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    Senior Member krazyj's Avatar
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    Angry

    I'll try to keep this short.



    I've been having intrapersonal/anxiety/life management issues for about 1-2 years. Ive been fucking around with medicines in that time - always managing to come back to Ritalin (in some form.. primarily Concerta).



    Ive been on some form of Ritalin for 7-8 years (and Im only 20), so it felt like a good idea to take a considerable amount of time off. For the past 2-3 months I went off of it. I felt, for the first time in my teen/adult life what it was like to be off of Ritalin.



    Other than the lack of energy and mental sharpness, it wasnt too shabby. I felt relaxed and felt the 'ebb and flow' of life much, much more.



    The reason for this extended break is that I feel Ritalin seemingly accumulates in my body and, after a few days back on it, Ill get the side-effects described at the beginning of the post.



    About 6 months ago, I started experimenting so I could rid myself of this anxious/constantly-in-the-zone/OCD feeling by laying off the Ritalin for short periods of time. Like a week or two. Id start taking Ritalin again and, for 3 or 4 days it would be fine. Side effects would be nil, things would be great. Then, sure as the sun rises, the side-effects would creep back after a couple days. This has happened on multiple occasions.



    So I said fuck it. Winter break was 1 month+ long so I stopped taking Concerta. I stopped a little early and held back on it for a few weeks after getting back. This went on for about 2 months. It went great and about a month in, I started to REALLY feel what it was like to be off the medicine for the first time in my life.



    It definitely took a month or so to clear my system. I noticed a complete and stable mood change after a month. It was everything youd expect to be when one would stop taking Ritalin. Nothing out of the ordinary.





    But, in the past month or so, I feel like Ive been hit with a severe atypical depression. It is a distinct one and a new feeling. For example, on 2-3 occasions I've felt so depressed that I couldnt even get my homework done at night. I just went to bed. I figured this was a delayed withdrawal from lack of dopamine so I started back up with Concerta and it lightened my depression but it still hangs around.



    And curiously enough, the anxiety side effects havent kicked in yet but I feel them creeping in. Ill give it a few days.



    Things really came to a peak just in the past hour. In the course of 60 minutes, I went from having 3 assignments to do to feeling so depressed that I couldnt finish them no matter what. So, I took:

    -a step back

    -a rhodiola rosea

    -and ate some nuts since I hadnt eaten much today.

    The overwhelmingness has subsided at least enough where I can push myself to get my work done but I still feel that lingering depression. This was like a definite whirlwind of emotion in 60 minutes, though. I feel, now, like Ive just had a good cry (yeah, emo.) or I just finished working out (endorphins kicking in, maybe?).



    (This shit even happens when Im drunk! I can be out at a party and go from picking up ladies to being so depressed I gotta leave so no one will see me.)



    Ive been back on Concerta for a few weeks now and, while its nice to not have the anxious side-effects, Ive been kind of on the 'hypo' end of the spectrum. Oddly, Ive been ridiculously hypersomnic. Like distinctly, noticeably, hypersomnic. The distinctness of it goes hand in hand with the distinctness of the depression. I cant wake up in the mornings no matter what, now. I typically oversleep by 2 hours. Thank god Im in college. Throw in a little insomnia (but think thats a result of taking Concerta late and/or stacking Provigil + Concerta).





    Oh yeah, in the past few weeks Ive sprinkled some Provigil in there on and off. I took samples for a few days, realized my insurance wouldnt cover it and stopped taking it, then started taking really small amounts with Concerta. Provigil made me feel pretty good, pretty awake, even a little relaxed so I figured Id stick with it while I can.



    I just got a bottle of Focalin Ill be trying tomorrow because I have a suspicion that the racemic mixture is involved in the slow metabolism.





    So now... what the fuck is wrong with me?

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    Senior Member Frangible's Avatar
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    Quote Originally Posted by krazyj' post='454834' date='Feb 5 2008, 06:10 PM
    I'll try to keep this short.



