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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Caslon540 on February 16, 2005, at 2:20:37
I'm wondering what the maximum adult dose is considered to be for Adderall (not what the official literature says, but how much doctors actually prescribe in real life to people with my problem). I'm currently on 30 mg Adderall XR, 20 mg regular Adderall, 300 mg Effexor XR, and 80 mg Geodon. I also take anywhere from 200-600 mg of caffeine in pill form (equivalent to 2-6 cups of coffee) and 400 mg of magnesium taurate. (I read on another board that magnesium helps keep amphetamine tolerance down.)
I'm on stimulants due to severe fatigue and hypersomnia from depression. (Before I started them, I was sleeping 20 hours a day, at least half of the week.) I started on Ritalin first, but my tolerance escalated rapidly, and after 4-5 months I switched to Adderall, which I've been on for about 9.5 months now (thanks to the magnesium, I guess).
OK, here's where the problem gets really long: I think I was able to function significantly better on Ritalin than I do now on Adderall, but a confounding factor when comparing the two is that I started taking Geodon at the same time as Ritalin, and have stayed on the same dose of Geodon ever since. Right around the time I switched from Ritalin to Adderall, I developed galactorrhea, and have had it since then. I've been examined, had blood tested, and was told it is probably caused by the Geodon. I think I've read that antipsychotics can take a few months to be fully effective (please correct me if I'm wrong), so I'm thinking that maybe one of the reasons Adderall hasn't worked as well for me as Ritalin is that the Geodon started causing side effects around the time I started taking Adderall.
Progressively over the past 5 months, I've been having problems staying alert throughout much of the day, regardless of whether I have 8 hours or even 12 hours of good sleep the night before. I'm most alert after I take my morning Adderall XR 30 mg dose, which has always seemed to last only about 4 hours. I take 40 mg of Geodon and 300 mg of Effexor XR later in the morning or at lunchtime. Curiously, it is shortly after I do this that I become very fatigued, followed by an inability to generate motivation to do anything, even tasks that are unchallenging yet enjoyable. I take 10 mg of regular Adderall at 2 PM, and then another 10 mg at 6 PM. I've noticed no effect from either of these doses for the past month. I usually feel a little sharper late in the evening, when the early dose of Geodon is probably wearing off. I take my second 40 mg Geodon dose at whatever time I go to bed for the night.
Why could this mental/physical drop-off be happening every single day? I don't think my Adderall tolerance is going up, because the XR has had pretty much the same effect every morning for months. When I wake up, I seem to have a clean slate regarding whatever it is that had pulled the plug the day before. I'm inclined to think the Geodon is interfering with the Adderall, as Adderall is a dopamine agonist and Geodon is an antagonist, but I'm not clear on the details, so I could easily be mistaken.
If it helps to know, I started the Effexor so long before anything else I'm on now that I can't even remember what year it was.
Do you think lowering the Geodon dosage would ameliorate this problem? Or should I ask/beg my psychiatrist to increase the Adderall? I'm kind of scared that if I ask for a higher Adderall dosage, he'll take me off of stimulants completely, because he just raised it about 4 months ago.
I assume people with ADHD are prescribed stimulants for years. Is a year and 3 months a ridiculously long time to be prescribed stimulants for a problem the complete OPPOSITE of hyperactivity?
I apologize that this is so wordy.
Posted by ixus on February 16, 2005, at 2:28:32
In reply to HELP! Adderall w Geodon用roblem, posted by Caslon540 on February 16, 2005, at 2:20:37
I tried Concerta, it has done nothing to me but increased hypersomnia + anxiety when stopped working (10-12 hours after intake). Try to solve your problems with antidepressants rather than stimulants.
Posted by Caslon540 on February 16, 2005, at 3:43:51
In reply to Re: HELP! Adderall w Geodon用roblem, posted by ixus on February 16, 2005, at 2:28:32
I tried Concerta too. It did nothing to me, period. Here are the drugs I've tried (some were eventually combined) and their effects: Prozac (increased anxiety), Wellbutrin (severe "body high," felt like I was on recreational drugs all the time), Zoloft (total zombie), Strattera (helped with concentration but not hypersomnia), Provigil (worked for only 2 weeks), Concerta (see above), Ritalin (worked, then tolerance), Abilify (dr. switched to Geodon before I noticed anything), Seroquel (horrible for hypersomnia), Zyprexa (threw away after one dose because it was the worst experience of my life).
