![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Peter on November 22, 2001, at 1:25:46
Hi all:
Well, I've posted a few threads on adderall in the past 2 weeks and here's another one. I've been taking it for almost 3 weeks, gradually increasing the daily dose. I'm now up to 5mg 3 times a day (every 4 hours). Most of the adderall's undesirable side-effects have dissipated by now, but I seem to be quite irritable throughout the whole day. BTW, I'm also on 750mg depakote for bipolar and up to 2 mg klonopin daily for anxiety/SP. I've been taking these two meds for years. I've always taken my depakote all at once at bedtime since it also helps me sleep, but, in light of my newfound irritability my pdoc instructed me to take 250mg in the a.m. I started doing that today and I noticed that my irritability did in fact decrease, but that along with that alot of the positive concentration/motivation effects of the adderall seemed to virtually disappear, and I just felt sedate all day - I didn't even feel like leaving my apartment. I got in touch with my pdoc who said the fatigue from the daytime depakote dose can in fact initially mask the positive adderall effects, but he said my body should be able to adjust over the next few days. But, I gotta say -I've noticed even before this whole daytime depakote experiment that the general positive effects of the adderall were dissapearing; during the beginning of the treatment, I experienced an elevated mood; I was able to sit in restaurants and talk long after I'd finished eating instead of always feeling like moving and rushing to something else to stimulate me; it even helped with my SP - I felt more comfortable and confident around people, and was willing to try new experiences that I otherwise would have considered boring. In addition, I no longer felt like I needed alcohol to make things fun - so I could actually sit at dinner and have a soda. It was great! Then, after just these few weeks, all I feel is a tiny annoying stimulation/irritation for sometimes as little as 1 hour and then NOTHING. This in turn makes me feel like taking more adderall, which worries me as a sign of dependance. Does anyone have experience with this happening? Aside from the fact that the effects are hardly present any longer, I'm especially curious as to why the DURATION of the drug's effects seems to have diminished so drastically (I used to feel it for 4-5 hours, now it's 1-2, if that). My doc said that the med has NOT 'pooped out', yet he doesn't want to consider increasing the dose until after my irritability is calmed down.. In fact, he wants to switch me to 10mg adderall XR, since I'd been annoyed by the inconvenience of multiple dosing. This leads to my next question - is anyone familiar with adderall XR? I'm especially confused by the fact that my doc wants me to take 10mg XR once daily, whereas I've been taking 15mg daily of normal adderall, which, as I've mentioned, doesn't even seem to work anymore. Finally, I wanted to ask about ADD. My brother took a complete neuropsychological test that concluded that he does have ADHD. I wanted to also take the test for a more definitive prognosis, but my pdoc recommended against it, saying it is unnecessary, and that he's pretty sure I had ADD as a young child (from what I've told him-but I don't trust my own memory), and that now it has either transformed into mild bipolar disorder or it has remained alongside the bipolar disorder. It seems like so much speculation to me, especially since I was a drug addict for years and I don't want to be on amphetamine unless I REALLY need it for ADD. I'm also angry that my pdoc just told me this theory last month about that he had suspected comorbid ADD/bipolar since I first met him 6 years ago. But he didn't suggest stimulants until just last month! Instead, over the last 6 years,on top of mood stabilizers, I've been on every SSRI, moclobemide, effexor, wellbutrin, dopamine agonists, and other meds, none of which had lasting benefits on my recurrent depressive/antisocial/anxiety episodes. In fact, all the AD's seemed to do after awhile was to make me more impulsive (triggering some mania) and cause me to crave and relapse on alcohol/drugs. So finally he puts me on adderall. I don't know if I'm on it as an unconventional treatment for my mixed diagnosis, or if I really have an underlying ADD. Not being sure is bothersome; I'm afraid that this rapid tolerance I'm experiencing is a sign of dependance and I even sometimes crave the idea of taking it even though it's not working very well. It's all pretty twisted. Anyone else on stimulants for comorbid diagnoses or for ADD that has not been diagnosed through common neuro tests? Sorry for the length and I hope I haven't been totally incoherent. Thanks in advance for your help.
Peter
Posted by manowar on November 23, 2001, at 23:06:03
In reply to adderall update neuropsychological tests, posted by Peter on November 22, 2001, at 1:25:46
Hi Peter,
I've been diagnosed with ADD and cyclothymia. I just started on the stimulants about 3 months ago. I also have had the same concerns. I take Adderal XR (30 MG a day), Wellbutrin, Aricept, along with Seroquel. I love the Adderal XR -very smooth effect. My doc (he specializes in ADD) doesn't seem to be overly concerned with upping the dose of the stimulants if he sees fit. His reasoning is that eventually the tolerance to the attentional effects of the drug will stop once we find the right dosage. He assures me that the stimulants are not anti-depressants. Evidently euphoria can be a side effect from the psychostimulants for some folks along with weight loss and some other good ones. He assured me that these were just SIDE EFFECTS. They do wear off:( That's why they're lousy for weight loss. They may work well for a couple weeks but that's it. But the Adderal is for concentration and cognitive enhancement-- not euphoria, diet and good sex. The dose can be increased as tolerance sets in. He assured me that eventually we would find a good dose for me. But since the side effects make me feel good unlike the horrendous side effects of the ADs, it's kinda freaky. But remember, if you do have ADD, you're doing the right thing for yourself. Psychostimulants are very effective for people with attention problems. Drug abusers (or at least the ones I've known in the past) would not be interested in Adderal XR. They aren't hanging out selling Ritalin. They use stuff that is a hundred times more potent. It's good that we're concerned, but from what I've read and heard, these drugs are a lot safer than the ADs- well at least the dirty tricyclics and MAOI's. Anyway, I did have a Neurological exam, and it did confirm that I had ADD along with cyclothymia. I had a SPECT scan done and what I saw on the computer screen convinced me that ADD, depression, bipolar etc. are physical problems that can be seen - its not just speculation.>I'm now up to 5mg 3 times a day (every 4 hours).
