My understanding is that Zoloft also effects dopamine so according to Dr Amens ideas, it ought to be perfect for overfocused type ADD. I'm also inattentive type. Effexor is his first recommendation but it has too much norepenephrine & messed with my sleep. I'm just a few days on Z & not noticing the seratonin effects particularly but it does make me jittery and oddly ritalin seems to smooth that out. I have been able to feel emotional (teary lovey stuff) as well as enjoy spinal chills listening to music. That pleasure thrill part was completely blocked on effexor but I wasn't taking a stimulant at that time. It decreases my tolerance for alcohol which is probably a good thing since I drink too much. I don't feel sleepy in the day like effexor but the ritalin may be the difference there also. Effexor gave me a sedated sort of calm feeling immediately but Z does not seem to yet. I have what my doc calls repressed anxiety (constant tenseness, not relaxed) and I lean toward OCD or at least I tend to hyperfocus like a madman while procrastination. I'm hoping the Z will address this part, the ritalin tends to make me more hyperfocused but is a great mood lifter for getting the dopamine to reactivate my numb pleasure center & get off my bum to actually do the things I need to do to move forward in life. Actually I was talking a different overseas med that is pure dopamine without the norepenephrine that ritalin has and I'm suprised that ritalin actually feels mellower than that now. Concentration is not really a big issue for me, it's more like daydreaming distracted hyperfocusing. I need a pill that makes me calm and responsible LOL.

Well anyways I haven't had any of the icky side effects from zoloft that I got from effexor, apart from feeling a bit queasy in the morning hours after taking it and having less tolerance for alcohol, I haven't noticed much but I've been on vacation travelling, camping and visiting family so I've not really tried it in my 'normal' routine, if there is any such thing.

I'd be interested in other's opinions about the stuff. It's supposed to be very powerful but maybe 50mg isn't that much.

I'm OCD type too. This has caused me just as many problems as ADD. Zoloft as well as Prozac really changed my life, helped me quit obsessing on crazy negative ideas. I took Zoloft in school and it worked well with my motivation. Prozac was a nightmare with motivation, and I couldn't study worth a crap. I wasn't on stims at the time. All I wanted to do is play and meet girls on Prozac. I think the Dopamine is probably the difference. You might look into adding a little Provigil for NE, which is a motivational transmitter.

I ended up giving up on the Zoloft due to sleep problems which developed about 3 weeks into the trial. I took it for 44 days. I couldn't tell that it had any magic effect on me but the dopamine effect was obvious. Maybe because the dopamine also reaches a steady state, I had trouble sleeping on that. I also have 50 Prozac that I got in case the withdrawal was a problem (a couple weeks of feeling icky but not too bad). I have some adrafinil ordered which is sort of a more affordable version of Provigil. I've been cutting back on the drinking too & it's possible that messed with my sleep instead of the Zoloft. I maybe would do better with fewer drugs, not more.

The sad thing about ADD is that so many people go untreated because they are given the wrong combo of meds and give up after the first failure. There maybe as many combination of meds and/or dosages as there are people being treated. I'm on the opposite spectrum of sleep. I have no problem going to sleep, in fact, I took the zoloft and prozac at night. My problem is sleeping too much. As a kid I was classic ADHD, but i'm borderline narcoleptic/chronic fatigue. Provigil is definitely a option. I was taking a small dose of reboxetine, but it destroyed my sex life. I ordered some Milnacipran(ADD/wakefulness), and am going to add Zoloft(OCD) at night and 5mg of adderall(ADD) a few times a day. If the milnacipran fails I'll probably replace it with Provigil.

Here's a very cool link on psychopharmacology:

http://www.depression-webworld.com/brainstormsndx.htm

I found that Zoloft made my ADD symptoms worse I couldn't take it more than two weeks. I was very aggitated and couldn't sleep. I'll never go down that road again. Capt Kylos

no side effects for me...Its the only ssri that keeps me motivated. I take it at night and sleep like a baby!

Zoloft will not be effective for ADHD "overfocused" type or any other type. Zoloft has practically no effect on Dopamine. It's an SSRI. Wellbutrin would be far more effective for regulating Dopamine.

