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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Cydnie on February 21, 2011, at 19:09:30
I am trying to figure out why or how pristiq seems to be the only anti-depressant that I can use if I don't want the dreaded adderall crash, that has made me feel suicidal. I went back on pristiq, and though I had side effects, and it's never entirely gotten me out of my depression, the adderall helps immensely and I don't crash at the end of the day. So I tried a bunch of other anti depressants, TCAs, SSRIs, seems I keep ending with a crash, so I went back to pristiq and crashes stopped again! Could it be the NE? I can't figure out why. My pdoc just told me we'll try effexor xr and see if I have less side effects and see if it keeps the crash away, but I just read on this site that it effects dopamine much more than pristiq, so now I am nervous that effexor won't work like pristiq in stopping the crashes. I just took it tonight, and will report back if anyone's interested. But I would love to hear any theories on neurotransmitters that maybe pristiq was hitting differently, because my pdoc told me no one would be able to answer it. I guess it can be just my own body chemistry reacting? No clue!
Posted by desolationrower on April 4, 2011, at 3:46:11
In reply to could pristiq prevent adderall crash?, posted by Cydnie on February 21, 2011, at 19:09:30
hey.
could you be a bit more analytical, i am confused which drugs you took with which other drugs, what the reaction was, etc.
paragraphs markers are your (my) friend
-d/r
Posted by Cydnie on April 4, 2011, at 9:23:50
In reply to Re: could pristiq prevent adderall crash?, posted by desolationrower on April 4, 2011, at 3:46:11
Hi there D/R - sorry for one long paragraph, oh, you're not going to like my reply to the first e-mail (about PEA). I tend to write stream of consciousness.
Since I wrote this about pristiq, I've taken selegiline and Emsam, as well as remeron. I've done really well mood-wise with selegiline (had to stop for the allergy) and when I first started remeron at just 15mg, along with my adderall, I seemed to be in full depression remission for the first time in over a year, and this was a depression full of despair.
My doctor upped my dose of remeron, and every time he did I got more depressed, so he thought it was too much Norepinephrine (though I don't know if I agree, because when I had effexor XR and pristiq, and felt too much, usually I just felt jittery or irritable, but this depression was a dark despair that came in in a few days faster and harder).He cut back my remeron, and I still felt awful, so he added in alternative things (maca, rhodiola rosea), but I think I was taking way too much melatonin (9mg) at night for too long which I think affected my hormones, rearranged too much (I think it is a neuromodulator? or neurohormone?) and affected me in a big way.
I stopped melatonin completely last week, didn't sleep that 1st night, but the next night fell asleep for about 12 hours (so unlike me, passed out in my clothes, my husband unable to wake me and I hadn't taken anything else!) Have started to feel better each day slowly. But that's another subject (sorry!)
I was thinking, and still wondering, if norepinephrine, or serotonin, from an SNRI can prevent a mood crash from adderall. I didn't ever mind the energy crash, but the mood crashes were unbearable.
I wondered if it was a possibility, or had anyone else ever taken adderall alone, or with something else that didn't prevent a mood crash, but found that something, like an SNRI, did prevent it? I'd love to hear!
Thanks! (Hope this was more readable :)
Posted by desolationrower on April 5, 2011, at 20:58:03
In reply to Re: could pristiq prevent adderall crash? » desolationrower, posted by Cydnie on April 4, 2011, at 9:23:50
>
> Hi there D/R - sorry for one long paragraph, oh, you're not going to like my reply to the first e-mail (about PEA). I tend to write stream of consciousness.
> Since I wrote this about pristiq, I've taken selegiline and Emsam, as well as remeron. I've done really well mood-wise with selegiline (had to stop for the allergy) and when I first started remeron at just 15mg, along with my adderall, I seemed to be in full depression remission for the first time in over a year, and this was a depression full of despair.
> My doctor upped my dose of remeron, and every time he did I got more depressed, so he thought it was too much Norepinephrine (though I don't know if I agree, because when I had effexor XR and pristiq, and felt too much, usually I just felt jittery or irritable, but this depression was a dark despair that came in in a few days faster and harder).yeah they both affect norepinephrine, but in different ways. I think it also affects different areas of the brain differently (alpha2 receptors are localised ot some locations more than otehrs, etc)
and jittery/irritable could be from too much 5ht2 from the sri. i'm still not quite sure what was taken with what. if you had a moderate dose of remeron with a sri and still felt the same jitteriness, then probably not.
> He cut back my remeron, and I still felt awful, so he added in alternative things (maca, rhodiola rosea), but I think I was taking way too much melatonin (9mg) at night for too long which I think affected my hormones, rearranged too much (I think it is a neuromodulator? or neurohormone?) and affected me in a big way.
thats probably way too much melatonin. I take .5mg.
