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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 ChicagoKat on July 27, 2012, at 15:06:50
Hi all,
I'm new here, so hello! I fall into what seems to be a sadly common condition; those who are treatment-resistant and have tried ever depressant ever made only to have them fail or poop out on you. I have also failed ECT. Eventually, my psychiatrist, a truly wonderful doctor, decided to try stimulants as a last resort. He put me on IR ritalin, and it worked wonderfully! For once, I was able to get out of bed and do things and enjoy things. However, I developed sever anxiety after a couple of months on this wonderful drug, due to a visit by my Mom (we have a horrible relationship and my therapist says she emotionally abused me) I could not take the Ritalin when I was so anxious b/c I developed toxic symptoms, not to mention it didn't help with the anxiety!
My question is this: Since the visit with mom is over, my anxiety has dissapated, and I'm back to straight depression. So, with my doc's OK, I went back on Ritalin, but sadly it no longer seems to be efficacious :( I'd been off of it for weeks, so it's doubtful it's tolerance. Has anyone else had this happen? Does anyone have any idea why it's happening? I'm back in bed again, and would much prefer getting out of it and back into life!
thanks so much,
Kat
Posted by Lou Pilder on July 27, 2012, at 15:21:41
In reply to Ritalin not working? Depression, posted by ChicagoKat on July 27, 2012, at 15:06:50
> Hi all,
>
> I'm new here, so hello! I fall into what seems to be a sadly common condition; those who are treatment-resistant and have tried ever depressant ever made only to have them fail or poop out on you. I have also failed ECT. Eventually, my psychiatrist, a truly wonderful doctor, decided to try stimulants as a last resort. He put me on IR ritalin, and it worked wonderfully! For once, I was able to get out of bed and do things and enjoy things. However, I developed sever anxiety after a couple of months on this wonderful drug, due to a visit by my Mom (we have a horrible relationship and my therapist says she emotionally abused me) I could not take the Ritalin when I was so anxious b/c I developed toxic symptoms, not to mention it didn't help with the anxiety!
>
> My question is this: Since the visit with mom is over, my anxiety has dissapated, and I'm back to straight depression. So, with my doc's OK, I went back on Ritalin, but sadly it no longer seems to be efficacious :( I'd been off of it for weeks, so it's doubtful it's tolerance. Has anyone else had this happen? Does anyone have any idea why it's happening? I'm back in bed again, and would much prefer getting out of it and back into life!
>
> thanks so much,
> Katkat,
You wrote,[...Does anyone have any idea why it's happening?...].
Yes, I have an idea as to why it's happening.
Posted by ChicagoKat on July 27, 2012, at 15:36:30
In reply to Lou's response- » ChicagoKat, posted by Lou Pilder on July 27, 2012, at 15:21:41
Hi Lou,
Would you be willing to share with me why you think it's happening?
Thanks,
Kat
Posted by Phillipa on July 27, 2012, at 15:51:01
In reply to Re: Lou's response-, posted by ChicagoKat on July 27, 2012, at 15:36:30
Kat welcome to babble. Great to have a new member. As For the Ritalin. I'm sure someone that is very knowledgeable on these med will answer. Unfortunately this is not me. Good Luck and try and stay out of bed!!! Phillipa
Posted by ChicagoKat on July 27, 2012, at 15:56:04
In reply to Re: Lou's response- » ChicagoKat, posted by Phillipa on July 27, 2012, at 15:51:01
Thanks so much for the welcome, Phillipa :)
Regards,
Kat
Posted by Brynb on July 27, 2012, at 18:17:06
In reply to Ritalin not working? Depression, posted by ChicagoKat on July 27, 2012, at 15:06:50
Hi Kat,
I have MDD w/ anxiety (or bipolar--it's not clear cut) and my depressive episodes are pretty severe. I've tried stimulants in the past (though not Ritalin specifically) and they weren't effective for me in the long term, either.
I too have tried many different meds over the years (as many here have) and right now I'm currently taking a regimen that's (seemingly) working (though I'm trying not to get too excited as things always poop out on me). Have you exhausted all the AD classes (SRIs, NRIs, TCAs & MAOIs)? Or combos of these? It seems many here have done well using combos as well as using off label meds that work well on depression.
