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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by laima on January 4, 2007, at 16:31:04
Why are stimulants not recommended as antidepressents, anyway?
Because they konk-out much too fast? Risk of a daily crash contrained for depressed individuals? Toxicity? Just wondering.
Posted by meAgain on January 4, 2007, at 16:55:44
In reply to stimulants as antidepressents, posted by laima on January 4, 2007, at 16:31:04
I once read that stimulants were used for depression in the past, I could see why. Maybe they arent prescribed for depression because there is too much risk for dependence and abuse with stimulants and there are so many people today that need antidepressants, too many people would be taking them...I dont know, just a guess :) wish they were prescribed for depression, they help me more than any of the other meds i have been on. I take concerta and it really helps me but I have to take 3 other meds for depression!! yuk
Posted by med_empowered on January 4, 2007, at 19:15:55
In reply to Re: stimulants as antidepressents, posted by meAgain on January 4, 2007, at 16:55:44
I dont know, really. People always talk about stimulant abuse in the past, but it seems like most people did OK--there weren't huge rates of amphetamine psychosis or heart attacks from high doses of RX meth or anything. I read that in the early 60s, Beat kids and other young people starting getting heavy into rx speed--they'd forge prescriptions, find pill-mill docs to write scrips, that kind of thing. In california, there was even a problem with pharmacies selling IV amphetamines and barbiturates w/o a prescription--as a result, manufacturers stopped shipping those out to most pharmacies.
Anyway, it seems like the stimulants-for-depression thing never really went away...since stims are mostly in schedule II, though, docs do have to worry about the DEA, and these days the DEA is a force to be reckoned with. Also, I sometimes think that when docs prescribe something that makes the patient feel like crap, they feel like they're "real doctors," since I guess "treatment" sucks but "drugs" feel good. Plus, docs these days have really bought into alot of this anti-drug BS..some younger shrinks adamantly refuse to RX benzos, even though they have minor addictive potential and are cheaper and safer than a lot of alternatives.
Posted by elanor roosevelt on January 4, 2007, at 21:51:03
In reply to Re: stimulants as antidepressents, posted by med_empowered on January 4, 2007, at 19:15:55
just added 5mg adderall to my 10 mg of Lexapro. I was amazed that my pdoc agreed to this but he did.
I think there is too much worry over possible abuse potential of drugs. If you are under care of a pdoc that should be monitored.
Not enough worry about the abuse potential of bad pdocs and bad drugs. We get abused by an industry that is led by PR agencies, not by knowledge and/or compassion.
Hello -- when a drug makes you feel very bad and a doctor tells you to keep trying, fire him/her.
Posted by laima on January 4, 2007, at 21:56:11
In reply to Re: stimulants as antidepressents, posted by elanor roosevelt on January 4, 2007, at 21:51:03
Well, why do all the package inserts and online drug monographs always say, "Not for use by depressed individuals or to treat depression", etc? Why are stimulants not popular as monotherapy for depression?
Posted by MIke Lynch on January 4, 2007, at 21:59:54
In reply to Re: stimulants as antidepressents » elanor roosevelt, posted by laima on January 4, 2007, at 21:56:11
Because they can cause depression, it's not going to be in your system 24/7, you take it in the day then what happens when it wears off at night? Are you going to take another one? Well it's obvious why that would be a problem
Posted by laima on January 4, 2007, at 22:03:24
In reply to Re: stimulants as antidepressents, posted by MIke Lynch on January 4, 2007, at 21:59:54
Well, I got some mood dips with ritalin, but not with adderall. Do you suppose the dips and the possibility of mood swings are the reasons they are not reccomended for depression then? That's my best guess.
> Because they can cause depression, it's not going to be in your system 24/7, you take it in the day then what happens when it wears off at night? Are you going to take another one? Well it's obvious why that would be a problem
Posted by laima on January 4, 2007, at 22:22:52
In reply to Re: stimulants as antidepressents, posted by laima on January 4, 2007, at 22:03:24
Well, on the other hand- if it came down to a choice of feeling crappy day and night, or feeling pretty good during the day and pretty crappy at night (but knowing that the morning would be much better), I'd still go for the latter. I think that would probably be better than feeling blah day and night, too.
