![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by Philidor on August 21, 2004, at 19:51:35
Ok, once again after a two-week hiatus I'm back on stimulants for my ADHD, and once again after less than 3 days of relief from my symtoms I'm back taking double the amount prescribed. Once again I'm gonna run out nearly a week before my next RX, and have to go cold turkey again.
I put it to you guys with the same tolerance problem that anyone here who says he's found some drug or herb that will reverse, stop or prevent stimulant tolerance is pxxxxing out of his ear. there is no such drug---at least not yet discovered.
If there were, the word would be all over the street AND the internet in a flash. It's like the Holy Grail, lots of people searching for it, no body has found it. Simple logic.
So All you geniuses who claim that gulping cough syrup till you puke or taking grampa's Alzheimer's meds or whatever will make the Ritalin work again are simply full of it.
The only answer is giving up the Adderall OR taking a (forced) drug "vacation" for a week at least to restore your tolerance, and then do the same thing again with another flavor of speed.
(I like that word "vacation" for drug withdrawal. Some vacation!)Maybe someday they WILL find a drug that reverses stimulant tolerance (a.k.a. poop-out), and when they do, believe me, you'll hear about it.
Yours irritably,
Phil
Posted by mmcconathy on August 21, 2004, at 21:04:37
In reply to The Truth about Stimulant Tolerance, posted by Philidor on August 21, 2004, at 19:51:35
yes i hope they do come out with some more stimulant tolerace crap. Anyways, i know L-Tyrosine is a good anti-tolerace that makes more dopamine, which could easily fight stimulant tolerance.
Anyways, i love your sarcasim too.
Matt
Posted by Ame Sans Vie on August 22, 2004, at 6:18:17
In reply to The Truth about Stimulant Tolerance, posted by Philidor on August 21, 2004, at 19:51:35
Don't get your panties all in a bunch just because some people have done their research and found something that *does* work to prevent (or at least delay) stimulant tolerance. My guess is that you haven't done your research into this, nor have you tried the currently studied treatments available, or else you wouldn't be quite so unnecessarily bitter.
As far as your assertion that if stimulant tolerance prevention/reversal were possible then it'd be breaking news, then obviously you're not aware of the power the pharmaceutical industry holds, nor the fact that it takes ten or fifteen years for almost any new pharmaceutical development to see the light of day. Prozac (well, fluoxetine at least) has been around since the 70's... Cymbalta since the late 80's. Yet the discussion of the latter never appeared on these message boards until just a few years ago.
Dextromethorphan is about to be available (or perhaps already is?) in a formulation with morphine called 'Morphidex' which has been proven to both prevent and reverse morphine tolerance. By the same (plus additional) mechanisms, dextromethorphan and many other NMDA antagonists provide the same benefit for stimulant tolerance.
~Michael
(14 months using Adderall for depression with NO development of tolerance to euphorigenic or antianergic effects, thanks to DXM)
Posted by linkadge on August 22, 2004, at 8:23:03
In reply to The *Real* Truth about Stimulant Tolerance, posted by Ame Sans Vie on August 22, 2004, at 6:18:17
I agree with AME. The real truth is that tollerance is really realtive. One of the theories about proper stim use is that ADHD kids have a problem with dopamine release in certain arease of the brain. Stims are supposed to correct this. I know of a kid who used ritalin for 10 years with no tollerance. It was simple. If he took it he behaved and was calm, if he didn't he wasn't.
The stim tollerance you are talking about (street tollerance) is a whole different issue. This takes place in people who generally get more from the drug than just 'normalized attention'. People looking for a high or for a sence of power, or a feeling of being better than everyone else, are not going to get that feeling consistanly because it is not normal.
yes there are many supplements that help diminished function of stimulants for ADHD but *vitrually none* that will help diminished function of stimulants as recreational drugs.
As a rule of thum, if the drug creates a better ballence, it is likeley to work for longer. If the drug creates an imbalence, then your body is likely to reject it.
Ask yourself this question, are you using the drugs to create ballence, or imballence???
Linkadge
Posted by KaraS on August 22, 2004, at 13:46:19
In reply to The *Real* Truth about Stimulant Tolerance, posted by Ame Sans Vie on August 22, 2004, at 6:18:17
This might be a dumb question but do the NMDA antagonists prevent or minimize stimulant crashes as well?
