Suggest Treatment For Depression And Light Headedness

Posted on Wed, 18 Jan 2017

Question: I have had endogenous depression for 40 years and have been on various meds. Right now I'm on rexulti and wellbuterin. I'm still slightly light headed and my thinking is not quite fast enough, almost like the neurotransmitters aren't going fast enough to make me a little more alert also. Without completely knowing my background, what med do you think might help me? XXXXXXX

Answered by Dr. Alexander H. Sheppe (32 minutes later)

Brief Answer:
Consultation

Detailed Answer:
Hello, and thanks for your question.

You are describing a lack of alertness and poor attention. You are currently taking Wellbutrin and Rexulti and have tried Provigil and Ritalin before. My first thought is that the Ritalin dose was not high enough. What doses of Provigil and Ritalin did you take when you were taking them, and for how long?

Dr. Sheppe

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Alexander H. Sheppe (24 hours later)

I was on provigil for three months with no success, probably a low dose that he never raised. Instead he put me on ritalin of 5 mg, then 10, then 15, and finally he went hesitantly to 20 mg only when I asked for it. He didn't want it to make me nervous. I'm still on that dose today. I'm still feeling no better so either it doesn't work or I'm not taking enough of it. I was told that I could take more as I feel that I need it. What do you think? XXXXXXX

Answered by Dr. Alexander H. Sheppe (18 hours later)

Brief Answer:
Followup

Detailed Answer:
I would not take higher doses of Ritalin -- 20mg is high. I would instead switch to a different medication, such as Adderall XR, Provigil, or Concerta.

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In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Alexander H. Sheppe (19 hours later)

Whey do you think Adderall XR might work and why didn't provigil or ritalin didn't work? And how do they work in the brain? What dose would I start with? Do you really think that's my problem? XXXXXXX

Answered by Dr. Alexander H. Sheppe (2 minutes later)

Brief Answer:
Followup

Detailed Answer:
Each stimulant works differently by affecting the dopaminergic pathway in the brain slightly differently. Sometimes a person metabolizes each of these drugs differently based on small genetic differences. This is why sometimes we require trials of several drugs within a class to find one that works for you. This is why I recommend Adderall XR. Typically a starting dose is 20mg once in the morning. I do indeed think this might help you.

Please remember to rate and close this answer thread when you are finished and satisfied.

In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers

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Above answer was peer-reviewed by : Dr. Yogesh D