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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Peter on February 19, 2002, at 17:43:10
Hi all:
I'm BP II,SP, and possible ADD. I've gone through many meds over the last 7 years. Depakote was my foundation med for years, but I eventually found it to have too much of a 'wet blanket' effect on me, so my pdoc switched me to Neurontin, which is 'lighter' and also has the added plus of helping anxiety (like SP). So I've been on klonopin and Neurontin for a few weeks now; my anxiety and hypomania are getting better, but I have terrible bouts of depression which leave me hopeless, helpless,irritable, and generally debilitated. Today, my pdoc told me to start Adderall XR (10mg), saying that it will hopefully help to get my dopamine levels more even (He thinks the problem is more with dopamine than serotonin; besides, all the SSRI's I've taken have made me impulsive and hypomanic). I've tried Adderall XR before, but with depakote, and it eventually got me anxious. His theory is that it could work better with Neurontin, noting the anti-anxiety effects of Neurontin, and that it could further even out my mood swings and alleviate my depressive episodes. 2 questions: 1) Has anyone taken Adderall XR for this type of episodic depression (in other words, not primarily for ADD)? Any positive responses? 2) Has anyone taken this combo of meds (Neurontin, klonopin, and Adderall XR) for similar symptoms as I have (hypomania, anxiety, SP, depression)? Any good responses? Thanks.
Posted by Ritch on February 19, 2002, at 21:19:38
In reply to Neurontin + Adderall question, posted by Peter on February 19, 2002, at 17:43:10
> Hi all:
> I'm BP II,SP, and possible ADD. I've gone through many meds over the last 7 years. Depakote was my foundation med for years, but I eventually found it to have too much of a 'wet blanket' effect on me, so my pdoc switched me to Neurontin, which is 'lighter' and also has the added plus of helping anxiety (like SP). So I've been on klonopin and Neurontin for a few weeks now; my anxiety and hypomania are getting better, but I have terrible bouts of depression which leave me hopeless, helpless,irritable, and generally debilitated. Today, my pdoc told me to start Adderall XR (10mg), saying that it will hopefully help to get my dopamine levels more even (He thinks the problem is more with dopamine than serotonin; besides, all the SSRI's I've taken have made me impulsive and hypomanic). I've tried Adderall XR before, but with depakote, and it eventually got me anxious. His theory is that it could work better with Neurontin, noting the anti-anxiety effects of Neurontin, and that it could further even out my mood swings and alleviate my depressive episodes. 2 questions: 1) Has anyone taken Adderall XR for this type of episodic depression (in other words, not primarily for ADD)? Any positive responses? 2) Has anyone taken this combo of meds (Neurontin, klonopin, and Adderall XR) for similar symptoms as I have (hypomania, anxiety, SP, depression)? Any good responses? Thanks.
Your potential combination is exactly what I want to try. I have the same symptoms you mention, but never have tried Adderall with Klon. + Neurontin. It seems I need a little SSRI too. I have only tried Adderall with Neurontin in simple combination. It made me too panicky. But, I was withdrawing from an SSRI while the trial took place. I would definitely give it a try and report back what happens :). You might want to try a lower dose first-say 5mg/day to start.Mitch
Posted by Peter on February 20, 2002, at 0:04:30
In reply to Re: Neurontin + Adderall question » Peter, posted by Ritch on February 19, 2002, at 21:19:38
I would definitely give it a try and report back what happens :). You might want to try a lower dose first-say 5mg/day to start.
>
> Mitch
>
Hi Mitch:
I'll keep you updated. But I have a question: I know you recommended I try 5mg/day to start, but the lowest available capsule strength for Adderall XR is 10mg. My pdoc actually told me, if it's possible, to empty out half the contents of the capsule and start on that. But I looked up prescribing info for Adderall XR and it states that you should not divide the dose of a single capsule-that you should not take any less than the entire contents at one time. I believe the reason for this is because some of the tiny beads in the capsule are immediate-release, and some are delayed-release. If I tried (very sloppily, probably) to divide it, I'd probably get unequal doses of immediate and delayed beads. With that in mind, plus the fact that the prescribing info says the starting dose for someone new to the med is one 10mg capsule/day, don't you think it would be ok if I just swallowed the whole capsule? What's the worst that could happen? If I feel a little revved up and anxious, I can always take a little more klonopin (I have flexible daily klonopin doses anyway). What do you think?
Peter
Posted by Peter on February 20, 2002, at 0:09:19
In reply to Re: Neurontin + Adderall questionMitch, posted by Peter on February 20, 2002, at 0:07:13
Posted by Ritch on February 20, 2002, at 12:36:07
In reply to Re: Neurontin + Adderall question, posted by Peter on February 20, 2002, at 0:04:30
> Hi Mitch:
> I'll keep you updated. But I have a question: I know you recommended I try 5mg/day to start, but the lowest available capsule strength for Adderall XR is 10mg. My pdoc actually told me, if it's possible, to empty out half the contents of the capsule and start on that. But I looked up prescribing info for Adderall XR and it states that you should not divide the dose of a single capsule-that you should not take any less than the entire contents at one time. I believe the reason for this is because some of the tiny beads in the capsule are immediate-release, and some are delayed-release. If I tried (very sloppily, probably) to divide it, I'd probably get unequal doses of immediate and delayed beads. With that in mind, plus the fact that the prescribing info says the starting dose for someone new to the med is one 10mg capsule/day, don't you think it would be ok if I just swallowed the whole capsule? What's the worst that could happen? If I feel a little revved up and anxious, I can always take a little more klonopin (I have flexible daily klonopin doses anyway). What do you think?
