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Old 01-16-2011, 06:11 PM   #1 (permalink)
 
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Default Adderall +/- WellButrin effects/experiences?

Hi everybody,

I'm new to the forum after googling stuff related to SAD.

A small blurb about me before I ask my question, I am formally diagnosed with major depressive disorder with social anxiety. The social anxiety causes the depression which causes more anxiety, and so on and so forth.

I was on Zoloft and then Lexapro for many years (I am now 22) but was switched to Wellbutrin (300mg XL) when I was 20 which helped with my depression without causing bad side effects down below the belt. The SSRI's helped with anxiety a lot -- Wellbutrin not so much, but I liked it better overall.

I was put on Adderall XR (20mg) about 6 months ago after complaining of ADHD which has also been a problem for me. I know Adderall and Wellbutrin both work on norepinephrine and dopamine in a similar but not identical action. The Adderall has been a huge help for my ADHD and has made me feel pretty good about myself during the day, even giving me some pseudoconfidence in social situations.

However lately (the past month or so) I've been feeling -very- depressed in the evenings, and have become extremely paranoid...bordering on schizophrenic-like paranoia relating to my social affairs, causing severe anxiety at times. The paranoia can and does happen at any time, triggered, and originally started with the Wellbutrin (I call it hypervigilance) but has been worsened by the Adderall. It's also given me crying fits every few weeks or so which seems to have a "purging" effect on pent up emotions and I feel very good for the week following such an episode. Sometimes during the day, I can become very moody and go from a good mood to a sad or horrible angry mood back to normal again -- anxiety is usually underlying these moods.

Doc gave me low-dose Xanax to take as needed for anxiety. Technically wanted me to take it daily but expressed concern about dependence so we agreed on an as needed basis.

Doc also suggested stopping the Wellbutrin entirely but left it up to me to decide after I expressed discomfort with the idea.

Was wondering if anybody here has taken the Adderall and Wellbutrin combo and could provide some insight into the two drugs working at the same time, and how it affected them (and the social anxiety). If I had to pick between the two, the Adderall does more for me than the Wellbutrin but I don't know which is more beneficial in a brain-chemistry sense.

I'm strongly considering stopping the Wellbutrin now, and seeing if it takes the edge off some of the anxiety and moodiness. Maybe the Adderall on its own will be more well-rounded for me in terms of the ADHD and not making things worse with Wellbutrin.

Thank you for any advice or helpful comments!
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Old 01-16-2011, 06:42 PM   #2 (permalink)
 
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Hi there, and welcome.

You may want to check out the thread I recently started about Wellbutrin: http://www.socialanxietysupport.com/...d-data-111599/ And, by all means, please feel free to add your experiences with it there; I'm trying to collect data points, and it sounds like you have atypical depression (check the differences in that thread).

Adderall has several MOAs and, in general, far more activity than Wellbutrin. Unlike Wellbutrin, it's not a reuptake blocker, but almost acts like a catecholamine itself at the monoamine transporters and prevents monoamine uptake. It also, in sufficient doses, directly stimulates monoamine release from the neuron into the synapse. Finally, it's a weak MAO inhibitor. Wellbutrin is mainly a noradrenaline and dopamine uptake inhibitor, as well as a nicotinic antagonist, which is why it's used to help quit smoking.

Can you give an example of the paranoia you experience? In what situations does it manifest? Are you walking along a street and think people want to kill you, are reading your mind, what? Are you getting any other delusional or psychotic manifestations? Does anger or severe anxiety accompany this paranoia?

Paranoia isn't all that rare with stimulants (mostly due to dopaminergic activity...it's almost like a light psychosis), and Wellbutrin is a weak stimulant... add Adderall to that and I could see there being an issue over time. Do you do any recreational drugs or take anything else that you haven't mentioned?

Are the crying fits triggered by anything in particular, or do they appear spontaneous? Do they happen at particular times of day?

The moodiness, crying spells, night-time depression, and paranoia you describe sound almost like a bipolar condition trying to unmask itself but not fully doing so or being obscured by your medications. This is also consistent with the early onset and episodic nature of your depression. Has your p-doc discussed this possibility with you, as well as the possibility of introducing a mood stabilizer like Lamictal into your cocktail?
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Old 01-16-2011, 11:08 PM   #3 (permalink)
 
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Hello and thanks for your feedback! I checked out that page. I'm not sure if the atypical depression fits me. In fact, that's how I kinda felt while on the SSRI's... overeating, slept like 16 hours, anhedonia, no libido, lethargic, inattentive etc. I'd frequently nap for no reason.

Switching to the Wellbutrin reversed most of that. But I mainly wanted to switch because of the sexual side effects which ironically made me more anxious. The SSRI's though were probably most helpful in treating the actual symptoms of the SAD. Now things are probably the opposite. I barely eat (maybe 1200-1500 calories a day tops, breakfast and dinner), can get by with just 6 hours of sleep and no need to nap, libido is pretty good but I wouldn't say overactive (I'm a 22 year old guy... so it should be kind of high) and I'm very attentive especially when it interests me.

I'm pretty familiar with biochemistry when it comes to neurotransmissions so those MOA's of Adderall make sense. I knew it had weak MAOI activity and could put VMAT and DAT in reverse. I did not know however that it wasn't a DA or NE reuptake inhibitor like Wellbutrin was or that it had DA/NE agonist activity.

