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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by ChicagoKat on December 9, 2012, at 12:19:33
Hi all. I've been taking Ritalin for a while, except for several weeks recently when I was on Nardil, which was a complete failure. I thought having that long holiday off Ritalin would have it working great for me again. Instead it is giving up on me. When I get a Ritalin 'crash' I don't get more depressed, paradoxically I get bad anxiety. For a while Ritalin would work great for an hour or two before I had my crash. That time of feeling good quickly kept getting shorter, and it's gotten to the point that taking Ritalin immediately gives me anxiety. I feel like Ritalin was my last hope, but I thought I'd ask all the wonderful people here on PB if they had any ideas or advice that would help.
Here are all the meds I've been on that either don't help/don't work anymore/or give me intolerable side effects:
All SSRIs (except Luvox, my old insurance would not cover it), all SNRIs, Imipramine, Desipramine, Nortriptyline, amitriptyline, wellbutrin, remeron, lamictal, lithium, trazodone, ensam, nardil, marplan, parnate (current insurance does not cover it), deplin, all AAPs,strattera, nuvigil, adderall, concerta, vyvanse, and now ritalin.
I most likely have forgotten one or two.
But do any of you have any ideas or advice? Would it be worth it to try Luvox, now that my new insurance covers it? Or does anyone have any different ideas for combos, etc? I've had ect, so if I can't find a drug regimen that would work, I'm destined to spend the rest of my life severely depressed,at least until a new drug should come out that would work for me.
Thanks in advance for any replies.
Kat
Posted by SLS on December 9, 2012, at 13:13:47
In reply to Need advice; Ritalin giving up on me, posted by ChicagoKat on December 9, 2012, at 12:19:33
I know that Wellbutrin produced anxiety in you, but did it help your depression at all?
I am unclear as to whether or not you have ever tried Parnate, despite the expense. Have you ever taken Parnate 40 - 80 mg/day for at least 4 week? The time it takes to titrate to these dosages doesn't count.
Parnate + Ritalin/Focalin might be a combination worth investigating. If you are a partial responder, you could then add drugs like Lamictal, Abilify, and lithium. I know Lamictal was neutral for you, but I don't recall what were the difficulties you encountered when taking Abilify. Were you able to take it for more than a week?
Wait for a new drug? I know how that goes. Until then, you can find hope in taking new combinations of old drugs. You could try adding anti-glutamatergic drugs together:
1. Memantine
2. Lamictal
3. NAC
4. MinocyclineIf you haven't tried Parnate yet, I would encourage you to do so. Take out a loan if you have to. It is my thinking that because you are a partial responder to Nardil, there is a reasonable chance that you will respond better to Parnate.
- Scott
Posted by rjlockhart37 on December 9, 2012, at 14:22:10
In reply to Re: Need advice; Ritalin giving up on me » ChicagoKat, posted by SLS on December 9, 2012, at 13:13:47
Kat there's Focalin XR which lasts 10 hours...its like adderall xr....it may help but I must tell you there is always going to be a rebound period...it really sucks, get the benzos ready with nuerontin and some wine...it should make it easier to deal with. I know exactly about the crash...its draining leaving in bad mood, and feeling wasted on a stimulant. Also there's something called Clonodine...its not euphoric but it will help during the rough periods of crashing on focalin, or Ritilin.
Wellbutrin...somewhat gives a mild stimulant effect after focalin/ritilin wears off...i've been on 450mg 10 yearso ago...when I was taking adderall xr...it did sustain some dopamine, but its not going to continue the stimulant levels, when they wear off its bad. There's also Strattera...but it works only on NE, which could make anxiety just like wellbutrin can too.
Parnate like scott is good choice but its difficult to get a doctor to choose it unless they have it in their minds to use. My doc told me its outdated and too many side effects, which is silly because alot of people here on babble take parnate and nardil.
