Mental Health Wellbutrin (Bupropion) for ADD?

[dcrmt]

That's what I thought too. I'm starting to have serious doubts about my psychiatrist. She started me off on wellbutrin for ADD, because ADD is a deficiency in dopamine she said, seemed plausible. Now she prescribes me an SNRI to treat the same symptoms? A drug that does nothing for dopamine? Seems very weird to me. Furthermore she did not want me to try methylphenidate (ritalin) because she has no experience with this and it can be harmful as well when misused. Her solution? Prescribe an SNRI that has A LOT more consequences, side-effects and withdrawal than methylphenidate does and is only succesfull in the treatment of ADD in a small number of cases. So no I don't think I'll be starting on these meds. She's going to ask why I only call 8 days after she prescribed me the drugs (was holding out because I wanted to roll on NYE and SNRI's completely mute the effects of MDMA) but I'll figure out some story to tell her.

Yeah... I think you probably dodged a bullet there. I'd get a new doctor ASAP. Prescribing these drugs to someone who isn't even depressed is insane.

Supposedly in high doses venlafaxine does have some effect on dopamine, but it's still stupid. SSRI/SNRI's can have the opposite effect too.
Zoloft would actually make more sense, it's at least a weak dopamine re-uptake inhibitor at normal doses but it's still a dumb idea.

 

[BlueBull]

Ah that explains something. I was prescribed 150mg venlafaxine daily. That's a pretty high dose if I understand correctly. So my guess is she was aiming to produce some effect on the dopamine-system by dosing high, at which point the venlafaxine starts to affect dopamine as you mentioned. But is this not something incredibly stupid to try? Because venlafaxine primarily works on serotonine and norepinephrine you would get heavy effects on these two to get a very mild effect on dopamine? That sounds incredibly stupid to me, though I have very little knowledge of neuroscience.

I know what her next step is going to be when the efexor didn't work, because she told me. Prescribe me seroquel, an anti-psychotic

 

[dcrmt]

Ah that explains something. I was prescribed 150mg venlafaxine daily. That's a pretty high dose if I understand correctly. So my guess is she was aiming to produce some effect on the dopamine-system by dosing high, at which point the venlafaxine starts to affect dopamine as you mentioned. But is this not something incredibly stupid to try? Because venlafaxine primarily works on serotonine and norepinephrine you would get heavy effects on these two to get a very mild effect on dopamine? That sounds incredibly stupid to me, though I have very little knowledge of neuroscience.

Yeah. It is incredibly stupid.
It's like you have a nail to bang down and you go "nope, lets not use the hammer, or the mallet, or the sledgehammer... lets use this shovel"

I know what her next step is going to be when the efexor didn't work, because she told me. Prescribe me seroquel, an anti-psychotic

Are you serious?
what the fuck. Don't even go back there. Just run.

What the fuck. That'll have the opposite effect to what you want.

Nobody should be on anti-psychotics unless they're Schizophrenic or Bipolar and actually need them.

 

[BlueBull]

Thanks for the replies dcrmt, it kind of confirmed what I already thought. Anyone else that can share some more insight on the usefulness or uselessness of this treatment? I want to be sure I don't overlook anything before I give my psychiatrist a call

 

[Abject]

150mg isn't exactly a high dose, but it is stupid to start off at 150mg.
low dose SNRI and high dose SNRI are two completely different modes of action.
>150mg it is basically an SSRI. I think after 75mg SERT is maxed out, and at 150mg NE is affected.
So at 250mg, there is no more SERT activity than 150mg (arguably 75mg) whereas you get more NE activity.
As for DA, well you need quite a large dose to reach activity.

As you can see here, the difference between SERT-NE is quite smaller than NE-DA activity.
Your psych is not prescribing this for DA activity. Quetiapine won't do shit for ADHD, either.
If you mentioned to your psych that you have depression, (s)he will be hesitant to prescribe amphetamine/stimulants.

All of this is pretty useless to you, though.
If your psych is adamant on anti-depressants you could always suggest a (reversible) MAOI
From what you've said, she seems pretty useless though. If I were you I would look for someone else.

