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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 shellie on July 13, 2000, at 22:49:07
Okay, so my first day of ridalin--5mg with Nardil.
My primary symptoms are depression (not all the time, but can be really awful, immobilizing), fatigue (every afternoon--very severe), and dissociation.
If I hadn't had a fairly easy time in school, I would think I had ADD, I identify with almost all the characteristics (hyperfocus, easily bored, hard time transitioning, read so fast I mix up words, etc.). Anyway, my pdoc attributes these to dissociation and some OCD type characteristics, not ADD.
I want to get the depression and tiredness under control. I knew I was tired of depression, but I also have realized I'm tired of feeling fatigue--all physical tests come out normal; I am on thyroid-natural combination of Ts. Its mostly in the late afternoon, I am so tired that if I don't take a nap I feel sick and like a zombie.I have been like this for years. Luckily I run my own business so I set my schedule, but I hate having to take a nap--I always have to plan for it; make excuses to people, etc.
Question: I have been reading everything on both the board and tips about ritalin. I found one clue under stimulants for chronic fatigue syndrome where one doc said ritalin is better for mood; dexedrine is better for fatigue. Has anyone found this to be true? My first dose, no added energy that I could perceive. Can you take both dexedrine and ritalin together--to hit both problems. I am getting impatient; I don't want to waste anymore of my life.
Has anyone gotten increased energy from ritalin? shellie
Posted by C.M. on July 14, 2000, at 1:33:03
In reply to Ritalin augmentation questions. PLEASE HELP!-LONG, posted by shellie on July 13, 2000, at 22:49:07
Has anyone gotten increased energy from ritalin? shellie
==================================================
Most certainly. Ritalin is a real pick me up for me.
However, I think like the stimulating effect of Vivactil better, and the stimulating effect lasts all day. In fact, the Vivactil stimuating effect last so long, it interferes with my sleep, so I only take it on days when I didn't get enough sleep.
CM
Posted by JohnL on July 14, 2000, at 3:41:14
In reply to Ritalin augmentation questions. PLEASE HELP!-LONG, posted by shellie on July 13, 2000, at 22:49:07
Shellie,
It could be that one of the stimulants will turn out to be what you need. But which one? I don't think there is any way to predict without personal trials of each. Or as I prefer to look at it...personal comparisons.
What we see in writing (i.e. Ritalin for mood, Dexedrine for fatigue, etc.) should be taken with a grain of salt. We all have different chemistries. What works one way for a certain group of people will not work the same way for another group of people. Individual responses to particular stimulants vary dramatically.
I think the best approach is to try them all for comparison to identify the best match for you. It doesn't matter what was best for someone else, right? It matters what's best for you. Only trial and error will tell you which is best. The good thing is that stimulants work (if they are to work) within 24 to 72 hours. So you don't need long drawn-out torturous trials. You could try one after another for a week each and then choose your favorite for a longer trial.
After all is said and done, I still feel the best med in the world for chronic fatigues, depression, lack of drive, is not even available in the USA. Too bad. It is Adrafinil.
Also, in case you hadn't considered it, Nardil could be responsible for some of the things you're feeling. The kinds of side effects you describe wouldn't surprise me at all. But anyway, with or without Nardil, you could consider comparing all the stimulant choices, and include a 4 week trial of Adrafinil.
JohnL
Posted by shellie on July 14, 2000, at 9:54:36
In reply to Re: Ritalin augmentation questions. PLEASE HELP!-LONG, posted by JohnL on July 14, 2000, at 3:41:14
John. I was totally ready to go the adrafinil route but my pdoc is worried about combining it with an MAOI, since it causes release of serotonin and dopamine. Would you worry about that?
btw, I think you're right--the extreme afternoon tiredness is probably related to the nardil, but I've don't do well on ssris, and nardil seems to have the least side effects for me. I would be very scared that I'd bottom out if I try to get off the nardil and try just adrafinil. Last time off the nardil, I ended up in the hospital, waiting to start and have it kick in again. Because of my business, I can't afford to bottom out again, so that's why I'm doing the augmentation route. Thanks, for your advise, Shellie
Posted by shellie on July 14, 2000, at 10:06:29
In reply to Re: Ritalin augmentation questions. PLEASE HELP!-LONG, posted by C.M. on July 14, 2000, at 1:33:03
Thanks c.m. for your info. Unfortunately I can't take tricyclics, so I can't duplicate your good results. But it is good to know that ritalin did pick you up some, maybe I just need to be patient. Thanks again, shellie
Posted by Ant-Rock on July 14, 2000, at 13:17:59
In reply to Re: Ritalin augmentation questions. PLEASE HELP!-LONG, posted by C.M. on July 14, 2000, at 1:33:03
> Has anyone gotten increased energy from ritalin? shellie
>
> ==================================================
>
> Most certainly. Ritalin is a real pick me up for me.
