![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by english on September 28, 2009, at 0:47:20
hi,
i'm currently unmedicated for both my adhd and my depression. i also have a lot of problems with social anxiety. i'm not doing all very well and want to start looking into medications again. the problem is i'm not really sure where there is left to go - i don't really respond very well to stimulants. they make me feel very robotic and cold and often depressed. i can hardly interact with people while i'm on them, i'd have no 'color' at all, and would sink much father back into my head. they also didn't make me any more motivated or passionate, with the effect generally being that i'd be more focused but wouldn't actually do any better in school, i'd only be more focused at the things i liked to do to begin with. i'd still fall into the same behavioral habbits. aside from this, i already have problems keeping up my weight. my parents also strongly disliked what the medications did to me.
i've tried:
strattera
adderall XR
ritalin
metadate
concertaalso wellbutrin for both adhd/depression, which didn't work for me, mostly because of some bad memory problems which cropped up. short term memory issues don't exactly help adhd much.
anyway, i'm curious what the possibilities for me might me? i can supply a more detailed description of my mental state, if that would help, i've been pretty vague here.
i don't want to try try an ssri since they'll have an inhibitory effect on dopamine, moreover, i seem to hear a lot about them having a generally 'numbing' quality to them, which i don't need any more of. i also don't really want to combine a stimulant and an ssri, i'd rather avoid the stimulants if i can.
would nardil help with adhd at all? would it possibly make it worse?
thanks!
Posted by psych chat on September 28, 2009, at 1:07:22
In reply to depression/adhd-pi options?, posted by english on September 28, 2009, at 0:47:20
St. Johns Wort - Kira brand $10/box
Posted by english on September 28, 2009, at 11:02:21
In reply to Re: depression/adhd-pi options?, posted by psych chat on September 28, 2009, at 1:07:22
i didn't really notice anything while i was on SJW. i tried the perika brand. i've also tried pretty much all available natural supplements for depression/adhd, btw, so it'd be great if we could keep this to prescription drugs. i pretty much already have the health/supplement front covered already.
Posted by Phillipa on September 28, 2009, at 12:01:17
In reply to depression/adhd-pi options?, posted by english on September 28, 2009, at 0:47:20
Didn't help me might help you what about cymbalta or effexor with wellbutrin. Just a thought. Phillipa
Posted by linkadge on September 29, 2009, at 9:03:08
In reply to Re: depression/adhd-pi options? » english, posted by Phillipa on September 28, 2009, at 12:01:17
Effexor may be worth a try. Nortriptyline and imipramine have documented effects in depression / ADHD.
Theoretically, cymbalta would be good for cognition on account of its affinity for the norepinephrin reuptake pump.
Try omega-3 too, if you havn't already. Its good for depression and ADHD.
Linkadge
Posted by desolationrower on September 29, 2009, at 17:07:15
In reply to depression/adhd-pi options?, posted by english on September 28, 2009, at 0:47:20
low dose naltrexone
prn low dose psilocin
-d/r
Posted by desolationrower on September 29, 2009, at 17:55:59
In reply to Re: depression/adhd-pi options?, posted by linkadge on September 29, 2009, at 9:03:08
oh, yohimbe is great for energy w/o the 'focus' effect of stimulants. of course, that means its not going to help with studying or somehting. best use as needed.
-d/r
Posted by english on September 29, 2009, at 19:16:19
In reply to Re: depression/adhd-pi options?, posted by desolationrower on September 29, 2009, at 17:55:59
hey,
thanks for the responses everyone. i've looked up everything suggested so far. what i forgot to mention is that i've narrowed my critera down a little further - i don't want to take anything with any marked anticholinergic effects whatsoever. i find that medications/substances which do this tend to be "dumb drugs", cause memory/focus problems, etc.
i've also responded very well to substances which do the opposite, such as piracetam, alpha-gpc, and other choline sources, finding they generally improve my focus, memory, and energy levels if not causing too much agitation. they also seem to become depressive after longterm use, probably due to 5HT or DA antagonism.
i'm really not willing to tolerate any medications which reduce cognition/clarity/memory. i'm starting college soon, and generally care a lot about retaining information that i've read or been exposed to. i'm also already really aloof and spacey and stuff that does this doesn't really seem to help in that department.
this cancels out the TCAs and the SSRIs. i really like very little of what i've read about the SSRIs, their efficacy seeming suspect and me not particularly liking how they cause dopamine depletion - that seems contridicted for adhd.
i'm considering selegiline, either with piracetam/alpha-gpc or in conjunction with an SSRI. i may want to add piracetam with the SSRI/selegiline combination as it increases acetlycholine receptor density which would cancel out the anticholinergic effects- i don't know if that would be contradicted or not. i doubt there has been any research, either.
