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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Kim T. on April 1, 2000, at 23:53:13
I have heard many of you talk of your doctors prescribing ritalin to help to boost your antidepressant. I am on 400mg. Wellbutrin,which is the only thing I have been able to tolerate. Has anyone had any experience with Wellbutrin and Ritalin or Dexadrine or Adderall?
Posted by DC on April 2, 2000, at 1:38:34
In reply to Depression, posted by Kim T. on April 1, 2000, at 23:53:13
I have been trying dexedrine for a few weeks and now adderal. I am stil trying to figure out if it helps me. For the first couple of weeks it seemed to--I was more talkative, more energetic, and more motivated. Then one day I felt tired so I took a little more than usual. I still felt tired so I took a little more. And again. Then I realized that I was becoming sort of catatonic and feeling VERY strange. I stopped the drug the next day but still had NO ENERGY whatsoever. FOr the next week I was extremely depressed; I felt as if I'd been hit by a truck. Now I find that I can only tolerate a tiny tiny amount of either Dexedrine or Adderal. If I take more than that I get paranoid, stop talking, and feel like I'm going crazy. I have never had any reaction like this to meds. I wish I could get back the feeling I had initially. I was also taking Neurontin at the time, but now I find that makes me feel kinda weird, too. Does anybody know what might have caused this crash?
Posted by CarolAnn on April 2, 2000, at 9:35:09
In reply to Depression, posted by Kim T. on April 1, 2000, at 23:53:13
Kim, I am also on 400mgs. of Wellbutrin. It never helped me with very much, especially with my fatigue. I was on Ritalin for a while, but was starting to abuse it. Now I take 10mgs. of Adderall three times per day. It felt more helpful at the beginning, but I am still better taking it than not takin it. For a little more info, see note to DC(below this post). Good luck! CarolAnn
Posted by CarolAnn on April 2, 2000, at 9:46:57
In reply to Terrible CRASH after two weeks on Dexedrine, posted by DC on April 2, 2000, at 1:38:34
DC, I have been on Adderall(10 mgs. 3 times/day) since before Christmas. I had the same experience, it seemed very helpful the first couple weeks, then MUCH less noticeable effect. You don't want to be taking more than your dose, that will lead to increased tolerance and probably addiction (I experienced this on Ritalin). My Pdoc said that it is normal to feel the slide down in the effectiveness of Adderall, because your body adjusts to it. But, even if you aren't feeling that dramatic effect, it is still helping you. Whatever you do, don't stop taking *any* stimulant "cold turkey", this will definitly cause a crashing depression(almost suicidal, for me!)! Now, what I have done sometimes to feel that initial effectiveness of Adderall, is to take a break for a week or so (taper down a few days, first). Of course, you want to try to pick a week that you don't need the extra lift. Then when you start taking it again, it's almost the same as when you first started. You just might not want to tell your doctor you are doing that though, they get a little funny about things like that. Anyway, best of luck to you, and I'd love to hear how it goes, if you feel like posting. CarolAnn
Posted by kazoo on April 2, 2000, at 10:41:13
In reply to Terrible CRASH after two weeks on Dexedrine, posted by DC on April 2, 2000, at 1:38:34
> I have been trying dexedrine for a few weeks and now adderal. I am stil trying to figure out if it helps me. For the first couple of weeks it seemed to--I was more talkative, more energetic, and more motivated. Then one day I felt tired so I took a little more than usual. I still felt tired so I took a little more. And again. Then I realized that I was becoming sort of catatonic and feeling VERY strange. I stopped the drug the next day but still had NO ENERGY whatsoever. FOr the next week I was extremely depressed; I felt as if I'd been hit by a truck. Now I find that I can only tolerate a tiny tiny amount of either Dexedrine or Adderal. If I take more than that I get paranoid, stop talking, and feel like I'm going crazy. I have never had any reaction like this to meds. I wish I could get back the feeling I had initially. I was also taking Neurontin at the time, but now I find that makes me feel kinda weird, too. Does anybody know what might have caused this crash?
> Does anybody know what might have caused this crash?
^^^^^^^^^^^^
It's simple biological physics: what goes up, must come down.
> I wish I could get back the feeling I had initially.
^^^^^^^^^^^^
Which was what? You didn't say what this "feeling" was originally?
> I was more talkative, more energetic, and more motivated.
^^^^^^^^^^^^^^^^^
This is the "false sense of well-being" the PDR mentions. And this is supposed to be a bad thing since it's
listed under "Adverse Reactions" (I'm not sure where).> Then one day I felt tired so I took a little more than usual.