>
> However, I think like the stimulating effect of Vivactil better, and the stimulating effect lasts all day. In fact, the Vivactil stimuating effect last so long, it interferes with my sleep, so I only take it on days when I didn't get enough sleep.
>
> CMCM,
I know nothing about vivactil. Is it an energising tricyclic? Does it cause cognitive problems? Is it reccomended for unipolar depression with a fatigue component? What is your main reason for taking it?
Sorry about all the questions, It's just that I don't hear much about it and my pdoc never suggested trying it. Thanks for any info you can provide.
Sincerely,
Anthony
Posted by Libby on July 14, 2000, at 13:19:47
In reply to Ritalin augmentation questions. PLEASE HELP!-LONG, posted by shellie on July 13, 2000, at 22:49:07
Shellie... I wanted to post a little of my experience in the hope some of it may be helpful
to you...My symptoms were primarily depressive also. I definitely got some benefit from Effexor XR, but it was only partially effective. When I went back to work (in a new job, this one more boring, sedentary, and routine than the last) I noticed some old behaviors had gotten much worse:
- my tendency to "drift off" in conversations
- my daydreaming
- my extreme distractability
- my inability to process some types of information. In my case, I had difficulty gathering info in meetings, in phone conversations, and in written reports.Of course, these symptoms can indicate a number of disorders. In my case, I had been treated, with mixed results, for depression. There was no reason to suspect a dissociative disorder, so I wasn't left with much to go on. I finally decided to stop worrying so much about cause and research how to correct the symptoms. That led me to the idea of augmenting with stimulants. The reasearch I found indicated that even if I wasn't ADD, stimulants might address my symptoms and allow me to function. By that time, I had been functioning at such a low level for so long that I was on the verge of giving up.
I asked my doc about Ritalin and the possibility of ADD. He asked a few questions and said it was a possibility, but he thought I might be Bipolar II, Rapid-Cycling. Because my advanced degrees and previous success at work, he went with the Bipolar trials first... So I went through mood stablizers, anti-psychotics, tranquilizers, anti-convulsants... Most of them made me feel much worse. Zyprexa helped with the daydreaming, but nothing else seemed to have a beneficial effect at all.
Eventually, I felt so much worse that I refused to take any more "Bipolar" drugs and pretty much insisted that he consider ADD. He FIRMLY insisted on an evaluation by and Adult ADD specialist, concurrent with a trial of Ritalin. Ritalin was a miracle for me. From the very first dose, *everything* got better... I was eventually diagnosed with severe ADD, as well as dyslexia.
It turns out that my ADD was helped by growing up in a very structured home by parents who started teaching me to read and do simple math before I could talk in complete sentences. I was also helped by a very high IQ, which allowed me to generate some pretty effective adaptive behaviors for school. The area where my ADD was most evident was in personal relationships. There, my extreme moodiness, inattentiveness, distracability, and impulsivity were clear. A little reading helped me see these as potential ADD symptoms. I had always thought of them as strictly emotional problems. The reading helped me see that lots of women's ADD symptoms manifest as relationship problems. Because my problems mostly all in the area of relationships, I think I tended to focus more on my emotional symptoms rather than the cognitive disturbances that were behind the emotions. For example, the reason I cried when I locked my keys in the car wasn't that I was having a Bipolar mood swing. It was because I literally couldn't figure out what my next move should be. Simple problems like this seemed more than I could manage because they required a series of actions: finding a phone, figuring out which locksmith to call, giving him directions, waiting for him to arrive (a BIGGIE)... etc. To most people, these are little things, but for me, especially at the end of a tough day, they were literally more than my brain could handle. No one believed me when I tried to explain that to them. They'd usually say, "That's ridiculous. You're an intelligent person...surely you can handle a simple problem like that."
Even my therapist didn't understand this until I finally got it myself and was able to tell him WHY I reacted so emotionally to "little" things...
The process of ADD diagnosis was useful in that it forced me to look at my work and school behaviors from a different angle. I can see how
distractability and impulsivity can be acted out in ways other than grades and performance ratings.
