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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on August 22, 2006, at 18:30:49
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 22, 2006, at 16:05:14
Is he adding it for antidepressant augmentation, or for attention?
If he is using it for augmentation, I would pick a different agent.
How is your blood pressure on the emsam alone ??
Linkadge
Posted by mayzee on August 22, 2006, at 20:35:55
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 22, 2006, at 18:30:49
> Is he adding it for antidepressant augmentation, or for attention?
>
> If he is using it for augmentation, I would pick a different agent.
>
> How is your blood pressure on the emsam alone ??
>
> LinkadgeI went to see that pdoc specifically because, although I started to show improvement on 9mg EMSAM, the low blood pressure side effects were intolerable (dizzyness, dimmed vision, FATIGUE, etc.) I still have very low bp even at 6mg EMSAM.
He's suggesting the addition of ritalin to 1) augment the AD effect of EMSAM at 6mg; 2) improve energy/alertness (fatigue has always been a big part of my depression); and 3) maybe increase blood pressure.
I do not have ADD/ADHD, but I do have concentration/focus problems due to my depression (atypical MDD/TRD).
I haven't seen any case studies of EMSAM+ritalin, but have seen info about use of ritalin with other MAOIs (see Willyee's thread above on unconventional use of MAOI)
Thanks for your input Linkadge!
--mayzee
Posted by Paulbwell on August 23, 2006, at 2:06:40
In reply to Re: Linkage, posted by linkadge on August 22, 2006, at 15:37:17
> Just a few questions. Does 80mg work the way it did at the very start? Does 80mg give you the same effect that you had when you first started the medications?
No the 'honeymoon period is gone, there was a time when i could wake up early, take 30mgs, drink Tea, chew Nicotine gum, and all day i would fell well, alert interested and on the ball, often "in the zone" feeling where things just darn well fit-was wonderfull while it lasted-This while Ritalin calmed and focused me-This phenomonon i have read about-stim tolerance? sensitivity?.
Now it often makes me nervous, irritable, insecure. I want so bad to capture thoes feelings of a year ago
>
> And yes, there is growing evidence that methlyphenidate can cause long term structural changes to the heart. It is a stimulant with perepherial effects too. I will try to find the links, but this is essentially what the whole debate is about at recent.
>
> If you really want, just type in ritalin + cardiac, or methylphenidate + cardiac into your favorite search engine.
>
> Linkadge
>
>
> I'm sure you can find Cardiac probs with Rit, but i have read Medline articles where Meth/amphetamines typically do this more, and Desoxyn HAVING THE LEAST PNS ACTIVATION TOO.Cheers
Posted by laima on August 23, 2006, at 12:19:55
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 22, 2006, at 18:28:50
My doctor endorses this unorthodox combo, but emphasizes LOW dose of ritalin only- to boost disfunctionally low blood pressure. (Does not really endorse using amphetamines, though.) The danger is of course, as you point out, risk of overstimulation. He says he's treated loads of patients this way, and no one ever got into any danger as long as they followed instructions and didn't cheat by taking extra-and were extra careful with concurrent use of other stimulants, ie caffeine. Also said to be sure to keep an eye on blood pressure with a home heart-rate monitor. He's also a medical professor, so I reckon I can be confident he's keeping up on all the latest studies and such.I was using this with NO problem whatsoever, until the week we had 100 degree temps each day and I went up on EMSAM- I got anxious, so all ritalin was cut as precaution. However, now my blood pressure is so low that I can barely function, so I am going to ask about going back on a tinier amount, ie just 5 mg instead of 15 per day. Definately, having used ritalin before selegeline and after- I conclude that selegeline amplifies its effects.
> Hmm, I'm not sure about this. I would see if you can find any reports of the two being combined safely.
>
> The main problem I see is overstimulation. There are a few different paths by which dopamine can be metabolized, MAO-B, and DAT are two of these systems.
>
> Combining selegeline and ritalin would reduce both of these pathways, which could definately lead to overstimulation.
