Posted by zeugma on February 2, 2005, at 15:51:05
In reply to Re: Stimulant withdrawal » zeugma, posted by ed_uk on February 2, 2005, at 7:20:00
> Hello Z,
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> >I am breaking down rapidly and losing the ability to function.
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> Do you think that your current fatigue and depression may be mainly caused by methylphenidate withdrawal? As you know, stim withdrawal can easily cause both these symptoms even in people with no history of depression or narcolepsy.
>
Hi Ed. yes I know, and it's nasty withdrawal, absolutely brutal to go from 60 mg to 0 with no taper. I essentially had no choice, because the stim itslef was interfering with my ability to work by causing extreme nervousness, irritability, etc., as well as physically wasting me away. I realized also that when the MPH was withdrawn, I had put the nortriptyline back to 75 from 50 mg as the cardiac interaction with MPH was no longer a danger. This was done with pdoc's consent, of course. THEN adding the Strattera onto that was putting my brain through so many changes at once that I think I was literally overwhelmed. Nortriptyline's effects are very dose dependent-I am apt to forget this as it is actually the most well-tolerated, over a wide dose range, psychotropic I have ever taken. I suppose I've adjusted the nortrip so many times that it seemed like nothing to put it back at 75 mg. Well, actually, I think a lot of the reason the Ritalin went bad was because of the nortrip going down to a sub-therapeutic dose. I am definitely feeling the effects of the 75 mg nortrip today, a definite antidepressant effect.yes, I still trust him, though whether he trusts me is an open question. I don't know about the strattera. Thinking now, I realize that just raising the NOR and going cold turkey off the MPH was in itself an enormous med change, the likes of which I've never experienced.
> >I called a sleep doc and am trying to make an appointment.
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> Excellent- I hope s/he can see you quickly.Yes, but sleep clinics are enormously expensive. I am going to have to have a sleep study done, and it runs into the thousands of dollars. And I assume I will have to wash out my meds. I am in touch with one clinician and trying to work out a feasible way to proceed. At this point the sooner the better, so I will know by tomorrow which clinician I will see and what kind of washout it will entail.
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> > know I have pharma options but at this time have no mental health professional whom I trust, abd I am in a debilitated state right now.
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> You do trust your current pdoc though, don't you? He may not be the best but I thought you still trusted him.see above, I do, though I admit I am puzzled by his high regard for Strattera. As far as I am concerned nortriptyline is a far more trustworthy med.
>
> Can you take some time off work???
>I took some days off last week when I was literally flattened by stim withdrawal (yes, I'm speaking literally). And then going up 25 mg on nortrip plus 25 mg strattera- well, that's crazy. Though I don't fault my pdoc for this. His decision to pull the plug on the MPH was the correct one, and he advised me to take the rest of the week off, as he told me I wouldn't be feeling too great. Understatement of the millenium :)
> Best Regards,
> Ed.
>
In case you are interested, I have some info on Strat's pharmacology:Atomoxetine Ki values:
Ne transporter: 4.5 nM
5HT transporter: 152 nM
DA transporter: 1451 nM4-hydroxyatomoxetine:
NE transporter: 3.0 nM
5HT tranporter: 43 nM
kappa opiod receptor: 95 nM
mu, delta receptors: > or = 422 nM.Apparently, in extensive metabolizers 4-hydroxy plasma levels are higher than parent drug, and its half-life is 6-8 vs. 5 hrs. What do you think of this pharmacology? Thanks for all your support,
z
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poster:zeugma
thread:446337
URL: http://www.dr-bob.org/babble/20050202/msgs/451881.html