Searching for the right medicine... | ADHD Information

I thought I should go ahead and put my question up here at the top, as I ended up typing out a long-winded post (as usual).

I am ADHD Inattentive type. I have been on Strattera and now EMSAM. Neither seem to help me function throughout the day going from task to task.

I am looking for feedback from other Inattentive types who have found a medication that allows you to focus throughout the day, going from task to task, and helps with the Inattentive behavior (e.g. - Zoning out reading the internet for hours, not realizing how much time has gone by, etc.)

In your experiences what medication best helps you to maintain a flow of focus that allows you to perform all of the tasks that you need to get done in a day without being taken off track and getting nothing accomplished?

Thank you for any insight you can provide! I am starting to feel depressed that neither medication has worked for me. I just want to find something that will bring me out of this life-long fog.

Background:

I have had problems all my life, ever since I was a child. It has been mistaken for laziness, depression, etc.

I have tried dealing with it on my own for years. I could never overcome myself. I would always fall back into the same patterns.

After seeing 3 different people about my problems, (one Neurologist, one Psychiatrist, and now an APMHNP), my current doc has started treating me for ADHD. I am the Inattentive type. I can hyperfocus on things that interest me, spend hours on the internet researching and reading, but I can't get a damn thing done around the house. I can focus on my workouts, but I can't go from task to task in my normal day. I always end up leaving the dishes to be washed right before I cook dinner, so we always eat late. I take forever to get ready to do things and go places. I have a hard time making decisions. I am always misplacing things. I have also had problems with anxiety.

I have been on Clonazepam for about 3 or 4 months now. I rarely if ever experience physical anxiety symptoms anymore even if I know I'm in a stressful situation.

My current practitioner started me on Strattera. It basically zapped the life out of me and made my inattentiveness worse. I went back to him after a month (I was on 60mg at that point) and after seeing how lethargic it made me, he told me to stop taking it.

He then suggested the EMSAM patch, 6mg/24 hours. He said that we would know if it will work for me within 3-5 days, since the EMSAM patch is much faster acting than oral. He said I could start the patch that day (I had taken 60mg Strattera that morning) so I did. About 5 or 6 hours later I felt great. I had energy, I had no social anxiety whatsoever and I hadn't even taken my evening dose of Clonazepam. The next day I had a great workout and lots of energy, I cleaned the entire kitchen and had everything ready to prepare dinner before 5pm.

The next day I didn't feel as good, and I didn't sleep well that night. I had vivid dreams, one of which was quite disturbing, but no anxiety associated with it. This downward trend continued for the next days. This is day 6 and today I found myself once again, right back where I started, zoned out for 3 hours reading on the internet, and I had no idea I had wasted so much time until I got up to go to the bathroom. The patch doesn't seem to be helping my symptoms. I have emailed my practitioner after the 5 days as he instructed so hopefully he will have another option for me.

how long have you been on the Strattera? It takes 4-6 weeks.

I was on the Strattera for 4 weeks. When I went in for my appointment 4 weeks later and he saw how lethargic I was and I told him it was making me really tired he took me off of it and put me on the EMSAM patch. He said we would know if the EMSAM patch works for me within 3-5 days. This is day 7 and I feel like I could curl up and go to sleep right now.

I just hope he responds to my email and offers an alternative because my next appointment isn't until November.

mevsmybrain39343.4546180556

Well, during our first visit he discussed the options and explained that we would try a variety of medications to find what works. He then explained that the medicines that work on Dopamine could cause anxiety so we would try Strattera first.

But EMSAM 6mg/24 hours is an MAO-B inhibitor, which increases dopamine in the brain, and my anxiety hasn't increased. I just want to find something that works. At this point my Inattentive symptoms are causing me far more grief than anxiety is (which I don't have very much of at all anymore since starting Clonazepam).

I'm just so tired of being dysfunctional. I just want to be able to go through a day functionally and not have to wonder if tomorrow I will be a million miles away and not get anything done.

