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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 cybercafe on January 7, 2003, at 0:24:23
or can you take the same dose of ADD drugs forever?
stims work fast, make you feel great, and have no side effects...
so what's the bad news?
Posted by jonh kimble on January 7, 2003, at 0:27:50
In reply to do people develop a tolerance to stims?, posted by cybercafe on January 7, 2003, at 0:24:23
the bad news is they caused tolerance in me, very very fast(a day or two). but if they dont, you might have a winner.
Posted by Noa on January 8, 2003, at 17:02:15
In reply to do people develop a tolerance to stims?, posted by cybercafe on January 7, 2003, at 0:24:23
I think it depends on the person. I feel fortunate that I am able to use this medication stably. When I first started taking adderall (regular relese) I did increase it from 2x10 and 1x5 to 3x10, but then didn't increase it after that. When I switched to the xr, I started at 30 mg and have been at that dose for a while, and have really not felt a craving for more. And I think there are many people who can also take this medication without tolerance problems. On the other hand, I have read other accounts of people who do develop more of a tolerance, and some who become rather addicted.
That is not to say I don't have some "dependence" on it--if stopped suddenly, it feels awful.
Posted by viridis on January 8, 2003, at 22:21:30
In reply to Re: do people develop a tolerance to stims?, posted by Noa on January 8, 2003, at 17:02:15
Response to stimulants seems to vary a lot among individuals (no surprise there). I've been taking 5-10 mg Adderall/day for about a year, and it still helps, although I do sometimes space the doses quite closely, whereas at first I took them several hours apart. So far I've stuck to a 10 mg/day limit, although I'm sure that more wouldn't cause any problem. I also skip it for a day or two here and there and haven't noticed any withdrawal. My pdoc likes this (taking stimulant "vacations"), because he feels it decreases the chance of tolerance developing.
The main thing I notice when I'm off it is that my thinking is less focused, and if I discontinue it for more than a couple of days, I can feel low-level depression creeping in. But nothing dramatic happens, and I certainly don't crave it (I am on a very low dose, though).
I'm planning to give Straterra a try soon. Although I'm quite happy with Adderall, I'm interested in trying this new alternative, and it would be more convenient not to have to deal with a Schedule II med (although the Adderall prescriptions haven't been a big deal, they have to delivered by courier and I have to be there to sign for them).
Posted by aminated on January 10, 2003, at 23:37:22
In reply to Re: do people develop a tolerance to stims?, posted by viridis on January 8, 2003, at 22:21:30
I've been taking Adderall 3x20 mg for over 4 years in addition to ADs for treatment-resistant depression. I haven't had to raise the dose at all since settling on this one as being effective (in the first 2 or 3 months of taking it). It only acted like an AD the first few weeks, that can't be helped, but it keeps me motivated, interested in life and mentally clear. I DO THINGS instead of just sitting around ruminating on my feelings (watch TV), and activity has an indirect antidepressant effect that i can feel better than I can crappy Wellbutrin etc. which alone does nothing much.
So even though i'm long-since tolerant to the mood-elevating effect of stims, i haven't noticed any tolerance to the motivating-activating effect in 4+ years on the same dose.
Posted by fachad on January 11, 2003, at 2:09:29
In reply to do people develop a tolerance to stims?, posted by cybercafe on January 7, 2003, at 0:24:23
> or can you take the same dose of ADD drugs forever?
Here's a thought I had a few months ago about tolerance to stims. The whole thread may be of interest to you:
http://www.dr-bob.org/babble/20020215/msgs/94906.html
> stims work fast, make you feel great,
They do work fast, but they don't always make you feel great. I personally think accepting the loss of the "feel great" feeling and continuing to derive benefits after it is gone is the key to years of ongoing usefulness of a fixed dose of stimulants.
> and have no side effects...
And as for "so side effects"...you are completely mistaken about that. They all make your blood pressure go up and your heart beat faster. They all can produce anxiety.
Ritalin makes me feel extremely gloomy and melancholy when it wears off...which is about every 2 hours.
Adderall was absolutely intolerable for me. It makes my heart race and gave me worse dry mouth than Elavil.
Dex is the best of the lot for me, but it still makes my heart race sometimes, and it makes me edgy, and easily prone to anger. Dex also gives me a peculiar dry throat that sometimes becomes sore.
> so what's the bad news?
The big bad news is that they are Schedule II Controlled Substances. That means you will have to hand-carry a hand-written prescription every month from your doctor to the pharmacy. No refills are allowed.
It also might make some docs suspect you of being a "drug seeker". There's a whole mess that comes along with that. For most it's not a problem, but it really could create a huge problem if someone had the right combination of bad luck.
There are plenty of posts here at PSB from people who have had trouble with docs because they "asked" for stimulants.