^^^^^^^^^^^^^^^^^
This is the problem with this grenre of drugs. People, like myself, tend to make excuses to take more and more
of this stimulant, and this can "possibly" be interpreted as a form of habituation (I know I'm going to hear
it on this one!).> I still felt tired so I took a little more.
^^^^^^^^^^^^^^^^^
What you experienced was the "paradoxical effect"; i.e., the opposite of what the drug is supposed to do.
This is the rationale behind giving stimulants to hyperactive children. Instead of bouncing them off the
walls, as was happening to you, this reverse condition, or state of being, occurs. In street terms, it's
called "over-amping."> If I take more than that I get paranoid...
^^^^^^^^^^^^^^^^^
The "Mad-Hatters Syndrome," as batty as a bed-bug.It seems you cannot tolerate stimulants very well ... you can draw your own conclusions.
Take a "drug holiday"; i.e., just stop COLD ... it's tough to do, I KNOW, but the choices
are limited. If this proves too difficult to do, try tapering off using a DIFFERENT drug, such
as Ritalin. I wouldn't try tapering off using the SAME drug, because you'll find yourself
making new "excuses" to take more, or not do it at all.***IMPORTANT***
Alert your doctor about what you're experiencing and have HIM help you
taper off. After all, YOU are HIS responsibility! And don't be surprised
if your doctor cops an attitude toward this whole affair!Greetings to Kim T., and Buono Fortunno.
kazoo
Posted by Cass on April 2, 2000, at 16:13:51
In reply to Re: Terrible CRASH after two weeks on Dexedrine, posted by kazoo on April 2, 2000, at 10:41:13
I tried Adderall for just over a week on a small dose, 5 mg four times a day. That was too much, so I went down to 2.5 mg four times a day. I had to keep going down on the dose because it was causing too much anger and frustration to rise to the surface. Now, after quitting, I am experiencing the worst depression I have had in a long time. I am very discouraged, but I'll probably try Ritalin next.
Posted by Ant-Rock on April 2, 2000, at 20:08:40
In reply to Re: Terrible CRASH after two weeks on Dexedrine, posted by kazoo on April 2, 2000, at 10:41:13
Hi Kazoo, Anthony here;
I get the impression you don't consider stimulants viable AD's. The reason I'm asking is that I'm in the process of a Ritalin trial for depression/fatigue. You mentioned a "false sense of well being". Yet my pdoc says he has an older patient who failed all treatments including ECT, and he is doing wonderfully on ritalin. This patient was concerned that he would have to take this stimulant for the rest of his life. But aren't the standard ad's taken by many people indefinitely?
I am certainly not trying to attack your post Kazoo, in fact I really enjoy all your posts, but I got kinda bummed out thinking about possibly finding a drug that really might help me, only to have to give it up because it is really just a temporary high that wears off. Anyway, let me know if I'm getting the wrong impression from your post. Take care,Anthony
Posted by DC on April 2, 2000, at 23:21:10
In reply to Re: Terrible CRASH ...(Kazoo), posted by Ant-Rock on April 2, 2000, at 20:08:40
Hi, Anthony. I haven't been on stimulants very long but I have tried dexedrine and adderal. I'm sorry to hear about your disappointment, but I think your fears are justified. Adderal is longest acting of the stimulants (except there may be an extended release form of ritalin). But even people on adderal sometimes have to take it four times a day. These drugs do not give a steady uplift in mood like you might get from a good AD, and they are more dangerous because they are addictive. Even if you don't get that great a response, you might still want more because they do seem to cause depression when they wear off. Just be careful.
Posted by Kim T. on April 3, 2000, at 1:09:35
In reply to Re: Terrible CRASH after two weeks on Dexedrine, posted by kazoo on April 2, 2000, at 10:41:13
My doctor had prescribed Adipex for diet and I did very well both with the wieght and the energy. I didn't get as nervous as I once had and I suspect it was because of the wellebutrin. But the combination of the two I think were good for me. Unfortunately, my pharmacist said that it is a state law that you can only take it for 3 months on and after 6 months you can start taking it again. I don't know about that but it seems to be a waste all the way around. Anyone ever hear of someone being prescribed Adipex for depression?
Posted by Kim T. on April 3, 2000, at 1:22:13
In reply to Re: Terrible CRASH ...(Kazoo), posted by DC on April 2, 2000, at 23:21:10
> Hi, Anthony. I haven't been on stimulants very long but I have tried dexedrine and adderal. I'm sorry to hear about your disappointment, but I think your fears are justified. Adderal is longest acting of the stimulants (except there may be an extended release form of ritalin). But even people on adderal sometimes have to take it four times a day. These drugs do not give a steady uplift in mood like you might get from a good AD, and they are more dangerous because they are addictive. Even if you don't get that great a response, you might still want more because they do seem to cause depression when they wear off. Just be careful.