That is a very small dosage. You'll like the Adderal XR. It's smooth in effect and one dose lasts all day long. Right now I take 30 mg a day. I hated taking Ritalin and Adderal because I had to take a dose every three or four hours. It just made me feel like a drug addict having to take so many pills throughout the day. So taking the XR once in the morning is a psychological plus for me.
>My doc said that the med has NOT 'pooped out', yet he doesn't want to consider increasing the dose until after my irritability is calmed down.
That makes perfect sense if he’s concerned that an increased dose of Adderal might trigger more irritability and a manic or hypomanic state.
By the way, did your doctor put your brother on a psychostimulant, and if so, how's he doing?
-- T
Posted by Peter on November 24, 2001, at 2:20:49
In reply to Re: adderall update neuropsychological tests, posted by manowar on November 23, 2001, at 23:06:03
> Hi manowar,
Thanks alot for your info and comfort. As you probably guessed in my long thread, I've just gotten to a point of trying so many meds that the very act of trying a new one is anxiety-provoking for me. As a result, I tend to obsess over the medication, the credibility of my pdoc and my diagnosis, etc..I can really get myself pretty crazy. But thanks for everything-I'm more calm about taking the Adderall and I'm looking forward to starting on the Adderall XR, since I too felt like an addict popping pills throughout the day. Unfortunately, since the XR is so new, I've had a great deal of trouble getting my prescription filled. I finally found this one pharmacy that can order it for me and hopefully get it to me by the end of next week. I wanted to ask you, though, if the XR really works over a full 12 hour span like its producers claim . The reason I ask is because all the info I read on normal Adderall claimed that it lasts for 8 or more hours but, like you, I found that each dose lasted only 3 or 4 hours, and I was thus having to take it 3 times a day to cover a full 12 hours. From your experience, does a single dose of XR really cover that long a period? The other question I had for you pertains to the SPECT scan. Wow! I had heard of this, but I was unaware that you could actually SEE the physical manifestations of psychological disorders. If I could take that scan, it would save me a great deal of further distress about the accuracy of my diagnosis, which my pdoc has designated as bipolar/ADD/SP. Of course it's a little late for me to take the complete neuropsychological exam, since I've already been on adderall for almost a month and my doc said it's unecessary- he still claims his assessment of my diagnosis is accurate, but I think a burden would really be lifted from my mind if I could find out something more convincing and concrete than his word. So I'd like to take some sort of testing; the problem with the neuro test is that I'd have to taper off the adderall in order to take the test and then start from scratch. But the SPECT scan sounds like a great solution. Is it a commonly available procedure?
> By the way, did your doctor put your brother on a psychostimulant, and if so, how's he doing?
My brother goes to a different doctor than I do. he sees a psychiatrist while I see a psychopharmocologist. His doctor placed him on Concerta, but, as far as I know, my brother was having undesirable side-effects (sweating, raciness, etc.) - and he was taking the lowest possible dose (18mg). So, his doc decided that normal ritalin is best for him for now. It seems like my doc is much more on the 'cutting edge' of psychopharm. (makes sense, since it's his specialty), but sometimes he prescribes drugs to me for unconventional reasons. I mean, as he put it, even if I don't have ADD (though he THINKS I do), the stimulant could help in combination with the depakote and klonopin to further stabilize my mood and help my concentration/motivation. I just sometimes feel uncomfortable taking meds other than for the reasons for which they're intended. But I guess I should trust him - he's the expert, not me.
Peter
Posted by manowar on November 28, 2001, at 9:36:23
In reply to Re: adderall update neuropsychological tests, posted by Peter on November 24, 2001, at 2:20:49
Hi Peter,
I’m sorry it took me so long to get back with you. I found that it is very useful to use this website as a way for us to share information, hope, and encouragement. It also forces me clarify ideas in my mind, which takes time.I wouldn’t worry about obsessing over your problems. We all do. That’s why I really like this forum, it allows for us to obsess together as a group. But I think it’s a very constructive way to obsess. I have learned a lot here, mainly by doing searches of the archives. But it’s a lot more fun to get involved in ongoing dialog. Anyway, I just wanted to tell you that you have a great attitude. Keep digging and asking questions, you’ll find hope, comfort, support and helpful info along the way.
To be honest, I’m pretty new at taking the psychostimulants myself, but don’t worry, I’ll be happy to give my opinion. ADD was added to my diagnosis of cyclothymia just three months ago. Along with Wellbutrin for my depression, my pdoc prescribed 10 mg of Ritalin twice a day. I really found that it was helping me concentrate, not obsess, and get more work done, but the Ritalin would only last me for three or four hours at a time and I came down from it pretty hard. After a few weeks on that regimen, I got more used to it, and the ups and downs were not as bad as when I started taking it. I found a doctor that specialized in ADD and he started me on Concerta then Medadate which are both just sustained release versions of Ritalin (methylphenidate). They both worked pretty well, but the doctor wanted me to try the new Adderal XR and compare it with the others. I never have had regular Adderal prescribed to me in the past, but the Adderal XR to me worked better and smoother than the Concerta or Medadate. The drug is so new that my insurance doesn’t cover it. I think it’s about $2 a pill, but to me it’s well worth it. You will be amazed at how well the XR form of Adderal works. Yes, it does last for 12 hours, and it works very well.
