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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by g_g_g_unit on June 5, 2009, at 0:58:28
hi, i've decided that my best chance for remission now might come about through the combination of a stimulant with memantine in order to vanquish the last traces of brain fog, so that i can then go about installing positive, permanent changes in my lifestyle; CBT is helping a lot, but not really w/ mental energy, which is what i really need in order to go back to working. i'm going to propose this idea to my pdoc on monday. my concern though regards people's complains that stimulants can often make them feel 'robotic'; i'm wondering if this is more to do with tolerance (which memantine prevents) or is it a characterstic of certain stims rather than others?
i know that when memantine assumed an amphetamine-like effect during the early stages of dosing, i experienced an almost manic onslaught of ideas, boundless mental energy, etc. which ultimately ended up exasperating my underlying perfectionistic behaviours (and thus making itself more of a hindrance than help in terms of mental flexibility). i'm guessing that it's not really possible to compare that effect to using a stim since Memantine only affects D2, while stims hit more Dopamine receptor sites?
anyway, for the sake of cognitive energy + flexiblity, with minimum CNS activation, what's the best route to take? would i perhaps be better off with something like deprenyl?
Posted by garnet71 on June 5, 2009, at 4:06:47
In reply to stimulant recommendation, posted by g_g_g_unit on June 5, 2009, at 0:58:28
Generic dextroamphetamine is a one of the cleanest drugs I've ever taken, and has all the qualities you mentioned: low CNS activation (w/10 mg dose), flexibility? works about 4 to 6 hours-smooth on/smooth off; helps tremendously with motivation and to a lesser extent, but not too much "less", cognitive ability. No robot-like symptoms lol. I get no side effects from it. I had to taper on real slow the first week though, it was a little too activating at first, but once I got used to it, it just makes me feel more normal. i don't feel like I'm taking a drug at all on 10 mg.
It allows me to be more productive again, but not 100%. It has helped me more than any psychotropic I've taken over the past 3 years.
I do have severe anxiety at times, but it does not seem to have any affect on it, but is not good to take if you are having major anxiety symptoms. If I'm having a panic attack, I don't take it, but when the anxiety dissipates, I go right back on it the next day. I think it prevents anxiety in some way, being able to be more productive and all leaves less time to procrastinate and dwell on stressors. It helps keep you on task with priorities.
The only thing I don't like about it is I can't take it in the evenings when I need to be doing my homework, so I think I'll have to find another drug to either augment or replace it; something that stays in your system 24 hours a day. It would be great for someone who doesn't have a lot to do in the evenings, though.
This drug has saved me from failing out of college, or put another way, helped reverse the adverse affects of being on SSRIs for so long; not sure which; but it has had a positive affect on my life no matter how I look at it, even if it is only a temporary fix.
Good luck
Posted by garnet71 on June 5, 2009, at 4:21:40
In reply to stimulant recommendation, posted by g_g_g_unit on June 5, 2009, at 0:58:28
Forgot to say...if you live in the land of conservative doctors like where i live, they might be reluctant to prescribe dextro. My last PDoc was hesitant, but gave me the script when I asked, followed by "i can't treat you anymore".
But I just saw a new psychiatrist this week who said "I don't think you really have ADD....but I really don't have a problem with you taking the dexstrat".
So go figure.
Posted by emme on June 5, 2009, at 4:42:27
In reply to stimulant recommendation, posted by g_g_g_unit on June 5, 2009, at 0:58:28
Hi. I've done well with Focalin. Lamictal and Abilify do most of the work for depression. The Focalin cleans up some of the remaining fatigue and helps me get more done. It has fewer CNS effects for me than Ritalin, which made me feel too revved up. Focalin takes about an hour to kick in. No robotic feeling, just more alertness. I do avoid it when I will be in an intense situation such as a busy meeting because I will become overstimulated. But for a day when I need to focus, it's good.
Both my current pdoc and my former pdoc, who started me on Focalin, have a common sense approach and are unafraid to use stimulants to augment antidepressants. My current pdoc believes that using stimulants helps depression by helping people get more done and feel better about their lives.
emme
Posted by g_g_g_unit on June 5, 2009, at 5:05:48
In reply to Re: stimulant recommendation » g_g_g_unit, posted by emme on June 5, 2009, at 4:42:27
well, at the moment i'm kind of trapped in a bad situation: 8 months ago i gave up my life's passion as a freelance writer due to mental burnout from SSRI's. in the meantime, i've been working extra hours at my part-time job at a library in order to pay for physiotherapists, psychologists, psychiatrists, meds, etc. the more i work at a computer + lift books, the worse my pain (overuse syndrome = nerve pain in arms + legs) gets, meaning my depression worsens, meaning i spend more on therapists, meaning i have to work extra hours, etc.
