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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by mtdewcmu on April 30, 2011, at 14:53:02
Do serotenergic agonist drugs oppose the benefits of stimulants with regard to inattention? You can find support for almost anything in the literature, but what has been your experience?
Posted by Christ_empowered on April 30, 2011, at 15:28:25
In reply to Do SSRIs and Stimulants Oppose?, posted by mtdewcmu on April 30, 2011, at 14:53:02
I found antidepressants to soften the impact of stimulants, with the exception of Tofranil-PM. The Tofranil seemed to boost the stimulant and the stimulant seemed to provide more antidepressant "oomph" out of the Tofrani.
I don't know if I'd say that the antidepressant+stimulants are somehow opposed to each other (I found benefit from an antipsychotic plus stimulant, so I may not have the same issues you do), but I would say that the combo gave more mood elevation than it did concentration enhancing effects.
Posted by mtdewcmu on April 30, 2011, at 15:36:45
In reply to Re: Do SSRIs and Stimulants Oppose?, posted by Christ_empowered on April 30, 2011, at 15:28:25
Thanks for your reply and that's interesting about Tofranil.
Antipsychotics have a very different mechanism of action from SSRIs, so you would expect the interaction to be different.
> I don't know if I'd say that the antidepressant+stimulants are somehow opposed to each other (I found benefit from an antipsychotic plus stimulant, so I may not have the same issues you do), but I would say that the combo gave more mood elevation than it did concentration enhancing effects.
Posted by desolationrower on April 30, 2011, at 18:38:26
In reply to Re: Do SSRIs and Stimulants Oppose? » Christ_empowered, posted by mtdewcmu on April 30, 2011, at 15:36:45
i'd say they are mostly on different axises, but at high doses i think it makes it worse.
-d/r
Posted by mtdewcmu on April 30, 2011, at 18:55:04
In reply to Re: Do SSRIs and Stimulants Oppose?, posted by desolationrower on April 30, 2011, at 18:38:26
> i'd say they are mostly on different axises, but at high doses i think it makes it worse.
>
> -d/rSorry... high doses of what makes what worse?
Posted by 10derheart on April 30, 2011, at 21:32:03
In reply to Do SSRIs and Stimulants Oppose?, posted by mtdewcmu on April 30, 2011, at 14:53:02
I took Prozac 20 mg and anywhere from 5-10 mg q day up to at least 60 mg q day of IR Ritalin for about 18 months for inattentive ADD. The combo was extremely effective for ADD symptoms and the comorbid depression. Only transitioned to Strattera alone becasue 1) depression was so much improved (w/psychotherapy) and 2) my GP at the time had a fit that pdoc was using a stim because I was being treated for hypertension and he was **sure** the Ritalin was exacerbating that (made no sense but it's a long story...) So we tried the Strattera and I have been on it ever since (7 years +)
I think at that time (2002-2004) that combo was very popular for ADD. In hindsight I had anxiety I never understood nor could I identify it as such to my docs, so I think the Ritalin made that worse while it was helping all the ADD symptoms that end up triggering both depression and anxiety....yeah, it gets to be a vicious cycle sometimes. Because of that, Strattera really was/is a better route for my inattention.
Posted by mtdewcmu on April 30, 2011, at 22:31:07
In reply to Re: Do SSRIs and Stimulants Oppose? » mtdewcmu, posted by 10derheart on April 30, 2011, at 21:32:03
> I took Prozac 20 mg and anywhere from 5-10 mg q day up to at least 60 mg q day of IR Ritalin for about 18 months for inattentive ADD. The combo was extremely effective for ADD symptoms and the comorbid depression. Only transitioned to Strattera alone becasue 1) depression was so much improved (w/psychotherapy) and 2) my GP at the time had a fit that pdoc was using a stim because I was being treated for hypertension and he was **sure** the Ritalin was exacerbating that (made no sense but it's a long story...) So we tried the Strattera and I have been on it ever since (7 years +)
It's true that stimulants can cause or exacerbate hypertension, but if you need them, you need them. You could add antihypertensives until your BP was reduced enough if need be.
>
> I think at that time (2002-2004) that combo was very popular for ADD. In hindsight I had anxiety I never understood nor could I identify it as such to my docs, so I think the Ritalin made that worse while it was helping all the ADD symptoms that end up triggering both depression and anxiety....yeah, it gets to be a vicious cycle sometimes. Because of that, Strattera really was/is a better route for my inattention.If you have the kind of ADD where Strattera controls it, then I would absolutely prefer Strattera.
Posted by mtdewcmu on April 30, 2011, at 22:35:01
In reply to Re: Do SSRIs and Stimulants Oppose? » mtdewcmu, posted by 10derheart on April 30, 2011, at 21:32:03
I basically came to the conclusion today that I need to get out in front of the depression, so I'm going to 40mg of Celexa unless I absolutely cannot get by. Tomorrow I'm planning to take a stimulant holiday to try to catch up on rest and sleep and hope that makes Dexedrine more effective next week.
