![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by cybercafe on February 12, 2003, at 20:24:39
i find it intolerable
Posted by fachad on February 12, 2003, at 20:52:04
In reply to how do you handle stimulant rebound depression?, posted by cybercafe on February 12, 2003, at 20:24:39
A couple of suggestions:
First, find out which of the stimulants causes the least rebound depression for you. For me, immediate release methylphenidate causes by far the worst rebound depression, and Adderall causes far too many somatic side effects like racing heart and dry mouth; so dextrostat is the logical choice. It causes a little rebound depression for me, but not much.
Next, consider an extended release preparation like Concerta, Adderall XR, or Dexedrine Spansules. The slow onset/slow wear off will make the rebound much less dramatic.
If you cannot afford the extended release meds (they are all brand only and often not covered by insurance), consider splitting your doses to create a "virtual extended release" effect. For example, if you take three 10mg methylphenidate tablets at 8 AM, 12PM, and 4PM, break those scored tablets into halves or even quarters and take 1/2 tablet every 2 hours instead of a whole tablet every 4 hours, etc.
Finally, for me a very low dose of a tricyclic AD like doxepin or trimipramine makes me feel warm and fuzzy and smoothes the stimulant wear off. Just a small dose, like 10 mg or 25 mg is sufficient.
Posted by Tina P on February 12, 2003, at 21:07:44
In reply to how do you handle stimulant rebound depression?, posted by cybercafe on February 12, 2003, at 20:24:39
Could one of you brief me on what stimulant rebound depression is? And, does this include the use of all stimulants, or only those mentioned in the previous posts? The info would be greatly appreciated! Thanks!
Posted by cybercafe on February 12, 2003, at 23:08:04
In reply to Re: how do you handle stimulant rebound depression? » cybercafe, posted by fachad on February 12, 2003, at 20:52:04
> Finally, for me a very low dose of a tricyclic AD like doxepin or trimipramine makes me feel warm and fuzzy and smoothes the stimulant wear off. Just a small dose, like 10 mg or 25 mg is sufficient.
my doc says if you combine a stimulant with an antidepressant you get a really powerful synergy.. have you found that to be true?
i want to take an AD as well as a stimulant, but my doc says its too dangerous for someone who is bipolar like me
is concerta better than ritalin sr? i am thinking of moving to the UK and trying that out
Posted by fachad on February 12, 2003, at 23:31:35
In reply to Re: how do you handle stimulant rebound depression?, posted by cybercafe on February 12, 2003, at 23:08:04
> my doc says if you combine a stimulant with an antidepressant you get a really powerful synergy.. have you found that to be true?
Not for me, at least not at those low doses.
> i want to take an AD as well as a stimulant, but my doc says its too dangerous for someone who is bipolar like meADs, particularly TCAs have been known to cause bipolars to go into mainia.
> is concerta better than ritalin sr? i am thinking of moving to the UK and trying that out
Concerta is WAY better than ritalin SR.
Posted by IsoM on February 13, 2003, at 13:41:09
In reply to Re: how do you handle stimulant rebound depression?, posted by fachad on February 12, 2003, at 23:31:35
I don't get rebound stim depression by taking my doses in smaller, more frequent doses. It gives me a more level state of alertness than taking one dose in the morning & the other in mid-afternoon. I break it into smaller doses so when the final dose wears off, it's much more gradual & doesn't feel anything more than normal end-of-the-day tiredness.
Perhaps it helps too that I take Provigil & it's done wonders for my mood though it had no effect on my sleepiness. That's what the stim is for.
An extra:
Ritalin has a very strong up & down effect on me while Dexedrine is much gentler. And Dexedrine SR simply works by releasing the first half immediately & then the second half 5 or 6 hours later. It doesn't release slowly over the course of the day. But I don't know how other XR or SR versions of stims may work.
Posted by noa on February 13, 2003, at 18:52:53
In reply to Re: how do you handle stimulant rebound depression? » cybercafe, posted by fachad on February 12, 2003, at 20:52:04
I had bad rebound with immediate release ritalin. A little less with sustained release ritalin. With regular adderall, I didn't get rebound depression, but I got really unfocused between doses. With adderall xr, I don't have any problems.
Posted by viridis on February 13, 2003, at 23:09:28
In reply to Re: how do you handle stimulant rebound depression?, posted by noa on February 13, 2003, at 18:52:53
I don't seem to get the rebound that some others experience, although I haven't tried Ritalin. Regular Adderall is fine for me; I take a couple of small doses a day and they just wear off gradually. Provigil was similar, but didn't help with focus the way that Adderall does. My pdoc did comment that Ritalin is often too "harsh" for adults, especially those with anxiety problems, and prefers Adderall (although he will try Ritalin if necessary).
Posted by cybercafe on February 14, 2003, at 1:08:53
In reply to Re: how do you handle stimulant rebound depression?, posted by fachad on February 12, 2003, at 23:31:35
> > i want to take an AD as well as a stimulant, but my doc says its too dangerous for someone who is bipolar like me
>
> ADs, particularly TCAs have been known to cause bipolars to go into mainia.yeah.... because of their action on norepenephrine... but then stims also work on norepenephrine no?