My doctor has suggested Vivactil and MAOIs, but I'm a lot more scared of anti-depressants now than stimulants, and feel that to remove stims and change ADs at this moment could be disastrous, given my history with ADs versus stims, and that if I lose much more time right now, the future I've been struggling to build here for the past 5 years will totally collapse and I'll have to move back in with my parents 500 miles away. On top of that, my doctor even said that anti-depressants won't be as effective as stimulants for fatigue and hypersomnia. It'd be nice if they were, so that I wouldn't have to deal with pharmacists questioning the prescriptions my doctor gives me every month (that feature security images in heat-sensitive ink that I could never reproduce, no less) like I'm some kind of criminal. If I wanted to get high every day, I would've stayed on Wellbutrin! I don't know why it had that effect on me, but ugh, that was frightening.
> I tried Concerta, it has done nothing to me but increased hypersomnia + anxiety when stopped working (10-12 hours after intake). Try to solve your problems with antidepressants rather than stimulants.
Posted by ixus on February 16, 2005, at 7:51:50
In reply to Re: HELP! Adderall w Geodon用roblem, posted by Caslon540 on February 16, 2005, at 3:43:51
My opinion is that stimulants simply don't work in depression/anxiety states and coexisted symptoms. For atypical depression MAOIs have been proven to be most effective ones. I also believe that atypicals are very sensitive to CNS depressants like alcohol, benzo and other staff (stimulants are also depressants).
So far I tried many AD, only Parnate works. It may be that Nardil would be even better, unfortunately I can't get it.
Posted by Phillipa on February 16, 2005, at 18:14:48
In reply to Re: HELP! Adderall w Geodon用roblem, posted by ixus on February 16, 2005, at 7:51:50
I still can't believe all the Posters who believe in TCA's and MAOI's. I'm obviously more afraid of drugs than I think I am. What I do know is that the newer AD's don't effect me at all. Maybe it's time I got as much courage as you have. Fondly, Phillipa
Posted by ixus on February 17, 2005, at 3:41:13
In reply to Re: HELP! Adderall w Geodon用roblem ｻ ixus, posted by Phillipa on February 16, 2005, at 18:14:48
MAOIs are safe if you watch yourself (changes in BP after meals etc.) over some period of time. I don't think TCA are more dangerous than SSRI. They have worse side effect profile. But SSRI may cause strong suicidal anxiety which is also VERY unsafe.
New drugs are over marketed. Tones of dollars are spent on their promotions.
It seems also that clinical trials with new AD are
cheat (For instance I have not meet anyone successful on moclobemide on this forum. On the other hand on it is stated on the official sites that it has the same power as older non-reversible MAOI).
Posted by Caslon540 on February 17, 2005, at 3:41:59
In reply to Re: HELP! Adderall w Geodon用roblem, posted by ixus on February 16, 2005, at 7:51:50
> My opinion is that stimulants simply don't work in depression/anxiety states and coexisted symptoms.
My opinion is that they do. :)
> For atypical depression MAOIs have been proven to be most effective ones. I also believe that atypicals are very sensitive to CNS depressants like alcohol, benzo and other staff (stimulants are also depressants).
I've been told by a mental health professional specifically that I do NOT have atypical depression. I guess my other symptoms don't match it or something. I also have or have had some symptoms that don't match major depressive disorder at all. And one thing underlying all this, that I neglected to mention, is probably the autoimmune "lupus-like syndrome" (as described by my former rheumatologist) I was treated for a while back. Chronic fatigue is a common symptom of lupus and is treated with stimulants.
Posted by ixus on February 17, 2005, at 3:59:35
In reply to Re: HELP! Adderall w Geodon用roblem, posted by Caslon540 on February 17, 2005, at 3:41:59
Lucky you ;-)
BTW you mentioned only about depression, fatigue and hypersomnia. It perfectly matches to a. depr.