Posted by Phillipa on May 1, 2011, at 0:04:36
In reply to Re: Do SSRIs and Stimulants Oppose?, posted by mtdewcmu on April 30, 2011, at 22:35:01
Great idea as with children don't they take no stimulants on weekends and holidays? Phillipa
Posted by desolationrower on May 1, 2011, at 16:05:58
In reply to Re: Do SSRIs and Stimulants Oppose? » desolationrower, posted by mtdewcmu on April 30, 2011, at 18:55:04
> > i'd say they are mostly on different axises, but at high doses i think it makes it worse.
> >
> > -d/r
>
> Sorry... high doses of what makes what worse?inattention
Posted by desolationrower on May 1, 2011, at 16:06:27
In reply to Re: Do SSRIs and Stimulants Oppose?, posted by desolationrower on May 1, 2011, at 16:05:58
high dose of sri that is
Posted by mtdewcmu on May 2, 2011, at 14:34:28
In reply to Re: Do SSRIs and Stimulants Oppose?, posted by desolationrower on May 1, 2011, at 16:05:58
It's Monday. Yesterday I took a break from Dexedrine. Unfortunately, I've taken 30mg of Dexedrine already and the effect is not recovered from Saturday. In fact, it seems like it may have diminished further. It appears that I'm either suffering from a tolerance problem, or my fears about Celexa inhibiting the effects are being realized. Fortunately, it is not completely without benefit.
Posted by bleauberry on May 2, 2011, at 16:33:34
In reply to Do SSRIs and Stimulants Oppose?, posted by mtdewcmu on April 30, 2011, at 14:53:02
I think a majority of clinicians would probably say stimulants improve ssri efficacy, not oppose it. The stimulants add the NE/dopamine component that the SSRIs are squashing out.
Posted by mtdewcmu on May 2, 2011, at 17:55:22
In reply to Re: Do SSRIs and Stimulants Oppose?, posted by bleauberry on May 2, 2011, at 16:33:34
> I think a majority of clinicians would probably say stimulants improve ssri efficacy, not oppose it. The stimulants add the NE/dopamine component that the SSRIs are squashing out.
I'm more concerned with the opposite interaction. The SSRI interfering with the stimulant.
Posted by mtdewcmu on May 2, 2011, at 18:08:57
In reply to Monday and diminished effects, posted by mtdewcmu on May 2, 2011, at 14:34:28
I guess it's working decently well. Phew.
Posted by Phillipa on May 2, 2011, at 21:57:41
In reply to Re: Monday and diminished effects, posted by mtdewcmu on May 2, 2011, at 18:08:57
Glad reading late. So now working? Phillipa
Posted by mtdewcmu on May 2, 2011, at 23:17:44
In reply to Re: Monday and diminished effects » mtdewcmu, posted by Phillipa on May 2, 2011, at 21:57:41
> Glad reading late. So now working? Phillipa
I guess. Last week I felt a good motivation from it for the most part. Today I felt effects, but no motivation and I felt grumpy. Eventually I had to go to my parents' house so I didn't continue trying to work. I forgot that music helps me focus on work when on Dex. I am going to try to take less Celexa tomorrow and take it later in the day.
Posted by mtdewcmu on May 3, 2011, at 12:26:07
In reply to Re: Monday and diminished effects » mtdewcmu, posted by Phillipa on May 2, 2011, at 21:57:41
I added the Wellbutrin back in and I'm delaying taking the Celexa. So I took 300mg Wellbutrin XL and 20mg Dexedrine so far. It seems to be making a difference, because I am seeing my problems more in a constructive way so far today, rather than the woe-is-me way that is more typical. That is all I ask from these meds.
Posted by Phillipa on May 3, 2011, at 20:03:40
In reply to Tuesday, posted by mtdewcmu on May 3, 2011, at 12:26:07
No celexa yet? You added a big dose of wellbutrin back into the mix. Was going to suggest bedtime for the celexa. Phillipa
Posted by mtdewcmu on May 3, 2011, at 23:27:31
In reply to Re: Tuesday » mtdewcmu, posted by Phillipa on May 3, 2011, at 20:03:40
> No celexa yet? You added a big dose of wellbutrin back into the mix. Was going to suggest bedtime for the celexa. Phillipa
I am going to skip Celexa altogether today. I plan to restart at 20mg tomorrow. Yes, I restarted WB at a relatively high dose, but it's a weak drug, at least compared to Dexedrine, and I only have the 300mg tabs. I am at a point where I have a lot to do these next few weeks and so productivity is priority #1. Today was productive. I need this to continue.
Posted by Phillipa on May 4, 2011, at 0:09:10
In reply to Re: Tuesday » Phillipa, posted by mtdewcmu on May 3, 2011, at 23:27:31
No side effects from just stopping the celexa that is good. Yes can see how wellbutrin would be weak compared to a stimulant med. Good Luck tomorrow and post how you are doing. Phillipa
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