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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 manowar on December 5, 2001, at 15:05:19
Hello,
I’m trying to figure out what AD I should try next. I would invite anyone to read my post and give me suggestions. I’m tired of fruitless experimentation and I’m ready to get on the fast track of wellness. Thank you very much for your help.I have been diagnosed with Cyclothymia (predominantly depressed mood), ADHD (inattentive type with features of the limbic subtype) and Frontal/Temporal Lobe Disorder.
My SPECT pdoc (acting as a consulting physician) thought it would be a good idea to find a mood stabilizer like Tegretol, Neurontin or Depakote. I started on Neurontin (100mg x 3 times a day) a couple days ago. So far it seems to make me feel spaced out. I hope this will wear off. Is there anyone out there that has had success with GABA, fish oil or whatever or offer me any advice at all on the mood stabilizers? I’m brand new to them.
He suggested an activating AD. I’ve been taking Wellbutrin for a couple years and it doesn’t seem to do anything for me at all. I guess the only reason I continue to take it is because it doesn’t give me the horrible side effects like the SSRIs (pretty dumb huh?), and maybe it can help me as an augmenting med. I also have tried Effexor (sexual side effects), Desipramine (worked before, but when I tried it last year-no help), Reboxetine (no help), along with a slew of SSRIs, which I have grown to despise. I don’t think I have a Serotonin problem. I think that a drug that affected D or NE might do the trick.
What should I try next?
Should I go back to a TCI? If so, what?
Could Desipramine+Wellbutrin be helpful
Imipramine is still considered the “Gold standard” for ADs, should I try that next?I know that Elizabeth highly praises the MAOI’s. Should I go that route next?
I’m now taking 72 mg of Concerta +20 mg of Ritalin in the late afternoon for ADD. I started taking Adderal about three weeks ago, and it seemed to be working fine at first- but it threw me in a major black hole a couple weeks ago, and because of polypharmacy it took me a week and a half to find out that the Adderal was the culprit. My pdoc told me that depression was a common side effect from Adderal. It sure was a great diet pill though!
I’ve read that prefrontal cortex functioning heavily affects mood. I don’t know if the dose of Concerta is enough to normalize cortical functioning. Maybe I need to add a dose of Modafinil or Adrafinil? Any suggestions?
He lastly suggested that a memory enhancing med at a later date to enhance temporal lobe function. He suggested Aricept.
I’m so frustrated and I’m ready to get on with my life and start getting better. Any suggestions, opinions or comments would be greatly appreciated.
--Tim
Posted by Jenna S. on December 7, 2001, at 18:52:27
In reply to What AD next? Please help if you can, posted by manowar on December 5, 2001, at 15:05:19
> I’ve read that prefrontal cortex functioning heavily affects mood. I don’t know if the dose of Concerta is enough to normalize cortical functioning. Maybe I need to add a dose of Modafinil or Adrafinil? Any suggestions?Would you consider an atypical antipsychotic? I have read that they improve prefrontal cortex functioning. I've taken Zyprexa and Risperdal and found that they gave me a greater clarity of thought. I don't take them now because of side effects and worries about potential side effects. I believe the improvement in the prefrontal cortex occurs because antagonism of 5HT2A receptors somehow increases dopamine there. It would be nice if there was a drug that just blocked those receptors and nothing else. I don't need or want dopamine blocking as well.
>
> I’m so frustrated and I’m ready to get on with my life and start getting better. Any suggestions, opinions or comments would be greatly appreciated.Fixing psychiatric problems is SO frustrating - if only they could know exactly which drug we need, instead of these endless trials... I hope the next one works for you :)
Jenna
Posted by IsoM on December 7, 2001, at 20:36:49
In reply to What AD next? Please help if you can, posted by manowar on December 5, 2001, at 15:05:19
Tim, I'll plead ignorane about a number of things -
I know nothing about Concerta. After I post this I'm going to look it up to see what it is & what it does.