Tyrosine and dl phenylalanine, which are at health food stores...they will give you a mild stimulant effect after focalin wears off....it will not be the same feeling but you can feel the alertness and motivation it gives, passivly.
maybe there need to look at other options...effexor or prisque would be a ok look but its not a psychostimulant, or mild stimulant like wellbutrin. Prozac is stimulating for me a while back...i was on 80mg...it will help with the mood, seriously. Ill try to think of something else...scott also said Namenda which would increase some cognitive stuff....but the mood part I don't know how it would be.
stay strong....keep the mood levelers klono, nuerontin, wine...they will help somewhat.. ready when the crash comes
Posted by Phillipa on December 9, 2012, at 15:28:15
In reply to Need advice; Ritalin giving up on me, posted by ChicagoKat on December 9, 2012, at 12:19:33
Kat it just occured to me that an old poster who had been on nardil, parnate, returned to prozac and today he's working full time, raising his family and feels great. Goggle Crazyhorse on babble. He's also a frien of mine on FB Phillipa
Posted by Lou Pilder on December 9, 2012, at 15:39:11
In reply to Re: Need advice; Ritalin giving up on me » ChicagoKat, posted by SLS on December 9, 2012, at 13:13:47
> I know that Wellbutrin produced anxiety in you, but did it help your depression at all?
>
> I am unclear as to whether or not you have ever tried Parnate, despite the expense. Have you ever taken Parnate 40 - 80 mg/day for at least 4 week? The time it takes to titrate to these dosages doesn't count.
>
> Parnate + Ritalin/Focalin might be a combination worth investigating. If you are a partial responder, you could then add drugs like Lamictal, Abilify, and lithium. I know Lamictal was neutral for you, but I don't recall what were the difficulties you encountered when taking Abilify. Were you able to take it for more than a week?
>
> Wait for a new drug? I know how that goes. Until then, you can find hope in taking new combinations of old drugs. You could try adding anti-glutamatergic drugs together:
>
> 1. Memantine
> 2. Lamictal
> 3. NAC
> 4. Minocycline
>
> If you haven't tried Parnate yet, I would encourage you to do so. Take out a loan if you have to. It is my thinking that because you are a partial responder to Nardil, there is a reasonable chance that you will respond better to Parnate.
>
>
> - ScottFriends,
It is written here,[...Parnate and Ritalin/Focalin might be a combination worth investigating...].
Both of these drugs are CNS stimulants that could cause death when combined. So consider this in any investigating of this combination.
Lou
Posted by jono_in_adelaide on December 9, 2012, at 18:07:49
In reply to Re: Need advice; Ritalin giving up on me » ChicagoKat, posted by SLS on December 9, 2012, at 13:13:47
I would try and find a way to try parnate, make whatever cuts you need to to pay the cash price for it.
Parnats plas a tricyclic (say nortriptyline 75mg at bedtime) would also be worth a go.
Push the Parnate doseage to the limits of tollorance, upto 80mg/day, and let blood levels guide the nortriptyline dose (within the range of 50-150mg/day)
Atarax might help the anxiety.
Abilify in a low to moderate dose would also be worth a shot.
If you can pay the $260 for 2 months Parnate in cash to try it, it would be well worth while, it could totaly change your life.
Posted by SLS on December 9, 2012, at 19:54:47
In reply to Lou's warning-kunpsidderdiss » SLS, posted by Lou Pilder on December 9, 2012, at 15:39:11
Apparently, the combination of tranylcypromine (Parnate) and methylphenidate (Ritalin) is safe enough for NASA.
http://www.ncbi.nlm.nih.gov/pubmed/7522239
Some of our more enlightened doctors use methylphenidate to combat MAOI-induced hypotension in addition to treating treatment-resistant depression. That is not to say that the combination should not be administered without excercising caution.
http://www.ncbi.nlm.nih.gov/pubmed/15554766
- Scott
Posted by ChicagoKat on December 10, 2012, at 11:43:31
In reply to Re: Need advice; Ritalin giving up on me » ChicagoKat, posted by SLS on December 9, 2012, at 13:13:47
Thanks for the advice Scott. I always love getting advice from you. Each time I tried Wellbutrin I got anxiety from the very start, and I did not notice any relief of my depression. It could be that I was getting relief, but that the sever anxiety overwhelmed it. I don't know. It's a drug that I would love to be on if it worked and had no serious side effects. I really need to lose weight, and it might help me stop smoking too. My husband was put on it and he lost 70 pounds!!! I'm jel.
