40 replies to this topic

[Mind_Paralysis]

Indeed.

 

I've tried so many drugs, with limited effect, or if there was an effect, it was buried in such tremendous side-effects that it ended up being a zero-sum game.

 

So, I have SCT - Sluggish Cognitive Tempo.

 

It's hypothesized to be connected to the Superior Parietal Lobe and the posterior Default Mode Network - areas highly influenced by Norepinephrine. The fact that regular stimulants do not work, yet there is some evidence for Atomoxetine, supports these ideas.

SCT-ers in the USA report higher efficacy on symptoms from Evekeo and Adderall, than they do from MPH or D-AMP - Evekeo and Adderall both contain LEVO-amphetamine - this drug is completely out of reach in my jurisdiction - since there's evidence that D-AMP works better on regular ADHD, it has become a non-entity in health care - completely replaced with D-AMP.

 

My psychiatric Dr. has contacted the local equivalent of the FDA to get a license to prescribe the racemic form, but they are, according to him, not even replying to the enquiry - he's either lying, or this is the case - either way, I know from other sources that it's difficult to get prescribed since D-AMP became the norm.

 

So...

 

*HOW* do I get it?!

 

And please, if anyone has any ideas, don't suggest the Darknet marketplace or any such nonsense - they'd be selling me a mix of amp, MDMA, an RC, glucose, and DETERGENT. Such an unreliable source is out of the question.

 

What I'm thinking... is to find someone whom has prescribed Evekeo, but wants to make a trade for Dexedrine - perhaps someone on /r/adhd over at Reddit, or someone over at one of the ADHD-forums.

 

 

[jack black]

how about substituted amphetamines? have you looked there?

disclamer: i'm fairy ignorant about amphetamines (you can tell from my recent thread on it).

Edited by jack black, 28 January 2018 - 10:17 PM.

[Mind_Paralysis]

how about substituted amphetamines? have you looked there?

disclamer: i'm fairy ignorant about amphetamines (you can tell from my recent thread on it).

 

Hmm, well... the problem is that the research is much thinner on those compounds - they're also hard to obtain, and some of them are also illegal. I've actually tried one of them - Buproprion - first time I used 300 mg sublingual, I would say I got almost 80% clearing of symptoms! But that was probably not real therapeutic effect, more like euphoria, since subsequent usage of the drug have not produced such results.

 

Bupe' is interesting in the fact that it's by many accounts more selective towards NE than DA, and would then in theory have more effect on SCT-symptoms than Amphetamine - alas, so is not the case. (it's of course primarily a nicotine antagonist, which will alter the effects)

 

Anyways, it's not a bad idea, so I'm going to have a closer look at them.

 

 

Another possibility is of course Focalin - DextroMethylphenidate - it's actually more selective towards NE than DA! (unlike the racemic mix) I actually know one fellow with SCT whom vouches for it's efficacy. It's also not available in my jurisdiction however...

[Mind_Paralysis]

Right, so I've contacted a Dr. in my jurisdiction whom used to specialize in treating ADHD with Amphetamine in particular - he's been into bouts with our local version of the FDA and the Dr's association in the past, so he should have the knowledge and experience regarding how one obtains or applies for a license of Racemic Amphetamine, if anyone does.

 

Well, here's to hoping he replies soon, and that he knows what the score is!

 

Otherwise, I'll try some ADHD-boards and Reddit, to try and arrange a trade for Racemic Amphetamine.

[Finn]

There is plenty of illegal prescription drug amphetamine going around, so pretty sure drug dogs at customs are trained to sniff them out too. Adderall/Evekeo is not really used in EU, so it being shipped outside EU will increase the risk of it being detected.

[Mind_Paralysis]

There is plenty of illegal prescription drug amphetamine going around, so pretty sure drug dogs at customs are trained to sniff them out too. Adderall/Evekeo is not really used in EU, so it being shipped outside EU will increase the risk of it being detected.

 

Hmm, yes, I would agree.

 

Well, I guess I'll have to forego my purchase of a new computer if worst comes to shove, and simply go to the Americas! Whatever it takes...

[Hannes2]

Stinkorninjor, forgive me for hijacking your thread, but that "Sluggish Cognitive Tempo" disorder is really interesting to know about. I've previously never heard of SCT, but now that I read about it on Wiki, I recognize myself in most of the symptoms (apart from "slow moving or sluggish", whatever that is supposed to mean). I do not have any other ADHD symptoms, though.

 

I sense that SCT may be a co-factor, if not dominant in the development of my social anxiety disorder I'm officially diagnosed - unless these SCT symptons are not simply a consequence of SAD. I do get substantial relief from Tranylcypromine (Parnate) + stimulating stuff like coffein, modafinil, maybe also phenylpiracetam, so more dopaminergic, while buproprion alone was rather terrible. I will probably never get my hands on any amphetamine legally, but atomoxine may be worth a shot to test this hypothesis. Do you know any response rates for this and bupropion by any chance? (and if only anecdodically)

 

Edited by Hannes2, 06 February 2018 - 06:15 PM.

[Mind_Paralysis]

Stinkorninjor, forgive me for hijacking your thread, but that "Sluggish Cognitive Tempo" disorder is really interesting to know about. I've previously never heard of SCT, but now that I read about it on Wiki, I recognize myself in most of the symptoms (apart from "slow moving or sluggish", whatever that is supposed to mean). I do not have any other ADHD symptoms, though.

