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Should I combine Brintellix with Strattera, Edronax or Ritalin?

methylphenidate ritalin adhd edronax strattera brintellix

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#1 Heinsbeans

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Posted 14 November 2016 - 10:30 AM


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.


#2 Mind_Paralysis

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Posted 14 November 2016 - 07:53 PM

You need to first discern if you truly have ADHD or if you have SCT - Sluggish Cognitive Tempo.

 

If you have ADHD, then Ritalin - methylphenidate should be the drug of choice. But if you are SCT... then the stimulants could do more damage then good - because stimulants mostly affect Dopamine - which is good if you're adhd - that's a disorder of dopamine - but if you're SCT... then it won't end well - SCT is a norepinephrinergic disease.

 

Read more about SCT here:
 

https://en.wikipedia...cognitive_tempo



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#3 psychejunkie

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Posted 15 November 2016 - 05:49 AM

Hi,

 

By looking at your symptoms in detail (above link), I'd say you don't have ADHD; but you'll benefit from anything dopaminergic as low motivation is your main problem.

On the other hand, usually depressed patients taking dopaminergics quickly develop Anhedonia or Blunt Emotions, a common long-term side-effects from those drugs!

 

I suggest you to take Strattera (Atomoxetine) alone; you'll see much more benefit from Strattera if you add regular aerobic exercise and reading novels to your life-style.

 

Good luck



#4 Heinsbeans

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Posted 26 November 2016 - 01:16 AM

I likely don't have ADHD or SCT since my psychologist never mention that I have it. If I truly do have ADHD, it should've been picked up during childhood. Although, I've read some study saying that small percentage of people can actually develop ADHD in adulthood. He couldn't understand why I don't have any energy and motivation to do anything. He doesn't really like my reasoning of 'neurotransmitter imbalance' and he wanted to diagnose me with some type of disorder but he couldn't figure out what I have so he labeled me with avoidant personality disorder, which to me sounds like another way of saying 'lazy'.

 

I had my IQ and working memory tested and they both came back normal, I didn't get to do any executive function tests.

 

I could have a treatment resistant depression because I responded well to Cymbalta(SNRI) but not Lexapro(SSRI). It's even possible that perhaps I don't have any mental disorder but I'm naturally an unmotivated person and need psychoactive drugs to help me move forward in life. Despite scoring 112 in the IQ test, I don't believe that IQ test measures every aspect of cognitive function. For example, my restaurant supervisor is 27 years old and he still lives with his mom and has to get his mom to take him to work everyday. So I think people have different strengths and weaknesses.

 

I've tried modafinil a dozen times and while it helps with energy and concentration, it doesn't help with motivation, will power or prioritization. For motivation and will power, I've actually found NRI from Cymbalta significantly more helpful.

 

I've been on Brintellix since June and lately it's been making me very lethargic to the point that I don't have any energy to work. Caffeine wasn't helping so I had to start taking modafinil in the morning so that I have enough energy to work during evening shifts. I miss the energy, motivation and alertness I used to get from Cymbalta...

 

Because it takes at least 3 weeks for Strattera/Edronax to start working, I'm leaning towards trying a low dose(2.5 - 5mg) Ritalin first with 20mg Brintellix. In Australia, the lowest dosage of Ritalin only comes in 10mg. So I'm going to have to cut the pills in quarters with a pill splitter which could get imprecise. 

 

Another reason why I want to try Ritalin first is because it's the only class of drug that I haven't tried yet. I've already tried SSRI(Lexapro and Brintellix) and SNRI(Cymbalta). I know that Cymbalta isn't an NRI but I already know what NRI feels like since Cymbalta's affinity to NE is so high and I used to be on 120mg. So by giving Ritalin a trial first, I'll be able to know if I prefer the CNS or NRI sooner.

 

 

 


Edited by Heinsbeans, 26 November 2016 - 01:24 AM.


#5 Mind_Paralysis

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Posted 26 November 2016 - 02:51 AM

I likely don't have ADHD or SCT since my psychologist never mention that I have it. If I truly do have ADHD, it should've been picked up during childhood. Although, I've read some study saying that small percentage of people can actually develop ADHD in adulthood. He couldn't understand why I don't have any energy and motivation to do anything. He doesn't really like my reasoning of 'neurotransmitter imbalance' and he wanted to diagnose me with some type of disorder but he couldn't figure out what I have so he labeled me with avoidant personality disorder, which to me sounds like another way of saying 'lazy'.

 

I had my IQ and working memory tested and they both came back normal, I didn't get to do any executive function tests.

 

I could have a treatment resistant depression because I responded well to Cymbalta(SNRI) but not Lexapro(SSRI). It's even possible that perhaps I don't have any mental disorder but I'm naturally an unmotivated person and need psychoactive drugs to help me move forward in life. Despite scoring 112 in the IQ test, I don't believe that IQ test measures every aspect of cognitive function. For example, my restaurant supervisor is 27 years old and he still lives with his mom and has to get his mom to take him to work everyday. So I think people have different strengths and weaknesses.

 

I've tried modafinil a dozen times and while it helps with energy and concentration, it doesn't help with motivation, will power or prioritization. For motivation and will power, I've actually found NRI from Cymbalta significantly more helpful.

 

I've been on Brintellix since June and lately it's been making me very lethargic to the point that I don't have any energy to work. Caffeine wasn't helping so I had to start taking modafinil in the morning so that I have enough energy to work during evening shifts. I miss the energy, motivation and alertness I used to get from Cymbalta...

 

 

Because it takes at least 3 weeks for Strattera/Edronax to start working, I'm leaning towards trying a low dose(2.5 - 5mg) Ritalin first with 20mg Brintellix. In Australia, the lowest dosage of Ritalin only comes in 10mg. So I'm going to have to cut the pills in quarters with a pill splitter which could get imprecise. 

 

Another reason why I want to try Ritalin first is because it's the only class of drug that I haven't tried yet. I've already tried SSRI(Lexapro and Brintellix) and SNRI(Cymbalta). I know that Cymbalta isn't an NRI but I already know what NRI feels like since Cymbalta's affinity to NE is so high and I used to be on 120mg. So by giving Ritalin a trial first, I'll be able to know if I prefer the CNS or NRI sooner.

