18 replies to this topic

[Mind_Paralysis]

SO! : O

I was checking out the works and texts of Mary V. Solanto - a PhD and expert on cognitive behavioural treatments, as well as on ADHD and other attention-deficits.

She did a study on the cognition of people with SCT - to discern if we really have, or DON'T have, deficits in Executive Functioning - her findings appears to point in the direction that we do, but perhaps it's in different regions than people with ADHD...

 

BUT...! She also found something alarming - the adults with SCT whom were on STIMULANTS, were the ones whom showed the more conclusive deficits in EF! Now, you could say, "why, that must be because the SCT-ers on stimulants are of course the ones whom have co-morbid ADHD as well! Simple."

 

No.

 

THINK! Stimulants improve EF-deficits in ADHD DRAMATICALLY! In fact, they are still the SUPREME kings of that, when it comes to the known ADHD-drugs.

 

As such, these deficits in stimulant-treated SCT-ers can't be from ADHD - it's more likely to be caused by something else, and since the NON-stimulant treated SCT-ers didn't show deficits in EF, then damn, it's probably the stimulants! : O

 

Apparently, they may not just be more or less useless (in fact... as far as we can tell, they actually appear to have more of a positive effect even on neurotypicals!) - they might also be harmful towards SCT-ers.

 

 

Not sure what to think about this... should I give up on Stimulants all-together, all things considered? Or should I simply use them more sparingly then I have previously?

 

Currently finishing a two-week trial of Focalin, and the results have been highly varying - multiple types of dosings, multiple dosing-schedules - combined with Guanfacine and without - under the influence of Tianeptine and without Tia.

 

 

Give me your thoughts gentlemen - how much should be read into this?

 

(ok, maybe not much, since it's just one study, and even the researchers aren't drawing too many conclusions either)

 

 

Sluggish Cognitive Tempo, Internalizing Symptoms, and Executive Function in Adults With ADHD

http://journals.sage...087054716682337

 

 

[jack black]

Very good read. Helps me appreciate what SCT is, if it's a real thing. After reading this, i'm not sure myself if I or some people in my family might have one. This is after many years of soul searching and deciding that I have a mix of ADHD, ASD, and social anxiety.

Now, as to your question, I don't see why you read it as stimulants are harmful; my read they are useless and unmasking deficits that are otherwise fixed in ADHD. To prove stimulants harmful, you need to design a new prospective study, I'm afraid.

[CWF1986]

Unfortunately with regards to psychiatry in general, we're practically still reading tea leaves.  Even more so with SCT since there are so few studies and so little literature compared to other better documented disorders.

 

In your shoes, I would just keeping trialing things, give them a good fair chance, and keep a good log regarding what kind of changes they bring to you.  Not just how you feel, but what you're getting done in life professionally, family, etc.  I probably wouldn't log more than weekly, maybe bi-weekly because there's so much day to day variation even for the neurotypical.  

[Mind_Paralysis]

Uuurghl.... Fatigue - but most importantly - STRANGE DIZZINESS!

 

Currently in a state where I have discontinued Tianeptine, Focalin and Guanfacine, so I seem to be experiencing quite a bit of symptoms from that.

 

 

Anyways... you all bring up reasonable points - it's only one study, and it doesn't prove much - except that Stimulants probably don't help much with any of the symptoms of SCT - which we all kind of already knew.

 

 

The strange dizzy feeling I got when I discontinued Guanfacine is disconcerting though, as well as the warm forehead I've had for months now. Could my system still be messed up when it comes to the peripheral nervous system, from Guanfacine? Most likely... I really need to buy some kind of blood-pressure measuring equipment, so I can get some data on that.

[John250]

Uuurghl.... Fatigue - but most importantly - STRANGE DIZZINESS!

Currently in a state where I have discontinued Tianeptine, Focalin and Guanfacine, so I seem to be experiencing quite a bit of symptoms from that.


Anyways... you all bring up reasonable points - it's only one study, and it doesn't prove much - except that Stimulants probably don't help much with any of the symptoms of SCT - which we all kind of already knew.


The strange dizzy feeling I got when I discontinued Guanfacine is disconcerting though, as well as the warm forehead I've had for months now. Could my system still be messed up when it comes to the peripheral nervous system, from Guanfacine? Most likely... I really need to buy some kind of blood-pressure measuring equipment, so I can get some data on that.

Maybe the dizziness is acetylcholine related?

[Mind_Paralysis]

Maybe the dizziness is acetylcholine related?