 

I sense that SCT may be a co-factor, if not dominant in the development of my social anxiety disorder I'm officially diagnosed - unless these SCT symptons are not simply a consequence of SAD. I do get substantial relief from Tranylcypromine (Parnate) + stimulating stuff like coffein, modafinil, maybe also phenylpiracetam, so more dopaminergic, while buproprion alone was rather terrible. I will probably never get my hands on any amphetamine legally, but atomoxine may be worth a shot to test this hypothesis. Do you know any response rates for this and bupropion by any chance? (and if only anecdodically)

 

Well, for Bupropion, since it's also a releasing-agent, the response-time is the fastest - the effects will be noticeable within an hour to a couple of days - not many SCT-ers respond to Bupropion though, it should be noted.

 

Reboxetine and Atomoxetine (strattera) generally take several weeks to see a definitive response, since you have to work yourself up dosage-wise, and then reach steady-state.
 

 

When it comes to the typical stimulants, like R-AMP, the response is usually as fast as for the ADHD-ers - i.e, within an hour, or a few days, and then you'll know.

 

 

Interesting to meet another potential SCT-er! = ) In theory, there's a crap-load of us out there, but very few sadly are on the sites I frequent, nor in general ever get, or possibly seek, help. Society kind of wants to turn their eyes away from our potential problem, since it's less of a problem for everyone else.

 

Btw, dunno' if you've seen the data on this, but it's confirmed that people with SCT have more anxiety and generally a higher rate of comorbidity with anxiety-disorders than neurotypicals and ADHD-ers, so it's quite possible to have both at the same time.

 

Also, in closing, I checked out Tranylcypromine (parnate, etc) a bit closer, and apparently there's some evidence indicating that it's a weak NRI - like ATX and RBX in other words. As such... it wouldn't be strange if it had some effect on a disease connected to norepinephrine.

[Mind_Paralysis]

So... it's  been MONTHS!

 

And still no Racemic Amphetamine... This sh*t is rarer than f***ing fabergé eggs these days! I've recently been feeling like crap, activity slowing to a crawl, or rather - it's been redirected in the WRONG way! I can't do any of the things that would be good for me, can't cook, can't clean, can't exercise, can't put energy into seeing my friends and family - heck, all I can do is play video-games!

 

Currently on Dextroamphetamin + Atomoxetine + Tianeptine (because I can feel the atx making me slip into depression, so I need it to counteract that effect) so that may have something to do with it.

Anxiety is up, aggression is up - feelings of disappointment and entrapment are through the roof.

 

Really, I'm at my end of the road here.

 

 

The only good thing is that I've finally gotten the local version of the FDA to TALK to my Dr. and vice versa! Had to call both parties and goad them on almost incessantly - turns out there's been some kind of failure in the communications there, a letter with instructions to my Dr. wasn't sent, et c...

 

...

 

...The pain this realisation causes me is off the charts. The feeling of pushing a Sisyphean stone is overwhelming. Another thing that got me down is how, when I called my Dr. and FINALLY got the news, is that he doesn't seem all that bothered with it, because his reply is: "oh well, but I can't see that it'll be any sort of miracle drug..."

 

SERIOUSLY?! Son of a...! I'm sure he didn't mean anything by it, but when he has previously mentioned how he: "doesn't believe drugs will be what lifts you up" then it's incredibly disheartening!

THERE *IS* NOTHING BUT THE DRUGS, YOU IDIOT!

 

Everything else has failed - and WILL fail, that's what the science has shown! And I can't even get any of the extra goodies that other disabled people can get anyway, because my disease isn't acknowledged as sufficiently disabling, as Autism is, for instance.

 

Hence, the day I stop trying drugs, is the day I give up trying to lead a life with true and complete fullfillment - a life that's actually stimulating to my intellect - and since there is *NO* chance of that EVER happening without the drugs, then that's the day I f***ing kill myself you imbecill!!

 

Mottherf*** I'm mad... I've been pissed for days now... The rage is really starting to get to me - last night was the first time in at least a year, possibly multiple years, that I started slamming my fists into the literal wall with burning rage.

 

I know the warning signs here... The above implies irrationality and loss of affect control - it also implies some kind of self-mutilation or self-harm behaviour, which is definitely a problem.

 

 

Not sure how much longer I can wait! I feel the need to do something drastic here, or something or another will break - something must be done about this situation...

 

 

SO... what are my options here? How do I obtain such a hard to get drug? And obtain it SAFELY. Street-amp is utterly useless garbage, concocted by an assemblage of psychopathic chinese communist chemists and imbecillic druggies - it cannot be used medically, because it is NEVER, EVER the actual medication! It's always a mess.

 

SO... I need to find someone, somewhere... whom have the actual medical grade product, and is prepared to exchange it for Dextroamphetamine... but where do I find such a person?

WHERE?!!

Edited by Stinkorninjor, 28 April 2018 - 10:12 AM.

[Jason Burns]

If you have money you could go on vacation to a country with much more open prescribing of medications.  Say a 1month or 2month vacation to give time on the medication to see how you are doing. 

 

Thing for me is your anger and your motivation to put pressure on the gatekeepers in the system, it suggests to me your norepinephrine levels might not be the main problem.  Although maybe you just experience strong motivation for short periods while most of the time facing mental fatigue.

 

What different medications have you tried.. and what medications have people with the same diagnosis found benefit with?  You mentioned Strattera, did you try that medication to see what the effects were?

 

 

[Mind_Paralysis]

If you have money you could go on vacation to a country with much more open prescribing of medications.  Say a 1month or 2month vacation to give time on the medication to see how you are doing. 

