# Ritalin LA 40 mg 3x/day + Lexapro 40 mg 1x/day



## Inshallah (May 11, 2011)

Give me your opinions on my new medication combo please, or maybe some suggestions for possible improvements?

I switched the Concerta I was on back to Ritalin LA for financial reasons btw. (Concerta, even though it is clearly better than Ritalin LA due to a more gradual release mechanism, unfortunately also is twice as expensive. And these ADHD-meds aren't exactly cheap to begin with :|)


----------



## billyho (Apr 12, 2010)

Inshallah said:


> Give me your opinions on my new medication combo please, or maybe some suggestions for possible improvements?
> 
> I switched the Concerta I was on back to Ritalin LA for financial reasons btw. (Concerta, even though it is clearly better than Ritalin LA due to a more gradual release mechanism, unfortunately also is twice as expensive. And these ADHD-meds aren't exactly cheap to begin with :|)


Well, isn't Lexapro generic now? Depending on where you live I guess.

As for Ritalin, how about Focalin? Twice as strong as Ritalin and I believe it comes in an xr formula. I don't believe it is generic yet, but it depends on your insurance copay.


----------



## Inshallah (May 11, 2011)

Thx billy! But I'm sticking to the brand products. Focalin unfortunately also doesn't exist here  

No one else with an opinion?


----------



## metamorphosis (Dec 18, 2008)

Focalin FTW.  Highly recommend by many. Though I have never used it myself. Now that one is not generic and in the U.S. Lexapro is finally generic.
BTW, 40 mg is a hefty dose of Lexapro. Are you using it for OCD?


----------



## Inshallah (May 11, 2011)

Nope methamorph all for treatment resistant depression.


----------



## yay (Dec 31, 2012)

120mg ritalin sounds like a way too high dose. How much do you weigh? 120 kilos?


----------



## Inshallah (May 11, 2011)

yay said:


> 120mg ritalin sounds like a way too high dose. How much do you weigh? 120 kilos?


About 75 kg's. They are both very high doses for sure and I would also never recommend them for someone for whom the risk/benefit ratio doesn't justify trying them.


----------



## yay (Dec 31, 2012)

Is your doc okay with such a high dose?

40mg at once already sounds like an awful lot. Do you not get any side effects like high BP? Or have you slowly built a tolerance over time?

I heard that some people have good success with really tiny doses of MPH like 2mg. Did you also try out really small doses?


----------



## Inshallah (May 11, 2011)

Yes my psychiatrist is ok with it, but we follow up on my health weekly and extensively with the assistance of other specialists.

The Dopamine-Serotonin balance you hear so much about, must be quite important because basically the side effects I had when I was only taking MPH in the past month or so, as well as the side effects I had when I was only taking Lexapro in the past, have all either lessened in intensity or have even disappeared entirely. 

I even seemed to get more of this positive side effects trend each time the doses went up. 

Intuitively, I expected this to happen, even though you'd be inclined to expect the exact opposite. But I had/have a theory that would explain all of this and my psychiatrist apparently also thought the same.

I'm going to sleep now but will explain my reasoning on the why of this all tomorrow, should someone be interested.


----------



## Ben12 (Jul 8, 2009)

Just curious but is it really Ritalin LA? Like the LA formulation? I'm just wondering because taking 1 of the ritalin "LA" formulation tablets is effective for 8 hours. It works by giving I think about half of the dose immeditely and then the other half 4 hours later. Thus an 8 hour duration of action. I'm not trying to judge the 40mg 3 times daily of Ritalin LA but that's quite something. Is it really the LA formulation? Again I'm just curious because that's a large dose and quite the long duration of action.


----------



## yay (Dec 31, 2012)

Inshallah said:


> I'm going to sleep now but will explain my reasoning on the why of this all tomorrow, should someone be interested.


Yes share it with us.

40 mg Lexa is also damn high. The maximum dose is 20mg. Are you regularly getting ECGs? That would be very wise to see if there are changes.


----------



## Inshallah (May 11, 2011)

Ben12 said:


> Just curious but is it really Ritalin LA? Like the LA formulation? I'm just wondering because taking 1 of the ritalin "LA" formulation tablets is effective for 8 hours. It works by giving I think about half of the dose immeditely and then the other half 4 hours later. Thus an 8 hour duration of action. I'm not trying to judge the 40mg 3 times daily of Ritalin LA but that's quite something. Is it really the LA formulation? Again I'm just curious because that's a large dose and quite the long duration of action.


Yes it is, this one actually:









These long actibg version also only claim to "work upwards to", not that they necessarily do so in practice. And, they don't. Ritalin LA (or Rilatine MR over here) is supposed to idd have a duration of 2x 4h, thus 8 in total.

In reality I'm guessing it's around 4, maybe 5h max for me. So there's your reason


----------



## Ben12 (Jul 8, 2009)

What times during the day do you take the ritalin la?


----------



## Inshallah (May 11, 2011)

Every 5-6 hours or so. This is something you'll almost systematically see mentioned when Googling people's personal experiences with either one of the long acting MPH versions: they seldomly come close to the duration they supposedly should be able to reach.

Concerta is truely the longest acting and most stable MPH releasing of them all but it's double the cost of long acting Ritalin  (which is already expensive to begin with)


----------



## yay (Dec 31, 2012)

What's so bad about taking a pill every 3 hours? I think having instant Ritalin gives you more control and ability to plan.


----------



## Inshallah (May 11, 2011)

yay said:


> Yes share it with us.
> 
> 40 mg Lexa is also damn high. The maximum dose is 20mg. Are you regularly getting ECGs? That would be very wise to see if there are changes.


I'll try to do so tomorrow, if not tomorrow, then certainly somewhere early next week), it's already late here and I'm going to bed soon.

And with all of my current psychopharmaceuticals started up concurrently and titrated up very fast or even without titration, to above maximum dosages for Ritalin and Lexapro, trust me when I tell you, I am extremely slow cognitively at the moment.

In less than 2 weeks time:

Lexapro, we started up with 10 mg for 3 days, 20 mg for 3 days, 30 mg for 3 days and then 40 mg obviously

Ritalin LA (I was taking 27 mg Concerta 2x/day for about 2 weeks before this): we didn't titrate and simply started the 40 mg Ritalin LA 3x/day (or Rilatine MR as it's called over here in Belgium)

Tranxene (Clorazepate): again no titration, 15 mg 2x/day. I've been on several benzo's and holy ****, Tranxene is some seriously sedating stuff.

We will be doing frequent health check-ups (ECG's) among others. I accepted the frequent and stringent health monitoring only out of respect for my psychiatrist. I know she would feel (very) bad if we didn't do all of the health checking.

You have to understand: I've been suicidally depressed for a large % of my life and even when I wasn't suicidal, I was still depressed and didn't really want to live.

Tried a lot psychiatric meds, some really helped me, some didn't seem to anything, some made me more depressed. I've had 6 ECT-treatments (8 is generally seen as the absolute minimum for a good response) but because after 6 sessions, there was still no improvement whatsoever, we decided to call it quits.

Add to that several physical issues, mostly orthopaedic, I've undergone 18 surgeries, most of which major ones.