 

Possibly. When dopaminergic and norepinephrinergic activity lowers, which is what would be happening now, then Ach will go up, so yeah, my ach should be storming about right about now.

 

Not sure why it would make me dizzy though... But I must admit, I haven't actually studied acetylcholine all that much, nor its actions in the peripheral nervous system, which is what should be messing with me right about now.

 

I think I've noticed less blurry vision recently though, which is something I've been having on and off for a while - often a symptom of low ach -activity, which dopaminergics and norepinephrinergics can cause.

 

I certainly got blurry vision when I was on Bupropion, that's for sure! Sonofabitch... I thought I was developing near-sightedness back then! Turns out it was the bupe'.

 

I'm one of the people that seems to be easily affected by side-effects in the cholinergic system - I've noticed that with several drugs.
 

 

Still got headache and dizzyness btw, in case anyone's wondering.

Edited by Mind_Paralysis, 04 July 2018 - 07:50 PM.

[John250]

Possibly. When dopaminergic and norepinephrinergic activity lowers, which is what would be happening now, then Ach will go up, so yeah, my ach should be storming about right about now.

Not sure why it would make me dizzy though... But I must admit, I haven't actually studied acetylcholine all that much, nor its actions in the peripheral nervous system, which is what should be messing with me right about now.

I think I've noticed less blurry vision recently though, which is something I've been having on and off for a while - often a symptom of low ach -activity, which dopaminergics and norepinephrinergics can cause.

I certainly got blurry vision when I was on Bupropion, that's for sure! Sonofabitch... I thought I was developing near-sightedness back then! Turns out it was the bupe'.

I'm one of the people that seems to be easily affected by side-effects in the cholinergic system - I've noticed that with several drugs.


Still got headache and dizzyness btw, in case anyone's wondering.

I noticed when I don’t have amphetamines in me I get dizzy and brain fog. Using choline doesn’t seem to have any effect positive or negative.

[CWF1986]

When quitting guanfacine or clonidine cold turkey, rebound effects are not at all uncommon.  It seems like the simplest answer so unless there's good reason to believe otherwise, it sounds like if you want to stay off the meds you just gotta keep moving through this unpleasantness.  

 

Remember that dizziness, headache, and blurry vision can be symptoms of high blood pressure so that could be explained by rebound high blood pressure.  

[Mind_Paralysis]

When quitting guanfacine or clonidine cold turkey, rebound effects are not at all uncommon.  It seems like the simplest answer so unless there's good reason to believe otherwise, it sounds like if you want to stay off the meds you just gotta keep moving through this unpleasantness.  

 

Remember that dizziness, headache, and blurry vision can be symptoms of high blood pressure so that could be explained by rebound high blood pressure.  

 

A correct assumption. I can think a bit more clearly now, and it's logical to assume that is the case - I wasn't on the Guanfacine at a very high dosage, or for very long, but I am very sensitive to Alpha-2-a-downregulation - going off Guanfacine for the first time, cold turkey, actually caused a mild Adrenergic Storm! : O

 

So yes, it's probably that.

 

I've cursed and regretted going on Guan' many times now... It seemed like a logical, GOOD idea at the time! Especially since most people really CAN titrate out very, very quickly on even 4-5 mg per day dosages.

 

Sadly, I was not one of those people.

 

I still have a little bit of those symptoms, but I'm feeling a bit better now - I'll probably, realistically, have to keep away from all forms of adrenergics for at least one week.

 

Only problem is... I'm completely passive and utterly inactive in the meantime.

 

Without stimulants... or something otherwise stimulating... I'm a virtual sleep-walker. The rebound-effect from stims is of course enhancing this state, but it is more or less my natural state - the SCT-state.

 

Not entirely sure what combo to go for next though... I do think the Duloxetine + Focalin combo might be a good bet - I need to procure enough Duloxetine to give it a good trial though - probably gonna need around 60 mg daily for 30 days minimum - sadly, my Dr. appears to be on a vacation as well! There are other methods though, so we'll see...

 

 

I also realize that we've driven more or less completely off-topic here.

[CWF1986]

Well... while we're way off topic, I thought of a med fairly targeted to NRI that have even lower anti-Machr effects than desipramine.  It's in the tetracyclic antidepressant class.  This med has strong affinity for the H1 as an antagonist, but if you're taking focalin too that could help you get going in the morning if you're still in a haze by the time you wake up.  

 

Maprotiline

 

Since strattera and reboxetine gave partial relief of symptoms, but came with too many sides I thought if might be worth it to look into other meds selective for NRI.  

