd been helped more by my pdoc.
KS: I do think he's good in many ways but I think that one of his failings is that he's too optimistic. I think he should have spoken to me about tolerance and trying to prevent it.
> I think you'll do well on Dexedrine. It may take a few days or weeks of experimenting to find the right dose and to decide on generic vs. name-brand and tablets vs. Spansules. Some doctors will prescribe both the Spansules and the tablets to their patients so they can have the option of taking one or the other. Some people take both. For example, some people take the immediate release tablet in the morning and then take the sustained release a few hours later. Some take the SR first, and then take the tablet later in the day. Eventually, you'll get to know what's best for you. Please let us know how you're doing.KS: Thanks again. Right now I'm feeling discouraged. I think this medication is probably going to be a good match for me but it's such a limited solution. I'll definitely keep you posted.
Kara
Posted by KaraS on July 22, 2005, at 14:18:27
In reply to Re: Kara, regarding doxepin, posted by Sarah T. on July 22, 2005, at 1:50:50
> Hi. What is the half life of Doxepin? Is it that long that you'd need to stay off of it for a few weeks? The last time I tried a TCA, it FELT as if it was out of my system after about 4-5 days. I took a teensy, tiny dose, and it still took 4-5 days to get back to my old self. Unless Doxepin's half-life is really long like Prozac's, I doubt you'd need to wait several weeks.
I've seen the half-life listed as 8-25 hrs. I don't know why a range was given rather than just a single number. Dr. E. wanted me off of the doxepin for 12-14 days before the rEEG if I could handle it so that's why I chose the two week mark. When I went off it to try for that, I felt like it was completely out of my system somewhere in the 7-10 day range.
Posted by ed_uk on July 22, 2005, at 14:26:35
In reply to Re: Dexedrine questions » Sarah T., posted by KaraS on July 22, 2005, at 14:15:21
Hi K!
>When I started on the nort, probaby because of the tachycardia, I had a lot of energy. It felt great. I went off of it because I wasn't on a large enough dose and yet my pulse rate was about 100 bpm.
I wouldn't worry about the tachycardia. Except in people with certain types of heart disease, the tachycardia isn't dangerous. Adding a beta-blocker isn't necessary. Perhaps you should try nortriptyline again.
Ed x
Posted by KaraS on July 22, 2005, at 19:02:22
In reply to Re: Dexedrine questions » KaraS, posted by ed_uk on July 22, 2005, at 14:26:35
> Hi K!
>
> >When I started on the nort, probaby because of the tachycardia, I had a lot of energy. It felt great. I went off of it because I wasn't on a large enough dose and yet my pulse rate was about 100 bpm.
>
> I wouldn't worry about the tachycardia. Except in people with certain types of heart disease, the tachycardia isn't dangerous. Adding a beta-blocker isn't necessary. Perhaps you should try nortriptyline again.
>
> Ed xHi Ed,
You haven't been around much lately. Hope you've been studying hard!
I really didn't like the racing heart. I was very uncomfortable and I was always aware of it. It made sleeping very difficult as well. I had the same response to desipramine though I was on it for a much shorter time frame than the nort. I may try desipramine again as it's one of the few meds that could also help my ADD and one of the few that rEEG said might help me.
K
Posted by Sarah T. on July 23, 2005, at 1:37:16
In reply to Re: Dexedrine questions » Sarah T., posted by KaraS on July 22, 2005, at 14:15:21
Hi Kara,
I'm very tired tonight. I'll try to reply to you on Saturday or, latest, Sunday.
Good night.
S.
Posted by KaraS on July 23, 2005, at 2:33:44
In reply to Re: Dexedrine questions » KaraS, posted by Sarah T. on July 23, 2005, at 1:37:16
> Hi Kara,
>
> I'm very tired tonight. I'll try to reply to you on Saturday or, latest, Sunday.
>
> Good night.
>
> S.
No problem. whenever you're up to it.K
Posted by ed_uk on July 23, 2005, at 7:10:37
In reply to Re: Dexedrine questions » ed_uk, posted by KaraS on July 22, 2005, at 19:02:22
Hi K!
