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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Ame Sans Vie on August 5, 2004, at 11:25:17
Hi all! Decided to take a much-needed computer holiday (for the most part), but the time has come once again for me to beseech your wisdom on a particular matter.
Last I posted here, I was taking:
--Klonopin 3mg AM, 2mg noon, 3mg PM
--Fluoxetine 40mg
--Adderall 30mg BID-TID
--Delsym (dextromethorphan polistirex) 30mg BID... that's the best I can remember, anyway. And for those who aren't familiar with me, a "quick" rundown of my problems would include dysthymic disorder, atypical depressive disorder, avoidant personality disorder, dependent personality disorder, obsessive-compulsive disorder (mild), social anxiety disorder, panic disorder w/agoraphobia, adult attention deficit disorder w/o hyperactivity (primarily impulsive type)... yeah, I'm just a big mess, lol. I'm a 21 year-old male, btw.
So obviously I wouldn't be begging for advice if everything were going well with my meds. The fluoxetine (Prozac) worked wonderfully for a while in conjunction with the other meds, but not even all that amphetamine could allay one side effect which didn't appear until just over a month ago -- horrible weight gain. Sure, I was feeling mentally well, but I'm at a point where I'm very focused on my *physical* health now that I've just about got the mental thing under control. So the Prozac was dropped like a bad habit four weeks ago and I've dropped twelve pounds since (it's a start!).
After quitting the Prozac I developed another symptom -- sleeplessness. Of course, most people would admonish me for my high stimulant dose at this point, but it turns out amphetamine wasn't the problem, but the solution. An extra dose *before bedtime* and I sleep like a baby!
Finally, just prior to quitting the Prozac my doctor increased my Klonopin dosage to counteract some agitation the antidepressant was causing. So my new regimen is as follows:
-Klonopin 5mg q8h
-Adderall 30mg 7AM, noon, 5PM and 10PMI also switched recently from Delsym (to prevent amphetamine tolerance) to Dexalone -- a considerably less vile-tasting alternative, lol. It's OTC and comes in packages of 10 or 30 capsules, each containing 30mg DXM HBr.
Here's the deal: I go back to see my pdoc Wednesday, and at our last appointment he suggested adding Wellbutrin XL to the mix. I've been on Wellbutrin before but never really gave it a chance to work because the dry mouth at the beginning of treatment was pretty awful. Still, I'm willing to try it again.
Does anyone know of any documented cases and/or studies concerning the concomitant use of amphetamines with bupropion? I realize that going forth with this proposed plan means I may re-experience that insomnia/agitation, but with all this Klonopin, *that* I can deal with, lol. MAOIs are out of the question because of Medicaid's ridiculous limitations on prescription amounts (Parnate - 100 x 10mg monthly; Nardil - 100 x 15mg monthly; Marplan - not covered; Eldepryl - gives me hallucinations).
Or should I just wait for Cymbalta to hit pharmacies and give it a go instead? (if I can wait that long!)
Thanks!
~Michael
Posted by TheOutsider on August 5, 2004, at 13:31:10
In reply to Long time no see..., posted by Ame Sans Vie on August 5, 2004, at 11:25:17
a
Posted by sb417 on August 5, 2004, at 23:02:17
In reply to Long time no see..., posted by Ame Sans Vie on August 5, 2004, at 11:25:17
Hi Michael. Welcome back. Regarding your question about Wellbutrin and amphetamine. . . First, let me say that I've read quite a few of your posts, and it appears as if you are able to tolerate "polypharmacy" a lot better than some of us, so you might do very well on a Wellbutrin + Amphetamine combination. I do know that Wellbutrin's parent compound, bupropion, mildly inhibits cytochrome P450 2D6, and Wellbutrin's major metabolite, hydroxybupropion, is a substrate of 2D6. Amphetamines are also 2D6 substrates. If you have a "good version" of 2D6 (i.e., if you don't have a genetic polymorphism which causes a deficient version of 2D6), then the mild inhibition caused by bupropion might not interfere with the metabolism of the drugs and you might not have a problem. The fact that you were able to combine Prozac with your other medications seems to indicate that you can tolerate combinations that I couldn't tolerate. I also want to mention, however, that I have known other people (besides myself) who cannot combine Wellbutrin with amphetamine. Some people just get too agitated or sick feeling, and I know of one fatality. I'm sorry to mention that fatality, but I think it's important for people to realize how highly variable and individual our reactions are. The person who died was a student who was on Wellbutrin. She took Adderall to cram for final exams and went into cardiac arrest. Again, because you seem to be able to tolerate other multi-drug combinations well, you might not have any problem at all. Perhaps you can start really, really slowly, with minute doses and see how you feel. Keep in mind that, even if you don't have a liver enzyme problem, Wellbutrin can be very activating, so you may want to cut it in tiny pieces for the first week or so. Good luck, and let us know how you're doing.
