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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by linkadge on August 23, 2006, at 16:30:31
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 22, 2006, at 20:35:55
If I recall wylee's ritalin augmentation did not go over too well at all. I don't know if it was overstimulating or what, but I think he ended up in the hospital.
If you do add it go very slowly, try the lowest dose possable and cut that in half (if possable). There may not be an interaction, but in theory, at least, it could lead to over stimulation.
Linkadge
Posted by linkadge on August 23, 2006, at 16:33:27
In reply to Re: Linkage Rit » linkadge, posted by Paulbwell on August 23, 2006, at 2:06:40
You're right, the stronger the stimulant the more likelyhood of cardiac events.
Linkadge
Posted by linkadge on August 23, 2006, at 16:36:11
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by laima on August 23, 2006, at 12:19:55
Whatever you do, DON'T DRINK GREEN TEA on the combination of segeline + ritalin.
If you do, you will have inhibition of DAT, COMT, and MAO-B, the (only?) three pathways available for dopamine metabolism.
This would very likely lead to overstimulation.
Linkadge
Posted by laima on August 23, 2006, at 16:50:00
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 16:36:11
What??? I've done this, never had any warning, never had any adverse event. Where did you hear this? Maybe it depends on how much ritalin...with selegeline I've never used higher than grand total of 15 mg spread out over the day-and that's not a lot. And guess what- still a bit sleepy.
> Whatever you do, DON'T DRINK GREEN TEA on the combination of segeline + ritalin.
>
> If you do, you will have inhibition of DAT, COMT, and MAO-B, the (only?) three pathways available for dopamine metabolism.
>
> This would very likely lead to overstimulation.
>
> Linkadge
Posted by linkadge on August 23, 2006, at 19:43:10
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by laima on August 23, 2006, at 16:50:00
Dopamine doesn't always lead to behavioral activation.
Interesting though, how much green tea did you drink?
Linkadge
Posted by laima on August 23, 2006, at 19:59:56
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 19:43:10
Not much- a cup here and there. I'm more of a coffee-type.> Dopamine doesn't always lead to behavioral activation.
>
> Interesting though, how much green tea did you drink?
>
> Linkadge
Posted by mayzee on August 23, 2006, at 20:39:46
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 16:30:31
> If you do add it go very slowly, try the lowest dose possable and cut that in half (if possable). There may not be an interaction, but in theory, at least, it could lead to over stimulation.
>Linkadge,
What do you mean by "over stimulation"? ...feeling hyper? anxious? or over stimulation of the heart (racing?) or ???
Thanks,
mayzee
Posted by laima on August 23, 2006, at 21:05:04
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 23, 2006, at 20:39:46
Too much ritalin with selegeline (or without selegeline) = wired, jittery, severly overcaffinated feeling. (But calmable with a benzo if you goof.)
> > If you do add it go very slowly, try the lowest dose possable and cut that in half (if possable). There may not be an interaction, but in theory, at least, it could lead to over stimulation.
> >
>
> Linkadge,
>
> What do you mean by "over stimulation"? ...feeling hyper? anxious? or over stimulation of the heart (racing?) or ???
>
> Thanks,
> mayzee
>
>
Posted by Paulbwell on August 24, 2006, at 1:53:32
In reply to Re: Linkage Rit, posted by linkadge on August 23, 2006, at 16:33:27
> You're right, the stronger the stimulant the more likelyhood of cardiac events.
>
>
>
> Linkadge
Hi Ya Link!Your bringng up of Cardiac damage with Rit, is valid-(if someone is, abusing, IVing, snorting huge amounts.
But in average doses, cardiac damage is prolly less toxic than smoking-(which my dad has been doing for 45 years, 68yo) and is in good health.
I know of a 62yo with sever Narcolepsy, who has been taking Desoxyn (quite high doses~60-80mgs) for ~45 years. he recently had a heart angioplasty procedure done=heart damage, prolly from the methamphetamine, strange considering (as i mentioned) Desoxyn has the least PNS activation Vs CNS action.
Cheers
Posted by linkadge on August 24, 2006, at 15:39:59
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 23, 2006, at 20:39:46
Probably different for different people. Too much dopamine, hallucinations perhaps, too much goal directed behavior, inability to turn off certain thought patterns perhaps.
Linkadge
Posted by linkadge on August 24, 2006, at 15:43:23
In reply to Re: Linkage Rit » linkadge, posted by Paulbwell on August 24, 2006, at 1:53:32
The risks for stimulant treatment with ritalin are still existent.
