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Anti-depressants that also work for ADHD


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Every time I read about ADHD it is just yes.. yes.. that's me.. yes.. oh yeah that's me.. that too.. two of those... but in my country you can't get a dx without school reports from your childhood (that was decades ago! who's that organized?) and testimonials from your parents or other people who knew you as a child.. this is not possible.

On the other hand I am in the middle of the longest bout of depression I remember having, and I'm tired of waiting it out. I remember reading several times about people here who, for one reason or another, couldn't take regular ADHD stimulants and so were prescribed certain anti-depressants instead.

I heard effexor is good for concentration, any more?
If the drug is contraindicated for people who have been known to suffer from delusions that would be good to know

I tried to talk to a doctor about this before but I really felt like she didn't want to know. She said "you poor thing" in a voice I can only describe as exasperated and even sarcastic. So I'll go to someone else. I get it, she's only a doctor, she hasn't got proper training in this.. but that's who you go to in my country.

 I figure they'll suggest a drug and they'll be like "I'm going to give you a prescription of paroxetine, lol!" and I'll be like "ummmmm... what about venlafaxine?" or whatever. I can pretend a family member was on it because if I say some lovely people on an internet forum recommended it or i read about it on SexyDoctor4u dot com they probably won't take me seriously.

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  • 1 month later...

No dx without school records in your country, or with your particular doc, or in your area? That's amazingly inflexible. It's not clear to me that, if you have those symptoms, using an ADD med won't help, whatever the reason is for the  symptoms. My own grade school records only hint at ADD symptoms. I was one of those smart kids so I didn't have to pay attention every minute to learn the material. On the other hand, depression often causes symptoms like ADD. My own pdoc didn't make the ADD diagnoses until my depression started to lift a bit. 

I don't know if the DSM V is the latest, but it might be worth looking in whichever version is the latest and seeing what it has to say about ADD. Not sure if that will be persuasive or not. I vaguely remember that it might not be as dogmatic about that stuff as it was. Maybe a library near you has it?

Welbutrin is an antidepressant that's also said to help with ADD, maybe more on the energy side. Possibly helps me a bit. Plus it's not as likely to cause sexual problems as many SSRI's. Or weight gain either, if I remember correctly.

I've heard Strattera was originally developed as an antidepressant. For some people it helps with ADD stuff, which is what it's "officially" for, these days. It's supposed to take a bit of time to take effect, unlike stimulants, which are almost immediate. I take dexedrine, which takes about an hour to fullylly kick in.

I understand neither of the above is particularly abusable. Here in the USA, they're not as restricted as stimulants are.

If you can get some time with a talented shrink, you may find that helpful, for either set of symptoms. At least if you're willing to do some work and some hard thinking. 

P.S. Shrink is American slang for therapist, psychologist, etc.

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Effexor definitely helped me in that area.

I don't have an official ADHD dx, but I'm fairly certain it's an issue.  When I was in-patient they attempted to give me adderall, wellbutrin, but I was terrified of stimulants at that point, so I end up taking Effexor.

However, I don't know if I'd recommend Effexor.  Lots of side effects and hard to come off of...but if all else fails Effexor did pull me out of a nasty depression and pretty much eliminated all my other issues, OCD, Anxiety, Panic, def helped with concentration.

Edited by BrianOCD
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Like the others have said Wellbutrin and Effexor are two known to have stimulating properties. Zoloft I read can help retain mental vigilance, but I don't know about concentration. Pristiq should be mentioned also because it is essentially a similar drug to Effexor but with slightly different chemical makeup, but mainly the same effects more or less. MAOI can be used to treat ADHD but good luck getting a script for one of those. They have lots of food interactions and dangers associated with them. Trycyclic antidepressants also may benefit ADHD. Clonidine, not and antidepressant, also might help with ADHD.

If you have depression and ADHD, I think it might be better to treat them separately. So treat the ADHD with a stimulant like Adderall or Ritalin and the depression with Paxil, Lexapro, or an SNRI, SSNRI, or trycyclic.

Personally, I found Rexulti to really help me in terms of motivation, getting things done, becoming more organized and time-oriented, although it's an atypical antipsychotic. 

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I don't know what goes on in other countries, but here in the USA,  generic atomoxetine (aka Strattera) has just been approved. 

In a separate development, I've been taking it for a few days myself. For me, the side effects have been minimal. A little more trouble staying asleep, but I was already having some of that. But I wonder if being used to Welbutrin and Prozac has something to do with that. Ask me in a few weeks, and I may be able to report results. What I've  heard is that it only works well for some people, so any one person's experience may not be relevant. I have my fingers crossed, because I've been really stuck. 

