![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 15 to 39 of 64. Go back in thread:
Posted by linkadge on January 14, 2007, at 17:10:12
In reply to Re: Depressives' sensitivity to stimulants!, posted by med_empowered on January 14, 2007, at 16:48:54
But who says depressives want to be high? A number of people with depression just want to feel normal. I think there needs to be a certain type of personality (perhaps thrill seeking) that would compromise a healthy state for an unhealthy one.
It may be true that depressives are more sensitive to stimulants, but one could argue the other way, that because they need less to get an effect, that they'd be *less* likely to abuse it, like a cheap drunk isn't doesn't drink more than a expesnive drunk, because they get drunk on less alchohol.
Nevertheless, I still don't see how somebody with depression would be looking for a "high" any more than somebody with just ADHD.
Linkadge
Posted by linkadge on January 14, 2007, at 17:15:06
In reply to Re: Depressives' sensitivity to stimulants!, posted by med_empowered on January 14, 2007, at 16:48:54
I can see how stimulant crashing might be more dangerous for a depressed person.
Linkadge
Posted by laima on January 15, 2007, at 0:19:09
In reply to Re: Depressives' sensitivity to stimulants!, posted by linkadge on January 14, 2007, at 17:15:06
I agree, I think the concern about a depressed person experiencing a crash from stimulants is probably the most legeit reason doctors might want to not use them, but the thing is, I don't think a crash is guarenteed. I don't think I experience this from the low doses I use. Have they plain forgotten then about how useful stimulants can be? I think they should decide patient by patient, not just forget about them altogether.I'm interested to hear about when ADD and ADHD were er, "discovered". Were these disorders first organized before or after stimulants fell out of favor for depression? I mean, I believe in them, I identify with the innattentive type attention deficit, but I'm curious about how the history sorts out. I also think there might be some overlap with the symptoms, ie, innattentive and frustrated due to depression, or attention deficit?
> I can see how stimulant crashing might be more dangerous for a depressed person.
>
>
> Linkadge
Posted by linkadge on January 15, 2007, at 9:02:37
In reply to Re: Depressives' sensitivity to stimulants!, posted by laima on January 15, 2007, at 0:19:09
I agree, I didn't really crash from ritalin when I was depressed. Infact I felt ok at the end of the day because I had got more done, and that I had dug myself a little futher out of the hole.
Linkadge
Posted by SLS on January 15, 2007, at 10:27:31
In reply to Re: Depressives' sensitivity to stimulants!, posted by med_empowered on January 14, 2007, at 16:48:54
> I think, like a lot of things in psychiatry, the stims for add, but not for depression practice isn't based on good science.
Bad science then? It seems to be based on something.
> Stims can be good antidepressants.
For what percentage of people suffering with MDD or BD do you think they would be good antidepressants?
> Since the 40s, they have been used widely, and often safely, for depression.
Why did they stop?
> I think psychiatry has taught that antidepressants are meds "specifically" for depression
I can see this. Remember, though, that it was the old-timers like Nathan Klein who got to see the differences in efficacy between amphetamine and imipramine who helped establish a trend in thought that these newer drugs better target affective disorders.
> (but not very good ones)
When they work, they can be miracle drugs for those who had suffered.
> and stimulants are "specifically" for ADHD.
There are plenty of doctors who have open minds when it comes to the use of psychotropics. I have seen quite a few. I think you'll find, though, that the majority have found through experience that amphetamine monotherapy does not produce a persistent antidepressant response for MDD and BD. If the clinical experience of experts represents bad science, I am often inclined to respect it. And yes, I have tried amphetamine monotherapy. I experienced an antidepressant effect for the first 3-4 hours after my first dose. That was about it, despite continued treatment at 20mg.
> The problem is, psychiatry isn't like real medicine,
Would this include diagnosis?
> where you have discrete disorders that respond to specific medications. You're dealing with a whole person here--feelings, thoughts, past, present, a whole brain--so there's going to be a lot of variability in terms of what works and what doesn't.
