Psycho-Babble Medication Thread 269769

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Re: Do wellbutrin etc., inadvertently raise serato

Posted by MamaB on October 16, 2003, at 12:24:42

In reply to Re: Do wellbutrin etc., inadvertently raise serato » Ame Sans Vie, posted by loolot on October 16, 2003, at 11:14:01


Serotonin Dopamine are a see-saw » automatedlady
Posted by 3 Beer Effect on June 4, 2002, at 14:15:26

In reply to Apathy on SSRIs, posted by automatedlady on June 3, 2002, at 19:40:11

Check in the archives for the above individual, he/she explains this about as well as I have ever heard. MamaB

 

Some advice and non-serotonergic ideas for you... » loolot

Posted by Ame Sans Vie on October 17, 2003, at 3:22:10

In reply to Re: Do wellbutrin etc., inadvertently raise serato » Ame Sans Vie, posted by loolot on October 16, 2003, at 11:14:01

> > Actually, I believe Wellbutrin has a direct effect on serotonin... or so I've read.
>
> Thanks ASV.

Anytime. :-)

> Do you have links to any articles?

I don't have any cut and dry information on this yet, but I'll start doing some research and let you know by tomorrow. I'm rather interested too as I just started taking both Prozac and Wellbutrin XL.

> This is interesting because my Pdoc was suggesting I could try and take a large dose (like 600 mg!) of Wellbutrin because mine is pooping out and nothing else seems to work.

I'm sure there are those who require such a high dose, but *be careful*! I'd guess such a raise in dose could be quite dangerous as bupropion can induce seizures and it appears that seizure risk raises exponentially with every dose increase. All the official literature on the subject I've come across *warns* not to exceed 400mg/day (I mean, it doesn't just list 400mg as the maximum FDA recommended dose -- it considers higher doses to be quite risky territory). I believe the seizure risk is 1/1,000 at 200mg/day and 1/250 at 400mg/day (I may be wrong on the 200mg part, but the rest I'm sure of) -- 600mg could greatly increase your risk of seizure... 1/100? Who knows... I personally wouldn't take those odds, but that's just me. :-)

Be especially careful if you do end up increasing dose to 600mg and you're taking a benzodiazepine. Make sure you never run out of the benzo too early -- as most of us know, there's quite a likelihood of convulsions when benzos are stopped cold turkey. I imagine that the vastly decreased seizure threshold from higher-than-recommended doses of bupropion could be an almost guaranteed seizure should you miss a few doses of a benzo. The same goes for many other CNS depressants (alcohol, barbiturates, Xyrem [sodium oxybate; GHB] and novel agents such as Ambien [zolpidem], Sonata [zaleplon], Placidyl [ethchlorvynol], Doriden [glutethimide], Miltown/Meprospan/Equanil/Neurospan [meprobamate], Soma [carisoprodol] and Noctec [chloral hydrate]).

Oh, and just one last thing which is pretty important... following poop-out, it seems that, more often than not, a dose increase does very little or no good.

> Now I am thinking it isnt good idea,, bc I dont do well on seratonin, I think.

Well, perhaps you can take comfort in knowing that bupropion's serotonergic effect (if it really has one) is very weak at best. I'm practically positive you wouldn't even notice it. After all, it is prescribed as an adjunct to serotonergic antidepressants to combat sexual side effects (as are quite a few other drugs), and it's widely held that bupropion is helpful in this way via its effects on DA and NE. If bupropion truly had a meaningful effect on serotonin, which would most likely be though reuptake inhibition, I doubt it would work as well as it does -- there are even names for combos of SSRIs + bupropion, such as "Cel-Well" -- Celexa taken with Wellbutrin. This is gaining a lot of popularity due to bupropion's obvious success in many cases, so once again, I'd hazard to guess that the serotonergic activity is nothing to concern yourself with.

> Are there any ADS which are not at all seratonergic? Maybe dopamine agonists?

Dopamine agonists (i.e. Symmetrel [amantadine], Mirapex [pramipexole], Dostinex [cabergoline], Parlodel [bromocriptine], Requip [ropinirole]) *usually* tend to be more useful for symptoms *associated* with mood disorders but which aren't always a factor in the depression. It seems that many symptoms relieved fall more under the personality disorder heading (In other words, they're most often not very useful for depression, but -- if motivation, confidence, drive, libido, and anhedonia are all things that could use a boost, I'm most definitely all for DA agonists. So atypical depression of many types may benefit greatly from a DA agonist. I'd probably recommend trying an ergot-derived drug though (i.e. Dostinex, Parlodel) before getting to the others. The reason is simply the dangerous sleep attacks that Mirapex, and fairly often Requip as well, tend to induce. Though they are wonderful, wonderful drugs if you:

A.) are lucky enough to not experience the narcoleptomimetic effects of the drugs, or...
B.) take a good stimulant along with the drug to ward off these side effects... Wellbutrin alone can be enough of a stimulant to get this job done, though Provigil (modafinil) seems quite promising as well (in theory), as do amphetamines (Adderall, Dexedrine, DextroStat, Desoxyn, amphetamine sulfate), methylphenidate (Ritalin, Concerta, Metadate-CR et al.), magnesium pemoline (Cylert... not recommended -- serious liver complications with long-term use), adrafanil (less safe than Provigil, though similar in effect, and you have to order it from overseas -- whole hell of a lot cheaper though), Strattera ('atomoxetine' or 'tomoxetine'), Edronax (reboxetine)... or perhaps even mildly stimulating OTC remedies (though some find these to be much more than mildly stimulating, so be careful)... such as NADH (nicotinamide adenine dinucleotide -- expensive, but quite worth it for many!), DL-phenylalanine, L-tyrosine, pregnenolone, TMG (trimethylglycine), DMG (dimethylglycine), ALA (alpha-lipoic acid), DMAE (dimethyl amino ethanol), CoQ10 (coenzyme Q10, CDP-choline(cytidine 5-diphosphocholine), higher doses of picamilon, acetyl-L-carnitine, B-complex vitamins (in doses five-to ten times the RDA), pantothenic acid, Oriental ginseng... hell, even cinnamon, betel nut and cayenne pepper, lol. I feel obligated to add that although not generally stimulating, fish oil and other sources of essential fatty acids should really be taken by every adult (IMHO). That's all I can think of off the top of my head at the moment, lol.