 

Thing for me is your anger and your motivation to put pressure on the gatekeepers in the system, it suggests to me your norepinephrine levels might not be the main problem.  Although maybe you just experience strong motivation for short periods while most of the time facing mental fatigue.

 

What different medications have you tried.. and what medications have people with the same diagnosis found benefit with?  You mentioned Strattera, did you try that medication to see what the effects were?

 

Thank you for replying, it means a lot.

 

Yes, I sometimes have odd spurts of activity, which happens in general either when I'm put under a lot of stress or when something that truly engages me happens (something good). These are generally very short-lived, and I usually return quickly into a state of what I can only call stupor.

 

Anyways, that sounds like Bipolar, but I have been evaluated for this, and I do not fit the diagnosis. The fact that I react inconsistently to multi-drug use also seems to confirm this - if I was bipolar, then I should go sky-high when combining things like Sertraline and Methylphenidate, which I have done, at high dosage - yet the effect on my activity-state was fairly weak, not at all mania-inducing. (very powerful peripheral side-effects though, as is to be expected from 65 mg MPH and 200 mg Sertraline.)

 

Anyways, it seemed as if my anger may have been caused partially from extended use of D-AMP, and I have now cut the dosage to merely 1 mg, and added sublingual Mirtazapine last night, in order to make sure I get proper sleep - this seems to have calmed me down substantially - tomorrow will be a complete break from D-AMP, before I return to my prescribed regimen once more.

 

Of course, the brain-fog from Mirtazapine is rather troublesome today... luckily I won't have to deal with it more than the following 14 hours or so.

 

 

I have evaluated most ADHD-drugs on the market - the only two which I have as of yet not evaluated, are Dextro-Methylphenidate (focalin) and Levo-Dextro-Amphetamine (evekeo).

 

List of drugs trialled:

 

Concerta (DL-MPH - 22 % IR / 78% ER - about 25% improvement of symptoms, less in time)

Medikinet (DL-MPH - 100% IR - about 25% improvement of symptoms, less in time)

Ritalin LA (DL-MPH - 50 % IR / 50 % ER - about 25% improvement of Symptoms, less in time)

 

Vyvanse (Lis-D-AMP - 0% IR / 100% ER - about 33% improvement of symptoms, less in time)

Zenzedi (D-AMP - 100% IR / 0% ER - about 33% improvement of symptoms, less in time)

 

Modafinil (100% IR - about 20% improvement of symptoms, less in attention, more in fatigue, less in time)

Armodafinil (100% IR - about 20% improvement in symptoms, more peripheral side-effects)

 

Strattera (ATX 100% IR - 20% improvement, primarily attention, worsens fatigue in time)

Reboxetine (RBX 100% IR - 15% improvement, both attention and fatigue, terrible peripheral side-effects)

 

Intuniv (GXR 0% IR / 100% ER - 20% improvement, primarily attention, worsens fatigue with higher dosage)

 

In general, the stimulants appear to level out their benefits at very low dosages, 10-18 mg of MPH, 2,5-5 mg of D-AMP, and after this threshold, they only cause negative effects.

 

The same appears to be accurate for Modafinil, 100-150 mg is the limit.

 

My response to stimulants are in line with the general opinion and experience from individuals with SCT-symptoms, i.e a very limited effect.

 

I have also trialled combinations of multiple of the drugs above, as well as various dosings, but I was just struck with greater brain-fog, making any further elucidations on my drug-trials impossible - I will return with this info shortly.

Edited by Mind_Paralysis, 30 April 2018 - 10:31 AM.

[Mind_Paralysis]

In truth, the medications which are claimed to have benefit for people whom identify with my symptoms of SCT, appear to be mixed - there are differing opinions - something I've noticed, is also how some of us claim that a drug is helping for a week or two, but then we change our tune and claim that it does not work.

Hence, there is a bit of confusion regarding what actually works.

 

In theory, some of the data implies that the ratio of neurotransmitters involved when compared to traditional, hyperactive ADHD, is inverted - I.E, Norephinephrine plays the central role, while dopamine has a more limited role - somewhat of a reversal of ADHD, where the ratio is inverted.

 

Attentional networks in the back of the head, have been implicated via the latest neuroimaging data - the Superior Parietal Lobe, as well as the posterior Default Network lobes have shown abnormal activity. This is gross contrast to ADHD, which shows a prominent role for the Frontal Lobe.

 

 

I, however, have not undergone neuroimaging, so it is hard to say if my symptoms are TRULY connected to either of the above mentioned networks - in truth, we remain in the dark, when it comes to the basis for my symptom - only a proper activity-monitoring neuroimaging session can give something substantial here.

 

 

Anyways, Modafinil appears to be the favoured drug among many, since it's the least prone to cause side-effects in SCT-ers, even though the benefit is also limited. In theory, Atomoxetine is the drug that should have sufficient effect, but in my case at least, I can infer that this is not the case.

 

The two stimulant-drugs DL-AMP and D-MPH have both shown theoretically higher affinity for Norepinephrine than their more commonly prescribed brethren, whom show a higher affinity for Dopamine - this is why I theorize that these should be more effective - they are of course also the ONLY drugs I have yet to actually trial, so there's really no choice but to go for them anyway.

Edited by Mind_Paralysis, 30 April 2018 - 10:33 AM.

[Jason Burns]

I am thinking imipramine(Torfanil).  But you might already be getting a lot of the same benefits from Tianeptine.

 

I mean if Mirtazapine doesn't work out, which I think there is a decent chance you could get major benefit from Mirtazapine.  It works like a miracle for some people, while being disastrous in others.    

