Posted by Ellen S. on March 26, 2003, at 11:01:00
In reply to Re: do stims make you lazy? » Ellen S., posted by Ritch on March 26, 2003, at 9:00:55
> > I'm wondering how common it is for stimulants to make people anxious, or to contribute to anxiety.
> >
> > Several months ago, my teenage son's pdoc prescribed Adderall to help him wake up in the morning -- to overcome the severe sedation he was experiencing due to his various medications (Celexa, Eskalith, and Geodon) for anxiety and depression. For a long time he took the Adderall only when he was having serious difficulty waking up to get to school, but on the doctor's advice he started taking it every day. Now his anxiety is out of control (he can wake up in the morning OK, but he is often too anxious to leave the house or even to get out of bed), and we suspect that the Adderall may be contributing to the anxiety. Have others had this experience?
>
> If you already have a pre-existing anxiety disorder they definitely *can* make it worse. You might try a switch from Adderall to dexedrine to see if that rids him of most of the residual anxiety.Thanks, Ritch. Is there really a big difference between Adderall and dexedrine with respect to anxiety? I didn't know dexedrine was still available, but I see it at http://www.rxlist.com/cgi/generic/dextroamphetamine.htm .
> If that doesn't work I would look at stopping the stimulant and focus on the other three meds and see if those might be causing most of the trouble with somnolence (esp. Geodon and Celexa). Antipsychotics can create a lot of sleepiness, Celexa can cause drowsiness and both of them could cause some insomnia at night making it tough to get up in the morning.
We definitely would like to get him off the stimulant and address his sedation by reducing the medication(s) that cause it. We had expressed concerns about the sedation for a long time and wanted to see if his meds could be adjusted to reduce the sedation effect, but the pdoc strongly prefers to add meds to deal with side effects (rather than adjusting other meds to deal with the cause of the side effects), so he prescribed the Adderall.
We suspect that the Geodon is the biggest contributor to the sedation effect, but on the couple of occasions when he has skipped his 20 mg/day of Geodon to see how things go without it, he feels the difference (he is more easily upset by "stuff" that happens) and we notice a difference in his behavior. Thus, the Geodon is an important part of his treatment. He's just (today) started a trial of Abilify, which I am hoping might do the same things for him that the Geodon does but without the sedation effect, but for now the Abilify has been added to the mix, instead of replacing something else.
>He is taking Eskalith? Is he also dx'ed as bipolar?
>Interesting question. He was started on the Eskalith to augment the SSRI he was taking for depression. The effect was dramatic. He had been on an SSRI for about a year with no more than a limited effect that we could see -- although the pdoc he had been seeing during that time was convinced it was working -- but within a week after adding lithium he pulled out of a suicidal state and was feeling and acting pretty good.
The professionals who have worked with him most closely and on a continuing basis (including 24/7 hospitalization) have given him a dx of GAD plus mood disorder NOS. His psychologist-therapist strongly believes the anxiety is the main issue, with the depression secondary (due to my son's feeling that his life was out of control due to his inability to function normally), and we think he has a good understanding of the situation. However, the current pdoc is convinced that he is bipolar (mostly based on a pencil-and-paper questionnaire and the fact that lithium has been helpful) and keeps trying to add additional medications as "mood stabilizers." (Abilify is the latest in the list. Previously he has tried increasing the Geodon -- which was originally prescribed by an out-of-town specialist *not* as a mood stabilizer, but that was abandoned due to too many side effects. Also, my son took a fairly large dose of Lamictal for several months without any sense that it was doing anything other than mildly fogging up his head.)
We've taken the attitude that we seriously doubt the BP diagnosis (there's no family history, and the various other professionals he's worked with say he's nothing like a BP kid in his behavior), but we have agreed to cooperate with treatment that would help with *either* BP or the dx's that we believe.
poster:Ellen S.
thread:211849
URL: http://www.dr-bob.org/babble/20030325/msgs/213041.html