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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by kilo8 on May 3, 2015, at 17:51:08
Hello,
I have a problem. I need Dexedrine for ADHD. Ritalin and other drugs don't help.
But at the same time I also have depression and ocd and also need a serotonergic antidepressant.
But I'm scared cause I read there are cases where people got a serotonin syndrome from such a combo.
Obviously Amphetamines also release some serotonin unlike ritalin.
I dont know what to do now.
I dont want to live in fear of serotonin syndrome all the time when going on such a combo.
Posted by Christ_empowered on May 3, 2015, at 18:17:16
In reply to SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by kilo8 on May 3, 2015, at 17:51:08
what are the symptoms of your depression? Your doc may be able to Rx something besides an SSRI.
Posted by rjlockhart37 on May 3, 2015, at 21:10:09
In reply to SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by kilo8 on May 3, 2015, at 17:51:08
there's no interactions between amphetamine and SSRI's, i was on dexedrine spansules and prozac at 80mg, it actually enhances amphetamines's actions......
amphetamine doenst really release serotonin, it's methamphetamine that releasees and thats why its more abusable and stronger.......it's actions are stronger....
you should ask about prozac with dexedrine......adderall is known to cause more anxiety than dexedrine, even though there both amphetamines, adderall is levoamphetamine and dextroamphetmine, dexedrine is just plain dextroamphetamine by itself, less adrenaline and NE release....
Posted by kilo8 on May 3, 2015, at 22:47:42
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by rjlockhart37 on May 3, 2015, at 21:10:09
Hello,
what other antidepressant should my doc give me?
I mean TCAs would be even more problematic.
Also SSRIs and Cymbalta never worked for me ALONE.
But what shall I do? I have ocd & anxiety which is why I think I simply need to take something serotonergic.
I also had remeron,wellbutrin,stablon,lexapro. All useless!@ rjlockhart
Prozac + Amphetamines is bad according to Dr Charles Parker. He's into ADHD. He said Prozac blocks Amphetamines from being metabolized (D6 pathway) and then they build up and this can cause problems after a while.
I'd not want to mix Prozac with Dex because of this. I'd rather try Zoloft or go back to Lexapro but Lexapro 20mg alone didnt help me at all which is why I dont really want to take something again which didnt work in the past.
Posted by tom2228 on May 4, 2015, at 9:03:01
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by kilo8 on May 3, 2015, at 22:47:42
I wouldn't worry about it, at all. For a while I was on an MAOI (Marplan) + Desoxyn (which is more serotonergic than Dexedrine) AND a tricyclic (desipramine). I am still on the same combination except with Vyvanse instead of the Desoxyn, and I've never had a problem. I've been on Dexedrine + SSRI before as well. Many people respond to both drugs better when in combination and each diagnosis is attended to. The risk of serotonin syndrome with this combination is more of a rare theoretical concern that rarely, rarely pans out in the real world. Serotonin syndrome typically occurs only with the combination of an MAOI + an SSRI or a drug like MDMA.
And I agree about the Prozac, best to avoid that as the amphetamine will build up in your system and can change your dose as well as a whole host of other problems. I wanted to pull my hair out after a month of Prozac + Adderall. Same goes for amphetamines with Wellbutrin, although some people do just fine. Best to avoid the trouble IMO and stick to SSRIs besides Prozac and Paxil.
Posted by Christ_empowered on May 4, 2015, at 9:46:22
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by tom2228 on May 4, 2015, at 9:03:01
ummm...I took Tofranil-PM w/ a good bit of Adderall, not too many problems. I don't think TCA drugs are as terrible as people make them out to be, especially if you're already on a stimulant (would help with sedation).
Ever been on seroquel? It can help depression. I'm obsessed w/ seroquel+stimulants because an acquaintance of mine found sweet, sweet relief with seroquel PM and adderall AM.
I get your fear of serotonin syndrome. Also...in my experience, docs just Rx w/o regard to you know...science, or whatever...so even w/ a decent shrink, there's reason for worry.
Ummm...ever tried supplements for you OCD and what not? Clearly, I don't mean that to exclude pharmaceuticals, just asking. I seem to recall reading about NAC, inositol being good OCD. Maybe 5htp, too? Anyway...
