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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by dcruik518 on February 22, 2009, at 20:39:54
I've tried taking a number of ssri's with Adderall and none of them seem to work well. In fact they seem to counteract the stimulating effects of the adderall and make me apathetic and lazy. My theoretical explanation for this is that the SSRIs must compete for and win out some of the receptors that would normally go to the Adderall. Does this make any sense pharmacologically? Is what I'm experiencing typical or not? Does it even make any sense to take these two kinds of drugs together? Or would it make more sense to mix adderall with a tricyclic or perhaps even an MAOI?
Posted by twinch42085 on February 22, 2009, at 23:48:42
In reply to amphetamines and ssris counteract each other???, posted by dcruik518 on February 22, 2009, at 20:39:54
I have read that MAOIs are not suppose to be taken with adderall due to serious side effects.
Is your pdoc prescribing adderall and MAOIs?
Twinch
Posted by Phillipa on February 23, 2009, at 0:15:23
In reply to Re: amphetamines and ssris counteract each other???, posted by twinch42085 on February 22, 2009, at 23:48:42
I've heard the same Phillipa
Posted by dcruik518 on February 23, 2009, at 3:14:40
In reply to Re: amphetamines and ssris counteract each other???, posted by twinch42085 on February 22, 2009, at 23:48:42
You're right, it's not generally recommended to mix stims and MAOIs and I'm not doing that now, but I can be done under an expert and I've done it in the past. (So have Scott and others on here, I believe) The real danger is mixing MAOIs with SSRIs; that causes serotonin syndrome. Anyway, neither of you addressed my actual question, which was about whether SSRI's and stimulants, namely Adderall, compete with eachother for receptors.
Posted by dcruik518 on February 23, 2009, at 14:40:32
In reply to amphetamines and ssris counteract each other???, posted by dcruik518 on February 22, 2009, at 20:39:54
Here's the post from above, I'm thinking of maybe switching from adderall to parnate. Thanks, D
> I've tried taking a number of ssri's with Adderall and none of them seem to work well. In fact they seem to counteract the stimulating effects of the adderall and make me apathetic and lazy. My theoretical explanation for this is that the SSRIs must compete for and win out some of the receptors that would normally go to the Adderall. Does this make any sense pharmacologically? Is what I'm experiencing typical or not? Does it even make any sense to take these two kinds of drugs together? Or would it make more sense to mix adderall with a tricyclic or perhaps even an MAOI?
Posted by bleauberry on February 23, 2009, at 16:34:37
In reply to amphetamines and ssris counteract each other???, posted by dcruik518 on February 22, 2009, at 20:39:54
Everyone has different chemistry and response. Adding stimulants to ssris is a fairly popular strategy. A girl I know told me yesterday her 20mg prozac for anxiety and mild depression was making her drag and feel sleepy all day. She added 10mg Adderall to it and felt great. No anxiety. No depression. Lots of energy and she caught up on housecleaning. The prozac had already been in place for a month before adding adderall.
So while they might not be a good mix for some people, they are a great mix for others. Maybe it is a matter of balance. In your case, maybe there is a need for less of the ssri and more of the stimulant? Or a different ssri? I mean, they are quite different in their feel and how they mix with other things. And not to forget, some people actually get calm and sleepy on stimulants.
Posted by desolationrower on February 27, 2009, at 2:34:51
In reply to Scott, Desolation, what's your take on this?, posted by dcruik518 on February 23, 2009, at 14:40:32
> Here's the post from above, I'm thinking of maybe switching from adderall to parnate. Thanks, D
>
> > I've tried taking a number of ssri's with Adderall and none of them seem to work well. In fact they seem to counteract the stimulating effects of the adderall and make me apathetic and lazy. My theoretical explanation for this is that the SSRIs must compete for and win out some of the receptors that would normally go to the Adderall. Does this make any sense pharmacologically? Is what I'm experiencing typical or not? Does it even make any sense to take these two kinds of drugs together? Or would it make more sense to mix adderall with a tricyclic or perhaps even an MAOI?
