Posted by LouisianaSportsman on July 7, 2014, at 15:44:18
In reply to Best dopamine enhancing selective med, posted by Sugardog on July 6, 2014, at 20:21:36
Sugardog,
Thank you so much for posting such an intricate synopsis. Very well done, this kind of stuff is what I really like: my hobby is providing a synopsis of advice right back to ya!
Rj sort of stole some of thunder with the exact suggestions of the medications I was going to recommend: Desoxyn and Focalin. However, at the bottom I elaborate on the best dopamine enhancing selective medication for you, but it's tricky.
Focalin IR is dexmethylphenidate. Take the Ritalin (methylphenidate) dosage and divide it by 2 and that's the equivalent dosage of Focalin. Basically, in layman's terms, Focalin is the "good stuff" of methylphenidate so it's half of it, thus half the dosage. 30mg. = 60mg. of regular Ritalin. It is said to be much smoother and likely has less NE reuptake. I would try this medication first.
I myself was on Desoxyn recently and it was very smooth. I have a very good psychiatrist and had addiction issues that she knew about and still had it prescribed to me, but every psychiatrist is different; if you can't get it prescribed, Zenzedi is your best bet. Typically, Dexedrine (pure dexamphetamine) has come in 5mg. and 10mg. tablets only, but this comes in a variety of dosage strengths: 2.5, 5, 7.5, 10, 15, 20, and 30mg. so you can tailor it to where you need to be in terms of dosing. I find IR medication is always better than the extended release medication when it comes to stimulants, but that's my preference. I've written about it extensively somewhere on the board.
Now, beyond the typical stimulants, we can get creative. I will give you some treatment advice first. I think you would do well on Abilify (aripiprazole). It is a dopamine partial agonist and add-on antidepressant. I think it could alleviate symptoms relate to some of the abberrations in the genes, depression problems which may be the root of some your main problem with anxiety which would allow you to handle stimulants better. You probably have already tried Abilify, however.
OK, lets get back to dopamine *enhancers*.
I highly suggest Nuvigil (armodfafinil). It is superior to Provigil but more expensive, underrated due to cost. I've been on it and I've noticed that it helps wake up and add subtle boost to my day. Many people with fibromyalgia swear by it and you're a 47-old woman with depression problems: a lot of patients with fibromyalgia fit that stereotype.
^^ This is an option than can be concomitant with any therapy. You need to ask yourself now: how much do you value your Lexapro? I believe that the EMSAM patch would be a perfect fit. The B-subtype selective MAOI selegiline is approved for the treatment of depression in the form of a transdermal patch (EMSAM). There have been numerous reports of users taking this drug in conjunction with phenethylamine. This is a dietary supplement that could increase dopaminergic synthesis and boost the effects of the EMSAM. There needs to be a two-week "wash-out" period where you do not consume any 20mg. escitalopram pill as MAOI and SSRI together is a risk of serotonin syndrome.
Basically, you could try a two week "wash-out" of your Lexapro for EMSAM, augment Abilify for depression related to that "wash out" and switch your Adderall to Focalin and add Nuvigil. I suggest taking Nuvigil with whatever stimulant you are on. You could try it PRN to measure the effect of the stimulant versus the effect of the Nuvigil and judge if you need both or not. I think the modafinils would add an extra boost in your day that you need along with the stimulants, especially with someone that has depression. I think a EMSAM + Abilify (at a low-dose activating effect) + Focalin + Nuvigil + Klonopin + Lyrica would work wonders. Yes, you could switch your gabapentin over to Lyrica as I've found it to be a more effective anxiolytic.
A theoretical regimen:
EMSAM 6mg./24hr.
Abilify 5mg.
Focalin 5mg. BID
Nuvigil 50mg.
Lyrica 100mg.
Klonopin 0.5mg.LOL! I know this is wild, but you could use my suggestions as a possible rubric? Just how I'd handle it if I were in your shoes. The above is a very sophisticated regimen that definitely blasts dopamine and anxiety out of the water!
Anyways take my advice with a grain of salt and good luck with everything!
poster:LouisianaSportsman
thread:1067983
URL: http://www.dr-bob.org/babble/20140609/msgs/1068011.html