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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by blueberry on August 21, 2006, at 19:02:46
So my new pdoc has given me ritalin to augment my prozac for partially treatment resistant depression. Antidepressants do pretty much get rid of most of the depression, but leave me in a very blunted ambitionless emotionless life that has been devastating over the years. He sees that as a big issue, even as big as the depression itself, and wants to fix it. He believes either lithium, ritalin, or wellbutrin will do the job.
Currently taking 10mg prozac, 2.5mg zyprexa, and .25mg to .75mg xanax per day. The xanax more than anything really seems to help my mood a lot, but leaves me tired and ambitionless.
Anyway, let's assume I like ritalin. Haven't tried it yet. How does it work for people, say, 3 years down the road, 5 years, 10 years? I know tolerance will develope. But is it a good antidepressant augmentor for the long haul? Or is it best used for short term emergencies only?
Posted by finelinebob on August 21, 2006, at 20:40:50
In reply to Tell Me About Longterm Ritalin, posted by blueberry on August 21, 2006, at 19:02:46
I've been taking it, more on than off, for maybe 6 years. I'm ADD as well. It still works. What works even better, for me, is Focalin. If I remember the explanation that my PDoc gave me correctly, methylphenidate (Ritalin) has two isomers (ways the molecules can order themselves). One of these two has proven to be more effective for addressing ADD, and that's dextromethylpheidate (Focalin). It does help with my mood better than Ritalin.
YMMV. Talk to your PDoc. It's a relatively new drug -- $50 co-pay on my insurance -- but I consider it more than worth it.
Posted by linkadge on August 21, 2006, at 21:12:16
In reply to Re: Tell Me About Longterm Ritalin, posted by finelinebob on August 21, 2006, at 20:40:50
I had the option to use ritalin to augment antidepressants, but I (personally) chose against it.
There are some risks, but I don't know if you want my opinion on that.
For starters, ritalin turns on "addiction genes" known as "Intermediate-early genes" or deltafosB. These substances build up in the neucleus accumbens and have recently been associated with addiction. These genes are turned on by harder drugs like amphetamines and cocaine. The problem is that the genes stay on for a very long time, even after the drug is discontinued.
It is being debated that this could make the user dependant on the substance or similar substances, and cravings for the drug may go a long time.
Long term ritalin use can also cause lasting changes in reward capacity. For instance, if mice are given it for a while, they often develop reward deficits for a long time after the drug is discontinued. Unlike other antidepressants, ritalin directly activates the pleasue centres of the brain.
You will crash on ritalin. That means that when the drug leaves your system you will become depressed. You don't crash on prozac since it has such a long halflife, but ritalin crashing is no fun at all.
I havn't heard too many accounts of it working long term for depression. I know paulbwell was using it for depression, he started at 20mg and last time I heard he was at 80mg. I remember him saying something along the lines that it wasn't as effective as when he first started, so tollerance to the mood elevating effects does develop.
This mediaction may pose long term cardiac risks. It appears to increase the risk of sudden cardiac events, as well as perhaps causing structural changes to the cardiac muscle.
This medication appears to cause chromisomal abnormalities which is a risk factor for cancer.
http://www.news-medical.net/?id=7996
Methlyphenidate + SSRI combination is very powerful, but I think that you will end up getting worse down the road (personally).If you do use it, stick to low doses, and try not to increase the dose. Wellbutrin might be a better option since it does have more long term data supporting its use as an antidepressant.
Linkadge
Posted by Phillipa on August 21, 2006, at 21:45:10
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 21, 2006, at 21:12:16
Link what happens to kids? Could this be a factor in developing bipolar? Love Phillipa
Posted by Paulbwell on August 22, 2006, at 7:37:54
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 21, 2006, at 21:12:16
was given 20mgs feb 94, last script was for 80mgs-stil works.
Dextroamphetamine is where it's at-everyone says so, smoother, calmer.
Rit doesn't cause Cadriac damage, longterm Meth/amphetamines do
Cheers
Posted by linkadge on August 22, 2006, at 15:37:17
In reply to Linkage » linkadge, posted by Paulbwell on August 22, 2006, at 7:37:54
Just a few questions. Does 80mg work the way it did at the very start? Does 80mg give you the same effect that you had when you first started the medications?
And yes, there is growing evidence that methlyphenidate can cause long term structural changes to the heart. It is a stimulant with perepherial effects too. I will try to find the links, but this is essentially what the whole debate is about at recent.
If you really want, just type in ritalin + cardiac, or methylphenidate + cardiac into your favorite search engine.
Linkadge
Posted by mayzee on August 22, 2006, at 16:05:14
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 21, 2006, at 21:12:16
Hi Linkadge,
Any further thoughts (or cautions) on Ritalin as an add-on to EMSAM? I just had a consult with a psychopharmacologist who wants me to try low dose ritalin with my 6mg EMSAM patch.
Thanks,
mayzee
Posted by linkadge on August 22, 2006, at 18:28:50
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 22, 2006, at 16:05:14
Hmm, I'm not sure about this. I would see if you can find any reports of the two being combined safely.
