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I've been relatively stable with a few jags here and there for almost 2 years, and suddenly I'm experiencing some depression that has me in tears at times, as well as anxiety that results in panic attacks so bad that I feel like I can't breathe. I'm very emotionally labile, reactive to any trigger, sending me to seclusion with my depression.

The only thing that has changed is that I swapped Dexedrine to Bontril-PDM for my weight management (and with Bontril-PDM, off-label ADHD management, idiopathic hypersomnia management, and treatment of refractory bipolar depression). I'm thinking this may be the trigger, but I needed to take a break from Dexedrine because my receptors were too desensitized to it and I was starting to gain weight, sleep all day, become very inattentive (like almost having wrecks kind of inattentive), and feel a little depressed. So I may have identified my trigger, but I need to take a good break from Dexedrine so when I resume it, it will work as it did when I first started it.

My question is how does one prevent depression (neurochemical, not cognitive)? Is there something that can be temporarily added to my cocktail? I see my pdoc Friday. I have tried lithium and it causes seizures. Depakote makes me a zombie. Lamictal causes horrendous acne. I'd rather not add a second antipsychotic. Increasing the antidepressants seem to do nothing. 

Should I just get back on Dexedrine ASAP? Or continue to give it a break and try other alternatives? I thought about trying Ritalin again, but a much higher dose than I've tried before, like 40-60 mg in Metadate CD form (the only form I felt anything from with methylphenidate). Concerta and regular Ritalin are useless, and I've heard bad things about Ritalin LA.

Any responses or insight would be much appreciated! Thanks in advance! :) 

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7 hours ago, mikl_pls said:

I've been relatively stable with a few jags here and there for almost 2 years, and suddenly I'm experiencing some depression that has me in tears at times, as well as anxiety that results in panic attacks so bad that I feel like I can't breathe. I'm very emotionally labile, reactive to any trigger, sending me to seclusion with my depression.

The only thing that has changed is that I swapped Dexedrine to Bontril-PDM for my weight management (and with Bontril-PDM, off-label ADHD management, idiopathic hypersomnia management, and treatment of refractory bipolar depression). I'm thinking this may be the trigger, but I needed to take a break from Dexedrine because my receptors were too desensitized to it and I was starting to gain weight, sleep all day, become very inattentive (like almost having wrecks kind of inattentive), and feel a little depressed. So I may have identified my trigger, but I need to take a good break from Dexedrine so when I resume it, it will work as it did when I first started it.

My question is how does one prevent depression (neurochemical, not cognitive)? Is there something that can be temporarily added to my cocktail? I see my pdoc Friday. I have tried lithium and it causes seizures. Depakote makes me a zombie. Lamictal causes horrendous acne. I'd rather not add a second antipsychotic. Increasing the antidepressants seem to do nothing. 

Should I just get back on Dexedrine ASAP? Or continue to give it a break and try other alternatives? I thought about trying Ritalin again, but a much higher dose than I've tried before, like 40-60 mg in Metadate CD form (the only form I felt anything from with methylphenidate). Concerta and regular Ritalin are useless, and I've heard bad things about Ritalin LA.

Any responses or insight would be much appreciated! Thanks in advance! :) 

I might consider going back to the Dexedrine if you think that’s the major issue- it could give you time to get something stabilizing on board and then try a switch back...cuz you don’t want to hit the point we’re it gets bad enough that adding Dexedrine back won’t fix the mood issues, cuz then ur kinda stuck...especially since you’ve tried the usual suspects 

What’s ur current AP? 

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23 hours ago, BrianOCD said:

Anything happen recently that has you bothered or is it just kind of out of the blue depression?

It's just out of the blue depression that has gradually set in and is getting worse.

21 hours ago, Iceberg said:

I might consider going back to the Dexedrine if you think that’s the major issue- it could give you time to get something stabilizing on board and then try a switch back...cuz you don’t want to hit the point we’re it gets bad enough that adding Dexedrine back won’t fix the mood issues, cuz then ur kinda stuck...especially since you’ve tried the usual suspects 

What’s ur current AP? 

That's very true.