Posted by med_empowered on January 4, 2007, at 23:15:33
In reply to Re: stimulants as antidepressents, posted by laima on January 4, 2007, at 22:22:52
I dont think the "no stims for depression" thing is really based on good science. Think about it: alot of ADs, especially the energizing ones, operate like slow-acting stimulants, by pumping up neurotransmitter levels. Some, like EMSAM, are even partially metabolized into amphetamine/methamphetamine. So its not like today's treatments are that much different. Some docs I'm sure still give patients stims for depression w/o other stuff--in fact, its a pretty standard treatment for old or sick patients who may not tolerate ADs or who are on other meds that may have drug/drug interactions. If you google it, you'll see a lot of stuff on using ritalin in old people and ritalin and amphetamines in cancer and aids patients. The practice certainly isn't dead.
Also, I think the whole war-on-drugs thing recast stimulants are dangerous and addictive, where before the medical community had noted a dependence problem, but also saw that there were very real benefits from the meds. Now that Adderall is around and is seen as "medicine" first and "amphetamine/controlled substance" second, I suspect that more docs are (or will be) using stims in depression. Plus, there's that new ritalin patch, and there's work underway on less abusable forms of dexedrine so...I think we may well see a resurgence of stims-for-depression rx-ing.
Posted by laima on January 5, 2007, at 8:04:06
In reply to Re: stimulants as antidepressents, posted by med_empowered on January 4, 2007, at 23:15:33
This would be nice- sometimes I swear I get far more relief from adderall than from Emsam, and before that, same was true for me for ritalin. There are tons of stimulant-for-depression testimonials on remedyfind, too. Some of those people have been using them for a couple years.
> I dont think the "no stims for depression" thing is really based on good science. Think about it: alot of ADs, especially the energizing ones, operate like slow-acting stimulants, by pumping up neurotransmitter levels. Some, like EMSAM, are even partially metabolized into amphetamine/methamphetamine. So its not like today's treatments are that much different. Some docs I'm sure still give patients stims for depression w/o other stuff--in fact, its a pretty standard treatment for old or sick patients who may not tolerate ADs or who are on other meds that may have drug/drug interactions. If you google it, you'll see a lot of stuff on using ritalin in old people and ritalin and amphetamines in cancer and aids patients. The practice certainly isn't dead.
>
> Also, I think the whole war-on-drugs thing recast stimulants are dangerous and addictive, where before the medical community had noted a dependence problem, but also saw that there were very real benefits from the meds. Now that Adderall is around and is seen as "medicine" first and "amphetamine/controlled substance" second, I suspect that more docs are (or will be) using stims in depression. Plus, there's that new ritalin patch, and there's work underway on less abusable forms of dexedrine so...I think we may well see a resurgence of stims-for-depression rx-ing.
Posted by NYCguy on January 5, 2007, at 8:55:26
In reply to stimulants as antidepressents, posted by laima on January 4, 2007, at 16:31:04
From personal experience, the crash from stims is horrible. I had to augment with Cymbalta to make the Adderall at all tolerable.
Of course, Cymbalta at 60mg took away much of the anti-ADD benefit that the stims gave me. Maybe it was just the Cymbalta that was crap... but I'd bet that other SRIs would diminish the effect as well.
>
> Why are stimulants not recommended as antidepressents, anyway?
> Because they konk-out much too fast? Risk of a daily crash contrained for depressed individuals? Toxicity? Just wondering.
Posted by linkadge on January 5, 2007, at 16:08:23
In reply to Re: stimulants as antidepressents, posted by med_empowered on January 4, 2007, at 23:15:33
I think the big problem is with dosing. With antidepressants, (at least theoretically), the mood should steadily improve with continued dosing.
With stimulants though, you will get fast acting results, but a severe depression may get more severe when the dose wears off.
Linkadge
Posted by elanor roosevelt on January 5, 2007, at 19:31:34
In reply to Re: stimulants as antidepressents » elanor roosevelt, posted by laima on January 4, 2007, at 21:56:11
isn't it odd
and it is so common for people to need treatment for both> Well, why do all the package inserts and online drug monographs always say, "Not for use by depressed individuals or to treat depression", etc? Why are stimulants not popular as monotherapy for depression?
