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Dependance or Depression relapse- stimulant addiction?


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 I've posted on this topic before, because I'm really wondering why this is happening to me, but not on other people that have been on higher-dose stimulants (without breaks) for MUCH longer....

I re-instated Ritalin (after a 4 month break) due to increase in work cognitive tasks. Pdoc increased the dosage because previous dose was starting to not cut it, wearing off early. I Was told I could experiment, but to take weekends/breaks off in order to "rest" . In the last 3 weeks, I've noticed drastic improvements in my mood, motivation, ability to focus on intellectual tasks/reading, and a positivity, calmness in general.

Problem is, I am psychologically addicted. When I try to break on the weekends, I can't get out of bed, barely prepare food for myself (despite hunger), and shower, basically, these symptoms are MUCH worse than before I was taking it! I'm concerned that I'll need to keep increasing the dose, take it everyday, and eventually, it will make my condition/functioning worse in the long run (exacerbating the problem). I had old pdocs that would not prescribe me stimulants for exactly this reason.....(I am not ADD.....it is for TRD.)

Any ideas guys? I'm very compliant, and have no inclination to abuse the dosage. This is the only thing that's made a dent in my mood and functioning and does not seem like a long-term solution!

Edited by Blahblah
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What do you expect from a powerful stimulant n ?  Your CNS has learned how to work in a environment where the level of stimulation is high.If you cold turkey it your CNS needs time to adjust. You will be very tired during this period. Personally I think you should take it every day or step it down before you quit.

Psychologically addicted. eh. That is a non condition as all addictions are psychological. Are you craving the drug and cranking up the dose, higher than the way it was prescribed ? If you are not this is no addiction. Or dependence. Maybe not tolerance. You kick the legs out by stopping something very powerful, the CNS needs time to readjust. Take your med all the time unless you are committed to a slow taper off.

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5 hours ago, notloki said:

What do you expect from a powerful stimulant ?  Your CNS has learned how to work in a environment where the level of stimulation is high.If you cold turkey it your CNS needs time to adjust. You will be very tired during this period. Personally I think you should take it every day or step it down before you quit.

Psychologically addicted. eh. That is a non condition as all addictions are psychological. Are you craving the drug and cranking up the dose, higher than the way it was prescribed ? If you are not this is no addiction. Or dependence. Maybe not tolerance. You kick the legs out by stopping something very powerful, the CNS needs time to readjust. Take your med all the time unless you are committed to a slow taper off.

I am strictly following my pdocs recommendations, you don't need to be snarky.  I am taking it exactly as she prescribed. She said she usually recommends people break on weekends, to avoid increased tolerance (and avoid having to always up the dose).  I do feel like I am addicted because I cannot stop taking it on the weekends like she suggests. I do "crave" taking it (versus stopping it altogether on weekends) I feel dependent in this way, like I must take them every single day of the week now, otherwise my functioning is screwed. 

 

3 hours ago, Velvet Elvis said:

It's normal for your ADD symptoms to be worse than your baseline if you are on stimulants and skip a day.  Aside from a couple years recently when I was off them for insurance reasons, I've pretty much taken stimulants every day for 20 years. 

I am actually not ADD. I was prescribed it as an add-on because my depression is treatment-resistant (in that my dysthymia and anhedonia isn't relieved by antidepressants). I know that people with diagnosed ADD typically take it everyday for decades because it's indicated for ADD. For depression, it's a bit different and controversial it seems (in my experience with pdocs) They hesitate to even prescribe it to me and then if they do, they don't want to usually keep someone with depression on it, because it is "not  indicated for long term depression" and can cause you to "cycle" erratically. 

@Velvet Elvis It sounds like stimulants have continued to be just as effective for you (even after 20 years?) That is surprising to me (very positive) but its good to hear that they don't necessarily always "poop out"

Edited by Blahblah
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My pdoc also told me to try and not take it on the weekends or when I have nothing to do.  I have adhd, but I started taking ritalin then dexedrine mainly for treatment resistant depression.  It is hard not to take it every morning just to get up and going.  I have a lot of trouble with energy.  I did take one this morning, so tomorrow I will probably not take it to see how I do.  

I know I am dependent on it, without it I just can't get anything done.  But I'm also dependent on all my other meds to function as well.  It is what it is, I wish I didn't need it, but right now I do. 