Abilify 20 mg is my current AP. It is my brain glue, and nothing else seems to work. I go bananas if I try to lower it or come off it. Going from 30 mg to 20 mg was scary enough.

8 hours ago, DammitJanet said:

I’m wondering how much of it has to do with the bf turbulence?

Well, this started before my BF turbulence. Also, FWIW, he has become a lot more affectionate since I told him "I love you." He also is sure to keep his dog under control when we show affection for each other (i.e., make sure he's in another room, put his foot on his back and scratch it with his foot, etc.)

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I’m tending to agree with restarting dexedrine and regroup. Then you can make a plan. At least for me, if depression gets too bad, I can’t think well enough to plan any more. But maybe there’s another out, I tend to think go with whatever worked and then figure a plan when you’re in a better place. FWIW. 

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Thanks everyone. I tried to get my pdoc to prescribe Metadate CD, but she is apparently done prescribing stimulants for me. I'll have to go through my NP, who has to go through my doc, who is opposed to prescribing those meds when I have a pdoc. But I worry if I tell them my pdoc won't prescribe them that it will come across that I do something weird with them like abuse them or sell them.

My pdoc added pindolol 5 mg for depression (in lieu of propranolol) and added Seroquel 25 mg for sleep. She also switched my benzo from Tranxene to regular doses of Xanax.

Edited by mikl_pls
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2 hours ago, mikl_pls said:

Thanks everyone. I tried to get my pdoc to prescribe Metadate CD, but she is apparently done prescribing stimulants for me. I'll have to go through my NP, who has to go through my doc, who is opposed to prescribing those meds when I have a pdoc. But I worry if I tell them my pdoc won't prescribe them that it will come across that I do something weird with them like abuse them or sell them.

My pdoc added pindolol 5 mg for depression (in lieu of propranolol) and added Seroquel 25 mg for sleep. She also switched my benzo from Tranxene to regular doses of Xanax.

Why is pdoc done Rx ing stims? Also I’d be careful with that doc/np thing...you don’t want then to think of you as “shopping around” (even though I’m not saying u are you know how it is with the opioid crisis bah blah blah) 

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11 hours ago, mikl_pls said:

Thanks everyone. I tried to get my pdoc to prescribe Metadate CD, but she is apparently done prescribing stimulants for me. I'll have to go through my NP, who has to go through my doc, who is opposed to prescribing those meds when I have a pdoc. But I worry if I tell them my pdoc won't prescribe them that it will come across that I do something weird with them like abuse them or sell them.

My pdoc added pindolol 5 mg for depression (in lieu of propranolol) and added Seroquel 25 mg for sleep. She also switched my benzo from Tranxene to regular doses of Xanax.

Yeah...like the others said, be careful with going to a second doc for a controlled substance...I’m not sure if it’s a new law or just more reinforced now, for doctor shopping...a felony, I think. Perhaps a consultation with a new pdoc? I just don’t want to see you get into trouble. 

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13 hours ago, mikl_pls said:

Thanks everyone. I tried to get my pdoc to prescribe Metadate CD, but she is apparently done prescribing stimulants for me. I'll have to go through my NP, who has to go through my doc, who is opposed to prescribing those meds when I have a pdoc. But I worry if I tell them my pdoc won't prescribe them that it will come across that I do something weird with them like abuse them or sell them.

My pdoc added pindolol 5 mg for depression (in lieu of propranolol) and added Seroquel 25 mg for sleep. She also switched my benzo from Tranxene to regular doses of Xanax.

I know you love your pdoc, but why is she against stims so much? Would a sleep specialist dr be willing to prescribe something? Mine prescribed nuvigil, although she did have to clear it with my pdoc first. A lot of drs are doing this now. They collaborate.

And a new thing in my state is that you have to show your ID to obtain a prescription for a controlled substance. Not sure if it is all controlled substances or just certain ones. But I’m not sure if your pdoc would find out if you have to do this in your state. I don’t know. I have to sign a statement that reads I will not sell or give my klonopin (or back when I was on it, lunesta) to anyone. And this was just a policy at my county clinic. 

