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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by kelv on December 21, 2006, at 21:19:04
Hi,
It seems that in the 60's uppers+downers and combos were in vogue. Most folks medicate with both, either pharms or Coffee and Alcohol etc...
Many don't like the blahs that accompany SSRI, or MS, AP, AD use.
Do many here medicate with scripted or not, uppers+downers to function ok?
Posted by med_empowered on December 22, 2006, at 11:16:46
In reply to Upper+downer for Anx/dep, posted by kelv on December 21, 2006, at 21:19:04
I think the upper/downer combo is making something of a comeback, just in a different form.
Look at Provigil: its common now for depressed or anxious or even psychotic patients to be given provigil along with whatever else it is they're being given. Some anxious patients are also treated with a benzo+stimulating AD, like Wellbutrin (which really is more a stimulant than an AD anyway). And a number of ADHD people I know are given Ritalin or Adderall plus a benzo for daily, regular use. Plus, anti-depressants often have built-in sedative, stimulant, and neuroleptic effects (in the same med), so it could be argued most people on ADs are on an upper+downer combo.
Posted by becksA on December 22, 2006, at 12:49:56
In reply to Re: Upper+downer for Anx/dep, posted by med_empowered on December 22, 2006, at 11:16:46
I know for many it does work, and I am actually prescribed both my regular very high dose of klonopin (which btw I'm slowly tapering off now...down to 10mg from 14mg in a little over a month.) In any case for whatever reason, I'm EXTREMELY tolerant to benzos, which is why we think it may not be social anxiety which is my main problem, because I tried every single one maxed out and then some, and it wasnt until 14mg of klonopin that I felt any help. (So I'm trying lithium as I taper off)
Sorry to drift from the subject. as you can see I also have ADD and am prescribed concerta. Even that I find to be rough on my anxiety, with a harsh comedown...and I take a very small dose. (Adderal was much worse. I would take the smallest dose (5mg) and the comedown was hell....depression for hours. Concerta has proved to be a better. Not perfect, but good enough that I can take it to help me study.
Posted by Tom Twilight on December 22, 2006, at 12:55:03
In reply to Re: Upper+downer for Anx/dep, posted by med_empowered on December 22, 2006, at 11:16:46
I'm no medical conservative :)
Still I think Upper+Downer combos need to be aproached with caution.
I got into reall trouble during my finals because I ended up taking Dexedrine during the day to help me study & Remeron at night to help with the insomnia & anxiety from the Dex.
Unfortunatly the Remeron made me so sleepy I needed more Dex to stay awake
Which made me more anxious and inturn need more Remeron!To be fare I wasn't being monitored by a responsible doctor at the time, which didn't help
Having said that I think the combination can be great.
I found that a low dose of Dex was really helpful for overcoming the fatigue and Sleepiness induced by Clomipramine.
Just be careful, thats my advice!
Posted by Quintal on December 22, 2006, at 13:41:39
In reply to Upper+downer for Anx/dep, posted by kelv on December 21, 2006, at 21:19:04
That's a good question and one I've been thinking about myself for a while. My Parnate+Klonopin combo was the nearest I've come to the 'Purple Hearts' et al of the 60's and 70's.
http://amphetamines.com/dexamyl.html
I'm Hmmm Hmmm-ing after reading this: (From a person who used it in the early sixties:) Dexamyl was a great help for losing weight, because the amphetamine controlled your apetite but the (I always thought it was) phenobarbital kept you from getting shaky from the amphetamine. I was really sorry to see it go off the market, as all the more recent stuff like Prozac etc. does not work for me.
Retrieved from "http://en.wikipedia.org/wiki/Dexamyl"
Another interesting first hand experience of Dexamyl:
http://www.addforums.com/forums/archive/index.php/t-12628.htmlIt seems Chairman_MAO also had the same idea as me re: Parnate+Benzo cocktail:
http://www.dr-bob.org/babble/20050428/msgs/491060.htmlQ
Posted by med_empowered on December 22, 2006, at 13:59:16
In reply to Re: Upper+downer for Anx/dep » kelv, posted by Quintal on December 22, 2006, at 13:41:39
yeah..i've kind of wondered why, with the current rise in rx-ing of amphetamines, no one has brought back the upper/downer pills. I mean, they're working on new, less-abusable forms of amphetamine, so...why not mix it with a less abusable benzo (tranxene, klonopin, frisium) and see if that works?