Feel better!
Posted by ChicagoKat on July 27, 2012, at 19:40:07
In reply to Re: Ritalin not working? Depression » ChicagoKat, posted by Brynb on July 27, 2012, at 18:17:06
> Hi Kat,
>
> I have MDD w/ anxiety (or bipolar--it's not clear cut) and my depressive episodes are pretty severe. I've tried stimulants in the past (though not Ritalin specifically) and they weren't effective for me in the long term, either.
>
> I too have tried many different meds over the years (as many here have) and right now I'm currently taking a regimen that's (seemingly) working (though I'm trying not to get too excited as things always poop out on me). Have you exhausted all the AD classes (SRIs, NRIs, TCAs & MAOIs)? Or combos of these? It seems many here have done well using combos as well as using off label meds that work well on depression.
>
> Feel better!
>
>Hi Brynb,
Thanks for your info and your well-wishes :) Yes, I have tried all the classes of antidepressants.....MAOIs worked great for me until they caused ataxia that made me fall, so had to be stopped :( that's when we gave up and tried the stimulants. I'm intrested in modafinil now, it doesn't have ataxia listed as a side-effect, so I'll ask my psychiatrist about it when I see him.
Thanks again, and I hope you feel better too!
Kat
Posted by Lou Pilder on July 27, 2012, at 20:08:53
In reply to Re: Lou's response-, posted by ChicagoKat on July 27, 2012, at 15:36:30
> Hi Lou,
>
> Would you be willing to share with me why you think it's happening?
>
> Thanks,
> KatKat,
What I see here could be a classic scenerio repeated over and over. What happens is this:
You have an encounter with the prescriber of the drug in a situation that opens the door to a temporary shift to experiance a sort of wellness from your depression. The catalyst is {hope}. The prescriber recognizes the open door and uses suggestion tactics to lead you to believe that the drug that is given to you will "work". You believe that the drug (Ritalin) will do whatever it is expected for it to do and it does. Some prescribers study this type of placebo effect and are very good at it. It can involve a lot of tactics, even by bringing in another person in a white lab coat and a pink complexion. This all gives the taker of the drug an expectation that the drug will "work". There are even the size and the color of the pill that comes into play here. (this is not the same as a conversion reaction), it is a placebo response. Now placebo responses can last a long time and it doesn't matter what the drug is. It is the {expectation} that causes it to "work". When the placebo effect stops, then the drug could have caused addiction. Now you got trouble my friend.
Lou
Posted by Lou Pilder on July 27, 2012, at 20:33:38
In reply to Lou's reply-ihnribbersity » ChicagoKat, posted by Lou Pilder on July 27, 2012, at 20:08:53
> > Hi Lou,
> >
> > Would you be willing to share with me why you think it's happening?
> >
> > Thanks,
> > Kat
>
> Kat,
> What I see here could be a classic scenerio repeated over and over. What happens is this:
> You have an encounter with the prescriber of the drug in a situation that opens the door to a temporary shift to experiance a sort of wellness from your depression. The catalyst is {hope}. The prescriber recognizes the open door and uses suggestion tactics to lead you to believe that the drug that is given to you will "work". You believe that the drug (Ritalin) will do whatever it is expected for it to do and it does. Some prescribers study this type of placebo effect and are very good at it. It can involve a lot of tactics, even by bringing in another person in a white lab coat and a pink complexion. This all gives the taker of the drug an expectation that the drug will "work". There are even the size and the color of the pill that comes into play here. (this is not the same as a conversion reaction), it is a placebo response. Now placebo responses can last a long time and it doesn't matter what the drug is. It is the {expectation} that causes it to "work". When the placebo effect stops, then the drug could have caused addiction. Now you got trouble my friend.
> Lou
>Kat,
Here is a video that I think could be helpfull in any dicussion here.