Just a quick endorsement though <g> -- I brought DA agonists to my pdoc's attention months ago when I decided I wanted to ask him for Mirapex. During our 45-minute appointment the other day (45 minutes!?! I love my doctor! xD ), he mentioned that, thanks to my bringing the psychotherapeutic potential of DA agonists to his attention, he's thusfar been able to successfully treat two other treatment-resistant melancholic patients with them (both of whom he had pretty much given up on since both refused ECT or MAOIs). In these patients he tried an SSRI + DA agonist + benzo approach. They were never able to tolerate SSRIs before, but with the DA agonists were happy as clams, according to the doctor. So now he likes to do this regularly -- prescribe a bit of one of these medications along with sexually detrimental antidepressants, even in patients who are trying ADs for the first time. He says he's had less than half the complaints of sexual dysfunction from SSRIs (particularly Paxil, Celexa, and Prozac) he used to since he started making this combo pretty much standard practice. He also noted that, though it isn't obvious to some of the patients right away, he has been able to detect a much greater air of confidence and assertiveness around those treated this way after just 2-4 weeks of treatment at most.

His patients have had too much difficulty with sleepiness on Mirapex and Requip though (like me... grrr...), and he says Dostinex and Parlodel (both quite similar; ergot-derived) exert the best effect in most patients he's treating this way, though a few patients find Symmetrel more helpful. Since Dostinex and Parlodel help to normalize androgen levels, it could be that they're most helpful in those whose hormones are out of whack in some way.

Of course there's also Eldepryl/selegiline/deprenyl/whatever-you-want-to-call-it which is the MAO inhibitor that raises levels of dopamine at doses of 5-10mg without affecting serotonin or norepinephrine. No dietary restrictions at standard doses as with Nardil and Parnate.

I've also heard of Sinemet-CR (carbidopa/levodopa) being used successfully as an adjunct in treating mood abnormalities. This is also primarily a drug for Parkinson's disease which is the immediate precursor to dopamine. Of course, by becoming dopamine within the brain, levels are increased. L-dopa (short for levodopa) can also be purchased at most health food stores, and of course a prescription isn't needed -- this form of l-dopa is plant derived (from Mucuna pruriens I believe... someone correct me if I'm wrong). You'd need to take high doses to notice any true effect though, most likely -- without the carbidopa that's in Sinemet, much of the l-dopa bcomes dopamine before it attempts to enter the brain. Dopamine can't pass the blood-brain barrier. Carbidopa helps to prevent the early transformation from occurring and so I suggest the prescription form.

Of course I also mentioned Edronax (not available in the U.S.) and Strattera above. They don't affect serotonin or dopamine, at least to any appreciable degree. Their actions are to inhibit reuptake of norepinephrine, thus increasing its levels in the brain. Some find these drugs make wonderful antidepressants. And naturally there are the classical stimulants I also mentioned above (amphetamines, methylphenidate).

If you're interested in what *I* would do if I were you... hmmm.... well, I'd remain at the current dose of bupropion (unless your returning depression is bordering on suicidal ideation, of course... then I most certainly would seek help at an institution) and ask the doc about adding on Dostinex, Parlodel, Symmetrel, Sinemet-CR, Edronax, Strattera, high-dose Provigil (400-800mg daily?), amphetamines, and/or methylphenidate. I'd also begin taking:

*Fish Oil: If you don't already take it that is... it's really a necessity; usually about 2-6 grams daily, with food, and label should indicate a 3:2 ratio of EPA to DHA in the oil -- the more it contains, the better, and a common amount of EPA to DHA is 360mg/240mg per gram of oil; only purchase from a reputable health food store where they keep their fish oil refrigerated. When you buy it off a shelf you never know if it's lost potency, but refrigeration helps preserve it.

*NADH: 5mg daily; increase dose until adequate

*DL-phenylalanine: Terrific supplement -- absolutely worth a one-month trial at about 500-1,000mg three times daily... after that it's fairly likely you'll want to continue it. It should be taken on a completely empty stomach, along with vitamins C and B6 (though the vitamins should be taken with food) -- these vitamins are essential to the conversion of phenylalanine to dopamine, norepinephrine, epinephrine, and phenylethylamine (the brain's "love chemical" [phenylethylamine is abundant in the brains of those who are in or falling in love]; the "chocolate amphetamine" [it's found in chocolate, which more than likely is a prime reason that chocolate and romance are so closely intertwined]); the L-phenylalanine is more stimulating, while the D-phenylalanine, according to several (many?) studies is especially great at increasing activity of your body's "natural morphine", and I can attest to this wonderful effect

*A very good whole-food multi-nutrient supplement if you can afford the $30 or more per month -- I prefer Super Earth Formula manufactured by Bluebonnet which is the most complete supplement I've seen to date, though several companies make a product called Green Source which is less expensive and still pretty good. I highly recommend spending the money on the ultra-high quality supplements, though Centrum or something similar will be helpful too, to a lesser extent unfortunately. Don't but store-brand multivitamins though! Very often these copycats are of ghastly inferior quality. I might suggest http://www.puritanspride.com -- they carry some very inexpensive, complete multinutrient supplements there.

*Liquid B-vitamin complex: pills are okay, but liquid B's absorb much more efficiently it seems; this should be taken three or four times daily at least, depending on the quantity of each vitamin in the product -- just try not to take more than 200mg vitamin B6 daily (keeping in mind the supplementary B6 taken with the phenylalanine should you decide to try it) as it could be dangerous. This stuff can be found in most Walmarts, though their brand doesn't contain as much of the vitamins as some more expensive ones... it's cheap though, and so I use it and just take 8ml four times daily instead of the recommended 1ml one to three times daily.

*Ginsengs and "Ginseng": Oriental ginseng is arguably the more stimulating of the two common ginsengs. The other ginseng is American ginseng. I put the second "Ginseng" up there in quotes because it is actually the herb eleuthero root, which used to be called Siberian ginseng (it's not actually a form of ginseng at all, though it acts somewhat like it -- more stress relieving for most than Oriental and American ginseng). It's less energizing but is a very good adaptogen (though if I were to recommend an adaptogen, it'd surely be ashwagandha or reishi mushroom which are superb stress-relievers). If it's a Wellbutrin boost you're after, I'd go for the Oriental ginseng. Failing that, I'd try the other stuff I listed above (especially betel nut, TMG/DMG, ALA, acetyl-L-carnitine, CoQ10, CPD-choline, and DMAE, in that order) which may also prove very useful.