No, I have never actually been on Parnate. You seem to be very strongly in favor of it, and I am still 'washed', taking only Focalin and Elavil at bedtime. Maybe I'll pay for it for a month and see how it does. If it works great, I'd be more than willing to shell out the money to ease my depression. You said to take out a loan if I have to, and it made me think about the process of buying a car. I thought about it, and taking out a loan so I could have relief from depression is something I'd *much* rather do to be able to get a med that helps my depression than to buy a new car.
Abilify gave me profound agitation from the get-go. I absolutely could not tolerate it. Got the same effect from all other AAPs, with the exception of Zyprexa. I was on that for about a year. Then I got akathisia from it. so no more antipsychotics of any kind for me!!
Once again, I think I may print out your post, if it's OK with you, to show to my pdoc and see what he thinks. Thanks so much Scott!
Kat> I know that Wellbutrin produced anxiety in you, but did it help your depression at all?
>
> I am unclear as to whether or not you have ever tried Parnate, despite the expense. Have you ever taken Parnate 40 - 80 mg/day for at least 4 week? The time it takes to titrate to these dosages doesn't count.
>
> Parnate + Ritalin/Focalin might be a combination worth investigating. If you are a partial responder, you could then add drugs like Lamictal, Abilify, and lithium. I know Lamictal was neutral for you, but I don't recall what were the difficulties you encountered when taking Abilify. Were you able to take it for more than a week?
>
> Wait for a new drug? I know how that goes. Until then, you can find hope in taking new combinations of old drugs. You could try adding anti-glutamatergic drugs together:
>
> 1. Memantine
> 2. Lamictal
> 3. NAC
> 4. Minocycline
>
> If you haven't tried Parnate yet, I would encourage you to do so. Take out a loan if you have to. It is my thinking that because you are a partial responder to Nardil, there is a reasonable chance that you will respond better to Parnate.
>
>
> - Scott
Posted by ChicagoKat on December 10, 2012, at 11:48:23
In reply to Re: Need advice; Ritalin giving up on me, posted by rjlockhart37 on December 9, 2012, at 14:22:10
LOL rj, you are right on with a great method to deal with the crash. I do everything you suggest except the wine. strangely i developed a revulsion for alcohol after i had ect. but other wise, i use exactly what you said: a benzo plus Neurontin :)
Thanks for the advie; I hope you are well
Kat> Kat there's Focalin XR which lasts 10 hours...its like adderall xr....it may help but I must tell you there is always going to be a rebound period...it really sucks, get the benzos ready with nuerontin and some wine...it should make it easier to deal with. I know exactly about the crash...its draining leaving in bad mood, and feeling wasted on a stimulant. Also there's something called Clonodine...its not euphoric but it will help during the rough periods of crashing on focalin, or Ritilin.
>
> Wellbutrin...somewhat gives a mild stimulant effect after focalin/ritilin wears off...i've been on 450mg 10 yearso ago...when I was taking adderall xr...it did sustain some dopamine, but its not going to continue the stimulant levels, when they wear off its bad. There's also Strattera...but it works only on NE, which could make anxiety just like wellbutrin can too.
>
> Parnate like scott is good choice but its difficult to get a doctor to choose it unless they have it in their minds to use. My doc told me its outdated and too many side effects, which is silly because alot of people here on babble take parnate and nardil.
>
> Tyrosine and dl phenylalanine, which are at health food stores...they will give you a mild stimulant effect after focalin wears off....it will not be the same feeling but you can feel the alertness and motivation it gives, passivly.
>
> maybe there need to look at other options...effexor or prisque would be a ok look but its not a psychostimulant, or mild stimulant like wellbutrin. Prozac is stimulating for me a while back...i was on 80mg...it will help with the mood, seriously. Ill try to think of something else...scott also said Namenda which would increase some cognitive stuff....but the mood part I don't know how it would be.