-K
Posted by KaraS on August 22, 2004, at 15:24:00
In reply to Re: The *Real* Truth - Ame or Linkadge, posted by KaraS on August 22, 2004, at 13:46:19
z,
I meant to address the previous post to you as well. Thanks.
Posted by Philidor on August 22, 2004, at 18:19:00
In reply to The *Real* Truth about Stimulant Tolerance, posted by Ame Sans Vie on August 22, 2004, at 6:18:17
Ame,
First of all WHO TOLD YOU ABOUT MY PANTIES?Second, I left a post to you the other day, which I guess you never read:
http://www.dr-bob.org/babble/20040817/msgs/379462.htmlAnyhow, pleased to meet you.
A couple of things about what you say above. I congratulate you on your not developing any tolerance to Adderall, but then a lot of people NEVER develop tolerance, or not much, to stimulants even after years of use.
So the question is, Have you EVER had to take much more Add than 30mg a day because it stopped working? If so, how much were you taking ?
If not, what makes you think your non-tolerance is because of the DXM, and not just God-given?
Reminds me of that joke about the guy who sees his friend applying this really smelly ointment to himself.
"PEEE-YEW!", says his friend, "What IS that awful stuff you're putting on?"
"It's tsetsefly repellent. I don't want to get sleeping sickness!" say the guy.
"But, you fool," says his friend, "there are no tsetse flies on the whole continent?"
"I know," says the guy, "the stuff really works!"
And I don't care how powerful the drug companies are, if somebody found that drinking Robitussin could prevent or reverse drug tolerance, it would be all over the street and the internet and Rush Limbaugh, for example, would not have developed his addiction nor would many other people who find they need higher and higher doses of opiates to relieve their pain.
And yes, I do read the studies, which interest me far more than the brilliant theorizing: the proof of the pudding is in the eating. An yeah, I've heard of Mophidex.
The latest testing indicates that DMX enhances the effects of smaller doses of morphine but actually LESSENS the potency of high-doses of morphine. Go figure.
But this has nothing to do with "tolerance" per se.
HOWEVER, A study done a couple of years ago came to the fascinating conclusion that DMX in MICRO-DOSES actually DOES reverse tolerance to opioids. For that see my earlier posts:
http://www.dr-bob.org/babble/20040817/msgs/379176.html
...and the post just before it, in which I offer the very hypothesis you do, that if DMX works for opioid tolerance might it possibly work for stimulant tolerance? But all of this remains
speculative.It is far from PROVEN as you seem to think.
The whole business of drug tolerance is fascinating and incredibly complex. For a brief but intensely interesting take on theject by a pioneer in Ritalin use for ADHD, I invite readers to check out:
http://www.adders.org/info28.htm
Phil
Posted by elleff on August 23, 2004, at 0:50:27
In reply to The Truth about Stimulant Tolerance, posted by Philidor on August 21, 2004, at 19:51:35
Dear Philidor
This may be of no use nor benefit, but I post this link because I happened to come across this old paper recently:
"Inhibition of Amphetamine Tolerance and Metabolism by Propranolol" - Shoeman DW, Sirtori CR, & Ararnoff DL, Journal of Pharmacology and Experimental Therapeutics (1974) v191 (1):68 - 71.
This reports studies on the pharmacokinetics and anorectic effect of amphetamine on laboratory rats, which showed, from my amatuer reading, an inhibition of amphetamine breakdown rather than any alteration in pharmacodynamics.
I haven't seen nor heard any references to similar effects on humans on this board or elsewhere however.
regards
elleff
Posted by elleff on August 23, 2004, at 0:54:56
In reply to Re: The Truth about Stimulant Tolerance, posted by elleff on August 23, 2004, at 0:50:27
> Dear Philidor
>
> This may be of no use nor benefit, but I post this link because I happened to come across this old paper recently:
>
> "Inhibition of Amphetamine Tolerance and Metabolism by Propranolol" - Shoeman DW, Sirtori CR, & Ararnoff DL, Journal of Pharmacology and Experimental Therapeutics (1974) v191 (1):68 - 71.
>
> This reports studies on the pharmacokinetics and anorectic effect of amphetamine on laboratory rats, which showed, from my amatuer reading, an inhibition of amphetamine breakdown rather than any alteration in pharmacodynamics.
