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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by mtdewcmu on April 29, 2011, at 23:25:22
Hi,
I just restarted Dexedrine this week. It has done wonderful things for productivity and it makes mental work possible and pleasant when it would otherwise be impossible. I also went back on Celexa around the same time. I had previously gotten up to 60mg of Celexa while being on it for years. I could feel potent effects from Celexa immediately this time, and I have been aiming for 40mg. However, when I first took 40mg together with Dexedrine, it seemed to make the Celexa side effects stronger to the point where I felt like I was on a different planet. Sort of like a depersonalization mixed with LSD. So, I have taken only 20mg Celexa most days this week. The Dexedrine has gotten less effective over the past few days. Yesterday and today I took 40mg Celexa to try to help with lingering depression symptoms, and although I seemed to sleep better last night, the Dexedrine felt significantly less helpful today.
So, I am trying to figure out how to manage depression symptoms and ADD symptoms simultaneously. The lessening effects of Dexedrine could be attributable to either rapidly increasing tolerance, an accumulating sleep debt, or an interaction with Celexa. I know that serotonin and dopamine can oppose each other, and the Dex has seemed less effective on those days when I've taken the higher dose of Celexa. But I also slept better last night, which I think may have been thanks to the higher dose of Celexa. So I need to figure out how much Celexa I can take while not inhibiting Dexedrine. If Dex tolerance is the main problem, then I should take the 40mg of Celexa and take the weekend off Dex to help reduce tolerance. If Celexa dopamine inhibition is the main problem, then I should stay at the lower dose of Celexa. If a sleep debt is the main problem, then I should go to 40mg of Celexa and try to find other interventions to benefit sleep. Depression has interfered with my sleep before, so I'm not sure if the sleep debt is more attributable to Dexedrine or depression.
Over the past week I have taken Dexedrine first thing in the morning, and I almost immediately feel good and like doing work. However, in the afternoon and evening when I'm waiting for it to wear off enough to sleep, I have felt somewhat anxious and depressed. So another question in my mind is whether I'll just have to get used to crashing from late afternoon until evening most days, or if the evening malaise is more a symptom of depression that had been masked and then unmasked by the Dexedrine. If it is indeed depression, then that argues strongly for an increase in Celexa.
I know this is a confusing mess, and I'll probably figure this out on my own sooner or later from trial and error, but any comments or suggestions are welcome.
Posted by mtdewcmu on April 29, 2011, at 23:49:17
In reply to Dexedrine + Celexa help (long), posted by mtdewcmu on April 29, 2011, at 23:25:22
I forgot to mention that I went cold turkey off of Wellbutrin 300mg at the beginning of the week. I am hoping to get a feel for Dexedrine before trying a combination with Wellbutrin if absolutely necessary. So Wellbutrin withdrawal could be a factor. But any w/d from Wellbutrin should have improved lately, rather than worsening. I'm also still taking Remeron 15mg at night, which I doubt is having any major impact positive or negative.
Posted by Phillipa on April 30, 2011, at 0:33:45
In reply to Forgot to add..., posted by mtdewcmu on April 29, 2011, at 23:49:17
I'm thinking withdrawal from wellbutrin. No experience with dexadrine but you seem to need the 40mg of celexa as sleep is important. Phillipa
Posted by floatingbridge on April 30, 2011, at 0:35:23
In reply to Dexedrine + Celexa help (long), posted by mtdewcmu on April 29, 2011, at 23:25:22
Hey MtDew, I never did find a way to completely avoid the crash. I messed with ways of tolerating it. I would plan my day accordingly to accommodate it, and self-talk going down. Wish I could offer you something more substantial.
I'm hoping you will have better results--that would be great.
Hang in there.
(And play with dose timing? Sleep agent or are you not interested right now?)
Posted by mtdewcmu on April 30, 2011, at 0:45:20
In reply to Re: Forgot to add... » mtdewcmu, posted by Phillipa on April 30, 2011, at 0:33:45
> I'm thinking withdrawal from wellbutrin. No experience with dexadrine but you seem to need the 40mg of celexa as sleep is important. Phillipa
Thanks Phillipa. Sleep is important, but so is being productive. Celexa seems to be impairing the productivity benefit, but it could just be coincidental or transient.