The paranoia is extremely complex, and it is transient, but it almost always is associated with an anxious situation or anxiety attack at worst. An example would be sitting in class and thinking that people are making fun of me behind my back or that I'm being critiqued and laughed at. I often picture myself in other people's brains thinking what I would be thinking if I was them (if that makes sense): i.e. in a conversation I will be thinking about the person I'm talking to thinking about me and what they are probably saying to themselves (oh that kid is a loser or something) as we are talking. This is what I meant by hypervigilance - I almost feel too alert of what is going on around me at times and I rationalize these paranoid thoughts to make them seem very real.

So for another example, if I'm thinking about someone thinking about me, I will almost react as if it really has happened and feel anxious and embarrassed. Then I will "snowball" that problem into more problems... start feeling that I'm no good in general and want to just isolate myself to avoid these scenarios.

This "hypervigilance" started manifesting on the Wellbutrin and was probably worsened like you suggested when I started taking the Adderall because of the effects on enhancing dopamine. I never react angrily to my paranoia, nor do I ever act aggressively or blame someone else. It is always self-punishment(mental punishment, not physical)/self-loathing, introversion, sadness and depression.

A situation where I will become instantaneously angry or irrational would be best exemplified when I'm driving. I feel like on Adderall I need to drive fast (its nickname Speed applies well here) and when some other guy gets in front of me and is going "too slow" and I can't pass him, I'll flip out. I'll start cursing and make deep sighs and frustrate myself and work myself up to a bad mood just because "this jerk" has to drive the speed limit. Maybe that's a bad example since I'm a New York driver but it's little everyday annoyances like that which set me off. I also tend to get extremely angry in video games. If I lose, I take it personally and have broken many controllers from throwing them (that's as far as I've ever been violent though, only inanimate objects). This happened to a lesser extent on the Wellbutrin but the Adderall on top has amplified this aforementioned behavior.

A situation where I will become sad/depressed/anxious would be when plans I've made for the day or in advance get disrupted, altered, or don't play out as intended. Say, I want to grab lunch with a friend but he gets caught up -- I sometimes will feel depressed over that because now the plans are screwed up and I'm on my own. Or if I'm out drinking with some buddies and am having a good time but some girl gives me a weird look, it can set me off feeling bad about myself. The SAD kicks in big time there.

The crying fits are usually "triggered" by one of these small "setbacks" or "events" that derails me from whichever path I'm on for a day but the underlying cause is usually when I start thinking of all the stress and pressure I'm under in school and in life and how things aren't going well and I snowball them all up and just cry. For like 2-5 minutes. Then afterwards it's like I purged out all the bad emotion and I feel pretty good for a few days -- not much anxiety or depression.

The moodiness and night time depression I thought were from the Adderall. Obviously it wears off at night so I feel kinda depressed later in the day. The moodiness can happen whenever (even in the afternoon while on it). I probably feel best in the late morning, early afternoon but I think that coincides with the stimulant buzz I get from the drug, just usually blissful and ignorant to problems.

As for recreational drugs... well I used to smoke pot quite frequently (started doing so frequently about 2-2 1/2 years ago) but recently it has started to make me EXTREMELY paranoid almost to the point where I've felt my heart race out of fear/impending doom and when I'm with other people the social anxiety becomes unbearable, I get ridiculously hypervigilant, like 10 times more so than if it was just a usual day. So I've been scared to smoke these days as it makes anxiety worse.

Since I'm of age, alcohol is legal for me and I don't binge drink but I do periodically drink 1-2 high alc% beers to relax when I'm tense and I have (infrequently) mixed the 1-2 drinks with the low dose Xanax (0.25mg) to get a more loopy effect. But I know benzos +alcohol are dangerous so it's never a big mix.

I don't do anything else regularly but I have done LSD twice (2 years ago) and Mushrooms twice (most recently in September). Don't like those either because of anxiety.

I probably should mention supplements while I'm going through all this.

Since I have some background in chemistry, I thought it would be helpful if I co-administered my meds with 1500mg L-tyrosine, and 50mg of 5-hydroxytryptophan (5-HTP) to help replenish depleted DA/NE/SE from the Adderall so that I didn't have such bad crashes. I also take a multivitamin and fishoil with that.

No I have not discussed any of the minute details I have said here with my doctor because I don't want to freak him or my parents out. Plus I don't like the idea of being on 100 meds nor can I afford it.

Sorry for writing a book here, but thank you so much for your help thus far.
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Old 01-17-2011, 09:36 AM   #4 (permalink)
 
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Adderall and Wellbutrin together?? I think that would give me a panic attack from the deepest depths of hell. I wonder what the point of prescribing both simultaneously would be. Don't wouldn't that just be excessive norepinephrine reuptake?
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Old 01-17-2011, 12:44 PM   #5 (permalink)
 
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Adderall and Wellbutrin together?? I think that would give me a panic attack from the deepest depths of hell. I wonder what the point of prescribing both simultaneously would be. Don't wouldn't that just be excessive norepinephrine reuptake?
I was surprised when my family doctor gave me Adderall XR knowing I was already on Wellbutrin (albeit, from a different doc) for that reason as well.