 

"Should have been picked up during childhood"  - mate... if you're a talented child and have SCT - then chances are damn near 100 (HUNDRED!) % that your attention-deficit would not have been picked up. My own symptoms weren't picked up  (even though I was thoroughly tested as a child) until I was more than 27 years old and made the diagnosis myself! I then came to an agreement with the medical services that this was the case.

All of your symptoms, and the fact that you have reacted well to both Modafinil and Cymbalta implies difficulties with alertness and norepinephrinergic systems - aka SCT!

 

SCT is a disorder of the Superior Parietal Lobe - a region of the brain where Norpinephrine plays a key role in modulating activity - Norepinephrinergic Alpha-2-receptors are the most densely populated receptor-type in that area.

 

Read the thread me and the boys have, on it - "Increasing Activity in the Superior Parietal Lobe?"
 

http://www.longecity...ietal-lobe-spl/

 

 

Your Doctor IS right to diagnose you with a disorder - and guess what? Most of us SCT-ers, we have anxiety-disorders as a secondary diagnosis - Avoidant Personality being one of the more common - anxiety disorders are as common among SCT-ers as conduct-disorders among the ADHD-ers. So, the fact that he slapped that on you... it's actually ANOTHER sign towards SCT.

 

 

You are correct in that IQ-tests can't quite pick up the nuances of cognitive difficulties - I actually test as one of the top 10% of the population, but I can't get my life working at all - my cognitive skills can't beat my cognitive ailments.
 

A curious thing though, is that it would seem that for a certain percentage of both ADHD-ers and ASD-ers, it would seem as if they DO test slightly lower than the mainline population... not sure why that was the case, but it does seem to happen - us SCT-ers alas, have enhanced verbal intelligence (but decreased physical intelligence), which unfortunately (in this case) means we won't score lower than the regular folks on this type of test.

 

 

Now, I won't tell you not to try Ritalin, because you do need to know if it will help you or not - it should be noted though, that if you have SCT - you need NE, not DA - MPH is, alas, ineffective against SCT - mainly because not only is it selective for DA, but it's also a 5ht-agonist, which is the source of the intense anxiogenic effect which some report from the drug - when you mix that with someone who already has anxiety disorders... well, you figure it out.



#6 jadamgo

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Posted 27 November 2016 - 07:17 AM

Your symptoms certainly don't sound like ADHD, but they could be SCT. 

 

Depending on who you ask, the gold standard for treating SCT is either modafinil, or adderall. (It has to be adderall because it needs to include levoamphetamine. Vyvanse or dexedrine don't work as well.)

 

Both have critics who say they're addictive drugs with side effects, and tolerance/rebound problems. Both have fans who say the problems are worth being able to live normally.

 

You could try atomoxetine or milnacipran too. They have fewer critics, and fewer fans as well. 



#7 Heinsbeans

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Posted 30 November 2016 - 08:12 AM

I have unfortunate news. Today, I had another appointment with a Psychiatrist and after she read the report from the psychologist, she wants to put me on anti-psychotics...again. Mainly because my IQ test results came back normal so she probably believes there's nothing wrong with me. I had a feeling that this was going to happen.

 

When my psychiatrist increased my dosage of Cymbalta to 120mg, I didn't like the way it was causing emotional blunting. So I asked her if I could try SSRI and NRI separately and tweak the dosage to find the right spot. But when told her that, she decided to put me on anti-psychotic not because I have schizophrenia, but to fix my 'problematic thoughts'. But I declined because I've heard that anti-psychotics are bad in the long-run and they can shrink the brain. But my psychiatrist is adamant this time and she's not going to prescribe me anything else besides anti-psychotics because my IQ turned out normal. So I'm afraid I won't be seeing her anymore. 

 

I really hate being the guinea pig of my psychiatrist. She acts like she's right and knows everything about me and becomes offended and pissed off as soon as I share my thoughts on which medication I think might help me. I'm the one that's taking the medication so I feel like I should have the right to share my thoughts as well.

 

I guess it's true when people say that many medical professionals has a 'God complex'. I think this could be part of the reason why self-medication through nootropics is rising. It's because doctors aren't willing to work with you and it's so hard to get prescribed anything else besides SSRI. I don't know whether that's due to their arrogance or because they get paid by the pharmaceutical company to endorse certain medications. If fact, SSRI and anti-psychotics are two of the most over-prescribed medications.

 

I feel used by her since I've been spending so much time and money on her and now she turns around and does this to me. It costs me $250 to see her each appointment(I get back $165 from Medicare). Not only that, but It takes months to make each appointments with her and this is the fourth time that she only had a chat with me and didn't prescribe or switch my medication. I've been wanting to to do an adjunctive therapy(Reboxetine or Strattera) with Brintellix since July this year....and now it's almost December.

 

When I told my psychiatrist that Brintellix is helping with my clarity in thinking more than Lexapro but it's making me too lethargic and unmotivated to the point that I started to decline my shifts at work. She gave me this apathetic look and told me, "Then you can stop taking it. But I'm not going to switch your medication."

 

I'm going to try and get prescribed Reboxetine from a general practitioner tomorrow for my treatment resistant depression. I doubt they'll let me try Strattera since it's for ADHD. I really think that Edronax/Strattera + Brintellix is going to help me since I responded well to Cymbalta and it was life changing. Wish me luck.

 


Edited by Heinsbeans, 30 November 2016 - 08:39 AM.

  • Agree x 1

#8 Mind_Paralysis

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Posted 30 November 2016 - 12:42 PM

I wish you luck. = )

 

And yes, I do believe trying Reboxetine is worth it, because you have indeed responded favorably to other Norepinephrinergic compounds.



#9 Heinsbeans

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Posted 01 December 2016 - 03:37 AM

Update: The general practitioner wasn't comfortable in prescribing Edronax or Wellbutrin because it's not commonly used in Australia. So I asked to go back to Cymbalta because Brintellix was causing too much lethargy to the point that I started missing work and losing money. But he was also not comfortable with prescribing anything else besides SSRIs and told me to see a Psychiatrist. My Psychiatrist is blackmailing me by saying she's not going to switch medications or prescribe anything else besides antipsychotics. I really hate how ridiculously strict Australia is with their regulations.