>I really didn't like the racing heart. I was very uncomfortable and I was always aware of it. It made sleeping very difficult as well.
:-( Adding atenolol should help.
Ed x
Posted by KaraS on July 23, 2005, at 16:07:24
In reply to Re: Dexedrine questions » KaraS, posted by Sarah T. on July 23, 2005, at 1:37:16
FYI, here's an interesting post on the generic version that I just purchased. Maybe you tried only the generic IR or you didn't try the BARR generic version of the spansules? (Ignore the title of the post.)
Posted by alohashirt on July 24, 2005, at 22:15:39
In reply to Re: Dexedrine spansules - generic by BARR » Sarah T., posted by KaraS on July 23, 2005, at 16:07:24
> FYI, here's an interesting post on the generic version that I just purchased. Maybe you tried only the generic IR or you didn't try the BARR generic version of the spansules? (Ignore the title of the post.)
>
> http://www.dr-bob.org/babble/20040127/msgs/307389.htmlI've had the opposite experience. For a few months I had the
Malenkrodt generic spansules, which were OK, then the drug store started providing Barr generic, which seemed much less effective.
Next month I asked my doctor and he wrote Dispense As Written so they gave me brand name Smith Kline dexedrine XR spansules and these are much more consistent.Problems:
1) If I take it too late (after 2.00pm ) I find it hard to sleep
2) It raises my blood pressure which I now have to treat
Posted by KaraS on July 25, 2005, at 0:30:03
In reply to Re: Dexedrine spansules - generic by BARR, posted by alohashirt on July 24, 2005, at 22:15:39
> > FYI, here's an interesting post on the generic version that I just purchased. Maybe you tried only the generic IR or you didn't try the BARR generic version of the spansules? (Ignore the title of the post.)
> >
> > http://www.dr-bob.org/babble/20040127/msgs/307389.html
>
> I've had the opposite experience. For a few months I had the
> Malenkrodt generic spansules, which were OK, then the drug store started providing Barr generic, which seemed much less effective.
> Next month I asked my doctor and he wrote Dispense As Written so they gave me brand name Smith Kline dexedrine XR spansules and these are much more consistent.
>
> Problems:
> 1) If I take it too late (after 2.00pm ) I find it hard to sleep
> 2) It raises my blood pressure which I now have to treat
>Sorry to hear about your blood pressure problems. Do you mind if I ask you how much dexedrine you take daily and how much it raised your blood pressure? Does it raise blood pressure directly or does it do so by increasing heart rate?
k
Posted by KaraS on July 25, 2005, at 0:52:29
In reply to Re: Dexedrine questions » KaraS, posted by ed_uk on July 23, 2005, at 7:10:37
> Hi K!
>
> >I really didn't like the racing heart. I was very uncomfortable and I was always aware of it. It made sleeping very difficult as well.
>
> :-( Adding atenolol should help.
>
> Ed x
Ed,My doctor said that atenolol and the other cardio specific beta blockers aren't a problem if you have asthma. Is that true?
K
xxx
Posted by Sarah T. on July 25, 2005, at 2:30:31
In reply to Re: Dexedrine questions » Sarah T., posted by KaraS on July 22, 2005, at 14:15:21
> >> > > KS: But you can't really judge from the immediate release how strongly a dose of sustained release will be for you, can you?
ST: Hi Kara. I'm sorry it's taken me so long to respond. I've been very busy and very tired lately. Among other things, this weather is really getting to me. Anyway, I think that the immediate release dosing can probably help approximate the dosage for sustained release, but I don't think you can judge exactly. Like almost all of these psychiatric meds, I think you just have to start at the LOWEST dose possible and slowly work up to a dose that feels right for YOU.