I also know nothing of "prefrontal cortex functioning" & how a person would know how his/hers function.What I can say is I do have ADHD (among other things) but as for the hyperactivity part, I generally seem to have only two speeds - idling or full-steam ahead. I seem to have trouble doing things at a reasonable speed like most people. I tend to either be sluggish feeling, little movement, or when I do get going, I'm in very fast mode. If I slow down much, I get very sleepy & want to quit or crawl back to bed to sleep. I also have mild narcolepsy, not so bad as to fall asleep but I drag about feeling *sleepy* all the time, but not necessarily *tired*. I have other symptoms of narcolepsy, my former doc was pretty sure it's narcolepsy.
Anyway, I started adrafinil (as you've read from my previous posts) about a month ago. It IS working. Whether it'll keep on working, I'll just have to find out. The effects still seem to be coming. Here's some of the benefits I've noticed so far:
- not sleepy all the time & no longer yawning constantly (it's such a THRILL not to drag myself though the day)
- feeling much more alert & "with it"
- not nearly as forgetful about simple everyday things as before
- better able to remember what I hear or read (my auditory memory has always been notoriously bad, but it's improved immensely - at least for me)
- being able to mentally keep track of what I've been trying to think out. If I had a list of items to follow through mentally before, I'd feel lost after the first few items. My thoughts felt like a slippery bar of soap - the harder I tried to hold them in mind, the more likely they'd go shooting out my head. It doesn't happen so badly now.
- and lastly, mood enhancement. I kept this last as I've read it doesn't happen for everyone.I'm going about my daily routine with a gentle smile on my face & often singing quietly or humming to myself, something I do when I'm at peace with myself. I even looked outside the other day at the dripping rain falling from the bare trees, something that always felt so dreary before, & I was struck with how beautiful it looked!
I already take Synthroid for low thyroid functioning (which of course helps with mood) & Celexa. I'm weaning myself off Paxil (which worked very well but I hated the dependence on never missing a dose or even being late taking it). I tried going off Paxil completely before but sadly had to go back on it - Celexa wasn't enough. Now with adrafinil, I don't seem to need the Paxil. Hurrah!!
Sorry this is so long, but when I want to know drug reactions, I always want to know *every* last little detail that may be beneficial to understand.
I found that Ritalin and/or Dexedrine helped in my focus & alertness but I hated the peaks & valleys. None with adrafinil. It's a nice level feeling. Also it gives me an alertness without the hyper feelings that the other stimulants gave me, making me almost too jittery & talkative but not necessarily more productive.
> Hello,
> I’m trying to figure out what AD I should try next. I would invite anyone to read my post and give me suggestions. I’m tired of fruitless experimentation and I’m ready to get on the fast track of wellness. Thank you very much for your help.
>
> I have been diagnosed with Cyclothymia (predominantly depressed mood), ADHD (inattentive type with features of the limbic subtype) and Frontal/Temporal Lobe Disorder.
>
> My SPECT pdoc (acting as a consulting physician) thought it would be a good idea to find a mood stabilizer like Tegretol, Neurontin or Depakote. I started on Neurontin (100mg x 3 times a day) a couple days ago. So far it seems to make me feel spaced out. I hope this will wear off. Is there anyone out there that has had success with GABA, fish oil or whatever or offer me any advice at all on the mood stabilizers? I’m brand new to them.
>
> He suggested an activating AD. I’ve been taking Wellbutrin for a couple years and it doesn’t seem to do anything for me at all. I guess the only reason I continue to take it is because it doesn’t give me the horrible side effects like the SSRIs (pretty dumb huh?), and maybe it can help me as an augmenting med. I also have tried Effexor (sexual side effects), Desipramine (worked before, but when I tried it last year-no help), Reboxetine (no help), along with a slew of SSRIs, which I have grown to despise. I don’t think I have a Serotonin problem. I think that a drug that affected D or NE might do the trick.
> What should I try next?
> Should I go back to a TCI? If so, what?
