Psycho-Babble Medication Thread 1105687

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stimulants for treatment-resistant depression?

Posted by Roslynn on August 11, 2019, at 14:37:06

Hi, anyone using a stimulant as a main component of their depression treatment and has it been successful?

Is this more of an add-on/augmentation thing or can they be used as monotherapy for depression?

Thank you for any help!

Roslynn

 

Re: stimulants for treatment-resistant depression?

Posted by Christ_empowered on August 11, 2019, at 16:54:23

In reply to stimulants for treatment-resistant depression?, posted by Roslynn on August 11, 2019, at 14:37:06

there have been a few studies...i want to say they used Ritalin (?)...in the elderly and/or people with ongoing health issues (depression in those undergoing treatment for HIV, for instance) in which the stimulants...

were reasonably well-tolerated and worked faster than conventional antidepressants (which is to be expected). I heard about one small study on NPR in which Ritalin was used with celexa in older people, and there was an "accelerated response," no serious problems with drug induced psychosis, agitation, etc., no abuse if I recall correctly...

with amphetamines, it seems results a bit more mixed. I've read that adding about 15mgs/dexedrine had the same effect as a round of ECT (eek!), and then I've also read that other studies...not so much.

there's a patent out there, in the outer regions of cyberspace...amphetamine AM, remeron PM. sounds like a modified goof ball to me, but...OK. makes sense. I have an acquaintance who was (is?) on Adderall xr AM and then seroquel xr, PM...covers lots of bases, not TD or anything, neither too much sedation nor excessive stimulation.

my -personal- , just some individual on the internet advice would be to start with some sort of all day Ritalin or Focalin, see how that goes. in add/adhd, some people are on 2 forms of the same stimulant, to provide longer coverage...a long acting Ritalin AM, a focalin or Ritalin tablet sometime later in the day, that kinda thing.


other than that...when I took stimulants, I still needed other stuff, but I was...young and stoopid and also...not you, obviously. :-)

i hope this helps. another word of advice from some random person would be to start low, go slow...

and if the stimulant gets the job done, consider an occasional drug holiday.


and that is all. :-)

 

Re: stimulants for treatment-resistant depression?

Posted by linkadge on August 11, 2019, at 17:14:28

In reply to Re: stimulants for treatment-resistant depression?, posted by Christ_empowered on August 11, 2019, at 16:54:23

I would agree with the previous poster. There is mixed evidence that they can work in pure unipolar depression, but there is much more evidence that they can treat depression when it co-occurs with ADHD.

I think (like with marihuana) that the evidence has been skewed a bit by the reluctance to seriously study a potentially addictive treatment for depression (even though they are routinely prescribed for ADHD).

There are some studies where they work quite well as adjuncts, especially when hardcore fatigue is present.

I used Ritalin as an adjunct for a while and it was quite helpful. Although, there is a bit of up and down that you have to deal with.

Linkadge

 

Re: stimulants for treatment-resistant depression?

Posted by rjlockhart37 on August 11, 2019, at 17:33:24

In reply to Re: stimulants for treatment-resistant depression?, posted by linkadge on August 11, 2019, at 17:14:28

dexedrine is used for depression sometimes, like what said treatment resistant, it's an add on to a antidepressant. But usally they don't go very high in the dose, the maximum dose i've ever seen someone take is 90mg of dexamphetamine spansules, at a NA meeting for their adhd. they took 4 spansules at morning and 4 spanules in after noon to last exacly 12 hours.

dex was a antidepressant marketed in the 1960s, if you go throuhg the pharmacutical ads, they put "make you day better with dexedrine" for depression. They also had something called Dexamyl, which was a combination of dexamphetamine and amobarbital, it was mainly an antidepressant. But people abused it and dexamyl at higher did produce stimulantion like dexedrine by itself, the barbiturate... amobarbital would counter act the stimulation to keep it leveled, but people reported cognitive impairment because of it. It was later remvoed from market for various reasons. But there are tons of old ads from 50s and 60s marketing dexedrine, methedrine for depression. But they moved away from dopamine meds and started the tricyclic antidepressants targeting serotonin and NE.

yes definitely it could help, the only thing is when dexederine were's off your not in a good mood, its makes you kinda irritable and tired.

