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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by TriedEveryDrug on December 25, 2008, at 9:43:32
Hi,
I was dx'ed with inattentive-type add about 10 years ago.
Nothing really helps my symptoms except desipramine. It brings me out of my fog and lets me get things done, get better grades, do better work...
But for me, that is a really miserable drug with terrible side effects (I get almost psychotically angry constantly, high levels of anxiety, moodiness, social phobia off the scale).
But it really works like nothing else has.
I have tried other TCAs - none did anything really.
I have tried stimulants - adderall, adderall XR, ritalin, focalin - these make me 'hyperfocus' on nonsense things and do not really help my symptoms.
I have tried strattera - a tiny bit of help, but not worth the side-effects.
I have tried effexor and pristiq - effexor at higher doses seems to start working a little, but I have crohn's disease and both of these make my crohn's symptoms much worse.
I have tried remeron, ssris, emsam, wellbutrin, aricept, lamictal, gabapentin, provigil at high doses.
I have tried combos - ssris + wellbutrin, + adderall, lamictal + adderall - lots and lots of combos.
I have tried fish oil and other supplements.
My pdoc is out of ideas. desipramine is out of the question because of the side-effects. Even at tiny tiny doses (as low as 5mg). Desipramine doesn't mix too well with anything else either.
Any other ideas? Something overlooked? My doc is pretty good and he says my case baffles him completely.
My brain MRI looks semi-normal except for a hypocampus that is a bit small and evidence of a possible stroke while I was a fetus - but no abnormalities in the executive areas. I also had some sort of experimental high res EEG that didn't show anything except I'm not fully awake when I'm awake, and a slight tendency to be obsessive (my doc and I are skeptical of this eeg - a different doc did it).Anyway, if someone has any other ideas I'd greatly appreciate it.
Happy Holidays
Posted by SLS on December 25, 2008, at 11:40:15
In reply to Ideas for inattentive-type ADD treatment?, posted by TriedEveryDrug on December 25, 2008, at 9:43:32
What if the ADD is comorbid with bipolar disorder or major depression?
- Scott
Posted by Sigismund on December 25, 2008, at 18:07:47
In reply to Re: Ideas for inattentive-type ADD treatment? » TriedEveryDrug, posted by SLS on December 25, 2008, at 11:40:15
Is there evidence for the use of tianeptine with IBS, and by extension with Chrohn's disease?
Unlikely to be of much use for the ADD though.
Posted by TriedEveryDrug on December 25, 2008, at 20:16:53
In reply to Re: Ideas for inattentive-type ADD treatment? » TriedEveryDrug, posted by SLS on December 25, 2008, at 11:40:15
> What if the ADD is comorbid with bipolar disorder or major depression?
>
>
> - Scott
My pdoc for a while had a theory that I might have mild bipolar spectrum something or other, and thus the Lamictal, which just made me feel weird and angry.Are you suggesting the despiramine exacerbated possible bipolar?
If that were the case, what would you suggest trying?
Oh - one other thing I forgot to mention - I've tried guanfacine and I believe it helps with the inattentiveness a tiny bit, and helps with motivation some - even though this drug supposedly isn't supposed to have that effect.
Thanks.
Posted by TriedEveryDrug on December 25, 2008, at 20:23:46
In reply to Re: Ideas for inattentive-type ADD treatment?, posted by Sigismund on December 25, 2008, at 18:07:47
> Is there evidence for the use of tianeptine with IBS, and by extension with Chrohn's disease?
>
> Unlikely to be of much use for the ADD though.I did get my hands on some Stablon from france, as a matter of fact.
Didn't do anything for me, good or bad, as far as I could tell.
I hadn't heard of it being used for IBS. Though crohn's is IBD, which is allegedly completely different from IBS, I've had some relief from IBS treatments.
Tangential: One somewhat strange thing - wellbutrin is being used in a clinical trial for crohn's, because it supposedly down regulates Tumor-Necrosis-Factor, which plays a role in inflammation. Those extremely pricey engineered mouse antibody drugs (remicade, humira, etc.) target the same compound...
Thanks
Posted by SLS on December 25, 2008, at 20:58:15
In reply to Re: Ideas for inattentive-type ADD treatment? » SLS, posted by TriedEveryDrug on December 25, 2008, at 20:16:53
> > What if the ADD is comorbid with bipolar disorder or major depression?
> My pdoc for a while had a theory that I might have mild bipolar spectrum something or other, and thus the Lamictal, which just made me feel weird and angry.If impulse control or aggression/hostility is a problem in the absence of Lamictal, I would look into taking Trileptal.
> Are you suggesting the despiramine exacerbated possible bipolar?