> Could Desipramine+Wellbutrin be helpful
> Imipramine is still considered the “Gold standard” for ADs, should I try that next?
>
> I know that Elizabeth highly praises the MAOI’s. Should I go that route next?
>
> I’m now taking 72 mg of Concerta +20 mg of Ritalin in the late afternoon for ADD. I started taking Adderal about three weeks ago, and it seemed to be working fine at first- but it threw me in a major black hole a couple weeks ago, and because of polypharmacy it took me a week and a half to find out that the Adderal was the culprit. My pdoc told me that depression was a common side effect from Adderal. It sure was a great diet pill though!
>
> I’ve read that prefrontal cortex functioning heavily affects mood. I don’t know if the dose of Concerta is enough to normalize cortical functioning. Maybe I need to add a dose of Modafinil or Adrafinil? Any suggestions?
>
> He lastly suggested that a memory enhancing med at a later date to enhance temporal lobe function. He suggested Aricept.
>
> I’m so frustrated and I’m ready to get on with my life and start getting better. Any suggestions, opinions or comments would be greatly appreciated.
> --Tim
Posted by manowar on December 8, 2001, at 12:03:33
In reply to Re: What AD next? Please help if you can » manowar, posted by IsoM on December 7, 2001, at 20:36:49
Thank you so much for taking the time to put down your experiences. I have heard nothing but good things about the Adrafinil. I have a stash at home that I got from Europe four or five months ago that I haven't even opened yet. But I'm going to be patient and wait until I see my pdoc in a week. As progressive as he is, I don't think he would want me to try an European drug w/o FDA approval, but he may consider letting me try Modafinil.
> I know nothing about Concerta. After I post this I'm going to look it up to see what it is & what it does.
The Concerta is just a new form of Ritalin extended release that works very well. It works much more smoothly than Ritalin by itself. When taking a capsule, 1/3 of it is released immediately, 1/3 in three hours, and 1/3 three hours later. When I take one at 8:00 AM it will last me until 5-6 PM. At that time I take a regular Ritalin.
> I also know nothing of "prefrontal cortex functioning" & how a person would know how his/hers function.The Prefrontal Cortex is part of the brain that when it is not functioning right is implicated in depression, ADHD and Narcolepsy.
I had scans done which showed serious deficits in different areas of the brain.
> What I can say is I do have ADHD (among other things) but as for the hyperactivity part, I generally seem to have only two speeds - idling or full-steam ahead. I seem to have trouble doing things at a reasonable speed like most people. I tend to either be sluggish feeling, little movement, or when I do get going, I'm in very fast mode. If I slow down much, I get very sleepy & want to quit or crawl back to bed to sleep. I also have mild narcolepsy, not so bad as to fall asleep but I drag about feeling *sleepy* all the time, but not necessarily *tired*. I have other symptoms of narcolepsy, my former doc was pretty sure its narcolepsy.About the two speeds, me too! It's like I have an on/off switch in my brain. Of course, I have no control over the switch. When it works, everything is fine- no depression, I sleep six to eight hours, can concentrate well, motivated, etc. When it doesn't work--anhedonia, apathy, depression, I sleep too much, can't concentrate, etc...
>
> Anyway, I started adrafinil (as you've read from my previous posts) about a month ago. It IS working. Whether it'll keep on working, I'll just have to find out. The effects still seem to be coming. Here's some of the benefits I've noticed so far:
> - not sleepy all the time & no longer yawning constantly (it's such a THRILL not to drag myself though the day)
> - feeling much more alert & "with it"
> - not nearly as forgetful about simple everyday things as before
> - better able to remember what I hear or read (my auditory memory has always been notoriously bad, but it's improved immensely - at least for me)
> - being able to mentally keep track of what I've been trying to think out. If I had a list of items to follow through mentally before, I'd feel lost after the first few items. My thoughts felt like a slippery bar of soap - the harder I tried to hold them in mind, the more likely they'd go shooting out my head. It doesn't happen so badly now.
