View Full Version : Stimulants and SSRI - has/is anyone on both?


kimmyh51
02-24-09, 07:36 AM
Hi

I was wondering if anyone has been prescribed both?

I was prescribed SSRI (prozac) a couple of years ago by a gp when i was stressed at work, and stoped them a while later didnt find them a lot of use, except maybe a little calming

anyway somehow my specialist in australia (who diagnosed my adhd) got the idea i was still on the SSRI's - I didnt realise he thought this till I got a letter from him (when I moved to a different country & needed to get my case history for the new Dr), and it said that I was on fluoxetine (prozac) and dexamphetamine. I assume he mis-heard me when taking my history, and when I said i had been prescribed but no longer took them, he thought I was still on them. Though he never prescribed them for me himself (if he had I would have said why are you giving me these?)

anyway, since then i have seen there are studies and some seem to say that ssri + adhd stims may be more effective than stims alone

I still have some fluox left and could probably get my gp to prescribe more if need be, so was wondering if i should try them together? At the moment my dexamphetamine prescription is less than I need. So I am wary of the SSRI possibly making the dex less effective, but also wondering if it might make it work better? (seeing as my dr here is too scared to up my dex dose even though my specialist said i will need more than what i am on)

can anyone who has been on both tell me the following from their experience:


The differerence betwen SSRI + stims, vs stims only (if you have been on stimulants alone at any point)

Any positive or negative effects you see of the SSRI in combination with the stims - and whether the SSRi act any differently taken with dexamphetamine or ritalin than it does when taken by itself?

I felt when on the SSRI that they made me a little zombie like - not majorly... but just that i didnt care as much - one way or the other about things.

On one side that could be good as I can get really angry as an adhd symptom and depressed so they evened that out...

on the other i dont want to lose happy emotions and i felt that if i was excited or creative etc, that they dulled that (unlike other ppl seem to get as posted on here, I do not have that problem with dexamphetamine and dont feel it at all affects my creativity or personality or makes me a zombie - if anything the opposite)

however i have only taken SSRI's by themselves, and I do find that my mood in general can be quite low without my adhd meds. I actually thought I had depression not adhd, and it was only because thru googling depression and finding some symptoms fit but not all, and then googling symptoms and getting ADHD keep coming up, that I realised it was adhd.

Actually I wonder if i have adhd and depression, or at least depression as a side effect? I think adhd in me causes depression - but its an angry depression which is a little different to what i read about depression in depressed, non adhd ppl.

anyway enough rambling

I guess I would like to hear from anyone who has tried SSRI's particularly fluoxetine/prozac in conjunction to stimulants, and how they found SSRI + stim, vs SSRI alone or stims alone?



thanks

firstdesserts
02-24-09, 11:39 AM
I did Ritalin and then Ritalin and Prozac for a few years. Yes, they did seem to interact, but I discontinued the Ritalin when I realized they only made me think I was thinking better. I'm presently looking for an effective med for ADHD inattentive.

andyr
02-24-09, 12:02 PM
I've taken Concerta 72mg since October, and it can make me anxious sometimes. I completely stressed out after New Year (the usual money issues) and then thought maybe I also have OCPD and general anxiety. Been taking Paroxetine (Paxil) 20mg for a month.

What you're describing sounds very familiar, particularly the feeling that there's "stressed" or "zombie" and not much between, and no guarantee on any particular day which it will be. I found that the SSRI works against Concerta, and increased the Concerta to compensate. But that's just an arms race, and doesn't really solve the problem.

My psychiatrist is a great guy but admits that he doesn't have a lot of practical ADHD experience, and he's now trying to get specialist advice.

I think that Strattera might be worth trying. It's quite new, but is said to have better results with inattentives and SCTs than stimulants. It also reduces anxiety in some cases. Go check out the two presentations on YouTube by Russell Barkley (they're both about 80 mins long, but well worth it).

Note of caution: whatever you do, don't take your leftover SSRI without getting a new prescription, because if you can't get a new bottle when these run out, you'll have to go cold turkey.

Scarletta
02-24-09, 01:53 PM
I take Lexapro with Adderall and it seems to work out fine.

