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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on April 22, 2010, at 20:26:36
In reply to Re: Best meds for ADD/Depression/SLS, posted by stargazer2 on April 22, 2010, at 15:16:54
You will beat this again. I know you will. What meds you thinking of other than add med? Love Phillipa
Posted by desolationrower on April 23, 2010, at 17:34:36
In reply to Re: Best meds for ADD/Depression/SLS, posted by stargazer2 on April 22, 2010, at 15:16:54
you can use nicotine while on an maoi
if TCAs especially the secondary tcas didn't help, strattera is not very promising
-d/r
Posted by bulldog2 on April 24, 2010, at 14:10:45
In reply to Re: Best meds for ADD/Depression/SLS, posted by desolationrower on April 23, 2010, at 17:34:36
> you can use nicotine while on an maoi
>
> if TCAs especially the secondary tcas didn't help, strattera is not very promising
>
>
>
> -d/rlexapro 10 mg, nortiptyline 50 mg, ritalin 10 mg times 3...high success rate with this combo for add/depression...nortriptyline helps with the add also...My p-doc loves this combo...!!
Posted by floatingbridge on April 27, 2010, at 1:10:19
In reply to Re: Best meds for ADD/Depression/Linkage » stargazer2, posted by SLS on April 22, 2010, at 10:27:33
stargazer, I'm no poster child for recovery, but after about ten years of ad's and dx's, my pdoc added dexedrine spansuals. Pretty big difference. My own experience with strattera was poor. The two meds are very different.
One thing. With this type of med, efficacy shows fairly quickly.
(My background ad is pristiq--I'm not recommending it per se. And some other stuff. Let me know if you'd like more info.)
BTW an Israeli study had success treating add in kids w/ segilene.
Good luck--!
Posted by stargazer2 on April 27, 2010, at 20:58:45
In reply to Re: Best meds for ADD/Depression/SLS, posted by bulldog2 on April 24, 2010, at 14:10:45
Thank yu that sounds promising.
One combo that worked for me was Celexa, Wellbutrin and Adderall.
It was in 2001, I think, and all of the meds were brand so finding the differnce with generic makes a mess of things that might have worked in the past.
You know I was checking prices out on Costco.com and the cost of Strattera and Focalin were through the roof. I think Focalin was $500 for 30 days supply! That's crazy...no wonder we are running out of money for health care...it will only get worse.
Posted by stargazer2 on April 27, 2010, at 21:04:20
In reply to Re: Best meds for ADD/Depression » SLS, posted by floatingbridge on April 27, 2010, at 1:10:19
Thank you for your insight and experience.
I'm not sure what we will try but I know I like Adderall years ago but they probably messed the formula up like they end up doing when they make a generic in a foreign place with no quality controls.
It really is a crap shoot with all of the meds and now the generics and their variabilities, it makes an already difficult process much harder.
YOu have depression and ADD like me? Whatis Pristiq like and don't go there you say? Not that great for you?
We'll chat again. I had to cancel my appt this week and wanted to wait another week so that the Nardil is totally out of my system, so we don't waste an appt just looking at eachother! Duh..
Later...
Posted by floatingbridge on April 27, 2010, at 21:23:38
In reply to Re: Best meds for ADD/FloatingB, posted by stargazer2 on April 27, 2010, at 21:04:20
Hi Stargazer, I was just thinking about you.
Your question about pristiq is best answered, I think, by relating how it became part of my cocktail.
After a year of trials--prozac, lexapro, abilify, we tried pristiq. Side effects were minimal, but so was effect. We took it up to 100 at which point my depression worsen and I had cognitive s/e's. I became desperate, we backed down the dosage and went into a holding pattern (the taper would be awful for me). Then we tried dexedrine. The results were immediate for both depression, social anxiety and add. (Like you, inattentive.) So I have no idea how the pristiq works in my cocktail. Lately I've consider a side-switch to effexor or tramadol for pain issues.
I only caution about pristiq because it can be tough for some to kick.
You sound brighter today--I hope that's true.