> KS: The reason I asked is that I have a feeling when I ask Dr. E. about the tolerance issue, that he will say something about my needing the drug so it won't happen. I may be wrong but he tends to have this view that when you get on the right meds, that they don't poop-out. But that obviously isn't the case here. I'll have to talk to him about it. (Also, I have CFS (episodic) which also contributes to my cognitive problems.)>
ST: Oh, yes, I've had doctors like that. They seem to have these standard lines, which may have some element of truth. I don't agree that if you're on the right meds, they won't poop out on you. I think nearly all psychotropic meds, not just stimulants, poop out eventually for most people. I have met a few people here and on other boards who've managed to stay on stimulants many years without pooping out. If I remember correctly (and I apologize if I'm wrong), I think Fachad and possibly Viridis have been on some stimulant for many years without any poop out. I don't think they had to raise the dose much at all. But I think Fachad and Viridis are men (again, I apologize if I'm wrong about that). The reason I mention their gender is that, as long as they're not abusing stimulants and/or as long as they're being really careful about trying to stave off poop-out, men seem to be able to get more months or years out of stimulants, especially when compared with women of a certain age. I believe that estrogen and its effects on neurotransmitters greatly influences how women respond to stimulants.
> > > KS: I'm a complete sloth on weekends as it is so it couldn't be much worse but this isn't a great solution for me to still have so much dysfunctional time.ST: If you are able to combine stimulants with an antidepressant, I think that would be the best solution. Unfortunately, due to my inability to tolerate polypharmacy, I've been unable to find a good AD + stimulant combo, but that doesn't mean you can't find one. Although you and I seem to have many similar reactions to medications and our diurnal rhythms are similar, we are still different. So, please don't assume that you can't tolerate something just because I couldn't.
>> > > KS: According to Dr. E and from my experience, SSRIs haven't done much for me. Effexor helped with mood somewhat. I'm wondering if I could take it with a stimulant. I'd stay at 150 mg. or lower so the amount of NE would be minimal. Can they be safely combined?ST: I'm almost certain that they can be combined. Do you know Noa? She has posted here for years, but I haven't seen her around much lately. I know that she was on Effexor + Serzone + Adderall for a very long time. Prior to taking Adderall, I think she was on another stimulant, possibly some form of methylphenidate. I think she gained a lot of weight from Effexor, but I do believe it helped her mood and life in other ways so much that she decided to stay on it. I shouldn't be speaking for her, so I hope I haven't misinformed you. I'm just relaying the impression I've gotten from many of her posts. Oh, she also took some thyroid meds.
> KS: Isn't that strange how you could react so differently to the Adderall? Maybe it's just not a good match for you.
ST: I still haven't figured that out yet. It's so odd because about 69 or 70% of Adderall is dextroamphetamine. Only a small portion is dextroamphetamine sulphate, which is the same as Dexedrine. There are a few other dextroamphetamine salts in Adderall (dextroamphetamine combined with counter-ions other than the sulfate ion), but it's still dextroamphetamine. Then there's some levoamphetamine and some of the racemic mixture. I believe that the reason I have difficulty with it is either due to the levoamphetamine, which is known to have more peripheral effects (tremors, palpitations, etc.) and/or the dextroamphetamine salts other than dextroamphetmaine sulfate are too insoluble for me, so they don't dissolve thoroughly in my body, or perhaps they dissolve too slowly.
> > KS: I wonder why you didn't have that much trouble stopping Dex most times but that one time it took 8 weeks and it was total hell. How would I be able to hold down a job while going through that kind of a withdrawal? I wonder what AD I could take that would help me enough with withdrawal given that they haven't helped me much in the past anyway...
ST: There may have been several reasons for the extreme difficulty I had that one time. There were a lot of other stressors in my life at the time and, probably more important, I wasn't able to exercise as often as I usually do during that 8-week stretch. Exercise is a very important component of my antidepressant regimen. In fact,in many ways, I believe it's been the best and most reliable AD I've even "taken." It's just not enough. I'd say that exercise is a critical adjunct or augmentor of other antidepressants and, for me, the exercise has to be fairly rigorous in order to work as an AD. I have to swim or run and get my breathing and heart rate up. Although walking is an excellent exercise, it just doesn't do anything for my mood.
