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Dr. Bob is Robert Hsiung, MD,
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Posted by gromit on August 11, 2005, at 20:29:23
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 11, 2005, at 19:55:54
> I took the 3.75 mg. almost two hours ago. My pusle rate is now the same as it was before I took the Dex. It feels like it's higher though. I guess I'm more physically aware of my heart beating. I feel like I've just had a little bit of coffee along with a Valium - a little bit of tension along with more sedation. Sounds like a paradoxical response, doesn't it? I'm really bummed.
When I first started ritalin my heart rate went up and I got that wired/tired feeling you describe. It went away pretty quickly, within a couple of days. My BP and pulse were actually lower than pre ritalin at the last check. Maybe you just need to give it a little time at a steady dose.
Rick
Posted by alohashirt on August 11, 2005, at 21:06:48
In reply to Re: Dexedrine update » alohashirt, posted by KaraS on August 11, 2005, at 12:52:13
I take the (branded) spansules. The generic extended release
has been inconsistent, especially the Barr variety.
Posted by alohashirt on August 11, 2005, at 21:14:19
In reply to Re: Dexedrine update, posted by gromit on August 11, 2005, at 20:29:23
> > I took the 3.75 mg. almost two hours ago. My pusle rate is now the same as it was before I took the Dex. It feels like it's higher though. I guess I'm more physically aware of my heart beating. I feel like I've just had a little bit of coffee along with a Valium - a little bit of tension along with more sedation. Sounds like a paradoxical response, doesn't it? I'm really bummed.
>
> When I first started ritalin my heart rate went up and I got that wired/tired feeling you describe. It went away pretty quickly, within a couple of days. My BP and pulse were actually lower than pre ritalin at the last check. Maybe you just need to give it a little time at a steady dose.
>
>
> Rick
>I find that ritalin doesn't change my heart rate or BP but amphetamines do significantly. Both meds seem to increase the effects of caffeine significantly and sometimes a latte could make me very anxious and jittery.
Posted by KaraS on August 11, 2005, at 21:30:08
In reply to Re: Dexedrine update, posted by gromit on August 11, 2005, at 20:29:23
> > I took the 3.75 mg. almost two hours ago. My pusle rate is now the same as it was before I took the Dex. It feels like it's higher though. I guess I'm more physically aware of my heart beating. I feel like I've just had a little bit of coffee along with a Valium - a little bit of tension along with more sedation. Sounds like a paradoxical response, doesn't it? I'm really bummed.
>
> When I first started ritalin my heart rate went up and I got that wired/tired feeling you describe. It went away pretty quickly, within a couple of days. My BP and pulse were actually lower than pre ritalin at the last check. Maybe you just need to give it a little time at a steady dose.
>
>
> Rick
>
Thanks so much. That's really encouraging!
K
Posted by KaraS on August 11, 2005, at 21:32:16
In reply to Re: Dexedrine update » KaraS, posted by alohashirt on August 11, 2005, at 21:06:48
> I take the (branded) spansules. The generic extended release
> has been inconsistent, especially the Barr variety.
I think you may have told me that earlier. I have the Barr variety here. If I eventually get a stimulating response and find insconsistent results, then I'll try the branded version.Thanks.
K
Posted by KaraS on August 11, 2005, at 21:34:15
In reply to Re: Dexedrine update, posted by alohashirt on August 11, 2005, at 21:14:19
> > > I took the 3.75 mg. almost two hours ago. My pusle rate is now the same as it was before I took the Dex. It feels like it's higher though. I guess I'm more physically aware of my heart beating. I feel like I've just had a little bit of coffee along with a Valium - a little bit of tension along with more sedation. Sounds like a paradoxical response, doesn't it? I'm really bummed.
> >
> > When I first started ritalin my heart rate went up and I got that wired/tired feeling you describe. It went away pretty quickly, within a couple of days. My BP and pulse were actually lower than pre ritalin at the last check. Maybe you just need to give it a little time at a steady dose.
> >
> >
> > Rick
> >
>
> I find that ritalin doesn't change my heart rate or BP but amphetamines do significantly. Both meds seem to increase the effects of caffeine significantly and sometimes a latte could make me very anxious and jittery.
If/when the stimulating response happens, I'll definitely stay away from caffeine.k
Posted by ed_uk on August 12, 2005, at 1:22:25
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 11, 2005, at 18:20:21
Hi K!
>Might a calcium channel blocker induce depression?
Calcium channel blockers have occasionally been associated with depression, although (probably) not as often as beta blockers.
>Or destabilize someone who is bipolar?
Verapamil has been tried as a mood stabiliser. A few people seem to respond.
