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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 44. This is the beginning of the thread.
Posted by barbaracat on September 25, 2005, at 13:35:11
Well, it's med merry-go-round again. My symptoms have gone from classic bipolar mixed states to classic lethargic sleep all day blahs. They cycle like this every few years. My pdoc talked me into trying the one med I haven't tried and have been very wary of - amphetamine, i.e., Adderall. First things first, any suggestions on how to not develop escalating tolerance?
I can see how I fit an ADD profile and have suspected such for some time now but it's always been confusing as to whether it's really ADD, or the scattering results of bipolar, stress, depression. It's difficult to stay focused when feeling like crap. Or I have all of the above including ADD. I do know that when I was 18-21 I thrived on recreational speed. My drug of choice where just enough calmed me like nothing else. But of course, what feels good can always feel better and I overdid it to the point of blowing my circuits out and developed raving meth toxicity. So I'm really afraid of the stuff.
I think I've developed some wisdom with age and would definitely not abuse it and it just may help me. I don't want to try Wellbutrin yet one more time. It makes me feel awful. I didn't like Concerta one bit and Ritalin had a bad let down. Amphetamines in the right dose did it for me before and might be the ticket. I'm willing to try. It's just that I've got a pretty tweaky nervous system and the idea of a pstim feels like throwing fire on gasoline.
So, any one who'se been there? Helped by Adderall, glad you did it and didn't need to keep increasing to the point of addiction? - Barbara
Posted by SeekingAdvice on September 25, 2005, at 16:10:42
In reply to Adderall and preventing tolerance?, posted by barbaracat on September 25, 2005, at 13:35:11
> I don't want to try Wellbutrin yet one more time. It makes me feel awful.
In what way did it make you feel awful?
Did it improve your ADD problem?> So, any one who'se been there?
Well, I haven't tried Adderal because it would definitely aggrevate my Anxiety disorder. I like Wellbutrin, but I am having some difficulty (see above post).
I wish you the best of luck with your problem. Good for you for growing up and getting off the speed. I got off of cocaine, x, and whatever I could find at the same age as you. That's great.
Love,
SeekingAdvice
Posted by barbaracat on September 25, 2005, at 16:23:23
In reply to Re: Adderall and preventing tolerance?, posted by SeekingAdvice on September 25, 2005, at 16:10:42
> In what way did it make you feel awful?
> Did it improve your ADD problem?**Awful might be too strong a word. I felt fretful, not at peace. Even on low doses I felt pressure behind my eyeballs. I didn't suspect I had ADD at the time since major depression (later upgraded to bipolar depression) was the most glaring symptom. But no, I'd have to say the feeling of being wired was not helpful for ADD focus. It did not help with the depression either.
My husband, on the other hand, has become a new man on it. He suffered from 'The Grey Zone' depressions, no motivation or energy. Since he's been on 300mg XR I finally have the happy productive guy I always knew was underneath the grey guy. Plus, it has definitely helped him in the lumber department, if you get my drift. - Barbara
>
> > So, any one who'se been there?
>
> Well, I haven't tried Adderal because it would definitely aggrevate my Anxiety disorder. I like Wellbutrin, but I am having some difficulty (see above post).
>
> I wish you the best of luck with your problem. Good for you for growing up and getting off the speed. I got off of cocaine, x, and whatever I could find at the same age as you. That's great.
>
> Love,
> SeekingAdvice
>
Posted by fairywings on September 25, 2005, at 17:20:58
In reply to Adderall and preventing tolerance?, posted by barbaracat on September 25, 2005, at 13:35:11
I'm on adderall xr and it's helped and i haven't built up a tolerance. I don't have bi-polar or depression though.
One thing i can tell you is to titrate up slowly because if you double the dose, and double, and double trying to hit the right dose, and you miss, you'll get obsessive, not want to leave the house or do anything, and get depressed. (sounds like the state of mind where you are now) that's how i got - a black hole depression, but when we backed off, we hit the right dose.
