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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Mr.Scott on March 27, 2005, at 14:42:17
I have been taking Adderall XR for a few months now. At first I took 20mg, then 30mg, now 40mg. I will not go any higher.
My initial response was mild euphoria and wonderful relief of my atypical depressive symptoms. Then I had only solid relief of my atypical depressive symptoms. Now I believe I have only irritability, mild agitation, and some dysphoria among other side effects, i.e (excessive cigarette smoking, some sweating, etc.)
I'm very unhappy about this, and am wondering if anyone has any suggestions. I also take .5mg to .75mg of klonopin and 12.5mg-25mg of Zoloft. My diagnosis has changed many times, and I'm extremely intolerant of most meds. SSRI's cause me parkinsons symptoms, TCA's overstimulate me, MAOI's are either intolerable or poop out. I've run the gamut of stabilizers and even done a course of outpatient ECT with modest success for a deep and dark Major Depression.
What's going on here with the adderall? Tolerance? Or is this a mood cycle? Any help or suggestions from experience with stims are greatly welcomed.
Thanks,
Scott
p.s. I just took 500mg of Depakote to see how this effects me and if it resolves any of the depressive/dysphoria stuff.
Posted by Ritch on March 27, 2005, at 15:25:58
In reply to Help Please, Re: Adderall and other Stims., posted by Mr.Scott on March 27, 2005, at 14:42:17
> I have been taking Adderall XR for a few months now. At first I took 20mg, then 30mg, now 40mg. I will not go any higher.
>
> My initial response was mild euphoria and wonderful relief of my atypical depressive symptoms. Then I had only solid relief of my atypical depressive symptoms. Now I believe I have only irritability, mild agitation, and some dysphoria among other side effects, i.e (excessive cigarette smoking, some sweating, etc.)
>
> I'm very unhappy about this, and am wondering if anyone has any suggestions. I also take .5mg to .75mg of klonopin and 12.5mg-25mg of Zoloft. My diagnosis has changed many times, and I'm extremely intolerant of most meds. SSRI's cause me parkinsons symptoms, TCA's overstimulate me, MAOI's are either intolerable or poop out. I've run the gamut of stabilizers and even done a course of outpatient ECT with modest success for a deep and dark Major Depression.
>
> What's going on here with the adderall? Tolerance? Or is this a mood cycle? Any help or suggestions from experience with stims are greatly welcomed.
>
> Thanks,
>
> Scott
>
> p.s. I just took 500mg of Depakote to see how this effects me and if it resolves any of the depressive/dysphoria stuff.Hi Scott, what happened to the Trileptal trial? I think you said you were on that the last time I read any of your posts. If the Adderall isn't making your anxiety any worse, the Depakote add might be just the thing to take with it. I had a fairly decent response in the past using Dep+Clon+Effexor+Adderall, also Dep+Clon+Effexor+Ritalin worked rather well, too. I suppose I could have been taking Zoloft instead of Effexor and got a reasonably good reaction. Maybe Depakote could be used to combat stim poopout?
Posted by Phillipa on March 27, 2005, at 16:41:59
In reply to Re: Help Please, Re: Adderall and other Stims. » Mr.Scott, posted by Ritch on March 27, 2005, at 15:25:58
Okay, I guess I'm stupid, but how does a stimulant help if you have anxiety. I can see how it would help with depression. I think I would go through the roof if I ever tried adderall. Or does it have a paradoxical effect? Fondly, Phillipa
Posted by scatterbrained on March 27, 2005, at 20:14:53
In reply to Re: Help Please, Re: Adderall and other Stims., posted by Phillipa on March 27, 2005, at 16:41:59
Adderall seems to have an anti anxiety affect for me while other stimulants such as provigil and strattera seem to make my anxiety worse.
Posted by Mr.Scott on March 28, 2005, at 1:41:16
In reply to Re: Help Please, Re: Adderall and other Stims. » Phillipa, posted by scatterbrained on March 27, 2005, at 20:14:53
Yes indeed. Whereas straterra, Provigil, and even drugs like desipramine, and possibly fluoxetine sent me climbing the walls, amphetamine had anti-anxiety effects that surpassed even benzos! Ritalin was not quite as clean in that regard, but still surprising for a stimulant.I can't explain, but if you can imagine anxiety as a symptom of a neurological disorder or something other than just the symptom anxiety itself. And that disorder gets corrected even than the anxiety goes away. That was at least my experience here.
Now I feel less impressed with the theory and wonder if I was just mildly high on therapeutic doses of amphetamines for awhile.
Posted by Mr.Scott on March 28, 2005, at 1:49:53
In reply to Re: Help Please, Re: Adderall and other Stims. » Mr.Scott, posted by Ritch on March 27, 2005, at 15:25:58
Well...I felt great relief from the dysphoria with the dep. Problem is that the stuff has made me itch like a shedding snake must feel. Maybe that subsides, or a lower dose (I took 500mg) might be in order. I also took about 300mg of neurontin, 12.5mg Zoloft, and .5mg klon today along with 30mg Adderall. But I did not recapture the 'magic' of Adderall. It was like the initial magic with Prozac over 10 years ago, it came and went unless I'm just in a funky place right now which could be.I slept for 7 hours tonight after taking the Dep/Neurontin combo, and now it's time for bed. I really did need the sleep though.
