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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by MightyKondrian on December 28, 2018, at 13:16:47
After 3 months on Ritalin I've come to the conclusion thats its not really a mood drug for me. It might have even worsenen depression and anxiety in the long run.
Seen doc today. Found out that Parnate is extremely hard to get on in the UK now. Not only does it take heaps of paperwork (so I'm told) but the current price is £10 per pill. I'm NHS so they certainly aren't going to want to pay for that! What's that, at least £40 per day? So thats a big no.
I also been on Phenelzine now for 2 yrs. Half that time on 120mg. I asked surely its pointless? I've felt it do nothing since I restarted it. He said it will be doing something. I mean, do it's actions stay the same long term whether it poops out or not? Does it still inhibit MAO to the same degree whether you feel it or not, or poops out? Can MAO build a tolerance to Nardil's inhibition (forget GABA for now)? If not, and inhibition is its main function then what else is going on? The mystery of psychopharmacology. Nobody really knows. A jigsaw with missing pieces.So anyway I'm to start D-amphetamine (Dexedrine?) in place of the Ritalin starting next weds. today I drop from 15 to 10mg. Well I have to to make it last till next week. Cant afford a stim crash even a mild one. Now he said start on 2.5mg. I laughed. (I used to take 1/2g hits of the stuff). But after checking some Ritalin-amphetamine equivalent dose charts the best source says 10mg Ritalin = 3.75mg D-amphetamine. Does that sound about right?
Posted by bleauberry on December 29, 2018, at 8:14:28
In reply to Stimulant switch., posted by MightyKondrian on December 28, 2018, at 13:16:47
Personally I found Ritalin and Adderall to be remarkably different. So I don't know about equivalency dosing. Ritalin was mood brightening for me in addition to anti-anxiety...I only had anxiety when it wore off. Adderall was deeply and darkly depressing, within hours of consumption, with massive anxiety.
I think patients respond well to one or the other but not both. Just my own observations. So the fact that you didn't do well with Ritalin may be a good clue that you do well with Adderall instead.
Not sure if Modafinil is available or how much it costs where you are. But look into that one to combine with whatever else you take.
> After 3 months on Ritalin I've come to the conclusion thats its not really a mood drug for me. It might have even worsenen depression and anxiety in the long run.
> Seen doc today. Found out that Parnate is extremely hard to get on in the UK now. Not only does it take heaps of paperwork (so I'm told) but the current price is £10 per pill. I'm NHS so they certainly aren't going to want to pay for that! What's that, at least £40 per day? So thats a big no.
> I also been on Phenelzine now for 2 yrs. Half that time on 120mg. I asked surely its pointless? I've felt it do nothing since I restarted it. He said it will be doing something. I mean, do it's actions stay the same long term whether it poops out or not? Does it still inhibit MAO to the same degree whether you feel it or not, or poops out? Can MAO build a tolerance to Nardil's inhibition (forget GABA for now)? If not, and inhibition is its main function then what else is going on? The mystery of psychopharmacology. Nobody really knows. A jigsaw with missing pieces.
>
> So anyway I'm to start D-amphetamine (Dexedrine?) in place of the Ritalin starting next weds. today I drop from 15 to 10mg. Well I have to to make it last till next week. Cant afford a stim crash even a mild one. Now he said start on 2.5mg. I laughed. (I used to take 1/2g hits of the stuff). But after checking some Ritalin-amphetamine equivalent dose charts the best source says 10mg Ritalin = 3.75mg D-amphetamine. Does that sound about right?
Posted by rjlockhart37 on January 5, 2019, at 16:35:46
In reply to Stimulant switch., posted by MightyKondrian on December 28, 2018, at 13:16:47
i don't know the exact equivalent, methyphendiate is less potant, much less than dexamphetamine....i would start on 5mg, that is a good starting dose, and the wear off period is not as bad, but it's when you move up to higher doses is when the wear off is not so pleasant, i would always tell myself it's gonna wear off in 2 hours, get ready for it. I was on Vyvanse 70mg twice daily, vyvanse is a substituded amphetamine, it lasts around 7 10 hours, you could give vyvanse a try also, but i rerermber the crash on vyvanse was kind grueling, it slowly wore off. Lower doses have less of a drop, but when i was on it, i had to take moderately high doses, because it improved thinking and being able to function
ask you doctor just if you could try dexedrine spansule 10mg, it lasts 6 hours generally, you would have 5mg release then another dose later
Posted by pedr on January 16, 2019, at 11:57:07
In reply to Re: Stimulant switch., posted by bleauberry on December 29, 2018, at 8:14:28
> Personally I found Ritalin and Adderall to be remarkably different. So I don't know about equivalency dosing. Ritalin was mood brightening for me in addition to anti-anxiety...I only had anxiety when it wore off. Adderall was deeply and darkly depressing, within hours of consumption, with massive anxiety.
>
> I think patients respond well to one or the other but not both. Just my own observations. So the fact that you didn't do well with Ritalin may be a good clue that you do well with Adderall instead.
>
> Not sure if Modafinil is available or how much it costs where you are. But look into that one to combine with whatever else you take.
>I'd just like to echo all these observations personally. Concerta (Ritalin long-acting) lifted me right out of TR depression (alongside Abilify FWIW) only to poop-out after 3-4 weeks. I switched to Vyvanse (Adderall long-acting) and got another month of vastly-reduced depression before that pooped-out.
I still take Adderall and it helps with my focus but not my mood, which is a known facet of stims and depression (the mood-boost fades but the focus-boost does not).
Modafinil and Nuvigil both can be World-beating one day and like a sugar pill the next for me. I can't figure it out, it's "nuts". And very frustrating.
Posted by pedr on January 16, 2019, at 12:02:45
In reply to Stimulant switch., posted by MightyKondrian on December 28, 2018, at 13:16:47
> I also been on Phenelzine now for 2 yrs. Half that time on 120mg. I asked surely its pointless? I've felt it do nothing since I restarted it. He said it will be doing something. I mean, do it's actions stay the same long term whether it poops out or not? Does it still inhibit MAO to the same degree whether you feel it or not, or poops out? Can MAO build a tolerance to Nardil's inhibition (forget GABA for now)? If not, and inhibition is its main function then what else is going on? The mystery of psychopharmacology. Nobody really knows. A jigsaw with missing pieces.
So I have 20+ years of TRD and have tried Nardil twice and Parnate once. The first time I tried Nardil, I was blessed to have a progressive PDoc who also prescribed stimulants alongside it. It was by FAR the best treatment I've ever been on.
Sadly that ended and the other two attempts simply didn't work. On Parnate I got insomnia and significantly more depressed. On Nardil attempt #2 it simply did nothing. Sure the "texture" or facets of my depression changed but my overall mood was still in the toilet.
So I say yes, it's a waste of time. MAOI's don't work for everyone by a long measure. Your PDoc needs a slap.
I'm titrating up on Trintellix and Rexulti at the moment after doing a genesight DNA test that helped identify meds that simply won't work for me (which include most of the other SSRI's).
FWIW I've done Ketamine, ECT, dTMS (42 sessions!) and all did zip.
HTH, Pete
This is the end of the thread.
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