Edited by Heinsbeans, 01 December 2016 - 03:51 AM.


#10 Mind_Paralysis

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Posted 01 December 2016 - 09:07 AM

Update: The general practitioner wasn't comfortable in prescribing Edronax or Wellbutrin because it's not commonly used in Australia. So I asked to go back to Cymbalta because Brintellix was causing too much lethargy to the point that I started missing work and losing money. But he was also not comfortable with prescribing anything else besides SSRIs and told me to see a Psychiatrist. My Psychiatrist is blackmailing me by saying she's not going to switch medications or prescribe anything else besides antipsychotics. I really hate how ridiculously strict Australia is with their regulations.

 

Find a new psychiatrist.

 

However, the fact that she's so adamant about the antipsychotics is somewhat disconcerting... are you ENTIRELY certain that you don't have Schizophrenia Simplex, or perhaps OCD? There must be some kind of reasoning behind her thinking here...
 


  • Good Point x 2

#11 Heinsbeans

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Posted 02 December 2016 - 04:55 AM

Why is she so eager to put me on antipsychotics? I think these are the reasons:

  1. Since my IQ and working memory came back normal, she could think that my mental complaints such as low motivation and low mental energy is negative false beliefs or lies and want to change my thinking through antispychotics.
  2. Since I've already tried SSRI, SNRI and Atypical SSRI, she probably thinks that antipsychotics should be the next step. She probably genuinely believes that antipsychotics are the standard protocol for treatment resistant depression.
  3. Since my psychologist brought up the possibility that I may have mild autistic spectrum disorder, there was additional reason for her to put me on antipsychotics.
  4. She possibly gets share of the pay by the pharmaceutical company to prescribe antipsychotics as much as possible.
  5. She verbally told me that she felt very offended when I shared my thoughts on which medication might help me. So she might want to get back at me by wasting my money, time(multiple useless appointments) and tranquillising and possibly ruining my life with antipsychotics. Many medical professionals has a 'God complex' after all and they like to take advantage of the mentally ill.

But despite all of the above reasons, I still think that antipsychotics aren't right for me and it's not worth the risk. I personally think such a potent and high risk drugs like antipsychotics for depression should only be used for cases where the individual is suicidal/danger to oneself and needs something to work immediately. Antipsychotics are said to be even more riskier than psychostimulants which says something:

 

http://mentalhealthd...sk-medications/

http://mentalhealthd...ge-volume-loss/

 

I've asked for people's opinion on reddit and most agree that antipsychotics are unnecessary for me and not worth the risk: https://www.reddit.c...antipsychotics/

 

Like I've mentioned earlier, at the very least, I'd much rather go back on Cymbalta since it was life changing. But I didn't like the way Cymbalta was causing emotional blunting. I'm not getting as much emotional blunting on Brintellix and it's helping with my mental clarity (possibly due to antagonism of various 5-HT receptors) so I really think that doing an adjunctive therapy with Reboxetine is going to work better than Cymbalta. Could stimulants help me with my avoidant personality and low motivation? Obviously, just like it can help even the healthiest people become more productive and motivated. But I think Reboxetine + Brintellix is the good middle ground between safety and effectiveness and I think it's going to be sufficient for me.

 

Nothing happened in my last appointment with the Psychiatrist on the 30th of Nov besides her telling me that she really wants to put me on antipsychotics. Because I declined, she didn't prescribe me anything and I ended up just wasting $250(got back $165 from Medicare) and got nowhere. She also made another appointment on the 16th of December and my Psychiatrist wants to talk to my mom this time. I'm guessing that she's probably going to try and convince her that I need to be on antipsychotics. But no matter what she does, I'm never planning on taking antipsychotics. If she still won't prescribe me Reboxetine or even let me go back on Cymbalta, I guess it's time to see a new Psychiatrist.


Edited by Heinsbeans, 02 December 2016 - 05:30 AM.


#12 NG_F

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Posted 05 December 2016 - 10:09 AM

She sounds like a close minded sheep.  It looks as if she's just going through the "typical progressive protocol" that most do . ie) starting on SSRI <SNRI, add Abilify or flavor of the month. If those fail she'll probably add Wellbutrin-  Meaning to ask you, have you tried asking her to personally script Wellbutrin for you ? Please don't tel me that  Pdoc's make recommendations but your GP has the right to agree or disagree? Shit man, that seems like having to jump 2 fences if that's the case.  I know how some claim it's relatively worthless but some have had robust therapeutic response if you can push the dosage. Of course be aware of higher dosages lowering your seizure threshold. You could def do a Brit, Cymbalta or Lexapro/ Wellbutrin combo

 

She's saving Amp& stims and MAO Inhibitors until she's exhausted everything else.  I wouldn't hold my breath for the latter ! lol I personally really like Mlilnacipran for motivation and anergia. Just monitor your BP regularly please. 

 

I agree with stink, you should find a different Pdoc if that's relatively easy to do  BUT try and work with her until you can show her you're not challenging her every idea. Best of Luck and keep us updated  :-D



#13 Heinsbeans

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Posted 12 December 2016 - 04:44 AM

The final say comes from the Psychiatrist for prescribing medications. GPs in Australia is very hesitant to prescribe anything else besides SSRI.
 
When I was taking 120mg of Cymbalta back in May 2015, it was working really well for motivation, will power, arousal, energy and mood. But it was making me emotionally blunted and I didn't like the way I felt on it. So I asked my Psychiatrist if I could switch to Lexapro + Strattera or Wellbutrin. But she was hesitant to prescribe Wellbutrin because it's not used for depression in Australia and she'd have to prescribe it off-label which she isn't comfortable in doing. She also didn't want to put me on Strattera and her reasoning was because it takes too long (at least 3 weeks) to start working. Both reasons are ironic since the antipsychotics that she wants to put me on (Paliperidone) is also used off-label and it takes several weeks to start working. I think she just really wants to put me on antipsychotics.
 
The good news is that It's not a big deal that I can't go on Wellbutrin. Because later on, I've found out that it's anticholinergic and many people report feeling the cognitive side effect on it. Recent study shows that anticholinergic drugs increase the risk of developing dementia later in life. So I'd much rather go on Reboxetine or Atomoxetine which isn't known to be anticholinergic. Reboxetine might be better than Atomoxetine since it's supposed to be slightly better tolerated.
 
