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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Alkaline78 on May 27, 2020, at 17:18:57
Hey All, I'm wondering if there are some ADHD people out there who wouldn't mind sharing any successes they've had with medications that increase Norepinephrine, (NE) levels, in conjunction with stimulants/cocktails including stimulants, for treatment of their ADHD.
I've been treated with a combo of Vyvanse, (and Dexedrine IR PRN), Trintillex + Rexulti, plus Wellbutrin for about six years. The Wellbutrin definitely gave me more motivation at first, and helped me feel more 'on top' of things, but it also caused anxiety. I'm pretty sure it interacted adversely with the Vyvanse, as a partial 2D6 blocker. I take a high dose of Vyvanse, but even as a, (presumably) fast metabolizer of 2D6 substrates, I could feel the medication "backing-up" in my system if I took full doses of all my meds for more than about five days consecutively, necessitating a 1 day medication holiday, every five days, (roughly).
I stopped taking Wellbutrin about 6 months ago, because of the anxiety, and medication "build-up" described, and while those side effects are gone, I feel pretty listless and unmotivated, definitely not in ideal condition to look for a promising job, (6 more credits to graduate), and perform optimally at work.
I've been reading that levo-milnacipran, and some tricyclics are alternative NE boosting agents, and I'm interesting to hear if anyone with ADHD on a comparable medication cocktail has tried these, (especially desipramine or nortryptaline), as an adjunct to their stimulant+ regime, and if so, how well did it work?To make things more complicated, I'm still having trouble sleeping, which could be that my dose of Vyvanse at 160 mg is too high, but much lower, and the drug doesn't allow me to concentrate adequately. My former pdoc told me that when the optimal regimen of medications is found, the brain circuitry is sufficiently stimulated, such that many sleep problems dissipate.
I'm hoping that if I am able to sort out the NE issue, (a blood test has indicated I have low levels of NE), that I'll be able to sleep before 3 AM, potentially with a decrease in the vyvanse dosage, as is necessary. Thoughts?
Thanks in advance for everyone's input!
Posted by linkadge on May 28, 2020, at 9:50:14
In reply to Adult ADHD Success Stories /w NE booster + Stims, posted by Alkaline78 on May 27, 2020, at 17:18:57
I'm not a heavy user of ADHD meds, but I'm currently working through a possible transition from Ritalin to atomoxetine. Ritalin makes me a bit depressed, but atomoxetine doesn't work quite as well.
Interestingly, a few times I took a low dose of both and noticed synergy. Ritalin is a bit more selective towards dopamine than norepinephrine. I feel like I would benefit from a NDRI with a bit more selectivity towards norepinephrine.
Ritalin seems to work a bit more on my body while atomoxetine seems to slow down chaotic thinking a bit better (for me at least).
Linkadge
Posted by undopaminergic on May 29, 2020, at 11:12:08
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by linkadge on May 28, 2020, at 9:50:14
> Ritalin makes me a bit depressed, but atomoxetine doesn't work quite as well.
>Didn't you say Ritalin induced remission?
-undopaminergic
Posted by linkadge on May 29, 2020, at 14:39:49
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by undopaminergic on May 29, 2020, at 11:12:08
I say a lot of things because nothing works consistently for me. I get a few days max before everything gets f*ck*d up.
Linkadge
Posted by beckett2 on May 29, 2020, at 17:56:58
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by linkadge on May 29, 2020, at 14:39:49
> I say a lot of things because nothing works consistently for me. I get a few days max before everything gets f*ck*d up.
>
> LinkadgeAdderall? Ritalin has too much body sensation.
Posted by linkadge on May 30, 2020, at 15:00:36
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by beckett2 on May 29, 2020, at 17:56:58
I might try see about this. My biggest difficulty right now is reading. A few sentences in and my mind has completely wandered. I'm still physically reading the words, but my mind is somewhere else and I am processing nothing.
Linkadge
Posted by beckett2 on May 30, 2020, at 16:17:18
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by linkadge on May 30, 2020, at 15:00:36
Adderall has been great. Smoother than Dexedrine. Taking it for a year w/o dosage change. I sympathize with the reading situation :/ good luck
Posted by Alkaline78 on June 2, 2020, at 13:58:26
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by beckett2 on May 30, 2020, at 16:17:18
> Adderall has been great. Smoother than Dexedrine. Taking it for a year w/o dosage change. I sympathize with the reading situation :/ good luck
I wonder if Adderall inhibits NE reputake more than dexedrine.. I know its more 'activating' in some way for some people.. do you feel like Adderall makes you feel more organized, and motivated than Dexedrine does, in some way? The main thing I like about vyvanse is its release mechanism, you don't feel like even the long acting Adderall formulations kind of dump everything on you, creating two peaks and drop off's throughout the day? That's what I hated about biphentin, (Canadian layered bead ritalin formulation delivering in two doses), I always felt like I was crashing.. Thanks so much to everyone, for your input..
