Posted by Megz on October 24, 2008, at 21:27:55
In reply to Any MAOI + Methylphenidate, posted by JNew12 on October 16, 2008, at 10:55:30
I take 12 mg of Emsam (the MAOI patch) and 10-20 mg of Adderall 2-3 times a day. After trying just about every antidepressant (and many combinations), I've finally found something that works for me (depression, chronic fatigue syndrome and a slew of other diagnoses depending on the day/doc).
I have great trust and faith in my psychiatrist. While the MAOI alone provided much relief from my depression, it did not do enough to help my concentration problems. My doctor and I discussed at length the risks of adding a stimulant, including any symptoms to look out for and an action plan in case I developed any of them (ranging from sending him an e-mail to going to the ER, depending on severity). He has strictly supervised me while I've been on both drugs. For the first month and a half, I took my blood pressure twice a day (once before the Adderall and again an hour after taking it), e-mailed him my BP values once a week and came in every two weeks to double-check my BP and discuss any symptoms. After six months, I can report few side effects and great success.
The blood pressure is obviously a serious concern. When I took just Emsam, my blood pressure dropped from 120/80 to 110/70 (both considered normal). After adding the stimulant, I ranged from 120/75 (right before I'd take Adderall) to 125/75 (an hour later). After a few months, my blood pressure seemed to level off at about 120/75. I currently take my BP a couple of times a week and visit my doctor monthly.
I'm not saying MAOIs and stimulants are generally safe in combination. My doctor made it clear that there were risks involved, and I had to sign a release saying I'd been advised of the danger. However, we were both committed to carefully monitoring the situation so we could minimize the risks as much as possible. He even had me start with 5 mg of Adderall once a day (which does nothing for me) just to see what would happen the first week.
I don't know if the Emsam delivery method (being a patch) was a factor in the lack of problems I experienced. At my 12 mg dose, they recommend following all of the usual dietary restrictions (which aren't necessary at 6 mg). I've made no changes to my diet with Emsam, but I rarely consume foods with high tyramine content (pre-Emsam or now), so it wasn't much of an issue for me. I have reduced my coffee consumption to no more than two cups each morning, as any more than that elevates my heart rate and makes me anxious.
I'm sorry this is so long. A couple quick points:
- I was on Emsam for a year, starting at 6 mg and slowly working up to 12 mg, before adding the Adderall.
- I'd been on Adderall and Ritalin before the Emsam. We didn't try Ritalin this time because it had never worked as well for me.
- I don't know what effect an extended-release stimulant would have. My doctor thought it might have made my blood pressure more consistent - instead of the rise I experienced each time I took Adderall and the subsequent fall as it wore off. However, I'm kind of a wimp about taking pills, so I prefer the tablets to the XR capsules.
I'm extremely lucky to have a psychiatrist who is committed to ensuring my safety while trying to find the best results. If we hadn't both been willing to invest the time and effort needed to monitor this, the risks would have been much higher.