Is an maoi's with a little stim possible? One doc said maybe emsam with stim. A friend did well on parnate and adderall, but I don't know the dosages.
Best to you. You'll land on your feet.
Posted by Phillipa on April 27, 2010, at 21:27:41
In reply to Re: Best meds for ADD/FloatingB, posted by stargazer2 on April 27, 2010, at 21:04:20
Stargazer hang in there. I just know things are going to get better for you. Love Phillipa
Posted by stargazer2 on April 28, 2010, at 19:52:50
In reply to Re: Best meds for ADD/FloatingB » stargazer2, posted by floatingbridge on April 27, 2010, at 21:23:38
Perceptive of you to notice I seem better..I've been off Nardil for about 2 weeks and although the first week was hard, it seems OK now.
As a matter of fact, I did try Nardil with a stim...sort of my own trial and then I confessed to my doc who wasn't really happy, but I convinved him it was helping. The only problem was that I had a hypertensive reaction so
we were never able to continue that combo...Then I did some research and convinced my doc to allow me to take Nardil and Wellbutrin (he would not have without my research, but I had to try it) and that is the combo I have been on for a few months.
I really think a stim like Adderall will work again for me, since it did in the past and my doc would not allow me to take Nardil and Adderall, just too risky and no one wants that on their conscience.
So that is why I have to come off Nardil. I really think if I can prove the stims are key to my depression, I will need to take and ADD med, in addition to an AD.
Today I took a hit of a stim (leftovers)generic Adderall, but not the XR which is much better than the short acting meds. I do better with meds if take them only 1x a day.
So I feel better thus proving my theory I have untreated ADD which makes me depressed and scattered, which can look like depression.
I just looked up Pristiq and it sounds like it is chemically related to Effexor, which I took and had horrible results. I failed so many AD's over the years that it is not possible to tell what one will work. Actually I'm still on Wellbutrin so I'll probably stay on that when I start a stim unless the combo is too activating...
That's the story for now.
SG2
Posted by floatingbridge on April 29, 2010, at 18:13:29
In reply to Re: Best meds for ADD/FloatingB, posted by stargazer2 on April 28, 2010, at 19:52:50
Hi Stargazer,
So you might stick with the wellbutrin as ad coverage and add some adderall?
Here's the study about selegine and adhd:
http://www.ncbi.nlm.nih.gov/pubmed/12921918Some people like provigil--and that as you know can be taken with an maoi. You seem to really know your meds.
Good luck--and I'd like to know how you do--would you keep us posted? I'm intermittent here, but will look.
I like once a day coverage, too. My moods are pretty changable, so I avoid anything that might creates valleys.
fb
Posted by stargazer2 on April 30, 2010, at 21:12:29
In reply to Re: Best meds for ADD/FloatingB » stargazer2, posted by floatingbridge on April 29, 2010, at 18:13:29
FB,
Sure happy to share my experiences with whomever might be interested/helped.
I know my meds from 30 years of dealing with the monster. I went from Nardil in 85 to 2010 and still in a search and find mission. I have had successes, thank God, as that would not have been a life worth living...
I did try Ensam (selegeline) patch a few years ago and did not have any great improvement.
I went through a really horrible few years when it seemed like nothing was going to work, hence my active role in researching what might be changed, added.Prior to that I faithfully followed my doc's advice but I was ready to throw the towel in unless I could get a breakthrough and that is why I started on Synthroid and added Wellbutrin to Nardil...my doc would not allow any stims including Provigil so that was no help.
So, we'll see what happens next week. I will post so you can follow if it helps your situation at all.
Bye for now...
Posted by chujoe on May 1, 2010, at 9:14:53
In reply to Re: Best meds for ADD/Depression/Linkage, posted by stargazer2 on April 22, 2010, at 8:28:01
I think ADD can absolutely be an underlying cause of depression -- or comorbidity, as the pdocs so artfully put it. In my case, the ADD has contributed to a sense of worthlessness and hopelessness that's now being treated successfully with Cymbalta, but the ADD issue is still there and I'm thinking about adding an ADD med like provigil, since I can't take stims because of anxiety and tremor.