I'll experiment around, but maybe what I'm looking for doesn't really exist. I mean amphetamine has a rich history of seducing people into an eventually nasty state of affairs!
Scott
Posted by Ritch on March 28, 2005, at 10:43:38
In reply to Re: Help Please, Re: Adderall and other Stims., posted by Phillipa on March 27, 2005, at 16:41:59
> Okay, I guess I'm stupid, but how does a stimulant help if you have anxiety. I can see how it would help with depression. I think I would go through the roof if I ever tried adderall. Or does it have a paradoxical effect? Fondly, Phillipa
I think what happens is that it allows you to focus on one thing and your mind isn't going off on all sorts of ruminative tangents. Of course, if it makes you *hyperfocus* on something unpleasant then it's probably going to make things worse. Wellbutrin was the worst for provoking anxiety for me. Ritalin also caused quite a bit and Adderall somewhat.. but it was just a generalized yuck feeling I got. Dexedrine I found to indeed have a calming effect---but it didn't work as well for my attentiveness like Ritalin or Adderall... strange. I never got panicky in any way whatsoever on dexedrine.
Posted by Ritch on March 28, 2005, at 10:48:05
In reply to Re: Help Please, Re: Adderall and other Stims. » Ritch, posted by Mr.Scott on March 28, 2005, at 1:49:53
>
> Well...I felt great relief from the dysphoria with the dep. Problem is that the stuff has made me itch like a shedding snake must feel. Maybe that subsides, or a lower dose (I took 500mg) might be in order. I also took about 300mg of neurontin, 12.5mg Zoloft, and .5mg klon today along with 30mg Adderall. But I did not recapture the 'magic' of Adderall. It was like the initial magic with Prozac over 10 years ago, it came and went unless I'm just in a funky place right now which could be.
>
> I slept for 7 hours tonight after taking the Dep/Neurontin combo, and now it's time for bed. I really did need the sleep though.
>
> I'll experiment around, but maybe what I'm looking for doesn't really exist. I mean amphetamine has a rich history of seducing people into an eventually nasty state of affairs!
>
> Scott
Yes, it can lead to a lot of trouble. When I was trying Ritalin I needed to increase Depakote from 250-500 to offset the anx. from the Ritalin. The short-lived crashing didn't help either. But, I wasn't depressed though. I'm a lightweight re: stims, 10mg of dexedrine or 20mg of Ritalin was plenty for me through the day..
Posted by Gabbi-x-2 on March 28, 2005, at 17:09:59
In reply to Re: Help Please, Re: Adderall and other Stims., posted by Phillipa on March 27, 2005, at 16:41:59
> Okay, I guess I'm stupid, but how does a stimulant help if you have anxiety. I can see how it would help with depression. I think I would go through the roof if I ever tried adderall. Or does it have a paradoxical effect? Fondly, Phillipa
I thought I'd go through the roof when I was prescribed dexedrine too, as the main symptom of my depression is anxiety. Dexedrine was a god send though, It was one of the crucial components of my remission. I think what Ritch said is right, it seems to enable to me do more things, (I'm much more social) and not just ruminate, in that respect it has long-lasting anti-anxiety effects too, I actually am able to do things to improve my life tangibly, rather than just rid myself of the anxiety.
Posted by scatterbrained on March 28, 2005, at 17:17:41
In reply to Re: Help Please, Re: Adderall and other Stims. » Phillipa, posted by Gabbi-x-2 on March 28, 2005, at 17:09:59
Have you tried adderall? If so, is dex more helpful? I'm on adderall but the problem is that it wears off, and I build up a tolerance.
Posted by Gabbi-x-2 on March 29, 2005, at 19:17:38
In reply to Re: Help Please, Re: Adderall and other Stims. » Gabbi-x-2, posted by scatterbrained on March 28, 2005, at 17:17:41
> Have you tried adderall? If so, is dex more helpful? I'm on adderall but the problem is that it wears off, and I build up a tolerance.
No, I'm sorry I can't help you, I've never tried Adderall. Dexedrine has really been perfect for me. I take a small amount 15mgs, in the extended release, I've taken it for years and it's still
excellent. If I feel Í'm building a tolerance to it sometimes I'll boost it with baking soda, or pseudo ephedrine, or Í'll stop taking it for a couple of days, but I realize for some people that's hard to do. I have heard (on this board) that Dexedrine is less jarring than Adderall as far as the wearing off goes, you might want to google for that information.
Posted by stresser on March 29, 2005, at 20:09:34
In reply to Re: Help Please, Re: Adderall and other Stims. » scatterbrained, posted by Gabbi-x-2 on March 29, 2005, at 19:17:38
What happens if you take adderall with ephedra? -L
Posted by Gabbi-x-2 on March 30, 2005, at 16:29:17
In reply to Re: Help Please, Re: Adderall and other Stims. » Gabbi-x-2, posted by stresser on March 29, 2005, at 20:09:34
> What happens if you take adderall with ephedra? -L
Well I don't know exactly, as I've never been on Adderall. It wouldn't be recommended because both accelerate your heart rate. I did take ephedra with my small amount of dexedrine on occassion to no ill effect, it noticeably increased the c.n.s stimulation, and didn't increase my anxiety, but I did feel slightly overstimulated without being able to focus.