>
> I haven't seen nor heard any references to similar effects on humans on this board or elsewhere however.
>
> regards
>
> elleffPS sorry, forgot to include the link (but it's not much use because no abstract available):
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=4418151
Posted by sb417 on August 23, 2004, at 1:01:22
In reply to Re: The Truth about Stimulant Tolerance, posted by elleff on August 23, 2004, at 0:50:27
>> > This reports studies on the pharmacokinetics and anorectic effect of amphetamine on laboratory rats, which showed, from my amatuer reading, an inhibition of amphetamine breakdown rather than any alteration in pharmacodynamics.> > regards
> > elleffHello elleff. Your interpretation makes sense. Propranolol mildly inhibitis the enzyme, cytochrome P450 2D6. Amphetamines are substrates of that same enzyme, so if that enzyme is inhibited, there may not be enough available to thoroughly metabolize amphetamine.
Posted by Philidor on August 23, 2004, at 11:15:03
In reply to Re: The Truth about Stimulant Tolerance, posted by elleff on August 23, 2004, at 0:54:56
> > Dear Philidor
> >
> > This may be of no use nor benefit, but I post this link because I happened to come across this old paper recently:
> >
> > "Inhibition of Amphetamine Tolerance and Metabolism by Propranolol" - Shoeman DW, Sirtori CR, & Ararnoff DL, Journal of Pharmacology and Experimental Therapeutics (1974) v191 (1):68 - 71.
> >
> > This reports studies on the pharmacokinetics and anorectic effect of amphetamine on laboratory rats, which showed, from my amatuer reading, an inhibition of amphetamine breakdown rather than any alteration in pharmacodynamics.
> >
> > I haven't seen nor heard any references to similar effects on humans on this board or elsewhere however.
> >
> > regards
> >
> > elleff
>
> PS sorry, forgot to include the link (but it's not much use because no abstract available):
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=4418151
>
Greetings elleff, thanks for that link.My only comment on the study---since I'm unable to read it, is that it's 30 YEARS OLD! If proprananol, a beta-blocker that is used all the time by doctors, did indeed prevent tolerance developing to stimulants in HUMANS, it would be common knowledge and routinely prescribed for just that purpose. (As a psych-med, it's still sometimes used to treat "stage fright", among other things, with mixed results.)
The fact that it is not, and that you've seen nothing further published on the subject, should tell you something.
This sort of thing happens ALL THE TIME in phamaceutical research. A single study on lab rats indicates that drug X cures or prevents disorder Y, causing initial interest, or even excitment, which quickly fades when follow-up studies fail to produce the same result.
That's why it's wise to withhold judgement until all the results are confirmed, and to ignore the impressive-sounding theorizing from so-called experts giving you lots of "scientific" reasons why melatonin, or whatever, is bound to be the answer to insomnia, (or whatever).
"Show me the money!", I say.
Best,
Phil
PS Of course,there's no harm in TRYING some of these potential remedies as long as the costs and risks are acceptable to you. You never know. Like, I've tried melatonin for insomnia myself, (and gotten the same disappointing results as most people.)
Posted by alesta on August 23, 2004, at 11:43:49
In reply to Re: The *Real* Truth about Stimulant Tolerance, posted by Philidor on August 22, 2004, at 18:19:00
hi, phil,
i enjoyed your stimulating, thought-provoking commentary. and i agree: show me the money!:)
amy :)
Posted by Dr. Bob on August 23, 2004, at 13:44:22
In reply to The *Real* Truth about Stimulant Tolerance, posted by Ame Sans Vie on August 22, 2004, at 6:18:17
> All you geniuses who claim that gulping cough syrup till you puke or taking grampa's Alzheimer's meds or whatever will make the Ritalin work again are simply full of it.
>
> Philidor> My guess is that you haven't done your research into this ... or else you wouldn't be quite so unnecessarily bitter.
>
> obviously you're not aware of the power the pharmaceutical industry holds
>
> Ame Sans ViePlease don't jump to conclusions about others or post anything that could lead others to feel accused or put down.
Anyone who has questions about this or about posting policies in general, or who is interested in alternative ways of expressing themselves, should see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Also, follow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Thanks,
Bob
Posted by Philidor on August 23, 2004, at 15:58:30
In reply to Re: please be civil » Philidor » Ame Sans Vie, posted by Dr. Bob on August 23, 2004, at 13:44:22
Dear Doc,
Your point is well taken and in the future I will honor your request.
