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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Peter on November 8, 2001, at 1:24:56
Hi all:
Today was my first day increasing Adderall to .5mg in morning and .25mg in afternoon. I'm still having trouble with the really sleepy, spacy state I'm in when the last dose wears off (@7p.m). I get so tired that I'm useless for the rest of the night. What's really wierd is that, even though the effects wear off, I become restless hours later and my resting heart rate remains fairly high (up to 88bpm sitting and up to 105bpm standing)(I'm 25 years old, male). It's now 2 a.m. and I'm wide awake, even though I already took 750mg depakote and 1mg klonopin ,which I do every night before bed. But, because of my problem of getting so tired when my 2nd dose of adderall wears off in the afternoon, my pdoc suggested that tomorrow I take 3 doses spread thru the day = .5mg in morning, .25mg 4 hrs. later, and finally another .25mg 4 hours after that. This sounds sensible to me, in terms of it keeping my energy level more consistent and balanced through the late afternoon/evening so I could function. But, if my resting heart rate is already relatively high this late at night from taking 2 doses of Adderall, I doubt I'll be able to sleep at all starting tomorrow when I'm taking 3 doses! The only thing I can think of is adding a bit of beta-blocker before I go to bed. I have some 20mg Inderal left from years ago (Feb.1999!). Do you think it's safe to take some before bed? Would it help? How much is a good single dose? And, finally, is the stuff still gonna work since it's so old?
Thanx
Posted by Peter on November 8, 2001, at 10:45:46
In reply to Adderall heart rate, posted by Peter on November 8, 2001, at 1:24:56
> oops! I put the decimals in the wrong place - what I meant was 5mg and 2.5mg doses. Sorry. While I'm hear I might as well add that when I woke up today my resting heart rate was still @103bpm!! Isn't that too high? I'm 25 and I weigh about 180!
Posted by Mitch on November 8, 2001, at 12:50:35
In reply to Re: Adderall heart rate, posted by Peter on November 8, 2001, at 10:45:46
> > oops! I put the decimals in the wrong place - what I meant was 5mg and 2.5mg doses. Sorry. While I'm hear I might as well add that when I woke up today my resting heart rate was still @103bpm!! Isn't that too high? I'm 25 and I weigh about 180!
Yes, that HR does sound quite high. Mine went up too while I was on it, but not *that* much! I wouldn't take the Inderal. Did you tell your doctor about the HR elevation? Also, other meds you may be taking could be contributing. If you are swilling coffee all day that will do it too. You mentioned taking 750mg/day of Depakote and I think some Klonopin(?). Do you take that spread out all day? You might ask your doctor about taking it all at bedtime to get you to sleep, and then just take the Adderall during the day. Who knows, maybe if you got some better sleep the HR thing might back off some.
Mitch
Posted by Peter on November 8, 2001, at 13:39:26
In reply to Re: Adderall heart rate » Peter, posted by Mitch on November 8, 2001, at 12:50:35
> > Well I'm already taking all 750mg depakote at night before bed, and I already cut out the coffee when I started the adderall. As for the klonopin, I take .5mg in morning, .5mg afternoon, and then 1mg at bedtime. I find that spreading it throughout the day helps me with daytime anxiety/panic. The mystery of it all is that, though my heart rate goes up pretty high, I don't FEEL racy. If anything, I just feel spacey and calm. Maybe this is just a proper response of ADD individual to a stimulant? In fact, today is the first day I took 5mg adderall after waking and it did nothing except make me a little spaced-out and irritable; could it be losing its benefits this early? Also, why did you advise against the Inderal? Will it just further space me out?
Thanks,
Peter
>
> Yes, that HR does sound quite high. Mine went up too while I was on it, but not *that* much! I wouldn't take the Inderal. Did you tell your doctor about the HR elevation? Also, other meds you may be taking could be contributing. If you are swilling coffee all day that will do it too. You mentioned taking 750mg/day of Depakote and I think some Klonopin(?). Do you take that spread out all day? You might ask your doctor about taking it all at bedtime to get you to sleep, and then just take the Adderall during the day. Who knows, maybe if you got some better sleep the HR thing might back off some.
