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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by MB on July 17, 2000, at 12:06:34
I've been noticing lately that it is far more common today for docs to use stimulants as adjuncts to antidepressant therapy than it was ten years ago, when I was diagnosed. Is the theory that antidepressants are often only partially effective, and that stimulants give the extra boost out of depression? I am curious, and always have been, why stimulants aren't just used as monotherapy (aside from abuse problems) in the treatment of depression. Personally, I can't imagine being depressed on a stim (maybe anxious, but never depressed). I guess for non-ADDers, side effects of stims can be rough, but are they any rougher than the side effects of antidepressants?
Just wondering
MB
Posted by Libby on July 17, 2000, at 12:48:22
In reply to Stimulants as monotherapy for Depression?, posted by MB on July 17, 2000, at 12:06:34
MB... I found it a little disturbing that my doc was more willing to diagnose Bipolar than ADD and that he was more willing to prescribe anti-convulsants, tranquilizers, and anti-psychotics than a stimulant.
Posted by stjames on July 17, 2000, at 21:27:25
In reply to Re: Stimulants as monotherapy for Depression?, posted by Libby on July 17, 2000, at 12:48:22
> MB... I found it a little disturbing that my doc was more
willing to diagnose Bipolar than ADD and that he was more willing to prescribe anti-convulsants, tranquilizers, and anti-psychotics than a stimulant.
James here....Bi polar and stims don't always mix as stims can
start cyclying in some. Stims are often used to
counteract sedation from AD or depression itself.
Stims work is synergy with AD's increasing the effectiveness
of each med. I talked about this in a long post 1-3 sessions ago, take ]
a look at the archive. As monotherapy stims are great at first but
can make you more depressed over time. Mood is 24/7 so you need a
longer acting med than a stim to have even mood.
Taking stim w/AD often means you can take less of the AD's
and stims if taken together. I need 150 mgs Effexor on Dex
and 300+ off dex. If I take dex when I am signifanctaly
depressed it makes things worse but if I am stable
the benifits are taking less of each and excellent
mood, I would say normal mood.james
Posted by danf on July 18, 2000, at 4:38:47
In reply to Stimulants as monotherapy for Depression?, posted by MB on July 17, 2000, at 12:06:34
To add to what James has said.
Stims are not used for monotherapy because they do not work as treatment for depression. For some they work in combo with an AD.
If they worked, they probably would not be addictive at a proper dose. This seems to be the case when they are used in a combination regimen.
one can certainly be agitated on a stim & still very depressed.
Posted by Libby on July 18, 2000, at 11:40:35
In reply to Re: Stimulants as monotherapy for Depression?, posted by stjames on July 17, 2000, at 21:27:25
Thanks James... It's good to know that BEFORE I start tapering off the AD. Are you Bipolar, by the way?
Posted by stjames on July 18, 2000, at 12:11:50
In reply to Re: Stimulants as monotherapy for Depression?, posted by Libby on July 18, 2000, at 11:40:35
> Thanks James... It's good to know that BEFORE I start tapering off the AD. Are you Bipolar, by the way?
James here....
No "just" depression and ADD. I don't know any Bipolar's with ADD but do know some Bipolars. Their experiences with stims have not been positive.
james
Posted by Libby on July 18, 2000, at 13:03:09
In reply to Re: Stimulants as monotherapy for Depression?, posted by stjames on July 18, 2000, at 12:11:50
> No "just" depression and ADD. I don't know any Bipolar's with ADD but do know some Bipolars. Their experiences with stims have not been positive.<
I think Janice (here) is both.
My trials of "Bipolar" drugs (particularly mood stablizers) flopped just as miserably. My moods may or may not have been stable. I was too out of it to tell. However, I will say that IF they were stable, they were stable at the lowest possible point. I never felt more depressed in my life.I guess it makes sense to try mood stablizers first, given that stims are really bad for Bipolars... but I am still a little angry about going through trial after trial (weeks!) of mood stablizers and other "zombie" drugs before my doc was willing to consider a simple three day trial of Ritalin. I know it is more unusual to find undiagnosed ADD in an adult than to find a mood disorder... it's just frustrating when you're one of the ones who bucks the statistics...
Posted by noa on July 18, 2000, at 18:03:41
In reply to Re: Stimulants as monotherapy for Depression?, posted by Libby on July 18, 2000, at 13:03:09
Another problem with stims for depression is that they are short acting and can cause rebound depression when they wear off. Antidepresssants, I think, can produce a smoother, more even effect.
Posted by jojo on July 19, 2000, at 16:29:17
In reply to Re: Stimulants as monotherapy for Depression?, posted by noa on July 18, 2000, at 18:03:41
> Another problem with stims for depression is that they are short acting and can cause rebound depression when they wear off. Antidepresssants, I think, can produce a smoother, more even effect.
I tried Dexadrine for several years before I could get antidepressants. This was in the middle of the 70', when my then psychoanalyst told me that antidepressants were like aspirin, they helped with the pain, but didn't
get to the "real" cause. (Expletive Deleted).
About 5% of the time it helped me get something accomplished
but generally just made me a stimulated depressive.
Antidepressants made me much less depressed, but
lacking both energy and "directed attention". Adderall and Ritalin
provided help in that area, and increassed the effectivness of the antidepressants.
I presently take 20 mg Celexa, 15 mg Remeron, 150mg
Wellbutrin, and 20-40 mg of Adderall or Ritalin.
The Adderall seems to be more effective, but it lasts too
long, and may be the cause of my difficulty in
falling asleep. I would like to try Desoxyn or get
Dexadrine legally, but so far haven't been able to.
I just switched psychiatrists (my fourth), so maybe
I can try them now. I don't want to frighten
him by asking for them though. I have stopped the Adderall
for a week or two and experienced no craving whatsoever.
I even wondered if amphetamine "addiction" actually
occured, but from what I've read here, it does in some people.
Interestingly, when I first tried AD, I tried imipramine
and I think Triavil, neither of which helped. Several
years later, I read a research article that said
that people who experience euphoria from amphetamine
respond to imipramine, but not Elavil, while those
who do not experience euphoria respond to Elavil
but not imipramine. I tried Elavil, and it helped.
Also effective were Prozac, and Celexa. Neither Wellbutrin
or Remeron taken alone (but with stimulents)
provided antidepression. I currently add them
to the Celexa because I cut down or stop the Celexa
for a few days
every week or so, and increase the Remeron to 30 mg, so that I can have an orgasm.
then I take 20 mg of Celexa for a few days before
returning to 20 mg
taken alone
This is the end of the thread.
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