So I hope this answers your questions.
Posted by viridis on January 11, 2003, at 3:28:05
In reply to Re: ...develop a tolerance to stims? - Answers » cybercafe, posted by fachad on January 11, 2003, at 2:09:29
Just a couple of comments -- these address Adderall, the only pstim I've taken by prescription (besides Provigil, and Wellbutrin, if you count that as a stimulant).
I find that Adderall produces a calming, focused effect at low doses (I have severe anxiety problems but also ADD, and Adderall really does have the "reverse effect" on me that some have disputed here). My pdoc says that in his experience, ADD patients prone to anxiety can have problems with Ritalin -- he's found it too anxiogenic, and much more likely to cause "crashes" than Adderall. But he does prescribe it for some patients, if it works.
The schedule II thing is a pain, but at least where I am, I can get a 3-month prescription by mail order. The downside is that it has to be delivered by courier, and I have to be there to sign for it. But at least it's only every 3 months.
My pdoc doesn't think that getting a prescription from another doctor will be a problem, should I move. I'm on a low dose, and have a legitimate ADD diagnosis.
I am going to try Strattera soon, though -- it looks promising, and the prescribing issues should be simpler, if it works as well as Adderall.
Posted by HannahBeGood on January 11, 2003, at 21:14:10
In reply to Re: do people develop a tolerance to stims?, posted by Noa on January 8, 2003, at 17:02:15
> I think it depends on the person. I feel fortunate that I am able to use this medication stably. When I first started taking adderall (regular relese) I did increase it from 2x10 and 1x5 to 3x10, but then didn't increase it after that. When I switched to the xr, I started at 30 mg and have been at that dose for a while, and have really not felt a craving for more. >
> That is not to say I don't have some "dependence" on it--if stopped suddenly, it feels awful.
> <clipped>Noa~
When u say 'it feels awful', may I ask u what u mean, specifically? I use dexedrine, and my MAJOR symptom when I stop is simply irrepressible fatigue & an undeniable need to sleep for at least 2 days straight.By the middle of the third day, I begin to come out of the fog. I am awake and fairly normal, no nasty physical symptoms. However, I must use stimulants for both my ADD and to achieve any kind of relief from my TRD and anxiety.Hannah
>
Posted by HannahBeGood on January 11, 2003, at 21:24:30
In reply to Re: do people develop a tolerance to stims?, posted by viridis on January 8, 2003, at 22:21:30
>
>
> The main thing I notice when I'm off it is that my thinking is less focused, and if I discontinue it for more than a couple of days, I can feel low-level depression creeping in. But nothing dramatic happens, and I certainly don't crave it (I am on a very low dose, though).
<clipped>Viridis~
Do you not feel any 're-bound' fatigue on ur 'holidays? I wd. like to take more of them,as they do help my p-stims maintain their efficacy, but one of my atypical dep. symptoms is excessive daytime sleepiness, and when I go off my stim, I am quickly ensconced in a deep sleep session which lasts at least 48 hrs. (w/breaks for bathroom and juice). I cannot deny this urge to sleep off the extra energy I am able to expend when helped by p-stim therapy.
Just curious if u feel more fatigued or sleepy yourself, and do you slleep more on ur 'holiday'?
Hannah
Posted by HannahBeGood on January 11, 2003, at 22:53:46
In reply to Re: ...develop a tolerance to stims? - Answers » cybercafe, posted by fachad on January 11, 2003, at 2:09:29
> > or can you take the same dose of ADD drugs forever?
>
> Here's a thought I had a few months ago about tolerance to stims. The whole thread may be of interest to you:
>
> http://www.dr-bob.org/babble/20020215/msgs/94906.html
>
> > stims work fast, make you feel great,
>
> They do work fast, but they don't always make you feel great. I personally think accepting the loss of the "feel great" feeling and continuing to derive benefits after it is gone is the key to years of ongoing usefulness of a fixed dose of stimulants.
>
> > and have no side effects...
>
> And as for "so side effects"...you are completely mistaken about that. They all make your blood pressure go up and your heart beat faster. They all can produce anxiety.
>
> Ritalin makes me feel extremely gloomy and melancholy when it wears off...which is about every 2 hours.
>
> Adderall was absolutely intolerable for me. It makes my heart race and gave me worse dry mouth than Elavil.
>
> Dex is the best of the lot for me, but it still makes my heart race sometimes, and it makes me edgy, and easily prone to anger. Dex also gives me a peculiar dry throat that sometimes becomes sore.
<clipped>Hi fachad~
Good points~
I have tried all 3, plus Wellbutrin.