[Pereise1]

If it's Levoamphetamine you're looking for, Selegiline at borderline MAOA blocking levels, like 10-20mg, should metabolize into a decent amount of Levoamphetamine and Levomethamphetamine. I definitely can't take more than 2.5mg selegiline with my regular prescription of 40mg Dextroamphetamine for what it's worth.

[Keizo]

move to the US and you might be able to get d-meth prescribed

 

Regarding racemic amphetamine... Here in Sweden I remember seeing the Recip 5mg tablets on fass.se (I think they removed it from their page, or maybe it was just an image someone linked and it wasnt on fass). Some people on flashback.org allegedly have gotten it prescribed, a few rare individuals.

No idea if anyone still is getting it prescribed. https://www.google.s...hrome&ie=UTF-8'

 

https://www.google.s...1.0.1T0CCK0H6NA

 

Edited by Keizo, 30 April 2018 - 07:08 PM.

[CWF1986]

I've read reports of people with 'adhd' who have been prescribed the anti-obesity medicine phentermine who report that it's worked better for their symptoms than any other adhd medicine.  If it's available in your country, maybe you might have a better shot of getting prescribed that off-label than evekeo.  

 

It's the most selective norepinephrine releasing agent that's on the legal market in many nations that I can think of.  

[Mind_Paralysis]

Cheers for all of the replies, lads! = )

 

 

 

I am thinking imipramine(Torfanil).  But you might already be getting a lot of the same benefits from Tianeptine.

 

I mean if Mirtazapine doesn't work out, which I think there is a decent chance you could get major benefit from Mirtazapine.  It works like a miracle for some people, while being disastrous in others.    

 

 

Tianeptine and Imipramine doesn't really work the same way - Tianeptine has such a different MOA that even though it has a tricyclic structure, I would personally rank it like a completely different drug-class - after all, we do so with other tricyclic drugs, like the tricyclic Antipsychotics for instance.

 

Although Imipramine is a potent SNRI, I honestly can't say that it looks like a good fit for me - all of the potential side-effects, along with the effects on other neurotransmitter-systems doesn't exactly fill me with enthusiasm... Nah, no first-generation TCA's for me.

 

But cheers for the suggestion - it does bring me back to ANOTHER drug not available in my jurisdiction - the SNRI MILNACIPRAN could be something... alas, it would be just as tricky to get prescribed.

 

 

I can already tell you that Mirtazapine doesn't work, btw - I've previously been on it long-term for sleeping-disorder and depression, and all it did was cause aggression and fatigue in the long run. It's good for short uses once or twice a week, but nothing else - I get hit so hard with the sedation, that every basic cognitive function takes a nose-dive - I become a walking dead, a living zombie on this drug. I react the same to nearly every antihistamine that crosses the BBB - very badly.

 

 

If it's Levoamphetamine you're looking for, Selegiline at borderline MAOA blocking levels, like 10-20mg, should metabolize into a decent amount of Levoamphetamine and Levomethamphetamine. I definitely can't take more than 2.5mg selegiline with my regular prescription of 40mg Dextroamphetamine for what it's worth.

 

Hmm...! Selegiline? Well, it's not entirely out of the question - but my impression was that the overall effects of Selegiline will still tilt towards dopamine?

There's also the fact that it's hard to say if it will have any effect - it's not a drug that's been trialled by anyone online with SCT, as far as I can tell, and then there's the usual problem with diet restrictions - I'm not too keen on those - but still, Selegiline is a safer drug than older MAOI's.

 

I will actually take this one into consideration!

 

 

move to the US and you might be able to get d-meth prescribed

 

 

Lol! Uh yeah... thanks, but no thanks - Meth is proven to be neurotoxic at very small dosages, so I'd rather not! D-meth is of course, just like D-AMP, also selective for dopamine, so that would be a useless drug for someone like myself.

 

Going over to the U.S.A and getting DL-AMP prescribed is something I have considered though, so that's not necessarily a bad idea.

 

 

I've read reports of people with 'adhd' who have been prescribed the anti-obesity medicine phentermine who report that it's worked better for their symptoms than any other adhd medicine.  If it's available in your country, maybe you might have a better shot of getting prescribed that off-label than evekeo.  

 

It's the most selective norepinephrine releasing agent that's on the legal market in many nations that I can think of.  

 

Phentermine, eh? I recall having a look at this drug in the past - I believe the reason I skipped it, is because of the fact that it's been found to rarely cause heart-related issues. Having a look at it now, I can definitely see how it could be worth a shot - it's alas, not available in my jurisdiction either though...

 

Still, if I went to the U.S, it might be worth a shot at getting it prescribed - the side-effects worry me a bit though.

 

I'm going through the various drug-information services for different countries, within the EU, and it's actually looking pretty grim... It doesn't seem to be prescribed anywhere in the E.U.

 

 

Edited by Mind_Paralysis, 01 May 2018 - 10:41 AM.

[Mind_Paralysis]

move to the US and you might be able to get d-meth prescribed

 

My apologies here btw - I incorrectly assumed you meant Dextro- METHAMPHETAMINE! 0_o

 

Not dextro-Methylphenidate, which I assume is what you meant now.
 

[Keizo]

My apologies here btw - I incorrectly assumed you meant Dextro- METHAMPHETAMINE! 0_o

 

Not dextro-Methylphenidate, which I assume is what you meant now.
 

