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?
poster:Alkaline78
thread:1110370
URL: http://www.dr-bob.org/babble/20200511/msgs/1110443.html