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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by 3 Beer Effect on April 4, 2002, at 23:27:18
I take what is considered a high dose of Dexedrine 20 mg for ADD & Social Phobia an hour before work on an empty stomach, & don't drink anything acidic- I just drink water all day.
As posted before I take 'Dextrostat' instead of Dexedrine because it is the same thing (dextroamphetamine) but is available in 10 mg tablets. Dextrostat is a name brand & not generic dextroamphetamine (although it is cheap- 32 cents per 10 mg tablet) & is made by the makers of Adderall (Shire), so i'm ASSUMING it is of equal efficacy as an equal amount of Dexedrine which is only available in 5 mg tablets.
Anyways & more importantly, in every psychopharmacology textbook i've ever read they say 20 mg of Ritalin= 10 mg of Dexedrine. So far, it seems that even 20 mg of Dextrostat/Dexedrine is weaker than Ritalin 20 mg, which doesn't make much sense. I also take Lamictal as an anti-depressant which I am now at 125 mg and am titrating to 150 mg tommorow night (I find it sedating rather than activating- couldn't tolerate any other anti-depressants). Along with the Lamictal I take 2 mg/day of Klonopin for social phobia & 2 mg at night for sleep.
It seems to me that the Lamictal may be blunting the effects of the Dextrostat? Doesn't Lamictal act as a mood-stabilizer by putting a ceiling & a floor on dopamine & norepinephrine levels, so the Dextrostat is unable to break through the "dopamine ceiling" & thus doesn't work very well? I know that Lithium basically cancels out the actions of amphetamines. Is Lamictal anti-dopaminergic? Before, I started Provigil & Lamictal at the same time about 2 months ago, & the Provigil seemed to lose effectiveness more & more as I raised the Lamictal dose.
I also noticed that before I started taking any anti-depressants, benzos, or any other psychiatric drugs that when I took 20 mg of Ritalin or 20 mg of Adderall, which is pretty similar to Dextrostat/Dexedrine- they both worked great & I even raised my GPA from a 2.2 to a 3.0.
Now the 20 mg of Dextrostat I take doesn't seem anywhere near as strong as 20 mg of Adderall or 20 mg of Ritalin. Any thoughts or ideas/explanations on why the Dexedrine/Dextrostat at this high dose isn't working very well or of any interactions between Lamictal or Klonopin & amphetamines? The only stimulant stronger than Dexedrine is supposed to be Methamphetamine (desoxyn)!(My original plan was to take 10 mg of Dextrostat in the morning to study & 10 mg for work in the evening, but this isn't possible due to the lack of efficacy so far of even 20 mg at once).
Posted by Zo on April 5, 2002, at 0:10:10
In reply to Does Lamictal 'blunt' the effects of Dexedrine?, posted by 3 Beer Effect on April 4, 2002, at 23:27:18
I can only speak to the Dexadrine SR - Lamictal combo, and my answer would be no, not at all. The kind of stim that I get from Dex is of an entirely different kind than a mood upswing.
Tho it's interesting to try to figure out these things scientifically, in practice and in point of fact, there is no other basis for decision than how you, personally, do on each of these drugs, and at what doses. The best behavioral med pdocs will tell you this--and so can I, from loooong experience with many meds.
I have Dex caps in both 5 and 10 mg.
I don't find Lamictal to be anti-dopaminergic, and I live in a terrible dopamine deficit (without meds.) So much so that I am quite mad, I mean have a non-functioning mind, without Dex.
Adding Lamictal was what finally ended my decades-long Bipolar II depression. I was already on Dex, Effexor and Ativan to get to sleep. Had great success with Zyprexa before Lamictal, but also put on weight, olanzapine really f**cks with the blood sugar, as is known to its makers!
As to your varying doses, I think Kramer put it well yesterday. . .and like him, I think it's not important what isnt working, what's important is to do everything to be able to take what is. For me, that means benzos or whatever else I need to moderate pstims.
You may be experiencing side effects from the increase. I've read yours posts lots. . and see maybe a little more organized an approach might be helpful? They're basically rules of logic:
Never start two meds at once, it's impossible to accurately assess either.
Be very careful to discern the difference between side effects of increases (or decreases), and what the drug itself has to offer you.
Keep written records or a chart, to assess later, perhaps with someone else, for a more objective, accurate basis for these choices.
I've also added Provigil, six months later. .. interesting med!
Dextrostat is desoxyn? (sp?) My pdoc said it would be like calling up the feds to go thru his file cabinet--the only Rx he's ever refused to write, not that I needed it anyway. But I am a proponent of trying out all the pstims before deciding which one works best.
Make sense?
