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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 Jay2112 on January 3, 2023, at 11:24:38
I personally have found some relief from combining stims and a.p.'s. Anyone else? I read it can prevent or slow down tolerance to stims. It also seems to greatly help akathisia as well as restless legs. I find throwing in amitriptyline as well makes for bit of nice, relaxing experience, with it's anticholinergic effects.
Jay
Posted by rjlockhart37 on January 12, 2023, at 12:01:13
In reply to Combining stims and antipsychotics? Yes/No?, posted by Jay2112 on January 3, 2023, at 11:24:38
they used to combine thorazine with dexamphetmine in the 1960s, under a brand. Benzo's and stimulant seem to make the ride more smoothe and easy, while antipsyotics seem to work more with nuerotransmitter regulation. Less dopamine, but without the effect from GABA as benzo's do
Posted by Christ_empowered on January 20, 2023, at 9:42:38
In reply to Re: Combining stims and antipsychotics? Yes/No?, posted by rjlockhart37 on January 12, 2023, at 12:01:13
ThoraDex was one of the neuroleptic+upper combination pills (modified "goof ball," I suppose) available from the 50s-early 80s. Eskatrol was more popular I think...low dose compazine and dexedrine. Ever looked at vintage psych drug ads? to me, they're fascinating...speaks volumes about psychiatry, plus all the social aspects (social class, gender, etc.).
I saw a vintage ad for one that sounded like a whole med cocktail in 1 pill...Ritalin plus rauwolfia alkaloids (somewhat popular in the 50s, it seems), plus a low dose of some sort of anticholinergic (to help counter any adverse effects from the rauwolfia alkaloids...those work through dopamine depletion), plus meprobamate.
Sociohistorical ramblings aside...
I think it comes down to dosing, the drugs involved, and the needed effects. I would personally -not- advise mixing a high potency neuroleptic (old or new) with an amphetamine. Ritalin...maybe. Again...some old ads for Ritalin advise using it in hospitalized inpatients on stable neuroleptic protocols (back then, that almost always meant high doses).
I had an acquaintance who was on seroquel at night and adderall in the AM, both (if I recall correctly) at lower end of therapeutic doses. That actually lines up with thoradex...low potency, sedating neuroleptic plus amphetamine.
I seem to recall reading that the TD risk can go up, which makes sense intuitively, but I can't find the info now.
Adding in a GABA sedative seems, intuitively, that it might help further reduce the neuroleptic dosage and mitigate adverse effects from the upper and smooth out any problems between (and after) upper doses, but...
benzodiazepines obviously carry a number of risks. gabapentin at low to moderate doses might present a viable alternative (?), but again: the additional risks are not 0.
I guess...well, its between you and your treatment provider(s), obviously. I'd advise to take some b-vitamins and antioxidants with any neuroleptic. The big, big, big question becomes: is a neuroleptic necessary in this situation? and that's between you and the prescriber.
Posted by undopaminergic on January 21, 2023, at 4:24:29
In reply to Re: Combining stims and antipsychotics? Yes/No?, posted by Christ_empowered on January 20, 2023, at 9:42:38
>
> I think it comes down to dosing, the drugs involved, and the needed effects. I would personally -not- advise mixing a high potency neuroleptic (old or new) with an amphetamine. Ritalin...maybe.
>As of my last review of the literature (PubMed), regarding the use of stimulants in schizophrenia, adding an amphetamine to neuroleptics was found to be useful to mitigate some symptoms like working memory dysfunction, and worsening of psychosis could usually be handled with a dose adjustment of the antipsychotic. Methylphenidate (Ritalin) was not found to be useful.
-undopaminergic
Posted by Christ_empowered on January 21, 2023, at 10:35:16
In reply to Re: Combining stims and antipsychotics? Yes/No?, posted by undopaminergic on January 21, 2023, at 4:24:29
wow. i had no idea. I vaguely remember a study of Vyvanse in stable outpatients with a Schizophrenia diagnosis that went OK.
thanks for the information.
This is the end of the thread.
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