>I shouldn't have any problems taking my thyroid medication (T4) with the Dex, should I?
No, not unless you're taking so much you're hyperthyroid!
Ed xxx
Posted by ed_uk on August 12, 2005, at 1:24:45
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 11, 2005, at 19:55:54
Hi K,
>I guess I'm more physically aware of my heart beating.
It could be due to anxiety about taking the Dex.
>Sounds like a paradoxical response, doesn't it? I'm really bummed.
Don't come to any conclusions just get, it can take several weeks and a lot of dose/regimen titration to get the best out of a stimulant.
Ed xx
Posted by KaraS on August 13, 2005, at 15:14:54
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 12, 2005, at 1:22:25
> Hi K!
>
> >Might a calcium channel blocker induce depression?
>
> Calcium channel blockers have occasionally been associated with depression, although (probably) not as often as beta blockers.
Dr. E. doesn't believe that beta blockers cause depression. He said the studies showing that were done on very sick heart patients. I think he may be an extreme optimist who doesn't want to believe the negative risks of some medications.>
> >Or destabilize someone who is bipolar?
>
> Verapamil has been tried as a mood stabiliser. A few people seem to respond.Ok, so what it does works in the right direction here.
> >I shouldn't have any problems taking my thyroid medication (T4) with the Dex, should I?
>
> No, not unless you're taking so much you're hyperthyroid!
>
> Ed xxx
Thanks,Kara
xxx
Posted by KaraS on August 13, 2005, at 15:17:15
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 12, 2005, at 1:24:45
> Hi K,
>
> >I guess I'm more physically aware of my heart beating.
>
> It could be due to anxiety about taking the Dex.
I think that's part of it but maybe not the whole story. We'll see.
> >Sounds like a paradoxical response, doesn't it? I'm really bummed.
>
> Don't come to any conclusions just get, it can take several weeks and a lot of dose/regimen titration to get the best out of a stimulant.
>
> Ed xx
Yeah, I'm still open to it working. I've had enough people tell me that that happened to them but it turned around at a higher dose.K
xx
Posted by zeugma on August 13, 2005, at 15:47:34
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 13, 2005, at 15:17:15
> > Hi K,
> >
> > >I guess I'm more physically aware of my heart beating.
> >
> > It could be due to anxiety about taking the Dex.
>
>
> I think that's part of it but maybe not the whole story. We'll see.
>
>
> > >Sounds like a paradoxical response, doesn't it? I'm really bummed.
> >
> > Don't come to any conclusions just get, it can take several weeks and a lot of dose/regimen titration to get the best out of a stimulant.
> >
> > Ed xx
>
>
> Yeah, I'm still open to it working. I've had enough people tell me that that happened to them but it turned around at a higher dose.
>
> K
> xx
>
> Hi kara, Ed is right, stimulants don't always work immediately- the only meds I've ever taken that had that kind of immediate effect are benzos (and Strattera). Stims are the hardest meds to calibrate because there really is no way to gauge what the effective dose will be.-z
Posted by ed_uk on August 13, 2005, at 18:10:46
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 13, 2005, at 15:14:54
Hi K,
>Dr. E. doesn't believe that beta blockers cause depression.
Well... they're certainly a lot more likely to cause fatigue than depression.
~Ed xx
Posted by KaraS on August 13, 2005, at 19:07:45
In reply to Re: Dexedrine update » KaraS, posted by zeugma on August 13, 2005, at 15:47:34
Posted by KaraS on August 13, 2005, at 19:09:34
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 13, 2005, at 18:10:46
> Hi K,
>
> >Dr. E. doesn't believe that beta blockers cause depression.
>
> Well... they're certainly a lot more likely to cause fatigue than depression.
>
> ~Ed xx
I'm really hoping that doesn't happen. I'm sick of feeling fatigued and without energy. Maybe if the stimulant kicks in, it won't be a problem.K
xx
Posted by ed_uk on August 14, 2005, at 9:32:59
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 13, 2005, at 19:09:34
>Maybe if the stimulant kicks in, it won't be a problem.
That's what I was thinking. Also, atenolol and bisoprolol aren't as fatiguing as propranolol. Verapamil can be useful if beta blockers cause fatigue.
Ed xx
Posted by KaraS on August 14, 2005, at 15:58:39
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 14, 2005, at 9:32:59
> >Maybe if the stimulant kicks in, it won't be a problem.
>
> That's what I was thinking. Also, atenolol and bisoprolol aren't as fatiguing as propranolol. Verapamil can be useful if beta blockers cause fatigue.