Posted by tulip04 on April 1, 2005, at 5:34:27
In reply to Re: Help Please, Re: Adderall and other Stims., posted by Phillipa on March 27, 2005, at 16:41:59
Phillipa
I am on Adderall XR 10mg once a day and I actually found it helped my anxiety. Generally I don't think ADD meds are good for anxiety but in my situation my anxiety was actually being caused by my inability to focus and get my work done, causing anxiety of not succeeding. My anxiety was worse when I was doing nothing, like watching tv or driving, where as if I was really busy at work, I wouldn't feel anxious at all
because I was too focused on something else to get anxious. Now, the adderall has helped me focus all around and I rarely need to pop a xanax to get rid of that anxious feeling.. Just a thought but I think it all depends on what the root cause of the anxiety is in the first place.
Posted by paulbwell on April 1, 2005, at 14:09:08
In reply to Re: Help Please, Re: Adderall and other Stims., posted by tulip04 on April 1, 2005, at 5:34:27
Low dose Amphetamine (10-15mg) or methylphenidate (20-30mg) IMPROVES steadinesss, balance, alertness, hand-eye coordination, and attention. This I believe ,and have experienced will reduce anxiety, indirectly. When the mind is processing fewer thoughts and stimuli, each thought or attention to concentrated matter, becomes clearer and free from distracting material, with the results being less frustration and Anxiety.
Makes sense.
Posted by willyee on April 1, 2005, at 19:03:30
In reply to How Psycho-Stimulants may lessen anxiety, posted by paulbwell on April 1, 2005, at 14:09:08
> Low dose Amphetamine (10-15mg) or methylphenidate (20-30mg) IMPROVES steadinesss, balance, alertness, hand-eye coordination, and attention. This I believe ,and have experienced will reduce anxiety, indirectly. When the mind is processing fewer thoughts and stimuli, each thought or attention to concentrated matter, becomes clearer and free from distracting material, with the results being less frustration and Anxiety.
>
> Makes sense.
Cant say this is true with every stimulant and every person,but i will say this....sedating meds,opposite of a stimulant taken alone never help anxiety for me,instead worsens it,and only seemed helpful in cases when excess stimuli was present,or in small doeses to assist with social avoidance.Think of your major sedatives,alcholol,and weed...how many people exper heightened anxiety with these two drugs,esepcialy weed?FGood observation i actualy thought if this myself a few times.
Posted by paulbwell on April 3, 2005, at 4:35:20
In reply to Re: How Psycho-Stimulants may lessen anxiety, posted by willyee on April 1, 2005, at 19:03:30
I often experience improved sleep, after 20-30mgs IR Methylphenidate.
As stated Psychostimulants improve attention, and narrow focus, attention to whatever someone may CHOOSE to pay attention too. If sleep is what someone CHOOSES to focus on, sleep will often be more successfully acheived.This med quietens down 'white noise' and clears my head, from intruding thought, combined with a CHOICE to sleep, allowing for a greater chance of sleep induction.
Posted by franco neuro on April 4, 2005, at 11:19:57
In reply to Re: How Psycho-Stimulants may help sleep!, posted by paulbwell on April 3, 2005, at 4:35:20
This is an interesting topic. It is true that by raising dopamine levels in the prefrontal cortex stimulants, in effect, raise the signal to noise ratio. This allows one to block out the static and "white noise", and focus more on the task at hand without unwanted distraction. This should certainly have a calming effect.
However, becoming fatigued or sedated on a medication that is supposed to raise dopamine (or norepinephrine levels for that matter) is definitely a paradoxical response. This is what's happening to me right now on Wellbutrin. While it isn't a stimulant, it is supposed to be an "activating" and in many cases anxiety potentiating drug. This is to be expected since it's primary mechanism of action (as far as anyone knows) is blocking the DA and NE reuptake pumps, which should increase the levels of these neurotransmitters at the site of action. The synapse.
My question is what's causing this paradoxical response?
-Downregulated post synaptic receptors may cause one to have less of a response to increased dopamine in the synapse, but shouldn't cause a paradoxical response.
-Depleted presynaptic stores may cause the paradoxical response if one were taking a true dopamine agonist (one that facilitates it's release), but not one that simply blocks the reuptake pump as Wellbutrin is supposed to be doing.
-An over-sensitive autoreceptor. As the DA levels increase in the synapse, due to increased secretion or blocked reuptake, this triggers the autoreceptor to signal the presynaptic cell to stop releasing DA into the synapse. The more sensitive the autoreceptor the greater the paradoxical repsonse. This would also cause chronically low synaptic dopamine levels. This seems to be the most logical scenerio to me.
Any thought on this? I'd love some feedback and to know what other possible mechanisms might explain why some people are wiped out by pro-dopamine meds. I really need to fix my brain soon...
This is the end of the thread.
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