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Long term effects of using DextroAmphetamine??

JohnBoy2000

JohnBoy2000

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May 11, 2016
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Basically - currently taking three drugs.

Mirtazapine - alpha 2 blocker
Vortioxetine (Brintellix) - SSRI'ish - blocks lots of 5ht receptors
Atomoxetine - NRI

Spent a long long time of experimentation to arrive on this combination but - brintellix was finally the drug that I found combined well with a potent noradrenaline combination, to alleviate social based complaints.

However - my concern is - my pulse, resting heart rate, is typically between 90 at 115 BPM.

For someone my age and health and shape - that's SUPER high.

So, I was considering a trial of replacing atomoxetine - the culprit - cause it fucks with cardiac potassium channels, with - a more traditional ADHD stimulant.

I don't have ADHD.

I also tried Ritalin before at 20 mg and - it dindu' nuffin'.

BUT, I know the likes of Adderall is not your traditional reuptake blocker, and it has a more sustained half life than Ritalin.

I google scholar'd this already and - very little in the way of meaningful information but, one paper abstract seemed to allude to atomoxetine being at least as, if not more potent, at fucking about - cardiac wise - in comparison to amphetamine.

Is this wide of the mark?

Anyone have experience with Adderall/amphetamines - or thoughts in general on this situation??
 
I never got that effect from atomoxetine. For me it did basically nothing, like reboxetine, except some mild urinary issue IIRC. But I was a long distance runner with a very long resting HR, like 45. Even not exercising it's in the low 50s. So maybe I didn't notice it? I only took it for a week. But I have definitely experienced elevated HR on all stims including Adderall (my 2nd fave stim, after meth). Nothing worrisome but noticeable. Based on that & what I know about amphetamines, I doubt Adderall would be better. But everyone is different.

I would also be concerned about neurotoxicity & increased anxiety with Adderall, depending on dose & frequency.

How do you like vortioxetine? It's one of the few ADs I'd like to try but haven't. What effects good & bad do you get from it?
 
fairnymph said:
I never got that effect from atomoxetine. For me it did basically nothing, like reboxetine, except some mild urinary issue IIRC. But I was a long distance runner with a very long resting HR, like 45. Even not exercising it's in the low 50s. So maybe I didn't notice it? I only took it for a week. But I have definitely experienced elevated HR on all stims including Adderall (my 2nd fave stim, after meth). Nothing worrisome but noticeable. Based on that & what I know about amphetamines, I doubt Adderall would be better. But everyone is different.

I would also be concerned about neurotoxicity & increased anxiety with Adderall, depending on dose & frequency.

How do you like vortioxetine? It's one of the few ADs I'd like to try but haven't. What effects good & bad do you get from it?
Click to expand...

Cheers - nice feedback.

Vortioxetine - compared to SSRI/SNRI's - I love it.

Via 5ht blocking, it does increase other NT's, including NA/NE.

No sexual dysfunction.
For me - this is huge.
SSRI/SNRI's make me want to poke my eyes out cause of this.

Max dose is 20 mg.
I found 5 mg insufficient, and 15 too much; 10 is just right for me; long half life, so I dose it at night and it helps me sleep.


I was thinking of this funny comparison about a week ago.

You know, a lot of them fucking psychos that went postal with machine guns in the US?
SSRI's - I can relate to that feeling whilst on them.

They turn me into a huge misanthropist - Lexapro especially.
I just fucking hate the world.

I'm not even remotely like this unmedicated.

Brintellix - for me personally, just makes me so easy going and willing to socialize etc.

In my mind - I've created this kind of, behavioural paradigm, related to pharmacological architecture of each drug - brintellix - cause it works by BLOCKING receptors primarily, creates an "acceptance" in my personality, where traditional SSRI's created a horrible forwardness and aggression.

That's my take on it at least.
 
