At the age of 25, I went to see a general practitioner about my struggles and low achievements in life. I haven’t got a driver’s license yet, I still only have a casual waiter job, I couldn’t handle college and dropped out of it and I still live with my mom. My younger brother on the other hand is only 21 and he has graduated from college, obtained his driving(P2) license, bought his own car and moved out with his girlfriend. For some reason, he seems to find it easy in life and I’ve just been struggling most of my life even though I’ve been trying just as hard. I know it’s bad to compare myself with my brother but my mom often puts me down by complaining why I haven’t done anything yet and if she's going to have to take care of me forever.
Here’s my symptoms is more detail: https://1drv.ms/w/s!...kuHx5OZr9i3UhFU
After telling this to my doctor, I was told that I was simply “depressed” and I was put on Lexapro which other than stabilising my mood, it made me significantly unmotivated/not care about anything, worsened my memory, caused brain fogs and emotional blunting.
I’ve then switched to seeing a psychiatrist who put me on 120mg Cymbalta which helped with my motivation/will power and energy but it wasn’t perfect, caused emotional blunting and I felt like I could be taking something better. So I'm now on 20mg Brintellix which subjectively has improved my memory and other cognitive functions more than Cymbalta and it’s not causing as much emotional blunting which I’m pretty happy with. But in return, it has made me very lethargic and unmotivated/drive-less. Now I know for certain that SSRIs alone is not for me since both Lexapro and Brintellix significantly lowers my motivation and makes me lethargic.
I did see a psychologist as well and even though I wasn’t diagnosed with ADHD, my psychiatrist is generous enough to let me try Strattera, Edronax, Methylphenidate or Dextroamphetamine. But she wants me to continue taking some form of antidepressant to control my anxiety so I'm sticking with Brintellix.
I was originally considering adding Strattera or Edronax to Brintellix to mimic SNRIs since I’ve responded so well to Cymbalta. But since motivation/will power and chronic avoidance is an issue, I’m leaning towards stimulants which might work better than Strattera/Edronax since it also targets the dopamine system. And between dextroamphetamine and methylphenidate, I'm leaning towards methylphenidate since it appears to be the lesser of two evils. Both are said to potentially cause neurotoxicity, but I've heard that methylphenidate is gentler thus it's believed to be less neurotoxic. Here's the comparison I've made.
The Long Term Effects of Methylphenidate (Ritalin) Use
Methylphenidate (Concerta/Ritalin) Induced Neurotoxicity
Selegiline might also be good for this but it’s more often used for depression than ADHD symptoms and I’ve heard that it’s quite dangerous and most people discontinue it anyway due to increase in anger.
I have looked at other medication which seems promising:
http://mentalhealthd...linical-trials/
http://mentalhealthd...-pipeline-2015/
But none of these medications are going to come out anytime soon and I need to get my life on track now, not in 10 years time.
So here are my questions:
Q1.) Do you think it’s better to combine Brintellix with Edronax, Strattera or Ritalin?
Q2.) If I was to start taking methylphenidate, what's the best way to avoid build up of tolerance, dependence and neurotoxicity? Is it by sticking to lowest effective dose(5 - 10mg) and taking in "as needed" basis? Is IR or XR better? I've heard that IR is better to avoid fast onset of tolerance because it stays in the body shorter and the body will have more time to be away and recover from the drug.
I actually want to try Focalin(Dexmethylphenidate) because Levomethylphenidate was found to be not as effective for treating ADHD symptoms and has a undesirable side effect on the Peripheral Nervous System. But unfortunately, only Ritalin or Concerta is available in Australia.
Edited by Heinsbeans, 14 November 2016 - 10:56 AM.