Most definitely. I'm glad to see that we are in agreement that there are treatments that do indeed work.
> Also, I think part of the problem is that in the 60s speed was so abused
Yes, it was.
> docs are slow to prescribe "addictive" substances,
Why the quotation marks given your above statement?
> and patients continue to suffer while paying out $$$ for ineffective treatment.
The only treatments that are ineffective are the ones that don't work. Sorry. But that's the state of the art - best guess trial and error. You don't think that deciding between Spiriva and Advair for COPD isn't an exercise in trial and error? Why should psychiatry be singled-out in this regard?
> I think it boils down to this: psychiatric patients get screwed.
Perhaps you are - not me, thanks.
> If you're a heart patient and your medication s/e suck, your doc works with you.
Ok.
> Depression? Bipolar? Schizophrenia? Stick with it. If you're in chronic physical pain, a reasonable doc will work with you, possibly with very strong, potentially addictive meds. Psychic Pain? Can't leave the house? Too apathetic to function? Too damn bad. Take your Paxil and shut up.
This has not been my experience with psychiatrists, and I don't think I could agree with such a generalization. If you have been treated this way, then you have not been given a fair opportunity to achieve wellness. You might consider using the Internet as a resource to find a competent and professional doctor who cares and is willing to work with you. There are plenty of them.
> That, I think, is the problem: shrinks really don't respect or value their patients.
Another generalization. How can such things be so universally accepted as fact? Bad science.
- Scott
Posted by linkadge on January 15, 2007, at 13:20:44
In reply to Re: Depressives' sensitivity to stimulants! » med_empowered, posted by SLS on January 15, 2007, at 10:27:31
Not, med empowered, but I am going to comment on various comments.
>For what percentage of people suffering with MDD >or BD do you think they would be good >antidepressants?I think it was interesting that on remedy find, a stimulant was more highly rated than all other antidepressants. Like was mentioned, some of those people had been on one for years.
>Why did they stop?I think they stopped because they found a drug that couldn't get you high. Antidepressants aren't really in the patients best interest, they are just more practical.
>I have seen quite a few. I think you'll find, >though, that the majority have found through >experience that amphetamine monotherapy does not >produce a persistent antidepressant response for >MDD and BD.
To be fair, many of the doctors willing to experiment with stimulants are probably dealing with treatment resistant patients. Treatment resistant patients aren't a fair way to compare drugs, since they have often failed conventional treatments too. Stimulants are never prescribed first line.
>Why the quotation marks given your above >statement?Just becasue a substance has a potential for abuse, doesn't mean that it always leads to abuse.
The benzos are a good example. There are people who have used theraputic doses for years. I don't think a doctor should cut off a trial of a benzodiazapine just because it has abuse potential.The SSRI's have become the treatment modality for anxiety disorders to replace the benzodiazapines for the express reason that they are less addictive. This doesn't imply that the SSRI's are any more effective for anxiety disorders, only thay they are perhaps safer (or at least they are promoted as being safer). Another example would be how the SSRI's have replaced the TCA's dispite any significant proof of superior efficacy.
>Perhaps you are - not me, thanks.Well it seems SLS, that you have had some of the most open, understanding, and experiementive doctors available. If your doctor said, I won't prescribe an MAOI because they are unsafe, then you would have been screwed.
>Too apathetic to function? Too damn bad. Take >your Paxil and shut up.Its true. With depression, doctors just reach a point, then they conclude you are a complainer and that your suffering is somehow your own fault.
>This has not been my experience with >psychiatrists, and I don't think I could agree >with such a generalization. If you have been >treated this way, then you have not been given a >fair opportunity to achieve wellness.There are a lot of people who have not been given a fair opportunity to achieve wellness. 3-5 minaute psychiatris appointments once every 6 months would be a perfect example.