Done a few suicide attempts which were both close calls requiring resuscitation and I still have an euthanasia-request-procedure running for close to 2 years now.

Conclusion(s): after my (his)story everyone probably is able to put this hardcore pharmaceutical approach in the correct context, as well as my current complete disinterest in my health. (wanting to die and being concerned about your health, a bit contradictory no?  SHOULD I ever manage to become truly depression-free, then of course I will become concerned about my health just like anyone else that WANTS to live.

I also just realized that typing out all of this (and also finding, the right words) took me at least an hour, probably closer to 90 mins. I'm guessing that I'm about 10 times cognitively slower than I normally am + I might just have given my theory now already, but oh well, I'll come to it


----------



## Inshallah (May 11, 2011)

yay said:


> What's so bad about taking a pill every 3 hours? I think having instant Ritalin gives you more control and ability to plan.


You're thinking is correct. But I've talked with several ADHD'ers about this and almost all of them switched to the longer acting versions and stuck with them.

Apparently, the IR version gives much more fluctuations, which are already problematic with the longer acting versions. (apart from Concerta) Concerta gives a consistent effect with no noticeable fluctuations and thus also less of a crash (or even no crash at all).

The IR version also produces a stronger ("dopamine rush") peak than the longer acting versions, so there is more abuse potential AND the crash/comedown is also harsher. Again, told to me by experienced ADHD stim-junks.

Then there's still the walking around with pills all day, every day and you'll probably have to take them in public view regularly. Maybe, that's ok for you and then it's fine. I myself would rather not have to that on a daily basis.

Also don't forget: in the beginning, Ritalin for ADHD was used predominantly for school going children under 18. They were given their pills by their parents, teachers, ... So they didn't run the risk of the higher abuse potential because they never actually had the pills, it went like this: teacher said "time for your pill Timmy, here's a glass of water".


----------



## jimmythekid (Apr 26, 2010)

The main reason I take Concerta is that instant release pills are too tempting to abuse. Every now and then I end up snorting a pile of Ritalin dust. 

Concerta is quite abuse proof. You can't crush the pills and they are very hard to disassemble. I don't think you'd catch a buzz swallowing the pills due to the slow release.


----------



## Inshallah (May 11, 2011)

jimmythekid said:


> The main reason I take Concerta is that instant release pills are too tempting to abuse. Every now and then I end up snorting a pile of Ritalin dust.
> 
> Concerta is quite abuse proof. You can't crush the pills and they are very hard to disassemble. I don't think you'd catch a buzz swallowing the pills due to the slow release.


Concerta is superior to every other methylphenidate form by FAR. But 1 box of 20 mg Ritalin LA costs €31 here in Belgium, while 1 box of 27 mg Concerta costs €62 ...


----------



## Inshallah (May 11, 2011)

"The pharmacokinetic profile of Concerta 18 mg once daily was compared with that of immediate-release methylphenidate 5 mg 3 times a day and sustained-release methylphenidate 20 mg once daily in a study of 36 adults.[12] The immediate-release methylphenidate demonstrated fluctuations in peaks and troughs associated with 3-times-daily dosing, while the sustained-release formulation resulted in a rapid increase in methylphenidate concentration with a peak at about 4 hours, followed by a rapid decline. It is thought that the rapid increase in the plasma concentration of methylphenidate may be associated with acute tolerance, while the subsequent rapid decline in plasma levels may account for the reduced therapeutic benefit of the first-generation sustained-release methylphenidate formulation, compared with 3-times-daily dosing.[10] In contrast, following oral doses of Concerta 18 mg, mean methylphenidate plasma concentrations increased rapidly over the first 2 hours, followed by a slower increase for the next 3-4 hours followed by a gradual decline thereafter. Peak concentrations were reached at 6-8 hours and gradually declined to baseline by 24 hours (Figure 1). This pharmacokinetic profile, with lower peak concentrations than either the 3-times-daily immediate-release or sustained-release formulations, eliminates the large fluctuations associated with these older preparations, securing continued clinical control without the well known "peaks and valleys" of the immediate-release formulation. Recent studies have indicated that the presence of food does not affect the absorption of Concerta.[13]"


----------



## yay (Dec 31, 2012)

@ Inshallah

I didn't know that you're in such bad health. I'm really sorry for you. 
Are you depressed because of your bad health or also because of other things? I also don't see how a person could not be depressed when the health isn't good. I also have many health issues and it's totally dragging me down. 

/ Concerta

I read opinions about concerta at other forums and many people didn't like it and said that they were tired in the morning and totally awake in the evening and stuff like that. 

Should everybody at least try all MPH versions out there in order to be able to tell which one's best? I mean if you never tried it you also can't tell.

But from what I read you also can't simply do the math and then come up with the right concerta dose. For example if you take 50mg instant Ritalin throughout the entire day then would this be the same as getting 50mg concerta or are there still differences?

But an advantage of shorter acting ritalin would be that you could drink in the evening when the ritalin isn't working anymore, right? Otherwise if the ritalin is still active drinking wouldn't be a good idea. But when the effect has worn off then drinking should be allowed, right?


----------



## jimmythekid (Apr 26, 2010)

You can drink on Ritalin generally. 

Instant release is more flexible and cheap. Those are the real advantages. My psychiatrist said IR is also better for treating fatigue or depression. She wanted to put me back on it recently.


----------



## yay (Dec 31, 2012)

Why is it better against depression? You mean kinda like whenever you're depressed you throw in another ritalin? 
But when you already got yourself covered for the whole day then you can't simply throw in an additional pill when you feel depressed cause then you'd be exceeding your dosage. :blank


----------



## jimmythekid (Apr 26, 2010)

I'm not sure why its supposed to be better. It was my shrink who said that so I don't think it would be because you can keep popping them or something.


----------



## Inshallah (May 11, 2011)

yay said:


> @ Inshallah
> 
> I didn't know that you're in such bad health. I'm really sorry for you.
> Are you depressed because of your bad health or also because of other things? I also don't see how a person could not be depressed when the health isn't good. I also have many health issues and it's totally dragging me down.
> ...


Thx. The depression was always present so that came first, but obviously, I would be surprised if all of the health stuff had an anti-depressive influence haha. I do also think it would be near to impossible to not get depressed when someone gets that on top of it.

I've tried 2 of the 3 and since what I saw as improvements of Concerta over Ritalin LA, should only be more pronounced over Ritalin IR, there's your aswer.

Concerta (apart from lasting the longest and causing the least peaks and valleys) also starts working the fastest if I'm not mistaken.

Apart from it's cost, I can't see a single reason to not opt for Concerta. You can always add one or a few IR doses here and there to make it perfect for your schedule.

I think (apart from costing twice as much), Concerta may be less popular than it would be if it were easier (or possible at all) to crush and snort, or whatever it is abusers do with it. Apparently, a Concerta tablet isn't easy to get into "snortable" material.


----------



## gilmourr (Nov 17, 2011)

I didn't even know that doctors would prescribe 40 mg of escitalopram. That's a lot. 20 mg and I was insomniac for like 2 nights.


----------



## Inshallah (May 11, 2011)

jimmythekid said:


> You can drink on Ritalin generally.
> 
> Instant release is more flexible and cheap. Those are the real advantages. My psychiatrist said IR is also better for treating fatigue or depression. She wanted to put me back on it recently.