    I've been having intrapersonal/anxiety/life management issues for about 1-2 years. Ive been fucking around with medicines in that time - always managing to come back to Ritalin (in some form.. primarily Concerta).



    Ive been on some form of Ritalin for 7-8 years (and Im only 20), so it felt like a good idea to take a considerable amount of time off. For the past 2-3 months I went off of it. I felt, for the first time in my teen/adult life what it was like to be off of Ritalin.



    Other than the lack of energy and mental sharpness, it wasnt too shabby. I felt relaxed and felt the 'ebb and flow' of life much, much more.



    The reason for this extended break is that I feel Ritalin seemingly accumulates in my body and, after a few days back on it, Ill get the side-effects described at the beginning of the post.



    About 6 months ago, I started experimenting so I could rid myself of this anxious/constantly-in-the-zone/OCD feeling by laying off the Ritalin for short periods of time. Like a week or two. Id start taking Ritalin again and, for 3 or 4 days it would be fine. Side effects would be nil, things would be great. Then, sure as the sun rises, the side-effects would creep back after a couple days. This has happened on multiple occasions.



    So I said fuck it. Winter break was 1 month+ long so I stopped taking Concerta. I stopped a little early and held back on it for a few weeks after getting back. This went on for about 2 months. It went great and about a month in, I started to REALLY feel what it was like to be off the medicine for the first time in my life.



    It definitely took a month or so to clear my system. I noticed a complete and stable mood change after a month. It was everything youd expect to be when one would stop taking Ritalin. Nothing out of the ordinary.

    But, in the past month or so, I feel like Ive been hit with a severe atypical depression. It is a distinct one and a new feeling. For example, on 2-3 occasions I've felt so depressed that I couldnt even get my homework done at night. I just went to bed. I figured this was a delayed withdrawal from lack of dopamine so I started back up with Concerta and it lightened my depression but it still hangs around.



    And curiously enough, the anxiety side effects havent kicked in yet but I feel them creeping in. Ill give it a few days.



    Things really came to a peak just in the past hour. In the course of 60 minutes, I went from having 3 assignments to do to feeling so depressed that I couldnt finish them no matter what. So, I took:

    -a step back

    -a rhodiola rosea

    -and ate some nuts since I hadnt eaten much today.

    The overwhelmingness has subsided at least enough where I can push myself to get my work done but I still feel that lingering depression. This was like a definite whirlwind of emotion in 60 minutes, though. I feel, now, like Ive just had a good cry (yeah, emo.) or I just finished working out (endorphins kicking in, maybe?).



    (This shit even happens when Im drunk! I can be out at a party and go from picking up ladies to being so depressed I gotta leave so no one will see me.)



    Ive been back on Concerta for a few weeks now and, while its nice to not have the anxious side-effects, Ive been kind of on the 'hypo' end of the spectrum. Oddly, Ive been ridiculously hypersomnic. Like distinctly, noticeably, hypersomnic. The distinctness of it goes hand in hand with the distinctness of the depression. I cant wake up in the mornings no matter what, now. I typically oversleep by 2 hours. Thank god Im in college. Throw in a little insomnia (but think thats a result of taking Concerta late and/or stacking Provigil + Concerta).

    Oh yeah, in the past few weeks Ive sprinkled some Provigil in there on and off. I took samples for a few days, realized my insurance wouldnt cover it and stopped taking it, then started taking really small amounts with Concerta. Provigil made me feel pretty good, pretty awake, even a little relaxed so I figured Id stick with it while I can.



    I just got a bottle of Focalin Ill be trying tomorrow because I have a suspicion that the racemic mixture is involved in the slow metabolism.

    So now... what the fuck is wrong with me?


    Methylphenidate has a very short half-life, the only place it's going to accumulate is in your bladder.



    My theory is, however incorrect it may be, that the medication is causing sleep disturbances for you, which catch up to you after a while. The stimulant nature of it also masks much of the fatigue and tiredness from you. So instead of taking a nap, you instead get anxious, irritable, lose control of your emotions, and have decreased frontal lobe function. So you start eating modafinil, caffeine, whatever else, and that helps a little, but probably only makes things worse in a week or two's time.



