![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 107. This is the beginning of the thread.
Posted by ed_uk on January 23, 2005, at 16:36:18
Has anyone on babble found desipramine effective for the treatment of ADD?
Ed.
Posted by zeugma on January 24, 2005, at 19:28:24
In reply to Desipramine and ADD, posted by ed_uk on January 23, 2005, at 16:36:18
hi Ed.
Did you find lofepramine helpful for ADD? It's metabolized to desipramine.
I have a feeling that Strattera, for whatever reason, is more helpful for ADD than any of the TCA's. I'm going on an assumption that desipramine and nortriptyline are more like each other than either is to Strattera. Speaking from personal experience, while there was definite, if slow, improvement from nortriptyline, there was a more drastic and immediate effect from Strattera that helped with concentration.
-z
Posted by ed_uk on January 27, 2005, at 11:57:35
In reply to Re: Desipramine and ADD » ed_uk, posted by zeugma on January 24, 2005, at 19:28:24
Hi Z!
>Did you find lofepramine helpful for ADD?
No!
Have you ever tried desipramine?
Ed.
Posted by zeugma on January 27, 2005, at 12:44:44
In reply to Re: Desipramine and ADD » zeugma, posted by ed_uk on January 27, 2005, at 11:57:35
>
> No!
>
> Have you ever tried desipramine?
>
> Hey Ed!I've brought up desipramine to my pdoc but he says that it is nearly identical in clinical effect to nortriptyline. The only difference according to him is that higher dosages of desipramine are usually needed to get an AD effect. This is interesting in light of the fact that DMI is about four times more potent at its putative site of action than nortrip. What I can say, if Dement and associates are correct and NE reuptake inhibition is the mechanism by which cataplexy is controlled (leaving MAOI's out of the question for the moment), then 100 mg nortriptyline does the trick, and has a reputation for being more anxiolytic to boot. The antihistamine effect of NOR is also good for 'sleep hygiene' (i.e. it makes sure I get to sleep on time, and this is crucial for me). Not to mention, it helps my allergies.
-z (on his 3rd pot of half-caffeinated coffee, playing raucous music at extremely high volumes to ward of drowsiness)
>
>
>
>
Posted by zeugma on January 27, 2005, at 13:05:29
In reply to Re: Desipramine and ADD » ed_uk, posted by zeugma on January 27, 2005, at 12:44:44
is if there was a reason to think I could tolerate Provigil on it. provigil appears to be the only stim that is not anxiogenic and does not cause cardivascular complications with TCA's. if there was some reason Provigil-DMI wouldn't cause the crazy s/e that Provigil-NOR did, I would be ecstatic. But I don't see any such reason. basically, I'm sc*wed.
-z
Posted by ed_uk on January 27, 2005, at 13:08:18
In reply to Re: Desipramine and ADD » ed_uk, posted by zeugma on January 27, 2005, at 12:44:44
Hi Z!
>The antihistamine effect of NOR is also good for 'sleep hygiene' (i.e. it makes sure I get to sleep on time, and this is crucial for me). Not to mention, it helps my allergies.
The antihistamine effect might worsen your daytime drowsiness though. Also, it is possible that the 5-HT2 antagonism from nortriptyline is worsening your daytime drowsiness. You may prefer desipramine!
If you took desipramine instead of nortriptyline you could always take a short-acting sedative antihistamine to help you sleep. You could treat your allergies with a non-sedating antihistamine. Although desipramine is generally only modestly effective for most forms of anxiety, it is sometimes very effective in blocking panic attacks. If you find nortriptyline to be anxiolytic it is quite possible that you might also benefit from desipramine.
RE amphetamines.
To be honest, there doesn't appear to be any definate consensus on whether methylphenidate is more or less likely than the amphetamines to cause cardiovascular side effects.
Adderall causes more cardiovascular side effects than Dexedrine so it would not be a good choice for you. If you took Dexedrine immediate release you could adjust your regimen so that your plasma concentration of dextroamphetamine was low at meal times- this may reduce the risk of weight loss. A beta blocker may be useful for cardiovascular side effects. What cardiovascular side effects did you experience with methylphenidate?