Lou
To see this video:
A. Pullup Google
B. Type in:
[youtube, Gwen Olsen, Pharma in business]
uaually first...pic of woman..posted on March 7, 2008... time is 7 min
Posted by Tomatheus on July 27, 2012, at 21:56:28
In reply to Ritalin not working? Depression, posted by ChicagoKat on July 27, 2012, at 15:06:50
Hello Kat, and welcome to Psycho-Babble. I'm going to say right off the bat that I can't really explain why you're no longer responding to Ritalin. My best guess would be that there's probably a biological explanation as to why you seemed to stop responding to the medication after you discontinued it and then resumed taking it, but I don't know for sure. Maybe you would have stopped responding to the Ritalin even if you hadn't temporarily discontinued it, or (and this is probably more likely) perhaps there was something about discontinuing the medication that made it less likely that you'd respond to it again.
One thing that I would do if I were you would be to check to make sure that you're taking the same version of Ritalin that you were taking before. Sometimes generic versions of medications don't always work as well as the brand-name versions of the medications or even other generic versions made by different manufacturers. So, I would check to make sure that the version of Ritalin that you're taking now is the same as the one that you were taking before you discontinued it. If you are taking the same version of Ritalin that you were taking before, I'd consider asking your doctor about a time-release version of Ritalin. I don't know how the instant-release version of Ritalin compares with the time-release versions of the medication as far as effectiveness is concerned, but I don't think that it would hurt at this point to try a slightly different version of the same medication (Ritalin/methylphenidate) to see if you can get your responsiveness to the medication back.
That basically sums up my thoughts on your situation. I'm sorry that you're in the situation that you're in, and it certainly is my hope that you'll find some way to recapture at least some of the benefits that you had after you initially started taking Ritalin. I also wish you luck in finding a good fact-based explanation as to why you're no longer responsive to Ritalin. I'm not sure if you'll find a good detailed explanation because there are limits to our understanding of the way drugs affect our physiology, feelings, and behaviors, but I do hope that you get some responses that you find to be at least satisfactory.
Tomatheus
Posted by rjlockhart04-08 on July 27, 2012, at 23:18:05
In reply to Ritalin not working? Depression, posted by ChicagoKat on July 27, 2012, at 15:06:50
it depends on your doctor but a long time ago they used combine amphetamines with barbitrates for depression and social withdrawl [mainly inhibited]. You may want to ask to switch to dextroamphetamine but for this case you may request to be either switched to Provigil or take it with Ritilin. I think taking an anyxiolic paticularlly lorazepam would help in this case.
Still, if your doctor avoids benzos ask about Nuerontin, Lyrica, or Vistiril.
best luck to you...
rj
Posted by SLS on July 28, 2012, at 0:48:46
In reply to Ritalin not working? Depression, posted by ChicagoKat on July 27, 2012, at 15:06:50
What was your reaction to Wellbutrin?
What was your reaction to Lamictal?
What was your reaction to Abilify?
Have you ever been screened for PTSD?
- Scott
Posted by ChicagoKat on July 28, 2012, at 21:26:43
In reply to Re: Ritalin not working? Depression » ChicagoKat, posted by SLS on July 28, 2012, at 0:48:46
> What was your reaction to Wellbutrin?
>
> What was your reaction to Lamictal?
>
> What was your reaction to Abilify?
>
> Have you ever been screened for PTSD?
>
>
> - ScottMy reaction to Wellbutrin was that it made me feel so agitated I almost felt crazy. I gave it 3 tries, all with the same result.
My reaction to Lamictal was that it did nothing to affect my mood, all it did was made me feel a bit fatigued.
Abilify, along with all the atypicals, makes me feel agitated. It's probably the akathisia that these drugs can cause, but it was bad enough to make in unbearable.
My current therapist, who is wonderful, believes that I have experienced PTSD from emotional and verbal abuse I received ever since I was about two, combined with the incredibly violent verbal arguments my parents had, combined with my Dad's alcoholism. She also thinks I perhaps have PTSD from, of all things, ECT, because to me it was an absolutely horrifying experience, it made me feel so terrible, and to this day I have nightmares about it and flashbacks, and every morning since I had it I wake up with fear in the pit of my stomach.
Sorry for the long response, but I hope I sufficiently answered your questions Scott.