 

Re: stimulants for treatment-resistant depression? Roslynn

Posted by pedr on August 11, 2019, at 20:41:43

In reply to stimulants for treatment-resistant depression?, posted by Roslynn on August 11, 2019, at 14:37:06

I'm not going to talk about the current data on this. I'm going to talk about my own extensive experience with using methylphenidate-based and amphetaminergic meds to treat my decades-long severely Treatment Resistant Depression.

In a nutshell, the four Adderall doses I take every day afford me brief glimpses of feeling "normal". I briefly want to do things, care about things and feel mostly human basically. Other than those periods, I desperately want to be dead.

And before everyone jumps on the "stimulants are short term, this won't last" wagon, I've been taking this amount of Adderall for over a year. Yes, it is hugely less effective (for my depression) than when first prescribed, but it's still literally invaluable to me for the aforementioned reasons.

I cannot convey how important stimulants are to me in my fight against TRD.

FTR my regimen is Lexapro, Rexulti, Abilify, Trazodone, Buspar, Adderall.

Pete

 

Re: stimulants for treatment-resistant depression? pedr

Posted by linkadge on August 12, 2019, at 7:18:09

In reply to Re: stimulants for treatment-resistant depression? Roslynn, posted by pedr on August 11, 2019, at 20:41:43

I wouldn't say that stimulants are short term. I mean, they can be, but not always.

Ritalin, for example, is a dopamine / norepinephrine reuptake inhibitor. It has minimal monoamine releasing effects. I don't see this as being any different than say desipramine on norepinephrine.

If you're getting high, your brain will fight that off, but if it is restoring some sort of balance, then who knows how long it will last.

 

Re: stimulants for treatment-resistant depression?

Posted by Roslynn on August 12, 2019, at 14:24:30

In reply to stimulants for treatment-resistant depression?, posted by Roslynn on August 11, 2019, at 14:37:06

Thank you everyone for your messages which were very helpful.

Right now I am taking Ritalin twice a day but I feel a little strange about it because my afternoon dose almost overlaps my afternoon lorazepam dose which I have to take for anxiety. I can't help but feel that these two are canceling each other out in the afternoon?? This is bizarre.

 

Re: stimulants for treatment-resistant depression? Roslynn

Posted by pedr on August 12, 2019, at 14:30:34

In reply to Re: stimulants for treatment-resistant depression?, posted by Roslynn on August 12, 2019, at 14:24:30

> ...I can't help but feel that these two are canceling each other out in the afternoon?? This is bizarre.

I find that my Adderall dose raises my mood even if I've taken Lorazepam or Valium. It does seem to blunt the alertness though.

HTH.

 

Re: stimulants for treatment-resistant depression?

Posted by linkadge on August 12, 2019, at 18:13:59

In reply to Re: stimulants for treatment-resistant depression? Roslynn, posted by pedr on August 12, 2019, at 14:30:34

Ritalin won't cancel our the lorazepam directly. Although one is a 'stimulant' and one is a 'sedative' they don't have directly opposing actions.

Linkadge

 

Re: stimulants for treatment-resistant depression? pedr

Posted by SLS on August 12, 2019, at 22:44:49

In reply to Re: stimulants for treatment-resistant depression? Roslynn, posted by pedr on August 11, 2019, at 20:41:43

> FTR my regimen is Lexapro, Rexulti, Abilify, Trazodone, Buspar, Adderall.

How did you come to the conclusion that a combination of Rexulti + Abilify worked better for you than using only one of these two drugs in your regime?


- Scott

 

Re: stimulants for treatment-resistant depression? SLS

Posted by pedr on August 13, 2019, at 7:35:54

In reply to Re: stimulants for treatment-resistant depression? pedr, posted by SLS on August 12, 2019, at 22:44:49

> > FTR my regimen is Lexapro, Rexulti, Abilify, Trazodone, Buspar, Adderall.
>
> How did you come to the conclusion that a combination of Rexulti + Abilify worked better for you than using only one of these two drugs in your regime?
>
>
> - Scott

Oops my bad SLS, replace Rexulti with Fetzima. I'd had a few whiskies by the time I'd written that... (BTW whisky helps elevate my mood with seemingly little downside the next day).

