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SSRI + amphetamine / methylphenidate potentiation? combinations? memantine?

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tenshu2k

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Quick Background:
Therapeutic user. Formerly abused alcohol + mdma. Diagnosed with anxiety, some social anxiety, stammering speech, brain fog. Started SSRI last year (escitalopram) + lorazepam for sleep.
Recently underwent IQ testing: (high verbal iq, average performance iq). Decided to explore stimulants with a possible atypical ADD diagnosis. Would like to get off SSRI, unhappy with weight gain and lack of motivation/energy.

I seem to respond well to stimulants, started methylphenidate and I've taken amphetamine in the past.

What combination that is least anxiety inducing? I'm looking for some anecdotal evidence or articles to support.

Also, what is the effect of SSRI's on other amphetamines, not just methylphenidate. Do they generally blunt the effects, potentiate, or no effect? Would a NDRI be better in combination?

Any information about memantine usage to reduce tolerance?

Articles:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921647/ SSRI antidepressants potentiate methylphenidate (Ritalin)-induced gene regulation in the adolescent striatum
http://www.springerlink.com/content/r26808kqrqk08318/ The mixed amphetamine salt extended release (Adderall XR, Max-XR) as an adjunctive to SSRIS or SNRIS in the treatment of adult ADHD patients with comorbid partially responsive generalized anxiety: an open-label study


Thanks!
 
A little input i can offer is about ssri+amphetamines.

Amphetamines actually potentiate SSRI's. studies have shown the adderall boosts the plasma levels of nearly every ssri. Prozac being the most effected at a 22-30% increase.

From personal experience with extensive amphetamine use as well as various ssri's and snri's, i can say that Adderall to me felt much stronger while on prozac. When i was taking prozac adderall would feel great. huge boost of mood and confidence. When i got off prozac it wasnt the same. I began taking nearly double the dose to get similar effects.

While on effexor (SNRI) amphetamines seemed to be unaffected. I noticed no difference from when i wasn't on an antidepressant/anxiety

I also was on wellbutrin a few years ago. Speculation has it that wellbutrin and adderall have synergenic effects. I can tell you that was not the case for me. Wellbutrin blunted the effects of amphetamines greatly for me. it was rather strange. I believe that wellbutrin creates competition over receptor sites and in turn lowers the amount of amphetamine able to be active
 
Have you examined diet and excercise? Do you get cardio done? Regular excercise and eating right does a whole lot to alleviate brain fog and other ADD symptoms. And it's non anxiogenic!

Methylphenidate is pretty tame as stimulants go. Most people prefer the pure isomer (Focalin) over racemic (Ritalin) claiming it is less jittery and anxiogenic. Some people don't find it anxiogenic at all. Maybe it's dose. Don't expect it to be the same re: potentiation as amphetamine - methylphenidate does not have the same actions as amphetamines, it is closer to cocaine/MDPV as it is a NDRI.

You may want to examine 150-200mg caffeine daily as a stimulant 4-5 days a week, it is underrated IMO.
 
sekio said:
Have you examined diet and excercise? Do you get cardio done? Regular excercise and eating right does a whole lot to alleviate brain fog and other ADD symptoms. And it's non anxiogenic!

Methylphenidate is pretty tame as stimulants go. Most people prefer the pure isomer (Focalin) over racemic (Ritalin) claiming it is less jittery and anxiogenic. Some people don't find it anxiogenic at all. Maybe it's dose. Don't expect it to be the same re: potentiation as amphetamine - methylphenidate does not have the same actions as amphetamines, it is closer to cocaine/MDPV as it is a NDRI.

You may want to examine 150-200mg caffeine daily as a stimulant 4-5 days a week, it is underrated IMO.
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Try to keep clean on diet and regular exercise, as well as proper nutritional supplementation.

The caffeine+methylphenidate combo has been good so far, but slightly jittery.
 
Personally i would think about a different rout all together. This is just an opinion on my part and im not judging you in any way on your decision.

I feel that methylphenidate is a very temporary fix to a problem that in the end may become worse due to long time use of stimulant drugs.
The kind of anxiety you mention often responds well to stimulant meds. Increase of dopamine leads to increase of mood (more importantly a sense of confidence), brain clarity, and energy. SSRI's help with more of the generalized anxiety such as racing thoughts, constant worry, obsessing ect..

unfortunately the body responds to stimulant meds by metabolizing affected nurons in the synapse much more efficiently, thus leading to tolerance and the need for higher doses. you can only keep increasing doses for so long.

I would look into Wellbutrin. Wellbutrin is an NDRi (norepinephrine dopamine reuptake inhibitor) It acts as a weak stimulant without any recreational or addictive properties. Its similar to other antidepressant meds where it takes time to build up and become effective, but will lead to more sustainable effects. Its shown to work well for social anxiety and depression. It also has been show to work for ADD/ADHD, helping with clarity, concentration, and motivation similar to amphetamines.

I can really relate to how your feeling. I was on SSRI's for years and i really was unhappy with it. They caused me to feel heavy in the head, or brain fog. It hurt my concentration and motivation greatly. I really began to not really give a shit, thats when i began to use amphetamines. They worked for awhile but in the end left me with more problems. I believe they are also responsible for my greatly worsened depression by way of dopamine depletion.
 
