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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by linkadge on June 17, 2020, at 7:52:29
So I switched to atomoxetine from ritalin.
Ritalin was helping with focus but was causing some emotional issues. The atomoxetine seems to have less 'direct' impact on mood. I feel much more in 'this world' instead of in my own little world. I am (perhaps) leaning a bit more towards ADHD than bipolar.
Linkadge
Posted by SLS on June 17, 2020, at 8:41:50
In reply to Atomoxetine helping - fingers crossed, posted by linkadge on June 17, 2020, at 7:52:29
A friend of mine was diagnosed as having depression. Doctors hit him with a procession of antidepressants that never worked. His apartment was disorganized, and he didn't have enough energy to do very much. At some point, a doctor thought that perhaps they were looking at ADHD. Atomoxetine (Strattera) changed his life. He even cleaned and organized his apartment.
- Scott
Posted by iforgotmypassword on June 17, 2020, at 8:52:03
In reply to Atomoxetine helping - fingers crossed, posted by linkadge on June 17, 2020, at 7:52:29
I prefer NRIs over methylphenidate (Ritalin) because for some reason they are less likely to uncomfortably drive me and cause movements in my face that I'm prone to to start up--but oddly atomoxetine felt very qualitatively different from desipramine. Desipramine usually had a very under control and voluntary-feeling form of arousal, atomoxetine was less so, and could even be giggly and weird. I could not figure out what could account for this. Wondered for a while if alpha1 adrenoreceptor antagonism of desipramine was important in that calm, in-control feeling. Sadly, I gave up on atomoxetine to get enough of a better impression of it, other than it seemed lacking compared to desipramine--but with some silliness stirring I couldn't place that wasn't abrasive/overstimulated-feeling that desipramine did not have.
Posted by NKP on June 17, 2020, at 12:50:07
In reply to Atomoxetine helping - fingers crossed, posted by linkadge on June 17, 2020, at 7:52:29
What dose are you on?
Everything that I've read about atomoxetine says that one has to be patient as it takes a long time to really work.
I've been on 25 mg/day for about a month. I'll stay on this dose for another month, then evaluate whether to increase the dose.
So far I *think* that there is a minor but discernible improvement in my ability to get things done.
Posted by Lamdage22 on June 17, 2020, at 13:33:15
In reply to Atomoxetine helping - fingers crossed, posted by linkadge on June 17, 2020, at 7:52:29
Cool. It is funny how Stimulants (Dopamine) make some people more organized, other people become more organized when they take Dopamine blockers. I belong to the latter. Were you able to get help for your skin issue? That doesn't look like fun.
Posted by linkadge on June 17, 2020, at 15:45:24
In reply to Re: Atomoxetine helping - fingers crossed, posted by Lamdage22 on June 17, 2020, at 13:33:15
The skin issue may be improving a bit (hard to say). I won't rant on that now.
I'm only taking 25mg of atomoxetine at the moment. It is providing me enough mental energy to get through my day.
In the past few years my depression has morphed into hopelessness (not as much anxiety or sadness). It's hard to describe. It's like my thoughts are so 'painful' even though they are not logically formed thoughts. I had been using scopolamine (anticholinergic) which helped suppress / control these thoughts, but I haven't needed any in the past week. Honestly, I think my brain was in a hypercholinergic state (extreme pessimism, low energy, somewhat racing thoughts, constantly focusing on the big picture but paralyzed to do anything about it).
What I am noticing is that (on atomoxetine) my thinking is becoming more linear. For example, I am starting to see the things that I can do, rather than the things I can't do (or just seeing 'everything' in a big jumbled mess). It is also easier to start and continue tasks without giving up over something extremely small and trivial. Also, I am able to better 'get into' things like movies or books.
Also, there is a MASSIVE improvement to my hand writing. It's just SO easy to form the letters.
Currently ALL I am taking is:
- atomoxetine 25mg
- omega 3 (about 500mg of DHA)
- small quantity of CBD rich marihuana
- cyproheptadine (1mg) + melatonin 1mgI stopped lithium, Effexor AND mirtazapine.
Again, fingers crossed.
Posted by Lamdage22 on June 18, 2020, at 1:05:58
In reply to Re: Atomoxetine helping - fingers crossed, posted by linkadge on June 17, 2020, at 15:45:24
Not much Omega 3.. Some people need a high dose to respond.
