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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 mtdewcmu on April 14, 2011, at 10:49:55
I thought I'd start a new thread for a fresh start. I took 10mg of dex with a small latte at about 8:00 AM. I didn't bother to eat breakfast, but I had already taken my 300mg Wellbutrin XL. I hope this lets me stop Wellbutrin, so I can be spared the sweating and the expense.
It is way smoother than Ritalin. Absolute night and day difference. I am kind of getting the "glasses for my brain" feeling that people with ADD talk about. They've said it about Ritalin, but Ritalin did no such thing for me. This seems to be working. I actually took some trash out of my car trunk without having to specifically set out to do that, so that's a good sign. I'm getting a little of the vaunted euphoria, but it alternates with some lingering depressed ruminations, and I'm not certain it won't turn anxious yet. I feel more inclined to sit and stare at things than to do work for now, but I'm not going to force it. I have a month's worth of Dex and probably can continue taking it indefinitely, so there's plenty of time to just feel it out before I force myself to work.
Already at 40 minutes in, it's more promising than 40 minutes in to Ritalin. I'll post more as it unfolds.
Posted by mtdewcmu on April 14, 2011, at 12:42:35
In reply to Starting Dextroamphetamine, posted by mtdewcmu on April 14, 2011, at 10:49:55
It's been 2.5 hours and it seems like the more pleasant benefits are wearing off. I suppose it's still helping my concentration, but I am once again conscious of feeling tired and worn out from having poor sleep lately.
Posted by mtdewcmu on April 14, 2011, at 12:49:49
In reply to Re: Starting Dextroamphetamine, posted by mtdewcmu on April 14, 2011, at 12:42:35
Looking forward to stopping Wellbutrin tomorrow and seeing if dex can substitute. They seem redundant (there's that word again) to me and hopefully I will shed side effects by cutting out the excess.
Interestingly enough, last time I tried to stop WB I had annoyingly watery eyes and other muscarinic effects. I wonder how strong an antimuscarinic WB is. And I guess you can get rebound effects.
Posted by Phillipa on April 14, 2011, at 13:15:15
In reply to Re: Starting Dextroamphetamine, posted by mtdewcmu on April 14, 2011, at 12:49:49
My experience with wellbutrin landed me in the hospital after a week with benzos on board my pdoc thought I was hypomanic and dc'd it and was fine. I guess there is a difference between a stimulating med and one that is for depression. Good luck!!! Phillipa
Posted by mtdewcmu on April 14, 2011, at 14:20:52
In reply to Re: Starting Dextroamphetamine » mtdewcmu, posted by Phillipa on April 14, 2011, at 13:15:15
> My experience with wellbutrin landed me in the hospital after a week with benzos on board my pdoc thought I was hypomanic and dc'd it and was fine. I guess there is a difference between a stimulating med and one that is for depression. Good luck!!! Phillipa
I would be afraid to mix strong stimulants with benzos. I was just thinking about this. Benzos can cause poor judgment and blackouts, while amphetamines give you lots of energy. Not a combo I'd want to play with.
Posted by mtdewcmu on April 14, 2011, at 14:23:06
In reply to Re: Starting Dextroamphetamine » mtdewcmu, posted by Phillipa on April 14, 2011, at 13:15:15
> My experience with wellbutrin landed me in the hospital after a week with benzos on board my pdoc thought I was hypomanic and dc'd it and was fine. I guess there is a difference between a stimulating med and one that is for depression. Good luck!!! Phillipa
I'm not sure what you mean, though, because Wellbutrin is both mildly stimulating and an antidepressant. So how did that show the difference?
Posted by mtdewcmu on April 14, 2011, at 18:52:12
In reply to Re: Starting Dextroamphetamine » Phillipa, posted by mtdewcmu on April 14, 2011, at 14:23:06
I'm going to try to take a break from reading Dr. Bob's for a while. It's becoming an OCD-like compulsion, where I have to check for posts constantly or I feel like I might miss something. It's not you guys, you are great. If you send a babblemail, I will still get it. Later all.