I think you're right that she's saving the stimulants until she has exhausted everything else. Because she has mentioned to me that she's considering putting me on dextroamphetamine but she first wants to put me on antipsychotics. But the thing is, I'm not that desperate to go on stimulants since I know that NRI is enough. Could stimulants help me more than NRI? Sure, but I'm not wiling to risk damaging my brain from taking antipsychotics just to be able to go on stimulants. If I did listen to her and go on antipsychotics, I'm pretty confident that she's going to increase the dosage every time I complain that it's not helping with energy or motivation. And that's going to cause more side effects and antipsychotics are known to be extremely difficult to taper off.
 
After briefly skimming through several studies of atypical antipsychotics being used for treatment resistant depression, I'm still convinced that the risk far outweighs any potential benefits. From what I've read, antipsychotics may help offset some symptoms of depression but it doesn't improve the underlining cause nor does it improve the cognitive impairments associated with depression. Long-term use isn't recommended since it's not proven to be safe over long-term. Not to mention that since antipsychotics are strongly sedative, it's not likely going to help my issue of anergia/lethargy and low motivation/will power.
 
I found this article helpful in understanding how antipsychotics started becoming used for depression: https://www.buzzfeed...ipsychotic-boom
 
It's good to hear that Milnacipran is working for you :) I personally wouldn't want to go back on SSRI/SNRI without a 5-HT receptor agonism/antagonism since SSRI alone gives me emotional blunting. Plus, I feel more like myself on Vortioxetine than I did on Lexapro/Cymbalta. But the lack of energy and motivation is killing me and no amount of caffeine seems to help.
 
Guanfacine(Intuniv) was another consideration that I had. It looked interesting since it's a selective alpha-2a adrenergic receptor agonist but it's supposed to be sedating rather than energising (albeit less sedating than Clonidine). And it doesn't really help with motivation or energy but only in executive functioning such as planning, regulation of attention, processing and impulse control. So I think NRI like Reboxetine would work better since it increases energy and motivation. Besides, Guanfacine isn't available in Australia anyway. Clonidine is available in Australia but it's not used for ADHD and the highest dosage only comes in 150mcg per tablet and you need at least 0.1mg to treat ADHD [1] [2
 
So I'm still leaning towards moderate dose(4mg+) of Reboxetine in combination with 20mg Vortioxetine which I think would be sufficient for me to function and get my life back on track by motivating me to learn to drive, look for jobs etc.

Edited by Heinsbeans, 12 December 2016 - 05:39 AM.

  • Agree x 1

#14 NG_F

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Posted 12 December 2016 - 05:12 PM

Sounds like a great Plan.  I wish we had Roboxetine here in Canada. We have Atomoxetine, which I read and learned is close, but some people can get real nasty adverse effects from that and here it costs about $3.60 a pill   :|o

                                           I see that a lot of meds are cheaper in Ausi  and Edronax is available in Australia. Does your health insurance cover it completely ? Also have you or will you take Staterra if you're not getting the desired effect from the Roboxetine?



#15 Blake Thacker

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Posted 16 December 2016 - 05:56 AM

She sounds like a close minded sheep. It looks as if she's just going through the "typical progressive protocol" that most do . ie) starting on SSRI <SNRI, add Abilify or flavor of the month. If those fail she'll probably add Wellbutrin- Meaning to ask you, have you tried asking her to personally script Wellbutrin for you ? Please don't tel me that Pdoc's make recommendations but your GP has the right to agree or disagree? Shit man, that seems like having to jump 2 fences if that's the case. I know how some claim it's relatively worthless but some have had robust therapeutic response if you can push the dosage. Of course be aware of higher dosages lowering your seizure threshold. You could def do a Brit, Cymbalta or Lexapro/ Wellbutrin combo

She's saving Amp& stims and MAO Inhibitors until she's exhausted everything else. I wouldn't hold my breath for the latter ! lol I personally really like Mlilnacipran for motivation and anergia. Just monitor your BP regularly please.

I agree with stink, you should find a different Pdoc if that's relatively easy to do BUT try and work with her until you can show her you're not challenging her every idea. Best of Luck and keep us updated :-D


You mentioned a Brintellix + Cymbalta combination? Do you think the Brintellix ability to retain emotions will erase the Cymbalta emotional numbing effect?

#16 Blake Thacker

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Posted 16 December 2016 - 06:15 AM

I to had the best results with Cymbalta and hated the emotional numbing effects.

I have SCT and did not respond to stimulants which caused massive burnout.

There was a couple of people who took NSI-189 with their antidepressant and it brought back emotions fully. This should hold true with Cymbalta. Here is the Reddit link https://goo.gl/n9dmIm

P21 by Ceretropic is now back in stock. It gives excellent motivation, energy and focus as well as increased intelligence. It was isolated from Cerebroylsin which has been used for decades and is safe. There are many reddit reports of P21 starting up as of 12/12-16 as well as years back so keep an eye on their updates.

Intranasal insulin is used by some. Check out Lost_Falco's website and reddit. I have experienced increased irritability on it though. Most however respond well with increased energy and motivation.

NG_F mentioned combining Brintellix with Cymbalta. Brintellix may prevent emotional blunting from the Cymbalta if the Cymbalta is low dosed possibly? I remeber reading about a user on Effexor and Brintellix said they were much better in combination then either alone.

Vraylar is supposed to be the most motivating and mood boosting antipsychotic. It is the most recently released AAP.

Reboxitine is available without a prescription from IAS. 40$ 2 month supply

The reason it was more favorable over Straterra is because it lacks the kappa opiod agonism which leads to suicidal ideation and depression. This does not happenen in everyone and it is blocked by taking Tianeptine with Straterra.

Edited by Blake Thacker, 16 December 2016 - 06:39 AM.