Posted by linkadge on December 22, 2006, at 14:37:59
In reply to Re: Upper+downer for Anx/dep, posted by med_empowered on December 22, 2006, at 13:59:16
There is a synergistic potential for addiction between benzodiazapines and stimulants.
Kinda like speedballing, you're going to get synergistic effects on dopamine in the neucleus accumbens, you may end up depleating dopamine stores faster than each agent alone.
It will, of course, work very well, but the question is for how long?
Benzos and amphetamines are also slightly neurotoxic and a combination of the two might produce end up making things worse down the road.
Another potential problem is that benzos are not going to give you the best quality of sleep, so you may end up needing more stimulant during the day do make up for the lack of sharpness from benzo quality sleep.
Linkadge
Posted by Quintal on December 22, 2006, at 15:23:53
In reply to Re: Upper+downer for Anx/dep, posted by linkadge on December 22, 2006, at 14:37:59
>Another potential problem is that benzos are not going to give you the best quality of sleep, so you may end up needing more stimulant during the day do make up for the lack of sharpness from benzo quality sleep.
Well this applies to people taking benzos as a monotherapy or with ADs - more so, and even people taking ADs alone would be prone to this problem in theory as most cause disruptions of sleep architecture.
>Benzos and amphetamines are also slightly neurotoxic and a combination of the two might produce end up making things worse down the road.
Where is the evidence that benzos are neurotoxic? Why would this be worse than taking a benzo with an antidepressant - many of which may also be neurotoxic for all we know?
Q
Posted by linkadge on December 22, 2006, at 17:22:30
In reply to Re: Upper+downer for Anx/dep » linkadge, posted by Quintal on December 22, 2006, at 15:23:53
My biggest concern is that of tollerance.
Linkadge
Posted by laima on December 22, 2006, at 18:34:27
In reply to Re: Upper+downer for Anx/dep, posted by linkadge on December 22, 2006, at 14:37:59
I got stuck just like this once upon a time!
I didn't like that doctor at all.
> Another potential problem is that benzos are not going to give you the best quality of sleep, so you may end up needing more stimulant during the day do make up for the lack of sharpness from benzo quality sleep.
>
Posted by linkadge on December 22, 2006, at 20:30:42
In reply to Re: Upper+downer for Anx/dep » linkadge, posted by laima on December 22, 2006, at 18:34:27
In reality half the world is on upper downer combinations (caffiene + alchohol), but amphetamine and benzos are stronger.
Linkadge
Posted by Quintal on December 22, 2006, at 21:29:47
In reply to Re: Upper+downer for Anx/dep, posted by linkadge on December 22, 2006, at 20:30:42
I think we're just looking for a bit of help to switch us 'on' in the morning and 'switch off' at night, well that's obvious I suppose. Probably because we just don't have time to get going naturally in the morning and unwind at a leisurely pace at the end of the day?
People can get snared into a nasty habit even with humble caffeine - I've done it myself, and the withdrawals are not to be sniffed at for someone who has depressive tendencies to begin with.
Q
Posted by kelv on December 22, 2006, at 22:30:30
In reply to Re: Upper+downer for Anx/dep » linkadge, posted by Quintal on December 22, 2006, at 21:29:47
> I think we're just looking for a bit of help to switch us 'on' in the morning and 'switch off' at night, well that's obvious I suppose. Probably because we just don't have time to get going naturally in the morning and unwind at a leisurely pace at the end of the day?
Yes thats a large part of it. Most folks it's a Coffee/s in morning, then a few drinks at night, for the hardcore-Elvis style- it can be a handfull of Dex/Adderall/Desoxyn? tabs in the~late morning, then a combo of Hynotics/Benzos/even Barbiturates-Tuinal,Amytal, in the late Pm/early am-thought only with the help of an accomadating/scripting PsyDoc.:)and surrendering your days to function on meds.PS-watch out for thoes nightime deep fried Peanut Butter and Banana sandwiches-Elvis style:S
Posted by linkadge on December 23, 2006, at 10:07:03
In reply to Re: Upper+downer for Anx/dep » Quintal, posted by kelv on December 22, 2006, at 22:30:30
I would hazzard a guess that it could be done if your doses were kept low.