>
> I would (personally) look for case reports saying the two have been combined safely, before trying it.
>
> Linkadge
>
>
>
>
Posted by linkadge on August 23, 2006, at 16:30:31
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 22, 2006, at 20:35:55
If I recall wylee's ritalin augmentation did not go over too well at all. I don't know if it was overstimulating or what, but I think he ended up in the hospital.
If you do add it go very slowly, try the lowest dose possable and cut that in half (if possable). There may not be an interaction, but in theory, at least, it could lead to over stimulation.
Linkadge
Posted by linkadge on August 23, 2006, at 16:33:27
In reply to Re: Linkage Rit » linkadge, posted by Paulbwell on August 23, 2006, at 2:06:40
You're right, the stronger the stimulant the more likelyhood of cardiac events.
Linkadge
Posted by linkadge on August 23, 2006, at 16:36:11
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by laima on August 23, 2006, at 12:19:55
Whatever you do, DON'T DRINK GREEN TEA on the combination of segeline + ritalin.
If you do, you will have inhibition of DAT, COMT, and MAO-B, the (only?) three pathways available for dopamine metabolism.
This would very likely lead to overstimulation.
Linkadge
Posted by laima on August 23, 2006, at 16:50:00
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 16:36:11
What??? I've done this, never had any warning, never had any adverse event. Where did you hear this? Maybe it depends on how much ritalin...with selegeline I've never used higher than grand total of 15 mg spread out over the day-and that's not a lot. And guess what- still a bit sleepy.
> Whatever you do, DON'T DRINK GREEN TEA on the combination of segeline + ritalin.
>
> If you do, you will have inhibition of DAT, COMT, and MAO-B, the (only?) three pathways available for dopamine metabolism.
>
> This would very likely lead to overstimulation.
>
> Linkadge
Posted by linkadge on August 23, 2006, at 19:43:10
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by laima on August 23, 2006, at 16:50:00
Dopamine doesn't always lead to behavioral activation.
Interesting though, how much green tea did you drink?
Linkadge
Posted by laima on August 23, 2006, at 19:59:56
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 19:43:10
Not much- a cup here and there. I'm more of a coffee-type.> Dopamine doesn't always lead to behavioral activation.
>
> Interesting though, how much green tea did you drink?
>
> Linkadge
Posted by mayzee on August 23, 2006, at 20:39:46
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 16:30:31
> If you do add it go very slowly, try the lowest dose possable and cut that in half (if possable). There may not be an interaction, but in theory, at least, it could lead to over stimulation.
>Linkadge,
What do you mean by "over stimulation"? ...feeling hyper? anxious? or over stimulation of the heart (racing?) or ???
Thanks,
mayzee
Posted by laima on August 23, 2006, at 21:05:04
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 23, 2006, at 20:39:46
Too much ritalin with selegeline (or without selegeline) = wired, jittery, severly overcaffinated feeling. (But calmable with a benzo if you goof.)
> > If you do add it go very slowly, try the lowest dose possable and cut that in half (if possable). There may not be an interaction, but in theory, at least, it could lead to over stimulation.
> >
>
> Linkadge,
>
> What do you mean by "over stimulation"? ...feeling hyper? anxious? or over stimulation of the heart (racing?) or ???
>
> Thanks,
> mayzee
>
>
Posted by Paulbwell on August 24, 2006, at 1:53:32
In reply to Re: Linkage Rit, posted by linkadge on August 23, 2006, at 16:33:27
> You're right, the stronger the stimulant the more likelyhood of cardiac events.
>
>
>
> Linkadge
Hi Ya Link!Your bringng up of Cardiac damage with Rit, is valid-(if someone is, abusing, IVing, snorting huge amounts.
But in average doses, cardiac damage is prolly less toxic than smoking-(which my dad has been doing for 45 years, 68yo) and is in good health.
I know of a 62yo with sever Narcolepsy, who has been taking Desoxyn (quite high doses~60-80mgs) for ~45 years. he recently had a heart angioplasty procedure done=heart damage, prolly from the methamphetamine, strange considering (as i mentioned) Desoxyn has the least PNS activation Vs CNS action.
