![[dr. bob]](/dr-bob-sm.gif)
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 leor on October 6, 2002, at 14:34:25
Dear BabblersOver the past month I have been taking effexor (short acting form) for the management of the ‘overfocus' symptoms of my A.D.D. (17.85mg twice a day) I also take 15 mg of Dexedrine XR once a day. My DX is bipolar II plus non-hyperactive A.D.D
Effexor seems to do the job nicely - but not without some nasty side effects; mild headaches and mental ‘dulling'. While under the influence, it is difficult for me to feel that my brain is fully stimulated and allways a pall of mild mental & emotional exhaustion hangs over my body.
I am no stranger to such problems; on or off of medications. They are with me yearround but are at their most excrutiating during the winter when I suffer from severe seassonal affective disorder.
Now that I am taking dexedrine for focus, and effexor to prevent over-focus it seems that it might make sense to try a norepinephrine uptake inhibitor. According to my understanding, this neurotransmitter is responsible for regulating one's stamina.
A MEDICATION TO DEAL WITH MY LACK OF STAMINA
I am wondering whether anyone has suggestions about what medication to tryIn the past my body has had difficulty tolerating wellbutrin as well as the numerous SSRI and AD's that I've tried (except in very small doses). Are there norepinephrine uptake inhibitors that deal solely with norepinephrine other than wellbutrin? If not, which of the ones available is likely to have the least effect on my serotonin level?
A REVERSAL EFFECT ON WELLBUTRIN
When I was on the wellbutrin it made me very sedate to the point that I could scarcely summon up the stamina to go out of my house for about a week. After 10 days of that my p-doc took me off the med.In hindsight I wonder whether what I experienced could have been the ‘reversal effect' which people sometimes experience during the initial phase of using a medicine that acts on their neurotransmitters. Has anyone experienced this themselves or come across it in the medical literature?
My psychiatrist has his own suggestions about what meds I should try. Though I take them seriously I always like to understand the full range of options so I can do so me good research and than make an informed decision. Thank-you.
Blessings,
Leor
Posted by Jo Ann on October 6, 2002, at 15:47:56
In reply to norepinephrine uptake inhibitors (help please!) , posted by leor on October 6, 2002, at 14:34:25
Can you just clarify to me what "overfocus" effects you experienced from the dexedrine? I am on both meds as well, but Effexor has been pretty helpful in counteracting the dexedrine side effects without interfering with my ability to focus. I did, however, experience some intense side effects when I started the Effexor which were relatively short-lived. How long have you been taking dexedrine for?
Posted by leor on October 6, 2002, at 16:05:30
In reply to Re: norepinephrine uptake inhibitors (help please!) , posted by Jo Ann on October 6, 2002, at 15:47:56
>> Can you just clarify to me what
>> "overfocus" effects you experienced from the
>>dexedrine? I am on both meds as well, but Effexor has been pretty helpful in counteracting the dexedrine side effects without interfering with my ability to focus. I did, however, experience some intense side effects when I started the Effexor which were relatively short-lived.To clarify: the ‘overfocus affects' that I
referred to did not result from my using dexedrine. They are a component of my A.D.D. package. (It involves a propensity for my brain to
‘get stuck' into a thought patters, somewhat like a person who has OCD). Effexor is the first line of treatment for people who suffer from this subtype of A.D.D. according to Dr. Daniel Amen's book ‘healing the A.D.D. brain. Incidently, I highly recommend viewing his web site if A.D.D. is a topic of interest to you (www.brainplace.com)
>>How long have you been taking dexedrine for?I have been taking the dexedrine for nine months now.
Thanks,
Leor
Posted by Ritch on October 6, 2002, at 22:56:15
In reply to norepinephrine uptake inhibitors (help please!) , posted by leor on October 6, 2002, at 14:34:25
>
> Dear Babblers
>
> Over the past month I have been taking effexor (short acting form) for the management of the ‘overfocus' symptoms of my A.D.D. (17.85mg twice a day) I also take 15 mg of Dexedrine XR once a day. My DX is bipolar II plus non-hyperactive A.D.D
>
> Effexor seems to do the job nicely - but not without some nasty side effects; mild headaches and mental ‘dulling'. While under the influence, it is difficult for me to feel that my brain is fully stimulated and allways a pall of mild mental & emotional exhaustion hangs over my body.
>
> I am no stranger to such problems; on or off of medications. They are with me yearround but are at their most excrutiating during the winter when I suffer from severe seassonal affective disorder.
>
> Now that I am taking dexedrine for focus, and effexor to prevent over-focus it seems that it might make sense to try a norepinephrine uptake inhibitor. According to my understanding, this neurotransmitter is responsible for regulating one's stamina.