Another option is to choose a drug like valproate (an anticonvulsant) which can act as a sedative, but is probably safer long term than benzos.
I think the combination of valproate and stimulants is better tested, as people with bipolar disorder (using valproate as a mood stabilizer) often have comorbid ADHD requireing a stimulant.
I took high doses of caffiene + valproate for about 6 months. Infact, there is evidence that valprotate can actually reverse tollerance to drugs. So you might just get a sedative that makes the stimulant work for a longer time.
Linkadge
Posted by zmg on December 23, 2006, at 13:59:41
In reply to Upper+downer for Anx/dep-Be Careful, posted by Tom Twilight on December 22, 2006, at 12:55:03
I'm laughing because your situation sounds somewhat similar to my own (ages ago now!).
Only with me it was straight forward abuse, with a little guidance from the PDR (Physicians Desk Reference, great book).
If I remember this correctly (and it really has been years) I manged a combo that was terribly effective: Ritalin/Methylphenidate during the day to boost energy, creativity, dopamine, euphoria. I was taking much too much of it (goes without saying, I was quite addicted, so while I do rather relish the memory it was terribly, terribly hard to break and really not something I'd recommend). Methylphenidate stimulates the reticular activating center, part of your brain associated with attention (it of course stimulates lots of other things, but this seems to be the focus). So at night I'd take Soma/Carisoprodol which is a depressant that works on the same region (my copy of the PDR recommended it for treatment in cases of overdose, which I was of course achieving nightly).
It was an odd combo because it allowed me to be incredibly strung out abusing the Ritalin then sleeping like a baby pretty much on demand.
Of course finally I was taking such high doses of Ritalin and had developed such high tolerance that the only effects I could get would be things like palpitations and tingling in the extremities (not good signs).
Aside from cigarettes it was probably the hardest thing I've ever had to quit. Am I on a tangent here?
Hope everyones having a wonderful holiday.
Posted by Quintal on December 23, 2006, at 14:57:12
In reply to Re: Upper+downer for Anx/dep, posted by linkadge on December 23, 2006, at 10:07:03
>Another option is to choose a drug like valproate (an anticonvulsant) which can act as a sedative, but is probably safer long term than benzos.
Why do you think that? When I took Depakote I felt strange and spaced out. A few weeks after I started it I noticed loads of hair clogging the drain in the bottom of my shower - it freaked me out. Depakote also causes hormonal changes and has many potential serious side effects that benzos lack. I don't understand why you've started to think benzos are dangerous.
>Infact, there is evidence that valprotate can actually reverse tollerance to drugs.
I've read about this with Lamictal. I wasn't aware that Depakote could also reverse tolerance but I've never looked, do you have any links?
Q
Posted by linkadge on December 23, 2006, at 15:48:46
In reply to Re: Upper+downer for Anx/dep » linkadge, posted by Quintal on December 23, 2006, at 14:57:12
>Why do you think that? When I took Depakote I >felt strange and spaced out. A few weeks after I >started it I noticed loads of hair clogging the >drain in the bottom of my shower - it freaked me >out. Depakote also causes hormonal changes and >has many potential serious side effects that >benzos lack. I don't understand why you've >started to think benzos are dangerous.
Well, I suppose different people are disturbed by different side effects. Hopefully one would not need a dose as high as is used in bipolar. Perhaps <=250mg would do.
Valproate has multimechanism neuroprotective capaticy. It significantly increases BDNF, and the anti-apoptotic protein BCL-2. Amphetamines tend to decrease BCL-2, which opens the door to neuronal loss an atrophy. In addition valproate decreases GSK-3b, which plays a role in the regulation of circadian rhythem. Stimulants can alter genes like GSK-3b and clock-2 which alter the circadian rythem. GSK-3b inhibition is also neuroprotective. The intercellular activity of valproate too will be neuroprotective.
