Posted by temoigneur on May 12, 2004, at 15:58:52
I have a problem and I was wondering if anyone had any info & or experience with combining atypicals and stimulants. This would seem counterintuitive, and if it is ridiculous, it’s because I have little knowledge of the exact mechanisms of the different meds. What I do know is that when I was on Ritalin I did really well for a few hours – laser like focus, excellent thought clarity, and adequate organizational skills, this however, was followed by terrible depression and anxiety, actually the anxiety was there the whole time I think, I just didn’t notice it because of all the positive side effects.
Modafinil made me extremely anxious, Dexedrine made me anxious; I’m now on 300 Effexor, 10mg zyprexa, 15mg Remeron, and 5mg Klonopin. I’m very fatigued and I feel like a vegetable unable to engage properly, my mind and emotions are numb, and I’m sedated. I am however stable, and free from the crippling OCD and anxiety. Could adding a stimulant at this point be beneficial for the cognitive deficits or would it just have the same effect as lowering zyprexa? Is there any time when it would seem appropriate to use Atypicals or any antipsychotics with stimulants (Ritalin, Adderall).
A note on stimulants; - Dr. Goldberg if you see this, I obviously took the liberty of quoting you, I hope that’s alright.
From: Ivan Goldberg <Psydoc@psycom.net>
Subject: Adderall for child ADD
“It is interesting to see the controversy about Adderall. I would have predicted that Adderall would be too similar to Dexedrine to add any advantage. However I have found it to be as different as Ritalin. I don't think there is any predictability regarding response to Ritalin (methylphenidate), Dexedrine (dextroamphetamine), Adderall, or Cylert (pemoline). One may work or cause side effects when the other doesn't. I think my Adderall responders are unexpected because they are the Ritalin or Dexedrine failures. If I gave Adderall first, I would probably find similar difficulties with it.”Another ADD-OCD sufferer wrote;
“I have had great success with adderall and prozac. My brother has very severe ADD and OCD. Ritalin makes him sleep all the time, adderall made him very compulsive and obsessive, but he has had great success with Dexedrine. You just try a medication under a doctor's supervision until you find the one that is right for son. By the way, OCD and ADD are very common together since in many ways they are both attention issues.”I’m a 25 yr old male, I’ve been had these illnesses since I was 14/15. My, (Bentley), diagnosis is Tourrettes (very mild) OCD moderate-severe, and the full range of anxiety disorders, (severe). My psychiatrist concurs that I likely have ADD, from the way I responded to Ritalin. My energy/focus/cognition is fairly poor. Previously lowering the zyprexa caused the OCD to come back, but I haven’t tried lowering it while on effexor. I have thought about upping the effexor to 450 and trying to lower the zyprexa but my psychiatrist fears I’ll become frantic, as happened when I jacked prozac up to 80 recently, (wasn’t on effexor at that time).
Of note, years ago, there was a four month period, when I was virtually symptom free and ‘self-actualizing” or living up to my potential on just prozac, then, after four months, I the prozac stopped working over the course of a couple weeks. I initially responded to the prozac immediately, it kicked in the day I took it, I don’t know if this is a significant clinical phenomena in my pathology. This is so complicated, anyone who dares to tackle this is a first rate clinician in my mind, but somewhere underneath all this I have a good mind. Thank you so much.Ben
poster:temoigneur
thread:346213
URL: http://www.dr-bob.org/babble/20040510/msgs/346213.html