Posted by mtdewcmu on April 30, 2011, at 0:55:40
In reply to Re: Dexedrine + Celexa help (long) » mtdewcmu, posted by floatingbridge on April 30, 2011, at 0:35:23
> Hey MtDew, I never did find a way to completely avoid the crash. I messed with ways of tolerating it. I would plan my day accordingly to accommodate it, and self-talk going down. Wish I could offer you something more substantial.
>It's not at all clear yet how much is crash and how much is depression. Also it's hard to tell if the Dex is preventing me from sleeping well or the depression is. I have a tendency to wake up too early in the morning, which actually predates the Dex, but the Dex could be contributing. If SSRIs counteract the attention benefits, it will be really difficult to strike a balance. Doing nothing for the ADD is not an option.
> I'm hoping you will have better results--that would be great.
>
> Hang in there.Thanks. You too.
>
> (And play with dose timing? Sleep agent or are you not interested right now?)Timing is tricky, since it seems to take at least 8 hours to wear off enough to sleep. I already have melatonin, doxylamine (Unisom), Remeron, and valerian for sleep, but I left a message for my doc today asking for some Ambien. I didn't hear back today, so hopefully Monday.
Posted by floatingbridge on April 30, 2011, at 1:27:04
In reply to Re: Dexedrine + Celexa help (long) » floatingbridge, posted by mtdewcmu on April 30, 2011, at 0:55:40
Early awakenings have been a sign of depression in my case. Dexedrine didn't seem to affect those one way or another.
Dexedrine did affect sleep onset, but that has always been a personal problem, dex or no dex.
Also, my response changed over time. I finally grew so accustomed that I could sleep on it sometimes. At it's best, somewhere in the middle, it set my clock for me. 8:00 was sometimes lights out w/o a sleep aid. That was nice.
Posted by Christ_empowered on April 30, 2011, at 15:31:45
In reply to Dexedrine + Celexa help (long), posted by mtdewcmu on April 29, 2011, at 23:25:22
Sounds to me like you're experiencing a bit of a crash from the stimulant, mixed with some sort of underlying problem(s). Just a guess based on my own (limited) experience with stimulants.
Have you tried BuSpar? It should augment the Celexa and maybe help soften the crash, while also maybe, possibly, perhaps (one never can be quite sure about these things...) helping prevent/reduce SSRI side effects. Its kind of a pain--I think its still 3x daily dosing--but it might work.
Posted by Brainbeard on April 30, 2011, at 15:38:51
In reply to Dexedrine + Celexa help (long), posted by mtdewcmu on April 29, 2011, at 23:25:22
I have taken Dex in low doses, from only 2.5mg twice a day to 20mg in divided doses. I've taken it along with high dose clomipramine, which is an SRI in its own right. My experience is that the impressive initial effects of Dex waned fast due to tolerance. After some weeks, motivation and concentration wouldn't improve as much, although mood would still be lifted substantially. Dex is a subtle drug, but be assured that it will bring you down when the drug leaves your system. The prospect of tolerance, decreased effectiveness and dependency is what made me quit the drug recently.
Posted by mtdewcmu on April 30, 2011, at 15:46:43
In reply to Re: Dexedrine + Celexa help (long), posted by Christ_empowered on April 30, 2011, at 15:31:45
Thanks for your support. I am leaning more toward the explanation of unmasked depression, since I am relapsing into more of my unhealthy patterns even while the stimulant is going strong. The transient euphoria was probably what masked the problems.
> Sounds to me like you're experiencing a bit of a crash from the stimulant, mixed with some sort of underlying problem(s). Just a guess based on my own (limited) experience with stimulants.
>
> Have you tried BuSpar? It should augment the Celexa and maybe help soften the crash, while also maybe, possibly, perhaps (one never can be quite sure about these things...) helping prevent/reduce SSRI side effects. Its kind of a pain--I think its still 3x daily dosing--but it might work.