Posted by elanor roosevelt on January 5, 2007, at 19:36:59
In reply to Re: stimulants as antidepressents, posted by med_empowered on January 4, 2007, at 23:15:33
I think the whole war-on-drugs thing recast stimulants are dangerous and addictive, where before the medical community had noted a dependence problem, but also saw that there were very real benefits from the meds. Now that Adderall is around and is seen as "medicine" first and "amphetamine/controlled substance" second, I suspect that more docs are (or will be) using stims in depression. Plus, there's that new ritalin patch, and there's work underway on less abusable forms of dexedrine so...I think we may well see a resurgence of stims-for-depression rx-ing.Yes, and I am on the "medicinal" Adderall
Posted by laima on January 5, 2007, at 23:15:26
In reply to Re: stimulants as antidepressents, posted by elanor roosevelt on January 5, 2007, at 19:36:59
Well, an interesting development for me today. I told my doctor that I wasn't so sure Emsam was doing as much anymore as it used to- and that I felt like adderall was doing more than Emsam to keep me afloat. He said he wouldn't be surprised at all if Emsam wasn't helping me as much as before because I've been on selegeline for a year, and he increased adderall. So I asked, "Do I have to worry about adderall konking out quickly?" And he said, "Interesting you ask- it's antidepressents and long acting benzos that most often konk out- with short acting stimulants we don't tend to see as much tolerance, because the brain washes out and gets a break every night. Tolerance is most likely to develope with drugs that remain in the brain all day and night". Now- before dismissing-this is one of the most respected psychiatrists in my city, teaches psychopharmacology in med school, is consulted by other psychiatrists for tough cases, no new patients, desk covered with all the journals (full of post-its) all the time, etc, etc, etc. Not a person whose opinions should be easily dismissable. I was quite shocked to hear this, but it makes sense when I mull it over. (I noted he never says "always" or "never".)Sure enough, there are people on remedyfind who say they've been on adderall and other amphetamines for years. I'm amazed. Perhaps it's a matter of finding the right kind of dose- not so high that it can't flush out overnight.
Posted by kelv on January 6, 2007, at 1:23:40
In reply to Re: stimulants as antidepressents, posted by elanor roosevelt on January 5, 2007, at 19:36:59
>
> I think the whole war-on-drugs thing recast stimulants are dangerous and addictive, where before the medical community had noted a dependence problem, but also saw that there were very real benefits from the meds. Now that Adderall is around and is seen as "medicine" first and "amphetamine/controlled substance" second, I suspect that more docs are (or will be) using stims in depression. Plus, there's that new ritalin patch, and there's work underway on less abusable forms of dexedrine so...I think we may well see a resurgence of stims-for-depression rx-ing.Spot on!
A 1960's AD for Dexedrine stated it as "probably the basic anti-depressant and certainly the most documented'
As a veteran of 6 'standard' ADs-which made me feel like crap-the most satisfactory 'anti depressing' effect i'v had was with Ritalin and Dexamphetamine. They literally turned me from a vegatitive, psychomotor retardation state, to a lively, responsive state in a short time, and they kept on working too, it's when one starts 'seeking a high' that problems start.
It's because meds that have a noticable effect fairly rapidly, are deemed 'abusable' and all the Sch II status that goes along with it that deters this line of treatment, which has literally helped some when nothing has.
Posted by NYCguy on January 7, 2007, at 12:08:01
In reply to Re: stimulants as antidepressents » elanor roosevelt, posted by kelv on January 6, 2007, at 1:23:40
They literally turned me from a vegatitive, psychomotor retardation state, to a lively, responsive state in a short time, and they kept on working too, it's when one starts 'seeking a high' that problems start.
>I'm curious how one determines the difference between a "high" and an anti-depressant effect. Adderall seems to give most everyone a "buzz" in addition to the theraputic effects it has... but I doubt there's anyone out there who can take it every day for the AD effect without getting "spun." I could be wrong. Just my experience.
Posted by dbc on January 8, 2007, at 12:02:53
In reply to Re: stimulants as antidepressents » kelv, posted by NYCguy on January 7, 2007, at 12:08:01
Dexedrine did alot of good for me and made me a generally productive human. Unfortunately, it also caused a latent panic disorder to surface and completely wreak havok in my life. I've been in the ER more times in the last two months than my entire life. I stopped the D-amphetamine over a month ago and the panic just keeps on coming.
I mean i've had panic attacks before but these are something entirely different.
