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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 Mr_ADD on August 17, 2002, at 14:44:30
I've got a question - my doc's have been experimenting with some meds for ADD over the past three weeks. The last time they tried, about two years ago, nothing worked - even a high dosages. Anyway, I've had a lot of other problems too so they wanted to stop trying as I was on so many other meds (for major depression, anxiety, a severe sleep disorder, etc.). I have made significant improvements over the past year and everyone feels that I'm finally ready for some vocational retraining (I'm trying to go back to college to get yet another degree) because I've been on disability for PTSD (see, I am a mess) for over two years now, my docs wanted to try some other meds now before life gets too busy again.
Two weeks ago, I was put on 20mg of Adderall XR and was told if I didn't have any response, to double it a week later. Well, it didn't and I did. A week later, still no response (my doc's ever ran a test to see what was happening - nothing except for side effects - I felt tired, apetite supression, and they felt I was more anxious than I've been in a while). So, a week ago (Friday), they put me on Concerta at 72mg and Neurontin (can't remember the dose at the moment). Anyway, my doc called Tuesday to see how I was doing - again, absolutely nothing (except, I now realize, in hind sight, that I had become anxious and agitated), so he told me to increase the dose to 108mg. I know that's very high but also know that I've got a history of not responding to other ADD meds at high doeses. Well, a little more than an hour later I had a final job interview for a temp-part-time job at my church. Needless to say, I completely fell apart, emotionally, and have been that way ever since. I've also been very agitated, suddenly depressed, and extremely tense. No impact, whatsoever for the ADD issues. Furthermore, I didn't get hired because I still need help from others at this time instead of being able to give something to others. This has now caused yet another major problem for me as I've had severe financial problems due to being on disability.
My doc took me off Concerta last night and I'm feeling better today (although still a bit anxious and tense - NOTHING like the Hell I've gone through this week). My psychologist, who runs an ADD support group at church, has offered to speak with person who interviewed me (I'm not sure if that will help though because I was a real mess was in at the time).
Have any of you been on this high of a dose for Concerta (I searched the board and couldn't seem to find anything) or have you experienced the same extreme emotional stuff while on it?
Thanks!
Posted by Mr_ADD on August 21, 2002, at 10:33:35
In reply to Concerta and mood problems, posted by Mr_ADD on August 17, 2002, at 14:44:30
Is anyone here? I really would like to know about other people's experiences. Thanks!
Posted by ADD'er in SC on August 22, 2002, at 20:21:08
In reply to Re: Concerta and mood problems, posted by Mr_ADD on August 21, 2002, at 10:33:35
Boy, that's some tolerance. Not sure what the max dose is on concerta. I do take Adderall 30XR.
This seems to work for me, but when I was at 20 mg, I had to go up. 40 probably would have been too much.Not sure why your tolerance is so high. Any other meds being taken? If so, what? Also, psychostimulants do interact with acidic substances....ie, acorbic acid, fruit juice - causing delayed absorption. I have heard to take it with milk, which I have done with success.
How about in the past with other meds? Same tolerance? I'm somewhat at a loss on this one. Wish I could be of more help.
Best of luck,
Posted by BLPBart on August 23, 2002, at 1:41:59
In reply to Re: Concerta and mood problems, posted by ADD'er in SC on August 22, 2002, at 20:21:08
> Boy, that's some tolerance. Not sure what the max dose is on concerta. I do take Adderall 30XR.
> This seems to work for me, but when I was at 20 mg, I had to go up. 40 probably would have been too much.
>
> Not sure why your tolerance is so high. Any other meds being taken? If so, what? Also, psychostimulants do interact with acidic substances....ie, acorbic acid, fruit juice - causing delayed absorption. I have heard to take it with milk, which I have done with success.
>
> How about in the past with other meds? Same tolerance? I'm somewhat at a loss on this one. Wish I could be of more help.