Also, if you're interested in understanding the very basics of drugs, you might wanna start here

 

[BlueBull]

150mg isn't exactly a high dose, but it is stupid to start off at 150mg.
low dose SNRI and high dose SNRI are two completely different modes of action.
>150mg it is basically an SSRI. I think after 75mg SERT is maxed out, and at 150mg NE is affected.
So at 250mg, there is no more SERT activity than 150mg (arguably 75mg) whereas you get more NE activity.
As for DA, well you need quite a large dose to reach activity.

As you can see here, the difference between SERT-NE is quite smaller than NE-DA activity.
Your psych is not prescribing this for DA activity. Quetiapine won't do shit for ADHD, either.
If you mentioned to your psych that you have depression, (s)he will be hesitant to prescribe amphetamine/stimulants.

All of this is pretty useless to you, though.
If your psych is adamant on anti-depressants you could always suggest a (reversible) MAOI
From what you've said, she seems pretty useless though. If I were you I would look for someone else.

Also, if you're interested in understanding the very basics of drugs, you might wanna start here

That's just the thing, I am not depressed, not in the slightest. I made that very clear to her from the start. I have (non-dibilitating) social anxiety and ADD. The anxiety I knew, the ADD she diagnosed me with and that is what the drugs are for according to her, to treat the ADD, nothing else. She said she was going to try drugs for the ADD and therapy for the anxiety, so it's not even the fact that she could think that the anxiety stems from depression. Thanks for the info, that was very enlightening! Oh by the way, the two reasons she doesn't want to try methylphenidate (I myself am hesitant to try amphetamines) is firstly because she knows I smoke weed and thus fears for the abuse potential these drugs have (which I realise and am not worried about, but hey...) and secondly because she has no experience with methylphenidate in adults...

 

[BlueBull]

Sorry to revive an old topic but I have my next appointment in a few days and I want to make sure I covered all bases. So far I concluded from replies by you guys, research and thinking about it myself that the last substance she prescribed me (venlafaxine) is not something smart to prescribe for ADD and certainly not at those doses (though at the doses needed to affect dopamine it is still not smart). Furthermore her future plans to prescribe seroquel, an antipsychotic, when the venlafaxine didn't work is also not a good idea. Now my last question is: does anyone have a different opinion on this? Like a reason why she prescribes me venlafaxine for ADD when it does nothing for dopamine and it has loads of side-effects? Something I'm overlooking? I don't want to tell her I can't follow her logic and there's no therapeutic application for venlafaxine in ADD only to hear I have missed something and she has good reason to prescribe it.

The only thing I can think about is that she secretly thinks I am depressed (which I am not) and is hoping the AD will solve that. But that seems impossible to me because by doing that she is going behind my back and lying about the real reason behind this. To me it seems no psychiatrist would do that, no? Anyways I am going one more session to see if she will try what I'm going to suggest, which is to prescribe methylphenidate (I want to stay away from amphetamines myself if possible but the AD she prescribed is even more powerful and comes with a lot of side-effects. So that's why I want to try methylphenidate, not an amphetamine but has amphetamine-like properties with much less neurotoxicity and addiction potential). If she won't or doesn't come up with a valid alternative I will ask for a referral to someone with experience in attention disorders

*edit* Also, when all else fails and I have to ask for a referral, how do you tell a psych you want to be referred to someone with experience in attention disorders (which she admitted she doesn't have) because her treatment doesn't make any sense? It's like 10 years studying to become a psych and I am a layman so I find this very difficult. Furthermore she's like 45-50 years old so she has a lot of experience too (though not with ADD/ADHD)...

 

[Wasted_talent]

Perhaps modafinil is worth a try (don't mix with alcohol) or perhaps piracetam taken as a supplement to a good healthy diet.
I can empathise with your story; wellbutrin (bupropion) really didn't work for me; perhaps to quit smoking.
methyphenidate really did make me edgy like 10 cups of coffee but with the after effects.
parnate (tranylcypromine) was a horrid experince as my blood pressure would drop like a stone, and likewise I'd end up on the floor four hours.
venlafaxine aka effexor has some brutal side effects, like 'brain zaps' for want of another expression when trying to taper down.
After 4 years the best that's on offer is atomexetine, or straterra. despite my addiction consultant, and another consultant recommending to my GP dexamphetamine is the best option.
I hated the notion of people being obnoxious on speed; so didn't try it till my late 20's.
It is like night and day though; there is many different antioxidants and supplements to partially overcome the free radicals, DA receptor site degradation. Just be aware to take 'drug breaks' from time to time so's not to overload and become addicted, it is manageable.
It was odd just to feel 'normal' and not scattered.
The other price to pay is creativity, but it comes back while not under the influence.
Sleeping is another gargantuan pain. But for yours truly caffine, modafinil has the same effect.

