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Mood/Anxiety/AD/LD Issues--Next Steps in Decades of Attempts?

anxiety adhd

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#1 whiteelephant

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Posted 30 July 2019 - 07:21 AM


Currently on memantine and Strattera. 

Also on lithium orotate, magnesium and b6.  Not noticeable mood effects of any of those supplements.

Have been on SSRis (celexa, Prozac), SNRI (pristiq), TCAs(very brief stint), Adderall (too overfocused), concerta (still couldn't plan/focus abstract topics more succinctly), intuniv (hard to perceive noticeable benefit, seemed to help with mood reactivity and focus a bit, but I was only able to get to 2 mg). I've gotten genomind testing and 23andme done, but several psychiatrists that I've spoken with haven't found these to be predictive of medication prescriptions (though dr bruce kehr makes it seem life changing).  I am in therapy, have been in therapy for years, and can't make progress from week to week as I always have some worry--whether immediate panic or longer term existential crisis/negativity about my incompetence.  The thought changing is overwhelmingly disproven by my current realities.

 

Because of my focus issues, I can't envision a career that I consistently perform well in.  Despite success in more structured settings, I fail in areas where my degree is required.  I've amassed debt that's hard to pay off.  And it's hard to get passed paying off debt to actually carving a life that feels proportional to the effort I put in.  I'm not afraid of hard work, but it hasn't amounted to much due to my inconsistency. 

 

I have mood issues as well that affect work and my relationships.  I fear failure/incompetence/mediocrity and rejection.  While my mood may brighten in response to positive moments, I get fearful/worried at slightest indicators otherwise.  I get easily frustrated and assume failure.  The other day, I accidentally parked in a street cleaning area and my car was towed.  I assumed I lost it because that's how inconsistent I am.  This plummets me into despair/frustration/hopelessness that takes a lot of effort to dig out of.  

 

The two symptoms I'm trying to improve

1. ability to have envision long term goals when things aren't concrete.  Planning is difficult for me with anything.  I get torn between so many extraneous ideas and can't just focus on the most essential details.  When it's abstract, and difficult to accomplish, it's even harder.

2. Poor frustration tolerance/mood reactivity.  Quickly plunge into negative opinions about myself and what's possible on the slightest of instants.

 

 

 

Mood has been worse since I started the Strattera, in fact I do feel suicidal (though I'd never act on it), but the Strattera does provide benefits. 

 

Right now, my psychiatrist is open-minded, but prescribes with limited reasoning about the match of phenotype to a specific drug.  This has resulted in years of endless trials and my not being able to get things together.  

 

Dr. Dodson mentions that the mood is a rejection sensitivity issue (not necessarily based in studies, but perhaps in clinical experience) and prescribes clonidine/intuniv and/or possibly MAOIs for this symptom.  This symptom also resembles the mood reactivity in atypical depression. 

 

I do have an ANK3/CACNA1C marker.  Perhaps that points to lamictal being an option, though it doesn't seem to help with those things?  I wanted to avoid lamictal.  I had read on here that someone was able to go off lamictal by using Inositol.  I realize perhaps that N=1 was overly optimistic.  

 

Or I could go back on Pristiq.  Which would provide some but not enough benefit.  

 

Perhaps if I was truly more capable I wouldn't need to rely on medications.  I have had  a fair amount of family/life stress (mom passed away from cancer three years ago after a three year battle, dad is chronically depressed), but I would've been able to right myself.  So maybe this is just a matter of accepting lesser competence and a lesser life despite accomplishments.  


Edited by whiteelephant, 30 July 2019 - 07:24 AM.


#2 whiteelephant

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Posted 31 July 2019 - 12:13 PM

I guess this is the end of the line and I have to accept my limited life.  My doctors can't help.  I can't help me.  And it's stupid to think there are other strategies that I haven't tried that I might navigate to.  And silly to post here thinking that something so untractable could be solved with forum participants. 



