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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Ted Brosnan on November 4, 2004, at 11:26:39
Hello. I am waiting for the official diagnosis for ADHD. It looks very likely that I do have it and I am 22 years old now.
I have noticed improvement in my concentration problems with Wellbutrin at only 150mg a day. I noticed (not sure thought) some help with 2 or 4 mg of Edronax (similar to Strattera a NARI). But they helped only marginally, not much.
The thing is that I have social anxiety (or even evoidant personality disorder). I think that the stimulants might be very helpful for my ADHD but would worsen my SA. I got real paranoid on the Wellbutrin.
Does anyone have any experience with taking either Parnate or Nortriptyline for ADHD?! These two might help ADHD (esp Parnate) and esp Parnate can help Social Anxiey greatly.
P.S. I have got some Nortriptyline here but concerned about taking it. Would it worsen the anxiety, I have read some post that it's anxiolytic, has anyone experienced the same?!
And how long would it take it to start helping the ADHD and what dosage?!
Any inputs would be highly appreciated.
Ted.
Posted by TheOutsider on November 4, 2004, at 11:57:24
In reply to Parnate or Nortriptyline for ADHD/ADD?, posted by Ted Brosnan on November 4, 2004, at 11:26:39
Ted you have asked some very interesting questions, I am in a similar situation to you in that I have social anxiety and also (probably) inatentive type ADHD.
Unfortunatly I don't have experience with either drug.
There a deffinetly studies that show parnate as being helpful for ADHD, not sure if the same can be said for Nortriptyline.
I think that Parnate would be helpful for the amotivational aspects of ADHD, which I suffer from a lot, don't know if Nortriptyline would be as good.
Posted by banga on November 4, 2004, at 12:43:36
In reply to Re: Parnate or Nortriptyline for ADHD/ADD?, posted by TheOutsider on November 4, 2004, at 11:57:24
I am also interested in this question--I have depression, anxiety and symtpoms of ADD. In addition I drink coffee incessantlywhich supposedly hints at need for a stimulant.
Posted by King Vultan on November 4, 2004, at 14:17:33
In reply to Parnate or Nortriptyline for ADHD/ADD?, posted by Ted Brosnan on November 4, 2004, at 11:26:39
> Hello. I am waiting for the official diagnosis for ADHD. It looks very likely that I do have it and I am 22 years old now.
>
> I have noticed improvement in my concentration problems with Wellbutrin at only 150mg a day. I noticed (not sure thought) some help with 2 or 4 mg of Edronax (similar to Strattera a NARI). But they helped only marginally, not much.
>
> The thing is that I have social anxiety (or even evoidant personality disorder). I think that the stimulants might be very helpful for my ADHD but would worsen my SA. I got real paranoid on the Wellbutrin.
>
> Does anyone have any experience with taking either Parnate or Nortriptyline for ADHD?! These two might help ADHD (esp Parnate) and esp Parnate can help Social Anxiey greatly.
>
> P.S. I have got some Nortriptyline here but concerned about taking it. Would it worsen the anxiety, I have read some post that it's anxiolytic, has anyone experienced the same?!
>
> And how long would it take it to start helping the ADHD and what dosage?!
>
> Any inputs would be highly appreciated.
>
> Ted.
I have some ADD symptoms but probably not enough to fully qualify for a diagnosis; I also have social phobia and have tried Wellbutrin, nortriptyline, Nardil, and Parnate. All of these drugs were more effective for my ADD symptoms than SSRIs and Effexor. For ADD, I would probably rate them1) Parnate
2) Wellbutrin
3) Nardil
4) nortriptylineNortriptyline probably would have rated higher, but I suffered extreme sedation on it, to an ususual degree. I found Parnate and Wellbutrin clearly superior to the other two drugs for my ADD symptoms, particularly in improving drive and motivation.
For my social phobia, which has panic attack elements mixed in, manifested by rapidly increasing anxiety and runaway, profuse sweating, I would rank them:
1) Parnate
2) Nardil
3) nortriptyline
4) WellbutrinI found even the Wellbutrin helpful, however, as it did increase my assertiveness. However, my panic attack symptoms seem to require a drug that works heavily on norepinephrine, and it just was not as effective in this regard as the other three drugs.
Todd
Posted by TheOutsider on November 4, 2004, at 16:33:47
In reply to Re: Parnate or Nortriptyline for ADHD/ADD?, posted by banga on November 4, 2004, at 12:43:36
> I am also interested in this question--I have depression, anxiety and symtpoms of ADD. In addition I drink coffee incessantlywhich supposedly hints at need for a stimulant.
It certainly does!
I also drink coffee constantly when I'm at work, although I can function okay without it so long as I'm not required to hold sustained attention.
When I take dexedrine it completelt eliminates my caffein craving.
Unfortunatly I'm running out so I'm having to use caffein most of the time now.
Posted by zeugma on November 4, 2004, at 20:10:28
In reply to Re: ADHD/ADD? For Banga, posted by TheOutsider on November 4, 2004, at 16:33:47
I have severe ADD, plus narcolepsy. Nortriptyline is effective for some of the symptoms of narcolepsy, and does help a little with ADD. Actually, I would rate it above Ritalin for ADD, although I am hardly typical.
I drink gallons of coffee a day to stay awake. I mean 'awake' in a very minimal sense. But it's better than nothing, or Ritalin, which I am discontinuing.
Provigil worked for my ADD, but its side effects were intolerable.
I am going to mention Parnate to my pdoc tomorrow. I am not in a pleasant place right now, and I've seen a case report or two of Parnate's efficacy in narcolepsy and ADD.
