Posted by fachad on February 19, 2002, at 20:45:12
In reply to Re: Questions about depression, posted by Elizabeth on February 16, 2002, at 11:50:47
Elizabeth wrote:
"My guess is that people who have sudden miraculous responses when a stimulant is added to an ineffective antidepressant are responding to the stimulant and that discontinuing the antidepressant would probably make little or no difference (except for causing fewer side effects and saving the patient some money)."
That's exactly how it worked for me - after a long trail of ineffective ADs, my pdoc added Ritalin. Later, I discontinued all ADs and just took Ritalin, and it's remained effective against my depression at the same dose for years.
I did switch to Concerta, so you can forget about that "saving some money" part.
> > Unfortunately, typical pstims like Dexedrine can help depression for a little while, but the effect soon wears off, and we're back to square one again. That's why no pdocs that I know of in this area of the country prescribe typical pstims like Dexedrine for people with depression.
>
> That's the reputation of stimulants. I don't know if it's really true. It certainly isn't true for everyone; amphetamine was a standard treatment for depression before MAOIs and TCAs were discovered. A relative of mine who died a couple years ago took it for years with no tolerance developing. I think it's more likely that the doctors in your area who never prescribe Dexedrine for depression are simply very conservative, because stimulants can be very effective for some depressed people who need catecholaminergic drugs rather than serotonergic ones.
>
> > The good news is that if an antidepressant is not working, some pdocs will augment an antidepressant with a pstim and sometimes the combo works wonders.
>
> If tolerance really were an inevitable consequence of taking stimulants for depression, people would become tolerant regardless of whether they were also taking an antidepressant or not. Also, I think that in most cases, if an antidepressant really isn't working, switching to something else is a better idea than augmenting. My guess is that people who have sudden miraculous responses when a stimulant is added to an ineffective antidepressant are responding to the stimulant and that discontinuing the antidepressant would probably make little or no difference (except for causing fewer side effects and saving the patient some money).
>
> > Try the non-serotonergic, non-tricyclic drugs like Wellbutrin. Wellbutrin has a very benign side effect profile and is very stimulating for most people.
>
> I haven't been too impressed by what I've heard about Wellbutrin. It seems to work well for some people, but most people who take it are using it for augmentation or to counteract SSRI (or, occasionally, MAOI) side effects. If someone needs a catecholaminergic drug rather than a serotonergic one, I would expect a stimulant (Dexedrine, Adderall, Ritalin/Concerta, Cylert, Provigil) to be more effective than Wellbutrin.
>
> > Another avenue to take is to try Modafinil (Provigil).
>
> This seems like a better idea than Wellbutrin. I've heard many positive stories about modafinil. The main complaint people seem to have is that it costs too much. It really isn't a great antinarcoleptic since it doesn't treat cataplexy; it's better for depression and ADD, IMO. The risk of tolerance to modafinil is probably not that different from the risk of tolerance to Dexedrine.
>
> > It is considered a pstim, but fortunately it’s not a controlled drug like other pstims.
>
> It is a controlled substance, but like Cylert, it's only C-IV.
>
> -elizabeth
poster:fachad
thread:16036
URL: http://www.dr-bob.org/babble/20020215/msgs/94717.html