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7 hours ago, Blahblah said:

I am strictly following my pdocs recommendations, you don't need to be snarky.  I am taking it exactly as she prescribed. She said she usually recommends people break on weekends, to avoid increased tolerance (and avoid having to always up the dose).  I do feel like I am addicted because I cannot stop taking it on the weekends like she suggests. I do "crave" taking it (versus stopping it altogether on weekends) I feel dependent in this way, like I must take them every single day of the week now, otherwise my functioning is screwed. 

 

I am actually not ADD. I was prescribed it as an add-on because my depression is treatment-resistant (in that my dysthymia and anhedonia isn't relieved by antidepressants). I know that people with diagnosed ADD typically take it everyday for decades because it's indicated for ADD. For depression, it's a bit different and controversial it seems (in my experience with pdocs) They hesitate to even prescribe it to me and then if they do, they don't want to usually keep someone with depression on it, because it is "not  indicated for long term depression" and can cause you to "cycle" erratically. 

@Velvet Elvis It sounds like stimulants have continued to be just as effective for you (even after 20 years?) That is surprising to me (very positive) but its good to hear that they don't necessarily always "poop out"

After a while  they aren't as effective as they were at first but they are still a hell of lot better than nothing.

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Why not increase  the dose slowly to compensate for loss of effectiveness ? That what I have done for decades. I have increased by 10 mg every now and then. I started at 35 mg/day and here I am, 10 years later, at 90 mg/day.  Doing just fine. It works out to an increase or 10 mg/day around every year, but always if I need it. The doctor must keep meticulous notes and justification for the increases. He keeps a number of journal articles that say increases due to tolerance are OK. That going above 40 mg/day is OK, some need it. He uses those when the insurance balks or the DEA comes knocking.

I know a person who sees an ADHD specialist who has some patients above 100 mg/day. She is on 120 mg/day. Calmest person I know.

That kills the big pink elephant in the room.

 

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  • 4 weeks later...
On 13/10/2018 at 8:22 PM, gb84 said:

My pdoc also told me to try and not take it on the weekends or when I have nothing to do.  I have adhd, but I started taking ritalin then dexedrine mainly for treatment resistant depression.  It is hard not to take it every morning just to get up and going.  I have a lot of trouble with energy.  I did take one this morning, so tomorrow I will probably not take it to see how I do.  

I know I am dependent on it, without it I just can't get anything done.  But I'm also dependent on all my other meds to function as well.  It is what it is, I wish I didn't need it, but right now I do. 

OK so I have TRD and am in exactly the same boat. I've tried 100+ meds, dTMS, ECT, Ketamine and nothing sticks. The only thing that touches my depression is stimulants. The best I've ever done was on MAOI's + stimulants but now I can't find a doc who will prescribe that combination since it's contraindicated. I too am very conscientious and observant of the dosages prescribed. I bought myself a blood pressure cuff and was very careful. 

I also find that, as the literature says and I knew beforehand, the stimulant (be it methylphenidate-based or amphetamine-based) loses efficacy over time. It's absolutely galling, life-destroying, gutting, pick your description. Like you say, without the Adderall/Ritalin/Vyvanse/Concerta/Dexedrine ER dose, I am just suffer immobile in bed. One thing I didn't fully realise that my new PDoc said is that the aspects of stims that help executive-function tend not to lose efficacy over time, which is kind of puzzling/frustrating.

My PDoc is trying Mirapex (since I do best with dopaminergic meds seemingly) but so far it's just making me uber somnolent.

Best of luck to you.

Edited by sming
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13 minutes ago, sming said:

OK so I have TRD and am in exactly the same boat. I've tried 100+ meds, dTMS, ECT, Ketamine and nothing sticks. The only thing that touches my depression is stimulants. The best I've ever done was on MAOI's + stimulants but now I can't find a doc who will prescribe that combination since it's contraindicated. I too am very conscientious and observant of the dosages prescribed. I bought myself a blood pressure cuff and was very careful. 

I also find that, as the literature says and I knew beforehand, the stimulant (be it methylphenidate-based or amphetamine-based) loses efficacy over time. It's absolutely galling, life-destroying, gutting, pick your description. Like you say, without the Adderall/Ritalin/Vyvanse/Concerta/Dexedrine ER dose, I am just suffer immobile in bed. One thing I didn't fully realise that my new PDoc said is that the aspects of stims that help executive-function tend not to lose efficacy over time, which is kind of puzzling/frustrating.