Cheers
Posted by linkadge on August 24, 2006, at 15:39:59
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 23, 2006, at 20:39:46
Probably different for different people. Too much dopamine, hallucinations perhaps, too much goal directed behavior, inability to turn off certain thought patterns perhaps.
Linkadge
Posted by linkadge on August 24, 2006, at 15:43:23
In reply to Re: Linkage Rit » linkadge, posted by Paulbwell on August 24, 2006, at 1:53:32
The risks for stimulant treatment with ritalin are still existent.
The problem is that there has not been a lot of directed research into the issue. While is has been known that people who abuse stimulants have higher likelyhood of cardiac event, ritalin is only now beginning to get the thorough investigations that it needs.
http://amphetamines.com/methylphenidate/black-box.html
Linkadge
Posted by laima on August 24, 2006, at 16:30:53
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 23, 2006, at 19:43:10
Now that I think of it, I thought I should mention that though I drink it several times a week, I do not boil my water the full way, (because I don't like it so hot) and take the tea packet out soon- so it's not strong green tea.
But I'm still curious, where did you hear about this green tea thing, or is it a personal educated theory?
Thanks.
Posted by linkadge on August 24, 2006, at 18:54:33
In reply to Re: about that green tea... » linkadge, posted by laima on August 24, 2006, at 16:30:53
It would have to be an educated theory :)
No, its not writtain on the back of the pill bottle.
I know that green tea is a COMT inhibitor. Dopamine can be metabolized by DAT, MAO-B or COMT. So one could expect synergistic actions of the level of dopamine by taking agents capable of inhibiting these enzymes.
Its really just something to consider.
Linkadge
Posted by laima on August 24, 2006, at 21:08:57
In reply to Re: about that green tea..., posted by linkadge on August 24, 2006, at 18:54:33
Educated theories are good! But I won't ever be the one to prove you right, thanks to my poor tea-making skills.> It would have to be an educated theory :)
>
> No, its not writtain on the back of the pill bottle.
>
> I know that green tea is a COMT inhibitor. Dopamine can be metabolized by DAT, MAO-B or COMT. So one could expect synergistic actions of the level of dopamine by taking agents capable of inhibiting these enzymes.
>
> Its really just something to consider.
>
> Linkadge
Posted by mayzee on August 24, 2006, at 23:10:44
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 22, 2006, at 18:30:49
> Is he adding it for antidepressant augmentation, or for attention?
> If he is using it for augmentation, I would pick a different agent.
>Hi Linkadge,
What different agent (instead of ritalin) would you pick for AD augmentation?
(my scenario is that I got some initial improvement at 9mg EMSAM but had to back off due to low blood pressure problems)Thanks,
mayzee
Posted by Paulbwell on August 25, 2006, at 0:50:28
In reply to Re: about that green tea..., posted by linkadge on August 24, 2006, at 18:54:33
> I know that green tea is a COMT inhibitor. Dopamine can be metabolized by DAT, MAO-B or COMT. So one could expect synergistic actions of the level of dopamine by taking agents capable of inhibiting these enzymes.
>
> Its really just something to consider.
>
> Linkadge
So i take it you are saying that drinking green tea, slows down the CNS dopamine destruction action?-whether inhibited by Ritalin or Amphetamine?Cheers
Posted by linkadge on August 25, 2006, at 17:10:57
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 24, 2006, at 23:10:44
You could try very slowly adding tyrosine or phenylalanine from a health food store. You could also perhaps try caffiene tablets, or coffee itself.
Have you tried wellbutrin by itself?
Nortryptaline or desipramine might also be good antidepressants by themselves, for low energy type of depression.
Linkadge
Posted by linkadge on August 25, 2006, at 17:16:21
In reply to Re: about that green tea... » linkadge, posted by Paulbwell on August 25, 2006, at 0:50:28
Yes. Generally when you take some substance that inhibits one pathway of metabolism there is a comepensatory increase in the other metabolic pathways.
