I am familiar with some of Shulgin's work, and I've also read some of his stuff, as well. However, to be perfectly honest, the PDR and the BNF are my Shephards, I shall not want. . . as a the international lay pharmacologist's prayer goes, I believe.

One thing I would like to clear up regarding my earlier statement about the grand mal seizure brought on by the use two drugs prescribed to a child suffering ADHD and taken as prescribed. One was ritalin, as I made clear above. Unfortunately, my description of the other drug as "an anti-depressant" may have been misleading. The drug in question was Effexor--probably first generation, before XR. Effexor strongly inhibits both serotogenic reuptake and reuptake of norepinephrine, and weakly inhibits dopamine reuptake. (Note that Paxil also inhibits reuptake of all three, but because "it is a potent and highly selective inhibitor of serotonin. . .reuptake" and "has only very weak effects on norepinephrine and dopamine reuptake," it is classified as an SSRI.) Thus, you can see that , as far as potential interactions caused by the stagnation of nuerotransmitters go, Effexor is in quite a different class than any of the selective serotonin reuptake inhibitors. Effexor itself carries a seizure risk--a much higher one than an SSRI-- and thus is drug which should certainly not be taken concurrently with methylphenidate, which fundamentally lowers the seizure threshold.

Unfortunately, I cannot comment on the threat of seizure with Serraxa, the norepinephrine-reuptake inhibitor approved in the past year as the first non-scheduled drug for the treatment of ADHD, either in combination with methylphenidate or without, since my PDR is from 2001. Presumably the AMA's party line on this would be to do as much to discourage concommitant use of the two as possible, regardless of the safety issues.

However, I don't mean to dismiss any concerns that you might have about the possibility of a neurological event occuring during concommitant use of an SSRI and methylphenidate. I'm sure anyone who has ever had the experience of going on OR off an SSRI, especially those with the shorter half-lives (like Paxil or Zoloft), in particular in the care of a careless doctor, couldn't help but notice unusual neurological activity. Particularly evident in the clinical trials were neurological events including: numbness and tingling sensations (paresthesia) and overall bodily weakness (asthenia), tremors, excessive tiredness, dizziness, insomnia, and nausea. These side effects accounted for dropout rates, amongst the different trial groups tested, between 10 and 20%. Further study shows that the likelihood of experiencing all of these adverse neurological effects is dose dependant.
KISS (that's to me, BTW) Paroxetine obviously does a number on your brain, and not just in the ways you want it to. The adverse neurological events mentioned are only those that would be considered extremely common. I would definitely argue that Paxil let's your brain's guard down, which means lowering the seizure threshold.

Most SSRIs do this to a greater or lesser degree, and if you have ever had a grand mal seizure, you are hyper-vigilant about anything that might strike you as an unusual neurological event. In general, if you feel like your brain might be creeping on you, let's hope you--or anyone, for that matter--would have the sense not to add ritalin. Because, while SSRI's may lower the seizure threshold, methylphenidate actually causes them.

However, my inquiries have yet to produce an instance with an SSRI such as that with the Effexor. In the PDR records of the SSRIs that I have looked at (and I have looked at almost all of them, because I have been on almost all of them) I have found no SSRI that will send you to the hospital if you combine it with a drug in a reasonable amount, unless that drug is mentioned on a little yellow sticker on your prescription bottle.

So, chances are, Paxil and 10mg of ritalin a day are not going to give you a seizure or arrythmia. Nonetheless, please bear in mind that 1) Paxil causes drowsiness, fatigue, and general weakness in a very large percentage of it's patient population, and the higher your dose, the stronger the side effects. 2)Any doctor who prescribes Paxil should be willing to reckon with these adverse affects. . .If the benefits of the medication outweigh the side effects, the doctor should be ready and willing to prescribe a safeadult alternative to combat the adverse affects. Otherwise, alternate medications should be pursued.

Because it is a mind-altering drug, a stimulant, it's simply not a good idea to self administer methylphenidate if you are in treatment with an anti-depressant. What goes up, must come down.