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Dr. Bob is Robert Hsiung, MD,
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Posted by CareBear04 on February 7, 2005, at 11:05:01
In reply to No more strattera, posted by zeugma on February 7, 2005, at 10:43:11
dear zeugma,
i know what it feels like to not be able to work like before and to feel depressed about it. there's no doubt about it-- i'm a bum now-- but somehow, in the past week or two, i've started to be at peace about it. my drs don't understand; they think i'm giving me. still, whether or not you're a religious person, maybe you can agree that sometimes we just need to rest to find direction for the future and to rejuvenate ourselves. i've spent the past two years frustrated since, of that time, i've only been back to school one semester. i've been on about three dozen medications, most of them duds. i know the stimulant path is maybe most frustrating of all because it deals with your livelihood, your ability to function, and your energy. i don't know what to say except that i feel with you, and i wish you the best.
Posted by ed_uk on February 7, 2005, at 11:15:04
In reply to No more strattera, posted by zeugma on February 7, 2005, at 10:43:11
Hello,
>I can't take even 25 mg strattera, as it is making me uncontrollably depressed. I don't know if it's causing it, actually, but it certainly isn't helping it and I continue to feel like I am breaking down.
I was worried that you might not be well since you haven't posted for a few days. I'm so sorry that you're feeling bad. I'm sure that you'll fell better once the Strattera is out of your system, it seems like a very bad drug for you. Are you taking 100mg of nort?
>My current pdoc can do no more for me, and I am scheduling an appt. with a sleep doc.
Do you know when you'll be able to see him/her? I'm sure they'll be able to help you :-)
>unfortunately this will not save my current job. And it depresses me to not work. But I am falllng apart.
Can you take a break from work until your better? Won't they let you go back after taking a break? I know what it feels like to have nothing to do, it can be depressing.
Best,
Ed.
Posted by zeugma on February 7, 2005, at 11:24:49
In reply to Re: To Zeugma » zeugma, posted by ed_uk on February 7, 2005, at 11:15:04
thanks care bear and ed for your support. I am going to take 100 mg nortriptyline tonight and wait for the Strattera to clear out of my system. I am also waiting for the sleep doc to call me back. I wanted to limp through these problems without changing pdocs etc. but that is no longer possible. I have never had this problem (drug-induced depression) with anything but Strattera and I consider it very irresponsible of my pdoc to represecribe it when I had a similar reaction to it last year. I hope I feel better soon.
-z
Posted by ed_uk on February 7, 2005, at 11:38:05
In reply to Re: To Zeugma, posted by zeugma on February 7, 2005, at 11:24:49
Hi Zeugma!
>I am going to take 100 mg nortriptyline tonight and wait for the Strattera to clear out of my system.
Good idea :-) Keep thinking about how much better you felt before you took the Strattera- you'll soon feel like that again.
>I have never had this problem (drug-induced depression) with anything but Strattera and I consider it very irresponsible of my pdoc to represecribe it when I had a similar reaction to it last year.
My already low opinion of Strattera just went down a notch!
>I hope I feel better soon.
I know you will :-) I hope you can go back to work when you're better.
Ed.
Posted by zeugma on February 7, 2005, at 11:39:36
In reply to Re: To Zeugma, posted by zeugma on February 7, 2005, at 11:24:49
it is doubly irresponsible of him to retry it when this was not merely the 2nd time I had done so. I had used it in Oct. or Nov. when on a subtherapeutic dose of Ritalin and it induced dysphoria then, too, which was why I stopped it (I can deal with stomach pain, but not sustained dysphoria and increased fatigue). It was notable that this time when I retried it it was purely out of trust in him, as there is no pharmacological evidence that it is superior to TCA's in terms of efficacy or tolerability (I had brought up desipramine and he maintained Strattera was better for ADD. I do not believe Lilly has conducted trials against desipramine so how could he say this? Also I am sure desipramine would not induce this kind of dysphoric reaction.)
-z
Posted by zeugma on February 7, 2005, at 11:46:44
In reply to Re: Strattera » zeugma, posted by ed_uk on February 7, 2005, at 11:38:05
Posted by ed_uk on February 7, 2005, at 11:52:18
In reply to one more thing, posted by zeugma on February 7, 2005, at 11:39:36
Hello,
>I do not believe Lilly has conducted trials against desipramine so how could he say this?