Good luck and hang in there.
Posted by stargazer2 on May 4, 2010, at 11:33:39
In reply to Re: Best meds for ADD/Depression/Linkage, posted by chujoe on May 1, 2010, at 9:14:53
Hi, you addressed your post to Linkage but he is not one of the contributors to this posting so I wasn't sure if you meant someone else.
Has Cymbalta helped you at all? I took very briefly and was not able to tolerate the side effects...literally could not get out of bed for days. Not good with depression especially when it makes you worse.
Have you tried all of the stims, which ones? Did you try Adderall? It did not make me feel like Ritalin did, which was nervous and antsy.
It had a much smoother effect. What do you know about Provigil that makes you want to try that one?
Posted by floatingbridge on May 4, 2010, at 11:44:22
In reply to Re: Best meds for ADD/Depression/Chujoe, posted by stargazer2 on May 4, 2010, at 11:33:39
Hi Stargazer and chujoe,
(Linkage's post is third from top thread.)
I could see provigil addressing That cognitive part of add for some. Didn't work for me. BTW, I don't understand the relationship of add and depression-- or add can trigger depression, if anyone cares to address that:) My pdoc did say they suspect add hangs out on the same gene as bipolar and by extension, maybe depression. (Have I dazzled you with my use of scientific jargon?)
Stargazer, how is it going?
Posted by chujoe on May 5, 2010, at 14:36:53
In reply to Re: Best meds for ADD/Depression/Chujoe » stargazer2, posted by floatingbridge on May 4, 2010, at 11:44:22
Hi, I'm just getting used to the way these boards work, so it's entirely possible I responded to the wrong person.
Cymbalta has worked pretty well for me. My history: about ten years ago I had a major period of anxiety and was prescribed Zoloft, which worked well enough that I quit taking it after a couple of years. I can't say I was exactly mentally healthy after that, but I went the better part of a decade without taking pdrugs. Then last year I had another major episode of anxiety & depression, but mostly anxiety and was again given Zoloft (100mg), which helped briefly, then got very patchy and gave me the shakes. I saw a neurologist, who diagnosed essential tremor -- it's not that bad, but the Zoloft made it worse, so I was switched to Cymbalta, first 60mg, then 90. It works, though I tend to get sleepy in the middle of the day. I still have a bit of tremor, but it's less of a problem with the Cymbalta.
So my depression is more of the "activated" variety, characterized by anxiety and intrusive thoughts. My diagnosis includes a tendency to OCD. Anyhow, because of the tremor and anxiety, my pdoc thinks I shouldn't take stims.
It's only recently -- even though I'm an old guy of 59 -- that the ADD thing has been clear to me. All my life I thought & everybody else thought I was just disorganized & even though I've had a reasonably successful professional life, in hindsight I see that I've been hampered all along by my inability to stay on task, etc. Talking to my pdoc recently, I mentioned something I'd done & she said, "That's classic ADD."
I've been reluctant to medicate for ADD -- it seems like such a middle-school malady! And I've had it all my life, so why start now? On the other hand, if I had broken my toe when I was six and always walked with a limp and then an orthopedic surgeon said he could fix it, I'd go for it, right? Currently, I'm not taking anything for it, though the Cymbalta has taken care of the H part of ADHD -- I can sit still and watch a movie now without having to get up twelve times. And the Cymbalta has also given me my cognitive powers (such as they are) back to me -- at my age you begin to wonder about dementia & I have to say it has really relieved me of that fear -- I can think again. I just have a very hard time focusing on one train of thought for very long.
Well, that's probably more than you wanted to know, but it's very nice to have found a place where one can talk about these things openly and honestly in a supportive environment.
Posted by stargazer2 on May 5, 2010, at 22:45:51
In reply to Re: Best meds for ADD/Depression/Chujoe, posted by chujoe on May 5, 2010, at 14:36:53
Welcome Chujoe...I'm somewhat of an oldtimer myself but still want to be trested for ADD as I believe it has contributed to alot of anxiety and feelings of low self esteem my whole life.