> - and lastly, mood enhancement. I kept this last as I've read it doesn't happen for everyone.
>
> I'm going about my daily routine with a gentle smile on my face & often singing quietly or humming to myself, something I do when I'm at peace with myself. I even looked outside the other day at the dripping rain falling from the bare trees, something that always felt so dreary before, & I was struck with how beautiful it looked!That is fantastic! I am so happy for you.
> I already take Synthroid for low thyroid functioning (which of course helps with mood) & Celexa.
I am very interested in thyroid drugs. I don't have low thyroid, but it seems to rank very high as an augmenting agent.
> Sorry this is so long, but when I want to know
drug reactions, I always want to know *every* last little detail that may be beneficial to understand.Thank you very much:)
> > Hello,
> > I’m trying to figure out what AD I should try next. I would invite anyone to read my post and give me suggestions. I’m tired of fruitless experimentation and I’m ready to get on the fast track of wellness. Thank you very much for your help.
> >
> > I have been diagnosed with Cyclothymia (predominantly depressed mood), ADHD (inattentive type with features of the limbic subtype) and Frontal/Temporal Lobe Disorder.
> >
> > My SPECT pdoc (acting as a consulting physician) thought it would be a good idea to find a mood stabilizer like Tegretol, Neurontin or Depakote. I started on Neurontin (100mg x 3 times a day) a couple days ago. So far it seems to make me feel spaced out. I hope this will wear off. Is there anyone out there that has had success with GABA, fish oil or whatever or offer me any advice at all on the mood stabilizers? I’m brand new to them.
> >
> > He suggested an activating AD. I’ve been taking Wellbutrin for a couple years and it doesn’t seem to do anything for me at all. I guess the only reason I continue to take it is because it doesn’t give me the horrible side effects like the SSRIs (pretty dumb huh?), and maybe it can help me as an augmenting med. I also have tried Effexor (sexual side effects), Desipramine (worked before, but when I tried it last year-no help), Reboxetine (no help), along with a slew of SSRIs, which I have grown to despise. I don’t think I have a Serotonin problem. I think that a drug that affected D or NE might do the trick.
> > What should I try next?
> > Should I go back to a TCI? If so, what?
> > Could Desipramine+Wellbutrin be helpful
> > Imipramine is still considered the “Gold standard” for ADs, should I try that next?
> >
> > I know that Elizabeth highly praises the MAOI’s. Should I go that route next?
> >
> > I’m now taking 72 mg of Concerta +20 mg of Ritalin in the late afternoon for ADD. I started taking Adderal about three weeks ago, and it seemed to be working fine at first- but it threw me in a major black hole a couple weeks ago, and because of polypharmacy it took me a week and a half to find out that the Adderal was the culprit. My pdoc told me that depression was a common side effect from Adderal. It sure was a great diet pill though!
> >
> > I’ve read that prefrontal cortex functioning heavily affects mood. I don’t know if the dose of Concerta is enough to normalize cortical functioning. Maybe I need to add a dose of Modafinil or Adrafinil? Any suggestions?
> >
> > He lastly suggested that a memory enhancing med at a later date to enhance temporal lobe function. He suggested Aricept.
> >
> > I’m so frustrated and I’m ready to get on with my life and start getting better. Any suggestions, opinions or comments would be greatly appreciated.
> > --Tim
Posted by manowar on December 8, 2001, at 17:43:36
In reply to Re: What AD next? Please help if you can, posted by Jenna S. on December 7, 2001, at 18:52:27
>
> > I’ve read that prefrontal cortex functioning heavily affects mood. I don’t know if the dose of Concerta is enough to normalize cortical functioning. Maybe I need to add a dose of Modafinil or Adrafinil? Any suggestions?