Unfortunately it can be very difficult to find a doctor that uses SPECT. I decided to go to the Amen clinic in California. That clinic is the only one that I knew of that specializes in using SPECT to help diagnose and to evaluate mental disorders. I read Amen’s book a couple years ago called “Change your Brain, Change your Life”. He shows images of patients’ scans along with their case histories. What he has found is that mental disorders are fairly predictable depending on how certain parts of the brain appear to be functioning. To me it makes perfect sense. A lot more sense than the idea that the brain is a just a sack of chemicals that need to be balanced. In depression, what he refers to as the “deep limbic” area of the brain (which contains the thalamus, amygdala, cingulate gyrus and deep temporal lobes) tend to over function and the left prefrontal cortex tends to under function. With ADD, during concentration the left prefrontal cortex shuts down, which explains why that when people with ADD try to concentrate they often can’t. He has a good site – www.brainplace.com. I also found that I had other functioning problems too, that I never even suspected. But that is exactly why I went to the clinic anyway, was to see if there were other underlining problems that explained why I have been so “treatment resistant” over the past several years. I noticed that there have been a few people in Psychobabble in the past that have talked about him, and they were pretty skeptical of his work. I also suspected that his work was “junk science”, until I went to his clinic and had the procedure done. Now I would be his poster boy if he wanted. The scans really clarified what my problems were and a good game plan for treating them, not only with drugs, but aerobic exercise, better diet along with a couple dozen more ideas.
When I told my pdoc about Dr. Amen, I was surprised to find out that his work was pretty well known. My doctor encouraged me to go there for an evaluation. I did a little research, enough to find out that SPECT is not used that often. The only clinics I could find were in major cities. So I decided to bite the bullet, go to Cali to have the scans done. I did this over three days in August. It cost me $2750 out of pocket (My insurance later reimbursed me $2300!) to have two scans done, someone to record my history, a doctor to read over my history, evaluate the scans and to meet with me for two hours. The two scans had to be done over two separate days. One scan was done at rest and the other scan was done while I was concentrating. The scans were very revealing, and more than anything, by having this done it gave me comfort in knowing that it was not my fault why I was feeling the way I did. I also think that with a person like me that has several overlapping problems, it helps a pdoc pinpoint where the problems are as to give an accurate diagnosis so that the right meds can be prescribed and so forth. Unfortunately the scans did not make my problems go away, but I’m glad that I had it done. Hopefully it won’t be long until we find the right medication mix to help me with my problems. Anyway, good luck and I hope I have been helpful--- Tim
Posted by Mitch on November 28, 2001, at 12:10:47
In reply to Re: adderall update neuropsychological tests, posted by manowar on November 28, 2001, at 9:36:23
>
>..... Unfortunately it can be very difficult to find a doctor that uses SPECT. I decided to go to the Amen clinic in California. That clinic is the only one that I knew of that specializes in using SPECT to help diagnose and to evaluate mental disorders. I read Amen’s book a couple years ago called “Change your Brain, Change your Life”. He shows images of patients’ scans along with their case histories. What he has found is that mental disorders are fairly predictable depending on how certain parts of the brain appear to be functioning. To me it makes perfect sense. A lot more sense than the idea that the brain is a just a sack of chemicals that need to be balanced. In depression, what he refers to as the “deep limbic” area of the brain (which contains the thalamus, amygdala, cingulate gyrus and deep temporal lobes) tend to over function and the left prefrontal cortex tends to under function. With ADD, during concentration the left prefrontal cortex shuts down, which explains why that when people with ADD try to concentrate they often can’t. He has a good site – www.brainplace.com. I also found that I had other functioning problems too, that I never even suspected. But that is exactly why I went to the clinic anyway, was to see if there were other underlining problems that explained why I have been so “treatment resistant” over the past several years. I noticed that there have been a few people in Psychobabble in the past that have talked about him, and they were pretty skeptical of his work. I also suspected that his work was “junk science”, until I went to his clinic and had the procedure done. Now I would be his poster boy if he wanted. The scans really clarified what my problems were and a good game plan for treating them, not only with drugs, but aerobic exercise, better diet along with a couple dozen more ideas.Hi Tim,
You mentioned having cyclothymia and ADD (I have BPII and ADHD). Is Adderall XR and Wellbutrin the only meds you are taking-no mood stabilizers? If not, what rationale does your pdoc use for *not* needing them? Just curious,
Mitch
Posted by Peter on November 28, 2001, at 12:51:22
In reply to Re: adderall update neuropsychological tests, posted by manowar on November 28, 2001, at 9:36:23
> Hi Tim:
Thank you so much for the great info. I'm really learning alot and I appreciate all the help you're giving me. I brought the SPECT scan up to my pdoc and he sent me an email saying it's a great thing but it wouldn't give me the verificaion I need. I'll have to ask him exactly what he meant by that. I looked at the AMEN clinic site - really interesting stuff. But if I did end up getting a SPECT scan, I wanted to know two things: 1) Is there somewhere that you know of where I can get it done in the New York area (I couldn't find anyplace on the web); 2) When you get the scan, do you need to be off all medications? If I do in fact need to be off all meds (which would make sense), it could really take months and months + some really rough times to get off of all that I'm on.