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#3 Junipersun

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Posted 02 August 2019 - 10:55 AM

As even your doc brought it up, I would suggest going down the maoi route. Parnate is the gold standard for depression, anxiety and ESPECIALLY rejection sensitivity. People with social anxiety disorder love it for that reason. In addition to that, it works as a super mild amphetamine, which gets more pronounced at bigger dosages (50mg+). It has done wonders for my concentration related problems, especially in combination with other substances. The tritration up to a reasonable dose until reaching the therapeutic effect might be a hell of a ride though. An addon may be needed to deal with the initial side effects. MAOIs are a life changer for many, I would not lose hope until you tried that option. If you have any question concerning dose, side effects or possible add ons to help with any residual symptoms later on feel free to ask!


Edited by Junipersun, 02 August 2019 - 10:56 AM.


#4 whiteelephant

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Posted 02 August 2019 - 02:36 PM

Thanks Junipersun.  My current doctor actually won't prescribe an MAO-i and I haven't found one who would.  He wants to put me on lamictal.  This is something I've also gotten recommendations for.  I was trying to avoid lamictal.  But  I'm also torn because the strattera already bumps my heart rate up and .I have some irritability now.  Most of the time, I've gotten used to being in a state where I'm not thinking about goals and larger picture because my life doesn't live up to my expectations.  When I am confronted by frustrating or uncertain situations, I become worried about rejection or my competence.  I don't know if there are ways to increase my proactive thinking in addition to reducing my reactivity.  



#5 Junipersun

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Posted 03 August 2019 - 03:46 PM

There absolutely are doctors out there prescribing maois. If your doc is not willing to aggressively deal with your problem if your life quality is shit as you describe, you have to take action and find someone who will.  Where are you from? If you live in a bigger city in the US or europe you may find help asking on the social anxiety board for psychs prescribing maois in treatment resistant cases.


Edited by Junipersun, 03 August 2019 - 03:47 PM.


#6 RYAN474

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Posted 05 August 2019 - 02:18 PM

With mood issues many people have reported major improvements with a carnivore diet. I am one of them, although my mood was actually pretty good already with hormone optimization (TRT, Thyroid), good sleep, and a few basics like magnesium. It got a significant upgrade when I switched to carnivore. 

Here are a few links: 

 

https://www.biohacke...7-amber-ohearn/  (bipolar woman who resolved her issues with carnivore)

 

Georgia Ede (Psychiatrist) www.diagnosisdiet.com 

 

Mkhaila Peterson, Jordan Peterson

 



#7 whiteelephant

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Posted 06 August 2019 - 01:05 AM

Thanks both of you for your replies.  The Strattera does seem to make my mood worse in some ways, but my current doctor says it's not a side effect.  Do I go off the strattera even though it helps me focus?  I'm in Massachusetts.  I've literally been through so many psychiatrists.  Most give up because they can't help me.  Or they continue treating me until I'm on a bazillion medications.  Can't find someone who will prescribe an MAOI.  I've tried so much and nothing helps the mood/anxiety/attention issues well enough.  I just feel like I'm at a dead end.  

 

I've contemplated even trying neurofeedback again, although it worked sporadically the first time.  I just feel like there's little hope. 



#8 whiteelephant

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Posted 13 August 2019 - 01:28 PM

So, I'm unsuccessfully trying to find someone who uses MAO'is, but also knows how to treat executive funtion/mood swing issues.  I don't want to end up on an antipsychotic, and my attention issues are real and get ignored when I focus on the mood/anxiety issues.

My current MD says that MAOi's don't have a benefit for executive function.  Of course, not much does other than modafinal, Strattera, stimulants and intuniv.  (tried all but modafinil with either side effects or insufficient benefit).  

 

I could ask about swapping Strattera for a TCA (which has some executive function benefit) and adding lamictal if needed.  Or, I ask about MAOI, but I'm not sure what I could add for the attention benefit and/or any mood issue.  

 

Also, I have tachycardia induced by the medications, so I'd want to be wary of cardiac side effects.