>
> Ed xx
I have taken propanolol a few times before (a long time ago) on a PRN basis. I don't remember having any bad side effects from it. I don't know how it would have been had I been taking it regularly though. On the one hand I'm older and I seem to be more meds sensitive now. OTOH, atenolol should have less of a systemic effect than propranolol, right?k
Posted by ed_uk on August 14, 2005, at 16:39:25
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 14, 2005, at 15:58:39
Hi K,
If you've taken propranolol without wheezing, you ought to be able to take atenolol no problem. Propranolol is one of the worst beta blockers RE bronchospasm. Atenolol is usually better tolerated than propranolol.
Ed xx
Posted by Sarah T. on August 14, 2005, at 17:20:34
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 14, 2005, at 16:39:25
Hi there, ed,
Which one is Inderal? Is that Propanolol or atenolol? I know some musicians who used to take Inderal for stage fright. Supposedly it was very effective. I don't know whether they still use it or whether something "better" has replaced it.
Posted by KaraS on August 14, 2005, at 17:57:28
In reply to Re: beta blocker question » ed_uk, posted by Sarah T. on August 14, 2005, at 17:20:34
> Hi there, ed,
>
> Which one is Inderal? Is that Propanolol or atenolol? I know some musicians who used to take Inderal for stage fright. Supposedly it was very effective. I don't know whether they still use it or whether something "better" has replaced it.Inderol is propanolol. I don't know if atenolol is better. It's more cardio selective though.
Posted by KaraS on August 14, 2005, at 18:59:40
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 14, 2005, at 16:39:25
> Hi K,
>
> If you've taken propranolol without wheezing, you ought to be able to take atenolol no problem. Propranolol is one of the worst beta blockers RE bronchospasm. Atenolol is usually better tolerated than propranolol.
>
> Ed xx
Hi Ed,Yes, but I took the propanolol only a few times many years ago and it was before I had any allergy problems. Still, I think you're right that I'll be fine with it. In my last appointment I told Dr. E. that my resting pulse rate has been in the 80's and 90's so told me he wants me to start on the atenolol (as I knew he would).
He thinks that the atenolol will solve almost all of my anxiety and depression problems. He said that he has never had any success treating people until he has calmed them down. He has a little poem about treating "the high before the low and the fast before the slow". I think the high here might also refer to the overly high voltage areas of the brain. Anyway, I remain skeptical. He told me Friday that "you're not that ill". I think he was trying to reassure me that he will get me feeling better soon but it was hard not to take it as an invalidation of how bad I've been feeling. It's difficult for me to believe that a beta blocker alone will give me back my motivation.
He is also thinking that once the beta blocker is in place that the 5 mgs. of dexedrine will work for me and that 5 mgs. twice a day will be sufficient for my ADD. (He didn't mention it in terms of motivation. My gut is telling me that I'll need to at least double that amount to get any kind of motivation response.) I have to add that I think he's an extreme optimist. He believes that if one is on the right medication (and I'm assuming that he includes that one is also not taking anything else that is wrong for that person that can throw their system off), that poop-out does not occur. He thinks it would be foolish of me not to take the dexedrine every day. I don't buy this, do you?
I think he's an excellent diagnostician but I do question some of his beliefs about medication. I wonder if his optimism isn't misleading him at times - i.e. perhaps he doesn't want to believe in poop-out. OTOH, he has a reputation for having success with TRDs. His whole practice is devoted to us. This is probably because he thinks outside of the box. Therefore it makes sense that his treatment would be less conventional, right? So I think I will follow most of his advice (still not sure about the daily dexedrine) and see what happens. What do you think?
K
xx
Posted by Sarah T. on August 15, 2005, at 0:18:17
In reply to Re: beta blocker question » Sarah T., posted by KaraS on August 14, 2005, at 17:57:28
Posted by ed_uk on August 15, 2005, at 2:53:27
In reply to Re: beta blocker question » ed_uk, posted by Sarah T. on August 14, 2005, at 17:20:34
Hi,
Inderal = propranolol
Tenormin = atenolol>I know some musicians who used to take Inderal for stage fright.
It didn't work for me. I used to take 15mg diazepam (Valium) for concerts. I don't play anymore though.
~Ed
Posted by ed_uk on August 15, 2005, at 3:43:41
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 14, 2005, at 18:59:40
Hi K,
>In my last appointment I told Dr. E. that my resting pulse rate has been in the 80's and 90's so told me he wants me to start on the atenolol (as I knew he would).
Is the tachycardia bothersome? IMHO, sinus tachy can often be left untreated unless it's.......
a) uncomfortable
b) anxiety provoking
or c) severe - severe sustained tachycardia can damage the heart muscle leading to a condition called tachycardiomyopathy, which can cause heart failure. Heart failure due to tachycardiomyopathy can often be reversed by treatment with a beta blocker such as bisoprolol.