>
> stay strong....keep the mood levelers klono, nuerontin, wine...they will help somewhat.. ready when the crash comes
Posted by ChicagoKat on December 10, 2012, at 11:50:20
In reply to Re: Need advice; Ritalin giving up on me » ChicagoKat, posted by Phillipa on December 9, 2012, at 15:28:15
That's interesting Phillipa. I can't imagine Prozac working for me anymore. I we actually did try it about a year ago with no luck. Will talk more later; take care
Kat> Kat it just occured to me that an old poster who had been on nardil, parnate, returned to prozac and today he's working full time, raising his family and feels great. Goggle Crazyhorse on babble. He's also a frien of mine on FB Phillipa
Posted by ChicagoKat on December 10, 2012, at 11:52:42
In reply to Re: Need advice; Ritalin giving up on me, posted by jono_in_adelaide on December 9, 2012, at 18:07:49
I completely agree with you Jon. Seems everyone is saying try the Parnate, even if I have to shell out some moolah. I'm gonna tell my pdoc I will pay for it out of pocket; I know he wanted me to try it.
Kat
Posted by ChicagoKat on December 10, 2012, at 15:39:40
In reply to Need advice; Ritalin giving up on me, posted by ChicagoKat on December 9, 2012, at 12:19:33
Update: Back when I first wanted to try Parnate, some bonehead at the pharmacy said my insurance wouldn't cover it and that it would cost 130bucks out of pocket. And she is a pharmacist! I've always had problems with her. There is one other pharmacist there and she is a way cool chick. Seems I always get the pain in the *ss one though.
Anyways - stay on topic Kat - I checked with my insurance and Parnate most defiitely IS covered, and if I get the generic it is only 10bucks. So I talked to my pdoc and we're gonna give it a try. I kept myself washed b/c I knew in the back of my mind that something fishy was going on here. So I never started the Lexapro I was prescribed. I kept meaning to investigate the issue, but it always slipped my mind or there were more importaht things to do or there were more fun things to do after I took a dose of Ritalin. FINALLY looked it up today, and found out the info I reported above. What a complete ignoramous that pharmacist is. She's fairly old too. Next time I see her I am going to subliminally plant the word retirement into her brain.
OK - Kat keep on topic, dammit - maybe the Parnate will help. It's worth a shot. And I appreciate all advice and suggestions. Since many of you emphatically suggested Parnate, you got me to take the effort tocheck out if it's covered...so thank you!!!!! Keep all fingers and toes crossed; I will keep you all posted on how it goes. Thanks so much everyone!!
Kat
p.s. Does anyone else have the experience that everyone at the pharmacy knows your name? Since I go there so often, between my psych meds, and my antihypertensive meds, they know me well. To me that's kinda sad :(
Posted by jono_in_adelaide on December 10, 2012, at 16:43:08
In reply to Re: Need advice; Ritalin giving up on me » jono_in_adelaide, posted by ChicagoKat on December 10, 2012, at 11:52:42
Kat, two thoughts
Does your insurance have an appeals mechanism where they can be convinced to pay for non formulary drugs in extenusting circumstances
Does GSK have a patient assistance program for parnate?
Posted by jono_in_adelaide on December 10, 2012, at 16:58:35
In reply to Re: Need advice; Ritalin giving up on me, posted by ChicagoKat on December 10, 2012, at 15:39:40
Kat, thats great that Parnate is covered, congratulations!
Re being known in the pharmacy, I went to a pharmacy where my sister lives when i was in Adelaide rcently, which I hadnt been into for maybe 5 years, and asked for some ibuprofen.
The pharmacist asked if I had asthma, because he knew melissa (my sister) and her kids did...... thats some memory, remembering me after 5 years, and that i was another customers brother, and that her and her kids were asthmatic and couldnt take ibuprofen
Posted by SLS on December 10, 2012, at 17:00:13
In reply to Re: Need advice; Ritalin giving up on me, posted by ChicagoKat on December 10, 2012, at 15:39:40
I'm glad to hear that Parnate is now an option for you. Good luck with it.
Are you going to continue to take Ritalin?
