Posted by Clayton on November 4, 2003, at 23:02:45
In reply to Re: first dose of ritalin, posted by LightShifter on November 4, 2003, at 16:20:42
First "Does anyone have experience with Ritalin?". Goodness, yes! Read the other entries in this thread and other Ritalin related Psycho-Babble threads. And I hope a lot more people write in and give you helpful advice! I plan on being constructively speculative and rather irresponsibl here.
Second, You WILL notice a profound difference with Ritalin at a dose of 20mg max. It is a powerful stimulant similar to amphetamine. I can not take Ritalin as I abused amphetamines in my twenties (I'm 52 now) and exceptionally prone to addiction. A 20 mg initial dose taken as an experiemt "just to see if this stufff they give to people with ADD is really like speed" got me high as a kite. Forty minutes later, I almost swallowed another 80 mg. Three days later, I took 200 mg. It may be a wonderful, efficacios medicine for you and I hope it helps. For people like me, it is speed and speed is death.
Third, Klonapin is adddictive but not nearly as much as Xanax and Valium. Xanax is the best medicine on earth for panic attacks. I have severe SAD and took it for years and, although I abused it, it still saved my life. It has the virtue of being short-acting (subjective effects last about 90 minutes) so it gets out of your system and gives you back your memory and cognitive skills quickly. It actully seems to have a slightly stimulating, antidepressant effect (the docs call this "Euphoria" and explain that's why it's so addictive). It helped me start and follow through on tasks at work and home many times that I'd been procrastinating. Leaves me feeling wide-awake. For a non-addiction-prone person who does not need to be sedated for prolonged periods, it is a superb medicine for anxiety, especially of the panic variety. Next there is Valium with a subjective effect that can last up to six hours but also a euphoric component. So the docs like Klonapin - a long acting (about 6 hour) option with a very minimal potential for addiction (slower onset that equates to less euphoria). I think it's depressing! It also has an excessice sedative effect on me, wipes out cognitive and analytical ability and causes memory loss that approaches total amnesia of the previos six hours. But, again, some people tolerate this drug better than I do. It has proven efficacy for anxiety. I have totally given up tranquilizers. It's amazing how my memory has returned. Now I just want my head clear and my mind sharp. I need it that way to do my job.
Slight Correction: Effexor is an SSNRI. It blocks the reuptake of norepinephrine as-well-as sertonin. There are also SNRIs that act on norepinephrine only (Strattera is one) but the SSRIs are the darlings of the medical establishment right now.
I agree that bringing norephinephrine into play is essential to redressing depression. This is a relatively new discovery of the medical establishment. I also believe that you're (Dan) correct that there must be a proper balance between the two neurotransmitters. The "brainfog" described may well mean that relative seratonin levels are too high which can make you sleepy (or much worse). (Might be the Klonapin, too, but you know better than I).
What Worked For Me: Prozac did nothing for me. Paxil made perhaps a 25% improvement in my SAD symoptoms but did not help moood depression.
I found a new pdoc who supplimented the Paxil with Remaron. Remaron is unique. First it brings both seratonin and norepinephron into play. Secondly, it does so essentially by increasing production of these neurotransmitters, not by blocking their reuptake. This seems to have a different effect. For one thing, it works in about three days, not six weeks. For me, it was the keys to the kingdom!! It freed me and saved my life! My mood depresion improved 95%. I have not had a single SAD attack in the five months I've been on it. I am doing things I haven't done for decades.Dan. I'll bet you are right. Your Seratonin system may be fine and producing adequate levels. Your Noreprineorine system may be deficient and you need that neurotransmitter enhanced and in proper balance with seratonin levels.
Lightshifter, I agree you need to do try something to increase your norepineprhine levels. I am AMAZED your doc has not done this. Bupropion is a weak reuptake blocker of seratonin, norepinephine and dopamine in that descending order. Brcause it's chemically related to amphetamines (and facilitates a tiny increase in dopamine), I'm not surprised to see it used in an attempt to treat ADD. But the effect on norepinephron is way too weak. I will bet you anything your depression and anxiety will improve if you do something wise to increase norepinephrine.