...I wish you the best of luck.
Posted by kilo8 on May 5, 2015, at 22:54:24
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by Christ_empowered on May 4, 2015, at 9:46:22
Hello,
I have been trying NAC 600mg but I dont think it helps me. NAC actually raises glutamate this means if you have too much glutamate already it might even make it worse.How much seroquel do you take?
And what exactly are your issues?
Mine are depression,gad,ocd. I read that seroquel can be used as sleeping pill at a very low dose. But in general I'm scared of APs cause of the possible side effects. I'd also be scared of abilify cause of the risk of dyskinesia.@ tom
Wow, that is a hell of a combo! I mean desoxyn is methamphetamine right? Mixing this with a MAOI and a TCA sounds really risky to me. I mean is your doc totally experienced? I think most pdocs wouldn't even want to prescribe a MAOI without adding anything.
Does this combo at least help you? I mean when you go on such a combo does this mean that you are treatment resistant and nothing else worked before?
Posted by tom2228 on May 6, 2015, at 9:29:32
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by kilo8 on May 5, 2015, at 22:54:24
> Hello,
> I have been trying NAC 600mg but I dont think it helps me. NAC actually raises glutamate this means if you have too much glutamate already it might even make it worse.
>
> How much seroquel do you take?
> And what exactly are your issues?
> Mine are depression,gad,ocd. I read that seroquel can be used as sleeping pill at a very low dose. But in general I'm scared of APs cause of the possible side effects. I'd also be scared of abilify cause of the risk of dyskinesia.
>
> @ tom
>
> Wow, that is a hell of a combo! I mean desoxyn is methamphetamine right? Mixing this with a MAOI and a TCA sounds really risky to me. I mean is your doc totally experienced? I think most pdocs wouldn't even want to prescribe a MAOI without adding anything.
>
> Does this combo at least help you? I mean when you go on such a combo does this mean that you are treatment resistant and nothing else worked before?
>
>
Yeah Desoxyn is methamphetamine hydrochloride. It's more of a mellow medication than the dextroamphetamine I take now and can be quite effective for ADHD if you can motivate yourself to be productive, which is one of the reasons I'm on Vyvanse now instead -- I need all the drive I can get (but not as much as Adderall) at this point in my life.I was on the Desoxyn and Marplan for about 5 years and while it worked for some time, looking back I was still struggling, very much so last year, which is when I got on tricyclics as well, nortriptyline now desipramine. Once I got up to the dose I'm on now (125mg) my depression, motivation, and anxiety really started to improve. It also helps with my ADHD and cravings/ desire to use meth (I'm a recovering addict).
I still struggle with some depression here and there but since the desipramine and adding olanzapine and T3 (triiodothyronine) things are vastly improved. Since January I've gone from 5 years' unemployment, having dropped out of school, and shooting up street meth daily to a good job that I really like, being able to pay my rent and support myself for the first time in my life, and finally making friends.
I honestly struggle with hypomania the most these days. I know the desipramine plays a central role in that, but I need it at the dose it's at. Low-dose Depakote was just added to the lithium and low doses of olanzapine, Abilify, and Lamictal that I already take. It seems to be helping.
I'm on a lott of meds and the combination makes a lot of doctors shriek, but if it's done right the risk is overdramaticized. I've never had any sort of safety issue and my blood pressure has recently fallen since adding back the dextroamphetamine. The drama tends to lend itself to lack of experience among the majority of psychiatrists. It's been really hard to find a willing doctor since moving to the West Coast, but the one I just started seeing didn't even flinch. She said "Well it's highly inconventional, but everyone's different." And that was the end of it.
By the way, Seroquel (along with clozapine) has the lowest risk of EPS among the atypical antipsychotics. Zyprexa has pretty low rates of EPS too, which I'm on, and is a great add-on in low doses for depression and anxiety. Good luck
Posted by kilo8 on May 7, 2015, at 0:44:26
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by tom2228 on May 6, 2015, at 9:29:32
I'm glad that this works for you and you do better.