Could you ask her for her reasoning on this for us? Because imo, it makes no sense whatsoever. For depression, you'd want steady and stable, not the opposite as with the IR-version.

Unless her reasoning is like yay said: just take a pill when you're feeling extra bad. But even then, that might work for a short period and before you know it, you'll "start feeling a bit bad" more and more often and ... 

Both me and my psychiatrist were clear on this: a steady dose for a certain planned period, and unless something requires us to deviate from the plan, we stick to it.

I often get asked on here how I get certain meds or combinations of meds prescribed in (very) high dosages. Well, apart from my psychiatric/psychopharmaceuticals history and my other medical issues (although I always asked her to NOT take these into account and even now regularly remind her of this), she KNOWS I'm honest and that she can trust me.

Sometimes I read things on here about how they (as a patient) treat or go about their relationship with their psychiatrist. And then they wonder why they don't get the chance to try certain things... ?

Honesty and trustworthiness go a long way people, and I assume psychiatrists, of all people, would be the ones to judge the degree to which both are present or not present.


----------



## Inshallah (May 11, 2011)

gilmourr said:


> I didn't even know that doctors would prescribe 40 mg of escitalopram. That's a lot. 20 mg and I was insomniac for like 2 nights.


Read all of my posts in this thread, including the one below yours' and you'll understand


----------



## jimmythekid (Apr 26, 2010)

Well she told me shed just heard this at a conference, just that the guy presented it as hes had more success with the IR. Specifically it was about treating bipolar depression with stimulants. I wouldn't worry about it. Its not like its a guideline or concensus and if you find LA to work better for you that's all that matters. No way id be keen to go onto IR. That would mean meds on waking, midday, afternoon and bedtime. That doesn't appeal to me at all.


----------



## billyho (Apr 12, 2010)

Inshallah said:


> Could you ask her for her reasoning on this for us? Because imo, it makes no sense whatsoever. For depression, you'd want steady and stable, not the opposite as with the IR-version.
> 
> Unless her reasoning is like yay said: just take a pill when you're feeling extra bad. But even then, that might work for a short period and before you know it, you'll "start feeling a bit bad" more and more often and ...
> 
> ...


*
*
+1 for the bolded info.. 
one must build a relationship with your doc before you can get stims off label, memantine off label and any other drug you can find a case report for in some obscure journal. Even LDN.. Do what you gotta do to foster that relationship WITHOUT lying or cheating.

word!


----------



## billyho (Apr 12, 2010)

jimmythekid said:


> Well she told me shed just heard this at a conference, just that the guy presented it as hes had more success with the IR. Specifically it was about treating bipolar depression with stimulants. I wouldn't worry about it. Its not like its a guideline or concensus and if you find LA to work better for you that's all that matters. No way id be keen to go onto IR. That would mean meds on waking, midday, afternoon and bedtime. That doesn't appeal to me at all.


To me it doesn't make sense to give someone a short acting drug which can change so much behavior in only 4 hours when the object is to stabilise someones moods over a long period of time.. At least not using Ritalin IR as a PRIMARY rx for bipolor. Maybe as an adjunct when mood is stabilised and fatigue or deppression or concentration is lacking..

my .02 cecnts


----------



## jim_morrison (Aug 17, 2008)

billyho said:


> To me it doesn't make sense to give someone a short acting drug which can change so much behavior in only 4 hours when the object is to stabilise someones moods over a long period of time.. *At least not using Ritalin IR as a PRIMARY rx for bipolor. Maybe as an adjunct when mood is stabilised and fatigue or deppression or concentration is lacking..*
> 
> my .02 cecnts


I think that's what it's mostly used for, that or when ADHD is co-morbid which is quite common. I haven't seen anybody use stimulants as mono-therapy for bipolar disorder, but I think there is some mounting evidence that they (along with wellbutrin and provigil) are less likely than SSRI/SNRIs to cause a switch into hypo/mania.


----------



## jimmythekid (Apr 26, 2010)

Yeah, I think its only used as an adjunct. I don't know why IR would be better. Maybe it helps to have the level spike and slap you in the brain a few times a day?


----------



## Inshallah (May 11, 2011)

jimmythekid said:


> Yeah, I think its only used as an adjunct. I don't know why IR would be better. Maybe it helps to have the level spike and slap you in the brain a few times a day?


Haha lol, who knows! Would be about the only good reason I could think of for opting for the IR instead.


----------



## Inshallah (May 11, 2011)

*Opinions wanted*

Out of sheer curiosity:

How much higher should I be able to get my current doses pushed? I'm talking realistically here, so I should first manage my psychiatrist to agree on this AND (of course it raises all health risks) it would have to be OK health-wise, both in the short and long term. Again, considering the context/my situation. (if it would cut 10 years off my life, perfectly acceptable trade-off given my past and present)


----------



## yay (Dec 31, 2012)

Inshallah said:


> Thx. The depression was always present so that came first, but obviously, I would be surprised if all of the health stuff had an anti-depressive influence haha. I do also think it would be near to impossible to not get depressed when someone gets that on top of it.


Have you been to a therapist? Not that I have a high opinion of psychotherapy. I think that it's pretty much a joke. I mean what should a therapist tell someone like you? A few stories about people who had even more surgeries and who are still happy? These anecdotes of people who supposedly still manage to be happy don't help anyone with depression. I mean if it was so simple to get rid of depression by simply changing your perspective then nobody would be depressed for a long time and figure out how to help himself.



> I think (apart from costing twice as much), Concerta may be less popular than it would be if it were easier (or possible at all) to crush and snort, or whatever it is abusers do with it. Apparently, a Concerta tablet isn't easy to get into "snortable" material.


What sucks is that concerta isn't available everywhere. Otherwise it might be worth a try. The stuff which I have supposedly lasts 6 hours which means you'd need at least 2 doses per day.


----------



## jim_morrison (Aug 17, 2008)

Inshallah said:


> Out of sheer curiosity:
> 
> How much higher should I be able to get my current doses pushed? I'm talking realistically here, so I should first manage my psychiatrist to agree on this AND (of course it raises all health risks) it would have to be OK health-wise, both in the short and long term. Again, considering the context/my situation. (if it would cut 10 years off my life, perfectly acceptable trade-off given my past and present)


I think you're already at the max dose for your meds. If their not helping your depression enough after 4 weeks or so then given how refactory you are I'd ask my doctor about augmenting with something. You've responded favorably to Abilify in the past if memory serves me correctly? Theres also Lamictal, etc.


----------



## jimmythekid (Apr 26, 2010)

Yeah, I don't think your doc would want to go much higher. Augmenting makes more sense to me. My cocktail is helping me but I don't think any of the drugs on their own would cut it. So even if you've tried something before and it only helped a little, it could be just what you need now.


----------



## Inshallah (May 11, 2011)

yay said:


> Have you been to a therapist? Not that I have a high opinion of psychotherapy. I think that it's pretty much a joke. I mean what should a therapist tell someone like you? A few stories about people who had even more surgeries and who are still happy? These anecdotes of people who supposedly still manage to be happy don't help anyone with depression. I mean if it was so simple to get rid of depression by simply changing your perspective then nobody would be depressed for a long time and figure out how to help himself.
> 
> *I've been to several, both for SA and for depression. For something specific as SA, it certainly (could) have significant benefits.
> 
> ...


