Psycho-Babble Medication Thread 547904

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Ritalin 80mgs-not doing it anymore?- Restlessness

Posted by Paulbwell on August 28, 2005, at 22:33:00

Comments?

 

Re: Ritalin 80mgs-not doing it anymore?- Restlessness » Paulbwell

Posted by ed_uk on August 29, 2005, at 3:39:33

In reply to Ritalin 80mgs-not doing it anymore?- Restlessness, posted by Paulbwell on August 28, 2005, at 22:33:00

Perhaps you should taper the Ritalin and try desipramine.

~Ed

 

Re: Ritalin 80mgs-not doing it anymore?- Restlessness

Posted by utopizen on August 29, 2005, at 15:31:51

In reply to Re: Ritalin 80mgs-not doing it anymore?- Restlessness » Paulbwell, posted by ed_uk on August 29, 2005, at 3:39:33

> Perhaps you should taper the Ritalin and try desipramine.
>
> ~Ed

That's a possibility. I'm glad to know if _anyone_, including Ed, has ever found success with anything.

I'm unaware of much clinical trials supporting the use of this med in controlled trials; it is important to emphasize some may respond more than others because depression often may mimic symptoms of AD/HD, according to my psychopharmacologist.

He actually told me that one of the ways docs determine a diagnosis is by treating a patient with a certain drug, and observing the response that follows.

Therefore, let's suggest I had depression, and took an antidepressant like desipramine. I'd say, "wow, my mental energies are back, I can concentrate, wow!"

And I'd never know whether it's just a novel reaction, if it's depression, or if it's falling in love or whatever.

So moral of story: I'm not discounting Ed. I'm also not suggesting Ed has depression alone, or has depression, or doesn't have depression. This isn't even about Ed.

Moral is: If you talk to your doc about desipramine, he'll probably give it a shot, but mostly 'cause it's an antidepressant.

Keep in mind, from my own experience, "stimulant burnout" is basically often early stages of depression complicating your AD/HD. Which is why an antidepressant combined with a stimulant ain't ever a bad idea-- stimulants can cause dysphoria, so it's actually wise to take one with antidepressants in general.

I would be ill advised to think your energy levels are "tolerance" only-- you'll find if you have any luck with getting a mood bounce back for you one day, somehow, you'll find a much lower dose may even work better.

In the meantime, I advise if you have somnolence to augment with Provigil.

And if not on an SSRI, go on on. If on one, switch or up the dose markedly.

And Ritalin @ 80mg is quite a bit. Consider Adderall, Desoxyn, Dexederine, Straterra.

 

Re: Ritalin 80mgs-not doing it anymore?- Restlessness » utopizen

Posted by ed_uk on August 29, 2005, at 16:00:13

In reply to Re: Ritalin 80mgs-not doing it anymore?- Restlessness, posted by utopizen on August 29, 2005, at 15:31:51

Hi John,

>So moral of story: I'm not discounting Ed. I'm also not suggesting Ed has depression alone, or has depression, or doesn't have depression. This isn't even about Ed.

??? Indeed, it's not about me.

I was suggesting a non-stimulant treatment since Paul appears to be tolerant to Ritalin.

Desipramine can be effective for ADD. There are numerous controlled trials, here is an example........

Am J Psychiatry. 1996 Sep;153(9):1147-53.

Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder.

Wilens TE, Biederman J, Prince J, Spencer TJ, Faraone SV, Warburton R, Schleifer D, Harding M, Linehan C, Geller D.

Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.

OBJECTIVE: Despite the increasing awareness of attention deficit hyperactivity disorder (ADHD) in adults, there are a limited number of controlled pharmacologic studies of this disorder; most of the trials have focused on the psychostimulants. Because the tricyclic anti-depressant desipramine has been found to be effective in treating ADHD in pediatric groups, the authors tested its efficacy in adults with ADHD. METHOD: The authors conducted a randomized, 6-week, placebo-controlled, parallel-design study of desipramine at a target daily dose of 200 mg in 41 adult patients with DSM-III-R ADHD. They used standardized structured psychiatric instruments for diagnosis and, as the dependent variables (outcome), used separate assessments of ADHD, depressive, and anxiety symptoms at baseline and at each biweekly visit. RESULTS: There were highly significant differences in the reduction of ADHD symptoms between adults receiving desipramine and placebo. Within the desipramine-treated group, there were clinically and statistically significant differences between baseline and the week 6 end point for 1) reduction of 12 of 14 symptoms of ADHD and 2) decreases in the broad categories of hyperactivity, impulsivity, and inattentiveness. In contrast, placebo-treated patients showed no differences between baseline and end point for any of the ADHD symptoms assessed. According to strict, predefined criteria for response, 68% of desipramine-treated subjects and no subjects in the placebo group were considered positive responders. Response to desipramine was independent of dose, level of impairment, gender, or lifetime psychiatric comorbidity with anxiety or depressive disorders. CONCLUSIONS: These results, similar to findings in children and adolescents with ADHD, indicate that desipramine is effective in the treatment of ADHD in adults.