Bmwfan said that Adderall isn't a DA/NE reuptake inhibitor so maybe it wouldn't be too much reuptake necessarily but rather too much norepinephrinergic activity in general (reuptake from Wellbutrin + reverse transport and agonism from Adderall).

Either way, I have a feeling the combination of the two is causing me some problems at this point and as of today I knocked my dose down to 150mg XL wellbutrin (I had some old 150s laying around from when I first started originally) and plan to cut it off entirely by Wednesday or Thursday. Didn't want to go cold turkey.
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Old 01-17-2011, 01:08 PM   #6 (permalink)
 
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Originally Posted by DarthNova View Post
I was surprised when my family doctor gave me Adderall XR knowing I was already on Wellbutrin (albeit, from a different doc) for that reason as well.

Bmwfan said that Adderall isn't a DA/NE reuptake inhibitor so maybe it wouldn't be too much reuptake necessarily but rather too much norepinephrinergic activity in general (reuptake from Wellbutrin + reverse transport and agonism from Adderall).

Either way, I have a feeling the combination of the two is causing me some problems at this point and as of today I knocked my dose down to 150mg XL wellbutrin (I had some old 150s laying around from when I first started originally) and plan to cut it off entirely by Wednesday or Thursday. Didn't want to go cold turkey.
maybe your family doctor just assumed you were going to quit the Wellbutrin when he gave you the Adderall.

On another note. AMPHETAMINE RULES!!! it takes a broken down young girl's tricycle and turns it into a Bugatti Veyron!
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Old 01-17-2011, 01:47 PM   #7 (permalink)
 
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maybe your family doctor just assumed you were going to quit the Wellbutrin when he gave you the Adderall.

On another note. AMPHETAMINE RULES!!! it takes a broken down young girl's tricycle and turns it into a Bugatti Veyron!
I don't know, he never mentioned going off the Wellbutrin -- he ignored it pretty much and eventually was prescribing me refill prescriptions for both medications when I stopped seeing the other doctor. Money is a bit tight for specialists.

And yeah, I agree with you that amphetamine is great...and it has done wonders for a guy like me. Combined with daily exercise, I've gotten into the best shape of my life and it has boosted my self-esteem and confidence thanks to the effects it has on my metabolism and appetite. And when it's working strongest in the morning, early afternoon -- I feel great about myself. It also can make me feel pretty bad later in the day though.

I do try and maintain the utmost respect for that drug's power, however. It is not only addictive in many ways, but can also be one of your biggest enemies if you lose respect for it. If you're a fan of the Greeks, it's kind of like the Greek god Dionysus.

Dionysus was a two-faced god. When showed the proper respect and reverence, he was angelic and treated the Greeks well -- they were jovial and serene, and life was good. But when disrespected or slighted, he literally became the devil or "Satan" and rained absolute hell and misery on Earth, and tortured his followers. If you've ever read The Bacchae, he mind controls the city of Thebes for disrespecting him and even causes a mother to murder her son in a frenzy without the mother even knowing. Just an extreme example of fiction, but you get the point

Adderall has made me feel really badly at times, especially when I know the day is going to be stressful and when bad things can happen to me in my personal life -- yet I will take it anyway just so that I feel good until the bad happens and boy oh boy can it make life suck during such adversity. I also think the Wellbutrin makes the highs and lows a lot more pronounced, which is one of the major reasons I made this thread hoping to find out more from other people like me.
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Old 01-17-2011, 02:34 PM   #8 (permalink)
 
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Hello and thanks for your feedback! I checked out that page. I'm not sure if the atypical depression fits me. In fact, that's how I kinda felt while on the SSRI's... overeating, slept like 16 hours, anhedonia, no libido, lethargic, inattentive etc. I'd frequently nap for no reason.

Switching to the Wellbutrin reversed most of that. But I mainly wanted to switch because of the sexual side effects which ironically made me more anxious. The SSRI's though were probably most helpful in treating the actual symptoms of the SAD. Now things are probably the opposite. I barely eat (maybe 1200-1500 calories a day tops, breakfast and dinner), can get by with just 6 hours of sleep and no need to nap, libido is pretty good but I wouldn't say overactive (I'm a 22 year old guy... so it should be kind of high) and I'm very attentive especially when it interests me.
As I mentioned in the other thread, two of the most sensitive symptoms of atypical depression are oversleeping and overeating, often with carb cravings. Do you have either of these symptoms when depressed, usually? SAD, if by that you mean seasonal affective disorder, is often atypical, but not always.

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I'm pretty familiar with biochemistry when it comes to neurotransmissions so those MOA's of Adderall make sense. I knew it had weak MAOI activity and could put VMAT and DAT in reverse. I did not know however that it wasn't a DA or NE reuptake inhibitor like Wellbutrin was or that it had DA/NE agonist activity.
Yep, it's pretty amazing.

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The paranoia is extremely complex, and it is transient, but it almost always is associated with an anxious situation or anxiety attack at worst. An example would be sitting in class and thinking that people are making fun of me behind my back or that I'm being critiqued and laughed at. I often picture myself in other people's brains thinking what I would be thinking if I was them (if that makes sense): i.e. in a conversation I will be thinking about the person I'm talking to thinking about me and what they are probably saying to themselves (oh that kid is a loser or something) as we are talking. This is what I meant by hypervigilance - I almost feel too alert of what is going on around me at times and I rationalize these paranoid thoughts to make them seem very real.
It doesn't really sound like psychotic paranoia; it sounds more like extreme social anxiety and focusing, rather than on yourself in social situations, on other people. The noradrenergic activity of both drugs could probably also be partially responsible for this.

