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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by ihatedrugs on October 5, 2010, at 13:54:53
Hi everyone,
I haven't posted here in a while but have kept in touch by reading your posts. Last time I posted, I was taking Nuvigil which worked ok for about six months but it then waned some. In addition, I gained 10 pounds while on it, perhaps because I was feeling better (even though it curved my appetite in the beginning). In addition, I have been having severe intermittent muscle pain/tension for the past two years (possibly Fibromyalgia/Chronic Fatigue) which has progressed to an almost everyday ordeal. I went to the rheumatologist and underwent a whole bunch of blood tests of which I will learn the results in a week (though I'm expecting everything to come up negative...as always). Nonetheless, in an attempt to keep my energy levels up (I'm a high school teacher) and at least lose a couple of pounds ( I'm prediabetic) I suggested the pdoctor to let me try adderall as I know it helps some people with their depression as well as energy. She hesitantly agreed. Well, in the 20 something years I have had this most hideous disease, this is the only med that gives me back myself. I don't get hyper, anxious, aggressive but just calm. I has worked better than any of the other expensive trash I have taken before (which includes pretty much all.)So my dr. and I decided to alternate between Nuvigil and adderall to avoid tolerance build up and for economic reasons. I don't know how long this will work but it has for the past three months and although is not always perfect, I feel better than I have in many years. I don't abuse the drug so the abuse potential doesn't scare me. In fact, I take weekends off the medicine to avoid tolerance as much as possible. Also, I read a post by someone about Curcumin and I ordered the one he suggested. I have been taking it for a week and my inflammation is getting better. (could be coincidental).I don't suffer with ADD just unipolar semi-treatment resistant depression exacerbated by PMS. My question is how many here are using an amphetamine-like substance to treat depressive symptoms and why are doctor so hesitant to prescribe this to long established patients(whom they not won't abuse it) and not hesitant to prescribe hideous drugs like Zyprexa, Geodon, Seroquel and others AP as antidepressants which don't work in many of us and create a repertoire of side effects too long to list. Could these descisions be influenced by money? After all, Nuvigil costs me $100.00 after insurance and adderall (generic) $1.00 after insurance.
Posted by Christ_empowered on October 5, 2010, at 14:47:29
In reply to Most success with adderrall for depression, posted by ihatedrugs on October 5, 2010, at 13:54:53
I'm glad you found something that works for you.
I don't know how common it is for doctors to prescribe stimulants for depression...I don't think anybody keeps tabs on "off-label" prescribing, so there's really no way to tell. It seems to be becoming more common as docs finally admit that the antidepressants don't work so well, after all.
I don't doubt that part of the reason amphetamines are under-utilized for depression is money. The FDA restricted the sale of amphetamine preparations for depression in the early 1980s; since then, docs who use stimulants for depression have had to do it "off-label," with the result being that most docs will gladly prescribe heavily promoted "antidepressant" drugs that have questionable effectiveness, but they'll hesitate to prescribe other medications.
This is unfortunate, especially would you think about how easy it is for people with ADD/ADHD to get stimulants to help them; why should it be less common to use the same medication in depression? Also, like you said, most amphetamine products are cheap these days, which is a definite plus for patients (and insurers). I also don't see why more docs don't just give a good old fashioned "test dose" of amphetamines; just give the patient a couple days worth and see how it works out. That's how they did it back when "uppers" were all the rage for depression.Anyway...thanks for your post, and again, congratulations on finding an effective treatment.
Posted by ihatedrugs on October 5, 2010, at 15:38:37
In reply to congratulations!, posted by Christ_empowered on October 5, 2010, at 14:47:29
Thanks,
I hope it keeps on working. I don't think I could bear another big let down.Greetings
Posted by Hombre on October 5, 2010, at 17:03:48
In reply to Most success with adderrall for depression, posted by ihatedrugs on October 5, 2010, at 13:54:53
Made me think of this:
(fluoxetine + d-amphetamine for anergic depression)
Posted by Maxime on October 5, 2010, at 18:42:33
In reply to Most success with adderrall for depression, posted by ihatedrugs on October 5, 2010, at 13:54:53
I am on Adderall XR right now. I am still on my other psych meds though. The Adderall was added to help get me going so that I don't stay in bed all day with the covers over my head. It helps a lot (plus now I have job). However, I feel like it is masking my depression. Like I can feel the depression underneath the Adderall (if that makes sense).