What's scary though is the thought that somebody with depression might require such a cocktail to get better. I mean I know that my doc would NEVER give me such a cocktail but what if I needed it to get better?
My ex-pdoc basically dropped me telling me he can't help me anymore after I tried a few drugs. He was a real jerk and not very motivated. He did not even offer a MAOI or a TCA. He acted like they don't even exist.What also sucks is HOW shall I decide what to add or what to try next? I mean there are so many possibilites. I dont know how to figure this out.
And my pdoc is very busy and always has his whole waiting room full with patients. When I see him there really is no time to discuss very much. I can't go to him and then talk about theories for half an hour. I wish I could. When I go to him then basically there's only enough time to say that the old drug didn't work and then quickly come up with a new drug and usually I am the one who makes a suggestion and he simply agrees but when he has to come up with an own suggestion he just pulls something out of his hat and this is even worse than me coming up with a suggestion so basically I have to decide on my own what to do and this also makes me feel left alone but it's still better than having a doctor dictate you what to try next.I also wasted way too much time with sh*tty pdocs. I wish I had more time to experiment with more drug combos. But I'm faxing my final exams at the university and this means that I needed to become functionable as soon as possible. I do not have years left to experiment with stuff. I should already have found something which works long time ago but havent been able to.
I also cannot do risky experiments with drugs in a phase where I know I have to learn and function.How much T3 do you take?
And do you have your ft3 and ft4 levels supervised so that you dont become hyperthyroid?And how long do antipsychotics usually take to work? Do you also have to give them 6-8 weeks like SSRIs or do you notice if they work much sooner? If the effect started kicking in fast then I could try low dose Abilify for example and if it doesn't work get off it.
But I also dont know if Abilify would mix well with stimulants cause Abilify also affects dopamine. It could as well ruin the effect of stimulants.
Posted by phidippus on May 7, 2015, at 22:41:11
In reply to SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by kilo8 on May 3, 2015, at 17:51:08
You will not get serotonin syndrome. Also, did you know Dexedrine can help OCD?
Eric
Posted by kilo8 on May 9, 2015, at 0:47:25
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome? » kilo8, posted by phidippus on May 7, 2015, at 22:41:11
No i did not know that where you do get this?
What freaks me out is that I read in a huge guidebook on psychopharmaceuticals which basically every psychiatrist uses where i live and the author who's a professor of psychiatry also writes in the chapter about amphetamines that combining them with SSRI is risky because of serotonin syndrome!
Reading this made me much more anxious again. I mean this guy is a professor. If there was no risk then why should he write this!?
Posted by Christ_empowered on May 15, 2015, at 11:32:49
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by kilo8 on May 9, 2015, at 0:47:25
I mean, its possible...serotonin syndrome can happen even when someone is treated only w/ an SSRI. Crazy...
..but I don't think its common, even w/ an amphetamine. The combo is fairly common. Amphetamines are used in depression, ADD/ADHD, OCD, sometimes in Bipolar, rarely in stable schizophrenic people...
...maybe its because he's a professor? I mean, there's a huge difference between your work-a-day shrink and an academic shrink in how they approach things, or at least that's what I've heard and read. I dunno.
Ever tried a TCA? TCA+amphetamines probably would be less likely to cause serotonin syndrome. Just a thought...
Posted by kilo8 on May 17, 2015, at 17:29:34
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by Christ_empowered on May 15, 2015, at 11:32:49
hi,
why do you think TCA + amph would be less likely to cause SS? I mean if a TCA also affects serotonin like amitryptiline then where is the difference to a SSRI?
Posted by Christ_empowered on May 17, 2015, at 19:14:13
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by Christ_empowered on May 15, 2015, at 11:32:49
sorry, I should have clarified. I'm *definitely* no expert, and it depends on the tca, but...my prescribing doc told me I was safer on tofranil+adderall than on cymbalta+adderall.
second, third hand information...scientific, I know.
Posted by phidippus on May 18, 2015, at 10:18:45
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by kilo8 on May 17, 2015, at 17:29:34
There is no difference between a TCA and SSRI-both promote the release of serotonin.