The cycle is clearly problematic, though, in that it seems to often lead to further isolation, self-deprecation, and depression. The l-tyrosine you take could also be worsening this, in theory, because it's metabolized into l-dopa and then the three catecholamines dopamine, norepinephrine, and epinephrine as well as directly into norepinephrine in one part of the brain. You're taking a substantial amount of l-tyrosine.

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A situation where I will become instantaneously angry or irrational would be best exemplified when I'm driving. I feel like on Adderall I need to drive fast (its nickname Speed applies well here) and when some other guy gets in front of me and is going "too slow" and I can't pass him, I'll flip out. I'll start cursing and make deep sighs and frustrate myself and work myself up to a bad mood just because "this jerk" has to drive the speed limit. Maybe that's a bad example since I'm a New York driver but it's little everyday annoyances like that which set me off. I also tend to get extremely angry in video games. If I lose, I take it personally and have broken many controllers from throwing them (that's as far as I've ever been violent though, only inanimate objects). This happened to a lesser extent on the Wellbutrin but the Adderall on top has amplified this aforementioned behavior.
It's not surprising that the Adderall and the Wellbutrin have made you more irritable; they do this for a lot of people in isolation, but when combined, it can be particularly prominent. This specific issue may not be especially problematic if you're generally able to control your behavior.

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A situation where I will become sad/depressed/anxious would be when plans I've made for the day or in advance get disrupted, altered, or don't play out as intended. Say, I want to grab lunch with a friend but he gets caught up -- I sometimes will feel depressed over that because now the plans are screwed up and I'm on my own. Or if I'm out drinking with some buddies and am having a good time but some girl gives me a weird look, it can set me off feeling bad about myself. The SAD kicks in big time there.
I can relate to that. Adderall, in particular, can exacerbate mood lability, but that mood lability usually exists already. Now, emotional lability is present inherently in ADHD, and then also to some extent generalized social phobia/avoidant personality traits.

Quote:
The crying fits are usually "triggered" by one of these small "setbacks" or "events" that derails me from whichever path I'm on for a day but the underlying cause is usually when I start thinking of all the stress and pressure I'm under in school and in life and how things aren't going well and I snowball them all up and just cry. For like 2-5 minutes. Then afterwards it's like I purged out all the bad emotion and I feel pretty good for a few days -- not much anxiety or depression.
Did you used to cry often prior to starting WB or Adderall? Or were you less emotional/moody, in general?

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The moodiness and night time depression I thought were from the Adderall. Obviously it wears off at night so I feel kinda depressed later in the day. The moodiness can happen whenever (even in the afternoon while on it). I probably feel best in the late morning, early afternoon but I think that coincides with the stimulant buzz I get from the drug, just usually blissful and ignorant to problems.
Adderall's crash can definitely leave one depressed, and the drug itself as I mentioned can exacerbate mood lability, although it isn't usually quite as pronounced as I'm gathering yours are.

Now, it could be you'd do better on dexedrine, Vyvanse, Focalin (basically Ritalin enantiomer), Ritalin, or even straight methamphetamine (Desoxyn). Have you tried any other stimulants?

Quote:
As for recreational drugs... well I used to smoke pot quite frequently (started doing so frequently about 2-2 1/2 years ago) but recently it has started to make me EXTREMELY paranoid almost to the point where I've felt my heart race out of fear/impending doom and when I'm with other people the social anxiety becomes unbearable, I get ridiculously hypervigilant, like 10 times more so than if it was just a usual day. So I've been scared to smoke these days as it makes anxiety worse.
I can relate to not wanting to smoke pot due to anxiety. I had a horrible panic attack a few months ago on it (first time I'd ever experienced a panic attack, but sadly not the last since). I was pretty messed up because of it for a while. I thought I nearly went psychotic for an instant and heard a voice, but in retrospect, it could have just been my internal voice slightly modified. It's hard to really remember when a panic attack was coming on at exactly the same time. I also had severe OCD at the time with intrusive, aggressive thoughts.

Quote:
Since I'm of age, alcohol is legal for me and I don't binge drink but I do periodically drink 1-2 high alc% beers to relax when I'm tense and I have (infrequently) mixed the 1-2 drinks with the low dose Xanax (0.25mg) to get a more loopy effect. But I know benzos +alcohol are dangerous so it's never a big mix.
Not the worst thing but not good, either.

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I don't do anything else regularly but I have done LSD twice (2 years ago) and Mushrooms twice (most recently in September). Don't like those either because of anxiety.
'Shrooms, huh? Must have been interesting.

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I probably should mention supplements while I'm going through all this.

Since I have some background in chemistry, I thought it would be helpful if I co-administered my meds with 1500mg L-tyrosine, and 50mg of 5-hydroxytryptophan (5-HTP) to help replenish depleted DA/NE/SE from the Adderall so that I didn't have such bad crashes. I also take a multivitamin and fishoil with that.
As I mentioned, that's a substantial amount of tyrosine, with the drugs you're taking. It's probably contributing to your severe anxiety/paranoia, and certainly not making it any better. I'm not sure it has any real effects in terms of helping with Adderall tolerance or anything.

