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I'm wondering if anyone has any experience with or can point me in the direction of information on efficacy of taking 2 NON-stimulants together. I've spent some time looking for research (and/or anecdotal evidence) on the topic and have come up empty. Everything I've been able to find has been on combining one stimulant with one non-stimulant.

More/background info: I was not diagnosed with ADHD until my late 20s. I was previously on Strattera for several years. It was slightly helpful, but I was still having significant difficulties (at work and at home) related to ADHD. I was only recently able to convince my provider (psychiatric NP) that my quality of life was really suffering because of these difficulties, so we tried Adderall, which she had previously been super hesitant to do because I also have bipolar II (but I've only ever had 2 true hypomanic episodes in my LIFE). The Adderall did not go well. It most definitely helped with the ADHD, but I was also not behaving normally. Not hypomania (my sleep was excellent), but more animated speech, appearing disorganized even though my thoughts were actually CLEARER and I FELT more calm, etc. Significant enough that coworkers noticed and were concerned. So I've been off the Adderall for about a week. I'm hoping I can restart the Strattera soon, since it was partially beneficial (and I didn't have any side-effects from it).                         I guess I'm just looking for something to give me a little hope that something can help more than the Strattera. (I've tried--and continue to try--non-medication strategies as well. And I assume methylphenidate is also off the table--at least with my current provider--due to my reaction to Adderall combined with bipolar dx. Even though I've read that you can react horribly to an amphetamines but do just fine on a methylphenidate.). I did try bupropion on top of the Strattera a couple years ago (not helpful plus made me anxious/agitated). I guess that pretty much just leaves guanfacine or clonidine, and I doubt there's really much in the way of research on either of those combined with Straterra, especially in adults.

Thanks!

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What about methylphenidate like Ritalin or focalin? I have never heard of using 2 concurrent non stims, of course that doesnt mean it can’t be done. Have you ever tried a long acting stim? Vyvanse is a common extended action amphetamine...or did you try the adderall XR? In which case some people (me) do better with immediate release meds 

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Thanks for your response! Yes, I was on Adderall XR (was up to 40 mg when discontinued ~2 wks ago, started in May, first stimulant I've ever been on), with a tiny 5 mg IR dose later in the (because the XR only lasted 7-8 hours). I would LOVE to try methylphenidate at some point in the future. But I don't see it happening any time soon (or maybe at all) with this provider. I may push for it (or switch providers) after some time passes. I'm now working on getting myself out of a predicament at work due to my behavior on the Adderall (it was way overblown, but in a safety-sensitive job, one or two people voice one concern and then all of a sudden it's a big thing...). It's frustrating, because I would have been on a lot more solid ground at work if it weren't for the ADHD symptoms that were the reason for going on Adderall in the first place! 

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@mikl_pls as always I am impressed by your detailed med category rundown. However, I think we have to be careful of labeling the NP as overly skiddish as the OP did actually suffer real life consequences when taking the medicine that the prescriber was worried about 

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I've taken Strattera, guanfacine, and clonidine as an adult, but not together.  I was taken off of Strattera during a psychotic episode, because I tend to react badly to antidepressants, and that was the last antidepressant-like thing that was in my cocktail.  I took guanfacine and clonidine separately.  I haven't tried most antidepressant augmentation strategies for ADHD.  I found guanfacine and clonidine a lot more relaxing than Strattera, but Strattera was the only thing that seemed to help with concentration and attention out of the three for me, but I didn't notice it, other people did.  It didn't feel anything like a stimulant, but apparently it really made a difference in my behavior that other people noticed and I couldn't detect at all.  Guanfacine and clonidine seemed to help more with the weird restless anxiety and greater difficulty controlling my frustration.  I don't have a super firm ADHD diagnosis, though.  

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