Thanks,
Peter
Posted by manowar on November 28, 2001, at 14:28:40
In reply to Re: adderall update neuropsychological tests » manowar, posted by Mitch on November 28, 2001, at 12:10:47
> You mentioned having cyclothymia and ADD (I have BPII and ADHD). Is Adderall XR and Wellbutrin the only meds you are taking-no mood stabilizers? If not, what rationale does your pdoc use for *not* needing them? Just curious,
>
> Mitch
I forgot to mention that I was also taking klonipin 1.5 MG in the evening. My doc thought that the klonipin is not that effective as a mood stabilizer and could be making my depression worse so he had me stop taking that and started me on Seroquel a couple weeks ago. I had some bad side effects with the Seroquel, so I have stopped taking it. So right now I'm not taking anything to stabilize my mood, but I will see my doc in a week. My doc in California told me that a good mood stabilizer was very important. He suggested I try Neurontin on his report, but for some reason my doc up here wanted to try me on Seroquel. Anyway, what should I ask my doc to try next-- an atypical mood stabilizer like Neurontin or something like lithium or depekote?
--Tim
Posted by manowar on November 28, 2001, at 15:18:51
In reply to Re: adderall update neuropsychological tests, posted by Peter on November 28, 2001, at 12:51:22
Hello again Peter,
Thank you very much for the compliments. I'm glad I can help.What do you mean your doctor won't give you verification? Do you mean that he refuses to refer you to another doctor that uses SPECT? If that's the case I really don't think you need a referral to find a doctor that uses SPECT anyway.
To answer your first question: Sorry, I don't know of any clinics in the New England area (I live in TN). But I'm sure they are there.
In regards to your question about meds: Yes, they generally do want people to be off all meds for two weeks, but many times that is not a practical consideration. I really don't think it’s a big deal. But on the day of the scan they especially want you to not drink any coffee, smoke, or take any stimulant medication because that greatly influences the scan. But you'll have to ask the doctor.
--Tim
Posted by stjames on November 28, 2001, at 22:41:31
In reply to Re: adderall update neuropsychological tests » Peter, posted by manowar on November 28, 2001, at 15:18:51
>
> What do you mean your doctor won't give you verification? Do you mean that he refuses to refer you to another doctor that uses SPECT?James here.....
I would suspect that the issue is that there is no standard for SPECT scans in terms on Mental Illness, therefor the tests are just one persons opinion based on very new imaging technology.
james
Posted by Mitch on November 28, 2001, at 23:32:27
In reply to Re: adderall update neuropsychological tests, posted by manowar on November 28, 2001, at 14:28:40
> > You mentioned having cyclothymia and ADD (I have BPII and ADHD). Is Adderall XR and Wellbutrin the only meds you are taking-no mood stabilizers? If not, what rationale does your pdoc use for *not* needing them? Just curious,
> >
> > Mitch
> I forgot to mention that I was also taking klonipin 1.5 MG in the evening. My doc thought that the klonipin is not that effective as a mood stabilizer and could be making my depression worse so he had me stop taking that and started me on Seroquel a couple weeks ago. I had some bad side effects with the Seroquel, so I have stopped taking it. So right now I'm not taking anything to stabilize my mood, but I will see my doc in a week. My doc in California told me that a good mood stabilizer was very important. He suggested I try Neurontin on his report, but for some reason my doc up here wanted to try me on Seroquel. Anyway, what should I ask my doc to try next-- an atypical mood stabilizer like Neurontin or something like lithium or depekote?
> --TimTim,
Neurontin was the only mood stabilizer that I have taken that seems to help with anxiety, attentiveness, and moodswings. Depakote, Lithium, etc., seem to work well for one problem or the other but worsen or do little for the others. ADHD-wise only Neurontin and Trileptal seemed to *help* with attention. Lithium, Depakote, Gabitril, and Topamax all worsened cognitive functioning (sometimes to the point of derealization). I haven't tried Lamictal, however.
It is interesting that you mentioned Seroquel. There was a short interval of a few weeks when I hit what I call a "total clear spot" when I was on Neurontin 300mg bid, Adderall 5mg AM, and was still experiencing edginess from the pstim (what to do?). Seroquel 25mg at bedtime got added. The mornings were a little rough (even after my Adderall dose), but when the Seroquel *wore off* later in the day I had a really boosted focus that was really incredible. I didn't get hypomanic at all. Just quiet and focused-no restlessness-needing to continually move around. Mind you-this was when the D2 receptors were becoming *unoccupied*. But, I got some dystonia even from a small dose of Seroquel and had to stop it. The pstim eventually made me too panicky and it got ditched as well. That was very dissapointing. I really believe that if my pdoc would have simply added Klonopin (for the anxiety) to my Neurontin and Adderall it might have all worked out ok.