Posted by sb417 on August 5, 2004, at 23:38:08
In reply to Re: Long time no see... » Ame Sans Vie, posted by sb417 on August 5, 2004, at 23:02:17
It just occurred to me that at least once, and possibly twice, over the past few years, I read that cutting Wellbutrin, thereby exposing it to air, can hasten its deterioration. I don't know whether that means it actually goes bad or whether it just loses its potency faster. Also, I'm pretty certain that what I read was in reference to the older, immediate release Wellbutrin and may not have anything to do with the sustained release versions. I've also heard widely varying comments on what cutting sustained release Wellbutrin does to the time release mechanism. Some say that cutting it turns it into immediate release, and others say that it remains sustained release. Please check with your doctor about this. From reading your posts, it looks as if your doctor is very attentive and responsive, so please discuss the Wellbutrin + amphetamine combination with him. Oh, and one more thing -- the dxm you are taking is also a 2D6 substrate. You'll be taking a lot of medications that require the same enzyme for metabolism. If you have a healthy, robust version of 2D6, that may not pose a problem.
Posted by KaraS on August 6, 2004, at 7:32:25
In reply to Long time no see..., posted by Ame Sans Vie on August 5, 2004, at 11:25:17
You answered the first message I posted here. I have wondered how you were doing and hoping the fact that we hadn't heard from you was a good sign. Hope the Wellbutrin works out for you.
-Kara
Posted by Ame Sans Vie on August 6, 2004, at 14:18:51
In reply to Glad to have you back! (nm), posted by TheOutsider on August 5, 2004, at 13:31:10
Posted by Ame Sans Vie on August 6, 2004, at 14:32:04
In reply to On second thought. . ., posted by sb417 on August 5, 2004, at 23:38:08
Thanks so much for your input! I'm glad to hear that someone here has heard of the bupropion + amphetamine combination. I am sorry to hear about that fatality you mentioned though... but as you mentioned, my ability to withstand even the most robust polypharmacy without incidence will most likely preclude me from being exposed to that type of danger. Also, I make extra sure to never take more than my prescribed 120mg of Adderall daily, and I am hoping that may decrease to 80mg or so (20mg QID) with the addition of Wellbutrin XL.
I've always very well tolerated interactions mediated by CYPIID6, so (thank God) that shouldn't be an issue. Though I understand there is some dispute in the scientific community as to the extent of bupropion's IID6 inhibition (i.e., some say it is a quite mild inhibitor, some put it at the higher end of the "moderate inhibition" scale). But, as you said, if I was able to tolerate a very powerful inhibitor such as fluoxetine so well, bupropion certainly shouldn't pose a problem in that regard. As far as the dextromethorphan is concerned, my doctor has consulted with colleagues at the University of Houston and they've come to the unanimous conclusion that the low dose I'm taking bears little chance of interfering. Besides, if it weren't for the DXM HBr, I'm sure I'd be taking upwards of 300mg Adderall per day by now! :-O (btw, I use the Adderall primarily as an antidepressant)
Again, thanks a bunch for the thorough analysis of my prospective meds!
All the best,
~Michael
Posted by Ame Sans Vie on August 6, 2004, at 14:38:01
In reply to Welcome back! » Ame Sans Vie, posted by KaraS on August 6, 2004, at 7:32:25
> You answered the first message I posted here.
Hi there, Kara! While I don't recall the exact exchange of information that took place between us (I used to answer *a lot* of inquiries here), I'd love if you'd refresh my memory and give me an update -- I hope you're doing well or on your way there! And any advice I may be able to provide, I'd be more than happy to of course.
> I have wondered how you were doing and hoping the fact that we hadn't heard from you was a good sign. Hope the Wellbutrin works out for you.
Thanks so much. :-) Yeah, it was more or less a good sign... now I just need to focus on getting rid of this "Prozac-fat" and hoping that the Wellbutrin XL provides that little bit of extra "oomph" I really need.
