My doctor has been prescribing different meds to see which work for me. He's reluctant to prescribe Adderall because of the (artificial FDA-created) shortage. Here's what we've tried so far:
Wellbutrin: Awful, made me feel depressed and generally shitty, quit after a few days.
Strattera: Better reading comprehension, less scattered thoughts. But I was sometimes tired, confused, and unfocused after meals. Also I had a weird tingly sensation on my tongue like I was drinking soda.
Strattera plus Methylphenidate: My doctor had me take a lower dose of Strattera with 10 mg time-release Methylphenidate for a week as a transition between the two. The combo was effective in that it got me to focus, but it effectively killed my inner monologue and made it nearly impossible to have any creative thoughts. Made me feel like the aliens in Blindsight: intelligent but not sentient.
Methylphenidate: What I'm on right now. 10 mg time-release first thing in the morning, plus another 5 mg quick release in the afternoon if I'm feeling tired or unfocused (not sure if I should make that an everyday thing). Generally, it seems very similar to caffeine, but more mellow and consistent over time, and I've been able to cut my caffeine use in half. It seems to help with focus and energy, but not as much with procrastination (I should really be doing chores right now).
I've seen people on here and elsewhere say that Vyvanse helped them, should I ask my doctor if I should try that next? Or does it have the same problems with shortages that Adderall does? Would Strattera plus Vyvanse have the same effects as it did with Methylphenidate?
DISCLAIMER - I AM NOT A DOCTOR JUST AN ADHD NERD (but your doctor really should have told you this):
Methylphenidate (MPH, Concerta, Ritalin) and Dexamphetamine (Adderall, DEX, as Vyvanse/Elvanse: Lisdexamphetamine/LDX) are stimulants and the most well researched ADHD medications with highest efficacy rates. They are considered the first-in-line medication when treating ADHD. DEX has slightly better response rates in trials, but it's really a coin toss what works for you.
Strattera (Atomotexetin) is usually the third choice when the other two fail. Lower response rate than MPH and DEX, but works for some people. The combination with a short release MPH or DEX is fairly common to get started / help in criticial situations.
Wellbutrin/Bupropion shows strictly worse response rates and is not registered as ADHD medication in many places. Sometimes it gets prescribed as anti-depressant or if all other medication attempts have failed, but it should not be first in line for ADHD at all. I am honestly a little worried that your doctor would prescribe it for ADHD.
I am not familiar with the medication availability in the US, but unless there are very specific contra-indiciations, a first treatment attempt should be done with MPH or DEX, a second with the other one. I personally take LDX (Vyvanse) and it absolutely changed my life for the better.
plus another 5 mg quick release in the afternoon if I'm feeling tired or unfocused (not sure if I should make that an everyday thing)
Your medication level falls over the day, even with an extended release and a "rebounding" effect in the afternoon is extremely common. Do not feel bad about treating your ADHD if you need it. On the other hand: Being tired in the afternoon if you have been active/working during the day is just... normal. I use an advanced recovery technique i call "napping", but of course it's upon you to decide what you need. You could also consider increasing your XR dosage and see if that helps you through the afternoon.
Could Wellbutrin/Bupropion be proposed if lack of motivation could be caused by either ADHD or Depression and the doctor is unsure?
If the doctor is unsure, they should perform proper differential diagnostics or request a second opinion. Many doctors of course will never admit that they lack the knowledge to perform a proper ADHD diagnosis beyond the standardized questionnaire.
If there is a strong indication for both, a psychiatrist must figure out if the ADHD is the (or one of the) major cause of the depression or the depression is it's own thing. And then treat first what is more critical to the well being of the patient.
Bupropion is an anti-depressant and should be prescribed as such, even though it is an amphetamine-derivative. Pharma companies have tried to qualify it as ADHD medication as well, but it simply doesn't show efficacy beyond placebo.
Likewise, if you give a depressed person some Adderall, you now have an highly anxious, still depressed person tweaked out on speed that's gonna get a serious dopamine crash after 3-4 hours. The stuff is, unfortunately, highly specific and can be dangerous if admitted wrongly.
US doctors are fairly known to... let's say, medicate first and ask questions later, due to the broken for-profit healthcare system and pharma lobbying. I don't blame any patient struggling to take what they can get, but maybe we shouldn't throw useless psychoactive drugs around because we couldn't bother to have another session of diagnosis.
US doctors are fairly known to... let's say, medicate first and ask questions later
That fits with my experience
I was given this combo for anxiety/depression. It helped me for the depression. Also helped me quit smoking. I was also taking lexipro for anxiety symptoms.
This was me prior to realizing my anxiety is probably a symptom of adhd after talking to a lot of people and starting researching it. I lost my insurance, so I haven't started down the adhd treatment path yet.
Thanks for all the info!
Wellbutrin/Bupropion shows strictly worse response rates and is not registered as ADHD medication in many places. Sometimes it gets prescribed as anti-depressant or if all other medication attempts have failed, but it should not be first in line for ADHD at all. I am honestly a little worried that your doctor would prescribe it for ADHD.