>
>its not competition for the same receptors (amphetamine itself works (mainly) through the transports for noradrenaline and dopamine, which nerotransmittres then interact with adrenoceptors adn DA receptors; sris block the serotonin transports and so increase serotonin for serotonin receptors, although most sris have some effect on other receptors or enzymes, like sigmas, 5ht2c, or ezymes ), amphetamine doesn't have much effect on serotonin (unless you happen to get some desoxyn). but the sertonergic system inhibits the dopaminergic (maybe the NA) system in various places, the sertonin 2a, 2c, and 3 receptors have been implicated specifically, although its quite complicated. Generally though, boosting serotonin with an sri will cause apathy, even in those not taking stimulants (and if you're apathetic ot begin with, and the pdoc decides to give an sri and refuse to prescibe a stimulant, you could end up in a half year of brain fuzz so deep you can't do anything.) I think that the 'apathy' effect is related to the therapeutic effect, if you worry too much and it just makes you apathetic about pointless trivialities, then you can focus on life and have less anxiety.
sometimes it works to take them together: its not cancelling each other out, just the side effects of each cancelling each other out, adn you get the AD effect of sri and focus from stim w/o any apathy or jitteryness. various combinations can work, its not very predictable whcih will hit the spot, and what little predictive studies have been done haven't been good at helping decide wheter to pick a tca, sri, or whatever.
-d/r
Posted by Garnet71 on February 27, 2009, at 23:43:05
In reply to Re: Scott, Desolation, what's your take on this?, posted by desolationrower on February 27, 2009, at 2:34:51
"(and if you're apathetic ot begin with, and the pdoc decides to give an sri and refuse to prescibe a stimulant, you could end up in a half year of brain fuzz so deep you can't do anything.)"
I went for years on and off with that brain fuzz from SSRIs until just a few weeks ago when I went back to former PDoc who prescribed me Ritalin with Buspar. I am so much better now. Still not up to par as a few years ago, but 100 times better. I suffered for years.
Taking buspar for anxiety though, don't know how it works with depression. However, I do know that xxRIs caused depression in me, although they somehow elminated the anxiety symptoms. Good luck.
Posted by SLS on February 28, 2009, at 6:53:28
In reply to amphetamines and ssris counteract each other???, posted by dcruik518 on February 22, 2009, at 20:39:54
> I've tried taking a number of ssri's with Adderall and none of them seem to work well. In fact they seem to counteract the stimulating effects of the adderall and make me apathetic and lazy. My theoretical explanation for this is that the SSRIs must compete for and win out some of the receptors that would normally go to the Adderall. Does this make any sense pharmacologically? Is what I'm experiencing typical or not? Does it even make any sense to take these two kinds of drugs together? Or would it make more sense to mix adderall with a tricyclic or perhaps even an MAOI?
There seem to be quite a few posts concerned with drugs cancelling each other out. I don't think that happens very often. Two drugs might act on separate competing tracts. One may dominate over the other, or the net results are two behavioral effects occurring simultaneously. In your case, the SSRI cognitive impairments arise separately and in addition to amphetamine enhancements of percieved energy and perhaps some attentiveness, but I doubt it will cause the SSRI fog to vanish.Take one step at a time. Perhaps someone knows of an effective strategy for eliminating brain fog. I'm sorry to say that I do not.
I don't know how long you have given this cognitive side effect to dissipate, but I have had brain fog on several SSRIs and Effexor. Zoloft and Effexor were particularly bad at first. However, beyond 8 weeks, the fog dissipated. I don't remember what happened to the apathy except that I experienced it with some of the SSRIs. I don't have as clear a recollection about it disappearing.
I think some people judge the efficacy and side effects of drugs immediately upon beginning treatment; the result of which being to discontinue them far to early. It is their right to do so, of course, but as alternatives disappear with each successive drug trial, you would think that it becomes more urgent to find one that works. You often can't do that with 4 week trials. On the other side of the fence, I don't believe that it often happens that a drug will make the depression feel worse at first and later go on to produce an antidepressant response better later in treatment. No one is forcing anyone to stay on a drug that they don't want to be on. I am just making a plea for more tolerance of startup side effects and more patience in allowing a drug to work.
- Scott
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