I know for myself, I will take the wellebutrin for the rest of my life. I don't have a problem with it because it helps better than nothing. I have tried so many other things and I am not completely in a full blown depression, but I am hanging on the edge of it every day. "Oh here we go again." I want something that is going to make me smile and really look forward to the next day because I know I can't do this on my own. I don't connect that way or something. I want something thats going to help me take pride in cleaning my house and getting my fat bottom off of the couch. Go to work with a good attitude. I guess if it doesn't come to me naturally is there something so wrong with getting it someplace else? The addiction part is a bad drawback. I don't think Adipex is addictive. I had no problem when I didn't have any more. I need a good doctor to help me through this and that is one of my biggest hurdles besides the depression. Anyone know of a good doctor around Columbus, Ohio?
Posted by kazoo on April 3, 2000, at 2:12:57
In reply to Okay so why can't I try Adipex?, posted by Kim T. on April 3, 2000, at 1:09:35
Adipex is phentermine, the PHEN in the dastardly PHEN/FEN combination.
This drug is INDICATED in the PDR as an anoretic; i.e., a weight loss drug EXCLUSIVELY.
Though it may help in your depression, it's not prescribed for that purpose.
The anti-depressant effect you get from this drug, though beneficial, is not what this
drug was intended for; therefore, don't go marching into your doctor's office requesting
this drug as an antidepressant because that would be contrary to their bible, the PDR, and
they'll send you on your merry way.[This is a bit off topic: bear with me]
RETIN-A (tretinoin)is a topical cream used to treat "acne vulgaris," or cluster-zits as I call it.
During the testing of this cream, it was discovered that its unique exfoliation properties
made wrinkles and discolorations disappear! Once the word was out, millions and millions of women (and men, too!)
pestered their doctors day and night for scripts of this "miracle" cream that even Estee Lauder
couldn't match. To keep their patients happy, and to SHUT THEM UP, they wrote the scripts, but
they were also faced with a moral/ethical question. Was it "right" to prescribe this product to treat
a condition NOT INDICATED in the PDR. This was certainly a problem, but not one without a solution.
Within a few years, the same company introducted a new product, RENOVA, which is just RETIN-A in a different
package, but with RENOVA the indications are for skin discolorations and wrinkles. Old wine, new bottles ...
This way doctors can protect themselves legally, ethically, morally and FINANCIALLY.Some other time: the MERIDIA fiasco
[eof]
> ... my pharmacist said that it is a state law that you can only take it for 3 months...
What state do you live in? This seems awfully odd! This restriction could possibly stem
from the generalized paranoia tacked on to stimulants. Are you sure it's not your insurance
that's making a fuss?You said you took Adipex in conjunction with Wellbutrin. This is interesting because for
3 years I've taken Prozac in conjunction with Tenuate DOSPAN (which, ironically, is very
closely related to Wellbutrin). I've always contended that in some cases, the concurrent
use of two drugs usually work better than if either are used singly.Have your doctor write on the prescription "MEDICAL NECESSITY," or have him write out a note
claiming that it's a {Kantian} Categorical Imperative that you use this drug beyond the 3 month
period for obvious health reasons.Greetings to Kim T.
kazoo
Posted by CarolAnn on April 3, 2000, at 10:21:01
In reply to Re: Okay so why can't I try Adipex?, posted by kazoo on April 3, 2000, at 2:12:57
Hi kazoo, I would love to have the story on Meridia. I keep seeing the commercials for it, but have not been able to find any real information. What exactly is the stuff? For example: I know that Zyban is just Wellbutrin packaged for smokers, is Meridia just a name for something else? The ads say not to take it with antidepressants, is that because it is an antidepressant? Anyway, whatever info you have, would be very helpful, I've been trying to research the stuff for my mom. Thanks for sharing! CarolAnn
Posted by kazoo on April 3, 2000, at 11:20:38
In reply to Re: kazoo, please tell about Meridia..., posted by CarolAnn on April 3, 2000, at 10:21:01
> I would love to have the story on Meridia.