 

 

[Mind_Paralysis]

Well... while we're way off topic, I thought of a med fairly targeted to NRI that have even lower anti-Machr effects than desipramine.  It's in the tetracyclic antidepressant class.  This med has strong affinity for the H1 as an antagonist, but if you're taking focalin too that could help you get going in the morning if you're still in a haze by the time you wake up.  

 

Maprotiline

 

Since strattera and reboxetine gave partial relief of symptoms, but came with too many sides I thought if might be worth it to look into other meds selective for NRI.  

 

It's an interesting idea, sadly stimulants don't actually help me with the sedation from H1-antagonists - believe me, I've tried multiple dosages.

 

MODAFINIL is the only drug that helps with the sedation - which is logical, it's a form of histamine-agonist. (hence why it causes skin-rashes for instance)

 

Still, it wouldn't be impossible to try it out - I think I'm more interested in Duloxetine or Milnacipran as a combo for low-dose stimulants though.

[John250]

It's an interesting idea, sadly stimulants don't actually help me with the sedation from H1-antagonists - believe me, I've tried multiple dosages.

MODAFINIL is the only drug that helps with the sedation - which is logical, it's a form of histamine-agonist. (hence why it causes skin-rashes for instance)

Still, it wouldn't be impossible to try it out - I think I'm more interested in Duloxetine or Milnacipran as a combo for low-dose stimulants though.

Maybe you respond better to it’s effects on orexin. How does nicotine work for you?

[CWF1986]

Milnacipran

 

An SNRI that has greater affinity for the NET than the SERT!?  Of course it's not available in the US as an antidepressant 

[Mind_Paralysis]

Maybe you respond better to it’s effects on orexin. How does nicotine work for you?

 

Hard to say - I've never used Nicotine recreationally and the only time I was on it, was while under a very high dosage of Bupropion - it helped a bit with word-retrieval and blurry vision, as I recall it.

 

And it's possible that the Orexin-effects are behind it - but orexin in itself tells the brain to rev' up the activity of other neurotransmitter - like histamine, for example.

 

I heartily recommend low-dose Modafinil for H1-antagonist sedation though, no matter what! = )

(it should be noted that while I find moda' helpful with the h1-hangover, I don't feel it helps all that much with cognition when I just take it for the treatment of sct+adhd)

Edited by Mind_Paralysis, 07 July 2018 - 10:48 AM.

[Mind_Paralysis]

An SNRI that has greater affinity for the NET than the SERT!?  Of course it's not available in the US as an antidepressant 

 

It's not available in my jurisdiction either...

I just noticed that it's allowed in a neighbouring country though! : D Might have to go there and get a subscription.

 

Btw, it should be noted, that apparently, even though the affinity for the NET looks greater than for 5htt ON PAPER... apparently the actual observed effects on neurotransmitter-activity, is far more balanced.

The levo-rotary variation of Milnacipran - LEVOmilnacipran, is apparently the first one that TRULY causes more N than S.

 

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

 

 

On another note- this is the first day on a combo of Duloxetine and Focalin - so in theory I'm now fully on a reasonably balanced SNDRI now. :o

 

Only on 30 mg though, and day 1, so it's probably not doing almost anything yet.

[MichaelFocus22]

Their the only thing that remotely work, secondly their's only theoretical evidence from  Dr. Barkley and most of his research is out of date at best. We need new studies not being funded my for profit pharmetucutical industry, to actually get good quality treatment. Not these half assed pills that work incorrectly. Ultimately don't take your label, so seriously, just be mindful of it. Labeling yourself anything is very dangerous as much as having something instrinsically wrong with you. Go for a walk, go enjoy your life.

[CWF1986]

It's not available in my jurisdiction either...

I just noticed that it's allowed in a neighbouring country though! : D Might have to go there and get a subscription.

 

Btw, it should be noted, that apparently, even though the affinity for the NET looks greater than for 5htt ON PAPER... apparently the actual observed effects on neurotransmitter-activity, is far more balanced.

The levo-rotary variation of Milnacipran - LEVOmilnacipran, is apparently the first one that TRULY causes more N than S.

 

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

 

 

On another note- this is the first day on a combo of Duloxetine and Focalin - so in theory I'm now fully on a reasonably balanced SNDRI now. :o

 

Only on 30 mg though, and day 1, so it's probably not doing almost anything yet.

 

Just in case someone in the states was looking for a balanced SNRI, there is one that's FDA approved!