Mitch
Posted by Peter on November 28, 2001, at 23:41:20
In reply to Re: adderall update neuropsychological tests » Peter, posted by manowar on November 28, 2001, at 15:18:51
> Hey Tim and all:
yeah, my doctor told me that any SPECT results will not influence what meds he will treat me with. I've been going to him since 1997, and he's very established in psychopharmacology. He's had me on countless medications over the years, and sometimes his reasoning for giving me this or that drug are just too complex for me to follow. So I trust him, and he's very sensitive to my own concerns. As for my concerns, I guess my main one is just the fact that I'm still unsure about my diagnosis. And that's why the SPECT sounds like an interesting option. But he really believes that I'm mild bipolar/SP/possible ADD. But man, I remember when I first went to him in '97 I was just coming off of a 2 year hard drug spree-I went to rehab, was always relapsing, etc..in fact, when I first met him for my initial consultation, I was on heroin! I don't even remember it, but he ended up diagnosing me as bipolar/possible ADD (I don't even know what I told him!). So I left recovery programs, and I haven't touched illicit drugs in years. But, I'm still concerned that I've sort of been like a gineau pig with my pdoc-whenever I felt depressed, he'd throw in an SRI; whenever I had a panic attack or other anxiety, he'd throw in a benzo. Now, years later, I'm "sober" from illegal drugs, but I'm still on depakote, klonopin, and, most recently, the adderall. I'm just worried that, although this guy is respectable, the diagnosis he gave me might not be accurate. I don't have any memories of my being bipolar, although I guess alot of my past drug-seeking behaviours might have been due to hypomanic episodes. As for depression, I've had my share, but all the SSRI's seem to work for a short time, but end up dulling my emotions and causing me to relapse on drugs/alcohol. So I know it's all really tricky - my pdoc says even if I don't officially have ADD (since sometimes it's hard to distinguish adult ADD and bipolar), the adderall can help with motivation and mood elevation without leading to impulsivity and dulling my emotions like the SSRI's did. But I'm worried about taking adderall if I don't have ADD - it's a serious drug and it's not meant to be used for anything else. Sometimes I wonder if I even have a disorder. I've wondered how I would do on NO medication, since I was placed directly on depakote and other meds right after I came off of my hard drug years - so I haven't had much time in my adult life (I'm 25) without ANY substances in my body, prescribed or not. This is why I have periods of wondering about my diagnosis, the possibility of SPECT scans, etc..sometimes it feels like I'm on all this medication just because of the speculation of my pdoc. Sorry I'm talking on and on - if you had the patience to get to the end of this, you really don't have to respond. I just needed to vent, and this is a good place to do it.
Peter
Posted by manowar on November 29, 2001, at 11:37:33
In reply to Re: adderall update neuropsychological tests » manowar, posted by Mitch on November 28, 2001, at 23:32:27
> > > You mentioned having cyclothymia and ADD (I have BPII and ADHD). Is Adderall XR and Wellbutrin the only meds you are taking-no mood stabilizers? If not, what rationale does your pdoc use for *not* needing them? Just curious,
> > >
> > > Mitch
> > I forgot to mention that I was also taking klonipin 1.5 MG in the evening. My doc thought that the klonipin is not that effective as a mood stabilizer and could be making my depression worse so he had me stop taking that and started me on Seroquel a couple weeks ago. I had some bad side effects with the Seroquel, so I have stopped taking it. So right now I'm not taking anything to stabilize my mood, but I will see my doc in a week. My doc in California told me that a good mood stabilizer was very important. He suggested I try Neurontin on his report, but for some reason my doc up here wanted to try me on Seroquel. Anyway, what should I ask my doc to try next-- an atypical mood stabilizer like Neurontin or something like lithium or depekote?
> > --Tim
>
> Tim,
>
> Neurontin was the only mood stabilizer that I have taken that seems to help with anxiety, attentiveness, and moodswings. Depakote, Lithium, etc., seem to work well for one problem or the other but worsen or do little for the others. ADHD-wise only Neurontin and Trileptal seemed to *help* with attention. Lithium, Depakote, Gabitril, and Topamax all worsened cognitive functioning (sometimes to the point of derealization). I haven't tried Lamictal, however.
>
> It is interesting that you mentioned Seroquel. There was a short interval of a few weeks when I hit what I call a "total clear spot" when I was on Neurontin 300mg bid, Adderall 5mg AM, and was still experiencing edginess from the pstim (what to do?). Seroquel 25mg at bedtime got added. The mornings were a little rough (even after my Adderall dose), but when the Seroquel *wore off* later in the day I had a really boosted focus that was really incredible. I didn't get hypomanic at all. Just quiet and focused-no restlessness-needing to continually move around. Mind you-this was when the D2 receptors were becoming *unoccupied*. But, I got some dystonia even from a small dose of Seroquel and had to stop it. The pstim eventually made me too panicky and it got ditched as well. That was very dissapointing. I really believe that if my pdoc would have simply added Klonopin (for the anxiety) to my Neurontin and Adderall it might have all worked out ok.
>
> MitchMitch,
Thanks a lot for the info. I made an appointment to see my doc today. Now that I'm just taking the Adderal XR and Wellbutrin I really notice that the Adderal is really kind of dragging my mood down even lower than normal. So I'm going to ask him to put me back on the Medadate (methylphenidate XR). The Medadate and Concerta are practically the same but I felt the Medadate kick in a little sooner than the Concerta.I hate polypharmacy because it can be so damn confusing. It's hard to tell whether you feel worse because of a side effect of one of your drugs, or because of a combination that may not suit your particular system - or whatever. It takes so long for AD's to be effective. You have to be very patient and suffer through side effects to really give a drug a good trial. What a racket!
Anyway, what I'm trying to figure out is this: Since at this time I'm only taking Wellbutrin which by itself is not helping me, should I ask my doctor to stop taking that too, and start a trial of Neurontin clean? My pdoc in CA that evaluated the scans told me that the first order of business is to find a good mood stabilizer to stabilize function in the temperate (sp?) lobes which for me are under functioning and the basil ganglia which is slightly over functioning. I guess that finding one drug at a time to help one problem at a time would be the most logical approach to my treatment.
>There was a short interval of a few weeks when I hit what I call a "total clear spot" when I was on Neurontin 300mg bid, Adderal 5mg AM, and was still experiencing edginess from the pstim (what to do?).
What is pstim?
