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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by cybercafe on December 28, 2002, at 21:50:26
or is it limited to people with pre-existing
depressive disorders?does it mean i should be taking an antidepressant in addition to a stim?
(rebound depression, i mean, in the evening when the stim starts to wear off i get depressed)
thanks ;)
Posted by Gabbix2 on December 28, 2002, at 23:32:44
In reply to does everyone get rebound depression on a stim?, posted by cybercafe on December 28, 2002, at 21:50:26
I don't know if everyone gets it, but its a very normal reaction when it wears off to get rebound fatigue/mild depression. Unless its severe depression I wouldn't think you'd need an anti-depressant. Its happened to me occasionally and I find taking a milder herbal stimulant like gotu-kola or ginseng mid afternoon helps prevent it.
Posted by Noelle on December 29, 2002, at 4:50:30
In reply to Re: does everyone get rebound depression on a stim?, posted by Gabbix2 on December 28, 2002, at 23:32:44
I knew I had anxiety but I have often wondered if my depression was caused by my stimulant. I have been on ADD off and on for a while. I have found that you have to treat the depression and then go back on the stim. I have done both at the same time and its difficult, both seem to interfere with oneanother. I started taking the Stim in the early evening but then I just didn't want to go to bed bad cycle.
Posted by ZeeZee on December 29, 2002, at 10:11:40
In reply to does everyone get rebound depression on a stim?, posted by cybercafe on December 28, 2002, at 21:50:26
Yes, depression is a common side effect of stim's during the wash out period. My son has ADD and has used Dex since he was 9. He's now 19 and a college student. The depression and irritablitly has always occured while the drug was wearing off. However, when not on it, weekends and holidays, he feels totally fine - none of those symptoms at all. AD's are sometimes prescribed to help with this roller coaster effect. There are some long acting stim's that are intended to avoid the "let down" syptoms, but they pose their own s/e's.
Posted by Ritch on December 29, 2002, at 10:34:58
In reply to does everyone get rebound depression on a stim?, posted by cybercafe on December 28, 2002, at 21:50:26
> or is it limited to people with pre-existing
> depressive disorders?
>
> does it mean i should be taking an antidepressant in addition to a stim?
>
> (rebound depression, i mean, in the evening when the stim starts to wear off i get depressed)
>
> thanks ;)
I never got any rebound evening depression from Adderall (it was smooth enough I didn't notice it). I *did* have that problem with dexedrine when it wore off, however. Ritalin was weird, I never got any rebound depression from it wearing off at all. Strangely, I would have *increased* depression if the dose was too *high*.
Posted by ZeeZee on December 29, 2002, at 11:09:46
In reply to Re: does everyone get rebound depression on a stim? » cybercafe, posted by Ritch on December 29, 2002, at 10:34:58
My son hates how he feels either on it or coming off of it. He takes Dex because of severe anorexia with Adderall and tics with Ritalin. He uses it because he has to to get through school. He hates how it flattens his mood, makes him very serious and quiet, and causes sexual dysfunction.
Posted by Ritch on December 29, 2002, at 16:36:30
In reply to Re: does everyone get rebound depression on a stim? » Ritch, posted by ZeeZee on December 29, 2002, at 11:09:46
> My son hates how he feels either on it or coming off of it. He takes Dex because of severe anorexia with Adderall and tics with Ritalin. He uses it because he has to to get through school. He hates how it flattens his mood, makes him very serious and quiet, and causes sexual dysfunction.
The mood flattening can be a real bummer. I've got bipolarII mixed in with ADHD and stims make me lose my sense of humor almost entirely. Also, I noticed some loss of empathy for others. It was even difficult to feel sad in any way. I *do* need mood stability but I can't stand the icky, jittery, blah, type of alertness.
Posted by SLS on December 29, 2002, at 20:48:39
In reply to Re: does everyone get rebound depression on a stim? » ZeeZee, posted by Ritch on December 29, 2002, at 16:36:30
> > My son hates how he feels either on it or coming off of it. He takes Dex because of severe anorexia with Adderall and tics with Ritalin. He uses it because he has to to get through school. He hates how it flattens his mood, makes him very serious and quiet, and causes sexual dysfunction.
>
> The mood flattening can be a real bummer. I've got bipolarII mixed in with ADHD and stims make me lose my sense of humor almost entirely. Also, I noticed some loss of empathy for others. It was even difficult to feel sad in any way. I *do* need mood stability but I can't stand the icky, jittery, blah, type of alertness.Have you ever considered trying Lamictal? Unfortunately, it is a real pain in the ass to get started on, but I believe that it has pro-dopaminergic effects, perhaps mediated by modulating glutamatergic neurotransmission. I have no concrete reason for believing it would help, other than a gut feeling. If anything, Lamictal would activate your mood rather than flatten it. Care to be a guinea pig? :-)
- Scott
Posted by Ritch on December 29, 2002, at 22:27:57
In reply to Re: does everyone get rebound depression on a stim?, posted by SLS on December 29, 2002, at 20:48:39
> > > My son hates how he feels either on it or coming off of it. He takes Dex because of severe anorexia with Adderall and tics with Ritalin. He uses it because he has to to get through school. He hates how it flattens his mood, makes him very serious and quiet, and causes sexual dysfunction.
