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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by connie on March 2, 2001, at 23:38:19
I am currently taking 40 mgs. of celexa daily. i am depressed as all get out and have absolutely no energy. i am seeing a new doctor tuesday. i've read that low doses of ritalin can take the edge off of the fatigue. i need a quick solution to my fatigue while waiting for the correct a.d. and dosage to "kick in." do most drs. willingly prescribe ritalin?
thanks,connie
Posted by HenryO on March 3, 2001, at 2:21:33
In reply to Ritalin?, posted by connie on March 2, 2001, at 23:38:19
Ritalin works well as an anti-depressant for me.
Posted by SalArmy4me on March 3, 2001, at 3:45:48
In reply to Ritalin?, posted by connie on March 2, 2001, at 23:38:19
I think it would be easier to just add Wellbutrin. That would protect you against the chance of addiction, and it has more of an antidepressant potential than Ritalin--although stimulants were the first antidepressants.
> I am currently taking 40 mgs. of celexa daily. i am depressed as all get out and have absolutely no energy. i am seeing a new doctor tuesday. i've read that low doses of ritalin can take the edge off of the fatigue. i need a quick solution to my fatigue while waiting for the correct a.d. and dosage to "kick in." do most drs. willingly prescribe ritalin?
> thanks,connie
Posted by Aurelie on March 3, 2001, at 10:20:47
In reply to Re: Ritalin?, posted by SalArmy4me on March 3, 2001, at 3:45:48
Ritalin can be very addictive, and should only be prescribed when medically necessary (usually in the case of narcolepsy or ADD/ADHD). If I were you, I would be very hesitant to look to this drug as a quick "pick me up" -- it is a Schedule II narcotic, not a "harmless" prescription pill. Wellbutrin is a good suggestion if you're looking to add meds, but if I were you, I would consider the alternatives. When my depression wasn't responding well to Prozac, my doctor suggested adding an exercise program, which has been a life saver -- it's a safe, natural way to elevate mood, with no chance of chemical dependency. I now walk or run every day, and lift weights 3x/week, and I find that I feel better than I've felt in years.
Posted by PhoenixGirl on March 3, 2001, at 15:30:20
In reply to Re: Ritalin?, posted by Aurelie on March 3, 2001, at 10:20:47
I read about a study that showed that taking Ritalin orally was not addictive. I think it was done by a well known organization against drug abuse, but I'm blanking on the name. The gist of the study is that when Ritalin has an effect quickly (ie by snorting), addiction happens, but not when it reaches effective slowly. That's what the study found anyway.
> Ritalin can be very addictive, and should only be prescribed when medically necessary (usually in the case of narcolepsy or ADD/ADHD). If I were you, I would be very hesitant to look to this drug as a quick "pick me up" -- it is a Schedule II narcotic, not a "harmless" prescription pill. Wellbutrin is a good suggestion if you're looking to add meds, but if I were you, I would consider the alternatives. When my depression wasn't responding well to Prozac, my doctor suggested adding an exercise program, which has been a life saver -- it's a safe, natural way to elevate mood, with no chance of chemical dependency. I now walk or run every day, and lift weights 3x/week, and I find that I feel better than I've felt in years.
Posted by SLS on March 3, 2001, at 20:36:53
In reply to I don't know about that, posted by PhoenixGirl on March 3, 2001, at 15:30:20
Hi folks.
> > Ritalin can be very addictive,What is the definition of the word "addiction"?
Does it differ from the word "dependence"?
It can certainly be abused.
I think it is crucial to acknowledge and understand the differences between these two words so as to understand the rationale for the use of drugs in general.
> > and should only be prescribed when medically necessary
I would replace the word "necessary" with the word "desirable".
> > (usually in the case of narcolepsy or ADD/ADHD).
Any one drug can be an exceptionally effective, or perhaps the best treatment for many indications other than those officially approved by the FDA. As for Ritalin, I believe that it is perfectly legal to use it for conditions other than its official indications; an action known as "off label" usage. It might be informative to produce a list of conditions for which the use of Ritalin can be the ideal treatment of those currently available.
> > If I were you, I would be very hesitant to look to this drug as a quick "pick me up"
I agree. I would be hesitant as well. Perhaps there are cases for which Ritalin is used effectively in such a manner to allow someone to remain gainfully employed.
