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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Eddie Stefurak on July 17, 2000, at 19:38:53
MB, also, medically and possible ethically speaking, monotherapy with stimulants to treat depression may not be such a good idea. Here's why: if a patient is depressed, depending on his or her personality, the moods, worries, fears, and thoughts in general are so scattered and unstable. Sure, a stimulant might take that away for a little while but anyone who has abused stimulants knows that it can very easily send your elation crashing down into irritability and more emotional instability when the drug wears off. Amphetamines increase two main neurotransmiters called norepinephrine and dopamine which create central nervous system stimulation and pleasurable "reward" signal in the brain. This is why most users crave it when they don't have anymore. However, I believe in combo with an SSRI antidepressant in low dosage, a stimulant could be quite beneficial, but in reality, I would imagine that you would be hard pressed to really find someone who actually thinks they are not going to abuse it and/or become somewhat dependent on it when they experience an amphetamine high.
Thanks,,please feel free to write back. I'm new and I'm pre-Medicine at University of Georgia looking to go into psychiatry. This is a great website
Posted by shellie on July 17, 2000, at 20:13:39
In reply to MB-stimulants, posted by Eddie Stefurak on July 17, 2000, at 19:38:53
Re: "Amphetamines increase two main neurotransmiters called norepinephrine and dopamine which create central nervous system stimulation and pleasurable "reward" signal in the brain. "
So how is it when I am proscribed ritalin, I feel no effects from it. No speeding up, no high, zero?
What is the problem with my neuotransmiters that I get no pleasurable "reward" signal?
shellie
Posted by MichaelF on July 17, 2000, at 20:36:26
In reply to MB-stimulants, posted by Eddie Stefurak on July 17, 2000, at 19:38:53
Funny how Dexedrine relieves my depression yet calms me at the same time.
I do not experience any "high", if anything I find myself too sedated.
MichaelF
Posted by shellie on July 17, 2000, at 21:13:39
In reply to Re: MB-stimulants » Eddie Stefurak, posted by MichaelF on July 17, 2000, at 20:36:26
> Funny how Dexedrine relieves my depression yet calms me at the same time.
> I do not experience any "high", if anything I find myself too sedated.
> MichaelFMichael--did it take a while to relieve your depression? Because I took ritalin for three days and if anything it increased my depression. My pdoc has never talked about using dexidrine. Aderall was mentioned. I wonder how dexidrine differs from ritalin in its action. Wasn't dexedrine the main diet stimulant? shellie
Posted by Libby on July 18, 2000, at 11:58:18
In reply to Re: MB-stimulants » Eddie Stefurak, posted by MichaelF on July 17, 2000, at 20:36:26
Like Micheal said, I don't get high on Ritalin. For the first day, I was aware of "speeding." After that, the differences I observed were that the mental fog cleared, my sleep patterns became normal, my jangled nerves were soothed, and I lost my appetite (that one is a little hard to get used to).
I actually took double my current dose once, during the initial trial. It put me to sleep
almost immediately... so for me, Ritalin seems pretty much self-regulating. 'Course what I didn't consider when I jumped into this thread is that I am taking Ritalin for ADD, which means I really shouldn't say anything about it as monotherapy for depression. Sorry I missed that rather obvious point.
Posted by JohnB on July 18, 2000, at 14:09:11
In reply to MB-stimulants, posted by Eddie Stefurak on July 17, 2000, at 19:38:53
>I would imagine that you would be hard pressed to really find someone who actually thinks they are not going to abuse it and/or become somewhat dependent on it when they experience an amphetamine high.
Studies have shown this not to be the case
in low dosage therapy, and there is no "amphetamine
high" if used correctly
Posted by MichaelF on July 18, 2000, at 16:54:43
In reply to Re: stimulants » MichaelF, posted by shellie on July 17, 2000, at 21:13:39
>Michael--did it take a while to relieve your depression? Because I took ritalin for three days and if anything it increased my depression. My pdoc has never talked about using dexidrine. Aderall was mentioned. I wonder how dexidrine differs from ritalin in its action. Wasn't dexedrine the main diet stimulant? shellie
Shellie,
In my case Dexedrine relieved my depression within about two hours of taking my first dose. According to Dr. Jensen, who has been mentioned before on this board, it is quite common for a med to act positively this quickly if it is the "right" med for the individual. If memory serves me correctly, he believes the "right" med for an individual will have a positive effect within 24 hours. This was certainly the case for me.
I tried Ritalin but could not tolerate even the smallest of doses. Adderall sent me into a horrible depression within a few days of initiating it. For whatever reason, the long acting version of Dexedrine, called "spansule" has the same effect for me as the Adderall did.
Finding the right med for me was definitely a process of trial and error. I have reacted negatively to every SSRI that I have tried after having experienced what my doctors believe to be serotonin syndrome about five years ago. I experienced serotonin syndrome one year after my nutritional doctor added tryptophan to the Prozac I had been taking for several years. Once I experienced the serotonin "overload", I could no longer tolerate any med that boosted serotonin. Although I live in Canada, I contacted Dr. Jensen in California and he came up with a number of suggestions, one of which was Dexedrine. I take 30mg per day of Dexedrine in two divided doses along with 1mg of Stelazine with each dose of Dexedrine. Dexedrine by itself seems to push my dopamine levels just a little too high and Stelazine controls this slight elevation.