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#17 NG_F

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Posted 16 December 2016 - 07:41 AM

Blake : Thanks for sharing and will def check out those options and recommendations. However, maybe you misread or misunderstood. I would never suggest Brintellix (Vortioxetine) combined with any other SSRI   :|o  That was an either or with combining either Brit, or Cymbalta, or Lexapro  with Wellbutrin. Having said that , I have read of a few reports where users have needed small amounts of  Lexapro with Brintellix to achieve adequate OCD and anxiety mitigation. The drug is still fairly new, so although it hits very unique  5HT receptors in an optimal way ...https://en.wikipedia...ki/Vortioxetine and it wouldn't be exactly like taking 2 SSRI's simultaneously, One should still tread very carefully! Those that DID add the small amount of Lexapro SSRI to the vortioxetine ~ Brintellix reported no deleterious or troublesome effects whatsoever  :-D

 

Blake, I seen that on IAS and I realaize that many meds are coming from China now. How would you rate their integrity and quality lately? It's been a while since I dealt with them. Interesting Re: Kappa agonism , as Suboxone has indications for the use of treatment resistant depression and one Mechanism of action is via it's Kappa antagonism, so this would make sense about  Streaterra  :cool:



#18 Heinsbeans

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Posted 17 December 2016 - 05:11 AM

As expected, my psychiatrist refused to prescribe me anything else(not even Reboxetine). And she had a chat with my mom and managed to convince her that I need to be on antipsychotics. So I gave up and she handed me the prescription for 0.5mg Risperidone. I'm supposed to take 0.5mg every night and increase the dosage to 1mg after 7 - 10 days and eventually up to 2mg. I asked if there's going to be any interaction between Trintellix and Risperidone's 5-HTr antagonism and she said it should be fine.
 
Because of the anergia/lethargy from just being on Trintellix, I've been missing so many days of work and stopped going to the gym as often. I asked her if Risperidone will help with energy and she said it can which doesn't sound too convincing considering it's a sedative/tranquilliser...
 
I took one tablet last night and I know it's too early to tell, but all it did was make me sedated and drowsy. I don't know how Risperidone is going to help with my anergia and low motivation.. But we'll see how I go for the next 3+ months. From my past experience, when the drug is right for me, I can feel the positive effects right away from day one even at the lowest dosage (e.g. Trintellix, Cymbalta).
 
And yes, my pdoc has already tested my hormone and thyroid levels and all came back within range[1]. She even had me do MRI which also came back normal[2].
 
Because I'm partially responding well to Trintellix, I just need to add something to help with the lack of motivation and anergia. I still feel like low dose Reboxetine would've been a safer and more effective choice for me especially when combined with the 5-HTr antagonism of Trintellix. I'm considering whether or not to change my psychiatrist or keep taking Risperidone. If I decide to change to another psychiatrist, it will take weeks for the referral to get through and months to be able to see them. 
 
Not sure why she chose Risperidone when Aripiprazole and Quetiapine are more commonly used. With Aripiprazole I can understand since the lowest dosage available in Australia is 10mg[1][2] which is too high for starting (although pill splitter could be used which I have). But why not Quetiapine?[1][2] I know that ratings doesn't really mean anything Risperidone only has 18 reviews on https://www.drugs.co...depression.html. Maybe she didn't choose it for my best interest but rather to fatten her wallet.
 
In your opinion, is Risperidone a good choice?
 
I think there's several reasons why my psychiatrist is so adamant to prescribe me anything else besides antipsychotics:
  1. My mom saw my nootropics in my bedroom and became concerned and she started talking about it my psychiatrist.
  2. My mom also told her that I'm in my bedroom a lot and constantly researching about everything which she see's as a 'problem' and my psychiatrist agrees. 
  3. I wanted to be honest with my psychiatrist so I told her about all of the nootropics I was self-medicating in the past before I went on antidepressants. So she could see this as a 'substance use' and further confirm that I need to be on antipsychotics. Which is ironic since I never drink or smoke and I only briefly used nootropics to see if it helps with my depression and stopped when I realised it was useless.
  4. She's following protocol and since I didn't respond to 2 SSRI(Lexapro and Trintellix) and 1 SNRI (Cymbalta), she believes that the next trial needs to be adjunctive antipsychotics.
 
Besides Vraylar (Cariprazine), there's also Rexulti (Brexpiprazole). But I don't know if they're better than the Risperidone I was prescribed. But it doesn't matter since neither is available yet in Australia.
 

 


Edited by Heinsbeans, 17 December 2016 - 05:40 AM.


#19 Heinsbeans

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Posted 17 December 2016 - 09:20 AM

I've been researching about antipsychotics and here's what I've found so far.
 
I think the antidepressant effect from atypical antipsychotic is coming from the 5-HT antagonism and I'm basically already accomplishing that with Trintellix(5-HT1A, 1B, 1D, 3, 7). Although it couldn't hurt to further antagonise them with atypical antipsychotics.
 
Risperidal (Risperidone) and (Abilify) Aripiprazole has an Anticholinergic Cognitive Burden Scale of 1. But Seroquel (Quietiapine) has ACB score of 3[1].
 
Personally, I'm uncomfortable in taking any medicine that's even rated ACB of 1 but I'd be very uncomfortable in taking Quetiapine for sure. I'm not sure what the ACB scale of Latuda (Lurasidone) is but the pharmacology does look better than Risperidone. It also doesn't appear to be anticholinergic and it's available in my country.
 
I wonder why my psychiatrist didn't choose Lurasidone. Maybe because it only comes in 40mg which might be too high.[1][2]. But again, I have a pill splitter so I could split it in 20mg if needed. I might discuss Lurasidone with my psychiatrist next time.
 
This is what I don't understand about psychiatrists. They tell me that it's not my job to do research, but I keep finding better medicines than the ones they prescribed. In fact, I'm the one who asked for Trintellix because I wasn't completely satisfied with Cymbalta and I think it was a right choice.
 
They're supposed to be really smart people and I'm paying them a lot of money. So why do I keep finding medicines that's better than the one they prescribed?

Edited by Heinsbeans, 17 December 2016 - 09:23 AM.

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#20 Finn

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Posted 17 December 2016 - 11:20 AM

 

Not sure why she chose Risperidone when Aripiprazole and Quetiapine are more commonly used. With Aripiprazole I can understand since the lowest dosage available in Australia is 10mg[1][2] which is too high for starting (although pill splitter could be used which I have). But why not Quetiapine?[1][2] I know that ratings doesn't really mean anything Risperidone only has 18 reviews on https://www.drugs.co...depression.html. Maybe she didn't choose it for my best interest but rather to fatten her wallet.
 