Prozac actually potentiates amphetamine stimulants because it is a potent CYP 2D6 inhibitor. And amphetamine uses CYP 2d6 (enzyme) to metabolize it. With the prozac blocking some of that enzyme, the amphetamine sticks around longer in your system.

elegy
02-24-09, 09:55 PM
I'm on Celexa and Focalin, among other things. I honestly can't tell you if stims alone vs. stims + SSRI has a different effect on me, because I've never been on stims alone. I've never been on an SSRI alone, now that I think about it. :p

bobC
02-25-09, 11:43 PM
Scarletta,

CYP 2D6 is a liver enzyme that can break down amphetamines in the liver. However only a tiny fraction of amphetamines <2% are broken down by the liver. The end result is SSRI's have no significant effect on amphetamine half-life. Amphetamines are removed from the body by the kidney's not the liver.

OP,

I found the combination of SSRI's + stimulants to be somewhat "wakeful". At very low dosages I find some benefit from SSRI's. However low-mid dosages of SSRI's tend to sap my motivation. I end up feeling focused, social, and sitting on the couch.

BobC

Howard_C
02-26-09, 01:54 AM
Scarletta,

CYP 2D6 is a liver enzyme that can break down amphetamines in the liver. However only a tiny fraction of amphetamines <2% are broken down by the liver. The end result is SSRI's have no significant effect on amphetamine half-life. Amphetamines are removed from the body by the kidney's not the liver.

BobC


I don't want to weigh in on Prozac or SSRI's and how they may impact amphetamine metabolism (as I have no idea or opinion),
but isn't the liver - through CYP2D6 or other enzymatic agents - responsible for a significant metabolism of amphetamine prior to renal excretion ?

***

" Amphetamine is reported to be oxidized at the 4 position of the benzene ring to form 4-hydroxyamphetamine, or on the side chain α or β carbons to form alpha-hydroxy-amphetamine or norephedrine, respectively. Norephedrine and 4-hydroxy-amphetamine are both active and each is subsequently oxidized to form 4-hydroxy-norephedrine. Alpha-hydroxy-amphetamine undergoes deamination to form phenylacetone, which ultimately forms benzoic acid and its glucuronide and the glycine conjugate hippuric acid. Although the enzymes involved in amphetamine metabolism have not been clearly defined, CYP2D6 is known to be involved with formation of 4-hydroxy-amphetamine.
.

With normal urine pHs approximately half of an administered dose of amphetamine is recoverable in urine as derivatives of alpha-hydroxy-amphetamine and approximately another 30%-40% of the dose is recoverable in urine as amphetamine itself.
.

Urinary recovery of amphetamine has been reported to range from 1% to 75%, depending on urinary pH, with the remaining fraction of the dose hepatically metabolized. Consequently, both hepatic and renal dysfunction have the potential to inhibit the elimination of amphetamine and result in prolonged exposures. "

http://www.rxlist.com/adderall-xr-capsules-drug.htm

****

Another question is...to what degree does metabolism actually relate to potentiation?

It seems that metabolism, elimination and potentation are all seperate variables to some degree.

Couldn't an inability to metabolize result in lower potentiation, as active metabolites may not be present?

I'd welcome any additional information or views ....

Scarletta
02-26-09, 08:38 AM
I don't have the time right now, but strong CYP 2D6 inhibitors DO affect amphetamine, and Prozac is one of the strongest. That's why there's a potential "interaction" between them. I'll find the info to cite here later.

jeffpuffer
02-26-09, 09:15 AM
I noticed when I was taking lexapro that it diminished the euphoric/mood-lifting effects of almost anything I took. Adderall (even the first time I took it) had no "rush" or anything like that. After weaning off it, the adderall seems like it's working 10x better.

kimmyh51
02-26-09, 09:22 AM
I take Lexapro with Adderall and it seems to work out fine.

Prozac actually potentiates amphetamine stimulants because it is a potent CYP 2D6 inhibitor. And amphetamine uses CYP 2d6 (enzyme) to metabolize it. With the prozac blocking some of that enzyme, the amphetamine sticks around longer in your system.


