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Discussion Starter · #1 · (Edited)
Stimulant + MAOI journal

Update 11/22/2015
Mild tachycardia + increased anxiety = switched to Wellbutrin. All is well. :)

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Update 04/02/2015

Current combination is Parnate (60mg) Adderall (20mg) Lamictal (300mg) Valium (5mg). This is a decrease in Parnate and Adderall doses. I don't feel like I need as much Adderall and the higher doses were pushing me too much, and I'm attempting to regulate sleep better by reducing Parnate.

Loving the therapy program Mind Over Mood (Greenberger & Padesky) supplemented with the Social Anxiety Audio Series and a few other resources.

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Update 02/11/2015

Current combination is Parnate (70mg) Adderall (25mg) Lamictal (300mg) Valium (5mg).

Current supplements include B-vitamin w/ methylfolate ("Seeking Health" brand), magnesium citrate, vitamin D, N-acetylcysteine, probiotics ("Align"), fish oil.

Current self-guided cognitive therapy program: Mind Over Mood (Greenberger & Padesky).

Current status: looking forward to SPRING PLANTING SEASON! :D

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Update 11/26/14
Current combination is Parnate (70mg) Adderall (30mg) Lamictal (300mg) Topamax (100mg) as well as some various supplements and is working very well in conjunction with Cognitive Behavioral Therapy and Mindfulness-Based therapy.

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I am now taking an unusual medication combo that I think will help out a lot. I thought I would do a mini journal of experiences.

Combining MAOIs (which are rarely used to begin with) with stimulants is not common. They are officially contraindicated because of a risk of increased blood pressure and dangerous hypertension. However, I am convinced that they can be safely combined and can constitute an extremely powerful antidepressant combination where other treatments fail.

Some background. I suffer from social anxiety, depression (mild bipolarity around the edges), panic disorder, generalized anxiety, and an assortment of oddities too numerous to list.

As of 04/05/2014 I am on:
  • Parnate (tranylcypromine) 90 mg. MAOI type antidepressant/anxiolytic
  • Lamictal (lamotrigine) 300 mg. Mood stabilizer and antidepressant booster
  • Cytomel (liothyronine) 50 mcg - Thyroid medication used as antidepressant booster
  • Xanax (alprazolam) .5 mg. Benzodiazepine as needed for anxiety/panic
Also:
  • Bunches of supplements (vitamin D, Align probiotic, multivitamin, fish oil, methylfolate, B12).
  • Caffeine, in coffee, soda, and pill form. I would estimate ~ 600-800 mg/day. I've built up a lot of tolerance. Reduced to 200/day
Now adding:
  • Adderall (amphetamines) 20 mg/day. Immediate release version. Stimulant Switched to Ritalin (methylphenidate) 60 mg/day immediate release.

Wish me luck!
 

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Discussion Starter · #2 · (Edited)
From another post on 04/04/14:

So far it's doing some good things, but not all that I would have liked. I have noticed:

The Good

- Increased focus. I worked in the garden and put up a potato cage thingy - it took me a while, but I was able to keep going until it was done.
- Increased motivation. I got some **** done that I have been putting off. It didn't even bother me to do it (usually I groan inwardly when I think about my to-do list).
- Less anxiety. I feel calmer.
- Decreased appetite. I actually ate less than 2000 calories for once and did not feel the urge to completely binge out on simple carbs.
- Less compulsive hair pulling. Trichotillomania is a small but real issue that I have (just throw it on the pile of crazies that I have). I have had much, much less compulsive hair pulling. (I pull out beard hairs and eyebrow hairs.)

The Bad
- I seem to have word-finding difficulties. I keep forgetting what things are called. I almost feel slightly dumber. I dunno. It's really odd.
- Sometimes I'm very focused but then other times I will forget what I was doing next, or blank out. Almost like my short term memory is reduced. This seems at odds with how amphetamines work so I can't figure this one out.

The Unknown
- I do not feel more energetic. I still feel frail and tired.
- No increase in sociability. I am content to totally not leave my house or talk to anybody. My neighbor was outside working on his car when I went to get the mail, and I very carefully avoided him and totally ninja'd my way to the mailbox and back. Ugh.
- I feel absolutely no "euphoria" that others describe.
 

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Discussion Starter · #3 ·
For 04/05/2014

I took 10 mg Adderall when I woke up at 6:30, 5 mg around 1:00PM, 5 mg around 3:00 PM. Dose #2 was probably taken a few hours too late. That third dose did not have much punch, I was still sleepy at 5:30 and ended up taking a nap.

Blood pressure does go up. It looks like 5 mg Adderall raises BP by about 10 mm systolic, 0-5 diastolic. Around that? I'll keep measuring and come up with an average.