Methylphenidate is much less destructive than amphetamine wrt brain chemistry. It too is a NDRI just like Wellbutrin, though Wellbutrin also shows strange effects at some nicotinic acetylcholine receptors (MPH does not) - I'm not sure I like that very much.
 
sekio said:
Methylphenidate is much less destructive than amphetamine wrt brain chemistry. It too is a NDRI just like Wellbutrin, though Wellbutrin also shows strange effects at some nicotinic acetylcholine receptors (MPH does not) - I'm not sure I like that very much.
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You are correct, but methylphendate is shown to cause tolerance over time. I know compared to amphetamines its much less "extreme" I just feel that down the road, be it a year or five years, it could worsen things.
As i said before its just my opinion, and i can certainly see the logic behind the op's current regimen. Maybe im just focusing to hard on what could happen, not what is happening
 
Not to be argumentative, but even caffeine is shown to cause tolerance and withdrawal that can be incredibly hellish to go through.

I expect any long-term stimulant use is probably not good for your psyche.
 
Even in small doeses, I personally wouldn't mix pharm grade SSRI's with amps. Seratonin syndrome is a bitch.
 
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Serotonin syndrome is a bitch indeed. I was in the hospital once for it. Back when i was ignorant about pharmacology and researching... i was given a large amount of dxm while on prozac. My friends said i was just having a panic attack. it was a very uncomfortable experience. I went from feeling like i was naked in a snow storm to being in a sleeping bag in the blazing sun.
 
Cloroxtastebad said:
Serotonin syndrome is a bitch indeed. I was in the hospital once for it. Back when i was ignorant about pharmacology and researching... i was given a large amount of dxm while on prozac. My friends said i was just having a panic attack. it was a very uncomfortable experience. I went from feeling like i was naked in a snow storm to being in a sleeping bag in the blazing sun.
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What was your temp up to? Hyperpyrexia starts at 104*, and once you cross that point things to to hell in a handbasket pretty quick.
 
Fairly sure if your friends think you're having a panic attack, they're not going to be equipped with a thermometer.

That said - the human body is amazingly resilient. Many people have suffered through serotonin syndrome and lived - although every single one of them will tell you it was hell. It's generally the massive overdoses (Pethidine and MAOIs) or chronically mismanaged cases (where kids cook themselves or otherwise go totally psycho) that are deadly.
 
RR279 said:
What was your temp up to? Hyperpyrexia starts at 104*, and once you cross that point things to to hell in a handbasket pretty quick.
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When I arrived at the hospital my temperature was 103.8 I believe. My blood pressure was through the roof with short periods of hypotension. I'm not sure what my maximum temp was, at the time I was delerius and experienceing full blown hallucinations.

This back in my 10th grade of high schoool
 
I'm assuming the risk for serotonin syndrome is pretty low with methylphenidate + ssri (at normal dosages), considering I was given the prescription by my physician. I also can't see any information suggesting that there is an interaction.
 
tenshu2k said:
I'm assuming the risk for serotonin syndrome is pretty low with methylphenidate + ssri (at normal dosages), considering I was given the prescription by my physician. I also can't see any information suggesting that there is an interaction.
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I would not worry about that one bit. Even an ssri and prescribed amphetamines such as dexamphetamine, lisdeamphetamine, and amphetamine have little to no risk associated with serotonin syndrome. Its when you begin to mix Stims with serogenic activity that a problem can occur. Those stims being street drugs for the most part.
 
Cloroxtastebad said:
I would not worry about that one bit. Even an ssri and prescribed amphetamines such as dexamphetamine, lisdeamphetamine, and amphetamine have little to no risk associated with serotonin syndrome. Its when you begin to mix Stims with serogenic activity that a problem can occur. Those stims being street drugs for the most part.
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So, Desoxyn would be one I'm guessing?
 
Dysphoric said:
So, Desoxyn would be one I'm guessing?
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Correct. I would avoid desoxyn and ssri's

Because of methamphetamines more prominent effect on monoamine oxidase it causes 5HT transportation to reverse, which leads to large quantities of serotonin being released in the synaps. Combine those effects with an ssri can certainly lead too serotonin syndrome.
 
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I've combined Adderall with memantine, and noticed little effect. Aricept and amphetamine, however, is superb.... it's like taking rocket fuel. It potentiates one another so much, though, I would get anxious at 10mg-- I just took 5mg of Aricept, which is the starting dose. It takes about 3 months to fully kick in, but when it does, you feel awesome-- thoughts are effortless, fast, and mood is elevated somewhat. You feel like you want to take over the world. It's very under-rated. Try it. There's all sorts of studies for the adjunct use of aricept for executive dysfunction associated with AD/HD, and cognitive impairment (which can be residual cognitive impairment from depression, or drugs).

It also reduces craving of amphetamine in drug abuse studies.
 
any amphetamine does that when combined with an SSRI. I've taken Desoxyn with SSRIs before... someone's either prone to serotonin syndrome, which can be triggered by a lot of things, or they're not. If someone has a history of combining a stimulant like Ritalin or Adderall with an SSRI, they're fine. I would advise against a short-acting stimulant, and suggest something liek Vyvanse instead. Vyvanse is less likely to abuse, because it gets you off the mindset of taking a drug around a given task, which can lead to abuse (by escalating a dose according to the nature of the task's importance, or tediousness, etc).
 
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