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Re: adderal and other questions-

Posted by viridis on August 30, 2002, at 2:38:59

In reply to Re: adderal and other questions- » viridis, posted by hildi on August 29, 2002, at 13:20:43

Hi Hildi,

My dosing schedule of Klonopin (clonazepam) has changed quite a bit. Initially, my pdoc prescribed 1 mg to be taken at bedtime. The half-life is supposed to be long enough to last through the next day, but for me, it wore off by about mid-morning. This wasn't much help; I have a pretty demanding job that involves long hours, lots of interaction with people, public speaking, and dealing with diverse and unexpected situations. So, I changed the dosing to 0.25 mg 4X/day, in part because initially (first week or two) Klonopin did have some side effects -- sleepiness, lack of coordination, and forgetfulness -- and I didn't want a big dose all at once. I found myself using Xanax (alprazolam) quite a bit during this time to further reduce anxiety. I mentioned my change in dosing to my pdoc, and he said this was fine as long as it worked and I was comfortable with it. He also commented that this several-times-a-day dosing schedule is popular with some prescribers.

As I got used to Klonopin, I quickly changed to 0.5 mg 2X/day (morning and afternoon). That was better. Now, I just take 1 mg in the morning, along with 5 mg Adderall at the same time. I often take another 5 mg Adderall later in the day, but have never exceeded 1 mg/day Klonopin.

I still take Xanax occasionally, 0.25-0.5 mg, but just for especially stressful situations. I take it rarely enough that I can still feel its anti-anxiety effects coming on, especially if I dissolve it under my tongue (very bitter, though). In contrast, I don't "feel" anything from Klonopin, just a relief of anxiety and tension that lasts all day. By the way, I gather that Ativan (lorazepam) can be used in a similar way to Xanax, although I've never tried it.

I also take Neurontin, 400 mg 3X/day. As I mentioned earlier, I'm not sure it does much, but my pdoc recommends that I stay with it because he suspects it adds a subtle level of stability. For me, it has no discernable side effects.

Re: stimulants: I've just used Adderall. It's an amphetamine (Adderall is a combination of several amphetamine salts; dexedrine is another example of an amphetamine). Ritalin (methylphenidate) is closely related to the amphetamine group of drugs (I've never tried Ritalin, although my pdoc initially suggested this as an alternative if Adderall wasn't effective). This group of drugs is generally considered "strong" and has abuse potential for some, so is tightly regulated, at least here in the US. This is why doctors are cautious in prescribing these drugs -- the prescriptions are filed with state and federal regulatory agencies, they're subject to audits etc., these drugs have street value, and they're wary of drug abusers. In contrast, modafinil (Provigil) belongs to a different, much newer class of stimulants, and is much less closely regulated. Adrafinil was developed in France and is the "parent' drug of modafinil, but isn't available in North America. Free samples of Provigil are easily available, but you'd never (at least in the US or Canada) be able to get a trial sample of Adderall, Ritalin, etc. Ironically, Adderall and Ritalin (generally considered most effective for ADD) are prescribed much more freely to children with ADD than to adults with the same condition.

My pdoc considers Provigil a "mild" stimulant (of course, it depends in part on what dose you take, just as with amphetamines). He isn't subject to close scrutiny when he prescribes it, so it isn't surprising that he tried it first, especially since it's very effective for certain people. It wasn't the best for me, but it didn't cause any problems and is certainly worth trying.

I get the impression that you're in a different country. This is partly because you're able to order benzos by mail, something that I don't think would be possible (at least legally) here. Wherever you are, I suspect that your doctor is subject to closer scrutiny when prescribing amphetamine stimulants like Adderall than with modafinil etc. So again (and it looks like you agree) Adderall or Ritalin might be something to gradually build up to if necessary, once the anxiety is tamed and you've tried other stimulants that your doctor is more comfortable with. Asking for Adderall or Ritalin right off the bat makes a lot of doctors suspicious (and by the way, so does asking for Xanax, which at least in the US is considered much more subject to abuse than Klonopin and some other benzos, whether it really is or not)

Just a couple of other questions/comments: First, it sounds like you're trying the benzos on your own (unless I misunderstood). Does your doctor know this? He or she really should be aware of the medications you're taking, and it would be best to get the benzo prescription(s) from your doctor if possible, or change doctors if necessary. Again, I may have totally misunderstood, but I got the impression that you ordered the benzos independently.

Second, you mentioned earlier that your doctor is very insistent on SSRIs. These work wonderfully for some (I know several people whose lives have been dramatically improved by Prozac, Paxil, Celexa, etc.) but for others of us they're just awful. I'm one of the latter, and would never touch an SSRI again. Some doctors simply refuse to accept that this class of drugs isn't effective for everyone, prescribe them to anyone who complains of depression or anxiety, and continue to push them even when the patient reports serious side effects after weeks of use. It took me many years and several doctors before I found one who actually understands how to treat me effectively (without SSRIs), and with whom I can actively discuss my treatment. So, if you're not happy with your current doctor, or don't feel they're communicating with you properly, it's definitely worth trying others. There are good ones out there; it may just take some searching.

Best of luck!



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