In your opinion, is Risperidone a good choice?
 

 

Risperidone has been on the markets about 10 years longer than Aripiprazole and few years longer than Quetiapine, so it is probably less expensive in most markets. While in drugs.com Aripiprazole has more than twice as many reviews than Risperidone for all usages, in Finland for example Risperidone has led Aripiprazole in DDD sale statistics (designated daily dosage).

 

FINNISH STATISTICS ON MEDICINES (both in Finnish and English)

http://www.julkari.f...ilasto_2015.pdf

 

Drugs.com in America-centric site. The total amount of reviews reflects the popularity of drugs on American markets, and the popularity of drugs in American markets is heavily influenced by drug industry, more probably than in any other western country, whereas in Finland drug industry's influence is much less of a factor than in most other western countries. 

 

So what you are basically saying that you suspect your doctor is a puppet of drug industry fattening her wallet, because she doesn't follow the trends set by American drug industry, and give you the much newer, more expensive Aripiprazole pushed aggressively by American drug industry, but rather she gives you older cheaper Risperidone.  :ph34r:

 

 

 

http://www.sciencedi...163725814001272

The drug discovery program that led to the discovery and development of vortioxetine (Brintellix) had its origins in the hypothesis (Artigas, 1993) derived from studies of combined SERT inhibition and 5-HT1A receptor modulation. However, during the drug discovery phase of the project, the target profile was redirected toward a combination of SERT inhibition, 5-HT1A receptor agonism and 5-HT3 receptor antagonism. Combined 5-HT1A receptor stimulation and SERT inhibition have been hypothesized to lead to rapid desensitization of somatodendritic 5-HT1A autoreceptors and an enhanced antidepressant effect through activation of post-synaptic 5-HT1A receptors.

 

 

The main thing that differentiates Brintellix from SSRIs, is (almost) full agonism (96%) of 5-HT1A receptors, the first thing you check when adding antipsychotic to that is the binding affinity for 5-HT1A, to check that it is not antagonist or partial agonist of that receptor with strong affinity.

 

The lower the Ki [nm], the stronger the affinity

 

https://en.wikipedia...ne#Pharmacology

 

 

https://en.wikipedia...le#Pharmacology

 

https://en.wikipedia...ne#Pharmacology

 

https://en.wikipedia...ne#Pharmacology

 
Risperidone has least conflicting receptor profile of those 3, it isn't even close. 
 
 
 
http://www.longecity...chometric-test/
I feel like I got my “stupid” genes from my dad’s side 
 

 

 

Believing that and at the same time believing that you are smarter and more knowledgeable than your pdoc and  psychologist, is not logical. You've shown poor judgement in past in delaying getting professional help despite of obviously severe issues, and also one of your SSRI trials is pretty much a textbook example of how SSRI trial is not supposed to go. No, you don't quit it on day 3, because on day 1 the nausea caused you to vomit after gym exercise, and you didn't get beneficial effects on day 3 yet. Your baseless criticism of your pdoc choosing Risperidone over Aripiprazole and Quetiapine also shows your limits in participating designing your own medication. Your psychologist and pdoc probably have good reasons for their suggestions. Admitting that you are not the smartest or the most knowledgeable person in the room can be quite nice, since smarter and more competent people are much more likely to be able to help you than stupid and incompetent ones.

 
And for fuck sake you are not even seeing a doctor about your problems! No one online is more likely to be able to help you than your doctor. You try the clinically tested treatments before experimenting with random shit like noopept and asking people on the fucking internet for help. That's what's logical, that's what makes sense.  
 
 
 
 

 

Spoiler
 
 

 


Edited by Finn, 17 December 2016 - 11:25 AM.

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#21 Mind_Paralysis

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Posted 17 December 2016 - 11:39 AM

 

 

Not sure why she chose Risperidone when Aripiprazole and Quetiapine are more commonly used. With Aripiprazole I can understand since the lowest dosage available in Australia is 10mg[1][2] which is too high for starting (although pill splitter could be used which I have). But why not Quetiapine?[1][2] I know that ratings doesn't really mean anything Risperidone only has 18 reviews on https://www.drugs.co...depression.html. Maybe she didn't choose it for my best interest but rather to fatten her wallet.
 
In your opinion, is Risperidone a good choice?
 

 

Risperidone has been on the markets about 10 years longer than Aripiprazole and few years longer than Quetiapine, so it is probably less expensive in most markets. While in drugs.com Aripiprazole has more than twice as many reviews than Risperidone for all usages, in Finland for example Risperidone has led Aripiprazole in DDD sale statistics (designated daily dosage).

 

FINNISH STATISTICS ON MEDICINES (both in Finnish and English)

http://www.julkari.f...ilasto_2015.pdf

 

Drugs.com in America-centric site. The total amount of reviews reflects the popularity of drugs on American markets, and the popularity of drugs in American markets is heavily influenced by drug industry, more probably than in any other western country, whereas in Finland drug industry's influence is much less of a factor than in most other western countries. 

 

So what you are basically saying that you suspect your doctor is a puppet of drug industry fattening her wallet, because she doesn't follow the trends set by American drug industry, and give you the much newer, more expensive Aripiprazole pushed aggressively by American drug industry, but rather she gives you older cheaper Risperidone.  :ph34r:

 

 

 

http://www.sciencedi...163725814001272

The drug discovery program that led to the discovery and development of vortioxetine (Brintellix) had its origins in the hypothesis (Artigas, 1993) derived from studies of combined SERT inhibition and 5-HT1A receptor modulation. However, during the drug discovery phase of the project, the target profile was redirected toward a combination of SERT inhibition, 5-HT1A receptor agonism and 5-HT3 receptor antagonism. Combined 5-HT1A receptor stimulation and SERT inhibition have been hypothesized to lead to rapid desensitization of somatodendritic 5-HT1A autoreceptors and an enhanced antidepressant effect through activation of post-synaptic 5-HT1A receptors.

 

 

The main thing that differentiates Brintellix from SSRIs, is (almost) full agonism (96%) of 5-HT1A receptors, the first thing you check when adding antipsychotic to that is the binding affinity for 5-HT1A, to check that it is not antagonist or partial agonist of that receptor with strong affinity.