 

He recommends I add Pristiq to the mix of memantine and strattera. I'm a SCL6a4 short allele, so I don't know if the research compellingly points out I won't benefit from the serotonin mechanism.  And also a CYP2D6 poor metabolizer (this seems to have more weight than the PD markers), so it limits my options.

 

My impulsivity, not in action, but in thinking things/anticipating/thinking ahead through is still pretty terrible even with the medications.  Perhaps my emotion regulation issues and ability to keep to things is part impulsivity part depression too.  

 

Attention has never been fantastic even after all of the options so I don't know if there's any hope to improve that.  I struggle with planning, organizing, anticipating. 

 

Thoughts?  Feeling so discouraged and stuck.  



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#9 BieraK

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Posted 15 August 2019 - 07:27 AM

I can't understand how a doctor could say that a MAO-I does not have any effect on focus?
How someone who studied a lot of time could say that?

You have two MAO enzymes. MAO-B: It degrades (catabolism) and breaks dopamine mainly. The best drugs for inhibiting mao-b are selegiline and rasagiline. Dopamine produces pro-oxidant metabolites like DOPAC and DOPAL. MAO-B inhibition prevents dopamine catabolism and by doing so you protect your dopaminergic neurons from damage, since there is no MAO-B produced pro-oxidant dopamine metabolites. However selegiline the standard MAO-B inhibitors enhances dopamine in other ways different compared to rasagiline, selegiline increases BDNF and GDNF that are neuroprotectant by its own. Second seligine is a CAE a Catecholamine Enhancer. So you could try with selegiline, best way of taking it is orally 1 mg a day

 

MAO-A: This enzyme is so interesting because there is an interesting theory of the Warrior vs Worrier related to how the levels of this enzyme are, so you could be a low MAO-A person or a high levels MAO-A person, I still don't know well how the genetic polymorphism related to the level to this enzyme interacts with personality but you could search by your own on times when focus is working well on you.
MAO-A degrades Serotonin but it also degrades NOREPINEPHRINE. That's why MAO-A inhibitors not only could enhance mood in a serotonin related way (however as I understand of all the neurotransmitters serotonin is the absolute boss in terms of complexity, it is a f**cking neurotransmiter difficult to dominate). 

Norepinephrine: as you could now Atomoxetine is a Norepinephrine reuptake inhibitor. This NT is of great importance in terms of focus and concentration, in the prefrontal cortex DOPAMINE is recycled by the Norepinephrine transporter (NET) and breaked by the COMT and MAO-A enzymes. The Dopamine transporter recycles dopamine in the mesolimbic area but its job in the prefrontal cortex is of an small if any importance, that's why you need some norepinephrine for focus and concentration and that's why Atomoxetine works for Slow cognitive tempo and ADD/ADHD, because it's enhances dopamine and norepinephrine in the needed areas for focus, concentration, working memory and organisational skills, the lovely prefrontal cortex.
--------------------------------------------------------------

 

So you could enhance focus by: inhibition norepinephrine catabolism in the prefrontal cortex by the inhibition of MAO-A. COMT inhibition prevents norepinephrine and dopamine catabolism in the PFC also but there is only one pharmaceutical drug used in parkinsons disease that do such work Tolcapone (or Entacapone?) however the drug has some nasty sides like liver toxicity. 

Atomoxetine does not prevent norepinephrine nor dopamine catabolism it only prevents the neurotransmitter from being recycled, so it accumulates in the synaptic cleft for more time.

 

The norepinephrine side effects: I know by personal experience, enhancing norepinephrine in some people could be a bad choice because it enhances irritability, impulsivity, anger, lack of patience with people, anxiety, sweating and vasoconstriction. I'm one of those guys, I had not tested my genes yet, but apparently of what I lack is from dopamine not norepinephrine.

However I have found a drug (or two) that enables me to handle norepinephrine very well, so I no longer suffer from side effects like irritability, anxiety or vasoconstriction

Guanfacine. You could start with low doses, I only use 0.025 mg x 2 a day.