I meant methamphetamine. But yeah there are more choices there. I have however heard of someone in Sweden getting Adderall, but they I think had to pay for a lot of the cost (very expensive). As far as methamphetamine causing brain damage in low doses I have never seen a references nor bothered to look it up. I do hear that it helps rats recover from brain damage. https://www.scienced...278584615000469 so if you are a rat that gets your brain smashed you should probably move to the US.

 

In general there seems to be a lot of mystery and a lot of people who must be wrong about various stimulants. E.g. some people say d-methamphetamine being more peripherally stimulating and causing high blood pressure etc than d-amphetamine, others the opposite. 

 

I suppose another suggestion is to combine medicines, e.g. Atomoxetine (strattera) and d-amphetamine. Not sure if that is sane or not. I myself have tried d-amphetamine, regular methylphenidate, strattera, bupropion.... Strattera certainly had a lot of that tense adrenaline feeling about it IME, and almost no day-dream-inducing pleasantness like amphetamine or methylphenidate can have. But I am only diagnosed with regular ADHD.

Edited by Keizo, 03 May 2018 - 06:47 PM.

[CWF1986]

Have you considered 2nd gen tricyclics?  In particular, desipramine and nortriptyline come to mind.  Desipramine being more activating and nortriptyline is usually calming and even sedating for some.  

 

If one of those by itself didn't work, but provided some relief you could try it with one the methylphenidate preparation available to you.  Have you tried a stim with guanfacine or clonidine?  It does help a ton with peripheral sides.  I've found beta blockers can help too, but they don't do anything for adhd of course.  I remembered in another thread you were contemplating taking reboxetine with guanfacine.  Did you get a chance to try it?  If so, how'd it go?  I wish I could tolerate the blood pressure meds (both alpha agonists and beta blockers), but they make me gain weight and I'm much more prone to depression which is already a struggle for me even while taking an antidepressant.  

 

Unfortunately, some of us (myself included) require more than one med to control adhd.  I imagine the same can be said of SCT (or really any behavioural health issue).  That combo for me is nortriptyline and adderall.  A tricyclic and a stimulant used to not be at all an uncommon med combo for people with adhd so there is some history there.  The most worrisome thing about the combo is cardiac sides, but if you're a good responder to blood pressure meds that can largely be mitigated and 2 of those meds are known to help with adhd.  

 

Younger docs might be uncomfortable with the TCA and stimulant combo, but older docs who used to prescribe TCAs a lot since SSRIs weren't around probably would be less likely to see a problem with it and more experienced with what to expect from patients who have taken TCAs.  

[Mind_Paralysis]

Have you considered 2nd gen tricyclics?  In particular, desipramine and nortriptyline come to mind.  Desipramine being more activating and nortriptyline is usually calming and even sedating for some.  

 

If one of those by itself didn't work, but provided some relief you could try it with one the methylphenidate preparation available to you.  Have you tried a stim with guanfacine or clonidine?  It does help a ton with peripheral sides.  I've found beta blockers can help too, but they don't do anything for adhd of course.  I remembered in another thread you were contemplating taking reboxetine with guanfacine.  Did you get a chance to try it?  If so, how'd it go?  I wish I could tolerate the blood pressure meds (both alpha agonists and beta blockers), but they make me gain weight and I'm much more prone to depression which is already a struggle for me even while taking an antidepressant.  

 

Unfortunately, some of us (myself included) require more than one med to control adhd.  I imagine the same can be said of SCT (or really any behavioural health issue).  That combo for me is nortriptyline and adderall.  A tricyclic and a stimulant used to not be at all an uncommon med combo for people with adhd so there is some history there.  The most worrisome thing about the combo is cardiac sides, but if you're a good responder to blood pressure meds that can largely be mitigated and 2 of those meds are known to help with adhd.  

 

Younger docs might be uncomfortable with the TCA and stimulant combo, but older docs who used to prescribe TCAs a lot since SSRIs weren't around probably would be less likely to see a problem with it and more experienced with what to expect from patients who have taken TCAs.  

 

Ugh! Difficult to reply... SCT is fogging everything up!

 

I've tried the following combinations:

 

Guanfacine = Maybe 20% improvement? It only helps with planning and such, not with my primary issue - low mental energy and brain-fog.

 

Reboxetine + Guanfacine = very little effect... Reboxetine hardly seems to have any effect at all, mostly peripheral. I did notice slightly improved mood, so the antidepressant effect is there. Terrible, terrible constipation and mouth-dryness.

 

Atomoxetine + Guanfacine = Impossible to tell how much it improved - the sedation was so bad that I was constantly disoriented.

 

Methylphenidate + Guanfacine = A good combo at first - almost 50% improvement of symptoms, but the effects quickly tapered off - higher dosages of both induce depression in me, so I couldn't continue trialling this. I started out low on both, which was the best effect.

 

Dextroamphetamine + Guanfacine = Less effective than MPH and Guan' actually. Hard to tell how effective it was.

 

Atomoxetine + Dextroamphetamine + Guanfacine = Pretty good! I'd say the first week or so on this combo improved symptoms by almost 50%! The side-effects were out of this world though... highly varying sleep-quality, insomnia, and unbelievable CONSTIPATION! I was on 3 different laxatives to get things going... Once I started tapering the ATX and Guan' it was like the floodgates opened.

 

Modafinil + Atomoxetine = Pretty good! The effects seemed to lessen after just a few days though - I'd say about 40% improvement at peak performance.

 

Modafinil + LisDexamphetamine = Terrible insomnia, anxiety, cardiac symptoms. They actually seemed to make each other less effective.