> That, I think, is the problem: shrinks really >don't respect or value their patients.I would agree. I think they just get tired of hearing people complain, esp. since they know most of their drugs are placebos.
Linkadge
Posted by psychobot5000 on January 15, 2007, at 15:12:56
In reply to Re: Depressives' sensitivity to stimulants!, posted by laima on January 15, 2007, at 0:19:09
> I agree, I think the concern about a depressed person experiencing a crash from stimulants is probably the most legeit reason doctors might want to not use them, but the thing is, I don't think a crash is guarenteed. I don't think I experience this from the low doses I use.
>______________Me neither. Been prescribed amphetamines and several formulations of methylphenidate, and never experienced any sort of 'crashing.' The benefit merely recedes, and I move back to baseline, usually feeling better because I'm more accomplished. 'Crashing' does not seem to happen to the majority of patients, as far as I can tell. Though certainly a substantial minority.
>
Were these disorders (ADD) first organized before or after stimulants fell out of favor for depression?
>_______________...As for why docs generally stopped using stims for depression, I think the primary reason (besides bad publicity for stims, and the headache of dealing with meds that have abuse-potential) was the creation of conventional ADs. I've read that amphetamine was referred to as "the antidepressant" in the 1940s, but the better efficacy (for many patients) of tricyclics seems to have led to its downfall as a first-line treatment.
> I mean, I believe in them, I identify with the innattentive type attention deficit, but I'm curious about how the history sorts out. I also think there might be some overlap with the symptoms, ie, innattentive and frustrated due to depression, or attention deficit?
>___________
The symptoms of 'depressive pseudodementia' are near-identical to 'innattentive ADD,' and many of the pdocs I've met have been aware of this similarity. The DSM-IV specifically states that one of the criteria for diagnosing ADHD is that the ADHD symptoms not be caused by another psychiatric disorder, and I think that the similarity to many depressive states is part of the reason why.There is also some bias in theory, I think, as today's docs sometimes prefer to think that depression is dependent on serotonin, and stims don't affect it as much as DA and NA. Also, conventional ADs could be interpreted (because they produce a steady state of mood-elevation and such) as resolving the underlying problem of depression, whereas the withdrawal of benefit from the patient (from stims), as the blood-levels recede, seem to suggest that stimulants only treat the symptoms without treating the cause.
I can understand practitioners' reasons for being wary, and their desire to use other meds for first and second-line treatments, but I think they should be more open to them thereafter, especially for treatment-resistant depression, and as adjuncts to other treatment(MAOis included).
Posted by blueberry1 on January 15, 2007, at 16:10:20
In reply to Stims vs conventional ADs, no crashing, AD theory » laima, posted by psychobot5000 on January 15, 2007, at 15:12:56
I say give the patient a stimulant sooner rather than later. It offers the potential of immediate benefit vs a 6 week wait. If it doesn't work in 1 week, forget it. No big loss of time compared to switching or starting antidepressants.
It also takes the whole overlap theory stuff between ADHD, ADD, anxiety, and depression off the table. Either the stim will help the patient or it won't, plain and simple. Most important, win or lose, it is a FAST trial. Even the most ill patients can afford one week. But 6 weeks can be an eternity.
In the fear of abuse, that is easy for doctors to monitor with careful prescribing practices (for example, instructions to the pharmacy to only issue one week's worth of the prescription at a time). In terms of tolerance or poopout, that happens with some people and not others. Just like every other conventional med on the market. For a very skeptical fearful doctor, they could at least let a patient who likes a stimulant use it at first while starting an antidepressant and slowly withdraw it as the antidepressant takes over. In the end if the antidepressant alone doesn't do the job, at least everyone knows what will.
Mileage obviously varies. Some people get horribly depressed on stimulants. Go figure.
Posted by laima on January 15, 2007, at 16:11:12
In reply to Re: Depressives' sensitivity to stimulants!, posted by linkadge on January 15, 2007, at 9:02:37
Me too! A sense of satisfaction to relish.