Some doctors have a habit of thinking that new drugs are always better, they are very susceptible to Big Pharma's propaganda! I very much doubt that Lilly would dare to conduct such a trial. In one of my lectures the other day we got taught 'New drugs are only approved after it has been demonstrated that they are clearly superior to existing drugs.' (I do pharmacy btw). Our minds are being filled with bulls**t!
Ed.
Posted by zeugma on February 7, 2005, at 12:45:55
In reply to Re: one more thing » zeugma, posted by ed_uk on February 7, 2005, at 11:52:18
Our minds are being filled with bulls**t!
Yes, only too literally in this case.I became sick of arguing with my pdoc about this last year, as he was neither going to produce evidence nor budge. I also became sick of arguing it with my therapist, who took the line that 'newer is better' (well, this is america after all). I should have dumped them both, unfortunately one tries to play along with mental health professionals for as long as possible in the hope of getting relief despite atavistic attitudes (and in my case, it is hard for me to function, period, without chemical help).
I've come to expect a certain lack of reason from people in mental health professions. I'll derive what grim amusement I can from today from pondering that one :)
-z
Posted by zeugma on February 7, 2005, at 18:05:34
In reply to Re: one more thing » ed_uk, posted by zeugma on February 7, 2005, at 12:45:55
I'm still going thru stim withdrawal, and now that I'm going to be d/c'ing Strattera, I decided to stay at 75 nortrip for the time being because I am so d*mmed anxious about the effect these drugs are having on me that I want to make as few changes as possible in the space of 24 hours. The strattera dysphoria is a peculiar, anhedonic feeling that should dissipate within a day or two independently of any antidepressant effect of other drugs. (I suppose that Ki of 95 nM is low enough in my case...) I wonder why the TCA's are so much more reliable than these new drugs. My own theory is that since we don't have a clue about the brain yet, relatively speaking, it is the serendipitious discoveries that yield better meds, because we literally don't know what we're aiming at and are more likely to produce favorable results by pure chance than by 'designing' a drug 'rationally.'
-z
Posted by ed_uk on February 8, 2005, at 10:08:07
In reply to still going thru stim w/d, posted by zeugma on February 7, 2005, at 18:05:34
Hi Z!
>I've come to expect a certain lack of reason from people in mental health professions. I'll derive what grim amusement I can from today from pondering that one :)
Lol :-)
>I wonder why the TCA's are so much more reliable than these new drugs. My own theory is that since we don't have a clue about the brain yet, relatively speaking, it is the serendipitious discoveries that yield better meds, because we literally don't know what we're aiming at and are more likely to produce favorable results by pure chance than by 'designing' a drug 'rationally.'
Perhaps Strattera and/or desipramine bind to numerous receptors that haven't even been discovered yet, that might explain some of the apparant differences between them. What do you think? New receptors are being discovered all the time. Most drugs won't have even been tested to find out whether they bind to these 'new' receptors. Anyway, the function of recently discovered receptors is generally poorly understood.
Ed.
Posted by banga on February 8, 2005, at 11:18:51
In reply to Re: still going thru stim w/d » zeugma, posted by ed_uk on February 8, 2005, at 10:08:07
RE Why tricyclics may be better:
I think the newer drugs are almost overengineered...they are SO specific that they initially right the problem--the imbalance--but then go too far and disrupt the imbalance because they act so powerfully on the target but not on anything else. Like letting in cold water in the bath to cool off the bathwater...but if you overdo it it all swings to the other extreme. People talk about brain fog and apathy etc. The older "dirtier"drugs may act more broadly and not overpush the whole system.
Posted by SLS on February 9, 2005, at 20:19:11
In reply to still going thru stim w/d, posted by zeugma on February 7, 2005, at 18:05:34
> I'm still going thru stim withdrawal, and now that I'm going to be d/c'ing Strattera, I decided to stay at 75 nortrip for the time being because I am so d*mmed anxious about the effect these drugs are having on me that I want to make as few changes as possible in the space of 24 hours. The strattera dysphoria is a peculiar, anhedonic feeling that should dissipate within a day or two independently of any antidepressant effect of other drugs. (I suppose that Ki of 95 nM is low enough in my case...) I wonder why the TCA's are so much more reliable than these new drugs. My own theory is that since we don't have a clue about the brain yet, relatively speaking, it is the serendipitious discoveries that yield better meds, because we literally don't know what we're aiming at and are more likely to produce favorable results by pure chance than by 'designing' a drug 'rationally.'
