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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 84. This is the beginning of the thread.
Posted by stargazer2 on April 21, 2010, at 11:15:02
Hi,
I am interested in being treated for ADD (non-attentive, disorganized, brain overload), as well as depression. I am currently on Nardil but cannot be prescribed any real meds for ADD because of interactions with a MAO.
MY only chance to treat the ADD successfully is to stop NArdil (risky)to try some of the newer meds that have become available in th elast few years (Concerta, Focalin, Vyvanase,etc).
Has anyone been in this situation and what meds were eventually successful in treating the ADD with depression.
I am in the process of weaning off Nardil (30 mg) and I have a constant headache this week.
Thanks for any help. The biggest risk is the depression coming back with a vengeance and this greatly concerns me so I am not 100% onboard with this plan, although my pdoc is in agreement with trying it now, as I am not working at the moment.
Any thoughts?
Posted by Phillipa on April 21, 2010, at 12:30:28
In reply to Best meds for ADD/Depression, posted by stargazer2 on April 21, 2010, at 11:15:02
Stargazer I'm sorry your're having problems again. Darn was hoping the nardil would do it once and for all for you. Love Phillipa
Posted by linkadge on April 21, 2010, at 18:58:12
In reply to Re: Best meds for ADD/Depression » stargazer2, posted by Phillipa on April 21, 2010, at 12:30:28
Parnate is an MAOI with stimulant effects. There are reports that it causes less cognative dulling than nardil. I didn't tollerate it, but it did help with corborbid cognative issues I was having.
Linkadge
Posted by stargazer2 on April 22, 2010, at 8:10:30
In reply to Re: Best meds for ADD/Depression » stargazer2, posted by Phillipa on April 21, 2010, at 12:30:28
Anyone with life long depression, as I've had, knows it's only a matter of time before it catches up with you again. Having gone through this numerous times, it is never easy to have it happen again. I think I'm getting to the end of this fight...there is never a way out. And I mean never, as I have tried everything. What makes someone in this situation want to go on? I don't get it.
Posted by stargazer2 on April 22, 2010, at 8:28:01
In reply to Re: Best meds for ADD/Depression, posted by linkadge on April 21, 2010, at 18:58:12
I took Parnate only once and remember it did absolutely nothing for me.
I'm trying to find out if there is a combination med for ADD and depression as I think I had heard there was. Do you think ADD can cause depression? I am literally unable to have my brain sort out information that comes in and this eventually is the undoing of me (if that makes any sense). I find this has happened to me numerous times and has forced me to quit jobs because of it. I'm not sure what is going on but I wanted to go this route as approaching the depression as the primary diagnosis has failed. Now I'm trying to go after ADD. I just don't know what to do anymore. I think when someone has severe depression it might just make more sense to throw the towel in, as the fight becomes too difficult. Unless you have the energy to devote every waking hour to finding solutions. I have tried to do that but it has exhausted me again.
Sorry, thanks for your post, at least you are all still trying, it amazes me that there are so many fighters. That shows a strength greater than what I would think anyone with depression could have.
Posted by SLS on April 22, 2010, at 10:27:33
In reply to Re: Best meds for ADD/Depression/Linkage, posted by stargazer2 on April 22, 2010, at 8:28:01
What were you experiencing in the past that led to a diagnosis of depression? What are the drugs that helped you along the way? How old were you when the symptoms first appeared?
Roughly half of the people who have ADD also have another psychiatric disorder like depression, bipolar disorder, or an anxiety disorder.
I know one person who reported being depressed fail to respond to a bunch of standard antidepressants. At some point, his doctor began to suspect ADD. Once he was given Strattera, his depression vanished and he became functional for the first time in many years. You might consider combining Effexor with Strattera. Wellbutrin had been considered for the treatment of ADD in the past, but I don't know if more recent studies have demonstrated its effectiveness.
- Scott
Posted by stargazer2 on April 22, 2010, at 15:16:54
In reply to Re: Best meds for ADD/Depression/Linkage » stargazer2, posted by SLS on April 22, 2010, at 10:27:33
Thank you for your response...
Answers to your questions:
1.) Symptoms in appeared in my teens (after my sister died), although even younger than this I was extremely shy and self conscious. My symptoms were many, inc. self consciousness, social anxiety, anergia, solmnolence, anhedonia, feeling different, suicidal thoughts.2.) Only drugs that have ever helped are Nardil (worked immediately in 1987), it was the second or 3rd med tried after tricyclic failure. Marplan worked until discontinued (2003) for a few years. Some success (not completely) but able to work 3 so-so years on combination of Wellbutrin, Celexa and Adderall XR. Adderall was the key that I thought that perhaps there is an ADD component to the depression.
Any other med tried alone or in combo have failed.