My PDoc is trying Mirapex (since I do best with dopaminergic meds seemingly) but so far it's just making me uber somnolent.

Best of luck to you.

Good luck with your search as well.  I wish there was a cure all, but we do what we can. 

I've found that now with vraylar I don't need as much of the stimulant.  I went down from 15mg 3x a day to 10mg 2x and it is working as well.  Hope the trend continues. 

Trying to keep a more positive attitude as winter approaches.  Usually I am asleep most of the time till spring comes around. 

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On 11/11/2018 at 6:56 PM, sming said:

OK so I have TRD and am in exactly the same boat. I've tried 100+ meds, dTMS, ECT, Ketamine and nothing sticks. The only thing that touches my depression is stimulants. The best I've ever done was on MAOI's + stimulants but now I can't find a doc who will prescribe that combination since it's contraindicated. I too am very conscientious and observant of the dosages prescribed. I bought myself a blood pressure cuff and was very careful. 

I also find that, as the literature says and I knew beforehand, the stimulant (be it methylphenidate-based or amphetamine-based) loses efficacy over time. It's absolutely galling, life-destroying, gutting, pick your description. Like you say, without the Adderall/Ritalin/Vyvanse/Concerta/Dexedrine ER dose, I am just suffer immobile in bed. One thing I didn't fully realise that my new PDoc said is that the aspects of stims that help executive-function tend not to lose efficacy over time, which is kind of puzzling/frustrating.

My PDoc is trying Mirapex (since I do best with dopaminergic meds seemingly) but so far it's just making me uber somnolent.

Best of luck to you.

Me too...! Huuuuuuuuuuuge battle to even get someone to prescribe at all. But literally the only thing that has made a noticeable difference in my depression. Moreso with focus, motivation, follow through. Energy levels are improved . The eventual loss in effectiveness I notice, first shows up as: less energy, larger appetite returns, mood-lifting effects goes away....I start to feel really blah and tired again, drink more coffee, struggling to do much. When I'm completely off, I slide quickly into what you describe (listless in bed, doing nothing). Then come the negative ruminations which are totally paralyzing and can lead to a full blown depressive episode.

It's very effective for executive functioning and clarity of thought. I hope this benefit never goes away. When I am motivated, organized and focused, I'm able to actually get sh*t done, I feel productive, then more confident. Even when I'm not super depressed, I have problems with lack of drive, procrastination, organization, laziness, anhedonia, causing me to become overwhelmed, self-critical and avoidant. i just don't know what else I can do other than increase dosage every 9 months. If the pdoc will even agree to that!

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34 minutes ago, Blahblah said:

Me too...! Huuuuuuuuuuuge battle to even get someone to prescribe at all. But literally the only thing that has made a noticeable difference in my depression. Moreso with focus, motivation, follow through. Energy levels are improved . The eventual loss in effectiveness I notice, first shows up as: less energy, larger appetite returns, mood-lifting effects goes away....I start to feel really blah and tired again, drink more coffee, struggling to do much. When I'm completely off, I slide quickly into what you describe (listless in bed, doing nothing). Then come the negative ruminations which are totally paralyzing and can lead to a full blown depressive episode.

It's very effective for executive functioning and clarity of thought. I hope this benefit never goes away. When I am motivated, organized and focused, I'm able to actually get sh*t done, I feel productive, then more confident. Even when I'm not super depressed, I have problems with lack of drive, procrastination, organization, laziness, anhedonia, causing me to become overwhelmed, self-critical and avoidant. i just don't know what else I can do other than increase dosage every 9 months. If the pdoc will even agree to that!

My new, new PDoc (long story) has already said that 60mg Adderall is the limit - same as my previous 2 PDoc's. I understand their point of view but I just wish they could feel how I feel when not on stimulants. I guarantee they'd prescribe a higher dose.