Ed.
Posted by ed_uk on January 27, 2005, at 13:15:04
In reply to the only reason I would switch to DMI » zeugma, posted by zeugma on January 27, 2005, at 13:05:29
BTW, have you ever taken adrafinil (olmifon)?
Ed.
Posted by zeugma on January 27, 2005, at 13:30:03
In reply to Re: the only reason I would switch to DMI » zeugma, posted by ed_uk on January 27, 2005, at 13:15:04
No, but it's metabolized to modafinil, so i would be wary of it.
-z
Posted by ed_uk on January 27, 2005, at 13:38:15
In reply to Re: the only reason I would switch to DMI, posted by zeugma on January 27, 2005, at 13:30:03
Hi,
>No, but it's metabolized to modafinil, so i would be wary of it.
I know, but some people who can't tolerate modafinil seem to prefer it. See the archives.
Did you see my previous post?
Ed.
Posted by zeugma on January 27, 2005, at 13:42:48
In reply to Re: Desipramine » zeugma, posted by ed_uk on January 27, 2005, at 13:08:18
> Hi Z!
>
> >The antihistamine effect of NOR is also good for 'sleep hygiene' (i.e. it makes sure I get to sleep on time, and this is crucial for me). Not to mention, it helps my allergies.
>
> The antihistamine effect might worsen your daytime drowsiness though. Also, it is possible that the 5-HT2 antagonism from nortriptyline is worsening your daytime drowsiness. You may prefer desipramine!
>that's true. although to be honest I don't feel more drowsy during the day on nortriptyline than I did on nothing at all. And curiously, I felt less tired on 100 mg nortrip than I did on lower dosages. Although that's probably because I was able to stay asleep better.
> If you took desipramine instead of nortriptyline you could always take a short-acting sedative antihistamine to help you sleep. You could treat your allergies with a non-sedating antihistamine. Although desipramine is generally only modestly effective for most forms of anxiety, it is sometimes very effective in blocking panic attacks. If you find nortriptyline to be anxiolytic it is quite possible that you might also benefit from desipramine.
True. But I wonder whether desipramine would have the same effect on ADD as Strattera. I suppose there's only one way to find out.
> RE amphetamines.
>
> To be honest, there doesn't appear to be any definate consensus on whether methylphenidate is more or less likely than the amphetamines to cause cardiovascular side effects.
>
> Adderall causes more cardiovascular side effects than Dexedrine so it would not be a good choice for you. If you took Dexedrine immediate release you could adjust your regimen so that your plasma concentration of dextroamphetamine was low at meal times- this may reduce the risk of weight loss. A beta blocker may be useful for cardiovascular side effects. What cardiovascular side effects did you experience with methylphenidate?
>
> Ed.
>
rapid heartbeat, chest pains, sudden dizzy spells after exertion, which lessened after lowering the nortrip dosage. also my heart rate was much more rapid at peak levels of Rit (late morning/early afternoon) causing fluctuations that could not have been good for my system.your idea about dexedrine is a good one and helpful. dexedrine is also supposed to be less anxiogenic than adderall, and frankly i can't elevate my anxiety level much past where I am now.
thanks for the info. I am seeing pdoc today so it is especially valuable to have this knowledge.
-z
Posted by ed_uk on January 27, 2005, at 13:58:44
In reply to Re: Desipramine » ed_uk, posted by zeugma on January 27, 2005, at 13:42:48
>rapid heartbeat, chest pains, sudden dizzy spells after exertion, which lessened after lowering the nortrip dosage. also my heart rate was much more rapid at peak levels of Rit (late morning/early afternoon) causing fluctuations that could not have been good for my system.
Atenolol may be useful. Beta-blockers are unsafe in asthmatics. Your pdoc may be uncomfortable prescribing a beta blocker so you may need to go to your GP/PCP.
Ed.
Posted by zeugma on January 27, 2005, at 14:00:01
In reply to Re: the only reason I would switch to DMI » zeugma, posted by ed_uk on January 27, 2005, at 13:38:15
> Hi,
>
> >No, but it's metabolized to modafinil, so i would be wary of it.
