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Dr. Bob is Robert Hsiung, MD,
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Posted by floatingbridge on November 13, 2009, at 17:43:44
In reply to Re: Stimulants for TRD, posted by uncouth on November 13, 2009, at 14:41:36
> My guess is that in the short run, most people tend to respond similarly to stims -- short term, immediate mood lifting and activation.
>
> My guess is that in the long run, stimulants can either be very good or very bad for people, depending on genetics and specifics of their disorder.
>
> I think stimulants caused a permanent adjustment in my brain's reward system, such that my current default state has become apathy, anhedonia, amotivation. I am considering going back on stimulants, but hoping something else (bupropion and antipsychotics) can normalize. Not holding my breath though.
>Uncouth, how long did you take stimulants for?
> I sometimes wonder if God made me by design like this - to not derive much pleasure from this world. Sure makes it painful and hard to live in it though.Please, Uncouth, I'm so sorry you feel this could be a possibility. (I have thought --and think--similar thoughts.) I'm glad that you posted and shared this, and I want to say that you were not made to suffer. Life is unfair, but there is a place in God's heart, or the universe, or however one would phrase it, for everyone--all of us. I try to remember this every day (w/ varying degrees of success).
many hugs,
fb
Posted by floatingbridge on November 13, 2009, at 17:57:11
In reply to Stimulants for TRD, posted by tensor on November 13, 2009, at 4:31:35
> Hi,
>
> what are your experiences with using stimulants as amphetamine for treatment-resistant depression? I used to take modafinil for a pretty long period of time but it simply does not work anymore. So I'm now looking at other options.
> I was thinking that I could take it monday-thursday and have a drug holiday friday-sunday as I did with modafinil to not develop tolerance, this way I would at least get things done four days a week as opposed to zero now. What do you think?
>
>
> Thanks.Hi Tensor,
Well, I've been taking Dexedrine for 8 months now, along w/ pristiq and various benzos (anxiety was a problem before the dex came on board. I've built up a tolerance, but not to the mood elevation--I mean, it is not the euphoria I first experienced, but it stills brightens me in a way nothing else has. I deal w/ the crash in various ways, and it's taken months to figure out a way to minimize the crash (which can be very ugly and painful). I am going to try the brand dexedrine spansules. I found out my insurance will cover them for not much extra. Generic IR and the Barr generic spansules do not last nearly as long as they should. The Barr spansules wear off after 4-5 hours! (The pamphlet says 10-12!) (I did not respond well to provigil.)
I've never taken drug holidays, so I cannot speak to that. I keep my daily dex consumption low and do not increase unless in an emergency.
Hope this was of some help. Do you take any other meds?
Posted by ColoradoSnowflake on November 13, 2009, at 18:33:05
In reply to Re: Stimulants for TRD » tensor, posted by floatingbridge on November 13, 2009, at 17:57:11
Hi all:
Dexedrine plus alcohol was the best combo I have ever had.......was wonderful and I had a ball for 20 years. Then they kicked my a**, I hit the wall, and it's been shades of awful ever since.
Parnate + Provigil + Nortrip has been the best since then, but doesn't compare to my old remedy!
hugs to everybody,
gayle
Posted by floatingbridge on November 13, 2009, at 18:34:10
In reply to Re: Stimulants for TRD » tensor, posted by floatingbridge on November 13, 2009, at 17:57:11
>
> Hope this was of some help. Do you take any other meds?Umm, sorry Tensor--bad memory. Just re-read your thread about your new combo. My bad.
Good Luck!
fb
Posted by southernsky on November 14, 2009, at 1:06:24
In reply to Stimulants for TRD, posted by tensor on November 13, 2009, at 4:31:35
It doesn't seem unreasonable to use drugs that enhance the dopamine system, imo. I'm not sure why it's more acceptable to target seratonin and noradreneline while ignoring dopamine...
Dextro helped me in that I didn't experience the horrible side effects from SSRIs that were worse than the depression itself. I never felt euphoria from dextro, but its affect has decreased after about a year on a low dose. Overall it does help and is much better for me than ssris.
There is a lot of research out there that TRD is a result of personality disorders, which point to characteristics that should be treated with therapy. One of the red flags of a personality disorder or comorbid personality disorder is repeated negative responses from psychotropic drugs.
As for me-i don't see the delineation between personality disorders (character disorders) and neurotic depression/disorders, its only seems to be a caterorgization used for treatment purposes, but it is something worth researching and learning about.
Posted by pingles on November 14, 2009, at 6:19:39
In reply to Stimulants for TRD, posted by tensor on November 13, 2009, at 4:31:35
Posted by SLS on November 14, 2009, at 6:27:12
In reply to Re: Stimulants for TRD, posted by southernsky on November 14, 2009, at 1:06:24
> It doesn't seem unreasonable to use drugs that enhance the dopamine system, imo. I'm not sure why it's more acceptable to target seratonin and noradreneline while ignoring dopamine...