*What version exactly do you have?*


----------



## Inshallah (May 11, 2011)

jim_morrison said:


> I think you're already at the max dose for your meds. If their not helping your depression enough after 4 weeks or so then given how refactory you are I'd ask my doctor about augmenting with something. You've responded favorably to Abilify in the past if memory serves me correctly? Theres also Lamictal, etc.


I'm at double the max dosage of both to be exact 

The things we'll mainly have to watch out for are QT interval elongation and possibly also serotonin syndrome. (even though most sources state MPH has no effect on serotonin, some say it does, some sources say it raises serotonin indirectly)

We're going to give these meds in these doses the full 6-8 weeks needed for a correct assessment without exception. But SHOULD it still not suffice, purely hypothetical, what do you all see as "could be done"?

Adding an antipsychotic or a mood stabilizer is going to make both the Lexapro and the Ritalin less effective, so that's not a viable option. I'm 100% sure what I saw as symptoms of mania a while back, we're different manifestations of the same disease. (that being "major depressive disorder" officially)


----------



## Inshallah (May 11, 2011)

*Also*

(Even though the Tranxene has been out of the mix since at least 1 week) I am tired as **** all the time. I feel like I'm on an even more sedating version of Mirtazapine, even though Stahl's Prescribers' Guide clearly gives both meds a 1 out 4 as far as sedation (1 = the least sedating) is concerned.

What's up here?


----------



## yay (Dec 31, 2012)

Inshallah said:


> *What version exactly do you have?*


This here:

http://www.drugs.com/uk/medikinet-xl-spc-7736.html


----------



## jim_morrison (Aug 17, 2008)

Inshallah said:


> Adding an antipsychotic or a mood stabilizer is going to make both the Lexapro and the Ritalin less effective, so that's not a viable option. I'm 100% sure what I saw as symptoms of mania a while back, we're different manifestations of the same disease. (that being "major depressive disorder" officially)


Depends which one, Abilify is selective to D2/D3 receptors so it allows MPH to stimulate D1 & 4 receptors. This combo is used for treatment resistant ADHD sometimes according to Dr. Stephen Stahl.

http://stahlonline.cambridge.org/pr...name=Methylphenidate (d,l)&title=Therapeutics


----------



## Inshallah (May 11, 2011)

yay said:


> This here:
> 
> http://www.drugs.com/uk/medikinet-xl-spc-7736.html


Basically another version of the Ritalin LA I'm taking apparently, It's supposed to last up to 8h but indeed does come nowhere close to that, at least not the Ritalin LA but I assume it'll be the same for Medikinet XL, that's why I take it 3 times a day. (my guess is that for me, it works +- 5h)


----------



## Inshallah (May 11, 2011)

jim_morrison said:


> Depends which one, Abilify is selective to D2/D3 receptors so it allows MPH to stimulate D1 & 4 receptors. This combo is used for treatment resistant ADHD sometimes according to Dr. Stephen Stahl.
> 
> http://stahlonline.cambridge.org/pr...name=Methylphenidate (d,l)&title=Therapeutics


I see, but still, wouldn't this still result in making the MPH less effective overall?

Even though to a lesser degree than other antipsychotics would, but still?


----------



## yay (Dec 31, 2012)

@ Inshallah

I'm supposed to take 10mg now 2 times per day. That would be the same as taking 5mg instant Ritalin 4 times a day. I can't really say that I get any effect from this. Is it too low to feel anything?


----------



## Inshallah (May 11, 2011)

yay said:


> @ Inshallah
> 
> I'm supposed to take 10mg now 2 times per day. That would be the same as taking 5mg instant Ritalin 4 times a day. I can't really say that I get any effect from this. Is it too low to feel anything?


No effect whatsoever, neither good nor bad effect(s)? Assuming your Medikinet isn't fake (do you have it from one of those online pharmacies or?), I'd say a definite yes, your current dose is too low.

Luckily for you I see there is no 15 mg version so you won't have to go through that one first :teeth But if it isn't fake and you aren't feeling anything in terms of therapeutic benefits or side effects, maybe suggest immediately going to the 30 mg version? If 20 brought nothing, I'd be very surprised if 20 will deliver.


----------



## Inshallah (May 11, 2011)

Yet another question (got this from Crazymeds): "Heart arrhythmia problems like torsades de pointes (TdP)/prolonged QT interval (QTc). This happens more often than I had originally thought, as both Celexa (citalopram) and Lexapro (escitalopram) are on the list of drugs to totally avoid if you have a history of TdP/QTc/cardiac arrhythmia."

My psychiatrist already told me about this and I then asked her if this risk with other SSRI's isn't there or at the least, is less. 

She replied that citalopram happened to be the one they tested this on so this holds true for any SSRI. True or not?


----------



## jim_morrison (Aug 17, 2008)

Inshallah said:


> I see, but still, wouldn't this still result in making the MPH less effective overall?
> 
> Even though to a lesser degree than other antipsychotics would, but still?


Possibly, it's hard to say without trying it, but since abilify is a partial agonist of certain dopamine and serotonin receptors it may actually help by stopping the receptors from down-regulating, I think this is why they add it to SSRI's for depression when their not working fully.

Admittedly I'm simplifying things alot, but consider as an example how they tend to use suboxone (mu partial agonist) for opioid dependance and addicts tend to stabilize on it and not need to up the dose as they would with full agonists.


----------



## Inshallah (May 11, 2011)

jim_morrison said:


> Possibly, it's hard to say without trying it, but since abilify is a partial agonist of certain dopamine and serotonin receptors it may actually help by stopping the receptors from down-regulating, I think this is why they add it to SSRI's for depression when their not working fully.
> 
> Admittedly I'm simplifying things alot, but consider as an example how they tend to use suboxone (mu partial agonist) for opioid dependance and addicts tend to stabilize on it and not need to up the dose as they would with full agonists.


It's like you said, and as all of us experienced psychopharmaceutical users know, you never really know what will happen. You know what you expect based on theory, but often it turns out much different in practice.

Look at what I'm on: twice the maximum dosage of supposedly the best SSRI + twice the maximum dosage of Ritalin. You would expect this to have a Hiroshima-effect on my depression, in reality, even though I've only been on both combined at these dosages for 3 weeks, I am having no improvement whatsoever.

I'm even slightly more depressed now then I was 3 weeks ago, butt that's situational/pure coincidence.

*But wouldn't you expect at least some mood improvement after 3 weeks on this?*

I'm giving this the full 8 weeks no matter what, who knows maybe after 4 or 6 weeks something magically appears out of nowhere, but it isn't looking too promising at the moment.

How the **** can this be possible? :idea

Either way: time to start preparing the next attempt.

I'm contemplating either 600 mg Effexor or Phenelzine (which is called Nardelzine here). Personally, I lean more towards the 600 mg Effexor because I'm not too keen on the whole MAOI-thing. I'm also seeing more and more negative Nardil experiences popping up everywhere so it certainly isn't the magic bullet some make it out to be. (never believed it anyway, if it were, everyone would be on it)


----------



## jimmythekid (Apr 26, 2010)

Honestly, whenever I'm trying a new treatment, I go in without expectations. The way any person reacts is so unpredictable. For any drug, if you read online reviews, you'll find some who got better, some who got worse, some who stayed the same, got side effects, didn't get them etc. 

