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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by sgtbob on July 1, 2001, at 15:52:38
I thought this site might be of use to those people who are having severe problems with the fatigue associated with depression. The site explains the benefits that drugs like dexedrine and adderall can provide for people with depression and narcolepsy. I have been suffering from major bi-polar depression since 1995 with severe problems with fatigue, etc. I tried a bunch of the antidepressents with no success. Now I just have to find a doctor willing to try me on either dexedrine or adderall in addition to wellbutrin and effexor. I just can't stand sleeping 10-12 hours a day and taking naps in addition to that. I live in Tennessee and have heard that they don't like to prescribe it for people with depression. If anyone has any ideas on how I could convince a doc. to prescribe it; I would be really grateful. The website is http://members.fortunecity.com/siriusw/dexedrine.htm
Posted by SalArmy4me on July 1, 2001, at 19:42:21
In reply to dexedrine or adderall for depression fatigue, posted by sgtbob on July 1, 2001, at 15:52:38
Posted by Mr. Scott on July 1, 2001, at 20:53:52
In reply to Re: dexedrine or adderall for depression fatigue, posted by SalArmy4me on July 1, 2001, at 19:42:21
Stimulants are routinely used to augment antidepressants. I personally believe them to be of only short term value, as tolerance develops to many of the effects.
Posted by Zo on July 1, 2001, at 23:09:24
In reply to dexedrine or adderall for depression fatigue, posted by sgtbob on July 1, 2001, at 15:52:38
What you need is the diagnosis of ADD. Not hard to get. I know of some people with CFS/FM who are getting Dex that way, for its profound pain relief and energizing effect.
Good luck!
Posted by Zo on July 1, 2001, at 23:11:35
In reply to Re: dexedrine or adderall for depression fatigue, posted by Mr. Scott on July 1, 2001, at 20:53:52
> I personally believe them to be of only short term value, as tolerance develops to many of the effects.
That's not my actual *experience*, going on five years now. I became sensitive to the dyes in Wellbutrin. .. and still needed and will always need dopamine supplementation. Which is all they are.
Posted by chiaratara on July 1, 2001, at 23:14:20
In reply to Re: dexedrine or adderall for depression fatigue, posted by Mr. Scott on July 1, 2001, at 20:53:52
I would love to find something that would counter the fatigue I fell on Paxil and Effexor. I can fall asleep at the drop of a hat.
As far as convincing your physician to try something else, tell your dr. that the Anti-Depressants help with your mood but you are having trouble functioning. That seems to be the buzzword.
Maybe your doctor would try some other medications that aren't necessarily stimulants but have stimulant effects such as Wellbutrin or Prozac. I tried both but became agitated and had horrible headaches in addition to being "stimulated."
I am still looking for something that might give me a bit more pep as well, so any suggestions would be appreciated.
Chiaratara
Posted by forgetful on July 2, 2001, at 19:53:45
In reply to Re: dexedrine or adderall for depression fatigue » Mr. Scott, posted by Zo on July 1, 2001, at 23:11:35
> I became sensitive to the dyes in Wellbutrin. ..
How did you know you were sensitive to the dyes? What happened to let you know that? Just wondering. I'm on Welbutrin and still having some trouble with depression, word finding problems, and some confusion.
Posted by Sulpicia on July 5, 2001, at 1:16:35
In reply to dexedrine or adderall for depression fatigue, posted by sgtbob on July 1, 2001, at 15:52:38
> My teen has bipolar II. Her symptoms consist mainly of severe depression manifested
by hypersomnia -- 22 hours a day's worth.
Her med coctail:
lamictal 400 mgs [an energizing mood stabilizer]
wellbutrin 300 mgs
adderall 20 mgs
The adderall was used as AD add-on and then later the pdoc
sort of casually added ADD to her dx.
Needless to say this combo would be out of the question for
a bipolar who experiences hypomania or mania on a regular basis.There is some literature on stimulants as add-ons for treatment of depression.
Do you know how to use PubMed to search?
ADD is often comorbid with bipolar -- you can find the DSM IV criteria
under diagnosis at the ADD site at About.comWhen describing your symptoms to the pdoc, don't use "fatigue."
From what you describe your depression is not adequately treated. YOu
are not tired -- you're depressed. Communicate that.
Best of luck,
S.
Posted by chiaratara on July 5, 2001, at 16:40:00
In reply to Re: dexedrine or adderall for depression fatigue, posted by forgetful on July 2, 2001, at 19:53:45
> > I became sensitive to the dyes in Wellbutrin. ..
>
> How did you know you were sensitive to the dyes? What happened to let you know that? Just wondering. I'm on Welbutrin and still having some trouble with depression, word finding problems, and some confusion.i am not the one you are addressing, however, i was convinced i was getting hives from wellbutrin. my doctor was skeptical, but they ceased once i went off the drug. anyone with similar problems?
