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Mental Health Atomoxetine vs Typical stimulants for High-functioning Autism-spectrum Disorder with life-destroying ADHD symptoms?

Flynnal

Flynnal

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Aug 14, 2012
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I've often wondered what the real differences are between atomoxetine and the typical stimulants (ie. dexamphetamine, Vyvanse, and Ritalin, not sure if there are others, perhaps there are).

I keep hearing conflicting reports...some say that atomoxetine is in fact a stimulant - an adrenergic stimulant, and that typical stims are both dopaminergic and adrenergic, so the former does one neurotransmitter and the typicals do both neurotransmitters.

I have major life-destroying ADHD symptoms and in all probability some kind of high-functioning autism-spectrum disorder (so there are probably two comorbidities), which of these medications are most likely to help me in the long term? I know of people who are on either of these for a long term treatment. I'm not interested in anything else other than just treating the problem so I can get on with my life and start to live normally. I have a GP who was nice enough to prescribe 10mg Strattera x 56 with 1 repeat to see if this actually works, but I'm not sure whether I should go ahead and try this out or whether I should wait until I see a specialist?

It's an interesting conundrum. One of which I'm not looking terribly forward to. Tried so many different antidepressants and antipsychotics over the years - Abilify being by far the worst one, could have murdered someone on that shit). All they did was make me feel worse or erased my sexuality and that's if they did anything at all! Benzos don't really work well either, they slow my brain down but I still get irritable and distracted on them and do way way way too much daydreaming to get anything meaningful done, as in household chores and work related stuff (surprise surprise benzos and antidepressants/antipsychotics won't do shit because I have ADHD+Aspergers LOL!).

PS: Same GP also gave me plenty of prednisone too hahaha.
 
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AFAIK, strattera is less abusable.

It was actually recommended to me but i ended up not taking it.

Other than that.. 🤷‍♂️

I don't see any harm in it, TBH, especially if your psychiatrist thinks it is a good fit for you.
 
I had been on ritalin for about a year and strattera for about two years.

With myself it was more cognitive impairment as my neurons basically weren't firing.

ADHD as far as I recall from Stahls pharmacology book, is related more to tonic vs phasic nerve firing so it may be a little different in effect and outcome for that condition, but for myself I dosed it with the noradrenaline autoreceptor blockers either Mianserin or mirtazapine.

Shit was rocket fuel for me personally - it can basically increase NA activity to the maximum possible extent, phenomenal drug if that's what you're looking for.

No real sexual sides with it either (unlike meth - horrible shit).

But again you're using it for ADHD so your condition and thus dose etc is likely to be very different.

For me the sweet dose was 80 mg, the recommended dose, but cause of it's short half life I had to hit another 10 mg midway through the day or I'd just get totally out of sync.

It was a complicated enough drug to dose effectively, but I kept a meticulous log of my dosing and times etc and eventually figured it out.

Again for me, without the combination of mirtazapine/mianserin it actually made things WORSE, cause NA enhancers due to autoreceptors slow down NA discharge, but with adrenergic blockers - awesome stuff for increasing NA based signalling (transmitter primarily implicated in my symptoms of fatigue).
 
It was also expensive as hell, don't know if it's still on patent.

madness00 said:
Figure what out?
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That the initial daily dose of exactly 80 mg rendered optimal activation without overdoing it and inducing side effects of GI overactivation and uncontrollable flatulence (yes really), then a top up dose of 10 mg at exactly 4 pm to compensate for the 4 hour half life - which if not dosed would cause the autoreceptor blocker dosed at 10 pm to actually induce severe insomnia due to excess fluctuation in NA levels.

Took about..... 4 months of meticulous logging and a lot of insomnia to figure out that dosing schedule.
 
I get gassy, but it's not uncontrollable.

More just consistent.

But it still strikes me interesting that you were logging for such a long time.

How is your reaction such a controlled variable?
 
madness00 said:
I get gassy, but it's not uncontrollable.

More just consistent.

But it still strikes me interesting that you were logging for such a long time.

How is your reaction such a controlled variable?
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My reaction was not remotely controlled, it was subject to intense variation.

Varying it to the point of optimization was pretty much the object of the exercise.
 
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JohnBoy2000 said:
ADHD as far as I recall from Stahls pharmacology book, is related more to tonic vs phasic nerve firing so it may be a little different in effect and outcome for that condition, but for myself I dosed it with the noradrenaline autoreceptor blockers either Mianserin or mirtazapine.
Click to expand...

I actually use mirtazapine. It does a great job for insomnia and helps me sleep...something that not even benzodiazepines like diazepam can do. But there are times when it doesn't work. Usually only once in a blue moon. No big deal for me as I solved the insomnia problem largely with just this one drug.

JohnBoy2000 said:
Again for me, without the combination of mirtazapine/mianserin it actually made things WORSE
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I sort of got a bit lost along the way. Was this combined with Ritalin or Strattera? Or was it combined with dexamphetamine?
 