I thought i had read somewhere something that said that

but in that case how come so many people seem to feel in their experience that prozac or ssris reduce the effectiveness of stimulants?

give I am on a too low dose of dex already, the thought that prozac would make it less effective is a pretty strong deterrant for me...

bobC
02-27-09, 03:31 AM
Serotonin decreases stimulation in the brain which counters stimulants, but serotonin only plays a strong roll in the middle areas of the brain.

Stimulants increase dopamine which stimulates 4 specific regions of the brain including motor function, frontal cortex, brain stem, and reward center.

So basically the combination counters eachother in the center of the brain, but still stimulates the frontal cortex, cerebellum, and brain stem.

Also stimulants increase NE levels which effect the entire brain/body. higher NE levels are quickly regulated in the brain + may or may not inhibit stimulation in the entire brain (depending on alpha2 receptor regulation).

Scarletta,

Amphetamine is cleared out via renial action. At normal PH levels about 1/2 is cleared in urine as hydroxy-amphetamine and 30-50% in urine as unchanged amphetamine. The remaining 1-10% is metabolized into NE and cleared normally + phenylacetone which breaks down into benzoic acid then huppuric acid.

Basically the liver converts some amphetamine into a less stable, but active stimulant which then degrades slowly into NE + phenylacetone.


from Baselt RC. Disposition of Toxic Drugs and Chemicals in Man, Second Edition. Davis, Calif.: Biomedical Publications, 1982.
"
Amphetamine is largely unaffected during metabolism. The entire dose is probably eliminated in the urine over a period of several days. About 30% is excreted unchanged in 24 hours in normal urine. In acidic urine, the amount excreted increases up to 74% and decreases to 1% in basic urine.
"

Scarletta
02-27-09, 11:10 AM
Here's one link:

http://www.springerlink.com/content/jwjhkgl15k87a3k6/

That both Prozac and Zoloft potentiate amphetamine probably due to the CYP action.

bobC
02-27-09, 02:50 PM
The potentiation is more likely due to sertonin increasing digestion rates + increasing blood sugar.

BobC

Scarletta
03-03-09, 08:38 AM
Do you have any proof for that?

Check this out: "Based on well-documented research of rat metabolism of amphetamines on CYP 2D1, and on this clinical presentation, one is lead to the conclusion that amphetamine salts are metabolized to some extent by CYP 2D6. This report demonstrates what appears to be a significant drugdrug interaction due to enzymatic inhibition of metabolic clearance by paroxetine, which caused a relative accumulation of amphetamines and resulted in trichotillomania. A resolution of symptoms was seen when an antidepressant that does not significantly inhibit CYP 2D6 was combined with a lower dose of mixed amphetamine salts."

from http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=327

And from wikipedia, it lists contradindications:

"CYP2D6 (liver enzyme) inhibitors (http://en.wikipedia.org/wiki/CYP2D6#CYP2D6_Ligands), e.g., most SSRIs (http://en.wikipedia.org/wiki/SSRI) such as fluoxetine, citalopram, paroxetine, etc. Some anti-psychotics (http://en.wikipedia.org/wiki/Anti-psychotic) such as thioridazine (http://en.wikipedia.org/wiki/Thioridazine), haloperidol (http://en.wikipedia.org/wiki/Haloperidol), and, levomepromazine (http://en.wikipedia.org/wiki/Levomepromazine). The stimulant (http://en.wikipedia.org/wiki/Stimulant) cocaine (http://en.wikipedia.org/wiki/Cocaine). Methadone (http://en.wikipedia.org/wiki/Methadone), a opioid (http://en.wikipedia.org/wiki/Opioid) analgesic (http://en.wikipedia.org/wiki/Analgesic) and anti-addictive (http://en.wikipedia.org/wiki/Anti-addictive). There are additional drugs that inhibit CYP2D6, it is important to find out if any medication or drug that is being taken is a CYP2D6 inhibitor. Taking a CYP2D6 inhibiting drug along with Adderall (amphetamines (http://en.wikipedia.org/wiki/Amphetamines) in general) will lead to a elevated level of Adderall in the system and the drug will also remain longer in the body, this can lead to undesired or possibly serious side effects. "

Parterxred
05-13-13, 08:15 PM
I am only able to take Adderall in conjucntion with Paroxetine(SSRI) and Lamotrigine(Anti-Convulsant). My initial experience with the Adderall alone was a 24 hour panic attack.

