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Best Ways to Guide Nootropic/Medication/Biological Interventions

adhd anxiety depression

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#1 whiteelephant

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Posted 10 July 2019 - 03:27 AM

Another post from me.  Just wanted to seek feedback on my larger assessment of whether my attempted biological interventions are working.  While I don't hope for miraculous solutions, I do hope to control my symptoms enough to allow me to address my issues with lifestyle and therapy.  Unfortunately, I'm not at that point.  I have ADD (possibly LD), anxiety, depression.  I have issues focusing on things from week to week.  I end up having weekly issues and rather than focusing on themes and applying general solutions, I have to deal with each solution one weed at a time.  I'm perpetually stuck at the net in a tennis match.  Part of it is the emotional poise/perserverance to get used to the frequency of things and implement a system.   Part of it seems attentional.


Right now, I'm struggling to figure out how much is anxiety and how much is attentional.  Are there better ways to map phenotype to something to target?  I have no glaring deficiencies or health issues.  I did do 23andme, but the research on actionability seems not there (in the equivalent cancer world (where I held a very accesory role), if you targeted a loosely associated biomarker found in rats in humans, you fail to get results because there are many interactions and interceptions).  A previous doctor used QEEG to map brain waves to medication solutions.  I briefly tried neurofeedback, but I'm not sure the practitioner implemented the right protocol.  So, nothing other than phenotype has really guided me to something better than 30% improvement.  The alternative has been trawling the research, as many here do, to look for possible associations and hope that some definitive links have been shown for whatever abnormality.  


Right now, I am on memantine 28 mg (as of 2 months) and Strattera 40 mg (poor CYP2d6 metabolizer, on this since February).  I had attempted to go up further, but had exercise induced tachycardia.  Also, wary this dose may be at the ceiling because I had such side effects.  I am on aetonolol to counteract the heart rate effects which prohibited any normal intensity exercise.


It had seemed the Strattera partially helped when things were excessively predictable.  Now, my attention seems sporadic.  Also, previously when I started Strattera, I was on Intuniv and Pristiq, but since went off both due to the heart rate issue.  At the time, neither seemed like they were doing much (but perhaps they were keeping me from more excessive dysfunction).  When I first went off these two medications, I seemed to be able to focus.  But then my mood plummets.


I am very situation dependent.  My mood can plummet based on what I experience in a moment.  Same with my self esteem.  Same with my attention.  


I am wondering how much of this is because my anxiety is not controlled and how much is a poorly controlled attention issue.  Right now, I often am restless and worried that I can't accomplish things.  This has real roots in frequent unpredictable mistakes despite my implementing systems.  I also am impatient with longer tasks, have poor frustration tolerance and rush through a lot of things.  Trying to plan and implement a system takes a lot of deliberate effort that I cannot always initiate.  Either I rush or I get frustrated.  I can't have a more controlled process.  


Are there ways to map my symptoms to targetable biological interventions?  Things like braverman's neurotransmitter test combined with researching brain areas seems inexact.  The psychiatrist I currently work with only believes research guides inhibitory/excitatory drug selections.  So, he'll interpret my symptoms along this dichotomy and prescribe accordingly.  This turns into endless medication trials. If I can't fully construe my symptoms, the whole picture doesn't get addressed.  But even the surveys seem to map very similar phenotypes to pretty different problems.

Would appreciate any input.

Also tagged with one or more of these keywords: adhd, anxiety, depression

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