Right now I am coming off of NArdil to try some of the meds my pdoc would never prescribe while on Nardil.
Great to hear that about Strattera since I have always claimed to my pdoc that I believed the ADD may be the diagnosis that has made me feel incapable of organizing my thoughts and has led me to feel inadequate and incapable of doing anything right. I have no memory for anything I read, forget alot of things and cannot pay attention to anyone after a few minutes.
Thanks again for your insight and analytical ability.
Posted by Phillipa on April 22, 2010, at 20:26:36
In reply to Re: Best meds for ADD/Depression/SLS, posted by stargazer2 on April 22, 2010, at 15:16:54
You will beat this again. I know you will. What meds you thinking of other than add med? Love Phillipa
Posted by desolationrower on April 23, 2010, at 17:34:36
In reply to Re: Best meds for ADD/Depression/SLS, posted by stargazer2 on April 22, 2010, at 15:16:54
you can use nicotine while on an maoi
if TCAs especially the secondary tcas didn't help, strattera is not very promising
-d/r
Posted by bulldog2 on April 24, 2010, at 14:10:45
In reply to Re: Best meds for ADD/Depression/SLS, posted by desolationrower on April 23, 2010, at 17:34:36
> you can use nicotine while on an maoi
>
> if TCAs especially the secondary tcas didn't help, strattera is not very promising
>
>
>
> -d/rlexapro 10 mg, nortiptyline 50 mg, ritalin 10 mg times 3...high success rate with this combo for add/depression...nortriptyline helps with the add also...My p-doc loves this combo...!!
Posted by floatingbridge on April 27, 2010, at 1:10:19
In reply to Re: Best meds for ADD/Depression/Linkage » stargazer2, posted by SLS on April 22, 2010, at 10:27:33
stargazer, I'm no poster child for recovery, but after about ten years of ad's and dx's, my pdoc added dexedrine spansuals. Pretty big difference. My own experience with strattera was poor. The two meds are very different.
One thing. With this type of med, efficacy shows fairly quickly.
(My background ad is pristiq--I'm not recommending it per se. And some other stuff. Let me know if you'd like more info.)
BTW an Israeli study had success treating add in kids w/ segilene.
Good luck--!
Posted by stargazer2 on April 27, 2010, at 20:58:45
In reply to Re: Best meds for ADD/Depression/SLS, posted by bulldog2 on April 24, 2010, at 14:10:45
Thank yu that sounds promising.
One combo that worked for me was Celexa, Wellbutrin and Adderall.
It was in 2001, I think, and all of the meds were brand so finding the differnce with generic makes a mess of things that might have worked in the past.
You know I was checking prices out on Costco.com and the cost of Strattera and Focalin were through the roof. I think Focalin was $500 for 30 days supply! That's crazy...no wonder we are running out of money for health care...it will only get worse.
Posted by stargazer2 on April 27, 2010, at 21:04:20
In reply to Re: Best meds for ADD/Depression » SLS, posted by floatingbridge on April 27, 2010, at 1:10:19
Thank you for your insight and experience.
I'm not sure what we will try but I know I like Adderall years ago but they probably messed the formula up like they end up doing when they make a generic in a foreign place with no quality controls.
It really is a crap shoot with all of the meds and now the generics and their variabilities, it makes an already difficult process much harder.
YOu have depression and ADD like me? Whatis Pristiq like and don't go there you say? Not that great for you?
We'll chat again. I had to cancel my appt this week and wanted to wait another week so that the Nardil is totally out of my system, so we don't waste an appt just looking at eachother! Duh..
Later...
Posted by floatingbridge on April 27, 2010, at 21:23:38
In reply to Re: Best meds for ADD/FloatingB, posted by stargazer2 on April 27, 2010, at 21:04:20
Hi Stargazer, I was just thinking about you.
Your question about pristiq is best answered, I think, by relating how it became part of my cocktail.
After a year of trials--prozac, lexapro, abilify, we tried pristiq. Side effects were minimal, but so was effect. We took it up to 100 at which point my depression worsen and I had cognitive s/e's. I became desperate, we backed down the dosage and went into a holding pattern (the taper would be awful for me). Then we tried dexedrine. The results were immediate for both depression, social anxiety and add. (Like you, inattentive.) So I have no idea how the pristiq works in my cocktail. Lately I've consider a side-switch to effexor or tramadol for pain issues.
I only caution about pristiq because it can be tough for some to kick.
You sound brighter today--I hope that's true.
Is an maoi's with a little stim possible? One doc said maybe emsam with stim. A friend did well on parnate and adderall, but I don't know the dosages.
Best to you. You'll land on your feet.