Overall, I'd say I'm about 85% recovered and have been for some time now... definitely a record for me! :-D
All the best,
~Michael
Posted by sb417 on August 6, 2004, at 15:44:56
In reply to Re: On second thought. . . » sb417, posted by Ame Sans Vie on August 6, 2004, at 14:32:04
Please clone your liver enzymes and send some to me. C'mon! Spread the wealth around!
Posted by Jasmineneroli on August 6, 2004, at 15:57:50
In reply to Re: Welcome back! » KaraS, posted by Ame Sans Vie on August 6, 2004, at 14:38:01
Hi Mike!
SOOO good to know you're OK. I haven't been here either, over the last 6 months (just a bit here & there), too busy with a new business...that I believe a little "prayer" from you encouraged!!!
I've been having some psych ups and downs though and a lot of "life" happenings (mostly to my immediate family members)...won't go into it here.
I really hope your family situation is settled too, now.
As to your weight issues from Prozac.....aaaagh! I can relate to that. Remeron was the evil culprit in that regard for me last year! I work out a lot and take some supplements to help metabolize fat ( no "excitatory" products like Ephedrine or Guarana tho'). I've found that the exercise/supplement combo speeds up my metabolism and my weight is now stable. You might want to try a similar approach to either augment the Wellbutrin experiment, or as a substitute if that fails and you need another AD.
As I recall, you used to exercise(?). Do you still?? If your condition(s) aren't lowering your energy and drive right now (and I've been THERE too!) try upping your physical output and incorporate some supplements that won't mess-up your poor hard-working liver!!!! I suggest CLA and chromium picolinate or chromium polynicotinate to start.
All my very best wishes, as always!
Jas
Posted by KaraS on August 6, 2004, at 22:33:55
In reply to Re: Welcome back! » KaraS, posted by Ame Sans Vie on August 6, 2004, at 14:38:01
> > You answered the first message I posted here.
>
> Hi there, Kara! While I don't recall the exact exchange of information that took place between us (I used to answer *a lot* of inquiries here), I'd love if you'd refresh my memory and give me an update -- I hope you're doing well or on your way there! And any advice I may be able to provide, I'd be more than happy to of course.
>
> > I have wondered how you were doing and hoping the fact that we hadn't heard from you was a good sign. Hope the Wellbutrin works out for you.
>
> Thanks so much. :-) Yeah, it was more or less a good sign... now I just need to focus on getting rid of this "Prozac-fat" and hoping that the Wellbutrin XL provides that little bit of extra "oomph" I really need.
>
> Overall, I'd say I'm about 85% recovered and have been for some time now... definitely a record for me! :-D
>
> All the best,
> ~Michael
I doubt you'd remember. There were a couple of questions about 5 mg. of methylphenidate making me sleepy.Anyway, I'm glad that you're doing well but I'm also glad that you're back.
Kara
Posted by Viridis on August 7, 2004, at 0:59:24
In reply to On second thought. . ., posted by sb417 on August 5, 2004, at 23:38:08
It's perfectly safe to cut Wellbutrin SR -- I checked with the manufacturer, since I had such a bad reaction to the 150 mg dose. The medication is imbedded in a slowly-dissolving wax (the slow release has nothing to do with the pill coating), and there's only a slight increase in release rate for cut pills, just in the 1st 15 minutes. They even faxed me graphs of the pharmacokinetics of divided vs. intact pills, and the rate of release was nearly identical.
They do recommend, however, that the pills be divided close to the time of use, since they absorb water from the atmosphere and can lose potency over time once split.
Half the dose gave me about half the side effects, which were still intolerable. But there's no danger at all in splitting the pills. They just discourage it because, among other things, it's hard to achieve exact dosing that way.
Posted by Ame Sans Vie on August 7, 2004, at 2:27:20
In reply to Dividing Wellbutrin SR » sb417, posted by Viridis on August 7, 2004, at 0:59:24
Interesting... do you happen to know if the same applies to Wellbutrin XL? I'd prefer to start off with as low a dose as possible and titrate not more than 50-75mg every two weeks since I'll be taking it with Adderall...
Thanks!
~Michael
Posted by Ame Sans Vie on August 7, 2004, at 2:40:10
In reply to Re: Dividing Wellbutrin SR » Viridis, posted by Ame Sans Vie on August 7, 2004, at 2:27:20
According to http://www.wellbutrin-xl.com:
"Swallow tablets whole. Do not chew, cut, or crush tablets. The WELLBUTRIN XL tablet is covered by a shell that slowly releases the medicine in your body. You may notice something in your stool that looks like a tablet. This is the empty shell passing from your body."