I think the idea exists that anything that enhances dopaminergic neurotransmission through reuptake inhibition or synaptic release will produce addiction. Two very good antidepressants used in the 1980s were potent reuptake inhibitors of dopamine (DA). One of these, amineptine, displayed some addictive responses, but nothing to the degree of cocaine, another DA reuptake inhibitor. The other drug, nomifensine displayed no such addictive potential. There is also Wellbutrin, an antidepressant drug that is touted as being a DA reuptake inhibitor. So, things are not so simple as to be able to categorize all DA drugs as being addictive. Some of the new drugs in clinical stages of development are reuptake inhibitors of the three biogenic amines implicated in depression: serotonin (5-HT), norepinephrine (NE), and dopamine. Assigned the moniker "triple uptake inhibitors", I have not yet seen any indication that they display addictive properties.
> As for me-i don't see the delineation between personality disorders (character disorders) and neurotic depression/disorders,
What exactly is a neurotic depression?
- Scott
Posted by linkadge on November 14, 2009, at 9:19:43
In reply to Re: Stimulants for TRD » southernsky, posted by SLS on November 14, 2009, at 6:27:12
I have been using methylphenidate in combination with amitriptyline.
What I notice is that it does produce very fast and a very complete feeling of remission. I have been crashing though. Perhaps an evening dose would help that.
I don't feel so much euphoria as I do the drug moving me from internal to external. When I am depressed, all I feel is internal and nothing external means anything. The stim helps shift that ballance - at least temporarily.
Linkadge
Posted by tensor on November 14, 2009, at 9:29:11
In reply to Thanks alot for your input, very helpful! (nm), posted by pingles on November 14, 2009, at 6:19:39
LOL, pingles is actually a friend of mine and I was accidentally logged in as her when posting :-) So it's me, tensor, who is thanking.
Posted by floatingbridge on November 14, 2009, at 10:01:07
In reply to Re: Stimulants for TRD, posted by southernsky on November 14, 2009, at 1:06:24
> There is a lot of research out there that TRD is a result of personality disorders, which point to characteristics that should be treated with therapy. One of the red flags of a personality disorder or comorbid personality disorder is repeated negative responses from psychotropic drugs.
>
> As for me-i don't see the delineation between personality disorders (character disorders) and neurotic depression/disorders, its only seems to be a caterorgization used for treatment purposes, but it is something worth researching and learning about.southernsky,
I read something about this just yesterday (as I was contemplating my own trd) and found it very interesting, at least in my own case. I will not speak for others and their experience.
fb
Posted by bulldog2 on November 14, 2009, at 10:48:37
In reply to Re: Stimulants for TRD, posted by linkadge on November 14, 2009, at 9:19:43
> I have been using methylphenidate in combination with amitriptyline.
>
> What I notice is that it does produce very fast and a very complete feeling of remission. I have been crashing though. Perhaps an evening dose would help that.
>
> I don't feel so much euphoria as I do the drug moving me from internal to external. When I am depressed, all I feel is internal and nothing external means anything. The stim helps shift that ballance - at least temporarily.
>
> Linkadge
>
>
>
>
>
>There are longer timed formulations for ritalin and that includes a patch which can be removed when you wish to sleep.
Interesting your comment on moving the internal to external. When depressed I keep processing all my thoughts. Where in meditation you let them flow by in depression you latch onto them and experience emotions.I know I am coming out of depression when I become interested in external stimuli which includes becoming more sociable.
I am experimenting with 10 mg of amitriptyline with my vyvanse (50 mg). Seems to take the raw edges off. I want to see if it prolongs the vyvanse action and slows tolerance.
Posted by linkadge on November 14, 2009, at 12:50:18
In reply to Re: Stimulants for TRD » southernsky, posted by floatingbridge on November 14, 2009, at 10:01:07
>There is a lot of research out there that TRD is >a result of personality disorders
According to some I suppose. According to others TRD is a result of bipolar disorder.
Linkadge
Posted by southernsky on November 14, 2009, at 13:05:33
In reply to Re: Stimulants for TRD, posted by linkadge on November 14, 2009, at 12:50:18
sorry i meant to post this here instead of below.
yes Linkadge-many different theories out there.Here's a view from a professor at Columbia University about poor drug treatment response:
But in fact there is a body of literature that shows that when patients have a comorbid
personality disorder, its more difficult to treat their Axis I conditions. For example, if you have a patient who is depressed and who has narcissistic or borderline PD, that person is likely going to be difficult to treat. They may be failing various trials of meds, and knowing about their PD would be very helpful in understanding why. Or, a patient with panic disorder may not be responding to medication because they have a comorbid avoidant personality disorder. This is one reason drug companies exclude such patients from clinical trials, because they want the best response rate they can get.http://www.thecarlatreport.com/expertqa/diagnosing-personality-disorders
Hope it is helpful for some. I thought this interview was very interesting and informative.