I don't know what Dr. Amen's studies say, but if someone is "overfocused," it would imply they have far too much dopamine in action. Increasing the amount of Dopamine would merely increase focus on given topics...so it wouldn't really be that effective...

Not to seem argumentative, but...

Sertraline (Zoloft) has about 10 times the binding affinity to dopamine receptors than Bupropion (Wellbutrin). At least that's what my pharmacology text book indicates. Both Wellbutrin and Zoloft are relatively mild inhibitors of Dopamine. Wellbutrin is primarily a norepinephrine blocker. In fairness, Wellbutrin does make up for its lack of binding affinity in its relatively high bio-availabilty.

In clinical trials Zoloft is the only SSRI that "does not" show a decrease in vigilence (the mental process of paying close mental attention), which is thought to be a result of its action on dopamine.

http://www-np.unimaas.nl/PsyPharm/NCDEU/schmitt529.pdf

Someone who has overfocused ADD doesn't imply too much Dopamine. Overfocused ADD is more of a serotonin (too low) dysfunction. The ADD aspect is a function decreased dopamine. Dr. Amen has had excellent success with SSRI's + Stimulant with this type of ADD.

Because of its action on dopamine, Zoloft seems to be the best choice for "over-focused" ADD. It seems to be the best choice of the SSRI's overall because it doesn't decrease vigilance like the others. I've had excellent success with my over-focus ADD with Zoloft. It's Dr. Amen's first choice for treating this type of ADD.

Hmm, I may stand corrected. I am aware that Sertraline HCl binds to a bunch of receptors, and also I am aware that it does not show a decrease in vigilance, however, I'd wonder about it being compared to Bupropion...Bupropion acts on dopamine and norepinephrine strongly in contrast to other SSRIs, hence its indication in aiding in quitting smoking: it can replace nicotine cravings by allowing dopamine to remain in nicotonic receptors longer. However, it's also a question of what receptor sites are being called into question, since dopamine can be both excitatory and inhibitory, depending on the receptor sites...

I'm not familiar with Dr. Amen's work or his theories or studies, as I think the irreplicability of his studies and non-disclosure of his research techniques calls serious question on the integrity of his findings. Serotonin levels being too low would not have a major effect on sustained concentration, however. Sustained concentration is mainly a function of NE and DA, not 5-HT.

I would put it to you that the stimulant is the actual drug of effect in dealing with ADHD, because of most stimulant's strong reuptake inhibitory action on DA, such as with Methylphenidate. The information you've reported is somewhat unreliable, firstly because of Dr. Amen's relatively unscientific approach and the inability to replicate many of his findings, and secondly because there are two independent variables being manipulated: SSRI and stimulant administration. I would hold that without the SSRI, the stimulant would be just as effective, with a possible increase of stimulant side effects otherwise smoothed by the SSRI.

I apologize for any confusion or mispeaking I might have done...as I said, I don't know what "overfocused" type ADHD is...I'm only familiar with, and I only work with, DSM-IV recognized classifications. For ADHD Predom. Inattentive Type, I would say that NE reuptake blockers such as Amoxetine or Bupropion would be strongly recommended.

As far as Sertraline's effect on DA, I quote the pharmacological information released by Pfizer:
"In vitro studies in animals also suggest that sertraline is a potent and selective inhibitor of neuronal serotonin reuptake, and has only very weak effects on norepinephrine and dopamine neuronal reuptake. In vitro strudies have shown that sertraline has no significant affinity for adrenergic (alpha1, alpha2, beta), cholinergic, GABA, dopaminergic, histaminergic, serotonergic (5HT1a, 5HT1b, 5HT2) or benzodiazepine receptors; antagonism of such receptors has been hypothesized to be associated with various anticholinergic, sedative, and cardiovascular effects for other psychotropic drugs. The chronic administration of sertraline was found in animals to downregulate brain norepinephrine receptors, as has been observed with other drugs effective in the treatment of major depressive disorder."

