Posted by psychobot5000 on January 15, 2007, at 15:12:56
In reply to Re: Depressives' sensitivity to stimulants!, posted by laima on January 15, 2007, at 0:19:09
> I agree, I think the concern about a depressed person experiencing a crash from stimulants is probably the most legeit reason doctors might want to not use them, but the thing is, I don't think a crash is guarenteed. I don't think I experience this from the low doses I use.
>______________Me neither. Been prescribed amphetamines and several formulations of methylphenidate, and never experienced any sort of 'crashing.' The benefit merely recedes, and I move back to baseline, usually feeling better because I'm more accomplished. 'Crashing' does not seem to happen to the majority of patients, as far as I can tell. Though certainly a substantial minority.
>
Were these disorders (ADD) first organized before or after stimulants fell out of favor for depression?
>_______________...As for why docs generally stopped using stims for depression, I think the primary reason (besides bad publicity for stims, and the headache of dealing with meds that have abuse-potential) was the creation of conventional ADs. I've read that amphetamine was referred to as "the antidepressant" in the 1940s, but the better efficacy (for many patients) of tricyclics seems to have led to its downfall as a first-line treatment.
> I mean, I believe in them, I identify with the innattentive type attention deficit, but I'm curious about how the history sorts out. I also think there might be some overlap with the symptoms, ie, innattentive and frustrated due to depression, or attention deficit?
>___________
The symptoms of 'depressive pseudodementia' are near-identical to 'innattentive ADD,' and many of the pdocs I've met have been aware of this similarity. The DSM-IV specifically states that one of the criteria for diagnosing ADHD is that the ADHD symptoms not be caused by another psychiatric disorder, and I think that the similarity to many depressive states is part of the reason why.There is also some bias in theory, I think, as today's docs sometimes prefer to think that depression is dependent on serotonin, and stims don't affect it as much as DA and NA. Also, conventional ADs could be interpreted (because they produce a steady state of mood-elevation and such) as resolving the underlying problem of depression, whereas the withdrawal of benefit from the patient (from stims), as the blood-levels recede, seem to suggest that stimulants only treat the symptoms without treating the cause.
I can understand practitioners' reasons for being wary, and their desire to use other meds for first and second-line treatments, but I think they should be more open to them thereafter, especially for treatment-resistant depression, and as adjuncts to other treatment(MAOis included).
poster:psychobot5000
thread:721931
URL: http://www.dr-bob.org/babble/20070113/msgs/722569.html