Posted by shelliR on July 7, 2001, at 13:35:38
In reply to Re: dexedrine or adderall for depression fatigue, posted by chiaratara on July 5, 2001, at 16:40:00
Chiaratara. After not being able to tolerate any stimulent, I have tried concerta for the past few days and I feel more energy
without the weird feelings that dexedrine and plain adderall give me. And I was very skeptical; I didn't even want to try it.
Shelli
Posted by Lorraine on July 8, 2001, at 22:08:38
In reply to Re: dexedrine or adderall for depression fatigue » chiaratara, posted by shelliR on July 7, 2001, at 13:35:38
> Chiaratara. After not being able to tolerate any stimulent, I have tried concerta for the past few days and I feel more energy
> without the weird feelings that dexedrine and plain adderall give me. And I was very skeptical; I didn't even want to try it.
> ShelliShelli: Would you please keep me posted on the concerta?
Posted by shelliR on July 8, 2001, at 23:18:37
In reply to Re: dexedrine or adderall for depression fatigue » shelliR, posted by Lorraine on July 8, 2001, at 22:08:38
> Shelli: Would you please keep me posted on the concerta?Hi Lorraine. After a couple of weeks of no deep depression, but also no motivation or energy, I added concerta Friday, and felt okay. Saturday I increased the prozac from 20mg to 20mg, 40mg every other day. Yesterday was sort of blah, but today I totally totally crashed. I had to work for a couple of hours this morning (photo shoot) then went back to bed for most of the day. I think I am not going to take the concerta tomorrow; I'm sure that between concerta and oxycontin my body is feeling pushed and pulled. I don't feel anywhere near the way (almost normal) I felt when I was on just on nardil and it was working.
I may push to be put on parnate, although my pdoc doesn't like MAOIs since he can't mix everything with them. The other option may be estrogen replacement. I would try concerta again, but something happened with the three drugs that sent me plummeting. So I'll cut out concerta first and see if I feel better. I also have a fear that maybe I am becoming habituated to this dose of the OC, and it is no longer as effective. Or maybe I just had a horrible day that will pass.
Will let you know what's happening.
Shelli
Posted by Lorraine on July 9, 2001, at 12:01:11
In reply to Re: dexedrine or adderall for depression fatigue » Lorraine, posted by shelliR on July 8, 2001, at 23:18:37
>
> > Shelli: Would you please keep me posted on the concerta?
>
> Hi Lorraine. After a couple of weeks of no deep depression, but also no motivation or energy, I added concerta Friday, and felt okay. Saturday I increased the prozac from 20mg to 20mg, 40mg every other day. Yesterday was sort of blah, but today I totally totally crashed. I had to work for a couple of hours this morning (photo shoot) then went back to bed for most of the day. I think I am not going to take the concerta tomorrow; I'm sure that between concerta and oxycontin my body is feeling pushed and pulled. I don't feel anywhere near the way (almost normal) I felt when I was on just on nardil and it was working.
>
> I may push to be put on parnate, although my pdoc doesn't like MAOIs since he can't mix everything with them. The other option may be estrogen replacement. I would try concerta again, but something happened with the three drugs that sent me plummeting. So I'll cut out concerta first and see if I feel better. I also have a fear that maybe I am becoming habituated to this dose of the OC, and it is no longer as effective. Or maybe I just had a horrible day that will pass.
>
> Will let you know what's happening.
>
> ShelliHi Shelli:
I am keeping a mood chart now. I adapted it from a bipoloar med chart that the NIMH put together. I find it so hard to tell what is affecting what. Am I cycling? Are my break-through episodes just down cycles or event caused or is my medication not working? Anyway, time to start charting is what I decided. If you want to send me you email address, I'll be happy to forward the chart form to you. It might help.
Posted by shelliR on July 10, 2001, at 20:22:39
In reply to Re: dexedrine or adderall for depression fatigue » shelliR, posted by Lorraine on July 9, 2001, at 12:01:11
Hi Lorraine,
Thanks for the chart offer, but right now I have nothing to chart. I went off both the prozac and concerta. I got scared at the magnitude of my depression on Sunday, and felt I wasn't willing to put in a six week trial with a crash on the third day. So now I have just the oxycontin and Klonopin. I am either going to try the estrogen patch (need to get more info and talk to my gyn) and/or wait six weeks and try parnate. I've never tried it; I was given nardil and that worked so well for me that I never found any reason to change. If I do try estrogen, then I may chart my moods. I am hoping to be able to read the whole article, because as I mentioned in another thread ,the success rate for "remission of depression" was less than 30%. In the blurb I read from Reiters, it is being recommended for mild perimenopausal depression. Plus there are other studies in which HRT caused depression. My pdoc is for trying it, but I actually trust my gyn more.