Sounds promising. I liked venlafaxine but after 2 wks at max dose it pooped out. Fluoxetine worked wonderfully for 6yrs at 120mg but stopped working & gave me an EPS hand tremor. Duloxetine didn't do anything but prevent orgasm, as all SSRI/SNRIs do for me. Including Zoloft which made me an anxious zombie. I wouldn't risk trying paroxetine. So still have citalopram & fluvoxamine to try, & vortioxetine. I'm already anorgasmic due to high dose pain meds so it's not like it can get worse.
 
^Do you think this is better in MH? I'd think so but I'd like to know what y'all think.

I mean, go by what your doctor says. Maybe a stimulant isn't the best option. Maybe you took the wrong dose. Maybe another stimulant would work, but I'd stay far away from any sort of amphetamine preparation if you abuse drugs/if there's a risk of abusing it even just once. It sends you down the slippery slope fast.

Just to be clear, straterra does induce dopaminergic activitiy in the profrontal cortex, which is (generally) where you want it, in order to focus more. Wellbutrin might work for ADHD--I found it to not, though. Mindfulness meditation, funny as it sounds, does give our cognition a sharper edge, so to speak.

How is your sleep cycle.
 
AlphaMethylPhenyl said:
^Do you think this is better in MH? I'd think so but I'd like to know what y'all think.

I mean, go by what your doctor says. Maybe a stimulant isn't the best option. Maybe you took the wrong dose. Maybe another stimulant would work, but I'd stay far away from any sort of amphetamine preparation if you abuse drugs/if there's a risk of abusing it even just once. It sends you down the slippery slope fast.

Just to be clear, straterra does induce dopaminergic activitiy in the profrontal cortex, which is (generally) where you want it, in order to focus more. Wellbutrin might work for ADHD--I found it to not, though. Mindfulness meditation, funny as it sounds, does give our cognition a sharper edge, so to speak.

How is your sleep cycle.
Click to expand...

I was interested more so in the pharmacology of elevated HR on atomoxetine; typically I've gotten more scientific based insights on this forum.


One thing that does interest/concern me is what seems to be referred to as, the "amphetamine crash".

As in, end of the day - all the energy goes and one crashes into lethargy and low mood.

Is this typical, even with long term use, even on the XR formulation?

Cause, you know - I like to hit the discotheque a couple times a week and, starting my day at 8 am - last thing I need is to crash into lethargy and despair whilst I'm trying to get my dancing on.

That might sound like a joke but - it would be a genuinely be a huge lifestyle adjustment and consideration for me, if this is unquestionably a prominent facet of using Dexedrine.

Whereas - despite the half life, atomoxetine is considered a "24 hour drug".

My only real reason for switching to Dexedrine would be due to the heart rate issue - I've already got one useful insight into past experience with this on this thread - perhaps any more contributions - Dexedrine elevating BP/HR??


PS - like I said, 20 mg Ritalin basically did nothing for me - not sure if this is any kind of indicator as to the potential effectiveness of Dexedrine?
 
The amphetamine crash is extremely common & you should definitely be wary of it. Ritalin works in a different way & is a much weaker stim overall. Ritalin does almost nothing for me - sometimes caffeine does more. But Adderall has a powerful effect on me. I love it for dancing, btw. But if you're concerned about your HR...probably not optimal.

I do think this would be better suited to Mental Health.
 
JohnBoy2000 said:
I was interested more so in the pharmacology of elevated HR on atomoxetine; typically I've gotten more scientific based insights on this forum.
Click to expand...

You mean of atomoxetine on heart rate? Heart rate isn't a drug.

From the "fight-or-flight" response. It simulates the effects of an active HPA axis by inhibiting the reuptake of (mostly) NE. There isn't much more than that.

Wait, are you asking if an NRI raises blood pressure?

I don't feel threatened by that passive aggression...I actually have pharmacology and biopsychology courses under my belt.

By the way, half-life doesn't categorically and causally bear on therapeutic effect.

