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Re: amphetamine for depression Frankie

Posted by Elizabeth on February 23, 2002, at 17:22:45

In reply to Re: amphetamine for depression, posted by Frankie on February 22, 2002, at 1:21:15

> I would first off, not recommend taking a stimulant with an MAO-I.

It's risky, but some people can get away with it, and it's often worth the risk. Remember that hypertensive episodes such as those you'd get on MAOIs are very easy to treat; you just need to be able to monitor your BP. In the past, the MAOI-stimulant combination was commonly used in TRD.

> Amphetamines will be wonderful for depression, but only if you have the lethargic type. If you are unmotivated, unwanting to get out of bed, always tired, etc... Ritalin, Dex., Adderal, will all be great additions. But, if you are the anxious depressive type, like I am, I would not advise the stimulant.

A lot of times, anxiety and lethargy go together. Atypical depression, for example, generally includes lethargy, and it's frequently comorbid with an anxiety disorder such as panic disorder or social phobia. So while your advice looks good on paper (or on my computer screen), it turns out that reality is not so straightforward.

> The MAO-I will be great for this, but the stimulant will increase any type of anxiety disorder.

I've actually met people with social phobia who felt *better* on stimulants. Improved self-confidence, I'm guessing.

> I tried a small dose of Ritalin recently, and my head felt like it was going to explode. My mind was out of control!

A professor of mine said that when he tried it (apparently all med students take speed to stay awake), he became "quasi-psychotic." (He didn't elaborate on what he meant by that.) Some people just don't feel good when they take stimulants, and you can't really predict who will have this kind of reaction by their baseline level of anxiety.

> But, Ritalin is pretty harsh. Dex. is much milder.

Dexedrine is a stronger stimulant than Ritalin is, but it's possible that Ritalin has side effects (in particular, peripheral side effects) that are milder or nonexistent with Dexedrine.

> If it is more lethargic, shoot for a Wellbutrin, or Adderal, in combination with a low dose of an SSRI.

Hmm. I'm definitely lethargic and anergic, but SSRIs did nothing for me, and Wellbutrin made me feel awful. (I've only tried a stimulant once -- Cylert -- and it seemed to help keep my circadian cycle regulated and to improve my concentration and ability to focus. Not so much effect on mood, but I was only taking a small dose. Definitely didn't make anxiety worse.) I think SSRIs could potentially be counterproductive for an anergic patient, because of the "apathy syndrome" that sometimes occurs with long-term SSRI use.

> If it is anxiety based, an MAO-I, or SSRI in combination with a small dose of a benzodiazepine.

I think if you're going to use an SSRI to treat anxiety, you should have a benzo to take as-needed. SSRIs can greatly worsen anxiety in people who have anxiety disorders, initially. If you're going to treat panic disorder with an SSRI, it's best to start low (e.g., 5 mg Prozac or equivalent) and go slow.

> The MAO-I's are the most versatile, from what I have read. I have yet to try one though. I don't want to have to watch everything I eat for fear of a fatal reaction.

A lot of people have the same fear, but this fear really isn't justified. (Also, a lot of people who require MAOIs have hypochondriacal tendencies which cause them to blow the risk way out of proportion.) The necessary dietary restrictions are quite few, and they foods you need to avoid are not ingredients that might be in some dish without your knowledge. I think that the food restrictions shouldn't scare anyone away from taking MAOIs. People who take them don't have to live in constant fear, or anything of the sort.





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