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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Philidor on July 3, 2004, at 14:53:48
It appears to be no secret that they do:
"Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause STRIKING AND SUSTAINED INCREASES in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated." (emphasis mine)
SOURCE: http://www.ethex.com/pages/pdf/58177031204_PIS.pdf
My question is, why has this fact not gotten greater attention and application in the treatment of ADHD and narcolepsy?
Dr. Bob????
Posted by 1980Monroe on July 3, 2004, at 18:21:38
In reply to Tricyclics boost amphetamine?, posted by Philidor on July 3, 2004, at 14:53:48
wow that's intresting, let chemist awnser this, Dr. Bob maybe too. i thought its only Atypical antidepressants that can do that but guess not.
Posted by anxiety_free on July 4, 2004, at 9:04:28
In reply to Tricyclics boost amphetamine?, posted by Philidor on July 3, 2004, at 14:53:48
> It appears to be no secret that they do:
>
> "Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause STRIKING AND SUSTAINED INCREASES in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated." (emphasis mine)
>
> SOURCE: http://www.ethex.com/pages/pdf/58177031204_PIS.pdf
>
> My question is, why has this fact not gotten greater attention and application in the treatment of ADHD and narcolepsy?
>
> Dr. Bob????Hi! In the past (and occasionally now, as well) tricyclics are used for ADHD/Narcolepsy...in ADHD sometimes a tricyclic can be used alone. But, tricyclics have more side effects than newer drugs , and since they're old there aren't many companies pushing them (except for the kinda new Tofranil...Tofranil PM). But I have ADHD and depression and my doc gave me a tricyclic (Tofranil PM) because it will boost my stimulant,which helps ADHD and depression. But most of the time when a doc opts for anti-depressant therapy for ADHD, they go for wellbutrin, sometimes adding other agents...and of course now there's straterra. Its too bad really..tricyclics are cheap, effective, and they have decades of research behind them.
Posted by Sad Panda on July 4, 2004, at 11:04:22
In reply to Tricyclics+Amphetamines, posted by anxiety_free on July 4, 2004, at 9:04:28
> > It appears to be no secret that they do:
> >
> > "Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause STRIKING AND SUSTAINED INCREASES in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated." (emphasis mine)
> >
> > SOURCE: http://www.ethex.com/pages/pdf/58177031204_PIS.pdf
> >
> > My question is, why has this fact not gotten greater attention and application in the treatment of ADHD and narcolepsy?
> >
> > Dr. Bob????
>
> Hi! In the past (and occasionally now, as well) tricyclics are used for ADHD/Narcolepsy...in ADHD sometimes a tricyclic can be used alone. But, tricyclics have more side effects than newer drugs , and since they're old there aren't many companies pushing them (except for the kinda new Tofranil...Tofranil PM). But I have ADHD and depression and my doc gave me a tricyclic (Tofranil PM) because it will boost my stimulant,which helps ADHD and depression. But most of the time when a doc opts for anti-depressant therapy for ADHD, they go for wellbutrin, sometimes adding other agents...and of course now there's straterra. Its too bad really..tricyclics are cheap, effective, and they have decades of research behind them.
>
>
>Nortriptyline or Desipramine would be the TCA's to use. Desipramine gives the most stimulation with the least side effects while Nortriptyline is a stimulant, anxiolytic & mild sedative rolled in to one. SSRI's don't really have much of a side effects advantage compared to TCA's, just different side effects.
Cheers,
Panda.
Posted by Philidor on July 13, 2004, at 15:11:34
In reply to Re: Tricyclics+Amphetamines » anxiety_free, posted by Sad Panda on July 4, 2004, at 11:04:22
Ok, but I'm just struck by the language of that PI.
"STRIKING AND SUSTAINED INCREASES in the concentration of d-amphetamine in the brain;"I mean, this sounds like it should be major news... that a little (or more than a little) nortryptiline or some other TCI could have such a dramatic effect in boosting response to amphetamine. Yeah I know SSRIs and others are sometimes used to help amphetamine treatment, but STRIKING AND SUSTAINED INCREASEs?? I mean, this should be more than just a "by the way" comment. I just don't get it. It sounds like they're saying Tricyclics have a huge augmenting effect on amphetamines! It should be BIG NEWS, should it not?