>
> Mitch
Posted by Mitch on November 8, 2001, at 23:53:52
In reply to Re: Adderall heart rate, posted by Peter on November 8, 2001, at 13:39:26
> > > Well I'm already taking all 750mg depakote at night before bed, and I already cut out the coffee when I started the adderall. As for the klonopin, I take .5mg in morning, .5mg afternoon, and then 1mg at bedtime. I find that spreading it throughout the day helps me with daytime anxiety/panic. The mystery of it all is that, though my heart rate goes up pretty high, I don't FEEL racy. If anything, I just feel spacey and calm. Maybe this is just a proper response of ADD individual to a stimulant? In fact, today is the first day I took 5mg adderall after waking and it did nothing except make me a little spaced-out and irritable; could it be losing its benefits this early? Also, why did you advise against the Inderal? Will it just further space me out?
> Thanks,
> Peter
> >
Hi Peter,I just advised against taking the Inderal because it appeared you hadn't consulted with your doctor about the HR issue and you were going to self-medicate with an old med you had handy-that's all. I don't know if it would be a good or bad thing objectively and I have never taken beta-blockers or Inderal personally.
I would think that if your Adderall dose remained the same for a few weeks (letting your body adapt to it), this might resolve with time. I am a little tempted however to think you might benefit by switcing to Dexedrine instead. I had some minor blood pressure issues (and headaches) when taking Adderall. It is my understanding that d-amphetamine has fewer autonomic effects than the l-amphetamine that is contained in Adderall. Also, if you have a panic history the Adderall might not be a good fit. I never got the chance to try Dexedrine in place of Adderall to find out personally however. The irritability isn't really a good sign, either. I would ask your pdoc about a Dexedrine switch and tell him about your heart-rate concerns.
Mitch
Posted by Peter on November 9, 2001, at 1:05:59
In reply to Re: Adderall heart rate » Peter, posted by Mitch on November 8, 2001, at 23:53:52
> Hey Mitch,
First of all, thank you so much for helping me out again - you've really been easing my mind with great advice and info since I started the adderall. You know, it's been so new to me - beginning a new med always sort of stresses me out. So thanks for the much needed support. Now, I'm going to ask my doctor about Dexedrine-sounds interesting. But I also found out something pretty cool - I did consult my doctor already about the inderal, and he recommends that I take it for a few really good reasons: firstly, it will help lower and control my heart rate, and I've taken it in the past with no bad side-effects. If it works well, he'll switch me over to the LA version, which is just once a day. Interestingly, he said that if the adderall continues to work to focus and calm me, I'll probably be able to taper off of the klonopin (which for me would be quite an accomplishment since I've been on it for 3 years and I feel quite dependent on it). The reason for stopping the klonopin is not only because the adderall can relax me(that strange reverse ADD reaction to stimulants), but also because the Inderal, in addition to keeping my heart rate healthy, is also effective for social anxiety and panic (and, of course, it is not an addictive, controlled substance like klonopin). So, in the the end, if all works well, I'll only take 1 Inderal LA each morning, adderall 3x each day, and depakote at night, without popping klonopins all day. This will obviously be far down the road if everything works out, but I thought it was an interesting change off of meds. Out of curiosity, what do you take now? Is everything working ok? Well, thanks again. Probably talk to you soon.
Peter
> Hi Peter,
>
> I just advised against taking the Inderal because it appeared you hadn't consulted with your doctor about the HR issue and you were going to self-medicate with an old med you had handy-that's all. I don't know if it would be a good or bad thing objectively and I have never taken beta-blockers or Inderal personally.
>
> I would think that if your Adderall dose remained the same for a few weeks (letting your body adapt to it), this might resolve with time. I am a little tempted however to think you might benefit by switcing to Dexedrine instead. I had some minor blood pressure issues (and headaches) when taking Adderall. It is my understanding that d-amphetamine has fewer autonomic effects than the l-amphetamine that is contained in Adderall. Also, if you have a panic history the Adderall might not be a good fit. I never got the chance to try Dexedrine in place of Adderall to find out personally however. The irritability isn't really a good sign, either. I would ask your pdoc about a Dexedrine switch and tell him about your heart-rate concerns.
>
> Mitch
Posted by Mitch on November 9, 2001, at 9:26:09
In reply to Re: Adderall heart rate, posted by Peter on November 9, 2001, at 1:05:59
> > Hey Mitch,
> First of all, thank you so much for helping me out again - you've really been easing my mind with great advice and info since I started the adderall. You know, it's been so new to me - beginning a new med always sort of stresses me out. So thanks for the much needed support. Now, I'm going to ask my doctor about Dexedrine-sounds interesting. But I also found out something pretty cool - I did consult my doctor already about the inderal, and he recommends that I take it for a few really good reasons: firstly, it will help lower and control my heart rate, and I've taken it in the past with no bad side-effects. If it works well, he'll switch me over to the LA version, which is just once a day. Interestingly, he said that if the adderall continues to work to focus and calm me, I'll probably be able to taper off of the klonopin (which for me would be quite an accomplishment since I've been on it for 3 years and I feel quite dependent on it). The reason for stopping the klonopin is not only because the adderall can relax me(that strange reverse ADD reaction to stimulants), but also because the Inderal, in addition to keeping my heart rate healthy, is also effective for social anxiety and panic (and, of course, it is not an addictive, controlled substance like klonopin). So, in the the end, if all works well, I'll only take 1 Inderal LA each morning, adderall 3x each day, and depakote at night, without popping klonopins all day. This will obviously be far down the road if everything works out, but I thought it was an interesting change off of meds. Out of curiosity, what do you take now? Is everything working ok? Well, thanks again. Probably talk to you soon.
