Posted by zeugma on December 21, 2004, at 15:56:19
In reply to Re: Stimulant Side Effects, posted by ed_uk on December 21, 2004, at 14:40:58
Stimulants I've taken: standard release Ritalin, Cylert, Provigil, Ritalin LA.
The standard release Ritalin was co-prescribed with Prozac, and I believe the Prozac side effects completely obscured whatever the IR Ritalin could have done. Given my later experiences with Ritalin, I now believe the low dose of ritalin did nothing, good or bad, and the Prozac set off major panic attacks.
Cylert is the smoothest stimulant I have experienced. I was at a therapeutic dosage, and experienced none of the notorious crashing that plagues other stimulants. Unfortunately, I lost too much weight on it, and was taken off at my doctor's order. Now, of course, it is unavailable in much of the world and the treatment of last recourse in the U.S., due to hepatotoxicity concerns. A shame, because this stim appears unique in its smooth action (although when you get to a therapeutic dosage of Provigil, there is something close to this).
Provigil: A remarkable drug. It both woke me up and calmed me. My colleagues were blown away by how awake I seemed, and how calm. Writing posts was not the marathon activity it is now, where my speeding mind outruns my body's sluggishness and aggravates my lack of coordination: I was coordinated on this drug. And I did not need to increase my clonazepam, even transiently. Unfortunately, the side effects were so horrendous that I had to go off it, reluctantly, after a five-month trial in which I experimented with different dosages, combined it with Ritalin, etc., in an attempt to stay on it despite the s/e. I won't describe the side effects, as I don't have the energy right now, and I don't think they are typical. The drug, once you get up to 150 mg/day at am, doesn't have much of a crash. I wish I could have stayed on it, combining it with ritalin since the two appeared to work well together. Oh well.
Ritalin LA: At dosages of 20 mg/day or less, discernible effects only in the presence of Provigil. At 30 mg/day (once in am), a little more awake, a little less need for caffeine, truly horrible crash about noon (I typically take it at 6:30 am, so Novartis' claim that this is a once-a-day med is either false or I am an exceptional case). To remain functional through the afternoon, I have to take another 30 mg at noon. Side effects: anxiety through the roof, loss of appetite. The appetite loss is beginning to lift (it's been 2 months on this dose) and the anxiety? well, I have had to take clonazepam prn, sometimes as much as 2 mg/day. I don't like this but the anxiety is intense and counteracts the gain in wakefulness.
On weekends when I take 'med holidays' a single 30 mg capsule is worse than nothing, because it elevates my energy only slightly, and causes a terrible crash. Caffeine moderates the crash somewhat, but caffeine causes its own crashes (albeit lesser). On weekends, when I wake up at 11 am, I take a 30 mg capsule, but it seems to be the second capsule that does the real work (mornings are still bad on ritalin, but less bad than they used to be without a stim, and despite the warning on my pharmacy sheet, I need to have at least one cup of coffee in the am, and sometimes another as the first dose wears off around noon. The second dose usually needs less augmenting with caffeine, but I sometimes have to if I plan to be productive after 5 pm), and I am struggling with the dilemma of taking 30 mg extended release Ritalin at about 4 pm, when theoretically it will be releasing MPH at 8 pm, near enough to bedtime to give me insomnia (if I lose even an hour of sleep the effects are bad!).
The ritalin LA capsule is designed to mimic IR Ritalin 4 hrs. apart, and for me 5 hours or so is its duration of action. That's better than caffeine, at least, and it IS more effective.
I take it TCA's and amphetamines are a riskier combination. As it is, taking 100 mg nortriptyline potentiates the 60 mg Ritalin LA, for some reason. Maybe it's because 75 mg nortriptyline makes me drowsy and 100 mg doesn't, and I can't even speculate on why this might be. It seems like the 60 mg Ritalin just doesn't work as well without the higher nortrip dose (noradrenergic effects?).
There are those who say Adderall and dexedrine are smoother and less anxiogenic than Ritalin. the little information I have been able to glean indicates that amphetamines are more likely to have pharmacodynamic interactions with TCA's, and to be honest I have gotten somewhat used to ritalin's quirks that I am reluctant to switch. I've added back in buspirone, 15 mg hs, as it seems to do *something* that makes me feel better- it makes my sleep-wake transitions easier. this is not a delayed effect, it occurred immediately after reinstating the dose. I have so many sleep and wake problems that anything that makes them less oppressive is welcome.
-z
-z
poster:zeugma
thread:432501
URL: http://www.dr-bob.org/babble/20041217/msgs/432529.html