Thanks,
Kat
Posted by ChicagoKat on July 28, 2012, at 21:32:38
In reply to Re: Ritalin not working? Depression, posted by rjlockhart04-08 on July 27, 2012, at 23:18:05
> it depends on your doctor but a long time ago they used combine amphetamines with barbitrates for depression and social withdrawl [mainly inhibited]. You may want to ask to switch to dextroamphetamine but for this case you may request to be either switched to Provigil or take it with Ritilin. I think taking an anyxiolic paticularlly lorazepam would help in this case.
>
> Still, if your doctor avoids benzos ask about Nuerontin, Lyrica, or Vistiril.
>
> best luck to you...
> rjThanks for the advice, rj. I had been thinking of asking my doc about switching to dextroamphetamine or Provigil. He has no problem with prescribing benzos and right now I am on Ativan. I have never taken Neurontin or Lyrica, but I have read good things about them and depression, especially the Lyrica, so I will ask him about that too.
Thanks again,
Kat
Posted by ChicagoKat on July 28, 2012, at 21:40:53
In reply to Re: Ritalin not working? Depression, posted by Tomatheus on July 27, 2012, at 21:56:28
> Hello Kat, and welcome to Psycho-Babble. I'm going to say right off the bat that I can't really explain why you're no longer responding to Ritalin. My best guess would be that there's probably a biological explanation as to why you seemed to stop responding to the medication after you discontinued it and then resumed taking it, but I don't know for sure. Maybe you would have stopped responding to the Ritalin even if you hadn't temporarily discontinued it, or (and this is probably more likely) perhaps there was something about discontinuing the medication that made it less likely that you'd respond to it again.
>
> One thing that I would do if I were you would be to check to make sure that you're taking the same version of Ritalin that you were taking before. Sometimes generic versions of medications don't always work as well as the brand-name versions of the medications or even other generic versions made by different manufacturers. So, I would check to make sure that the version of Ritalin that you're taking now is the same as the one that you were taking before you discontinued it. If you are taking the same version of Ritalin that you were taking before, I'd consider asking your doctor about a time-release version of Ritalin. I don't know how the instant-release version of Ritalin compares with the time-release versions of the medication as far as effectiveness is concerned, but I don't think that it would hurt at this point to try a slightly different version of the same medication (Ritalin/methylphenidate) to see if you can get your responsiveness to the medication back.
>
> That basically sums up my thoughts on your situation. I'm sorry that you're in the situation that you're in, and it certainly is my hope that you'll find some way to recapture at least some of the benefits that you had after you initially started taking Ritalin. I also wish you luck in finding a good fact-based explanation as to why you're no longer responsive to Ritalin. I'm not sure if you'll find a good detailed explanation because there are limits to our understanding of the way drugs affect our physiology, feelings, and behaviors, but I do hope that you get some responses that you find to be at least satisfactory.
>
> TomatheusThanks for your post Tomatheus. It is a good line of thinking because I was originally on the 10mg tablets (two per dose), but then I was switched to the 20mg tabs. What I find that is also of interest is that now, not only does the Ritalin not have an effect on my mood, but it also does not affect my blood pressure and heart rate the way it used to. They both previously got high enough that I had to be on 3 antihypertensives, and now I actually have low blood pressure, without any antihypertensives, even when I take my ineffective Ritalin. So I will investigate this and, if nothing else, request to go back on the 10mg tabs.
Thanks again,
Kat
Posted by SLS on July 29, 2012, at 0:49:22
In reply to Re: Ritalin not working? Depression, posted by ChicagoKat on July 28, 2012, at 21:26:43
Perhaps you have "developmental ptsd".
http://www.positivehumandevelopment.com/developmental-ptsd.html
If developmental PTSD is a component of your condition, you could look to trying things that reduce norepinephrine (NE) activity or glutamate (GLU) activity.
1. Prazosin (Minipress)
Prazosin is a NE alpha-1 antagonist originally used as an antihypertensive. It has a great deal of data supporting its use in PTSD. It tends to be a very "clean" drug with regard to side effects. It may produce some sedation, fatigue, and dizziness at first, but these things usually disappear rather quickly.