    And guess what bucko, "intrapersonal/anxiety/life management issues" can also cause depression. So you might actually be depressed, dysthymic, or some shit on top of everything else. Stimulants are a great antidepressant but they're not an instant panacea.



    My suggestion: go get some trazodone, stop all stimulants but methylphenidate and lower the dose / take it AM or early afternoon only if possible, and focus on rest and relaxation, instead of spreading yourself even more thin and compounding the problem.
    <span style="color:#660000"><span style="font-size:8pt;line-height:100%"><span style="font-family:Arial Narrow">"... </span></span></span><span style="font-family:Arial Narrow"><span style="font-size:8pt;line-height:100%"><span style="color:#8b0000">fresh bread, which deforms elastically is not frangible." --Wikipedia</span></span></span>

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    "artiste" graatch's Avatar
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    Some people are being prescribed alpha-2 agonists (like Tenex, preferable to clonidine) to reduce the adrenergic side effects of psychostimulants. I bet it is effective for reducing the inescapably-in-the-zone feeling too, providing a more relaxed focus, although too much will surely reduce the positive benefits.



    Desoxyn (which apparently has something like a 2:1 norepinephrine:dopamine release -- compare to dextroamphetamine's 5:1) is also something that people report provides a much more relaxed, controlled focus. I think it should be used much more.



    Most dopamine agonists also apparently provide alpha-2 agonism by some mechanism (hence sedation) -- and this is what I'm interested in adding to a psychostimulant. Pramipexole for example.
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    Senior Member Frangible's Avatar
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    Quote Originally Posted by graatch' post='454940' date='Feb 5 2008, 09:50 PM
    Some people are being prescribed alpha-2 agonists (like Tenex, preferable to clonidine) to reduce the adrenergic side effects of psychostimulants. I bet it is effective for reducing the inescapably-in-the-zone feeling too, providing a more relaxed focus, although too much will surely reduce the positive benefits.



    Desoxyn (which apparently has something like a 2:1 norepinephrine:dopamine release -- compare to dextroamphetamine's 5:1) is also something that people report provides a much more relaxed, controlled focus. I think it should be used much more.



    Most dopamine agonists also apparently provide alpha-2 agonism by some mechanism (hence sedation) -- and this is what I'm interested in adding to a psychostimulant. Pramipexole for example.


    Methylphenidate has less effect on adrenergic systems than even methamphetamine. a-2 agonists may help but I'm somewhat dubious as the focus effect as well as the wakefulness/insomnia are both mediated by dopamine.
    <span style="color:#660000"><span style="font-size:8pt;line-height:100%"><span style="font-family:Arial Narrow">"... </span></span></span><span style="font-family:Arial Narrow"><span style="font-size:8pt;line-height:100%"><span style="color:#8b0000">fresh bread, which deforms elastically is not frangible." --Wikipedia</span></span></span>

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    Senior Member krazyj's Avatar
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    Thanks for the replies.



    Frangible, your theory is interesting and makes sense. One question I have though is that I feel completely and absolutely unmotivated without Ritalin. I have clearly had a need for Ritalin since I was very young. My mother always goes back to telling me how I was a baby almost and shed given me Ritalin and noticed that I was as cute as could be and wasnt (as much of) a terror that I would be off my medicine.



    The one question I have is how much is too much? I feel that if I dont take enough, that I will never achieve the awesome productivity I can achieve (even with all these problems,.I can flex an amazing amount of mental muscle everyday). Right now, regarding focus, I feel the dosage is a bit on the high side but I wouldnt imagine being able to lower it much more and being happy with it. Do you think something like trazodone would do most of the work in fixing up my situation?



    One question, why isnt trazodone a first line treatment for depression? I swore Id never take a nasty SSRI no matter how bad things got because of the side effects profile but this one looks good.. pretty damn good, actually. 'Sex drive increase'?... sign me up. I just dont understand why it wouldnt be prescribed if its a.) effective b.) doesnt kill your wanker

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    Senior Member Frangible's Avatar
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    Quote Originally Posted by krazyj' post='454947' date='Feb 5 2008, 10:11 PM
    Thanks for the replies.