What helps you may be low doses of a drug considered not very effective. You never know.


----------



## Inshallah (May 11, 2011)

jimmythekid said:


> Honestly, whenever I'm trying a new treatment, I go in without expectations. The way any person reacts is so unpredictable. For any drug, if you read online reviews, you'll find some who got better, some who got worse, some who stayed the same, got side effects, didn't get them etc.
> 
> What helps you may be low doses of a drug considered not very effective. You never know.


I completely agree and compliment your insight and intelligence. You should always do this concerning anything in life, no expectancies, no disappointments (or lesser ones).

Although in this particular case jimmy, I think you can agree with me that something significant should have occurred (or should be starting to occur), no?

I mean, I must be close to the strongest AD combo in pill-form a psychiatrist can prescribe here. I don't think you'd find a psychiatrist adding the maximum official Ritalin dosage to say Nardil. Let alone double the maximum dose.

Anyone have any ideas on how to boost antidepressant action even more here? Upping the doses of both? Is there something to add that would really add to the AD-effect and not just add something for the sake of adding. (although jim's Abilify-suggestion COULD work, I personally very much doubt it since it's also seen as a mood stabilizer)


----------



## yay (Dec 31, 2012)

Inshallah said:


> No effect whatsoever, neither good nor bad effect(s)? Assuming your Medikinet isn't fake (do you have it from one of those online pharmacies or?), I'd say a definite yes, your current dose is too low.
> 
> Luckily for you I see there is no 15 mg version so you won't have to go through that one first :teeth But if it isn't fake and you aren't feeling anything in terms of therapeutic benefits or side effects, maybe suggest immediately going to the 30 mg version? If 20 brought nothing, I'd be very surprised if 20 will deliver.


No it's not fake. I would never buy something like this online.

Even if there is no 15mg version since there are 5mg and 10mg pills my doc will probably still suggest me to either go to 15mg or to 20mg next time.
I mean even 20mg Medikinet would basically be like 10mg instant MPH. I have taken the 5mg pill on an empty stomach which you usually shouldn't do cause then the entire content will be absorbed and you don't get the time-released effect and from 5mg I feel nothing. Maybe a little jittery in the forearms.

I also saw that it's not even pure MPH. The 10mg pill contains around 8.6mg pure MPH cause it's bound to some other stuff. I don't know if other MPH products are the same and if they're also bound to other stuff so that you don't get 100% pure MPH.


----------



## Inshallah (May 11, 2011)

yay said:


> No it's not fake. I would never buy something like this online.
> 
> Even if there is no 15mg version since there are 5mg and 10mg pills my doc will probably still suggest me to either go to 15mg or to 20mg next time.
> I mean even 20mg Medikinet would basically be like 10mg instant MPH. I have taken the 5mg pill on an empty stomach which you usually shouldn't do cause then the entire content will be absorbed and you don't get the time-released effect and from 5mg I feel nothing. Maybe a little jittery in the forearms.
> ...


There's always fillers in timed release medications as far as I'm aware of, so you're not extra disadvantaged there 

I would certainly push for the 20 mg version given your complete non-response to 10 mg. Maybe even the 30 mg version but I doubt your doc will consider a 3-fold increase.


----------



## Inshallah (May 11, 2011)

Since I have a general (justified imo) bad vibe about this medication regimen delivering me the antidepressant result I need, even after having given it 6-8 weeks, I'm thinking about my next attempt already.

In order of personal preference:

1) Effexor 600 mg/day + possibly also Methylphenidate, although in a much lower dosage and maybe it isn't a bad idea as well (in theory it is, but we all know that...) to try the regular IR Ritalin?

2) Phenelzine: not a fan of short half life psychopharmaceuticals, especially not for AD's. The food and medication interactions are also something I really would have to be worried about, since I myself am prone to forgetting and small mistakes, and unfortunately, my family even more so lol Not to mention I'll undergo some more surgeries in the near future and they'll possibly require for the Phenelzine to be stopped weeks beforehand each time.

3) Another series of ECT treatments: would no doubt be the best choice short term but I'm a lifelong major depressive person so in the long run... It's not so much the ECT itself that would be the issue, but the general anesthesia it requires each time would result in me breaking the Guinness World Record of undergone general anesthesias probably :blank 

Plus it requires taking at least half a day (a full day more likely) off of work for in my case at least 1 of 5 working days + someone needs to pick you up at the clinic at noon each time as well. (they simply don't you go home without someone picking you up) 

Opinions on my current regimen and/or the next attempts I had in mind? Or some suggestions on anything/everything? The more the merrier, so give it to me baby :banana


----------



## yay (Dec 31, 2012)

@ inshallah

Have you tried adding some tyrosine as Dopamine precursor? I read online that some people do this and seem to have success with it and then require less MPH. But I don't know how safe this is.

And have you tried a MAOI already? Maybe this would work for you. 
I'm beginning to wonder if it's possible that I do not have enough neurotransmitters in the first place and that's why nothing which I take seems to have an effect on me.


----------



## Inshallah (May 11, 2011)

yay said:


> @ inshallah
> 
> Have you tried adding some tyrosine as Dopamine precursor? I read online that some people do this and seem to have success with it and then require less MPH. But I don't know how safe this is.
> 
> ...


Haven't tried the l-tyrosine but that also isn't something I'd be willing to do since I've had a bad experience in the past with 5-htp already.

Haven't tried a real MAOI no, maybe it's time for that now. Although I'm not looking forward to it!

Would Effexor/Venlafaxine maybe work better in combination with either MPH or Dexamp, than the Lexapro or SSRI's in general? At first sight, I woudln't know why it would but who knows :idea


----------



## gilmourr (Nov 17, 2011)

Inshallah said:


> Since I have a general (justified imo) bad vibe about this medication regimen delivering me the antidepressant result I need, even after having given it 6-8 weeks, I'm thinking about my next attempt already.
> 
> In order of personal preference:
> 
> ...


PHENELZINEEEEEEEEEEE. I don't even think the half life matters because it's not like a SSRI where when 5 half lives go by things begin to **** the bed. Because it irreversibly inhibits MAO enzymes it gradually regenerates MAO once nardil is out of your system (or basically, 55 hours). But I believe the MAO regeneration is a logarithmic curve where you will feel okay for the first few days off of Nardil and then you'll really experience withdrawal around the beginning of the second week.

Also, the diet is a joke for 90% of people. I really wouldn't be concerned about this. Just KNOW the signs of a hypertensive crisis.

You should REALLY try this because it's a mechanism you haven't tried.

Or try parnate if you respond well to stimulants since it is like a semi stimulant based AD.