>I did think a little bit about Buspar, but Buspar doesn't have a stellar reputation for being a great med.
Posted by mtdewcmu on April 30, 2011, at 16:01:29
In reply to Re: Dexedrine + Celexa help (long), posted by Brainbeard on April 30, 2011, at 15:38:51
> I have taken Dex in low doses, from only 2.5mg twice a day to 20mg in divided doses. I've taken it along with high dose clomipramine, which is an SRI in its own right. My experience is that the impressive initial effects of Dex waned fast due to tolerance. After some weeks, motivation and concentration wouldn't improve as much, although mood would still be lifted substantially. Dex is a subtle drug, but be assured that it will bring you down when the drug leaves your system. The prospect of tolerance, decreased effectiveness and dependency is what made me quit the drug recently.
That's interesting. Over the past week of using Dex, I have found the opposite -- the effect on concentration seems to be more durable than the effect on mood. As far as motivation, it seems to be continuing to help, but a little less each day. I think I will take tomorrow off Dex to try to regain some of the effects next week. The best effects seem to occur early in the morning, when it is first kicking in. Redosing around midday does not seem to have a major effect. On the flip side, there was much less afternoon anxiety as the week went on. I guess the less you go up, the milder the coming down. Either that, or the Celexa is taking effect.
I have found Dexedrine to be less crashy than Ritalin. Part of the problem with Ritalin, though, was the fact that it didn't help me concentrate on anything but my reaction to the drug, so I was more sensitive to any comedown effects. With Dex, I actually get things accomplished, so I am not left pondering the crash as much.
Posted by floatingbridge on April 30, 2011, at 16:21:34
In reply to Re: Dexedrine + Celexa help (long) » Brainbeard, posted by mtdewcmu on April 30, 2011, at 16:01:29
Dex always helped my concentration--even towards the end of my usage.
The mood benefits diminished.
Good luck Mt Dew.
Posted by Phillipa on April 30, 2011, at 20:15:41
In reply to Re: Forgot to add... » Phillipa, posted by mtdewcmu on April 30, 2011, at 0:45:20
So you feel depression is creeping back in? Phillipa
Posted by mtdewcmu on April 30, 2011, at 22:37:57
In reply to Re: Forgot to add... » mtdewcmu, posted by Phillipa on April 30, 2011, at 20:15:41
I am afraid that the depression is/was creeping back, so I decided today that I need to stay with 40 of Celexa and hope that I can get the best of both worlds. Celexa is really a nice drug for me.
Posted by Phillipa on May 1, 2011, at 20:02:12
In reply to Re: Forgot to add... » Phillipa, posted by mtdewcmu on April 30, 2011, at 22:37:57
I'm seriously glad it is such a good med for you. Feel better today? Hoping so. Phillipa
Posted by mtdewcmu on May 1, 2011, at 20:26:11
In reply to Re: Forgot to add... » mtdewcmu, posted by Phillipa on May 1, 2011, at 20:02:12
> I'm seriously glad it is such a good med for you. Feel better today? Hoping so. Phillipa
Thanks, Phillipa. This is my first Dexedrine holiday. I was afraid that I would feel horrible and be tempted into taking some and ruining the holiday, but it was not the case. I feel very sluggish today, but that is not unusual for me without Dexedrine (the Celexa startup could be contributing to sluggishness as well). I am not sure whether I am inherently low-energy, or if my energy just sputters out and goes to waste when I can't stay focused on anything. I have basically written off today as far as getting anything accomplished. I have to get dressed and place my rent check in a mailbox. That is all I absolutely need to do today. Normally I would be worried that this sluggishness would carry over to next week, but thankfully I can take Dexedrine tomorrow and it will truly be a new day.
Posted by Phillipa on May 1, 2011, at 21:42:50
In reply to Re: Forgot to add... » Phillipa, posted by mtdewcmu on May 1, 2011, at 20:26:11
Positive thinking excellent and good nights sleep make for a good day tomorrow!!! Phillipa
This is the end of the thread.
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