> PeterOh, I didn't realize that you were taking the XR version. It should be OK to take 10mg. If it was the standard Adderall at 10mg I would probably find it way too buzzy. I didn't have any Klonopin when I took mine. Just took 100mg of Neurontin 3x daily with a morning 5mg tab of Adderall. It worked OK for several weeks. I *complained* about anxiety, but I didn't have any real troubles with that for a couple of months.
Mitch
Posted by Peter on February 21, 2002, at 2:06:31
In reply to Re: Neurontin + Adderall question » Peter, posted by Ritch on February 20, 2002, at 12:36:07
> Oh, I didn't realize that you were taking the XR version. It should be OK to take 10mg. If it was the standard Adderall at 10mg I would probably find it way too buzzy. I didn't have any Klonopin when I took mine. Just took 100mg of Neurontin 3x daily with a morning 5mg tab of Adderall. It worked OK for several weeks. I *complained* about anxiety, but I didn't have any real troubles with that for a couple of months.
>
> Mitch
>
>Hi Mitch:
Today was my first day on Adderall XR with my Neurontin (3 x day: 200mg+ 100mg + 200mg) and klonopin (1.5mg daily). I found that while I had short bursts of clarity, focus, and slight mood elevation, on the whole I felt very spacey and 'air-headed' most of the day. Within 6 hours of my morning dose I felt like I had a 'pot hangover', and later on through the night I simply felt brain dead. Also, although I never felt racy, my heart rate at times went up to 120bpm, which I know is way too high.
I told my pdoc about these problems and he recommended that I either add a beta-blocker to the adderallXR (to lower the heart rate) and adjust doses until it's more effective, or switch to Concerta. He said there's a chance I might not encounter the high heart rate with Concerta, and supposedly Concerta works longer than adderall XR, which would be nice since I'm a musician and I do most of my work late at night. Also, my past experiences with beta-blockers (Inderal, Tenormin) were negative-they gave me ice cold hands and feet, which really hindered my ability to play music.
Do you know anything about Concerta-if it really lasts longer than AdderallXR? Is it as effective? Thanks,
Peter
Posted by Ritch on February 21, 2002, at 9:52:32
In reply to Re: Neurontin + Adderall question, posted by Peter on February 21, 2002, at 2:06:31
> >Hi Mitch:
> Today was my first day on Adderall XR with my Neurontin (3 x day: 200mg+ 100mg + 200mg) and klonopin (1.5mg daily). I found that while I had short bursts of clarity, focus, and slight mood elevation, on the whole I felt very spacey and 'air-headed' most of the day. Within 6 hours of my morning dose I felt like I had a 'pot hangover', and later on through the night I simply felt brain dead. Also, although I never felt racy, my heart rate at times went up to 120bpm, which I know is way too high.
> I told my pdoc about these problems and he recommended that I either add a beta-blocker to the adderallXR (to lower the heart rate) and adjust doses until it's more effective, or switch to Concerta. He said there's a chance I might not encounter the high heart rate with Concerta, and supposedly Concerta works longer than adderall XR, which would be nice since I'm a musician and I do most of my work late at night. Also, my past experiences with beta-blockers (Inderal, Tenormin) were negative-they gave me ice cold hands and feet, which really hindered my ability to play music.
> Do you know anything about Concerta-if it really lasts longer than AdderallXR? Is it as effective? Thanks,
> Peter
Yuck! It doesn't sound you and Adderall is mixing very well. I noticed the "wavy" energy levels all day on it, too. Some of that "waviness" may be your Neurontin levels fluctuating, too. It has about a 5 hr half-life. Amphetamine is too similar to adrenaline. I haven't tried methyphenidate (Ritalin), or dexmethylphenidate (Focalin), however. Maybe the new Focalin would be something to mention to your doc. Concerta is plain old Ritalin, but in a more sophisticated releasing form. I have heard good things about it. But, you tend to be stuck on relatively high doses-I believe 18 and 36mg. I wonder if the Focalin (dexmethylphenidate) would be even less likely to raise heart rate than Ritalin? Focalin has a short half-life though like non-sustained release Ritalin. I wonder if you just took the immediate release stuff anyway with your first two Neurontin doses-might it work better?good luck,
Mitch
Posted by Peter on February 21, 2002, at 10:31:17
In reply to Re: Neurontin + Adderall question » Peter, posted by Ritch on February 21, 2002, at 9:52:32
Thanks so much for your help, Mitch. I'll check out Focalin and Concerta with my doc.
Peter
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