>
>
> A MEDICATION TO DEAL WITH MY LACK OF STAMINA
> I am wondering whether anyone has suggestions about what medication to try
>
> In the past my body has had difficulty tolerating wellbutrin as well as the numerous SSRI and AD's that I've tried (except in very small doses). Are there norepinephrine uptake inhibitors that deal solely with norepinephrine other than wellbutrin? If not, which of the ones available is likely to have the least effect on my serotonin level?
>
>
> A REVERSAL EFFECT ON WELLBUTRIN
> When I was on the wellbutrin it made me very sedate to the point that I could scarcely summon up the stamina to go out of my house for about a week. After 10 days of that my p-doc took me off the med.
>
> In hindsight I wonder whether what I experienced could have been the ‘reversal effect' which people sometimes experience during the initial phase of using a medicine that acts on their neurotransmitters. Has anyone experienced this themselves or come across it in the medical literature?
>
> My psychiatrist has his own suggestions about what meds I should try. Though I take them seriously I always like to understand the full range of options so I can do so me good research and than make an informed decision. Thank-you.
>
> Blessings,
>
> Leor
>
>
>
>
Leor, very interesting post indeed. I'm BP-II+ADHD as well. The only *very* selective NE-reuptake inhibitors around are Reboxetine (in Canada), and atomoxetine (still in clinical trials for ADHD). I'm taking Effexor (very-low-dose)+Wellbutrin (medium-dose), and Ritalin 20mg daytimes and Depakote+Neurontin+Klonopin (all low-dose) at night. I tend to get EASILY hypomanic with SSRI's (5mg of Celexa, i.e.). However, I am now taking 150mg of WB, and 20mg of Ritalin, and it is like: "Did I take anything??". If I take more of *any* SRI (which does makes it easier to switch tasks), I get out of control and start cycling more. Is it a reduced *inhibition* from the SRI that causes this by increasing impulsiveness and making thoughts TOO fluid?The "reversal" effect of Wellbutrin-I think you are definitely onto something there. I also notice some paradoxical tiredness from it. I bought a blood pressure machine (at the request of my pdoc because of polypharmacy and stimulant med), and measured my BP all day long and recorded all my meds. When the WB was supposed to be peaking-my blood pressure was dropping.. I don't understand it. I am supposed to go to 200mg WB later in the week.
Posted by Ritch on October 6, 2002, at 22:57:58
In reply to Re: norepinephrine uptake inhibitors (help please!) , posted by leor on October 6, 2002, at 16:05:30
Posted by SLS on October 8, 2002, at 7:03:36
In reply to Re: norepinephrine uptake inhibitors (help please!) » leor, posted by Ritch on October 6, 2002, at 22:56:15
> The only *very* selective NE-reuptake inhibitors around are Reboxetine (in Canada), and atomoxetine (still in clinical trials for ADHD).
Desipramine (Norpramin) is very selective for NE relative to the other monoamines (5-HT and DA). It is often used successfully to treat ADHD. Another antidepressant drug selective for NE is maprotiline (Ludiomil).
- Scott
Posted by Ritch on October 8, 2002, at 8:58:46
In reply to Re: norepinephrine uptake inhibitors (help please!), posted by SLS on October 8, 2002, at 7:03:36
> > The only *very* selective NE-reuptake inhibitors around are Reboxetine (in Canada), and atomoxetine (still in clinical trials for ADHD).
>
>
> Desipramine (Norpramin) is very selective for NE relative to the other monoamines (5-HT and DA). It is often used successfully to treat ADHD. Another antidepressant drug selective for NE is maprotiline (Ludiomil).
>
>
> - Scott
Hi Scott, Yes I've tried desipramine before and it worked great (during the day for focus) and by taking just 10mg at bedtime. But, I had this pounding heart on it (accompanied by blurred vision). I just didn't list it due to the anticholinergic effects. Nortriptyline worked somewhat, but I had to take a much larger dose. Never tried Ludiomil. I'm on WB 150mg/day now + Ritalin 20mg. I wonder how long I will have to give the WB before it will kick in for focus issues? The Ritalin works OK, but it seems like the WB *defeats* it somehow. I responded to that tiny dose of desipramine after just 7-10 days. I've been on this dose of WB for a similar amount of time.-Mitch
Posted by jrbecker on October 8, 2002, at 13:34:11
In reply to Re: norepinephrine uptake inhibitors (help please!) » SLS, posted by Ritch on October 8, 2002, at 8:58:46
back in my days in advertising, I was privy to a lot of the research data on tomoxetine (atomoxetine), since my agency was in a bid to get the advetising account for the drug when it started its marketing campaign. The data looked great. It is much subtler than the stimulants and supposedly much more of an alternative ADHD preferred treatment in comparison to other ADs. Lilly is really excited about this drug and so is my own pdoc for congruency in my own therapeutic regimen for atypcial dep. I have moderate problems with focus and motivation, largely from the fact that NE is highly associated with atypical depression's etiology.