Wellbutrin gave me chest pain for one hour after every dose I ever took. I tried it 3 times,no, 4, b/c none of the other AD's helped me at all (I was not yet with my current p-doc). I dealt w/the chest pain, b/c I knew it wd. go away, but during my first trial it also gave me terrible muscle cramps in in my upper back. The next 2 times, the cramps lessened and disappeared. This was all 3 or so years ago. I tried it again in early 2002 along w/Adderall b/c Add. was not stimulating enuf, even at high doses. Wham! First dose of WB 100mgs (in combo with Adderall 60 mgs a day) almost immediately made me feel like I was speeding my way to heart attack city. I took 40 mgs. propanolol and 1 mg. clonazepam, and once the WB was out of my system, I said to myself`'You're a great drug for some people, but this is our final parting!'Ritalin did nothing good for me. I felt nothing 'til taking b/t 45-60mgs. at one dose. I felt angry, super-anxious, totally dysphoric for 45 minutes, then I crashed, had to nap for 1-2 hours to regain my calm and that was it. And I had started at 5mgs.2x's a day, titrating up. For me, a truly nasty drug, right up there w/Stadol (a pain med spray) which gave me the only actual panic attack I've ever had.(I do have an anxiety disorder-so...maybe ritalin is NOT the answer for those who are both addled and jumpy).
Adderall alone was effective for about a month, and along w/FXR pulled me out of a 3 month long bout of major depression. But, it gave me terrible dry mouth as well, and we had to keep increasing the dose, to the point where pharmacists were looking at me warily. And, I felt drowsy on the high dosage, not stimulated, so I asked if we could try Dexedrine and p-doc said sure.
I now use between 20 to 80 mgs. of dexedrine a day, a combination of 15mg. dex spansules(long-acting) and 5 mg. Dexstrostat tabs(IR). My p-doc allows me to fine-tune my needs daily. I usually end up w/2 or 3 spansules and 1 or 2 dex tabs, staying in the 40 to 60 range. IT's good to know I am allowed the freedom to go high or low. I also use clonazepam 1-4 mgs. prn daily and at least 1 40mg. propanolol daily, altho I can go up to 120mgs. in divided doses prn, but have rarely if ever gone above 80. These are for vascular headache prevention, but are also great for smoothing out physical symptoms of anxiety (chest pressure-yuk!) more effectively than the clonazepam, which I describe as my mental/intellectual anxiolytic (and mood stabilizer).I am a mixed bag, no exact diagnosis as yet, my doc is not big on detailed diagnostic labels, we are treating symptoms still & fine-tuning as we go. I will be able to spend more time w/my talk therapist this year, which is good. There is some manic-depression in my tree, and I have always been very moody. In fact, my main problem now is maintaining a consistent mood.I have never had an attack of mania, altho alcohol often makes me quite hypo-manic. I pretty much quit drinking altogether when I got pregnant 7 years ago. I have no desire for it at all when on A-D's or klonopin.
I deal w/on-going chronic pain, which is controlled by low-dose darvocet ( which helps slightly w/my TRD) and carisoprodal (gen. Soma), prn. When my pain flares occur, they must be dealt with promptly, or I am completely unable to maintain any functionality or emotional stability.
I rarely take my stims while in a bad flare, b/c I need the deep sleep to heal strained and damaged muscle tissue from fibro and herniated discs.I do take Lexapro 15mgs for the past 10 weeks. And, I have been quite consistent w/it. I came off 300 mgs FXR very slowly while starting the Lex. Been ostensibly 'off' the FXR for about 3 weeks, but I do still get a weakish, dizzying brain swoosh every 3 days or so, even now. I then take about 8 or 10 granules of the FXR and no withdrawal effects for next sev'l days. That FXR is some strong jhoo-jhoo.
Don't know if the Lex is doing me any good,really. Probably did help me drop the FXR, which was putting me to sleep.
I am so pleased that my dr. allowed me to titrate up to an effective dosage of p-stim (per my own evaluation/opinion)that did not cause distracting side-effects. It really made me feel like he saw me as a a thinking, rational person who had suffered long enuf and deserved relief, even if it took a lot of trial and effort, and an open attitude towards polypharmacy.(I have tried dozens of A-D's, analgesics, sleep aids & muscle relaxants thru the years). When I reached the point where I felt I was getting the best effect possible (at this time) from the dexedrine, I wanted no more (I was very afraid of becoming hopelessly addicted & craving more, more, more!) and even enjoy my drug holidays, altho I'm pretty useless due to sleepiness during them.
So, that's my sideview, verbose as usual.
Hannah
Posted by HannahBeGood on January 11, 2003, at 23:26:42
In reply to do people develop a tolerance to stims?, posted by cybercafe on January 7, 2003, at 0:24:23
> or can you take the same dose of ADD drugs forever?
>
> stims work fast, make you feel great, and have no side effects...