Posted by Fromage47 on August 16, 2004, at 2:46:48
In reply to Tricyclics+Amphetamines, posted by anxiety_free on July 4, 2004, at 9:04:28
Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause STRIKING AND SUSTAINED INCREASES in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated."
See - what that sort of indicates to me (the first sentence, at least) is that the amphetamines actually potentiate the effects of the tricyclic, not vice versa. Is anyone currently on a combo of a tricyclic and amphetamines and can vouch for its effects? Or does anyone know which one potentiates which, or if they both potentiate each other?
Posted by SLS on August 16, 2004, at 8:18:34
In reply to Re: Tricyclics+Amphetamines » anxiety_free, posted by Fromage47 on August 16, 2004, at 2:46:48
> Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause STRIKING AND SUSTAINED INCREASES in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated."
>
> See - what that sort of indicates to me (the first sentence, at least) is that the amphetamines actually potentiate the effects of the tricyclic, not vice versa. Is anyone currently on a combo of a tricyclic and amphetamines and can vouch for its effects? Or does anyone know which one potentiates which, or if they both potentiate each other?
I have taken Dexedrine as monotherapy and as an adjunct to Parnate and desipramine in an attempt to treat depression. It felt the same to me both times. For what it is worth, it did not feel as if the amphetamine potentiated the tricyclic. Of course, this is the very subjective experience of a person very resistant to the antidepressant effects of numerous drugs.I don't think one should consider a simple pharmacokinetic interaction between these drugs leading to an increase in the concentration of desipramine to be the same as a pharmacodynamic synergism. Simply raising the dosage of desipramine would suffice as a treatment alternative. The question is whether amphetamine + desipramine is more effective than only increasing desipramine to maximum dosages. For me, adding amphetamine to desipramine produced a transient improvement that could not be illicited by simply increasing the dosage of desipramine.
In short, I think there is the possibility that adding amphetamine to a tricyclic can provide benefits not possible from simply increasing the dosage of that tricyclic. However, for me, this benefit was indistinguishable from using amphetamine alone.
Since both amphetamine and TCA provide benefit for different aspects of ADD, the two together probably might work additively rather than synergistically. I think the real question regarding "potentiation" is whether adding TCA to amphetamine in ADD provides additional improvment to attentional deficits.
- Scott
Posted by Sad Panda on August 16, 2004, at 9:15:20
In reply to Re: Tricyclics+Amphetamines, posted by SLS on August 16, 2004, at 8:18:34
The main benefit of secondary TCA's combined with Amphetamines or Ritalin is probably that the long half life of the TCA's can smooth over the ups & downs of the short half life stimulants. Blood pressure would stay close to normal too.
Cheers,
Panda.
Posted by Philidor on August 16, 2004, at 10:12:09
In reply to Re: Tricyclics+Amphetamines, posted by Sad Panda on August 16, 2004, at 9:15:20
> The main benefit of secondary TCA's combined with Amphetamines or Ritalin is probably that the long half life of the TCA's can smooth over the ups & downs of the short half life stimulants. Blood pressure would stay close to normal too.
>
> Cheers,
> Panda.--------------------------------------------------------------------------------
I'll shut up and let Dr. Ratey ("Driven to Distraction") have the last word:
From : John Ratey <jratey@tiac.net>
Sent : Sunday, July 18, 2004 8:24 AM
To : [Philidor]
Subject : Re: TCAs to boost Stimulants for ADHD?
one runs into the interaction with the cardiac issues-- I use these together often and usually use norpramin in lower doses -- they are vastly under used meds in depression and panic and adhd-- this equation is not so simple however
----- Original Message -----
From: [Philidor]
To: jratey@tiac.net
Sent: Friday, July 16, 2004 6:36 PM
Subject: TCAs to boost Stimulants for ADHD?