> I agree, I didn't really crash from ritalin when I was depressed. Infact I felt ok at the end of the day because I had got more done, and that I had dug myself a little futher out of the hole.
>
>
> Linkadge
Posted by laima on January 15, 2007, at 16:17:05
In reply to Re: Depressives' sensitivity to stimulants!, posted by linkadge on January 15, 2007, at 13:20:44
Isn't it true though, that if a doctor goes crazy writing prescriptions for stimulants, and a number of patients end up abusing them, selling them, depressed patient has a hard crash--or who knows what- doctor's liscence is in jeopardy? That may be a motivation for exercising restraint in writing these prescriptions. Doctors may understandably prefer to first try non-abusable precriptions first.
Posted by laima on January 15, 2007, at 16:27:14
In reply to Stims vs conventional ADs, no crashing, AD theory » laima, posted by psychobot5000 on January 15, 2007, at 15:12:56
Thanks for all of the interesting information.Yes, I think most of us are aware that the DSM changes from edition to edition, with new disorders , such as "internet addiction" being added, and some, such as "homosexual" being removed. There were some articles in the New York Times late last fall about the malleability of the existing disorders, too. As for that seratonin emphasis, I can't help but wonder if the emphasis wasn't invented or exaggerated by the marketers of SSRIs- I mean, if only it were that simple for all of us.
As for the assertion that stimulants only treat symptoms not causes, I'd have to protest. I don't mean it's not at all true, I actually think the same claim could be made for many antidepressents. And if a stimulant prompts a lethargic person to get up, socialize, and get involved with activities and life in general, leading to a sense of satisfaction and engagement- whose to say that it is "only treatingt symptoms"? I think it's fuzzy.
Posted by linkadge on January 15, 2007, at 17:43:12
In reply to Re: Stims vs conventional ADs, no crashing, AD theory » psychobot5000, posted by laima on January 15, 2007, at 16:27:14
The serotonin theory is very weak.
There are only a limited number of studies showing that serotonin breakdown products are lower in depression. Studies involving serotonin depletion are conflicting and do not fully support a serotonin hypothesis.
Let us even suppose that metabolite levels of serotonin are low in depression. That could be an indicator of a lot of things. It is interesting to note that SSRI's and MAOI's actually lower the levels of serotonin breakdown products by inhibiting the metabolism of serotonin. So, SSRI's or MAOI's are not fixing any of the observable differences in depressives.
YOu take a paitent with low levels of serotonin breakdown products, put them on an SSRI, and now their serotonin breakdown products are even lower.
What on earth does that say?
It says nothing about what is wrong, nor does it even say that the drugs correct anything.
For all we know the low metabolite levels are a result of undermetabolism of serotonin. Ie metabolism pathways are already sluggish.
Its really just a bunch of B.S. to make the layman thing its all technical, and that the drugs are space age, and that psychiatry is so advanced.
Linkadge
Posted by SLS on January 15, 2007, at 19:37:49
In reply to Re: Depressives' sensitivity to stimulants!, posted by linkadge on January 15, 2007, at 13:20:44
Doctors don't use amphetamine monotherapy to treat MDD and BD because it doesn't work. It tends not to bring one to remission and keep them there for more than a week or two. It is not the best kept secret in psychiatry that it does. It is not some long-lost piece of knowledge that the most dedicated of researchers have neglected to revisit.
> Well it seems SLS, that you have had some of the most open, understanding, and experiementive doctors available.
I trained them well. :-)
I am priveledged to have worked with some of the best. I've learned quite a bit from various perspectives. However, I have never generalized to an entire profession a set of characteristics, good or bad, in ways that I have seen here. Making such a polarized generalization that is all inclusive is not a reflection of reality. There are too many good doctors out there.
> I think they just get tired of hearing people complain, esp. since they know most of their drugs are placebos.
How apropos.