>
> -z
I wonder what would happen if you were to take an anticholinergic like Akineton...
- Scott
Posted by zeugma on February 10, 2005, at 16:30:00
In reply to Re: still going thru stim w/d, posted by SLS on February 9, 2005, at 20:19:11
I wonder what would happen if you were to take an anticholinergic like Akineton...
It seems like you're thinking what I'm thinking... that the cholinergic-aminergic imbalance is so pronounced that it produces movement-disorder- and akathasia- type symptoms (and it does, though my docs son't take these seriously- when younger I used to pace incessantly, now I can barely get myself out of my chair, though I am so tense that I would love to pace if given the energy...) I'm also thinking that a stim is out of the question, for several reasons. I wonder if protriptyline might be the answer.
-z
Posted by ed_uk on February 11, 2005, at 6:42:03
In reply to Re: still going thru stim w/d » SLS, posted by zeugma on February 10, 2005, at 16:30:00
Hi Z,
>I wonder if protriptyline might be the answer.
Protriptyline tends to cause a lot of side effects. Anyway, it doesn't have any clear advantages over desipramine. It is sometimes claimed that protriptyline is 'stimulating' in a way that desipramine is not- I am convinced that this is a myth. Protriptyline is potently anticholinergic, cardiovascular side effects such as hypotension are common and it sometimes causes a rash. Basically, I'd stay away from it!! There are better drugs available!
Best Regards,
Ed.
Posted by ed_uk on February 11, 2005, at 7:24:57
In reply to Re: still going thru stim w/d » zeugma, posted by ed_uk on February 11, 2005, at 6:42:03
Hi Z,
Wow, my last post was a bit negative wasn't it?! Sorry about that, I was in a bad mood :-S
Ed.
Posted by zeugma on February 11, 2005, at 15:24:29
In reply to Re: still going thru stim w/d » zeugma, posted by ed_uk on February 11, 2005, at 6:42:03
Hi Ed.
I haven't read much that is good about protriptyline. The one place I did read a positive comment was on a chat board for narcolepsy in which a woman claimed to take 15 mg a day with no side effects and great efficacy. Everything else was negative, so you are simply affirming the consensus on this one. The thing that concerns me is its lack of antihistaminic effect- yes, that might make for a 'stimulating' experience (and it would truly be interesting to see if its being more stimulating than DMI is a myth or not) but I am skeletal, and that it was I was put on nortriptyline, and not DMI, in the first place. I can't tell you how much better I feel, physically and emotionally, to have the strattera out of my system. The stuff truly was poisonous to my emotions.
So now I'm on just three drugs- 100 mg nortriptyline, 30 mg buspirone, 1 mg clonazepam. Now I am down to nearly zero side effects. And I have an appetite- not a large one, but the thought of food does not fill me with dismay. And the combination is good for my nerves. Oh, and tons, TONS of caffeine. Why is caffeine the only tolerable stimulant I can take?
It's amazing how three drugs has basically zero side effects, and then when I add a fourth, my system seems to become overwhelmed. I'm filled with fatigue, but at least I don't feel the anxiogenic roller coaster of Ritalin or the dysphoric alertness of strattera. Just the normal, everyday, dead-on-my-feet exhaustion that seems resistant to everything. It's better than what I felt on ritalin.
-z
Posted by SLS on February 12, 2005, at 9:20:38
In reply to Re: still going thru stim w/d » SLS, posted by zeugma on February 10, 2005, at 16:30:00
> I wonder what would happen if you were to take an anticholinergic like Akineton...
>
>
>
> It seems like you're thinking what I'm thinking... that the cholinergic-aminergic imbalance is so pronounced that it produces movement-disorder- and akathasia- type symptoms (and it does, though my docs son't take these seriously- when younger I used to pace incessantly, now I can barely get myself out of my chair, though I am so tense that I would love to pace if given the energy...) I'm also thinking that a stim is out of the question, for several reasons. I wonder if protriptyline might be the answer.