2. Clonidine (Catapres)
Clonidine is a NE alpha-2 agonist originally used as an antihypertensive. It reduces NE from the opposite side of the synapse from prazosin. Clonidine has been used to treat PTSD for a few years, but it sometimes causes depression as a persistent side effect. I don't know the statistics on the frequency of this.
3. Topiramate (Topamax)
Topiramate was developed as an anticonvulsant, but has utility for other conditions. It does quite a few things pharmacologically, including increasing gamma-amino butyric acid (GABA) activity and reducing glutamate activity through mechanisms that are different from those of the benzodiazepines.
4. Tiagabine (Gabitril)
Tiagabine is a GABA reuptake inhibitor originally developed as an anticonvulsant. There are conflicting opinions regarding the utility of tiagabine to treat PTSD. Tiagabine is unpredictable. It reduces anxiety and promotes sleep in some people, and does quite the opposite in others.
My doctor believes that developmental PTSD is a component of my depressive disorder. I have been using prazosin since December, 2011 with good results. I combine it with several other drugs. The severity of my depression has ameliorated a great deal. Prazosin has a short half-life (3 hours), so it is best taken three times a day. My current dosage is 6 mg/day (2 mg t.i.d.) To me, prazosin feels like an antidepressant rather than an anxiolytic.
- Scott
Posted by ChicagoKat on July 29, 2012, at 13:28:59
In reply to Re: Ritalin not working? Depression » ChicagoKat, posted by SLS on July 29, 2012, at 0:49:22
> Perhaps you have "developmental ptsd".
>
> http://www.positivehumandevelopment.com/developmental-ptsd.html
>
> If developmental PTSD is a component of your condition, you could look to trying things that reduce norepinephrine (NE) activity or glutamate (GLU) activity.
>
> 1. Prazosin (Minipress)
>
> Prazosin is a NE alpha-1 antagonist originally used as an antihypertensive. It has a great deal of data supporting its use in PTSD. It tends to be a very "clean" drug with regard to side effects. It may produce some sedation, fatigue, and dizziness at first, but these things usually disappear rather quickly.
>
> 2. Clonidine (Catapres)
>
> Clonidine is a NE alpha-2 agonist originally used as an antihypertensive. It reduces NE from the opposite side of the synapse from prazosin. Clonidine has been used to treat PTSD for a few years, but it sometimes causes depression as a persistent side effect. I don't know the statistics on the frequency of this.
>
> 3. Topiramate (Topamax)
>
> Topiramate was developed as an anticonvulsant, but has utility for other conditions. It does quite a few things pharmacologically, including increasing gamma-amino butyric acid (GABA) activity and reducing glutamate activity through mechanisms that are different from those of the benzodiazepines.
>
> 4. Tiagabine (Gabitril)
>
> Tiagabine is a GABA reuptake inhibitor originally developed as an anticonvulsant. There are conflicting opinions regarding the utility of tiagabine to treat PTSD. Tiagabine is unpredictable. It reduces anxiety and promotes sleep in some people, and does quite the opposite in others.
>
> My doctor believes that developmental PTSD is a component of my depressive disorder. I have been using prazosin since December, 2011 with good results. I combine it with several other drugs. The severity of my depression has ameliorated a great deal. Prazosin has a short half-life (3 hours), so it is best taken three times a day. My current dosage is 6 mg/day (2 mg t.i.d.) To me, prazosin feels like an antidepressant rather than an anxiolytic.
>
>
> - Scott
Scott, thank you very, very much for all this info. I believe you have let me know about a condition that may well have a lot to do with explaining why I am the way I am. I will certainly take your list of meds for my doc to see, and i bet he will give me a trial of one of them.
Thanks again,
Kat
Posted by Christ_empowered on July 30, 2012, at 16:10:25
In reply to Re: Ritalin not working? Depression » ChicagoKat, posted by SLS on July 29, 2012, at 0:49:22
I think Vyvanse is the big *it* drug for anything requiring an upper these days, but you have other options (dexedrine, adderall, possibly methamphetamine).