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No I have not discussed any of the minute details I have said here with my doctor because I don't want to freak him or my parents out. Plus I don't like the idea of being on 100 meds nor can I afford it.
I think for your own sake, you should really discuss at least the paranoia and mood lability with your doc. He may try you on a different stimulant class altogether, like methylphenidate. Or he may adjust the dosages of the WB or the Adderall. At this point, I'm not really sure what I can suggest myself, because of the complexity of the situation. My gut feeling is that you have some bipolarity that's being masked or obscured by the stimulant and the WB, and that a mood stabilizer might really help out. I would mention this to your doc and see what he says.
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Old 01-17-2011, 06:13 PM   #9 (permalink)
 
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As I mentioned in the other thread, two of the most sensitive symptoms of atypical depression are oversleeping and overeating, often with carb cravings. Do you have either of these symptoms when depressed, usually? SAD, if by that you mean seasonal affective disorder, is often atypical, but not always.
When I was on the SSRI antidepressants, and felt depressed, I would sleep a lot and tend to eat a lot of sugary carbfilled foods, yes. But since changing to Wellbutrin this no longer happens -- even when I'm depressed. I'm not sure whether I "innately" (sans medication) exhibit this behavior since I've almost always been on a med, though. It is possible the Wellbutrin counteracts these effects by its mechanism of action or that the SSRI's caused it with their side effects and MOA. I'm not sure.

And I meant social anxiety disorder when I used the SAD acronym, I totally forgot that seasonal affective disorder was also abbreviated SAD -- sorry for the confusion.


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It doesn't really sound like psychotic paranoia; it sounds more like extreme social anxiety and focusing, rather than on yourself in social situations, on other people. The noradrenergic activity of both drugs could probably also be partially responsible for this.

The cycle is clearly problematic, though, in that it seems to often lead to further isolation, self-deprecation, and depression. The l-tyrosine you take could also be worsening this, in theory, because it's metabolized into l-dopa and then the three catecholamines dopamine, norepinephrine, and epinephrine as well as directly into norepinephrine in one part of the brain. You're taking a substantial amount of l-tyrosine.
I agree completely with everything you said. It is almost always associated with anxiety of a social situation to further corroborate your suspicion. I am hoping that my cessation of the Wellbutrin eliminates some of the noradrenergic-mediated problems I'm dealing with. It may make the Adderall less prone to cause it on its own.

The L-Tyr I suspected could be contributing to the problem as well, and my knowledge of its role in catecholamine biosynthesis is what gave me the idea to supplement it in the first place. The Adderall makes me not eat much, so I take great strides to ensure I get enough of the essential nutrients that the meager amounts of food I eat fail to provide (through supps). I've noticed that when I don't take the Tyr, there are times I don't feel the Adderall working as well or at all, leading me to the suspicion my diet wasn't providing enough amino acids to adequately replenish monoamines.

After discovering Adderall also affected 5-HT (albeit not as much as DA/NE), I started supplementing 5-HTP and noticed immediate improvements in moodiness, anxiety and sadness later in the day. Also made me feel less edgy/irritable.

Quote:
I can relate to that. Adderall, in particular, can exacerbate mood lability, but that mood lability usually exists already. Now, emotional lability is present inherently in ADHD, and then also to some extent generalized social phobia/avoidant personality traits.
Oh god, this has got to be my biggest gripe with Adderall is that lability. I thought it was just me or my depression/Soc.anxiety that caused me to be an emotional rollercoaster. I was not aware that ADHD patients also suffered from this, so I am probably suffering from a double-whammy in this regard. Supplementation with the 5-HTP (50mg/day) has helped mitigate how labile I am. Right now though it is probably the most immediate problem I'm dealing with because it can trigger full blown depressive episodes or anxiety attacks, especially when paranoia is involved.

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Did you used to cry often prior to starting WB or Adderall? Or were you less emotional/moody, in general?
Cried much more often prior to WB or Addy (while on the SSRIs) and in much greater severity. After starting WB, I found it difficult to actually physically cry -- despite feeling like I wanted to. The SSRI's also made me less emotionally labile and moody. The WB on it's own definitely brought out the moodiness in me, and despite having trouble physically crying, I did still feel the need to pretty often. The Adderall has exacerbated things in both regards, making me much more moody and the need to cry has certainly become more common.

Quote:
Adderall's crash can definitely leave one depressed, and the drug itself as I mentioned can exacerbate mood lability, although it isn't usually quite as pronounced as I'm gathering yours are.

Now, it could be you'd do better on dexedrine, Vyvanse, Focalin (basically Ritalin enantiomer), Ritalin, or even straight methamphetamine (Desoxyn). Have you tried any other stimulants?
Interesting you mention this. I was originally started on 30mg Vyvanse back in March of 2010 but I found it to be very weak when it did work, and it felt like the entire drug wore off by 2pm (If I took it at 9am). Clearly not something that is ideal when you expect the extended release action to last all day. Doc tried 40mg, but alas the problem did not go away.