The main problem I see is overstimulation. There are a few different paths by which dopamine can be metabolized, MAO-B, and DAT are two of these systems.
Combining selegeline and ritalin would reduce both of these pathways, which could definately lead to overstimulation.
I would (personally) look for case reports saying the two have been combined safely, before trying it.
Linkadge
Posted by linkadge on August 22, 2006, at 18:30:49
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 22, 2006, at 16:05:14
Is he adding it for antidepressant augmentation, or for attention?
If he is using it for augmentation, I would pick a different agent.
How is your blood pressure on the emsam alone ??
Linkadge
Posted by mayzee on August 22, 2006, at 20:35:55
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 22, 2006, at 18:30:49
> Is he adding it for antidepressant augmentation, or for attention?
>
> If he is using it for augmentation, I would pick a different agent.
>
> How is your blood pressure on the emsam alone ??
>
> LinkadgeI went to see that pdoc specifically because, although I started to show improvement on 9mg EMSAM, the low blood pressure side effects were intolerable (dizzyness, dimmed vision, FATIGUE, etc.) I still have very low bp even at 6mg EMSAM.
He's suggesting the addition of ritalin to 1) augment the AD effect of EMSAM at 6mg; 2) improve energy/alertness (fatigue has always been a big part of my depression); and 3) maybe increase blood pressure.
I do not have ADD/ADHD, but I do have concentration/focus problems due to my depression (atypical MDD/TRD).
I haven't seen any case studies of EMSAM+ritalin, but have seen info about use of ritalin with other MAOIs (see Willyee's thread above on unconventional use of MAOI)
Thanks for your input Linkadge!
--mayzee
Posted by Paulbwell on August 23, 2006, at 2:06:40
In reply to Re: Linkage, posted by linkadge on August 22, 2006, at 15:37:17
> Just a few questions. Does 80mg work the way it did at the very start? Does 80mg give you the same effect that you had when you first started the medications?
No the 'honeymoon period is gone, there was a time when i could wake up early, take 30mgs, drink Tea, chew Nicotine gum, and all day i would fell well, alert interested and on the ball, often "in the zone" feeling where things just darn well fit-was wonderfull while it lasted-This while Ritalin calmed and focused me-This phenomonon i have read about-stim tolerance? sensitivity?.
Now it often makes me nervous, irritable, insecure. I want so bad to capture thoes feelings of a year ago
>
> And yes, there is growing evidence that methlyphenidate can cause long term structural changes to the heart. It is a stimulant with perepherial effects too. I will try to find the links, but this is essentially what the whole debate is about at recent.
>
> If you really want, just type in ritalin + cardiac, or methylphenidate + cardiac into your favorite search engine.
>
> Linkadge
>
>
> I'm sure you can find Cardiac probs with Rit, but i have read Medline articles where Meth/amphetamines typically do this more, and Desoxyn HAVING THE LEAST PNS ACTIVATION TOO.Cheers
Posted by laima on August 23, 2006, at 12:19:55
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 22, 2006, at 18:28:50
My doctor endorses this unorthodox combo, but emphasizes LOW dose of ritalin only- to boost disfunctionally low blood pressure. (Does not really endorse using amphetamines, though.) The danger is of course, as you point out, risk of overstimulation. He says he's treated loads of patients this way, and no one ever got into any danger as long as they followed instructions and didn't cheat by taking extra-and were extra careful with concurrent use of other stimulants, ie caffeine. Also said to be sure to keep an eye on blood pressure with a home heart-rate monitor. He's also a medical professor, so I reckon I can be confident he's keeping up on all the latest studies and such.I was using this with NO problem whatsoever, until the week we had 100 degree temps each day and I went up on EMSAM- I got anxious, so all ritalin was cut as precaution. However, now my blood pressure is so low that I can barely function, so I am going to ask about going back on a tinier amount, ie just 5 mg instead of 15 per day. Definately, having used ritalin before selegeline and after- I conclude that selegeline amplifies its effects.
> Hmm, I'm not sure about this. I would see if you can find any reports of the two being combined safely.
>
> The main problem I see is overstimulation. There are a few different paths by which dopamine can be metabolized, MAO-B, and DAT are two of these systems.
>
> Combining selegeline and ritalin would reduce both of these pathways, which could definately lead to overstimulation.
>
> I would (personally) look for case reports saying the two have been combined safely, before trying it.
>
> Linkadge
>
>
>
>
Posted by linkadge on August 23, 2006, at 16:30:31
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 22, 2006, at 20:35:55
If I recall wylee's ritalin augmentation did not go over too well at all. I don't know if it was overstimulating or what, but I think he ended up in the hospital.
If you do add it go very slowly, try the lowest dose possable and cut that in half (if possable). There may not be an interaction, but in theory, at least, it could lead to over stimulation.
Linkadge
Posted by linkadge on August 23, 2006, at 16:33:27
In reply to Re: Linkage Rit » linkadge, posted by Paulbwell on August 23, 2006, at 2:06:40
You're right, the stronger the stimulant the more likelyhood of cardiac events.
