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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by bleauberry on May 8, 2018, at 12:41:31
I miss my Ritalin. I was on it for about a year. It helped so much. Hobbies, activities, social, endurance, anxiety, sleep, mood, multi-tasking - all greatly improved.
If your primary symptom is in the realm of anhedonia/amotivation, I think either of these two meds holds way more potential than any other psych meds I can think of. SSRIs, TCAs and APs are likely to make these symptoms worse not better. Generally speaking.
I stopped Ritalin for surgery and never got back on it. I don't need it. But it does make life considerably better. It made me grind my teeth. It made it hard to get an appetite - good for a heavy person but I am not heavy. The cost was $120 month cash. \I'm just curious who else has had experience with Ritalin or adderall? As mono therapy or cocktail? (mine was mono therapy)
Just opinion, but I think these stimulants offer far greater potential to improve quality of life for psychiatric patients than nearly all of the other meds prescribed. My last doctor felt that way too.
Posted by Christ_empowered on May 8, 2018, at 19:58:13
In reply to Anyone Tried Ritalin or Adderall?, posted by bleauberry on May 8, 2018, at 12:41:31
I do think stimulants can be helpful. Now that I think about it, the absolute best blues-busting combination, for me, was Ritalin+Klonopin+Abilify. I mean, long-term...not a good idea, especially with the TD risk going up with stimulants mixed with neuroleptics, all that...but it "got the job done," quickly and effectively.
Interestingly enough, amphetamines are now dominating the stimulant market. Seriously. I guess its advertising? There was an article on mad in america about a possible "stimulant epidemic" on the way, because street meth and Rx stimulants are both causing problems. Ugh.
Posted by SLS on May 9, 2018, at 8:33:00
In reply to Re: Anyone Tried Ritalin or Adderall?, posted by Christ_empowered on May 8, 2018, at 19:58:13
I've tried Ritalin, Focalin, Dexedrine, Adderall and Vyvanse.
I like Focalin better than Ritalin. It seems smoother and doesn't produce a precipitous letdown. If for some reason I were to go back to it, I would try the Focalin XR version. Actually, I might use it to help ease Parnate withdrawal, which is mostly fatigue for me.
For me, caffeine works better than all of the above, but I can't use it every day or else tolerance develops. Caffeine is pretty cool. It doesn't work at monoamine synapses. Instead, it is an adenosine receptor blocker. Adenosine works to modulate neural activity. It normally reduces it and brings on sleepiness. Blocking the receptor disinhibits this braking mechanism and causes increases in alertness and concentration.
- Scott
Posted by bleauberry on May 10, 2018, at 6:08:25
In reply to Re: Anyone Tried Ritalin or Adderall?, posted by Christ_empowered on May 8, 2018, at 19:58:13
You reminded me of a very important concept - weighing the balance between benefits versus risk.
With the risk of TD or other longterm complications, I wonder, is that an acceptable risk in order to experience a time period of respectable wellness and engagement in life?
Does it make more sense to suffer year after year as only a fraction of yourself, so as to avoid hypothetical speculative side effects sometime way out in the future, and we don't even know if we live that long in the first place....or does it make more sense to live robust as much as possible and deal with any risks if they show up?
Benefit versus risk. Looking back, I wish I had taken on more risk earlier and suffered less. There is already a ton of risk in not being as well as possible. Life is too short. imo
>
>
> I do think stimulants can be helpful. Now that I think about it, the absolute best blues-busting combination, for me, was Ritalin+Klonopin+Abilify. I mean, long-term...not a good idea, especially with the TD risk going up with stimulants mixed with neuroleptics, all that...but it "got the job done," quickly and effectively.
>
> Interestingly enough, amphetamines are now dominating the stimulant market. Seriously. I guess its advertising? There was an article on mad in america about a possible "stimulant epidemic" on the way, because street meth and Rx stimulants are both causing problems. Ugh.
>
>
Posted by bleauberry on May 10, 2018, at 6:16:09
In reply to Re: Anyone Tried Ritalin or Adderall?, posted by SLS on May 9, 2018, at 8:33:00
Cool.
My doc finds wide spectrum benefit from the stimulants with a wide spectrum of patients. Sometimes I wonder why they aren't prescribed more often. Well actually, I personally think Adderall is maybe over-prescribed, while Ritalin is under-prescribed. Adderall is basically just a doctor approved street drug in controlled doses that leads to the same longterm problems of meth addiction. Ritalin is in a different class, a different mechanism, and personally I think it is a better friendlier med for long term.
Adderall made me super depressed within hours of dosing. Anything that does reuptake inhibition has done that to me. My brain does not like stagnant pools of neurotransmitters with slowed down firing - which is what reuptake inhibitation does to me.
I'm not sure but I think Ritalin is more of a releaser, more than a reuptake thing. It causes more firing and more activity, without a stagnant pool. My brain likes that.
Despite both meds being stimulants for ADD and ADHD, I think they both have great potential in psychiatry, I think they are generally under-utilized, especially Ritalin, and of the two I think Ritalin is the better choice. Most doctors/patients seem to go straight to Adderall. Not sure why.
Anyway. I like the stimulants and think they could play a bigger role than they currently are.
> I've tried Ritalin, Focalin, Dexedrine, Adderall and Vyvanse.