 

The lower the Ki [nm], the stronger the affinity

 

https://en.wikipedia...ne#Pharmacology

 

 

https://en.wikipedia...le#Pharmacology

 

https://en.wikipedia...ne#Pharmacology

 

https://en.wikipedia...ne#Pharmacology

 
Risperidone has least conflicting receptor profile of those 3, it isn't even close. 
 
 
 
http://www.longecity...chometric-test/
I feel like I got my “stupid” genes from my dad’s side 
 

 

 

Believing that and at the same time believing that you are smarter and more knowledgeable than your pdoc and  psychologist, is not logical. You've shown poor judgement in past in delaying getting professional help despite of obviously severe issues, and also one of your SSRI trials is pretty much a textbook example of how SSRI trial is not supposed to go. No, you don't quit it on day 3, because on day 1 the nausea caused you to vomit after gym exercise, and you didn't get beneficial effects on day 3 yet. Your baseless criticism of your pdoc choosing Risperidone over Aripiprazole and Quetiapine also shows your limits in participating designing your own medication. Your psychologist and pdoc probably have good reasons for their suggestions. Admitting that you are not the smartest or the most knowledgeable person in the room can be quite nice, since smarter and more competent people are much more likely to be able to help you than stupid and incompetent ones.

 
And for fuck sake you are not even seeing a doctor about your problems! No one online is more likely to be able to help you than your doctor. You try the clinically tested treatments before experimenting with random shit like noopept and asking people on the fucking internet for help. That's what's logical, that's what makes sense.  
 
 
 
 

 

Spoiler
 
 

 

 

You certainly gave *me* something to think about here with this as well - could you by chance have a look at my case as well?

 

I had a previously decent relationship to my Dr.'s, but after revealing that I used NSI-189 and Tianeptine this relationship has gone a bit sour. They're eyeing me for Bipolar NOS, and in the meantime they've taken away Vyvanse and Atomoxetine, leaving me utterly incapacitated from my burnout and SCT.

 

Previously I had a awesome Dr. who was an expert in Neuropsychiatric disorders and he was the first to prescribe me Modafinil - he was also knowledgable about SCT and that it's a proposed diagnosis, as well as what differs us SCT-patients from the regular ADHD-set of patients.

 

He's even a passing acquaintance of Dr. Barkley's!

I had never before felt so trusting and positive about a Dr.-Patient -relationship as when I was signed up with his practise. (he's a private dr)
 

However, I moved from the city where he's located, and now I'm back in my small home-town, and honestly... they don't give ANY confidence to me! I feel as if they're not taking me seriously, and unlike my former Pdoc they don't accept that I have knowledge regarding my disorder, and that my input is valuable.

 

 

How the h*ll am I going to solve this...? I need both Modafinil, Gabapentin and especially Atomoxetine to function - but they are reluctant to give me ample treatment.

 

Should I just accept their idea that I'm bipolar NOS and try to live as a sick-pensioner for the rest of my life? Because honestly, Quetiapine doesn't help - in any way.

(it should be noted that the evaluation for affective disorders have barely started, I've merely done the first basic essay)



#22 Heinsbeans

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Posted 08 January 2017 - 05:06 PM

I've been taking Risperidone since 30th of Nov every night but it's not right for me. I haven’t noticed any benefits besides increase in lethargy/fatigue, decreased motivation, flattened emotion, anhedonia, apathy, difficulty concentrating and drowsiness. I’m having extreme difficulty working even for just 4 hours on this medication so I won’t be able to continue taking it.

 

Since my psychiatrist refuses to let me try other medication until I go up to 3mg, I’m going to see another psychiatrist for a second opinion.

 

I'm considering trying to create a combination with the following antidepressants: Vortioxetine, Duloxetine, Mirtazapine, Reboxetine, Bupropion, Lurasidone, Aripiprazole, Brexipiprazole(unavailable in AU), Cariprazine(unavailable in AU), Flibanserin(unavailable in AU), Pramipexole and Rotigotine:

 

Option#1 (Vortioxetine + Reboxetine)

I'm leaning towards Vortioxetine + Reboxetine but I'm unsure if the next psychiatrist will be comfortable in prescribing it considering it has a bad reputation. 

 

Option#2 (Vortioxetine + Mirtazapine)

The next thing I'm considering is Vortioxetine + Mirtazapine but I'm slightly hesitant to try it because it's a potent histamine antagonist (1.6nM). Some people say the drowsiness subsides over time while others say it never goes away and have to stop taking it. It also has a mAChrs antagonism of 670nM which isn't significant but still fairly anticholinergic and it could be slightly anti-nootropic. If only the NaSSA, S32212 comes out already...

 

Option#3 (Vortioxetine + DA agonists) 

I'm still researching about DA agonists/partial agonists for depression but from my limited research it sounds like it's not a good long-term solution: https://www.reddit.c...ng_term2_weeks/

Does anyone take DA agonists(e.g. Rexulti/Vraylar) with SSRI for depression and are they worth it long-term? Rexulti in particular is also a 5-HT2A and A2c adrenergic antagonist which should help with energy and boost the antidepressant effect from SSRI.

 

Option#4 (Bupropion)

Even though I'm reluctant to try Bupropion because it's a nAChrs antagonist which some people say has negatively affected their memory, I might have to consider it since it's the best antidepressant for motivation and energy. Unfortunately, it can't be combined with Vortioxetine due to interactions.

 

Any thoughts on which combination of antidepressants in my list produces the best nootropic effect with the increase in motivation and energy?

 

I've been asking reddit as well and I've learnt a lot about 5-HT antagonism thanks to /u/hootnoot: https://www.reddit.c...chotics_for_my/


Edited by Heinsbeans, 08 January 2017 - 06:01 PM.


#23 Mind_Paralysis

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Posted 08 January 2017 - 05:24 PM

Heinsbeans, remind me - have you tried Tianeptine?

 

I would actually go for a combo of Tianeptine and REBOXETINE rather than Vortioxetine + Reboxetine myself.

 

On the other hand, you'll probably never get it prescribed - it's not used in Australia, as far as I know.

