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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 Saragram on November 25, 2002, at 9:38:52
I am doing very well on Lexapro for depression and anxiety, but occasionally need a xanax for breakthrough anxiety, usually in reaction to a stressful conversation/situation. Last week my pdoc confirmed my long-held belief that I've got ADD and have probably had it all my life. She referred me back to my GP for additional medication. The problem is that I am scared S**tless of taking ANY stimulant -- even caffiene gives me a case of the jitters, and the few times I've tried stimulants for dieting, it felt AWFUL. Won't any of the common ADD drugs do the same thing? BTW, I also have high blood pressure and am on a beta blockers and ACE inhibitor for that. Advice, PLEASE!
Posted by Ritch on November 25, 2002, at 13:28:34
In reply to What to take for ADD that won't worsen anxiety???, posted by Saragram on November 25, 2002, at 9:38:52
> I am doing very well on Lexapro for depression and anxiety, but occasionally need a xanax for breakthrough anxiety, usually in reaction to a stressful conversation/situation. Last week my pdoc confirmed my long-held belief that I've got ADD and have probably had it all my life. She referred me back to my GP for additional medication. The problem is that I am scared S**tless of taking ANY stimulant -- even caffiene gives me a case of the jitters, and the few times I've tried stimulants for dieting, it felt AWFUL. Won't any of the common ADD drugs do the same thing? BTW, I also have high blood pressure and am on a beta blockers and ACE inhibitor for that. Advice, PLEASE!
You could ask about Provigil. There have been some posters here that have found that it seems to have *lessened* their social anxiety. It's kind of pricey-haven't tried it myself. There's an occasional person who responds well to Buspar. I think they have approved a transdermal patch of buspirone for pediatric ADHD. Tricyclics like desipramine (esp.) and nortriptyline have been successful, but given your hypertension they may not be wise. Some folks find Wellbutrin to work well and not cause anxiety, but that tends to be the exception not the rule. good luck
Posted by utopizen on November 25, 2002, at 18:48:26
In reply to Re: What to take for ADD that won't worsen anxiety??? » Saragram, posted by Ritch on November 25, 2002, at 13:28:34
Just take some Desoxyn and Phenobarbital.
Desoxyn will work on ADD, while the Phenobarbital will work against your anxiety. It's a great combo.If it doesn't work, try Pentobarbital, or Seconal.
Posted by Donna Louise on November 25, 2002, at 19:46:34
In reply to Re: What to take for ADD that won't worsen anxiety, posted by utopizen on November 25, 2002, at 18:48:26
> Just take some Desoxyn and Phenobarbital.
>
> Desoxyn will work on ADD, while the Phenobarbital will work against your anxiety. It's a great combo.If it doesn't work, try Pentobarbital, or Seconal.Back in the '60's during my early self-medicating years, I used to abuse a drug called desbutal and that is what it was, one side was desoxyn and the other phenobarb, all in one pill. Supposed to be for dieting. I wonder if it is even manufactured these days...just reminescing, don't mind me.
Donna Louise
Posted by BekkaH on November 25, 2002, at 21:06:36
In reply to Re: What to take for ADD that won't worsen anxiety, posted by utopizen on November 25, 2002, at 18:48:26
Utopizen, I beg to differ with you. I think that the amphetamines can be - and are - very useful; however, Desoxyn, which is methamphetamine, is notorious for its neurotoxicity and should be used ONLY in the most severe, treatment-refractory cases. Long ago, methamphetamine was thought to be a safe drug. Now we know better. These days, Desoxyn/methamphetamine is used in research to create animal models of Parkinson's Disease and Schizophrenia.
Posted by Ritch on November 25, 2002, at 21:33:33
In reply to What to take for ADD that won't worsen anxiety???, posted by Saragram on November 25, 2002, at 9:38:52
> I am doing very well on Lexapro for depression and anxiety, but occasionally need a xanax for breakthrough anxiety, usually in reaction to a stressful conversation/situation. Last week my pdoc confirmed my long-held belief that I've got ADD and have probably had it all my life. She referred me back to my GP for additional medication. The problem is that I am scared S**tless of taking ANY stimulant -- even caffiene gives me a case of the jitters, and the few times I've tried stimulants for dieting, it felt AWFUL. Won't any of the common ADD drugs do the same thing? BTW, I also have high blood pressure and am on a beta blockers and ACE inhibitor for that. Advice, PLEASE!