The problem is that there has not been a lot of directed research into the issue. While is has been known that people who abuse stimulants have higher likelyhood of cardiac event, ritalin is only now beginning to get the thorough investigations that it needs.
http://amphetamines.com/methylphenidate/black-box.html
Linkadge
Posted by laima on August 24, 2006, at 16:30:53
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 19:43:10
Now that I think of it, I thought I should mention that though I drink it several times a week, I do not boil my water the full way, (because I don't like it so hot) and take the tea packet out soon- so it's not strong green tea.
But I'm still curious, where did you hear about this green tea thing, or is it a personal educated theory?
Thanks.
Posted by linkadge on August 24, 2006, at 18:54:33
In reply to Re: about that green tea... » linkadge, posted by laima on August 24, 2006, at 16:30:53
It would have to be an educated theory :)
No, its not writtain on the back of the pill bottle.
I know that green tea is a COMT inhibitor. Dopamine can be metabolized by DAT, MAO-B or COMT. So one could expect synergistic actions of the level of dopamine by taking agents capable of inhibiting these enzymes.
Its really just something to consider.
Linkadge
Posted by laima on August 24, 2006, at 21:08:57
In reply to Re: about that green tea..., posted by linkadge on August 24, 2006, at 18:54:33
Educated theories are good! But I won't ever be the one to prove you right, thanks to my poor tea-making skills.> It would have to be an educated theory :)
>
> No, its not writtain on the back of the pill bottle.
>
> I know that green tea is a COMT inhibitor. Dopamine can be metabolized by DAT, MAO-B or COMT. So one could expect synergistic actions of the level of dopamine by taking agents capable of inhibiting these enzymes.
>
> Its really just something to consider.
>
> Linkadge
Posted by mayzee on August 24, 2006, at 23:10:44
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 22, 2006, at 18:30:49
> Is he adding it for antidepressant augmentation, or for attention?
> If he is using it for augmentation, I would pick a different agent.
>Hi Linkadge,
What different agent (instead of ritalin) would you pick for AD augmentation?
(my scenario is that I got some initial improvement at 9mg EMSAM but had to back off due to low blood pressure problems)Thanks,
mayzee
Posted by Paulbwell on August 25, 2006, at 0:50:28
In reply to Re: about that green tea..., posted by linkadge on August 24, 2006, at 18:54:33
> I know that green tea is a COMT inhibitor. Dopamine can be metabolized by DAT, MAO-B or COMT. So one could expect synergistic actions of the level of dopamine by taking agents capable of inhibiting these enzymes.
>
> Its really just something to consider.
>
> Linkadge
So i take it you are saying that drinking green tea, slows down the CNS dopamine destruction action?-whether inhibited by Ritalin or Amphetamine?Cheers
Posted by linkadge on August 25, 2006, at 17:10:57
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 24, 2006, at 23:10:44
You could try very slowly adding tyrosine or phenylalanine from a health food store. You could also perhaps try caffiene tablets, or coffee itself.
Have you tried wellbutrin by itself?
Nortryptaline or desipramine might also be good antidepressants by themselves, for low energy type of depression.
Linkadge
Posted by linkadge on August 25, 2006, at 17:16:21
In reply to Re: about that green tea... » linkadge, posted by Paulbwell on August 25, 2006, at 0:50:28
Yes. Generally when you take some substance that inhibits one pathway of metabolism there is a comepensatory increase in the other metabolic pathways.
Taking selegeline for instance, decreases MAO-B, but it increases DAT. So that the extra dopamine can be taken up by DAT.
Now, if you take a DAT inhibitor like ritaline, wellbutrin, cocaine etc, then you've blocked two pathways for metabolsm.
COMT is another pathway for dopamine and norepinephrine metabolism, so blocking it could be another way to dam up dopamine.
There are a few snags of course. The first being that these pathways are probably designed to prevent excess stimulation of dopamine receptors. There may be a consequence of excess stimulation.
The second snag is that green tea is also an acetylcholinsterase inhibitor. So it can increase acetycholine as well as dopamine. Aceylchonsterase inhibitors can cause depression by thesmeleves in certain people.
Linkadge
Posted by laima on August 25, 2006, at 23:21:51
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 25, 2006, at 17:10:57
ps- I find ritalin to be more effective and predictable than phenylalanine-and much shorter acting. If I take the phenylalanine in am, it can keep me up at night. Not so with low dose ritalin.
> You could try very slowly adding tyrosine or phenylalanine from a health food store. You could also perhaps try caffiene tablets, or coffee itself.
>
> Have you tried wellbutrin by itself?
