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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Glydin on November 1, 2005, at 15:18:28
I have noted some folks with anxiety issues discussing the use of stimulants. I don't seem to be able to tolerate much of anything in the way of stims. I've not tried RX stims, nor am I interested in that..... However, I would like to have my ability to use caffiene back and to be able to use the rare pseudofed ("contriband" in the US now - sigh) for sinus congestion.
It seems to me counterintuitive to be able to use stims if you have anxiety issues due to the reactions I have.
Anybody have ideas why some tolerate and some don't with a rationale for that finding?
Posted by med_empowered on November 1, 2005, at 17:22:18
In reply to Stimulant use in Anxiety Suffers, posted by Glydin on November 1, 2005, at 15:18:28
Stim tolerance seems so variable. For instance: I have had some pretty bad social phobia and generalized anxiety. I also have "mood issues" which have been given a number of diagnoses--Mood Disorder NOS, Bipolar II/NOS, so on and so forth. Anyway, you'd think that with all my panic attacks and intense anxiety, I'd freak out if given stims, but I did fine--on low-to-moderate dose dextroamphetamine. Ritalin I hated (both the LA and Focalin forms). Sudafed actually causes more anxiety and tension for me than amphetamine did. I dont know what to tell you in terms of explaining it...I guess, for me, amphetamine helped "keep my thoughts together", so the anxiety didn't make me "lose control" of my thought processes. That made it easier for me to focus on overcoming irrational thoughts. It also made me more sociable (at the right doses), which was certainly helpful.
Posted by CleverGuy on November 1, 2005, at 18:29:13
In reply to Re: Stimulant use in Anxiety Suffers, posted by med_empowered on November 1, 2005, at 17:22:18
While not under doctors orders, I noticed the same affect from Dexedrine on my anxiety. If your anxiety is socially based, I think it is a great help. I attribute it to the extra confidence boost it may give.
Posted by zeugma on November 1, 2005, at 18:47:00
In reply to Re: Stimulant use in Anxiety Suffers, posted by CleverGuy on November 1, 2005, at 18:29:13
I have noted that there are not only different anxiety subtypes among individuals, there are also comorbidities among variant anxiety disorders in myself.
For example, Ritalin caused dreadful, dreadul generalized anxiety, but potently reversed my social phobia (which incidentally is severe enough to be avoidant personality disorder). So I was sociable but literally shaking from head to toe.
Klonopin calms me, helps block social phobia-induced panic attacks, but is not a drug that makes me comfortable with socializing. and provigil is a drug that intensifies my already marked introversion.
So I suppose it depends on anxiety subtypes present in an individual. I believe Ritalin actually has promise for disorders traditionally classed as anxiety disorders (social phobia, depersonalization) but unfortunately exacerbates other components of my anxeity/stress disorders.
By the way, I just took a Vivarin in an attempt to stay awake. I think I have consumed such vast amounts of caffeine over the years that I am ingesting placebo. At least it doesnt exacerbate anxiety.
-z
Posted by SLS on November 1, 2005, at 18:51:02
In reply to subtypes of anxiety, posted by zeugma on November 1, 2005, at 18:47:00
Soooooooo....
What happens when you combine Ritalin + Klonopin?
Have you ever tried Adderall. Many people describe it as being "smooth". I've never tried it.
- Scott
Posted by Glydin on November 1, 2005, at 19:03:42
In reply to Re: Stimulant use in Anxiety Suffers, posted by med_empowered on November 1, 2005, at 17:22:18
Hi med,
I think I'm lamenting over ther feel I USED to get from caffiene. I was a java junkie and it was a dear friend.... but, not anymore. It seems like such a small thing and I know it's not good to be overboard with it but Golly, I miss that "pep" it use to give me..
Take care,
Glydin
Posted by zeugma on November 1, 2005, at 19:11:46
In reply to Re: subtypes of anxiety » zeugma, posted by SLS on November 1, 2005, at 18:51:02
> Soooooooo....