 

 

So, as you can tell, I've tried quite a few things. The most effect seems to be from combos, yes - but the effects are still not consistent, and they all have diminishing returns - some from less effects, some from increased discomfort from the side-effects - that's to be expected from combination-therapy, certainly.

 

The gold combos which multiple ADHD-PI and SCT -people seem to prescribe to, that I have seen mentioned, appear to be the following:

 

Evekeo + Guanfacine

 

Focalin + Guanfacine

 

Those are apparently the best. Those are also the only ones I've got left to try... TYPICAL! >_<

[CWF1986]

I can't help but wonder if one those two tricyclics I mentioned would be the middle ground between reboxetine and atomoxetine.  It kind of sounds like reboxetine was speedy like in the way too much pseudoephedrine can be and atomexetine would conk you out so it doens't sound like it would be outside the realm of reason to think desipramine or nortriptyline would be your goldilocks zone.  

 

The one thing I can think of that might make these meds bad for you is that both are known to cause constipation due to the affinity for the machr's.  Anytime I had an increase of dose of the nortriptyline, I would have mild constipation for about a week.  

 

Have you ever tried modafinil with theacrine?  I've tried adrafinil with it and it has very good effects for me.  The combination for me was greater than just the sum of the parts.  It got even better with oxiracetam as far as motivation goes.  This is my go to when I want to take an adderall break.  

[Mind_Paralysis]

I can't help but wonder if one those two tricyclics I mentioned would be the middle ground between reboxetine and atomoxetine.  It kind of sounds like reboxetine was speedy like in the way too much pseudoephedrine can be and atomexetine would conk you out so it doens't sound like it would be outside the realm of reason to think desipramine or nortriptyline would be your goldilocks zone.  

 

The one thing I can think of that might make these meds bad for you is that both are known to cause constipation due to the affinity for the machr's.  Anytime I had an increase of dose of the nortriptyline, I would have mild constipation for about a week.  

 

Have you ever tried modafinil with theacrine?  I've tried adrafinil with it and it has very good effects for me.  The combination for me was greater than just the sum of the parts.  It got even better with oxiracetam as far as motivation goes.  This is my go to when I want to take an adderall break.  

 

I haven't really looked into it, no - the side-effects from TCA's are perhaps exaggerated, but the fact that they have anticholinergic side-effects is especially troubling to me - the anti-cholinergic effects of ATX and RBX are actually secondary in nature - in the peripheral nervous system, the intestines to be accurate, NE has the same see-saw effect on aCh as Dopamine has in the central nervous system.

 

And it's not just maCh-anti-effects I'm sensitive too - with prolonged use, Bupropion actually causes significant memory-degradation for myself, as well as a decrease in visual acuity - these are the effects of anticholinergic effects on the nicotine-receptors.

 

Overall, this clearly shows to me that I'm generally sensitive to acetylcholine-disruptions - hence, I'm very hesitant to go on traditional TCA's.

 

 

Tianeptine is different, since it works in a completely different way - I don't experience the usual sides from it at all. I've started coming to the conclusion that I need to go Phosphate with Tia though, because there are multiple other people out there that also feel Sulphate is much less effective - I thought I was perhaps imagining things at first, and gave it the benefit of the doubt - but it seems to be legit - there are actual treatment-differences for some people, between the two forms of Tianeptine.
 

 

I give you thanks for making me have a look at other NRI's though! = ) It should be noted, Focalin is of course an NRI - a more selective one than Ritalin - fast-acting and with a short enough half-life to disrupt sleep less too! It would be my ideal candidate methinks, actually...

 

 

EDIT:

Modafinil with Theacrine? Haven't tried it. What does Theacrine do? Is it that supplement for weight-lifting, the one that helps with glycogen-metabolism?

Edited by Mind_Paralysis, 06 May 2018 - 11:17 AM.

[CWF1986]

Theacrine falls into the xanthine family like caffeine and theobromine.  Tolerance builds much more slowly compared to caffeine if it happens at all.  It's much less physically stimulating and much more mentally stimulating.  It also last longer than caffeine.  Even by itself, I was very pleasantly surprised by how well it works.  I've tried so many things most of which have minimal effect, but this is as strong an effect as caffeine with different subjective effects.

 

In combination with adrafinil it gives me motivation and clear-headedness.  It doesn't help me with restlessness and impulsivity for me like vyvanse or adderall.  But those are non-issues for you so I think it's a combo that might be right up your alley.  Add a stimulating racetam like oxiracetam or phenylpiracetam and the motivational and cognitive effects are increased even more.  

[Mind_Paralysis]

Theacrine falls into the xanthine family like caffeine and theobromine.  Tolerance builds much more slowly compared to caffeine if it happens at all.  It's much less physically stimulating and much more mentally stimulating.  It also last longer than caffeine.  Even by itself, I was very pleasantly surprised by how well it works.  I've tried so many things most of which have minimal effect, but this is as strong an effect as caffeine with different subjective effects.

 

In combination with adrafinil it gives me motivation and clear-headedness.  It doesn't help me with restlessness and impulsivity for me like vyvanse or adderall.  But those are non-issues for you so I think it's a combo that might be right up your alley.  Add a stimulating racetam like oxiracetam or phenylpiracetam and the motivational and cognitive effects are increased even more.  

 

HMM!!

 

THEACRINE, eh? Now this... this is some interesting stuff... A non-habit-forming Adenosine-antagonist! Seems safe, as well as legal. Really, I have nothing to lose with this one! Going to look closer on this one - is it available at the usual nootropics-vendors?
 

Edited by Mind_Paralysis, 07 May 2018 - 07:34 PM.