Some doctors will put a patient on a stimulant whilst waiting for an AD to kick in.
I also know of several people on this board who take Ritalin for their depression and nothing else.
I am really happy that you are doing so well!
Posted by Phillipa on October 5, 2010, at 19:05:35
In reply to Re: Most success with adderrall for depression » ihatedrugs, posted by Maxime on October 5, 2010, at 18:42:33
Seems also like a huge corrolation between autoimmune illnesses and thyroid function. Since the thyroid levels are now lowered many could be walking around with hight TSH's by new standards as their docs arent aware. TSH only should be between l-2. Speckled pattern is antineuclear test for autommune ANA. And welcome back to both Ihated drugs and Maxime. Phillipa
Posted by Maxime on October 5, 2010, at 20:09:21
In reply to Re: Most success with adderrall for depression, posted by Phillipa on October 5, 2010, at 19:05:35
> Seems also like a huge corrolation between autoimmune illnesses and thyroid function. Since the thyroid levels are now lowered many could be walking around with hight TSH's by new standards as their docs arent aware. TSH only should be between l-2. Speckled pattern is antineuclear test for autommune ANA. And welcome back to both Ihated drugs and Maxime. Phillipa
Thank you Phillipa. :)
Are you saying that a stimulant can lower you TSH? I don't think that is possible. Maybe I misunderstood your message.
Posted by Phillipa on October 5, 2010, at 21:06:49
In reply to Re: Most success with adderrall for depression, posted by Maxime on October 5, 2010, at 20:09:21
I again don't know just know a lot of medical. I feel this would be a good google search any autoimmune changes with stimulants? Phillipa
Posted by Maxime on October 5, 2010, at 22:50:16
In reply to Re: Most success with adderrall for depression » Maxime, posted by Phillipa on October 5, 2010, at 21:06:49
> I again don't know just know a lot of medical. I feel this would be a good google search any autoimmune changes with stimulants? Phillipa
Well, you are the queen of Googling! I will leave this one to you! ;)
Posted by floatingbridge on October 6, 2010, at 1:48:51
In reply to Most success with adderrall for depression, posted by ihatedrugs on October 5, 2010, at 13:54:53
My shrink prescribed dex after treating me for about 8 months. I didn't ask, was scared, and only much later realized how *lucky* I was. Most docs are scared, brainwashed, cautious....
Yeah, turned the lights on so to speak. However, I'm afraid my depression is bleeding through :(. Oh well.
He said a few weeks ago that twenty years ago he would NEVER had prescribed it--let alone let me adjust my daily dose. Said he was brainwashed by FDA and popular addiction studies.
Hope it works and keeps working. Didn't know you have obscure physical symptoms to deal with. I do, too. My doctors are so happy happy with all the negative tests results. I swear sometimes I'd welcome a lupus diagnosis, as terrible as that sounds.
Hang in there lady. And don't take my downturn of mood as an indicator of your success' longevity.
A high-school teacher? Wow! That's demanding work. Do you find it rewarding.
Good to see you again
Posted by creepy on October 6, 2010, at 14:23:05
In reply to Most success with adderrall for depression, posted by ihatedrugs on October 5, 2010, at 13:54:53
Using amphetamine alone for treating depression is largely regarded as bad practice. It is used sometimes for augmenting another medication with antidepressant properties.
Its good for concentration and fatigue, but I dont know that it offers much in the way of pain relief. Youd want a NRI for pain and fatigue.
desipramine, atomoxetine, maybe wellbutrin. Personally I like desipramine a lot. The pain relief is good and the anxiety is low.
I wouldnt depend on it to keep your depression in check over the long term. Usually the first few doses will make you feel really good. Once your body becomes used to the drug the response falls off. Over the long term you will likely need more to keep the AD effect.
Id stick to using it for concentration and fatigue, but look into something else for the pain relief and AD effect, its just too risky.