Posted by SLS on April 14, 2011, at 20:23:33
In reply to Taking a break from Dr. Bob's, posted by mtdewcmu on April 14, 2011, at 18:52:12
Strattera?
Be well.
- Scott
Posted by Phillipa on April 14, 2011, at 21:55:47
In reply to Re: Starting Dextroamphetamine » Phillipa, posted by mtdewcmu on April 14, 2011, at 14:23:06
I guess only that for people with strong anxiety that wellbutrin is too stimulating. That's what happened to me. The pdoc wasn't a good one at all. Phillipa
Posted by mtdewcmu on April 15, 2011, at 7:46:15
In reply to Re: Taking a break from Dr. Bob's » mtdewcmu, posted by SLS on April 14, 2011, at 20:23:33
> Strattera?
>
> Be well.
>Thank you, and you as well. I'm not sure what you're asking, but I tried Strattera a couple years ago and it did me no good.
Posted by mtdewcmu on April 15, 2011, at 8:09:05
In reply to Re: Taking a break from Dr. Bob's » mtdewcmu, posted by SLS on April 14, 2011, at 20:23:33
I wrote up a little outline for when I call my pdoc with an update. I'll copy it here. I appreciate any advice.
* Transition to Luvox going well
--- no diarrhea since change
--- no Paxil w/d
--- not sure yet about sweating
--- no notable s/e from Luvox* Dexedrine showing promise
--- no significant s/e
--- would like to increase dose to at least 20mg/d* Plan to Decrease Wellbutrin
--- I will cut 300mg tabs in half as don't want to buy 150mg tabs
--- this is to decrease s/e and because WB no longer helps with focus* Changes in symptoms
--- appetite has decreased over past 1-2 wks (to below normal)
--- have suffered from early-morning awakenings recently
--- I think my MDD has exacerbated
--- change meds proactively, or wait?
``` * could increase Luvox to more than 100mg
``` * could add short-acting hypnotic
``` * could just wait and see
Posted by SLS on April 15, 2011, at 8:22:19
In reply to Med Plan and Questions, posted by mtdewcmu on April 15, 2011, at 8:09:05
> I wrote up a little outline for when I call my pdoc with an update. I'll copy it here. I appreciate any advice.
>
> * Transition to Luvox going well
> --- no diarrhea since change
> --- no Paxil w/d
> --- not sure yet about sweating
> --- no notable s/e from Luvox
>
> * Dexedrine showing promise
> --- no significant s/e
> --- would like to increase dose to at least 20mg/d
>
> * Plan to Decrease Wellbutrin
> --- I will cut 300mg tabs in half as don't want to buy 150mg tabs
> --- this is to decrease s/e and because WB no longer helps with focus
>
> * Changes in symptoms
> --- appetite has decreased over past 1-2 wks (to below normal)
> --- have suffered from early-morning awakenings recently
> --- I think my MDD has exacerbated
> --- change meds proactively, or wait?
> ``` * could increase Luvox to more than 100mg
> ``` * could add short-acting hypnotic
> ``` * could just wait and see
Perhaps you are a tricyclic responder. These drugs seem to be particularly effective where early morning awakenings and ruminations are present.- Scott
Posted by mtdewcmu on April 15, 2011, at 9:05:29
In reply to Re: Med Plan and Questions » mtdewcmu, posted by SLS on April 15, 2011, at 8:22:19
>
> Perhaps you are a tricyclic responder. These drugs seem to be particularly effective where early morning awakenings and ruminations are present.
>I appreciate the suggestion. I tried Elavil at one time and I liked the effects, but my heart rate increased steadily until it was uncomfortably fast by a few days in. This was not a high dose, either. I went through the same thing with Flexeril. So I think I am sensitive to the cardiac effects of tricyclics.