I also see how lucky I was to have discovered amphetamines as a study aid in college and grad school... and how fortunate to find a job that was pretty much a perfect match for an ADD... *conceptual* design. When I was forced to move to a more structured environment, my performance at work fell completely apart.What I find strangest about my experience is that my doc was more willing to diagnose me with rapid cycling Bipolar II than to consider ADD, even though I had no history of manic behavior at all! That's pretty scary... and to me it makes a great case for taking responsibility for your own treatment! No doc or therapist can know my experience as well as I know my own... I went into his office talking about my emotions, so he focused on emotional disturbances. When I started focusing on cognitive symptoms, so did he. In my case, now that the cognitive symptoms are under control, there just haven't been that many emotional problems. Disclaimer: I haven't been taking Ritalin that long, so I expect there are still some emotional problems, but they are no longer everyday concerns.
If I had been willing to accept a diagnosis of depression or Bipolar, both of which seemed wrong to me, I might still be taking the wrong meds and might never have experienced what life can be like when a person is able to pay attention!
Best...
L.
Posted by SLS on July 14, 2000, at 15:26:16
In reply to Ritalin augmentation questions. PLEASE HELP!-LONG, posted by shellie on July 13, 2000, at 22:49:07
If JohnL is right about Nardil, and Ritalin augmentation is not an adequate solution, perhaps Parnate would be the better of the MAO inhibitors for you. It tends to act a bit like a stimulant and has been used to treat ADD from time to time.
- Scott
Posted by shellie on July 14, 2000, at 20:26:17
In reply to Ritalin augmentation Shellie LONG RESPONSE!, posted by Libby on July 14, 2000, at 13:19:47
Hi Libby, I had followed your thread on the board about ritalin working--it worked so fast for you--and everything became so obvious. That is really great--it was like an amazing story.So far, I feel nothing from the ritalin-day 2, 10mg. I was very depressed this afternoon and wondered if the ritalin was making me worse. I don't know how long it takes to kick in for depression, if it's going to kick in.
It's interesting. I could tell the same story as you about losing keys and getting locked out of my car and totally freaking out. But I look at it through dissociation. When things happen and I get overwhelmed, kids inside start freaking out. They have different voices than me--well they sound like their age-- 3 1/2 to 10. They have been discribed as both ego states and alters; I am totally co-conscious with them, so that is why it is a judgment call.
And that's why I don't think I'm ADD, although my last therapist was sure I am (as well as dissociative). When I had to get my car fixed, both body work and brakes at two different places and rent a car, I just kept pushing it out of my mind, because it felt too confusing. Finally I broke it down into steps--- rent car, take car to brake place, bodywork place picks up car from brake place, etc., and then I was able to get it done, and it was actually quite simple. I feel like all my energy has to go into my work, because I am so easily distractable and so easily overwhelmed.
If my first two days of ritalin are any indication, I am not ADD, because I felt no difference. I was sent for testing from my pdoc, but it was very different than yours, no test on a stimulant. Mostly I had a huge scatter--I have no memory for names, or names of things, and I could not remember anything about a random drawing I had copied. But in other tests, I score very very high. The pscyhologist wrote up that the high scatter was due to test anxiety. That was really lame, since I have the same problem with what things are called, even when I'm by myself. She said she couldn't evaluate the ADD because I remember so little about my childhood.
Anyway, so far, I've been disappointed in stimulants--and I'm getting impatient. I like my pdoc a lot, but sometimes I'd just as well take over the whole process by myself, so it would go faster.
btw, did your pdoc ever apologize to you for his misdiagnosis? If you're still working, have you noticed the dramatic change with ritalin that you have a home? shellie
Posted by shellie on July 14, 2000, at 22:09:50
In reply to Re: Ritalin augmentation questions. PLEASE HELP!-LONG, posted by SLS on July 14, 2000, at 15:26:16
Thanks Scott. Parnate is on my list of possibilities to try. I've seen conflicting evidence of whether you need to wait between an maoi switch. I'm still going first through the augmentation route, since at least my reactions to Nardil are predictable. So far, second day of ritalin 10mg, no stimulating effects. I really don't think I have ADD, mostly depression and a dissociative disorder. shellie
Posted by C.M. on July 14, 2000, at 23:24:53
In reply to Re: Ritalin augmentation questions. PLEASE HELP!-LONG » C.M., posted by Ant-Rock on July 14, 2000, at 13:17:59
> CM,
> I know nothing about vivactil. Is it an energising tricyclic? Does it cause cognitive problems? Is it reccomended for unipolar depression with a fatigue component? What is your main reason for taking it?
> Sorry about all the questions, It's just that I don't hear much about it and my pdoc never suggested trying it. Thanks for any info you can provide.