If you want to take Atomoxetine or a MOA-A inhibitor mix it with low doses guanfacine, the drug will feel like a different animal ;)

 

Guanfacine enhances the focus effect from stimulants and at the same time reduces side effects like anxiety, increased blood pressure and vasoconstriction

 

 

Another pharmaceutical option: Try to search for the "Ootosan Stack" several people uses it in a Facebook group. It consists of Moclobemide (A MAO-A inhibitor lacking of the typical tyramine side effects of old drugs of such class), Selegiline (MAO-B inhibitor, CAE enhancer, increases antioxidant enzymes and growth factors like GDNF and BDNF), Memantine (It is used for preventing tolerance and for regulating NMDA activation by excess Ca2++). 

 

The other drug that I use everyday with Guanfacine is Memantine. 5 mg everyday, only side effect: increased blackouts from alcohol, so for now I'm using 2,5 mg without problems. It basically erases all the "mental noise" in your inner self, it is so easy to just sit down and put your mind in a silence mode. It combines so well with low doses guanfacine for me, so for now I don't feel any anxiety like in the past and my mind feels better, less "shit" going around thinking about self-distracting things like "why I am so imperfect?" "why I need to suffer from this, that was so bad...why it happened, the world is so bad", zero mental shit about useless things and in the long way it ables to "reset" your mind. You only will get rid of bad patterns of thoughts by having "victories", by learning by successes and preventing the thoughts associated to failure to coming back and dominate you, by doing so your brain will make less powerful the connections of such thoughts and will make more powerful and long-lasting the connections of the right ones.

 

My other lovely drug is Bromantane, however it has some problems 1) Tolerance develops with time 2) High price. But you are a different person in such drug, I think it even changed my personality to a more confident, organised and goal oriented person in the long-term. Bromantane works by increasing the enzyme Tyrosine Hydroxylase, this enzyme converts Tyrosine to L-DOPA. So your brain has more dopamine going around. However as an ADHD sufferer I can tell you, more dopamine in brain don't do nothing for my main problem: HOW TO DO BORING TASKS, HOW TO HAVE THE MOTIVATION FOR DOING BORING WORK THAT I DON'T CARE FOR LONG HOURS. That's why because for such thing you need to enhance dopamine  concentration in the synaptic cleft to activate D2 receptors and other receptors. More dopamine in your monoamine vesicles or just in the mesolimbic area is not enough, you need dopamine in the synaptic cleft in the mesolimbic area and norepinephrine and dopamine in the PFC, again in the synaptic cleft for doing its job. That's why DRIs like methylphenidate and amphetamines (Dexedrine is the best of all amphetamines) are so good for taking care of ADD/ADHD symptoms.

 

I have tried Methylphenidate extended release and in my experience is so difficult to not get in love with the drug, I was able to control my muscles, respiration, extended focus and the most important I was not feeling like a robot all the time (this happened with Modafinil that I don't take anymore), I was able to change from tasks, so one minute I was a focus robot goal oriented machine and the next minute I was a social butterfly. However I felt the sides from Methylphenidate, it only started to work well when I combined it with guanfacine and Trimethylglycine (Betaine). I think have methylation issue.  

 

So try to find the combination of drugs that works for you, you have your genes tested for you only need the money and the help of a good doctor. 

 

Some of my mood issues similar to yours were erased with Bromantane+Memantine+Guanfacine.

 

I have also heard of similar problems get relieved by the concomitant use of Moclobemide+Memantine+Guanfacine. You looks like atomoxetine is overcharging your brain and peripheral nervous system from norepinephrine, apparently this is related to the MAO-A and COMT genes. Too much dopamine and norepinephrine in the PFC could lead to anxiety and concentration issues, thats was what happened to me with Methylphenidate, I was unable to understand what I was reading, my brain was only able to be in a zen mode, zero, blank state. 

 

 

 


Edited by BieraK, 15 August 2019 - 07:47 AM.

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