my rationale is that a stimulant might provide me with the motivation (i have pretty much zero reward sensitivity at the moment, not to mention poor word recall, inability to fully coordinate my thoughts etc.) to return to working as a writer, which will then create a positive feedback cycle, as my pain lessons due to having to work less at the library, and having more time for physical rehabilitation etc. etc. my current pdoc was adventurous enough to let me try memantine; however he doesn't know very much about me (i've only seen him twice) and is not very sensitive to my complaints about cognitive functioning. my plan is to write out exactly the symptoms i'm experiencing and how they're affecting my life, with the additional proviso that i have an actual life plan that i am trying to follow through on (i.e. i did experience success as a writer prior to brainfog onset from general burnout, i guess, plus a whole slew of ssri trials performed last year). failing his compliance, i have a friend who knows of a pdoc who treats ADD and is more sympathetic to cognitive complains (my friend also agrees, incidentally, that dexamphetamine is the best stim).
Posted by bleauberry on June 5, 2009, at 5:11:14
In reply to stimulant recommendation, posted by g_g_g_unit on June 5, 2009, at 0:58:28
I cannot provide scientific proof to back it up, but I can submit with strong certainty from experience on this topic, that your brain fog is from an infection. Not a brain disorder.
You may be able to hide the symptoms for a while with medications but they will do nothing to slow the progress of the underlying pathology.
In the meantime you certainly deserve to feel as best you can. There really is no other method than trial and error. The popular ones in that category are Ritalin, Adderall, and Provigil. Of the three, I favor Provigil as a first start, since it is so often helpful in symptoms of Fibromyalgia, Chronic Fatigue Syndrome, and Depression, which in my view at least 50% of those cases have an unseen undiagnosed bacterial and/or yeast infection. Brain fog is almost universal in them, and again, its the toxins of the infection doing it. Most likely yeast.
Illness+stress+sugar+meds=yeast=brainfog.
Posted by g_g_g_unit on June 5, 2009, at 7:02:07
In reply to Re: stimulant recommendation, posted by bleauberry on June 5, 2009, at 5:11:14
> I cannot provide scientific proof to back it up, but I can submit with strong certainty from experience on this topic, that your brain fog is from an infection. Not a brain disorder.
do you say that based on brain fog in general? or the symptoms i've presented here in the past? what are the diagnostic criteria for identifying an infection? is it possible for a GP to diagnose, or would i have to go through a naturopath (my experience with naturopaths - at least those backing a specific product-line - is that they will tend to greenlight any potential diagnosis you put forward, as long as there's some premade herbal formula designed to combat it).
my instinct has always been that it's the result of depression, which in turn manifested due to both chemical factors (ssri withdrawal) as well as psychological ones (decreased confidence in my ability to 'perform' in areas that are important to me [social, professional] as a result of withdrawal). then again, my recent bouts of pain (and positive response to curcumin) lead me to think that some kind of low-grade inflammation might also be at work.
>
> You may be able to hide the symptoms for a while with medications but they will do nothing to slow the progress of the underlying pathology.
>
> In the meantime you certainly deserve to feel as best you can. There really is no other method than trial and error. The popular ones in that category are Ritalin, Adderall, and Provigil. Of the three, I favor Provigil as a first start, since it is so often helpful in symptoms of Fibromyalgia, Chronic Fatigue Syndrome, and Depression, which in my view at least 50% of those cases have an unseen undiagnosed bacterial and/or yeast infection. Brain fog is almost universal in them, and again, its the toxins of the infection doing it. Most likely yeast.
>
> Illness+stress+sugar+meds=yeast=brainfog.provigil would be really easy to get an 'rx for, since my gp's offered it to me before. my impression was that it simply promoted 'alertness' (i.e. a lack of fatigue), and that traditional stims were better for mental stimulation?
my only worry is that stims might exacerbate my OCD, though my hope is that memantine might prevent that. then again, like i say, my feeling is that the extra push provided by a stim would be crucial in creating a positive feedback cycle for me, so that i could then withdraw off it once i'm settled and have made the appropriate life adjustments. i was also planning on adding in anti-depressant like st john's wort.
my only worry is that if i fail to get a stim rx, then that doesn't leave me with many options for augmentation. deprenyl's attractive, but something i don't wanna mess around with without supervision. someone recommended i try nicotine lozenges in 2mg doses, but being hooked on nicotine ain't exactly ideal either.
