Are stims always contraindicated with history of psychotic episode?

[mcjimjam]

I got taken off Vyvanse as apparently it's contraindicated in psychosis. Does this mean I can never ever take a stim again. It didn't seem to worsen the psychosis and calmed my anxiety quite a lot. I ask because if I ever get stable I really need stims to be able to work or study...

Do any of you guys take them despite a psychotic episode in your past?

[Iceberg]

5 minutes ago, mcjimjam said:

I got taken off Vyvanse as apparently it's contraindicated in psychosis. Does this mean I can never ever take a stim again. It didn't seem to worsen the psychosis and calmed my anxiety quite a lot. I ask because if I ever get stable I really need stims to be able to work or study...

Do any of you guys take them despite a psychotic episode in your past?

Yes, it’s not unheard of, given that the psychosis is totally managed. I’d imagine it depends on the comfort level of the doc tho 

[Butterflykisses]

Stims make me crazy, I wish I could handle them, but I lose my mind..

Same thing happens if I drink coffee...

[Blahblah]

6 hours ago, mcjimjam said:

I got taken off Vyvanse as apparently it's contraindicated in psychosis. Does this mean I can never ever take a stim again. It didn't seem to worsen the psychosis and calmed my anxiety quite a lot. I ask because if I ever get stable I really need stims to be able to work or study...

Do any of you guys take them despite a psychotic episode in your past?

yep. my episode was 20 years ago, likely exacerbated by medication. Its def a red flag and concern for most pdocs, usually they would wait until they really know your symptoms and reaction to meds. At the time I was prescribed, my depression was not responding to antidepressants, my main symptoms were apathy, fatigue and lethargy which greatly effected my ability to function (all I could do was lay around sleeping most days, making me more depressed).

A stimulant was the only add-on (to my mood stabilizer) that changed that and dramatically helped my symptoms at the time, helped with motivation and interest. It's been over 2 years, I've been extremely compliant and i have had no problems. Were you recently having any symptoms related to psychosis or was it just a precautionary measure? Pdocs might be more inclined if you are on a mood stabilizer at the same time.

I see you're on Parnate...I've never tried that one. How do you like it?

Edited June 27, 2019 by Blahblah

[notloki]

Parnate is contraindicated with amphetamine. There is a true risk of serotonin syndrome mixing MAOI's and amphetamine. It can be a very effective combo but the patient needs to be followed carefully. Most docs don't have the knowledge about MAOI's and/or don't want to spend the time monitoring them. AFAIK Ritalin, et al, are safe with MAOI's.

[Iceberg]

51 minutes ago, notloki said:

Parnate is contraindicated with amphetamine. There is a true risk of serotonin syndrome mixing MAOI's and amphetamine. It can be a very effective combo but the patient needs to be followed carefully. Most docs don't have the knowledge about MAOI's and/or don't want to spend the time monitoring them. AFAIK Ritalin, et al, are safe with MAOI's.

My medscape thing says methylphenidate is also contraindicated with parnate- although we all know that there is sometimes a little wiggle room in interaction checker 

[notloki]

1 hour ago, Iceberg said:

My medscape thing says methylphenidate is also contraindicated with parnate- although we all know that there is sometimes a little wiggle room in interaction checker 

I guess I was right. Dr. Ken Gillman makes good points and he is considered the expert when it comes to serotonin syndrome  https://psychotropical.com/maois-and-cns-stimulants/

Quote

Methylphenidate

Methylphenidate and MAOIs have been in use together for 40 years, so it would be surprising if someone had not ingested the combination by now: death, or morbidity, from such an event has not been reported (whereas it has with amphetamine). Methylphenidate is most widely used as a treatment for attention-deficit hyperactivity disorder (ADH) in children. It has been supposed to have serotonergic effects; if that is so it would be predicted to be at high risk of precipitating serotonin toxicity if combined with MAOIs. There are no definite case reports indicating serotonin toxicity with methylphenidate in combination with MAOIs, or other serotonergic drugs (see above) [17-20].

 

[HydroCat]

Overactivation of certain Dopamine receptors is thought to contribute to psychotic symptoms.

Antipsychotics generally reduce Dopaminergic activity on these receptors.

(most) Stimulants are essentially the opposite - they increase Dopamine levels and cause more activation of these receptors. Theoretically, they may increase the risk for psychosis.

That being said, antipsychotics block certain Dopamine receptors but not others. So a stimulant taken together with an AP may do something... not sure what the effect will feel like though.

There are stimulants that do not affect Dopamine at all (like Atomoxetine/Straterra) or have a weak effect on it (like Modafinil/Provigil).