I just say that because Adderall worked on my melancholy better than Ritalin. Also, I got away with lower doses and fewer side effects. Some docs, for whatever reason, prefer Ritalin for mood elevating effects. I don't know what's up with that...amphetamines are an old school classic for the blues. Ritalin came out later, as a sort of milder amphetamine.
Then again...with hypertension, I don't know if that's the greatest idea (see...this is where you talk to your doc, lol). Maybe Provigil/Nuvigil?
I certainly understand taking a low-to-moderate dose stim over any sort of AD. The ADs aren't that great and I doubt the side effect profile is that much better than a stimulant. Plus, you can go off and on stimulants pretty much as needed/desired...not so much with AD drugs.
Posted by ChicagoKat on July 30, 2012, at 16:53:42
In reply to maybe an amphetamine?, posted by Christ_empowered on July 30, 2012, at 16:10:25
> I think Vyvanse is the big *it* drug for anything requiring an upper these days, but you have other options (dexedrine, adderall, possibly methamphetamine).
>
> I just say that because Adderall worked on my melancholy better than Ritalin. Also, I got away with lower doses and fewer side effects. Some docs, for whatever reason, prefer Ritalin for mood elevating effects. I don't know what's up with that...amphetamines are an old school classic for the blues. Ritalin came out later, as a sort of milder amphetamine.
>
> Then again...with hypertension, I don't know if that's the greatest idea (see...this is where you talk to your doc, lol). Maybe Provigil/Nuvigil?
>
> I certainly understand taking a low-to-moderate dose stim over any sort of AD. The ADs aren't that great and I doubt the side effect profile is that much better than a stimulant. Plus, you can go off and on stimulants pretty much as needed/desired...not so much with AD drugs.Thanks so much for your recommendations. I just saw my doc today and he put me on Nuvigil, but I was wondering how long that takes to kick in b/c I'm having NO effects from it yet.
I tried Vyvanse, but the highest dose, 70mg, was actually too low for me. I seem to do best with IR stims, cos Concerta was a disaster too.
I would actually like to try dexedrine if the Nuvigil is ineffective.
I'm on stims now b/c every single other AD has pooped out on me or had bad side effects. The saddest case was with Nardil....I was on it for a few weeks and I was starting to feel great, absolutely no anxiety, sleeping better, feeling more positive about life. Then I developed ataxia and suffered 4 falls, so the Nardil had to be stopped. But I'm almost starting to think that I'd rather have a risk of falling than feeling the depression/anxiety I have been feeling since Ritalin stopped working.
Thanks again,
Kat
Posted by phidippus on July 31, 2012, at 20:43:22
In reply to Ritalin not working? Depression, posted by ChicagoKat on July 27, 2012, at 15:06:50
I'm wondering if you might have ADHD, which is often co-morbid with depression. The Ritalin may be treating the ADHD and some of the depression.
Note: meds don't 'poop out'. Symptoms get worse. You may want to try an AD for your baseline deprression andd then augment witth other meds like Ritalin or Memantine. You may need more than one medication to treat your depression.
Do you worry a lot?
Eric
Posted by chicagokat on August 1, 2012, at 19:38:51
In reply to Re: Ritalin not working? Depression » ChicagoKat, posted by phidippus on July 31, 2012, at 20:43:22
> I'm wondering if you might have ADHD, which is often co-morbid with depression. The Ritalin may be treating the ADHD and some of the depression.
>
> Note: meds don't 'poop out'. Symptoms get worse. You may want to try an AD for your baseline deprression andd then augment witth other meds like Ritalin or Memantine. You may need more than one medication to treat your depression.
>
> Do you worry a lot?
>
> EricHi Eric,
Do I worry a lot? lol - there's a reason why my mom calls me a worrywart....nice nickname, huh :(
but i've been screened for ADD and was found to not have it.BUT I have great news - Ritalin is working for me again!!!!!! Thank goodness, I was reaching the point of abject despair. I saw my pdoc today and told him the news and he has no idea why it did that....sometimes I feel like I must be his most frustrating patient! But he's a wonderful doc, and so nice, you can tell he really cares.
Thanks everyone for your suggestions!
Kat
This is the end of the thread.
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