 

Fetzima (levomilnacipran) 

https://en.wikipedia...Levomilnacipran

 

It may very well be more selective for the NET than the SERT as Mind_Paralysis pointed out and certainly more than it's parent milnacipran.

 

Would love to see studies on if and how much it could help with ADHD and SCT symptoms!  I'll look when I have the chance, but I encourage others to as well!

[Mind_Paralysis]

Just in case someone in the states was looking for a balanced SNRI, there is one that's FDA approved!

 

Fetzima (levomilnacipran) 

https://en.wikipedia...Levomilnacipran

 

It may very well be more selective for the NET than the SERT as Mind_Paralysis pointed out and certainly more than it's parent milnacipran.

 

Would love to see studies on if and how much it could help with ADHD and SCT symptoms!  I'll look when I have the chance, but I encourage others to as well!

 

Indeed - I've hypothesized about this quite a bit myself.

There's actually a bit of proof for DULOXETINE, which has a much lesser affinity for NE, and since other NRI's also have some evidence...

 

 

I actually just found this rat-study, but sadly, the symptoms that appear to be treated by LevoMil' is just the standard PFC-related impulsivity - no doubt because of dopamine-reuptake from NET in that region.

 

Milnacipran Remediates Impulsive Deficits in Rats with Lesions of the Ventromedial Prefrontal Cortex

https://www.ncbi.nlm...les/PMC4376543/
 

Would be interesting though - there's some logic to it - SNRI's are the most effective treatments for anxiety according to one metareview from 2015 - and that's something Barkley mentions, how us SCT-ers are more anxious than adhd-ers, and how drugs that treat anxiety appears to have some effect. (he also mentions how the attention-deficit in ptsd and ocd is much more similar to the attention-deficit in sct than the one in adhd)

[jack black]

 

Would be interesting though - there's some logic to it - SNRI's are the most effective treatments for anxiety according to one metareview from 2015 - and that's something Barkley mentions, how us SCT-ers are more anxious than adhd-ers, and how drugs that treat anxiety appears to have some effect. (he also mentions how the attention-deficit in ptsd and ocd is much more similar to the attention-deficit in sct than the one in adhd)

 

this is interesting indeed. I'm going through Dr Amen's book on ADHD and other brain impairments that he can see on the brain scans. 

I pass his checklist test for ADHD and anxiety too. Not surprisingly since I know well I'm anxious, especially during social events and public performance (like lectures in front of large groups).

 

I have plenty of ADHD symptoms too, like chaotic life, procrastination, impulsiveness, unfinished projects, novelty seeking, hyperfocus on favorite subjects, etc. Now, he mentions that anxiety can paradoxically lead to decreased motivation and procrastination due to avoidance of difficult or painful events. This rings so true in my case, as my life was/is full of avoidance. Also, I had PTSD earlier in life due to a car accident with injuries and sometimes slight OCD-like traits. 

 

What if some/many cases of anxiety are misdiagnosed as ADHD, including SCT? 

 

I never took SNRI. SSRI made me happy, but lazy. Same with serzone. 

 

Have you tried SNRI or MAOi? I'm going to try seleginine next. This week i'm doing adrafinil (and it's clearly helping; yesterday I finished one book and read most of another and did a few chores on my list too).

 

BTW, cursory search yields many hits, including:

 

 

Interestingly, a growing body of research suggests that individuals who have high trait, or baseline, anxiety also suffer from deficits in executive control. For instance, a number of studies have found that high anxiety individuals, such as those with Generalized Anxiety Disorder (GAD), have a decreased ability to ignore irrelevant information, especially when that information is threatening6, and greater difficulty switching attention between tasks7. In fact, "difficulty concentrating" is one of the primary symptoms of GAD8. Though researchers are still examining exactly how anxiety affects executive functioning, the most prominent theory poses that anxiety specifically interferes with an aspect of executive functioning known as attentional control9. This interference makes concentrating and switching attention from task to task more difficult for individuals high in anxiety.

Why might this relationship exist? One potential explanation is that, perhaps, very anxious individuals have less "space" in working memory due to their worries, which disrupts their attentional control. It is like high anxiety individuals are constantly carrying around extra information in their mind (i.e., their worries) meaning that they have less space to flexibly handle new things. To use the hand metaphor described above, it would be as if you had to carry around an extra object everywhere you went, making it more difficult to pick up or examine new objects. Consequently, high anxiety people may be more easily distracted by new information and have a harder time switching their attention between competing sources of information (e.g., two different people talking simultaneously).

https://www.anxiety....late-to-anxiety

Edited by jack black, 09 July 2018 - 03:40 PM.