Taking selegeline for instance, decreases MAO-B, but it increases DAT. So that the extra dopamine can be taken up by DAT.
Now, if you take a DAT inhibitor like ritaline, wellbutrin, cocaine etc, then you've blocked two pathways for metabolsm.
COMT is another pathway for dopamine and norepinephrine metabolism, so blocking it could be another way to dam up dopamine.
There are a few snags of course. The first being that these pathways are probably designed to prevent excess stimulation of dopamine receptors. There may be a consequence of excess stimulation.
The second snag is that green tea is also an acetylcholinsterase inhibitor. So it can increase acetycholine as well as dopamine. Aceylchonsterase inhibitors can cause depression by thesmeleves in certain people.
Linkadge
Posted by laima on August 25, 2006, at 23:21:51
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 25, 2006, at 17:10:57
ps- I find ritalin to be more effective and predictable than phenylalanine-and much shorter acting. If I take the phenylalanine in am, it can keep me up at night. Not so with low dose ritalin.
> You could try very slowly adding tyrosine or phenylalanine from a health food store. You could also perhaps try caffiene tablets, or coffee itself.
>
> Have you tried wellbutrin by itself?
>
> Nortryptaline or desipramine might also be good antidepressants by themselves, for low energy type of depression.
>
>
> Linkadge
Posted by mayzee on August 25, 2006, at 23:24:12
In reply to Re: Tell Me About Longterm Ritalin, posted by linkadge on August 25, 2006, at 17:10:57
> You could try very slowly adding tyrosine or phenylalanine from a health food store. You could also perhaps try caffiene tablets, or coffee itself.
Thanks for your suggestions. I don't know anything about either tyrosine or phenylalanine (I think Laima is trying that with Emsam); but I will try to do some research to learn about them.
> Have you tried wellbutrin by itself?Yes, I did trials adding Wellbutrin to Paxil, and then Wellbutrin by itself (up to 450mg). It didn't help my depression and wasn't at all activating for me
> Nortryptaline or desipramine might also be good antidepressants by themselves, for low energy type of depression.
I'll note these for future. I asked the pdoc consult about TCAs and he said he thought they were better tried for acute and/or melancholic depression rather than chronic atypical. But if I'm not lucky, I'm sure I'll get around to them some day.
Thanks again for your input. I have a lot to learn!
--mayzee
Posted by laima on August 25, 2006, at 23:43:49
In reply to Re: Tell Me About Longterm Ritalin » linkadge, posted by mayzee on August 25, 2006, at 23:24:12
My update:I got back today to a low dose of ritalin, much lower than before, and am backing off phenylalanine for now in order to not get too risky or complicated. The phenylalanine helped my mood, as is Emsam- but the p- was NOT helping to boost my sluggish, faint feeling low blood pressure. That faintness and sluggishness was interfering with my goals and activities, making me feel like a chronic loser...sort of countering the otherwise positive effect of the Emsam and phenylalanine, if that makes sense. My other options to raise blood pressure were to take steroids (no thanks) or to wear weird sounding pantyhose (NO THANKS). Caffeine is jittier than low dose ritalin, in my experience, and hurts my stomache if I drink enough to get any effect. I think there is just no contest between caffeine and ritalin. And I've already been using so much salt I'd not be able to swallow my food if I used any more- plus it made me all puffy, too.
I asked if selegeline could "amplify" or prolong effects of other drugs, and the answer was "YES".
So I'll see how it goes- so far- I'm feeling MUCH better today! Active and more social!
Don't misunderstand- I am still a huge admirer of phenylalanine- and once took phenylalanine and tyrosine together (with nothing else), and that combo was very effective for awhile.
> > You could try very slowly adding tyrosine or phenylalanine from a health food store. You could also perhaps try caffiene tablets, or coffee itself.
>
> Thanks for your suggestions. I don't know anything about either tyrosine or phenylalanine (I think Laima is trying that with Emsam); but I will try to do some research to learn about them.
>
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