I have to advise against self-medicating with venlafaxine. It has a NASTY discontinuation syndrome that needs to be managed by tapering the dose down gradually, and perhaps replacement with fluoxetine for a few weeks when you get near the minimum dose. It's hard to do all that without a doctor.
ADHD doesn't come and go. However, it commonly presents alongside major depressive disorder (and depressive disorder NOS) which can certainly come and go, and the inattentiveness would definitely get worse during depressive episodes. However, if you have ADHD, then there will be a daily amount of inattentiveness and/or hyperactivity-impulsivity that never goes away, except when you're really interested in something. (That's because the attentional systems in the brain responsible for being fascinated by something are usually very well-developed in ADHD to compensate for the dysfunctional voluntary attention circuitry. That, or they just aren't very inhibited by the voluntary attention system.)
You report feeling very depressed on ritalin and modafinil; what doses did you take?
Melatonin can be helpful at night, as mentioned above. But if you take more than about 1mg, you risk feeling groggy in the morning. 0.3mg or 0.25mg should be plenty. That said, if you don't mind the grogginess, you can get some crazy dreams at 5mg and up. Cognitive performance depends very heavily upon getting proper rest, so if you're having any sleeping problems that come and go cyclically then you may have found your answer.
On the subject of cycles, if it's yearly, then check out Seasonal Affective Disorder.
I don't see lithium as being particularly helpful to you. Lithium is primarily an anti-manic mood stabilizer, though it can sometimes be added to antidepressant medicines and psychotherapy to help them work a bit better. Lamictal stands a significantly better chance of helping you. It's a mood stabilizer that has more antidepressant effects. The people who report the most cognitive enhancement from it are those whose depression is successfully treated by it. Those who report the most cognitive impairment are on high doses and usually don't suffer from much depression.
Get your hormones checked out. It could be something as simple as a thyroid or adrenal gland problem, though such problems don't usually fluctuate as much as you mentioned. Still, it wouldn't hurt to know for certain.
Back to antidepressants: venlafaxine could work, but again you really ought to be prescribed it by a doctor you know and trust. You could, instead of venlafaxine, try another antidepressant. Wellbutrin might work -- but get a free sample instead of filling an expensive prescription for it, because you didn't have a good reaction to stimulants in the past. Tricyclics would make you feel better, but I doubt you'd like the side effects. The SSRIs... well, you'd have to try them for yourself, because different people have very different reactions to them. There's always the MAOIs, and if you have the money or insurance coverage you could try the EmSam patch which is much easier to deal with than the other MAOIs. If you can afford tianeptine, it's definitely worth a try. But if you use it, be warned that the initial euphoriant effect goes away after a few weeks. DON'T stop taking it when that happens, because there's some lag time between when the euphoria goes away and when the antidepressant and long-term cognitive enhancement effects start to appear.
Edited by jadamgo, 30 November 2010 - 03:52 AM.