Switched me to 20mg Addy XR in June and that has done the trick for me. Doesn't feel too strong, but not exactly weak either. And it lasts the full work/school day. I did some research and found out that the levoamphetamine present in Adderall can actually exacerbate anxiety (Vyvanse as you probably know already is pure dextro) and the L-amp is noradrenergic by nature. I've suspected this feature of the drug may be what has made things worse as far as NE-mediated anxiety/paranoia is concerned, but overall I rather have the Adderall than the ineffective Vyvanse. Perhaps the Wellbutrins DA reuptake effects somehow screwed up Vyvanse's longevity since that is all dextro? Not sure.

Have not considered Ritalin but I've taken it (recreationally, to study in years past) and it made me feel like a zombie and gave me heart palpatations, so not sure of its effectiveness. I'm a bit uncomfortable taking methamphetamine (Desoxyn) due to its neurotoxicity (I know reg amph is no angel here either, but not as bad). Plus I doubt the doc would even consider it as an option.

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I can relate to not wanting to smoke pot due to anxiety. I had a horrible panic attack a few months ago on it (first time I'd ever experienced a panic attack, but sadly not the last since). I was pretty messed up because of it for a while. I thought I nearly went psychotic for an instant and heard a voice, but in retrospect, it could have just been my internal voice slightly modified. It's hard to really remember when a panic attack was coming on at exactly the same time. I also had severe OCD at the time with intrusive, aggressive thoughts.
Yeah, and the worst part of it all was that I used to be fine when I smoked. In fact, I used to smoke it to quell my anxiety and now it just seems to cause or exacerbate it. A buddy told me that pot + Adderall is a big no-no, especially if you are prone to paranoia. Perhaps that is what is causing it considering I didn't smoke very often during the 6 months I've been on Addy. It also appears that the strain of pot makes a big difference in whether I feel good or bad (sativa vs. indica I guess). I can relate to you hearing voices though, I probably get auditory hallucinations when high more than anything. Oh well, more money in my pocket if I'm not doing that anymore

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'Shrooms, huh? Must have been interesting.
First time I did it was not very effective since the SSRI negated a lot of the cool effects, but I had a good time nonetheless. The second time I did it was, for the most part, good... but I definitely had my lows which were REAL bad. I was smart though and took steps to stop me from going down the "bad road" when I recognized it and also had a spotter to help change the mood if things were going south. My two buddies I did it with were not so fortunate Acid on the other hand, never again -- both times I did it were horrible and it lasts so damn long unlike Shrooms, it was like 16 straight hours of hell requiring lots of benzodiazepines to knock me out for most of it.

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I think for your own sake, you should really discuss at least the paranoia and mood lability with your doc. He may try you on a different stimulant class altogether, like methylphenidate. Or he may adjust the dosages of the WB or the Adderall. At this point, I'm not really sure what I can suggest myself, because of the complexity of the situation. My gut feeling is that you have some bipolarity that's being masked or obscured by the stimulant and the WB, and that a mood stabilizer might really help out. I would mention this to your doc and see what he says.
Thanks for all the advice, I will bring up the notion of a mood stabilizer and see what the doctor thinks but I won't be able to see him for at least two months while at school. I really appreciate your insights though, it's nice to be able to talk to someone who can relate to your behavior as well as the biochemical/scientific aspects of these behaviors and drugs. In the meantime, I guess I'll see how things go taking only the Adderall and my supplements while losing the reuptake inhibition effects on DA/NE conferred by WB.
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Old 01-17-2011, 08:38 PM   #10 (permalink)
 
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When I was on the SSRI antidepressants, and felt depressed, I would sleep a lot and tend to eat a lot of sugary carbfilled foods, yes. But since changing to Wellbutrin this no longer happens -- even when I'm depressed. I'm not sure whether I "innately" (sans medication) exhibit this behavior since I've almost always been on a med, though. It is possible the Wellbutrin counteracts these effects by its mechanism of action or that the SSRI's caused it with their side effects and MOA. I'm not sure.
That does sound suspiciously like atypical depression, but it's hard to say with the SSRI obscuring things. I haven't heard of SSRI directly causing all the atypical depressive symptoms, though; that's not all that plausible. It sounds more like the depression was a breakthrough episode.

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I agree completely with everything you said. It is almost always associated with anxiety of a social situation to further corroborate your suspicion. I am hoping that my cessation of the Wellbutrin eliminates some of the noradrenergic-mediated problems I'm dealing with. It may make the Adderall less prone to cause it on its own.
It may, but I also hope that your depression doesn't recur. It's sort of playing with fire, in my book. Sure you can't consult your p-doc before simply stopping the WB? Also, know that there are possible withdrawal effects with the WB; it may be better to taper.

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The L-Tyr I suspected could be contributing to the problem as well, and my knowledge of its role in catecholamine biosynthesis is what gave me the idea to supplement it in the first place. The Adderall makes me not eat much, so I take great strides to ensure I get enough of the essential nutrients that the meager amounts of food I eat fail to provide (through supps). I've noticed that when I don't take the Tyr, there are times I don't feel the Adderall working as well or at all, leading me to the suspicion my diet wasn't providing enough amino acids to adequately replenish monoamines.
This is possible, but you'd be surprised how little food we need to synthesize enough monoamines. People eat horrible, sugary diets--or very little--and don't have psychiatric issues; I believe the two are totally independent, although certainly unhealthy diets and blood glucose swings do not help. If you're noticing benefits from it, maybe that's enough reason to keep using it. It does complicate the diagnostic picture a bit, though.

