Sick from stimulants, please help.

[crekkora]

I'm posting this on BL because I think this crowd probably has more experience with long-term high dose stimulant use than the average psych forum. I don't even know if this is "allowed" because technically there's nothing illicit/recreational about my problem, but I'm really desperate for advice from people who aren't just going to say "u shouldn't have let ur T put u on stimulants in the first place" or whatever. I did my best to read all the rules of this forum and subforum and I hope this post is okay here. Let me know if not, please. I know this issue is kind of minor next to say, opiate wds, but it's fucking up my life in a serious way.

Point form!

- About two years ago, I was started on stimulants for depression of the lethargic variety in hopes that it would give me more energy and augment the effects of my antidepressant (Pristiq).
- I was on 70 mg Vyvanse and 20 mg Ritalin for most of that time, and was doing great until a couple of months ago, when I suddenly started feeling very ill (shaky, nauseous, exhausted) a couple hours after taking the Vyvanse in the morning (the Ritalin was for the evenings).
- I cut down on the Vyvanse, which didn't help, so I cut it out completely and replaced it with smallish doses of Ritalin (10-20 mg) every few hours. That worked for a few days, but then I started getting sick again, so my psychiatrist recommended I try to quit stimulants or at least take a drug holiday.
- I spent about five days tapering down and then finally taking nothing for two days, and spent those last days lying in bed feeling paranoid and nearly suicidal.
- Because I had a lot of crap to do for work/school (I'm a grad student), I had to give up, which I hated because I had been pumped about quitting and getting back some control over myself.
- After another brief stint with Ritalin my psychiatrist put me on 60 mg Adderall ER last week (30mg in am and afternoon).
- That also worked for a couple of days, but now I'm back to feeling horrible - tired, nauseous, weak, irritable/nasty, crying a lot, hating myself/everyone. I tried halving my dosage for a couple of days (15mg/2x/day) and felt pretty much the same.
- In case it matters, I am 24 yrs old, 5'7", 118 lbs, vegan (before you ask, blood tests came back normal).

--tl;dr--

I was doing fine on stimulant rx for nearly two years. Then I started getting sick from them for no apparent reason. But I get even more sick without them.

--

I just don't know what I'm doing wrong. Am I taking too much? Too little? Too consistently? Too inconsistently? How long will it actually take to feel somewhat normal (my psychiatrist told me two days... ) if I stop taking them?

I am so fucking frustrated. My psychiatrist is awesome, but he can't explain what's going on with me and I think he suspects I'm lying/exaggerating (I probably would if I were him, because why would I suddenly get sick after being fine for two years?). I can barely function and my life isn't even very demanding right now - but my responsibilities (I'm in the mental health field) are still very important to me and my patients. I don't need to feel awesome, I just need to feel like I'm not going to break down in some way at any moment.

Thank you so much for any help.

 

[piebald]

i can only speak to my experience with being prescribed stimulants but to me those doses sound pretty high..10-20 mg of ritalin is a low daily dose maybe..but you were told to take it every few hours? 60 mg of adderrall also seems pretty high to me. and did you say 70mg of vyvanse WITH 20 mg of ritalin?? to me all of those seem VERY high (just speaking from experience..just my opinion) Were these the doses you were being prescribed or were you taking more than you should have? most of the starting doses for those drugs are like 20-30 mgs/day (i think?)
also a "drug holiday" should be more than 5 days..i have no idea what your health issues could be but its certainly possible that it could have something to do with the drugs..those seem like BIG doses for someone whos 118 pounds.

 

[crekkora]

^^ I wasn't told to; I was trying to replace the Vyvanse. It ended up being about 40-70mg per day spread out, but my psych didn't seem alarmed by it. But yeah, it does seem like a lot. It's just weird that it only started affecting me after two years. Or maybe not weird?

I guess I should also have mentioned that I know you guys aren't doctors. I'm just looking for any kind of support/advice/starting point for fixing this.

 

[piebald]

idk that just seems like alot of stimulants for someone your size and you should def listen to your body. it is normal to have some discomfort/depression etc upon stopping and you can have some rebound symptoms but they shouldnt last to long or be to bad..you have to give yourself more than a few days to adjust...it took me months to feel like i could be productive and "normal"after ending stimulants. maybe you should explore some other non stimulant options or talk to another doctor about whats going on? i just think those are high doses, i could be wrong but to me it sounds like alot..and that absolutely would make you feel sick!

 

[Dave]

I think that this would do far better in OD. I'll send it there presently.