Posted by floatingbridge on October 6, 2010, at 15:19:12
In reply to Re: Most success with adderrall for depression, posted by creepy on October 6, 2010, at 14:23:05
Hi Creepy, I wouldn't think an amphetamine based stimulant therapy alone would be good for depression either.
My own experience to date with snri's were unhelpful, and what was called a nari (or is it nri), was abysmal failure w/ lasting health complications :(
I haven't exhausted the possibilities of that category-- esp despramine that you mention. I've heard really favorable reports. I also haven't tried neurontin (another class, have you?), but I really hesitate to go there yet.
I have read some evidence that
amphetamine can, for some, potentiate (sp?) the analgesic effects of other medications. I found that true for me before I read the studies (from Stanford I think.) They are also have or currently are studying T3 add-on and fibromyalgia.If you don't mind, what is currently working for you?
And did I misunderstand ihatedrugs' post? My assumption was she is using other med(s) as well....
Hope you have some good regime working for you, meds, lifestyle....
fb
Posted by Phillipa on October 6, 2010, at 19:53:39
In reply to Re: Most success with adderrall for depression » Phillipa, posted by Maxime on October 5, 2010, at 22:50:16
Not much out there. If I'd identified a specific autoimmune disease might have gotten more. Oh well Phillipa
http://www.suite101.com/content/cfsme-and-stimulants-a156131
Posted by ihatedrugs on October 6, 2010, at 22:52:20
In reply to Re: Most success with adderrall for depression » ihatedrugs, posted by Maxime on October 5, 2010, at 18:42:33
I do understand what you are saying. I sort of feel the same way in that the depression is lurking around waiting for the Adderall to wear off. But if we think about it that is the same with all the pills we have been taking. The minute we stop taking them the beast comes back. So they also just mask the problem. At least Adderall affords me a few hours of calmness and energy; something I never got from most of the other meds I have tried.
I hope you are doing well.
> I am on Adderaesll XR right now. I am still on my other psych meds though. The Adderall was added to help get me going so that I don't stay in bed all day with the covers over my head. It helps a lot (plus now I have job). However, I feel like it is masking my depression. Like I can feel the depression underneath the Adderall (if that makes sense).
>
> Some doctors will put a patient on a stimulant whilst waiting for an AD to kick in.
>
> I also know of several people on this board who take Ritalin for their depression and nothing else.
>
> I am really happy that you are doing so well!
Posted by ihatedrugs on October 6, 2010, at 22:59:47
In reply to Re: Most success with adderrall for depression, posted by Phillipa on October 5, 2010, at 19:05:35
Thanks for the warm welcome. I never really leave but sometimes stay in the periphery and learn from you guys by reading your posts. I hope my new test results come back with some sort of diagnosis...I'm tired of feeling like crap and hearing doctors say everything is h*nky dory with me. I really have faith that this rheumatologist we'll find something.
Greetings
> Seems also like a huge corrolation between autoimmune illnesses and thyroid function. Since the thyroid levels are now lowered many could be walking around with hight TSH's by new standards as their docs arent aware. TSH only should be between l-2. Speckled pattern is antineuclear test for autommune ANA. And welcome back to both Ihated drugs and Maxime. Phillipa
Posted by ihatedrugs on October 6, 2010, at 23:21:08
In reply to Re: Most success with adderrall for depression » ihatedrugs, posted by floatingbridge on October 6, 2010, at 1:48:51
Ha ha, funny how we want to hear a concrete diagnosis. I told my husband I would rather take Lupus than hearing one more time that everything looks great. I think stimulants arm us with the ability of using something whenever our bodies can't respond. Everytime I have a mandatory meeting early in the morning I thank the Lord for Adderall because I know I couldn't get out of bed. And I don't know if you've noticed but when I take Adderall not only does it affect my mood but my body aches seem to subside as well.
Perhaps you could try another stimulant other that Dex. I alternate between Nuvigil and adderall and so far no problems.
As for teaching, it is a most difficult job as you work in various capacities; teacher, advisor; friend; mother; shoulder to cry on; control outbursts; hear f you more than you care to, deal with psycho parents, demanding administration...However, those few students you actually reach, make it all worthwhile.