Then, from Gold Standard Media's "Clinical Pharmacology"
"Bupropion selectively inhibits the neuronal reuptake of dopamine and is significantly more potent than either imipramine or amitriptyline in this regard. Actions on dopaminergic systems, however, require doses higher than htose needed for a clinical antidepressant effect. The blockade of norepinephrine and serotonin reuptake at the neuronal membrane is weaker for bupropion than for tricyclic antidepressants...
...the mechanism by which bupropion enhances the ability to abstain from tobacco smoking is unknown, but is probably related to the inhibition of noradrenergic or dopaminergic neuronal reuptake. The resultant increase in norepinephrine may attenuate nicotine withdrawal symptoms. Increase dopamine at neuronal sites may reduce nicotine cravings and the urge to smoke."

For the Pfizer report, visit www.zoloft.com
For the GSM report, it can be found on in the Clinical Pharmacology database on infotree.

I can provide PDFs of both if needed via email.

I wasn't really trying to appeal to Dr. Amens authority, even though I highly respect his clinical work on ADD. If you read his books he down plays brains scans in favor of personal history for diagnosis of ADD. He has accumulated more ADD case studies than anyone in his field. Dr. Amen bases his ideas and his treatments on these case studies, not on spect scans. A theory is judged on how closely it resembles the facts, not on the character of the theorist. I take Dr. Amen seriously because of thousands of ADD patients that he has observed and treated, not because he links human behavior to anomalous brain scans.

Here's a link for one of the researchers involved in the buproprion trials. If you look at the chart provided it shows that sertraline does have about 10 times the binding affinity of buprpion. However, he does conclude that bupropion more potently increases dopamine due to other factors.

http://www.preskorn.com/columns/0001.html

Setting aside Dr. Amen, my experience with zoloft w/out stimulants is that it definitely helped my type of ADD while other SSRI's made it worse over time.

My position is that zoloft is somewhat significant in regard to ADD, over-focused type in particular, yet needs to be augmented with a simulant or an nri such as wellbutrin.

Alright, I see where you were coming from. I would hold that case studies are not generalizable and invalid as far as determining causes of behavior, or the results of medication in those studies, simply because they are by definition ideographic studies.

I do see the results of the study, and I found it very interesting. Thank you for sharing. I notice both that sertraline does bind more to DA receptors, and bupropion has seemingly more effect, so it seems as if we were both correct.

I would wonder if Zoloft's effectiveness in your ADHD is more a function of it reducing other worry thoughts and allowing your brain more time to relax...which would be a common effect. If so, I would be curious as to whether or not you have any other comorbid conditions which may be causing the symptoms of ADHD, without your actually having it exactly...

I am still not familiar with the information on which Dr. Amen bases his classifications of ADHD types. From what I understand, the "overfocused type ADHD" appears to resemble Obsessive Compulsive Disorder or Obsessive Compulsive Personality Disorder far closer than it resembles ADHD on the DSM-IV. I wonder if Dr. Amen is not trying to call things ADHD when they aren't, for whatever reason?

Ah well. Thanks again for sharing the bupropion information, I am not so intimately familiar with the drug and found that very fascinating.

Alright, I see where you were coming from. I would hold that case studies are not generalizable and invalid as far as determining causes of behavior, or the results of medication in those studies, simply because they are by definition ideographic studies.I'm not sure I'm follwing you. Empircal evidence is the basis of modern scientific and research. There is no other way to make a generalization other than looking for patterns in the data (case studies). I'm not saying Amen's conclusions are exact, but they seem to fit the real world fairly well. All theories are flawed, but that is no reason to disregard them. Amen's diagnosis and treatment for the particular diagnosis seems to be fairly predictable.

I would wonder if Zoloft's effectiveness in your ADHD is more a function of it reducing other worry thoughts and allowing your brain more time to relax...which would be a common effect. If so, I would be curious as to whether or not you have any other comorbid conditions which may be causing the symptoms of ADHD, without your actually having it exactly...Yes, a part Zoloft's effectivess on over-focused ADD is its ability increase serotonin, and therefore ease symptoms of anxiety and worry. But, I've taken other SSRI's (like prozac) that helped with anxiety, but clearly made my ADD worse. Zoloft's action on dopamine seems to be the difference as to why it helped with both w/out agravating the other. Dr. Amen has treated 1000's of patients and has run into the same problem. Stimulants or SSRI's alone make this type worse. Stimulants make worry worse, and SSRI's make the ADD worse. Yes, there is a co-morbidity: OCD and ADD. This co-morbidity has been documented independently by numerous researchers and clincians.