If you've done ECT and it didn't correct your issues, then more treatments will just help in the short term. Only do it if you're nearing suicidal depression


----------



## Inshallah (May 11, 2011)

gilmourr said:


> PHENELZINEEEEEEEEEEE. I don't even think the half life matters because it's not like a SSRI where when 5 half lives go by things begin to **** the bed. Because it irreversibly inhibits MAO enzymes it gradually regenerates MAO once nardil is out of your system (or basically, 55 hours). But I believe the MAO regeneration is a logarithmic curve where you will feel okay for the first few days off of Nardil and then you'll really experience withdrawal around the beginning of the second week.
> 
> Also, the diet is a joke for 90% of people. I really wouldn't be concerned about this. Just KNOW the signs of a hypertensive crisis.
> 
> ...


You make all and only good points there gilmourr! I'll talk it over with my psychiatrist tomorrow, I'll at least mention Phenelzine, because she has no personal experience with it whatsoever (I already) enquired a while ago and I'd need to be off the SSRI and maybe also off the stimulant for 2-3 weeks before we start it up. Parnate is not available here, only Phenelzine and Moclobemide as far as MAOI's go.

I have been suicidal for a large chunk of my life so that's a non-issue (as weird as it sounds). If I adhered to the "Get yourself hospitalized asap when you you start having suicidal thoughts", then I would have been in 1 for half of my life or so LOL (actually not lol @ all but in my case, it's become a coping mechanism or something)


----------



## gilmourr (Nov 17, 2011)

Inshallah said:


> You make all and only good points there gilmourr! I'll talk it over with my psychiatrist tomorrow, I'll at least mention Phenelzine, because she has no personal experience with it whatsoever (I already) enquired a while ago and I'd need to be off the SSRI and maybe also off the stimulant for 2-3 weeks before we start it up. Parnate is not available here, only Phenelzine and Moclobemide as far as MAOI's go.
> 
> I have been suicidal for a large chunk of my life so that's a non-issue (as weird as it sounds). If I adhered to the "Get yourself hospitalized asap when you you start having suicidal thoughts", then I would have been in 1 for half of my life or so LOL (actually not lol @ all but in my case, it's become a coping mechanism or something)


well yeah, but I mean suicidal thoughts to the point where you're like crying 24/7, severe headaches, body pain and every breathe of air feels like sinking to the bottom of a pool. I'm sure you know the difference between like casual suicidal thoughts and suicidal thoughts that are so intrusive that you need to be sedated.

It's even weird hearing myself type out that casual suicidal thoughts or like passive thoughts are baseline/normal. All I know is that there are definitely levels to it lol


----------



## Inshallah (May 11, 2011)

gilmourr said:


> well yeah, but I mean suicidal thoughts to the point where you're like crying 24/7, severe headaches, body pain and every breathe of air feels like sinking to the bottom of a pool. I'm sure you know the difference between like casual suicidal thoughts and suicidal thoughts that are so intrusive that you need to be sedated.
> 
> It's even weird hearing myself type out that casual suicidal thoughts or like passive thoughts are baseline/normal. All I know is that there are definitely levels to it lol


I understand, my guess is that after a while and after having had so many of such episodes, it's become as standard as taking a piss to me. I still cry occasionally when thinking about how terrible this all must be for my family. I don't even think I could still cry for myself, there have been many instances where people we're crying over something related to me, while in my presence, and I was basically the only 1 not crying.

I'd say get yourself fixed ASAP before this (should be only a) temporary state, becomes you, as it has for me.


----------



## jim_morrison (Aug 17, 2008)

Inshallah said:


> Would Effexor/Venlafaxine maybe work better in combination with either MPH or Dexamp, than the Lexapro or SSRI's in general? At first sight, I woudln't know why it would but who knows :idea


Maybe, atleast in theory. I think SNRIs keep DA/NE activity going in the prefrontal cortex unlike SSRIs which blunt it, so you don't lose your executive function as badly. Weird thing is some people take stimulants with atypical antipsychotics and the effect of either isn't antagonized so I don't know what makes SSRIs effect on dopamine so unique.


----------



## Inshallah (May 11, 2011)

jim_morrison said:


> Maybe, atleast in theory. I think SNRIs keep DA/NE activity going in the prefrontal cortex unlike SSRIs which blunt it, so you don't lose your executive function as badly. Weird thing is some people take stimulants with atypical antipsychotics and the effect of either isn't antagonized so I don't know what makes SSRIs effect on dopamine so unique.


May be worth a shot, I know the sexual side effects will be less on high dose Effexor at least.

What do you say jim, try the Venlafaxine instead or? I'm having too much of the SSRI's classical negatives at the moment either way so. (sex dysfunction obviously, but also apathy, tiredness). Seems like the Serotonin is overwhelming the DA and NA a bit too much.


----------



## jim_morrison (Aug 17, 2008)

Inshallah said:


> May be worth a shot, I know the sexual side effects will be less on high dose Effexor at least.
> 
> What do you say jim, try the Venlafaxine instead or? I'm having too much of the SSRI's classical negatives at the moment either way so. (sex dysfunction obviously, but also apathy, tiredness). Seems like the Serotonin is overwhelming the DA and NA a bit too much.


If going up and down doesn't work try turning right. Lol random metaphor I guess. If your going through the same type of drugs S/N/DRIs without help then to be honest I'd try something completely different like Lamictal. If you are planning on getting prescribed Xyrem, it alone may be enough. 
I think there's only so far that unipolar depression can still be considered unipolar, at some point of treatment resistance the diagnosis should change.


----------



## Inshallah (May 11, 2011)

jim_morrison said:


> If going up and down doesn't work try turning right. Lol random metaphor I guess. If your going through the same type of drugs S/N/DRIs without help then to be honest I'd try something completely different like Lamictal. If you are planning on getting prescribed Xyrem, it alone may be enough.
> I think there's only so far that unipolar depression can still be considered unipolar, at some point of treatment resistance the diagnosis should change.


Just seen my psych and she seemed to think Venlafaxine would co-operate better with a stimulant than an SSRI would so we're probably going to go that route.

Lamictal is also an option. Are stimulant-Lamictal combinations common practice? How much (or ideally not at all) does Lamictal counteract the stimulant?


----------



## jim_morrison (Aug 17, 2008)

Inshallah said:


> Just seen my psych and she seemed to think Venlafaxine would co-operate better with a stimulant than an SSRI would so we're probably going to go that route.
> 
> Lamictal is also an option. Are stimulant-Lamictal combinations common practice? How much (or ideally not at all) does Lamictal counteract the stimulant?


I'm on both at the moment actually - Lamictal and Dexamphetamine. I don't think they interact negatively, in a way they might work together because I believe both are dopaminergic but in radically different ways.

Can't hurt to try venlafaxine with a stimulant since you don't seem to get excessive side effects from either one I guess.


----------



## Inshallah (May 11, 2011)

jim_morrison said:


> I'm on both at the moment actually - Lamictal and Dexamphetamine. I don't think they interact negatively, in a way they might work together because I believe both are dopaminergic but in radically different ways.
> 
> Can't hurt to try venlafaxine with a stimulant since you don't seem to get excessive side effects from either one I guess.


Better yet, you'd expect my BP, heart rate and ECG to worsen on 40 mg Lexapro and about 100 mg Dexamph right? When they took all 3 yesterday, all 3 were better than before LOL

Lamictal is an option I'll be keeping in mind for the future. I've only heard good things about it which is extremely rare for a psychopharmaceutical.