i really like what i've read about nardil and parnate, as well, and feel like the potential hazards are way overplayed. it wouldn't be that big of a deal for me to emiminate tyramine containing foods or whatever. i've already dealt with a soy free, dairy free, preservative free, additive free, gluten free, meat free diet for over a year in the past (it didn't do a whole lot of good, btw), so i'm pretty sure i can handle it.
i do get the impression that the drugs tend to be used in very 'serious' cases, and i'm not sure if i qualify as this. i think my depression is largely nonendogenous, that is, i have a lot of problems which i think about a lot and which are very pervasive and mostly seem like they lack solutions or 'ways out', kind of being double-binds, paradoxes, etc. then again, my mood wasn't particularly great before any of these problems developed.
let me say a little more about my affect: it's frequently very flat. part of this, i think, is my personality (whether innate or part of some longer causal chain, whatever). my depression doesn't have a 'deep' quality too it, i wouldn't really even call it sadness. i really can't even feel sad most of the time. it's more just like aching. it's a lot of ego-ache, which is painful, and obviously very shallow, but not really "sad". it's mostly just like i'm empty. i don't really have anything which i sincerely care about. i used to be highly apathetic, and i feel like the only reason i'm not quite as apathetic anymore is because i feel so much need to overcompensate for all of damage i've done during the time that i was apathetic. i can't cry at all, only very rarely. most people see me as very stoic and unemotional, some have even jokingly referenced/made fun of the "thousand yard stare" that i seem to have. other times i can be more animated and engaging, depending on my mood.
it feels like i'm viewing the word though a shade of grey, not blue.
this was again really oversimplified but hopefully it paints a somewhat more clear picture of what kind of treatment i might need. my view of it is that i probably don't have enough dopamine. i need something stimulating, as well. i'm frequently downing coffee and chain smoking and stuff and never really seem to feel awake enough, i'm fairly lethargic most of the time.
so then about nardil/parnate: would i be overshooting was i to aim for getting one of these prescribed? what would happen if a moderately depressed person took one? would it be overkill? i'm attracted to nardil and parnate because neither of them seem like they have numbing qualities to them. they seem 'activating'. another thing is that i get the impression that they're not prone to decreasing your creativity like the SSRIs as known for. they also don't have any negative effects on cognition and seem stimulating, not numbing. is it possible any p-doc would even think of prescribing me one of these, given my limited medication history?
also, aside from the potential dietary interactions, is there also potential for particularly brutal side effects? from what i've read on here, it doesn't even seem like most people experience many, or that they'll go away in time. weight gain would actually be a plus for me, as i'm 6'4 and 155 and eat huge amounts of food and never seem to be able to gain any weight. that was another problem with the ADD meds. so, yeah: is it really that big of a deal supposing you follow the diet?
what do you guys think selegiline might do for me? it's available online for reasonable prices. i'm thinking 5 mg/day, so just selective mao-b inhibition.
i'm also working on finding a p-doc and setting up an appointment, so i'll probably hold on the l-deprenyl until i talk to him first. if i don't like the options he gives me i'll probably give selegiline a shot, or maybe combine an SSRI with selegiline.
Posted by english on September 29, 2009, at 22:19:04
In reply to Re: depression/adhd-pi options?, posted by desolationrower on September 29, 2009, at 17:07:15
> prn low dose psilocin
>
> -d/rso, uh, would i just nibble on a little bit of shroom every couple hours? how would we define low dose, here? an 8th (3.5 grams) goes for about $30 - $40 dollars around here, so this could get a bit expensive. how much would i be ingesting on a daily basis? what about tolerance?
Posted by english on September 29, 2009, at 22:33:50
In reply to Re: depression/adhd-pi options?, posted by english on September 29, 2009, at 22:19:04
perhaps selegiline + LSD/psilocybin microdoses? LSD has some affinity for the dopamine receptors (D5 in particular, less so for the others) which i like. however it might be difficult for me to buy larger quantities in liquid form, generally i tend to see the tabs.
or what about Selegiline + micro dose psilocybin + low dose ER methylphenidate?
so many options!