The feeling good, wanting to feel better and better was the problem, and going beyond feeling good, you get too high a dose which is not good at all. It takes some trial and error, but sounds like you have a good p-doc.good luck,
fw
Posted by Phillipa on September 25, 2005, at 18:59:52
In reply to Re: Adderall and preventing tolerance? » barbaracat, posted by fairywings on September 25, 2005, at 17:20:58
Confused. How does ADD fit in with a dx of bipolar? I would think it would make you cycle up. Fondly, Phillipa
Posted by barbaracat on September 25, 2005, at 19:06:29
In reply to Re: Adderall and preventing tolerance?, posted by Phillipa on September 25, 2005, at 18:59:52
Theory goes that quite a few bipolars are also ADD, comorbidly. You'd think it would aggravate mania and I'm concerned about that. But again, the theory goes that at the correct dose it should actually promote a calming and balancing effect on the frontal lobes. But that correct dose has to be carefully monitored.
It does seem hopelessly confusing, but surprising how frequently ADD rides along with all the mood disorders.
> Confused. How does ADD fit in with a dx of bipolar? I would think it would make you cycle up. Fondly, Phillipa
Posted by Phillipa on September 25, 2005, at 21:02:31
In reply to Re: Adderall and preventing tolerance? » Phillipa, posted by barbaracat on September 25, 2005, at 19:06:29
Barbara, Just Babbled you. I really need to discuss meds and diagnoses with you . Fondly, Phillipa
Posted by pseudoname on September 26, 2005, at 12:00:31
In reply to Adderall and preventing tolerance?, posted by barbaracat on September 25, 2005, at 13:35:11
Barbara,
I use Adderall XR for unipolar depression. It's effective for me but only for the worst, most lethargic, painful, catatonic episodes. Within an hour of taking it, I feel hopeful and able to live when moments earlier I was totally suicidal and despairing. Adderall doesn't help me with my less-severe depressive days, which is most of them.
I don't have ADD but I notice improved reading concentration on Adderall. But, you know, reading all the "Slate" archives is not something I really need to be doing, and that seems to be a big draw if I'm online when it kicks in! LOL!
I manage the tolerance by taking it at most 3 or 4 days a week. If I've gone without it for at least 3 days, I take 20mg. If I've taken 20mg for the last 2 days, I take 30mg. But after 3 Adderall days in row, I know it won't work on the fourth. I've never tried it higher than 30mg, because I got into super-high levels of Ritalin that way with terrible crash afterward, and I don't want to screw up the really important (if limited) help Adderall does give me.
Ritalin-type let-downs haven't occurred on the on Adderall XR doses I've used. The "XR" version is important, I think. But I can tell throughout the day when the next set of pellets dissolve their enteric coating.
On bipolarity & amphetamines: There's some info that giving someone amphetamines when they're in a manic phase can quickly bring them *out* of the manic phase. Interesting.
Good luck!
Posted by barbaracat on September 26, 2005, at 12:19:23
In reply to Adderall, tolerance, manic treatment, posted by pseudoname on September 26, 2005, at 12:00:31
Thanks for your very helpful post, exactly what I was looking for. Very interesting piece of info on the manic stuff since that's a big concern. I don't mind a bit of hypomania at all but the mixed states depressions are the pits and to be avoided. Do you remember where you saw it?
Your rotating regimen sounds very reasonable. In fact, I use a similar schedule for the opiates I take when my fibromyalgia is acting up to avoid tolerance and dependency.
I don't have the XR so I'll make sure to tell my pdoc for next time. - Barbara
>
> I use Adderall XR for unipolar depression. It's effective for me but only for the worst, most lethargic, painful, catatonic episodes. Within an hour of taking it, I feel hopeful and able to live when moments earlier I was totally suicidal and despairing. Adderall doesn't help me with my less-severe depressive days, which is most of them.
>
> I don't have ADD but I notice improved reading concentration on Adderall. But, you know, reading all the "Slate" archives is not something I really need to be doing, and that seems to be a big draw if I'm online when it kicks in! LOL!
>
> I manage the tolerance by taking it at most 3 or 4 days a week. If I've gone without it for at least 3 days, I take 20mg. If I've taken 20mg for the last 2 days, I take 30mg. But after 3 Adderall days in row, I know it won't work on the fourth. I've never tried it higher than 30mg, because I got into super-high levels of Ritalin that way with terrible crash afterward, and I don't want to screw up the really important (if limited) help Adderall does give me.