I'll definitely ask at my next appointment. I think this was prescribed before I had a diagnosis of ADHD and he thought it was depression or something else. Or possibly because I was wary of stimulants.
I use an advanced recovery technique i call "napping"
Napping has never worked well for me, I usually wake up feeling groggy and tired, if I can fall asleep in the first place.
Thanks for all the info!
Hope it helps a little. Keep trying and feel free to give an update.
Napping has never worked well for me, I usually wake up feeling groggy and tired, if I can fall asleep in the first place.
Never did for work for me either. Until i got medicated. The fact that i can fall asleep, nap comfortably for 30-40 minutes and get up with a clearer head and some energy recovered, while on 70mg LDX still makes me wonder what the fuck is wrong with my brain.
Strattera made me quick tempered. Not a good thing since I have comorbid anxiety that already gives me the peacefulness of a wasp.
Vyvanse was the best I've tried so far, and I want to get back on it.
Dexamphetamine/Lisdexamphetamine
The most efficacious, although with significant side effects including aggravating burnout and likely increasing the occurrence of autistic catatonia in me
Methyphenidate
Little effect, no side effects to speak of
Modafinil
Mild-moderate effect, minor side effects
Clonidine
Significant effect, side effects at higher doses
Guanfacine
Taken concurrently alongside clonidine (don't ask lol), uncertain effects due to having very similar mechanism of action as clonidine. No side effects noticed.
Amantadine
Mild-moderate effect, no side effects
Reboxetine
Major, intolerable side effects. I am sensitive to these class of meds.
Venlafaxine
As above
Capriprazine
Minimal effectiveness, typical side effects for this class of meds.
Aripiprazole
Minimal effectiveness, no significant side effects noted.
Haven't tried atomoxetine or bupropion as of yet.
Focalin tbh
Vyvanse lasted forever and adderall killed my appetite
Methylphenidate time release for me, 54mg seems to be a good balance. I'm also on a heavy dose of dutasteride, which has funny enough positively balanced my mood. Prosac too. But I still procrastinate and it seems to be getting less effective, but I have SAD and less daylight seems to be negatively effecting me along with Burgerland culture, I've had some really bad dysphoria and depression lately.
I have SAD and less daylight seems to be negatively effecting me along with Burgerland culture
same
It's doubly sad because I love the dark and winter. :-(
Vyvance has been a gave changer for me. I'm more calm and less prone to tipping into a rage over little things. I've had success getting it through Caremark if you have that available to you. It really helped me with reading and task switching.
Is this a stimulant? I've read about a lot of success with Vyvance but I'm old and kinda too tired to to take stimulants anymore
It's slow release dexamfetamine. Less peak and crash than dex, I've found, but uses the same chemical pathway.
Yeah it is. Def can't take it and have anything caffeinated like in the hour after taking of. Gives me the jitters.
I tried Adderall, Focalin, Dexedrine, and Vyvanse, and I had various issues with all of them, though some were more effective than others.
Strattera plus Wellbutrin SR (not XR, which is what most people on Wellbutrin take, that lasts too long for me) is what I've been on for 7 years, and that combo works great for me. Wellbutrin SR gets rid of the fatigue/depression from Strattera, but because Wellbutrin also reduces activity of the CYP2D6 enzyme, it effectively turns me into a slow metabolizer of Strattera, which makes it last the whole day, rather than wearing off after 5ish hours. This effect is listed as a drug interaction between Strattera and Wellburin, but if you know what you're doing, this effect is a big advantage of combining the two.
I'm productive up until whenever I choose to sleep, but because Strattera does not keep me awake (some people take Strattera before bed, which I don't recommend, that made it less effective for me), I can sleep whenever the Wellbutrin SR wears off.
I am careful to stay away from alcohol and caffeine, as either of these will greatly increase Strattera's side effects.
I also took a pharmacogenetic test to confirm that I don't have gene-drug interactions with either Strattera or Wellbutrin. It showed that I have a moderate gene-drug interaction with SSRIs, which explained why they didn't work well for me
Because Wellbutrin makes me a slow/"poor" metabolizer of CYP2D6, my Strattera dosage isn't high (60mg, even though 80mg is typical for someone of my weight).
I am careful to stay away from alcohol and caffeine, as either of these will greatly increase Strattera's side effects.
Maybe that was my problem
Focalin made me stutter and fell off hard after elementary school. Vyvanse did actually nothing for me at all. Concerta had very diminishing effectiveness around high school. literally only Adderall (in conjunction with Strattera) somewhat works for me nowadays and it's a high dose of it as well
Did you ever take Strattera by itself or with another medication? Any weird side effects?
I took strattera alone and also with concerta. Don’t remember concerta vs concerta/strattera but dropping off adderall to take it solely made me super impulsive and unproductive, killed a semester for me. I’m a bit of a case in which I have always needed a higher dosage of stimulants to function best, so YMMV.