They are getting very strict about certain meds in a lot of different manners. As others have said, I’d hate to see you get into trouble.

I hope the med changes she made help. But if you really need a stim, I’d have a serious discussion with her about how much they help and why you need one, etc. If she still won’t listen, maybe it is time to look for a different pdoc. As sad as that will be. 

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Sad when you have to go here and there and risk labeling or worse when you’re just trying to do what’s right for your personal biochemistry. Do be careful, wish I had good advice here otherwise. It’s a sad state of affairs when “innocent “ people with MI get shut down by regulation not really meant for their situation at all. I only hope my pdoc never retires or leaves my HMO after hearing this. 

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12 hours ago, DammitJanet said:

Yeah...like the others said, be careful with going to a second doc for a controlled substance...I’m not sure if it’s a new law or just more reinforced now, for doctor shopping...a felony, I think. Perhaps a consultation with a new pdoc? I just don’t want to see you get into trouble. 

yes. In my state before Pdoc prescribes adderall now he has to check an online registry that tells him if I've gotten it from any other doctors. It seems they're getting really strict a lot of places.

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On 5/25/2019 at 11:39 PM, Lapis.Lazuli said:

I've never even heard of some of the meds you describe or have taken/are on. Is Tranxene a benzodiazepine? I've never even heard of it. I've only ever heard of and tried the well-known mainstream benzos (Valium, Ativan, Xanax, Klonopin, Librium). I'm just asking because I feel like my Klonopin isn't helping much anymore. I even switched to the name brand Roche one and it doesn't seem any different. I don't know if I just need my dose increased or if I need a switch to another benzo. I'm already on 2 different ones though.

Yes, Tranxene is a long-acting benzo. It's less "slam-you-on-the-side-of-the-head" than Klonopin for me.

On 5/25/2019 at 11:39 PM, Lapis.Lazuli said:

Does your Pdoc know that you go to your other docs for psyche meds? Just curious because my Pdoc is very strict about only him prescribing any psyche meds to me. He had it added into my medical chart that no other doctor is allowed to prescribe any psyche meds to me at all. I tried getting a psyche med from my PCP and my PCP saw the note in my chart and refused to prescribe that psyche med so I know it's there. It sucks but at the same time it keeps me accountable and probably is for my own safety.

I don't know and I don't care. She pissed me off when she blew up at me about discussing dosage equivalencies and I pointed out that there was a discrepancy in her prescribing Dexedrine vs Adderall, and that I provided a sound, logical argument with sources to prove that she was biased against Dexedrine for no good reason other than the stigma. My NP will get almost anything for me through my GP (who comes in the door walking out he rushes so fast...). My pdoc actually encourages GPs to prescribe psych meds in between appointments because it helps the patient and her both.

That's kinda tough and rigid what your pdoc did. That's not very typical. It must be an ego thing or I dunno...

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On 5/25/2019 at 11:56 PM, Iceberg said:

Why is pdoc done Rx ing stims? Also I’d be careful with that doc/np thing...you don’t want then to think of you as “shopping around” (even though I’m not saying u are you know how it is with the opioid crisis bah blah blah) 

I have no idea. She become more and more conservative with the dosing and then quit altogether. I'm not abusing them, I'm not selling them, and I'm not taking them in a devious way. I respect stimulants and take them accordingly and exactly as prescribed. I switch them around every now and then becuase it seems to help them keep working. But this most recent switch to Bontril, even though it's at the ultra high dose, was probably a mistake.

Oh I see the same NP/doc every time. They give me 3 months worth of prescriptions of Dexedrine (but when I switched to Bontril he gave me 1 month, probably because he wants to check in on me sooner than 3 months to see if it's working or something).

To my knowledge, I definitely am not behaving in any manner so as to appear that I'm "shopping around." Yes, I know, it's ridiculous. But I go to the same pharmacy, a family-owned one who all know me by first name, and no one has ever questioned me or asked me about my prescriptions. I did however take my prescription to Walgreens and they acted very suspicious (my pdoc's prescription, the one without the stimulant... the only controlled substance is Xanax...) They asked me a lot of questions and stuff. I'm out of town and needed to fill my meds. They had to order two of them... pindolol and desipramine, not surprisingly, so I will have to pick them up tomorrow before I start summer classes.