 

So, from these options:
 

Vortioxetine + Reboxetine

 

Seems the best.



#24 Heinsbeans

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Posted 08 January 2017 - 05:36 PM

It is available in Australia, although probably rarely prescribed. If you search for reboxetine on PBS website it will show up: http://www.pbs.gov.a...term=reboxetine


Edited by Heinsbeans, 08 January 2017 - 05:41 PM.


#25 Finn

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Posted 20 May 2017 - 06:23 AM

By the way, are you still eating meals like this you mentioned elsewhere?

 

https://docs.google....H9wld1aIUo/edit

http://www.ibsgroup....s/#entry1141321

 

 

I become sluggish and sleepy after eating a meal multiple times a day and end up having to take a nap 2 - 4 times a day. Microwaved oatmeal with organic brown rice milk and honey is the worst, I instantly become sluggish and fall asleep after eating them.

 

 

Instant oatmeal is worse than Coco Pops, chocolate version of Rice Krispies, when it comes to both glycemic index and glycemic load. Rice milk glycemic index is in range of 79-92, also worse than Coco Pops, not sure of brown rice milk.

 

http://www.health.ha...d-for-100-foods

 

Some people advocate microwave/instant oatmeal as healthy and fast meal option, but it really is not. 


Edited by Finn, 20 May 2017 - 07:16 AM.


#26 Mind_Paralysis

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Posted 20 May 2017 - 11:17 AM

It is available in Australia, although probably rarely prescribed. If you search for reboxetine on PBS website it will show up: http://www.pbs.gov.a...term=reboxetine

 

I meant Tianeptine - but good to see that you've got Reboxetine! = ) Considering the side-effects profile of Atomoxetine, I honestly think it might be worth it to try Reboxetine first, instead.

 

My search on the PBS website confirmed my fears - you're out of Tianeptine down under!



#27 Heinsbeans

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Posted 09 April 2018 - 09:31 PM

Long story short, because of my refusal to take Risperdal, my private psychiatrist referred me to a public psychiatrist. The public psychiatrist made me wait 3 months before switching meds because she believed "therapy" from a psychologist would work for my motivation issues and anergia which in the end it did nothing. I already had therapy sessions prior to that which I did for 4 weeks so I wasn't surprised it didn't help me as I feel that my issues are more biological. Anyways, after 3 months, the only thing she allowed to prescribe me was Cymbalta but only because I was already prescribed it earlier. So no Zyban or Reboxetine. I stopped seeing a psychiatrist as I gave up on them. And I've recently started taking Atomoxetine from the darkweb as a last resort. I've tried modafinil for almost a year and while it helped initially for motivation and anergia, it just wasn't sustainable as NRI. It's too early to tell but I think Atomoxetine is working better than modafinil on me. I think I can finally start living my life and learn to drive a car and find a full-time job.

 

My initial plan was to do 23andMe and see if I have any genetic bio-markers for ADHD-PI or other disorders that my psychiatrist possibly missed. But after 8 weeks of waiting, the saliva test came back as untestable so I had to wait another 4 weeks for reshipping and plus another 4 - 8 weeks for second test. So I decided to just try the medication first while also doing the 23andMe the second time.

 

Also, over the past 6 months, I have managed to reduce the Brintellix dosage to 5mg. I'm not sure if I should stay on it or make the switch to just Atomoxetine. I'm considering getting off Brintellix for now and perhaps go back on it again if Atomoxetine starts causing sexual side effects like decreased sex drive.

 

Lastly, this is the psychology report that I was referring to in the first post: https://imgur.com/a/yRz6H


Edited by Heinsbeans, 09 April 2018 - 10:05 PM.

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#28 Mind_Paralysis

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Posted 18 April 2018 - 05:21 PM

Long story short, because of my refusal to take Risperdal, my private psychiatrist referred me to a public psychiatrist. The public psychiatrist made me wait 3 months before switching meds because she believed "therapy" from a psychologist would work for my motivation issues and anergia which in the end it did nothing. I already had therapy sessions prior to that which I did for 4 weeks so I wasn't surprised it didn't help me as I feel that my issues are more biological. Anyways, after 3 months, the only thing she allowed to prescribe me was Cymbalta but only because I was already prescribed it earlier. So no Zyban or Reboxetine. I stopped seeing a psychiatrist as I gave up on them. And I've recently started taking Atomoxetine from the darkweb as a last resort. I've tried modafinil for almost a year and while it helped initially for motivation and anergia, it just wasn't sustainable as NRI. It's too early to tell but I think Atomoxetine is working better than modafinil on me. I think I can finally start living my life and learn to drive a car and find a full-time job.

 

My initial plan was to do 23andMe and see if I have any genetic bio-markers for ADHD-PI or other disorders that my psychiatrist possibly missed. But after 8 weeks of waiting, the saliva test came back as untestable so I had to wait another 4 weeks for reshipping and plus another 4 - 8 weeks for second test. So I decided to just try the medication first while also doing the 23andMe the second time.

 

Also, over the past 6 months, I have managed to reduce the Brintellix dosage to 5mg. I'm not sure if I should stay on it or make the switch to just Atomoxetine. I'm considering getting off Brintellix for now and perhaps go back on it again if Atomoxetine starts causing sexual side effects like decreased sex drive.

 

Lastly, this is the psychology report that I was referring to in the first post: https://imgur.com/a/yRz6H

 

Hmm.

 

I just read the psychological report above. I'm afraid that I must agree with your psychologists assessment - you do present with some features of ASD - Autism Spectrum Disorder - the fact that you aren't interested in making friends and socializing, and that you struggled with some of the more higher level Verbal comprehension challenges imply that you may have some difficulty understanding abstracts concepts.

 

You should probably consider that you may have such a diagnosis - this doesn't necessarily mean you don't have some form of ADHD-PI or SCT as well - there is, after all, a very high co-morbidity.
 

 

The fact that you have a high average working memory as well speaks partially against you having SCT, as well as you having average processing speed.



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#29 Kirill Losik

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Posted 02 June 2020 - 07:04 AM

I've recently started taking Atomoxetine

 

Hi, I've read your posts on this forum and reddit and found that we have very very rly similar symptoms and response to medications.

 

How was it?

 

What is your current state and what are you taking now?



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