>
> Ritalin-type let-downs haven't occurred on the on Adderall XR doses I've used. The "XR" version is important, I think. But I can tell throughout the day when the next set of pellets dissolve their enteric coating.
>
> On bipolarity & amphetamines: There's some info that giving someone amphetamines when they're in a manic phase can quickly bring them *out* of the manic phase. Interesting.
>
> Good luck!
Posted by pseudoname on September 26, 2005, at 14:23:48
In reply to Re: Adderall, tolerance, manic treatment » pseudoname, posted by barbaracat on September 26, 2005, at 12:19:23
> Very interesting piece of info on the manic stuff since that's a big concern. ... Do you remember where you saw it?
Sorry. I can't believe I didn't save the page since I usually save all that kind of stuff. I remember it was a pdoc, speaking informally, about using amphetamines when someone was "stuck" in a manic phase. He said other pdocs were always surprised when they tried it because it's so counterintuitive.
I've Googled quite a bit for it just now and can't find the page at all. I'll keep looking, though.
I did find this, though, about bipolar kids taking amphetamine for ADD:
<quote>
[M]ania ratings did not differ significantly between the amphetamine and placebo.... Only one subject [of 40?] experienced a worsening of mania....Previous concerns about the possibility of worsening mania with stimulant use were largely based on case reports and retrospective studies.... The compelling findings of the current study support considering the use of stimulants in addition to mood stabilizers for children who have symptoms of both bipolar and hyperactivity disorders.
Published in "Journal Watch Psychiatry" February 24, 2005
<unquote> from http://psychiatry.jwatch.org/cgi/content/full/2005/224/1There might be more references, like for adults, there.
Posted by pseudoname on September 26, 2005, at 14:33:33
In reply to Re: Adderall, tolerance, manic treatment » pseudoname, posted by barbaracat on September 26, 2005, at 12:19:23
I Googled "counterintutive amphetamine mania" and the first hit was it!
Posted by barbaracat on September 26, 2005, at 15:17:02
In reply to Adderall, tolerance, manic treatment, posted by pseudoname on September 26, 2005, at 12:00:31
Where have you been all my life, dear Adderall? Oh yeah, speed, I remember. Maybe this is why I took to it so ferociously when I was a depressed teen. It was the only time I felt happy and obviously I was self-medicating. I took to it recreationally a tad too well back then and have been terrified of it since. I'm older and wiser now and would love to keep things nice and mellow.
I took only 10mg but it's like the the lights came on in cobwebby parts of my brain. I can feel little pops of life force going off in my frontal lobes. Colors are alive. My normal low-level constant fibro pain is gone, gone, gone. Why would this be? Cause I'm havng too much fun? Is this what healthy normal people feel like? Is it really possible to do more than plod through life?
After 6 weeks of inert misery after I hurt myself from the fall, feeling like petrified sludge after increasing the Cymbalta, doing nothing but lie on the couch feeling like a failure I actually went out for a walk with a friend earlier. Sun! Air! Moving body parts! Yakked her ear off but that could be a combination of the med and the fact that I've pretty much communicated only in grunts to my husband for the past 6 weeks. A living breathing friend I actually felt like talking to was almost too much excitement. I'm skipping around and my friend kept saying 'you were pretty hurt, are you sure you're up for this?' Hell, yes! Gad, I felt like Julie Andrews coming over that mountaintop 'The hills are alive...'
I feel focused, involved, motivated and awake. If this has been the missing piece all this time, all these 30 years of one med after another, if it turns out I was really on the right track after all when I was popping bennies and white crosses in my youth, then I will be a bit miffed it took all this time, but still very grateful.
I'm still not 100% sure ADD is me. Anyone might feel this good on this med cause amphetamines are a popular street drug for good reason. But I give a rip as long as it works. It's like I've finally found the rest of me. Please God don't let this poop. With a good anti-tolerance regimen let it last. - BarbaraCat
Posted by barbaracat on September 26, 2005, at 15:26:07
In reply to Whoa! It was on Babble!! » barbaracat, posted by pseudoname on September 26, 2005, at 14:33:33
Whoa! is right! This is important stuff. I'm going to get this info to my pdoc.
I understand partially that amphetamines act somewhat differently in that they don't recycle the neurotransmitters but dump them into the synapse and cause depletion. Have you ever tried supplementing with amino acids like DL-phenylalanine or L-tyrosine to build the stores of dopamine and NE back up?