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After discovering Adderall also affected 5-HT (albeit not as much as DA/NE), I started supplementing 5-HTP and noticed immediate improvements in moodiness, anxiety and sadness later in the day. Also made me feel less edgy/irritable.
That makes some sense, especially with the long-term effects of amphetamine.

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Oh god, this has got to be my biggest gripe with Adderall is that lability. I thought it was just me or my depression/Soc.anxiety that caused me to be an emotional rollercoaster. I was not aware that ADHD patients also suffered from this, so I am probably suffering from a double-whammy in this regard. Supplementation with the 5-HTP (50mg/day) has helped mitigate how labile I am. Right now though it is probably the most immediate problem I'm dealing with because it can trigger full blown depressive episodes or anxiety attacks, especially when paranoia is involved.
Has your paranoia triggered full-blown depressive episodes, even on Wellbutrin? How long do these episodes last, and what are your symptoms?

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Cried much more often prior to WB or Addy (while on the SSRIs) and in much greater severity. After starting WB, I found it difficult to actually physically cry -- despite feeling like I wanted to. The SSRI's also made me less emotionally labile and moody. The WB on it's own definitely brought out the moodiness in me, and despite having trouble physically crying, I did still feel the need to pretty often. The Adderall has exacerbated things in both regards, making me much more moody and the need to cry has certainly become more common.
It's odd that you have difficulty crying on Wellbutrin. Spontaneous crying spells, the opposite problem, seem to be fairly common on the drug. On the other hand, you did mention occasional crying that seemed cleansing. Crying itself is a functional process with cathartic effects. SSRIs sometimes have that emotional blunting effect likely due, at least in part, to similar reasons that they also induce sexual dysfunction: activation of 5HT2C receptors and .

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Interesting you mention this. I was originally started on 30mg Vyvanse back in March of 2010 but I found it to be very weak when it did work, and it felt like the entire drug wore off by 2pm (If I took it at 9am). Clearly not something that is ideal when you expect the extended release action to last all day. Doc tried 40mg, but alas the problem did not go away.

Switched me to 20mg Addy XR in June and that has done the trick for me. Doesn't feel too strong, but not exactly weak either. And it lasts the full work/school day. I did some research and found out that the levoamphetamine present in Adderall can actually exacerbate anxiety (Vyvanse as you probably know already is pure dextro) and the L-amp is noradrenergic by nature. I've suspected this feature of the drug may be what has made things worse as far as NE-mediated anxiety/paranoia is concerned, but overall I rather have the Adderall than the ineffective Vyvanse. Perhaps the Wellbutrins DA reuptake effects somehow screwed up Vyvanse's longevity since that is all dextro? Not sure.

Have not considered Ritalin but I've taken it (recreationally, to study in years past) and it made me feel like a zombie and gave me heart palpatations, so not sure of its effectiveness. I'm a bit uncomfortable taking methamphetamine (Desoxyn) due to its neurotoxicity (I know reg amph is no angel here either, but not as bad). Plus I doubt the doc would even consider it as an option.
Ah, so you've tried some others. Yeah, I'm not sure most p-docs would want to prescribe straight meth... it's definitely more neurotoxic, and probably considerably more addictive. Still, I do know of people on it (legally) and NMDA antagonists like memantine, even magnesium citrate, can help greatly in reducing tolerance. Crayzymeds on here loves memantine.

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Yeah, and the worst part of it all was that I used to be fine when I smoked. In fact, I used to smoke it to quell my anxiety and now it just seems to cause or exacerbate it. A buddy told me that pot + Adderall is a big no-no, especially if you are prone to paranoia. Perhaps that is what is causing it considering I didn't smoke very often during the 6 months I've been on Addy. It also appears that the strain of pot makes a big difference in whether I feel good or bad (sativa vs. indica I guess). I can relate to you hearing voices though, I probably get auditory hallucinations when high more than anything. Oh well, more money in my pocket if I'm not doing that anymore
Yeah, mixing pot and amphetamine doesn't sound like the best idea.

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First time I did it was not very effective since the SSRI negated a lot of the cool effects, but I had a good time nonetheless. The second time I did it was, for the most part, good... but I definitely had my lows which were REAL bad. I was smart though and took steps to stop me from going down the "bad road" when I recognized it and also had a spotter to help change the mood if things were going south. My two buddies I did it with were not so fortunate Acid on the other hand, never again -- both times I did it were horrible and it lasts so damn long unlike Shrooms, it was like 16 straight hours of hell requiring lots of benzodiazepines to knock me out for most of it.
Sounds intense... I don't have the guts to do shrooms or acid. Stories like yours only affirm my fears.