    Frangible, your theory is interesting and makes sense. One question I have though is that I feel completely and absolutely unmotivated without Ritalin. I have clearly had a need for Ritalin since I was very young. My mother always goes back to telling me how I was a baby almost and shed given me Ritalin and noticed that I was as cute as could be and wasnt (as much of) a terror that I would be off my medicine.



    The one question I have is how much is too much? I feel that if I dont take enough, that I will never achieve the awesome productivity I can achieve (even with all these problems,.I can flex an amazing amount of mental muscle everyday). Right now, regarding focus, I feel the dosage is a bit on the high side but I wouldnt imagine being able to lower it much more and being happy with it. Do you think something like trazodone would do most of the work in fixing up my situation?



    One question, why isnt trazodone a first line treatment for depression? I swore Id never take a nasty SSRI no matter how bad things got because of the side effects profile but this one looks good.. pretty damn good, actually. 'Sex drive increase'?... sign me up. I just dont understand why it wouldnt be prescribed if its a.) effective b.) doesnt kill your wanker


    Well first of all, I'm not saying to drop the methylphenidate, just take the minimum amount needed (only you know what that is, and it likely varies over time) and stop other stims (caffine, modafinil). The problem is you may feel awesomely productive, but if you are on edge from long-term sleep deprivation and paralyzed by anxiety, how much are you truly, objectively accomplishing? Sometimes those feelings are just that, and don't translate into reality. Right now I've been taking 10mg of dexedrine/day but before that I was taking 40mg/day, despite the fact I feel tired when I should feel tired now, and not feeling super-lucid, I actually get more done and have a lot less anxiety, and my sleep quality has been improved. I think when you find taking more of a drug doesn't give you what you're looking for, you might be dosing in the wrong direction. And I think it largely comes down to sleep quality.



    Trazodone isn't the best antidepressant out there. It shouldn't be used during the day unless you have really really bad anxiety. It should be taken as a sleep aid as even the lowest dose tablet (50mg) is quite sedating. It will not fix all your problems, but it will do a good job at counteracting the effects of stimulants and restoring some sleep architecture. Beware that for a while you'll have morning grogginess, which will mostly go away in time. Trazodone doesn't get Rx'd much as an antidepressant due to the sedation, it does get Rx'd as a hypnotic much more often, even in people without depression.



    I can't say for certain if this is valid advice for you or not, but you did mention sleep problems, so addressing those may prove beneficial to your mood and energy levels. Talk to your doctor, and all that.
    <span style="color:#660000"><span style="font-size:8pt;line-height:100%"><span style="font-family:Arial Narrow">"... </span></span></span><span style="font-family:Arial Narrow"><span style="font-size:8pt;line-height:100%"><span style="color:#8b0000">fresh bread, which deforms elastically is not frangible." --Wikipedia</span></span></span>

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    Senior Member krazyj's Avatar
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    Quote Originally Posted by Frangible' post='454951' date='Feb 6 2008, 12:25 AM
    Talk to your doctor, and all that.


    Yeah yeah. Thanks for a nod in a different direction.

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    Quote Originally Posted by krazyj' post='454952' date='Feb 5 2008, 09:29 PM
    Yeah yeah. Thanks for a nod in a different direction.


    Way to go to show some gratitude towards someone who's helping you out



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    "artiste" graatch's Avatar
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    Methylphenidate has less effect on adrenergic systems than even methamphetamine.


    True enough, but methylphenidate also has a way of increasing adrenergic stimulation due to the the striatal dopamine stimulation (you directed me to that piece of information, I think). Certainly people describe the "locked in" focus much more often with methylphenidate than with Desoxyn.



    I also think methylphenidate's binding affinity at norepinephrine may be underestimated. There are some oddly mixed messages from the studies.



    a-2 agonists may help but I'm somewhat dubious as the focus effect as well as the wakefulness/insomnia are both mediated by dopamine.