> I Googled "counterintutive amphetamine mania" and the first hit was it!
>
> http://www.dr-bob.org/babble/20000508/msgs/32818.html
Posted by Sarah T. on September 26, 2005, at 19:51:36
In reply to Adderall, tolerance, manic treatment, posted by pseudoname on September 26, 2005, at 12:00:31
Hi pseudoname,
That was a very interesting and helpful post. I benefited greatly from Dexedrine until I developed a tolerance to it. I wish that I had taken it as judiciously as you are taking Adderall. Actually, I did handle things fairly well, but it pooped out anyway. I wish I had received better guidance from my pdoc on how to stave off tolerance. I got most of my information from this site, but not until after I'd already experienced some poop out.
I believe that some of the tolerance I experienced may have been due, in part, to my unruly female hormones. Towards the end of the time that I was on Dexedrine, I had to take estrogen for a week or so for a gynecologic problem. During that brief period on estrogen, I found that I required MUCH less Dexedrine. Several years ago, I read an abstact about women requiring much lower doses of amphetamines when they were on estrogen. Nevertheless, with all the bad news about estrogen lately, I have no intention of going on it for any length of time, not even after I'm in menopause. I'm not sure how I'll manage when I reach that point.
Anyway, I admire the care and restraint with which you are using Adderall. I am bookmarking your post.
Sarah
Posted by Sarah T. on September 26, 2005, at 20:02:56
In reply to Re: Adderall and preventing tolerance? » barbaracat, posted by fairywings on September 25, 2005, at 17:20:58
> One thing i can tell you is to titrate up slowly because if you double the dose, and double, and double trying to hit the right dose, and you miss, you'll get obsessive, not want to leave the house or do anything, and get depressed. (sounds like the state of mind where you are now) that's how i got - a black hole depression, but when we backed off, we hit the right dose.
> The feeling good, wanting to feel better and better was the problem, and going beyond feeling good, you get too high a dose which is not good at all. It takes some trial and error, but sounds like you have a good p-doc.> good luck,
> fw>Hi fairlywings,
What you say is SO true. With amphetamines, there is such a fine line between too much and not enough, but I found that to be even more true for Adderall.
When I used to read other message boards, I found so many posts from people saying that stimulants make them tired and that they can go right to bed after taking stimulants. My impression of those cases is that they are either taking too much or they have developed tolerance or they are on the wrong drug. For many people, at the right dose, stimulants provide an alert yet calm focus. If you become over-focused or hyper-focused, obsessional, fatigued or just plain zombie-like, that probably means it's time to adjust the dosage or to consider trying another medicine.
Posted by Sarah T. on September 26, 2005, at 20:05:55
In reply to Re: Adderall and preventing tolerance?, posted by Sarah T. on September 26, 2005, at 20:02:56
Posted by barbaracat on September 26, 2005, at 21:19:35
In reply to Re: Adderall, tolerance, manic treatment » pseudoname, posted by Sarah T. on September 26, 2005, at 19:51:36
Hi Sarah,
Something to keep in mind when you reach 'that time' in a women's life. Those tests we all heard about were based on prempro, or conjugated horse urine estrogens and synthetic progesterones. The conjugated estrogens, i.e., horse urine, contain 7 estrogens to the 3 that we humans require. That means the liver has to do something with the other 4. Not knowing what the f*** to do, it recirculates and concentrates and eventually turns it into the most potent of estrogens, the kind that induces breast and uterine cancers. Why don't they get it? Because the pharma companies pay for the research and in this case could not find a way to get out of the evidencial truth of the matter and just blamed it on hormones carte blanche.It's really a trajedy because now most women hear about this travesty in women's hormones and don't realize there's an alternative. Bioidentical hormones based upon individual test results.
Saliva tests seem to be an accurate way to measure hormone levels and treatment should be based on these results. But does conventional medicine pay attention? Unfortunately, not. But fortunately, we do have alternatives. Check 'em out. Don't go by what your HMO OB/Gyn suggests.