>
> -zI would give Akineton a quick trial. You know, there is a balance between muscarinic and dopaminergic systems. It might possibly be involved in your presentations - even the narcolepsy, although I would have to look into that more. It might be nice to try a pure antimuscarinic and not confound any results with what protripyline does.
- Scott
Posted by ed_uk on February 12, 2005, at 9:58:42
In reply to Re: still going thru stim w/d » ed_uk, posted by zeugma on February 11, 2005, at 15:24:29
Hi Z!
Glad you're feeling better :-)
>The thing that concerns me is its lack of antihistaminic effect- yes, that might make for a 'stimulating' experience
Desipramine has very little anti-histamine activity.
>I can't tell you how much better I feel, physically and emotionally, to have the strattera out of my system. The stuff truly was poisonous to my emotions.
:-) Strattera is a strange drug!
>Why is caffeine the only tolerable stimulant I can take?
You haven't tried all the stimulants yet!
Best,
Ed.
Posted by zeugma on February 13, 2005, at 16:47:54
In reply to Re: still going thru stim w/d » zeugma, posted by ed_uk on February 12, 2005, at 9:58:42
I'm not eager to try another stimulant. for one thing three drugs feels like enough, four and the s/e start to become noticeable. Nortriptyline is a very 'natural' feeling drug, if you know what I mean. It makes me a little more emotional than I ordinarily would be, and it stops the REM problems at 100 mg pretty efficiently. Clonazepam makes it possible to stand on supermarket lines without going through agony. Buspirone... well, there is the theoretical rationale of alpha-2 antagonists potentiating noradrenergic AD's, and that seems to be true in my case.
if I do try another stim, it's going to have to be with atenolol, after an EKG, under the auspices of someone who knows what they're doing. right now I have only limited trust in any pdoc to know what they're doing.
-z
Posted by Maxime on February 13, 2005, at 19:56:04
In reply to Re: Stimulant withdrawal » zeugma, posted by CareBear04 on February 3, 2005, at 13:18:59
Has anyone gone through the same withdrawal symptoms I had? I was dizzy and throwing up for several days and had the cold sweats. Is this normal if you quit something like Adderall or I am a freak?
Maxime
Posted by zeugma on February 13, 2005, at 20:04:41
In reply to Re: Stimulant withdrawal, posted by Maxime on February 13, 2005, at 19:56:04
I had dizziness, and a general feeling of weakness for a good while after d/c'ing Ritalin abruptly. Of course, I added on strattera quickly as a replacement, so that could have contributed to these symptoms, then Strattera brought on an intense dysphoria of its own.
Extreme anergia, beyond my already anergic baseline, and a feeling of being in slow motion (which I am, my reflexes are in their usual dysfunctional state- with a reaction time like mine, driving a car is impossible). Withdrawal from a stim is very unpleasant.
-z
Posted by ed_uk on February 15, 2005, at 8:15:26
In reply to Re: still going thru stim w/d » ed_uk, posted by zeugma on February 13, 2005, at 16:47:54
Hi Z :-)
How are you doing?
>for one thing three drugs feels like enough, four and the s/e start to become noticeable.
Lol Z, I think that was due to which drugs you were taking, not how many.
>if I do try another stim, it's going to have to be with atenolol, after an EKG, under the auspices of someone who knows what they're doing.
Yes, you might need to see a cardiologist.
Best,
Ed.
Posted by zeugma on February 15, 2005, at 16:38:44
In reply to Re: still going thru stim w/d » zeugma, posted by ed_uk on February 15, 2005, at 8:15:26
> Hi Z :-)
>
> How are you doing?
>
> >for one thing three drugs feels like enough, four and the s/e start to become noticeable.
>
> Lol Z, I think that was due to which drugs you were taking, not how many.well there's the nortriptyline, 100 mg. i think it's a good drug BUT doesn't cover all my symptoms (it isn't all that stimulating, and doesn't calm me down much either: the paradox i've been grappling with is that i needed to be simultaneously calmed and stimulated); there's buspirone, 30 mg, which has negligible s/e but which i would be happy to dispose of if given a reason to do so; there's clonazepam 1 mg, which keeps a lid on the anxiety but which adds to the asthenia, so i keep the dose as low as possible.