Posted by Lamdage22 on June 18, 2020, at 1:07:40
In reply to Re: Atomoxetine helping - fingers crossed, posted by Lamdage22 on June 18, 2020, at 1:05:58
Is suicidality an issue? I like to take Lithium as kind of a supplement at about 200mg. If it is becoming an issue, it might be that lithium helped in that regard.
Posted by undopaminergic on June 18, 2020, at 3:09:19
In reply to Re: Atomoxetine helping - fingers crossed, posted by linkadge on June 17, 2020, at 15:45:24
>
> What I am noticing is that (on atomoxetine) ...
>
> Also, there is a MASSIVE improvement to my hand writing. It's just SO easy to form the letters.
>Amazing! NRIs *increase* my tremor.
>
> Again, fingers crossed.
>Good luck!
-undopaminergic
Posted by porkpiehat on June 18, 2020, at 14:28:05
In reply to Re: Atomoxetine helping - fingers crossed, posted by Lamdage22 on June 17, 2020, at 13:33:15
> Cool. It is funny how Stimulants (Dopamine) make some people more organized, other people become more organized when they take Dopamine blockers. I belong to the latter. Were you able to get help for your skin issue? That doesn't look like fun.
Which Dopamine blockers do you mean? I do really well on Buspar before the anger kicks in. Some atypicals also help but i'm not sure if it's the dopamine action or another property.
Posted by porkpiehat on June 18, 2020, at 14:30:23
In reply to Re: Atomoxetine helping - fingers crossed, posted by linkadge on June 17, 2020, at 15:45:24
> The skin issue may be improving a bit (hard to say). I won't rant on that now.
>
> I'm only taking 25mg of atomoxetine at the moment. It is providing me enough mental energy to get through my day.
>
> In the past few years my depression has morphed into hopelessness (not as much anxiety or sadness). It's hard to describe. It's like my thoughts are so 'painful' even though they are not logically formed thoughts. I had been using scopolamine (anticholinergic) which helped suppress / control these thoughts, but I haven't needed any in the past week. Honestly, I think my brain was in a hypercholinergic state (extreme pessimism, low energy, somewhat racing thoughts, constantly focusing on the big picture but paralyzed to do anything about it).
>
> What I am noticing is that (on atomoxetine) my thinking is becoming more linear. For example, I am starting to see the things that I can do, rather than the things I can't do (or just seeing 'everything' in a big jumbled mess). It is also easier to start and continue tasks without giving up over something extremely small and trivial. Also, I am able to better 'get into' things like movies or books.
>
> Also, there is a MASSIVE improvement to my hand writing. It's just SO easy to form the letters.
>
> Currently ALL I am taking is:
>
> - atomoxetine 25mg
> - omega 3 (about 500mg of DHA)
> - small quantity of CBD rich marihuana
> - cyproheptadine (1mg) + melatonin 1mg
>
> I stopped lithium, Effexor AND mirtazapine.
>
> Again, fingers crossed.
>
>
Can you explain this "hypercholinergic" cluster of symptoms and how you relate it to cholinergic activity?
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Posted by Lamdage22 on June 18, 2020, at 20:50:07
In reply to Re: Atomoxetine helping - fingers crossed » Lamdage22, posted by porkpiehat on June 18, 2020, at 14:28:05
Antipsychotics.
> Which Dopamine blockers do you mean? I do really well on Buspar before the anger kicks in. Some atypicals also help but i'm not sure if it's the dopamine action or another property.
Posted by Lamdage22 on June 19, 2020, at 4:43:57
In reply to Re: Atomoxetine helping - fingers crossed, posted by Lamdage22 on June 18, 2020, at 20:50:07
Dopamine really needs to be right. Too little or too much, you will definitely feel it. Dopaminergic or dopamine-blocking drugs are not a joke.
Posted by porkpiehat on June 19, 2020, at 4:56:05
In reply to Re: Atomoxetine helping - fingers crossed, posted by Lamdage22 on June 18, 2020, at 20:50:07
It's funny NE drugs tend to help me focus but also put me in an uncomfortable zone of some kind where I feel very detached.
My estimatation is that it's my brain's PTSD response to NE/adrenaline, which can cause serious withdrawl/deatchment from what I've read.