At the moment, I'm leaning towards 450-600 mg Venlafaxine + 1 or 2 (in half the dose I would have taken it on it's own) of the stimulant(s).

Maybe I just created a novel pharmaceutical strategy, because I haven't heard of Dexamph and MPH being combined :clap


----------



## jim_morrison (Aug 17, 2008)

Inshallah said:


> Better yet, you'd expect my BP, heart rate and ECG to worsen on 40 mg Lexapro and about 100 mg Dexamph right? When they took all 3 yesterday, all 3 were better than before LOL
> 
> Lamictal is an option I'll be keeping in mind for the future. I've only heard good things about it which is extremely rare for a psychopharmaceutical.
> 
> ...


Your docs getting pretty heroic with your med combo, I'm surprised she hasn't tried Symbyax yet.

What is your purpose for taking the stimulants mostly, depression or somnolence related stuff? Coz it seems like your on a narcoleptics dose!


----------



## GotAnxiety (Oct 14, 2011)

What your body weight and height? inshallah do you smoke?


----------



## Inshallah (May 11, 2011)

jim_morrison said:


> Your docs getting pretty heroic with your med combo, I'm surprised she hasn't tried Symbyax yet.
> 
> What is your purpose for taking the stimulants mostly, depression or somnolence related stuff? Coz it seems like your on a narcoleptics dose!


She called 10 mg Escitalopram "too low of a dose to have any effect" today 

It's for depression, although can also come in handy for the other stuff


----------



## Inshallah (May 11, 2011)

GotAnxiety said:


> What your body weight and height? inshallah do you smoke?


I'm 1m90 and around 75 kg's. I don't smoke. Why? :teeth


----------



## Inshallah (May 11, 2011)

So I mailed a few other psychiatrists to ask them about the dopamine-serotonin balance, why this combination isn't working synergistically or at the least, seems to be canceling out the stimulant.

Someone forwarded it to one of the more well known psychiatrists in the country and he replied that both dopamine and serotonin should be elevated, so there is, or should be, synergism. But that despite the boost in dopamine, my serotonin is too high because of the dosage, because of something specific to my chemistry, and several other possible reasons.

So basically, it's either up the serotonin (which I/we will not be doing obviously ) or up the dopamine (doubtful but more likely than upping serotonin), until the balance is where I feel it should be to have the stimulant effect I seek, combined with enough serotonin to do what serotonin does, but no more.

I replied asking whether this can be accomplished better with an SNRI instead of an SSRI, or whether it doesn't matter. I'm quite curious about what his answer is going to be I must say.


----------



## jim_morrison (Aug 17, 2008)

Inshallah said:


> So I mailed a few other psychiatrists to ask them about the dopamine-serotonin balance, why this combination isn't working synergistically or at the least, seems to be canceling out the stimulant.
> 
> Someone forwarded it to one of the more well known psychiatrists in the country and he replied that both dopamine and serotonin should be elevated, so there is, or should be, synergism. But that despite the boost in dopamine, my serotonin is too high because of the dosage, because of something specific to my chemistry, and several other possible reasons.
> 
> ...


If Stahl's theory is anything to go by, the purported mechanism by which SSRI's help treat anxiety and depression is though 5-HT1A receptors, with it's indirect agonism at 5-HT2 receptors (and maybe others) being counter-intuitive an responsible for many of the side effects including sexual dysfunction, apathy and basically anything related to blunting of DA/NE.

So maybe augmentation with something that's a 5-HT1A partial agonist and/or a 5HT2 antagonist is needed for you to get the right response to SSRIs and less blunting of stimulants.


----------



## Inshallah (May 11, 2011)

jim_morrison said:


> If Stahl's theory is anything to go by, the purported mechanism by which SSRI's help treat anxiety and depression is though 5-HT1A receptors, with it's indirect agonism at 5-HT2 receptors (and maybe others) being counter-intuitive an responsible for many of the side effects including sexual dysfunction, apathy and basically anything related to blunting of DA/NE.
> 
> So maybe augmentation with something that's a 5-HT1A partial agonist and/or a 5HT2 antagonist is needed for you to get the right response to SSRIs and less blunting of stimulants.


I'm all ears jim  Which meds would accomplish that?

Does what you said in your 1st paragraph hold true for SNRI's as well?

And "If Stahl's theory is anything to go by" -> not a fan of his?  (he's basically the only one I have "free e-books" of so don't hold back, I'm not a Stahl-fanboy haha)


----------



## jim_morrison (Aug 17, 2008)

Inshallah said:


> I'm all ears jim  Which meds would accomplish that?
> 
> Does what you said in your 1st paragraph hold true for SNRI's as well?
> 
> And "If Stahl's theory is anything to go by" -> not a fan of his?  (he's basically the only one I have "free e-books" of so don't hold back, I'm not a Stahl-fanboy haha)


On no I'm not against his theory's at all, I think he is an excellent psychiatrist with a gift for communicating it to the general public. If there were more like him and less like Heather Ashton I think the world would be a better place.

As for which med does what I said above, there's a few meds out there that do these things, very low dose Asenapine seems to show promise IMO at the doses where it's mostly targeting serotonin receptors, so about 2.5mg.

Asenapine elevates cortical dopamine, noradrenaline and serotonin release

Apart from that, older meds like trazodone or buspar might help to an extent.

It holds true to to SNRIs to an extent, but they mostly counteract the negative actions of serotonin on dopamine in the frontal cortex, so their not as robust.


----------



## yay (Dec 31, 2012)

Inshallah said:


> Would Effexor/Venlafaxine maybe work better in combination with either MPH or Dexamp, than the Lexapro or SSRI's in general? At first sight, I woudln't know why it would but who knows :idea


Effexor + MPH is among Stahl's heroic combos.
It would hit DA,NE and serotonine compared to SSRI + MPH which wouldn't hit NE. I think Effexor + MPH would definitely be stronger than SSRI + MPH but stronger could also mean more side effects. I'd rather try a SSRI + MPH which is also what I'm planning to do. I want to try stablon or zoloft but I'd first like to try stablon.


----------



## Inshallah (May 11, 2011)

*Help me make my final choice*

My primary objectives are:

1) boosting Dopamine up as high possible

2) NA: as little boosting up of NA as possible, boosting it down a bit would be even better

3) Serotonin will be plenty in every option

Options: (The individual medications would be taken in their highest respective prescription dosages, at least initially)

a) Escitalopram + Dextroamphetamine

b) Escitalopram + Methylphenidate

c) Venlafaxine (at high dose for it to be an SNDRI) + Dextroamphetamine

d) Venlafaxine(at high dose for it to be an SNDRI) + Methylphenidate

The biggest Dopamine-boost possible, the least Noradrenaline-boost possible without adding med(s) and Serotonin will be fine for a, b, c & d.

Let's hear it gents and explain why you'd choose one over the three others please! :clap


----------



## yay (Dec 31, 2012)

If you want little NE boost then Effexor is probably not the right drug.
Maybe wellbutrin would be better. I'm not sure but I think that wellbutrin is more of a DA booster than a NE booster than effexor. But wellbutrin + MPH would also be a pretty strong combo and it wouldn't target Serotonin.
I think I'd try SSRI + MPH. You could try Celexa and if this doesn't work then you could also try Zoloft or Prozac. If none of this works you could still consider other combos.


