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Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by LouisianaSportsman on May 20, 2014, at 18:37:26

In reply to Been Seeking Adult ADHD 20mnths. Success! One prob, posted by dixieland on May 20, 2014, at 16:59:32

(Note: I think your doctor is brilliant and should post here. I don't think I've been more impressed by a cocktail on this forum and I find it hard to believe that you're so much, but there are no malicious interactions. It's a bit hard to believe this is even real, good medicine like this is hard to come by these days.)

This is the skeleton I'd work around here:

Daytrana 15 mg (1.6mg/hr)
Focalin 7.5 mg
Focalin XR 15 mg X 2

I do not think this overdosing at all; in fact, many patients have skiddish doctors when it comes to correctly dosing schedule II drugs. I also like how your keeps your blood plasma level stable with the Daytrana, gives you an immediate boost in the morning with the IR, and then supplements with the XRs. This is one of the best methylphenidate strategies I've seen utilized on the internet to date.

Nuvigil 50mg. X 3: I've always advocated the use of this with stimulants and I'm glad your doctor does too. I'm also glad that you use it strategically at that after-lunch portion of the day to reduce fatigue. Very smart use of this nootropic.

Adding the Namenda XR 28 mg ^^^ is a good augmentation to stimulant therapy, has good results in ADHD trials (as a D2 agonist) and can theoretically prevent tolerance buildup via NMDA receptors and glutamate. I'd say it's good to keep since you can afford it.

Fetzima 120 mg: Been around for awhile now as Savella. This akin to using Wellbutrin, but probably better since it has more a NE impact. I assume that the doctor thought that if responded well to Straterra, which you claimed gave you more focus that Focalin which is no small claim (also brings into play a minor drug interaction) that maybe this would benefit you as well. In that light, I see it being a good pick. You also mentioned stress being a factor in your life and this might help mitigate that a bit. Pretty good pick.

Aptiom 800 mg: I could see standing to lose this one although these is some evidence that carbamazepine had some limited effectiveness for ADHD. This version, an metabolite of Trileptal, came out just in time for use in your cocktail or otherwise, there would be some drug-drug interactions. It does reduce your seizure risk but so does the Lyrica and Klonopin. Your doctor likely didn't want your moods to be up and down by the use of all of these stimulants, benzos, antidepressants, etc. and wanted to use a mood stabilizer with ADHD benefits. I'll trust his intuition and say that this is an appropriate medication for you. Might be somewhat stress-relieving. It's brand new.

Lyrica 150 mg x 3: Finally! A doctor that knows how to appropriately dose pregabalin for anxiolytic response. This truly is an amazing medication for a number of reasons as you mentioned and you may not need the Klonopin. Good pick.

Klonopin Wafers 1 mg X 3: Best maintenance benzo for generalized anxiety there is. May not need both Lyrica and Klonopin, but I see synergy here especially since you said you get good sleep with it.

Intuniv 3 mg: With the BP concerns arising from your other medications, this is likely a good pick with ADHD benefits as well. Solid choice.

One caveat: Mirapex ER 3.75 mg: I don't see much benefit with this one. Are you taking it before bed? That's when you should be taking it or I think that's when your doctor intended for you to take it. Perhaps you made a mistake here? Was it for sexual side effects? I think you were unclear here. Was it for Fetzima's sexual side effects? It is neurotrophic and promotes the growth a new neurons and could relax you to fall asleep via the DA pathway. I think you meant to put this in the night category. If not, you could stand to lose it.

I think you're on one of the best advanced treatments for Adult ADHD currently offered in psychiatry to be honest. I think you have an extremely intelligent doctor who knows what he is doing-- not the doctor in the phonebook.

I think you know who to trust.




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