![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Cass on March 6, 2000, at 23:09:06
I've been thinking a lot about ADD and whether or not I might have it. I know that ADD drugs are stimulants, and something about that concerns me. When I was on a stimulating AD, specifically, Wellbutrin, I became paranoid and I believe, psychotic, as well. It was nightmarish and something I would never want to experience again. Do the chemicals in ADD drugs such as Adderall and Ritalin work on the same part of the brain as a stimulating antidepressant such as Wellbutrin? Any information would be appreciated.
Posted by ChrisK on March 7, 2000, at 7:01:32
In reply to The effect on the brain: ADs vs. ADD drugs, posted by Cass on March 6, 2000, at 23:09:06
I can't explain how they work but I know how I have reacted to both. My main AD is Nortriptyline with Zyprexa as an augment. I was doing OK on this combo but was still very apathetic. My pdoc had never tried Wellbutrin with me because I do have a history of GAD and Panic. I finally asked that we try Adderal to get me out of the apathy and he gave me both Wellbutrin and Adderal. It has made a big difference in my moods. I take low doses of each and don't have an anxiety problem but do have the energy to go to the gym and become a little more active.
I guess I'm saying that the right AD and stimulant combo can eliminate the anxiety factor in the stimulants. So far it has worked for me but like I said I'm on low doses.
Chris
Posted by Janice on March 7, 2000, at 12:30:37
In reply to The effect on the brain: ADs vs. ADD drugs, posted by Cass on March 6, 2000, at 23:09:06
> I've been thinking a lot about ADD and whether or not I might have it. I know that ADD drugs are stimulants, and something about that concerns me. When I was on a stimulating AD, specifically, Wellbutrin, I became paranoid and I believe, psychotic, as well. It was nightmarish and something I would never want to experience again. Do the chemicals in ADD drugs such as Adderall and Ritalin work on the same part of the brain as a stimulating antidepressant such as Wellbutrin? Any information would be appreciated.
hi Cass,
Hopefully more people who know more than I do, will respond. In the meantime, if you take a stimulant and it is what you need, you will know very quickly. I took ADs unsuccessfully for 5 years, and 1 hour after taking Dexedrine, I KNEW it was hitting the spot.
Many dr.'s seem hesitant to prescribe them because they generally help everyone (whether or not you have ADHD) to varying degrees, are addictive and have a street value.
Physically, I believe, they are easier to tolerate than ADs and are often given to elderly and vunerable people as an first line AD. ZERO side effects for me, other than turning my vegetable-like lifeform into a fully functioning human being.
It hasn't affected my mood (also bipolar) other than simply feeling better because I can DO THINGS, FINISH THINGS, GET OUT OF BED, etc.
I believe they work on Dopamine / Norephen????. Hopefully a more medical person can help you with this part. Janice
Posted by Sarah on March 7, 2000, at 13:03:37
In reply to Re: The effect on the brain: ADs vs. ADD drugs, posted by Janice on March 7, 2000, at 12:30:37
Yes, Adderall I know works on Dopamine. I was on Effexor (which is a broad range AD). When it was working on my serotinin level it was fine, but when my dose was upped and starting working on my Dopamine(sp) I was a mess. I became very anti-social, depressed, and just generally weird. It was awful! The funny thing is, though, my new pdoc has me on Adderall now and I feel great! My ADD is in check and I am getting things done! I haven't had a need for an additional AD like I have in the years past, mainly I believe because my depression was a by product of my ADD and it has never been treated directly before now. There have been a few studies about the addiction factor of Adderall and ritalin; it seems ppl who are truly ADD/ADHD don't abuse them like a non Adder would. I guess they are just so thrilled to finally feel "normal" that it is enough of a "high". Hope I have helped some...
Posted by Noa on March 7, 2000, at 14:25:59
In reply to Re: The effect on the brain: ADs vs. ADD drugs, posted by Sarah on March 7, 2000, at 13:03:37
At what point does effexor start to work on dopamine, and what does it do to the dopamine system?
Posted by Sarah on March 7, 2000, at 14:36:26
In reply to Re: The effect on the brain: ADs vs. ADD drugs, posted by Noa on March 7, 2000, at 14:25:59
> At what point does effexor start to work on dopamine, and what does it do to the dopamine system?
Hey,Noa, I am not entirely sure when it starts messing with the dopamine. I was fine on 75 but when that was doubled to 150 that was when I got messed up. EWWEEE, I don't even like to think of it! From what my last pdoc said, that was even a low dose for that med. Effexor is a very interesting drug, I intend to do some more research on it...
Posted by michael on March 7, 2000, at 16:30:28
In reply to Re: The effect on the brain: ADs vs. ADD drugs, posted by Sarah on March 7, 2000, at 14:36:26
> > At what point does effexor start to work on dopamine, and what does it do to the dopamine system?