I keep thinking I'll get it all figured out and it will be too late to help me. It has affected my ability to form relationships and be able to work without getting bored or losing interest in things.
I do OK but I always thought something was getting in my way, which was my ability to remember, organize and follow through with any task.
Some have said to me, how could you have ADD if you finished college and have been able to work ...I say it wasn't easy but I forced myself to do it, plain and simple.
Glad Cymbalta helped you...I thought it was one of the worst for me...made my depression so much worse.
Posted by chujoe on May 5, 2010, at 23:01:38
In reply to Re: Best meds for ADD/Depression/Chujoe, posted by stargazer2 on May 5, 2010, at 22:45:51
Stargazer, I think a lot of successful people have various sorts of ADD issues that they have found ways to work around. I'm a college professor, which is a career that allows me to structure my own time. That can be good when I'm successful ant structuring it, but I feel like I have wasted many opportunities for advancement and greater success by being unable to get my sh*t together, letting deadlines slip by, having sixteen projects going at once, etc.
I'm having a consult tomorrow with the psych NP to talk about meds. I don't want to feel like it's too late -- I think I can still accomplish some things if I can learn to focus better. So I'd encourage you to look into treatment for ADD -- I'm certain it can contribute to depression.
Posted by floatingbridge on May 6, 2010, at 10:38:21
In reply to Re: Best meds for ADD/Depression/Chujoe » stargazer2, posted by chujoe on May 5, 2010, at 23:01:38
Hi Chujoe,
Welcome, too! My add treatment started at 50--another late-comer. The treatment addition also broke my depression--an unexpected bonus.
Good luck w/ your consult. There's a variety of treatments for add-- or adhd in your case. I'm sure you'll find something helpful that will not aggravate your tendency towards tremor. Best to you.
Posted by chujoe on May 6, 2010, at 17:53:31
In reply to Re: Best meds for ADD/Depression/Chujoe » chujoe, posted by floatingbridge on May 6, 2010, at 10:38:21
Well, this is a surprise, the NP wanted to try me on a low dose of Ritilin in addition to the Cymbalta. If it makes the tremor or anxiety worse, we'll try something else. Anybody else use this combination, or any SNRI + stim?
Posted by floatingbridge on May 6, 2010, at 18:04:08
In reply to Re: Best meds for ADD/Depression/Chujoe » floatingbridge, posted by chujoe on May 6, 2010, at 17:53:31
Chujoe,
Yes, works for me, even with my anxiety issues. I prefer an extended release stimulant. Vyanaase is good too, at least by report--haven't tried it. Best to you.
Posted by chujoe on May 6, 2010, at 19:29:20
In reply to Re: Best meds for ADD/Depression/Chujoe » chujoe, posted by floatingbridge on May 6, 2010, at 18:04:08
Thanks fb. I have anxiety too. The NP says we can go to an extended release once we see how this affects me -- I'm happy to take a slow, step-by-step approach to this.
Posted by hrguru on May 7, 2010, at 8:24:21
In reply to Re: Best meds for ADD/Depression/Chujoe, posted by chujoe on May 5, 2010, at 14:36:53
Well let's see...I am on Adderall (immediate release) for ADHD and Wellbutrin for BP Depression.
You mentioned Cymbalta: Years back, before I was on a stimulant, I used to take Cymbalta, and it worked very well for me- for anxiety and depression *I have a sneaking suspicion that it's because it made me mildly hypomanic, so there would be days I was so sublimely happy that if the sun was shining, I would literally be fighting tears of joy!* That's a good feeling of course, but an AD really shouldn't do that ;)
Then after about a year, it just stopped working. Which sucked. It was as if the pharmacist had switched my script with a placebo or sugar pills. The depression came back in full-force. So I thought, well I guess it's curtains for this drug. Word of advice, if you ever decide to stop taking it, consult your doctor first, because it's an absolutely horrendous withdrawal experience- you have to titrate off of it SUPER carefully and slowly (with your doc's help). This is coming from someone who is an ex-opiate addict (perhaps the worst withdrawals known to mankind). Now don't get me wrong...By comparison, coming off of opiates was, of course, much worse :) But Cymbalta was a nightmare to quit, and it should be handled carefully, that's all.