Incidentally, I ran my meds on an interaction checker that I have access to and I found the following major interactions:
"Increased mirtazapine serum concentrations (34 fold) have been reported following the addition of fluvoxamine, a CYP3A4 inhibitor, to stable mirtazapine regimens."
"Fluvoxamine induced an increase in the AUC and peak concentrations of melatonin by 23-fold and 12-fold, respectively after the coadministration of a 5 mg melatonin dose in several healthy volunteers. The mechanism is unknown. The interaction may increase the sedative effects of melatonin"
So I think I will decrease my mirtazapine and be cautious with melatonin. Melatonin is said to potentiate some of the effects of amphetamines, and IIRC it carries a slight risk of seizure.
Posted by mtdewcmu on April 15, 2011, at 9:06:58
In reply to Re: Med Plan and Questions, posted by mtdewcmu on April 15, 2011, at 9:05:29
> "Increased mirtazapine serum concentrations (34 fold) have been reported following the addition of fluvoxamine, a CYP3A4 inhibitor, to stable mirtazapine regimens."
That should read 3-4 fold, not 34 fold.
Posted by SLS on April 15, 2011, at 9:26:06
In reply to Re: Med Plan and Questions, posted by mtdewcmu on April 15, 2011, at 9:05:29
> >
> > Perhaps you are a tricyclic responder. These drugs seem to be particularly effective where early morning awakenings and ruminations are present.
> >
>
> I appreciate the suggestion. I tried Elavil at one time and I liked the effects, but my heart rate increased steadily until it was uncomfortably fast by a few days in. This was not a high dose, either. I went through the same thing with Flexeril. So I think I am sensitive to the cardiac effects of tricyclics.The elevation in heart rate and the sensation of palpitations comes with the territory. These effects can mitigate over time. Nortriptyline is significantly less anticholinergic than amitriptyline and less noradrenergic than desipramine. The cardiac effects of nortriptyline may be the mildest among the tricyclics, although I would consider trimipramine as a potential treatment.
As an aside, a combination of Effexor and Wellbutrin is often effective when neither alone is sufficient to treat depression. Both drugs have been reported by some to help with adult ADD.
- Scott
Posted by mtdewcmu on April 15, 2011, at 17:51:21
In reply to Re: Med Plan and Questions » mtdewcmu, posted by SLS on April 15, 2011, at 9:26:06
> The elevation in heart rate and the sensation of palpitations comes with the territory. These effects can mitigate over time. Nortriptyline is significantly less anticholinergic than amitriptyline and less noradrenergic than desipramine. The cardiac effects of nortriptyline may be the mildest among the tricyclics, although I would consider trimipramine as a potential treatment.
>That is interesting, and I did not know that. I don't remember exactly what my heart rate got up to, but it was high enough that it seemed prudent to stop Elavil and Flexeril.
However, I'm not really looking to add new drugs at the moment. Incidentally, Luvox has potentially dangerous interactions with a lot of TCAs. Luvox is a potent inhibitor of several CYP450 enzymes. I am happy with Luvox so far, so I have no plans to stop taking it.
> As an aside, a combination of Effexor and Wellbutrin is often effective when neither alone is sufficient to treat depression. Both drugs have been reported by some to help with adult ADD.
>I am not going to consider trying Effexor until the price of the generic XR comes way down. I'm already taking WB, but I'm trying to phase it out in favor of the -- much more potent -- Dexedrine. Luvox is doing surprisingly well, so I don't think I'll need Effexor for the time being.
Posted by floatingbridge on April 15, 2011, at 18:20:17
In reply to Taking a break from Dr. Bob's, posted by mtdewcmu on April 14, 2011, at 18:52:12
> I'm going to try to take a break from reading Dr. Bob's for a while. It's becoming an OCD-like compulsion, where I have to check for posts constantly or I feel like I might miss something. It's not you guys, you are great. If you send a babblemail, I will still get it. Later all.
Hang in there MtDew. Sending good thoughts your way. Thank you for some great information and support. You may babblemail me whenever.
take good care of yourself,
fb
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