Posted by southernsky on November 14, 2009, at 13:14:17
In reply to Re: Stimulants for TRD, posted by southernsky on November 14, 2009, at 13:05:33
I just reread that article/interview from my last post, and it seems the relevance of personality disorders may be more influential than I first realized.It will be interesting to see if the DSM is changed to reflect the growing clinical and researcher consensus about addressing the relevance of PDs.
"Now, most clinicians and researchers in personality disorders are saying it is time to move PDs to Axis I."
also from article:
So what do you think is likely to happen in DSM-V?
Its likely that personality disorders will be on Axis I. Moving disorders form Axis II to Axis I has happened before. When we went from DSM-III to III-R, the autism community wanted autism to be on Axis I, and so it was moved. Then, when
we went from DSM III-R to DSM-IV, the learning disorders community wanted learning disorders to go to Axis I, and we made that change. But the mental retardation community still liked the idea that MR was special, and they wanted it to stay on Axis II. Now, most clinicians and researchers in personality disorders are saying it is time to move PDs to Axis I.
Posted by SLS on November 14, 2009, at 13:15:30
In reply to Re: Stimulants for TRD, posted by southernsky on November 14, 2009, at 13:05:33
Would you say that most personality disorders are psychogenic or biogenic?
- Scott
Posted by SLS on November 14, 2009, at 13:22:17
In reply to Re: Stimulants for TRD » southernsky, posted by SLS on November 14, 2009, at 13:15:30
> Would you say that most personality disorders are psychogenic or biogenic?
I guess it doesn't have to be an either-or dichotomy. I have seen borderline personality disorder (BPD) respond well to a combination of Zyprexa and CBT. Either one alone was inadequate.
- Scott
Posted by bulldog2 on November 14, 2009, at 14:04:52
In reply to Re: Stimulants for TRD » southernsky, posted by SLS on November 14, 2009, at 13:15:30
> Would you say that most personality disorders are psychogenic or biogenic?
>
>
> - ScottMy opinion is that they are biogenic. I know of a family where the father was narcissitic, kleptomania, and was bipolar. He could only be medicated for bipolar. Also borderline personality disorder. Complete lack of an ability to empathize.
All his children suffer from the same maladies and showed signs at an early age. Once could say that was environmental. However Two of the children grew up in a home separate from the father at an early age. Both were narcissistic and stole and lack of a conscience.
I think environmental has been overstressed in those with personality disorder and biology underplayed. Our society frowns on anything that claims that human behavior is due to biology. Makes one look like a fascist.
I would think that it is hard to medicate these types of personality disorders and also hard to change them through psychotherapy. The narcissitic person with no feeling of guilt is more likely to try and outwit the therapist because the narcissistic pd person doesn't think anything is wrong with him/her. Certainly difficult to treat and outlook not that good. Just my opinion.
Posted by bleauberry on November 14, 2009, at 15:02:14
In reply to Stimulants for TRD, posted by tensor on November 13, 2009, at 4:31:35
My experiences with stimulants.
Ritalin, immediate mood and energy boost. I always carry tiny chunks of it around with for an emergency. I rarely use them, but they are kind of like my security blanket. I'v never taken Ritalin long enough to see if I would develop tolerance issues. I have used it in combination with SSRIs or as monotherapy.
I have read of several accounts on pubmed when frail senior citizens experience depression, Ritalin works rapidly. It was generally chosen over antidepressants due to fast action, more reliable performance, less side effects, easy for even a frail system to tolerate, and less toxic.
Adderall, gives me immediate profound worsening of depression and a sort-of fearful panicy short circuit feeling. I do not like Adderall at all. Some of my friends or neighbors have had good results combining it with prozac.
I used Adrafinil 300mg for several years in combination with prozac and zyprexa. It kicked in over about a 6 week period. While prozac and zypexa had brought me up to about 60% from a starting low of 20%, adrafinil raised it to about 95%. Eventually other problems unknown at the time (Lyme and related complications) made my psych meds not work well anymore, make me worse, or give me intense side effects. But before that, Adrafinil was a good friend. Today it makes me more depressed, so something definitely changed over time.
Today my favorite stimulant is Olive Leaf extract. It is not thought of as a stimulant or antidepressant, but frequently is found helpful for chronic fatigue, chronic pain, chronic depression, and brain fog. That's why I tried it. I suspected the reported internet benefits were hype, but from my own experience I guess I was wrong. Not a single bullet miracle, but definitely fills a hole that nothing else has been able to. It seems to be a smooth invisible stimulant and mood improver. Though I felt some benefits almost right away, they were soon drowned out by a Herx reaction. By the end of the bottle things were looking a lot better. I think this is a keeper.