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On 5/26/2019 at 8:42 AM, DammitJanet said:

Yeah...like the others said, be careful with going to a second doc for a controlled substance...I’m not sure if it’s a new law or just more reinforced now, for doctor shopping...a felony, I think. Perhaps a consultation with a new pdoc? I just don’t want to see you get into trouble. 

I'm technically taking it for obesity/weight loss. But they know I have ADHD and idiopathic hypersomnia, which they were the first to diagnose both of them before I started seeing a pdoc, so I think they're okay with it. I'm definitely not doctor shopping. I've been seeing these guys since the old doctor retired and they opened up that clinic. I went to high school with one of the doctors' little brothers.

I have seriously considered seeing if I can get in with my brother's pdoc. It'd be about a ~1+ hour drive there and then another one back, but I would be coming to Huntsville (near Madison, where his pdoc is) enough that it would probably be feasible.

I just simply don't mention stimulants to my pdoc. The last session was the first time I had brought up a stimulant in about two years, and I think she might know already that I'm taking a stimulant because they do a drug test every visit. I would say I have nothing to hide, but I have withheld that information verbally, so I guess that's a form of lying to her about it. But she hasn't brought it up, and she acted very unprofessional and downright mean when I had that discussion with her about stimulant dosing, so I figured "fine. No more stimulants from you. I'll see someone who will prescribe the dose I need, not 10 mg Adderall or whatever..."

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On 5/26/2019 at 10:34 AM, sugarsugar said:

Sad when you have to go here and there and risk labeling or worse when you’re just trying to do what’s right for your personal biochemistry. Do be careful, wish I had good advice here otherwise. It’s a sad state of affairs when “innocent “ people with MI get shut down by regulation not really meant for their situation at all. I only hope my pdoc never retires or leaves my HMO after hearing this. 

That's right. I don't know what her deal is with the stimulants. She regularly prescribed me 40-60 mg Adderall, and even 90 mg Adderall XR once or twice, then suddenly the limit was 30 mg, then 20 mg, then 10 mg, then nothing. She is a very experienced doctor though, and she knows her stuff, especially the oldie meds that these fresh, green pdocs coming straight out of med school are afraid to consider prescribing like TCAs and MAOIs... She's also very open to suggestions. She actually asks me what I want to do with my meds now rather than asking me what's been going on and then telling me what she's going to do with my meds. If she thinks something I say is a good idea, then she'll do it; otherwise, if she doesn't, she won't, but she'll also explain why. Sometimes her explainations are a bit of a stretch, but I just go with it.

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17 hours ago, argh said:

Vigorous and regular exercise, so long as i can catch it before it becomes impossible.

That's something I've been meaning to get back into. I was doing C25K (actually have attmpted it 2 or 3 times), but I keep stop going to the gym because I hate going by myself, and my friend who agrees to go with me so long as I pay for his membership quits going after like 2-3 weeks. I really need a reliable, consistent workout buddy.

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17 hours ago, Unstrung Harp said:

yes. In my state before Pdoc prescribes adderall now he has to check an online registry that tells him if I've gotten it from any other doctors. It seems they're getting really strict a lot of places.

I wouldn't be surprised if they put a "limited distribution" on stimulants or even put them as schedule I soon... It's fucking ridiculous.

_________________________

My plan when I run out of Bontril is to cross--titrate back onto Dexedrine, but start at a low dose. Like do 105 mg Bontril + 5 mg Dexedrine, then taper off the Bontril one pill/day at a time/week and add 2.5 mg Dexedrine/day/week until I'm at 10 mg. I think that way I would be resensitized to it (since I haven't taken it in about a month) and that way also, assuming I respond to 10 mg, I would have somewhere to go. Either that or I might try Metadate CD + Ritalin prn as I've never been prescribed anything more than 30 mg Ritalin and it did nothing. Focalin XR 25 mg made me jittery and anxious, so I don't think I want to go with that.

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