>
> What happens when you combine Ritalin + Klonopin?
Hi Scott.I did combine Ritalin and klonopin. What happens is that Ritalin seems to change the way Klonopin functions when used as a counterbalance to Ritalin-induced anxiety. It had something of a 'disinhibiting' effect that was not desirable. Or perhaps the Klonopin simply had no effect when combined with Ritalin. I was taking 2 mg a day (ordinarily 1 mg is all I can tolerate due to excess sedation at even 1.25 mg) to seemingly no effect. But it seemed like it was worth a shot, simce the Ritalin was so beneficual in other ways, to push the Klonopin dose as high as I could get it in order to tolerate the Ritalin.
>
> Have you ever tried Adderall. Many people describe it as being "smooth". I've never tried it.
>
I have never tried Adderall. I am awaiting lab results to determine if I have had serious adverse reactions to Provigil (possibly diabetes). Provigil works for a symptom cluster of my ADHD, one quite distinct from the one Ritalin worked on (remember those venn diagrams from school? they would come in handy in illustrating the differential effects these drugs have on the many symptom clusters or subtypes of narcolepsy, anxiety, depression, ADHD, etc. that I instantiate).if the results are diabetes or other dreadful thing Provigil is doing to me, Adderall or Dexedrine it will be. of course, i may need more klonopin for a while, too.
-z
>
> - Scott
Posted by CleverGuy on November 1, 2005, at 20:35:13
In reply to subtypes of anxiety, posted by zeugma on November 1, 2005, at 18:47:00
I totally agree that the subtypes of anxiety and the grey areas in between are vast and respond differently, and quite strangely, to psychostimulants. That is why we have all been through so many drugs; they work differently in everybody and differently for every disorder. Trial and error. I would like to know what you thought of Provigil. How is it when compared to the classic psycostimulants. Not for use in treating anxiety, I can see that is a mess. Rather, for their normal uses to stimulate the brain, does Provigil work as well as Ritalin or the amphetamines?
Posted by zeugma on November 1, 2005, at 20:54:10
In reply to Re: subtypes of anxiety, posted by CleverGuy on November 1, 2005, at 20:35:13
> I totally agree that the subtypes of anxiety and the grey areas in between are vast and respond differently, and quite strangely, to psychostimulants. That is why we have all been through so many drugs; they work differently in everybody and differently for every disorder. Trial and error. I would like to know what you thought of Provigil. How is it when compared to the classic psycostimulants. Not for use in treating anxiety, I can see that is a mess. Rather, for their normal uses to stimulate the brain, does Provigil work as well as Ritalin or the amphetamines? >>
well, i have never taken amphetamines, but i can compare it to ritalin. Now my own reaction and comorbidities result in idiosyncracies of response, but here is what I would say:
Ritalin helps with perception, feeling awake, feeling fully 'there,' thinking quickly (perhaps too quickly), speeds my reflexes.
Provigil helps my physical coordination, mental organization, triggers less panicked responses, and it's easier to keep my desk clean (tradeoff: on Ritalin my desk is a mess but I can sift through rapidly to find something I need, on provigil my desk is more orderly but I sift less rapidly. Net effect identical).
Ritalin is better for focus. provigil is better for staying calm enough for implementing a plan. and yet the frustrating thing is that combining them would seem to be the perfect combo, but instead of canceling each other out as Ritalin cancelled out Klonopin for me, the side effects just multiplied exponentially and i also felt like the Rit was speeding me up and the Provigil slowing me down, and it was sort of both happening at once, if you can imagine that. It gave me very strange feelings.
I think Provigil (aka Attenace, aka Sparlon) has received an approvable letter from the FDA, and is set to be marketed early next year for pediatric ADHD. I think other posters might be able to comment on the focus/organization dichotomy that these drugs present.