Antecedent:

Is there any particular reason you don't want to take stimulants? They help a lot of people, including me, at least to some extent. It's really nice not falling asleep in  after-lunch meetings. (I wouldn't fall asleep when they talked about stuff I was responsible for, but the rest of the time...zzzzzzzzz)  You can get a therapeutic effect in an hour or so. There are definitely side effects, at least in the beginning, but they're mostly manageable. There is a certain amount of bureaucratic hassle, though. At least here in the USA.

Prozac and Welbutrin don't seem to affect my ADHD symptoms much, though I gather Welbutrin is helpful for some people. 

P.S. I'm disappointed. I was not able to find SexyDoctor4u dot com  ;-)

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I'll throw in my two cents: Wellbutrin has been suggested to me by many docs to combat both depression and ADD. Sadly, I experienced the worst hallucinations of my life (and the first ones!) after taking it for like two weeks, so that's not an option for me.

If they won't treat your ADD, tell them you have chronic fatigue, maybe? Adderall and the like have been prescribed for that from what I gather having been on CB for a couple years now.

I definitely feel your pain with the ADD going untreated. When I was in college, doctors would NOT prescribe me ADD meds for fear I'd turn around and sell them to fellow students who needed to pull all-nighters. You know, college, when I would most need the meds. Now that I've been graduated for 5 years, they're cool with it, because I work in an office environment and really, really can't focus... UGH.

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29 minutes ago, mikl_pls said:

I think I've read somewhere that selegiline, either as Eldepryl or Emsam, has been used for ADHD, as well as some of the other MAOIs.

Checked pubmed - selegiline could be added, but it lacks case reports and has somewhat poor research overall (would be rated "low"), but see below for the major caveat. As for the other MAOIs, evidence for them appears substantially more limited, although I didn't check each one separately like I did for selegiline.

The list has lacked MAOIs for so long because of several reasons, but the most major one is because they aren't really that viable a treatment option for most people due to the whole dietary restriction issue (and yes Stahl brushes it off, but that's in the context of treatment-resistant depression, not ADHD). Selegiline is the only irreversible one without a dietary restriction (with the Emsam patch), and that's still only for lower doses of it too - higher doses still require dietary restrictions, and so do all other irreversible MAOIs. The single reversible MAOI on the list doesn't have dietary restrictions at all. But an argument can be made for including at least selegiline... hmm...

After some more research I finally decided to add selegiline in the end, so it's in there now. I suppose it's past time for another round of general updates, but there's a major network meta analysis that the EAGG is working on right now that I think I should probably wait on, so I did some minor partial ones instead.

Are there any other major candidates that were overlooked (outside of the irreversible MAOIs)?

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6 minutes ago, JustNuts said:

Are there any other major candidates that were overlooked (outside of the irreversible MAOIs)?

Well, I think you pretty much got it with the Wikipedia link. lol  I mean, it mentions several of the TCAs that are pseudo-commonly being used for ADHD.

Although I didn't see protriptyline mentioned. I've read of protriptyline (Vivactil) being used for narcolepsy and ADHD because of its stimulating properties. I've read it's arguably the most stimulating TCA. (Out of personal experience, it was definitely more stimulating and less sedating than desipramine and nortriptyline as far as the secondary amines go).

Theoretically speaking...

Clomipramine (Anafranil) could probably be used in higher doses in which its active metabolite concentrations are higher (which is a potent NRI), especially in cases in which OCD is comorbid, but I think clomipramine is associated with a lot more cardiac side effects, but not as much as desipramine probably.

I imagine maprotiline (Ludiomil), a TeCA, could technically be used, since it's a pretty potent NRI, but has rather potent antihistamine properties as well, so I dunno. Amoxapine (Asendin) could also be used, also being mostly an NRI, but also has AAP properties too, and while it may be sedating (at least to me), it may promote attention and focus and help with hyperactivity.

Also, if buspirone (BuSpar) could be used, whether it be due to the 5-HT1A agonism/partial agonism yielding downstream dopamine release or the presynaptic dopamine antagonism yielding increased dopamine levels, at least in regards to 5-HT1A partial agonism leading to downstream dopamine release, I suppose maybe Viibryd and Trintellix (with its multimodal actions on its various receptors causing norepinephrine and acetylcholine release too, and I think histamine release?) could be used too. But I don't know of any med in the US that preferentially antagonizes presynaptic dopamine receptors only...  maaaaaaaybe low, low doses of the 1st-gen antipsychotic thiothixene (Navane)?

Also, while the evidence for milnacipran (Savella) was "negligible," it being an SNRI, Fetzima could theoretically be used. Also, desvenlafaxine (Pristiq), what with it being related to venlafaxine (Effexor).

