Any recommendations? I took one that you take at night. It slightly improved my focus during day. But would leave me sleepy all day. Even with taking it before bed.
Guanfacine is another, I haven't tried it, so I can't give any first hand experience. I think it's used more to help blood pressure & agitation that can come up with adhd
Welbutrin is also commonly used.
I guess if you’re arguing (I know you are not, I am just putting unsolicited info out) in terms of what amphetamines are the worst… methamphetamine, pharmaceutical grade & at the equivalent therapeutical dosage for ADHD symptoms - which is something like 5mg-15mg max, & potentially up to 45mg for the very worst cases of chronic fatigue syndrome - is actually less hard than others on your body from a neurotoxicity standpoint, as well as on your vascular system in general. You can also very easily take naps on it (at those dosages).
It just happens to be highly addictive because of the whole blood brain barrier crossing thing. & then once you get out of that therapeutic dosage into “recreational/abusive” dosages… that is when meth is very bad.
So if you don’t have an addictive personality & can control yourself, prescribed methamphetamine (Desoxyn, not sure if a generic exists) is otherwise the safest treatment for ADHD if expected to be consistently on it for decades/life.
I believe it then goes
DextroAmphetamine
50:50 Racemic Amphetamine (Evekeo may be brand for this in US?)
Adderall (which is 3:1)
From least harm on your body to most harm over time.
My doc & I for the time being found Vyvanse was nearly perfect for me, & essentially perfected it by adding a small (10mg) instant-release DextroAmphetamine (Zenzedi, specifically branded - seems to be the most perfected formulation in the US pharmacy system as of now.) along with it to kickstart things in the morning. There are also times when I’m scripted to just take multiple 10mg IRs a day instead of the entire Vyvanse dosages for other medical reasons & potential need to rest. Mentioning rest: a non-negligible portion of people on an otherwise perfectly working Vyvanse dosage seem to need a mild-moderate sleep aid towards the end of the day. & where you may think that just indicates a lowering of the dosage, that is mostly wrong & ruins the “otherwise perfectly working” aspect.
I only mention all of this unsolicited advice/information as I’ve for far too long now, & with medical practitioners in family, seen anecdote after anecdote of people prescribed Adderall (IR or ER) eventually trying pure DextroAmphetamine IR (previously known as Dexedrine, now Zenzedi, & of course generic) - or ER like Vyvanse - & finding that it works much, much better than Adderall. Typically from a standpoint of less irritability/jitteryness/emotional blunting & more focus & ability to change task to task if needed. For whatever reason though (obviously, industry money slushing around related), Adderall is prescribed at a ridiculously higher rate than pure DextroAmphetamine. There’s also a decent amount of people who’ve only heard the term Adderall & don’t know DextroAmphetamine exists. Finally, that in some rare cases, meth is genuinely the correct drug for treatment. I honestly think if you’re being prescribed an amphetamine, doctors should have to inform you of all amphetamine based medication able to be prescribed for your condition & the potentially pros/cons comparisons - but I am nobody in this world.
Methamphetamine is legally available by prescription in the US, but in many other countries that is not true. Here in Australia, it is technically legal to prescribe, but effectively unavailable, because no pharmaceutical company is authorised to sell it. (It is unclear to me if that is because the government refuses to authorise it, or merely that no company thinks the potential revenue is sufficient to justify the hassle of seeking that authorisation.) Even in the US, from what I hear, many refuse to prescribe it at all, or only do so sparingly, because (apparently) the DEA likes to give methamphetamine prescribers extra "attention".
Methylphenidate (Ritalin/Concerta/etc) is notably absent from your list. I've heard claims (not sure how true they are) that methylphenidate has less neurotoxicity than amphetamines. Related compounds to (racemic) methylphenidate include dexmethylphenidate and serdexmethylphenidate (a prodrug, as lisdexamfetamine/Vyvanse is).
Other drugs I know of that are sometimes used for ADHD include guanfacine, clonidine, modafinil, armodafinil, atomoxetine (Strattera), bupropion (Wellbutrin) and phentermine (usually prescribed as a weight-loss drug, but has been used off-label for ADHD).
I’m in this category. But thankfully 0.5mg melatonin is all it takes to get a good night sleep, and that seems safe enough even as a habit.
I have been pondering for a very long time what the best options may be. I feel as if low dose benzos are a great option, but also that unless you’re somewhat affluent, finding a doc willing to prescribe & help you through amphetamines & benzos would be hard. Likely something like 0.5mg klonopin, small dose temazepam, or same for lorazepam. Likely not alprazolam.
0.3mg melatonin used to help my insomnia before I was ever prescribed amphetamines, but somewhere between when I was not prescribed them, started a low dosage of Amitriptyline for nerve pain, & now - 0.3mg-0.5mg melatonin started to make me wake up extremely agitated & have nightmares no matter what (like clockwork) - & the higher dosage gummies, like 3mg to 10mg, gave me a great variety of extremely realistic dreams.
