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So I'm officially diagnosed with ADHD Inattentive type and I need help focusing. The only caveats are that my doctor knows I have a storied history with substance abuse and thus will not prescribe me any controlled substances which is probably a good thing. However, I've also tried Strattera in the past and the only thing it served to do was turn me into a complete psychopath. Intense anger like I have never felt before, which made me lash out and do nasty things that I wouldn't dream about doing otherwise, so that's a no go. Is there any other option for someone like me?

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I not experienced in inattentive but have you tried stim toys? also mindfulness might help. It's hard at first but every stray thought is a chance to bring yourself back to the moment.

im sorry this probably isn't very helpful, I know more about depression side of things :( let me know if you ever want to talk.

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stim toys can be so many things. they are basically objects that give you tactile stimulation. things like spinner rings and stress balls are more commonly used but there are lots of options, there's even mouth safe ones if you need oral stimulation. (i am big an gnawwing on things when i get overwhelmed) they kind of give you a point to ground you, i guess. Getting to know more about stimming in general might be helpful, see what works for others and try it out

if your interested check out stimtastic.co 's fidget jewelry for more ideas (and it doesnt have to be jewelry, i just find it more convenient than carrying things, but anything that feels good to you either by weight/texture/movement could be used)

i also find most forms of mindfulness stressful..mindful eating is a good exercise to try though, way less intense than the full body scans.

Edited by MayRyan

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I guess the only thing I'm not understanding is how stim toys help stay on focus. Like lemme give you an example, if I sit down and decide to draw I can only stay on it for about 5 minutes at a time before I have to put it down and do something else, like my mind just gives up the ghost after 5 minutes and says "Hey it's time for something else, you're bored bored bored." But then whatever the next thing is, the cycle continues. The only thing that can hold my grasp is video games, it seems. But when drawing, I sort of need both hands free, so I don't see how the stim toys could be helpful. Other things include reading, following conversations, etc. 

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i see your point how that may not help your situation. Next I'd suggest making intentional activity changes. do what you can for as long as you can and then do something else, something quick but need you to get up and move around. dont try to push yourself to do something when youve lost interest just set it aside and go for a walk, take a jot bath. get back to it when your brain has settled down. dont fight yourself.

i dont have any tips for conversations though....stimtoys might be helpful in that case, something to help keep you in the moment without getting lost in your head while you listen.

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Just read this topic and thought I might chime in. I hope this helps.

It sounds like your dose of Strattera was too high.

This is from "Stahl's Essential Psychopharmacology" (4th ed.) by Stephen M. Stahl.

"There are numerous subtypes of α-adrenergic receptors, from presynaptic autoreceptors, generally of the α2A subtype to postsynaptic α2A, α2B, α2C, and α1 subtypes. α2A receptors are thought to be the primary mediators of the effects of norepinephrine in the prefrontal cortex regulating symptoms of inattention, hyperactivity, and impulsivity in ADHD. α2B receptors may be important in mediating sedating actions of norepinephrine. α1 receptors generally have opposing actions to α2 receptors, with α2 mechanisms predominating when norepinephrine release is low or moderate (i.e., for normal attention), but with α1 mechanisms predominating at norepinephrine synapses when norepinephrine release is high (e.g., associated with stress and comorbidity) and contributing to cognitive impairment. Thus, selective NRIs (like Strattera) at low doses will first increase activity at α2Α postsynaptic receptors to enhance cognitive performance, but at high doses may swamp the synapse with too much norepinephrine and cause sedation, cognitive impairment, or both (perhaps not exactly relating to your response to Strattera, but could be related pharmacologically...). Patients with these responses to selective NRIs may benefit from lowering the dose."