Don't trust to much what specialists say. Get second, third and maybe next opinion.
Maybe I have also lupus syndrome. I must read more about it. Thanks!> > My opinion is that stimulants simply don't work in depression/anxiety states and coexisted symptoms.
>
> My opinion is that they do. :)
>
> > For atypical depression MAOIs have been proven to be most effective ones. I also believe that atypicals are very sensitive to CNS depressants like alcohol, benzo and other staff (stimulants are also depressants).
>
> I've been told by a mental health professional specifically that I do NOT have atypical depression. I guess my other symptoms don't match it or something. I also have or have had some symptoms that don't match major depressive disorder at all. And one thing underlying all this, that I neglected to mention, is probably the autoimmune "lupus-like syndrome" (as described by my former rheumatologist) I was treated for a while back. Chronic fatigue is a common symptom of lupus and is treated with stimulants.
Posted by ixus on February 17, 2005, at 4:24:56
In reply to HELP! Adderall w Geodon用roblem, posted by Caslon540 on February 16, 2005, at 2:20:37
If this helps, to much serotonin causes dopamine depletion. It also works in the opposite way. Maybe Effexor is your problem.
Posted by Caslon540 on February 17, 2005, at 5:53:43
In reply to Re: HELP! Adderall w Geodon用roblem, posted by ixus on February 17, 2005, at 3:59:35
> BTW you mentioned only about depression, fatigue and hypersomnia. It perfectly matches to a. depr.
That's what I thought at first too...but isn't another characteristic of atypical depression that every day your mood is worst in the morning and better as the day goes by? I don't have that.
> Don't trust to much what specialists say. Get second, third and maybe next opinion.
Well, I see two people, a therapist and a psychiatrist, and only one said that I don't have it. I guess I should ask the other what he thinks.
Posted by Caslon540 on February 17, 2005, at 5:54:46
In reply to Re: HELP! Adderall w Geodon用roblem, posted by ixus on February 17, 2005, at 4:24:56
> If this helps, to much serotonin causes dopamine depletion. It also works in the opposite way. Maybe Effexor is your problem.
Yeah, I will consider that! Thanks.
Posted by Caslon540 on February 17, 2005, at 22:36:38
In reply to Re: HELP! Adderall w Geodon用roblem, posted by Caslon540 on February 17, 2005, at 5:54:46
Added 150 mg Wellbutrin and decreased Geodon by 20 mg today. I forgot to say anything to my doctor about the Effexor. This is half the amount of Wellbutrin I was on when I felt high all the time and freaked out. I'm kind of scared to be on it with as high a dose of Effexor as I take, but if it's bad I'll ask to decrease the Effexor.
Posted by ixus on February 18, 2005, at 1:03:34
In reply to update, posted by Caslon540 on February 17, 2005, at 22:36:38
What is the reason that you take Geodon, as you already know it is dopamine antagonist?
Some believe that antipsychotics in low dosage bind autoreceptors only, thus increase dopamine transmission (and acting like agonists). But your dosage is already high, probably affecting all dopamine receptors.
Posted by stargazer on February 19, 2005, at 14:17:32
In reply to Re: update, posted by ixus on February 18, 2005, at 1:03:34
I also wanted to know why Geodon was prescribed and how you responded to it initally. Also what dose were you started on and what was the progression of increases?
I just reluctantly (fearfully) started Geodon at a low dose of 20 mg. My initial response is almost immediate somnolence so there's no way I would go higher even 20 mg may not even be consider a "therapeutic" dose. But it all depends on what the drug was initiated for, what symptoms and how your initial response was to it.
My thinking about all of this depression stuff is we are started at doses that are way too high ("therapeutic") to begin with. My focus would be on decresing the Geodon if possible not increasing Adderall.
There's too many side effects to these meds to mix multiple meds and exceed doses that have not been tested. This is where bad results start to occur.
Best.
Stargazer
P.S. I also take Adderall 30 mg XR, Wellbutrin 150 mg and Celexa 40 mg.
This is the end of the thread.
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