[wisedude]

Hi firstly a quick explanation.

I was on Ritalin for 1.5 years years ago, it was a miracle but side effects forced me off.

Years later (and after an alcoholic period), I am 120kg, and a heavy smoker, so I don't fancy going back on a psycho-stimuilant at this stage.

Well I have been OBSESSED and spent a month basically doing nothing but reading and reading.

I just want to raise awareness of some options that may be of use for some people with ADHD, either to augment stimulants (when it is safe to combine them) or in some cases as an alternative.

There is a new antidepressant out, and its called antidepressant, but as far as a non-stimulant drug goes, I wonder if it is not also the holy grail in a sort of combined "adhd / anti-depressant" drug type?

Its called Brintellix (vortioxetine). It is not available in my country, and I am VERY jealous.

Why is this drug special?

Well it is not a primitive "Serotonin or Noradrenalin" re-uptake inhibitor, they probably make things worst as often as they make them better.

It focused on specific sub receptor types.

For example

It antagonized 5-HT7 which is strongly implicated in emotional regulation and cognitive resistance to stress in both the Prefrontal Cortex and well lets just say a couple of other ADHD "hot spots" in the brain.

When it is activates (agonized, opposite of antagonized) it SUCKS up activity around it in the PFC (Prefrontal Cortex), putting the brain to sleep. It also activates cAMP, and de-activation of that pathway has been associated with improved performance of the PFC in regards to ADHD.

It also reduces glutamate activity = bad, another chemical associated with ADHD pathology in those brain regions. So you want to antagonize and "turn off" the 5HT7 receptor. Now its interesting because some of these receptors you want to turn on, others off, they have opposite and contradictory effects. They are all serotonin sub-receptors but do not THINK the Serotonin Reuptake Inhibitor antidepressants have any RELIABLE effect on them, especially if they need to be deactivated! SSRI's probably make ADHD worst over all.

Well this drug does several such things, basically all of them known to improve activity in the prefrontal cortex and related brain regions.

For example it AGONIZES (activates) 5HT1a receptors which are plentiful in the prefrontal cortex, and this results in increase dopamine and noradrenalin activity.

It is basically from what I have read, and besides from stimulating dopamine (aka stimulants) the perfect ADHD drug as far as I am concerned or at least the perfect combination emotional problems/depression/adhd drug.

I am not going to cite lots of references at this point, I have them, but this thread could get HUGE if I start going that (do you really want to read 20-30 pages?)

Unfortunately unless I consider the tedious route of trying to get a prescription and ordering it from overseas, then I don't have access to that medication!

I have personally found the 5HT7 receptor antagonist, Solian (amisulpride) useful in doses from 100-150mg per day in helping with my unstable "adhd like" emotional regulation problems, including low stress threshold and anger- not a cure, but a big help. However that drug is only a mild to moderate antagonist, not as strong as the good drug further up!

There are a few other drugs people might not heave heard of, that could be useful in some situations, and some people will know this, but if you have not spent months reading through it all, then I am trying to get the information straight into your brain, in case the option may assist you.

"Zeldex" (Ziprasidone)

Is the only drug I can get here which is close (but not as good as the antidepressant above), but guess what? Its known to be sometimes prescribed off label for ADHD, because it hits most of the same similar receptor subtypes which increase prefrontal cortex (and some other) activity.

Now it is scary because its called an anti-psychotic. No I do not have psychosis

1. All drugs which lower dopamine as a major effect, well they call them anti-psychotics, because lowering dopamine helps with psychosis.

2. Dopamine lowering causes side effects and if strong is definitely BAD for ADHD.

However this drug is STRONG on the receptor effects on the 5HT system (antagonizing some, agonizing others, all in favor of PFC function).

So if you take a low dose such as around 5-10mg twice per day, you can still get the receptor effects without ramming into the dopamine blocking effects.

The bummer is you can't keep pushing it further than that because of the dopamine blocking effect= bad.

But it is certainly in low doses an ADHD drug, and a POWERFUL anti-depressant. One option I am strongly considering.

Well I have better stop babbling but I have found some even more obscure medications which may be of interest and many people may not have heard much about.

Oh it should be noted that the above drug, Zeldex also increases Noradrenalin (via transporter blockage)- moderate to mild in effect but may be of benefit- perhaps.

Like Strattera, increasing Noradrenalin results in special effects in the prefrontal cortex (main ADHD brain area).

In the PFC, the Noradrenalin neurons SUCK UP AND EAT dopamine! When you feed them Noradrenalin, they have food in their mouth and can't swallow dopamine, but what is more, over 1-2 weeks they reduce in number as a result of the feeding. So you end up with less of them, less of them to eat up the dopamine= more dopamine and Noradrenalin in PFC, equals better functioning.

It should be noted that also besides increase glutamate in PFC and various things that most of the receptor subtypes BLOCK a mechanism called cAMP which is implicated in PFC functioning and ADHD. Blocking it IMPROVES PFC function.

So there are various dualistic, complex actions.

The first antidepessant I mentioned, what was it ahh Brintellix is pretty low side effect, so its a pretty interesting, non-harsh, non-stimulant medication.

I have some other medications I will mention if interest is shown, just sharing what I have learned. IF people know other good medications and information, please I am always learning and I appreciate ANY constructive opinions / experiences.

Bye for now (I need to get to bed for today!)

[wisedude]

Ok a few teasers then I am off.

Okay most of you will have heard of :guanfacine its pretty mainstream in the US, but I think its a great medication for ADHD.

Melatonin taken 3 times daily in right dose *may* help PFC function.

Buspirone may be useful in some cases due to moderate 5HT1a agonism (activation).

Well I can't find my links for now and I am tired.

But I will say you have heard of Cylert (pemoline)? It was one of the top #3 ADHD drugs, but very rarely it kills people through liver failure. It got banned. But its important because it basically does NOT have the cardiovascular side effects of the other stimulants and is considered less abusable.

Moderate doses of Ardmodafinil may be of *moderate* assistance.

I'll come back with the best one's later!

[crylight]

Thank you so much for the research done. It will be a helpful discussion for myself and other people that I know who struggle with ADHD.