Also the risk of psychosis, cardio issues, stroke, just doesnt make stimulants worth it for me even at the therapeutic doses i was taking it at (45mg a day).
Posted by PeterP on January 12, 2007, at 17:31:15
In reply to Re: stimulants as antidepressents, posted by dbc on January 8, 2007, at 12:02:53
I find this discussion really interesting and relevant to my situation.
After trying many AD's, the last being Cymbalta which I'm almost completely off, my pdoc gave me a script for Adderall. I used to be a "gym rat" and for my age was in pretty good shape. The last couple of years I've become an an unmotivated slug and can't seem to get my butt off the couch to get to the gym. Now I'm there almost every day. I just seem to get SO much more accomplished every day and I'm in a much better mood. I've always been what I would call in a constant state of blah, never REALLY depressed but ......well, blah.
In the beginning the Adderall made me anxious but energetic, almost euphoric at times. Kind of like when I took cocaine 20 years ago. After about 3 weeks of between 30 to 35mg per day, thats gone. I am normally an anxious person and I tend to worry about a lot of things, especially socially and health matters, sometimes the Adderall exacerbates this. It's not usually too bad but sometimes I do much better taking between .25 to .5mg of xanax. I'm trying to do this a little as possible as I don't want to become addicted.
I have built up a tolerance to the Adderall I think but not it's energizing effect, just the euphoric effect. I think chasing the euphoric part is where people get into trouble with this drug. If taken regularly a dossage increase will always be needed to maintain that feeling.
Anyway, does anybody have any input on building a tolerance to its energizing effect? Could I maintain taking this on a daily basis and keep my dosage the same? I don't take it after 3pm so I can sleep at night.
My pdoc is thinking of trying me on EMSAM but so far I seem to be doing better on Adderall (with minimal Xanax usage)and nothing else. If I can stay off AD's I'd love it!
Anybody have any opinions?
Peter
Posted by laima on January 12, 2007, at 18:10:12
In reply to Re: stimulants as antidepressents, posted by PeterP on January 12, 2007, at 17:31:15
Interesting- your experience is much like my own. My doctor said tolerance isn't the same kind of problem with stimulants like adderall as it is for antidepressents, because it flushes out of the body on a nightly basis, giving the brain a chance to recoup. If that is true, I would speculate it's a good idea to not take it late in the day, and to stick with the smallest effective dose. But I wonder which effects he's talking about. I too have noticed that the tendency towards anything approaching euphoria wanes away with adderall, as well as with ritalin. But being able to engage with activities itself is anti-depressing, and I noticed no waning for that. Being able to complete tasks, reaching accomplishments, sociability- all of that is anti-depressing regardless of whether or not the drug itself can induce euphoria. The official reason I'm using adderall right now is for wakefulness and to raise blood pressure while on Emsam. Those effects show no sign of waning either, I'm impressed.> I find this discussion really interesting and relevant to my situation.
>
> After trying many AD's, the last being Cymbalta which I'm almost completely off, my pdoc gave me a script for Adderall. I used to be a "gym rat" and for my age was in pretty good shape. The last couple of years I've become an an unmotivated slug and can't seem to get my butt off the couch to get to the gym. Now I'm there almost every day. I just seem to get SO much more accomplished every day and I'm in a much better mood. I've always been what I would call in a constant state of blah, never REALLY depressed but ......well, blah.
>
> In the beginning the Adderall made me anxious but energetic, almost euphoric at times. Kind of like when I took cocaine 20 years ago. After about 3 weeks of between 30 to 35mg per day, thats gone. I am normally an anxious person and I tend to worry about a lot of things, especially socially and health matters, sometimes the Adderall exacerbates this. It's not usually too bad but sometimes I do much better taking between .25 to .5mg of xanax. I'm trying to do this a little as possible as I don't want to become addicted.
>
> I have built up a tolerance to the Adderall I think but not it's energizing effect, just the euphoric effect. I think chasing the euphoric part is where people get into trouble with this drug. If taken regularly a dossage increase will always be needed to maintain that feeling.
>
> Anyway, does anybody have any input on building a tolerance to its energizing effect? Could I maintain taking this on a daily basis and keep my dosage the same? I don't take it after 3pm so I can sleep at night.
