5 replies to this topic

[Heinsbeans]

Hello, so I'm currently on 200mg modafinil every second day to treat my sub-optimal executive functioning. Previously, I had been taking 200mg daily with success for the past three years. But due to this pandemic, I've decided to start taking it every other day in order to prolong my supply of the medicine. But now, I'm in need of another add-on that I can take every day in order to potentiate the efficacy of modafinil as well as to be able able to function on days I'm not taking modafinil. I'm currently deciding between low-dose atomoxetine or bupropion.

 

On one hand, atomoxetine seems like the logical next-step since it's an officially approved second-line treatment for ADHD. But it's also a kappa-opioid partial agonist, which can cause sedation and act as a pro-depressant. And depression has also been implicated to cause executive dysfunction. I'm currently not depressed as of now, but it's still a bit risky to start Strattera.

 

Source:

Atomoxetine, ADHD, and the Ongoing Debate About Increased Risk of Suicidal Behaviors: The Understudied Role of Kappa Opioid Receptor Agonism: https://pubmed.ncbi....h.gov/27283209/

Synthesis and Biological Evaluation of the Major Metabolite of Atomoxetine: Elucidation of a Partial Kappa-Opioid Agonist Effect: https://pubmed.ncbi....h.gov/15225731/

 

Then there's bupropion, a NDRI/NDRA which can obviously help with executive functioning. But it's also an nAChR antagonist which lowers acetylcholine levels in the brain (and hippocampus). And ACh are implicated in learning. So I don't know which drug has a better benefit to trade off ratio as a potential augmentation to modafinil. Any advice/opinions on which one would suit me better would be greatly appreciated. But please don't suggest methylphenidate or dextroamphetamine since it's next to impossible to get those prescribed in my country as an adult (I'm from Australia). Thank you.

[Keizo]

I have tried most meds for ADHD, just my personal anecdote is that Strattera is a million times more effective than bupropion for ADHD and similar symptoms. I found strattera somewhat unpleasant (but my tolerance to "tensions" back then was rather low compared to now, so maybe I'd like it today).

I can also see why bupropion is a popular drug in e.g. the US, for depression, due to it sharing some similarities with actual stimulants while at the same time being sort of pleasant and very mild. But I found bupropion completely useless for ADHD. 

Edited by Keizo, 05 April 2020 - 12:03 PM.

[Heinsbeans]

I have tried most meds for ADHD, just my personal anecdote is that Strattera is a million times more effective than bupropion for ADHD and similar symptoms. I found strattera somewhat unpleasant (but my tolerance to "tensions" back then was rather low compared to now, so maybe I'd like it today).

I can also see why bupropion is a popular drug in e.g. the US, for depression, due to it sharing some similarities with actual stimulants while at the same time being sort of pleasant and very mild. But I found bupropion completely useless for ADHD. 

Thanks for sharing your experience. Out of curiosity, have you ever tried modafinil? How would you compare that to Strattera/Wellbutrin? 

Also, I've actually briefly tried Zyban SR but I've always found myself discontinuing the medication after a week or two due to the side effects. Whereas with atomoxetine in comparison, I've managed to stay on it relative ease for just over 3 months due to the side effects being much more tolerable.
Although I do appreciate how Wellbutrin doesn't cause sedation/drowsiness or negatively affect my personality. At the same time, I didn't find it nearly as effective as Strattera when it came down to avoiding procrastination and sticking to a task.
Wellbutrin, at least initially does help a lot with motivation, concentration and certain aspect of cognition. But I always found myself just focusing on the wrong things and wasting time. Whereas whenever I take atomoxetine, not only does it aid in attention and focus, but it also seem to allow me to avoid procrastination much easier. The only negative aspect of Strattera is the effect it has on my personality/mood. I'm ISTJ and an introvert, so I already don't talk that often. And I just find the sedating/calming nature of Strattera to just pronounce my introversion even more which is not ideal.

[Keizo]

Thanks for sharing your experience. Out of curiosity, have you ever tried modafinil? How would you compare that to Strattera/Wellbutrin? 

 

Modafinil is not approved/used for ADHD in Sweden, and I never tried it nor the related compounds. Methylphenidate, dexamphetamine and atomoxetine are what is used here, and sometimes they might prescribe bupropion. Those I've had on scripts at various points. I've also tried various nootropics/supplements, the only one I really found useful specifically for ADHD was Fasoracetam, but sometimes it causes me brainfog and muscle tension so I've sort of forgotten about it.

 

I checked the wikipedia article for fasoracetam, so apparently it's classified as prescription only in AUS. Not sure what that is about, but it was studied for ADHD in recent years, and I think some new version is being studied at the moment for US market approval.

[Keizo]

 

Wellbutrin, at least initially does help a lot with motivation, concentration and certain aspect of cognition. But I always found myself just focusing on the wrong things and wasting time. Whereas whenever I take atomoxetine, not only does it aid in attention and focus, but it also seem to allow me to avoid procrastination much easier. The only negative aspect of Strattera is the effect it has on my personality/mood. I'm ISTJ and an introvert, so I already don't talk that often. And I just find the sedating/calming nature of Strattera to just pronounce my introversion even more which is not ideal.

 

I do share that particular feeling when it comes to strattera, that it seemed like it helped with procrastination and that sort of thing. I don't think I've gotten that kind of positive effect from any other ADHD medication or supplement. But all in all I don't think I'm going to try strattera again, I think I can just use what little willpower I have to direct my attention and make schedules and once I manage that for a few minutes my current medication does make it smooth from there. (Currently I'm taking elvanse/vyvanse which is great but I really need to pick and choose how I start my day or I waste hours and hours.) 

Edited by Keizo, 06 April 2020 - 11:32 AM.

[Heinsbeans]

I do share that particular feeling when it comes to strattera, that it seemed like it helped with procrastination and that sort of thing. I don't think I've gotten that kind of positive effect from any other ADHD medication or supplement. But all in all I don't think I'm going to try strattera again, I think I can just use what little willpower I have to direct my attention and make schedules and once I manage that for a few minutes my current medication does make it smooth from there. (Currently I'm taking elvanse/vyvanse which is great but I really need to pick and choose how I start my day or I waste hours and hours.) 

Yeah, if you already have access to the most effective medication for ADHD (methylphenidate/d-amp), then there's not much point taking Strattera. Unless of course, if you're still not getting full relief from stimulant monotherapy and require an add-on. Sometimes, psychiatrist augments low-dose Strattera (or Intuniv) on top of stimulant therapy to cover the full range of Adhd symptoms. Since both stimulants and Strattera/Intuniv treats Adhd symptoms through different pathways. But polypharmacy can come with its own side effects so it should only be reserved as last resort: 

It's a shame that fasoracetam is now in the same legality as modafinil in Australia (both Schedule IV). I was planning on trying fasoracetam sometime in the near future but that's just gotten a bit more risky now. But either way, fasoracetam seems to be only effective on those who has the polymorphism in the mGluR gene. I haven't figured out which exact mGluR gene the study is referring to so I haven't checked if I have it in my 23andMe result yet. https://www.reddit.c..._significantly/

Aside from Strattera, I've personally found 120mg Cymbalta to help quite well on my will power/perseverance in initiating (and sticking) to tasks I'm not interested in. But there was a huge downside with Cymbalta which is that it wasn't as effective on concentration as Strattera. Not only that, but it eventually lead to emotional blunting and sexual side effects. So overall, I much prefer Strattera over Cymbalta on executive functioning.