My initial post was written in a fit of pique and was aimed at NO ONE in particular. While I stand by the point behind it, I should have made it more tactfully.
Phil
Posted by zeugma on August 23, 2004, at 18:58:31
In reply to Re: The *Real* Truth - zeugma too, posted by KaraS on August 22, 2004, at 15:24:00
hi kara,
i can do little other than post the results of my own experiments in reducing stim tolerance- see my post in reply to alesta further down. It puzzles me about NMDA antagonists being potentially useful- my understanding of the function of NMDA receptors, based on the textbook i have quoted extensively from, is that NMDA receptors facilitate synaptic plasticity, which would seem to be a good thing, and i had always thought that PCP, a powerful dissociative agent, was a NMDA antagonist. I can only surmise that neuroadaptation to stimulant effects is responsible for tolerance, and that by blocking this adaptation, the mind remains in an artificially 'drug-naive' state. That's my guess from poring over my dubiously accurate textbook, which does not, of course, address the problem of stimulant tolerance at all. Shame- he should do better next time. (And maybe the next edition will contain glowing accounts of the antidepressive effects of noradrenergic neurotransmission, in the wake of Cymbalta's dazzling success. One can only hope.)
-z
-z
Posted by KaraS on August 23, 2004, at 20:57:48
In reply to Re: The *Real* Truth - zeugma too » KaraS, posted by zeugma on August 23, 2004, at 18:58:31
> hi kara,
>
> i can do little other than post the results of my own experiments in reducing stim tolerance- see my post in reply to alesta further down. It puzzles me about NMDA antagonists being potentially useful- my understanding of the function of NMDA receptors, based on the textbook i have quoted extensively from, is that NMDA receptors facilitate synaptic plasticity, which would seem to be a good thing, and i had always thought that PCP, a powerful dissociative agent, was a NMDA antagonist. I can only surmise that neuroadaptation to stimulant effects is responsible for tolerance, and that by blocking this adaptation, the mind remains in an artificially 'drug-naive' state. That's my guess from poring over my dubiously accurate textbook, which does not, of course, address the problem of stimulant tolerance at all. Shame- he should do better next time. (And maybe the next edition will contain glowing accounts of the antidepressive effects of noradrenergic neurotransmission, in the wake of Cymbalta's dazzling success. One can only hope.)
>
> -z
>
> -z
>
>
Thanks. Absolutely on the Cymbalta. Are you thinking of trying it or are you just saying that for everyone else?
Posted by zeugma on August 23, 2004, at 21:09:28
In reply to Re: The *Real* Truth - zeugma too » zeugma, posted by KaraS on August 23, 2004, at 20:57:48
I'm saying it for everyone else. Nortriptyline is working, although it has its inconveniences. But I am positive that Cymbalta is going to help many, many people.Do you plan to try it soon?
-z
Posted by KaraS on August 23, 2004, at 22:15:05
In reply to Re: The *Real* Truth - zeugma too » KaraS, posted by zeugma on August 23, 2004, at 21:09:28
> I'm saying it for everyone else. Nortriptyline is working, although it has its inconveniences. But I am positive that Cymbalta is going to help many, many people.Do you plan to try it soon?
>
> -z
>
>
z,
I have a really good feeling about Cymbalta as well. I'm not planning on trying it right away though. I have a couple of other things I'll try first but I'll probably end up trying it down the road. I'm watching all of the reports and keeping my fingers crossed for those who are tyring it now.Kara
Posted by zeugma on August 24, 2004, at 4:30:38
In reply to Re: The *Real* Truth - zeugma too » zeugma, posted by KaraS on August 23, 2004, at 22:15:05
Posted by Terry on August 24, 2004, at 10:06:42
In reply to The *Real* Truth about Stimulant Tolerance, posted by Ame Sans Vie on August 22, 2004, at 6:18:17
>
> ~Michael
> (14 months using Adderall for depression with NO development of tolerance to euphorigenic or antianergic effects, thanks to DXM)
What is DXM?Terry
Posted by Philidor on August 24, 2004, at 11:42:14
In reply to Re: The *Real* Truth - zeugma too » KaraS, posted by zeugma on August 23, 2004, at 18:58:31
To Zeugma:
"i can do little other than post the results of my own experiments in reducing stim tolerance- see my post in reply to alesta further down."Well, where the heck IS that post? I'd like to see those results.
