![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by utopizen on December 3, 2002, at 1:35:34
No one explained to me why uppers and downers are bad, it's just one of those things you're constantly told by never explained. Some vague notion of "one going up in your blood, the other going down" but why does this matter?
I mentioned to my p-doc that in the 60's, phenobarbital and methamphetamine were combined as one pill. I wondered if I could just have a Klonopin added to my Adderall regimen, and he was like, "well, that's where you get into the same problem with combining barbs with meth" (okay, he didn't say "barbs" or "meth"- lol)
Oh please! Klonopin isn't remotely as dangerous as a barb, not to mention millions of housewives took these barb and meth combos in the 60's for quite some time. But really, why is it a problem again? Does the heart get confused or something?
He also said he didn't want me on Ambien or Sonata or other sleeping pills b/c it's addictive and it's also a downer countering my day's Adderall.
Posted by viridis on December 3, 2002, at 2:55:42
In reply to So why is upper/downer combo bad again?, posted by utopizen on December 3, 2002, at 1:35:34
I think the general idea is that if you're taking something that makes you too "up", then need something to bring you "down", then need to go "up" again, and so on, you can get into a cycle of popping pills throughout the day to micro-regulate your alertness and mood, which in turn can lead to dependency, dose escalation, etc. I suspect that this was a genuine problem in the past (and still is for a few people).
But this is hardly a reason to avoid combination of drugs that have traditionally been classified as stimulants vs. tranquilizers, if the combination is appropriate. For example, if you have genuine ADD and anxiety problems (my situation), then a low dose of a benzo and a stimulant may be reasonable -- especially since one of the hallmarks of ADD is that some stimulants have a "paradoxical" calming effect. Klonopin and Adderall work well in combination for me at low doses of each, and it's not an up-down cycle, just stability after years of inappropriate treatment with SSRIs etc. But a lot of doctors simply don't understand this, or don't want to deal with the potential red tape. I think the best strategy is to find a doctor (ideally psychiatrist) who does understand, and is willing to provide appropriate treatment.
Posted by Mr Cushing on December 3, 2002, at 10:11:25
In reply to So why is upper/downer combo bad again?, posted by utopizen on December 3, 2002, at 1:35:34
Honestly man... I would look for a Doctor that comes from THIS Century. Even though it would be a hassle to find another Doctor, and you'll lose that comfortability factor, it all comes down to what helps you best. Benzos have helped me a great deal IF you're not using them as your primary medication. It's great as an "add-on" medication. If I start to feel a little bit out of it, it brings me back down to the "normal" level without making me want to pass out cold and sleep for the rest of the day. There are basically no side effects. And, 2 years ago, after taking both Celexa and Clonazepam for about 2 years, I quit both cold turkey because I wanted to see what would happen if I went without medications, and honestly, neither of them were that hard to quit.Maybe you could even still see the same doctor for Therapy and whatnot, but get another doctor to monitor your medications. That's actually what I'm looking into for myself at the moment because my PDoc is too old-school to know how to properly administer some of the newer MS's.
Posted by dave40252 on December 3, 2002, at 14:50:56
In reply to So why is upper/downer combo bad again?, posted by utopizen on December 3, 2002, at 1:35:34
> I mentioned to my p-doc that in the 60's, phenobarbital and methamphetamine were combined as one pill.
Was this a prescription medication or some recreational combo? The reason I ask is that years ago I was given a doctor's sample capsule (it was green and clear) of a medication. I remember it had such a marked effect - I just felt good, not speedy, not high, just good. I have a vague recollection of being told it was a mix of upper and downer. I have often thought that drugs like this could be a great help to many of us with treatment resistent problems and what a shame it is that doctor's ability to use these things has been limited by our government's obession with restricting the use of anything with abuse potential. Just think how many things docs won't give because of that misguided attitude.
Posted by utopizen on December 3, 2002, at 15:41:40
In reply to Re: So why is upper/downer combo bad again?, posted by dave40252 on December 3, 2002, at 14:50:56
It's actually rather easy to convince a doc to try Desoxyn, if your stims aren't working or producing things like eye tics or other ungodly things.
