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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by TriedEveryMedication on April 21, 2016, at 12:32:18
My ADD responds really well to NRIs. Well, specifically desipramine and strattera.
Problem with them (other than being on that anticholinergic list) is wicked insomnia. On them, I wake up at about 2am and can't get back to sleep until 5am.
The insomnia eventually destroys any benefit.
I tried reboxetine a long time ago, but I didn't think it did anything for me (maybe I didn't take it long enough or a big enough dose or maybe it was just counterfeit (bought it online).
I've been digging around. MAZINDOL has some NRI action but it is prescribed for obesity. Anyone try it?
someone on longecity recommended "prolintane"....
Any others to consider?
Posted by PeterMartin on April 22, 2016, at 1:06:30
In reply to Are there any other NRIs besides TCAs/strattera?, posted by TriedEveryMedication on April 21, 2016, at 12:32:18
In a discussion I was in recently SLS mentioned that Seroquel "has an active metabolite that acts as a norepinephrine reuptake inhibitor like many tricyclic antidepressants."
Posted by TriedEveryMedication on April 22, 2016, at 1:35:32
In reply to Re: Are there any other NRIs besides TCAs/strattera?, posted by PeterMartin on April 22, 2016, at 1:06:30
> In a discussion I was in recently SLS mentioned that Seroquel "has an active metabolite that acts as a norepinephrine reuptake inhibitor like many tricyclic antidepressants."
>
> http://www.dr-bob.org/babble/20160131/msgs/1086347.htmlI'd think the cognitive impairment from seroquel would wipe out any cognitive benefits I get from the NRI... which is the only reason I would take an NRI.
Posted by Christ_empowered on April 22, 2016, at 9:35:02
In reply to Are there any other NRIs besides TCAs/strattera?, posted by TriedEveryMedication on April 21, 2016, at 12:32:18
it looks like mazindol isn't readily available in the US :-(
Are stimulants an option? Provigil, Ritalin, the amphetamines, etc. ? I don't know if a doc would be willing to Rx a diet pill for ongoing ADD/ADHD treatment. I mean, its rational--most are Schedule III and Schedule IV, so you could actually get refills--but I don't know if its common practice, especially with all the advertising dollar$ being pumped into various Schedule II stimulant preparations.Having said that...back when I tried phendimetrazine by Rx (Bontril), it helped about as much as Adderall, with fewer side effects. Its Schedule III, I think...I was taking the 105 capsule in the AM. Phentermine (Adipex, etc.) is more popular, but it made me feel jittery and "off."
Other than that...Wellbutrin, probably at a high dose...I guess you could try an augmentation strategy w/ the Wellbutrin to get it to work better (since you mentioned insomnia, Remeron comes to mind...).
That's about all I have for you :-(
Some supplements are supposed to help w/ attention problems. I would imagine that's usually a last ditch effort.
Posted by TriedEveryMedication on April 22, 2016, at 11:14:30
In reply to Re: Are there any other NRIs besides TCAs/strattera?, posted by Christ_empowered on April 22, 2016, at 9:35:02
thanks for your suggestions. I'm at about at my last ditch effort :)
I've tried all the stimulants, wellbutrin, and so on. My doc has given me phentermine in the past, so I don't see why he wouldn't give me Phendimetrazine - that's one of the few things I have not tried. Seems to be in a different class. Prolintane seems to be of that class, too and is available online.
Posted by rjlockhart37 on April 22, 2016, at 23:54:01
In reply to Are there any other NRIs besides TCAs/strattera?, posted by TriedEveryMedication on April 21, 2016, at 12:32:18
the only other med that i know that increases NE is effexor and wellbutrin, that and prisque but effexor and prisque work moreo on serotonin and NE together, but they are noticable in NE increase
Posted by Christ_empowered on April 23, 2016, at 9:14:56
In reply to Are there any other NRIs besides TCAs/strattera?, posted by TriedEveryMedication on April 21, 2016, at 12:32:18
Tofranil is/was sometimes used for add/adhd, so is high dose cymbalta.
Posted by SLS on April 23, 2016, at 13:08:30
In reply to Are there any other NRIs besides TCAs/strattera?, posted by TriedEveryMedication on April 21, 2016, at 12:32:18
> My ADD responds really well to NRIs. Well, specifically desipramine and strattera.
>
> Problem with them (other than being on that anticholinergic list) is wicked insomnia. On them, I wake up at about 2am and can't get back to sleep until 5am.Perhaps you should simply treat the insomnia aggressively. There have been times when I responded well to an MAOI, with or without desipramine, in which I experienced total insomnia for days and days. The best choice was to then treat the insomnia as if it were a disorder on its own. The first time, I ended up using a combination of Halcion and Ativan. I slept satisfactorily, and ended feeling well for an extended period of time. I had no qualms about taking BZDs for the long-term. I still don't. At some point, you might be able to remove the sleeping medication and remain free of insomnia.
What have you tried for sleep so far?
> I've been digging around. MAZINDOL has some NRI action but it is prescribed for obesity.
Mazindol is a failed investigational antidepressant that later was found to be helpful in obesity. I believe its main target was brown adipose tissue. There, it would increase energy production in the form of heat to regulate body temperature and burn excess white adipose tissue (fat). I don't know. Maybe it would help you, but I wouldn't invest too much optimism in it.
I am guessing that you have already investigated guanfacine?