- Scott
Posted by SLS on January 15, 2007, at 19:44:18
In reply to Re: Depressives' sensitivity to stimulants!, posted by linkadge on January 15, 2007, at 13:20:44
> > I think they just get tired of hearing people complain, esp. since they know most of their drugs are placebos.
>
> How apropos.
Sorry for the sarcastic remark.:-(
- Scott
Posted by psychobot5000 on January 15, 2007, at 19:56:14
In reply to Re: Stims vs conventional ADs, no crashing, AD theory, posted by linkadge on January 15, 2007, at 17:43:12
Posted by psychobot5000 on January 15, 2007, at 20:10:50
In reply to Re: Depressives' sensitivity to stimulants! » linkadge, posted by SLS on January 15, 2007, at 19:37:49
> Doctors don't use amphetamine monotherapy to treat MDD and BD because it doesn't work. It tends not to bring one to remission and keep them there for more than a week or two. It is not the best kept secret in psychiatry that it does. It is not some long-lost piece of knowledge that the most dedicated of researchers have neglected to revisit.
>It is known that -some- people lose the mood benefit of stims with tolerance, and that in others it causes depression. Many patients find amphetamine monotherapy inadequate. But I've never seen any evidence indicating, (as many docs and writers manage to suggest) that therefore -everyone- loses the mood-elevating effect of stimulants with time. I think this is a conflation of theories of stimulant abusability (ie, response to downregulation after the initial dose) with a phenomenon experienced in a portion of patients. Many patients in this community seem to find stimulants very useful in the long term, after all--and we tend to be very treatment resistant.
I have read case-reports of people who use them successfully for the long term, even as monotherapy. Many docs will confidently state that amphetamine monotherapy doesn't work in the long term, but I find that these same docs are:
1) Young--fresh out of school, and with relatively limited clinical experience, also freshly indoctrinated with serotonin theory.
2) Refuse to write for stimulants in the first place--thus making it unlikely that they have much experience with their use in depression.
In any case, those of us in this community are not good benchmarks for AD efficacy, I'd say, since we tend to be resistant to everything. In fairness, I note that you were specifically condemning amphetamine -monotherapy-, which seems reasonable. But then...what medication is adequate as monotherapy?Best,
P-bot
Posted by SLS on January 15, 2007, at 20:15:12
In reply to Re: Depressives' sensitivity to stimulants! » linkadge, posted by SLS on January 15, 2007, at 19:44:18
There are some studies that demonstrate an association between an acute antidepressant response to amphetamine (but not methylphenidate) and a positive response to antidepressant (tricyclic) treatment.
Note that these mental giants were too dumb to consider using amphetamine chronically to see if it were useful as a long-term treatment. Perhaps it never entered their minds. It's funny, though. I didn't detect a trace of stupidity when I spoke to Dennis Murphy several years ago regarding selegiline and propargyl derivatives. Maybe he's just dumb when it comes to stimulants. Or maybe he's smart there too.
I don't have a problem with using amphetamine. I am not terribly concerned with abuse. I certainly believe that it has an important place as an augmentor of standard antidepressants. I might want to add Adderall to my regime if I get stuck. However, as monotherapy to treat MDD or BD, I question its efficacy beyond the acute response.
- Scott
----------------------------------------------Am J Psychiatry. 1978 Oct;135(10):1179-84. Related Articles, Links
Prediction of imipramine antidepressant response by a one-day dextro-amphetamine trial.
van Kammen DP, Murphy DL.
This study provides additional evidence that there is a moderate association between the acute activation, euphoria, and antidepressant responses to dextro-amphetamine and the antidepressant response to imipramine during a four-week trial. Comparison of the responses of 13 patients to dextro-amphetamine on two different days during a double blind trial indicated that differences in dextro-amphetamine response are consistent, replicable characteristics of individual depressed patients. The variables of sex, diagnosis, diurnal mood variation, platelet MAO activity, and MMPI scale scores were of minimal assistance in revealing factors that might be associated with activation or antidepressant responses to dextro-amphetamine in this small patient group. The authors suggest the need for larger-scale studies in this area.