Desoxyn is methamphetamine HCL. My benzophobic doc prescribed it even though he didn't know it existed before I told him. Odd.
And you can still get barbituates, only you have to become a dog or cat in a future life. Don't become a horse, because they typically receive high doses of Klonopin for sedation. Pets get these meds for epillepsy (sp) and so do people, for the same reason.
I'm reading up on barb books. It's awfully dangerous, given the therapeutic dose to the lethal dose's narrow margin. It's incredible how liberally Desbutal and Dexamyl were prescribed by docs in the 60's for weight loss and depression. Millions of these pills were sold.
Posted by Geezer on December 3, 2002, at 15:48:01
In reply to Re: So why is upper/downer combo bad again?, posted by dave40252 on December 3, 2002, at 14:50:56
> > I mentioned to my p-doc that in the 60's, phenobarbital and methamphetamine were combined as one pill.
>
> Was this a prescription medication or some recreational combo? The reason I ask is that years ago I was given a doctor's sample capsule (it was green and clear) of a medication. I remember it had such a marked effect - I just felt good, not speedy, not high, just good. I have a vague recollection of being told it was a mix of upper and downer. I have often thought that drugs like this could be a great help to many of us with treatment resistent problems and what a shame it is that doctor's ability to use these things has been limited by our government's obession with restricting the use of anything with abuse potential. Just think how many things docs won't give because of that misguided attitude.Believe the drug you are thinking of was called Dexamil(sp).
Posted by leslieg on December 3, 2002, at 17:01:35
In reply to So why is upper/downer combo bad again?, posted by utopizen on December 3, 2002, at 1:35:34
I'm a depressed narcoleptic. I take Provigil (a non-amphetamine "upper") during the day (as well as coffee and Lexapro). I also have Ambien to take on nights I need it. I saw both my pdoc and my sleep doc today and both are really happy with Ambien, call it a wonderfully safe drug. Can be abused, can be psyhologically addictive (anything can be, for that matter), but not physically addictive. Ambien wears off quickly (many folks wake up 4-5 hours after taking it, I do, but I get back to sleep easily enough.) It doesn't make you groggy in the am. I don't need to take more Provigil now that I'm also taking Ambien (4-5 nights a week.) I agree with other's advice -- your doc doesn't seem very much in the know about these newer meds.
> He also said he didn't want me on Ambien or Sonata or other sleeping pills b/c it's addictive and it's also a downer countering my day's Adderall.
Posted by jackt on December 4, 2002, at 7:51:34
In reply to Re: So why is upper/downer combo bad again?, posted by viridis on December 3, 2002, at 2:55:42
viridis,
do you take Klonipin at night only, or are you taking it with the Adderall during the day? I have GAD and ADD. Ritalin by itself only increases my anxiety. Klonipin taken at night ensures a good night sleep, but I am sort of out-of-it the next day and my short-term recall is terrible. Even the lowest doses of these medications have a severe impact on my body.
Currently, am trying Remeron at night and Ritalin during the day. If this doesn't work I'm going to add Effexor to the Remeron. I have never tried Adderall.
I've already tried Serzone, Buspar, Depakote and many of the benzos, but I never tried a drug combo until now. Other SSRIs haven't worked either, but I'm willing to give Effexor a try.
Do you have any thoughts?
Posted by BeardedLady on December 4, 2002, at 9:13:42
In reply to So why is upper/downer combo bad again?, posted by utopizen on December 3, 2002, at 1:35:34
My therapist takes Nyquil at night and Dayquil in the day. He's always telling me that it's okay for him to do it because he doesn't have an anxiety problem.
I have mentioned that I like how I behave on speedy drugs, like caffeine. I never used to have trouble falling asleep, though. But now that I take Serzone and a sleep aid sometimes (it feels like all the time, now), he says I can't have uppers of any kind anymore.
Go figure. I guess it's just not natural.
