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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by cybercafe on December 22, 2002, at 14:34:16
i was taking zyprexa+clonazepam for bp II, then when we threw in
30 mg of ritalin sr it seemed to do littledo anti-psychotics make ADD worse, or make stimulants less effective?
Posted by Ritch on December 22, 2002, at 18:12:53
In reply to do anti-psychotics make ADD worse??, posted by cybercafe on December 22, 2002, at 14:34:16
> i was taking zyprexa+clonazepam for bp II, then when we threw in
> 30 mg of ritalin sr it seemed to do little
>
> do anti-psychotics make ADD worse, or make stimulants less effective?
>
>
They make stimulants less effective. If you are taking enough of an AP, your D2 receptors are all pretty much going to be blocked and a stimulant would likely have little effect. They can make ADD symptoms worse, too. I remember when I was trying low-dose Seroquel at bedtime, I would have a rebound super-attentive effect about 16 hrs. post-dosing, when the D2 receptors were becoming unoccupied.
Posted by cybercafe on December 22, 2002, at 21:24:52
In reply to Re: do anti-psychotics make ADD worse?? » cybercafe, posted by Ritch on December 22, 2002, at 18:12:53
> > i was taking zyprexa+clonazepam for bp II, then when we threw in
> > 30 mg of ritalin sr it seemed to do little
> >
> > do anti-psychotics make ADD worse, or make stimulants less effective?
> >
> >
>
>
> They make stimulants less effective. If you are taking enough of an AP, your D2 receptors are all pretty much going to be blocked and a stimulant would likely have little effect. They can make ADD symptoms worse, too. I remember when I was trying low-dose Seroquel at bedtime, I would have a rebound super-attentive effect about 16 hrs. post-dosing, when the D2 receptors were becoming unoccupied.
>damn... actually i was reading an article on the journal of clinical psychiatry that implicated D4 receptors ...
and apparently olanzapine binds strongly to D4 receptors
but then i thought norepenephrine was also important in
ADD....what is the mechanism of action of ritalin, just
inhibition on the dopamine re uptake transporter?
Posted by Ritch on December 23, 2002, at 9:26:42
In reply to Re: do anti-psychotics make ADD worse??, posted by cybercafe on December 22, 2002, at 21:24:52
> > > i was taking zyprexa+clonazepam for bp II, then when we threw in
> > > 30 mg of ritalin sr it seemed to do little
> > >
> > > do anti-psychotics make ADD worse, or make stimulants less effective?
> > >
> > >
> >
> >
> > They make stimulants less effective. If you are taking enough of an AP, your D2 receptors are all pretty much going to be blocked and a stimulant would likely have little effect. They can make ADD symptoms worse, too. I remember when I was trying low-dose Seroquel at bedtime, I would have a rebound super-attentive effect about 16 hrs. post-dosing, when the D2 receptors were becoming unoccupied.
> >
>
> damn... actually i was reading an article on the journal of clinical psychiatry that implicated D4 receptors ...
>
> and apparently olanzapine binds strongly to D4 receptors
>
> but then i thought norepenephrine was also important in
> ADD....
>
> what is the mechanism of action of ritalin, just
> inhibition on the dopamine re uptake transporter?
Ritalin also blocks the NE reuptake pumps and releases NE as well. Do you think your pdoc would be willing to reduce the olanzapine a bit? It almost sounds like your DA receptors generally are fully occupied, and there just isn't any wiggle room to activate them.
Posted by Ritch on December 23, 2002, at 9:33:06
In reply to Re: do anti-psychotics make ADD worse??, posted by cybercafe on December 22, 2002, at 21:24:52
I had forgotten that AP's also antagaonize adrenoreceptors as well as DA receptors. That is why postural hypotentension is associated with them in a dose-dependent manner. That could be causing as much problem as the DA blockade. That would also help explain why NE release isn't doing much either.
Posted by cybercafe on December 23, 2002, at 14:39:01
In reply to Re: do anti-psychotics make ADD worse?? » cybercafe, posted by Ritch on December 23, 2002, at 9:26:42
i'll give you a full reply later mitch, but for now i should let you know that while taking zyprexa/clonazepam i was able to achieve a "sense of wellbeing" by drinking 2 litres of pepsi
> > >
> > > They make stimulants less effective. If you are taking enough of an AP, your D2 receptors are all pretty much going to be blocked and a stimulant would likely have little effect. They can make ADD symptoms worse, too. I remember when I was trying low-dose Seroquel at bedtime, I would have a rebound super-attentive effect about 16 hrs. post-dosing, when the D2 receptors were becoming unoccupied.
> > >
> >
> > damn... actually i was reading an article on the journal of clinical psychiatry that implicated D4 receptors ...
> >
> > and apparently olanzapine binds strongly to D4 receptors
> >
> > but then i thought norepenephrine was also important in
> > ADD....
> >
> > what is the mechanism of action of ritalin, just
> > inhibition on the dopamine re uptake transporter?
>
>
> Ritalin also blocks the NE reuptake pumps and releases NE as well. Do you think your pdoc would be willing to reduce the olanzapine a bit? It almost sounds like your DA receptors generally are fully occupied, and there just isn't any wiggle room to activate them.