Kind regards

~Ed

 

Re: Ritalin 80mgs-not doing it anymore?- Restlessn

Posted by med_empowered on August 29, 2005, at 19:44:50

In reply to Re: Ritalin 80mgs-not doing it anymore?- Restlessness » utopizen, posted by ed_uk on August 29, 2005, at 16:00:13

Stimulant+antidepressant combos are good for ADHD, depression, and some tricky variants of depression (for example, the combo helped me with treatment-resistant bipolar depression). In cases of really bad narcolepsy, Provigil can be added to a more traditional stimulant; I imagine that in your situation, this could help. I kind of think that if you did a switch to Dexedrine or Adderall (Desoxyn would be an option, but its usually chosen after failed trials of Ritalin and Adderall/Dexedrine) *and* added an AD (my votes would be for Pamelor, Cymbalta, or Effexor) you might get some relief. I suggest a switch just because Ritalin, for me at least, tended to "poop out" in general, and that got worse as the dose got up...my shrink switched me from 60mgs/Ritalin to 40mgs/Adderall, and I did much, much better. Good luck!

 

Re: Ritalin 80mgs-not doing it anymore?- Restlessness

Posted by utopizen on August 29, 2005, at 20:17:45

In reply to Re: Ritalin 80mgs-not doing it anymore?- Restlessness » utopizen, posted by ed_uk on August 29, 2005, at 16:00:13

Ed,

My apologies.

I was confusing despryl with a similiar-sounding drug.

It is well-established, and Bierderman is obviously no one to question the rep. of. Thanks for reminding me of this study.

 

Re: Ritalin 80mgs-not doing it anymore?- Restlessness

Posted by linkadge on August 30, 2005, at 7:38:36

In reply to Re: Ritalin 80mgs-not doing it anymore?- Restlessness, posted by utopizen on August 29, 2005, at 15:31:51

In my books stimulant burnout, is stimulant burnout.

It's not like "Stimulants shall work forever"
was ever the 11th commandment.

I burned out on ritalin just a fast (if not faster) on AD's as when off them.

Taking too many stims and AD's burns out your adrenal glands, as well as making me SEVERLY magnesium deficiant (thats what the hospital told me)

Linkadge

 

Re: Ritalin 80mgs-not doing it anymore?- Restlessn » utopizen

Posted by Chairman_MAO on August 30, 2005, at 12:50:55

In reply to Re: Ritalin 80mgs-not doing it anymore?- Restlessness, posted by utopizen on August 29, 2005, at 15:31:51

The real picture is even more complicated; some people with ADHD have a response to MAOIs that occurs within a few days of initiating treatment, way before the AD response. What do they have?

Classes of drugs are necessarily merely metaphysical constructs.

 

Re: I agree with linkadge

Posted by rjlockhart98 on August 30, 2005, at 23:05:22

In reply to Re: Ritalin 80mgs-not doing it anymore?- Restlessn » utopizen, posted by Chairman_MAO on August 30, 2005, at 12:50:55

Taking too many stimulants can burn out your adreanal glands. Umm especially Methamphetamine, that will damage dopamine nuerons severely if tooken consistantly at moderatly high doses.