I envy those who can stick to a daily routine and complete all the simple tasks it requires to keep a household running and at least somewhat tidy.

Thanks for the input about medicines that have worked for the inattentive behavior. I don't get to see my practitioner for another 7 weeks or so, so hopefully he will email me back with another medicine to try.

I also wonder why no stimulant, unless you are worried about it increasing anxiety.

Another option to research are the tricylcic antipepressants, for both anxiety and ADHD. My daughter takes Desipramine, but there's also Nortryptiline or Norpramin. She is also inattentive. We have had to continually up her dose to help with focus, so I cant say WOW this drug is magic, but her fidgeting and ability to go from task to task has been helped. Her anxiety is better. We are working out dosing right now to see if it is good enough for school, but sounds like in your case it may be worth at least looking into.

I appoplogize for not reading your entire post (It is late). Why have you not tried a stimulant? Both of my kids do well on focalin and concerta. The oldest is inattentive and the youngest combined. Thier doc does not have a preference for meds based on the type of adhd. He bases the med choices on the individual's needs. Just a thought but I have been using Provigil for 1 year now for exessive daytime sleepiness. I also noticed it helped my ADD symptoms and made me feel more human. It is used off-label for ADD and I know some adults that love it. I believe it is in the stimulant family. Ask your doc, see what he says. It gave me back my life.Gosh, you sound very much like me although I don't have much anxiety. I
too can waste hours on the internet then feel horrible about it. I can't
stick to a routine for the life of me and I am constantly frustrated with the
disorganization.

I do have some mild anxiety I guess.. I used to describe it as a constant
but mild frantic feeling. Like I have so much to do and I rarely get
anything done.

I don't have answers for you though. I am on wellbutrin and concerta.
This is only day 7 of the concerta. I have had mixed feelings on it and still
haven't made a solid opinion, but I will update if I have any helpful news.

The only thing I wanted to mention is I think that it is important to
remember the medication will not cause you to suddenly be organized. As
adult add'ers, we have developed strong habits and coping mechanisms
that we are going to have to change ourselves. I am hoping that I will find
a medication that will enable me to learn new habits and skills. So I guess
I want the medication to help curb the desire to switch tasks, help keep
my momentum going to follow through completely, stuff like that. But
again, I think it will be just as important to learn things like using a
planner, using a kitchen timer and other strategies.

I keep planning on getting a kitchen timer and starting slow.. making
myself work on a closet for just 15 minutes straight, then letting myself
stop.

BUT I KEEP FORGETTING TO BUY THE STUPID TIMER!!! I think I wrote it on
a list somewhere...

Good luck to you and I will watch to see how you are doing! I understand
how hard it is to wait for your next appointment too. [QUOTE=mevsmybrain]

Hi mevsmybrain!

I am a combined type ADHD, but inattentiveness is my primary issue. I am currently taking Prozac, Wellbutrin and Concerta. I am still working on the dose of the stimulant to find what helps the most.

The interesting thing is that I suffered quite badly from panic disorder some years ago. Very badly, actually - I was agoraphobic and housebound for some months before I started to recover. Although I DID recover (thanks largely to biofeedback and sheer will), I still have anxiety and panic attacks from time to time. I have spent my life filled with some level of anxiety, but I believe that this was greatly caused by undiagnosed ADHD (I was diagnosed this year at 33). I am "comfortable" with it in the way that it is normal for me. Panic attacks do not upset me the way they once did, although they are NOT fun.

When I first went to see my p-doc earlier this year, it was because I was depressed and saw myself spiraling down into self-destruction the same way I did years ago. He put me back on Prozac (which helps combat my anxiety and obsessions - I took this previously) first. However, he could tell just from talking with me that I really needed something that boosts dopamine (I can sleep endlessly and have been on the sluggish side my whole life). He was almost certain that he would need to add Wellbutrin, but wanted to see how the Prozac helped. When it did not improve my focus or energy level, he added Wellbutrin.