> > -- it is a Schedule II narcotic, not a "harmless" prescription pill.
I think it goes without saying that a large proportion of prescription pills are far from being harmless.
> > Wellbutrin is a good suggestion if you're looking to add meds,
Adding Wellbutrin in certain situations is a reasonable first choice over Ritalin.
> > but if I were you, I would consider the alternatives.
I agree. This would be absolutely necessary if Wellbutrin failed to be helpful. In some situations, Ritalin is the best second choice. In some situations, it is the only alternative that works. There are plenty of examples of this on the board.
> > When my depression wasn't responding well to Prozac, my doctor suggested adding an exercise program, which has been a life saver -- it's a safe, natural way to elevate mood, with no chance of chemical dependency. I now walk or run every day, and lift weights 3x/week, and I find that I feel better than I've felt in years.
You are fortunate indeed that exercise alone has been the modality of treatment that you have responded to. It is quite wonderful that you should be feeling so well. I am sure that you would not want to deny others from feeling as well as you do right now should, exercise not produce for them the desired effect. Remember, each of our biologies are as unique as snow flakes, and are differentially responsive to any one treatment regimen. I am sure that you would not deny others from feeling as well as you do should Ritalin be the only treatment that would allow them to.
> I read about a study that showed that taking Ritalin orally was not addictive. I think it was done by a well known organization against drug abuse, but I'm blanking on the name. The gist of the study is that when Ritalin has an effect quickly (ie by snorting), addiction happens, but not when it reaches effective slowly. That's what the study found anyway.
I came across the same information, but I don't remember where.
I don't think that I have run across anyone on this board who has had an insatiable craving for Ritalin which resulted in a habitual use beyond their ability to exercise volitional control. By contrast, I have seen examples of its abuse in that it has been taken in a manner that differed from how it was prescribed.
I don't think that there can be a black and white perspective here. Sometimes, I think it is our need to build models using the semantics of words and labels that limits are ability to more effectively understand an issue. The dictionary uses reciprocally the words "addiction" and "dependence" to aid in the portrayal of those words. Each word has several definitions based upon usage. They are listed as distinct alternative definitions. I have taken it upon myself to choose of the alternative definitions offered for these two words those that I felt served to produce a better understanding of what are the differences between them.
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ADDICTION n2: an abnormally strong craving
Source: WordNet ® 1.6, © 1997 Princeton University
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DEPENDENCE n1: lack of independence or self-sufficiency
Source: WordNet ® 1.6, © 1997 Princeton University
---------------------------------------------------------------
1. One can be physically dependent on a drug to serve an addiction of craving and psychological need.2. One can be physically dependent on a drug to maintain quality of life without being addicted to it.
3. One can be physically dependent on a drug to prevent a discontinuation withdrawal syndrome for having taken it chronically without being addicted to it.
One can be dependent upon digitalis without experiencing a craving for it should it be discontinued. However, the heart lacks the independence of self-sufficiency. This physical dependence makes itself evident when discontinuation results in a state of cardiac failure. I would say that such a person is physically dependent on digitalis. In another type of dependence, the body attempts to compensate for the presence of a drug by making adjustments in various functions. Very often, the body becomes physically dependent on some minimal amount of drug just to offset the adjustments already made by the body. To discontinue this drug at a rate that is greater than the rate at which the body can make adjustments in the direction of pre-exposure causes the phenomenon we know as "withdrawal". However, there is neither a craving for nor a psychological need to exhibit a habitual behavior. Effexor might be a good example of this scenario. I don't think I have seen anyone develop an addiction to Effexor. I have seen plenty become physically dependent on Effexor to enhance the quality of their lives. I have also seen the results of a prolonged exposure of the system to Effexor so that its discontinuation produces a withdrawal syndrome.
2 cents and some bandwidth.
- Scott
Posted by Sulpicia on March 3, 2001, at 20:42:29
In reply to Ritalin?, posted by connie on March 2, 2001, at 23:38:19
> Hi Connie -- While I have to agree with Aurelie's cautions, I would like to add a bit.