I do not know much about Dexedrine and it's use as a diet med, but for me it seems to have had no effect on my food intake.
I hope this helps,
MichaelF
Posted by MB on July 18, 2000, at 19:40:54
In reply to MB-stimulants, posted by Eddie Stefurak on July 17, 2000, at 19:38:53
So does being on an antidepressant along with the stim sort of act as a "buffer" from the hard crash that amphetamine abusers deal with?
Posted by MB on July 18, 2000, at 19:43:52
In reply to Re: MB-stimulants » Eddie Stefurak, posted by MichaelF on July 17, 2000, at 20:36:26
If you have this reaction to Dexedrine, I'm wondering how caffeine affects you. Do you get the same calming effect from it, or does it rev you up? Have you ever combined the two (ie. coffee with your Dexedrine)?
MB
> Funny how Dexedrine relieves my depression yet calms me at the same time.
>
> I do not experience any "high", if anything I find myself too sedated.
>
> MichaelF
Posted by MB on July 18, 2000, at 19:57:44
In reply to Re: MB-stimulants, posted by Libby on July 18, 2000, at 11:58:18
I find this all really interesting. I thought I had ADD for a while. I have a lot of the personality traits without the attention problems. I took a trial dose of Ritilin once, and it was like it *gave* me ADD. Couldn't complete a thought, let alone a project. Thoughts were racing. Right now I'm on Wellbutrin. I wanted to use it for depression because the weight/sex/fatigue side effects aren't as bad as with the SSRIs. Man, I thought I was going to go insane for the first few days. Even that, was too much for me. I'm wondering, Libby, if you've ever taken Wellbutrin. Did that stuff make you calm and sleepy like the Dexedrine?
MB
> Like Micheal said, I don't get high on Ritalin. For the first day, I was aware of "speeding." After that, the differences I observed were that the mental fog cleared, my sleep patterns became normal, my jangled nerves were soothed, and I lost my appetite (that one is a little hard to get used to).
>
> I actually took double my current dose once, during the initial trial. It put me to sleep
> almost immediately... so for me, Ritalin seems pretty much self-regulating. 'Course what I didn't consider when I jumped into this thread is that I am taking Ritalin for ADD, which means I really shouldn't say anything about it as monotherapy for depression. Sorry I missed that rather obvious point.
Posted by shellie on July 18, 2000, at 20:16:58
In reply to Re: stimulants » shellie, posted by MichaelF on July 18, 2000, at 16:54:43
Hi Michael. Thanks for the info. If Dr. Jenson believes that you can tell if a medication will work within 24 hours he must not use MAOIs, or SSRIs, is that true? Actually, maybe not--you do know very early the side effects of those ads, just not the effectiveness.
How many different combos (approximately) did you test with him? You obviously are a satisfied customer. Shellie
Posted by MichaelF on July 18, 2000, at 20:31:49
In reply to Re: MB-stimulants, posted by MB on July 18, 2000, at 19:43:52
I always take my Dexedrine with a cup of coffee. This tends to make me more focused but does not rev me up.
Paradoxically, when I drink coffee at night, it pretty well puts me to sleep.
MichaelF
> If you have this reaction to Dexedrine, I'm wondering how caffeine affects you. Do you get the same calming effect from it, or does it rev you up? Have you ever combined the two (ie. coffee with your Dexedrine)?
>
> MB
Posted by MichaelF on July 18, 2000, at 20:59:19
In reply to Re: stimulants » MichaelF, posted by shellie on July 18, 2000, at 20:16:58
> Hi Michael. Thanks for the info. If Dr. Jenson believes that you can tell if a medication will work within 24 hours he must not use MAOIs, or SSRIs, is that true? Actually, maybe not--you do know very early the side effects of those ads, just not the effectiveness.
>
> How many different combos (approximately) did you test with him? You obviously are a satisfied customer. ShellieShellie,
Dr. Jensen uses all types of meds, including SSRIs and MAOIs. He usually prescribes a 3 to 5 day trial and then evaluates the patient's reaction to the med. He uses each "reaction" to try to determine what neurotransmitters are causing problems.
I have tried many different combos of meds, so many that I think I have lost count! The major thing for me was adding a dopamine reducer to the various combos. With the dopamine reducer, I can take Prozac again but it's just not as effective compared to before my brain was "hurt" by too much serotonin.
I am very satisfied with Dr. Jensen and I highly recommend him. I discovered him after my own doctor threw up his hands and told me there was nothing more he could do for me. I will never forget that appointment. It wasn't but three months later that I was back in his office with a full blown depression, including suicidal ideation. Dr. Jensen has provided lots of ideas when my doctor thought we were at a "dead end", so to speak.