Linkadge
Posted by linkadge on August 23, 2006, at 16:36:11
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by laima on August 23, 2006, at 12:19:55
Whatever you do, DON'T DRINK GREEN TEA on the combination of segeline + ritalin.
If you do, you will have inhibition of DAT, COMT, and MAO-B, the (only?) three pathways available for dopamine metabolism.
This would very likely lead to overstimulation.
Linkadge
Posted by laima on August 23, 2006, at 16:50:00
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 16:36:11
What??? I've done this, never had any warning, never had any adverse event. Where did you hear this? Maybe it depends on how much ritalin...with selegeline I've never used higher than grand total of 15 mg spread out over the day-and that's not a lot. And guess what- still a bit sleepy.
> Whatever you do, DON'T DRINK GREEN TEA on the combination of segeline + ritalin.
>
> If you do, you will have inhibition of DAT, COMT, and MAO-B, the (only?) three pathways available for dopamine metabolism.
>
> This would very likely lead to overstimulation.
>
> Linkadge
Posted by linkadge on August 23, 2006, at 19:43:10
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by laima on August 23, 2006, at 16:50:00
Dopamine doesn't always lead to behavioral activation.
Interesting though, how much green tea did you drink?
Linkadge
Posted by laima on August 23, 2006, at 19:59:56
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 19:43:10
Not much- a cup here and there. I'm more of a coffee-type.> Dopamine doesn't always lead to behavioral activation.
>
> Interesting though, how much green tea did you drink?
>
> Linkadge
Posted by mayzee on August 23, 2006, at 20:39:46
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 16:30:31
> If you do add it go very slowly, try the lowest dose possable and cut that in half (if possable). There may not be an interaction, but in theory, at least, it could lead to over stimulation.
>Linkadge,
What do you mean by "over stimulation"? ...feeling hyper? anxious? or over stimulation of the heart (racing?) or ???
Thanks,
mayzee
Posted by laima on August 23, 2006, at 21:05:04
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 23, 2006, at 20:39:46
Too much ritalin with selegeline (or without selegeline) = wired, jittery, severly overcaffinated feeling. (But calmable with a benzo if you goof.)
> > If you do add it go very slowly, try the lowest dose possable and cut that in half (if possable). There may not be an interaction, but in theory, at least, it could lead to over stimulation.
> >
>
> Linkadge,
>
> What do you mean by "over stimulation"? ...feeling hyper? anxious? or over stimulation of the heart (racing?) or ???
>
> Thanks,
> mayzee
>
>
Posted by Paulbwell on August 24, 2006, at 1:53:32
In reply to Re: Linkage Rit, posted by linkadge on August 23, 2006, at 16:33:27
> You're right, the stronger the stimulant the more likelyhood of cardiac events.
>
>
>
> Linkadge
Hi Ya Link!Your bringng up of Cardiac damage with Rit, is valid-(if someone is, abusing, IVing, snorting huge amounts.
But in average doses, cardiac damage is prolly less toxic than smoking-(which my dad has been doing for 45 years, 68yo) and is in good health.
I know of a 62yo with sever Narcolepsy, who has been taking Desoxyn (quite high doses~60-80mgs) for ~45 years. he recently had a heart angioplasty procedure done=heart damage, prolly from the methamphetamine, strange considering (as i mentioned) Desoxyn has the least PNS activation Vs CNS action.
Cheers
Posted by linkadge on August 24, 2006, at 15:39:59
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 23, 2006, at 20:39:46
Probably different for different people. Too much dopamine, hallucinations perhaps, too much goal directed behavior, inability to turn off certain thought patterns perhaps.
Linkadge
Posted by linkadge on August 24, 2006, at 15:43:23
In reply to Re: Linkage Rit » linkadge, posted by Paulbwell on August 24, 2006, at 1:53:32
The risks for stimulant treatment with ritalin are still existent.
The problem is that there has not been a lot of directed research into the issue. While is has been known that people who abuse stimulants have higher likelyhood of cardiac event, ritalin is only now beginning to get the thorough investigations that it needs.
http://amphetamines.com/methylphenidate/black-box.html
Linkadge
Posted by laima on August 24, 2006, at 16:30:53
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 19:43:10
Now that I think of it, I thought I should mention that though I drink it several times a week, I do not boil my water the full way, (because I don't like it so hot) and take the tea packet out soon- so it's not strong green tea.
But I'm still curious, where did you hear about this green tea thing, or is it a personal educated theory?
Thanks.
Posted by linkadge on August 24, 2006, at 18:54:33
In reply to Re: about that green tea... » linkadge, posted by laima on August 24, 2006, at 16:30:53
It would have to be an educated theory :)
No, its not writtain on the back of the pill bottle.
I know that green tea is a COMT inhibitor. Dopamine can be metabolized by DAT, MAO-B or COMT. So one could expect synergistic actions of the level of dopamine by taking agents capable of inhibiting these enzymes.
Its really just something to consider.
Linkadge
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