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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by MarkG on June 8, 2001, at 12:09:32
Feeling extremely hopeless might be more accurate. Last week I tried Adderall for the first time and my body flat out rejected it. This week I'm trying Ritalin- so far little side effects but also with little evidence of efficacy (still at low doses though). The most concerning thing is that since I started the Adderall I have had a return of extreme depression. I have tried so many ADs over the years with very little success including:
1. Prozac made me feel jittery and anxious
2. Zoloft minimal effects
3. Paxil short trial; felt fluish
4. Effexor mildly effective for about 1 1/2 years
5. Remeron felt like a spaced out depressed zombie
6. Wellbutrin had more energy but didn't help much w/depression
7. Parnate helped a lot with extreme depression and worked for inattention for the first 2 weeksI have been trying one thing or another for the last 10 years. My doc has recently suggested Desiprimine. The depression/ADD symptoms go WAY back to childhood and there's been little change over the years. I seem to have always had processing probs (SLOW!) but have made good grades, especially in college- and made it to grad school in a competitive program. I've often felt like I'm slow, have a hard or impossible time being in conversations, and often feel somewhat unaware of what's going on around me- kinda out of the loop. This is having a big impact on my relationship (s), my career, and my LIFE yet I feel like there is not a whole lot I can do. Funny thing is that I feel like I KNOW I'm capable of feeling and doing better. Maybe it's those short lived times of feeling like "ah-hah, this is what its like to feel normal- WONDERFUL" that keep me hanging on and hoping for more. Sorry to rant on and on about my life, I think I just needed to vent. If anyone has any suggestions it would be much appreciated.
I'm at a complete loss. :(Frustrated,
Mark
(PS- Sulpicia, if your out there, thanks so much for your kind posts last week!!!)
Posted by phillybob on June 8, 2001, at 12:43:42
In reply to Depression and ADD: Beyond frustration, posted by MarkG on June 8, 2001, at 12:09:32
Hey, Mark!
I share similar problems as far as back to childhood and difficulties with anti-depressants and stimulants.
If you haven't gone to it yet, visit about.com for really great info on adult add/adhd. It talks all about "functional dysfunctionality" and getting depressed due to the dichotomy of knowing one is intelligent yet unable to perform to one's own expectations.
Anyhow, I am now finding success with 45 mg/nite of remeron and 10 mg/2-3X/day of adderall. I started out with 30 mg/nite of remeron about 4 weeks ago and moved up to 45mg/nite about a week ago.
I had a prescription of adderall from over 2 years ago which I then began to try in the day. I abandoned it after feeling more depressed from it! I've done the same with ritalin in the past few years, too.
But, I read somewhere here on this board of how much trial and error people had to go through in getting dosages right with adderall and picked it up again and ... i'm getting somewhere!
I really think that getting the AD (remeron) up to working snuff has helped me to tolerate the adderall as I got that to the right dose.
It's still very early, but so far so good. Good luck. You might want to re-consider such a combo.
[I just posted somewhere here that if the adderall does not hold its efficacy, I'll try another stimulant, then if not that, wellbutrin and thereafter effexor ... starting with more benign, fast-acting to less so. Total last resort is an MAOI, but I am wary of the poop-out on that, too, as you had experienced.]
Posted by MarkG on June 8, 2001, at 14:15:23
In reply to Re: Depression and ADD: Beyond frustration, posted by phillybob on June 8, 2001, at 12:43:42
Hi Phillybob,
Thanks for the reply. I'm glad to hear that you're having some success w/the Adderall-Remeron combo. I do think it's possible that I might have more luck w/ the stimulants if I was currently on an AD.
Question: what's your experience been like w/Remeron? I found that it definitely helped w/sleep and anxiety but I felt very spacey and emotionally blunted on it. This was at a fairly low dose (~15-20mg?).
Also, I do think if all else fails that an MAOI might be a good choice. Although you do have to monitor your diet somewhat, it may be worth it. It definitely was the most effective AD I've tried, unfortunately it's kind of dicey combining these w/stims. I stopped taking it only b/c I want to try to tackle my ADD sxs as well.
Best of luck- keep us up to date on how you're doing.
Mark
Posted by phillybob on June 8, 2001, at 14:35:34
In reply to Re: Beyond frustration » phillybob, posted by MarkG on June 8, 2001, at 14:15:23
> I do think it's possible that I might have more luck w/ the stimulants if I was currently on an AD.
It may just be crazy thinking, but I thought that without an AD working, I was able to focus more on my depression with the adderall which thus made me more depressed. :)
> Question: what's your experience been like w/Remeron?
I am usually very sensitive to all meds. I think what helped with the remeron was starting at 30 mg/nite. (I did this cause I instituted the prescription on my own with leftovers from a previous trial). While the sedation effects are greater, the AD effects seemed to be greater too. If you do try it again, I'd start with the 30mg/nite as long as you don't have much to do the next couple of days after and then move to 45mg if need be, etc.
> Also, I do think if all else fails that an MAOI might be a good choice.
Yeah, hopefully I won't need to go there. Good luck. Really, I've tried it all and there is definitely proper things occurring right at this point with this combo. The most success I had, besides Prozac when I first took it ever was a trial with Topamax solo, which, on hindsight, looks a bit like a hypomanic episode to me.
Posted by SalArmy4me on June 8, 2001, at 14:35:55
In reply to Depression and ADD: Beyond frustration, posted by MarkG on June 8, 2001, at 12:09:32
How about desipramine?
Wilens, Timothy E. MD et al. Six-Week, Double-Blind, Placebo-Controlled Study of Desipramine for Adult Attention Deficit Hyperactivity Disorder. American Journal of Psychiatry. 153(9):1147-1153, September 1996:
"...The magnitude of the reduction in ADHD symptoms with desipramine is similar to that reported in adults with ADHD who received robust doses of methylphenidate. Like methylphenidate, desipramine treatment resulted in significant reductions in the broad categories of inattention, impulsivity, and hyperactivity. The current findings with desipramine, together with previously reported findings with psychostimulants, support the notion that pharmacological agents effective in reducing ADHD symptoms appear to operate through their catecholaminergic properties...
Posted by JohnM on June 8, 2001, at 15:57:54
In reply to Depression and ADD: Beyond frustration, posted by MarkG on June 8, 2001, at 12:09:32
Nardil almost always works.
Posted by Zo on June 9, 2001, at 2:49:06
In reply to Re: Depression and ADD: Beyond frustration, posted by JohnM on June 8, 2001, at 15:57:54
One thing about ADD is, there is almost never one single thing that works. For me, for example, it's a combination of Dexedrine, sleep med, a little Adderall if I'm facing a particularly taxing day, and Effexor, ongoing, for depression. For stability. Some ADD people get a lot of help from Wellbutrin, which makes sense. I like the theory that with ADD, the right brain is going a mile a minute -- I know mine is -- and a boost of dopamine helps the Executive Function (that's really what it's called!) in the left brain have at least a chance of keeping up.
Posted by MarkG on June 11, 2001, at 20:06:01
In reply to Desipramine » MarkG, posted by SalArmy4me on June 8, 2001, at 14:35:55
It's always nice to get feedback. The desipramine/ritalin efficacy relationship is interesting... I read an old post which cited an article stating that mood elevation via Ritalin is predictive of a positive antidepressant effect from desipramine. Ritalin has been somewhat uplifting as well as helping with attention so far, although I think I metabolize it VERY quickly. Maybe Desipramine is worth a shot. Thanks again!
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