BL isn't going to tell you what drugs to take...

peace
 
AlphaMethylPhenyl said:
You mean of atomoxetine on heart rate? Heart rate isn't a drug.
Click to expand...


No no - I mean, my atomoxetine isn't happy about the effect my heart is having on it.

Wait....​

JdAPrv9.png


AlphaMethylPhenyl said:
From the "fight-or-flight" response. It simulates the effects of an active HPA axis by inhibiting the reuptake of (mostly) NE. There isn't much more than that.

Wait, are you asking if an NRI raises blood pressure?
Click to expand...

Atomoxetine seems clinically documented to cause cardiac issues due to HERT gene inhibition - something something - alpha subunit of potassium channels expressed on cardiac muscle.

Kind of drawing the comparison with dexamphetamine - which is obviously more stimulating - but doesn't mess about with potassium channels.


But I know quite a few folk in NSandP have tried both;

I guess - long term use - dexamphetamine, it loses potency after a while also, tolerance etc?​
 
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JohnBoy2000 said:
https://www.sciencedirect.com/science/article/pii/0006899384912216

Alright - this scares me for real.

Long term use potentially cause DA nerve degeneration?
Click to expand...

That study was done over only three days, not long-term, and is quite old. Some more-relevant recent research on long-term amphetamine use has been less negative:

Nora Volkow said:
Therefore, the results of both articles suggest that chronic MPH or AMP started in peri-adolescence/adolescence at clinically relevant doses do not significantly alter DA system development nor do they affect physical growth in non-human primates. They also suggest that they do not sensitize the brain to drug rewards (Gill et al, 2012) nor that they negatively affect cognitive or motor behaviors after discontinuation (Soto et al, 2012).
Click to expand...
 
Converted to human doses (from rat doses, ie x 0.162), it's around 30-50mg range, so not too outrageous. But I do agree more recent studies tend to disagree with those findings. I don't think you'll find it much easier on the heart though OP, and tolerance does build. Also, very hard to get hold of in the UK without a script.
 
CFC said:
Converted to human doses (from rat doses, ie x 0.162), it's around 30-50mg range, so not too outrageous. But I do agree more recent studies tend to disagree with those findings. I don't think you'll find it much easier on the heart though OP, and tolerance does build. Also, very hard to get hold of in the UK without a script.
Click to expand...

I'd find a doctor somewhere that write a script I'd imagine but - this is a drug that I would take, every day - without fail - for the rest of muh life.

The tolerance part - is the concern.

Having looked at the NHS SPC's on Strattera vs Dexedrine - Strattera is typically known to increase heart rate by 20 BPM+, in most people.

Dexedrine - typical 5 to 6 BPM +


And also - not sure how many of ya'll have tried Strattera but - the sweating - dear lord.
Climbing the stairs makes me sweat like a slave.
Before this drug - I never sweat, unnecessarily.

That being said - risk to benefit ratio - would long term dexamphetamine use be any easier?

I guess there's ultimately gonna be no answer as elucidating a actually trying the drug but, always good to weigh the options - I've found.
 
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So a 200-pound man is 90.7 kg. Multiply that by four and you get 363 mg. No one gets that dose.

vyvanse is a safer alternative to dexedrine. Dexedrine isn't given a lot.
 
Have you been on any amphetamine in the past? Long-term stimulant use can be complex in depression. Even short term has met some relatively disappointing results, apparent with Shire after some vyvanse trials failed a bit late stage. Others have done reasonably well.
https://www.sciencedirect.com/science/article/pii/S0165032716303871
https://journals.sagepub.com/doi/abs/10.1177/0269881117722998
That being said, stimulants can be useful adjuncts in depression of course, but just want to throw out a bit of caution in replacing the atomoxetine with a traditional stimulant.

Have you trialed just being without the atomoxetine in terms of your depression, to see if the balance of the vortioxetine and mirtazapine works with your regular day-to-day stuff? Sometimes not bad to limit polypharmacy. 90-115 resting is a bit high. All of this falls under reviewing with your psych of course.