-z
Posted by CleverGuy on November 1, 2005, at 21:26:41
In reply to Re: subtypes of anxiety » CleverGuy, posted by zeugma on November 1, 2005, at 20:54:10
Thanks for the info. I didn't realize you were using it for ADD or ADHD. That really negates my question as I suffer from neither. Provigil is now being prescribed for daytime sleepiness, anergic depression, shift workers, etc. I was more interested on how well it got you up, the speediness you feel with ritalin for example, rather than how it calmed you down and helped you focus. I don't think its affects would be similar in my situation. I appreciate the comments none the less. Always good to learn.
Posted by theo on November 1, 2005, at 21:53:03
In reply to Re: Stimulant use in Anxiety Suffers, posted by med_empowered on November 1, 2005, at 17:22:18
Are you still taking a stim or Abilify? Seems I read on another thread you gave up the meds for a while?
Posted by theo on November 1, 2005, at 21:58:09
In reply to Stimulant use in Anxiety Suffers, posted by Glydin on November 1, 2005, at 15:18:28
> I have noted some folks with anxiety issues discussing the use of stimulants. I don't seem to be able to tolerate much of anything in the way of stims. I've not tried RX stims, nor am I interested in that..... However, I would like to have my ability to use caffiene back and to be able to use the rare pseudofed ("contriband" in the US now - sigh) for sinus congestion.
>
> It seems to me counterintuitive to be able to use stims if you have anxiety issues due to the reactions I have.
>
> Anybody have ideas why some tolerate and some don't with a rationale for that finding?I remember having a pdoc tell me there was NO way I could handle a stim with my anxiety. I went to my GP and he gave me a trial of Concerta(ritalin) and to my surprise, it helped my anxiety and OCD! Most of my years of anxiety was from SSRI's but I had been on them so long I didn't realize it. The only reason I didn't stick with Concerta was that I was a little worried about it for long term use.
Posted by Declan on November 1, 2005, at 23:48:08
In reply to Re: subtypes of anxiety, posted by CleverGuy on November 1, 2005, at 21:26:41
Hi CG, I used Adrafinil for a year or so, and it might be like Provigil. Not as euphoric or prosocial as amphetamine, a cooler feeling. I had a lot of troubles and it was good at getting me up and out the door. But some people say Adrafinil is not like Provigil.
Declan
Posted by ed_uk on November 2, 2005, at 14:53:23
In reply to Re: subtypes of anxiety » CleverGuy, posted by zeugma on November 1, 2005, at 20:54:10
Hi Z
Why does your doc think you might have developed diabetes?
Kind regards
Ed
Posted by Paulbwell on November 3, 2005, at 5:20:31
In reply to Stimulant use in Anxiety Suffers, posted by Glydin on November 1, 2005, at 15:18:28
> I have noted some folks with anxiety issues discussing the use of stimulants. I don't seem to be able to tolerate much of anything in the way of stims. I've not tried RX stims, nor am I interested in that..... However, I would like to have my ability to use caffiene back and to be able to use the rare pseudofed ("contriband" in the US now - sigh) for sinus congestion.
>
> It seems to me counterintuitive to be able to use stims if you have anxiety issues due to the reactions I have.
>
> Anybody have ideas why some tolerate and some don't with a rationale for that finding?hell, i have taken Ritalin (generic) for 18 months , and it makes me want to sleep/lay down now.
after 18 months, after first stimulanting me, it now makes me tired.
Starting at 10mgs 2x day, now i can take 20mgs up to 5x daily and it calms my brain (somewhat) and allow me to lay down and rest.
the drugs, and the brain change in responce to what they are constantly dealth with!, which once sped you up can over time slow you down, so that, you can be content with resting/sleeping with the same compound.
I can take 30-40mgs Ritalin and sleep fine (thou wake up tired) after dosing!)
The Brain changes with what it is continually bombardided with.
Cheers
Posted by zeugma on November 3, 2005, at 16:51:18
In reply to Re: subtypes of anxiety » zeugma, posted by ed_uk on November 2, 2005, at 14:53:23
> Hi Z
>
> Why does your doc think you might have developed diabetes?