Posted by fairywings on September 27, 2005, at 6:48:17
In reply to Re: Adderall and preventing tolerance?, posted by Sarah T. on September 26, 2005, at 20:02:56
hi bcat,
I did find that when I first started taking the right dose I was tired and my reflexes were slower than normal, which was a normal response. I told my p-doc, and he said the adderall was slowing me down. Now I have a calm and focus, but I agree, you don't want to get to hyperfocus or obsessesed.
fw
Posted by fairywings on September 27, 2005, at 7:01:43
In reply to Re: Adderall, tolerance, manic treatment » Sarah T., posted by barbaracat on September 26, 2005, at 21:19:35
This is true bcat and sarah, my sister is on natural bioidentical estrogen, she's a chemist and wouldn't have anything else. So I do think, as women we need to be in control. Finding a good female GYN is the first place to start, or a male who is like minded, IMO.
Also, if anyone has the tendency toward breast cancer, they might talk to the ob about, as a matter of course, having their ovaries removed after childbearing. women aren't told they're more likely to die of ovarian cancer than b.c., which i think they have the right to understand.
fw
Posted by KaraS on September 27, 2005, at 8:34:26
In reply to Adderall first use - brrrriinggg! Hello!, posted by barbaracat on September 26, 2005, at 15:17:02
> Where have you been all my life, dear Adderall? Oh yeah, speed, I remember. Maybe this is why I took to it so ferociously when I was a depressed teen. It was the only time I felt happy and obviously I was self-medicating. I took to it recreationally a tad too well back then and have been terrified of it since. I'm older and wiser now and would love to keep things nice and mellow.
>
> I took only 10mg but it's like the the lights came on in cobwebby parts of my brain. I can feel little pops of life force going off in my frontal lobes. Colors are alive. My normal low-level constant fibro pain is gone, gone, gone. Why would this be? Cause I'm havng too much fun? Is this what healthy normal people feel like? Is it really possible to do more than plod through life?
>
> After 6 weeks of inert misery after I hurt myself from the fall, feeling like petrified sludge after increasing the Cymbalta, doing nothing but lie on the couch feeling like a failure I actually went out for a walk with a friend earlier. Sun! Air! Moving body parts! Yakked her ear off but that could be a combination of the med and the fact that I've pretty much communicated only in grunts to my husband for the past 6 weeks. A living breathing friend I actually felt like talking to was almost too much excitement. I'm skipping around and my friend kept saying 'you were pretty hurt, are you sure you're up for this?' Hell, yes! Gad, I felt like Julie Andrews coming over that mountaintop 'The hills are alive...'
>
> I feel focused, involved, motivated and awake. If this has been the missing piece all this time, all these 30 years of one med after another, if it turns out I was really on the right track after all when I was popping bennies and white crosses in my youth, then I will be a bit miffed it took all this time, but still very grateful.
>
> I'm still not 100% sure ADD is me. Anyone might feel this good on this med cause amphetamines are a popular street drug for good reason. But I give a rip as long as it works. It's like I've finally found the rest of me. Please God don't let this poop. With a good anti-tolerance regimen let it last. - BarbaraCat
Hi BarbaraCat,From what I understand, the first week on a certain dosage of a stimulant can give you quite a high but that settles down to a therapeutic level that isn't as amazing. Don't want you to be too disappointed or think that it has stopped working for you when that happens.
k
Posted by pseudoname on September 27, 2005, at 9:21:30
In reply to Re: Whoa! It was on Babble!! » pseudoname, posted by barbaracat on September 26, 2005, at 15:26:07
> Have you ever tried supplementing with amino acids like DL-phenylalanine or L-tyrosine to build the stores of dopamine and NE back up?
I have not, but I'm definitely going to be looking into this. I've tried those supplements in the past to no effect, but I haven't tried them when I was also using Adderall.
Thanks for the tip!
Posted by pseudoname on September 27, 2005, at 9:45:33
In reply to Re: Adderall, tolerance, manic treatment » pseudoname, posted by Sarah T. on September 26, 2005, at 19:51:36
Sarah,
Thanks for your kind words. I think the restraint I'm showing with Adderall is partly due to the fact that the XR version has a good time lag between taking the capsule and when it kicks in. I haven't shown such restraint with, say, caffeine. Coffee hits me within minutes of drinking it with a warm, fuzzy, feeling. So I drink more. Then an hour later, I try to get that warm fuzzy feeling again with another cup. Then the next morning, even though I *KNOW* from years of experience that caffeine won't give me hardly any buzz 2 days in a row, I'll drink 4 cups trying to get it! And the next day. Yuck.