All that being said...

I am on 60mg mirtazapine and 15mg vortioxetine. It definitely does work well for social stuff relative to many other drugs for me as well, though I can't say I ever remotely had the emotion numbing or callousness some people can feel on ssris.

Bupropion is an option, throwing it out there, though you would probably have to adjust your vortioxetine dose given the CYP2D6 interaction. I was on 150mg and 75mg with the above drugs VM. I didn't adjust my doses (because applying pharmacokinetics to real-life is overrated in humans...kidding) and didn't notice a significant difference, but it probably would make sense to do so.

Was the 20 mg ritalin with the VM or on a different drug regimen? May be worth giving it another shot or longer period of time. I am on methylphenidate ER with VM, and was on it along with 75mg bupropion and the VM, but I stopped bupropion. Currently trialing memantine in addition. I can't say I am a normal individual but just giving some options from a similar drug area and diagnosis (depression, no ADHD).

But yes, tolerance, abuse, side effects, worsening of depression/instability, mixed long-term efficacy, some things to give a bit of pause with stimulants and stimulant adjuncts in depression. A bit more research. But they are absolutely worth considering at times, weighing out what there is. They can work well in some cases, even where other modalities haven't worked. And can cause some misery too.

Also it is true atomoxetine does affect hERG potassium channels, generally an anti target in drug development. You have to shudder sometimes when you read on Bluelight the combinations people have with methadone or loperamide and strong hERG agents, but Torsades epidemics aren't breaking out I suppose. Also herg is human ether-a-go-go, still a fantastic protein name, up there with SMAD suppressor of mothers against decapentaplegic.

Good luck with your research and hope you can feel well!
 
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Cheers for the above ^^^ insights.


Staying with the triple combo - my HR was simply too high.

This may sound bizarre - and at the same time, I firmly want to keep the explanation in the realm from pharmacology, not mental health - but whilst vortioxetine was more acceptable than SSRI/SNRI's - it still basically turned me into, "a bitch".

SSRI related compounds are known to increase sociability etc - I assume via decreasing the impositional element to ones disposition.

Atomoxetine - I had been taking it in the morning.
I didn't think it was possible to dose it at night - due to NA activation.
But - it is.

And it seems to be making - oddly - the difference of night and day, via mitigation of that "impositional" facet, brought about by morning dosing, seemingly tempered via night time dosing.
I assume via the main "kick" of the drug having evened out come morning time.

So - hopefully this will straighten out that complaint.


As to the topic of amphetamines - just to put this in perspective; by example, it's listed in prescribers guides that atomoxetine can be dosed at night.

Is it possible to dose amphetamines at night?

As in - before bed?
With Remeron, say?

And still sleep well?

Or is dosing amphetamines at night, just unheard of?​
 
Glad to hear night dosing helps!

I haven't heard of dosing amphetamines at night, but I imagine it has happened at least once...generally though it would defeat thepurpose since you'd be asleep when you'd want the effects.
 
What's so fascinating to me about Amphetamine is that it actually improves brain function in the Amygdala and Caudate Nucleus and Basal Ganglia It allows these regions of the brain to properly communicate with each other when Amphetamine is taken at medical doses in the long-term. However, high or recreational doses of Amphetamine actually causes A LOT of issues within these regions of the brain and in the frontal lobe in general.

When amphetamine is taken at these doses (above 60 milligrams a day usually, but it depends on the person) it actually fries the mesocortical projection. Usually permanently. The brain adjusts and will adapt to the damage in the long-term, but overall - NEVER abuse amphetamines. Their have been studies on long-term amphetamine use and while medical doses actually improves brain function - abusive doses will destroy your brain.

doi:10.1001/jamapsychiatry.2013.277. PMID 23247506
doi:10.4088/JCP.12r08287. PMC 3801446. PMID 24107764
doi:10.1111/j.1600-0447.2011.01786.x. PMID 22118249
 
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