The Dexedrine/Stelazine combo does not help 100% but so far it is the best combination I have tried. I'm still looking though! Adrafinil has me intrigued - I placed my order for it this past Saturday. I have no idea what benefit it will be to me, whether it will replace the Dexedrine or augment it.
MichaelF
Posted by Libby on July 19, 2000, at 12:06:57
In reply to Re: MB-stimulants, posted by MB on July 18, 2000, at 19:57:44
Micheal... I don't take Ritalin for the calming effect per se because I don't have classic hyperactivity. I do tend to get agitated when I
become overwhelmed and have had constant problems with low-grade anxiety over nothing in particular.
I also have a severe *measured* attention deficit and dyslexia. In my previous job, which was very fast-paced and creative, I did well. However, in my new job, which requires a more *consistent* effort and attention to details, I found I couldn't function at all without Ritalin.I took Wellbutrin as an AD during one of several "depressive episodes" and did extremely well on it until it mysteriously pooped out. As I recall, it left me feeling a lot like the Ritalin does... energetic, but not agitated and mentally clear. I liked it well enough that I am going to request it if I ever need another AD.
I never got sleepy with Wellbutrin, but I never experimented with the dose. I started at the lowest dose and stayed there. With Ritalin, my doc suggested taking the higher dose just once, to see if I could get even more improvement, but since the higher dose put me to sleep, we stuck with the low dose.
Posted by shellie on July 20, 2000, at 20:52:24
In reply to Re: stimulants » shellie, posted by MichaelF on July 18, 2000, at 20:59:19
.
Posted by AndrewB on July 23, 2000, at 19:34:20
In reply to Look for my message-provigal failed 7/20- nm » MichaelF, posted by shellie on July 20, 2000, at 20:52:24
Michael,Thank you for sharing your experience with the Dexedrine/Stelazine combo as well as other stimulants. It is interesting to hear how different stimulants can have such widely varying effects in the same person.
By the way, are you ADD with or without the hyperactivity? What is your diagnosis?
What benefits do you notice by adding Stelazine to your Dexedrine.
What differences do notice between high and low doses of Dexedrine.
I think it is very relevant to your future medication trials to be aware that Stelazine in the low doses (1mg.) is roughly a dopamine enhancer. In low doses, as with (many) other neuroleptics, Stelazine preferential antagonizes the presynaptic dopamine autoreceptor. I assume its beneficial effects in your case are related to the antagonism of the presynaptic D2 dopamine receptor. Because of the autoreceptor’s influence on dopamine release and reuptake, its antagonism results in higher synaptic dopamine concentrations.
I always have thought that such higher concentrations of synaptic (extracellular) dopamine meant increased dopaminergic mediated nerve transmission. But upon reading the following excerpt which describes the differing effects of low and high dose stimulants, it appears that increased extracellular concentration of dopamine decreases nerve transmission:
“The anti-hyperactivity action of stimulants is mediated via post-synaptic dopamine D1 and D2 receptors. As just outlined, the enhanced output of dopamine by low doses of stimulant drugs reduces the impulse associated rise of dopamine, relative to the baseline. That is, the relative rise of dopamine during the impulse is lowered because of this elevated baseline. The smaller pulsatile surge of dopamine would result in less activation of the post-synaptic dopamine D1 and D2 receptors, thereby resulting in reduced psychomotor activity. These psychomotor-controlling dopamine receptors are hypothesized to vary their response in proportion to the relative rise in pulsatile dopamine, but there is no direct experimental work to validate this particular point. For example, the elevated extracellular dopamine would occupy more D1 and D2 receptors during rest, reducing or desensitizing these receptors from the dopamine which arrives during the nerve impulses. While this hypothesis may account for the hypolocomotor action of low doses of stimulants, high doses of stimulants cause marked elevations in the resting and pulsatile levels of extracellular dopamine, providing high enough extracellular levels of dopamine to oversaturate and overstimulate post-synaptic dopamine receptors, overwhelming the presynaptic inhibitory action of dopamine. These high levels are associated with hyperdopaminergic somatic, behavioral and psychological signs and symptoms which necessitate lowering the clinical dose.”
SOURCE: Hypothesis: “Methylphednidate elevates resting dopamine which lowers impulse-triggered release of dopamine” www.uclm.es/inabis2000/symposia/files/124/session.htmMichael, I don’t have any grand advice for you but I would like to say that you may want to try substituting Stelazine with other neuroleptics such as Zyprexa, risperidone and amisulpride. How did you respond to Wellbutrin? I’m having good results with the dopaminergic selegiline at low doses so far. It seems to substitute for a stimulant somewhat. (I’ve never taken stimulants so this is conjecture on my part. It does seem to compare closely to smooth version of amineptine.) It seems to combine well with a low dose neuroleptic for a very smooth increase in arousal and attention. In my case the neuroleptic is amisulpride. I think the neuroleptic may take away the anxiety I might feel if I were taking selegiline alone. Selegiline has been combined with a stimulant with good results. Other arousal agents to consider are Provigil, adrafinil and reboxetine.
AndrewB
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