Years ago I think I tried two different mood stabilizers. I wish I knew which ones they were so I could try to avoid them. But I do remember feeling the "dumbing down" effect, so my trials were very short. But I never had to have my blood tested. Don't you have to get your blood tested for all the regular mood stabilizers? I know that Neurontin is an atypical mood stabilizer that doesn't require blood testing.
I've read that psychostimulants can also act as mood stabilizers. Maybe the Medadate was slightly effective in that area.
Well hopefully today I'll get a script for the Medadate and Neurontin. Neurontin affects GABA doesn't it? Hopefully it will help me feel nice and cozy like the klonipin did when I took it in the evening. I really felt the Klonipin worked synergistically with the Ritalin. It was great to take the Klonipin at night because it just shut down any excess stress and tension that I might have gotten from the Ritalin. When I took the Ritalin in the morning it was like "HELLO-TOP OF THE MORNIN TO YA!” It was sort of like the Ritalin was the Ying to the Klonipin, which was my Yang. Anyway, I hope I get some relief with the Neurontin.
I went Mountain biking a couple weekends ago. I took my regular dose of Adderal XR (30 mg). Since stimulants improve cardiovascular threshold, and I had some extra Ritalin, I decided to take 20 mg of Ritalin before my ride. I had a blast! I wasn't in a hypomanic state or anything-- I just felt like a kid out there, just full of P & V. When I got home I got in an argument with my roommate, and I swear I could feel the adrenalin pump through my veins which is a sensation I hadn't felt in a very long time. Being that I have been in almost a continual state of lethargy and apathy in the last few years, it sure did feel good to be at that level of aliveness again. I've noticed that if after I take my morning dose of stimulants, if I augment the stimulants with exercise it seems to double the effectiveness of the drugs.
Have a great day.
--Tim
Posted by Peter on November 29, 2001, at 11:58:26
In reply to Re: adderall update neuropsychological tests, posted by manowar on November 29, 2001, at 11:37:33
> > Now that I'm just taking the Adderal XR and Wellbutrin I really notice that the Adderal is really kind of dragging my mood down even lower than normal.
Oh man, after all the great things you told me about adderall XR? I just started it today!! No, just kidding, I know it's effects are different for everyone. Wish me luck.
Peter
Posted by manowar on November 29, 2001, at 12:21:53
In reply to Re: adderall update neuropsychological tests, posted by Peter on November 28, 2001, at 23:41:20
Dittos to ya Peter,
You hit the nail on the head about having to trust doctors and even if a scan wouldn't change diagnosis and treatment that it might give you some clarity. Personally, I think that most doctors are egoists that like a patient to become completely dependant on them. They really seem to hate outside influence. My attitude is screw them. I'm the guy that feels like shit not them. I take complete responsibility for my problems. I think of my doctors as consultants. They really can only do one thing that I can't-- get me my psychoactive drugs. Actually sometimes, like in the case of Reboxetine or Picamilion-- I can get them from overseas when they can't get it at all (ha ha ha ha ha). It really felt good to tell this one pdoc that I was going to that I decided to start taking Reboxetine. His face got red. He was really pissed that I would ever think of something like that. He proceeded to tell me that I was not a doctor and I didn't know squat, and I agreed with him. But dammit I was getting a little desperate, and I didn't have any faith in him. I guess he knew that, and that's why he got so mad. What control freaks some of them are! But my doctor at the Amen clinic where I got the SPECT scans done told me that he admired my tenacity. Yes, SPECT is only a tool-- it's not a "doctor in a box". But for me by God, it was a powerful tool that really seemed to clarify where my problems were. I mean what harm can another evaluation do? Besides a small dose of radiation, a lot of money and some time off, I just don't know. I think most doctors in a private setting hate the idea of being consulted by another physician. It must be like kissing your sister:)Forget about SPECT. If you feel like a guinea pig (been there) and you don't feel like you've improved, it's your right to get another opinion. Don't be afraid to be assertive. Remember, they work for us.
Congrats on beating your addictive behavior. If you feel like you'd like to get another opinion, or an fMRI or a SPECT or whatever, you're the boss, and you have to live with your moods not a doctor. Go for it-- make your own decisions and best of luck to ya.
--Tim
Posted by manowar on November 29, 2001, at 13:01:45
In reply to Re: adderall update neuropsychological tests, posted by Peter on November 29, 2001, at 11:58:26
> > > Now that I'm just taking the Adderal XR and Wellbutrin I really notice that the Adderal is really kind of dragging my mood down even lower than normal.
> Oh man, after all the great things you told me about adderall XR? I just started it today!! No, just kidding, I know it's effects are different for everyone. Wish me luck.
> PeterHi Peter,
It's really the XR (extended release action) that I was bragging about not so much the drug. You shouldn't have any problems with the Adderal XR at all.You know its kinda wierd but when I started taking the Adderal XR, I felt like crap, but I thought it was a side effect to the Seroquel that I just started taking. In retrospect, I think that the Seroquel and the Addreral XR were both involved in making me feel like crap.
By the way, Good Luck.
--Tim
Posted by Mitch on November 29, 2001, at 13:13:20
In reply to Re: adderall update neuropsychological tests, posted by manowar on November 29, 2001, at 11:37:33
> Mitch,
> Thanks a lot for the info. I made an appointment to see my doc today. Now that I'm just taking the Adderal XR and Wellbutrin I really notice that the Adderal is really kind of dragging my mood down even lower than normal. So I'm going to ask him to put me back on the Medadate (methylphenidate XR). The Medadate and Concerta are practically the same but I felt the Medadate kick in a little sooner than the Concerta.