Good luck and hope the bleeding stops soon.
> My shrink prescribed dex after treating me for about 8 months. I didn't ask, was scared, and only much later realized how *lucky* I was. Most docs are scared, brainwashed, cautious....
>
> Yeah, turned the lights on so to speak. However, I'm afraid my depression is bleeding through :(. Oh well.
>
> He said a few weeks ago that twenty years ago he would NEVER had prescribed it--let alone let me adjust my daily dose. Said he was brainwashed by FDA and popular addiction studies.
>
> Hope it works and keeps working. Didn't know you have obscure physical symptoms to deal with. I do, too. My doctors are so happy happy with all the negative tests results. I swear sometimes I'd welcome a lupus diagnosis, as terrible as that sounds.
>
> Hang in there lady. And don't take my downturn of mood as an indicator of your success' longevity.
>
> A high-school teacher? Wow! That's demanding work. Do you find it rewarding.
>
> Good to see you again
>
Posted by creepy on October 6, 2010, at 23:23:48
In reply to Re: Most success with adderrall for depression » creepy, posted by floatingbridge on October 6, 2010, at 15:19:12
Right now nothing is working. I have mild depression, PTSD thats an issue when Im triggered, and some mild anxiety.
The only drug my doc has me on is the adderall. I took myself off of celexa after a month of fatigue, but it didnt help. I am no better or worse at the moment.
The last 3 months Ive had awful fatigue and brain fog along with lots of body pain and aches everywhere. The desipramine is great for that. Without it ID be a mess.
Doc refuses to re-prescribe, she wants me on cymbalta and I dont want to go there. Id rather not take any more SSRIs (and certainly not an SNRI notorious for discontinuation problems) Ive gained so much weight my health is suffering. Doc claims cymbalta is not a weight gainer, I disagree.
So you see Im probably depending on some of the AD effect from adderall as well. I know its a fleeting thing. And the ups and downs every day do me no good. Without it, Id have lost my job by now though.
I take breaks from the adderall on weekends and take the smallest amount I can so I dont become tolerant to it. Seems to work well Ive been on this dose for years. I worry about needing a larger dose because with that may come more anxiety and more pronounced mood swings as the drug peaks and wears off.
I think I notice some of what you mention about potentiating pain relief from the NRI. Maybe because adderall causes the release of NE as well?
Or provides more DA for conversion into NE?
The only bad part about desipramine is youll have some headaches, increased heart rate and BP issues for the first couple weeks. I take it at night so I can wake up in the AM and avoid headaches. It also interacts with a few common antidepressants.
Posted by ihatedrugs on October 6, 2010, at 23:25:05
In reply to Re: Most success with adderrall for depression, posted by creepy on October 6, 2010, at 14:23:05
Thanks for your advice. We are thinking of adding Cymbalta if I get diagnosed with CF/Fibro. I have tried it before and it works fairly. Any of the other SNRI drive me crazy.
Greetings> Using amphetamine alone for treating depression is largely regarded as bad practice. It is used sometimes for augmenting another medication with antidepressant properties.
> Its good for concentration and fatigue, but I dont know that it offers much in the way of pain relief. Youd want a NRI for pain and fatigue.
> desipramine, atomoxetine, maybe wellbutrin. Personally I like desipramine a lot. The pain relief is good and the anxiety is low.
> I wouldnt depend on it to keep your depression in check over the long term. Usually the first few doses will make you feel really good. Once your body becomes used to the drug the response falls off. Over the long term you will likely need more to keep the AD effect.
> Id stick to using it for concentration and fatigue, but look into something else for the pain relief and AD effect, its just too risky.