>
> My pdoc is thinking of trying me on EMSAM but so far I seem to be doing better on Adderall (with minimal Xanax usage)and nothing else. If I can stay off AD's I'd love it!
>
> Anybody have any opinions?
>
> Peter
>
Posted by psychobot5000 on January 12, 2007, at 18:24:39
In reply to Re: stimulants as antidepressents, posted by PeterP on January 12, 2007, at 17:31:15
> Anyway, does anybody have any input on building a tolerance to its energizing effect? Could I maintain taking this on a daily basis and keep my dosage the same? I don't take it after 3pm so I can sleep at night.
>
> My pdoc is thinking of trying me on EMSAM but so far I seem to be doing better on Adderall (with minimal Xanax usage)and nothing else. If I can stay off AD's I'd love it!
Tolerance seems to be largely individual--however, I too found i developed some tolerance to the mood-elevating effects of stimulants, over a period of weeks. The energetic effects did not go away, though. It's probably impossible to predict whether you'll develop further tolerance, but I think it unlikely. Some people on this board seem to have luck with taking occasional breaks of one or more days, to renew the effect of the medication, but it sounds like you may not need to do that.Some also say that methylphenidate/concerta is better for motivation than adderall.
Best of luck,
Pbot
Posted by laima on January 12, 2007, at 18:43:06
In reply to Re: stimulants as antidepressents, posted by psychobot5000 on January 12, 2007, at 18:24:39
Sadly, I rather get the idea that euphoria is always fleeting, even for the happiest and most well adjusted people. "Better than well", something like that. That's ok.
Posted by PeterP on January 12, 2007, at 19:21:01
In reply to Re: stimulants as antidepressents, posted by laima on January 12, 2007, at 18:10:12
> But being able to engage with activities itself is anti-depressing, and I noticed no waning for that. Being able to complete tasks, reaching accomplishments, sociability- all of that is anti-depressing regardless of whether or not the drug itself can induce euphoria.<Exactly! I'm not going to fool myself and expect euphoria. That's unrealistic for even "normal" people. If I can get back out and exercise and do the things I need to do without a struggle, I'm happy.... sort of :-).
I've chased euphoria many times in my younger years and it was ALWAYS a losing battle in every way. You eventually will pay the price. The way I'm functioning now is probably as much as I can ask for. I have to be realistic about life in general.
I just hope this mood and level of existance can be maintained.
I wish I had a low blood pressure problem! I have a minor kidney disorder that makes it imperative I keep my blood pressure low. Adderall isn't the answer for that though but who needs kidneys right?
Thanks for the response!
Peter
Posted by PeterP on January 12, 2007, at 19:30:40
In reply to Re: stimulants as antidepressents, posted by psychobot5000 on January 12, 2007, at 18:24:39
>Some people on this board seem to have luck with taking occasional breaks of one or more days, to renew the effect of the medication, but it sounds like you may not need to do that.
>
> Some also say that methylphenidate/concerta is better for motivation than adderall.<
Unfortunately, the breaks have been non-existant. I guess you could say I'm sort of addicted to the feeling I don't need to nap all day and just feel all around crappy about myself. Maybe I should just bite the bullet and say Sunday is really a day of rest and sleep all day. I guess a small price to pay for 6 good days.I was on Ritalin first and found it to be very "ragged". Adderall seems much smoother.
God, I never thought I would be on Amphetemines! Am I just killing myself? :-)
Peter
Posted by laima on January 12, 2007, at 22:13:05
In reply to Re: stimulants as antidepressents, posted by PeterP on January 12, 2007, at 19:30:40
>I was on Ritalin first and found it to be very "ragged". Adderall seems much smoother.
Isn't it strange? I got the same impression- that the amphetamines are smoother and somehow more natural feeling than ritalin. I feared and expected the opposite. I would have skipped ritalin...
And yes, I agree chasing euphoria seems to be the way people would get into trouble, and it really doesn't seem to be a natural state for anyone in the first place. It's a good thing to remember this, I am glad to keep it in mind. My theory about stimulants and trouble is, people get hooked on that initial hint towards euphoria and chase it. Especially since it can happen so quickly and dramatically. The temptation to up one's dose is there, but it wouldn't work out in the long run. Their real value seems to lie in staying awake, and in assisting with making actual strides, like engaging in activities and completeing tasks, etc.
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