1Buster
05-13-13, 10:06 PM
I can add that AD meds can cause reactions very particular to each patient. My P-doc followed what many articles call the norm for ADHDers with depressive symptoms.

He started by trying Wellbutrin (also used for ADHD sometimes) with my Vyvance (had already been taking 2+years) but I stopped after 10 days because of severely increased anxiety. After a few weeks of working on sleep probs, he prescribed Celexa. That worked well for a couple weeks, but then I made the mistake of drinking once and never stopped. Celexa has that effect on some people.

So now I'm taking BuSpar for the Anxiety and b/c it's also used to reduce alcohol cravings (but I'm pretty good at breaking though that and having a few beers anyway).

Different meds, even in the same class (e.g. SSRIs), work on different brain receptors, so even if one doesn't work well another in the same class might. It really is trial and error.

sarahsweets
05-14-13, 06:42 AM
I take an SNRI and adderall and do really well with both.

known_guy
05-14-13, 09:47 PM
Sorry, too lazy to read. The majority of the time I've been on an antidepressant (hmm, it seems vast majority) it's been in conjunction with stimulant medication(s). I also in past medication "trials" took only a stimulant. That was years ago. But I digress. It is fine, for me at least. [And sorry, too lazy to read through all the posts in this thread. :P]

Parterxred
07-17-13, 09:23 PM
Do you have any proof for that?

Check this out: "Based on well-documented research of rat metabolism of amphetamines on CYP 2D1, and on this clinical presentation, one is lead to the conclusion that amphetamine salts are metabolized to some extent by CYP 2D6. This report demonstrates what appears to be a significant drugdrug interaction due to enzymatic inhibition of metabolic clearance by paroxetine, which caused a relative accumulation of amphetamines and resulted in trichotillomania. A resolution of symptoms was seen when an antidepressant that does not significantly inhibit CYP 2D6 was combined with a lower dose of mixed amphetamine salts."

from http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=327

And from wikipedia, it lists contradindications:

"CYP2D6 (liver enzyme) inhibitors (http://en.wikipedia.org/wiki/CYP2D6#CYP2D6_Ligands), e.g., most SSRIs (http://en.wikipedia.org/wiki/SSRI) such as fluoxetine, citalopram, paroxetine, etc. Some anti-psychotics (http://en.wikipedia.org/wiki/Anti-psychotic) such as thioridazine (http://en.wikipedia.org/wiki/Thioridazine), haloperidol (http://en.wikipedia.org/wiki/Haloperidol), and, levomepromazine (http://en.wikipedia.org/wiki/Levomepromazine). The stimulant (http://en.wikipedia.org/wiki/Stimulant) cocaine (http://en.wikipedia.org/wiki/Cocaine). Methadone (http://en.wikipedia.org/wiki/Methadone), a opioid (http://en.wikipedia.org/wiki/Opioid) analgesic (http://en.wikipedia.org/wiki/Analgesic) and anti-addictive (http://en.wikipedia.org/wiki/Anti-addictive). There are additional drugs that inhibit CYP2D6, it is important to find out if any medication or drug that is being taken is a CYP2D6 inhibitor. Taking a CYP2D6 inhibiting drug along with Adderall (amphetamines (http://en.wikipedia.org/wiki/Amphetamines) in general) will lead to a elevated level of Adderall in the system and the drug will also remain longer in the body, this can lead to undesired or possibly serious side effects. "

This interaction is real. In fact, I believe that Paroxetine should be reserved as a last resort for any condition.

This medication combination is extremely effective for ME. However, my case is a letter more complex than usual so I plan to consult a Neurologist.

Cheshire Cat
07-18-13, 02:09 AM
A little while back I took antidepressants. In fact I went through the rainbow, as it were, of them before my doctors were willing to medicinally target my ADHD and prescribe stimulants. There was a period of time I was on both antidepressants and stimulants. Either way, the former did nothing to any significant degree, save some unnecessary and unhelpful side effects . I have since learned a little more about them and am of the mind that the current assortment are little more than active placebos.