Stimulants Ritalin with Adderall, possible serotonin syndrome?

[pablo8732]

I am a student and during exam periods (not throughout the year) i often use adderall or amphetamine sulphate as a study aid. ive never had any problems with it (aside from difficulty to sleep) since i first started a few years back. yesterday as normal, i had my adderall at 12, then had a little bit more around 3-4 (quite normal), then towards the end of the day, around 7-8 i thought i needed a boost and had a ritalin pill 10mg. about 20mins after taking the ritalin i didnt feel very well, i felt lethargic rather than energetic and a bit restless, i couldnt be bothered studying. it was almost like that tiredness feeling on the comedown of ritalin. i gave up with studies and just tried to relax then, didnt feel quite normal till around 1 or 2. when i had some weed and a zopiclone to sleep.

Ithis was quite a shock, as i had tried this combo in the same way a few times prior (including the day before this incident) with no issues, and it gave me an amazing boost, great focus. the previous times i had done this combo i had used more Ritalin too. so i was surprised of the adverse reaction. i usually have a very high tolerance and 10mg of ritalin on its own wont affect me much.

Googling the topic for a bit led me to some discussions that it might be serotonin syndrome. but a lot of the discussions focused on the use of amphetamines with SSRIs or antidepressants, rather than ritalin.

Can anyone shed some light on this and see if this would be likely, and what can be done about it? Im starting my exams from next week so would ideally like to continue the adderall, although without the ritalin.

 

[Ozle]

Neither amphetamine nor Ritalin should have much of an effect on serotonin in theory. Perhaps you're just feeling burnt out from overusing stims?

 

[Scevola]

I did the same before. After some time anxiety came because of my use of Speed to study. Before I could take 150 mg speed at once and feel fine, now even 20 mg street speed can leave me anxious and ill.

To check if this is a serotonin syndrome, you could check your pupils (huge with a SS) and most importantly your temperature. Sometimes it's just anxiety and checking for symptoms of SS calms me.
If you feel horrible, panic attacks and high temperature, go see a friend to be sure it's nothing serious. Then someone can help you if things go wrong.

Like Ozle said I don't see how you could have a SS with Ritalin or Adderall, only if you take antidepressants at the same time.

When I don't use stims for at least a week (even caffeine gives me anxiety now) I feel so much better with a lot of energy! So you could try lowering the dose too.

 

[Xzbtya]

Ritalin has some very weak affinity for 5HT(Serotonin)-1A receptor and acts as an agonist there. I believe it is in the high micromolar to millimolar range meaning that it is unlikely leading to any spikes in serotonin levels unless you're taking almost lethal doses of ritalin. Other than that it is blocking the reuptake of dopamine and norepinephrine similarly to amphetamine but without the releasing action of amphetamine. It's more likely you're dumping too many stimulants into your system over a short span of time and you're burning yourself out. Your brain probably needs some time to rest and recover.

Serotonin syndrome will usually includes a fever, dilated pupils, diarrhea, anxiety, elevated heart rate and nausea. There is definitely some overlap there with stimulant overdose as well but SS usually requires hospitalization and administration of serotonin antagonists and benzos. I would refrain from combining the two in general and take less of one or the other when you really need it. I know just from having a script for both at different times that I personally easily burn out after consecutive days or higher doses of taking either and on some days the effects can be dysphoric and anxiogenic. Make sure you're eating enough as well.

 

[pablo8732]

Ritalin has some very weak affinity for 5HT(Serotonin)-1A receptor and acts as an agonist there. I believe it is in the high micromolar to millimolar range meaning that it is unlikely leading to any spikes in serotonin levels unless you're taking almost lethal doses of ritalin. Other than that it is blocking the reuptake of dopamine and norepinephrine similarly to amphetamine but without the releasing action of amphetamine. It's more likely you're dumping too many stimulants into your system over a short span of time and you're burning yourself out. Your brain probably needs some time to rest and recover.

Serotonin syndrome will usually includes a fever, dilated pupils, diarrhea, anxiety, elevated heart rate and nausea. There is definitely some overlap there with stimulant overdose as well but SS usually requires hospitalization and administration of serotonin antagonists and benzos. I would refrain from combining the two in general and take less of one or the other when you really need it. I know just from having a script for both at different times that I personally easily burn out after consecutive days or higher doses of taking either and on some days the effects can be dysphoric and anxiogenic. Make sure you're eating enough as well.

Thanks for the advice guys, pleased to hear that it isn’t SS.

Today I had some Adderall in the morning too (not the wisest decision), felt fine at first, but when I had some more, I started getting symptoms such as slight nausea, confusion and dazedness, confusion, but they went away after a few hours and it was like normal Adderall again. It could very likely be overuse of Adderall/amphetamine but I have a bit of predicament as I have 2 exams on Monday and would like to take some Adderall prior to the exam as a little booster. Do you guys think I would be okay if I have Sunday off but use on Monday for exam? Also, would Ritalin be less likely to cause problems than Adderall in this regard?

 

[Xzbtya]

I can only speak for myself but I found that many times taking stimulants before a test would either lead to the confusion you described. This might be because if I take my prescription while I'm anxious it seems to lead to over focusing on one problem or making stupid mistakes. That or if I'm clear headed it sometimes leads to quick decision making it skipping reading entire questions because of that little confidence boost they give you, making me think I did much better than I actually did. I found this was the case more so with adderall than with focalin (ritalin's more active isomer). I find them excellent for performing tasks which require a stream of consciousness without interruption like writing an essay or cranking out figures for a paper or number crunching. Tests, not so much. I'd recommend a solid night's sleep before and a small dose to wake you up if you really need it or have something caffeinated instead.

 

[pablo8732]

I can only speak for myself but I found that many times taking stimulants before a test would either lead to the confusion you described. This might be because if I take my prescription while I'm anxious it seems to lead to over focusing on one problem or making stupid mistakes. That or if I'm clear headed it sometimes leads to quick decision making it skipping reading entire questions because of that little confidence boost they give you, making me think I did much better than I actually did. I found this was the case more so with adderall than with focalin (ritalin's more active isomer). I find them excellent for performing tasks which require a stream of consciousness without interruption like writing an essay or cranking out figures for a paper or number crunching. Tests, not so much. I'd recommend a solid night's sleep before and a small dose to wake you up if you really need it or have something caffeinated instead.

I completely understand what you are saying, but in previous years when I’ve studied using Adderall or Ritalin I have also taken an exam with them, and I’m concerned that if I do the exam sober, I wouldn’t be able to perform as well. But your post is quite reassuring, seeing as you avoid stimulants during the exam on purpose. Maybe I will try that this time . cheers

 

[Ksa]

At this point, asking if you got into Serotonin Syndrome is like getting from New York to New Jersey and asking if you're in Los Angeles yet.

 

[sekio]

Overdose of stimulants that release norepinephrine/adrenaline/dopamine is more technically "hypertensive crisis" and not "serotonin syndrome". Neither amphetamine nor methylphenidate release significant amounts of 5htp.

 

[Ksa]

Overdose of stimulants that release norepinephrine/adrenaline/dopamine is more technically "hypertensive crisis" and not "serotonin syndrome". Neither amphetamine nor methylphenidate release significant amounts of 5htp.

Yep that's why I always have clonidine along with Dexedrine under the mortar in the last 5 years, amphetamines have the bad habit of releasing what you wouldn't want them to release.

Nice squirrel you got there, giddy giddy squirrly