If the release mechanism involves the coating, then I guess splitting is out of the question. I have some Zyban that doesn't expire till next year... I'll talk to him about using that to titrate up.
But just because Wellbutrin SR can be cut I don't want to assume the same for Zyban... Viridis, do you happen to know if this is okay? Suppose I'll just call 'em up to find out if not.
~Michael
Posted by sb417 on August 7, 2004, at 20:13:23
In reply to Dividing Wellbutrin SR » sb417, posted by Viridis on August 7, 2004, at 0:59:24
Hi Viridis. Thanks so much for that information! I think you might have posted this information months ago, and I remembered your post but had not bookmarked it. Although I would not take Wellbutrin again, it is very useful information for others, especially for those just starting out on it.
Posted by Viridis on August 8, 2004, at 2:39:31
In reply to Sorry, Viridis, I found the answer ^^^^^ » Ame Sans Vie, posted by Ame Sans Vie on August 7, 2004, at 2:40:10
Hi Ames,
I'm not sure about the XL -- it's probably safest to call. I don't have the number handy, but just got it from their website (us.gsk.com, I think? Or something like that). Their tech support people were very helpful and knowledgeable. I'd guess that dividing Zyban would be OK, but this is just speculation -- I'd check to be sure.
Good luck!
Posted by Philidor on August 19, 2004, at 12:14:23
In reply to Long time no see..., posted by Ame Sans Vie on August 5, 2004, at 11:25:17
So my new regimen is as follows:
>
> -Klonopin 5mg q8h
> -Adderall 30mg 7AM, noon, 5PM and 10PM
>
> I also switched recently from Delsym (to prevent amphetamine tolerance) to Dexalone -- a considerably less vile-tasting alternative, lol. It's OTC and comes in packages of 10 or 30 capsules, each containing 30mg DXM HBr.
...
>
> ~MichaelMike,
If i weren't straight, I'd ask you for a date; we have so much in common. In addition to having most of the psychomaladies you do, well, for openers, my current daily RX regimen is:
Lexapro-20mg
Klonopin 3 mg (down from 4)
Dexedrine 10-20mg 4 times a dayThe dex I just restarted, after running out of Adderall 3 weeks ago. I informed my shrink that that it was starting to really work. Mood was fine w/o euphoria, slept like a baby, no SEs to speak of, I felt focused on my work and often "in the zone". He was obviously pleased. But then I told him, just one little thing, doc. I was wondering if we could raise the dose a tad, from 20mg qid to, oh, 100mg qid. See, in the past week I'd been averaging 690 mg a day (to a max of 740 mg, which DID put my teeth on edge at last). So anyhow, I'm nearly out and....
There was silence on the other end of the line, followed by a string of expletives. I'll condense this by saying he said he would give me NO more Adderall until our next appt. 3 weeks hence, if EVER, and after some other choice words, he hung up.
WELL! Rudeness galore, I thought. I did a quick taper down for 4 days until I ran out. Had a couple of very blue days after that, but nothing heavy. (I am not making this up!) I made up with him and got him to put me back on Dexedrine 80-90 mg MAX a day at our next appt. That was two days ago.
The 3 dex i took this am is having little effect. Time for my next dose. Anyhow, it's stupid to brag about "tolerance", like bragging about smoking a carton of Camels a day.) And all that Adderall I downed cost me $220! I wasn't trying to get high, and I didn't. (Getting drunk was much better.)
Sorry for the long post, but "Chemist" referred me to y'all:
http://www.dr-bob.org/babble/20040817/msgs/379323.html
and if you have any firsthand knowledge of how to reduce my fantastic tolerance to stims, I'm all ears and would appreciate it greatly.
Sincerely,
Phil
Posted by KraftyKr on October 1, 2004, at 21:07:08
In reply to Re: Long time no see..., posted by Philidor on August 19, 2004, at 12:14:23
I know I'm a little Delayed with my response to this post but I just found it online. I have been taking Adderall for a little over 3 years now and just about every time I meet with my Doctor the dose increases...(not a bad thing) I think I started at 10 mg (not sure how many/day) but now I'm 21 and about a month or so ago it was increased to 3 30mg tabs/day. My doctor usually writes me a script for a 3 month supply and one for a month supply so I can fill it that day. I also send the mail in script the same day which takes about 10 days to get back to me. The last time I went to my doctor she had written the wrong total on my mail in script which I told her about after I had mailed it in, so the next script she wrote was 30mg 4/day and it was predated for Sept 10th so my insurance would cover it, but I had ran out before that dater. I called to let her know and she wrote me another month script for 30mg 4/day, which is strange because she only changed to fic her mistake. Definitely no complaints on my end but I don't understand why one doctor would be so much more strict with the dose than the other.