Wellbutrin has been known to trigger anxiety because it works on dopamine AND norepinephrine. It works quickly - you can feel an effect right away - but takes 4 weeks or so to reach peak effect. Right away I felt calm and quiet inside. It was wonderful! I had some minor side effects over the first week or so, but I only had ONE panic attack while adjusting to it and it did not take long before I felt better than ever and CALMER than I have ever been. The Prozac might be helping to balance the effect of the Wellbutrin?, but all I know is that I feel a bazillion times better. I can get up in the morning without a struggle and 7-8 hours of sleep is enough.

After 3 months I still was not getting much benefit on focus. Wellbutrin did perk me up and curbed my impulsivity (a major issue for me). I was afraid of adding a stimulant because I thought for sure it would send me through the roof anxiety-wise. It seemed so counter-intuitive to what I could possibly need. I know that stimulants have the reverse effect for people with ADHD, but I was pretty sure that it would cause me problems since, like I mentioned, panic disorder is one of my co-morbid issues.

I was very wrong. I started on short-acting methylphenidate so I was able to find an effective dose. Immediately I was calmer - almost "at peace" and my head was quiet. I could follow my thoughts.

This was why I ended up trying stimulants in addition to the other meds. I was just not getting enough benefit for focus and my husband was ready to strangle me....

I'm just so tired of being dysfunctional. I just want to be able to go through a day functionally and not have to wonder if tomorrow I will be a million miles away and not get anything done.

Yup, I can relate to THAT.

I envy those who can stick to a daily routine and complete all the simple tasks it requires to keep a household running and at least somewhat tidy.

The important thing that I have learned through finding the right meds is that NOTHING will suddenly turn you into a superhuman organizer. When I found the right dose of stimulant I found that what it does is give me CONTROL. I am sure you realize this, but the key information is that (at least in my case) you have to learn HOW to control your brain.

I have spent my life flitting from one thought to the next, one task to the next - allowing myself to go where my brain forces me to. I always assumed that this was just normal (or at least not ABNORMAL) and part of my eccentric personality.... Now I have the ability to say (mentally) "SHUT UP" when distractions come and interfere with what I am doing, but I am in the process of learning how to do that, and REMEMBERING to do that. I don't have that skill so I am having to practice it. One thing I am getting ready to do is start to learn how to meditate. I think this could help me gain the control and learn the new habits that will reap me the best benefit from my medication.

I do still get distracted and have to stop myself to get back on track. The difference is that I CAN if I choose to. I can also concentrate more easily on what I am doing and if errant thoughts come, I can push them into the background more easily.

My husband takes Strattera, and it works pretty well for him. His ADHD is much more hyperactive/impulsive. He is finding that he seems to have a moment to reflect on what he does or says before just acting on it, but he is having to learn to take advantage of that just like me. It did help curb his line rage/traffic rage issues though.

Hang in there. I don't know if a dopamine-boosting medication would have the same effect on you as it does for me, but it was a very interesting paradox. It just goes to show that undiagnosed ADHD can cause all sorts of secondary issues that may be managed by finally treating the ADHD.

Remember that you are finally on the road to recovery after however-so-many years being untreated. Try to have patience. Read books on organization for ADHDers. Look into learning yoga or meditation. These things WILL help you while you are trying to find an effective medication (if you follow-through and do them consistently).

Good luck!

[/QUOTE]

Wow. I know you guys will probably be able to relate to this, but I completely forgot about this thread until I checked my email just now.

Thanks so much for all of the advice in this thread!

My p-doc replied to my email and said to stop taking the morning dose of Clonazepam and give the patch 10-15 days, then get back to him.

I notice my anxiety more now, I can "feel" it more now, but it is nothing terrible. I originally was presecribed benzodiazepenes (first Xanax then Clonazepam) because I had a 4 day long panic attack that wouldnt stop. After the Xanax from my GP ran out I started having panic attacks again so I found a psych and he put me on the Clonazepam.