Also spiked my heartrate by roughly 30bpm (aka a lot)
I’m glad that melatonin works for you because it’s quite convenient (well, I think having to take any pills is inconvenient, but I digress) - & also glad you can agree with the perfect dosage aspect/idea.
I have ran into middle of their career-ish psychiatrists who simply say it’s an absolute bullshit, but then mostly the entire generation of younger psychs, younger PharmD’s, a & large amount of internet psych anecdata agreeing. Conveniently, those middle aged psychs didn’t start their career when Vyvanse was even a thing, & all of the younger I mention have always known of it…
I just don’t understand why some docs outright refuse to believe such benign information/lived experiences from their patients, & presume their patient is lying to their face before they’d ever agree with them.
For those wondering of my excessively long posts… currently not on any amphetamines while dealing with other acute medical issues, but most definitely in a situation in which I have great need to distract myself. Long posts help with that, though maybe I should resign to saving them in my notes instead of hitting “reply” :P
I got the idea to augment with melatonin from a Slate Star Codex post. Since the author is a board certified psychiatrist, I decided to trust this info. Google should get you the original article, but here's my memory of it: melatonin is safe, little to no side effects, and should be taken by anyone as a first line attempt to fix sleep issues.
Melatonin is ridiculously safe. It basically has no detrimental effects in large doses. As a result, nutrition companies are in a war to make ever bigger over-the-counter doses because those sell better. But unfortunately while 5mg isn't toxic, it also makes me sleep 10 hrs and wake up groggy. As a result it's hard to find over the counter melatonin that is in the real dosage I want, 0.3 - 0.5 mg. However I found that Costco sells kids melatonin gummies with a 1 mg dosage, which is the smallest you can find on the market without paying extra. I just cut/bite the gummies in half to take approx 0.5mg a night. It's perfect, and I'm sorry it didn't work for you :(
The one thing that doesn't replicate for me from the SSC post is that he suggested taking melatonin 7(!) hours before sleep. I find I get tired upon taking melatonin immediately, and to take it early just screws ups my circadian rhythm.
Regarding the dream thing... Here's the weird thing: I have aphantasia when awake, and typically don't dream. But when I take melatonin I not only sleep better, but have vivid dreams that I remember upon waking. I guess I'm fortunate these don't turn into nightmares, generally. I guess I'm saying I can confirm your experience that melatonin leads to active dreaming, but maybe the nightmares are caused by something else? That is to say the melatonin is working to get you quality REM sleep, but some other interaction or issue is agitating you to make those dreams unbearable. Maybe worth talking to a doc about what can fix persistent nightmares.
Interestingly, adderall not having an all day effect is something I like about it. I take an XR in the morning and have a smaller IR in the afternoon. It gives me the flexibility to not take one or the other if I'm not feeling up for it.
> Melatonin is ridiculously safe. It basically has no detrimental effects in large doses. As a result, nutrition companies are in a war to make ever bigger over-the-counter doses because those sell better. But unfortunately while 5mg isn't toxic, it also makes me sleep 10 hrs and wake up groggy. As a result it's hard to find over the counter melatonin that is in the real dosage I want, 0.3 - 0.5 mg.
My sleep doc has advised ~0.5mg a couple hours before going to sleep. As I've come to understand it, taking it too soon before sleep is what causes the grogginess.
> However I found that Costco sells kids melatonin gummies with a 1 mg dosage, which is the smallest you can find on the market without paying extra. I just cut/bite the gummies in half to take approx 0.5mg a night. It's perfect, and I'm sorry it didn't work for you :(
I found some 1mg flavored chewable tablets that're easy to split in half. I've found the same brand at my grocery store and on amazon
It’s definitely a much more subtle effect vs actual medication.
Depends on the country. In Europe, it's not so easy. In the UK, the last I checked, it was contraindicated for long-term use, meaning it could be used for smoking cessation but not for long-term ADHD treatment.
> similar to amphetamines
Wellbutrin has a very different mechanism of action, and a different effectiveness profile. I wouldn't say it's "similar to amphetamines" in any clinical sense.
It is not a typical treatment, but a psychiatrist in the UK does have the discretion to prescribe Bupropion off-label.
In my own n=1 experience, as a fourth option, only after unsatisfactory trials of more traditional stimulants and Atomoxetine.
For me it was like rediscovering caffeine for the first time, which lasted about six months altogether. Then the positive effects waned and it became a self-inflicted case of acid reflux.
Would never describe it as being similar to amphetamines. The most praise I can give it is as "an antidepressant that kinda sorta works."
Can get with a prescription or found easily online. Would highly recommend it.
They actually have more side effects than amphetamines do, though Strattera works well for me as long as you absolutely always take it with food. (Otherwise it feels like you're getting kicked in the stomach.)