Of course this is just where I'd start personally, but it sounds like a pretty decent plan of attack to me. :-)

Okay, I'll stop rambling on, I'm sorry, lol. I'm just feeling truly awesome (mentally anyway... I start OxyContin and naltrexone on Monday when I return to my pain specialist) for the first time in a pretty good while and felt like writing a bit in-depth on this subject. Plus I went to the State Fair today and still have some excess adrenaline from those crazy rides they have (hmm... could that, two funnel cakes, and three Cokes have contributed to the fact that I'm still awake at 3:15AM? lol). I haven't been to the fair in two years due to the housebound agoraphobia. It was really great being there and running into old friends without all the agoraphobic/avoidant thoughts, worries of panic attacks, and depressive irritability. One very good old friend from high school that I ran into is about to become a daddy this month and then is getting married... pretty amazing how fast time is going now. High school was just two and a half years ago and he's starting a family... wow. I realize that most people more aged than me (<~~~ note tactful avoidance of phrase "older than me", lol) don't get wowed by this stuff quite so easily, but... wow. He's only 20 like me and bought a house, is about to have a kid and is getting married. This is one way I can tell I'm doing so much better, though... under normal circumstances, I'd probably be throwing a fit about my basically wasted life thusfar and wondering why it couldn't be me with all the good fortune, but all I feel is happy for him.

Okay, rambling again -- so sorry, lol. Well, I really hope something in here is helpful, and of course I'm always around and more than willing to help when I can so feel free to ask me whatever's on your mind whenever you want. Oh, and I didn't proofread this so I only hope it's not overly confusing -- let me know if you need anything cleared up. :-)

 

Re: Some advice and non-serotonergic ideas for you...

Posted by MamaB on October 17, 2003, at 6:54:07

In reply to Some advice and non-serotonergic ideas for you... » loolot, posted by Ame Sans Vie on October 17, 2003, at 3:22:10

Hi,
A couple of warnings from personal experience:

1) It is not a good idea to combine high doses of Wellbutrin (over 300mgm a day) with CNS stimulants (Ritalin, Dexadrine, Adderall etc.)
2) The same thing can happen with the combination of an SSRI and a high dose of Wellbutrin (especially Prozac)There is a certain population of caucasians, 10-20% I believe, who cannot metabolize this combination properly due to a lack of a liver enzyme.
3) Before you take ANY "natural" substance CHECK WITH YOUR PSYCHISTRIST. Do not trust the word of the person selling it to you!!
I have seen the results of all three of the above and it is not pretty. (med induced psychosis, seizures, sensory deficits) just to name a few) Granted, every individual is unique, but the above are only cautions. I will attempt to pass along some more technical info. shortly.

 

Re: Do wellbutrin etc., inadvertently raise seratonin?

Posted by djmmm on October 17, 2003, at 7:26:23

In reply to Do wellbutrin etc., inadvertently raise seratonin?, posted by loolot on October 15, 2003, at 18:23:18

> Do dopaminergic meds also cause a rise in seratonin?

It depends on the medication. Methamphetamine raises serotonin levels (at higher doses) Ritalin raises serotonin levels...interestingly, wellbutrin has virtually no effect on the serotonin system.

 

Re: Some advice and non-serotonergic ideas for you... » MamaB

Posted by Ame Sans Vie on October 17, 2003, at 10:12:23

In reply to Re: Some advice and non-serotonergic ideas for you..., posted by MamaB on October 17, 2003, at 6:54:07

> Hi,
> A couple of warnings from personal experience:
>
> 1) It is not a good idea to combine high doses of Wellbutrin (over 300mgm a day) with CNS stimulants (Ritalin, Dexadrine, Adderall etc.)

Well, this is not a problem at least 99% of the time. I'd be wary of adding a CNS stimulant to a dose above 400mg bupropion, but it's still *very* commonly done. Analogous to taking pstims with MAOIs, it's safest to start low with the stim and titrate up slowly. Many people (especially on this board) tend to be medication resistant and require doses (of Wellbutrin for example) which are a bit higher than the 400mg dose that any GP would be afraid to exceed. But these people need such high doses often because their bodies don't seem to respond terribly well to the drug, and thus a 400mg dose of bupropion for some people on this board may only have the effect of a dose 25% that size or less. Thus, a quite powerful antidepressant-augmenting agent such as a stimulant or opioid, may be many peoples' only hopes at living even partly normal lives... thank the gods on high that my psychiatrist understands my need for narcotic painkillers to treat depression since nothing else worse.

Also, just for example's sake, I've personally met several people in the real world (and many online as well) who take high dose Wellbutrin plus a stimulant for ADD/ADHD. If I recall correctly, seven of the people I've met in person have been on 400mg/day of bupropion plus above maximum doses of amphetamines or methylphenidate. Don't get me wrong though, I'm not saying this combination is safe for everyone. Just that, when one is working with a knowledgeable psychiatrist, many "rules" can be broken. I mean, I mentioned MAOI + stimulant above, and to many, many doctors, the idea is proposterous and they'd never consider it. This is certainly a more dangerous combination than stim + bupropion IMHO. Hell, some doctors are even combining tricyclics with MAOIs -- the key is start low(er than usual) and go slow. Perhaps, for example, 1.25-2.5mg of some form of amphetamine to begin with, raising the dose slowly only if no adverse effects are experienced. It actually is a very safe approach.

> 2) The same thing can happen with the combination of an SSRI and a high dose of Wellbutrin (especially Prozac)There is a certain population of caucasians, 10-20% I believe, who cannot metabolize this combination properly due to a lack of a liver enzyme.

Right, P450 CYP2D6 is the enzyme -- the same enzyme responsible for endogenous conversion of codeine into morphine. Those who are deficient in the enzyme will find that codeine has no effect -- it doesn't do much of anything, if anything at all, until the body transforms it into morphine.

As far as combining an SSRI and bupropion however, it's an *extremely* common practice. And for those CYP2D6 deficient, there are tons of other options for reversing SSRI side effects -- buspirone, gingko biloba, bethanechol, ciproheptadine, pramipexole, ropinirole, amantadine, cabergoline, bromocriptine, methylphenidate, amphetamine, methamphetamine, magnesium pemoline........

There's no question about it though -- a CYP2D6 deficiency should be tested for following one's first appointment, and most drugs should be withheld until results come back negative. There's just no excuse not to have that lab work done (especially if the patient is white), and of course it is ultimately the doctor's fault if he/she were to administer medications that affect the CYP2D6 pathway in any way (i.e. substrates, inhibitors, inducers) before testing for this if it results in discomfort for the patient (which is usually the worst case scenario when these deficients are prescribed substrates of this enzyme -- moderate discomfort that doesn't tend to last long at all in most).

> 3) Before you take ANY "natural" substance CHECK WITH YOUR PSYCHISTRIST. Do not trust the word of the person selling it to you!!

~~>WARNING: angry, frustrated words below, but not at all aimed toward you, MamaB. Guess it's just been quite some time since I've really expressed my views about this topic...... lots of stuff I needed to get out.