Zo
Posted by Bekka H. on April 5, 2002, at 1:02:34
In reply to Re: Does Lamictal 'blunt' the effects of Dexedrine » 3 Beer Effect, posted by Zo on April 5, 2002, at 0:10:10
Hi to 3 Beers and Zo,
Zo, it's good to have you back. 3 Beers, I have also been trying to combine Dex with Lamictal, but I am having the opposite problem -- sort of. I've had a lot of insomnia from Lamictal, and actually, once I added the Lamictal, I was able to "manage" on a much lower dose of Dex. (Constrast that with my attempts to combine Dex with an SSRI. . .In those instances, I kept having to raise the Dex dose to counteract the SSRI). Unfortunately, for the time being, I've had to put Lamictal on the back burner due to severe insomnia that lasted for four days after I stopped the Lamictal. I do intend to try it again, but I'm going to get ahold of the tiny 2 mg and 5 mg tablets. I know the titration will take an eternity, but I want to give it a chance.
Anyway, Zo, NO, dextrostat is NOT desoxyn! Dextrostat is SORT OF a generic version of Dexedrine. 3 Beers says it's not generic, but I think it is because when my doctor forgets to write "dispense as written" in that little box on the rx form, the pharmacist says he has to give me the generic, and the generic he dispenses is Dextrostat. Now, in my experience, Dextrostat doesn't feel as effective for me as the proprietary (name brand) Dexedrine. It feels as if it washes out faster, I experience rebound sooner, and it doesn't feel as potent or intense as Dexedrine tablets, but that's just me. I know some people who feel as if they are identical. For me, the Dextrostat feels as short-lived as Ritalin immediate release, and that's pretty short!
3 Beers, I have not heard that Lamictal counteracts Dexedrine. If anything, I have heard the opposite. A number of posters have said that taking Lamictal seems to delay stimulant tolerance, in much the same way that Memantine, that NMDA antagonist, does. Unfortunately, as I said, I haven't been able to experience this first hand because Lamictal has given me severe sleep problems, so I haven't been able to sustain it long enough to come to any conclusions.
3 Beers, do you eat enough? I have absolutely no idea how long it takes for the body to start generating ketones if one is not eating, but I've read that if one is in ketosis (which happens during starvation and semi-starvation), the urine will become highly acidic, and the amphetamines will be almost useless. I have never experienced this because I like to eat too much. I do try to take my Dex dose one hour before or two hours after a meal and, except for my morning dose (when I haven't eaten since the night before), I can't say that I'm ever in a state of starvation.
I would also like to find out HOW acidic the acidic foods are. Obviously, citrus fruits are acidic, a lot of other fruit juices are acidic, etc., but I have yet to find out how acidic things like coffee and coca cola are. I know coca cola and a lot of other sodas have phosphoric acid in them. For me personally, it would be almost impossible not to eat acidic foods throughout the day, and I think I'd drive myself nuts trying to figure out the pH of every morsel I ingest, so for now, I just avoid fruit juices and vitamin C until shortly before I go to bed.As for the 20 mg Ritalin = 10 mg Dex theory, I started out on Dex and then went to Ritalin when I was trying to lose my tolerance to Dex. I was never able to take a high enough dose of methylphenidate (i.e., never able to take the number of mg that would have been the equivalent of the number of mg of Dex I was taking). Who knows? Maybe that was the problem. Maybe that's why I didn't find MPH (methylphenidate) that effective, but I just couldn't tolerate more.
3 Beers, I wonder whether your Klonopin might be interfering with the Dex? Do you feel kind of groggy in the morning? I'm not an M.D., so I shouldn't suggest this, but what if you took a tiny bit less Klonopin and raised the Dex by a few milligrams? Is it possible that the Lamictal is potentiating the Klonopin? Do you think you could get by on less Klonopin, now that you're escalating Lamictal at regular intervals? If so, I would NOT stop Klonopin abruptly or taper it drastically, but maybe you can experiment a bit with changing the proportions?
If you're combining caffeine with Dex, just be careful with your heart rate and blood pressure. I drink much less coffee than I used to, but I need a little just to reach consciousness in the morning, and I usually have a little bit of caffeinated soda in the afternoon, around 4 p.m.
By the way, a very useful book to get is PSYCHOTROPIC DRUGS by Norman Keltner and David Folks. There is a lot of information on amphetamines and what causes and/or exacerbates tolerance and rebound.
One last suggestion for tonight. Have you communicated with another PB member named Hattree? She is another one who has successfully combined Lamictal and Dexedrine, so perhaps she could give you some ideas?
