Posted by Ritch on July 3, 2002, at 23:36:49
In reply to The interplay of anxiety, dexedrine cyclothymia, posted by leor on July 3, 2002, at 13:08:46
> Dear Psycho-babblers
> I am sending this message out into cyberspace in the hopes of gaining some advice about using Dexedrine as a treatment for my inattentive ADD in conjunction with my treatments for Cyclothymia and Anxiety disorder. At the same time, it may provide others who are considering using Dexedrine with some cautionary advice.
>
> Below I will discuss some of the problems associated with my use of Dexedrine use and pose questions that are related to them.
>
> ( 1 ) I suffer from Cyclothymia in addition to ADD. Do some p-docs vary the dosages of Dexedrine that they prescribe on a seasonal basis so as to accommodate their patient's decreased concentration level (resulting from cyclothymia)?
>
> ( 2 ) My observation of the affect that Dexedrine has on me is being complicated by my lack of a stable treatment for my Bipolar II. (I have tried various SSRIs and Anti-depressants over the past four years, so far without success). Where does one draw the line between ADD’s detrimental affect on concentration and the detrimental affect on concentration caused by anxiety disorder?
>
> ( 3 ) Some background information:
> When my dosage was raised to 30mg in March 2002 I had a hypomanic episode within 48 hrs.. As luck would have it, this problem coincided with the end of my university semester – a time of intense stress (because I had to make up for all the learning time lost earlier on owing to my seasonal affective disorder) A vicious cycle ensued. Thanks to the (unrecognised) mania, my expectations for the essay I was than writing morphed from reasonable to super-inflated. 32 of the following 56 days saw me take more Dexedrine than I had been proscribed (my p-doc was foolish enough to have placed monthly refills on my prescription). By the time I Self diagnosed my hypomania and resolved to wean myself off of the extra Dexedrine, I was taking 90mg per day (45 in two doses).
>
> About two-thirds of the way through my episode, the following symptoms broke through:
> Severe anxiety.
> Outbursts of violent hypothermia (at the rate of about one a week)
> OCD. (Obsessing without compulsions)
> Tolerance to my dosage.
> Sped-up heart-rate.
>
> On June 12th, with my dosage back to normal, I began a drug holiday, which was to last five days. Since re-starting the Dexedrine (@ 15 mg) I have benefited again from its relief of my ADD. There is still a too-high level of anxiety, however, and this is cause for concern. The scenario leaves me anxious to know:…………..
>
> ( 4 Is there a risk that I may start to build up tolerance to Dexedrine again owing to my previous abuse? If this is a possibility, what can I do to break out of that process without having to permanently stop taking Dexedrine?
>
> ( 5 ) What makes OCD appear in a person with an OCD tendency who is taking Dexedrine? Is it due to prolonged use or due to the dosage being too high?
>
> I was hospitalised for OCD (along with severe separation anxiety) as a child, ten years ago. At the time I was taking a high dosage of Ritalin, which had been prescribed for treatment of my ADD.
>
> ( 6 ) Was five days a long enough drug holiday? As previously noted, my anxiety level remains quite high. Perhaps this just indicates what my p-doc and I already know – that we must find a good anti-anxiety medication ASAP. On the other hand, I know that taking the Dexedrine increases the anxiety level somewhat and wonder whether this indicates that my use of the medication should be discontinued all together.
>
> ( 7 ) In order to treat the anxiety I am now taking 250 mg of Lamotragine. We are considering introducing Lithium to serve as a prophylactic for mania and a tricyclic to treat the cyclothymia. In past treatments with SSRI’s and anti-depressants I have experienced problems with fatigue and torpor, hence the shift of focus to these other classes of meds. Does this approach seem to make sense?
>
> -------------------- WORDS OF CAUTION
> If any of you are on this medication or are considering using stimulant medications be please be aware that they are potent drugs, with the power to do much help and also much harm. Just as you would work with your family, p-doc and pharmacist to ensure that you were getting the optimum positive affect from a medication you were using, take the time to set up safeguards so you can avoid falling into patterns of abuse and/or experiencing manias.
>
> I would have been the last person whom you would think would get into this kind of trouble. I never drink or get high off of dangerous thrills, have a support network and an optimistic disposition. Why me then?
>
> - Because my physician did not indicate to me that I was at risk for hypomania or what the warning symptoms for hypomania are. (All we ever spoke about was hyper-maina, )
>
> - Because I did not do the necessary homework about Dexedrine when I began to use it and therefore could not alert my parents as to the warning signals of abuse or other problems.
>
> - Because I was under crushing stress when I asked for the faithful increase to 30mg. Period of stress are particularly bad times to make dose adjustments if you are at risk of mania.
>
> Good luck on your journeys & thank you so much for responding,
>
> Leor
Leor,So, you have mixed symptoms of ADD, hypomania, and anxiety? Sounds like my troubles (with seasonal major depressions thrown in). You might try a long-acting sustained release stimulant at a lower dosage (say Adderall 10mg in the AM) combined with a first-line antimanic agent like Depakote (say 250-500mg at bedtime). You could try adding on low-dose Neurontin to help with anxiety during the day (say 100mg 2x-3x daily). Just some thoughts.
Mitch
poster:Ritch
thread:111294
URL: http://www.dr-bob.org/babble/20020628/msgs/111353.html