I am noticing a correlation between BP elevation and drug benefit. WHEN my BP went up, it correlated to times when I feel better, more energetic, motivated.

Each dose seemed to deliver positive effects ~ 1-2 hours afterwards and lasted 2 hours, followed by a let down. It was a real roller coaster day. So at some times I was feeling fantastic, at other times I felt slow, lethargic, unfocused. The word finding and odd memory problems I noted previously, I think were symptoms of the drug 'wearing off'.

Perhaps the dose is too high? Too low? There is Adderall XR - perhaps that would work better? Switch to methylphenidate type options? I don't know. It will take some time to iron it out.

Tomorrow I'll try 4 x 5mg for the day and try to get a steadier benefit.

I enjoyed the 10 mg dose. Nothing to write home about. It was enough that I played The Thermals a notch louder than usual and played air guitar for the cats. (They are a tough audience btw)
 

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Discussion Starter · #4 ·
04/07/2014

Yesterday I had the day off, pretty much stuck to gardening and testing the Adderall (hereafter I'll just say amphetamine). Getting the garden beds ready for potatoes, pumpkins, and peas (the three P's) plus ornnamental tubers (dahlias, oxalis, four oclocks, crocosmia etc). Trying strawberries in containers.

I did some safety checks. I tried stretching the dosing as 2.5 mg every 2 hours with blood pressure checks each time. The highest BP reading was 126/83, around mid-day. The lowest was 95/67 (in the evening). The low BP was yucky, very tired. I was on my usual caffeine regimen. I figured I should keep everything else consistent.

Average overall BP on 20 mg amphetamine/day over a fistful of days: 113/75. Just fine. I'm not interested in exceeding about 120/80 so I figure, I could probably go up to 30 maybe 40 mg, wouldn't do more than that. I can reduce caffeine, for one thing. Today I had less caffeine (maybe 300 mg) and 20 mg amphetamine stretched out throughout the day in 5mg or 2.5mg doses. It's kind of ridiculous that way but I was trying to see if I could keep it going level.

Been reading up on how amphetamine works, especially compared to methylphenidate (Ritalin). I had never really thought to study it. Ken Gillman (smart MAOI researcher) appears to endorse methylphenidate as the safer drug in combination with MAOIs. Looking at mechanism of action methylphenidate does look a little cleaner, since amphetamine can hijack things inside the presynaptic cell and dump out dopamine. I think? I could be reading this wrong.

I think methylphenidate is probably the better first choice in general and if amph. doesn't work, I'll see if I can switch. Frankly I was not expecting any offering of a C-II stimulant from the psych. I figured modafinil. I was not going to say no to Adderall. Okay, I guess I'll try it. wink.

Stahl, Essential Pharmacology, talks about tonic vs. phasic dopamine firing. You really have to watch the dosing. My impression, at least, is that improving tonic dopamine could provide benefits to motivation, energy, concentration etc. whereas phasic firing causes tolerance and problems. Long-acting, low doses are good. Short acting, high doses are bad. Basically, if you get euphoric, you're on too much. Bupropion works for depression but only affects 10-30% of DAT. Doesn't take much.

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At work I had a louder voice (something I always struggle with), less mumbling, better eye contact, less mental fatigue. Mild headache. Felt a bit more on edge. Not prosocial. I spoke better, but I didn't necessarily want to talk to people more. More awake and less lethargic. I need to sit down and plan out some organized chunks of days that I can trial different doses.

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Side note:

You know what needs the stimulant augmentation? NARDIL. The stims would help counter a lot of side effects (weight gain, fatigue, hypotension). You'd make a billion dollars off a pre-packaged med, pills of 15mg phenelzine and 2-5 mg amphetamine (or equivalent methylphenidate) in extended-release formulation. You could titrate them safely at the same time. Seriously this needs to be done. Pfizer, give me a call, let's talk.
 

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Discussion Starter · #5 ·
04/08/2014

I didn't sleep well last night. I woke up early around 5 am. The sleep quality was bad too, in a way I can't really describe but it "felt" different. I stayed on 20 mg today and it helped me stay plenty alert but I could feel sleep debt underneath. I felt very sped up and on edge. I think the dose is actually too high. At this point I'm comfortable with any dose up to 20 mg, in terms of blood pressure. So it's more a matter of finding the right amount. I'm going to take a day off, then restart it at 10 mg/day.
 