I am still not familiar with the information on which Dr. Amen bases his classifications of ADHD types. From what I understand, the "overfocused type ADHD" appears to resemble Obsessive Compulsive Disorder or Obsessive Compulsive Personality Disorder far closer than it resembles ADHD on the DSM-IV. I wonder if Dr. Amen is not trying to call things ADHD when they aren't, for whatever reason?I don't think you understand. I'm not sure anyone understands the complete mechanism of this particular type of ADD. But, a simple answer here is that people with classic OCD don't show the fundemental signs of ADD. Again, an important peice of evidence is that a combination of ssri and stimulant work very well for this type, while taking one as a single agent makes him worse. This was my experience before I read Dr. Amens Books. To say the least, I was highly impressed that his clinical findings had predicted my outcome so precisely.

As far as a lack of generalizability: case studies are not experimental. They are simply research performed on a single individual. Results of case studies can only be used for that particular case, and in devising theories as subjects for tests...the studies themselves are not generalizable.

I think my issue is mostly with the invention of the term "overfocused ADD." ADHD and Comorbid OCD is one thing...this "overfocused ADD" seems like OCD with ADHD symptoms to me, and I think that calling it "overfocused ADD" simply complicates things.

I take Zoloft for generalized anxiety, and Ritalin for ADHD. I also have Oppositional Defiant Disorder...according to Dr. Amen, I have overfocused and ring of fire type ADHD...but I prefer to call it "ADHD, ODD, and GAD."

It's simply a matter of phrasing. I would say that Zoloft is effective for Obsessive Compulsive Disorder. Ritalin is effective for ADHD. Your Zoloft works well for your OCD, and your stimulant works for ADHD...

Sorry, but i'm still not following you. Experiments are used to test hypothesis. Theories are formulated by looking at data (case studies).

Dr. Amens terminology doesn't seem complicated, and it certainly doesn't strike me as confusing. If anything he has made connections and provided answers. I guess I don't understand your critisism.

Zoloft helped my ADHD w/out stimulants. But, I do agree that a stimulant is needed for full effectiveness.

Hey, haven't much posted on here....but here goes. I was diagnosed 4 months ago (at 26) and I definitely fall within the over-focus camp. I've been taking (1)5mg dex and (2) 150 wellbutrins in the morning, with an adderal 30mg at lunch. I've been taking them as regularly as I possible, given the fact that I typically couldn't sleep until the wee wee hours of the morning for being up and preoccupied with thoughts of the past. I should note it's NOT the fretful anxious panicky preoccupation that used to keep me up. I've been a "night owl" since the tender age of 8, but I couldn't even sleep in the morning. Felt like someone was playing tug of war with my optic nerves. As of last week my doc put me on (1) 37.5 of effexor which I take in the morning. Sleep has definitely improved, but as of Wednesday, I feel my old inadequate lazy self making a comeback. Plus a little paranoid and groggy. Like someone threw a rock in the puddle that is my brain, muddying up the waters that were finally starting to clear. Is it possible to even be feeling this after only 7 days and at such a low dose? Just wondering if anyone has gone from effexor to zoloft, why did you, and the results were? Or any suggestions in general. Thanks!

Yes zoloft does have some dopamine re-uptake, and yes it does effect vigilance differently to other ssri's. Ocd and adhd can occur together, I would think that it is possible to have low serotonin and dopamine simultaneously. Medicines can effect the same neurotransmitters, but may be more selective to certain areas of the brain. Sertraline is a very good antidepressant if you can tolerate the side effects. Most researchers still are not completely clear how these medicines work, I'm sure things are happening inside the cell that they don't even have instruments and techniques to measure. When researchers are looking for antidepressants they first test a chemical on animal behavior(forced swim test), if it prolongs the time before an animal becomes hopeless (gives up) it is labeled an antidepressant. Once researchers have established antidepressant activity they then try and discern mechanism of action. Causes for attention problems are varied, focus should be on treating the symptoms rather than diagnosis. Yes, I do understand diagnosis is needed before treatment can start. Just for information purposes, wellbutrin is thought to additional effect the nicotinic receptors which some researchers believe may be involved in adhd.