I was up to 1 mg in the morning and 3 mg at night. I now only take 2 mg at night and none in the morning. I would prefer not to take the stuff at all, so maybe my p-doc and I can come up with an alternative combo.

The patch doesn't seem to be helping all that much, though I feel much better than when I was on Strattera. That stuff didn't sit well with me at all. I have the feeling that my doc is trying everything he can to not prescribe stimulants to me, so I don't know what he has in mind next. I kind of feel weird asking for a specific drug or type of drug, I don't want to seem like the infamous 'drug-seekers' you hear about on the news.

So now, I guess I wait it out, report back to him and hope he has something else up his sleeve. It feels kind of hopeless, like nothing will work for me. I am sure most of you know what I mean. But I understand that I have been waiting my whole life for treatment and my new doc has only been seeing me for 1.5 months now, so I have to give it time. It's just frustrating.

I am a stay-at-home-dad and I am raising our 2 year old daughter. I feel like I could be so much more for her with the right medication. Right now I have barely enough organization and willpower to keep everything going during the day and keep on top of my weight loss.

I gained a lot of weight over the years due to my lack of/sporadic activity levels and I would definitely use food to help deal with the anxious/racing feeling in my head. Nothing like a double cheeseburger, biggie size fries, and a sweet tea to bring on a sense of well-being eh? Well, around the time of my panic attacks I had a reality check and decided that our family was going to start eating healthy. Since then I have lost about 68 lbs. and about 20 of that since I started excersizing a couple months ago. I can feel myself slipping from my excersize with the changes in medication and disruptions in my schedule because of occasional travel due to my wife's job. We just got back home from travelling, my wife had 3 days of budget meetings with her company. I planned on working out in the hotel at night, but due to various reasons and my agoraphobia I didn't end up excersizing. It is a very important goal for me to lose this weight so that is something I can't let slip. I just sense that 'million-miles-away' feeling coming on when my workout schedule is disrupted, and it scares me to think that it could become just another memory like so many other incomplete projects/tasks in my life.

Ugh, sorry to ramble on. I will update the thread soon, I'll leave on the email notifications in case I forget about it again.

Thanks again for all of your support! It really does help to hear I'm not the only one going through this kind of stuff when it very often feels that way.

Thanks for your encouragement! I too like the benefits of Clonazepam, it really helped my anxiety to the point where I could be in a stressful situation and remain relaxed and calm. The only downside is that some of the side effects can exacerbate ADHD type symptoms, especially the memory problems.

The EMSAM patch is a new delivery system for the MAOI Selegiline. Selegiline is an old-school anti-depressant that when taken orally inhibits both MAO-A and MAO-B. It also affects the MAO-A&B enzymes in your GI tract when taken orally, which means that the patient must also have a restricted diet so as not to cause a possibly fatal hypertensive crisis or "Cheese Syndrome" (because it can be caused by consuming aged cheeses) http://en.wikipedia.org/wiki/Cheese_syndrome. So, it fell into disuse except as an end-of-the-line treatment for non-responding patients.

Well, the EMSAM patch is mostly used at higher doses (9mg/24hr & 12mg/24hr) for severely depressed individuals who do not respond to SSRI's and other anti-depressants. However, at the lowest dose, which is the one I am on (6mg/24hr), it only inhibits the MAO-B enzyme, which only increases Dopamine levels in the brain and this dosage does not require any dietary modification. [unlike higher dosages of this medications which inhibit both MAO A&B, increasing the levels of ALL of the commonly manipulated brain chemicals (Dopamine, Epinephrine, Norepinephrine, Seratonin) and requires a modified diet avoiding Tyramine-rich foods, supplements, and any stimulants.]

Sooo... First he tried Strattera, which raises levels of Norepinephrine, then he tried EMSAM 6mg/24hr which raises levels of Dopamine. I felt like crap on Strattera and had bad sexual side-effects. The only time I felt like this patch was working were the first two days, and I still had Strattera in my system at that point, so I wonder if I need both Dopamine and Norepinephrine increased. I'll let him be the judge of that. All I know is that it isn't working at this point, has caused me to feel really depressed on a few occasions and has also caused mood-swings that are unnerving to say the least. Hey, at least the sexual side-effects are gone! lol Still have the bad ADHD symptoms though.