It will launch in early '03.
Posted by Ritch on October 8, 2002, at 22:52:40
In reply to Re: norepinephrine uptake inhibitors (help please!), posted by jrbecker on October 8, 2002, at 13:34:11
> back in my days in advertising, I was privy to a lot of the research data on tomoxetine (atomoxetine), since my agency was in a bid to get the advetising account for the drug when it started its marketing campaign. The data looked great. It is much subtler than the stimulants and supposedly much more of an alternative ADHD preferred treatment in comparison to other ADs. Lilly is really excited about this drug and so is my own pdoc for congruency in my own therapeutic regimen for atypcial dep. I have moderate problems with focus and motivation, largely from the fact that NE is highly associated with atypical depression's etiology.
>
> It will launch in early '03.Thanks for the reply. The best meds for ADHD that I have tried thus far have been desipramine, Adderall, and methylphenidate products (Focalin and now Ritalin-LA). I am giving bupropion a go at 150mg/day for a while along with Ritalin. We are going to see if the bupropion (given ample time) can eliminate the Ritalin. However, now I wonder how atomoxetine and bupropion stackup with regard to ADHD efficacy. The only thing that gripes me about bupropion is the active metabolites long half-life (up to 30hrs) which causes insomnia problems.--Mitch
Posted by SLS on October 10, 2002, at 23:04:26
In reply to Re: norepinephrine uptake inhibitors (help please!) » jrbecker, posted by Ritch on October 8, 2002, at 22:52:40
> However, now I wonder how atomoxetine and bupropion stackup with regard to ADHD efficacy. The only thing that gripes me about bupropion is the active metabolites long half-life (up to 30hrs) which causes insomnia problems.--Mitch
Hi Mitch.Have you considered trying Effexor (venlafaxine)?
I recall seeing several studies showing it to be effective for ADHD. However, I don't recall if it was as effective for attentional features as it was for behavioral / mood features.
Here's a Medline link. You might need to copy-and-paste the entire link that follows into your browser. Clicking might not work.
ADHD and Effexor:- Scott
Posted by SLS on October 10, 2002, at 23:05:47
In reply to Re: norepinephrine uptake inhibitors (help please!) » Ritch, posted by SLS on October 10, 2002, at 23:04:26
Cool.
The link worked.
Posted by Ritch on October 11, 2002, at 9:39:28
In reply to Re: norepinephrine uptake inhibitors (help please!) » Ritch, posted by SLS on October 10, 2002, at 23:04:26
>
> > However, now I wonder how atomoxetine and bupropion stackup with regard to ADHD efficacy. The only thing that gripes me about bupropion is the active metabolites long half-life (up to 30hrs) which causes insomnia problems.--Mitch
>
>
> Hi Mitch.
>
> Have you considered trying Effexor (venlafaxine)?
>
> I recall seeing several studies showing it to be effective for ADHD. However, I don't recall if it was as effective for attentional features as it was for behavioral / mood features.
>
>
> Here's a Medline link. You might need to copy-and-paste the entire link that follows into your browser. Clicking might not work.
>
>
> ADHD and Effexor:
>
> http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=4&term=("attention+deficit"+OR+"adhd")+AND+venlafaxine&dispmax=200
>
>
>
> - ScottThanks for the link Scott. I am taking Effexor also, but only 12.5mg with WB in the morning. Effexor would work better if I could tolerate more of it. It seems that potent serotonin reuptake inhibitors tend to cause hypomania. I can't realize Effexor's advantages in the NE department unless I crank the dose way up-which I can't do. But, it is good for "task-switching" and great for anxiety. I wish there was another med (not a TCA), that was primarily an NE reuptake inhibitor, and also blocked the 5HT-transporter (but much less actively). I really wonder if just a 'pinch' of Reboxetine combined with a 'pinch' of Effexor would do the trick? I'm also taking Ritalin-LA 20mg in the afternoons, but it is uneven. I don't like stims much really-great for BP-depression, but they tend to make me too quiet and kind of "cold". Desipramine really made a difference, but I don't like the sleep-cycle disruption and anitcholinergic effects. It is like I can live in a fog and not be anxious, or I can clear the fog away but I am too uptight, it sucks. ---Mitch
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.