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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by bart on March 3, 2005, at 13:13:05
I know I'll probably see a redirect post from dr. bob about this but I'm curious to know.
just wanted to hear some ideas about what meds might be good for individual who is coming off meth 2 months ago but is on celexa and has blunted emotions and no motivation.I was thinking wellbutrin, provigil, mirapex, something like these?
Posted by Ame Sans Vie on March 3, 2005, at 14:14:26
In reply to med for former stim. addict?, posted by bart on March 3, 2005, at 13:13:05
Hi there,
I think you're on the right track with meds like bupropion and dopamine agonists. Provigil is also worth looking into, but only if you have good insurance! There have been studies that show positive results with former cocaine addicts treated with either bromocriptine (Parlodel) or amantadine (Symmetrel), and I would imagine that the MAO inhibitors selegiline (Eldepryl) and tranylcypromine (Parnate) could be helpful as well.
On the other, much more controversial, hand -- many former stimulant abusers find that substitution therapy (e.g., methylphenidate [Ritalin, Concerta, Methylin, Metadate], amphetamine [Dexedrine, DextroStat, Adderall], or methamphetamine [Desoxyn]) works incredibly well, *if they are absolutely sure they can control their urges to abuse the medication*. Pemoline (Cylert) is another option, though much less attractive, as it has potential to cause life-threatening liver damage. Of course, you'd need to have a psychiatrist who's very understanding to even make treatment like this feasible, but surveys of psychiatrists and substance abuse treatment centers a few years back reported that around 70% of these doctors either have used substitution therapy with stim abusers or are open to the idea. Just a thought.
Best of luck,
~Michael
Posted by med_empowered on March 3, 2005, at 15:16:56
In reply to Re: med for former stim. addict? » bart, posted by Ame Sans Vie on March 3, 2005, at 14:14:26
hey! Basically, I concur with everything the previous poster said; the tricyclics seem to be better-studied in terms of treating withdrawal-emergent depression...just like with other forms of more severe and/or resistant depression, you may end up on an anti-depressant "cocktail," like "California Rocket Fuel" (yes, shrinks, people with MDs, give drug mixtures these kind of names. this one is remeron and effexor, and I think there's a variant that uses wellbutrin as well). Also, the old adage that "time heals all wounds" should be remembered here; new research has suggested that the brain is capable of significant recovery after stimulant abuse (the studies I've read looked at cocaine), so early depression may well get better with the passage of time, in addition to improvements seen with medication(s) and/or therapy.
Posted by Spriggy on March 3, 2005, at 17:09:55
In reply to Re: med for former stim. addict?, posted by med_empowered on March 3, 2005, at 15:16:56
First of all, hats off to you for beating your addiction. I know it's one of those battles you will likely fight every day.. but it's one you can WIN.
So I think it's great you chose to fight the thing through and not let it keep you defeated. Congrats to you!!!
Now... I noticed on this new med I am on for mood stabilization, it says it is good for anyone coming off cocaine and other type of drugs.I'm not up to date on the difference between cocaine and meth so it may have absolutely no benefit to you but the drug is called Depakote.
Maybe you could do something like Wellbutrin during the day (since it's stimulating) and something like Depakote for mood stabilization in the evening.
Definitely share your thoughts with your dr. I think if they know where you are coming from, that gives them a big clue on how to "treat" you medically.
and once again, hats off to you! It's a task that doesn't need to go unnoticed.
This is the end of the thread.
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