>
> I know, but some people who can't tolerate modafinil seem to prefer it. See the archives.
>
> Did you see my previous post?
>
> Ed.
Yes, see above :)I'm not going to taker anything at this point that my pdoc doesn't prescribe for me, because I really feel that my life is in his hands. Adrafinil is not on the US formulary. not that that's the be-all and end-all, but I have to take what he says seriously because I simply don't have answers myself and I have reason to trust him. The effects of provigil were so weird and unsettling that I would be disinclined to use anything that metabolized to it. Admittedly I have not looked at the archives. But I'm sure you understand my reluctance.
I suppose something that I'm wondering about is whether I should scrap the TCA's entirely considering the fact that they have cardiovascular effects that can be compounded by a stimulant. What do you think about that issue?
thanks,
z
Posted by ed_uk on January 27, 2005, at 14:32:58
In reply to Re: the only reason I would switch to DMI » ed_uk, posted by zeugma on January 27, 2005, at 14:00:01
Hi Z!
>I'm not going to taker anything at this point that my pdoc doesn't prescribe for me....
I wasn't advising you to try it- I just wondered whether you had already tried it.
>I suppose something that I'm wondering about is whether I should scrap the TCA's entirely considering the fact that they have cardiovascular effects that can be compounded by a stimulant. What do you think about that issue?
I don't think it's a good idea. You need the nort to prevent sleep paralysis etc. I think that it would be perfectly possible to treat the cardiovascular side effects which may occur due to a stimulant. Did you have your blood pressure measured while you were taking methylphidate?
Tachycardia, chest pain and palpitations could be treated with atenolol or another cardioselective beta blocker. Most non-cardioselective beta-blockers (eg. propranolol) can cause vasoconstriction so it would be sensible to avoid them.
If you have hypertension, carvedilol may be useful. Carvedilol (Coreg) is both a beta-blocker and a vasodilator. It can be used to treat tachycardia and hypertension. Atenolol would be more appropriate if you don't have hypertension. I expect that you are not hypertensive because nort tends to lower blood pressure.
I am sure that you will find a solution to your problems :-)
Ed.
Posted by ed_uk on January 27, 2005, at 15:15:52
In reply to Re: Treating side effects » zeugma, posted by ed_uk on January 27, 2005, at 14:32:58
> Most non-cardioselective beta-blockers (eg. propranolol) can cause vasoconstriction so it would be sensible to avoid them.
Theoretically, it is possible that combining a non-cardioselective beta blocker with an amphetamine or methylphenidate may cause vasoconstriction and hypertension. The UK Dexedrine data sheet warns of this. Although atenolol would be expected to be safe, the UK data sheet for generic atenolol still suggests that it should not be combined with an amphetamine..... there are several possible reasons for this.......
1) The interaction has received little study.
2) Amphetamines are usually contra-indicated in people needing beta-blockers eg. patients with angina etc.
3) Amphetamines may reduce the beneficial effects of beta-blockers in the treatment of hypertension, angina etc.
4) Atenolol is not completely selective for the beta-1 receptor, it is theoretically possible that combining atenolol with an amphetamine may result in increased vasoconstriction and hypertension. Personally, I think this is highly improbable, atenolol would be more likely to reduce BP. In general, atenolol would be expected to be an effective and relatively safe treatment for the tachycardia and chest pain that stimulants can induce.Ed.
Posted by zeugma on January 27, 2005, at 18:59:13
In reply to Re: Treating side effects » zeugma, posted by ed_uk on January 27, 2005, at 14:32:58
hi ed,
Thanks for your kind and detailed replies. i really appreciate them.
The tachycardia, chest pain, etc. is very upsetting and troubling, obviously, and I did have my BP measured regularly during treatment. As you pointed out, NOR tends to reduce BP, and at no point was I hypertensive. But my heart rate fluctuated depending on time of day, and this was causing the chest pain etc. and making it impossible to exercise.