Posted by cybercafe on December 23, 2002, at 20:48:54
In reply to Re: do anti-psychotics make ADD worse?? » cybercafe, posted by Ritch on December 23, 2002, at 9:26:42
>
> Ritalin also blocks the NE reuptake pumps and releases NE as well. Do you think your pdoc would be willing to reduce the olanzapine a bit? It almost sounds like your DA receptors generally are fully occupied, and there just isn't any wiggle room to activate them.i'm taking the lowest dose of zyprexa i believe (5 mg) and probably require it for mood stability
Posted by Ritch on December 23, 2002, at 22:41:49
In reply to Re: do anti-psychotics make ADD worse?? » Ritch, posted by cybercafe on December 23, 2002, at 20:48:54
>
> >
> > Ritalin also blocks the NE reuptake pumps and releases NE as well. Do you think your pdoc would be willing to reduce the olanzapine a bit? It almost sounds like your DA receptors generally are fully occupied, and there just isn't any wiggle room to activate them.
>
> i'm taking the lowest dose of zyprexa i believe (5 mg) and probably require it for mood stability
Have you tried other meds that are not AP's (DA/NE receptor antagonists) for your bipolar (lithium/Depakote/etc.)? You could try increasing the Ritalin, but if a "midrange" 30mg isn't doing *anything*, then I would strongly suspect the olanzapine is completely blocking its effect. If an AP is required-what about a switch to low-dose hs Seroquel istead?
Posted by cybercafe on December 24, 2002, at 13:56:02
In reply to Re: do anti-psychotics make ADD worse?? » cybercafe, posted by Ritch on December 23, 2002, at 22:41:49
> Have you tried other meds that are not AP's (DA/NE receptor antagonists) for your bipolar (lithium/Depakote/etc.)? You could try increasing the Ritalin, but if a "midrange" 30mg isn't doing *anything*, then I would strongly suspect the olanzapine is completely blocking its effect. If an AP is required-what about a switch to low-dose hs Seroquel istead?
yeah i tried valporate and gabapentin ... i think i still cycled a bit on valporate, and i spent more time in mild depressive states ....
with zyprexa i don't feel depressed as much as apathetic ... i just don't want to get out of bed... once out of bed i just don't want to do anything
30mg of ritalin SR (which i've read is much weaker than normal immediate release) definately does some good ... i guess i can only hope another 10 mg makes a big difference
i don't want to change antipsychotics or even risk going off zyprexa because i feel i have been lucky that my EPS faded quickly and don't want to try my luck again
i dunno...i can't figure out if i should ask my doc for a better stimulant or to add an antidepressant, ug
thanks for replying Mitch :)
Posted by Ritch on December 25, 2002, at 8:53:27
In reply to Re: do anti-psychotics make ADD worse??, posted by cybercafe on December 24, 2002, at 13:56:02
> > Have you tried other meds that are not AP's (DA/NE receptor antagonists) for your bipolar (lithium/Depakote/etc.)? You could try increasing the Ritalin, but if a "midrange" 30mg isn't doing *anything*, then I would strongly suspect the olanzapine is completely blocking its effect. If an AP is required-what about a switch to low-dose hs Seroquel istead?
>
> yeah i tried valporate and gabapentin ... i think i still cycled a bit on valporate, and i spent more time in mild depressive states ....
>
> with zyprexa i don't feel depressed as much as apathetic ... i just don't want to get out of bed... once out of bed i just don't want to do anything
>
> 30mg of ritalin SR (which i've read is much weaker than normal immediate release) definately does some good ... i guess i can only hope another 10 mg makes a big difference
>
> i don't want to change antipsychotics or even risk going off zyprexa because i feel i have been lucky that my EPS faded quickly and don't want to try my luck again
>
> i dunno...i can't figure out if i should ask my doc for a better stimulant or to add an antidepressant, ug
>
> thanks for replying Mitch :)
>
From what I remember, I have read quite a few squawks about Ritalin-SR. You might ask about trying some Adderall instead. Maybe 20mg of XR. People often get a more robust response to a different stimulant. I have heard that is the smoothest amp-stim you can get. I only tried the regular version of Adderall and it was pretty even (over 8-12 hrs or so). You can also get the generic version of that fairly cheap. Have a good holiday---Mitch
Posted by jimmygold70 on December 25, 2002, at 11:32:30
In reply to do anti-psychotics make ADD worse??, posted by cybercafe on December 22, 2002, at 14:34:16
Antipsychotics (but not Seroquel) mask the dopaminergic effects of Ritalin, making it worthless. I think that noradreneric mechanism is probably more important for concentration, so adding a NE reuptake inhibitor (e.g. Edronax) and/or switching to a weaker D2 antagonist (Risperdal, Zyprexa,Geodon and Seroquel in that order) MIGHT make you more concentrated.
Jimmy
> i was taking zyprexa+clonazepam for bp II, then when we threw in
> 30 mg of ritalin sr it seemed to do little
>
> do anti-psychotics make ADD worse, or make stimulants less effective?
>
>
This is the end of the thread.
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