Posted by Phillipa on June 5, 2009, at 10:47:42
In reply to Re: stimulant recommendation, posted by g_g_g_unit on June 5, 2009, at 7:02:07
Anyone tried vyvanase heard that is really good long acting a friend is on it. Phillipa
Posted by ricker on June 5, 2009, at 11:17:42
In reply to Re: stimulant recommendation, posted by g_g_g_unit on June 5, 2009, at 7:02:07
I'm not to familiar with stims but from the reading I've been doing recently, I'd agree with bleuberry and go with provigil.
Rick
Posted by bleauberry on June 5, 2009, at 19:43:05
In reply to Re: stimulant recommendation, posted by g_g_g_unit on June 5, 2009, at 7:02:07
If you want to know how to diagnose a yeast problem, a Lyme problem, a bacterial problem, a parasite problem, a heavy metal problem, or a viral problem, it is actually fairly easy and cheap and you do not need a lab or a doctor or a naturupath to do it. A positive diagnosis is stunningly obvious. Too much info for this short post, but if you are interested in learning more, let me know.
My mention of provigil was simply based on the experience of others over the years here, at askapatient.com, revolutionhealth.com, and various forums that deal with Lyme, yeast, and mercury chelation, where brain fog and every psychiatric label you can name happen to be a universal problem in all of them. Any stimulant could help, but for some reason provigil is the one most people do best with. It is a more friendly more forgiving stimulant and it does more than wakefulness.
But inevitably, brain fog doesn't need a counter-balance medication to push against it when the underlying cause of it is removed.
If a stimulant worsens the OCD, that is yet another bingo in the diagnosis of a hidden infection.
You mentioned inflammation. I would not take that lightly. That is a serious clue. Inflammation doesn't just happen for some mysterious reason. It is the body's natural defense mechanism when it is under attack from something. It was the combination of the two words "brainfog" and "inflammation" that painted a pretty clear picture to me.
I don't know you, your history, your entire symtom presentation, and I can't see you, so obviously I am not venturing a diagnosis. I am merely trying to say what is very likely. More likely than you think. And I realize it is new stuff that you don't know much about. That's ok. The more you learn, the more progress you can make.
If I could go back and do it all again, knowing what I know today, and be a doctor, my first priority would be to immediately get the patient feeling better so they can get on with their lives, jobs, hobbies, and families. But the second priority, and actually the biggest most important priority, would be to eliminate the cause of their symptoms. Unfortunately, our doctors and most of us here do not do that. And we are still medicated and still sick decades later.
Posted by g_g_g_unit on June 5, 2009, at 19:50:43
In reply to Re: stimulant recommendation, posted by bleauberry on June 5, 2009, at 19:43:05
> If you want to know how to diagnose a yeast problem, a Lyme problem, a bacterial problem, a parasite problem, a heavy metal problem, or a viral problem, it is actually fairly easy and cheap and you do not need a lab or a doctor or a naturupath to do it. A positive diagnosis is stunningly obvious. Too much info for this short post, but if you are interested in learning more,let me know.
I would definitely be interested. do you have information on-hand? if so, i would be happy for you to babblemail me
Posted by g_g_g_unit on June 6, 2009, at 0:17:11
In reply to Re: stimulant recommendation, posted by g_g_g_unit on June 5, 2009, at 19:50:43
i should also add that the inflammation i experience is not random in nature; it occurs in my shoulder, and can be directly linked to occupational overuse. if there was some underlying pathology, i guess that might aggravate it, but i didn't wanna give the impression that i experience inflammation for no reason.
i'm also quite interested in proposing mirapex (which is available as a generic, and which a GP can prescribe [only specialists can prescribe stims here]). it seems to have great results in alleviating anhedonia (which i do suffer from), but is anyone aware of how it affects cognition?
Posted by Frustratedmama on June 6, 2009, at 8:11:59
In reply to Re: stimulant recommendation, posted by g_g_g_unit on June 6, 2009, at 0:17:11
Hi, Just wanted to add my 2 cents worth.... Vyvanse made my moods worse but is longer acting.... Adderall XR and Dexedrine spansules have been the most effective for me....(but I have Some adhd traits- impulsive type) Provigil did nothing for me and Focalin and Ritalin were not nearly as effective....