>
> I like Focalin better than Ritalin. It seems smoother and doesn't produce a precipitous letdown. If for some reason I were to go back to it, I would try the Focalin XR version. Actually, I might use it to help ease Parnate withdrawal, which is mostly fatigue for me.
>
> For me, caffeine works better than all of the above, but I can't use it every day or else tolerance develops. Caffeine is pretty cool. It doesn't work at monoamine synapses. Instead, it is an adenosine receptor blocker. Adenosine works to modulate neural activity. It normally reduces it and brings on sleepiness. Blocking the receptor disinhibits this braking mechanism and causes increases in alertness and concentration.
>
>
> - Scott
Posted by Tony P on May 19, 2018, at 22:09:04
In reply to Re: Anyone Tried Ritalin or Adderall? » SLS, posted by bleauberry on May 10, 2018, at 6:16:09
Small doses of Ritalin (2.5-5 mg) are wonderfully effective for me. If my general anxiety is high, I find it difficult to tolerate even small doses, but it gets me up & moving, with a more positive outlook, and clearer thinking. Ritalin doesn't give me a nasty tense jaw-clenching hangover, either, as the amphetamines do.
Modafinil is almost as good, and is milder and less addictive. More clarfying and activating, not quite as euphoric. A big plus: despite being use for alertness, it doesn't affect normal sleep.
Coffee is great in reasonable amounts - and it tastes good too!
Posted by Lamdage22 on May 20, 2018, at 10:14:36
In reply to Re: Anyone Tried Ritalin or Adderall?, posted by Tony P on May 19, 2018, at 22:09:04
What about Ritalin for depression & negative symptoms in Schizophrenia?
Posted by ed_uk2010 on May 20, 2018, at 13:20:27
In reply to Re: Anyone Tried Ritalin or Adderall?, posted by Lamdage22 on May 20, 2018, at 10:14:36
> What about Ritalin for depression & negative symptoms in Schizophrenia?
Hi Lamdage,
Stimulants aren't used in schizophrenia because of the risk of worsening psychosis.
Posted by Christ_empowered on May 21, 2018, at 12:59:08
In reply to Re: Anyone Tried Ritalin or Adderall?, posted by ed_uk2010 on May 20, 2018, at 13:20:27
hi. ritalin, in particular, was somewhat popular I think in the 60s, for people stable on neuroleptics. The FDA and DEA started cracking down on uppers in the 70s and 80s, so...these days, not so much.
I did see a small abstract for a study for Vyvanse for negative symptoms in patients who had been stable for a long time. I think it went well, at carefully controlled doses. I doubt they'll pursue an FDA indication, given psychiatry's love/hate relationship with uppers.
Provigil or NuVigil seem to be somewhat popular in carefully selected people. Wellbutrin would probably be a more acceptable option to most doctors, but then you'd have to worry about the seizure risk and drug-drug interactions.
I seem to recall reading that Mirapex is used off label in some forms of Bipolar depression...maybe that'd be helpful in some forms of Schizophrenia, too? Schizophrenia is a somewhat vague diagnosis, even in modern times, so what works for one person with "Schizophrenia" might prove to be a nightmare for another person with "Schizophrenia."
Posted by Lamdage22 on May 26, 2018, at 8:08:47
In reply to Re: Anyone Tried Ritalin or Adderall?, posted by ed_uk2010 on May 20, 2018, at 13:20:27
> > What about Ritalin for depression & negative symptoms in Schizophrenia?
>
> Hi Lamdage,
>
> Stimulants aren't used in schizophrenia because of the risk of worsening psychosis.Well i probably need more Dopamine in some areas and less in other areas of the brain. Hopefully one day a drug will adress this. My depression responds to dopamine for sure.
Posted by Tony P on May 31, 2018, at 18:31:38
In reply to Re: Anyone Tried Ritalin or Adderall?, posted by Lamdage22 on May 26, 2018, at 8:08:47
> > > What about Ritalin for depression & negative symptoms in Schizophrenia?
> >
> > Hi Lamdage,
> >
> > Stimulants aren't used in schizophrenia because of the risk of worsening psychosis.
>
> Well i probably need more Dopamine in some areas and less in other areas of the brain. Hopefully one day a drug will adress this. My depression responds to dopamine for sure.
>Afaik, it is being increasingly recognized that many schizophrenics suffer from depression as well, often treatment-induced. I should think Ritalin is somewhat risky, but it has the advantage of being both fast-acting and short-acting, whereas drugs like Prozac & Wellbutrin may take a long time to wear off if they create a problem.
My housemate is more bipolar than schizophrenic by diagnosis, although he strikes me as somewhat schizoid, and he is taking olanzapine prn for manic episodes -- but he's also taking Ritalin, which does seem to help him. He was on Prozac 40 mg/day, and has cut that back to 10mg, replacing it with Ritalin 10-20 mg/day.
I really favour Modafinil, I was on a low dose (100 mg/day) for a while; it has most of the positive effects of Ritalin, but with a lower addiction risk, and less roller-coaster effect. Unfortunately, I haven't been able to persuade my new GP to prescribe it for me yet. I'm taking very low doses of Ritalin myself off-Rx, 2.5-10 mg/day, and it helps me get active & feel positive better than my regular Wellbutrin.
This is the end of the thread.
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