690mg/day is a lot but I have easily taken over 400mg/day without even realizing it. It sucks when you get sucked into the Euphoria of the Adderall or start to become immune to it and have to increase the dose yourself.
The scariest things about Adderall is the fact that I can't see myself ever stopping the med. I have to much of a need for it...UGH!! The only way I could see myself ending the med is by going through a complete detox program...not a fun thought.
I know a few other people who take adderall, including my older sister and brother and a close friend (who I actually met at college because we were both poppin' the pill). My brother and I seem to have the highest tolerance for it but when my friend and I are both out of are scripts early all we do for the first few days is eat sleep and watch tv. Even weeks after running out of my script I Can't find the motivation to get anything done. The one benefit of running out is The I can catch up on a ton of sleep. Anybody else had the problem?
It's almost 10pm on friday night and I haven't slept since I woke up at 10 am on tuesday. It's been a like one really really long and tedious day with getting absolutely no sleep. The worst part is having to work a 10 hour shift Hearing weird noises and seeing weird things that aren't really there. I love taking the Adderall and when I'm in the euphoria I just don't want to sleep but it got to the point where all I wanted was at least an hour of sleep this morning but could not sleep cause of the meds and then finally at 6am I was in the perfect sleep mode, 30seconds and I would have been passed out but a cough killed that so instead I decided to get up and get ready for my 8am to 6pm work day. I'm sure I could talk all day on this subject and all my crazy encounters and side effects but my eyes are finally shutting...yaaay!!
If andybody has any feedback or thoughts PLEASE send...
Thanks
Kim
> So my new regimen is as follows:
> >
> > -Klonopin 5mg q8h
> > -Adderall 30mg 7AM, noon, 5PM and 10PM
> >
> > I also switched recently from Delsym (to prevent amphetamine tolerance) to Dexalone -- a considerably less vile-tasting alternative, lol. It's OTC and comes in packages of 10 or 30 capsules, each containing 30mg DXM HBr.
> ...
> >
> > ~Michael
>
> Mike,
> If i weren't straight, I'd ask you for a date; we have so much in common. In addition to having most of the psychomaladies you do, well, for openers, my current daily RX regimen is:
> Lexapro-20mg
> Klonopin 3 mg (down from 4)
> Dexedrine 10-20mg 4 times a day
>
> The dex I just restarted, after running out of Adderall 3 weeks ago. I informed my shrink that that it was starting to really work. Mood was fine w/o euphoria, slept like a baby, no SEs to speak of, I felt focused on my work and often "in the zone". He was obviously pleased. But then I told him, just one little thing, doc. I was wondering if we could raise the dose a tad, from 20mg qid to, oh, 100mg qid. See, in the past week I'd been averaging 690 mg a day (to a max of 740 mg, which DID put my teeth on edge at last). So anyhow, I'm nearly out and....
>
> There was silence on the other end of the line, followed by a string of expletives. I'll condense this by saying he said he would give me NO more Adderall until our next appt. 3 weeks hence, if EVER, and after some other choice words, he hung up.
>
> WELL! Rudeness galore, I thought. I did a quick taper down for 4 days until I ran out. Had a couple of very blue days after that, but nothing heavy. (I am not making this up!) I made up with him and got him to put me back on Dexedrine 80-90 mg MAX a day at our next appt. That was two days ago.
>
> The 3 dex i took this am is having little effect. Time for my next dose. Anyhow, it's stupid to brag about "tolerance", like bragging about smoking a carton of Camels a day.) And all that Adderall I downed cost me $220! I wasn't trying to get high, and I didn't. (Getting drunk was much better.)
>
> Sorry for the long post, but "Chemist" referred me to y'all:
>
> http://www.dr-bob.org/babble/20040817/msgs/379323.html
>
> and if you have any firsthand knowledge of how to reduce my fantastic tolerance to stims, I'm all ears and would appreciate it greatly.
>
> Sincerely,
>
> Phil
>
This is the end of the thread.
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