Eric
Posted by kilo8 on May 18, 2015, at 15:29:36
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome? » kilo8, posted by phidippus on May 18, 2015, at 10:18:45
i am on 150mg zoloft now. yesterday i took 15mg dexedrine. no side effects but i also dont know if it made me feel any better. i am really depressed right now.
Posted by phidippus on May 18, 2015, at 23:12:41
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by kilo8 on May 18, 2015, at 15:29:36
That's a hefty hit of Zoloft. Are you suree its working for you?
Eric
Posted by tom2228 on May 19, 2015, at 1:10:14
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome? » kilo8, posted by phidippus on May 18, 2015, at 10:18:45
> There is no difference between a TCA and SSRI-both promote the release of serotonin.
>
> EricEric, that's not true. A possible mechanism by which TCAs confer greater safety against serotonin syndrome is that most of them (not all) are 5-HT2a antagonists, which are used to treat SS. And they don't all necessarily promote 5-HT release -- according to Gillman, amitriptyline, for example, which is an SSRI, does not significantly increase serotonin levels.
Posted by phidippus on May 20, 2015, at 6:20:48
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome?, posted by tom2228 on May 19, 2015, at 1:10:14
Amitriptyline acts primarily as a serotonin-norepinephrine reuptake inhibitor and does increase the amount of serotonin occupying the synapse. It is no safer than any other antidepressant with reuptake qualities with regards to serotonin syndrome.
Eric
Posted by tom2228 on May 21, 2015, at 13:29:04
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome? » tom2228, posted by phidippus on May 20, 2015, at 6:20:48
> Amitriptyline acts primarily as a serotonin-norepinephrine reuptake inhibitor and does increase the amount of serotonin occupying the synapse. It is no safer than any other antidepressant with reuptake qualities with regards to serotonin syndrome.
>
> EricClearly you didn't read the source. According to Gillman things are not as simple as you so matter-of-factly state. If what you say is empirical, how do you explain how SRIs like clompiramine and imipramine cannot be combined with an MAOIs without producing SS while other TCAs with SRI properties, including amitriptyline can?
"Clomipramine is effective for obsessive compulsive disorder and has high affinity for the SERT, but it remains uncertain if amitriptyline is significantly serotonergic: it has been regarded as an SNRI by many observers and included in meta-analyses comparing SNRIs with other antidepressants. Highly selective reuptake inhibitors now exist for both the NAT and the SERT and these appear to be effective antidepressants, although it is not yet established that they are as effective as TCAs in severe melancholic and psychotic depressions. ST data elucidate the clinical relevance of HCR data and thereby suggest what degree of potency is clinically meaningful. A detailed explanation and discussion of this is contained in a recent review (Gillman, 2006a), including a discussion of the possible role of 5-HT2A receptors. The SERT affinities of amitriptyline, imipramine and clomipramine have been correlated with their therapeutic profile. ST data and the putative serotonin-mediated disorders, obsessive compulsive disorder (Stein et al., 1995; Fineberg and Gale, 2005) and cataplexy (Bassetti, 1999; Vignatelli et al., 2005), illustrate the differences in the propensity to precipitate serotonin-related changes. These are proportional to the increasing affinity for the SERT of amitriptyline weak, imipramine intermediate, clomipramine potent (Table 3). The most dramatic and serious drug interaction in humans is ST it can rapidly culminate in death from hyperthermia. This occurs predictably when a potent SRI is added to a therapeutic dose of an MAOI. Weakly serotonergic drugs such as l-tryptophan precipitate typical, dose-dependent, but mild, ST symptoms when combined with MAOIs (Oates and Sjoerdsma, 1960). This indicates that even small elevations of serotonin, added to the effects of an MAOI, are sufficient to precipitate clinical features of ST (for a detailed exposition of this argument see Gillman, 2006a). Amitriptyline does not produce ST when added to an MAOI (Gillman, 1998). It may thus be inferred that amitriptyline does not significantly raise serotonin levels in humans. In contrast, clomipramine frequently precipitates severe ST with MAOIs and causes fatalities. This indicates the SERT affinity at which TCAs become effective in raising serotonin; imipramine is intermediate."