Right now I'm so so grateful for the OC; I wake up depressed, take it, and in a little over an hour I feel okay. The longer though, that I stay in this depression mode, the further I feel from setting goals for myself. I feel like I'm losing myself. I think there's a thread about "coming back" that I haven't read on S-P-B that I think I'll read through.
Keep me updated on what is going on with you,
Shelli
Posted by Lorraine on July 10, 2001, at 22:05:23
In reply to Re: dexedrine or adderall for depression fatigue » Lorraine, posted by shelliR on July 10, 2001, at 20:22:39
Shelli: I don't think that you have to try the estrogen on a sequential basis. I think that estrogen takes some time to have an effect and at least my experience suggests that it does not cure major depression at least (i hope it does for you). My point is that you can try something else in the meantime unless there is really nothing to try during your wash-out period waiting to try an MAO. Wash-outs are so difficult.
My neurofeedback doesn't seem to have helped, although I'm going to meet with the director one more time to talk it through. My Inderal doesn't seem to be the answer to my hyperventilating either. It slams me down energy wise and doesn't fully control the hyperventilating. I'm really pretty distressed by the whole thing right now. So I need to call my pdoc and move on to desipramine. I'm tired of trying this and that ad nauseum, but of course, that is what I need to do until I stabilize.
Posted by shelliR on July 10, 2001, at 23:16:35
In reply to Re: dexedrine or adderall for depression fatigue » shelliR, posted by Lorraine on July 10, 2001, at 22:05:23
Hi Lorraine.That's really bad news about the neurofeedback. It is always good to have the next step planned. Is this your first try at a tricyclic?
BTW, what type of estrogen did you try? And did you try it in conjunction with an antidepressant?
There's nothing I can do during the washout period, but the oxy is helping a lot. I just hope I don't become habituated to this dose. I was getting worried about that, but I think when I dropped the concerta, the oxy seemed stronger again. Don't know the dynamics chemically. So next is to talk to gyn and then to research (on PB and elsewhere) if parnate is the best choice for an MAOI.
I can't believe this will ever end. The first depression I tried tricyclics and became disoriented. But this was in the late 70s, so I don't know if newer ones have come on the market. Then I tried nardil and that's been the only thing so far that has significantly worked for me. I was in a pretty good period of my life (business going well, started focusing more on the social/relationship part of my life), then bamp--black cloud that nardil couldn't fix. So my life went on hold. I am convinced that it does have to do with age and hormones, but that is no guarantee for the estrogen. But it does seem worth a try.
Good luck to both of us. Shelli
Posted by Lorraine on July 11, 2001, at 10:35:22
In reply to Re: taking new directions in depression treatment » Lorraine, posted by shelliR on July 10, 2001, at 23:16:35
>
> Hi Lorraine.
>
> That's really bad news about the neurofeedback.Extremely disappointing to me. It clearly has an effect. But they moved the receptor sites all around my head--(does this remind you of different drug trials?). So maybe it would work but it is hit and miss and I am running out of time and money.
> > It is always good to have the next step planned.
Boy are you right. I try to have a long term sort of plan. First, this, then that drug, if things get bad hospital (haven't done this yet) and if none works then ECT and so forth. I have two books to read if I become suicidal (written for people who are actively suicidal-- one if "Suicide, the Final Decision"). You have to develop these plans while you are in a good place, because, as you know, your judgment and perspective are the first thing to go when times get rough.
> >Is this your first try at a tricyclic?
Yeah, it will be. I'm hoping that Desipramine will have minimal side effects.
>
> BTW, what type of estrogen did you try? And did you try it in conjunction with an antidepressant?I'm on estratest, but I am going to go see a naturapathic doctor and revisit that issue along with having my thyroid re-examined as well as adrenal glands. Estratest is causing me to lose some hair (male pattern baldness from too much testosterone). My guess is I end up on estriol (the natural estrogen, which is weaker--thereby providing less heart and osteoporosis protection (neither run in my family), but has less associated breast cancer (which does run in my family) and doesn't require opposing progesterin (which is associated with depression). Yes, I took it with Wellbutrin and Serzone initially--it has helped my cognitive functions. So I kept it on even while the rest of my meds change.
>
> There's nothing I can do during the washout period, but the oxy is helping a lot. I just hope I don't become habituated to this dose.How long is your washout? I guess all you can do is lay low and watch the storm clouds from a distance.
> > I was getting worried about that, but I think when I dropped the concerta, the oxy seemed stronger again. Don't know the dynamics chemically.