Bekka
Posted by JohnX2 on April 5, 2002, at 9:41:58
In reply to Does Lamictal 'blunt' effects of Dex - 3beer Zo, posted by Bekka H. on April 5, 2002, at 1:02:34
(SWAG) Perhaps lamictal may raise the dexedrine dose required to feel the effect but lowers the potential to develop tolerance? This was my experience when I added Klonopin to Adderall (needed more Adderall, but smoother ride and less tolerance).John
> Hi to 3 Beers and Zo,
>
> Zo, it's good to have you back. 3 Beers, I have also been trying to combine Dex with Lamictal, but I am having the opposite problem -- sort of. I've had a lot of insomnia from Lamictal, and actually, once I added the Lamictal, I was able to "manage" on a much lower dose of Dex. (Constrast that with my attempts to combine Dex with an SSRI. . .In those instances, I kept having to raise the Dex dose to counteract the SSRI). Unfortunately, for the time being, I've had to put Lamictal on the back burner due to severe insomnia that lasted for four days after I stopped the Lamictal. I do intend to try it again, but I'm going to get ahold of the tiny 2 mg and 5 mg tablets. I know the titration will take an eternity, but I want to give it a chance.
>
> Anyway, Zo, NO, dextrostat is NOT desoxyn! Dextrostat is SORT OF a generic version of Dexedrine. 3 Beers says it's not generic, but I think it is because when my doctor forgets to write "dispense as written" in that little box on the rx form, the pharmacist says he has to give me the generic, and the generic he dispenses is Dextrostat. Now, in my experience, Dextrostat doesn't feel as effective for me as the proprietary (name brand) Dexedrine. It feels as if it washes out faster, I experience rebound sooner, and it doesn't feel as potent or intense as Dexedrine tablets, but that's just me. I know some people who feel as if they are identical. For me, the Dextrostat feels as short-lived as Ritalin immediate release, and that's pretty short!
>
> 3 Beers, I have not heard that Lamictal counteracts Dexedrine. If anything, I have heard the opposite. A number of posters have said that taking Lamictal seems to delay stimulant tolerance, in much the same way that Memantine, that NMDA antagonist, does. Unfortunately, as I said, I haven't been able to experience this first hand because Lamictal has given me severe sleep problems, so I haven't been able to sustain it long enough to come to any conclusions.
>
> 3 Beers, do you eat enough? I have absolutely no idea how long it takes for the body to start generating ketones if one is not eating, but I've read that if one is in ketosis (which happens during starvation and semi-starvation), the urine will become highly acidic, and the amphetamines will be almost useless. I have never experienced this because I like to eat too much. I do try to take my Dex dose one hour before or two hours after a meal and, except for my morning dose (when I haven't eaten since the night before), I can't say that I'm ever in a state of starvation.
> I would also like to find out HOW acidic the acidic foods are. Obviously, citrus fruits are acidic, a lot of other fruit juices are acidic, etc., but I have yet to find out how acidic things like coffee and coca cola are. I know coca cola and a lot of other sodas have phosphoric acid in them. For me personally, it would be almost impossible not to eat acidic foods throughout the day, and I think I'd drive myself nuts trying to figure out the pH of every morsel I ingest, so for now, I just avoid fruit juices and vitamin C until shortly before I go to bed.
>
> As for the 20 mg Ritalin = 10 mg Dex theory, I started out on Dex and then went to Ritalin when I was trying to lose my tolerance to Dex. I was never able to take a high enough dose of methylphenidate (i.e., never able to take the number of mg that would have been the equivalent of the number of mg of Dex I was taking). Who knows? Maybe that was the problem. Maybe that's why I didn't find MPH (methylphenidate) that effective, but I just couldn't tolerate more.
>
> 3 Beers, I wonder whether your Klonopin might be interfering with the Dex? Do you feel kind of groggy in the morning? I'm not an M.D., so I shouldn't suggest this, but what if you took a tiny bit less Klonopin and raised the Dex by a few milligrams? Is it possible that the Lamictal is potentiating the Klonopin? Do you think you could get by on less Klonopin, now that you're escalating Lamictal at regular intervals? If so, I would NOT stop Klonopin abruptly or taper it drastically, but maybe you can experiment a bit with changing the proportions?
>
> If you're combining caffeine with Dex, just be careful with your heart rate and blood pressure. I drink much less coffee than I used to, but I need a little just to reach consciousness in the morning, and I usually have a little bit of caffeinated soda in the afternoon, around 4 p.m.
>
> By the way, a very useful book to get is PSYCHOTROPIC DRUGS by Norman Keltner and David Folks. There is a lot of information on amphetamines and what causes and/or exacerbates tolerance and rebound.
>
> One last suggestion for tonight. Have you communicated with another PB member named Hattree? She is another one who has successfully combined Lamictal and Dexedrine, so perhaps she could give you some ideas?