>
>
Posted by floatingbridge on October 7, 2010, at 0:53:01
In reply to Re: Most success with adderrall for depression » Phillipa, posted by Maxime on October 5, 2010, at 22:50:16
Posted by floatingbridge on October 7, 2010, at 1:37:41
In reply to Re: Most success with adderrall for depression, posted by creepy on October 6, 2010, at 23:23:48
I'm kinda surprised that your doc won't extend your prescription for despramine. Then again, some docs are very conservative which seems to mean they go with the newer, mainstream drugs. My pcp (who I am slowly replacing) suggested lyrica so off-handedly. And frankly, while this particular doctor is no villain, he has zero curiosity about me as an individual patient. And all the advertisements for Lyrica, cymbalta. I am glad those
medications work for some patients. What's frustrating is when treatment
options are narrowed.Are you generally content with your doc otherwise? And no other contraindications or dangers with despramine? BTW, thank you for sharing the side-effects. My BP is ridiculously low, but my heart rate could be a problem. And you mention headaches.
Here's a weird thing. The nri I had trouble with was strattera. I did begin to have headaches, unusual for me. Then I started having raynaud's symptoms that
have not abated. It's almost like that particular drug (for me) had a cascading effect. That's the only way I can explain it.Thanks for suggesting adderall. That might be good. Seems many here have success with it. I might try provigil/nuvigil again, however my experience was negative. Kept my mind going (dysphorically) without alleviating any fatigue.
Ptsd is such a strange condition. I'm sorry you have to deal with it. Does your doc understand some of the health issues that can accompany it? I find that helps me tons. Best wishes to you.
Posted by Maxime on October 9, 2010, at 18:06:43
In reply to Re: Most success with adderrall for depression » ihatedrugs, posted by Maxime on October 5, 2010, at 18:42:33
I find that the Adderall helps me during my work day. I am teaching courses so I need to be really "up" and full of energy. Since my depression is so bad. I use every last bit of energy that I have for my work day. Once I am in my car to go home I sit there and bawl. My job isn't stressful, but being full of energy is really hard. I have to use all of my acting skills.
I would like to come off the Adderall XR soon.
Posted by creepy on October 11, 2010, at 8:35:57
In reply to Re: Most success with adderrall for depression » creepy, posted by floatingbridge on October 7, 2010, at 1:37:41
This doc has a good understanding of PTSD. Has tried some alpha blockers and such to work against the adrenal overload. Tried topamax too.
I can see no reason for stopping the desipramine when Ive had pain and fatigue well before stopping the celexa I was on. I can only assume she wants me on an SNRI because its more convenient for her.
Her original reason for stopping it was that she suspected it was implicated in weight gain. but I was on celexa at that point. Of the two of those celexa is by far the worst for weight gain.
Honstly I might stop taking medication for the PTSD entirely and put more effort into therapy.
The health issues are not worth it. I can manage most of the time with my coping skills.
Posted by creepy on October 11, 2010, at 8:40:14
In reply to Re: Most success with adderrall for depression, posted by Maxime on October 9, 2010, at 18:06:43
One reason I dont like adderall is that the mood swings are vicious. Are you sure the drug isnt wearing off and causing you depressive episodes late in the day?
I regularly get those when adderall wears off. little things make me emotional. my mood is unstable and irritable. Its happened enough that for me I know its the adderall. So when I start dwelling on depressing things I tell myself its not real and I think of something else. If you know theres an end in sight, the depression is bearable.
Posted by alchemy on October 11, 2010, at 12:44:44
In reply to Re: Most success with adderrall for depression, posted by creepy on October 6, 2010, at 14:23:05
creepy,
do you take a mood stabilizer?
do you think the adderall has induced more brain fog? I am wondering if it has contributed to being burned out so easily- which doesn't help work, etc.When I tried Adderall is probably when I realized there was some kind of bipolar issue with me.
Now I'm on Lamictal & take dexadrine, some days off, and some days less. Unfortunately the dexadrine doesn't help my mood. Sometimes it slightly increases my motivation. Sometimes it doesn't do anything. But I have always been an ultra rapid cycler with ongoing chemical/electrical/hormonal changes. Maybe at only certain "states" it has a more potent effect for me.
Posted by linkadge on October 11, 2010, at 13:21:05
In reply to Re: Most success with adderrall for depression, posted by creepy on October 6, 2010, at 14:23:05
>Using amphetamine alone for treating depression >is largely regarded as bad practice.
bad practice bad schmactis
Linkadge
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