> I stopped melatonin completely last week, didn't sleep that 1st night, but the next night fell asleep for about 12 hours (so unlike me, passed out in my clothes, my husband unable to wake me and I hadn't taken anything else!) Have started to feel better each day slowly. But that's another subject (sorry!)
>
> I was thinking, and still wondering, if norepinephrine, or serotonin, from an SNRI can prevent a mood crash from adderall. I didn't ever mind the energy crash, but the mood crashes were unbearable.norepinephrine, yeah it should. Milnacipran is probably the only snri with enough n to do so. I wouldn't think mirtazapine would because of the difference in mechanism, and that seemes a bit dangerous anyway.
> I wondered if it was a possibility, or had anyone else ever taken adderall alone, or with something else that didn't prevent a mood crash, but found that something, like an SNRI, did prevent it? I'd love to hear!
> Thanks! (Hope this was more readable :)
>I think a lot of people take an NRI with a stimulant, usually for ADHD. I took adderal with nortriptyline, but taking it alone was a while ago and wasn't depressed then either so i can't really say if there was a crash. I didn't notice it affecting my mood, though.
I noticed some itchiness when i worked out when i was taking selegeline. I couldn't really find anything that explained this.
NA has some relationship to the positive emotional effect of amphetamine. It is hard to translate research on AMP to human therapeutic use, since it is mostly written on models for addiction. here is one review touching on this http://www.nature.com/npp/journal/vaop/ncurrent/full/1301263a.html (note: what they say about modafinil is wrong in places, so it might not be too good :) )
>I am trying to figure out why or how pristiq seems to be the only anti-depressant that I can use if I don't want the dreaded adderall crash, that has made me feel suicidal. I went back on pristiq, and though I had side effects, and it's never entirely gotten me out of my depression, the adderall helps immensely and I don't crash at the end of the day. So I tried a bunch of other anti depressants, TCAs, SSRIs, seems I keep ending with a crash, so I went back to pristiq and crashes stopped again! Could it be the NE? I can't figure out why. My pdoc just told me we'll try effexor xr and see if I have less side effects and see if it keeps the crash away, but I just read on this site that it effects dopamine much more than pristiq,ok, it sounds like there might be two crashes you are having. one that is daily, as AMP wears off. Another a few weeks into treatment, when AD effect lessens?
A bit of sri might reduce crash. They tend to blunt emotions. d-venlafaxine has its greatest effect on 5ht. venlafaxine doesn't have much effect on DA except at gigantic doses, and even then not much. Overall, des-venlafaxine and venlafaxine are very similar, and its mostly a patent extender. One thing i dislike about snris is if it works, you don't know why. options:
AMP with a lowish dose of an sri, like citalopram. reason: if the sri was helping reduce crash, and AMP keeping the sri from being to fog-enducing.
AMP with a nri, like attomoxatine, desipramine, etc. to keep NA (an cortical DA) at a baseline level.
AMP with notriptyline & lowish sri: i think i mentioned elsewhere possibility that 5ht2 overstimulation caused the jitteryiness. nort would prevent this.
tranylcypromine.
it sounds like you have sleep problems too? your writing is a bit disorganized - an adhd drug might be called for too :)
-d/r
Posted by Cydnie on April 6, 2011, at 10:51:17
In reply to Re: could pristiq prevent adderall crash?, posted by desolationrower on April 5, 2011, at 20:58:03
Hi - thank you so so much for writing back and I appreciate all your thoughts on this. I only have a second because my little one (1 1/2) keeps me busy, which has a lot to do with my disorganized thinking (he interrupts a lot when I try to write, so it's usually written in sections!) and a lot to do with my lack of sleep! It's so funny, my undergrad degree was in creative writing! Boy, it just happened again, but I'm back. I had to write that back because it cracked me up that a lot has changed since I had the baby. Definitely harder to keep my mind going in one direction these days, since I feel like I need it to go in a million directions every other minute/second! I did have one pdoc tell me I did have some attention deficit issues awhile ago though, and I remember struggling in classes in school whenever I had a teacher with a certain teaching style that I just couldn't follow. So that along with little sleep and a hyperactive baby (that was seen my docs who told already told me they think she shows signs early for ADHD!! At 1 1/2!) I'm not surprised my writing's disorganized. Every moment I'm writing one line, I'm trying to do it so fast so that I can get it done before he's back again - that sounds bad, I just mean I have almost no alone time, ever, just when he's asleep and that's getting to be less and less each day! I know there are some others out there who understand - my obgyn told me you forget everything when you're pregnant because of your hormones, and you forget things after because you're head is in so many places trying to remember everything else because you're a mom and smile when they say, and that never gets any easier. Oh well, when I finally do get free time, and go back to my writing, it will have to be geared towards those who can read disorganized stream of consciousness work, ha! :) Thanks again for helping me out, D/R!
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