Anyone have similar effets?
Posted by undopaminergic on June 19, 2020, at 6:52:39
In reply to Re: Atomoxetine helping - fingers crossed » Lamdage22, posted by porkpiehat on June 19, 2020, at 4:56:05
> It's funny NE drugs tend to help me focus but also put me in an uncomfortable zone of some kind where I feel very detached.
>
> My estimatation is that it's my brain's PTSD response to NE/adrenaline, which can cause serious withdrawl/deatchment from what I've read.
>
> Anyone have similar effets?
>Yes, I got depersonalisation-derealisation from reboxetine (Edronax). This effect lasted (many years!) even though I quit the drug. It did not get worse with atomoxetine or ephedrine, but maybe if I had tried them first?
-undopaminergic
Posted by SLS on June 19, 2020, at 8:04:46
In reply to Re: Atomoxetine helping - fingers crossed » Lamdage22, posted by porkpiehat on June 18, 2020, at 14:28:05
> > Cool. It is funny how Stimulants (Dopamine) make some people more organized, other people become more organized when they take Dopamine blockers. I belong to the latter. Were you able to get help for your skin issue? That doesn't look like fun.
>
> Which Dopamine blockers do you mean? I do really well on Buspar before the anger kicks in. Some atypicals also help but i'm not sure if it's the dopamine action or another property.Buspar (buspirone) is metabolized in the body to become 1-PP. 1-PP is a NE alpha-2 antagonist. It increases the activity of noradrenergic neurons. The anger makes sense.
- Scott
Posted by SLS on June 19, 2020, at 8:14:26
In reply to Re: Atomoxetine helping - fingers crossed » Lamdage22, posted by porkpiehat on June 19, 2020, at 4:56:05
> It's funny NE drugs tend to help me focus but also put me in an uncomfortable zone of some kind where I feel very detached.
>
> My estimatation is that it's my brain's PTSD response to NE/adrenaline, which can cause serious withdrawl/deatchment from what I've read.
>
> Anyone have similar effets?
>
Prazosin, when taken throught the day, might be capable of reducing not only nightmares, but also the daytime symptoms - especially depression and anxiety. I received a significant antidepressant effect at 30 mg/day t.i.d. It is a remarkably clean drug. My only complaint is that it killed my sex-drive - which seems to have peristed for over a year since I stopped taking it. I don't know if there is a cause-and-effect that produces a residual loss of libido after the drug is discontinued. Still, if you can't find anything that works for you, prazosin should be near the top of your list.Prazosin blocks several types of NE alpha-1 receptors in the brain. My favored explanation is that its positive effects are due to NE alpha-1b antagonism.
- Scott
Posted by undopaminergic on June 19, 2020, at 11:31:31
In reply to Re: Atomoxetine helping - fingers crossed, posted by SLS on June 19, 2020, at 8:14:26
>
> Prazosin blocks several types of NE alpha-1 receptors in the brain. My favored explanation is that its positive effects are due to NE alpha-1b antagonism.
>Modafinil is supposedly a central alpha1B-adrenoceptor *agonist*, hence purportedly its "eugeroic" effects, as separate from its stimulant action. In my understanding, alpha1B is more sensitive to adrenaline than noradrenaline. Although adrenaline from the adrenal medulla does not cross the BBB, there are PNMT-positive neurons in the CNS.
(PNMT is the final enzyme in the chain of L-dopa -> ... -> adrenaline synthesis.)
-undopaminergic
Posted by linkadge on June 19, 2020, at 14:31:21
In reply to Re: Atomoxetine helping - fingers crossed » linkadge, posted by porkpiehat on June 18, 2020, at 14:30:23
>Can you explain this "hypercholinergic" cluster >of symptoms and how you relate it to cholinergic >activity?
Basically, its constant overthinking and always exploring (exhaustively) every single possible outcome to every single possible event to the point that have zero energy (mental or physical) to do anything. It also feels like hyper-awareness.
Now this could just be 'anxiety', but it's not always accompanied by feelings of fear. Also, anticholinergics (like scopolamine) seem to be the only antidotes to this state. That being said, the atomoxetine (perhaps by counteracting high acetylcholine) helps filter the thinking a bit more so that I can better chose what to think about.