> Peter
Peter,I am on a combo of Neurontin/Klonopin/Zoloft. I also have to "tap the brakes" with some Depakote at times during my cycling, and I have to pop a nortripytline cap every so often because of the irritable bowel that the Zoloft causes. Elizabeth (another poster here) thinks I would do better on an MAOI like Nardil or Parnate (rather than Zoloft). I agree, but my pdoc won't budge on the issue-also no more stimulants either-because of the panic that occurred on Adderall (I wasn't taking any Klonopin, etc. though). However, I am really interested in Provigil now (read Rick's posts above).
Mitch
Posted by Cressida on November 10, 2001, at 19:01:06
In reply to Re: Adderall heart rate » Peter, posted by Mitch on November 9, 2001, at 9:26:09
Peter, just so you know Adderall contains a recemic mixure of amphetamine. It has both dextroamphetamine and levoamphetamine. I have read and heard that the latter is responsible for the adverse cardiovascular effects.
Dexedrine, on the other hand, contains only dextroamphetamine.
Side-effects should improve in a matter of 1-2 weeks. Also, the medication will work better as your body adjusts. It took me about 2-4 weeks to gain the real benefit of Adderall. You have to give it a chance to work.
Posted by JohnX2 on November 12, 2001, at 9:18:01
In reply to Re: Adderall heart rate » Peter, posted by Mitch on November 8, 2001, at 23:53:52
I've taken Inderal many times when I had a racing
heart (I topped 120!) and it almost always stops it in its track.
Tends to flatten out the mood however. I generally
check for drug interactions 1st, as this is important.
If memory serves me correct, a lot of ADDers take the
bp medication tenex with Adderall to help tame any
hyperactive side effects.regards,
john
> > > > Well I'm already taking all 750mg depakote at night before bed, and I already cut out the coffee when I started the adderall. As for the klonopin, I take .5mg in morning, .5mg afternoon, and then 1mg at bedtime. I find that spreading it throughout the day helps me with daytime anxiety/panic. The mystery of it all is that, though my heart rate goes up pretty high, I don't FEEL racy. If anything, I just feel spacey and calm. Maybe this is just a proper response of ADD individual to a stimulant? In fact, today is the first day I took 5mg adderall after waking and it did nothing except make me a little spaced-out and irritable; could it be losing its benefits this early? Also, why did you advise against the Inderal? Will it just further space me out?
> > Thanks,
> > Peter
> > >
>
>
> Hi Peter,
>
> I just advised against taking the Inderal because it appeared you hadn't consulted with your doctor about the HR issue and you were going to self-medicate with an old med you had handy-that's all. I don't know if it would be a good or bad thing objectively and I have never taken beta-blockers or Inderal personally.
>
> I would think that if your Adderall dose remained the same for a few weeks (letting your body adapt to it), this might resolve with time. I am a little tempted however to think you might benefit by switcing to Dexedrine instead. I had some minor blood pressure issues (and headaches) when taking Adderall. It is my understanding that d-amphetamine has fewer autonomic effects than the l-amphetamine that is contained in Adderall. Also, if you have a panic history the Adderall might not be a good fit. I never got the chance to try Dexedrine in place of Adderall to find out personally however. The irritability isn't really a good sign, either. I would ask your pdoc about a Dexedrine switch and tell him about your heart-rate concerns.
>
> Mitch
Posted by Mitch on November 12, 2001, at 13:15:47
In reply to Re: Adderall heart rate » Mitch, posted by JohnX2 on November 12, 2001, at 9:18:01
Hi John,
This is a little off the subject, but I think you might be of some help. I see my pdoc later this week and my seasonal depression is due to start kicking in either next week or the week after (*always* by first week of December). I have tried low-dose Wellbutrin (75-150mg/day) for this in the past adjunctively with Neurontin/low-dose SSRI and it was effective, but I didn't like the edginess (slept OK, no irritability, though!)and I didn't like having to take 3 or 4 broken doses a day (kept crashing). Do you think Provigil would be less jagged than the Wellbutrin and allow me to sleep OK, or do you think it would be better to stick with what worked before (the WB)??