Pete

 

Re: stimulants for treatment-resistant depression?

Posted by Roslynn on August 13, 2019, at 14:55:51

In reply to stimulants for treatment-resistant depression?, posted by Roslynn on August 11, 2019, at 14:37:06

Thank you everyone for the helpful info!!

Roslynn

 

Re: stimulants for treatment-resistant depression?

Posted by Roslynn on August 13, 2019, at 15:01:18

In reply to Re: stimulants for treatment-resistant depression? Roslynn, posted by pedr on August 11, 2019, at 20:41:43

>
> In a nutshell, the four Adderall doses I take every day afford me brief glimpses of feeling "normal". I briefly want to do things, care about things and feel mostly human basically. Other than those periods, I desperately want to be dead.
>>
> I cannot convey how important stimulants are to me in my fight against TRD.
>
> Pete


Dear Pete,

I am so glad you found something that helps. That is invaluable. I am still searching.

By the way, I am assuming you take regular Adderall and not XR? Does one work better than the other for you?

Thank you,
Roslynn

 

Re: stimulants for treatment-resistant depression? pedr

Posted by Roslynn on August 14, 2019, at 14:08:45

In reply to Re: stimulants for treatment-resistant depression? Roslynn, posted by pedr on August 11, 2019, at 20:41:43

Dear Pete,

I am so glad you found something that helps. That is invaluable. I am still searching.

By the way, I am assuming you take regular Adderall and not XR? Does one work better than the other for you?

Does it work right away or does it take a while to build up?

Thank you,
Roslynn

 

Re: stimulants for treatment-resistant depression? Roslynn

Posted by pedr on August 14, 2019, at 15:15:40

In reply to Re: stimulants for treatment-resistant depression? pedr, posted by Roslynn on August 14, 2019, at 14:08:45

> Dear Pete,
>
> I am so glad you found something that helps. That is invaluable. I am still searching.
>
> By the way, I am assuming you take regular Adderall and not XR? Does one work better than the other for you?
>
> Does it work right away or does it take a while to build up?
>
> Thank you,
> Roslynn

Hi Roslynn,

thank you for the well wishes but I can only dream that it "works". It makes me feel more human for about 3 hours a day. The rest of the day I strongly want to not exist.

I am indeed taking 4x15mg Adderall (I break up 3x20mg tabs into 4 doses to spread out my good periods). I've been on Vyvanse with initial success but it began lasting shorter and shorter periods, as did Concerta (Ritalin XR). So I ended up with something dependable and predictable i.e. multiple IR doses.

It doesn't take time to build up, which is one great thing about stimulants. They work immediately - or not at all. On the flip side, they lose efficacy w.r.t. depression as they "build up" in your system, tragically.

HTH,
Pete

 

Re: stimulants for treatment-resistant depression? pedr

Posted by Roslynn on August 15, 2019, at 14:11:11

In reply to Re: stimulants for treatment-resistant depression? Roslynn, posted by pedr on August 14, 2019, at 15:15:40

>
> thank you for the well wishes but I can only dream that it "works". It makes me feel more human for about 3 hours a day. The rest of the day I strongly want to not exist.
>
> I am indeed taking 4x15mg Adderall (I break up 3x20mg tabs into 4 doses to spread out my good periods). I've been on Vyvanse with initial success but it began lasting shorter and shorter periods, as did Concerta (Ritalin XR). So I ended up with something dependable and predictable i.e. multiple IR doses.


Hi Pete,

Thank you for the information. I'm sorry it's only helpful for you for the three hours :( I truly hope something will come along to help you feel better longer.

 

Re: stimulants for treatment-resistant depression? Roslynn

Posted by linkadge on August 16, 2019, at 15:17:04

In reply to Re: stimulants for treatment-resistant depression? pedr, posted by Roslynn on August 15, 2019, at 14:11:11

I'm not sure if Ritalin may work a bit more on a longer term basis as it has a slightly different mechanism than amphetamines.

Amphetamines cause more monoamine release, which may deplete dopamine over time. Ritalin is more of a reuptake inhibitor than releaser.