On this I really do have to disagree -- psychiatrists (and at least 95% of all other allopathic practictioners) essentially know squat about holistic medicine -- very bad road for them to take if they plan on being around half a century from now. So, the vast majority of physicians will tell you to avoid them simply out of ignorance and the desire to make a buck -- of course allopathic medicine practitioners don't want their patients taking safer remedies which lack side effects, cost many, many times less in most cases and are extremely effective for so many. That's money right out of their wallet. I'd certainly never suggest ephedrine/ephedra/ma huang to anyone, but I guess until I start seeing horror stories on the news about *vitamins* and *minerals* (lol), I'll just stick with what's working -- and working QUITE well. And then thinking about all 50 or so prescriptions I've been on over the past three years that have made my life miserable and copmletely secluded for years... comparing those with the natural supplements I take? That's like comparing Adölf Hitler and Mother Theresa.

For a while, I was the in-store "expert" on herbal, vitamin, mineral, homeopathic, and many other remedies in a large chain health food store. Adverse interactions between prescription drugs and OTC remedies are rather few and far between. Side effects with most supplements are usually non-existant, and when they do occur, they are, in my experience suggesting remedies to folks and consequently getting feedback shortly thereafter, they light years away from being as debilitating as those brought on by most prescription drugs available. No addictive potential, high quality materials contained within them with study after study after study to support their use, tons of walking, talking testimonies of the riches of healthy self-medication (and you can find many examples in these forums, especially in Psycho-Babble Alternative)... and on top of it all, doctors who are occasionally unable, but much more often *unwilling* to help.

Besides -- these nutrients and other supplements we take are correcting a horrible imbalance caused by the disgusting American fast-food, couch potato way of living. The majority of these supplements are things that our bodies *SHOULD* have in them, but don't (or have grossly insufficient amounts of). DL-phenylalanine, methyl donors, vitamins, minerals, super green foods, activated coenzymes, neurotransmitter precursors capable of actual bodily utilization in the full... no reason to talk to your doctor about taking this stuff. Sure, DL-phenylalanine can't be taken with MAOIs -- those taking MAOIs should have been informed of this by their prescribing physician. L-tryptophan shouldn't be taken with most antidepressants -- but there is a quite clear warning on the label which tells you that. But TMG, DMG, DMAE, pregnenolone, ALA, fish oil...... no danger there unless there's an allergy. And everyone should certainly be taking fish oil -- if someone could actually get a doctor to sit down long enough to review the evidence which is ****HIGHLY**** in favor of it, I couldn't trust a doctor who told me not to take it. But get a doctor to spend even five minutes scanning over the research? Not unless someone owes you a Christmas miracle. But I've recently been blessed with great physicians who all realize the absolute importance of a two-way approach -- allopathic and holistic -- in medicine.

It's the internet age -- doctors and other professionals may not want educated patients/consumers/etc., but that's their own problem. A dying breed of professionals straining for their last breaths... the intelligent consumer will have most Snooty-You-look-like-a-drug-seeker-to-me-kid doctors extinguished sooner than we know. I just hope it can be in my lifetime. I've known more about allopathic and holistic medicine than any psychiatrist I've ever seen. I've been responsible for my own treatment for years because of around 8-10 psychiatrists, not one of them would get off their butts and research a bit to help their patients. It was myself who had to search the web endlessly, finding clinical abstracts, case studies, etc. to bring to my doctor to have him try my on a new medicine. No one should have to endure that, no one's live-in family should have to endure the terror of living with a mentally unstable human being. To me, and many many others with whom I've spoken, with very few exceptions, the money-grubbers' only utility lies in that they possess the almighty prescripion pads.

If humans really are the intelligent apes we so arrogantly think we are, then it shouldn't be long before all drugs -- Schedules I-V and everything left over -- become readily available to adults. Though I know that argument has been beaten to death, and no one's ever presented anything remotely resembling a rational reason that this should not happen.

> I have seen the results of all three of the above and it is not pretty. (med induced psychosis, seizures, sensory deficits) just to name a few) Granted, every individual is unique, but the above are only cautions. I will attempt to pass along some more technical info. shortly.

I know we all appreciate you're words of warning. Many of us at this board are old pros at this game though. Every aspect of it. So when the opportunity does come up, I always take a very strong stance toward more holistic approaches to therapy and less doctor interference, since any serious psychiatrist patient should strive to know much more about their (our) conditions than our doctor's do. And many of us here do -- goes with the territory.

 

Re: Some advice and non-serotonergic ideas for you...

Posted by MamaB on October 17, 2003, at 13:28:01

In reply to Re: Some advice and non-serotonergic ideas for you... » MamaB, posted by Ame Sans Vie on October 17, 2003, at 10:12:23

Dear Ame Sans Vie (and any other folks),
Without seeming arrogant or defensive, perhaps
I should clarify a few things.
First, I am a mental health professional with twenty years experience in the field and a good number of years of post-graduate education. I have witnessed first hand just about every idiosyncratic reaction to psychotropic medications
you can think of. I am very well aquainted with the functions of the enzyme I mentioned, CP2D6, and know about the function of P450 both from reading and research. I simply stay away from using medical, biochemical or neurochemical etymology when posting here. I do not claim to be an expert, but time, experience and education have kept me pretty well informed.
Now, all of that having been said, I should perhaps also say that I have spent my fair share of time on "the other side of the keys". I have been treated for depression for the past forty years myself, and for attention deficit disorder for the past twenty-two. (I was diagnosed before most people even knew that adults could have
AD(H)D.) I myself am one of those mentioned who might be called "treatment resistant" currently I take 500 mgm of buproprion (Wellbutrin) daily, and have recently begun taking Strattera. I used to follow this board, and returned to it when I began the Strattera to see what other's experiences have been on this medication. I also take several other psychotropic meds. There is a genetic component in my depression and my extended family and I have been part of an ongoing study at a major medical center.
Yes, you are correct, with larger, more long-term doses of Wellbutrin the problems I mentioned are far less likely to occur -- however not so at lower doses. I have witnessed three cases of negative reaction to the Wellbutrin/stimulant combination when the client was on less that 300mgm/day of Wellbutrin -- I have also experienced it myself when I was started on Wellbutrin while on Ritalin and Prozac. (This is why the Strattera may be a real blessing for me.)My post was merely a caution based on experience.
In case you are wondering, I am sixty two years old.

 

wellbutrin and strattera » MamaB

Posted by loolot on October 17, 2003, at 14:21:04

In reply to Re: Some advice and non-serotonergic ideas for you..., posted by MamaB on October 17, 2003, at 13:28:01

Hi Mama B
This is off topic and I know you posted about this before, but I am at the same stage as you. Wellbutrin was the only AD I responded really well to, I am on 450 and its pooping out. I tried adderrall and ritalin-didnt do well at all, maybe bc of what you mentioned with the wellbutrin.
Anyway, I was just prescribed strattera. Do you like this combination so far? I read you were having som problems on it?
I am also on 15-20 ish mcg of cytomel (really helps with energy) tyrosine, and fish oil supplements (also really great)
Just wondering if you like the strattera.
Also, I would encourage you to use medical lingo, etc on the board, since you are a professional. We would like to have info like that here!
I do agree with M.S.V that docs need to be more adveturous in some cases with meds, maybe there will be a change...