Many pdocs in the US are uncomfortable giving pstims for a short course until the med kicks
in because they are afraid of addiction, abuse etc. They also loathe the DEA complications
with the prescriptions. That said, my pdoc, who is amazing, and university faculty etc, does use
stimulants when necessary. For my daughter's severe hypersomnia, rather than letting her stay in
bed until the lamictal kicked in, he gave her adderall for the mornings -- she could have some sort
of life while waiting.If you can convince your pdoc, and if you take it as prescribed and for a short period of time, and
understand the warning signs of abuse or addiction, a stimulant might be an answer for you. It's my
sense tho that most pdocs reserve it for really severe problems with fatigue. You might also consider
adderall rather than ritalin, which wears off more quickly and abruptly, and can produce an unpleasant
and possibly depressing crash. Also be aware that celexa may interact with pstims; I take adderall for
ADD and tofranil for depression -- I had to get off paxil in big hurry when it interacted with the adderall
and made me incredibly depressed. Odds are remote that this will happen to you since med response is so
individual. Just be on the lookout and try and take the smallest possibly dose that is effective. Naturally
you'll have to goof around with the dosage because much of the prescribing info is for kids.
Good luck and I hope you feel better soon.
S.
Posted by Sulpicia on March 3, 2001, at 20:49:14
In reply to I don't know about that, posted by PhoenixGirl on March 3, 2001, at 15:30:20
> As a recovering addict I have to tell you that I and most of the addicts I know
could get addicted to horse poop, no matter the route of ingestion. Given the right
circumstances, it's entirely possibly to get addicted to ritalin or any other drug,
whether taken orally or otherwise. Snorting or any other abusive ingestion of ritalin
et al increases the possibility of addiction since it introduces a relatively large amount
directly into your system [thru your mucous membranes]all at once. The high this produces
may/will over time become harder and harder to get -- in susceptible individuals, addiction
can follow increasing tolerance to the drug.
S.
Posted by Sulpicia on March 3, 2001, at 22:23:21
In reply to Re: I don't know about that, posted by SLS on March 3, 2001, at 20:36:53
> Nice reply Scott and infinitely better than my fumbling attempts to
explain addiction/abuse. I agree 100%
Princeton University as a source of drug info???
The ubiquitous tigers will be pissed tonight...
Liz
Posted by Aurelie on March 4, 2001, at 0:25:32
In reply to Re: I don't know about that » SLS, posted by Sulpicia on March 3, 2001, at 22:23:21
Well, meet a Ritalin addict. The reason I posted my concerns is because I wanted to save someone the trouble that I've had. I was put on Ritalin as a pick me up, (as an addition to the Prozac, which I still take IN COMBINATION with the exercise) and became addicted not long after. Because the drug makes you feel so good, so alive -- which was amazing for me, as I had been depressed for years -- it was hard to resist taking more and more. In addition, tolerance builds up pretty quickly. Soon, I was snorting upwards of 15 20 mg. pills each day. Of course, a horrible crash does eventually occur, and your depression just deepens.
In no way do I feel that anyone has a right to deny anyone else from feeling as good as they can. This drug took me so low, I was just trying to help someone else avoid my mistake.
I sincerely hope that everyone finds the right combination of things that will work for them -- be it exercise, or drugs or anything else. If
Ritalin works for you, that's wonderful; but be watchful of the sneaky ways of addiction.
Posted by SLS on March 4, 2001, at 10:19:13
In reply to Re: I don't know about that, posted by Aurelie on March 4, 2001, at 0:25:32
Hi Aurelie.
> Well, meet a Ritalin addict. The reason I posted my concerns is because I wanted to save someone the trouble that I've had. I was put on Ritalin as a pick me up, (as an addition to the Prozac, which I still take IN COMBINATION
This was understood. I should have perhaps included this in my wording.
> with the exercise) and became addicted not long after. Because the drug makes you feel so good, so alive -- which was amazing for me, as I had been depressed for years -- it was hard to resist taking more and more.
> In addition, tolerance builds up pretty quickly. Soon, I was snorting upwards of 15 20 mg. pills each day. Of course, a horrible crash does eventually occur, and your depression just deepens
I think your description represents well the difficulty in trying to conceptualize the issue as black-and-white.