Publication Types:
* Clinical Trial
* Controlled Clinical Trial
PMID: 358845 [PubMed - indexed for MEDLINE]Display Show
-------------------------------------------------
1: J Clin Psychopharmacol. 1988 Jun;8(3):177-83. Links
Comment in:
J Clin Psychopharmacol. 1989 Dec;9(6):453-4.Amphetamine, but not methylphenidate, predicts antidepressant efficacy.
* Little KY.
Department of Psychiatry, University of Kentucky Medical Center, Lexington 40536-0080.
Several researchers have explored the possibility that acute stimulant response may predict eventual improvement after specific antidepressants. This review analyzes the relationship between stimulant response and nonspecific antidepressant response. In five studies, amphetamine responders were found to eventually improve after antidepressant treatment in 85% of the cases, while nonresponders improved in 43% of the cases. In contrast, acute methylphenidate responders and nonresponders eventually improved on antidepressants at equivalent rates. Amphetamine sensitivity appears to be a trait (possibly pharmacodynamic) that is independent of depressive illness but predictive of tricyclic responsiveness. Other evidence has suggested that amphetamine and methylphenidate cause similar behavioral and symptomatic effects through distinct mechanisms of potential clinical relevance. The most effective method for administering an amphetamine challenge and its appropriate clinical use remain unclear.
PMID: 3288653 [PubMed - indexed for MEDLINE]
Posted by linkadge on January 15, 2007, at 20:26:48
In reply to Re: Depressives' sensitivity to stimulants! » linkadge, posted by SLS on January 15, 2007, at 19:37:49
>Doctors don't use amphetamine monotherapy to >treat MDD and BD because it doesn't work.
I'm not so sure about that. Again, if it didn't work, or if conventional antidepressants worked better, you wouldn't see the ratings for certain stimulants superior to antidepressants on pages like www.remedyfind.com (recently changed to something new)
>It tends not to bring one to remission and keep >them there for more than a week or two.
When they were promoted for depression in the past, they must have been effective for more than a week. Some people develop tollerance to their effects for ADHD, some do not. I would suspect that some people can attain an antidepressant effect that lasts longer than for others.
>It is not the best kept secret in psychiatry >that it does. It is not some long-lost piece of >knowledge that the most dedicated of researchers >have neglected to revisit.
Well, in some ways it is being revisited. Psychostimulant augmentation is alluded to in many places, not officially promoted though, just as opiates are not officially promoted for depression. That doesn't mean there isn't a resurgance of interest in their theraputic potential.
When I took ritalin SR, it was a much better antidepressant than any SSRI. While some tollerance developed within a few months I still felt more fuctional, and more like myself than on SSRI's. It was virtually side effect free.
It also helped certain symptoms much more than others. In particular, social withdrawl, anhednonia, apathy, interest, energy etc.
I think that some are interested in stimulants for depression because many antidepressants do precious little to help these symtpoms if not make them worse.
Linkadge
Posted by linkadge on January 15, 2007, at 21:02:40
In reply to Re: Depressives' sensitivity to stimulants!, posted by SLS on January 15, 2007, at 20:15:12
>Note that these mental giants were too dumb to >consider using amphetamine chronically to see if >it were useful as a long-term treatment. Perhaps >it never entered their minds.
But its not about just that. There are many more factors involved in the decision against the widspread use of amphetamines for depression. In order for a drug to be approved, it needs to be effective in a substantial proportion of patients, and generally be without abusability.
Consider amineptine. Arguably a very effective antideprssant, with remarkably few side effects. Especially effective in certain populations unresponsive to other treatments. Why was it taken off the market? Purely because of abuse *potential*. Did every patient who took it abuse it? Of course not.