Posted by Phillipa on April 27, 2010, at 21:27:41
In reply to Re: Best meds for ADD/FloatingB, posted by stargazer2 on April 27, 2010, at 21:04:20
Stargazer hang in there. I just know things are going to get better for you. Love Phillipa
Posted by stargazer2 on April 28, 2010, at 19:52:50
In reply to Re: Best meds for ADD/FloatingB » stargazer2, posted by floatingbridge on April 27, 2010, at 21:23:38
Perceptive of you to notice I seem better..I've been off Nardil for about 2 weeks and although the first week was hard, it seems OK now.
As a matter of fact, I did try Nardil with a stim...sort of my own trial and then I confessed to my doc who wasn't really happy, but I convinved him it was helping. The only problem was that I had a hypertensive reaction so
we were never able to continue that combo...Then I did some research and convinced my doc to allow me to take Nardil and Wellbutrin (he would not have without my research, but I had to try it) and that is the combo I have been on for a few months.
I really think a stim like Adderall will work again for me, since it did in the past and my doc would not allow me to take Nardil and Adderall, just too risky and no one wants that on their conscience.
So that is why I have to come off Nardil. I really think if I can prove the stims are key to my depression, I will need to take and ADD med, in addition to an AD.
Today I took a hit of a stim (leftovers)generic Adderall, but not the XR which is much better than the short acting meds. I do better with meds if take them only 1x a day.
So I feel better thus proving my theory I have untreated ADD which makes me depressed and scattered, which can look like depression.
I just looked up Pristiq and it sounds like it is chemically related to Effexor, which I took and had horrible results. I failed so many AD's over the years that it is not possible to tell what one will work. Actually I'm still on Wellbutrin so I'll probably stay on that when I start a stim unless the combo is too activating...
That's the story for now.
SG2
Posted by floatingbridge on April 29, 2010, at 18:13:29
In reply to Re: Best meds for ADD/FloatingB, posted by stargazer2 on April 28, 2010, at 19:52:50
Hi Stargazer,
So you might stick with the wellbutrin as ad coverage and add some adderall?
Here's the study about selegine and adhd:
http://www.ncbi.nlm.nih.gov/pubmed/12921918Some people like provigil--and that as you know can be taken with an maoi. You seem to really know your meds.
Good luck--and I'd like to know how you do--would you keep us posted? I'm intermittent here, but will look.
I like once a day coverage, too. My moods are pretty changable, so I avoid anything that might creates valleys.
fb
Posted by stargazer2 on April 30, 2010, at 21:12:29
In reply to Re: Best meds for ADD/FloatingB » stargazer2, posted by floatingbridge on April 29, 2010, at 18:13:29
FB,
Sure happy to share my experiences with whomever might be interested/helped.
I know my meds from 30 years of dealing with the monster. I went from Nardil in 85 to 2010 and still in a search and find mission. I have had successes, thank God, as that would not have been a life worth living...
I did try Ensam (selegeline) patch a few years ago and did not have any great improvement.
I went through a really horrible few years when it seemed like nothing was going to work, hence my active role in researching what might be changed, added.Prior to that I faithfully followed my doc's advice but I was ready to throw the towel in unless I could get a breakthrough and that is why I started on Synthroid and added Wellbutrin to Nardil...my doc would not allow any stims including Provigil so that was no help.
So, we'll see what happens next week. I will post so you can follow if it helps your situation at all.
Bye for now...
Posted by chujoe on May 1, 2010, at 9:14:53
In reply to Re: Best meds for ADD/Depression/Linkage, posted by stargazer2 on April 22, 2010, at 8:28:01
I think ADD can absolutely be an underlying cause of depression -- or comorbidity, as the pdocs so artfully put it. In my case, the ADD has contributed to a sense of worthlessness and hopelessness that's now being treated successfully with Cymbalta, but the ADD issue is still there and I'm thinking about adding an ADD med like provigil, since I can't take stims because of anxiety and tremor.
Good luck and hang in there.
Posted by stargazer2 on May 4, 2010, at 11:33:39
In reply to Re: Best meds for ADD/Depression/Linkage, posted by chujoe on May 1, 2010, at 9:14:53
Hi, you addressed your post to Linkage but he is not one of the contributors to this posting so I wasn't sure if you meant someone else.
Has Cymbalta helped you at all? I took very briefly and was not able to tolerate the side effects...literally could not get out of bed for days. Not good with depression especially when it makes you worse.
Have you tried all of the stims, which ones? Did you try Adderall? It did not make me feel like Ritalin did, which was nervous and antsy.
It had a much smoother effect. What do you know about Provigil that makes you want to try that one?
Posted by floatingbridge on May 4, 2010, at 11:44:22
In reply to Re: Best meds for ADD/Depression/Chujoe, posted by stargazer2 on May 4, 2010, at 11:33:39
Hi Stargazer and chujoe,
(Linkage's post is third from top thread.)