It was almost a side issue today, though, during my session with my pdoc. The worst problem has been the anxiety. It is causing unbearable stress that is endangering my job, if not my life. I increased the clonazepam this week, but that is not a real solution, since it doesn't mitigate the 'edginess' I feel on Ritalin, and it also aggravates the sleep paralysis and other narcoleptic symptoms. So I am raising the nortriptyline back to 75 mg, which should help with those symptoms, and also improve my mood and lessen the 'edginess' (nortrip has a subtle calming effect that is nothing like clonazepam, which is for all-out anxiety). I'm also adding back strattera at 25 mg tomorrow. I wonder what you think of this. On paper, this is somewhat redundant, since presumably they are both NE reuptake inhibitors, although clearly nortriptyline has other actions as well. My pdoc's theory is that strattera is selective for different regions of the brain (TCA's=brainstem, Strattera=cortex).
He told me, basically, that I am going to have to deal with the fatigue myself (exercise, and coffee). Hopefully, the chest pains will be gone completely soon, and I will be able to exercise.
it's interesting that norepinephrine seems to send some people over the edge with anxiety. in my case it seems to be dopamine. now there's the interesting exception of Provigil. Are you still considering trying it?
-z
Posted by zeugma on January 28, 2005, at 14:21:46
In reply to Re: Treating side effects » ed_uk, posted by zeugma on January 27, 2005, at 18:59:13
Aust N Z J Psychiatry. 1998 Oct;32(5):650-7.
Attention deficit hyperactivity disorder and anxiety: is there an association with neurodevelopmental deficits?Vance AL, Luk ES.
Maroondah Child and Adolescent Psychiatry Service, Victoria, Australia. avance@papyrus.mhri.edu.au
OBJECTIVE: The co-occurrence of attention deficit hyperactivity disorder (ADHD) and anxiety is a well-established clinical observation. However, its status as a clinical construct is debated. We review the prevalence of 'ADHD and anxiety', its definitions, and its clinical correlates and we hypothesise that neurodevelopmental deficits may be increased in 'ADHD and anxiety'. METHOD: The authors identified empirical studies in the psychiatric and psychological literature. The search categories included hyperactivity, attention deficit hyperactivity disorder, attention deficit disorder and anxiety. RESULTS: 'ADHD and anxiety' is considerably more common in clinical than epidemiological samples. There are a range of definitions which address the situational variation in both ADHD and anxiety symptoms and the use of categorical and continuous variables to define them. Yet the nature of the anxiety is still unclear. It is associated with a poor response to psychostimulant medication treatment, and alternative pharmacotherapy approaches have been suggested. There is a controversy about whether neurodevelopmental deficits are associated with hyperactivity alone, or anxiety, or both. CONCLUSIONS: 'ADHD and anxiety' is important clinically because it is common and less responsive to psychostimulant medication. Important research issues include its heterogeneity which necessitates the collection of parent, teacher, and child self-reports of symptoms' presence or absence and the hypothesis that neurodevelopmental deficits may be increased in this group of children.
It wouldn't matter if I were able to solve the cardiac side effects, since the anxiety is so overwhelming, and is only mitigated by being at peak plasma levels, which calms me- but then once they drop (and it's a quick drop) I'm anxious as h*ll again and would have to re-dose at an even higher level to calm down. It's not practical. And taking more klonopin is no solution. Off ritalin for 2 days I can't stay awake, but at least my anxiety is falling.
The only exception I would make to the statement in the abstract is Provigil. It woke me up AND did not worsen anxiety. If you are severely anxious and have ADD or some other condition requiring a stim, I would try that first. Failing that, a TCA or strattera or both.
-z
Posted by ed_uk on January 28, 2005, at 14:29:45
In reply to Re: Treating side effects » ed_uk, posted by zeugma on January 27, 2005, at 18:59:13
Hi Z!
>Thanks for your kind and detailed replies. i really appreciate them.
You're welcome :-)
>The tachycardia, chest pain, etc. is very upsetting and troubling, obviously, and I did have my BP measured regularly during treatment. As you pointed out, NOR tends to reduce BP, and at no point was I hypertensive. But my heart rate fluctuated depending on time of day, and this was causing the chest pain etc. and making it impossible to exercise.