i spoke to my pdoc just now, and he wants me to retry Provigil at 50 mg tomorrow am. Now there is something crazy about retrying failed meds, but the Provigil failed because of weird side effects; it actually calmed me down and stimulated me, and I could swear the drug works on 5-HT (while taking it I felt no need to augment with buspirone). I'm trying to get thru the next few days at work in a functional state, because I have BAD ADDD, like I'm watching a reel of film sputter inside my head as I frantically struggle with the projector. What are your thoughts on Provigil?it's the first line med these days for narcolepsy. i know it concentrates in the hypothalamus, and i'm convinced (for some very simple reasons) that i have hypothalamus problems. the drug worked, it just caused bizarre but subjective side effects, unlike the ritalin, which caused objective s/e, like temper tantrums when it wore off and tachycardia. it is only in the last day or two that the chest pains have wholly dissipated.
i am convinced Provigil has some 5-HT effect that has not been elucidated yet. the drug calmed me the way SSRI's calm some people. how else can you explain a drug that gives a hypochondriac like the bizarre s/e I experienced (like feeling hot and cold simultaneously, and having swollen neck glands [ok, that's objective, I've got to have my pdoc look at my neck if I get that again]) without causing me to ramp up the klonopin? the ritalin had me so tense that some days I would take 2 mg of clonazepam and f*ck up my sleep completely.
i suppose this is only a stopgap until i can try dexedrine or something. But unfortunately, I am trying to hold down a job, and the caffeine pills aren't cutting it.
-z
>
> >if I do try another stim, it's going to have to be with atenolol, after an EKG, under the auspices of someone who knows what they're doing.
>
> Yes, you might need to see a cardiologist.
>
> Best,
> Ed.
>
>
Posted by zeugma on February 15, 2005, at 16:58:49
In reply to Re: still going thru stim w/d » ed_uk, posted by zeugma on February 15, 2005, at 16:38:44
I know it's a long shot, but I suppose it's just possible that the weird s/e I experienced on provigil were specific to nortriptyline, and that switching to desipramine might alleviate them. It's just a thought. Provigil was actually anxiolytic or at least neutral for me in that department, which as you know is a huge concern of mine. And provigil, unlike d-amphetamine, would not send me to the cardiologist (at least if my past experience, relatively extensive, with the drug is any indication). I really want to find a workable combination. If Provigil doesn't work out again, I am going to have to find something- an AP, an SSRI, a mood stabilizer, SOMETHING- to ease the terrible inner tension I constantly feel, and that comes out on stims in bursts of irritability. Of course, if it's something like akathisia, an SSRI or an AP would be a very bad idea...
thanks for listening to all this,
z
Posted by ed_uk on February 16, 2005, at 7:06:14
In reply to ed- your opinion please, posted by zeugma on February 15, 2005, at 16:58:49
Hi Zeugma!
>i needed to be simultaneously calmed and stimulated
Me too!!! I don't like caffeine either, it does nothing for me, I still feel tired.
>there's clonazepam 1 mg, which keeps a lid on the anxiety but which adds to the asthenia, so i keep the dose as low as possible.
Do you think it's worth trying a different benzo? I think I've asked you that before but I don't remember what you said. You could try a low dose of chlordiazepoxide or something like that? For whatever reason, some people find certain benzos more fatiguing than others. I have a friend who found chlordiazepoxide made him more tired than clonazepam but other people seem to find the opposite.
>he wants me to retry Provigil at 50 mg tomorrow am.
Perhaps it could be worth one last try. I'm a bit concerned that what you experienced before was some kind of unusual allergic/hypersensitivity reaction. The swollen lymph nodes (lymphadenopathy) reminded me of 'serum sickness'. It's probably way off but here's a link, may drugs can cause serum sickness but I've never heard of a case with modafinil......
http://www.emedicine.com/EMERG/topic526.htm>I know it's a long shot, but I suppose it's just possible that the weird s/e I experienced on provigil were specific to nortriptyline, and that switching to desipramine might alleviate them.
It's possible, that's all I can say really. Your Provigil side effects were quite unique, I really don't know what caused them.
>And provigil, unlike d-amphetamine, would not send me to the cardiologist
I wonder whether a cardiologist might suggest bisoprolol, it's more beta1 selective than atenolol- I think it penetrates the blood brain barrier to a greater extent though.
>if it's something like akathisia, an SSRI or an AP would be a very bad idea
What makes you think it was akathisia?
Best Regards,
Ed.
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