>
> so what's the bad news?Cyber-
As u can see,from the previous posts, the answer varies. Please read my post to fachad, which I meant to address to u as well, for my experiences.
For me, p-stims are a necessity for me to function at anything close to a level of normalcy, and possibly avoid as many depressive episodes as I have endured in the past.
I'm still fairly new to them, and only time will tell. But, they are the only class of drugs so far that can touch my long-term treatment resistant depression, daytime lethargy and the feeling of being locked out of my own very positive reservoir of potential capabilities and personal creativity. As an artist/designer who has suffered this extremely painful internal detachment and lack of control/access to what I consider to be my 'core' being (a love of beauty, the arts and the NEED to create) I now have hope, for the first time in years, that I might have found a supported (by my meds & med'l team) path which will allow me 'back into' my own truest self. And to express myself thru my art without having to drink alcohol, which I used intermittently for years to allow me to break down internal barriers and at least get a few paintings, drawings and architectural elevations on canvas/paper.
Sipping wine for hours was the only way I cd. concentrate, block out distractions, and the stimuli to which I was intensely sensitized & knocked off-balance by. Wine was my ADD/anxiety med, but, it's NO way to run your life. I finally found it physically and mentally intolerable. Even small amounts can cause me intractable pain and suicidal depressions upon rebound (hangover).
So, good luck, try to maintain a steady hand, and let me (us) know how things go.
Hannah
Posted by viridis on January 11, 2003, at 23:45:10
In reply to Re: ...develop a tolerance to stims? - Answers » cybercafe, posted by fachad on January 11, 2003, at 2:09:29
Re: blood pressure issues: My blood pressure used to be somewhat erratic, but now stays at about 120-something over 80-something (i.e., normal). I think Adderall contributes to this, because it relieves anxiety for me. I do take Klonopin as well, but I think it's the combination that works best. I certainly haven't noticed any elevation in blood pressure or heart rate from Adderall, but instead more consistency.
Posted by cybercafe on January 12, 2003, at 20:32:53
In reply to Re: ...develop a tolerance to stims? - Answers » cybercafe, posted by fachad on January 11, 2003, at 2:09:29
>
> The big bad news is that they are Schedule II Controlled Substances. That means you will have to hand-carry a hand-written prescription every month from your doctor to the pharmacy. No refills are allowed.
>
> It also might make some docs suspect you of being a "drug seeker". There's a whole mess that comes along with that. For most it's not a problem, but it really could create a huge problem if someone had the right combination of bad luck.
>
> There are plenty of posts here at PSB from people who have had trouble with docs because they "asked" for stimulants.
>
> So I hope this answers your questions.Ug... i was hoping to restart my career by moving from canada to the UK...
but i guess i can't expect to get a dose large enough to sustain me during the move
or expect a GP over there to prescribe them for me once i move ?what do you do if you want to take a vacation ?
pdocs are so busy.. will they really make time for you every 2 weeks to get a script when you have achieved remission (and so many others are so desperate to see them)?
Posted by cybercafe on January 12, 2003, at 21:53:37
In reply to Re: ...develop a tolerance to stims? - Answers » cybercafe, posted by fachad on January 11, 2003, at 2:09:29
is it really obvious when an ADD med starts working for you?
or do you have to continually test your concentration by trying out a fulltime job
.... when i would drink large doses of pop i would feel so stimulated and such pleasure that i wasnt as interested in my external environment
but first i would feel hyper and maybe even hypomanic, then as i took more i began to feel calm and just a general sense of wellbeing and calm i never got from antidepressants
Posted by Noa on January 12, 2003, at 22:12:50
In reply to Re: do people develop a tolerance to stims? » Noa, posted by HannahBeGood on January 11, 2003, at 21:14:10
Well, once I forgot to get a new scrip, so I had to go a couple of days without the adderall, and I felt very out of sorts and depressed.
Posted by viridis on January 13, 2003, at 2:57:37
In reply to Re: do people develop a tolerance to stims? » viridis, posted by HannahBeGood on January 11, 2003, at 21:24:30
It's hard to judge whether I feel more tired without pstims, because my "holidays" are usually those rare days when I don't have anything urgent coming up, and I'm usually feeling kind of burned out because I just finished some project. So, I tend to take it easy (but I plan it that way). I'm not big on sleeping anyway, so I might sleep 8 hrs/night when I'm off pstims (and on "vacation" in general), as opposed to 6 hrs while on them (and focused on work).
I really don't think Adderall has much effect on sleep for me, since I can take it any time of the day and still sleep well. I haven't noticed any rebound, other than that if I stay off it, I start to get a bit depressed again. But there's certainly no pronounced withdrawal or craving; my thinking is just less directed.
This is the end of the thread.
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