Concerning NMDA antagonists, you are quite right in saying that, NMDA antagonists (such as dextromethorphan (DMX)), should be worthless at best for inhibiting tolerance to morphine. But in one study it not only did, but REVERSED tolerance in human patients. Incredible? Well, the researchers who did the study thought so too:
"When we received the results from the first experiment, I couldn't believe it. Everything we knew up to that point indicated that it shouldn't work - but it did!" (said Dr.)Jhamandas."
http://opioids.com/tolerance/paincontrol.html
Apparently, DXM's biochemical action is dose-related. In micro-doses, it seems to work in reverse and becomes an NMDA agonist!
But this is just one study, and needs furthur investigation.
Phil
Posted by SLS on August 24, 2004, at 14:16:35
In reply to Re: The *Real* Truth - zeugma too, posted by Philidor on August 24, 2004, at 11:42:14
> "i can do little other than post the results of my own experiments in reducing stim tolerance- see my post in reply to alesta further down."
>
> Well, where the heck IS that post? I'd like to see those results.You might want to do a search here on Psycho-Babble for posts submitted by AndrewB. He was an excellent reporter of his experiences with various drug trials. His posts describing his success with memantine potentiating the psychostimulant and anti-social anxiety effects of Adderall are compelling. He later switched from memantine (Namenda), an uncompetitive NMDA receptor antagonist to acamprosate (Campral), a glutamate release inhibitor, a drug recently approved in the US for the treatment of alcoholism. He preferred the acamprosate, but I can't remember why.
- Scott
Posted by zeugma on August 24, 2004, at 17:41:34
In reply to Re: The *Real* Truth - zeugma too, posted by Philidor on August 24, 2004, at 11:42:14
My plan to address stimulant tolerance is very simple, and grows kind of naturally out of my circumstances. I had a prescription for Provigil and for Ritalin, with instructions to try them both. I tried Provigil first, which was my dr.s preference. It worked, but certain undesirable side effects- insomnia, GI distress- made it difficult to get up to 100 mg/day, let alone the 200 mg/day that is the target dosage. I tried the Ritalin next, in 10 mg LA capsules. That one worked with no s/e, so I stayed with that one for a while. Because I am also taking a TCA, and Ritalin can have cardio- s/e, I haven't wanted to push the dose any higher without consulting my dr. in person, but 10 mg is not enough. So I added 50 mg Provigil and it seems to have an augmentive effect. The two drugs work in different parts of the brain- see http://www.pnas.org/cgi/content/full/93/24/14128 -
so i'm not worried about redundancy, but of course no one has a clear idea of what modafinil does. I'll post later on what effect I think Provigil has on me, but that will be the topic for a separate thread.-z
Posted by Dr. Bob on August 24, 2004, at 19:35:02
In reply to Re: please be civil, posted by Philidor on August 23, 2004, at 15:58:30
Posted by Dave001 on August 24, 2004, at 20:30:52
In reply to Re: The *Real* Truth - zeugma too » Philidor, posted by zeugma on August 24, 2004, at 17:41:34
> My plan to address stimulant tolerance is very simple, and grows kind of naturally out of my circumstances. I had a prescription for Provigil and for Ritalin, with instructions to try them both. I tried Provigil first, which was my dr.s preference. It worked, but certain undesirable side effects- insomnia, GI distress- made it difficult to get up to 100 mg/day, let alone the 200 mg/day that is the target dosage. I tried the Ritalin next, in 10 mg LA capsules. That one worked with no s/e, so I stayed with that one for a while. Because I am also taking a TCA, and Ritalin can have cardio- s/e, I haven't wanted to push the dose any higher without consulting my dr. in person, but 10 mg is not enough. So I added 50 mg Provigil and it seems to have an augmentive effect. The two drugs work in different parts of the brain- see http://www.pnas.org/cgi/content/full/93/24/14128 -
> so i'm not worried about redundancy, but of course no one has a clear idea of what modafinil does. I'll post later on what effect I think Provigil has on me, but that will be the topic for a separate thread.
>Note that modafinil also causes significant induction of the CYP3A4/5 enzymes, and is an inducer of its own metabolism.
Dave
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.