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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 temoigneur on May 12, 2004, at 15:58:52
I have a problem and I was wondering if anyone had any info & or experience with combining atypicals and stimulants. This would seem counterintuitive, and if it is ridiculous, it’s because I have little knowledge of the exact mechanisms of the different meds. What I do know is that when I was on Ritalin I did really well for a few hours – laser like focus, excellent thought clarity, and adequate organizational skills, this however, was followed by terrible depression and anxiety, actually the anxiety was there the whole time I think, I just didn’t notice it because of all the positive side effects.
Modafinil made me extremely anxious, Dexedrine made me anxious; I’m now on 300 Effexor, 10mg zyprexa, 15mg Remeron, and 5mg Klonopin. I’m very fatigued and I feel like a vegetable unable to engage properly, my mind and emotions are numb, and I’m sedated. I am however stable, and free from the crippling OCD and anxiety. Could adding a stimulant at this point be beneficial for the cognitive deficits or would it just have the same effect as lowering zyprexa? Is there any time when it would seem appropriate to use Atypicals or any antipsychotics with stimulants (Ritalin, Adderall).
A note on stimulants; - Dr. Goldberg if you see this, I obviously took the liberty of quoting you, I hope that’s alright.
From: Ivan Goldberg <Psydoc@psycom.net>
Subject: Adderall for child ADD
“It is interesting to see the controversy about Adderall. I would have predicted that Adderall would be too similar to Dexedrine to add any advantage. However I have found it to be as different as Ritalin. I don't think there is any predictability regarding response to Ritalin (methylphenidate), Dexedrine (dextroamphetamine), Adderall, or Cylert (pemoline). One may work or cause side effects when the other doesn't. I think my Adderall responders are unexpected because they are the Ritalin or Dexedrine failures. If I gave Adderall first, I would probably find similar difficulties with it.”Another ADD-OCD sufferer wrote;
“I have had great success with adderall and prozac. My brother has very severe ADD and OCD. Ritalin makes him sleep all the time, adderall made him very compulsive and obsessive, but he has had great success with Dexedrine. You just try a medication under a doctor's supervision until you find the one that is right for son. By the way, OCD and ADD are very common together since in many ways they are both attention issues.”I’m a 25 yr old male, I’ve been had these illnesses since I was 14/15. My, (Bentley), diagnosis is Tourrettes (very mild) OCD moderate-severe, and the full range of anxiety disorders, (severe). My psychiatrist concurs that I likely have ADD, from the way I responded to Ritalin. My energy/focus/cognition is fairly poor. Previously lowering the zyprexa caused the OCD to come back, but I haven’t tried lowering it while on effexor. I have thought about upping the effexor to 450 and trying to lower the zyprexa but my psychiatrist fears I’ll become frantic, as happened when I jacked prozac up to 80 recently, (wasn’t on effexor at that time).
Of note, years ago, there was a four month period, when I was virtually symptom free and ‘self-actualizing” or living up to my potential on just prozac, then, after four months, I the prozac stopped working over the course of a couple weeks. I initially responded to the prozac immediately, it kicked in the day I took it, I don’t know if this is a significant clinical phenomena in my pathology. This is so complicated, anyone who dares to tackle this is a first rate clinician in my mind, but somewhere underneath all this I have a good mind. Thank you so much.Ben
Posted by Sebastian on May 12, 2004, at 19:59:26
In reply to Challenging, Zyprexa and Ritalin, posted by temoigneur on May 12, 2004, at 15:58:52
I mix zyprexa and wellbutrin. Great idea. The good effects add, the lazy tiredness goes away.
Zyprexa does good for your dopamine. Wellbutrin acts on norepineprin. The only thing canceling is your energy. Sort of like coffee and a sleeping pill. Or alcohol with caffine.
Posted by temoigneur on May 12, 2004, at 22:44:54
In reply to Re: Challenging, Zyprexa and Ritalin, posted by Sebastian on May 12, 2004, at 19:59:26
> I mix zyprexa and wellbutrin. Great idea. The good effects add, the lazy tiredness goes away.