- Scott
Posted by TriedEveryMedication on April 23, 2016, at 13:19:48
In reply to Re: Are there any other NRIs besides TCAs/strattera?, posted by rjlockhart37 on April 22, 2016, at 23:54:01
> the only other med that i know that increases NE is effexor and wellbutrin, that and prisque but effexor and prisque work moreo on serotonin and NE together, but they are noticable in NE increase
>
>effexor was decent for me. My attentional problems let up slightly and it didn't cause insomnia and anger like desipramine did.
then I started getting messed up liver levels from it, only at 150mg.
Posted by TriedEveryMedication on April 23, 2016, at 13:27:16
In reply to Re: Are there any other NRIs besides TCAs/strattera?, posted by SLS on April 23, 2016, at 13:08:30
> > My ADD responds really well to NRIs. Well, specifically desipramine and strattera.
> >
> > Problem with them (other than being on that anticholinergic list) is wicked insomnia. On them, I wake up at about 2am and can't get back to sleep until 5am.
>
> Perhaps you should simply treat the insomnia aggressively. There have been times when I responded well to an MAOI, with or without desipramine, in which I experienced total insomnia for days and days. The best choice was to then treat the insomnia as if it were a disorder on its own. The first time, I ended up using a combination of Halcion and Ativan. I slept satisfactorily, and ended feeling well for an extended period of time. I had no qualms about taking BZDs for the long-term. I still don't. At some point, you might be able to remove the sleeping medication and remain free of insomnia.
>
> What have you tried for sleep so far?
>
> > I've been digging around. MAZINDOL has some NRI action but it is prescribed for obesity.
>
> Mazindol is a failed investigational antidepressant that later was found to be helpful in obesity. I believe its main target was brown adipose tissue. There, it would increase energy production in the form of heat to regulate body temperature and burn excess white adipose tissue (fat). I don't know. Maybe it would help you, but I wouldn't invest too much optimism in it.
>
> I am guessing that you have already investigated guanfacine?
>
>
> - ScottThings thus far I've tried to counteract desipramine insomnia either didn't work or wrecked the substantial attentional improvements I've gotten from desip. It feels like such a delicate balance.
I've tried:
-remeron: fixed the insomnia, negated the desipramine
-Z drugs: did not fix the insomnia, still wrecked the desipramine effect
-ativan: same as the z drugs
-benadryl: didn't touch the insomniaI did try guanfacine several years ago. I went so far as to have an extended release version of guanfacine compounded before intuniv was released. It didn't do anything for me, but maybe I wasn't on it long enough. I used to have the bad habit of trying something for a couple weeks and if I don't see any effect at all, I drop it. Maybe because I'm used to things like desipramine working in 24-48 hours for my focus or paxil working within hours for anxiety. I know that's all wrong as 6-weeks is usually the amount of time for things to work for whatever reason.
Posted by SLS on April 23, 2016, at 15:30:05
In reply to Re: Are there any other NRIs besides TCAs/strattera? » SLS, posted by TriedEveryMedication on April 23, 2016, at 13:27:16
You are a tough case.
You might want to try a small amount of amitriptyline along with the desipramine. I guess cyproheptadine would be worth a look at. It is much like Remeron but without the NE altering properties.
Linkadge is good with resolving sleep difficulties.
I think maprotiline is still around. It is primarily a NRI. I don't remember reading any complaints about it causing insomnia.
- Scott
Posted by jonhed on April 23, 2016, at 19:40:25
In reply to Re: Are there any other NRIs besides TCAs/strattera?, posted by TriedEveryMedication on April 23, 2016, at 13:19:48
Maybe a long shot but if you seek an alternative with very high binding affinity for NET and DAT and alot less serotonin affinity than amitripyline, clomipramine and imipramine i would say nortriptyline.
It makes you sleepy from what i've heard.
and some random studie says it works for reducing some symptons in adhd.
Posted by TriedEveryMedication on April 23, 2016, at 21:44:42
In reply to Re: Are there any other NRIs besides TCAs/strattera?, posted by jonhed on April 23, 2016, at 19:40:25
> Maybe a long shot but if you seek an alternative with very high binding affinity for NET and DAT and alot less serotonin affinity than amitripyline, clomipramine and imipramine i would say nortriptyline.
> It makes you sleepy from what i've heard.
> and some random studie says it works for reducing some symptons in adhd.
>
>Hi,
For some reason nortriptyline does nothing for my ADD. Desipramine is like magic for it, even at a small dose like 25mg.
I don't know why there is a difference.
Posted by jonhed on April 24, 2016, at 17:33:52
In reply to Re: Are there any other NRIs besides TCAs/strattera? » jonhed, posted by TriedEveryMedication on April 23, 2016, at 21:44:42
There is a whole arsenal of medicines from the 50s that never did make it to the market, but i wouldn't recommend using such substances.
Trimipramine is still available in some countries, have you tried that one yet?
According to the all mighty wikipedia it's said to be the only medication for insomnia that don't screw up your REM sleep.
But i have no idea about it's subjective effects..
Posted by jonhed on April 24, 2016, at 17:50:23
In reply to Re: Are there any other NRIs besides TCAs/strattera? » jonhed, posted by TriedEveryMedication on April 23, 2016, at 21:44:42
I forgot to ask,
Have you tried an nmda-altering medication like memantine or amantadine?I thought about it when you where talking about cognitive benefits.
Also there is vortioxetine (brintellix) for cognitive benefits. But i don't know about that one for adhd..
If you find one that is perfect for you, i would very much like to know, couse i am also on the impossible mission to find a new medicine after several and several poop outs.
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