But the half-life of Sonata (it's life is only four hours, and it's half life is relatively short) never caused me trouble or gave me sleepiness during the day. I can't imagine it would be that much trouble.
When I don't get the answer I want or understand. I ask again. Get some satisfaction.
beardy
Posted by oracle on December 4, 2002, at 17:56:45
In reply to So why is upper/downer combo bad again?, posted by utopizen on December 3, 2002, at 1:35:34
The upper/downer combo can have weird
effects. Like wide awake one min and fast asleep
another. Knodding off, basically. A real pain
while driving or using a chainsaw.
Posted by viridis on December 5, 2002, at 4:07:30
In reply to Re: So why is upper/downer combo bad again?, posted by jackt on December 4, 2002, at 7:51:34
Hi Jackt,
I take my whole dose of Klonopin (1 mg) in the morning, along with 5 mg of Adderall, and then I often take another 2.5-5.0 mg Adderall later in the day. I tried taking Klonopin before bed at first, but found that the anti-anxiety effects wore off by the middle of the next morning or so.
It did take me a couple of weeks to get used to Klonopin (I was a bit sleepy, clumsy, and forgetful). Initially I tried different dosing strategies, dividing it throughout the day, but the side effects wore off pretty fast and I soon found that one dose in the morning was fine. I no longer notice any side effects at all.
Are you taking it on a regular basis, or just occasionally? It's possible that you just haven't gotten past the side effect stage, or are taking it so infrequently that it affects you strongly when you do. Or maybe you're just one of those people who's very sensitive to K. For some, substitution of another benzo (e.g., Xanax) can make all the difference. I respond very well to Klonopin and Xanax, but Valium, another benzo, makes me feel dull and sleepy.
I've never tried Ritalin -- my psychiatrist was in favor of a stimulant (for my ADD), but said that he thought Ritalin was the most likely to increase anxiety. I tried Provigil for a while, and it was fine, but didn't help enough with concentration and focus. It might be worth a try, though; my pdoc says he's seen some people with attention problems respond well, but considers it kind of hit-or-miss. I did find it energizing without making me anxious, and had no problems taking it with Klonopin. For me, Adderall works well and if anything, has a calming effect at low doses.
I also take Neurontin (400 mg 3X/day). My pdoc considers it a very "subtle" mood stabilizer. It made me very mellow the first few times I took it, and now I don't notice anything. Some here find it to be very good for anxiety on a long-term basis.
I can't tolerate SSRIs or Wellbutrin at all; I haven't tried Serzone or Remeron, so can't comment there, except to say that I have a couple of friends with anxiety and depression who have done very well with Serzone.
So, for me, Klonopin + Adderall (+ Neurontin, which I'm not sure is doing anything) is a very good combo. Others here have also commented on a "synergy" between K and Adderall, so it might be worth a try, and Neurontin might be too -- most doctors seem to consider it very safe.
I should add that I also take Xanax occasionally. It's no longer a big part of my treatment, but is great for shutting down anxiety, ruminating thoughts, and insomnia. Some people find it much better than Klonopin, especially for quick anxiety relief.
I hope this helps!
Viridis
Posted by jackt on December 12, 2002, at 11:14:50
In reply to Re: So why is upper/downer combo bad again? » jackt, posted by viridis on December 5, 2002, at 4:07:30
viridis,
Thanks for the reply. I have been out of town and just got the posting. I took Klonipin for about a month and for me, it made me very forgetful and in a fog. I tried reducing the dosage, but then it wasn't as effective on the anxiety.
The other benzo's work well on my anxiety, even better than Klonipin. However, they also make me feel more lazy and forgetful than Klonipin.
It's strange, my wife can take a Ativan and feel no effect whatsoever. I've tried Ativan, xanex, and valium. They all knock out my anxiety.
I'm at the end of my first week with the effexor/remeron combo. I'm going to give this regimen 5 -6 weeks. If it doesn't work, then I may try your suggestions of Adderall, neurtonin and possibly Klonipin again.
Thanks again for your help.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.