 

[Znegative]

Prescribed or not, stimulants are going to cause a crash upon quitting, which includes all the symptoms you mentioned, lethargy, depression, paranoia and anxiety.

You might consider Modafinil, it's a stimulant, but is actually used as an 'awakening-agent'. I find it to be much smoother compared to the amphetamines and ritalin.

 

[strigoi]

I know you said you like your psych, but does he spend therapy time with you? The first point you made was that the stimulants were to combat lethargic depression, so you are taking them to deal with side effects. I would think he would have approached this with the idea you would only be on the stimulants for a short time, and two years is not a short time.

I would make sure he is spending most of his energy trying to fix the problem and not just deal with the side effects. I am passionate about this because I had a doctor that did the same with me. I went in with a complaint, he gave me pills, those pills gave me side effects and he gave me more pills and on and on.

So far it seems to me the only difference between now and when you started seeing this doc is that you now have a drug addiction and are having a rough time trying to cut back. If he was making progress toward your recovery from depression he would have started lowering your stimulant doses long ago.

Maybe it's me, but prescribing stimulants for depression is just reckless. As someone else said, modafil would have been a more responsible choice (on the docs part)

 

[Titus]

Wish I could provide specific info that would address your med questions. Hope you find relief soon. I too work in the field and also see a psychiatrist (or have in the past and do off and on) and have taken various meds but not stims. A recent prescriber talked about possibly putting me on one but I have a documented hx with alcohol abuse so have found that most all dr's use rule of thumb in not prescribing me any addictive meds regardless of need or appropriateness or recommendations from specialists. So my feedback can't come from a place with specific knowledge about stims prescribed but I'd like to provide some input that I hope is helpful in some way.

I went through a similar experience in that I had a drastic change in my mental and emotional stability although it wasn't related to specific stim(s) prescribed/changed/etc. It seems like you have a lot on your plate being a grad student and also holding down a job. That's a lot of pressure in and of itself. Throw in problems with meds with fast onset to boot and that's a lot to have on your plate!

Also, everyone here is an individual. Your having problems and I don't think you should worry that your problems may seem less severe than someone else's like someone w/d'ing from opiates. IMO no one is any more or less deserving of help here than the next person.

And are you certain that the issue is with the stim you were on and cut back the dosage of? You would know best, but have you considered that the issue may be more complex? (not implying that it is just asking in case you have not considered this at all, better safe than sorry is one of the ways I approach life/problems- for good or bad so just asking so that all bases are covered).
Questions related to that: How long have you been on the anti-d before starting with a stim?
Also: Was the idea the psych's or did it come from your suggestion after complaining of the lethargy? Reason I ask is maybe a specific stim in addition to the anti-d your on isn't the best overall approach for you from a psycho-pharm tx approach. Has your dr discussed with you other possible approaches besides keeping the original anti-d and using a stim (or not) as a 2nd med as the only option psycho-pharmacologically? If other options have not been considered, maybe at some point it could be worthwhile to have that discussion. This should have all ran through your dr's mind when you first presented with the new prob, and should be happening ongoing and may be obvious to all but this is the reaons I asked about what drove the addition of the stim to the anti-d initially.

I hope that others have knowledge/info to share with you around the specific med's your asking aobut as I do not. My advice is more general. Try your best to be patient. Seems like you do a great job with self-awareness of your issues and the way your meds are impacting you so I'm sure you communicate all that to your psych. I really wish I could be more helpful, you have a lot on your plate and when psych's start making med adjustments it usually takes time to sort out.
Peace

 

[tricomb]

Prescribed or not, stimulants are going to cause a crash upon quitting, which includes all the symptoms you mentioned, lethargy, depression, paranoia and anxiety.

You might consider Modafinil, it's a stimulant, but is actually used as an 'awakening-agent'. I find it to be much smoother compared to the amphetamines and ritalin.

Excellent post. modafinil is great for it's purposes.

@OP, I am really sorry you're going through this hard time. I think you should slowly but steadily taper off your amphetamines.

 

[ScreamingButterfly]

I think everyone here has made good suggestions. I was wondering if you had been taking your medicine on an empty or full stomach? I've heard of people eating before they take their medicine to reduce upset stomach and the feeling of being jittery. In my opinion at least for me my medicine works better on an empty stomach but I know some people do get horrible nausea without eating anything. I really do hope you find something that works for you. I do have to kindly disagree with the person who said stimulants aren't good for depression. I don't believe everyone with depression should be on stimulants, if you can find something else that does work. I had very treatment resistant depression and the stimulant was one of the very few things that worked, in fact anti depressants didn't at all after years of trying. For treatment resistant depression I believe it should be an option. So to the OP if you do have a good psychiatrist maybe ask him about what other stimulant medicine is available that you haven't tried like the others have said. I wish you the best!