>
> Would you consider an atypical antipsychotic? I have read that they improve prefrontal cortex functioning. I've taken Zyprexa and Risperdal and found that they gave me a greater clarity of thought. I don't take them now because of side effects and worries about potential side effects. I believe the improvement in the prefrontal cortex occurs because antagonism of 5HT2A receptors somehow increases dopamine there. It would be nice if there was a drug that just blocked those receptors and nothing else. I don't need or want dopamine blocking as well.Thanks Jenna,
Yes I have tried one anti-psychotic. I started Seroquel about three weeks ago. I kinda felt a bit of cognitive impairment and I felt even more depressed as usual. After stopping the Seroquel, I still felt more depressed than usual and I determined that the Adderal that I started one week prior to the Seroquel was the culprit.
I stopped the Adderal a few days ago, and I feel a little better.
I also started taking Neurontin a few days ago. So far, it seems that I get the same side effects that I did with the Seroquel (e.g. cognitive impairment, a little dizzy when standing).
If I don't do well on the Neurontin, I'll keep the Seroquel or another anti-psychotic in mind.
I know this is stupid but what is the 5HT2A receptor?
Thanks for your support,
Tim
Posted by cmcdougall on December 10, 2001, at 9:43:19
In reply to Re: What AD next? Please help if you can » Jenna S., posted by manowar on December 8, 2001, at 17:43:36
I took Ritalin, then Concerta along with Effexor XR for about 18 months. I had taken Ritalin as an add-on with my ADs for about 5 years. When the Effexor pooped out, I switched to Celexa - HORRIBLE withdrawal from Effexor, had to be hospitalized.
Anyway, the mix of Celexa and Ritalin was just not taking care of me. I wanted to sleep all the time and had ZERO motivation. Two weeks ago, my pdoc had me add Provigil to my drug cocktail. I did not like it - it reminded me a little of mescaline that I took 30 years ago, without the euphoria. The provigil added a sharpness to my attention that was good, but I felt jittery and just wierd! And I still WANTED to sleep all day, even though I wasn't really sleepy anymore. STRANGE. I quit taking it after 1 week.
For the last week I have been taking Adderall and despipramine along with the Celexa and so far I really like it. I hate to think that the Adderall could make my depression worse. I never heard this before....
Well, good luck.
Posted by manowar on December 10, 2001, at 15:12:44
In reply to Tim, I tried Provigil (modafinal), posted by cmcdougall on December 10, 2001, at 9:43:19
> I took Ritalin, then Concerta along with Effexor XR for about 18 months. I had taken Ritalin as an add-on with my ADs for about 5 years. When the Effexor pooped out, I switched to Celexa - HORRIBLE withdrawal from Effexor, had to be hospitalized.
>
> Anyway, the mix of Celexa and Ritalin was just not taking care of me. I wanted to sleep all the time and had ZERO motivation. Two weeks ago, my pdoc had me add Provigil to my drug cocktail. I did not like it - it reminded me a little of mescaline that I took 30 years ago, without the euphoria. The provigil added a sharpness to my attention that was good, but I felt jittery and just wierd! And I still WANTED to sleep all day, even though I wasn't really sleepy anymore. STRANGE. I quit taking it after 1 week.
>
> For the last week I have been taking Adderall and despipramine along with the Celexa and so far I really like it. I hate to think that the Adderall could make my depression worse. I never heard this before....
>
> Well, good luck.
Hi,
I'm glad to hear that you're doing well.That was just my experience with the Adderal. I've noticed that lots of people here do really well with it and badly with the Ritalin, so who knows?
As hard as it was to stop the Klonipin a month ago, I think I'm going to see if I can start it again. Without it I feel mentally impaired. It seemed to work synergistically with the Ritalin.
I'm debating on whether I should try another TCA. An SSRI is out of the question, since I've tried most of them without any success. A MAOI is still a consideration. I only ever remember trying one TCA and that was desipramine. I did well on it for a while, but it pooped out. I never had tried a TCA with Ritalin and from what I've read, a TCA+pstim is one of the best combinations for treatment-resistant depression. I'm also going to see if my pdoc will augment T3 to my regimen. But I also want to try the Modafinil. I guess I'll have to be patient.