Actually, according to Gillman, the potential for SRI drugs to elicit SS is not uniform among drugs with this property:"The PET study of SERT binding from Meyer et al. (2004) demonstrates comparable SERT antagonism in human striatum (∼80%) from the minimum therapeutic dose of all the SSRIs and venlafaxine. That suggests two probable inferences: first, some other factor, for example, higher tissue levels, does indeed compensate for the low SERT affinity displayed by venlafaxine (Table 4), which is consonant with its relatively higher incidence of ST in overdose (twice that of SSRIs; Whyte et al., 2003). Second, a higher CNS tissue level (of venlafaxine compared to TCAs) is likely to be less than one order of magnitude of difference. If it was more than that, then venlafaxine would exhibit ST at therapeutic doses. This reasoning in turn indicates that the discrepancy between venlafaxine's SRI/NRI potency (approximately 200/1) is too large to enable substantial NRI effects at therapeutic doses, without engendering excessive serotonergic effects. That conclusion is congruent with the TYR30 data reviewed below. Data on ST indicate that the SERT affinity of amitriptyline and other tricyclics of lesser SERT affinity is insufficient to cause meaningful serotonergic effects in humans, whereas clomipramine causes marked and clinically relevant effects. This is in accordance with published reviews, which report ST only with imipramine and clomipramine, as reviewed in detail elsewhere (Gillman, 1998, 2006a). The difference in their affinity for the SERT is the most parsimonious explanation for this crucial difference. Further PET-derived SERT-binding studies, comparing all the TCAs directly under similar conditions, may further elucidate this important issue."
"The increasing evidence that SNRIs like clomipramine may be more effective antidepressants makes it especially important to establish the criteria and evidence for valid claims of SNRI action. Recent evidence from ST studies indicates that amitriptyline does not have clinically significant serotonergic effects and is probably not an SNRI drug (Gillman, 1998, 2006a); so it is probably wrong to include it in meta-analyses of SNRI effects."
Posted by phidippus on May 23, 2015, at 18:42:06
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome? » phidippus, posted by tom2228 on May 21, 2015, at 13:29:04
>how SRIs like clompiramine and imipramine cannot be combined with an MAOIs without producing SS while other TCAs with SRI properties, including amitriptyline can?
Do clomipramine and imipramine always produce SS when combined with MAOIs?
Is the MAOI test global and suitable for other kinds of medicines that modulate serotonin?
How often has amytryptaline been observed not to to cause SS with MAOIs
>it remains uncertain if amitriptyline is significantly serotonergic
And the way to test if it is serotogenic is to couple it with an MAOI? No, I think not.
>Weakly serotonergic drugs such as l-tryptophan precipitate typical, dose-dependent, but mild, ST symptoms when combined with MAOIs (Oates and Sjoerdsma, 1960). This indicates that even small elevations of serotonin, added to the effects of an MAOI, are sufficient to precipitate clinical features of ST (for a detailed exposition of this argument see Gillman, 2006a).
>
>Amitriptyline does not produce ST when added to an MAOI (Gillman, 1998). It may thus be inferred that amitriptyline does not significantly raise serotonin levels in humans.I don't know what I think of the inference. Something else could be going on. There are better ways to determine if amy is serotogenic.
>ious explanation for this crucial difference. Further PET-derived SERT-binding studies, comparing all the TCAs directly under similar conditions, may further elucidate this important issue."
I agree.
Eric
Posted by kilo8 on May 25, 2015, at 16:35:02
In reply to Re: SSRI + Dexedrine, dangerous bc serotonin syndrome? » tom2228, posted by phidippus on May 23, 2015, at 18:42:06
Hello,
my pdoc told me to switch from zoloft to vortioxetine. I had just started with zoloft but when I saw him he said vortioxetine is better and that I should switch.
I then switched to it and started taking 5mg. So far no effects. I don't really know if vortioxetine is better. It's new and not that well researched which worries me. What if there are side effects or interactions which aren't even known yet?I dont know how well vortioxetine can be mixed with amphetamines for example.
This is the end of the thread.
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