>
> > is concerta better than ritalin sr? i am thinking of moving to the UK and trying that out
>
> Concerta is WAY better than ritalin SR.please do tell!
Posted by cybercafe on February 14, 2003, at 1:09:55
In reply to Re: how do you handle stimulant rebound depression, posted by viridis on February 13, 2003, at 23:09:28
> I don't seem to get the rebound that some others experience, although I haven't tried Ritalin. Regular Adderall is fine for me; I take a couple of small doses a day and they just wear off gradually. Provigil was similar, but didn't help with focus the way that Adderall does. My pdoc did comment that Ritalin is often too "harsh" for adults, especially those with anxiety problems, and prefers Adderall (although he will try Ritalin if necessary).
damn... my doc says i can't take an amphetamine like dexedrine or adderall because they will cause mania (i'm bipolar type 2)
Posted by viridis on February 14, 2003, at 2:59:56
In reply to Re: how do you handle stimulant rebound depression, posted by cybercafe on February 14, 2003, at 1:09:55
Just curious -- what makes you "BP 2"? I guess I'm a bit skeptical of this category. I could easily have been diagnosed as such (but haven't been), and it seems to me to be a much more subjective diagnosis than BP 1 (which I know is real, based on experiences of a couple of friends who really do show the extreme mood swings, grandiosity, etc.). I'm not challenging your diagnosis, since I'm not qualified to do so, but it just seems like BP 2 has become a catch-all for hard-to-treat patients who happen to respond poorly to newer ADs such as SSRIs.
Posted by cybercafe on February 16, 2003, at 1:52:29
In reply to Re: how do you handle stimulant rebound depression » cybercafe, posted by viridis on February 14, 2003, at 2:59:56
> Just curious -- what makes you "BP 2"? I guess I'm a bit skeptical of this category. I could easily have been diagnosed as such (but haven't been), and it seems to me to be a much more subjective diagnosis than BP 1 (which I know is real, based on experiences of a couple of friends who really do show the extreme mood swings, grandiosity, etc.). I'm not challenging your diagnosis, since I'm not qualified to do so, but it just seems like BP 2 has become a catch-all for hard-to-treat patients who happen to respond poorly to newer ADs such as SSRIs.
it was pretty obvious to me... i had a lot of periods of feeling euphoria... thinking i was invincible, superior to others..... racing thoughts, pacing .... etc etc
Posted by viridis on February 16, 2003, at 4:02:58
In reply to Re: how do you handle stimulant rebound depression, posted by cybercafe on February 16, 2003, at 1:52:29
OK, that is different from me -- I've never felt invincible, although I do have periods of higher than normal confidence, and plenty of the racing thoughts, pacing etc. It seems that the key difference (from what you've described) is that when I get a bit manic, it really is a bit manic -- never out of control re: feelings of superiority etc. But I have experienced many episodes of highly agitated depression, which could qualify as dysphoric hypomania.
So, I guess my question is, what makes you BP 2 vs. BP 1? I still wonder whether BP 2 is a useful diagnosis, or just an artificial limitation on the meds you're allowed.
I don't mean this as a challenge to your pdoc or situation -- I'm just skeptical about the utility of the "bipolar spectrum" approach, and whether people who are designated BP 2 share a common disorder, or are just placed in a vague category for lack of a better diagnosis.
Posted by cybercafe on February 16, 2003, at 16:15:38
In reply to Re: how do you handle stimulant rebound depression » cybercafe, posted by viridis on February 16, 2003, at 4:02:58
> OK, that is different from me -- I've never felt invincible, although I do have periods of higher than normal confidence, and plenty of the racing thoughts, pacing etc. It seems that the key difference (from what you've described) is that when I get a bit manic, it really is a bit manic -- never out of control re: feelings of superiority etc. But I have experienced many episodes of highly agitated depression, which could qualify as dysphoric hypomania.
i suppose anything other than typical melancholic depression could be considered a "mixed state" ... it depends on what book/edition you go by
>
> So, I guess my question is, what makes you BP 2 vs. BP 1? I still wonder whether BP 2 is a useful diagnosis, or just an artificial limitation on the meds you're allowed.depending on your definition of hypomania... you could say i'm not type 1 because
1. i've never been psychotic .. never had hallucinations or strange delusions
or
2. my high moods don't interfere with social functioning... i.e. i'm not violent, don't quit my job and go on spending sprees, etc
(i have never broken the daily routine)>
> I don't mean this as a challenge to your pdoc or situation -- I'm just skeptical about the utility of the "bipolar spectrum" approach, and whether people who are designated BP 2 share a common disorder, or are just placed in a vague category for lack of a better diagnosis.don't worry about me being offended :) .... though i would appreciate any info regarding ritalin SR vs. Concerta
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.