ARRRGGGGHHHHH!
See ya,
Tim
Posted by Jenna S. on December 10, 2001, at 15:29:26
In reply to Re: What AD next? Please help if you can » Jenna S., posted by manowar on December 8, 2001, at 17:43:36
> Thanks Jenna,
>
> Yes I have tried one anti-psychotic. I started Seroquel about three weeks ago. I kinda felt a bit of cognitive impairment and I felt even more depressed as usual. After stopping the Seroquel, I still felt more depressed than usual and I determined that the Adderal that I started one week prior to the Seroquel was the culprit.
>
> I stopped the Adderal a few days ago, and I feel a little better.
>
> I also started taking Neurontin a few days ago. So far, it seems that I get the same side effects that I did with the Seroquel (e.g. cognitive impairment, a little dizzy when standing).
>
> If I don't do well on the Neurontin, I'll keep the Seroquel or another anti-psychotic in mind.
>
> I know this is stupid but what is the 5HT2A receptor?
>
>
> Thanks for your support,
> TimNo need to feel stupid for asking a question :)
The 5HT2A receptor is one of the serotonin receptors. Serotonin's chemical name is 5-hydroxy-tryptamine, which is a bit of a mouthful, so it gets shortened to 5HT.
I've had a look in my very incomplete file on what each receptor does and I've got antagonism of 5HT2A as increasing dopamine and reducing anxiety. Mirtazapine, nefazodone and atypical antipsychotics block 5HT2A receptors, amongst their other effects. You need to take a low dose of an atypical antipsychotic to benefit depression - low doses generally increase dopamine because the 5HT2A effect outweighs the dopamine blocking, but at higher doses this effect is reversed (I believe).
I've taken Neurontin myself, overall its effects on me were all mild, including any beneficial effect, so I stopped it after a few months. I did feel slightly dizzy, sedated and had a headache initially, these things passed after a few days though. I also got edema in my legs which also went away. My immediate memory was a bit impaired on it, for example looking at a roadsign and then immediately forgetting what it said, which wasn't very useful! I don't think that effect went away but it was all academic anyway since I wasn't going to continue it.
I haven't tried Seroquel and it is one I will be trying soon if other things don't work first. I'm still feeling depressed, and tired, on 450mg of bupropion, which I thought would at least have given me some energy!
Jenna
Posted by manowar on December 12, 2001, at 15:51:58
In reply to What AD next? Please help if you can, posted by manowar on December 5, 2001, at 15:05:19
Psychiatrists are drug dealers with an attitude.
I am such an idiot for listening and taking the advice from my pdoc.
At one point a couple months ago, I was completely symptom free for 5 WEEKS!
Of course, all good things must come to an end. We had to mess with my meds. If I’m doing fairly well in the future, someone please remind me not to overhaul my meds. What a disaster; I feel like crap.
I hope and pray that my pdoc will have enough pity in his heart to let me have the Klonipin again. If he doesn’t, I’ll have to find a new doctor, because I know how much that drug helps me. When I feel good or even just fair, I tend to forget what it’s like to be down. I’ll try not to let it happen again.
He told me that Klonipin was not a good mood stabilizer, and if it was doing anything, it was contributing to my depression. At that time, like an idiot, I forgot about all the begging and pleading that I did for years to no avail to get the Klonipin back into my routine. What was I thinking? He had me start Seroquel in place of the Klonipin. What was he thinking? I felt cognitively impaired from the Seroquel. So I tried Neurontin- same thing. It seems that most drugs just give me terrible psycho-side effects, and the only drugs that have ever done any good for me gave me either little side effects or pleasurable side effects.
I’m going to try to remember this fundamental rule in the future:
When there may be a reason to change my regimen, try very hard to not be impatient. If possible, only add or subtract one drug at a time.I can understand my inpatients, but he’s a pro—he shouldn’t have let that happen.
This is the end of the thread.
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