Posted by floatingbridge on November 14, 2009, at 18:07:44
In reply to Re: Stimulants for TRD, posted by bleauberry on November 14, 2009, at 15:02:14
bleauberry,
how do you take your olive leaf extract? And the dosage you've found useful for yourself?
fb
Posted by floatingbridge on November 14, 2009, at 18:09:52
In reply to Re: Stimulants for TRD, posted by southernsky on November 14, 2009, at 13:05:33
This is useful to me. I appreciate the post.
figuring things out in my own way,
fb
Posted by southernsky on November 14, 2009, at 18:30:14
In reply to Re: Stimulants for TRD » southernsky, posted by SLS on November 14, 2009, at 13:15:30
How do you determine if a symptom, throwing one out there-procrastination - is an effect from OCD, ADD, or a result of self-sabotage? Unconscious motivations for self sabatoge resulting from low self worth, such as not deserving to suceed in something...or an underlying dependency - patterns of feeling incapable of handling things, or doing them on your own, so it gets in the way of doing. Stuff "learned" by interacting with your parents as your self/personality is being formed...learned low self worth. But the underlying emotions behind the behaviors are often repressed.
The emotions repressed from way back when....meanwhile, we've formed unhealthy coping patterns during our childhood that extend through adulthood (an example would be repression). The repressed stuff emerges in indirect ways-the example here, being self sabatoge. The feelings are there-the low self worth-but if you had repressed it you would be unaware of the underlying motivations for the behavior and treat only the symptom of procrastination with medications as opposed to finding the emotions that cause the behavior and addressing them with the goal of change. Repression can be useful in some cases, but also very unhealthy. Just my opinons.
In my case, self-introspection with psychotherapy is starting to bring some things to the surface. The procrastination is a hypothetical example, though.
I answered your question with a question..but to directly answer your question below - I have no clue!
Would you say that most personality disorders are psychogenic or biogenic?
- Scott
Posted by southernsky on November 14, 2009, at 18:31:41
In reply to thanks for the link » southernsky, posted by floatingbridge on November 14, 2009, at 18:09:52
You are welcome Floatingbridge! I thought the perspective was very helpful too.
Posted by Phillipa on November 14, 2009, at 19:52:27
In reply to Re: thanks for the link » floatingbridge, posted by southernsky on November 14, 2009, at 18:31:41
Thank you southern sky. Great info. Love Phillipa
Posted by SLS on November 15, 2009, at 13:29:50
In reply to Re: Stimulants for TRD » SLS, posted by southernsky on November 14, 2009, at 18:30:14
Hi.
You have excellent insight into your psyche and psychology in general. I really can't add anything to what you have written here. Any doubts or confusion you have in your efforts to understand the Gestault is very much mirrored by the frustrations and conflicting opinions of the professionals. Drugs are the easy part.
- Scott
> How do you determine if a symptom, throwing one out there-procrastination - is an effect from OCD, ADD, or a result of self-sabotage? Unconscious motivations for self sabatoge resulting from low self worth, such as not deserving to suceed in something...or an underlying dependency - patterns of feeling incapable of handling things, or doing them on your own, so it gets in the way of doing. Stuff "learned" by interacting with your parents as your self/personality is being formed...learned low self worth. But the underlying emotions behind the behaviors are often repressed.
>
> The emotions repressed from way back when....meanwhile, we've formed unhealthy coping patterns during our childhood that extend through adulthood (an example would be repression). The repressed stuff emerges in indirect ways-the example here, being self sabatoge. The feelings are there-the low self worth-but if you had repressed it you would be unaware of the underlying motivations for the behavior and treat only the symptom of procrastination with medications as opposed to finding the emotions that cause the behavior and addressing them with the goal of change. Repression can be useful in some cases, but also very unhealthy. Just my opinons.
>
> In my case, self-introspection with psychotherapy is starting to bring some things to the surface. The procrastination is a hypothetical example, though.
>
> I answered your question with a question..but to directly answer your question below - I have no clue!
Posted by bearfan on November 16, 2009, at 17:29:06
In reply to Stimulants for TRD, posted by tensor on November 13, 2009, at 4:31:35
They can be helpful, but they are also habbit forming (maybe more than a benzo such as xanax). I really don't like the 'crash' either is sometimes is hard to get the prescriptions filed due to them being a schedule II. I actually like provigil (maybe even better than say Dexedrine). What about trying Nuvigl instead (if Provigil pooped out). Another option would be going to 400mg provigil.
This is the end of the thread.
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