 

[herbavore]

If she won't or doesn't come up with a valid alternative I will ask for a referral to someone with experience in attention disorders

*edit* Also, when all else fails and I have to ask for a referral, how do you tell a psych you want to be referred to someone with experience in attention disorders (which she admitted she doesn't have) because her treatment doesn't make any sense? It's like 10 years studying to become a psych and I am a layman so I find this very difficult. Furthermore she's like 45-50 years old so she has a lot of experience too (though not with ADD/ADHD)...

It is always tricky to be assertive with doctors but it is important. If you feel like you want another perspective you could say, "I am really grateful for the treatment I am getting here with you and I am also feeling that I could benefit from someone that has more experience with ADD in adults. Can you think of anyone that you would recommend?"

 

[Geaux Tigers!]

"Venlafaxine 150mg. for ADHD is not only off-label- it makes little sense based on neurotransmitter actions because a much larger dose is required to only negligibly effect dopamine. Venlafaxine is no more efficacious than placebo for someone who is indicated for ADHD; therefore, it is not worth risking discontinuation syndrome and other side effects of SNRI therapy. Furthermore, if your next course of action is quetiapine, I request treatment from a qualified psychiatrist."

 

[ProfessorGoad]

There are a number of non-stimulant ADD/ADHD medications, like strattera, available. Maybe one of them would help with you ADD symptoms and not impact your sleep as much.

 

[BlueBull]

"Venlafaxine 150mg. for ADHD is not only off-label- it makes little sense based on neurotransmitter actions because a much larger dose is required to only negligibly effect dopamine. Venlafaxine is no more efficacious than placebo for someone who is indicated for ADHD; therefore, it is not worth risking discontinuation syndrome and other side effects of SNRI therapy. Furthermore, if your next course of action is quetiapine, I request treatment from a qualified psychiatrist."

That's just it. She is a qualified psychiatrist. I don't know how it is in your country but in my country there are 2 types of mental doctors. Psychologists, which is the lowest of the 2 and only a few years studying. They can not prescribe drugs and their counsil is not covered by health insurance. And the clinical psychiatrist, the highest of the 2. If I'm correct that's about 10 years in school to get that degree. She is a clinical psychiatrist and not a young one either... But I completely agree with all the feedback. I am now certain she doesn't know what she is doing.

There are a number of non-stimulant ADD/ADHD medications, like strattera, available. Maybe one of them would help with you ADD symptoms and not impact your sleep as much.

As ProfessorGoad suggested I will first ask about non-stimulant ADD medication. Then if I find some interesting substance from wasted_talents comment I will discuss that. If that doesn't provide an answer I'm going to suggest to try methylphenidate. If she agrees we'll see how it goes. If she doesn't I'll talk a bit more until' the end of the sessions and then ask for a referral to someone with experience in attentions disorders. She shouldn't feel insulted by this because she admitted herself to not having any experience in that particular field. But that's why I was worrying she might have a hidden agenda to prescribe this stuff, the fact that the degree she has is one of the most difficult to obtain...

I thank you guys A LOT for all your replies. That's what I've come to love about this forum. You don't know anything about a particular substance, you ask a few questions and you are flooded with information from knowledgeable members in a matter of days. Kudos!

 

[Abject]

Best of luck mate.
There are plenty of fuckhead psychiatrists out there so don't put off a second opinion if you're not satisfied with this one.

 

[Geaux Tigers!]

non-stimulant ADD medication

I work in the States and have advised and directed psychotropic therapy for patients indicated for ADHD.

Non-stimulant medication utilized as monotherapy or as a primary agent is not effective. These are some options I'd consider when adding a non-stimulant AUGMENTATION medication for ADHD, however-- mainly desipramine or Intuniv (guanfacine ER).

 

[BlueBull]

So you would not choose wellbutrin (bupropion, 150mg daily) first. When that doesn't work try effexor (venlafaxine, 150mg daily) and when that doesn't work Seroquel (Quetiapine, intended dosage unknown) all as off-label treatment for ADD/ADHD?