Linkadge

 

Re: stimulants for treatment-resistant depression?

Posted by Christ_empowered on August 16, 2019, at 15:41:45

In reply to Re: stimulants for treatment-resistant depression? Roslynn, posted by linkadge on August 16, 2019, at 15:17:04

i was reading some David Healy material...

he recalled a patient whose depression responded to Dexamyl (dexedrine+amytal, a barbiturate-type sedative, once quite popular). The 'goof-balls' still get a bad name, but...

from reading over Healy's material, it seems that dosage escalation wasn't all that common, and true abuse was not frequent, either. This person/patient held steady at the same dose of Dexamyl for years...

and then, the DEA decided that uppers (especially combined with downers) were bad news, and the medical establishment also came to badmouth the stimulants for depression. I'm guessing that's when doctors began to draw an (artificial, more sociopolitical than medical) line between "real" treatments and mere "pep pills," etc.


not that uppers for depression are always the best idea (clearly, your doctor thinks it is for you, right now...), but...as Szasz often points out, psychiatry runs a lot on dogma and trends in prescribing, social changes, legal factors, etc....not bona fide medicine, healing, etc.

anyway...

--personal experiences-- have led me to believe that Ritalin, focalin are probably better for long term use than amphetamines. the crash is generally less severe, tolerance seems to be less of an issue, and ritalin seemed to play nicely with the other psych drugs (or at least...better than amphetamines...).

ok. i just mentioned dexamyl, yet again, to point out that combining uppers and downers is not necessarily a bad thing, its actually an old approach.

hope this helps. :-)

 

Re: stimulants for treatment-resistant depression? Christ_empowered

Posted by pedr on August 16, 2019, at 16:01:58

In reply to Re: stimulants for treatment-resistant depression?, posted by Christ_empowered on August 16, 2019, at 15:41:45

> i was reading some David Healy material...

that's funny. My dad knows him a little bit as they both worked at the same hospital in North Wales ( https://goo.gl/maps/386z1LPA8nvESoZH6 , https://davidhealy.org/curriculum-vitae/ ). He even asked Healy some stuff upon my behalf.

>
> he recalled a patient whose depression responded to Dexamyl (dexedrine+amytal, a barbiturate-type sedative, once quite popular). The 'goof-balls' still get a bad name, but...

I pray to see stimulants become "the next ketamine" i.e. the next drug that the establishment rediscovers is actually a very good antidepressant that was thrown out with the bathwater due to knee-jerk policy.

>
> from reading over Healy's material, it seems that dosage escalation wasn't all that common, and true abuse was not frequent, either. This person/patient held steady at the same dose of Dexamyl for years...

Right. I'd love to get another 20mg to cover another hour of my day but my PDoc won't budge. I "get it" but it also pisses me off no end. What actual harm would 80mg do that 60mg isn't already doing?

> and then, the DEA decided that uppers (especially combined with downers) were bad news, and the medical establishment also came to badmouth the stimulants for depression. I'm guessing that's when doctors began to draw an (artificial, more sociopolitical than medical) line between "real" treatments and mere "pep pills," etc.
>

Yup. It's a tragedy that sounds all too familiar. Think MAOI's, LSD, Ketamine...

>
> not that uppers for depression are always the best idea (clearly, your doctor thinks it is for you, right now...), but...as Szasz often points out, psychiatry runs a lot on dogma and trends in prescribing, social changes, legal factors, etc....not bona fide medicine, healing, etc.

Yup and a lot of CYA thrown in, tragically. A lot of PDocs are just too scared to prescribe what they really believe would help in my case I suspect.

>
> anyway...
>
> --personal experiences-- have led me to believe that Ritalin, focalin are probably better for long term use than amphetamines. the crash is generally less severe, tolerance seems to be less of an issue, and ritalin seemed to play nicely with the other psych drugs (or at least...better than amphetamines...).

Well YMMV as they say as I haven't observed that personally. Concerta/ritalin "pooped out" almost completely in terms of lifting my mood whereas Adderall hasn't. Fully. Yet. Sigh.
Don't get me wrong, I frikking hate feeling human for 1-hour patches 3 times a day and feeling hopelessly dependent on a stimulant. But it's the best arrangement I've found. Pretty fucking tragic when I write it down.