>
> Nortryptaline or desipramine might also be good antidepressants by themselves, for low energy type of depression.
>
>
> Linkadge
Posted by mayzee on August 25, 2006, at 23:24:12
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 25, 2006, at 17:10:57
> You could try very slowly adding tyrosine or phenylalanine from a health food store. You could also perhaps try caffiene tablets, or coffee itself.
Thanks for your suggestions. I don't know anything about either tyrosine or phenylalanine (I think Laima is trying that with Emsam); but I will try to do some research to learn about them.
> Have you tried wellbutrin by itself?Yes, I did trials adding Wellbutrin to Paxil, and then Wellbutrin by itself (up to 450mg). It didn't help my depression and wasn't at all activating for me
> Nortryptaline or desipramine might also be good antidepressants by themselves, for low energy type of depression.
I'll note these for future. I asked the pdoc consult about TCAs and he said he thought they were better tried for acute and/or melancholic depression rather than chronic atypical. But if I'm not lucky, I'm sure I'll get around to them some day.
Thanks again for your input. I have a lot to learn!
--mayzee
Posted by laima on August 25, 2006, at 23:43:49
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 25, 2006, at 23:24:12
My update:I got back today to a low dose of ritalin, much lower than before, and am backing off phenylalanine for now in order to not get too risky or complicated. The phenylalanine helped my mood, as is Emsam- but the p- was NOT helping to boost my sluggish, faint feeling low blood pressure. That faintness and sluggishness was interfering with my goals and activities, making me feel like a chronic loser...sort of countering the otherwise positive effect of the Emsam and phenylalanine, if that makes sense. My other options to raise blood pressure were to take steroids (no thanks) or to wear weird sounding pantyhose (NO THANKS). Caffeine is jittier than low dose ritalin, in my experience, and hurts my stomache if I drink enough to get any effect. I think there is just no contest between caffeine and ritalin. And I've already been using so much salt I'd not be able to swallow my food if I used any more- plus it made me all puffy, too.
I asked if selegeline could "amplify" or prolong effects of other drugs, and the answer was "YES".
So I'll see how it goes- so far- I'm feeling MUCH better today! Active and more social!
Don't misunderstand- I am still a huge admirer of phenylalanine- and once took phenylalanine and tyrosine together (with nothing else), and that combo was very effective for awhile.
> > You could try very slowly adding tyrosine or phenylalanine from a health food store. You could also perhaps try caffiene tablets, or coffee itself.
>
> Thanks for your suggestions. I don't know anything about either tyrosine or phenylalanine (I think Laima is trying that with Emsam); but I will try to do some research to learn about them.
>
Posted by mayzee on August 27, 2006, at 11:11:36
In reply to Re: Tell Me About Longterm Ritalin » mayzee, posted by laima on August 25, 2006, at 23:43:49
> I got back today to a low dose of ritalin, much lower than before
Hi Laima,
What's your daily dose of ritalin?
What's the longest period of time that you took ritalin before? Did you have any side effects from the ritalin?
Thanks,
mayzee
Posted by laima on August 27, 2006, at 12:03:32
In reply to Re: Tell Me About Longterm Ritalin » laima, posted by mayzee on August 27, 2006, at 11:11:36
With Emsam 9 I'm, using just 2.5 mg, in Am around 7-8, and then again around noon. So far it's working out gorgeously- I'm much more "alive", alert, and doing the things I need to and want to do! How satisfying! I'm not worrying about what I didn't get done... A huge help! This dose seems to be working well for me with this dose of Emsam- I am not getting ANY anxiety or jitteryness or anything like that. More like the calmer satisfaction of being able to concentrate and not beating myself up over not being able to do stuff, or for not being able to de-faintify myself.
My doctor did say, YES, Emsam can "amplify" effects of other drugs- perhaps that's why I had that panicky spell when I went up to the 9. I was using 15 mg per day then now it's 5.
I've taken it for months at a time before, at varying doses and in different drug combination trials. Too high of a dose for sure has side effects- including tendency to fixate, get overly enthusiastic, overly ambitious, euphoric, talk to much, not sleep or eat--sounds a lot like the descriptions of manic states that I've read about. But ps- that severe condition happened to me only on very high dose, long ago- when I moronically wondered, "hmm, if less is good, would more be better? Let me cheat and see..." This was somewhere in the appalling neighborhood of 90 mg- and it still never damaged my heart. (NO. DONT ANYONE DO IT. That idiocy caused me loads of problems, everything from bizarre behavior, to suicidalish crashes, to losing the trust of my then psychiatrist, to having to sheepishly try to get refills from pharmacists who threatened to call police, etc. And got branded as "drug abuse risk" for awhile. Dumb dumb dumb of me. I regret the "experiments", and they sure caused and exasperated mood swings, too.)