What does it feel like to crave Ritalin? What does it feel like to "crave" rather than "want" or "need"? At what point did you begin snorting it? Did the nature of your cravings and desire for the effects of Ritalin change in some way once you began to snort it?
I think that this is a good point to stress again that our biologies are as unique as snow flakes, and are differentially responsive to any one medication (compound). In my mind, it is easily conceivable that for some people, Ritalin acts and feels much like cocaine and is nearly as addictive as cocaine. Both Ritalin and cocaine do very much the same thing in the brain. Both inhibit the reuptake of dopamine in those limbic structures responsible for reward, drive, and vigilance. Perhaps, for some people, Ritalin acts very much more like cocaine than it does for the majority of people. Perhaps we can say that Ritalin is a non-addictive drug that infrequently produces the side-effect of addiction. ???
black-GREY-white
I have abused antidepressant medications in the past just to maintain the wonderful effect of reducing my pain of depression. This was especially true of drugs that would produce an immediate brief "blip" of improvement simply from changing the dosage, either up or down. I would self-medicate such that I would do just about anything to get back that good feeling. However, I can say that the word "crave" didn't sit right me. I'm not sure why. I wanted it real bad, though. Meanwhile, the whole time, I craved donuts.
> In no way do I feel that anyone has a right to deny anyone else from feeling as good as they can. This drug took me so low, I was just trying to help someone else avoid my mistake.
What exactly was your mistake?
> I sincerely hope that everyone finds the right combination of things that will work for them -- be it exercise, or drugs or anything else. If Ritalin works for you, that's wonderful; but be watchful of the sneaky ways of addiction.
For me, I would like to thank you for posting such an important caveat.
Sincerely,
Scott
Posted by pat123 on March 4, 2001, at 20:55:17
In reply to Ritalin?, posted by connie on March 2, 2001, at 23:38:19
I can tell you that with ADD most find a dose that
works and stay there, so tolerance does not build, requiring higher and higher doses. In fact, if this does happen, it indicates this class
may not be the right class to use.Pat
Posted by Noa on March 5, 2001, at 8:25:13
In reply to Re: Ritalin?, posted by pat123 on March 4, 2001, at 20:55:17
I think it has the potential to be addictive for some people. If you have a history of addiction, perhaps you should be wary. If you don't, procede slowly and be honest with your doctor, monitoring your use. I have read here many stories of successful use of stims for treatment, without addiction, and a few stories of people who developed cravings for it. Just recently, we heard from a high school student who was using way too much.
But I think that people with little reason to think they have vulnerability to addiction can consider taking stims for treatment, following doctors orders, of course. Just mho.
Posted by PhoenixGirl on March 6, 2001, at 16:00:58
In reply to I don't know about that, posted by PhoenixGirl on March 3, 2001, at 15:30:20
I don't know what to think about Ritalin and other pstims. People have had such different experiences with it. I have had insufficient responses to all antidepressants, and I'm considering trying a pstim. I want so much for it to help, maybe I'm psychologically trying to avoid seeing the possible negatives. I guess what I'm trying to determine is whether pstims are worth a try for augmenting my AD.
Posted by Noa on March 6, 2001, at 16:17:43
In reply to Re: I don't know about that, posted by PhoenixGirl on March 6, 2001, at 16:00:58
What does your pdoc say about it?
Posted by ShelliR on March 6, 2001, at 19:14:16
In reply to Re: I don't know about that, posted by PhoenixGirl on March 6, 2001, at 16:00:58
Phoenix Girl,
My pdoc tried all types of stimulents with me to augment my antidepressant. It is not thought anymore to be unusual or contraversial, and in many instances works. The stimulents made me feel too strange, so I didn't continue. I tried all of them and am glad I did, so now I don't have to wonder.
I wouldn't be scared off about this talk about addition--and stimulents used for ADD only. I think used for depression, stimulents are not often abused and they are certainly used to augent antidepressants for non-ADD.
Again, it is something to talk to your new doctor about when you get one. Shelli
Posted by Noa on March 7, 2001, at 16:32:31
In reply to Re: I don't know about that » PhoenixGirl, posted by ShelliR on March 6, 2001, at 19:14:16
>The good thing about psychostimulants is they are short acting, so you can try them and you know pretty quickly if they work for you or not.
This is the end of the thread.
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