> Sincerely,
> Anthony
==================================================
Hi Anthony,Viactil for me would be an energizing Tricylic. Literature indicates Vivactil as lacking in sedative and tranquilizing properties.
Congitive problems? I honestly do not know, but I would anticipate an increase in mental activity to occur.
Literature indicates Vivactil for all types of depression, and suitable for apathetic, withdrawn, depressed patients.
Originally I tried Vivactil for depression and anxiety back in 1995, but my vision blurred too much, so I couldn't take it daily. Since then, I have just used it on certain days(perhaps 2-3 days per month) simply as a stimulater to help me get through the day whenI don't get enough sleep the night before. For me, a plus side to the Vivactil over the Ritalin is that Vivactil seems to create a more positive mood for the day than the Ritalin does.
CM
Posted by JohnL on July 15, 2000, at 7:26:55
In reply to Re: adrafinil, posted by shellie on July 14, 2000, at 9:54:36
> John. I was totally ready to go the adrafinil route but my pdoc is worried about combining it with an MAOI, since it causes release of serotonin and dopamine. Would you worry about that?
>
> btw, I think you're right--the extreme afternoon tiredness is probably related to the nardil, but I've don't do well on ssris, and nardil seems to have the least side effects for me. I would be very scared that I'd bottom out if I try to get off the nardil and try just adrafinil. Last time off the nardil, I ended up in the hospital, waiting to start and have it kick in again. Because of my business, I can't afford to bottom out again, so that's why I'm doing the augmentation route. Thanks, for your advise, ShellieShellie,
I personally wouldn't be afraid of Nardil+Adrafinil. But that's just me. I could be all wrong. But the reasons I feel safe about it are because:
1) Release of serotonin and dopamine occur at the highest doses, according to the medication label information.
2) I always approach anything that's new to me--whether it be prescrips, herbs, whatever--with a real sense of caution. I like to dip my toes in the water, so to speak, before diving in. Actually, I'm that way with anything.Even if a doctor tells me XYZ med is 100% safe and has no side effects, I will go home and cut his recommended starting dose into half or even a quarter. I've been burned and learned. Some doctors just have no idea. They can err too much on the side of caution, preventing the patient from ever having a real chance of being completely well; or they can err too much on the side of naiveness (is that a word?) and scare the patient with too much too fast, or wrong choices altogether.
On the other hand, if the doctor tells me XYZ drug has some dangers and side effects, it's nice to be aware of that, but it doesn't change anything. I still cut his recommended starting dose in halves or quarters. The dangers and risks are planted in my mind, and I'm aware of what to be on the lookout for so I can catch anything bad real early before it gets out of hand.
Could Nardil and Adrafinil be dangerous? I'm sure they could. Anything could. But at lower or midish doses? Don't quote me, but I don't think so. I really don't. At my 600mg dose I don't feel any serotonin enhancement at all. I know what serotonin feels like. That's not what's happening. In your shoes I would feel comfortable splitting a 300mg pill of Adrafinil in half. It really does seem like a tame medication to me. Very effective, but very tame at the same time. If after 4 days or so all was well, I would go up to a whole pill a day. Four days later, if all was still well, I would go to 1 1/2 a day. I would probably stay at 2 pills a day for several weeks before making any more decisions. I don't see any danger in the combination as long as it is approached in a 'dip your toes' first manner.
I'm not suggesting you try it or warning you not to try it. I'm just saying that if I were in your shoes, this is how I would feel about it and this is how I would go about doing it. I understand up front--with myself anyway--that getting a doctor to go along with a medication from another country is not realistic. And I therefore have to take all responsibility for safety onto my own shoulders. The last thing I want to do is end up looking like a total fool in the emergency room. That's why I go real low at first. With anything and everything.
Hope this helps in some way.
John
Posted by michael on July 15, 2000, at 12:39:24
In reply to Re: adrafinil, posted by JohnL on July 15, 2000, at 7:26:55
When I'm trying to look at adrafinil & possible interactions, etc., I use modafinil as a surrogate, since it's next to impossible in my experience to find that type of info on adrafinil itself. Obviously, it's only an approximation, but better than nothing...?
Btw - the best site I've found for med research is: http://www.cp.gsm.com/
> > John. I was totally ready to go the adrafinil route but my pdoc is worried about combining it with an MAOI, since it causes release of serotonin and dopamine. Would you worry about that?