If you were to try a "first-line" stimulant, I found Dexedrine tablets to provoke the least amount of anxiety (overall) than either Ritalin, Focalin, or Adderall. You mentioned taking a stimulant for "dieting", which one did you take? Was it Ionamin or Tenuate? Tenuate is related to Wellbutrin chemically. Wellbutrin caused more anxiety for me than *any* of the classic stimulants. If your pdoc wants to try a stimulant, I would go with the very cheap Dexedrine tablets for a first trial. They have a duration of action of approx. 4-6 hrs, so they shouldn't keep you up at night. Try half a tablet (2.5mg) 2-3x daily and see how you do. Many folks with comorbid ADHD and anxiety find dexedrine to have a calming effect-you won't know until you give it a try.
Posted by utopizen on November 25, 2002, at 23:02:02
In reply to for ADD that won't worsen anxiety - utopizen, posted by BekkaH on November 25, 2002, at 21:06:36
> Utopizen, I beg to differ with you. I think that the amphetamines can be - and are - very useful; however, Desoxyn, which is methamphetamine, is notorious for its neurotoxicity and should be used ONLY in the most severe, treatment-refractory cases. Long ago, methamphetamine was thought to be a safe drug. Now we know better. These days, Desoxyn/methamphetamine is used in research to create animal models of Parkinson's Disease and Schizophrenia.
>>Oh, a little Desoxyn never hurt anyone. Animal models poo-ee. The levels that would cause parkinson's, are you kidding me? Desoxyn is regularly prescribed to children in this country.
I took it for a month, my doc let me try it to see if it would not make me as anxious... it did anyway, so I switched back to Adderall. If it was neurotoxic at therapeutic doses, the FDA wouldn't allow it-- and it certainly is not in the PDR, so you must "know better" than my doctor if this is the case.... where are you getting this info from? That's quite a charge against a widely used drug.
Posted by utopizen on November 25, 2002, at 23:23:24
In reply to Re: What to take for ADD that won't worsen anxiety, posted by Donna Louise on November 25, 2002, at 19:46:34
> Back in the '60's during my early self-medicating years, I used to abuse a drug called desbutal and that is what it was, one side was desoxyn and the other phenobarb, all in one pill. Supposed to be for dieting. I wonder if it is even manufactured these days...just reminescing, don't mind me.
>Well, I wasn't even born in the '70's, so definitely don't know... geez, I heard it was popular, didn't know it was that popular.
Desoxyn is still indicated for the treatment of ADD and "exogenous obesity." But many states have laws making it illegal to prescribe Desoxyn for weight loss, and the company who sells it isn't silly enough to have its sales people approach doctors for its weight loss abilities. Apparently the public thinks amphetamines shouldn't be used for weight loss (probably because they would work).
As for having Desoxyn and Phenobarbital in the same pill, the FDA thought it was too convenient for abusers to abuse that. I guess they figure if someone's going to abuse uppers and downers, they should at least work hard enough to get both pills separately. =)
But it's common to mix Desoxyn and Phenobarbital in a cocktail for anxious patients.There's a newer class of drugs called the benzodiazepeines, but I don't know too much about these yet- they seem experimental at this stage. Barbiutates have much more of a record with treating anxiety.
Posted by viridis on November 26, 2002, at 4:21:03
In reply to Re: What to take for ADD that won't worsen Donne, posted by utopizen on November 25, 2002, at 23:23:24
Benzodiazepines are newer than barbituates and amphetamines, but they've been around since at least the 1960s and are far from experimental -- they're been among the most-prescribed drugs in the world for decades and have an excellent track record for safety and effectiveness in anxiety disorders. Benzos almost completely replaced barbituates for this purpose; they include Valium, Xanax, Ativan, Klonopin, etc.