>
> Bekka
Posted by 3 Beer Effect on April 5, 2002, at 11:39:56
In reply to Re: Does Lamictal 'blunt' the effects of Dexedrine » 3 Beer Effect, posted by Zo on April 5, 2002, at 0:10:10
Zo, I mean Dexedrine/Dextrostat both of which are the dextroamphetamine are the strongest stimulant available except for Desoxyn which is pharmaceutical Methamphetamine Hcl (& b/c of its generic name is very rarely prescribed even though it is probably the best med for Narcolepsy or ADD & weight loss and lasts longer (b/c of better fat/lip solubility from the methyl addition?) than Dexedrine or even Adderall i think).
3 Beers.
>
> Dextrostat is desoxyn? (sp?) My pdoc said it would be like calling up the feds to go thru his file cabinet--the only Rx he's ever refused to write, not that I needed it anyway. But I am a proponent of trying out all the pstims before deciding which one works best.
>
> Make sense?
>
> Zo
Posted by fachad on April 5, 2002, at 15:04:38
In reply to Does Lamictal 'blunt' the effects of Dexedrine?, posted by 3 Beer Effect on April 4, 2002, at 23:27:18
For whatever it's worth, I take (up to) 40mg/day of DextroStat.
I used to frequently be able to do fine on less than 40mg/day, but since I started Ativan 2mg for sleep, I find that I need the whole 40mg, and I feel like I could use more.
This has really decreased my enthusiasm for benzos, and has totally quenched my desire to try Klonopin, because it lasts even longer than Ativan. Besides, to my surprise, I find that I don't even like the feeling of benzos. They make me feel dull and numb, not a pleasant feeling for me. (It is better than not sleeping though, or paying big $$ to wake up at 2AM, as was my experience with Ambien)
So, based on my experience, I would suggest that you consider the possibility that it's the Klonopin, not the Lamictal, that's interfering with your Dex.
P.S. What is your job that is so stressful and exhausting?
Posted by Zo on April 7, 2002, at 5:50:48
In reply to Re: Does Lamictal 'blunt' effects of Dex - 3beer Zo, posted by JohnX2 on April 5, 2002, at 9:41:58
Noooo. YMMV. . and I know exactly what you mean about Klonpin and Adderall, because I've been using a benzo at night to be able to FALL alseep. To shut up the brain chatter.
But the Dex-Lamictal combo is very different, they are not acting against each other as directly, in my experience. . only in the broadest sense of tension, perhaps. But then, Bekka's getting fierce insomnia with Lamictal, and I sleep like a log, thanks to Lamictal.
In what, six, seven months have not felt the need to raise my 10mg Dex, and have been stable on 250mg Lamictal. If I have a stressful day ahead where I have to be "on" like seeing my lawyer, I might take a third 5mg Dex. So I can APPEAR to act like other people. Ha. Poor left-brained sods.
Zo
Posted by Zo on April 7, 2002, at 5:54:11
In reply to For Me Benzos Interfere with Dexedrine » 3 Beer Effect, posted by fachad on April 5, 2002, at 15:04:38
Wow, are you benzo-sensitive! I'm impressed!.Have you tried generica Ativan, lorazepam? It's about the mildest thing going. But you should be able to experiment and find a benzo that does not leave you hungover, we're all different in that regard as well.
Zo
Posted by fachad on April 7, 2002, at 7:38:03
In reply to Re: For Me Benzos Interfere with Dexedrine » fachad, posted by Zo on April 7, 2002, at 5:54:11
Benzo sensitive, but in a weird way.
30mg temazepam did next to nothing for me for sleep, and no hangover.
2mg (as 2 1mg tablets) lorazepam was better for sleep, although it still feels like is it too low a dose for sleep. But then the next day it is still affecting me, making the dex less effective.
I am a little perplexed by this sleep med/benzo thing.
> Wow, are you benzo-sensitive! I'm impressed!.Have you tried generica Ativan, lorazepam? It's about the mildest thing going. But you should be able to experiment and find a benzo that does not leave you hungover, we're all different in that regard as well.
>
> Zo
Posted by Zo on April 8, 2002, at 22:20:32
In reply to Re: For Me Benzos Interfere with Dexedrine » Zo, posted by fachad on April 7, 2002, at 7:38:03
For me the benzo is just to *get* to sleep. . .my head just won't stop talking (typical ADD symptom.) But for actual quality sleep. . i got that from Zyprexa and I'm getting it from Lamictal.
Desyrel (trazadone) was fairly good. A friend gets it from Flexiryl. . but I'm too histamine sensitive for that. What else. . low dose Elavil, um. . . Benadryl. . there's more. .
I think your sensitivity is interfering with the effectiveness of what you might feel from Dex; I don't think it's blocking the drug itself.
What else have you tried for sleep?
Zo
This is the end of the thread.
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