^^^^^^^^^^^^
Greetings to CarolAnn:
The skinny on Meridia: it's a FAILED antidepressant! When trial studies revealed that
sibutramine (generic name) didn't do its stuff in the psychopharmacology department,
but did display a *mild* anoretic effect, Knoll immediately changed its marketing direction
and re-petitioned the FDA to indicate this drug as a DIET PILL. In other words, it changed
from one category to the next, an over-night sensation; however, the sad part of all of this
is that Meridia isn't even a good anoretic at that! It sucks. An because it was reclassified
as an anorectic, it, NATURALLY, had to have a control status attached to it (C-IV). If it had
remained an antidepressant, it would not have been a controlled substance.The same is true with Wellbutrin/Zyban, another farce. Wellbutrin has been kicking around
since the mid-to-late-1980s because I remember taking it. Most doctors avoided the drug at that time
because of the potential for seizures, although I didn't have any, and the SSRI's, specifically
PROZAC, had become the thrill of the moment. Since Zyban is Wellbutrin, I found that it did help
me to cut down on my smoking, but it didn't make me stop. Now this is going to sound like a stupid
statement, but perhaps if I had KNOWN, AT THAT TIME, that I COULD quit, I might have. Which brings
up another question about believing what you want/have to believe AS INDICATED.Sheesh ... I give up!
kazoo
Posted by Ant-Rock on April 3, 2000, at 16:23:20
In reply to Re: Terrible CRASH ...(Kazoo), posted by DC on April 2, 2000, at 23:21:10
> Hi, Anthony. I haven't been on stimulants very long but I have tried dexedrine and adderal. I'm sorry to hear about your disappointment, but I think your fears are justified. Adderal is longest acting of the stimulants (except there may be an extended release form of ritalin). But even people on adderal sometimes have to take it four times a day. These drugs do not give a steady uplift in mood like you might get from a good AD, and they are more dangerous because they are addictive. Even if you don't get that great a response, you might still want more because they do seem to cause depression when they wear off. Just be careful.
DC,
I appreciate your views on stimulants, but... to suggest that those of us whose depression is dopamine related, are pretty much out of luck, is a little short-sighted. If you go to Dr. Bobs psy Tips area, and do a search on "maoi's & stimulants", you will find plenty of info regarding successfully treated patients who have responded to stimulants, maoi's, and combo's of both. These responses are from several doctors experiences and in many cases are the only treatments that have helped these patients when everything else has failed.
Please don't take this post as a neagative rebuttal DC, but I really wouldn't want anyone, including yourself, to disregard a possible life changing treatment without getting as much info as possible.
Take care,
Anthony
Posted by saint james on April 3, 2000, at 18:48:45
In reply to Re: Okay so why can't I try Adipex?, posted by kazoo on April 3, 2000, at 2:12:57
> > ... my pharmacist said that it is a state law that you can only take it for 3 months...
> What state do you live in? This seems awfully odd! This restriction could possibly stem
> from the generalized paranoia tacked on to stimulants. Are you sure it's not your insurance
> that's making a fuss?
>james here...
This is true of all the diet meds as they really only work short term. 3 months in 1 year and that is it. If you are taking it for another reason you should be able to get around this.
My experience with Adipex is that it is icky.
j
Posted by KIM T. on April 4, 2000, at 1:32:38
In reply to Re: Okay so why can't I try Adipex?, posted by saint james on April 3, 2000, at 18:48:45
>
> > > ... my pharmacist said that it is a state law that you can only take it for 3 months...
> > What state do you live in? This seems awfully odd! This restriction could possibly stem
> > from the generalized paranoia tacked on to stimulants. Are you sure it's not your insurance
> > that's making a fuss?
> >
>
> james here...
>
> This is true of all the diet meds as they really only work short term. 3 months in 1 year and that is it. If you are taking it for another reason you should be able to get around this.
>
> My experience with Adipex is that it is icky.
>
> jI don't know why my insurance company would have anything to do with it - I was paying for it not them It was originally prescribed to me for wieght loss. I have put on over 150 lbs. mostly from depression but I can't get it off. The wellebutrin made me drop alot of wieght but then I came to a point where Okay, I'm not suicidal but I'm not living well either. Maybe I should just risk the siezures and raise my wellebutrin dosage. I live in Ohio.
Posted by Kim T. on April 4, 2000, at 1:42:26
In reply to Re: Okay so why can't I try Adipex?, posted by kazoo on April 3, 2000, at 2:12:57
> Adipex is phentermine, the PHEN in the dastardly PHEN/FEN combination.
> This drug is INDICATED in the PDR as an anoretic; i.e., a weight loss drug EXCLUSIVELY.
> Though it may help in your depression, it's not prescribed for that purpose.
> The anti-depressant effect you get from this drug, though beneficial, is not what this
> drug was intended for; therefore, don't go marching into your doctor's office requesting
> this drug as an antidepressant because that would be contrary to their bible, the PDR, and
> they'll send you on your merry way.
>
> [This is a bit off topic: bear with me]
> RETIN-A (tretinoin)is a topical cream used to treat "acne vulgaris," or cluster-zits as I call it.