 

Re: Some advice and non-serotonergic ideas for you » Ame Sans Vie

Posted by loolot on October 17, 2003, at 14:37:00

In reply to Some advice and non-serotonergic ideas for you... » loolot, posted by Ame Sans Vie on October 17, 2003, at 3:22:10

o be quite risky territory). I believe the seizure risk is 1/1,000 at 200mg/day and 1/250 at 400mg/day (I may be wrong on the 200mg part, but the rest I'm sure of) -- 600mg could greatly increase your risk of seizure... 1/100? Who knows... I personally wouldn't take those odds, but that's just me. :-)

Thanks so much A.S.V.!!!!
As always, a wealth of awesome information!

yes, I am inclined to agree about wellbutrin. My doc said that higher doses more than likely wont work. I guess I cold add a little topamax in to stop the seizure risk. I would rather just quit the stuff and switch to parnate, though, which is our last resort.
I have tried adderall and ritalin and didnt like the effects at all with the wellbutrin.It surprise me that I felt much more depressed when I was on the ritalin, bc I thought the dopamine would help.
Now I have a prescription for strattera, which I will start tomorrow.
I am also on cytomel, which is really helpful with the fatigue, and the fish oil and tryosine supplememnts help, too. I have phenyl. too, but I just read that it doesnt really work, that only the tyrosine does. What do you think?
How do those dopamine agonists regulate androgens? Would this be a bad thing for a woman? Are they androgenic?

 

Re: wellbutrin and strattera loolot

Posted by MamaB on October 17, 2003, at 14:49:01

In reply to wellbutrin and strattera » MamaB, posted by loolot on October 17, 2003, at 14:21:04

loolot
SO FAR I like the combination, however please remember I have only been on the Strattera 20mgm for 1 week. I will be happy to keep you posted. Just to keep things in order:
I came to this board to learn from other's experiencence, not to give professional advice -- I see too much of that, not just here, but on other boards on all kinds of topics (IMHO). One should be VERY judicious about giving medical advice over the internet, be they a professional, or someone who has "done a lot of reading". I have decided that IF I AM ASKED (depending on the situation) I will share my experience. However, I think I stepped over my own personally drawn line in my post before last one. All that does is bring every so-called-expert out of the woodwork wanting to contradict me. For that reason, I shall post as an inquirer, which is what I first had in mind. Don't be afraid to ask a question though,we all have much to learn. I am not sure why Dr. Bob lets some of this "advising" go on, but it's not my decision. Do you have an answer Dr. Bob?

 

a learning experience

Posted by zeugma on October 17, 2003, at 18:38:28

In reply to Re: wellbutrin and strattera loolot, posted by MamaB on October 17, 2003, at 14:49:01

I too was diagnosed with ADD (back then, it was called Minimal Brain Dysfunction, which is certainly more evocative if less 'politically correct') before adult ADD was the widely-diagnosed condition it is now. It has only been in the past three or four months, since adding Strattera to my other meds, that I feel cognitively 'normalized.' I had tried stimulants over the years with an unacceptable side effect- drastic weight loss. I was discontinued on Ritalin and Cylert against my wishes, but on my doctors' orders, because i was already terribly underweight. Meanwhile i've had concurrent depression since childhood, as well as Nonverbal Learning Disorder, a still poorly-understood condition which can be quite incapacitating on its own.

Luckily, though, I had learned some things over the last decade and a half (I'm 35 btw): SSRI's exacerbate my depression, but I was hospitalized in the late 80's and they put me on a TCA which caused the depression to remit. If I had known then what I was to find out later, I never would have gone off the TCA even though I felt, as the script says, much better. TCA's went out of fashion and ignorant pdocs always had the latest and greatest SSRI to whip out of their cabinets (I'm thinking of all the samples they were eager to unload on me). Finally over a year ago I found an ADD specialist who was a little more informed about meds (doctors can be frightfully ignorant people!) and was willing to go along with my strongly-voiced wish to go back on a TCA. Well, here I am on a TCA and now on Strattera too and feeling 'normal' for the first time in my life.

You're skeptical of those who give advice here, but I think(just IMO, but a olot of the evidence is rather convincing) that many of the people who regularly post here are far more knowledgeable than their own pdocs. 'A little learning is a dangerous thing,' true, but it is far better to hang out here where huge quantities of info flow back and forth, than in the old days, where a dry reference text might list some side effects of the meds and little in the way of actual explanation of how they worked. And no doctor can know the inside of my head the way I can :)

 

Redirect: why Dr. Bob lets this advising go on

Posted by Dr. Bob on October 17, 2003, at 19:33:11

In reply to Re: wellbutrin and strattera loolot, posted by MamaB on October 17, 2003, at 14:49:01

> I am not sure why Dr. Bob lets some of this "advising" go on, but it's not my decision. Do you have an answer Dr. Bob?

Yes, but I redirected it over to Psycho-Babble Administration:

http://www.dr-bob.org/babble/admin/20031008/msgs/270380.html

Bob

 

Re: a learning experience » zeugma

Posted by loolot on October 17, 2003, at 21:18:01

In reply to a learning experience, posted by zeugma on October 17, 2003, at 18:38:28

Which TCA are you on?

 

Nortriptyline (nm)

Posted by zeugma on October 17, 2003, at 21:34:53

In reply to Re: a learning experience » zeugma, posted by loolot on October 17, 2003, at 21:18:01

 

Re: a learning experience » zeugma

Posted by theo on October 18, 2003, at 17:50:45

In reply to a learning experience, posted by zeugma on October 17, 2003, at 18:38:28

What TCA are you taking?

 

Re: Some advice and non-serotonergic ideas for you » loolot

Posted by Ame Sans Vie on October 18, 2003, at 20:19:56

In reply to Re: Some advice and non-serotonergic ideas for you » Ame Sans Vie, posted by loolot on October 17, 2003, at 14:37:00

> o be quite risky territory). I believe the seizure risk is 1/1,000 at 200mg/day and 1/250 at 400mg/day (I may be wrong on the 200mg part, but the rest I'm sure of) -- 600mg could greatly increase your risk of seizure... 1/100? Who knows... I personally wouldn't take those odds, but that's just me. :-)
>
> Thanks so much A.S.V.!!!!
> As always, a wealth of awesome information!

lol, no problem... feels nice to be appreciated, thank you so much. :-) You'd be suprised how this board has improved my social phobia simply due to the fact that I always am made to feel welcome here, and being appreciated is even more of a confidence booster, lol. :-)

> yes, I am inclined to agree about wellbutrin. My doc said that higher doses more than likely wont work. I guess I cold add a little topamax in to stop the seizure risk. I would rather just quit the stuff and switch to parnate, though, which is our last resort.