Posted by Alkaline78 on June 2, 2020, at 14:25:55
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by linkadge on May 28, 2020, at 9:50:14
> I'm not a heavy user of ADHD meds, but I'm currently working through a possible transition from Ritalin to atomoxetine. Ritalin makes me a bit depressed, but atomoxetine doesn't work quite as well.
>
> Interestingly, a few times I took a low dose of both and noticed synergy. Ritalin is a bit more selective towards dopamine than norepinephrine. I feel like I would benefit from a NDRI with a bit more selectivity towards norepinephrine.
>
> Ritalin seems to work a bit more on my body while atomoxetine seems to slow down chaotic thinking a bit better (for me at least).
>
> Linkadge
I did try atomoxetine, it didn't hardly touch me at the top end of the conventional dose range, (which makes sense as it seems like I'm an UM for 2D6 substrates).
I've been wondering if something like desipramine, at a low dose, with blood levels being monitored, could be combined with vyvanse, and a primarily serotonergic anti-depressant like Trintillex, (which I take).Popular meds currently used to decrease NE reuptake seem to be Wellbutrin, Levo-milnacipran, and a few other obscure ones.. I'm just wondering why there isn't more written about NRI properties of tricyclics as a part of ADHD med regimens, as two or three of them have stronger NRI properties than wellbutrin, or levo-milnacipran..
I know that blood levels of tricylcics have to be monitored, until stable doses of all meds are achieved, as concomitant use of dexamphetamines and tricyclics can boost blood levels of the latter, (due to them both being primarily 2D6 substrates?), and that's probably why they aren't used as often together, but I'm wondering if they could be quite effective, and safe, when dosed correctly, with blood testing during titration.
The problem with Wellbutrin in combo with Vyvanse, is that Wellbutrin is a moderate to strong inhibitor of the 2D6 enzyme, and even for me, presumably an UM for 2D6, it caused the vyvanse to back up in my system, causing anxiety, and making my insomnia worse. Levo-milnacipran seems like it might have some potential, but based on what my pdoc said, I think it has a weaker effect than Wellbutrin.. Table 6, from this article, (file:///D:/ADHD%20Treatment/The%20Black%20Book%20of%20Psychotropic%20Dosing%20and%20Monitoring.html), seems to indicate that desipramine and protryptiline have stronger NRI effects than levo-milnacipran.
Btw Linkage, I remember you, from like a million years ago, (~2001-2005?), I was on here with the name "Temoigneur", I remember, you're like a brilliant biochemist, good to "see" you again.. how are things?
Posted by undopaminergic on June 3, 2020, at 0:32:06
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by Alkaline78 on June 2, 2020, at 13:58:26
>
> I wonder if Adderall inhibits NE reputake more than dexedrine..The primary mechanism of action of amphetamines is to release NE and DA.
-undopaminergic
Posted by linkadge on June 3, 2020, at 14:25:08
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by Alkaline78 on June 2, 2020, at 14:25:55
>Btw Linkage, I remember you, from like a million >years ago, (~2001-2005?), I was on here with the >name "Temoigneur", I remember, you're like a >brilliant biochemist, good to "see" you again.. how >are things?
Yeah, I've probably been around since the inception of babble. Things are meh. I'm feeling good at the moment, but I've been changing some meds and getting inconsistent results. Yourself?
Nortriptyline and desipramine have been used for ADHD (more so for desipramine). They are more selective norepinephrine reuptake inhibitors. The only problem with desipramine is it has some additional effects on ion channels that can affect heart rhythm. I (personally) would not use it in combination with other stimulants (unless you are strictly monitoring blood pressure and heart rhythms).
You could try adding zinc. Zinc can enhance the efficacy of dopamine reuptake inhibitors (increasing the functional inhibition).
Linkadge
Posted by Alkaline78 on June 3, 2020, at 17:34:56
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by linkadge on June 3, 2020, at 14:25:08
> >Btw Linkage, I remember you, from like a million >years ago, (~2001-2005?), I was on here with the >name "Temoigneur", I remember, you're like a >brilliant biochemist, good to "see" you again.. how >are things?