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The Bad
- I seem to have word-finding difficulties. I keep forgetting what things are called. I almost feel slightly dumber. I dunno. It's really odd.
- Sometimes I'm very focused but then other times I will forget what I was doing next, or blank out. Almost like my short term memory is reduced. This seems at odds with how amphetamines work so I can't figure this one out.
Have you tried taking out the caffeine? You're taking quite a lot. I noticed when I completely quit caffeine, taking adderall felt a lot smoother and a lot of the cognitive problems I experienced (similar to yours) disappeared.

IME Adderall + caffeine causes too much stimulation to the point that cognitive faculties are diminished, rather than enhanced as would be expected with stimulants.
 

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Discussion Starter · #7 ·
Have you tried taking out the caffeine? You're taking quite a lot. I noticed when I completely quit caffeine, taking adderall felt a lot smoother and a lot of the cognitive problems I experienced (similar to yours) disappeared.

IME Adderall + caffeine causes too much stimulation to the point that cognitive faculties are diminished, rather than enhanced as would be expected with stimulants.
Hmm that is a very good idea!

I haven't quit caffeine altogether, I have decreased substantially, just naturally. I might not go through caffeine withdrawals since Adderall would keep me alert and is a vasoconstrictor.
 

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Hmm that is a very good idea!

I haven't quit caffeine altogether, I have decreased substantially, just naturally. I might not go through caffeine withdrawals since Adderall would keep me alert and is a vasoconstrictor
I noticed adderall made quitting caffeine very easy. Since I was addicted to caffeine the psychological craving for caffeine was there, but basically any of the usual effects of caffeine w/d (headache, lethargy, depression) were masked by adderall.

To make quitting caffeine 100% pain free, maybe you can just reduce the dose by a certain fraction everyday until you're down to zero. The taper doesn't have to be too long since again adderall seems to take away a lot of the discomfort of caffeine w/d.

At the very least it's worth seeing what your current drug cocktail is like without caffeine. If nothing comes from it, at least you'd have lowered your caffeine tolerance, which is always nice. :)
 

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Caedmon, have you tried the Eugeroics? (Modafinil, adrafinil, armodafinil.) I just got put on Parnate, and I'm thinking of adding one for augmented effect, and to combat lack of energy/motivation. I found an interesting study that used modafinil as an add-on treatment for depressed patients...


"...The analysis revealed that modafinil improved the severity of depression as well as remission rates. Modafinil also showed beneficial effects on fatigue and sleepiness, with the added benefit of the comparable side effects to placebo."


Very clean profile, safe, effective; adrafinil can even be purchased over the counter...just a thought if ever you're interested. I'm quite jealous of your Parnate-Adderal combo, by the way. Do keep us updated with your progress. :)
 

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Discussion Starter · #10 ·
They have done studies specifically on modafinil combined with MAOI (I think phenelzine) and found beneficial. Modafinil has the advantage of having less effect on blood pressure and is only a schedule-IV substance in the U.S. I haven't taken it with Parnate but it is actually what I had asked for.

The doc suggested Adderall instead, so I decided to shut the hell up and let him be the expert. :)

Modafinil is an enzyme inducer, not sure on adrafinil. You'd need to check interactions.
 

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Caedmon how is the musclefatuige? I get it on Parnate if say i hanging laundry, a feeling of Lacticacid in my shoulders. Could be BP though...
Does adderal help with this?
 

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I am now taking an unusual medication combo that I think will help out a lot. I thought I would do a mini journal of experiences.

Combining MAOIs (which are rarely used to begin with) with stimulants is not common. They are officially contraindicated because of a risk of increased blood pressure and dangerous hypertension. However, I am convinced that they can be safely combined and can constitute an extremely powerful antidepressant combination where other treatments fail.

Some background. I suffer from social anxiety, depression (mild bipolarity around the edges), panic disorder, generalized anxiety, and an assortment of oddities too numerous to list.

As of 04/05/2014 I am on:
  • Parnate (tranylcypromine) 90 mg. MAOI type antidepressant/anxiolytic
  • Lamictal (lamotrigine) 300 mg. Mood stabilizer and antidepressant booster
  • Cytomel (liothyronine) 50 mcg - Thyroid medication used as antidepressant booster
  • Xanax (alprazolam) .5 mg. Benzodiazepine as needed for anxiety/panic
Also:
  • Bunches of supplements (vitamin D, Align probiotic, multivitamin, fish oil, methylfolate, B12).
  • Caffeine, in coffee, soda, and pill form. I would estimate ~ 600-800 mg/day. I've built up a lot of tolerance.
Now adding:
  • Adderall (amphetamines) 20 mg/day. Immediate release version. Stimulant
Wish me luck!
Good luck!, Caedmon.

How's the Lamictal, Does it help with oxidative stress induced by the stimulant and Parnate ?

Does the Lamictal help with muscle wear and tear and improves endurances/stress?