As I said the other day, if you're going to go off stimulants for more than a few days, I really think it's best to take an AD during that time. And if you're going to get off of stimulants for more than a few days, whether you take an AD or not, it's probably best to start the withdrawal when you are on vacation so that the worst part of the withdrawal (the first few days to a week) can coincide with when you don't have to be at work or school anyway. I know this all sounds very complicated, but, you know, I think it's pretty much the same for any psychiatric med withdrawal or start-up. I have to say that I get a bit impatient with people who stigmatize stimulants, stimulant withdrawal and stimulant neurotoxicity. Look what Paxil does to many people. I know people who got off of Paxil months or years ago, and they're still having brain zaps and all sorts of other horrid problems. Look what Zoloft does to so many of us. Before I started Zoloft, in spite of my depression, I had a healthy sex drive and ability, and I never chewed my cud/cheek. I was on Zoloft for 1.5 years, and I've been off of it for about six years. After six years, I still don't have the sex drive I had before Zoloft, and it wasn't until this year that my cheek chewing finally subsided. I had to spend $600.00 on a dental mouth guard because of what Zoloft did to me. Amphetamines never did that to me. SSRI's did.
>>> >> KS: Have you ever tried Wellbutrin? That can't be combined with stimulants, can it? I know you've taken at least one MAOI and weren't that thrilled with it. Did it or they not help enough with depression or were you just not able to stand the side effects?ST: I took Wellbutrin for a long time (years), and then I took it again during one of those two-month stretches when I got off of Dexedrine. The first time I took it, I thought it was the "least of the evils," but when I tried it again, I found it very agitating. It always gave me a lot of insomnia, both times. I am unable to combine stimulants with Wellbutrin, although I did try. For the first day, I felt OK, but after that one day, I started to feel horribly ill. I had high blood pressure, but I also felt ill in a way I've never felt before. It is difficult to describe how sick I felt on that combination, and I was scared enough that I never tried it again. I have come across several people on this board and on other boards who've successfully combined Wellbutrin and Dexedrine and Wellbutrin and Adderall! That always amazes me that ANYONE could tolerate that combo. I'm also stunned when I meet people who take stimulants plus Provigil.
Regarding MAOI's, I tried Parnate a few times. The only times I've ever exhibited any psychotic thoughts were on Parnate. I've met a few others here who've also had "weird" or bizarre thoughts on Parnate. I won't take it again. Oh, Parnate also made my circadian rhythms even whackier than they already are. That problem was helped when Ritalin was added, but the "weird" thoughts were an unacceptable side effect.
> KS: I do think he's good in many ways but I think that one of his failings is that he's too optimistic. I think he should have spoken to me about tolerance and trying to prevent it.ST: I know what you mean, and I'm angry that my pdoc didn't help me try to prevent tolerance, but it may be because he has never been through that himself; I don't know. I think some of these guys may have taken stimulants in college or medical school to get through a rough stretch, and then they probably got off the meds and "crashed" for a weekend and never took the stuff again. They probably don't have the personal experience of taking it for months or years, so they have no idea what that's like.
Oh, that reminds me. . . Another way to stave off tolerance is: DON'T use the medicine to mask fatigue. DON'T use it to cram for exams without sleeping, and DON'T use it drive across the country in a couple of days. Use it as you would an antidepressant. Make sure you get PLENTY of rest and eat really healthfully. I wouldn't use it to lose weight either, although I know there are a number of people who want it primarily for that purpose. Dexedrine never suppressed my appetite much, although Adderall did. That's another reason I don't like Adderall. I don't think it's healthy to have my appetite suppressed to that degree. I can't stress enough how important it is to eat healthfully, get lots of rest, stay well-hydrated primarily with water, and take days off from the meds whenever you can. Take the medicine one hour before, or two hours after, meals, and if you're going to have very acidic foods, orange juice or vitamin C, take them at night before bed, when you want the dexedrine to wash out anyway.
>> >> KS: Thanks again. Right now I'm feeling discouraged. I think this medication is probably going to be a good match for me but it's such a limited solution. I'll definitely keep you posted. > >
ST: I'm sorry to say that I think ALL of the currently available antidepressants and stimulants are limited solutions, but it's all we have right now.
Posted by Sarah T. on July 25, 2005, at 2:32:40
In reply to Re: Dexedrine spansules - generic by BARR » Sarah T., posted by KaraS on July 23, 2005, at 16:07:24
Hi Kara,
Thank you for this information on the generic version by BARR. Very interesting.
Again, I apologize for my tardiness in responding to you. I'm very frazzled these days.
S.
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