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...
Both are quite similar, and that is no surprise, given that Notrtiptyline is Amitriptyline's major metabolite.
When comparing both, we can ascertain the following: Amitriptyline has somewhat more SERT blocking going on, so might be slightly more "serotonergic" than Nortriptyline, although I am not quite sure if clinically relevant. Both are equally strong NRIs and 5HT2 antagonists. Amitriptyline is a stronger ALPHA1 blocker compared to Nortriptyline, so might cause more postural hypotension. Amitrptyline is a stronger antihistamine than Nortriptyline, so might cause more sedation and appetite. Amitriptyline is a stronger anticholinergic than Nortriptyline, so will probably cause more side effects. (Although stronger sedative and anticholinergic properties might be welcome, depending on the condition)
What I am interested in: Who's been on both and how did they compare? (not only theoretically, but practically)
picture source: https://abload.de/img/nortgpk1f.png
Sertraline standalone makes many people somewhat apathetic, indifferent and unmotivated, and that's why doctor Gillman suggests augmenting it with Nortriptyline OR alternatively taking Clomipramine standalone for the full SNRI effect...
Did anyone here try both combos? I am getting back on antidepressants and not sure how to proceed... but if I had to choose, I would preferably go for one of the two possibilities.
I am so very lost, angry, hurt, depressed, explosive, and drowning. I was put on latuda or my bipolar and depression acting up... I hate new meds for this reason. I started having my ptsd dreams again, ate everything in site and craved sugar omg terribly, have been depressed, cant color which i love to do, just wanna sleep, explosive anger, crying jags, hate life, nothing makes me happy, everything just sucks. Im so angry cause i feel like i did before i went on any meds, 20yr ago.
Im so confused i just feel like im grasping at air.. I was in the er the other night and they basically sent me home after giving my dose of larzapam i didn't take in the afternoon cause i doesn't help. My theory of it is it didn't help before the latuda what is gonna make it work coming off latuda or after off.. I remember why i drank now.. I didn't need to feel this then.. I want to drink so bad and wont cause I've been clean 6 yrs April will be 7 and i worked to hard to get here and refuse to prove others right. Im so so messed up i cant sleep cant watch TV cant color yet dont want to do any of the above either but if i dont sleep i hurt... has anyone felt this way.. It sux cause the battle to find meds to work will start tomorrow cause my liver doesn't process meds it flushes them out.. oh well sorry just needed to vent and hope someone can help
I'm sorry if this question is redundant....
@notloki I know you're knowledgeable here.
I've been getting very inconsistent effects from Ritalin. I recently increased my dosage, because I was experiencing more fatigue afternoons and having to nap. I take 20mg (extended in morning, before I get up), then I take 10mg (extended) after lunch. Pdoc said I could take 10mgIR no later than 3pm if needed.
I'm compliant with this routine. Dose 40 minutes before getting up, same exact breakfast every morning: oatmeal, fruit, yogurt, nuts, coffee. Yesterday, I felt pretty good and energetic in the morning (both mentally and physically). Then today, I feel focused..yet, (sort of zombie-dazed staring at screen), incredibly drowsy/tired and apathetic, like I really need to nap. I get plenty of sleep every night.
Is there a reason this is happening? Seems doses effect me differently all the time. I prefer extended because the IR (while it hits more noticeably) I feel more intense energy crash and can become moody...Note: Pdoc will not let me change until I hit the max (60mg), and other stimulants (even Adderall) are either extremely hard or impossible to get prescribed here.