>hi ed,
my doc thought I had develeped diabetes (possibly) because of persistent thrush. I suppose diabetes impairs the immune system? Anyway I don't have diabetes. Liver, blood, thyroid panels came back OK. I don't know what to do about the tongue at the moment. It is fortunate that the only thing I habitually use it for is to speak, if you know what I mean ;-) All I can say at the moment is that Provigil is unrivalled in its capacity to cause dry mouth. Strattera, nortriptyline, methylphenidate, and various permutations of the three result in veritable floods of saliva compared to what happens when Provigil is added :-( And sadly, as I have found, the dose that does not cause this effect does not work. :-(
The mouth infection is nasty, though, and my GP does not think that there are viable alternatives to clotrimazole. However, i have to get through life as best I can. hepatic damage, diabetes, immune dysfunction are reasons I would d/c Provigil. I am able to maintain a more normal weight on Provigil (this is an issue of immense importance to me). The thing is that my GP has done very thorough tests on me and does not think the Provigil poses a danger. The decision to try Dexedrine would have been made for me had my tests come back abnormal.
-z
> Kind regards
>
> Ed
Posted by ed_uk on November 3, 2005, at 17:10:41
In reply to Re: subtypes of anxiety » ed_uk, posted by zeugma on November 3, 2005, at 16:51:18
Hi Z :-)
>I suppose diabetes impairs the immune system?
It does!
>All I can say at the moment is that Provigil is unrivalled in its capacity to cause dry mouth.
What helps? Artificial saliva sprays? Sugar-free chewing gum? Dry mouth can certainly lead to infections.
>The mouth infection is nasty, though, and my GP does not think that there are viable alternatives to clotrimazole.
Nystatin pastilles (Nystan) are popular in the UK. Amphotericin pastilles (Fungilin) are also available.
Kind regards
Ed
Posted by zeugma on November 4, 2005, at 18:47:22
In reply to Re: subtypes of anxiety » zeugma, posted by ed_uk on November 3, 2005, at 17:10:41
Hi Ed,I am currently using artificial saliva, spray (for home) and lozenges (for work). I am also taking acidopholus on the advice of my GP.
Here's hoping these remedies work.
-z
Posted by paulbwell on November 6, 2005, at 3:53:19
In reply to Stimulant use in Anxiety Suffers, posted by Glydin on November 1, 2005, at 15:18:28
> I have noted some folks with anxiety issues discussing the use of stimulants. I don't seem to be able to tolerate much of anything in the way of stims. I've not tried RX stims, nor am I interested in that..... However, I would like to have my ability to use caffiene back and to be able to use the rare pseudofed ("contriband" in the US now - sigh) for sinus congestion.
>
> It seems to me counterintuitive to be able to use stims if you have anxiety issues due to the reactions I have.
>
> Anybody have ideas why some tolerate and some don't with a rationale for that finding?
My Psychiatrist, after thinking i had an anxiety disorder, gave me Xanax.he then thought i had an ADHD issue, so gave me methylphenidate, 10mgs 2x daily, now 20mgs 4x daily.
Dextroamphetamine, 5mg IR tabs, (Dexamphetamine) (Dexedrine-USA have been helpfull, at a dose of 40mgs 4x daily=120mgs.
It's a hassle taking 8 pills, 5mg IR Dexamphetamine, 3x daily, but WTF-whatever works.
My Pharmacist looks at me like i am some Dope fiend, when i pick up my 30 day script of 5mg IR 720-Dextroamphetamine tablets, but FH.
cheersCheers
Posted by ed_uk on November 6, 2005, at 14:37:35
In reply to Re: subtypes of anxiety » ed_uk, posted by zeugma on November 4, 2005, at 18:47:22
Hi Z
Did you find out whether nystatin pastilles are available in the US?
Ed
This is the end of the thread.
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