Just my personal opinion on the matter -- I would give the Parnate a go. Seems silly to have to add another pill into your regimen just to prevent another pill from giving you a seizure, ya know? Besides, Parnate is supposed to be a truly great drug for depression -- quite possibly the best there is.

> I have tried adderall and ritalin and didnt like the effects at all with the wellbutrin.It surprise me that I felt much more depressed when I was on the ritalin, bc I thought the dopamine would help.

Well, you know how some people who take Ritalin get that zombie effect? Did you feel like that at all? I know I'd sure feel depressed if that were the case... Anyway, Ritalin seems to affect norepinephrine more than dopamine in my experience. Either that or norepinephrine is just a stronger neurochemical. The norepinephrine is responsible for Ritalin's notorious mimicry of anxiety and nervousness in so many people who try it. For a dopamine boost, once again, I'd have to say that Parnate would appear to be a damn fine choice.

Have you tried higher-dose Provigil? What I mean is, the usual dose is 100-200mg, but some people get a great antidepressant effect at 400mg or so. I find it to be the best antidepressant in the world (better than MDMA [ecstasy]!), but it only worked for me at a dose of 1,000mg, which gave me bad headaches. However, I have a high tolerance to all drugs, so perhaps 400mg of Provigil could work miracles for you. Just food for thought -- and Provigil is the only "real" stimulant that can easily be taken with MAOIs, should you decide to give Parnate a whirl.

> Now I have a prescription for strattera, which I will start tomorrow.

Be sure to let me know how that works out -- I'm rather curious... if it provides extra energy, I just may add it to my dextroamphetamine that I already take for chronic fatigue and (to a lesser extent) depression and ADD w/o hyperactivity.

> I am also on cytomel, which is really helpful with the fatigue, and the fish oil and tryosine supplememnts help, too. I have phenyl. too, but I just read that it doesnt really work, that only the tyrosine does. What do you think?

I've never found tyrosine to work very well at all, especially now that I've tried phenylalanine. It most certainly does work, *wonderfully*. You can tell from the first dose (well, I could tell... and supposedly most people can). The DL-phenylalanine is unarguably the way to go though so you have the added benefit of extra endorphins working in your brain to make you feel good. It's the D-phenylalanine that affects endorphins; L-phenylalanine is the one that converts to tyrosine. Both forms also turn partly into phenylethylamine (the "love chemical", the "chocolate amphetamine" -- real amphetamine is beta-phenylethylamine; this stuff is alpha-phenylethylamine and is found to be in abundance within the brains of those who are madly in love with someone).

Oh, and glad to hear you're taking fish oil -- good for you. :-) Far too many people just dismiss that idea even after studies have shown it to be *extremely* effective at treating and preventing so many things. You mentioned taking other supplements as well... mind if I ask what they are?

I'd like to hear how the Cytomel is working as well... I have yet to supplement with any thyroid medications.

> How do those dopamine agonists regulate androgens? Would this be a bad thing for a woman? Are they androgenic?

To tell you the truth, I know very little about this. All I know is this:

1. These drugs stimulate ovulation in females.
2. They decrease lactation in females.
3. They inhibit prolactin, thus improving libido.
4. They're used to treat female infertility, to prevent postpartum lactation, to decrease hormone levels in giants (acromegaly), to treat symptoms of dysmenorrhea in patients with hyperprolactinemia, to improve menstrual cycles in patients with polycystic ovarian syndrome, and to supplement levodopa/carbidopa therapy in Parkinson's patients.

As you can see, they're used quite often on women, so I doubt they're harmful. Of course, this is something to discuss with your doctor anyway since they are prescription drugs.

 

Yeay, you're back Ame S.V.! and a Klonopin query

Posted by Jasmine Neroli on October 19, 2003, at 0:38:23

In reply to Some advice and non-serotonergic ideas for you... » loolot, posted by Ame Sans Vie on October 17, 2003, at 3:22:10

Hi Michael! I'm absolutely THRILLED to see you here again..and going to the State Fair AND goin' on the rides...woohooo! that's SOOOOO awesome.
I appreciate MamaB's concerns for you...but I think you are doing a great job of managing your illnesses :) Research and lotsa self-experiments, understanding your own body..that seems to be the key, I guess. I, for one, love to read your informative posts. They are always thought provoking and prompt further research for me, anyway. Your intelligence and creativity always comes through. I can hardly believe you are so YOUNG! Compared to me, Mike, you are just a baby!
Ha! You've got tons of life in front of you. I'm so happy to feel the optimistic tone of your new posts.
A question now and, yes, I am asking for an opinion, LOL. I've been on 30mg Buspirone for 10 days (up from 20mg previous 4 weeks). I think it's taken the edge off my anxiety at this higher dose, but I'm feeling very "blah" and somewhat slowed by it. Yesterday I had an anxiety attack start, so I took .5mg of my trusty Klonopin. Not only did my anxiety disappear, but my mood and energy lightened right up! I thought that this effect had happened before, when I was on Klonopin alone for a while. In fact at 1mg, it had a slight disinhibiting effect, I think,which felt great! I didn't pay much attention to this mood brightening at the time, but it was really noticeable yesterday, when I was feeling so sluggish and flat (prolly from the buspirone).
What do you think?? How can a GABA agonist do this?
Jas
Always your supporter :)

 

Re: Some advice and non-serotonergic ideas for you » Ame Sans Vie

Posted by loolot on October 19, 2003, at 20:48:30

In reply to Re: Some advice and non-serotonergic ideas for you » loolot, posted by Ame Sans Vie on October 18, 2003, at 20:19:56

ASV I am really surprised that you havent tried a thyroid supplement yet.
All of your symtoms say hypothyroid to me. Fatigue, fibromyalgia, depression.
You should absolutely try some cytomel. It might work wonders for you. Even if your blood tests are normal, try it anyway!
It really helped with my energy and mood, and overall healthful feeling.
I am also taking folic acid and B12 along with the tyrosine and fish oil.
I am on day 2 strattera. Im not sure about it, yet. It seems to work well for a couple of hours and then I get tired, pale and cold. I think it must be very short acting. I am going to keep on it for another few days and then decide.
For you, I would say cytomel all the way

 

Zeuma - some information, please

Posted by Kacy on October 21, 2003, at 14:51:57

In reply to Re: a learning experience » zeugma, posted by loolot on October 17, 2003, at 21:18:01

My doctor suggested I drop Effexor and add Desipramine to Strattera. Effexor (75 mg) helps with excessive ruminating and I don't want to give it up. I am add/inattentive. I have very low energy.