>
> I hate polypharmacy because it can be so damn confusing. It's hard to tell whether you feel worse because of a side effect of one of your drugs, or because of a combination that may not suit your particular system - or whatever. It takes so long for AD's to be effective. You have to be very patient and suffer through side effects to really give a drug a good trial. What a racket!Been there been doing that for quite awhile now!
I am very lucky to have a pdoc that is being *very* patient with me. When my moods change or my seasonal depressions wax and wane I want to tinker with meds and that can sometimes cause as many problems as they solve.>
> Anyway, what I'm trying to figure out is this: Since at this time I'm only taking Wellbutrin which by itself is not helping me, should I ask my doctor to stop taking that too, and start a trial of Neurontin clean? My pdoc in CA that evaluated the scans told me that the first order of business is to find a good mood stabilizer to stabilize function in the temperate (sp?) lobes which for me are under functioning and the basil ganglia which is slightly over functioning. I guess that finding one drug at a time to help one problem at a time would be the most logical approach to my treatment.I know I find this advice hard for myself to take, but you really need to change one thing at a time or you might find yourself clueless as to what is helping or causing problems. My advice is simply to add the Neurontin on to your Adderall XR and Wellbutrin and see what happens. Your pdoc suggested it. You might find that it will improve your mood and then you won't feel a need to switch your existing meds around. I don't know what it is about Neurontin (for me anyhow), but it *wakes* up my head. There is something I found in psychobabble tips a long time ago where a pdoc was using Neurontin and dexedrine (which Adderall contains)in combination for ADHD and it worked better than either med alone. Another thing-Neurontin is also helpful for temporal lobe epilepsy (as it is an anticonvulsant used for complex partial seizures which TLE most commonly triggers).
>
> >There was a short interval of a few weeks when I hit what I call a "total clear spot" when I was on Neurontin 300mg bid, Adderal 5mg AM, and was still experiencing edginess from the pstim (what to do?).
>
> What is pstim?Oh, just shorthand for psychostimulant which Adderall/Ritalin,dexedrine, etc. are.
>
> Years ago I think I tried two different mood stabilizers. I wish I knew which ones they were so I could try to avoid them. But I do remember feeling the "dumbing down" effect, so my trials were very short. But I never had to have my blood tested. Don't you have to get your blood tested for all the regular mood stabilizers? I know that Neurontin is an atypical mood stabilizer that doesn't require blood testing.The only one I know of that "requires" blood-level testing is Depakote. But that has more to do with research done on people presenting with full-blown mania and what blood-level range of Depakote was effective at quelling the manic symptomology.
People who are cyclothymic or BPII often respond adequately with "subtherapeutic" dosages of Depakote with resulting lower blood levels.>
> I've read that psychostimulants can also act as mood stabilizers. Maybe the Medadate was slightly effective in that area.My experience with pstims confirm that as well. They didn't seem to aggravate cycling like antidepressants obviously do for me (I have to keep them to a minimum). In fact, I mood-charted the entire time I was on Adderall and I had stopped all antidepressants. I was just taking Neurontin+Adderall and the cycling gradually just faded away. That may have more to say about antidepressants aggravating cycling than pstims dampening cycling, however. I am convinced that sleep/wakefulness architecture and levels of consciousness is at the core of the mood cycling problems somehow. The Adderall made my sleep very dense and restful while my daytime level of consciousness was improved and sharpened. When I was on various antidepressants my sleep seemed broken up, light, excessively dreamy, which resulted in a day-long fatigue with extreme focus and attention problems. When my asleep/awake situation is like that is when I am cycling the WORST. Who knows? Sleep deprivation/oversleeping-napping+cognitive dysfunction *provokes* worsened cycling? SSri's seem to be quite nasty for doing that. AD's with short half-lives seem less troublesome.
>
> Well hopefully today I'll get a script for the Medadate and Neurontin. Neurontin affects GABA doesn't it? Hopefully it will help me feel nice and cozy like the klonipin did when I took it in the evening. I really felt the Klonipin worked synergistically with the Ritalin. It was great to take the Klonipin at night because it just shut down any excess stress and tension that I might have gotten from the Ritalin. When I took the Ritalin in the morning it was like "HELLO-TOP OF THE MORNIN TO YA!” It was sort of like the Ritalin was the Ying to the Klonipin, which was my Yang. Anyway, I hope I get some relief with the Neurontin.Whenever I first started Neurontin (300mg 3x daily), I felt a dramatic anti-anxiety and antidepressant effect.
>
> I went Mountain biking a couple weekends ago. I took my regular dose of Adderal XR (30 mg). Since stimulants improve cardiovascular threshold, and I had some extra Ritalin, I decided to take 20 mg of Ritalin before my ride. I had a blast! I wasn't in a hypomanic state or anything-- I just felt like a kid out there, just full of P & V. When I got home I got in an argument with my roommate, and I swear I could feel the adrenalin pump through my veins which is a sensation I hadn't felt in a very long time. Being that I have been in almost a continual state of lethargy and apathy in the last few years, it sure did feel good to be at that level of aliveness again. I've noticed that if after I take my morning dose of stimulants, if I augment the stimulants with exercise it seems to double the effectiveness of the drugs.
> Have a great day.