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Thanks for all the advice, I will bring up the notion of a mood stabilizer and see what the doctor thinks but I won't be able to see him for at least two months while at school. I really appreciate your insights though, it's nice to be able to talk to someone who can relate to your behavior as well as the biochemical/scientific aspects of these behaviors and drugs. In the meantime, I guess I'll see how things go taking only the Adderall and my supplements while losing the reuptake inhibition effects on DA/NE conferred by WB.
No problem, and good luck! Maybe someone else here will chime in... there are some very knowledgeable people here (more so than me).
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Old 01-18-2011, 05:23 AM   #11 (permalink)
 
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Bmwfan said that Adderall isn't a DA/NE reuptake inhibitor so maybe it wouldn't be too much reuptake necessarily but rather too much norepinephrinergic activity in general (reuptake from Wellbutrin + reverse transport and agonism from Adderall).
Reuptake inhibition of a neurotransmitter pump generally blocks releasing agents (transport reversers) from acting. So for example, wellbutrin has substantial NRI properties, so it would more likely mitigate Adderall's NE releasing properties rather than enhancing them.
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Old 01-18-2011, 10:22 AM   #12 (permalink)
 
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Reuptake inhibition of a neurotransmitter pump generally blocks releasing agents (transport reversers) from acting. So for example, wellbutrin has substantial NRI properties, so it would more likely mitigate Adderall's NE releasing properties rather than enhancing them.
Now that is interesting. I was always curious about how a reuptake inhibitor like WB would affect something like Adderall whose pharmacology involves actions as a ND release agent, selective reversible MAOI and partial ND agonist acitivty.

I suppose it makes sense that a reuptake inhibitor could block the reverse transport of a transporter like DAT or NET (I wonder if Wellbutrin blocks VMAT too?) but I always thought that since reuptake inhibitors generally work on the outside of the transporters (synaptic side) that they generally wouldn't screw up pump (reverse) action that is based primarily on the cytosolic side.

I guess that also makes sense why SSRI's tend to negate indole-based hallucinogens like shrooms or LCD and why I didn't feel much of an effect from the mushrooms while taking Lexapro (and why MDMA users don't typically have the same experience on SSRI's either as they report).

So, I guess now I'm wondering whether the Wellbutrin was actually inhibiting or preventing Adderall from working as effectively as it can and if I should expect a different feeling once I fully cease taking the drug...

The other thing to consider perhaps is which particular subtype of dopamine and norepinephrine transporters Wellbutrin acted on unless it was indiscriminate and showed no preference for subtypes. And on the other side of the coin, does Adderall indiscriminately target all subtypes of DA/NE transporters or does it have specific preferences that Wellbutrin may not target as much. I wish information like this was more readily available instead of the vague descriptions provided on the package inserts (and generally therefore, wikipedia).

To Bmwfan: I am definitely not going cold turkey despite taking Adderall which could mask some of the "discontinuation/withdrawal symptoms" -- I changed to 150mg XL as of yesterday, and took another 150 today. Probably won't take anything tomorrow, then another 150 on Thursday, then see how I go with nothing anymore starting Friday.
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Old 01-18-2011, 11:20 AM   #13 (permalink)
 
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Default Personal experience of combo adderall/wellbutrin (also dexedrine/wellbutrin)

Hello Darth Nova and other readers, just wanted to share my experience on the Adderall/Wellbutrin Combo.
Sorry for incorrect grammar, im from europe, non-english-language country!
CURRENT MEDICATION:
ADDERALL/OCCASIONALLY ALSO DEXEDRINE
WELLBUTRIN
LEXAPRO
First expieriences described are of combination wellbutrin/dexedrine, but i switched to adderall after a while, which was (for me) pretty much the same in combination with wellbutrin, effects of the combination were the same, dexedrine or adderall - doesnt matter (but of course, possible in others than me)
i'm diagnosed with depression,social anxiety and ADHD-PI (predominantly inattentive), and I'm also very often expieriencing the "hypervigilance" in a similar way like you described it!
I was surprised, that the Amphetamine(i started with dexedrine) really calmed me down AND made the hypervigilance-feelings go away(of course beside the good initial effects of amphetamine against depression, social anxiety and adhd which just stayed something like a month or so...) At the beginning of amph-tratment I felt pretty normal again!
After the initial phase of the amphetamine treatment, the nice effects against depression and social anxiety, hypervigilance went away, only the focus and the possibility to motivate myself were left(but not in a acceptable enough intensity!)
COMBO:
my psychiatrist then prescribed me Wellbutrin(300XL) and it was ment to take in combination with Amphetamine.
INTENSIVENESS CHANGE OF THE AMPHETAMINE IN COMBINTION WITH WELLBUTRIN
Now what maybe could be interesting was, that without the Wellbutrin, I needed 10 Mg of dexedrine to notice an effect from it(duration 2-2.5 hrs, then a next dose). My psychiatrist told me nothing about how to take the dexedrine but i was a bit suspicious about the COMBO and took only 5mg, which was until now a too low dose for me.
What i noticed was, after the effect started off half an hour to fourty minutes later: It was way too strong!! It was not horrible, just a bit unconfortable, but i felt: "too much inside me..."
The next time,I took only 2,5mg of dexedrine and that dose seemed to give the same effect in intensity of the dexedrine, like i took 10mg when i was not on wellbutrin. For me personally, that showed a effect-strengt of the Amphetamine which i felt four times stronger when combined with wellbutrin...
When i switched later to Adderall( i wanted to see if its better than dexedrine), nothing changed this proportions.
SLIGHTLY CHANGED EFFECT OF AMPHETAMINE IN COMBINATION WITH WELLBUTRIN
what i also noticed was, that the effect of the amphetamine was slightly changed in combo: The amphetamine effect was lesser clean, not as clear than without wellbutrin, some dizzyness is now mixed with the effect...

Because i had to learn for important exams, i went off the wellbutrin for a month and a half and the amphetamine worked again like before. now i am again on wellbutrin(because it helped me for depression) and the amphetamine effect changed back again...
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