Question:

Having nothing to say, himself Eric has resorted to outright copying of other groups. If we wanted to read Dr. Bobs we would be there. – Hide quoted text — Show quoted text -> I copied and pasted this off the Dr. Bob’s tips and tricks section. One of the > main theories as to why antidepressants "poop out" and stop working is because > of dopamine depletion. This can be remedied by adding a dopamine agonist like > Amantadine, Ritalin, Mirapex, bromocriptine, etc. > "Patients who lose response to antidepressants > —— > When encountering patients who do well for the first few weeks on an SSRI > (especially Prozac) but then seem to lose their response after a few weeks I > have to decide whether to increase or decrease the dose. If the patient, at > that point, seems to have *new* sedation or apathy I conclude the dose is too > high and decrease it. If not, I increase it. Most of the time I end up > increasing the dose. If the patient seems to require a dose of the SSRI which > produces sedation or apathy in order to have an antidepressant effect then I > consider changing the time of day of administration (usually doesn’t help) or > adding a stimulant. > I confess that I have not seen many patients whose depression does better on > lower SSRI doses, but I have seen a bunch who get fewer side effects that way. > —— > It has been hypothesized by Don Klein and others that what looks like decreased > antidepressant effectiveness is really a state of akinesia resulting from > depletion of dopamine with continuing use of the SSRIs. Based on this > understanding one can treat the apparent fall-off in SSRI effectiveness with DA > agonists such as bupropion, amantadine, methylphenidate, dextroamphetamine, > etc. I have done this on many occasions, often with excellent results. > —— > I have often observed that patients who respond well to low doses of an > antidepressant, and lose the effect after a month or so, may regain the > therapeutic effect if their dose is increased to more usual doses. > This may be a manifestation of an initial placebo response followed by a > pharmacological response, or possibly something related to the pharmacokinetics > or pharmacodynamics of the drug. > —— > It seemed to me that once virtually no one developed tolerance to the > antidepressant effects of SSRIs. That was when all we had available was > fluoxetine. Nowadays, I prescribe more of the short-acting SSRIs, and it is my > impression that more than 5% to 10% of my patients develop tolerance to their > meds after taking them from one to twelve months. My patients seem to improve > with an incremental increase in dose; however, one increase usually predicts > that they will later need a second increase as the same phenomenon occurs. When > we reach the upper limit of the recommended dosage range, I switch to an > alternate antidepressant, which often works — but not always. Sometimes such a > patient will creep up on their dose of the second SSRI and then return to the > first one, usually with renewed effectiveness at the initial starting dose. > This phemnomenon seems so common that I mention to patients that it can happen > and that if it does I want them to contact me. > The data is impressionistic, but it seems to me that I see much more of this > "dosage creep" (and don’t you hate that terminology!) than I used to see. > —— > I have had a very similar experience. This is now spoken about in many > psychopharm conferences as "poop out." In my experience it sometimes happens as > late as 3 years into an SSRI (typically Prozac, since it’s been around the > longest), in as many as 20% of patients. > What is to be done? There is talk among "poop out" veterans of adding > bromocriptine since there is speculation that this might be a dopaminergic > depletion phenomenon. People have said this helps, but I haven’t used it yet > myself. > —— > I have a lot of experience seeing people who have failed to respond to a series > of antidepressants and/or are failing to respond to a medication which used to > help. I have found that evaluating four factors will usually get things back on > track: > sleep problems > alcohol use > thyroid problems and > subsyndromal bipolar symptoms. > Alcohol use, even in small amounts, can disrupt sleep in sensitive individuals > and I usually recommend complete abstention from alcohol. > The most common problem I have found, however, is the presence of subtle, > subsyndromal bipolar symptoms, current or past, which may or may not meet > criteria for mania or hypomania. These patients do best with the addition of > lithium or another mood stabilizer. > —— > This wearing off phenonemon seems to be an all too frequent occurence with the > new antidepressants, in particular moclobemide. Rather than increasing the > dosage, a few of my colleagues down here paradoxically suggest a day or two to > a week without medication, with good results! Maybe it’s got something to do > with enzyme induction. Although others have suggested that this wearing off > merely reflects an initial placebo response, I don’t think it fully explains > this phenomenon. > —— > Lee Dante wrote, in part: > This phenomena of the SSRI "poop out" can usually be reversed by adding 25 mg > of naltrexone (marketed in the US as Revia), usually on top of supper to avoid > transient nausea. In anywhere from two weeks to five of once daily dosing the > SSRI regains the full effect and often is perceived as working better than it > did at first. I have done this in over forty cases where this has been most > gratifying. At this dose of naltrexone the incidence of side effects is very > low, and the improvement is sustained over a period of years. It has been the > end of poop out in my practice. > —— > That reminds me of a patient with opiate dependence in the post-detox phase. He > was receiving 20 mg of fluoxetine for a comorbid major depression and was > improving when naltrexone 50 mg/day was added. Within 4 days, he was hypomanic. > On discontinuation of fluoxetine (on the presumption of a SSRI-induced > hypomania), he returned to his previous baseline over a period of one week. At > that time, I did not think much of a possible interaction between fluoxetine & > naltrexone. Now, I begin to wonder! > —— > I’ve used Remeron (mirtazapine) fairly often for Paxil "poop-out". > Eric > "Oh you didnt get better cause you didnt work hard enough in talk therapy. Its > YOUR fault!." Quote from Typical talk therapy asshole after therapy fails to > relieve severe depression > http://groups.yahoo.com/group/MergePsychiatryIntoNeurology/

Response:

- Hide quoted text — Show quoted text – > Having nothing to say, himself Eric has resorted to outright copying of > other groups. > If we wanted to read Dr. Bobs we would be there. > I copied and pasted this off the Dr. Bob’s tips and tricks section. One of the > main theories as to why antidepressants "poop out" and stop working is because > of dopamine depletion. This can be remedied by adding a dopamine agonist like > Amantadine, Ritalin, Mirapex, bromocriptine, etc. > "Patients who lose response to antidepressants > —— > When encountering patients who do well for the first few weeks on an SSRI > (especially Prozac) but then seem to lose their response after a few weeks I > have to decide whether to increase or decrease the dose. If the patient, at > that point, seems to have *new* sedation or apathy I conclude the dose is too > high and decrease it. If not, I increase it. Most of the time I end up > increasing the dose. If the patient seems to require a dose of the SSRI which > produces sedation or apathy in order to have an antidepressant effect then I > consider changing the time of day of administration (usually doesn’t help) or > adding a stimulant. > I confess that I have not seen many patients whose depression does better on > lower SSRI doses, but I have seen a bunch who get fewer side effects that way. > —— > It has been hypothesized by Don Klein and others that what looks like decreased > antidepressant effectiveness is really a state of akinesia resulting from > depletion of dopamine with continuing use of the SSRIs. Based on this > understanding one can treat the apparent fall-off in SSRI effectiveness with DA > agonists such as bupropion, amantadine, methylphenidate, dextroamphetamine, > etc. I have done this on many occasions, often with excellent results. > —— > I have often observed that patients who respond well to low doses of an > antidepressant, and lose the effect after a month or so, may regain the > therapeutic effect if their dose is increased to more usual doses. > This may be a manifestation of an initial placebo response followed by a > pharmacological response, or possibly something related to the pharmacokinetics > or pharmacodynamics of the drug. > —— > It seemed to me that once virtually no one developed tolerance to the > antidepressant effects of SSRIs. That was when all we had available was > fluoxetine. Nowadays, I prescribe more of the short-acting SSRIs, and it is my > impression that more than 5% to 10% of my patients develop tolerance to their > meds after taking them from one to twelve months. My patients seem to improve > with an incremental increase in dose; however, one increase usually predicts > that they will later need a second increase as the same phenomenon occurs. When > we reach the upper limit of the recommended dosage range, I switch to an > alternate antidepressant, which often works — but not always. Sometimes such a > patient will creep up on their dose of the second SSRI and then return to the > first one, usually with renewed effectiveness at the initial starting dose. > This phemnomenon seems so common that I mention to patients that it can happen > and that if it does I want them to contact me. > The data is impressionistic, but it seems to me that I see much more of this > "dosage creep" (and don’t you hate that terminology!) than I used to see. > —— > I have had a very similar experience. This is now spoken about in many > psychopharm conferences as "poop out." In my experience it sometimes happens as > late as 3 years into an SSRI (typically Prozac, since it’s been around the > longest), in as many as 20% of patients. > What is to be done? There is talk among "poop out" veterans of adding > bromocriptine since there is speculation that this might be a dopaminergic > depletion phenomenon. People have said this helps, but I haven’t used it yet > myself. > —— > I have a lot of experience seeing people who have failed to respond to a series > of antidepressants and/or are failing to respond to a medication which used to > help. I have found that evaluating four factors will usually get things back on > track: > sleep problems > alcohol use > thyroid problems and > subsyndromal bipolar symptoms. > Alcohol use, even in small amounts, can disrupt sleep in sensitive individuals > and I usually recommend complete abstention from alcohol. > The most common problem I have found, however, is the presence of subtle, > subsyndromal bipolar symptoms, current or past, which may or may not meet > criteria for mania or hypomania. These patients do best with the addition of > lithium or another mood stabilizer. > —— > This wearing off phenonemon seems to be an all too frequent occurence with the > new antidepressants, in particular moclobemide. Rather than increasing the > dosage, a few of my colleagues down here paradoxically suggest a day or two to > a week without medication, with good results! Maybe it’s got something to do > with enzyme induction. Although others have suggested that this wearing off > merely reflects an initial placebo response, I don’t think it fully explains > this phenomenon. > —— > Lee Dante wrote, in part: > This phenomena of the SSRI "poop out" can usually be reversed by adding 25 mg > of naltrexone (marketed in the US as Revia), usually on top of supper to avoid > transient nausea. In anywhere from two weeks to five of once daily dosing the > SSRI regains the full effect and often is perceived as working better than it > did at first. I have done this in over forty cases where this has been most > gratifying. At this dose of naltrexone the incidence of side effects is very > low, and the improvement is sustained over a period of years. It has been the > end of poop out in my practice. > —— > That reminds me of a patient with opiate dependence in the post-detox phase. He > was receiving 20 mg of fluoxetine for a comorbid major depression and was > improving when naltrexone 50 mg/day was added. Within 4 days, he was hypomanic. > On discontinuation of fluoxetine (on the presumption of a SSRI-induced > hypomania), he returned to his previous baseline over a period of one week. At > that time, I did not think much of a possible interaction between fluoxetine & > naltrexone. Now, I begin to wonder! > —— > I’ve used Remeron (mirtazapine) fairly often for Paxil "poop-out". > Eric > "Oh you didnt get better cause you didnt work hard enough in talk therapy. Its > YOUR fault!." Quote from Typical talk therapy asshole after therapy fails to > relieve severe depression > http://groups.yahoo.com/group/MergePsychiatryIntoNeurology/

Can  someone with glaucoma or hypertension safely take ritalin for ADD?

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