90bpm isn't really tachycardia. >100bpm is tachycardia.
I can definately see where your doc's coming from though, it is certainly possible that you'll develop troublesome tachycardia as you increase the dose of Dex. With your family history of heart disease, it makes sense to be extra cautious. IMHO, it would be best to start atenolol at 25mg/day.
>He thinks that the atenolol will solve almost all of my anxiety and depression problems.
It does sometimes help anxiety. I have a friend who finds atenolol very calming, he takes it for Ritalin-induced tachycardia! I've never heard of it helping depression.
>It's difficult for me to believe that a beta blocker alone will give me back my motivation.
It might allow you to tolerate a higher dose of Dex - which may improve your motivation.
>He thinks it would be foolish of me not to take the dexedrine every day. I don't buy this, do you?
It's always surprised me how few docs seem to prescribe 'as required' stimulants. Most people seem to take them every day.
Ed xx
Posted by KaraS on August 17, 2005, at 14:37:57
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 15, 2005, at 3:43:41
> Hi Ed,
>
> >In my last appointment I told Dr. E. that my resting pulse rate has been in the 80's and 90's so told me he wants me to start on the atenolol (as I knew he would).
>
> Is the tachycardia bothersome? IMHO, sinus tachy can often be left untreated unless it's.......
>
> a) uncomfortableonly occasionally
>
> b) anxiety provoking
I could probably make a case for that. Besides, fear has stopped me from doing so many things. This would prevent that I think.
> or c) severe - severe sustained tachycardia can damage the heart muscle leading to a condition called tachycardiomyopathy, which can cause heart failure. Heart failure due to tachycardiomyopathy can often be reversed by treatment with a beta blocker such as bisoprolol.Reversed? Wow. That's great and hard to believe. I know my increased heart rate is nowhere near the rate required to create tachycardiomyopathy.
> 90bpm isn't really tachycardia. >100bpm is tachycardia.I was doing some research and came across the actual definition so really my doctor is technically incorrect for calling my condition tachycardia.
> I can definately see where your doc's coming from though, it is certainly possible that you'll develop troublesome tachycardia as you increase the dose of Dex. With your family history of heart disease, it makes sense to be extra cautious. IMHO, it would be best to start atenolol at 25mg/day.
I have 25 mg. pills here. I know he wants me to start taking it once a day. Do I eventually take it twice or more a day? How often does one take beta blockers to insure continuous coverage?Also, I think that even if he weren't going to be starting me on a stimulant, that he'd prescribe the beta blocker. He really seems to think that my hyper adrenal (for lack of a better term - maybe hyperadrenalism is better?) is the root of my anxiety and depression.
> >He thinks that the atenolol will solve almost all of my anxiety and depression problems.
>
> It does sometimes help anxiety. I have a friend who finds atenolol very calming, he takes it for Ritalin-induced tachycardia! I've never heard of it helping depression.If you have severe anxiety (which I do when not medicated) then that can lead to depression, right (because your system starts making more cortisol instead of neurotransmitters?). So if an agent were to shut down the anxiety response, then depression is prevented, no?
> >It's difficult for me to believe that a beta blocker alone will give me back my motivation.
>
> It might allow you to tolerate a higher dose of Dex - which may improve your motivation.Very true but I don't think he was seeing it that way.
> >He thinks it would be foolish of me not to take the dexedrine every day. I don't buy this, do you?
>
> It's always surprised me how few docs seem to prescribe 'as required' stimulants. Most people seem to take them every day.It doesn't really surprise me. How often do you not want to think clearly? Or how often do you want to be sluggish and depressed? Did you see the explanation in another thread here where a poster talks about why some doctors prefer that patients take stimulants every day? I was happy to see that since I'd like to believe it's better to take them continuously.
K
xx
Posted by ed_uk on August 17, 2005, at 15:10:27
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 17, 2005, at 14:37:57
Hi K,
>Reversed? Wow.
As far as I know, tachycardiomyopathy is one of the rare types of heart failure which can often be reversed. Most types of heart failure are irreversible.
>I have 25 mg. pills here. I know he wants me to start taking it once a day. Do I eventually take it twice or more a day? How often does one take beta blockers to insure continuous coverage?
Atenolol is usually given once daily, at a dose of 25-100mg/day.... rarely up to ~150mg. It's occasionally given twice daily for angina.
>If you have severe anxiety (which I do when not medicated) then that can lead to depression, right (because your system starts making more cortisol instead of neurotransmitters?). So if an agent were to shut down the anxiety response, then depression is prevented, no?
Makes sense :-)
>How often do you not want to think clearly?
On a Sunday? ;-)
Ed xx
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