Even lower doses can stall one's appetite.
It's definately an abuseable drug, and like benzos, can have a dark side to consider. However, I feel both can also be wonderful. I think I'm reasonabley safe at the low dose I'm on, and I am confident that the improvement in my mood and functionality right now are worth the small risk that I do have to know exists.
There is debate about whether or not it can cause brain damage, and there are new FDA warnings that it can cause heart problems and/or damage. It raises blood pressure-good in my case! That's part of the rreason I'm using it in the first place! But my blood pressure and pulse are being monitored carefully. It helps that I am in good physical shape (I excercise a lot in order to help my mood-bonus side effects include being in good physical shape!), and my heart, despite the recent low and high blood pressure snafus, is actually in pretty fine shape. So again, I believe, and my doctor believes, that the benefits I'm getting from responsable, low dose use outweigh the risks, in my case.
Unlike my klonopin stuggles, I actually am not feeling any temptation these days to abuse or cheat with the ritalin. Don't know if that's a chemical reason- or just the memory of what happened when I did. I also don't want any hypertensive crisis. But whatever the reason, it's a good thing!
When I recently quit that 15 mg cold, all that happened was two days of dullness and fatigue, but then I was back to the same old "faint" that I described.
> > I got back today to a low dose of ritalin, much lower than before
>
> Hi Laima,
>
> What's your daily dose of ritalin?
>
> What's the longest period of time that you took ritalin before? Did you have any side effects from the ritalin?
>
> Thanks,
> mayzee
Posted by mayzee on August 27, 2006, at 20:37:04
In reply to Re: Tell Me About Longterm Ritalin » mayzee, posted by laima on August 27, 2006, at 12:03:32
Hi Laima,
Thanks for the info about your current ritalin dosage and past experience re. side effects.
I just started trying ritalin for the first time. So far I've just been taking 2.5mg in the morning. It seems to be helping! I do notice though feeling tired/sleepy in the late afternoon/evening. I guess when it wears off, huh? How long is ritalin supposed to last?
Did you get prescribed 2.5mg tablets? or larger ones that you cut? Trying to save me money my pdoc wrote the script for 20mg tablets, but I'm finding it too hard to cut 1/8th for 2.5mg. Anyway he really wants me to take 5mg once/day, in the morning.
Have you noticed your blood pressure improving?
Mine is still quite low even at the 6mg EMSAM patch; but I think it's a little higher with the ritalin.
best,
mayzee
Posted by laima on August 27, 2006, at 21:14:46
In reply to Re: Tell Me About Longterm Ritalin » laima, posted by mayzee on August 27, 2006, at 20:37:04
Hi Mayzee-
Wow! 20mg sound like large tablets! Not surprised to hear that they are hard to chop up accurately. I've got 5mg tablets which I simply split to take 2.5 in am, 2.5 later. I bought a pill-chopper at the pharmacy which makes it easier and neater- it's kind of like a little guilitine with a razor blade, and it was very cheap. Ritalin is supposed to last roughly 5 hours or so, which is why I take it in AM and again at noonish. Yes, I am sure that the tiredness you are talking about is the "wearing off" "backlash". "Backlash" is too strong of a word, but I can't think of a better one right now.
My blood pressure has improved enough on the grand total of 5mg daily that I couldn't be more pleased! I'm so much more lively and functional, without being at all wired or jittery!
Maybe ask your doctor about your late-day tiredness and what he thinks of you splitting the dose up?
But in any case, I'm so happy to hear things are improving for you!!!
Laima
> Hi Laima,
>
> Thanks for the info about your current ritalin dosage and past experience re. side effects.
>
> I just started trying ritalin for the first time. So far I've just been taking 2.5mg in the morning. It seems to be helping! I do notice though feeling tired/sleepy in the late afternoon/evening. I guess when it wears off, huh? How long is ritalin supposed to last?
>
> Did you get prescribed 2.5mg tablets? or larger ones that you cut? Trying to save me money my pdoc wrote the script for 20mg tablets, but I'm finding it too hard to cut 1/8th for 2.5mg. Anyway he really wants me to take 5mg once/day, in the morning.
>
> Have you noticed your blood pressure improving?
>
> Mine is still quite low even at the 6mg EMSAM patch; but I think it's a little higher with the ritalin.
>
> best,
> mayzee
This is the end of the thread.
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