No. I think desipramine is definitely contributing to producing the improvement in you ADD. It doesn't always produce a switch into mania. I would consider adding Wellbutrin. It might act synergistically with the desipramine to further improve the ADD.
What drugs made you feel worse?
How do you react to SSRIs and Effexor?
Provigil?
- Scott
Posted by Phillipa on December 25, 2008, at 22:59:02
In reply to Re: Ideas for inattentive-type ADD treatment? » TriedEveryDrug, posted by SLS on December 25, 2008, at 20:58:15
If one week of wellbutrin at only 150mg and benzos appeared to my long ago pdoc that was acting manic by sheer frustration by acting out daily routine in his office how is this med good for bipolar never have gotten that one? Seemed stimulating to me??? Love Phillipa
Posted by desolationrower on December 26, 2008, at 0:24:35
In reply to Re: Ideas for inattentive-type ADD treatment? » SLS, posted by TriedEveryDrug on December 25, 2008, at 20:16:53
Have you ever tried a neuroleptic, either with desipramine or a stim?
-d/r
Posted by TriedEveryDrug on December 26, 2008, at 0:53:19
In reply to Re: Ideas for inattentive-type ADD treatment?, posted by desolationrower on December 26, 2008, at 0:24:35
> Have you ever tried a neuroleptic, either with desipramine or a stim?
>
> -d/rThat is the one class of drug I have not tried.
I punched a few into epocrates w/ desipramine and they seem to all interact one way or another.
What would you recommend? Risperidone?
thanks
Posted by softheprairie on December 26, 2008, at 3:24:17
In reply to Re: Ideas for inattentive-type ADD treatment? » desolationrower, posted by TriedEveryDrug on December 26, 2008, at 0:53:19
> > Have you ever tried a neuroleptic, either with desipramine or a stim?
> >
> > -d/r
>
> That is the one class of drug I have not tried.
>
> I punched a few into epocrates w/ desipramine and they seem to all interact one way or another.
>
> What would you recommend? Risperidone?
>
> thanks
I am on 300 mg desipramine (and the beta blocker nebivolol/Bystolic at 2.5 mg to deal with the overfast heartbeat from the desipramine) and the old-timey neuroleptic perphenazine (currently 4 mg times 1.5 pills/day, but I think I want to go back up to 2 pills/day -had wanted to cut back), and thyroid adjunct (currently 50 mcg Cytomel). I am on these meds for depression; I also have some inattentive ADD, but the meds I'm on haven't helped my inattention (or, conversely, overfocus) as far as I can tell.When I first started desipramine (I gradually increased to 300 mg) I was also on a medium or smallish dose of mixed amphetamine salts, but they didn't mix well with the desipramine, and I made myself pick one or the other, and I picked the desipramine. Part of what got me to make the decision against the stimulant was that I didn't notice it doing much of late for either depression or attention. A side effect I have of the desipramine is more anxiety, as you mentioned. I tried a benzodiazepine to address that (Ativan/lorazepam), but I didn't notice any anxiety relief, just more tiredness, when that's already too present. Sorry if I'm not helpful -- I just got interested in your post since it discusses desipramine, and so few people are on it. But, you may want to look into perphenazine; I like it so far.
Posted by softheprairie on December 26, 2008, at 3:33:44
In reply to Re: Ideas for inattentive-type ADD treatment?, posted by softheprairie on December 26, 2008, at 3:24:17
I should clarify -- the perphenazine won't help the ADD; here, the perphenazine would help mood or be an adjunct to some other meds that do treat inattention.
Posted by TriedEveryDrug on December 26, 2008, at 7:34:25
In reply to Re: Ideas for inattentive-type ADD treatment?, posted by softheprairie on December 26, 2008, at 3:24:17
Hi softheprairie,
Thanks for your reply. I'm curious - do you take your desip at night or in the morning? I used to take it at night - it would knock me out and then I would wake up bright and ready to go. But then after the 3rd or 4th go around with it (the longest I've been on it was 3 months), it started keeping me awake at night.
Also the max dose I've been on was 50 or 75mg. Did you notice any of the side-effects decreasing as you increased the dose?
One thing for me that stopped the desipramine anxiety almost instantly was effexor. My doc said it was an ok combo, esp. at lower doses, but epocrates says there is a cardiac interaction.
I'll ask my doc about neuroleptics.
Regards.
Posted by softheprairie on December 26, 2008, at 12:04:23
In reply to Re: Ideas for inattentive-type ADD treatment? » softheprairie, posted by TriedEveryDrug on December 26, 2008, at 7:34:25
> Hi softheprairie,
>
> Thanks for your reply. I'm curious - do you take your desip at night or in the morning? I used to take it at night - it would knock me out and then I would wake up bright and ready to go. But then after the 3rd or 4th go around with it (the longest I've been on it was 3 months), it started keeping me awake at night.