But Adderall XR takes 1-2 hours before it hits me so whatever part of the brain is responsible for dependent consumption doesn't seem to be able to make the connection between those little orange pellets and the improved feelings. I think Dexedrine and regular Adderall release more amphetamine immediately. (Is that correct?)
It sounds like you've been off Dexedrine and Adderall for a while. A drug holiday of several weeks may be enough to completely re-set your systems. Maybe you could try Adderall again -- just sure to get the XR version. ;)
Also, I don't expect Adderall to do much for me except leverage me out of the worst suicidal despair. My other significant depressive, emotional, mental problems are pretty much untouched by it.
Posted by barbaracat on September 27, 2005, at 11:59:19
In reply to Adderall and supplements » barbaracat, posted by pseudoname on September 27, 2005, at 9:21:30
Note to Dr. Bob: I eventually get back to babble meds so please don't boot me over to Alt just yet.
Before you go out and spend too much money on those supplements... I've been communicating with a guy over on the Alternative board. He recommended Macuna pruiens instead which is a south American bean, standardized to contain high amounts of pure L-dopa. We both agreed that the two amino acids were less than great for us.
I did a search for ADD+macuna and came up with loads of hits where macuna has been used successfully as an alternative to pstims for ADD. Here's a link for a source with some interesting info on the herb.
http://store.yahoo.com/herbalpowers/macunapruriens.html
BTW, sorry to hear you have those crushing despairing depressions. For what it's worth, I spent most of my life thinking I had severe unipolar depression but my depressions were very different from how I heard others describe theirs. Mine were bleak and black and filled with anguish - agitated nightmarish things. SSRIs would always poop and with every increase I'd get worse to the point where I was in constant dread.
With the help of this board, I finally recognized I might really be bipolar and asked my pdoc to try lithium. The difference has been miraculous. I'm lucky in that I respond very well to low dose lithium, in fact, refuse to take the higher 'therapeutic range' dose cause I don't need to overdo it.
I still get depressed and anxious but nowhere near those awful hellish things that were just getting worse with the years. It's clear now that what I thought were unipolar depressions were really bipolar mixed states dysphoric mania. I'd had my share of whoopie-do hypomanias and some full-blown manic episodes but it was mainly awful depression and that's why it took so long to think outside the box.
We've all been on so many meds and perhaps you've already given Lith a try, but if not it might be worth it. If it's the right drug for you it works wonders. I personally hated all the other mood stabilizers I tried, all except lithium, which is calming, soothing, and even grows new neural dendrites! Best to you, Barbara
> > Have you ever tried supplementing with amino acids like DL-phenylalanine or L-tyrosine to build the stores of dopamine and NE back up?
>
> I have not, but I'm definitely going to be looking into this. I've tried those supplements in the past to no effect, but I haven't tried them when I was also using Adderall.
>
> Thanks for the tip!
Posted by barbaracat on September 27, 2005, at 12:06:21
In reply to Re: Adderall first use - brrrriinggg! Hello! » barbaracat, posted by KaraS on September 27, 2005, at 8:34:26
Thanks for the head's up. That was almost a bit too much. Like being madly in love is wonderful and delightful but pretty wearing. When my husband got home he said my eyes were bugging out and I was still flying - on only 10mg! I'm going to back off to 5mg for a while and take things easy.>
>
> Hi BarbaraCat,
>
> From what I understand, the first week on a certain dosage of a stimulant can give you quite a high but that settles down to a therapeutic level that isn't as amazing. Don't want you to be too disappointed or think that it has stopped working for you when that happens.
>
> k
Posted by pseudoname on September 27, 2005, at 14:20:00
In reply to Re: Adderall and supplements » pseudoname, posted by barbaracat on September 27, 2005, at 11:59:19
> ...perhaps you've already given Lith a try, but if not it might be worth it.
I've tried lithium and other stabilizers like depakote quite a bit over the years to augment ADs. I've gone up to high doses and in combo with stuff like TCAs, Prozac and Ritalin.
Alas, the stabilizers never helped at all. I'm glad lith did for you, though!
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