- Scott
Posted by baseball55 on December 10, 2012, at 17:29:47
In reply to Re: Need advice; Ritalin giving up on me, posted by ChicagoKat on December 10, 2012, at 15:39:40
That's great. I found it odd that insurance would cover nardil but not parnate. It's generic, not that expensive for the insurance companies.
Every at the pharmacy knows me too. Between my own meds and my husband's (hypertension, cholesterol, takes testosterone), I'm a frequent visitor. Doesn't bother me. It's nice to be known and the pharmacists and clerks are mostly nice and very helpful.
> Update: Back when I first wanted to try Parnate, some bonehead at the pharmacy said my insurance wouldn't cover it and that it would cost 130bucks out of pocket. And she is a pharmacist! I've always had problems with her. There is one other pharmacist there and she is a way cool chick. Seems I always get the pain in the *ss one though.
>
> Anyways - stay on topic Kat - I checked with my insurance and Parnate most defiitely IS covered, and if I get the generic it is only 10bucks. So I talked to my pdoc and we're gonna give it a try. I kept myself washed b/c I knew in the back of my mind that something fishy was going on here. So I never started the Lexapro I was prescribed. I kept meaning to investigate the issue, but it always slipped my mind or there were more importaht things to do or there were more fun things to do after I took a dose of Ritalin. FINALLY looked it up today, and found out the info I reported above. What a complete ignoramous that pharmacist is. She's fairly old too. Next time I see her I am going to subliminally plant the word retirement into her brain.
>
> OK - Kat keep on topic, dammit - maybe the Parnate will help. It's worth a shot. And I appreciate all advice and suggestions. Since many of you emphatically suggested Parnate, you got me to take the effort tocheck out if it's covered...so thank you!!!!! Keep all fingers and toes crossed; I will keep you all posted on how it goes. Thanks so much everyone!!
> Kat
> p.s. Does anyone else have the experience that everyone at the pharmacy knows your name? Since I go there so often, between my psych meds, and my antihypertensive meds, they know me well. To me that's kinda sad :(
Posted by ChicagoKat on December 11, 2012, at 4:14:37
In reply to Re: Need advice; Ritalin giving up on me » ChicagoKat, posted by SLS on December 10, 2012, at 17:00:13
> I'm glad to hear that Parnate is now an option for you. Good luck with it.
>
> Are you going to continue to take Ritalin?
>
>
> - ScottWe'll see what my pdoc says about the Ritalin in the future. For right now he says he feels a little squeamish about it because I need to take 100mg of amitriptyline to sleep
Kat
Posted by ChicagoKat on December 11, 2012, at 4:18:45
In reply to Re: Need advice; Ritalin giving up on me, posted by jono_in_adelaide on December 10, 2012, at 16:43:08
> Kat, two thoughts
>
> Does your insurance have an appeals mechanism where they can be convinced to pay for non formulary drugs in extenusting circumstances
>
> Does GSK have a patient assistance program for parnate?Jon, apparently my insurance DOES pay for parnate, and I should only have to pay 10 bucks for it. for some reason the pharmacy is submitting the claim twice, which makes the insurance company obviously want me to pay the full amount. at least that's what i found out from the insurance company. i gotta talk to the pharmacy tomorrow. it's just such a GREAT thing to have to deal with insurance problems when one is already feeling very depressed.
Sorry, sarcasm actually makes me feel better sometimes :)
Kat
Posted by ChicagoKat on December 11, 2012, at 4:21:12
In reply to Re: Need advice; Ritalin giving up on me, posted by jono_in_adelaide on December 10, 2012, at 16:58:35
> Kat, thats great that Parnate is covered, congratulations!
>
> Re being known in the pharmacy, I went to a pharmacy where my sister lives when i was in Adelaide rcently, which I hadnt been into for maybe 5 years, and asked for some ibuprofen.
>
> The pharmacist asked if I had asthma, because he knew melissa (my sister) and her kids did...... thats some memory, remembering me after 5 years, and that i was another customers brother, and that her and her kids were asthmatic and couldnt take ibuprofenThanks for sharing that Jon. It kinda gives me the warm fuzzies, hearing there are still communities out there where people all know each other and share life's joys and problems together.
Kat
This is the end of the thread.
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