Methylphenidate is an indirect-acting sympathomimetic. Pain on exertion is believed to result from the stimulation of beta-1 receptors in the heart. Atenolol is a selective beta-1 antagonist and is an effective treatment for tachycardia and angina ie. pain on exertion. I still think you should try it, how are you going to stay awake and alert without a stimulant? Start at 25mg/day atenolol and increase in steps of 25mg up to a maximum of 100mg/day if necessary. I expect you'd probably need 50-100mg. As I said, your pdoc is unlikely to be particularly familiar with atenolol, you may need to see a different doctor. As I said before, I would stay away from non-selective beta-blockers like propranolol.
>I increased the clonazepam this week, but that is not a real solution, since it doesn't mitigate the 'edginess' I feel on Ritalin...
Are you taking any MPH at all at the moment?
>I'm also adding back strattera at 25 mg tomorrow.
Why did you decide to try Strattera?
>I wonder what you think of this.
I must admit that I'm not the world's greatest fan of Strattera, it seems to make people fatigued and depressed.
>My pdoc's theory is that strattera is selective for different regions of the brain (TCA's=brainstem, Strattera=cortex).
Do you know whether there is any evidence to support this theory?
I have wondered whether Strattera may be more effective for some people because it lacks nort's antihistamine effect. Also, nort is a weak antimuscarinic. Antimuscarinic drugs impair cognitive functioning, memory and attention. Desipamine is less antimuscarinic than nort.
>He told me, basically, that I am going to have to deal with the fatigue myself (exercise, and coffee).
I don't really understand why your pdoc thought that it was ok to prescribe methylphenidate but won't let you try dextroamphetamine, I'm really not convinced that there is good logic behind this. Since it is theoretically possible that nortriptyline may potentiate the effects of dex, I would suggest that you start dex at a very low dose to see how it effects you eg. 1.25mg every four hours, three times a day. You could then increase the dose gradually as necessary. It might be necessary to combine it with atenolol.
Do the cardiovascular side effects of MPH cause you a lot of anxiety? If they do, perhaps atenolol would reduce your anxiety.
Ed.
Posted by zeugma on January 28, 2005, at 14:52:36
In reply to Re: Treating side effects » zeugma, posted by ed_uk on January 28, 2005, at 14:29:45
don't really understand why your pdoc thought that it was ok to prescribe methylphenidate but won't let you try dextroamphetamine, I'm really not convinced that there is good logic behind this.>
I'm not either. But I don't know all the premises!
Do the cardiovascular side effects of MPH cause you a lot of anxiety? If they do, perhaps atenolol would reduce your anxiety. >well, they do, but I have a lot of anxiety anyway :( And I am convinced at this point that stimulants will be anxiogenic for me, and that is a real, intractable problem. Of course dexedrine may be less anxiogenic than Ritalin. That's important for me to keep in mind, depending on what happens with Strattera.
About Strat: yes, it made me tired and depressed last year. And this time we didn't even discuss why strattera was better for ADHD than desipramine. The truth is that I don't think he knows either. On paper it looks like Strattera is desipramine with a short half-life. If that's the case, then I am trying desipramine after all :) I know it won't energize me, but MAYBE i can take afternoon naps to compensate for the tiredness- if I can get the Klonopin down, that is, and get my plasma levels of nort back up, plus the Strattera. Klonopin worsens the sleep paralysis stuff, that's why I'm not crazy about trying more anxiogenic drugs that will require higher doses of K to control the anxiety.I can find no reason for thinking strattera is more effective than a TCA for ADD. I only know that it was, for me, once upon a time.
-z
Posted by zeugma on January 28, 2005, at 14:59:44
In reply to Re: Treating side effects » ed_uk, posted by zeugma on January 28, 2005, at 14:52:36
On 100 mg nortriptyline, I had no 'word-finding' difficulties, etc., or other cognitive problems other than the ones I was born with. When I lowered the dose of nortrip, I experienced these kinds of difficulties, and I think they were due to the sleep disruption the lowered dose was causing. I know antimuscarinics have a bad reputation, but it seems my cholinergic system is literally in overdrive and that's why I get blasted with cataplexy etc. every time I lower the dose of the 'dumb-drug'.