    I'm not so sure. Guanfacine is prescribed for ADHD alone, as it seems to reduce hyperactivity, And again, there seems to be some success in the combination. I really think norepinephrine is a major factor here.



    Well first of all, I'm not saying to drop the methylphenidate, just take the minimum amount needed


    It's worth mentioning that, it seems to me, many people seem to describe an effect that's much more "locked in" and personality-blunting at the lower methylphenidate doses. Some of the discussion of methylphenidate's average lower efficacy for inattention compared to amphetamine, focuses on the idea that at the lower doses, methylphenidate mostly stimulates norepinephrine, and that's why lower doses of methylphenidate are often better for attention in ADD-Pi than higher doses. Strange, I know. I'll pull up the quote.



    Central norepinephrine transmission within certain boundaries = shifts the balance to prefrontal control?



    And in some ways/situations, is prefrontal control opposed to limbic spark and verve? Apollonian/Dionysian?
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    yea make sure your gettin the right amount of nutrients and sleep but would you consider switching to dexedrine or adderall for a try?



    some people just stop responding to certain medicines after long periods of use.....



    zoloft cured me of depression and anxiety for several years and then i came off for a short intermission and tryede to go back on and it made me much worse then before.....Still an unexplainable phenomanon to me



    if i was going to add anything itd be wellbutrin

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    alpha-2-adregenic receptors are stimulated by NE right??



    Im curious to why a agonist would be sedating and calming.....does it bind to the autoreceptors or something?

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    nevermind i think i found the answer





    so basically the A2 is the autorecpeter for the A1 becuase it produces negative feedback

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    Frang how much Dex do you take everyday and at what time do you take ur last dose? How many time do you wait between doses?

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    Quote Originally Posted by krazyj' post='454947' date='Feb 6 2008, 07:11 AM
    One question, why isnt trazodone a first line treatment for depression? I swore Id never take a nasty SSRI no matter how bad things got because of the side effects profile but this one looks good.. pretty damn good, actually. 'Sex drive increase'?... sign me up. I just dont understand why it wouldnt be prescribed if its a.) effective b.) doesnt kill your wanker
    Trazodone is given for depression on high doses.On doses between 50-100mg is considered as hypnotic.and yes,it Can knock you out.IMO you shouldn't take it during the day for anxiety reduction but only at night,for sleep.



    In fact doesn't increase your sex drive,just lacks the 'sexual sides'.. the common SSRI have ,but,has a weird side..priapism..DON'T use it as a sexual aid..if you do though,tell us about..to laugh..
    ---I AM NOT AS OTHERS..---

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    Senior Member krazyj's Avatar
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    Frangible, you were pretty spot on with the the sleep recommendation.



    I didnt outline this in the OP but the few days I tried to combine Ritalin and Provigil it went like this:

    *Day 1 - Feel great, awake, how I should feel

    *Day 2 - Still feelin pretty good, not as great as before though. Kind of couldnt wake up this morning, odd?

    ...

    *Day 5 - CRASH! Totally zapped, totally depressed, cant move. Overslept by 2 hours for 10+ hours of sleep and still VERY tired. A lack of energy like in a way I've never felt before.



    The theory that Provigil just masked even more of the having shitty sleep makes sense.



    I also lowered my dose and have been feeling at least a little better.





    So what kind of options do I have for ADD treatment? Is this Ritalin/sleep interaction inherently a side effect of stimulants or is there something I can do to structure my sleep different, etc? Ill talk to my doctor about the idea and bring up the trazodone.





    The only thing that pisses me off about all this is that Im in college and I feel like Im some kind of frail being that cant do anything. Most my friends go on 4-6 hours of sleep, have a bedtime of anywhere between 12PM and 6AM, drink a ton, do drugs and whatnot but godforbid if I get 7 hours of sleep instead of 8. Its like Ill be in a tailspin or something... fuck.