>
> Best of luck,I'm not sure how useful this will be but I'll tell you my experience with Concerta. I've been under treatment for major depression for a few years and have tried a number of anti-depressants. Most of the trial and error being due to intolerable side effects. During all of this my doc and I started to believe that ADD might be part of my problem so he started me on 10 mg/day of dexedrine with the use it for a week, up it to 20 if you don't feel anything routine. After I got to 30 and it didn't seem to be doing anything, he decided to try Concerta. I took 32 mg/day for a week but didn't feel anything. He then had me double it. My only reaction to it was a little bit of anxiety (it reminded me of when I'm dreading something that's going to happen later in the day and I have a little bit of "butterflies in the stomach" kind of feeling). I then went back to the dexedrine and tried 40 mg which ended up working well for me. Actually, as a result, I am now solely on dexedrine which appears to be working very well for both the ADD and the depression.
Posted by may-b on August 23, 2002, at 10:15:06
In reply to Re: Concerta and mood problems, posted by BLPBart on August 23, 2002, at 1:41:59
Hi BLPBart
> I've been under treatment for major depression for a few years and have tried a number of anti-depressants. Most of the trial and error being due to intolerable side effects. During all of this my doc and I started to believe that ADD might be part of my problem so he started me on 10 mg/day of dexedrine with the use it for a week, up it to 20 if you don't feel anything routine...I am now solely on dexedrine which appears to be working very well for both the ADD and the depression.
I am interested in your experiences with dexedrine to treat both depression and ADD.May I ask what are the features of your depression? i.e., atypical, etc.?
How long have you been managing on just dexedrine?
Thanks for your input,
may-b
Posted by Mr_ADD on August 24, 2002, at 12:46:11
In reply to Re: Concerta and mood problems, posted by ADD'er in SC on August 22, 2002, at 20:21:08
Thanks for your response. Yeah, I seem to have a horribly high tolerance - I've had the same thing with other ADD meds too - although my "normal" response to them has been "nothing." The first time the docs tried something, I took Ritalin. An hour later, I fell asleep and took a good nap. That was with a previous doc. My therapist, at that time, told me that he had another patient, who was a former drug addict, and that the dose I was on made this other guy high. (I've never had a drug problem.) Since then, they've also tried Dexedrine, Wellbutrin, even Prozac, and Depakote! As mentioned, we just tried Adderall and Concerta - UGH! To be honest, this is very frustrating. :( Oh, just looked at the Neurontin I was placed on at the same time as Concerta - I was taking 200 mg/day (100 mg in the morning and then again before bed).
Currently, I'm also taking Serzone (300 mg/day) for depression, Mirapex (.25-.75 mg/day) for Periodic Limb Movement Disorder (a sleep disorder - FYI, Mirapex is usually used as an anti-Parkinson's med).
During the past five years, I've also been on high doses of Effexor (a drug from Hell that should be banned - it was total torture trying to get off of that!), Zyprexia (makes you fat and did little else for me), Xanax, Klonopin (for anxiety and also as 1st attempt at a drug for my sleep stuff), Resperol (sp?) and Ambien (worst things I could have taken, considering my then undiagnosed sleep disorders). Prior to that, I seldom took anything other than aspirin.
Anyone else had such a variety at such high doses with no response? Thanks!
> Boy, that's some tolerance. Not sure what the max dose is on concerta. I do take Adderall 30XR.
> This seems to work for me, but when I was at 20 mg, I had to go up. 40 probably would have been too much.
>
> Not sure why your tolerance is so high. Any other meds being taken? If so, what? Also, psychostimulants do interact with acidic substances....ie, acorbic acid, fruit juice - causing delayed absorption. I have heard to take it with milk, which I have done with success.
>
> How about in the past with other meds? Same tolerance? I'm somewhat at a loss on this one. Wish I could be of more help.