I started Wellbutrin and Mirapex (as mentioned) and whilst they're nothing compared to Adderall, my low periods in between Adderall doses are not as low. I can still function, albeit begrudgingly, feeling shit and slowly. FTR I've temporarily done well on the "wakefulness promoting agent" Provigil (and its sibling Nuvigil). The problem is getting those prescribed is nigh on impossible. It's only approved for narcolepsy and sleep apnea IIRC and insurance wants evidence that you have those conditions first. Fuckers. TBH though Provigil "poops out" as well after a while. I fucking hate my brain.

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37 minutes ago, sming said:

My new, new PDoc (long story) has already said that 60mg Adderall is the limit - same as my previous 2 PDoc's. I understand their point of view but I just wish they could feel how I feel when not on stimulants. I guarantee they'd prescribe a higher dose.

I started Wellbutrin and Mirapex (as mentioned) and whilst they're nothing compared to Adderall, my low periods in between Adderall doses are not as low. I can still function, albeit begrudgingly, feeling shit and slowly. FTR I've temporarily done well on the "wakefulness promoting agent" Provigil (and its sibling Nuvigil). The problem is getting those prescribed is nigh on impossible. It's only approved for narcolepsy and sleep apnea IIRC and insurance wants evidence that you have those conditions first. Fuckers. TBH though Provigil "poops out" as well after a while. I fucking hate my brain.

Are you taking any stimulants now? And have you found stimulant breaks have been helpful or just problematic?  I notice you're taking both Lithium and Lamictal....Are those treating depression symptoms? I also wonder if being on Lamictal (or another mood stabilizer) can lower the effectiveness and some benefits of the stimulant?

Maybe down the road, if the Ritalin just really isn't cutting it, I could switch to Adderall? I think my pdoc said the max dose of Ritalin (extended) she prescribes is 60mg (which I'm sure the Adderall equivalent is much higher).

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On 11/11/2018 at 11:47 AM, sming said:

Masterfully unhelpful.

Sorry, what ? The OP had some, to me, unreasonable expectations. So I was asking what were their expectations to make sure I was understanding them. Little asinine comments like yours are the ones masterfully unhelpful.

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2 hours ago, notloki said:

Sorry, what ? The OP had some, to me, unreasonable expectations. So I was asking what were their expectations to make sure I was understanding them. Little asinine comments like yours are the ones masterfully unhelpful.

oh, touché monsieur! touché! 

Hilarious.

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2 hours ago, Blahblah said:

Are you taking any stimulants now? And have you found stimulant breaks have been helpful or just problematic?  I notice you're taking both Lithium and Lamictal....Are those treating depression symptoms? I also wonder if being on Lamictal (or another mood stabilizer) can lower the effectiveness and some benefits of the stimulant?

Maybe down the road, if the Ritalin just really isn't cutting it, I could switch to Adderall? I think my pdoc said the max dose of Ritalin (extended) she prescribes is 60mg (which I'm sure the Adderall equivalent is much higher).

Yes. I'm supposed to be transitioning to Dexedrine ER from Adderall but I'm finding it ineffective. This is really galling since several folk online had had really good responses to it :/

I daren't do a stimulant break but I might have to. I work Mon-Fri and help out with the kids Sat-Sun which would make said break very difficult to bear if nigh on impossible. I don't have any vacation days left either unfortunately since I was inpatient and off work for months :/

Both Lithium and Lamictal seemed to help temporarily (my signature is out of date) but that's my TRD MO. "It might work slightly for a bit" is the best I get.

I'd def recommend trying amphetamine-based meds. Very different to methylphenidate-y stuff. I've often mulled over switching between them month on month e.g. Jan = Adderall, Feb = Ritalin, March = Adderall and so on. Could be worth looking into - keep the old grey matter guessing (i.e. stop it from downregulating) or something like that. 

1 mg of Ritalin might not equate to 1mg Adderall remember. Also FWIW people respond differently to long-acting versions of both Ritalin and Adderall. I did well on Concerta and then Vyvanse for a good month or two. Those were the days...

Good luck amigo.

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25 minutes ago, sming said:

 keep the old grey matter guessing (i.e. stop it from downregulating) or something like that.

Good luck amigo.

Thanks @sming You can probably relate to my sense of my desperation to try and do whatever it takes to maintain the efficacy and keep it working for my broken brain. It was my pdoc that kept saying all I need to to is "take weekend med breaks or med holidays"  like that's the typical protocol and will prevent this rapid tolerance stuff.  Best of luck to you as well!

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