>
> Yeah, I've probably been around since the inception of babble. Things are meh. I'm feeling good at the moment, but I've been changing some meds and getting inconsistent results. Yourself?
>
> Nortriptyline and desipramine have been used for ADHD (more so for desipramine). They are more selective norepinephrine reuptake inhibitors. The only problem with desipramine is it has some additional effects on ion channels that can affect heart rhythm. I (personally) would not use it in combination with other stimulants (unless you are strictly monitoring blood pressure and heart rhythms).
>
> You could try adding zinc. Zinc can enhance the efficacy of dopamine reuptake inhibitors (increasing the functional inhibition).
>
> Linkadge
>
>
>
That's really good to know, about potential heart issues with desipramine + vyvanse.. I'm starting to wonder if I should initially try Adderall, and if that doesn't give me the "executive function" boost I'm looking for, maybe levo-milnacipran.. I'm going to read about zinc, thanks so much!!!I'm doing ok, such a long story, I'll give you the highlight.. I got into a pretty brilliant ADHD doctor, (by Canadian standards), and he put me on like nine different meds.. ok, maybe he was nuts, and eventually lost his license for neglecting patients, and inappropriate prescribing practises, (hence why I'm in between doctors), but changing some of the meds he started me on, I landed on a combo of vyvanse, Dex. IR, Trintillex,Rexulti, and Neurontin, (not sure how much the neurontin does), which allowed me to get through a Chemistry degree, (six credits left to graduate).. so I'm happy about that, but need something to boost my norepinepherine.
Also, since Canada became a communist country, and all our tax money is going to fund our idiot prime minister's foreign social justice campaigns, aimed at securing him a UN seat, (I digress), our health care is steadily deteriorating, and its hard to find an ADHD doctor up here, but I've managed to secure two appointments with a doctor who is supposed to be excellent starting at the end of the month, so I'm hoping he can help me. If not, I'm just going to find a doctor in NYC who does tele-medicine and try to find a GP up here who will work with him. I'm hoping to move to the US before too long, we're headed towards the sixty cent dollar up here.
Posted by Ruuudy on June 4, 2020, at 23:54:49
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by Alkaline78 on June 3, 2020, at 17:34:56
Lately, I've been wondering if it might be a good idea to switch up your stimulant meds every so often so your body doesn't develope tolerance.?.
I've been taking Zenzedi (dextroamphetamine), which is just about the same as Dexadrine.
I take a drug holiday from it at least once a week.
But I'm feeling like it's lost its edge lately.
Maybe Ishould try one of my wife's Adderall pills.?.I've also been taking Trintellix for about 4-1/2 months after trying a couple of other ssri's/snri's following poop-out of fluoxetine that I had been taking for just shy of 30 years.
Rudy
Posted by linkadge on June 5, 2020, at 8:27:40
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by Alkaline78 on June 3, 2020, at 17:34:56
I concur with Canada's broken health care system. The wait list for a psychiatrist is like 2 years here in Ontario. We shovelled billions of dollars into COVID (to keep the 95 year olds alive a few more years - no offence, but true), yet young Canadians commit suicide (or overdose) on a daily basis because they can't get the help they need. We (apparently) have no money to hire more psychiatrists. Also, you get the doctor's visit for free (with a very long wait list) but if you can't afford the medications you're screwed. Because I have no insurance, my access to medications is severely limited. You might be better off moving to the states. In Ontario housing prices are insanely unaffordable. I have been relying more on alternatives to treat my conditions. This is because of lack of access to health care professionals and inability to afford treatments. Both Canada and the US are in a f*ck load of debt, however. Don't expect them to take care of you. They all just take your money and give you little to show for it.
Posted by rjlockhart37 on July 1, 2020, at 0:48:59
In reply to Adult ADHD Success Stories /w NE booster + Stims, posted by Alkaline78 on May 27, 2020, at 17:18:57
If you took strattera or robexetine, which are NE boosters, norephinphrine reptake inhbit, sky rocket in norpehphrine, could cause more anxiety. Too much NE, if you did i would stick with strertta, heard not so good stories from robexetine
Posted by undopaminergic on July 1, 2020, at 4:46:18
In reply to Re: Adult ADHD Success Stories /w NE booster + Stims, posted by rjlockhart37 on July 1, 2020, at 0:48:59
> If you took strattera or robexetine, which are NE boosters, norephinphrine reptake inhbit, sky rocket in norpehphrine, could cause more anxiety.
>I think it's nervousness, not anxiety.
-undopaminergic
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