I could see provigil addressing That cognitive part of add for some. Didn't work for me. BTW, I don't understand the relationship of add and depression-- or add can trigger depression, if anyone cares to address that:) My pdoc did say they suspect add hangs out on the same gene as bipolar and by extension, maybe depression. (Have I dazzled you with my use of scientific jargon?)
Stargazer, how is it going?
Posted by chujoe on May 5, 2010, at 14:36:53
In reply to Re: Best meds for ADD/Depression/Chujoe » stargazer2, posted by floatingbridge on May 4, 2010, at 11:44:22
Hi, I'm just getting used to the way these boards work, so it's entirely possible I responded to the wrong person.
Cymbalta has worked pretty well for me. My history: about ten years ago I had a major period of anxiety and was prescribed Zoloft, which worked well enough that I quit taking it after a couple of years. I can't say I was exactly mentally healthy after that, but I went the better part of a decade without taking pdrugs. Then last year I had another major episode of anxiety & depression, but mostly anxiety and was again given Zoloft (100mg), which helped briefly, then got very patchy and gave me the shakes. I saw a neurologist, who diagnosed essential tremor -- it's not that bad, but the Zoloft made it worse, so I was switched to Cymbalta, first 60mg, then 90. It works, though I tend to get sleepy in the middle of the day. I still have a bit of tremor, but it's less of a problem with the Cymbalta.
So my depression is more of the "activated" variety, characterized by anxiety and intrusive thoughts. My diagnosis includes a tendency to OCD. Anyhow, because of the tremor and anxiety, my pdoc thinks I shouldn't take stims.
It's only recently -- even though I'm an old guy of 59 -- that the ADD thing has been clear to me. All my life I thought & everybody else thought I was just disorganized & even though I've had a reasonably successful professional life, in hindsight I see that I've been hampered all along by my inability to stay on task, etc. Talking to my pdoc recently, I mentioned something I'd done & she said, "That's classic ADD."
I've been reluctant to medicate for ADD -- it seems like such a middle-school malady! And I've had it all my life, so why start now? On the other hand, if I had broken my toe when I was six and always walked with a limp and then an orthopedic surgeon said he could fix it, I'd go for it, right? Currently, I'm not taking anything for it, though the Cymbalta has taken care of the H part of ADHD -- I can sit still and watch a movie now without having to get up twelve times. And the Cymbalta has also given me my cognitive powers (such as they are) back to me -- at my age you begin to wonder about dementia & I have to say it has really relieved me of that fear -- I can think again. I just have a very hard time focusing on one train of thought for very long.
Well, that's probably more than you wanted to know, but it's very nice to have found a place where one can talk about these things openly and honestly in a supportive environment.
Posted by stargazer2 on May 5, 2010, at 22:45:51
In reply to Re: Best meds for ADD/Depression/Chujoe, posted by chujoe on May 5, 2010, at 14:36:53
Welcome Chujoe...I'm somewhat of an oldtimer myself but still want to be trested for ADD as I believe it has contributed to alot of anxiety and feelings of low self esteem my whole life.
I keep thinking I'll get it all figured out and it will be too late to help me. It has affected my ability to form relationships and be able to work without getting bored or losing interest in things.
I do OK but I always thought something was getting in my way, which was my ability to remember, organize and follow through with any task.
Some have said to me, how could you have ADD if you finished college and have been able to work ...I say it wasn't easy but I forced myself to do it, plain and simple.
Glad Cymbalta helped you...I thought it was one of the worst for me...made my depression so much worse.
Posted by chujoe on May 5, 2010, at 23:01:38
In reply to Re: Best meds for ADD/Depression/Chujoe, posted by stargazer2 on May 5, 2010, at 22:45:51
Stargazer, I think a lot of successful people have various sorts of ADD issues that they have found ways to work around. I'm a college professor, which is a career that allows me to structure my own time. That can be good when I'm successful ant structuring it, but I feel like I have wasted many opportunities for advancement and greater success by being unable to get my sh*t together, letting deadlines slip by, having sixteen projects going at once, etc.
I'm having a consult tomorrow with the psych NP to talk about meds. I don't want to feel like it's too late -- I think I can still accomplish some things if I can learn to focus better. So I'd encourage you to look into treatment for ADD -- I'm certain it can contribute to depression.
Posted by floatingbridge on May 6, 2010, at 10:38:21
In reply to Re: Best meds for ADD/Depression/Chujoe » stargazer2, posted by chujoe on May 5, 2010, at 23:01:38
Hi Chujoe,
Welcome, too! My add treatment started at 50--another late-comer. The treatment addition also broke my depression--an unexpected bonus.
Good luck w/ your consult. There's a variety of treatments for add-- or adhd in your case. I'm sure you'll find something helpful that will not aggravate your tendency towards tremor. Best to you.
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