I have ADHD primarily inattentive, and until recently it was pretty much decently controlled. However, in the last 4-6 months, I have been suffering greatly from the inattentive symptoms so much so that they are practically debilitating. Also, my motivation to do anything, recreational or not, has just gone completely out the window. My room has been an absolute mess—an embarrassingly barely traversable sea of clothes and trash that I just cannot bring myself to pick one single thing up. I'm sure depression is a factor, but just... FUCK! I ran off the road the other day because I was flapping my gums talking to my friend and not paying attention to the road. I got a flat tire on my brand new set of 4 tires and bent the fucking rim of the wheel! That's going to cost a lot to fix... Going to have to probably leave my car at the dealership while they order the part to replace it with...
My pdoc just simply doesn't prescribe me stims anymore. Won't get into that. We got into an argument and now she's all vindictive about it. She barely prescribed 10 mg Adderall before that anyway as the death of her husband left her very conservative with prescribing, especially stims.
So my gdoc does my stims. He didn't know what to do. I asked about adding a little oral selegiline (Eldepryl) for the levoamphetamine metabolites (more noradrenergic = better for inattention) + MAO-B inhibition for more dopamine (better for motivation symptoms), but he said "that sent shivers down [his] spine just thinking about prescribing that" and preferred to stay away from it. So I asked about protriptyline (Vivactil), which I've taken before with some success, and he agreed. Problem is, it's so uncommon and hard to find that I'm going to have to use a mail-order pharmacy to get it, very likely.
Any self-proclaimed ADHD experts out there? Should I be searching for a second pdoc to see specifically for my ADHD? Someone who will go above the 60 mg max of Dexedrine for my ADHD? A second amphetamine stimulant? (Adding methylphenidate to amphetamine will cancel each others' mechanisms of action out...) I have tried all the amphetamine stimulants and so far Dexedrine is the most potent, even more potent than Desoxyn (methamphetamine), which I hated... I don't want to go back to Adderall because of the shortage... Evekeo my insurance doesn't pay for, but would actually probably be best for me because of my inattentive symptoms. (shrugs)
Anyone have any ideas on other augmenting options? Add something like phentermine? I don't think protriptyline (an NRI) is going to cut it. Atomoxetine 80 mg hasn't, desipramine 200 mg hasn't, and nortriptyline 150 mg hasn't either. I've tried amoxapine up to 150 mg I think, but it doesn't feel too potent, and has dopamine blocking, and maprotiline I'm afraid of the seizures and the sedation/weight gain...
Kinda thinking about giving an MAOI another try, but my pdoc is so so so stingy with those...
I started process of switching from Cymbalta to Remeron on March 25, and took my last dose of Cymbalta a few days ago. Other than a few days of extreme irritability, things have been going surprisingly smoothly. Except that I can't sleep. Not really. I'm rapid-cycling between moments of being awake and instantly dreaming as soon as I close my eyes. The waking moments seem precipitated by startling effects in the dream state, that usually have nothing to do with the content of the dream itself. The worst of these is the sudden sensation of being physically attacked by an evil presence. It seems to take me a little bit longer to wake up during these instances. Or at least that's how I perceive it.
How much of this is potentially the residual Cymbalta withdrawal effects, and how much of this is the "strange or unusual dreams" listed as a possible side effect of the Remeron?
And more importantly, how long can I expect this to last? If you experienced disturbed dreams while on Remeron, how long did it last for you, and did it turn out to be a deal breaker?
As far as I am informed you need stimulants for treatment of ADHD. Most commonly used are Methylphenidate and Atomoxetine. Sometimes stuff like Bupropion is applied. But what about classic antidepressants with stimulant (NRI) properties? Let's say Desipramine or Nortriptyline, Reboxetine!? Can they help to some degree?
Have a strong itch to drop Effexor...(I won't go cold turkey). It stopped my dysphoric crying spells, but now, 10 months later, I'm feeling increasingly flat, apathetic, numb, no motivation (even after dropping to 75mg). I hate how all A/Ds have this lobotomy effect on me longterm. It's initially fine in acute episodes, I'm not sad now, but I can't function properly, and I continue to score Moderate-Severe on the depression scale.
I think it's counteracting my Ritalin (which I increased to 30-40mg)? I don't want to increase Effexor above 150mg, I'd never be able to go off.
I'm trying dosing at night instead, will this make any difference @mikl_pls ? I skipped yesterday's morning dose (then came the intense nausea, over stimulation & brain slosh awfulness @10 hours later) and I took my dose with dinner.
I'm seriously considering going on low-dose mild SSRI instead (Prozac?) I'm sensitive to meds & side effects, and I'm also VERY worried about withdrawals. Especially from Effexor, they are the WORST, and I just read study that Effexor withdrawal syndrome is not dose-dependent:
Forgot to take Lamictal yesterday (I took my other meds). Holy Hell, I took my dose today (on schedule) and I STILL feel awful!! I've only been on 100mg....I thought Lamictal had a super-long half-life? Yesterday went like this:
10am - up, had breakfast
11am – slight Brain “swishes” started (was out the entire day)
12pm – Stronger Brain zaps start
1:30pm – Lunch (meat, salad/veg)
2:30pm – Sudden extreme exhaustion
4pm - more brain zaps => ZAP ZAP ZAP! 🤯
7pm - Irritability starts
11pm – Tea, bedtime, could not fall asleep (I haven't had insomnia in 2+ years)
...Night sweats…Restless legs.....
12am – Ruminations, feel weepy
..Insomnia ensues…(Toss & turn, sweaty/achey all night)
It's now 12pm,and I am STILL having brain zaps! I worry I’ll never be able ever taper, switch from, or withdraw from this med. You probably think well, with MI, WHY would you ever go off it? For me, longterm, these meds are band-aids. There is always a price. Ok, maybe great at preventing acute/severe depression, but as a result, they rob me of any spark, joy, elation, happiness, libido, sexual sensation/response, feelings of reward, love.... This disturbs me. I used to know what positive emotions felt like…
So I’m stable, existing.....but still lacking will or any interest in living....