Dear Doctor:I have seached in vain for a good answer to this question. I'll be brief. The following is a direct quote from the PDR on DEXTROSTAT: [etc]
Posted by Fromage47 on August 16, 2004, at 19:17:29
In reply to Re: Tricyclics+Amphetamines, posted by Philidor on August 16, 2004, at 10:12:09
Yeah - what about the cardio issues? That's anothe rimportant factor. I am on 75 mg of imipramine a day right now in conjunction with 40 mg of adderall, and I have noticed a big increase in jitteriness and shakiness since beginning the imipramine that was not present before when i was only on the adderall. I also feel my heart beating faster than normal. Anyone know about potential cardio risks from TCA and amphetamines?
Posted by zeugma on August 16, 2004, at 20:18:51
In reply to Re: Tricyclics+Amphetamines, posted by Sad Panda on August 16, 2004, at 9:15:20
> The main benefit of secondary TCA's combined with Amphetamines or Ritalin is probably that the long half life of the TCA's can smooth over the ups & downs of the short half life stimulants. Blood pressure would stay close to normal too.
>
> Cheers,
> Panda.i think this is right. The Ritalin wears off fairly quickly but the TCA keeps the feeling from being too drastic. Also TCA's boost the noradrenergic system, and this is closely involved with the dopaminergic system in many areas of the brain.
>
Posted by Philidor on August 17, 2004, at 9:39:05
In reply to Re: Tricyclics+Amphetamines, posted by Fromage47 on August 16, 2004, at 19:17:29
> Yeah - what about the cardio issues? That's anothe rimportant factor. I am on 75 mg of imipramine a day right now in conjunction with 40 mg of adderall, and I have noticed a big increase in jitteriness and shakiness since beginning the imipramine that was not present before when i was only on the adderall. I also feel my heart beating faster than normal. Anyone know about potential cardio risks from TCA and amphetamines?
No but I'll just comment that I recall many years ago taking Tofranil WITHOUT stimulants. I experienced those same symptoms, so bad I had to switch to another TCA.
Phil
Posted by Fromage47 on August 17, 2004, at 10:26:52
In reply to Re: Tricyclics+Amphetamines, posted by Philidor on August 17, 2004, at 9:39:05
Yeah man, like seriously it is pretty bad. I am having tachycardia, and I am not even sure how much of it is psychological. I have had a history of panic attacks in the past, but have not had any real issues with them for 2 years. However, I do understand how just the paranoia of fearing panic increases it anyway. But they are getting so intense that i think i am going to quit it. Phil, any other TCAs that caused to cardio problems/anxiety?
-Fromage
Posted by Philidor on August 17, 2004, at 11:40:02
In reply to Re: Tricyclics+Amphetamines, posted by Fromage47 on August 17, 2004, at 10:26:52
> Yeah man, like seriously it is pretty bad. I am having tachycardia, and I am not even sure how much of it is psychological. I have had a history of panic attacks in the past, but have not had any real issues with them for 2 years. However, I do understand how just the paranoia of fearing panic increases it anyway. But they are getting so intense that i think i am going to quit it. Phil, any other TCAs that caused to cardio problems/anxiety?
>
> -Fromage
NO. And I've tried most of them. Also most people do not have such problems w. Tofranil as we. So I would ask my doc to switch me at once to Norpramin, low-dose, if I were you, BASED ON THE EMAIL RESPONSE I GOT FROM DR> RATEY (which I posted earlier. You might copy and show it to your doc.)
Posted by 2ndXround on August 20, 2004, at 1:49:37
In reply to Re: Tricyclics+Amphetamines, posted by Philidor on August 17, 2004, at 9:39:05
Hi
I can't give the psychopharmocology behind this only my personal experience.
Combining Prozac and amphetamines caused hyper CNS problems big time for me. (Tachy, PVCs, PAC's, and PAT) Also lots of movement problems.
Now taking Effexor and amphetamine and doing fine.
This is the end of the thread.
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