 

Re: Utopizen are still taking desoxyn? (nm)

Posted by rjlockhart98 on August 30, 2005, at 23:06:11

In reply to Re: I agree with linkadge, posted by rjlockhart98 on August 30, 2005, at 23:05:22

 

Re: Ritalin 80mgs-not doing it anymore?- Restlessness

Posted by Bowtie Bob on August 31, 2005, at 5:22:48

In reply to Re: Ritalin 80mgs-not doing it anymore?- Restlessness » utopizen, posted by ed_uk on August 29, 2005, at 16:00:13

> Hi John,
>
> >So moral of story: I'm not discounting Ed. I'm also not suggesting Ed has depression alone, or has depression, or doesn't have depression. This isn't even about Ed.
>
> ??? Indeed, it's not about me.
>
> I was suggesting a non-stimulant treatment since Paul appears to be tolerant to Ritalin.
>
> Desipramine can be effective for ADD. There are numerous controlled trials, here is an example........
>
> Am J Psychiatry. 1996 Sep;153(9):1147-53.
>
> Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder.
>
> Wilens TE, Biederman J, Prince J, Spencer TJ, Faraone SV, Warburton R, Schleifer D, Harding M, Linehan C, Geller D.
>
> Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
>
> OBJECTIVE: Despite the increasing awareness of attention deficit hyperactivity disorder (ADHD) in adults, there are a limited number of controlled pharmacologic studies of this disorder; most of the trials have focused on the psychostimulants. Because the tricyclic anti-depressant desipramine has been found to be effective in treating ADHD in pediatric groups, the authors tested its efficacy in adults with ADHD. METHOD: The authors conducted a randomized, 6-week, placebo-controlled, parallel-design study of desipramine at a target daily dose of 200 mg in 41 adult patients with DSM-III-R ADHD. They used standardized structured psychiatric instruments for diagnosis and, as the dependent variables (outcome), used separate assessments of ADHD, depressive, and anxiety symptoms at baseline and at each biweekly visit. RESULTS: There were highly significant differences in the reduction of ADHD symptoms between adults receiving desipramine and placebo. Within the desipramine-treated group, there were clinically and statistically significant differences between baseline and the week 6 end point for 1) reduction of 12 of 14 symptoms of ADHD and 2) decreases in the broad categories of hyperactivity, impulsivity, and inattentiveness. In contrast, placebo-treated patients showed no differences between baseline and end point for any of the ADHD symptoms assessed. According to strict, predefined criteria for response, 68% of desipramine-treated subjects and no subjects in the placebo group were considered positive responders. Response to desipramine was independent of dose, level of impairment, gender, or lifetime psychiatric comorbidity with anxiety or depressive disorders. CONCLUSIONS: These results, similar to findings in children and adolescents with ADHD, indicate that desipramine is effective in the treatment of ADHD in adults.
>
> Kind regards
>
> ~Ed

Ed. I like your scientific way of looking at things. Data is important. Let's remember that both stimulants and the above meds are more effective than placebo for ADHD. I guess the true test would be a prospective, randomized, comparative study with sufficient numbers to rule out chance. I have ADD and would love to know if you have seen any of these. I have only seen studies comparing stimulants. Thanks.

 

Thank you all-Very Much!!!

Posted by Paulbwell on August 31, 2005, at 21:26:36

In reply to Re: I agree with linkadge, posted by rjlockhart98 on August 30, 2005, at 23:05:22

> "Taking too many stimulants can burn out your adreanal glands. Umm especially Methamphetamine, that will damage dopamine nuerons severely if tooken consistantly at moderatly high doses."

This is not a given, I know of a Narcoleptic bloke who has taken Desoxyn, (Medical Methamphetamine) for 40 years first, 4-5 15 mgs SR in the morning, now 4-5mgs tabs 4x a day=80mgs!!, AND he WORKS and has done so for MANY years -lucky him.


After taken Ritalin for 1.5 years, it along with moderate doses of Valium seems to have changed in effects. I'm thinking about taking Effexor (mentioned by a PsyDoc I saw) either alone or with the Ritalin, when i see my PCDoc on Monday. I tried Imipramine at 150mgs daily for Dep, second line ADD treatment and it had a host of SEs,I also began smoking as a result. since it metobilises to Desipramine is their any advantage?. I'm sure i have depresssion and need AD treatment. Stimulants seem to provide temporary and superficial relief to this.

Thank you All!!!


Cheers

 

Re: Ritalin 80mgs-not doing it anymore?- Restlessness

Posted by Paulbwell on August 31, 2005, at 21:32:14

In reply to Re: Ritalin 80mgs-not doing it anymore?- Restlessness, posted by utopizen on August 29, 2005, at 15:31:51

I take Magnesium Aspartate and 3 mgs EPA+DPA suppliments as well.

Only Concerta, Dextroamphetamine 5mg IR or another bloody AD is next in line.
Taken ADs :

-Prozac, Ok
-Celexa, No good
-Paxil, 3x, No good
-Serzone, Zombie.
-Imipramine, MMMMMMMM


Cheers


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