Posted by viridis on November 26, 2002, at 4:49:14
In reply to What to take for ADD that won't worsen anxiety???, posted by Saragram on November 25, 2002, at 9:38:52
If you have ADD, you may find that stimulants actually have a calming effect. I have anxiety problems and episodes of panic attacks, and also have ADD. Caffeine makes me very jittery, but Adderall (an amphetamine mixture) makes me calmer and more focused at low doses.
I've tried Provigil, and it was OK -- it kept me alert but didn't help too much with the concentration issues. It didn't increase my anxiety, though. Free samples seem pretty easy to obtain from doctors (it's being marketed aggressively), although prescriptions are very expensive unless you have really good insurance. Wellbutrin was awful for me and is notorious for increasing anxiety in those with anxiety disorders, although it might be worth a try, at an extremely low dose to start.
Whatever stimulant you try, I'd say just begin with a very low dose and see how it affects you. Emphasize to the doctor that you want to move very cautiously and (unless he/she advises against it -- be sure to ask) divide the pills if necessary. Again, you might be surprised and find that stimulants such as Adderall or Ritalin actually make you feel calmer. This is a common reaction with ADDers; just take it slow with very low doses until you know what to expect.
I'm not qualified to comment on the blood pressure issues etc; this is definitely something to discuss with your doctor.
Good luck!
Posted by utopizen on November 26, 2002, at 8:36:06
In reply to Re: What to take for ADD that won't worsen Donne » utopizen, posted by viridis on November 26, 2002, at 4:21:03
> Benzodiazepines are newer than barbituates and amphetamines, but they've been around since at least the 1960s and are far from experimental -- they're been among the most-prescribed drugs in the world for decades and have an excellent track record for safety and effectiveness in anxiety disorders. Benzos almost completely replaced barbituates for this purpose; they include Valium, Xanax, Ativan, Klonopin, etc.
>>
Phenobarbital came out in 1912.... that's quite a longer, more extended record. I'm still not convinced benzos are better for anxiety, given the data that compares the two.
Posted by mattdds on November 26, 2002, at 14:39:24
In reply to Re: What to take for ADD that won't worsen Donne, posted by utopizen on November 26, 2002, at 8:36:06
<<Phenobarbital came out in 1912.... that's quite a longer, more extended record. I'm still not convinced benzos are better for anxiety, given the data that compares the two.
What on earth are you talking about? There are a number of extremely good reasons that benzos are far superior to the barbiturates. Reasons for which the barbs have been almost entirely supplanted by benzodiazepines. The only indication I know of for barbs for which it is still useful (besides reducing meth or crack jitters) is treatment-resistant epilepsy!
First, the therapeutic index of diazepam (or other benzos) is several times that of phenobarbital. I believe the LD-50 of diazepam is something like 620 mg/kg, while phenobarbital is like 240 mg/kg. Do you know how much diazepam this would be? You would be drowning in a sea of little blue pills! On the other hand, phenobarb will depress your respiration after extremely small overdoses: the therapeutic index is a mere 2!! T.I. of diazepam is 20.7!
Second, benzodiazepines are WAY more *selective* anxiolytics, i.e. anxiolysis comes way before sedation on the anxiolysis-sedation spectrum in diazepam. With phenobarb, you cannot get anxiolysis without sedation. They come together in a neat little brain-fogging package. For example, one study involved some macaque monkeys with injuries to the septal area of the brain, making them permanently irritable. Benzos selectively calmed and tamed these monkeys, with no sedation. Barbiturates calmed them too, but only after a great deal of sedation. Other studies of people with these same brain injuries have shown the same results. Barbs also suppress neural activity in ALL areas of the CNS, including the cortex, slowing thinking. Benzos tend to be more selective for the hippocampus and the amygdala (the "fear" nucleus), areas involved in anxiety.
Last, barbs are extremely lipophilic, getting stuck in the lipid bilayer for long periods of time. This is the physiological basis of the notorious "barbiturate hangover". Anyone taking benzos knows that this does not occur.
So be careful in telling people that barbiturates have a better track record for anxiety. These are dirty, and somewhat dangerous drugs, especially if in the wrong hands. For the vast majority of cases, benzodiazepines are far more safe and effective. Could you kindly point out some of the "data" that you mentioned that indicates barbs are superior for anxiety?
Best,
Matt
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