>
> Hey,Noa, I am not entirely sure when it starts messing with the dopamine. I was fine on 75 but when that was doubled to 150 that was when I got messed up. EWWEEE, I don't even like to think of it! From what my last pdoc said, that was even a low dose for that med. Effexor is a very interesting drug, I intend to do some more research on it...I don't have the reference in front of me, but if I recall correctly, I read that effexor inhibits the reuptake of serotonin at lower dosages.
When the dose is in the 225mg - 300mg/day range, it also begins to work on norepinephrine as a reuptake inhibitor. More norepinephrine effect as dose increases.
Like I said, I'm not 100% certain if this info is correct, but I am pretty sure. I don't recall any mention of dopamine. Can anyone confirm or correct this?
Posted by bob on March 7, 2000, at 17:25:54
In reply to Re: effexor dosage effects, posted by michael on March 7, 2000, at 16:30:28
According to the Manual of Clinical Psychopharmacology, venlafaxine (damn book won't index drugs by their brand names, grrrrrrrrr) works primarily on seratonin with "moderate effects" on norepinephrine as well. Nothing in there about needing to hit a certain dosage to get the NE effects to kick in. It *does*, however, point out that "most depressed outpatients" respond to it in the 75-225 mg range, while refractory or melacholic depressives may need to go up to 375 mg.
The Handbook of Essential Psychopharmacology, on the other hand, lists effexor (cross-referenced to venlafaxine in its index =^) as having "marked effects" on seratonin, "moderate effects" on NE, and "modest effects" on dopamine, but only at higher levels.
So, putting the two together, I'd bet the story is that the dopamine effects kick in above 200mg, but you get the other two at any level.
bob
Posted by bob on March 7, 2000, at 17:57:30
In reply to The effect on the brain: ADs vs. ADD drugs, posted by Cass on March 6, 2000, at 23:09:06
> I've been thinking a lot about ADD and whether or not I might have it. I know that ADD drugs are stimulants, and something about that concerns me. When I was on a stimulating AD, specifically, Wellbutrin, I became paranoid and I believe, psychotic, as well. It was nightmarish and something I would never want to experience again. Do the chemicals in ADD drugs such as Adderall and Ritalin work on the same part of the brain as a stimulating antidepressant such as Wellbutrin? Any information would be appreciated.
-----------
Got so caught up with my mini-research project on effexor, I forgot about what I really wanted to say here...Hi Cass,
The first time I tried wellbutrin, I had a psychotic response to it ... the second time, at much lower levels than my first experience, I had enough warning signs to know I shouldn't go there again. On the other hand, I just started Ritalin over a week ago and I'm having a pretty good response to it for my mood, my anxiety, my concentration and focus, and my energy level.
I doubt they "work on the same part of the brain". Reading through some material on both, here's what I got:
How wellbutrin works is not all that well known (but that's coming from a 1997 publication, the Manual of Clinical Psychopharmacology, 3rd Ed.). More studies have been showing it has some effects on the NE system, and that this might be its primary mechanism as an AD. Apparently, links to wellbutrin and it's inhibition of the reuptake of dopamine show up most strongly in, would you believe, people who have a psychotic reaction to it, not those with a positive AD effect.
The same source describes the mechanism for Ritalin in terms of it "releasing dopamine into the synapse". It also notes, as someone around here has mentioned, that it appears that amphetamine-like stimulants typically are not abused by those who benefit from them as an AD.
[it also said something about hesitating to raise dosages to an optimal level due to fears of addiction, which now has me paranoid that I'm not taking enough ... you know what they say about a little knowledge ....]
That's about all I'm good for, tho, citing these passages. Someone else around here can probably tell you why blocking the reuptake of dopamine can lead to a psychotic reaction while releasing dopamine into the synapse doesn't.
But like the commercial says, I don't care about what all those studies say--I just know that it (ritalin) works (for me).
Anybody want to give a quick lesson on this? In terms this biology-phobe can understand? Thanks.
bob
[why do they call it "life science" anyway ... dissecting dead things and all, it should be called "dead icky science"]
Posted by Noa on March 7, 2000, at 18:59:18
In reply to Re: The effect on the brain: ADs vs. ADD drugs, posted by bob on March 7, 2000, at 17:57:30
I know that when kids are on higher doses of dexadrine, they can sometimes have mild psychotic symptoms--loose or bizarre thinking, paranoia, etc.
Posted by Noa on March 7, 2000, at 19:06:51
In reply to Re: effexor dosage effects, posted by bob on March 7, 2000, at 17:25:54
I have been looking through some abstracts on Wellbutrin, and it seems to be touted as a good AD for bipolar depression, both because it is less likely than other ADs to cause a manic switch, and because of the kinds of symptoms associated with bipolar depression, similar to atypical depression. For that reason, I think it would be a good one for me to try. But of course I am still confused and wish I could know more about the specific effects of my meds at different doses. The suggestion made in this thread that at higher doses effexor blocks the reuptake of dopamine made me wonder of at my dose (375) I am getting this dopamine reuptake blocking and if that is causing the AD effect to be less effective? Does this make any sense?