And

Mentally does it provide an uplifting mood?
 

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Caedmon. The methylfolate is intressting though, assuming it didn't help fully, henche the Adderal..
Did it help a little?

Tried 5-MTHF but only like 3mg/ day for 2 weeks, but thats to low a dose.
Thinking about buying some of the brand name Deplin. Or something equall

Prof Stahl take on methylfolate.
http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1267
 

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Discussion Starter · #14 ·
Caedmon. The methylfolate is intressting though, assuming it didn't help fully, henche the Adderal..Did it help a little?
Thanks for that link! It looks like Stahl is on board with the astronomical doses that are in Deplin. I haven't tried that option. Pricey!

I'm not sure how much my current use of methylfolate is helping. It probably doesn't hurt, and might prevent some problems.

Lamictal has some sort of folate interfering properties. I take the methylfolate kind under the assumption that perhaps it not only makes up the difference, but perhaps there is additional availability to my lil brain. I take "Active B12 Lozenge With L-5-MTHF" by Seeking Health Link: http://amzn.com/B00822JNTC 2 per day which is 1600 mcg folate.
 

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It's from 2007 though, but i have his latest book from mid 2013 and he somewhat writes the same.


But yeah the whole "methylation" thing is... Something i don't have the energy to read up on... But Methyl-Cobalamin(B-12) and such plays roles. Endocrinology...;)
 

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Discussion Starter · #16 ·
Caedmon how is the musclefatuige? I get it on Parnate if say i hanging laundry, a feeling of Lacticacid in my shoulders. Could be BP though...
I haven't really paid attention, I will though. I hurt my left knee a few days ago so I have not done much physical activity while it repairs itself.
 

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I haven't really paid attention, I will though. I hurt my left knee a few days ago so I have not done much physical activity while it repairs itself.
But that could take weeks!!! :eek:....:D
 

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Discussion Starter · #18 ·
Good luck!, Caedmon.

How's the Lamictal, Does it help with oxidative stress induced by the stimulant and Parnate ?

Does the Lamictal help with muscle wear and tear and improves endurances/stress?

And

Mentally does it provide an uplifting mood?
On the first two, I'm not sure. On the third question, it does. I forget that it does until I go without it. There is a very distinct mood boost when starting it and each time increasing the dose, at least for me. It seems to have some stimulating qualities. Over time that feeling diminishes but it prevents depression from "sticking" too much.

Think of it as like Teflon coating, and your mood as a frying pan. (oh boy) Keeps bad moments from "sticking" and threatening a relapse. Even when the acute benefits are gone, there is an underlying non-stick quality to it so that you can have 3 really ****ty days but the fourth day can be okay. Hope that makes sense. My guess is this is the antiglutamate property, which prevents overactivation from stress and downstream brain atrophy that can lead to depression. I'm talking out of my butt though, I'm not really sure.
 

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Vitamine C and E works against Oxidative stress... Im assuming that Parnate that has stimulating properties and liklyness to AMPH also can cause this.
 

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Discussion Starter · #20 ·
I thought MAOIs are actually neuroprotective, since they are inhibiting an oxidation enzyme. I might be confused though.

04/10/2014

I tried scaling back on caffeine. I only took 200 mg today + 17.5 mg amph. But by 2:00 I was tired again, yawning, falling asleep, and I could feel some hypotension. I got a really solid 8 hours of sleep last night so I don't think that was it. I think the balance was low. I need more of one or the other. Headaches are gone now though. At home, blood pressure 109/71

Mood was just fine. I noticed behaviorally, some things come easier. It's easier not to binge my flippin' face out in fritos and candy. I've stuck to my diet pretty well. It's also easier to let things go... things that would annoy me, something that would cause me to hold a grudge, I can let go. I have a much more animated affect, less blunted and weak.

My knee is still healing. Frustrating that I had built my way up in exercise to where i could run for 2 miles, now I'm socked and I haven't jogged in a week. Today I walked for 15 minutes on the treadmill and then it twinged. The exercise pre-dates taking amphetamine. I think it's just the longer days and warmer weather.

Motivation - very improved
Agoraphobic patterns - about the same, can't wait to hide
Irritability - better, because I can let arguments go
Anxiety - so-so, kind of generally amorphously anxious
Tiredness - much improved
Sociability - louder voice and more animation, but hyper-introverted as always

MAOI-induced fatigue - a little better. I can still feel the afternoon nap trying to take me down. Unfortunately the nap sensation kicks in around when the amph. levels are decreasing.
MAOI-induced hypotension - helps normalize it. I'm titrating off caffeine, and it's all balancing out.

Not a problem in sight in terms of hypertension. I think I've cleared that hurdle.
 
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