----------



## Inshallah (May 11, 2011)

yay said:


> If you want little NE boost then Effexor is probably not the right drug.
> Maybe wellbutrin would be better. I'm not sure but I think that wellbutrin is more of a DA booster than a NE booster than effexor. But wellbutrin + MPH would also be a pretty strong combo and it wouldn't target Serotonin.
> I think I'd try SSRI + MPH. You could try Celexa and if this doesn't work then you could also try Zoloft or Prozac. If none of this works you could still consider other combos.


Not sure whether Celexa is Citalopram or Escitalopram, but I'm Esc.

After close to 6 weeks though, it doesn't seem to do anything even at 40 mg/day. So either I up that to 3 times the standard dosage of 60 mg, or switch to yet another AD.

Not fun and certainly not expected of 2x the official max dosage of the best SSRI


----------



## yay (Dec 31, 2012)

Celexa and Lexapro are both unsafe in high doses they can cause dangerous heart arrythmia. I'd rather switch to another SSRI. Zoloft and Prozac don't have the arrythmia issue in higher doses.


----------



## istayhome (Apr 4, 2012)

yay said:


> Celexa and Lexapro are both unsafe in high doses they can cause dangerous heart arrythmia. I'd rather switch to another SSRI. Zoloft and Prozac don't have the arrythmia issue in higher doses.


Do you have any evidence to support this claim?


----------



## yay (Dec 31, 2012)

istayhome said:


> Do you have any evidence to support this claim?


No I just love making stuff up. :roll

http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm271275.htm

Because of the risk of QTc prolongation at higher citalopram doses, it is recommended that citalopram should not be given at doses above 40 mg/day.

Use in Patients with Concomitant Illness. Clinical experience with Celexa in patients with certain concomitant systemic illnesses is limited. Due to the risk of QT prolongation, citalopram use should be avoided in patients with certain cardiac conditions, and ECG monitoring is advised if Celexa must be used in such patients. Electrolytes should be monitored in treating patients with disease...

http://www.fda.gov/Drugs/DrugSafety/ucm269086.htm

*[8-24-2011] *The U.S. Food and Drug Administration (FDA) is informing healthcare professionals and patients that the antidepressant Celexa (citalopram hydrobromide; also marketed as generics)* should no longer be used at doses greater than 40 mg per day *because it can cause abnormal changes in the electrical activity of the heart. Studies did not show a benefit in the treatment of depression at doses higher than 40 mg per day.

Previously, the citalopram drug label stated that certain patients may require a dose of 60 mg per day.

http://www.ncbi.nlm.nih.gov/pubmed/15362595

This study shows SSRIs are relatively safe in overdose despite serotonin syndrome being common. *The exception was citalopram, which was significantly associated with QTc prolongation.* We believe that cardiac monitoring should be considered in citalopram overdose, particularly with large ingestions and patients with associated cardiac disease.


----------



## Inshallah (May 11, 2011)

Citalopram and Escitalopram both have a dosage-dependent increased risk of "QT-interval" prolongation. (which can eventually lead to a heart attack in susceptible individuals)

However, while the risk is somewhat higher with those 2 SSRI's, that same dosage-dependent risk is there for all SSRI's and basically all other AD's, AP's, ...

It's not THAT much greater with Citalopram and Escitalopram and obviously, they wouldn't be used (certainly not when other SSRIs are available) if the risk were real when one isn't predisposed to QT interval prolongation/heart issues.

I'm monitored by a cardiologist by the way. But only because my psychiatrist insisted on it. I couldn't care less about a possible heart attack atm or better yet, saw (since a while) lol


----------



## Inshallah (May 11, 2011)

yay said:


> No I just love making stuff up. :roll
> 
> http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm271275.htm
> 
> ...


For everyone's info: at first this counted only for Citalopram, somewhat later Escitalopram joined the club.


----------



## Inshallah (May 11, 2011)

http://www.kuleuven.be/anesthesie/assistenten/2010-2011/Van%20den%20Enden%2027-05-11.pdf

There's a list of meds known to cause this some pages down in this pdf.


----------



## istayhome (Apr 4, 2012)

As Inshallah points out, the risk that Yay/Thundercats/Mr. Freeze/ALPrAZOLAM points out is minimal enough as to be considered insignificant. Yay/Thundercats/Mr. Freeze/ALPrAZOLAM, there is no need to trar such an insignificant difference. 

Also, Yay/Thundercats/Mr. Freeze/ALPrAZOLAM, please don't be sarcastic with me. Despite your dishonesty and completely terrible attitude I do not attempt to instigate conflicts with you. You have been instructed by the moderators to treat me with the same same very basic decency. Let's stay away from any conflicts.


----------



## Inshallah (May 11, 2011)

Well in his defence for once b), IF you don't have any heart issues, don't sweat it, but still, the medical community has repeatedly singled out those 2. (maybe they didn't even test the others, who knows)


----------



## yay (Dec 31, 2012)

Inshallah said:


> However, while the risk is somewhat higher with those 2 SSRI's, that same dosage-dependent risk is there for all SSRI's and basically all other AD's, AP's, ...


That's not according to my info. I read that Celexa and Lexapro are in a higher risk category than the other SSRI when it comes to QT stuff.


----------



## Inshallah (May 11, 2011)

yay said:


> That's not according to my info. I read that Celexa and Lexapro are in a higher risk category than the other SSRI when it comes to QT stuff.


That's what I said bro. But it's not THAT important unless you have congenital heart issues.

And like I said, my psychiatrist confirmed my suspicion without me even really mentioning it: it is very likely that those 2 were singled out because they simply were the most studied as far as QT interval interference goes.

Remember that Citalopram and Escitalopram are the SSRI's with the least side effects, resulting in more people being on their respective maximum (or relatively high anyway) dosages.

Paxil, Zoloft, Prozac... you won't find as many maximum dosage users for these, as you'll find for Cit and Escit.


----------



## Inshallah (May 11, 2011)

As a last attempt at Antidepressants, I'm considering Clomipramine again. I've been it before for a few weeks but had interactions with painkillers and had to quit. It's generally considered "the best antidepressant ever" so I want to give it it 6-8 weeks.

*Clomipramine 250 mg/day* (max dosage) + *Dextroamphetamine or Ritalin IR* (possibly alternating the two but both in their max dosages or higher) + *Lyrica 4*150 mg/day* + *Clonazepam 0.5 mg 2x/day* (this was added recently, not sure if I'll keep it)

What do my med expert peeps have to say on this?


----------



## Birdynamnam (Apr 6, 2013)

Just be careful with home much you consume. I'm no doctor, but I think you should take a few days without using them once in a while. Ritalin/concerta can be VERY addictive. Also, if you use it too much it will only make you more paranoid and have more anxiety.


----------



## Inshallah (May 11, 2011)

Birdynamnam said:


> Just be careful with home much you consume. I'm no doctor, but I think you should take a few days without using them once in a while. Ritalin/concerta can be VERY addictive. Also, if you use it too much it will only make you more paranoid and have more anxiety.


No worries, I have yet to to become paranoid or more anxious, even on high dosages of both stimulants.

I'm medication resilient, always have been.


----------