Wow, you have lost a lot of weight since July! Congrats on that! I know what you mean about the cravings. I overhauled my diet around the time of my panic attacks. I was panicking about my health and the severity of the attack left something burned into me I guess, because I have been eating and cooking healthy ever since, and I know what you mean about the cravings. Those used to defeat me every time, but whatever it was that happened around my panic attacks, it stopped my cravings so it has been easier for me than ever to keep to a healthy diet. That's not to say that I NEVER have cravings, but they are nothing like they were. When I first started Strattera (which reduces appetite) I could have just skipped meals. It wasn't like I was repulsed by food or anything, I just could've gone without eating a lot of the time (though I made sure to eat so that I didn't mess up my weight loss).

You make a great point about eating protein in the middle of the day. When I first started losing weight, I was really underfeeding myself, even though I didn't know it. I was eating plenty of food, but a lot of salad and veggies with not enough protein or fat sources. It was weird when I started reading about healthy weight loss and found that I actually needed to UP my calories. I still don't eat as many calories as they say I should on the BMR/Expenditure calculators, but I eat a lot more and try to stick to 40% protein/40% carbs/20% fats whenever possible to maintain a balanced intake.

Oh well, back to waiting! Thanks again for your encouraging response!

mevsmybrain39349.4841087963[QUOTE=mevsmybrain]

Wow. I know you guys will probably be able to relate to this, but I completely forgot about this thread until I checked my email just now.

That is hilarious! Yeah, I certainly can relate....

Thanks so much for all of the advice in this thread!

My p-doc replied to my email and said to stop taking the morning dose of Clonazepam and give the patch 10-15 days, then get back to him.

I took Xanax and then Klonopin (clonazepam) years ago. I liked the Klonopin.

Just be careful weaning off that stuff if you do - take it slowly. The good news is that clonazepam has a longer half-life in the body than Xanax so withdrawl is usually easier. You may get an increase in anxiety just from the medication withdrawl vs from your anxiety disorder.

What the hey is an EMSAM patch, anyway? Yeah, you do have to be somewhat careful about asking for certain meds although you could try and find a doctor whois more comfortable prescribing ALL medications for ADHD. My doc was OK with prescribing stimulants but we tried some other things first.

Yes, it is very frustrating. But remember that you have just tried two options and there are a ton of other medications out there. As I stated above - you can also see if you can find a new doctor.

I feel your pain. I don't have kids, but my job pushes my organizational capacity to the edge....

First of all - GREAT JOB!!!!! Hang in there!

I can relate to your eating issues. I tend to go for fatty, salty or sweet comfort food with stress or if I am too busy and tired. I have struggled with my weight as an adult because of this. I have lost weight TWICE (40+ lbs) over the last 5 years and have not managed to keep it off for long. Both Wellbutrin and methylphenidate curbed my appetite somewhat - but more than anything they stopped my cravings. I have a much easier time making good choices concerning food. I have lost 35 lbs since July and have about 20 more to go. I have not been consistent in exercising but I am working on that. At least this time I feel like I have a chance at succeeding and keeping it off.

I travel a lot too, and it can be really tough to maintain discipline. Sometimes I will tell myself that I will eat something healthy at dinner and then when I get there and see that everyone else is getting the good stuff.....well, my willpower caves.

I am a South Beach diet fan. I feel great on it and it is pretty easy to travel and eat well on it. I bring protein shakes with me to have for breakfast (no free continental breakfast for me) and also some snack bars or nuts to eat during the day. This keeps me from being so hungry at major meals that I get carried away. So far it has helped a lot. I will be on the road for most of October so I am gearing up for that.