> --Tim
You might want to check your blood pressure at different times of the day to see what is happening with that. I got elevated BP from Adderall with headaches in the back of my head during heavy exercise. I was told to workout first thing in the morning before taking it.Mitch
Posted by manowar on November 29, 2001, at 16:36:21
In reply to Re: adderall update neuropsychological tests » manowar, posted by Mitch on November 29, 2001, at 13:13:20
Mitch,
Thanks a lot for the info. You seem to have the exact same mood profile that I do. I saw my doc this afternoon, and he wanted me to continue the Wellbutrin and take the Adderal XR (30 mg) every other day and chart my moods. He was disappointed that I stopped the Seroquel, but I swear it really dumned me down. I think he likes to use the Seroquel with ADD patients because I read that Seroquel's effect on D2 receptors does something to make stimulants more effective... But man, thanks for giving me some new hope about the Neurontin. I'm excited about trying it. My doc asked me if I ever had taken a mood stabilizer before and I told him that I tried a couple 5-7 years ago and they had a cognitive dulling effect. He told me that was quite typical of the mood stabilizers. But I think when I go back to see him in a week he'll start me out on the Neurontin if I'm lucky.As far as my BP goes,
I just had a physical a couple months ago and my bp is great. Every time I go see the doc they check my bp and its always good.Again thanks a mil for the info,
--Tim
Posted by fluffykitty on November 29, 2001, at 18:14:03
In reply to Re: adderall update neuropsychological tests » Mitch, posted by manowar on November 29, 2001, at 16:36:21
I second the Neurontin use and its usefulness. It works for me!
Posted by Mitch on November 29, 2001, at 23:12:13
In reply to Re: adderall update neuropsychological tests » Mitch, posted by manowar on November 29, 2001, at 16:36:21
Posted by Noa on December 1, 2001, at 14:39:09
In reply to Re: adderall update neuropsychological tests, posted by Peter on November 28, 2001, at 23:41:20
> >But I'm worried about taking adderall if I don't
have ADD - it's a serious drug and it's not meant to be
used for anything else.It is FDA approved for ADD, but that doesn't mean it is not meant for use with other disorders. There is a difference. As you may know, to get FDA approval, the company has to undergo a long and expensive research process. This is just to get the drug on the market. But because getting it on the market will yield major financial gain, it is worth it to them to put the time and money into the approval process. These preapproval/premarket studies focus usually on one target diagnosis (like ADD). The medication's therapeutic value for other diagnoses might not be studied (not necessary for getting it approved, why spend the money, etc.) Then, once a medication is on the market, doctors often find they are therapeutic for other diagnoses. Although there may be published reports of these "off label" applications, there may never be further controlled studies to get the medication *labeled* for those uses. The evidence of efficacy is often from clinical experience and anecdotal communications among doctors. Once there is experience with a med and it is known to be reasonably safe, there is no financial motive for anyone to fund a major study for publication, unless there is some kind of profit motive, such as getting approval for a medication's use in pediatrics, or some other very marketable sector.
So, this is a long way to say that Adderall IS used for things other than ADD and it is not unsafe to do so. It needs to be a decision based on the physician's clinical experience, and reports from other doctors of efficacy.
For example, I do not have ADD, but take Adderall as part of my antidepressant cocktail. It potentiates the antidepressant effects of my ADs and helps me feel calm and focused.
Posted by Noa on December 1, 2001, at 14:50:02
In reply to good luck with Neurontin add-on (nm), posted by Mitch on November 29, 2001, at 23:12:13
I kind of was aware of Amen using the scans in diagnosing ADD,etc., but didn't know others were doing so, too.
My understanding is limited--that of a non-scientist-- and also not up-to-date, but it had been that they aren't that useful (yet) in diagnosis because of cost effectiveness. How much info does it really yield compared to the cost? And, will it provide info that would be significant in the decision making process as to what medications to try.
Also, I thought that while group differences are evident in the scans, there isn't enough info on how individual difference might show up and how to interpret it as a diagnostic tool (as opposed to a research tool comparing groups). I think there is potential for the scans to be used diagnostically in the future, but from what I understand, right now the technology isn't exactly ready for the average doctor's office. I may be very cynical but I suspect that the biggest value of the scans done in the clinic are to provide data for Dr. Amen's research. I may be wrong. JMHO.
Posted by Elizabeth on December 1, 2001, at 15:40:35
In reply to Re: Amen Clinic and SPECT Scans, posted by Noa on December 1, 2001, at 14:50:02
> I may be very cynical but I suspect that the biggest value of the scans done in the clinic are to provide data for Dr. Amen's research. I may be wrong. JMHO.
Research is important, and in this field it is absolutely necessary that the proper research be done because the information available is so limited and because the potential benefits are so great.
But researchers should not be charging people to be research subjects. In this particular case I think it's extremely likely that there are plenty of other potential sources of funding. I also think that it's disingenuous, not to say dishonest, to portray current research hypotheses as facts for the purpose of attracting more clients (i.e., paying research subjects).
-elizabeth
Posted by noa on December 4, 2001, at 17:12:57
In reply to Re: Amen Clinic and SPECT Scans » Noa, posted by Elizabeth on December 1, 2001, at 15:40:35
Elizabeth, is that what is happening with Amen? I hope this is not concluded from my comments, because as I said, I don't know what the clinic is doing. But perhaps you have your own knowledge of what is happening at the clinic.
I agree with you in principal, just don't want my email to have started any slander rumors.
Posted by lizabent on August 9, 2005, at 15:31:17
In reply to Re: adderall update neuropsychological tests, posted by fluffykitty on November 29, 2001, at 18:14:03
Just a word of caution about neurontin: my mom was taking it for nerve pain in her neck. After about 6 months, she was spaced-out, forgetting things, and losing her way while driving to places she had been before. She didn't notice she was having trouble, so I called one of her trusted friends to ask her, and she said she saw the same symptoms developing. My mom had to switch meds due to these effects.
Just a cautionary note to you , since they may not tell you about those particular effects.
This is the end of the thread.
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