[CWF1986]

Yep.  

[Finn]

 

 

...The pain this realisation causes me is off the charts. The feeling of pushing a Sisyphean stone is overwhelming. Another thing that got me down is how, when I called my Dr. and FINALLY got the news, is that he doesn't seem all that bothered with it, because his reply is: "oh well, but I can't see that it'll be any sort of miracle drug..."

 

SERIOUSLY?! Son of a...! I'm sure he didn't mean anything by it, but when he has previously mentioned how he: "doesn't believe drugs will be what lifts you up" then it's incredibly disheartening!

THERE *IS* NOTHING BUT THE DRUGS, YOU IDIOT!

 

Everything else has failed - and WILL fail, that's what the science has shown! And I can't even get any of the extra goodies that other disabled people can get anyway, because my disease isn't acknowledged as sufficiently disabling, as Autism is, for instance.

 

 

 

 

 

Here is Barkley's latest version of his SCT lecture from February 16th of this year.

 

https://psych.vcu.ed...sentations.aspx

 

Echo360 version

https://ess.echo360....bb-0fda7ebb0a9d

m4v video version

https://ess.echo360....b0a9d/media.m4v

 

Interesting stuff related to possible causes of SCT and treatments starts at around 50 minutes, Echo360 scene/slide number 29. The beginning is pretty much just discussion of why SCT is separate disorder, classifications of ADHD subtypes etc.

 

 

Barkley has suggested in his representation slides that SCT might respond well to psychosocial interventions since ADHD-I responds better to them than ADHD-C to them and SCT correlates with inattentive symptoms whereas SCT correlates weakly or even inversely with hyperactive symptoms, also because internalizing symptoms respond to therapy, etc.

 

In his speech he is actually less reserved than in slides and mentions  Pfiffner's research according to which SCT responds very well to psychosocial interventions, that p< 0.0001 is much better than p values for SCT symptom reduction in that atomoxetine paper. 

 

 

Psychosocial Interventions for ADHD-Inattentive Type

Linda Pfiffner, PhD

Professor of Psychiatry, University of California, San Francisco

Handout for Conference Institute

CHADD’s 24th Annual International Conference, November 8, 2012

San Francisco, CA

 

Results from randomized controlled trials: Results from an initial randomized controlled trial (N=66) comparing CLAS (Child Life and Attention Skills Program) to usual care indicate significant improvement on mean parent and teacher ratings for inattention (p<.001, d=.97) and hyperactivity/impulsivity symptoms (p=.001, d=.84), sluggish cognitive tempo (p<.0001, d=1.07), organizational skills (Children’s Organizational Skills Scale) (p=.0093, d=.91), homework problems (Homework Problems Checklist, parent only) (p<.0001, d=1.36), and social skills on the Social Skills Rating System (p=.0065, d=.71)

 

 

 

If you have ADHD-I diagnosis, or depression diagnosis, maybe those can be used to get those treatments. 

 

 

https://www.longecit...ed/#entry792687

 

 

 

Currently undergoing S-OCD (for about 6 months I would say - other lesser OCD-traits have come and gone through the years) comorbid with Sluggish Cognitive Tempo and Burnout - I've been trying some CBT-like techniques, trying to argue with myself litterally - saying the opposite of the intrusive and illogical thoughts (of me deserving immediate death for any weakness or failure of any kind) and I have to say it's kind of a bust, when you try it yourself.

 

 

 

If going for CBT at some point, definitely avoid those ones that include the "thought disputing"/"thought challenging"/"debate with yourself" type of CBT. There is no evidence that this subcompotent of CBT really helps anyone, there is actually evidence that it hurts ruminative people, also there is reason why "start a debate against obsession" is never used for OCD treatment, nor is logical debate against phobia used for treating phobias etc. 

 

For Rumination Focused Cognitive Behavioral (RFCBT) short (over)simplified description would be: CBT without "the thought disputing"/" debate yourself" stuff.

 

There was one study where professor gave 3 different type of composed self-help booklets to students, one around the CBT with "though disputing" , one without it, and one based around study skills. "Thought disputing" booklet hurt ruminative students significantly, and wasn't really statistically better for non-ruminative students either when compared to the alternative booklets.

 

In other study, FMRI was done one patients before they were put in antidepressant therapy or CBT. Those whose default mode network had activity typical to rumination were actually worse off after CBT.

 

Another study showed that severely depressed did a lot worse on CT than they did on antidepressants or behavioral activation therapy, in less depressed the differences were smaller but still in favor of BA and antidepressants. Severely depressed were probably the most ruminative group.

 

ACT is good option free of "debate yourself" stuff. If you think brain/mind kinda like as having both software (programming) side and hardware side, I think ACT offers one of most satisfying explanations for the weaknesses and strengths of "the software side" and how they contribute to mental health stuff.

 

Steven  Hayes' Get Out of Your Mind and Into Your Life is really nice book.

 

It is also available as audiobook on pretty much all audiobook sites with free audiobook for new customer or free month offers, Audible, Audiobooks, Storytel, Bookbeat, etc.

 

Audibooks can be handy in a sense that they kinda "force" you to listen whereas it is easy to have paper book open on your lap and and not read it, but as long as you are not doing anything else at the same time audiobook kinda forces you to listen. 

 

I'll post more on  Barkley's comments on default mode network, Barkley's comments on medication later.

Edited by Finn, 08 May 2018 - 04:59 PM.

[Mind_Paralysis]

You da' man, Finn! = ) I had been contemplating PM'ing you about giving your 5 cents on where to go next with my treatment since I was more or less coming up empty recently.