Is that fair for the patient who would may have achieved long term remission with it? No. Its that psychiatry doesn't care about the exceptional patients. They only care about the all in one wonder drug fix-all.
Are we saying that investigators were too dumb to look at amineptine further? No, its just that they stopped when they encountered abuse potential.It was not removed for lack of efficacy. I don't even think it was removed because of any evidence of lack of long term efficacy.
If a potential antidepressant is shown to posess some abuse potential in mice, it is generally not investiaged further. Its just a no-no area. They have to make an overal rule.
It is interesting to note that amphetamine administration increases PEA concentrations, but that methylphenidate does not. I believe that long term amphetamine adminstration still affects PEA concentrations.
The activity of amphetamine also resembles the activity of PEA more than methyphenidate does. PEA concetrations are low in certain forms of depressive disorder, but not all.
http://www.neurotransmitter.net/adhdpea.html
Stimulants, urinary catecholamines, and indoleamines in hyperactivity. A comparison of methylphenidate and dextroamphetamine.
Children with attention deficit disorder with hyperactivity were given either methylphenidate hydrochloride or dextroamphetamine sulfate to compare the effects on urinary excretion of catecholamines, indoleamines, and phenylethylamine (PEA). Methylphenidate's effects were distinctly different from those of dextroamphetamine. After methylphenidate administration, both norepinephrine (NE) and normetanephrine (NMN) concentrations were significantly elevated, and there was a 22% increase in excretion of 3-methoxy-4-hydroxyphenylglycol (MHPG). In contrast, after dextroamphetamine treatment, MHPG excretion was significantly reduced and NE and NMN values were unchanged. Excretion of dopamine and metabolites was unchanged by either drug. Urinary PEA excretion was not significantly changed after methylphenidate treatment, but increased 1,600% in response to dextroamphetamine. Methylphenidate treatment did not significantly alter serotonin or 5-hydroxyindoleacetic acid excretion. Effects of dextroamphetamine were not tested." [Abstract]
Linkadge
Posted by SLS on January 15, 2007, at 21:06:12
In reply to Re: long-term stimulant AD use » SLS, posted by psychobot5000 on January 15, 2007, at 20:10:50
> > Doctors don't use amphetamine monotherapy to treat MDD and BD because it doesn't work. It tends not to bring one to remission and keep them there for more than a week or two. It is not the best kept secret in psychiatry that it does. It is not some long-lost piece of knowledge that the most dedicated of researchers have neglected to revisit.
> Many patients in this community seem to find stimulants very useful in the long term, after all
I certainly don't profess to read every post (I wish I could), but I don't recall anyone ever saying that they attained remission on stimulant monotherapy. But then again, I don't think I've seen anyone try it. I see lots of people using Adderall in combination with other drugs, though.
> --and we tend to be very treatment resistant.
Yes. Point well taken. That's why it is difficult to debate the efficacy of drugs based upon the historical experiences of people on Psycho-Babble. Antidepressants work. You might not know it from reading the posts on PB, but they do. I base my opinion on the whole as I have come to know it, and not on the relatively small community of treatment-resistant cases that we have here. I would rather take hope from the whole than hopelessness from the minority. Sometimes the difference between the two is the luck of choosing the right drugs in the sequence of trial and error, rather than a lack in the existence of an effective treatment.
My only motivation at this point for proposing the inferiority of amphetamine as monotherapy in MDD and BD is to save people time and possible frustration and discouragement. However, I wouldn't want to have someone skip over a possibly effective treatment based upon something that I had to say. So...
I don't think this is worth debating any further. Anything more would probably just be an academic exercise. I would not discourage anyone from trying amphetamine monotherapy if that is what has been decided as being the next step. Trial and error, right? There are plenty of questions one could ask about what are the parameters of a fair trial of amphetamine. How much? How long? I have my own ideas, but I'll let the experts chime in first.