>
> Zyprexa does good for your dopamine. Wellbutrin acts on norepineprin. The only thing canceling is your energy. Sort of like coffee and a sleeping pill. Or alcohol with caffine.Thanks, can I ask you,
what do you take the zyprexa and wellbutrin for, do you have an anxiety disorder? Does the wellbutrin make you feel like you imagine yourself to feel as if you were in perfect health. What purpose does the zyprexa serve, thank you so muchBen
Posted by ace on May 13, 2004, at 2:17:50
In reply to Need Expert Advice, TS/OCD/Anxiety/ADD, posted by temoigneur on May 12, 2004, at 23:23:11
Temo, did u drop Nardil??
I still think it would have helped you to raise Nardil to 90mg, lower Zyprexa and Klonopin....did u try this....and did you give it 6 weeks trial???
Ace.
Posted by Sad Panda on May 13, 2004, at 7:36:54
In reply to Challenging, Zyprexa and Ritalin, posted by temoigneur on May 12, 2004, at 15:58:52
> I’m now on 300 Effexor, 10mg zyprexa, 15mg Remeron, and 5mg Klonopin. I’m very fatigued and I feel like a vegetable
>
>
Hi Ben,Zyprexa & Remeron are both sedating drugs. Zyprexa pretty much does everything that Remeron does, so I would try lowering your dose of Remeron to 7.5 mg & see what that does after a week. You will probably find that you don't need Remeron at all.
Cheers,
Panda.
Posted by Bill LL on May 13, 2004, at 9:09:07
In reply to Challenging, Zyprexa and Ritalin, posted by temoigneur on May 12, 2004, at 15:58:52
I would definitely add a stimulant to your current meds. Maybe try Modafinil again first. It might work well with your current meds.
Posted by Sebastian on May 13, 2004, at 12:15:16
In reply to Re: Challenging, Zyprexa and Ritalin, posted by temoigneur on May 12, 2004, at 22:44:54
I have PTSD, saw a freind die. I also have bad anxiety, without zyprexa. Trying to get off it, after 5+ years. I was in a bad psychosis, a few years back. Had a lot of ECT's 8 years or so ago. The wellbutrin is prescribed for energy, which the zyprexa takes away. It's also keeping my number of ciggarettes down. I wouldn't think the wellburtrin is meaking me feel healthy. But it does: keeping smoking less, less tired, less lazy, better motivation, appatite supressant.
Talk later, lunch is over 15 min ago.
Posted by temoigneur on May 13, 2004, at 14:25:31
In reply to Re: Need Expert Advice, TS/OCD/Anxiety/ADD » temoigneur, posted by ace on May 13, 2004, at 2:17:50
Hi Andrew, Thanks for replying, so thoughtful,
> Temo, did u drop Nardil??
> Yes I dropped nardil, I went up to 90 like you did and got very depressed, I was on 2.5mg zyprexa the whole time. I don't know if the "new nardil" is a factor, I was taking the non-glossy, new nardil pill, and like I said i felt wretched.> I still think it would have helped you to raise Nardil to 90mg, lower Zyprexa and Klonopin....did u try this....and did you give it 6 weeks trial???
> I didn't stick with it for six weeks, I might have killed myself:( but I did stay at 60mg with less than phenominal results for a long period, over six week I believe, but I honestly can't remember, I switched pdocs at the same time, I was so lethargic on the nardil and zyprexa. I slept all day. Do you think the "old nardil" you get in Australia could make the difference?Ben
> Ace.
Posted by temoigneur on May 13, 2004, at 14:31:18
In reply to Re: Challenging, Zyprexa and Ritalin, posted by Sebastian on May 13, 2004, at 12:15:16
I'm so sorry you have to live with that. I zyprexa is so sedating, I'm going to think about the wellbutrin, thank you
Ben>
I have PTSD, saw a freind die. I also have bad anxiety, without zyprexa. Trying to get off it, after 5+ years. I was in a bad psychosis, a few years back. Had a lot of ECT's 8 years or so ago. The wellbutrin is prescribed for energy, which the zyprexa takes away. It's also keeping my number of ciggarettes down. I wouldn't think the wellburtrin is meaking me feel healthy. But it does: keeping smoking less, less tired, less lazy, better motivation, appatite supressant.
>
> Talk later, lunch is over 15 min ago.
Posted by temoigneur on May 13, 2004, at 14:38:05
In reply to Re: Challenging, Zyprexa and Ritalin, posted by Bill LL on May 13, 2004, at 9:09:07
Thank you, I really want to try this I'll ask my pdoc on wed. thanks again.
Also sad panda thank you, you seem knowledgeable about these medications, I'll bring this to my pdoc too
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