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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by temoigneur on November 30, 2005, at 23:11:16
Hi, I'm taking 10mg Zyprexa b.i.d. and 30mg methotrimperazine PRN. I don't really have interest in anything, and as in depression, everyday things are an effort. I notice that when I have a little caffeine, I feel more alert, that's not astounding, but I was wondering, might it be beneficial to add a low dose stimulant to my cocktail.
A psych. I respect told me taking ritalin, (no dose specified) was roughly equivalent to drinking eight cups of coffee. I was wondering if there was an extended release stimulant like concerta or adderall that could be taken at a very low dose, to make me feel energized, but not anxious, or psychotic.
I took ritalin before, and it gave me very bad mood swings. Now I'm on 325 Valproate, do you think this might help protect me against mood swings.
Posted by med_empowered on December 1, 2005, at 2:42:34
In reply to Antipsychotic + low dose stimulant??, posted by temoigneur on November 30, 2005, at 23:11:16
hey! You might be better served trying out Provigil, if your insurance will cover it...its milder than other stimulants, and less likely to induce psychosis or mood swings than other stimulants. I personally found that the peaks and valleys of Ritalin were simply the nature of the beast; that said, something like Concerta, Ritalin LA, of Focalin XR might help you avoid these pitfalls. I dont know what, if any, effects valproate will have upon ritalin-induced mood swings. Good luck!
Posted by Phillipa on December 1, 2005, at 23:00:30
In reply to Re: Antipsychotic + low dose stimulant??, posted by med_empowered on December 1, 2005, at 2:42:34
Med, is providgil that expensive? I only have Medicaire. Love your friend, Phillipa
Posted by med_empowered on December 1, 2005, at 23:40:51
In reply to Re: Antipsychotic + low dose stimulant?? » med_empowered, posted by Phillipa on December 1, 2005, at 23:00:30
Provigil *was* expensive, until pretty recently--a lot of insurance companies wouldn't cover it, even for narcolepsy, w/o proof that it was "the only effective and safe treatment" for a given patient.
From what I understand, Barr is trying to manufacture a generic Provigil. Short-term, that means prices will drop a little bit; you won't see really affordable Provigil until *lots* of companies are allowed to make it, which will be a while (if Barr wins, it will be the only company allowed to make generic Provigil for a good bit of time, which will keep prices artificially high).
I've heard of people having their doctors order it for them from Canada. The FDA recently scheduled Provigil as a Schedule IV..usually, controlled substances are not allowed in international transport. But I don't think Provigil is scheduled in Canada, so I imagine you could still have a Canadian pharmacy fill your Rx.
Posted by med_empowered on December 2, 2005, at 13:39:29
In reply to Antipsychotic + low dose stimulant??, posted by temoigneur on November 30, 2005, at 23:11:16
I'm not quite sure what you're being treated for; I'm assuming schizophrenia or schizoaffective disorder, since your treatment seems to be based on antipsychotic medication. Anyway, using low-dose stimulants in schizophrenia is actually a pretty old practice. On the downside, there's a risk of inducing psyhosis in stable patients. On the upside, it can often significantly improve "negative symptoms" and problems like depression, lethargy, etc. that often don't respond to neuroleptics or actually become worse than before treatment. Provigil is probably the best medication for this indication; it can induce/worsen psychosis, but the risk is smaller than with older stimulants. Ritalin is also sometimes used. I imagine the amphetamines would be avoided in schizophrenia, but I could be wrong.
Posted by temoigneur on December 2, 2005, at 18:52:47
In reply to One more thing..., posted by med_empowered on December 2, 2005, at 13:39:29
> I'm not quite sure what you're being treated for; I'm assuming schizophrenia or schizoaffective disorder, since your treatment seems to be based on antipsychotic medication. Anyway, using low-dose stimulants in schizophrenia is actually a pretty old practice. On the downside, there's a risk of inducing psyhosis in stable patients. On the upside, it can often significantly improve "negative symptoms" and problems like depression, lethargy, etc. that often don't respond to neuroleptics or actually become worse than before treatment. Provigil is probably the best medication for this indication; it can induce/worsen psychosis, but the risk is smaller than with older stimulants. Ritalin is also sometimes used. I imagine the amphetamines would be avoided in schizophrenia, but I could be wrong.
Thanks Med Emp. My diagnosis is schizo-affective. I have an anxious/obsessive edge; I tried provigil once and it badly exacerbated the psychosis, I need something though, I have such anhedonia, and apathy. Ritalin previously gave me bad mood swings, but didn't seem to be as bad as provigil. I'm wondering about low dose concerta, maybe 18mg. Med. Emp. do you know if it's somewhat common these days to combine an antipsychotic and a stimulant. I fear my doctor will say, "if you're apathetic, just reduce the antipsychotic, but I can't the symptoms, (thoughts) come back. Is it possible that the antipsychotics do a lot of desirable things, plus zap dopamine, and for some the combination of an antipsychotic and stimulant would be beneficial. Thank you
Posted by med_empowered on December 3, 2005, at 3:16:18
In reply to Re: One more thing... » med_empowered, posted by temoigneur on December 2, 2005, at 18:52:47
Its kind of common to combine the atypicals with stimulants..its kind of an "off-label" application when the atypicals are used for behavior problems, ADHD, bipolar, depressive states, etc. I honestly dont know how often stimulants are used in schizophrenia or schizoaffective these days.
I think you should consider the following: 1) add an antidepressant(s) + reduce the AP dose 2) reduce AP dose, add in trileptal, depakote, etc. 3) add in BuSpar and/or benzo 4) switch to Abilify, then adjust dosage......
any of these would be easier to do than adding a stimulant. If you add an antidepressant, be sure to reduce the AP dosage since SSRIs tend to increase AP blood levels. GOod luck!
Posted by temoigneur on December 5, 2005, at 1:57:57
In reply to Re: One more thing..., posted by med_empowered on December 3, 2005, at 3:16:18
> Its kind of common to combine the atypicals with stimulants..its kind of an "off-label" application when the atypicals are used for behavior problems, ADHD, bipolar, depressive states, etc. I honestly dont know how often stimulants are used in schizophrenia or schizoaffective these days.
>
> I think you should consider the following: 1) add an antidepressant(s) + reduce the AP dose 2) reduce AP dose, add in trileptal, depakote, etc. 3) add in BuSpar and/or benzo 4) switch to Abilify, then adjust dosage......
>
> any of these would be easier to do than adding a stimulant. If you add an antidepressant, be sure to reduce the AP dosage since SSRIs tend to increase AP blood levels. GOod luck!Thanks MedEmp. I live in canda Abilify's not available here, but I may be able to get it, I've dedicated a good portion of my life to get treatments that aren't avail. domestically. Kidding, but do you think Aripiprazole may help. It's very expensive, about $400/month, but I wonder about it, because it's said to *modify* dopamine levels, increasing them if too low and decreasing them if their too high. That would seem to be the ticket if indeed dopamine disregulation is at the root of my problem. I wonder why I haven't heard more about this drug.
Also, I do have an obsessive anxious component to my schizo affective, you don't think adding a 'smoother' stimulant at a low dose, like concerta might be alright. I'm already taking prozac and valproate 325, along with the the 10mg zyprexa and 30mg metho...... thanks so much
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