I have been thinking he was nuts to do two norepinephrine drugs and have been a little depressed over the options he is giving me. I want a dopamine drug. What are the differences? I am confused about what they are, even though I put desipramine in the search page here and read five or six (20 per page) pages of links. Don't you think that is an odd combination? I know your drug is similar to desipramine.

Strattera only lasts about seven hours for me. It's decline is really noticable at that point, and within an hour I have anxiety setting in. Does your TCA last longer?

 

Re: Zeuma - some information, please » Kacy

Posted by zeugma on October 22, 2003, at 9:24:48

In reply to Zeuma - some information, please, posted by Kacy on October 21, 2003, at 14:51:57

> My doctor suggested I drop Effexor and add Desipramine to Strattera. Effexor (75 mg) helps with excessive ruminating and I don't want to give it up. I am add/inattentive. I have very low energy.


Why does your dr. want you to drop Effexor? 75 mg is a fairly low dose of effexor.


> I have been thinking he was nuts to do two norepinephrine drugs and have been a little depressed over the options he is giving me. I want a dopamine drug. What are the differences? I am confused about what they are, even though I put desipramine in the search page here and read five or six (20 per page) pages of links. Don't you think that is an odd combination? I know your drug is similar to desipramine.
>
> Strattera only lasts about seven hours for me. It's decline is really noticable at that point, and within an hour I have anxiety setting in. Does your TCA last longer?


TCA's have half lives that are about 5 times longer than Strattera, i.e. 20-25 hours or more. If the Strattera wears off and anxiety returns it's probably the noradrenergic effect that is giving you the anxiety relief. On nortriptyline the effect is pretty 'smooth,' I'm not conscious of anxiety or lack of focus suddenly coming back (and unmedicated I have a lot of both).

Desipramine sems to be the most Strattera-like of the TCA's. It has only minimal sedation effect. The reason I added Strattera to nortriptyline was the nortriptyline simply wasn't waking me up enough. I still needed huge amounts of caffeine to stay awake through the day and my concentration was still poor. I did ask my pdoc about the differences between the drugs. The main one I gathered was that the Strattera was not cardiotoxic. I took this to mean that augmenting with Strattera would add NE effect without causing dangerous side effects elsewhere in the system- apparently norepinephrine agonism by itself is fairly safe, it's the effects on the heart that give TCA's their lethal potential. it seems that Strattera and TCA's stay out of each other's way in the cytochrome P450 system. It says in the Strattera prescribing info (at the website) that Strattera did not interfere with the metabolism of desipramine and therefore Strat won't cause desipramine to rise unexpectedly to dangerous levels as might happen with many SSRI's.

Are you having trouble sleeping? Nortriptyline is more sedating than desipramine and it helps me a lot with this problem. Proprtionally, nortriptyline affects norepinephrine less and serotonin more (relative to desipramine), and also blocks histamine, muscarinic and serotonin receptors more, leading either to increased side effects (weight gain, sleepiness) or to increased antidepressant/anxiolytic efficacy (if you have trouble sleeping, maintaining weight, etc.) Desipramine is a better treatment for ADD on its own (one study I read gave a 68 percent response rate to desip, while only 42 percent to nortrip). Nortriptlyine might be a better antidepressant.

Is there any particular reason you can't just increase the EFfexor? If you you have the XR version it will have a fairly long half life and will also block NE at higher doses. In fact some people have compared the effect of high-dose Effexor to nortriptyline. If you also need the sedation, though, nortriptyline itself would be better. Desipramine would probably be somewhere in between these two drugs in terms of its sedation effect, and would give a stronger noradrenergic effect.

 

one more thing

Posted by zeugma on October 22, 2003, at 10:04:04

In reply to Re: Zeuma - some information, please » Kacy, posted by zeugma on October 22, 2003, at 9:24:48

Maybe you could just raise the Strattera dosage or space it out so you don't crash?

 

Re: Zeugma - some information, please

Posted by Kacy on October 22, 2003, at 19:23:03

In reply to Re: Zeuma - some information, please » Kacy, posted by zeugma on October 22, 2003, at 9:24:48

Thanks for the information. I appreciate it.

How long did it take you to get a response to despramine? Does desipramine work on different norepinephrine sites? Is it a re-uptake inhibitor?

I went up to 225 mg. Effexor without any additional benefits. The side effects of a missed dose were too scary. It causes more sexual numbness too. Never got any NE-type response at all, at least not by measuring NE by Strattera and seeing no resemblance in the two drugs. In combination with Strattera, 75 mg. of Effexor works as well as 150 mg. Effexor without Strattera. That drug is for excessive ruminating and does the job well. I don't know why he wants to trade it for desipramine. I don't want the ruminating to come back. Could NE take care of that? Strattera by itself most certainly did not.

Do you mean to say that Effexor could make desipramine cause cardio problems? Could that be why he wants to trade Effexor off?

Strattera has been too sedating on the 100 mg. dose, so that's one of the problems. It's great in the morning, but it backfires in the afternoon. That problem went away at 80 mg. of Strattera as did some of the benefit. It won't go away at 100, so I'm leery of 120. The sedation does seem to be lessening some after five months, but so does the positive benefit. It doesn't help much with Add/inattentive issues but it does wonders for anxiety.

Splitting doses of Stratttera leaves no effect at all. I don't get anything from 60 mg. in the morning and 40 mg. at noon. It must just not be strong enough. I get zip-nada benefit when taking it in the evening. I wake up a little early but want to go back to bed an hour or two later. Unlike anyone else posting anywhere, I am getting only seven hours of response. It's been hard to convince my psychiatrist that it doesn't work 24 hours. Surprisingly, it's half-life is the same as Effexor's and Effexor does work 24 hours a day.

I absolutely don't need sedation. I'm way too sedate as it is, and none of the things that are supposed to be enervating or energizing give me any physical energizing effect. Some mental effect, though.

Sorry about misspelling your name.

 

Re: Zeugma - some information, please » Kacy

Posted by zeugma on October 22, 2003, at 20:52:30

In reply to Re: Zeugma - some information, please, posted by Kacy on October 22, 2003, at 19:23:03

> Thanks for the information. I appreciate it.
>
You're very welcome :)

> How long did it take you to get a response to despramine? Does desipramine work on different norepinephrine sites? Is it a re-uptake inhibitor?