Mitch
> I've taken Inderal many times when I had a racing
> heart (I topped 120!) and it almost always stops it in its track.
> Tends to flatten out the mood however. I generally
> check for drug interactions 1st, as this is important.
> If memory serves me correct, a lot of ADDers take the
> bp medication tenex with Adderall to help tame any
> hyperactive side effects.
>
> regards,
> john
>
>
Posted by JohnX2 on November 13, 2001, at 10:02:22
In reply to Re: Provigil or Wellbutrin? » JohnX2, posted by Mitch on November 12, 2001, at 13:15:47
I'm so *u*k*ed up that I tend to not mess with
things that work a this point but rather use
augmentation strategies to deal with side effects.
That way I can always back off the augmentation
strategy quickly without a severe remission which
I would risk by switching meds totally.I did try modafinil (provigil) once. It made me
much less edgy than Adderall for a comparision.
It works fast, so within a week you would know
whether or not to punt it.
Wellbutrin actually reduces my anxiety. The modafinil
had a short lived anti-depressant effect which
petered out after a few hours leaving me with a
too much coffee type tension headache. But this
has been a repeatable pattern for *me*. Your
results may vary.I would look for others on the newsgroup who
have responded similarly to meds that you did
as I am not the typical answer on this question. I will
remark that the provigil had no downside on
the anxiety.I took neurontin too and thought it was a great
med if you didn't have to dose the darn thing
exactly 3 times a day, 8 hrs apart (for me).
I can tolerate 2x a day, but 3x is annoying and
I forget.I'm tempted to try Tenex (guanfacine) which is
supposed to reduce hyperactivity without
much sedation. I have my own
motivation regarding one of my shoot-from-the
hips hypothesis that it would help with my headaches.anyways good luck and let me know how
things go,john
> Hi John,
>
> This is a little off the subject, but I think you might be of some help. I see my pdoc later this week and my seasonal depression is due to start kicking in either next week or the week after (*always* by first week of December). I have tried low-dose Wellbutrin (75-150mg/day) for this in the past adjunctively with Neurontin/low-dose SSRI and it was effective, but I didn't like the edginess (slept OK, no irritability, though!)and I didn't like having to take 3 or 4 broken doses a day (kept crashing). Do you think Provigil would be less jagged than the Wellbutrin and allow me to sleep OK, or do you think it would be better to stick with what worked before (the WB)??
>
> Mitch
>
>
> > I've taken Inderal many times when I had a racing
> > heart (I topped 120!) and it almost always stops it in its track.
> > Tends to flatten out the mood however. I generally
> > check for drug interactions 1st, as this is important.
> > If memory serves me correct, a lot of ADDers take the
> > bp medication tenex with Adderall to help tame any
> > hyperactive side effects.
> >
> > regards,
> > john
> >
> >
Posted by Mitch on November 13, 2001, at 13:03:45
In reply to Re: Provigil or Wellbutrin? » Mitch, posted by JohnX2 on November 13, 2001, at 10:02:22
Posted by Mitch on November 15, 2001, at 23:31:03
In reply to Re: Provigil or Wellbutrin? » Mitch, posted by JohnX2 on November 13, 2001, at 10:02:22
> I did try modafinil (provigil) once. It made me
> much less edgy than Adderall for a comparision.
> It works fast, so within a week you would know
> whether or not to punt it.
> Wellbutrin actually reduces my anxiety. The modafinil
> had a short lived anti-depressant effect which
> petered out after a few hours leaving me with a
> too much coffee type tension headache. But this
> has been a repeatable pattern for *me*. Your
> results may vary.
>
> anyways good luck and let me know how
> things go,
>
> john
John,I started 1/4 of a 75mg generic tab of bupropion twice daily in addition to my current meds (Neuron./Klon./Zoloft). I am to titrate that upwards every few days to a provisional "max" of 100mg/day. I could barely tell that I took it-which is a *good* sign! I think my med sensitivities are actualy signals from my body/brain that certain substances aren't really being tolerated well and perhaps maybe I should reconsider them. My pdoc confirmed your Zoloft discussion about motor functioning and dopamine interference ("Zoloft is the worst offender BTW"). Nothing was suggested for an SSRI swap at this time, though (perhaps because the dosage is already so low and SSRI's worsen my cycling-maybe an SSRI discontinuation may be in the future?).
