Is there a such thing as using two stimulants for therapy? Adderall helps me and so does Concerta. Do doctors ever combine the two? Are the health risks high? Why hasn't something like this been done?

I want to ask my doctor about it but if it really worked, I guess it would have been brought up.:confused:

Yeah and a few people here on the board combine stimulants like Dexedrine and Ritalin. I think any kind of combo treatment would probably work best over a single med treatment.

J

It depends on the doctor and the scary part is that some will refuse to prescribe them if you even ask so I guess it's hard to advise

It's not as uncommon as you might think.

Under my Dr's approval I have taken combinations of Desoxyn & Ritalin, Desoxyn & Focalin, Dexedrine & Ritalin, and Dexedrine & Focalin. The advantage of taking an amphetamine with a dose of methylphenidate (or dexmethylphenidate) is that it can allow for a lower effective dose of each drug due to the "synergistic" potential of the two drugs.

For example, Dexedrine is a potent dopamine agonist, which means that it improves the activity of dopamine. Ritalin on the other hand is believed to be a dopamine reuptake inhibitor, which means that it prevents the reuptake of dopamine from the dopamine saturated synaptic clefts. By combining these two drugs together I was able to take an overall lower dose due to the fact that the methylphanidate was actually preventing the reuptake of the dopamine that the amphetamine had directly or indirectly activated.

How much do they combine? Should I call my doctor and ask? Thanks.

What you are talking about is "off label prescribing".

It seems to be done more by sub-specialists.

From what I hear -- it is most often done by ADHD Specialists (psychiatrists) and Psychopharmacologists. http://www.pni.org/psychopharmacology/

(The latter specialise in complicated psychiatric drug regimens. e.g. giving Thyroid or Ritalin to people with chronic treatment-resistant Depression.

A scenario might be one where someone is having really vegetative Sx ['psychomotor retardation', hypersomnia, etc] and just CANNOT get out of bed, etc. You would see these folks at a long-term care "mood disorders ward" of a Provincial or State Hospital.)

http://en.wikipedia.org/wiki/Psychomotor_retardation

I have known a few people with Schiz/Bipolar or severe Personality Disorder/Psychosis/MPD-DID (or other complicated combinations of "serious mental disorder") -- who were on 5+ psych meds.

e.g antipsychotic (maybe 1-2x types), mood stabilizer (maybe 1-2x types), 1-2 anxiolytics (Ativan & Klonopin), SSRI, sleeping meds, etc.

THEN they'd be on other quasi-psych meds to control side effects of anti-psychotic induced 'Parkinsonism' (eg Cogentin), etc. (labels, labels, labels. *sigh* I hate 'em.)

re: 'Stimulant Combining'

I've been on Dexedrine and Wellbutrin.

Had to stop b/c of the jaw pain (TMJ). Too much muscle tension. Just take Dexedrine now.

I have heard also of Dexedrine/Effexor and Wellutrin/Effexor, etc.

(Effexor is generally a stimulating antidepressant. Zoloft is usually 50/50. Paxil is usually a sleeper. YMMV.)

The problem with high doses of stimulants is that when they wear off, the Exhaustian can be incredible. (Feels like Narcolepsy!) "What goes up must come down".

I'd really suggest exploring other brain-friendly (and blood flow) techniques like hard regular exercise. (Hallowell, Ratey and Amen really recommend this!)

How much do they combine? Should I call my doctor and ask? Thanks.We each can respond so differently to these things that it really varies from one person to the next. It's important to remember too that the whole point of me & my Dr. wanting to do this experiment was to try and achieve a lower effective dailly dose of stimulants. We did just that.

For example, my normal dose of Dexedrine is 20 mg per dose. However I learned that by taking 10 mg of Dexedrine along with 5 mg of Focalin that the results were the same if not better than taking 20 mg of Dexedrine alone. The Dexedrine & Ritalin combination was effective too, however the side effects of the Ritalin made it something that I did not like.

The only reason I am not still taking a Dexedrine & Focalin combination is due to the fact that Focalin is just too expensive, and the full dose of Dexedrine is cheaper and certainlly effective enough for me to perform well academically on a collegiate level.

Dextroamphetamine inhibits the reuptake of dopamine, so wouldn't they compete? And wouldn't some of the focalin block dextroamphetamine from entering the cells? Also, I think I remember something about dextroamphetamine not being much of an agonist at the doses we use for therapy, its mostly reuptake of dopamine at such concentration (this last bit of info I'm not to sure about).

I'm correcting myself, It looks like amphetamine does release dopamine from the cytoplasm at low concentrations, and at higher concentrations it also releases dopamine from the vesicles within the cytoplasm, but i still dont fully understand it.

but i still dont fully understand it.
Here's a link that offers some good insights into the molecular action of amphetamine. Hope this helps:

http://exploration.vanderbilt.edu/news/news_galli.htm

I've been on Adderall XR (20mg) and dexedrine (5mg) before.

I have been on Focalin and Dexedrine together for two weeks once and my doc said pick one after that because he felt 'uneasy'