An alternative option to stimulants and Strattera are the direct-acting α2-adrenergic agonists clonidine (Catapres) and guanfacine (Tenex), which are actually blood pressure medicines. They made extended release versions of these medicines, but they're indicated for pediatric patients only, and they're brand-name only, so if you have insurance and try to get them, I'm not sure how they would handle it, but for clonidine they made Kapvay, and for guanfacine they made Intuniv. Guanfacine is relatively more selective for α2Α receptors than clonidine, which targets all three subtypes of α2 receptors, plus the imidazoline I1 receptor (responsible in part for its blood pressure lowering effect, as well as its being more sedating than guanfacine along with its agonism of α2B receptors what with it being less selective than guanfacine). 

"By contrast, the selective α2Α receptor agonist guanfacine is 15-60 times more selective for α2Α receptors than for α2B and α2C receptors. Additionally, guanfacine is 10 times weaker than clonidine at inducing sedation and lowering blood pressure, yet it is 25 times more potent in enhancing prefrontal cortical function. Thus, it can be said that guanfacine exhibits therapeutic efficacy with a reduced side effect profile compared to clonidine. The therapeutic benefits of guanfacine are related to the direct effects of the drug on postsynaptic receptors in the PFC, which lead to the strengthening of network inputs, and to behavioral improvements."

Sometimes, certain tricyclic antidepressants are used for ADHD for people who can't use stimulants (or with doctors/pdocs who won't prescribe stimulants because of a patient's history). These include the secondary amine TCAs, like desipramine (Norpramin), protriptyline (Vivactil), and nortriptyline (Pamelor). The reason they are prescribed for this indication is because of their relatively stimulatory nature due to their relatively high selectivity for norepinephrine reuptake inhibition (sort of like Strattera, but they're pharmacologically less selective than Strattera when it comes to other receptors like muscarinic acetylcholine receptors and α1-adrenergic receptors, etc., which can cause side effects like dry mouth/constipation and orthostatic hypotension, respectively; however the latter mechanism of action may have some anti-anxiety actions and help with nightmares if one has trouble with that). Desipramine is the strongest norepinephrine reuptake inhibitor (NRI) of the three, followed be protriptyline, then nortriptyline. They have very little action on serotonin reuptake inhibition except in high doses.

Another option is the antidepressant bupropion (Wellbutrin), which itself acts similar to the stimulant methylphenidate (Ritalin), a norepinephrine-dopamine reuptake inhibitor (NDRI), but also has effects on certain nicotinic acetylcholine receptors which may also be beneficial for ADHD.

There are studies in using specific atypical antipsychotics which are dopamine partial agonists (instead of dopamine antagonists), like aripiprazole (Abilify) and Rexulti (brexpiprazole). Rexulti was even in trials for a clinical indication for ADHD, but it is presumed to have failed Phase II trials for this indication as it didn't move on to Phase III of the clinical trials; however, it may still be worth investigating with your pdoc/doctor as a possible treatment option if stimulants are strictly off the table as per your prescriber. The brand new atypical antipsychotic, Vraylar (cariprazine) may also be investigating, too. There aren't any studies that I can find with using it for ADHD, but it too is a dopamine partial agonist like aripiprazole and Rexulti.

Another possible treatment option (also off-label) would be that of the dopamine agonists, like pramipexole (Mirapex), ropinirole (Requip), and Neupro (rotigotine transdermal patch).

Speaking of patches, I know it's indicated mostly for pediatric patients, but have you spoken to your doctor about Daytrana? It's a transdermal patch with Ritalin in it that you wear for 9 hours of the day (or however long s/he specifies), and it lasts for I believe 2-3 hours longer after you take it off for up to 12 hours of coverage. Supposedly it's a far less abusable form of stimulant. If a stimulant is really what you need, and if there's a way you can take one with little to no risk of abusing it, why not at least humor the idea of giving it a try, you know? But if you're too afraid of trying it for fear of anything that might happen, I totally understand.

Best of luck to you! Hope you find something that works and doesn't cause any bad side effects!

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Wow, what an informative post, thank you so much. You've definitely given me some food for thought. Regarding the Strattera, my dose was low, around 40mg. Unfortunately it seems I'm very sensitive to it. Currently on phone so I can't say much for now other than thank you!

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