>
> ok. i just mentioned dexamyl, yet again, to point out that combining uppers and downers is not necessarily a bad thing, its actually an old approach.
>
> hope this helps. :-)

Well it may not have helped (it's not like I can get Dexamyl prescribed...) but it certainly was an interesting post. Thank you.

Pete

 

Re: stimulants for treatment-resistant depression? Roslynn

Posted by pedr on August 16, 2019, at 16:04:10

In reply to Re: stimulants for treatment-resistant depression? pedr, posted by Roslynn on August 15, 2019, at 14:11:11


> Hi Pete,
>
> Thank you for the information. I'm sorry it's only helpful for you for the three hours :( I truly hope something will come along to help you feel better longer.

You're welcome. Good luck to you.
Pete

 

Re: stimulants for treatment-resistant depression?

Posted by Ruuudy on September 15, 2019, at 13:27:33

In reply to Re: stimulants for treatment-resistant depression? Christ_empowered, posted by pedr on August 16, 2019, at 16:01:58

I had been taking Zenzedi for the past year or so, but I stopped taking it right before starting the Spravato (esketamine) treatments I have been taking for the past couple of months.

However, I happened to be out of town at a trade show where I needed some "pep" to get me going, so I busted out the Zenzedi, and I definitely felt a boost to my mood.
It's a bitch trying to fall asleep at night, though.

But I can tell you from my experience that simulants help me out with my depression.

I just switched over to Pristiq yesterday to replace the fluoxetine I've been taking for the past 29 years.
I also had a Spravato treatment this past Friday after not having one for over a month.
I just not so sure about the Spravato at this point - I think it might be being overhyped.
We'll see. I know it ain't cheap!!!

 

Re: stimulants for treatment-resistant depression? Ruuudy

Posted by pedr on September 15, 2019, at 13:53:54

In reply to Re: stimulants for treatment-resistant depression?, posted by Ruuudy on September 15, 2019, at 13:27:33

keep us posted on the Spravato.

I'm due to start in ~ 6 weeks. They're making me try it before I get VNS/DBS surgery done. It's highly unlikely to work because I've had Ketamine (for chronic pain) before and it made me feel belligerent, more depressed, hyper-irritable and just super miserable. Go figure.

You're right about the cost. Assuming my insurance coughs up, it's still $450 A TREATMENT out of my pocket and they require you try 8 treatments minimum (4 at the lower dose and 4 at the higher dose (or vice-versa)).

 

Re: stimulants for treatment-resistant depression? Ruuudy

Posted by pedr on September 15, 2019, at 13:54:01

In reply to Re: stimulants for treatment-resistant depression?, posted by Ruuudy on September 15, 2019, at 13:27:33

keep us posted on the Spravato.

I'm due to start in ~ 6 weeks. They're making me try it before I get VNS/DBS surgery done. It's highly unlikely to work because I've had Ketamine (for chronic pain) before and it made me feel belligerent, more depressed, hyper-irritable and just super miserable. Go figure.

You're right about the cost. Assuming my insurance coughs up, it's still $450 A TREATMENT out of my pocket and they require you try 8 treatments minimum (4 at the lower dose and 4 at the higher dose (or vice-versa)).

 

Re: stimulants for treatment-resistant depression?

Posted by bleauberry on October 18, 2019, at 16:38:38

In reply to stimulants for treatment-resistant depression?, posted by Roslynn on August 11, 2019, at 14:37:06

I am a huge fan of stimulants for treatment resistant depression, or any depression.

I believe they should be first line, not last line.

Ritalin is, by far, my favorite choice. It helps the most people with the most symptoms of any other med any doctor can prescribe.

Ritalin can work in hours to day, rather than weeks to months.

Modafinil is also a good choice, very often overlooked.

I tend to shy away from Adderall as it is just a prescription version of the street drug that usually doesn't end well in the long run.

Ritalin, Modafinil or any stimulant can work on their own. Sometimes they work better combined with a reuptake inhibitor like prozac, which is in my opinion still the best out there after all these years.


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