Flynnal said:
I sort of got a bit lost along the way. Was this combined with Ritalin or Strattera? Or was it combined with dexamphetamine?
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Strattera - strattera without mianserin/mirtazpine made cognizance worse for me.

And it needed to be adequately dosed.

It's cause of the noradrenergic autoreceptor setup.
 
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Flynnal said:
So it won't be of any use to me to treat ADHD?
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That's what I was saying in the initial post, ADHD nerve function is written to be "tonic" vs "phasic" release, i.e. slow and steady vs bursts then nothing etc.

For me, I needed consistent increase as the way my nerves were firing was, they weren't - no action potentials = no transmitter release.

With ADHD that's not the case,, you get HYPER FIRING, then slow, then HYPER etc.

(this is all in Steven Stahls "Essential Psychopharmacology" downloadable off library genesis btw).

......

There was a report on erowid where an ADHD patient did have success with mirtazapine/strattera combo for ADHD.

I'm not a Dr so I don't know the specifics of strattera in monotherapy for ADHD, but you can't compare its negative effect in monotherapy in me for fatigue symptoms, to you with ADHD symptoms.

It's possible strattera in mono could simply regulate your phasic nerve firing, treating ADHD, but really only an ADHD Dr would have clinical experience of seeing that.
 
JohnBoy2000 said:
And sorry, typo in the initial statement, "strattera WITHOUT mianserin/mirtazpaine was useless to me".
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Understood. I wonder what the effect of combining mirtazapine and the stimulants normally used to treat ADHD would be?

I haven't looked enough into it. I have heard Strattera can cause sexual dysfunction which is one of the side effects I'm concerned about. If it is anything like SSRIs or Effexor, it would be utterly useless to me if it causes sexual difficulties because I never ever tolerate those effects nor do I tolerate insomnia or difficulties falling/staying asleep.
 
Flynnal said:
Understood. I wonder what the effect of combining mirtazapine and the stimulants normally used to treat ADHD would be?

I haven't looked enough into it. I have heard Strattera can cause sexual dysfunction which is one of the side effects I'm concerned about. If it is anything like SSRIs or Effexor, it would be utterly useless to me if it causes sexual difficulties because I never ever tolerate those effects nor do I tolerate insomnia or difficulties falling/staying asleep.
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No no, it's not in the same zip code side effects wise.
SSRI's are devastating for sexual sides - make your life miserable.
Atomoxetine is not remotely like that.

I used mirtazpaine for sleep, and when I started the strattera combo, the sleep I got from mirtazapine improved, quite significantly also.
 
madness00 said:
My amphetamine farts aren't really bloated farts. They just come up real fast. If anything it's fun but scares my cat.
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This!

A perfect example of the difference between men and women.

Men think gas is fun and even fart on, or near, each other.

Women find our own gas HORR-if-fying. I’d rather give birth to a porcupine backwards.
 
On topic...

Straterra is a good 24-hour med for ADHD, but it doesn't work to increase attention as much as a stimulant, usually. Still about 20% of ADHD isn't really treatable with medication, and requires some sort of behavioral intervention.

If you were addicted to drugs(s) in the past, probably best to stick with Straterra.
 
AlphaMethylPhenyl said:
If you were addicted to drugs(s) in the past, probably best to stick with Straterra.
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That's kinda weird. I don't know what you are talking about here, but stimulants are first line treatments for ADHD, and one of the main problems with ADHD is a history of drug abuse. So telling people to stay away from the very treatments that will treat their condition seems pretty silly. And your comments regarding anti-psychotics in the other thread tell me you need to do more research in that area as well because you should be well aware that anti-psychotics can potentially cause serious and permanent damage and are metabolic poisons - I mean, my own fucking doctor alluded to that fact when I told her that they are metabolic poisons, because she admitted that they were when I argued with her about her stuck-up attitude towards drugs, which, my friend, it seems is very similar to your attitude towards drugs. Man boobs anyone? How about diabetes or permanent tics or movement disorders?

Sorry if this sounds harsh, and it is harsh, but you can't go around saying that first line treatments should be avoided if they are the very thing that will help someone who has ADHD.

That said, Strattera has been known to help some cases, but certainly not all. It might be the better choice for me, or I may need one of the first-line treatments. Also in Australia to be able to get Strattera on the PBS you NEED to have tried treatment with stimulants first, before they will sign off on an authority script in order to get it on the PBS, which means it's very expensive. Treatment with stimulants first and, if they are not helping, then Strattera might.

In Australia it's a second line treatment. I just wanted an opinion on the main differences between these treatment options.
 
No, they definitely don't go hand-in-hand all the time. Sounds like your doctor didn't want to get into a shouting match with you. The risk probably isn't worth the 30% or so greater efficacy of stimulants.
 
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