- Scott
Posted by Phillipa on January 15, 2007, at 21:06:49
In reply to Re: Depressives' sensitivity to stimulants!, posted by linkadge on January 15, 2007, at 20:26:48
RemedyFind is undergoing being bought out tried to register there both yesterday and today and they must be having problems or the deal isn't complete yet. If anyone finds out how to do it please let me know Thanks Phillipa
Posted by laima on January 15, 2007, at 23:05:22
In reply to Re: long-term stimulant AD use » SLS, posted by psychobot5000 on January 15, 2007, at 20:10:50
Indeed, there are many positive reports about using stimulants for depression on remedyfind. My own doctor says that many people use stimulants successfully for years- the theory is that they flush out at night, allowing the brain to recoup (unlike most conventional antidepressents). He was talking about ADD patients though. Even if the mood boost itself fades, I figure having concentration and wakefulness under control could do wonders for morale.> It is known that -some- people lose the mood benefit of stims with tolerance, and that in others it causes depression. Many patients find amphetamine monotherapy inadequate. But I've never seen any evidence indicating, (as many docs and writers manage to suggest) that therefore -everyone- loses the mood-elevating effect of stimulants with time. I think this is a conflation of theories of stimulant abusability (ie, response to downregulation after the initial dose) with a phenomenon experienced in a portion of patients. Many patients in this community seem to find stimulants very useful in the long term, after all--and we tend to be very treatment resistant.
>
> I have read case-reports of people who use them successfully for the long term, even as monotherapy. Many docs will confidently state that amphetamine monotherapy doesn't work in the long term, but I find that these same docs are:
>
> 1) Young--fresh out of school, and with relatively limited clinical experience, also freshly indoctrinated with serotonin theory.
>
> 2) Refuse to write for stimulants in the first place--thus making it unlikely that they have much experience with their use in depression.
>
Posted by blueberry1 on January 16, 2007, at 6:37:09
In reply to Re: Depressives' sensitivity to stimulants!, posted by SLS on January 15, 2007, at 20:15:12
I believe stimulants can and do work just like antidepressants for longterm therapy in some people...no more and no less than any other medication. The anecdotal hint of that is at remedyfind.
In some people stimulants probably fix the symptoms and not the cause. Same with antidepressants. In some people stimulants fix the actual cause. Same in some people with antidepressants. All depends on the individual cause and genetics.
While we usually like to think that antidepressants somehow correct an inherently wrong malfunction in the brain and reset it, stimulants can too. Granted many people do get an acute response that later fades. But then, that seems to happen real frequently with antidepressants too. There are people that like their stimulants as depression monotherapy for longterm. Some of them show up at remedyfind under the categories Provigil, Adderall, Dexedrine, and Desoxyn. They have all tried zillions of antidepressants. And there are a few lucky ones that get by nicely on their antidepressant for the longterm. I don't see any difference.
Posted by linkadge on January 16, 2007, at 11:53:55
In reply to Re: Depressives' sensitivity to stimulants!, posted by blueberry1 on January 16, 2007, at 6:37:09
There could be a lot of comorbidity too between depression and ADHD. One of the notable halmark differences in the brains of depressed people is hypometabolism of the left prefrontal cortex, the exact area that stimulants work to boost neural activity.
Depression is a bad cycle too. Negative mood affects concentration, poor concentration can result in the patient going into a deeper hole.
One suprising thing that ritalin did (for the duration that I took it) was improve sleep.
Even after the mood effects had somewhat faded, I was still sleeping better. Some people with ADHD notice this too, that sleep disturbances can decrease with stimulant treatment. So, I don't know whats up with that.Sometimes depression too is a rut, and if you can just get a little momentum to change certain things in ones life, then mood improvement may come more easily.
Linakdge
Posted by psychobot5000 on January 16, 2007, at 14:01:18
In reply to Re: long-term stimulant AD use » psychobot5000, posted by SLS on January 15, 2007, at 21:06:12
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