Or, is what I need more dopamine reuptake blocking? Would switching from effexor to wellbutrin help?
Posted by Cindy W on March 7, 2000, at 21:35:49
In reply to Re: effexor dosage effects, posted by Noa on March 7, 2000, at 19:06:51
> I have been looking through some abstracts on Wellbutrin, and it seems to be touted as a good AD for bipolar depression, both because it is less likely than other ADs to cause a manic switch, and because of the kinds of symptoms associated with bipolar depression, similar to atypical depression. For that reason, I think it would be a good one for me to try. But of course I am still confused and wish I could know more about the specific effects of my meds at different doses. The suggestion made in this thread that at higher doses effexor blocks the reuptake of dopamine made me wonder of at my dose (375) I am getting this dopamine reuptake blocking and if that is causing the AD effect to be less effective? Does this make any sense?
> Or, is what I need more dopamine reuptake blocking? Would switching from effexor to wellbutrin help?Don't know at what dosage the dopamine effects kick in...but 375 mg/day sure makes me feel better. What is the difference in terms of typical relief from depression, when effects due to serotonin, norepinephrine, and dopamine are compared?
Posted by Renee N on March 8, 2000, at 1:35:58
In reply to Re: effexor dosage effects, posted by Cindy W on March 7, 2000, at 21:35:49
Bob and Noa,
Are you guys on regular Effexor or XR? I've read that 225 is the top dose for XR. I think I need more...Renee N
Posted by JohnL on March 8, 2000, at 2:14:11
In reply to The effect on the brain: ADs vs. ADD drugs, posted by Cass on March 6, 2000, at 23:09:06
> I've been thinking a lot about ADD and whether or not I might have it. I know that ADD drugs are stimulants, and something about that concerns me. When I was on a stimulating AD, specifically, Wellbutrin, I became paranoid and I believe, psychotic, as well. It was nightmarish and something I would never want to experience again. Do the chemicals in ADD drugs such as Adderall and Ritalin work on the same part of the brain as a stimulating antidepressant such as Wellbutrin? Any information would be appreciated.
From what I've read, stimulants vary quite a bit within their class. It takes a very specific match between the drug and the person's chemisitry to achieve wellness without addiction/abuse. Several people here felt abusive with Ritalin, but then found Adderall to be a better choice.
While common choices are Ritalin, Adderall, Dexedrine, and sometimes Cyclert, other overlooked choices are Ionamin or Tenuate. Tenuate is a diet med that resembles Wellbutrin, but sometimes works great when Wellbutrin didn't. Ionamin is also a diet med. It resembles Dexedrine but sometimes is a better choice.
A book I was reading described stimulants as NE/dopamine replacement, to correct NE/dopamine failure. They all have various effects, ranging from stimulating release of neurotransmitters, reuptake inhibition, stimulating receptor sites, increasing blood flow into poorly circulated parts of the brain, and actually replacing failed NE/dopamine due to their molecular structures that resemble NE/dopamine. Very interesting way to interpret it. But just as it is with antidepressants, one may be a perfect match while the others aren't, depending on the person's unique chemistry.
When psychosis occurs on a stimulant, the book I was reading says it is because the stimulant is overcorrecting NE/dopamine in certain patchy parts of the brain, and that a small dose of an antipsychotic will rebalance things. I've heard great reports of stimulant+antipsychotic combinations when antidepressants alone were disappointing.
This is actually the route I will be trying at my pdoc appointment next Monday. My pdoc is going to give me a 4 day prescription each of Adderall, Dexedrine, Tenuate, and Ionamin. The purpose is to probe for the best match before continuing. The best match he says will be evident anywhere from 24 to 72 hours, but often the very first day. I already know I responded robustly to Ritalin...TOO robust. Need something a little tamer. Short trials of the other choices should identify a superior match, if indeed this is the correct treatment for me. We'll see. But according to my pdoc, he has used stimulants as monotherapy and as augmentations to treat depression for decades, with or without any symptoms of ADD or ADHD. He says a person does not need to qualify as ADHD to be treated successfully with a stimulant for depression.
Posted by medlib on March 8, 2000, at 2:41:33
In reply to Re: The effect on the brain: ADs vs. ADD drugs, posted by JohnL on March 8, 2000, at 2:14:11
Another incredibly useful post--THANKS, JohnL
BTW, my pdoc agreed to a more speeded-up trial of alternatives; your posts provided the impetus I needed to discuss this with him.