That was just my experience (and we are all different). Adderall XR is my current adhd med and seems to be working again (at a low dose- 10 mg). Helps me with focus, motivation, and getting things done! I can't (for the life of me) write reports without it - so it might be worth a shot for you as you say you are a writer. Just wanted to chime in here- hope it helps
Posted by g_g_g_unit on June 6, 2009, at 18:02:23
In reply to Re: stimulant recommendation, posted by Frustratedmama on June 6, 2009, at 8:11:59
> Hi, Just wanted to add my 2 cents worth.... Vyvanse made my moods worse but is longer acting.... Adderall XR and Dexedrine spansules have been the most effective for me....(but I have Some adhd traits- impulsive type) Provigil did nothing for me and Focalin and Ritalin were not nearly as effective....
> That was just my experience (and we are all different). Adderall XR is my current adhd med and seems to be working again (at a low dose- 10 mg). Helps me with focus, motivation, and getting things done! I can't (for the life of me) write reports without it - so it might be worth a shot for you as you say you are a writer. Just wanted to chime in here- hope it helps
>thanks frustredmama. from what i've read, consensus seems to be that dexedrine (and to a lesser extend adderall) are the cleanest stims. in the interests of making a case, i've printed out a paper which suggests that ssri-induced anhedonia is best treated using dopaminergics, as well as one outlying how dexedrine has little effect on OCD (and in some cases will improve it). hopefully that's enough to convince my pdoc to prescribe a stim off-label. otherwise, like i say there is also the possibility of mirapex, and maybe amisulpride .. which i guess are 'dirtier' options
Posted by surfergirl on June 7, 2009, at 19:37:40
In reply to Re: stimulant recommendation, posted by g_g_g_unit on June 6, 2009, at 18:02:23
I need to add my 2 pennies.
I have had "brain fog" stemming from fibromyalgia & lupus off & on for 10 years. I am sure that at times these things did contribute to BF. I really did not consider that I might need to see a PD until this year. He diagnoses me with ADD & narcolepsy.
I really like the effect of Adderal for me. My mind is clear & calm. My body is very relaxed. I can get my paperwork completed for work.
Also, I am an amateur musician but stopped playing after Christmas & dropped out of the church band I was in. Playing was just too stressful & I was making mistakes. I even stopped listening to music for a while. I have started playing the piano for pleasure again. My husband says I sound better than I have in several years(after surgery for thyroid cancer I sort of lost my timing & coordination for a long time & never fully got back to the same place)The music finally flows again.
I tried Provigil breifly for about 10 days but it was giving me headaches. It seemed to help the first couple of days but after I got the headache I was out of it & worse every day I was on it.
My PD says to stay away from caffeine since that interferes with the receptors for Adderal. It seems to be working better--focus, calm, & awake since I have been off caffeine. Does anybody's PD tell them to stay off caffeine when on Adderal? thanks!
surfergirl
Posted by garnet71 on June 7, 2009, at 20:03:24
In reply to stimulant recommendation, posted by g_g_g_unit on June 5, 2009, at 0:58:28
Hey-forgot to say (Surfergirl's post reminded me(thanks Surfergirl!)) that Dextroamphetamine did NOT take away my creativity AT ALL. I was very surprised; pleasantly surprised, that my creative thinking was not adversely affected by this drug. Again, it has just made me feel more "normal" (normal being how I was before depression/anxiety 9 yrs ago) than i have been in years w/xxRI treatment. Another couple of "pennies" offered.lol.
Posted by g_g_g_unit on June 8, 2009, at 1:17:29
In reply to Re: stimulant recommendation, posted by garnet71 on June 7, 2009, at 20:03:24
he denied me a stimulant prescription (accused me of seeking speed!); i even showed him a treatment plan which proposed using stims for ssri-induced anhedonia. he said i don't have anhedonia because i'm not currently on SSRI's (which didn't make any sense because the study claims that anhedonia is also an after-effect of SSRI administration). he's offered me moclobemide. i'm wondering if i should accept and just combine it with deprenyl, which i can easily obtain by mailorder
Posted by garnet71 on June 8, 2009, at 13:30:45
In reply to Re: stimulant recommendation, posted by g_g_g_unit on June 8, 2009, at 1:17:29
Sorry to hear that, sorry you didn't get the opportunity to try that drug. Using small therapeutic doses does not get you "high"; I really don't understand the controversy.
Maybe PDocs recommendation will prove better for you? I hope so.
BTW, what exact research paper are you referring to?
Posted by g_g_g_unit on June 8, 2009, at 17:55:37
In reply to Re: stimulant recommendation » g_g_g_unit, posted by garnet71 on June 8, 2009, at 13:30:45
sorry it's not really a study i guess. more a treatment proposal.
This is the end of the thread.
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