> >
> > The mood flattening can be a real bummer. I've got bipolarII mixed in with ADHD and stims make me lose my sense of humor almost entirely. Also, I noticed some loss of empathy for others. It was even difficult to feel sad in any way. I *do* need mood stability but I can't stand the icky, jittery, blah, type of alertness.
>
> Have you ever considered trying Lamictal? Unfortunately, it is a real pain in the ass to get started on, but I believe that it has pro-dopaminergic effects, perhaps mediated by modulating glutamatergic neurotransmission. I have no concrete reason for believing it would help, other than a gut feeling. If anything, Lamictal would activate your mood rather than flatten it. Care to be a guinea pig? :-)
>
>
> - ScottScott, I have considered it for quite some time. I have a pdoc that may be excessively concerned with safety issues, but OTOH I have a history of strange skin reactions to several medications and that has me paranoid about trying it. I'm even concerned about MAOI's because I have a very significant hypertensive reaction to very small doses of Effexor or Wellbutrin. For example, I can take zero Effexor and have a BP avg. of 124/67 and then take as little as 18.75mg of Effexor or 75mg of Wellbutrin for a few days and have a BP of something like 148/93. However... meds that tend to make me hypertensive also have been effective antidepressants. Lamictal would be something I would consider if other stuff wasn't working at least half-ass (Depakote/Trileptal, i.e.).---Mitch
Posted by viridis on December 30, 2002, at 14:36:32
In reply to does everyone get rebound depression on a stim?, posted by cybercafe on December 28, 2002, at 21:50:26
I find that low-dose Adderall (5-10 mg) wears off gradually, and I've never noticed any crash or rebound. It seems to work well as an antidepressant for me, together with low-dose Klonopin. I am very prone to depression, but haven't had a major episode since starting this combination.
Posted by noa on December 31, 2002, at 9:27:35
In reply to Re: does everyone get rebound depression on a stim? » cybercafe, posted by ZeeZee on December 29, 2002, at 10:11:40
I find it much better to be on a longer acting stim. Ritalin SR was better than plain ritalin. Adderall was better than Ritalin SR. Now I am on Adderall XR, which is even better for eliminating the rebound. But missing the dose altogether does not feel good.
Posted by SLS on December 31, 2002, at 12:57:08
In reply to Re: does everyone get rebound depression on a stim?, posted by noa on December 31, 2002, at 9:27:35
Hi folks.
Just curious, has anyone tried adding amantadine (Symmetrel)? A cousin drug, not yet approved by the FDA, named memantine seems to "smooth" out the effect of stimulants and helps prevent tolerance (the need for higher and higher dosages). Both drugs have similar properties (NMDA inhibition).
- Scott
Posted by IsoM on December 31, 2002, at 20:49:58
In reply to Re: does everyone get rebound depression on a stim?, posted by SLS on December 31, 2002, at 12:57:08
Seeing you asked, I'm curious if you've used it & how it felt to you. Or are you asking others 'cause you're as curious as I am about it?
Posted by SLS on January 3, 2003, at 20:54:17
In reply to Scott, have you used amantadine (Symmetrel)? » SLS, posted by IsoM on December 31, 2002, at 20:49:58
Hi IsoM.
> Seeing you asked, I'm curious if you've used it & how it felt to you. Or are you asking others 'cause you're as curious as I am about it?
No, I haven't tried it. I guess I was just trying to help, mostly. However, it is something that my doctor has considered. He describes it as having only moderate potency as an augmentor of antidepressants. Additionally, I might end up using it in the future to mitigate sexual side-effects if necessary. I have even heard of amantadine being used to prevent Zyprexa-induced weight gain. She claims it works, having been on and off the drug several times.
- Scott
Posted by HannahBeGood on January 5, 2003, at 12:47:17
In reply to Re: does everyone get rebound depression on a stim?, posted by noa on December 31, 2002, at 9:27:35
I have the wonderful convenience of being able to keep Dexedrine Spansules 15 mgs. and Dexstrostat 5 mgs. on hand so I can fine-tune my needs on a daily basis. I am not sure what my exact diagnosis wd. be. My therapists are not big on trying to fit me into a particular 'slot' and I think we are all still trying to address my symptoms as more details concerning my 'obstacles' surface.