Also indeed the fact that stimulants are very often used in tandem with a non-stimulant augmentation substance is something I ran into a lot when researching the disorder and its possible treatments. But she wants to use non-stimulant drugs as primary means of treatment (though the bupropion is supposed to be mildly stimulating it wasn't for me).

 

[a dream]

none of those are indicated for ADHD. Are you inattentive or hyperactive? Settle for nothing else! Seroquel in particular causes drowsiness and would require a significant buildup of tolerance to get over that, and she is probably thinking it would be useful to reduce hyperactivity or something? She is clueless, find someone who knows what they are doing.

 

[Geaux Tigers!]

So you would not choose wellbutrin (bupropion, 150mg daily) first. When that doesn't work try effexor (venlafaxine, 150mg daily) and when that doesn't work Quetiapine (Seroquel, intended dosage unknown) all as off-label treatment for ADD/ADHD?

Also indeed the fact that stimulants are very often used in tandem with a non-stimulant augmentation substance is something I ran into a lot when researching the disorder and it's possible treatments. But she wants to use non-stimulant drugs as primary means of treatment (though the bupropion is supposed to be mildly stimulating it wasn't for me).

I would never choose bupropion first and that is a low dose for ADHD. It doesn't make sense to try that first. The next step of switching to venlafaxine is, pardon my language, a joke. It does nothing for ADHD period. Nothing. It is in no way going to treat ADHD unless your ADHD is somehow caused by depression. Finally, the move to quetiapine is making a mockery of you, it antagonizes the very receptors that are deficient, there is a possibility that it may make your ADHD worse and not only that-- it has so many side effects. Stay away from it!

Find a doctor who has experience treating ADHD. This doctor doesn't know what she is doing. Her therapy is no good.

 

[BlueBull]

@a dream: I have extreme difficulties concentrating. So I would classify me as inattentive but not hyperactive (I have no problems sitting still). However she does not agree and is ADAMANT I am also hyperactive so yeah could be that she just wants to sedate with the seroquel. I don't know as I have no idea why she is sure I am hyperactive too, I show no classic symptoms of this (no restless legs 90% of the time, no unlimited energy, can sit still for hours on end if needed...) but still she thinks I am. She even said "all the symptoms of attention disorder fit, so therefor you must also exhibit some symptoms of hyperactivity. Did I not see your leg bounce a few times last session?" Firstly that isn't necessarily true (ADHD-PI or ADD with high levels of inattention versus ADHD-PHI with high levels of hyperactivity) and secondly the leg bounce I do very very seldom. Only when I'm very nervous, like when meeting a stranger and knowing you'll have to tell them some very personal stuff. I know people that do that occasionally that do not have any problems with ADD/ADHD. Besides that I do not display ANY symptoms of being hyperactive but according to her because I have an attention disorder I must be hyperactive. Which is looking at it all backwards...

@Geaux Tigers!: Alright, thanks for your feedback! I am going to try and see if she will let me steer the treatment a bit so is willing to try out my suggestions. It shouldn't bother her to try because she admitted she doesn't have any experience with ADD in adults so no harm can come from listening to suggestions.
If she isn't I will ask for a referral. Though I want to avoid this last resort because as far as talking goes she does seem like a good psych, I feel comfortable with her and for me that's quite rare so I'm going to try some other things first before switching doctors. However this attempted treatment with non-dopamine affecting drugs has to stop as it is obvious this isn't going to help as primary treatment...

 

[a dream]

Forget about this crank. Seriously. She is not a good psychiatrist. I don't have access to the DSM-III but when it was published in 1980 it was called "ADD with or without hyperactivity"; unless she literally missed out on the last 35 years there is no excuse for her to act this way.

 

[nuttynutskin]

She even said "all the symptoms of attention disorder fit, so therefor you must also exhibit some symptoms of hyperactivity. Did I not see your leg bounce a few times last session?"

That's ridiculous... If that's all it took to mean you had ADHD most of the population would be diagnosed with it. And the fact she would prescribe Seroquel (a bipolar drug) for ADD is asinine. Find a psych who actually has experience treating ADD because like others have said she has no idea what she's doing.