>
> Best of luck,
Posted by ADD'er in SC on August 24, 2002, at 13:30:12
In reply to Re: Concerta and mood problems, posted by Mr_ADD on August 24, 2002, at 12:46:11
What about your bp on high stim doses......has it been taken? Are there any other meds you have taken in the past which seem to have a stimulant effect but not labled as a stimulant? BTW, what does coffee do to you? How about sedating antihistamines.....'benadryl'etc...?
Posted by Mr_ADD on August 24, 2002, at 15:42:32
In reply to Re: Concerta and mood problems, posted by ADD'er in SC on August 24, 2002, at 13:30:12
I saw my primary care physician the day before I went off of Concerta. (He saw how agitated I was too). While my BP did go up, it wasn't a lot - I was about 120 over 80 (may have been 90) - normally, I run 90 to 105 over 80. Coffee, while I love it, doesn't do anything (I have no problem sleeping after having a cup or two at night). I'm not a big coffee drinker at the moment though. In college, long before I knew I had ADD, I used to drink a couple of pots at night when I studied (late at night was/is the only time I can really study because it's quiet) - perhaps I was unconciously noticing something. Now, if I have 4-6 cups a week, that's a lot.
I seldom, if ever take antihistamines - some of them can make be a bit sleepy.
Thanks!
Posted by BLPBart on August 26, 2002, at 1:24:13
In reply to Re: stims and mood problems » BLPBart, posted by may-b on August 23, 2002, at 10:15:06
> Hi BLPBart
>
>
> > I've been under treatment for major depression for a few years and have tried a number of anti-depressants. Most of the trial and error being due to intolerable side effects. During all of this my doc and I started to believe that ADD might be part of my problem so he started me on 10 mg/day of dexedrine with the use it for a week, up it to 20 if you don't feel anything routine...I am now solely on dexedrine which appears to be working very well for both the ADD and the depression.
>
>
> I am interested in your experiences with dexedrine to treat both depression and ADD.
>
> May I ask what are the features of your depression? i.e., atypical, etc.?
>
> How long have you been managing on just dexedrine?
>
> Thanks for your input,
>
> may-b
>
>I'm happy to share my depression experience with you. I'm not sure what catagory mine fits in exactly because my doctor has never said anything to me other than major depression. However, based on what I've read, I think it might be the atypical kind. I base this on the fact that when I get depressed, I get extremely lethargic. I don't ever want to get out of bed and just getting up and doing the simplest things can require a tremendous amount of energy.
One of the hard parts about trying to evaluate how effective the ADs have been for me is that I have the lethargy already with the depression. Then, when I was taking prozac which can often cause lethargy, it was difficult to determine if it was the drug or the original depression causing the problem.
For me, I have found that even when I was using the wellbutrin alone, which is supposed to be stimulating, I didn't feel depressed, but I felt extremely tired all of the time and just dragging around. On the dexedrine, I also don't feel depressed, but I don't feel tired. The nice part is, I don't feel wired or euphoric, just normal. I can wake up, have a cup of coffee, and go to work and function all day without feeling like falling asleep at my desk. I can then come home and be alert enough to manage to make dinner, cleanup the dishes, do some bills, whatever, and then go to bed at a reasonable hour. I haven't suffered any insomnia either.
I haven't felt like any of the depression is coming back right now, although it's only been about a month since I went completely off of the wellbutrin. I'm fairly optimistic, however, since this has been a particularly tough time for me. A lot of my depression revolves around some difficult, unresolved issues that my husband and I have and I have been seeing a counselor for a while and just in the last few months have been really getting to the meat of the problems. In some ways it's been good and made me feel better to recognize what some of them area, but it's also been very difficult to start recognizing some of the problems and get them out in the open - sort of like reopening old wounds. I've been feeling that if I can get through this without losing it, then I'll probably be on the path to some type of remission from the depression. Now, as far as ADD, obviously there's no remission for that so I'll stay on the dexedrine as long as my doc will write me prescriptions.
Hope that was informative. I'm happy to keep you posted.
This is the end of the thread.
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