Chemical Soup: Lightshifter, I agree you may be on too many meds. We are fortunate to live at a time when the current antidepressants and other medicines exist. They have saved lives! They have liberated people from hell on earth! The knowledge of the brain and nuerological system is voluminous and staggering. It has required the life's work of many gifted and brilliant and committed researchers to acquire this knowledge. PARADOX: We still understand almost NOTHING about how the brain actually functions. We have no idea how the brain stores memories. We do not understand how a single antdepressant (or other psychotropic)used alone without other drugs achieves its effect. We are LITERALLY in the DARK AGES of understaning the brain (perhaps in one or two hundred years, it will all be clear. I'm an optimist about scientific potential. I'm a realist about the current state of afairs). It is reasonnable to assume that they (multiple meds) have effects that are to some degree synergistic. No one has a prayer of understanding what this does to your brain or what the short and long-term results might be. People in the mental health field will tell you not to worry, it's standard practice to perscribe so many concurrent meds. I think they are to close too the situation and too vested in believing they can provide more help than present knowledge permits. It must be frustrating to dedicate your life to eliminating suffering only to realize how limited your options are.
SO: I think you DEFINITELY need to significantly boost norepinephine while reducing the number of meds you take. There are many options: SNRIs, SSNRIs (although Effexor failed you) and Remaron. I would be cautous about cutting off all support for seratonin by going directly to Strattera (an SNRI). It may ultimately be the right answer but serationin is impicated in most depression. How would you rank your problems from most to least severe? Anxiety, Depression, ADD? I have a prejudice for Remaron with a second antidepressant. Remaron in conjunction with Strattera might just work wonders! Remaron and Strattera will synergistically support norepinephrine while Remaron supports a single source of enhancemnet for seratonin. Or, you could try to depend primarily on Strattera as Dan suggests. If so, buy some 5HTP to support seratonin if you start feeling lousy and carefully titrate as a short term solution. Then drop the 5HTP and add an SSRI. Or add Remaron. You risk overboosting Norepinephine but for an ADD person, that might not be a huge risk. If you still need a stimulant after the double boost in Norepinehrine, try Provigil before you go to the amphetamine-class Ritalin.
TOO MUCH SERATONIN: There are well known effects of too much seratonin. There is "Seratonin Syndrome" when the supply becomes so great that it enters your blood stream causing hypertensive crisis. My dose of remaron was too high in conjunction with the SSRI, Paxil. After five months of fabulous relief, I suddenly became bipolar for the first time in my life. Yesterday, this cost me my family - wife and kidds, of twenty years. The doc dialed back the Remaron dose today to cut the seratonin. Unfortunetely, that will cut my norepinephine supply, too. Here prescribed Zyprexa as a short term solution to the mania until the reduced seratonin resolves the problem. We are in the dark ages. Be careful with your brain.
TAKE A RESPONSIBLE CHANCE: I just changed my mind (my right as a temporary manic-deoressive). Get a sample of Strattera as Dan suggests, get youself some OTC 5HTP as an emergancy seratonin suppliment if needed. Get yourself three days off work. Try to go a week med free to clean out your system a bit. Then settle in a safe and comfortable place and try the straterra. Remember, even if it seems to be the solution, you still have other drugs in your system. The Prozac will continue to support seratonin for a long time due to its half life. Your priorities are 1. BOOST YOUR NOREPINEPHRINE(I can't believe you pdic is doing next to nothing for that now), 2. Use caution in abandoning seratonin support 3. Reduce the number of meds you take, and 4. Use a stimulant like Provigil or a Dopamine enhancer like Ritalin if the ADD renmains a real problem.
poster:Clayton
thread:274890
URL: http://www.dr-bob.org/babble/20031030/msgs/276695.html