 

[crekkora]

i just think those are high doses, i could be wrong but to me it sounds like alot..and that absolutely would make you feel sick!

Thanks, maybe it's just that, my body is telling me to stop. Hmph.

I think that this would do far better in OD. I'll send it there presently.

Thanks. I didn't mean to be melodramatic by putting this in TDS, I just thought personal-type questions were against the OD rules.

I know you said you like your psych, but does he spend therapy time with you?

....


So far it seems to me the only difference between now and when you started seeing this doc is that you now have a drug addiction and are having a rough time trying to cut back. If he was making progress toward your recovery from depression he would have started lowering your stimulant doses long ago.

He's actually been my therapist as well, and probably the best one I've ever seen. The stimulants weren't prescribed until I'd been seeing him for a couple of years (so he knew me/my symptoms pretty well). And they worked amazingly well until all of a sudden they didn't.

And are you certain that the issue is with the stim you were on and cut back the dosage of?

I think so. I've been on all of them at varying doses, and the dosage doesn't seem to matter anymore. Grr.

Questions related to that: How long have you been on the anti-d before starting with a stim?

I started Pristiq concurrently with the first stimulant rx two years ago. We had tried a few before that which weren't having much effect and giving me nasty side effects. I guess I should also have mentioned that I'm on a small dose of an antipsychotic (Zyprexa) which was given to me around the same time also, and I know that helped a lot in itself.

Also: Was the idea the psych's or did it come from your suggestion after complaining of the lethargy?

Thanks so mcuh for all of your advice/empathy! It was his suggestion - unfortunately I had no idea stimulants could lead to these kinds of problems, and I don't think my T has really seen them with anyone else, either.

@OP, I am really sorry you're going through this hard time. I think you should slowly but steadily taper off your amphetamines.

Thank you. I guess I should - it's just hard, because I figure if the stims are making me sick regardless, I might as well go cold-turkey, but that doesn't work too well.

I think everyone here has made good suggestions. I was wondering if you had been taking your medicine on an empty or full stomach?

...

I do have to kindly disagree with the person who said stimulants aren't good for depression.

Eh, empty, full... it varies! Maybe I should try to be more consistent?

Also I agree with you re. stimulants for depression. I had all kinds of other treatment, including a stay at a really nice residential center after spending 3 days in the ICU after an intentional OD/suicide attempt, and transcranial magnetic stimulation which was also a fortune, and stimulants were really the only thing that worked for me (until now obviously). I guess I'm also reluctant to stop stimulants entirely because it was so incredible to get up in the morning and (after taking my pill) actually have some desire to talk to people and leave my apartment. But at this point I'd rather be depressed than completely non-functional physically. Kind of a shitty prospect, though, but I recognize that getting off them is probably the responsible decision at this point.

 

[Titus]

Prescribing stims or other drugs, there is always a trade off. All have side effects. Mostly, as patients we are content while the drugs are working for us and then mal-content when they are not (be that becuase of side's or w/ever).

Maybe a broader approach than just trying to fix the stim or no stim or which dose of which stim should be taken. Maybe a fresh medicatioin review taking a comprehensive look at your current life issues and symptoms. Maybe dumping all the meds ur on now and adding 1 then another anti-d is going to provide you with the best psycho-pharm help.

Just pointing out that a fresh look might help- without assuming that the prior approach was the correct one. Whether your current dr does that or one of their co-workers, or both.... it might help. So you see this dr for more than 15min med mgmt appt's that are typical of psych's in the usa? This can be good and bad. Having a separate person as a talk therapist brings in a fresh perspective getting to know the 'real you' while the psycho-pharm prescriber can look at you as a brain that has a body attached and is making it behave certain ways and figuring out which meds will help it behave better.....

 

[ixy]

Were you maybe taking some other medication, that you stopped taking when you started feeling sick? If you can't figure out what the problem is, like other ppl have said, you shot probably stop taking that stuff. You could try tapering down slower than over 5 days, like drag it out for a few weeks or so, maybe even longer. I don't have experience doing this with stims, but i know that with other drugs, they usually have u taper down really slow, like sometimes it's months depending on your dose and the drug. I would talk to your dr about it, tell him it was too unpleasant last time and maybe he can tell you a better way to do it.
If your really having a hard time, you could see if there's a way to get medical leave from school for a semester or something. your health should come first, you can always go back to school. Plus if you feel like shit, I imagine your work is gonna suffer, at least mine would.