Posted by english on September 29, 2009, at 23:00:57
In reply to Re: depression/adhd-pi options?, posted by desolationrower on September 29, 2009, at 17:55:59
oh, by the way, i've sort of realized that the nardil/parnate idea is a really bad one. it just seems like way to extreme of a measure. if a psychiatrist suggests it i may try it, but i'm not going to push for it. i know what would happen if it was prescribed to me: i'd take it for a while, and it might even work, but then i'd eventually reach this point where my detachment breaks and i'd become terrified of the idea of so intensely medicating myself. the part of myself which wants to try it is a very detached one; if i considered it from a deeper place i'm sure i would conclude that it isn't a very wise choice.
what are the odds of selegiline helping with focus/concentration issues?
also, this may be a strange question, but is there anything i can take which might be more likely to increase my ability to feel rather than blunt it?
Posted by Helena24 on October 1, 2009, at 5:12:29
In reply to Re: depression/adhd-pi options?, posted by english on September 29, 2009, at 23:00:57
I see you have done a lot of research.
I deal with add/depression too and I have tried a lot of drugs.
Stimulants and not selective mao-i's are not available in my country.
I had a short experiences with ritalin,(wich was good but not easy to obtain) and concerta (wich was bad).
SSRI's make the problem worse for me.
Selegiline and piracetam were disappointing.
My best results were with modafinil 100-200 mg and tianeptine (up to 225 mg,although effective dosage varies a lot and starts with 37,5 mg daily).Don't worry that it is a tricyclic/it has no anticholinergic effects at all.
It causes me no side effects.The other combo that was effective was 100-200 mg modafinil combined with very small dosage of desipramine (25-50 mg).
Both of these combinations improved my focus/motivation.
The first one improved mood somewhat better.
Kira (sjw) helped also after 3 weeks off continuous use.
Posted by desolationrower on October 1, 2009, at 23:38:43
In reply to Re: depression/adhd-pi options?, posted by english on September 29, 2009, at 22:19:04
> > prn low dose psilocin
> >
> > -d/r
>
> so, uh, would i just nibble on a little bit of shroom every couple hours? how would we define low dose, here? an 8th (3.5 grams) goes for about $30 - $40 dollars around here, so this could get a bit expensive. how much would i be ingesting on a daily basis? what about tolerance?i'd say not more than 2x a week at the most
-d/r
Posted by DStupid on October 3, 2009, at 13:23:37
In reply to Re: depression/adhd-pi options?, posted by Helena24 on October 1, 2009, at 5:12:29
I also have problems with attention, flat affect, and social anxiety. I found that I couldn't get all of them addressed in one combination. So here's my experience. My base is Prozac at 20 mg in the morning and .5 mg of Xanax at night. For social anxiety situations, I add Abilify 2 mg. For work where I typically don't interact with people, I add Ritalin LA (long acting) 10 mg. With Abilify, I become social and outgoing (no flat affect), but I can't do my desk job well, as I get distracted. With Ritalin LA, I become focused and do my job well, but I have no interest socializing. Past experience: Dexedrine, Ritalin (regular), Lexapro, Celexa, Paxil XR (terrible withdrawal), Zoloft (terrible), Norpramine, Elavil, Valium, Klonopin, and Ativan.
Posted by psychobot5000 on October 4, 2009, at 13:52:07
In reply to Re: depression/adhd-pi options?, posted by english on September 29, 2009, at 19:16:19
Many good options being discussed here, but safety can be an issue. I don't know for certain, but I wouldn't take Selegiline with an SSRI, even at low doses. Bodkin and Cole, Harvard MAOi experts who are fairly permissive with their guidelines, still consider SSRIs a complete no-go with any MAOis, as far as I know. Now, with 5mg/day of selegiline...maybe it would not actually be very dangerous...but make sure you go into this with your eyes wide-open, and be careful. Serotonin syndrome is serious business.
I would also be skeptical of any suggested regimen involving LSD, frankly.
Posted by linkadge on October 5, 2009, at 20:19:14
In reply to Re: depression/adhd-pi options?, posted by english on September 29, 2009, at 22:33:50
MAOI's are potentially mildly psychedellic in that they prolong the activity of tryptamine.
Linkadge
Posted by OhYouKnow on May 14, 2018, at 16:35:56
In reply to Re: depression/adhd-pi options?, posted by desolationrower on September 29, 2009, at 17:07:15
To English and Desolation Rower,
I use 6mg Emsam daily. It's prescribed to me by a doctor for medical purposes (abates my CFS/FM symptoms 85%).
I'm also on 3 mg of Low Dose Naltrexone (LDN).
LDN didn't really do anything for my depression but it did help my CFS/FM.
I typically am a lightweight and with other medical issues, I'm not very experimental. But I want to microdose mushrooms (no idea/preference what variety) for psychological "clarity" on some personal matters and issues. I'm looking for info about safety concerns of microdosing psylocibin while taking 6mg transdermal Emsam.
What do I need to look out for? Do I need a washout period?
This is the end of the 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.