 

I have been suggesting some CBT with a therapist (since I have indeed read the recent info on the DMN, and of course Barkley's previous talks about him being optimistic about CBT - so I figured something similar to perhaps OCD-related or phobia-fighting CBT could indeed be useful - great minds think alike!), but we were still doing introductory talks before we had to postpone because of economic reasons. (private psychologist - impossible to get a public one right now... the wait time for CBT is like 2 years...!)

 

 

Anyways, I might get some rebate from the government soon, so I'll hopefully be getting back to that soon - this CBT-info will be very helpful then!

 

On a  downer note, I have indeed hurt myself a bit too much with my "thought disputing" stuff - it's turned into a form of OCD in itself...! Gah...! Anyways, I'll be trying more of the "it's ok though - I'll get better" type of conversations from now on.

 

Would be interesting to finally see some Norepinephrinergic stimulant-testing for SCT-symptoms btw - Atomoxetine doesn't really work that way, and in general, most SCT-ers and ADHD-PI-ers seem to feel those work better than ATX - but, that's just hearsay, it may not actually be the truth of the matter.

Edited by Mind_Paralysis, 08 May 2018 - 07:47 PM.

[Mind_Paralysis]

Right, I've once more convened with my Dr. and he's once more been in contact with our local FDA, but the new digital licensing-system appears to be the biggest issue here... It apparently appears to have multiple issues, and many other Dr's are reportedly highly dissatisfied with it.

None the less... he's put in another application, this time for Focalin - DexMethylphenidate. No reply as of yet...

 

 

Meanwhile, I shall take the time to test myself rigorously for various potential differential diagnosis, MTHFR-mutations, metabolic disorders, testosterone-levels, the works.

 

And, it's time to take a closer look at all of the suggestions in the thread so far:

 

Selegiline (MAOI-B)

Tranylcypromine (MAOI-B+A)

 

imipramine (TCA - SNRI)

 

desipramine (TCA - NsRI - most activating TCA!) <-- Here's something interesting...

 

nortriptyline (TCA - NsRI - least side-effectsprone TCA ) sedation might be a problem, h1 antagonism. My CYP2D6 mutation is problematic too.

 

Phentermine (TAAR1-agonist - NE-releasing agent) <-- highly interesting. Legal in some EU-jurisdictions - france? Might be a good idea to go for a trip to get it prescribed.

 

Milnacipran (SNRI - similar to Duloxetine, but more selective towards NE)

 

modafinil + theacrine

 

 

Damn... a lot of drugs. Ok, let's see... To me, the most interesting drugs would be, in no particular order:

Phentermine, Selegiline and Desipramine.

 

 

None of those drugs are available in my jurisdiction however... But, what would you say about the ability to obtain them from the grey and black markets? How easy is it to get a hold of Selegiline for instance?

 

 

On another note, I've had an idea for a while now, of using Ethcathinone - what is everyone's take on this drug?

 

https://en.wikipedia...ki/Ethcathinone

 

It's the active prodrug of Cathinone, which itself is a NE-releasing agent, very selective towards NE even. However, after 2,5 hours, I understand that it's then metabolised into Cathinone, which is more like Amphetamine, i.e selective towards DA.

 

Could it have an effect on my symptoms?

[Finn]

 

Also, in closing, I checked out Tranylcypromine (parnate, etc) a bit closer, and apparently there's some evidence indicating that it's a weak NRI - like ATX and RBX in other words. As such... it wouldn't be strange if it had some effect on a disease connected to norepinephrine.

 

While NRI might be strong enough to be factor, for TCP (tranylcypromine) most of it's noradrenergic effect probably comes from MAO-A inhibition. 

 

In his representation based on brain imaging data Barkley seems to be leaning towards interpretation that while in ADHD, default mode network might be occasionally dysfunction due to lack of proper oversight from executive network, in SCT default mode network dysfunction might be the actual cause of issues and default mode network dysfunction is the thing that disrupts the posterior attention networks.

 

 ATX helping somewhat with SCT doesn't prove that only ADHD or purely or mainly noradrenergic meds will help with SCT. ATX has limited evidence of it helping with hoarding, in one study with 2 human subjects and mice, the mice marble burying behavior was reduced, and both human hoarders were also responders to ATX. SSRIs are the usual treatment to hoarding, not ADHD stimulants. 

 

Paroxetine is touted "the most potent and one of the most specific SSRI" . However this potency and specificity doesn't really result in superior results or superior side effect profile compared to alternatives, far from it, same with reboxetine. Selectivity is sometimes overrated.

 

In my opinion, when in doubt of the actual mechanism, or when possible comorbidities, might as well go broad and treat everything at the same time. 5HT/NE/DA is far from zero sum game. The "milder" of the two traditional MAOIs, TCP, rather than sucking at everything, seems to be good against anything, ADHD, MDD, PTSD, OCD, SAD, other anxieties etc. It isn't mood stabilizer nor antipsychotic, but can be used against bipolar depression without triggering mania, according to one BP expert Wes Burgess, who uses TCP on quite a few of his patients, he has never had any of patients enter mania under it. Also TCP can be used to treat scizophrenia negative symptoms without significant increase in psychosis risk. 

 

Since SCT mechanism is not properly known and because of possibility of comorbidities my suggestion would be go for broad spectrum combo to treat everything. Moclobemide (selective reversible MAO-A inhibitor) and modafinil combo could be used as "TCP Light", as a nice balanced triple action combo. 

Edited by Finn, 20 May 2018 - 06:27 AM.