I certainly have had bouts of depression or perhaps varying degrees of dysthymia w/occasional major dep. episodes for 30 yrs. I have ADD, some OCD symptoms, pervasive anxiety (in varying degrees, which, coupled w/unrelenting daytime sleepiness, causes me to isolate myself to a debilitating degree) all of which were just assigned the Dx of 'garden-variety' depression by a couple of docs, but NO a-d's alone worked for me.
I kept trying to explain to the docs that I was not having my most disabling symptoms because I was depressed, but, rather that I felt terrible/depressed b/c I could not access the parts of my brain that galvanized action, organized thinking, creativity, and the concept of 'future'. I could not, when I got to my worst point, visualize the satisfaction I wd. feel after doing something that was necessary to my family and to me for my own well-being (eat, bathe, keep a more organized house) at all. My internal reward system, that carrot our brains hold in front of out noses, by necessity, forever, was simply not in operational mode, so I had no ability to motivate, activate or execute to completion, much of anything.
When I was finally formally dx'd w/ADD 9/01, and began stim therapy, a sense of hope entered my life for the first time in yrs.I finally had the most important tool my brain requires (& naturally lacks) to have a life. A real life.
Back to your question, yes, I do feel , the 'crash' if I don't take my meds in such a way as to avoid it. My doc allows me to do this, since it is not difficult for me to sleep even if I take a low-dose stim after 6 p.m. In fact, that is often when I need it most, so that I can stay alert while my 6 yr. old is still wide awake, but moving into her sub-level fatigued cranky period which is always a bit of a strain on both of us.So, my answer-take enough of whatever p-stim med you prefer until you are actually ready to 'shut down' for the night. I love my couple of hours quietly active time, after my child is asleep. I'm an avid reader, artist, designer, love to research many subjects just for fun, on the net or by reading, and I always fall asleep with a book in hand. I cannot simply lie down and sleep. Well, I probably could, but I love the feeling of not being able to keep my eyes open another second when I have read myself into that drowsy, soporific state that will not be denied. sometimes it only takes 10 minutes, but, it removes my mind from 'my day' and I like that detaching before boarding Starship Sandman.
I am allowed up to 60mgs. of dex spansules daily with up to 20mgs. Dextrostat, in 5mg. doses, as boosters, prn. I also use clonazepam and lexapro, as well as propanolol. All of my dosages fluctuate with my daily needs, except the Lexapro, which stays at 15mgs. I rarely use the full amt. of Dex I am allowed, but it lowers my anxiety level simply knowing I have it if I need it. I call it the "in the med. cabinet if I need it" placebo effect.
Noa, may I ask ur dosage on Adderall? I dev'd tolerance quickly, I was allowed to go quite high on it, but I was also taking Effexor at the time and I know FXR has a serious side-effect of pronounced somnolence (for me) that does not fade with time.It really helped me get through a protracted grief cycle when my parents died, but I had to drop it once I felt I had that under control, due to the 'sleepy' side-effect. I also felt detached anf emotionally flattened, which actually helped me at that time, in a weird way, because I needed to be de-sensitized abit, so that time cd. pass and I cd. process without being completely torn apart by my emotionality, and the lack of control I felt concerning it.Afterward, I needed to re-connect,and be as alert as possible, so I left the FXR.
Do you only dose early, or can you take stims later in the day? Does the Add'l last long enough for you? I did think it was quite smooth, so smooth that I was not given enuf oomph to deny myself many naps more than I can afford a day.
But, the Dex (SR & IR) really are my best p-stim fit, as ritilan made me positively dysphoric and miserable.
Long-winded as usual-Hannah
Posted by Noa on January 5, 2003, at 15:05:28
In reply to Re: everyone get rebound depression: Noa/Cyber, posted by HannahBeGood on January 5, 2003, at 12:47:17
I take 30 mg adderall xr in the morning. I think it lasts long enough, most of the time, except perhaps when my day goes from 5 am to 12 midnight, but that is not the meds' fault!
I get the activation effect from effexor, not the sedating. Seems there are both these reactions to it. Someday, maybe they'll know why some people react one way and some the other way.
Posted by neetie on January 5, 2003, at 17:35:07
In reply to Re: does everyone get rebound depression on a stim, posted by viridis on December 30, 2002, at 14:36:32
I got rebound tiredness and irritability and depression from all stimulants I've tried (Ritalin, Adderall, Wellbutrin, etc), either after the dose wore off or after taking it for a few weeks. So far Abilify doesn't have that effect for me -- after a month it's still stimulating (like a really low dose of ritalin) and it hasn't worn off or caused irritability. Maybe it's too soon to say, but I think it's an excellent replacement for stimulants.
anita
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