Desipramine and nortriptyline are reuptake inhibitors. They also have some antagonisms of alpha-1 receptors, which can lower blood pressure (hence the common hypotension on TCA's). It's hard to say how long it took me to respond to nortriptyline (I never took desipramine). It was kind of slow. On the other hand, I made gradual but steady progress over a period of months (I was truly a wreck when I started on it last year).
>
> I went up to 225 mg. Effexor without any additional benefits. The side effects of a missed dose were too scary. It causes more sexual numbness too. Never got any NE-type response at all, at least not by measuring NE by Strattera and seeing no resemblance in the two drugs. In combination with Strattera, 75 mg. of Effexor works as well as 150 mg. Effexor without Strattera. That drug is for excessive ruminating and does the job well.
I think of drugs in the same way- if a drug is deoing it's job I don't want to ditch it without a DAMN good reason for doing so (like maybe it's killing me somehow!) It doesn't make sense to ditch something that's working welll in search of perfection that will probably never materialize. If 75 mg of Effexor is stopping a problem that is HIGHLY unpleasant for you (and it sounds like it really is!) then it's a good drug for you unless it's killing you some other way (doesn't sound like it is).

I don't know why he wants to trade it for desipramine. I don't want the ruminating to come back. Could NE take care of that? Strattera by itself most certainly did not.

It's interesting that Effexor and Strattera don't resemble each other subjectively for you. Nortriptyline and Strattera have some similarity, but the Strattera is much more activating for me. It's a good morning drug. No sedation at all.

>
> Do you mean to say that Effexor could make desipramine cause cardio problems? Could that be why he wants to trade Effexor off?

Desipramine can cause cardio problems on its own if the dose is too high or if its metabolism is inhibited by another drug (not Effexor particularily though). Maybe he knows something i don't, however.
>
> Strattera has been too sedating on the 100 mg. dose, so that's one of the problems. It's great in the morning, but it backfires in the afternoon. That problem went away at 80 mg. of Strattera as did some of the benefit. It won't go away at 100, so I'm leery of 120. The sedation does seem to be lessening some after five months, but so does the positive benefit. It doesn't help much with Add/inattentive issues but it does wonders for anxiety.

That's really interesting. What do you take for the inattention? It doesn't seem to have reduced my anxiety, but has worked wonders with my inattention- the exact reverse of your experience! No wonder psychopharmacolgy is an art, not a science.
>
> Splitting doses of Stratttera leaves no effect at all. I don't get anything from 60 mg. in the morning and 40 mg. at noon. It must just not be strong enough. I get zip-nada benefit when taking it in the evening. I wake up a little early but want to go back to bed an hour or two later. Unlike anyone else posting anywhere, I am getting only seven hours of response. It's been hard to convince my psychiatrist that it doesn't work 24 hours. Surprisingly, it's half-life is the same as Effexor's and Effexor does work 24 hours a day.
>

Effecor comes in an extended release formulation unlike Strattera. Strattera's half life is puzzling. I suppose in my case I benefit from nortriptyline's long half life.


> I absolutely don't need sedation. I'm way too sedate as it is, and none of the things that are supposed to be enervating or energizing give me any physical energizing effect. Some mental effect, though.

Well, then I would think desipramine would be a better TCA than nortriptyline for you. I wonder if your pdoc can give you a convincing reason for his choice of meds? The anti-ruminating effect of Effexor sounds like a serotonergetic effect to me which is backed up by Strattera's lack of effect on that problem. Desipramine is probably no better than Strattera in that regard. Then again, it has a longer half-life.
>
> Sorry about misspelling your name.

That's only ONE of my names :)

z
>
>

 

Re: Zeugma - some information, please

Posted by Kacy on October 22, 2003, at 22:14:25

In reply to Re: Zeugma - some information, please » Kacy, posted by zeugma on October 22, 2003, at 20:52:30

Thanks, again, for the answers.

I don't take anything for the inattentive add. That's what we are searching for. That's what I am searching for, anyway. I think it's what my doctor is avoiding. Two years and counting, although I did have some unproductive experiments with Ritalin and Adderal. I think I need some kind of elephant stimulant. What do they take?

 

elephant stimulants? » Kacy

Posted by zeugma on October 23, 2003, at 18:29:42

In reply to Re: Zeugma - some information, please, posted by Kacy on October 22, 2003, at 22:14:25

> Thanks, again, for the answers.
>
> I don't take anything for the inattentive add. That's what we are searching for. That's what I am searching for, anyway. I think it's what my doctor is avoiding. Two years and counting, although I did have some unproductive experiments with Ritalin and Adderal.

What happened on Ritalin and Adderall?

I think I need some kind of elephant stimulant. What do they take?

I have heard that elephants can be tranquilized with massive doses of Thorazine, but why would anyone want to stimulate an elephant?
Seriously, is the problem that existing stimulants aren't strong enough to wake you up? Then I can't imagine that desipramine would be any better than Strattera.

 

Re: elephant stimulants?

Posted by Kacy on October 24, 2003, at 8:28:58

In reply to elephant stimulants? » Kacy, posted by zeugma on October 23, 2003, at 18:29:42

What do you mean by "wake me up"? The only sedation problem I get is as a side effect of Strattera. I don't have sleeping problems very often or have waking up problems, and I never had a daytime sleepiness issue until this drug. It's Catch-22: a stimulant that puts you to sleep.

Ritalin was a good thinking drug, but didn't help a lot with direction or motivation. It reminds me of my old ten pm to two am thinking hours. They were a hallmark of my earlier years. (Sure liked those hours.) Ritalin worked for an hour and a half if I took 20 mg. on an empty stomach with some strong coffee and made sure I didn't eat for 40 minutes. So often, I couldn't get that just right. I need smaller meals, more often. Up, down, down, up some (if I timed it right) down, down, maybe up on the third dose. That doesn't work out well. I'd be lucky to get a response the third time. I can't imagine how doctors could think that would work for anyone even if they think you get the four and a half hours split up over the day. A short trial (on my own) with four doses a day, shorter times between pills and regular coffee seemed to be promising, but doctor's (apparently) can't prescribe 80 mg. a day and I really can't imagine drinking that much coffee all the time.

I tried Adderal but realized this summer (after reading posts here) that I screwed that trial up when I had old-fashioned oats cooked in apple juice every single morning that whole month. I got a half-hour or an hour at the end that was interesting and didn't know why it was kicking in so late. I never felt anything at all until then. I thought it just had a big kick at the end, theorizing the company was discouraging double-dosing that way. (Anecdotal evidence, ya know.)

I have to decide on the desipramine by Monday. If I do it, I sure hope it doesn't sedate in the afternoons like Strattera.

Does anyone out there know how long desipramine takes to work? A couple of weeks? A couple of months?


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