Yeah, the addiction stuff scares me because I hate unpleasant withdrawals.
So next is to talk to gyn and then to research (on PB and elsewhere) if parnate is the best choice for an MAOI.
From what I have read Parnate sounds like a good choice. It is on my list.
>
> I can't believe this will ever end.Hey, you and me both. Why can't they just put the lazy suzan on the counter and let us get through these drug trial quickly--life is passing us by.
The first depression I tried tricyclics and became disoriented. But this was in the late 70s, so I don't know if newer ones have come on the market.
I think the newer ones are supposed to be better.
> >Then I tried nardil and that's been the only thing so far that has significantly worked for me.Nardil is on my list as well. (weight gain? sexual dysfunction?) How were these for you.
> > I am convinced that it does have to do with age and hormones, but that is no guarantee for the estrogen. But it does seem worth a try.
Hormones effect everything and I believe that they are closely associated with depression. I hope it works for you.
>
> Good luck to both of us. ShelliMy thoughts exactly--nice to know I'm not the only one playing medication roulette.
Posted by shelliR on July 11, 2001, at 17:42:41
In reply to Re: taking new directions in depression treatment, posted by Lorraine on July 11, 2001, at 10:35:22
Hi Lorraine.
I read the lastest posts to and from Elizabeth and thought I should put in my two cents quickly re MAOIs and side effects, since you are deciding between MAOIs and tricyclics.
I had no weight gain and no sexual side effects on Nardil. I never felt drugged. My only side effects had to do with sleep and sleepiness. While I was on 45mg or higher, I fell asleep fine, but woke up every three hours, no matter what time I went to bed. And it wasn't the kind of wake up, to to BR, go back to sleep. I was very up and it took valium and time to fall back. Eventually I stayed on a dose of 30mg except in bad patches and then I didn't have that problem. The other problem was afternoon tiredness; I got exhausted every afternoon and had to take a nap for about 30 minutes. This was fine, except when I was working full time, it was hard to stay awake all day. Unfortunately, although I did try it with stimulants, I had never tried it with concerta, which I think would have helped alot.Actually, I still try to take a short nap in the afternoon. Even off nardil I become really tired and if I take at least a power nap, I am not at all tired and am productive in the evening. (I have to do a lot of printing in the evening, and also tend to do the treadmill in the early evening). So maybe that is just me, although I have heard of other people experiencing the same thing on nardil. And it didn't matter at all what time of day I took it. I ended up taking my pills all together, since spreading them out didn't help anything.
Although I have an extroverted personality (talk alot around people), I am in the Myer-Briggs sense an extreme extreme introvert and I think I need to totally withdrawal from the world (sleep, or meditate) to reenergize. So that may be the nap thing also.
I should read back though your posts, but my understanding is that nardil is better for depression and anxiety, and parnate is more energizing. It took a long time for Nardil to kick in --five weeks, but when it did, it was a wonderful drug for me. Also, in about 15 years on it, I didn't have any reaction to any food on the "don't eat list." YMMV. I've heard that parnate works faster, but maybe if you decide to do Nardil, you can keep increasing and it may kick in faster. I stayed at 45 mg the whole time waiting until it kicked in.
Good luck in your decision.
Shelli
Posted by Lorraine on July 12, 2001, at 12:00:02
In reply to Re: taking new directions in depression treatment » Lorraine, posted by shelliR on July 11, 2001, at 17:42:41
Shelli: It is so kind of you to chime in on this. I value your input.
> I had no weight gain and no sexual side effects on Nardil.Do you have weight gain or sexual side effects with SSRIs? I gained 40 lbs on Effexor and lost all interest in sex.
> I should read back though your posts, but my understanding is that nardil is better for depression and anxiety, and parnate is more energizing.
That's what I have heard as well. My difficulty is that I have depression, anxiety and a lack of energy. So the choice between Parnate and Nardil will be hard.
> > >It took a long time for Nardil to kick in --five weeks
Yikes! How did you bear it? I become a puddle unmedicated.
> > > but when it did, it was a wonderful drug for me. Also, in about 15 years on it, I didn't have any reaction to any food on the "don't eat list." YMMV.
15 years, that's wonderful! It does seem that people who do well on Nardil do well on it a long time.
> >I've heard that parnate works faster, but maybe if you decide to do Nardil, you can keep increasing and it may kick in faster. I stayed at 45 mg the whole time waiting until it kicked in.
Parnate has the advantage of being stimulating in terms of "speed" of response, I suppose.
Thank-you, Shelli for all your input. I will keep you posted. As I told Elizabeth, it gives me great comfort to know that there is someone else out there struggling with the same issues (getting stabilized on meds) that I am. It keeps me sane. It stops my foot from stepping over the ledge.
Lorraine
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