I am very reluctant to combine it with nortriptyline, though. I take a fairly high dose (100 mg/day) and some have gotten serotonin syndrome from the combination. Nortriptyline is the only med I have ever tried that is both tolerable and effective, other than Klonopin, and neither do much for wakefulness.
-z
Posted by jboud24 on November 5, 2004, at 14:45:56
In reply to Re: ADHD/ADD? For Banga, posted by zeugma on November 4, 2004, at 20:10:28
I take Adderall for social anxiety and mild/borderline ADHD. It helps my anxiety tremendously. The effect of adderall or dexedrine is vastly different from that of other psychostimulants: Provigil, Wellbutrin, Ritalin, Focalin, etc.
Amphetamines might just HELP your SP symptoms.
Just thought I would share my experience with you guys.Take care,
Justin
Posted by Psycho316 on October 12, 2013, at 11:46:28
In reply to Parnate or Nortriptyline for ADHD/ADD?, posted by Ted Brosnan on November 4, 2004, at 11:26:39
First off this will not be easy for me.
Diagnosed with ADHD as a child.
Am now almost 50 years old.
Back,neck,shoulder IBS and stomach problems so I was actually given Nortriptyline to address my nerve pain and fibromyalgia type symptoms.
I'm also carry depression because of constant pain.
I'm also taking Vicodin daily so the Nortriptyline is not being used alone. But, I did not even find out that Nortriptyline was used for ADHD till today. I can tell you first off that depression will probably be an issue.
I told my Doctor a month or longer after starting it that it controlled almost every problem that my other medicine's didn't control, Except for one, Depression.
(I knew it was an antidepressant to)
And after 2 1/2 months I can say it makes you depressed,unmotivated and tired. These big 3
have not realy changed after getting used to it and increasing dosage.I started at 10mg a day and am at 30mg x 2 at present. I asked for a second dose because I don't usually sleep more than 4-5 hours at a time. He gave me a 50mg single dose instead. Which I did not tolerate well, it made me spacey,slow and balance off. So I split the dose into 25mg twice a day.
I'll address Social Anxiety now. I'm not a 100% sure of the exact meaning. But if it includes freaking out and "snapping" when people agitate you then that's probably me. and I can say I'm calmer most of the time and it takes 2 to 3 times as much aggravation to cause me to "snap" as it used to with the Nortriptyline. BUT, waking up with no medicine in my system, I am still unpredictable and better left alone for an hour to an hour and a half till all my medicine is working. During this time I have about an 80% chance of sitting in front of my computer and crying. And about the same percentage for "snapping" if I'm aggravated by anyone.
But bear in mind that most people get lethargic and tired from Vicodin I do the opposite I get hype up from Vicodin so the Nortriptyline kind of levels me out.
An interesting note about Nortriptyline I noticed that this med. also helps with with-drawls for me on just about everything I tested like Vicodin and steroid with-drawls.
I take less Vicodin while on Nortriptyline.
I stopped taking steroids at 5 pills without weening myself. No shakes, No lightheaded feelings, or sweating and so on.I still think it is worth a try for ADD/ADHD
Posted by SLS on October 12, 2013, at 13:37:43
In reply to Re: Nortriptyline and my ADHD/ADD?, posted by Psycho316 on October 12, 2013, at 11:47:24
The dosage range for nortriptyline when used to treat depression is generally 75 - 150 mg/day.
- Scott
Posted by doxogenic boy on October 13, 2013, at 5:08:14
In reply to Re: Nortriptyline and my ADHD/ADD? » Psycho316, posted by SLS on October 12, 2013, at 13:37:43
> The dosage range for nortriptyline when used to treat depression is generally 75 - 150 mg/day.
When I used nortriptyline, I got over the therapeutic window with doses higher than 50 mg, but I am a slow metabolizer. When I used 150 mg, I got more than 3-fold over the therapeutic window and I felt crappy. 50 mg worked. So it is important to take blood tests, if there are too much side effects or lack of effect. Too high doses work just as bad as too low for this medicine.
http://www.nlm.nih.gov/medlineplus/ency/article/003430.htm
Therapeutic window for nortriptyline: 50 to 150 ng/mL
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816343/
Quote from the link above:
However, steady-state concentrations in plasma observed in the course of treatment with TCAs are poorly related to the administered dose, and values in patients who were given similar doses of TCAs can vary from 10- to 35- fold
Posted by SLS on October 13, 2013, at 7:14:57
In reply to Re: Nortriptyline and my ADHD/ADD? » SLS, posted by doxogenic boy on October 13, 2013, at 5:08:14
You are right, of course. Thanks for posting the links.
I think 75 mg/day will get more people well than 50 mg/day. Of course, there will be people who fall at either end of the dose-response bell curve. Personally, I used blood tests to help determine the optimum dosage of nortriptyline for me. Interestingly, Caucasians tend to be extensive metabolizers. I take 150 mg/day.
- Scott
Posted by doxogenic boy on October 13, 2013, at 15:51:17
In reply to Re: Nortriptyline and my ADHD/ADD? » doxogenic boy, posted by SLS on October 13, 2013, at 7:14:57
> I think 75 mg/day will get more people well than 50 mg/day. Of course, there will be people who fall at either end of the dose-response bell curve.
Yes, I agree with that. Most people will probably need higher dosages of nortriptyline than I. The strange thing is that I can use high dosages of most of the meds in my combo (see my signature) with very few side effects, even though I am a slow metabolizer. Could there be an explanation for that? Is it possible that, for example the tianeptine, works against the side effects of escitalopram?
>Personally, I used blood tests to help determine the optimum dosage of nortriptyline for me.
Was the optimum dosage for you in the upper half of the therapeutic window, or above?
- doxogenic boy
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