Mitch
Posted by JohnX2 on November 16, 2001, at 14:32:43
In reply to Looks like Wellbutrin-hey generic is cheap! » JohnX2, posted by Mitch on November 15, 2001, at 23:31:03
Mitch,Good luck with the Wellbutrin. I got the generic
pills by accident once because the pharmacy
messed up, they were a lot cheaper. I think
the sustained release needed for WB is overblown.
The parent compound bupropion hcl has a short
1/2 life and is not believed to be responsible
for the anti-depressant effect. One of its
metabolites, in particular hydroxy-bupropion has
an average 1/2 life of ~20 hrs. Usually a 20 hr
half life means once a day dosing. I split the
dosing into 2x a day to be safe. I don't do
well with 3x a day, I forget in the afternoon
or it is inconvienent.I don't think the manufacturer of WB would
want people to have this information however.
The scare about the seizures, which is totally
overblown IMHO, drives people to the sustained
release version which is conviently still covered
by patent protection!Good luck, hopefully no side-effects!
keep up posted.-john
> > I did try modafinil (provigil) once. It made me
> > much less edgy than Adderall for a comparision.
> > It works fast, so within a week you would know
> > whether or not to punt it.
> > Wellbutrin actually reduces my anxiety. The modafinil
> > had a short lived anti-depressant effect which
> > petered out after a few hours leaving me with a
> > too much coffee type tension headache. But this
> > has been a repeatable pattern for *me*. Your
> > results may vary.
> >
> > anyways good luck and let me know how
> > things go,
> >
> > john
>
>
> John,
>
> I started 1/4 of a 75mg generic tab of bupropion twice daily in addition to my current meds (Neuron./Klon./Zoloft). I am to titrate that upwards every few days to a provisional "max" of 100mg/day. I could barely tell that I took it-which is a *good* sign! I think my med sensitivities are actualy signals from my body/brain that certain substances aren't really being tolerated well and perhaps maybe I should reconsider them. My pdoc confirmed your Zoloft discussion about motor functioning and dopamine interference ("Zoloft is the worst offender BTW"). Nothing was suggested for an SSRI swap at this time, though (perhaps because the dosage is already so low and SSRI's worsen my cycling-maybe an SSRI discontinuation may be in the future?).
>
> Mitch
Posted by Mitch on November 16, 2001, at 23:50:24
In reply to Re: Looks like Wellbutrin-hey generic is cheap! » Mitch, posted by JohnX2 on November 16, 2001, at 14:32:43
>
> Mitch,
>
> Good luck with the Wellbutrin. I got the generic
> pills by accident once because the pharmacy
> messed up, they were a lot cheaper. I think
> the sustained release needed for WB is overblown.
> The parent compound bupropion hcl has a short
> 1/2 life and is not believed to be responsible
> for the anti-depressant effect. One of its
> metabolites, in particular hydroxy-bupropion has
> an average 1/2 life of ~20 hrs. Usually a 20 hr
> half life means once a day dosing. I split the
> dosing into 2x a day to be safe. I don't do
> well with 3x a day, I forget in the afternoon
> or it is inconvienent.
>
> I don't think the manufacturer of WB would
> want people to have this information however.
> The scare about the seizures, which is totally
> overblown IMHO, drives people to the sustained
> release version which is conviently still covered
> by patent protection!
>
> Good luck, hopefully no side-effects!
> keep up posted.
>
> -johnHi John,
I agree 100% about the SR version being questionably superior. I still feel the "crash" during the day (on either one). I am now at 1/4*75mg 3x daily (starting today). I notice less fluctuation in energy level this way. I notice the shorter parent drug half-life however is what gives me the best attentional improvement. I am certainly not upset however, that the longer-halflife metabolites are more responsible for the AD effect. But, in my case the ameliorating ADHD effect is what I am striving for mainly and if by *default* I dose adequately for an AD prophylaxis-then so much the better. The ability to sleep OK and even *better* on this med really surprises me. I got drowsy last nite earlier than usual and went to sleep-no trouble at all. Slept soundly with no early morning awakenings. Had some recallable dreams, but not an excessive amount. A good 7-8 hrs. sleep. I have noticed an improvement in sociability at work that I hadn't expected. I don't feel "chilly or aloof" towards people like I did on the Adderall.
Also, I took my morning dose and jumped on the stairmaster for a strong workout and I didn't get any headaches like I did on the Adderall. My resting HR is elevated, however. But, not by much.Mitch
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