-z
Posted by ed_uk on January 28, 2005, at 15:28:13
In reply to Re: Treating side effects » ed_uk, posted by zeugma on January 28, 2005, at 14:52:36
Hi,
>On paper it looks like Strattera is desipramine with a short half-life.
It is possible that the problem with atomoxetine may be due to its active metabolite rather than the parent compound. Kappa agonists cause dysphoria and fatigue- which is why they never achieved popularity as analgesics!
I think it would be good for you to try...
clonazepam + dextroamphetamine IR + atenolol + nortriptyline 100mg
Ed.
Posted by zeugma on January 28, 2005, at 17:01:43
In reply to Re: Treating side effects » zeugma, posted by ed_uk on January 28, 2005, at 15:28:13
> Hi Ed.
Hi,
>
> >On paper it looks like Strattera is desipramine with a short half-life.
>
> It is possible that the problem with atomoxetine may be due to its active metabolite rather than the parent compound. Kappa agonists cause dysphoria and fatigue- which is why they never achieved popularity as analgesics!
>
Yes, that's what i theorized when I read the report about 4-hydroxyatomoxetine's partial kappa agonism. And it may well be that this theory is correct and dysphoria and fatigue will hit me again. But just like I didn't throw out my Strattera from last year, and was able to use it PRN when I was forced off provigil suddenly (I have a lot of problems with stimulants, you see) my pdoc told me I could use Ritalin on weekends when my extreme jitteriness wouldn't be a problem (my job involves a lot of interpersonal interaction and the jitteriness is a major liability). I would only do that, though, if my GP or my pdoc agreed to prescribe me atenolol. And, actually, I would prefer not to do it at all, considering that 60 mg seems to be the minimum to get an effect, and it doesn't last all that long.
> I think it would be good for you to try...
>
> clonazepam + dextroamphetamine IR + atenolol + nortriptyline 100mg
>Yes, I think that is a good combination. the clonazepam needs to be kept to a minimum, because it aggravates my cataplexy (taking 1.5 mg for the last couple of days has made me a nervous wreck because of this in itself- it's so complicated) but if d-amph is less anxiogenic and atenolol keeps the cardiac problems under control, then I will definitely propose this combo to my pdoc if I have to d/c Strattera again, because of fatigue or dysphoria, or simply because i can't get anyhthing done because of exhaustion. One way that narcoleptics who can't tolerate stimulants manage the sleepiness is by scheduling naps during the day. Once all this clonazepam is out of my system and I'm back down to a maintainance level (1 mg) and the nortriptyline increase has kicked in, then Strattera might be genuinely useful for naps because I could take it at noon and its powerful NRI effect would let me nap in peace. That's my current thinking, but I'll have to see how it works out. Right now there's so much clonazepam in my system that I can't nap at all.
-z
> Ed.
Posted by ed_uk on January 29, 2005, at 17:26:59
In reply to Re: Treating side effects » ed_uk, posted by zeugma on January 28, 2005, at 17:01:43
Hi Z!
Good luck with the Strattera :-)
Have you ever taken more than 100mg of nortriptyline? I wondered whether you'd find it helpful for anxiety or ADD symptoms.
Also, have you tried any other benzos apart from clonazepam? Do they all worsen your cataplexy?
How long did you take Strattera for before it made you fatigued and depressed? The kappa agonists used as analgesics generally cause dysphoria and sedation with the first dose. Mmmm, I wonder what else Strattera is doing apart from acting as an NRI? I've often wondered the same thing RE reboxetine.
Ed.
Posted by zeugma on January 29, 2005, at 19:42:24
In reply to Re: Treating side effects » zeugma, posted by ed_uk on January 29, 2005, at 17:26:59
>
> Good luck with the Strattera :-)thanks!
>
> Have you ever taken more than 100mg of nortriptyline? I wondered whether you'd find it helpful for anxiety or ADD symptoms.
>It might be helpful for anxiety and even ADD, I don't know. 100 mg nortrip seems to be more stimulating than 75 mg, but nothing like the effects of Provigil or ritalin.
> Also, have you tried any other benzos apart from clonazepam? Do they all worsen your cataplexy?