> >
> > btw, I think you're right--the extreme afternoon tiredness is probably related to the nardil, but I've don't do well on ssris, and nardil seems to have the least side effects for me. I would be very scared that I'd bottom out if I try to get off the nardil and try just adrafinil. Last time off the nardil, I ended up in the hospital, waiting to start and have it kick in again. Because of my business, I can't afford to bottom out again, so that's why I'm doing the augmentation route. Thanks, for your advise, Shellie
>
> Shellie,
> I personally wouldn't be afraid of Nardil+Adrafinil. But that's just me. I could be all wrong. But the reasons I feel safe about it are because:
> 1) Release of serotonin and dopamine occur at the highest doses, according to the medication label information.
> 2) I always approach anything that's new to me--whether it be prescrips, herbs, whatever--with a real sense of caution. I like to dip my toes in the water, so to speak, before diving in. Actually, I'm that way with anything.
>
> Even if a doctor tells me XYZ med is 100% safe and has no side effects, I will go home and cut his recommended starting dose into half or even a quarter. I've been burned and learned. Some doctors just have no idea. They can err too much on the side of caution, preventing the patient from ever having a real chance of being completely well; or they can err too much on the side of naiveness (is that a word?) and scare the patient with too much too fast, or wrong choices altogether.
>
> On the other hand, if the doctor tells me XYZ drug has some dangers and side effects, it's nice to be aware of that, but it doesn't change anything. I still cut his recommended starting dose in halves or quarters. The dangers and risks are planted in my mind, and I'm aware of what to be on the lookout for so I can catch anything bad real early before it gets out of hand.
>
> Could Nardil and Adrafinil be dangerous? I'm sure they could. Anything could. But at lower or midish doses? Don't quote me, but I don't think so. I really don't. At my 600mg dose I don't feel any serotonin enhancement at all. I know what serotonin feels like. That's not what's happening. In your shoes I would feel comfortable splitting a 300mg pill of Adrafinil in half. It really does seem like a tame medication to me. Very effective, but very tame at the same time. If after 4 days or so all was well, I would go up to a whole pill a day. Four days later, if all was still well, I would go to 1 1/2 a day. I would probably stay at 2 pills a day for several weeks before making any more decisions. I don't see any danger in the combination as long as it is approached in a 'dip your toes' first manner.
>
> I'm not suggesting you try it or warning you not to try it. I'm just saying that if I were in your shoes, this is how I would feel about it and this is how I would go about doing it. I understand up front--with myself anyway--that getting a doctor to go along with a medication from another country is not realistic. And I therefore have to take all responsibility for safety onto my own shoulders. The last thing I want to do is end up looking like a total fool in the emergency room. That's why I go real low at first. With anything and everything.
>
> Hope this helps in some way.
> John
Posted by Sara T on July 15, 2000, at 13:20:02
In reply to Re: Ritalin augmentation » Libby, posted by shellie on July 14, 2000, at 20:26:17
> If my first two days of ritalin are any indication, I am not ADD, because I felt no difference.Shellie-
A word of caution, you might not be a Ritalin responder. ADD cannot be diagnosed by whether or not you respond to Ritalin or any other stim. Often what works for one ADDer, won't work with another, just like all meds.
I don't know how old you are, but hormones can also play havoc with cognitive abilities. If you can get any of your old school records together, that would help in the assessment of ADD.
Ritalin works right away. You may need to up the dosage. Or try another stim like Adderall.
Good luck,
Sara T.
Posted by shellie on July 15, 2000, at 13:45:45
In reply to Re: adrafinil, posted by michael on July 15, 2000, at 12:39:24
> When I'm trying to look at adrafinil & possible interactions, etc., I use modafinil as a surrogate, since it's next to impossible in my experience to find that type of info on adrafinil itself. Obviously, it's only an approximation, but better than nothing...?
>
> Btw - the best site I've found for med research is: http://www.cp.gsm.com/
>
Michael, Thanks for the med research site--I've bookmarked it. I tried modafinil and got really really tired, but that may have been also due to a change in generics that occurred at the same time for aderex, since the tiredness lasted for a whole week after I was off modafinil. I probably should give it another shot, but if the other was the culprit in the tiredness, the modafinil certainly did not counteract it. shellie
Posted by shellie on July 15, 2000, at 13:50:52
In reply to Re: Ritalin augmentation -Shellie, posted by Sara T on July 15, 2000, at 13:20:02
>
> > If my first two days of ritalin are any indication, I am not ADD, because I felt no difference.
Actually, I was just responding to others who said I sounded ADD. Looking back at my childhood, there is no indication, much more of dissociation and abuse. I am trying the ritalin as an augmentation to nardil, and just noted that I felt no difference with ritalin (day three, 10mg), except I woke up every hour last night, even though I hadn't taken ritalin since 2pm. shellie
This is the end of the thread.
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