> During the testing of this cream, it was discovered that its unique exfoliation properties
> made wrinkles and discolorations disappear! Once the word was out, millions and millions of women (and men, too!)
> pestered their doctors day and night for scripts of this "miracle" cream that even Estee Lauder
> couldn't match. To keep their patients happy, and to SHUT THEM UP, they wrote the scripts, but
> they were also faced with a moral/ethical question. Was it "right" to prescribe this product to treat
> a condition NOT INDICATED in the PDR. This was certainly a problem, but not one without a solution.
> Within a few years, the same company introducted a new product, RENOVA, which is just RETIN-A in a different
> package, but with RENOVA the indications are for skin discolorations and wrinkles. Old wine, new bottles ...
> This way doctors can protect themselves legally, ethically, morally and FINANCIALLY.
>
> Some other time: the MERIDIA fiasco
> [eof]
>
>
> > ... my pharmacist said that it is a state law that you can only take it for 3 months...
> What state do you live in? This seems awfully odd! This restriction could possibly stem
> from the generalized paranoia tacked on to stimulants. Are you sure it's not your insurance
> that's making a fuss?
>
> You said you took Adipex in conjunction with Wellbutrin. This is interesting because for
> 3 years I've taken Prozac in conjunction with Tenuate DOSPAN (which, ironically, is very
> closely related to Wellbutrin). I've always contended that in some cases, the concurrent
> use of two drugs usually work better than if either are used singly.
>
> Have your doctor write on the prescription "MEDICAL NECESSITY," or have him write out a note
> claiming that it's a {Kantian} Categorical Imperative that you use this drug beyond the 3 month
> period for obvious health reasons.
>
> Greetings to Kim T.
>
> kazooHello Kazoo
and you are telling me that the way to get around it is to have my doctor write that on an adipex prescription. Why is it that no one seems to understand that depression hit you in so many different ways and you must treat it in so many different ways. I don't know if my doctor will even understand - he is only a general practicioner. I fired my shrink or rather she fired me because she no longer takes my insurance.
Posted by kazoo on April 4, 2000, at 9:50:58
In reply to Re: Okay so why can't I try Adipex?, posted by KIM T. on April 4, 2000, at 1:32:38
> > > > ... my pharmacist said that it is a state law that you can only take it for 3 months...
> > > What state do you live in?
> I live in Ohio.^^^^^^^^^^^^^^
Take a memo: remind me never to live in Ohio ... Connecticut is BAD enough!
Greetings to Kim T.
kazoo
Posted by michael on April 4, 2000, at 20:55:08
In reply to Re: Okay so why can't I try Adipex?, posted by KIM T. on April 4, 2000, at 1:32:38
> >
> > > > ... my pharmacist said that it is a state law that you can only take it for 3 months...
> > > What state do you live in? This seems awfully odd! This restriction could possibly stem
> > > from the generalized paranoia tacked on to stimulants. Are you sure it's not your insurance
> > > that's making a fuss?
> > >
> >
> > james here...
> >
> > This is true of all the diet meds as they really only work short term. 3 months in 1 year and that is it. If you are taking it for another reason you should be able to get around this.
> >
> > My experience with Adipex is that it is icky.
> >
> > j
>
> I don't know why my insurance company would have anything to do with it - I was paying for it not them It was originally prescribed to me for wieght loss. I have put on over 150 lbs. mostly from depression but I can't get it off. The wellebutrin made me drop alot of wieght but then I came to a point where Okay, I'm not suicidal but I'm not living well either. Maybe I should just risk the siezures and raise my wellebutrin dosage. I live in Ohio.I may be wrong about this, since it's just off the top of my head... and I'm sure that someone will correct me if I am wrong...
I thought that at the max dosage of 400mgSR/day, the seisure risk was something like .4% - that's less than 1/2 of one percent...
Everyone has their own risk tolerance, but like anything else we discuss here, it's a matter of weighing the risks against the potential gains...
michael
Posted by Kathy on April 7, 2000, at 21:42:26
In reply to Depression, posted by Kim T. on April 1, 2000, at 23:53:13
Hi, I just wanted to comment to Kim that although I am not on wellbutrin presently, I do take ritalin to help with depression. I was on celexa and neurontin as well. The ritalin gives you that extra boost that some of us are badly in need of. I actually just went off of celexa in order to switch to another antidepressant. ( I am bipolar 11 and also have dysthymia)I am still on ritalin 3-4 times a day while we wait for the depakote to to stabilize. My point is ,that if I was not on ritalin now, I would be in no mans land. It has been a big help to me this past year. Good luck.
This is the end of the thread.
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