[Iceberg]

2 hours ago, notloki said:

I guess I was right. Dr. Ken Gillman makes good points and he is considered the expert when it comes to serotonin syndrome  https://psychotropical.com/maois-and-cns-stimulants/

 

I was not familiar with him, cool info! It’s always interesting/advantageous to know the difference between “theoretical” guidelines and “practical” guidelines. I have had the most success with the docs who aren’t afraid to Bend the recommendations a bit 

[notloki]

A little more about mixing amphetamines and MAOI:  https://psychotropical.com/maois-and-releasers-including-amphetamines/

[mikl_pls]

For the record, I have been on Parnate 40 mg and Dexedrine 30 mg without any issues. My blood pressure actually was lower than it was without the Parnate (which I believe is a common side effect, especially at first) and my heart rate was the same as before.

All that being said, more caution would be necessary with amphetamines with MAOIs than with methylphenidate/dexmethylphenidate.

Correct me if I'm wrong, but the deaths that occurred with mixing MAOIs and amphetamines occurred before they had established any "official" protocols for mixing them, like starting the stimulant first before the MAOI (one thing I read). That and they were using ultra-high doses of one or both agents.

Edited June 28, 2019 by mikl_pls

[notloki]

2 hours ago, mikl_pls said:

For the record, I have been on Parnate 40 mg and Dexedrine 30 mg without any issues. My blood pressure actually was lower than it was without the Parnate (which I believe is a common side effect, especially at first) and my heart rate was the same as before.

All that being said, more caution would be necessary with amphetamines with MAOIs than with methylphenidate/dexmethylphenidate.

Correct me if I'm wrong, but the deaths that occurred with mixing MAOIs and amphetamines occurred before they had established any "official" protocols for mixing them, like starting the stimulant first before the MAOI (one thing I read). That and they were using ultra-high doses of one or both agents.

My point is that the official PI contraindicates amphetamine. It is going to be hard to find a pdoc who will write scripts for this. It is hard finding a pdoc who knows what a MAOI is, let alone used it on patients. I suspect the deaths from combining Parnate and amphetamine were from hypertensive crisis

[mikl_pls]

3 hours ago, notloki said:

My point is that the official PI contraindicates amphetamine. It is going to be hard to find a pdoc who will write scripts for this. It is hard finding a pdoc who knows what a MAOI is, let alone used it on patients. I suspect the deaths from combining Parnate and amphetamine were from hypertensive crisis

Oh I see. This is very true!

[mcjimjam]

On 6/27/2019 at 6:12 PM, Blahblah said:

yep. my episode was 20 years ago, likely exacerbated by medication. Its def a red flag and concern for most pdocs, usually they would wait until they really know your symptoms and reaction to meds. At the time I was prescribed, my depression was not responding to antidepressants, my main symptoms were apathy, fatigue and lethargy which greatly effected my ability to function (all I could do was lay around sleeping most days, making me more depressed).

A stimulant was the only add-on (to my mood stabilizer) that changed that and dramatically helped my symptoms at the time, helped with motivation and interest. It's been over 2 years, I've been extremely compliant and i have had no problems. Were you recently having any symptoms related to psychosis or was it just a precautionary measure? Pdocs might be more inclined if you are on a mood stabilizer at the same time.

I see you're on Parnate...I've never tried that one. How do you like it?

My psychotic sx were recent yes. Parnate don’t know if it helps. I think it does. I started it when I had ECT so I don’t really remember how I felt at the time I started it. It seems to not have any side effects and one can generally ignore  the MAOI diet and eat whatever you want.

Edited June 30, 2019 by mcjimjam

[Blahblah]

1 hour ago, mcjimjam said:

My psychotic sx were recent yes. Parnate don’t know if it helps. I think it does. I started it when I had ECT so I don’t really remember how I felt at the time I started it. It seems to not have any side effects and one can generally ignore  the MAOI diet and eat whatever you want.

Does Parnate mainly help with anxiety? For some reason, I had thought it was for depression - do you feel tired or stimulated by it?

[notloki]

On 6/30/2019 at 4:12 AM, Blahblah said:

Does Parnate mainly help with anxiety? For some reason, I had thought it was for depression - do you feel tired or stimulated by it?

Sometimes it is used for anxiety or OCD symptoms. It is primarily an antidepressant. After all the SSRIs are first line for anxiety.

[mikl_pls]

On 6/30/2019 at 5:12 AM, Blahblah said:

Does Parnate mainly help with anxiety? For some reason, I had thought it was for depression - do you feel tired or stimulated by it?

Parnate, while is was very very stimulating, strangely enough, my anxiety disappeared. I may be an unusual case, but typically Nardil is used for people with high anxiety because it indirectly increases GABA levels. There are problems with liver toxicity with Nardil though. Marplan is related to Nardil, being a hydrazine, but without the liver toxicity and possibly without the GABA increasing. (Not much is known about Marplan as much as the others for some reason...)