Much appreciation,
medlib
> > I've been thinking a lot about ADD and whether or not I might have it. I know that ADD drugs are stimulants, and something about that concerns me. When I was on a stimulating AD, specifically, Wellbutrin, I became paranoid and I believe, psychotic, as well. It was nightmarish and something I would never want to experience again. Do the chemicals in ADD drugs such as Adderall and Ritalin work on the same part of the brain as a stimulating antidepressant such as Wellbutrin? Any information would be appreciated.
>
> From what I've read, stimulants vary quite a bit within their class. It takes a very specific match between the drug and the person's chemisitry to achieve wellness without addiction/abuse. Several people here felt abusive with Ritalin, but then found Adderall to be a better choice.
>
> While common choices are Ritalin, Adderall, Dexedrine, and sometimes Cyclert, other overlooked choices are Ionamin or Tenuate. Tenuate is a diet med that resembles Wellbutrin, but sometimes works great when Wellbutrin didn't. Ionamin is also a diet med. It resembles Dexedrine but sometimes is a better choice.
>
> A book I was reading described stimulants as NE/dopamine replacement, to correct NE/dopamine failure. They all have various effects, ranging from stimulating release of neurotransmitters, reuptake inhibition, stimulating receptor sites, increasing blood flow into poorly circulated parts of the brain, and actually replacing failed NE/dopamine due to their molecular structures that resemble NE/dopamine. Very interesting way to interpret it. But just as it is with antidepressants, one may be a perfect match while the others aren't, depending on the person's unique chemistry.
>
> When psychosis occurs on a stimulant, the book I was reading says it is because the stimulant is overcorrecting NE/dopamine in certain patchy parts of the brain, and that a small dose of an antipsychotic will rebalance things. I've heard great reports of stimulant+antipsychotic combinations when antidepressants alone were disappointing.
>
> This is actually the route I will be trying at my pdoc appointment next Monday. My pdoc is going to give me a 4 day prescription each of Adderall, Dexedrine, Tenuate, and Ionamin. The purpose is to probe for the best match before continuing. The best match he says will be evident anywhere from 24 to 72 hours, but often the very first day. I already know I responded robustly to Ritalin...TOO robust. Need something a little tamer. Short trials of the other choices should identify a superior match, if indeed this is the correct treatment for me. We'll see. But according to my pdoc, he has used stimulants as monotherapy and as augmentations to treat depression for decades, with or without any symptoms of ADD or ADHD. He says a person does not need to qualify as ADHD to be treated successfully with a stimulant for depression.
Posted by Noa on March 8, 2000, at 13:48:45
In reply to Re: effexor dosage effects-to Bob and Noa, posted by Renee N on March 8, 2000, at 1:35:58
> Bob and Noa,
> Are you guys on regular Effexor or XR? I've read that 225 is the top dose for XR. I think I need more...Renee NRenee, Yes I am on Effexor XR, and it is my understanding that one can definitely can go higher than 225. I read in one of the abstracts a recommendation that with refractory depression, doses up to 375 are recommended, and safe. I also know my pdoc told me he has patients on even higher doses than that.
Posted by bob on March 8, 2000, at 19:21:20
In reply to Re: effexor dosage effects-to Bob and Noa, posted by Noa on March 8, 2000, at 13:48:45
Renee, I'm not of Effexor, but like Noa said, what I've read about it advises that dosage levels up to 375 may be necessary for atypical or refractory depression.
JohnL, your pdoc falls in with one of the sources I mentioned -- the authors complained about how stimulants were underutilized, even in monotherapy, due to overblown concerns brought on by concerns over amphetamine abuse in our culture. I hope it works well for you ... just watch out for those antipsychotics! They can hit you like a ton of bricks ... I was on perphenazine at an extremely low level for a time, and it would knock me out every day.
Posted by Cindy W on March 8, 2000, at 21:29:58
In reply to Re: effexor dosage effects-to Bob and Noa, posted by bob on March 8, 2000, at 19:21:20
> Renee, I'm not of Effexor, but like Noa said, what I've read about it advises that dosage levels up to 375 may be necessary for atypical or refractory depression.
>
> JohnL, your pdoc falls in with one of the sources I mentioned -- the authors complained about how stimulants were underutilized, even in monotherapy, due to overblown concerns brought on by concerns over amphetamine abuse in our culture. I hope it works well for you ... just watch out for those antipsychotics! They can hit you like a ton of bricks ... I was on perphenazine at an extremely low level for a time, and it would knock me out every day.
Am on Effexor-XR 375 mg/day, and have had no problems. I just feel "normal" (no obsessive thoughts, no depression, less need to indulge in compulsive rituals--like shopping for things I don't need) when I get anxious. I have read that up to 500-600 mg/day may even be used at times for really refractory depression.--Cindy W
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.