I also almost always get a salad for lunch with some form of protein on it. So that way, when dinner comes along, I have eaten well all day and I am motivated not to blow it. It also helps minimize that damage if I do indulge a little. Then I just start over again the next day.

Ugh, sorry to ramble on. I will update the thread soon, I'll leave on the email notifications in case I forget about it again.

Not rambling - trust me. You should see some of my posts....

Thanks again for all of your support! It really does help to hear I'm not the only one going through this kind of stuff when it very often feels that way.

You are most definitely NOT alone. I understand totally how you feel though. This board has helped me feel so much better about myself.

[/QUOTE] katastrophee39349.3963657407

Well, I am off the EMSAM patch now. I got very depressed a few days while on the patch and also had angry mood swings. I told my doctor and he took me right off of it. Since EMSAM is an MAO-B Inhibitor I had to wait a week before I could take a new medication.

I am now taking Wellbutrin XL, today is my 5th day on the medicine at 150mg per day and SO FAR it is an amazing improvement! I am able to stay motivated throughout the day and when I have completed one task I move onto another instead of going back to my old pattern of completing one task and then zoning out.

I start out at 150mg for one week, then 300mg for a week, then the final dose of 450mg per day. The only downside so far is that this stuff is expensive because our pharmacy doesn't carry the generic. (about 0 for a month supply) But our insurance will cover 80% of the cost of name-brands through re-imbursement, so it comes out to be about 0/month which isn't bad. If we find a participating pharmacy that carries the Generic 150mg tablets it will cost us nothing, as our insurance covers 100% of the cost of Generics.

I am now down to 2mg Clonazepam, I only take it at night to help me sleep. My p-doc said I could take one during the day if needed, but I haven't needed it so far and I would prefer to take it only at night. Eventually after we get my ADD meds sorted out I hope to find an alternative to Clonazepam since it can be addictive, etc.

I think the Wellbutrin XL is helping my anxiety a lot on it's own. It also seems to boost my self-confidence and sense of well-being. I would definitely recommend giving Wellbutrin a try if Strattera, EMSAM, and others havent worked for you.

Thanks again for everyone's input. So far SO GOOD!

I really hope this stuff keeps working like it is. We shall see!

mevsmybrain39361.4191435185

Today is my 5th day on Wellbutrin XL @ 300mg, and I'm still chugging along!

I've been on Wellbutrin XL for 12 days now and it has worked wonders as far as keeping me active and going from task to task throughout the day.

I went from zoning out on the internet all the time, spending my time sitting around, to standing all day, getting everything done. Our house is immaculate, we eat dinner early in the evening instead of 9pm or later, and it has also greatly diminished my task-avoidance. That was a big thing for me, if there was a complicated task, or one that would require several disjointed steps to accomplish, I would just completely avoid doing that task. It was like those kinds of tasks were huge mountains to climb and I would just plain avoid them and do something that was instantly gratifying (surfing the net, for example). It has also helped to reduce my anxiety and boost my confidence.

This medicine has made an AMAZING difference for me so far. I just hope it keeps working like this!

You sound exactly like me. I started taking Ritalin again after my 2nd dd daughter was becuase I couldn;t even sit and play with her becuase I was so distracted. Nothing ever seemed to get done and my house was a mess. Starting the ritalin helped me a lot. I just make sure I don't take it too close to bed time.I have tried all the phychotropic drugs out there with no relief. Then my doc put me on Provigil it was amazing how I got my life back. 1 year later, I just had to go off due to complications. I had finally found something that made me normal and now nada. [QUOTE=mevsmybrain]

Today is my 5th day on Wellbutrin XL @ 300mg, and I'm still chugging along!

I've been on Wellbutrin XL for 12 days now and it has worked wonders as far as keeping me active and going from task to task throughout the day.

This medicine has made an AMAZING difference for me so far. I just hope it keeps working like this!

[/QUOTE]

I am so THERE. Tasks--what tasks?

Too bad I can't take wellbutrin--you've certainly sold me...