Benzodiazapines supress neuronal activity, but do not directly activate any of these neuroproective systems. Some studies show that benzodiazapines enhance the sterotypical behavior produced by amphetamines and other stimulants. So, a benzodiazapine might hasten tollerance to an amphetamine.
>I've read about this with Lamictal. I wasn't >aware that Depakote could also reverse tolerance >but I've never looked, do you have any links?
Valproate inhibits opiate tollerance if given *before opiates*.http://www.medscape.com/medline/abstract/15196792
Another study I found.
Yang P, Beasley A, Eckermann K, Swann A, Dafny N.
Valproate prevents the induction of sensitization to methylphenidate (ritalin) in rats.
Brain Res. 2000 Dec 29;887(2):276-284.Another abstract on valproate and ritalin sensization:
Linkadge
Posted by laima on December 23, 2006, at 16:53:10
In reply to Re: Upper+downer for Anx/dep, posted by linkadge on December 23, 2006, at 15:48:46
To clarify, are you saying valproate can help protect the brain from possible damage caused by using stimulants? Ie, help protect against effects such as amotivation or apathy induced by using stimulants?
> Valproate has multimechanism neuroprotective capaticy. It significantly increases BDNF, and the anti-apoptotic protein BCL-2. Amphetamines tend to decrease BCL-2, which opens the door to neuronal loss an atrophy. In addition valproate decreases GSK-3b, which plays a role in the regulation of circadian rhythem. Stimulants can alter genes like GSK-3b and clock-2 which alter the circadian rythem. GSK-3b inhibition is also neuroprotective. The intercellular activity of valproate too will be neuroprotective.
Posted by linkadge on December 24, 2006, at 12:09:11
In reply to Re: Upper+downer for Anx/dep » linkadge, posted by laima on December 23, 2006, at 16:53:10
>To clarify, are you saying valproate can help >protect the brain from possible damage caused by >using stimulants? Ie, help protect against >effects such as amotivation or apathy induced by >using stimulants?
Its hard to say. Wheather amotivation and apathy are induced by structural changes in the brain, or temporary biochemical alterations is the question.
I have never combined valproate with amphetamine or ritalin, but it may well be that the valproate blocks some of the effect of the stimulant as well.
I know that the two are often combined in bipolar comorbid ADHD, so there must be *some* advantage to adding the stimulant or else it wouldn't be done.
I would think that valproate could block the subjective wellbeing produced by stimulants, but I don't know the net effect of a long term combination of the two.
However, blocking sensitization produced by the drug would very likely help to preserve the effect of the drug.
I can't say much more as I havn't combined amphetamine or ritalin with valproate.
If you were to do so, I'd start with the lowest dose of stimulant as possable. I heard of a person combining marajuanna with dilantin who went on a magic carpet ride. Thought this is a slightly different combination :)
Linkadge
Posted by Quintal on December 24, 2006, at 15:43:18
In reply to Re: Upper+downer for Anx/dep, posted by linkadge on December 24, 2006, at 12:09:11
We've mostly been talking about using uppers during the day and downers at night, but that isn't how the 'Purple Hearts' etc. of the 1960's were used. Both the barb and amphetamine were contained in one tablet and consumed at the same time - in the morning presumably. Does this make a difference to tolerance and sleep issues etc.?
Q
Posted by linkadge on December 24, 2006, at 16:10:10
In reply to Re: Upper+downer for Anx/dep » linkadge, posted by Quintal on December 24, 2006, at 15:43:18
Hmm, what was Johnny Cash on ? I heard in an interview he took stims in the morning and sedatives at night.
I really don't know if it would make any difference to tollance.
Taking them both at once might be more rewarding, but withdrawing from a morning stim and nighttime sedative would be hard.
You'd feel like crap during the day, and then at night you would have rebuond insomnia.
Linkadge
Posted by Phillipa on December 27, 2006, at 12:35:48
In reply to Re: Upper+downer for Anx/dep, posted by linkadge on December 23, 2006, at 10:07:03
What was the TCA that was considered an upper downer in the 70's Love Phillipa
This is the end of the thread.
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