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    Quote Originally Posted by graatch' post='454940' date='Feb 5 2008, 08:50 PM
    Some people are being prescribed alpha-2 agonists (like Tenex, preferable to clonidine) to reduce the adrenergic side effects of psychostimulants. I bet it is effective for reducing the inescapably-in-the-zone feeling too, providing a more relaxed focus, although too much will surely reduce the positive benefits.



    Desoxyn (which apparently has something like a 2:1 norepinephrine:dopamine release -- compare to dextroamphetamine's 5:1) is also something that people report provides a much more relaxed, controlled focus. I think it should be used much more.



    Most dopamine agonists also apparently provide alpha-2 agonism by some mechanism (hence sedation) -- and this is what I'm interested in adding to a psychostimulant. Pramipexole for example.


    Good luck getting a Desoxyn prescription.

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    Senior Member krazyj's Avatar
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    Does anyone know what kind of tests might help in this situation too? A few different docs are suggesting different shit and theyre all pretty damn expensive. Ive already taken a hormone test for test, cortisol, etc (4 samples throughout day) and my other doc is suggesting a complete metabolic panel which is like $400 but Im suspicious thatll be useful.



    Im beginning to suspect the root of the problem is relating to my natural, baseline energy levels being too low (whether its a deficiency of some kind like adrenal fatigue or a sleep-related disorder... thats still in question).

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    Senior Member Frangible's Avatar
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    An overnight polysomnography may identify specific problems with your sleep but is quite expensive, so make sure your insurance will cover it first.



    Methylphenidate is probably the "gentlest" ADD treatment on sleep architecture, because of its short T1/2.



    Check out some trazodone, after a few weeks of tolerance to the next-day hangover see if things aren't a lot better for you. (you might also want to take it earlier in the evenings initially, and with some St. John's Wort and some Tums/calcium for faster clearance, or start at only 25mg)



    Don't neglect the behavioral/environmental aspect of things as well. Being socially connected, pursuing goals and making progress, doing things you enjoy, etc all matter in this as well.
    <span style="color:#660000"><span style="font-size:8pt;line-height:100%"><span style="font-family:Arial Narrow">"... </span></span></span><span style="font-family:Arial Narrow"><span style="font-size:8pt;line-height:100%"><span style="color:#8b0000">fresh bread, which deforms elastically is not frangible." --Wikipedia</span></span></span>

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    Senior Member krazyj's Avatar
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    Great information.



    Just to add a curveball to this thread, I am going to explore adrenal fatigue, too with my doctor...



    Earlier I felt like I could hardly keep my eyes open (at 7PM) so (since I have a test to study for) I took a 5mg ritalin and a protein shake... nothing I havent tried a million times without success but I figured I could only benefit from it at this point. This time, though, I threw in 500mg of Vitamin C w/ bioflavinoids and I instantly (and still... 2 1/2 hrs later) feel fan-goddamn-tastic. Eye openingly better.



    Luckily the saliva test I mentioned in my previous post was for adrenal fatigue so I should be hearing back from that in the next few days and Ill be sure to post up. For now though, Im off to eat 500mg more Vitamin C to see if it really is working.



    I will keep that information in mind though and appreciate you posting it up.



    Thanks again!

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    Senior Member krazyj's Avatar
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    For the record, I spoke with my compounding pharmacist regarding my 4 panel saliva test results.



    My results for estradiol were low, progesterone a little high, cortisol very low, DHEA pretty low, but, the main part, testosterone was WAY low.



    I think 25 ug/nl (or whatever unit is appropriate) when the range is 30.1-142.5 he said. And I'm a 20 year old male. With the testosterone level of a 50 year old women. I told him that would be an insult coming from anyone else.



    Anyways, hes giving me a bioidentical cream to try with 5mg T, 20mg Crysin, 5mg progest, and 5mg DHEA.

    Also, a definite hit on adrenal fatigue means Ill be starting those supplements as well.



    Hope this helps anyone out there with similar symptoms! Get a complete hormone panel (4 tests throughout the day) and talk to a compounding pharmacist! Those guys know the science of medicine... not doctors.

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