No, I haven't, it was hard enough to get the clonazepam! Doctors may be less leery of prescribing benzos in the US than UK, but only slightly. Alprazolam is seen as having a much higher abuse potential than clonazepam, so it's much harder to get prescribed. What is interesting about clonazepam is the fact that it's a powerful antiepileptic, and the fact that it triggers cataplexy made me realize that my sleep disorder was probably REM rather than NREM related. >
> How long did you take Strattera for before it made you fatigued and depressed? The kappa agonists used as analgesics generally cause dysphoria and sedation with the first dose. Mmmm, I wonder what else Strattera is doing apart from acting as an NRI? I've often wondered the same thing RE reboxetine.
>
it was quite a while. I was on strattera for nearly a year before the fatigue and depression became severe. strattera distinctly does NOT have a sedating or dysphoric effect on first dose, in fact it strikes me as a powerful antidepressant that is neutral as regards sedation. The depression and fatigue that later hit is another story, and my pdoc attributed it to the fact that I needed a stimulant, and my physical energy simply gave out. that's plausible, but leaves me where I started: the fatigue has been constant for years, and I have not been able to tolerate ANY stimulating medication (Wellbutrin, Ritalin, cylert, Provigil). I think this strongly negative history with stims caused him to skip the amphetamines. Part of the problem, as I see it, is that stims produce positive effects only when plasma levels are highest, and on the up- or down-slope I would experience severe irritability, anxiety, and marginal cognitive benefit. I don't see any way around this conundrum.
I wonder what your view of the effectiveness of reboxetine is. have you ever tried it? Like i said before, I really don't know the justification for adding strattera as opposed to simply increasing nortrip beyond 100 mg, except for the lack of cardiotoxicity. I even wonder if some of my response to strattera was placebo. I know people sometimes combine SSRI's, but that there is no evident justification for this, and psychopharmacological orthodoxy counsels against this kind of redundancy.Are you still trying to get on some kind of stimulant? I know you highly favor d-amphetamine over methylphenidate. Is this because d-amph is less anxiogenic?
-z
> Ed.
Posted by ed_uk on January 29, 2005, at 21:12:57
In reply to Re: Treating side effects » ed_uk, posted by zeugma on January 29, 2005, at 19:42:24
Hi,
>> Have you ever taken more than 100mg of nortriptyline?
>It might be helpful for anxiety and even ADD, I don't know. 100 mg nortrip seems to be more stimulating than 75 mg.Try it!
>Doctors may be less leery of prescribing benzos in the US than UK, but only slightly.
Don't be so sure! One thing I have noticed is that MUCH higher doses seem to be prescribed in the US, for much longer periods of time!
> Part of the problem, as I see it, is that stims produce positive effects only when plasma levels are highest, and on the up- or down-slope I would experience severe irritability, anxiety, and marginal cognitive benefit. I don't see any way around this conundrum.
I think you could probably overcome this by taking small dose very frequently (every couple of hours)- this would avoid any major peaks or troughs.
>I wonder what your view of the effectiveness of reboxetine is. have you ever tried it?
I've never tried it. Although Edronax is marketed here it's rarely prescribed to be honest. Do you want to try it?
>Are you still trying to get on some kind of stimulant?
Yes, but I doubt I'll ever get one though, I might as well be asking for IV heroin!
I know you highly favor d-amphetamine over methylphenidate. Is this because d-amph is less anxiogenic?
It would be interesting to see some scientific evidence that d-amph is less anxiogenic- there doesn't seem to be any, all the evidence I've got is anecdotal. If I had the opportunity to try any stim, I think I might actually try Ritalin first because of the evidence that high doses of d-amph *may* be neurotoxic in animals. I suspect that I'd end up on d-amph though, most adults seem to prefer it to Ritalin.
Ed.
Posted by zeugma on January 31, 2005, at 16:29:47
In reply to Re: Treating side effects » zeugma, posted by ed_uk on January 29, 2005, at 21:12:57
anyway, im done with strattera, it is triggering a severe depression again and my pdoc doesn't want to hear about it. i feel completely hopeless.
-z
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