Linkadge
Posted by linkadge on June 19, 2020, at 14:33:09
In reply to Re: Atomoxetine helping - fingers crossed » Lamdage22, posted by porkpiehat on June 19, 2020, at 4:56:05
I felt very detached on venlafaxine. I feel a bit detached on straterra but nothing like venlafaxine. Also, I feel less detached on atomoxetine than I did on ritalin.
Linkadge
Posted by linkadge on June 19, 2020, at 14:34:23
In reply to Re: Atomoxetine helping - fingers crossed » porkpiehat, posted by SLS on June 19, 2020, at 8:04:46
Anger on buspirone may **also be related to the reduction in serotonin function coming from the presynaptic 5-ht1a agonism.
Linkadge
Posted by porkpiehat on June 19, 2020, at 17:24:26
In reply to Re: Atomoxetine helping - fingers crossed » porkpiehat, posted by linkadge on June 19, 2020, at 14:31:21
> >Can you explain this "hypercholinergic" cluster >of symptoms and how you relate it to cholinergic >activity?
>
> Basically, its constant overthinking and always exploring (exhaustively) every single possible outcome to every single possible event to the point that have zero energy (mental or physical) to do anything. It also feels like hyper-awareness.
>
> Now this could just be 'anxiety', but it's not always accompanied by feelings of fear. Also, anticholinergics (like scopolamine) seem to be the only antidotes to this state. That being said, the atomoxetine (perhaps by counteracting high acetylcholine) helps filter the thinking a bit more so that I can better chose what to think about.
>
> LinkadgeAha. I asked because this just seems like me all the time lol
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Posted by SLS on June 19, 2020, at 19:55:41
In reply to Re: Atomoxetine helping - fingers crossed » SLS, posted by undopaminergic on June 19, 2020, at 11:31:31
> Modafinil is supposedly a central alpha1B-adrenoceptor *agonist*, hence purportedly its "eugeroic" effects, as separate from its stimulant action.
Modafinil has always been a bit of an enigma. First, it was dopamine reuptake inhibition. Then, it was orexin activation. It turns out that orexin is more important for alertness / cognition than it is for wakefullness."Modafinil-induced wakefulness can be attenuated by the alpha-1 adrenergic antagonist, prazosin, which led to the initial conclusion that modafinil stimulates the central alpha-1 adrenergic system. However, in vitro assay systems responsive to alpha-adrenergic stimulation have not shown that modafinil is a direct or indirect alpha-1 adrenergic agonist."
https://www.wellrx.com/modafinil/monographs/
- Scott
Posted by undopaminergic on June 20, 2020, at 5:06:18
In reply to Re: Atomoxetine helping - fingers crossed » undopaminergic, posted by SLS on June 19, 2020, at 19:55:41
> > Modafinil is supposedly a central alpha1B-adrenoceptor *agonist*, hence purportedly its "eugeroic" effects, as separate from its stimulant action.
>
>
> Modafinil has always been a bit of an enigma. First, it was dopamine reuptake inhibition. Then, it was orexin activation. It turns out that orexin is more important for alertness / cognition than it is for wakefullness.
>
> "Modafinil-induced wakefulness can be attenuated by the alpha-1 adrenergic antagonist, prazosin, which led to the initial conclusion that modafinil stimulates the central alpha-1 adrenergic system. However, in vitro assay systems responsive to alpha-adrenergic stimulation have not shown that modafinil is a direct or indirect alpha-1 adrenergic agonist."
>
>
> https://www.wellrx.com/modafinil/monographs/
>
>
> - ScottThe dopamine transporter binding of modafinil has been ascertained, including proven essential for its effects. I don't know about other actions. It would be ironic if the atypical stimulant profile of modafinil were due to the *lack* of noradrenergic actions, ie. selectivity for dopamine.
-undopaminergic
Posted by linkadge on June 21, 2020, at 8:06:18
In reply to Re: Atomoxetine helping - fingers crossed » SLS, posted by undopaminergic on June 20, 2020, at 5:06:18
>ie. selectivity for dopamine.
I think modafinil also doesn't bind to the typical dopamine transporter sites (i.e. in the manner of cocaine) but to other sites (akin to wellbutrin and / or benztropine). I've read about this but am not really up on the differences.
Linkadge
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