If it keeps workin for ya, though - stick with it! I loved it when I was on it!!
Now, as for ADD/ADHD meds: Adderall is the best I have tried and the only one I'll take is the orange oval shaped kind. The little round pink ones are awful. They're both generic brands, but I've found it actually makes a difference. With the orange ones, I feel just "normal," calm, and focused. It's a very smooth medication. If I have to take it in the afternoon or evening- I can even sleep on the stuff (but please understand, I am a freak of nature!) The pink ones have side effects (for me) which I don't like. I'm in grad school, so this is a must for me to be medicated, and the pink ones would always make me so incredibly tired (as though I had taken a sleeping pill) that I was falling asleep in the middle of class. So it was basically like I hadn't taken anything. They would sometimes make me pretty anxious to boot, which is a super fun side-effect- especially when you already had anxiety in the first place.The best medication I have ever taken for anxiety, and perhaps this works for me because I'm dx'd bipolar (I'm not sure), is Topamax. It's an anti-convulsant, and acts as a mood stabilizer. However, I do not have anxiety at all these days. It's wonderful. By the way, I have been dx'd OCD as well, and I have not had any obsessive-compulsive behavior since day 2 of taking this med. I'm really pleased with it. OCD is SO hard to find the right drug to treat, as it is a certain kind of anxiety- you understand what I mean since you and I can relate. You don't have to be bipolar to take Topamax. Some people take it for migraines, and obviously various types of epilepsy as well. In any case, you can always ask your doc for information. He/she is the expert ;)
Hope this helps (at least a little!)
Posted by chujoe on May 7, 2010, at 12:30:29
In reply to Cymbalta/ADHD/Topamax- reply to Chujoe, posted by hrguru on May 7, 2010, at 8:24:21
This is really useful information! For me, the best thing about Cymbalta was that it calmed down the core of my body, not just my mind. I realized, once I'd been on it a couple of weeks, that I had been sitting around with tensed muscles all my life! It also work very well on the slight OCD/intrusive thinking that I've had for a long time. I'll be very careful if I have to go off it, though at this point I'm very happy. I'll report back how the stims are working after I've had a few days experience. Thanks hrguru!
Posted by stargazer2 on May 7, 2010, at 13:41:37
In reply to Re: Cymbalta/ADHD/Topamax- reply to Chujoe » hrguru, posted by chujoe on May 7, 2010, at 12:30:29
Hi,
I saw my pdoc yesterday and although I had had previous success once using Adderall XR many years ago, my doc wanted me to start on Vyvanse, which he said lasts longer than Adderall XR and is similar in action (true?).Took my first dose about 10 AM and although I felt little in the first few hours, I came home and have been fairly productive since then. Too early to tell but I will post my results, if not daily, every few days. I may start a post on Vyvanse alone, to make sure others that can add their feedback see it.
I am feeling extrmely optimistic right now as I am convinced this has been the missing link inthe 20+ years of treatment for depression I have undergone, almost half my life.
I know if I was diagnosed today, I would have had a much better chance of being way beyond this point in my life. Nothing is guaranteed but I feel I have lost out to alot of opportunities due to neglecting this component of my depression.
I would be happy if I could have success with this and get back to working again, as I have at least another 10+ years to go. Of course it could all be just a figment of my imagination, but I hope and pray that this approach to treatment allows me a chance for normalcy and feeling good about myself, that I have been seeking for so long.
Fighting to have a normal life is exhausting and as long as my depression does not return with a vengeance, while I try and get the meds right, I will have a fighting chance.
Stargazer
Posted by chujoe on May 7, 2010, at 14:52:14
In reply to Started Vyvanse today/Fingers crossed, posted by stargazer2 on May 7, 2010, at 13:41:37
Stargazer, good luck with the new medication. I know exactly how you feel about lost time, but I'm trying to let go of regret and get going with my life now that I've found a way forward.
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