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2 hours ago, mikl_pls said:

Well, I think you pretty much got it with the Wikipedia link. lol  I mean, it mentions several of the TCAs that are pseudo-commonly being used for ADHD.

Although I didn't see protriptyline mentioned. I've read of protriptyline (Vivactil) being used for narcolepsy and ADHD because of its stimulating properties. I've read it's arguably the most stimulating TCA. (Out of personal experience, it was definitely more stimulating and less sedating than desipramine and nortriptyline as far as the secondary amines go).

Theoretically speaking...

Clomipramine (Anafranil) could probably be used in higher doses in which its active metabolite concentrations are higher (which is a potent NRI), especially in cases in which OCD is comorbid, but I think clomipramine is associated with a lot more cardiac side effects, but not as much as desipramine probably.

I imagine maprotiline (Ludiomil), a TeCA, could technically be used, since it's a pretty potent NRI, but has rather potent antihistamine properties as well, so I dunno. Amoxapine (Asendin) could also be used, also being mostly an NRI, but also has AAP properties too, and while it may be sedating (at least to me), it may promote attention and focus and help with hyperactivity.

Also, if buspirone (BuSpar) could be used, whether it be due to the 5-HT1A agonism/partial agonism yielding downstream dopamine release or the presynaptic dopamine antagonism yielding increased dopamine levels, at least in regards to 5-HT1A partial agonism leading to downstream dopamine release, I suppose maybe Viibryd and Trintellix (with its multimodal actions on its various receptors causing norepinephrine and acetylcholine release too, and I think histamine release?) could be used too. But I don't know of any med in the US that preferentially antagonizes presynaptic dopamine receptors only...  maaaaaaaybe low, low doses of the 1st-gen antipsychotic thiothixene (Navane)?

Also, while the evidence for milnacipran (Savella) was "negligible," it being an SNRI, Fetzima could theoretically be used. Also, desvenlafaxine (Pristiq), what with it being related to venlafaxine (Effexor).

Protriptyline failed the inclusion test. I will check later to see if any research exists on any of the others you've mentioned. The absolute minimum benchmark for inclusion on the enwiki list I linked is one positive case report and a theoretically viable MOA, so that rules out a good chunk of "theoretically this could work" stuff that hasn't actually been tried (or if it has, hasn't been published at all).

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On 7/5/2017 at 4:49 PM, ldo said:

 

Antecedent:

Is there any particular reason you don't want to take stimulants?

I'd love to try them but I can't get them without an ADD dx, which I can't get for the reasons mentioned above, whereas they give out antidepressants like candy.


Ido, DSM 5 still has "Several inattentive or hyperactive-impulsive symptoms present prior to age 12 years"

The infuriating thing is I remember that every single report I had as a child did contain something along the lines of "tends to drift" or "would work better with more concentration" but I  haven't got any of them.


Thanks so much for the advice and the stories guys. I could try wellbutrin (bupropion)... well there are so many! I just need to pick one, find out what it's called here.. and then remember its name for long enough to ask the doctor for it

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23 hours ago, Antecedent said:

I'd love to try them but I can't get them without an ADD dx, which I can't get for the reasons mentioned above, whereas they give out antidepressants like candy.


Ido, DSM 5 still has "Several inattentive or hyperactive-impulsive symptoms present prior to age 12 years"

The infuriating thing is I remember that every single report I had as a child did contain something along the lines of "tends to drift" or "would work better with more concentration" but I  haven't got any of them.


Thanks so much for the advice and the stories guys. I could try wellbutrin (bupropion)... well there are so many! I just need to pick one, find out what it's called here.. and then remember its name for long enough to ask the doctor for it

Write things down for when you go to the doctor. I always, always have to (ADD, lol). I feel more prepared with a list. 

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15 hours ago, heilmania said:

Write things down for when you go to the doctor. I always, always have to (ADD, lol). I feel more prepared with a list. 

I do the same thing.  I have to write down my symptoms, otherwise when I get there it'll be a mess and I'll end up confusing doc.

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On 7/9/2017 at 10:57 AM, heilmania said:

Write things down for when you go to the doctor. I always, always have to (ADD, lol). I feel more prepared with a list. 

 

8 hours ago, BrianOCD said:

I do the same thing.  I have to write down my symptoms, otherwise when I get there it'll be a mess and I'll end up confusing doc.

Meee tooooo!!!! OMG!!

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On 6/22/2017 at 0:39 AM, ldo said:

On the other hand, depression often causes symptoms like ADD. My own pdoc didn't make the ADD diagnoses until my depression started to lift a bit. 

 

This is true. I thought I had adult ADD and went to get tested, and they found my problems concentrating and focusing were in large part due to mild depression that I was experiencing as a person with bipolar. I didn't even realize I was depressed, at the time before being told that's what it was. 

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