When to take it is an interesting question. I've read it can go either way -- some find it activating, some sedating. I'm not quite sure how I find it; I think neutral to a little activating, although I have had some insomnia, but I don't think it's related to the desip dose. Anywho, to answer: right now I'm taking 5 pills of 50 mg at waking up and the last 50 mg pill later when I take one of my metformin pills (for type 2 diabetes) at a meal.
That's a kind of odd schedule, but I had been taking it spaced at two to three times a day, and forgot a few times the mid-day dose, which I told the pdoc, and he said I should be able to take it all once a day (length of action-wise) if I don't have the side effects of it all at once (I had been having some headaches at each dose increase to deal with, not as bad if doses spread out throughout the day, but they thankfully subsided, usually after a few days); he advised me to move by one 50-mg pill at a time towards taking all at the same time, at any hour preferred. I haven't made the move of the last pill yet; I could, but haven't been forgetting of late the 2nd dose, so am not in much of a hurry. At my next time to reauthorize the Rx, I think I'll switch to 3 pills times the 100 mg dose, to keep the dose the same and maybe save my insurance a few dollars by taking a lower # of pills per day.
>
> Also the max dose I've been on was 50 or 75mg. Did you notice any of the side-effects decreasing as you increased the dose?My headaches at each 50-mg increase got less severe at each increase.
The anxiety I think has gotten worse as I've gotten to higher doses. This is kind of complicated to me to explain -- the anxiety is mixed in with the tachycardia/rapid heartrate and heart palpitations, and they're all helped by the beta blocker which my primary care dr is in charge of, and I've wanted more of the beta blocker, to deal with the anxiety caused by the desipramine, but she sees my heartrate as now fine on the dose I'm at of beta blocker. She didn't up it at my appt. 3 months ago, but I asked again at my recent appt., I asked to be allowed it also PRN, and she only wrote the latest Rx for one dose a wk PRN, which I find stingy of her. I'm dealing with some bitterness there, esp. since I know my pdoc is fine with upping the beta blocker, but that since the primary care dr. is the one who Rxed it initially, I have to go through her for it. I was Rxed the little dose of beta blocker back when my desipramine dose was only 100 mg, I think it was, and yet now that it's 300 I still have to deal with more anxiety, but the same low dose of beta blocker. I do have PRN use of perphenazine, also, but I don't like the sedation, and have most of the contents left of my bottle of Ativan, but it was a disappointment to me relief-wise, and is sedating.
>
> One thing for me that stopped the desipramine anxiety almost instantly was effexor. My doc said it was an ok combo, esp. at lower doses, but epocrates says there is a cardiac interaction.Thanks for adding that fact about relief via Effexor.
>
> I'll ask my doc about neuroleptics.
>
> Regards.To thee as well.
Posted by desolationrower on December 26, 2008, at 18:08:00
In reply to Ideas for inattentive-type ADD treatment?, posted by TriedEveryDrug on December 25, 2008, at 9:43:32
some people notice benefit for ADHDi symptoms from abilify monotherapy, so i might try that first.
-d/r
Posted by psychobot5000 on December 27, 2008, at 19:19:35
In reply to Re: Ideas for inattentive-type ADD treatment?, posted by desolationrower on December 26, 2008, at 18:08:00
There is actually some slight evidence that Tianeptine may be modestly beneficial in ADD. Some also find it a fairly effective adjunct to reduce anxiety, so possibly it could be useful to add to the desipramine for that? (and potentially to help some symptoms related to Crohn's--I have no idea whether research into that has been pursued beyond early stages, but it could be a bonus)
It sort of does seem like using an adjunct with the desipramine, as others are suggesting, might be a good route. Don't know where you live, but maybe agomelatine (potential anxiolytic, with increased DA in frontal cortex) could be considered for that (when it comes out).
Posted by softheprairie on December 27, 2008, at 21:25:06
In reply to Re: Ideas for inattentive-type ADD treatment?, posted by psychobot5000 on December 27, 2008, at 19:19:35
Thank you for the information.
> There is actually some slight evidence that Tianeptine may be modestly beneficial in ADD. Some also find it a fairly effective adjunct to reduce anxiety, so possibly it could be useful to add to the desipramine for that? (and potentially to help some symptoms related to Crohn's--I have no idea whether research into that has been pursued beyond early stages, but it could be a bonus)
>
> It sort of does seem like using an adjunct with the desipramine, as others are suggesting, might be a good route. Don't know where you live, but maybe agomelatine (potential anxiolytic, with increased DA in frontal cortex) could be considered for that (when it comes out).
This is the end of the thread.
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