View Full Version : Need some suggestions for either SSRI or SNRI to add to Adderall XR?

09-05-14, 09:51 AM
***Further information and history is included at the bottom of the post due to the length of this post.

I am currently taking Adderall XR 3x a day and am looking at adding an SSRI or SNRI to help with some issues that had been left now that my ADHD symptoms are under control.

Whenever I get to the point where my symptoms are under control, this constant low level sadness seems to take over and I start feeling dull and lifeless. Always tired, and the Adderall does nothing for improving energy and I am unable to even "feel it" but my symptoms are under control according to my family and my husband.

Basically I am looking for suggestions of what anti-depressant would be good to add. The pdoc is thinking effexor (a CYP 2D6 substrate as well) until I get the results back from the genetics study that I elaborated on below and if I am in fact a rapid metabolizer, then we could go back to the inhibitors to hopefully get more efficacy from my Adderall dosage which should help me cut down on the overall amount as well as improve the duration of effectiveness.

Does anyone have any other suggestions for anti-depressants or perhaps anything we haven't thought of that could cause a problem with either of the zoloft or the effexor?

*** Below is further information about the genetics study that I mentioned above.... it's relevant but I wanted to separate it due to the length of the post.

A few days ago I participated in a genetic study in order to analyze my P450 pathways in order to move forward with an appropriate anti-depressant, as well as to confirm the theory that I am a rapid metabolizer via the 2D6 pathway.

I was initially put on Adderall XR while I was on 150mg of Zoloft (which is an inhibitor of the 2D6 pathway) and we began lowering the zoloft it due to occasional back up of the Adderall leading to a toxic feeling, at this time I could feel both releases of the Adderall XR and I was also taking the anti-histamine diphenhydramine (also an inhibitor) on a regular basis.

I did my research and brought it to the doctor and we determined that just to be safe, we would take me off the zoloft and the anti-histamine.

During the taper, I remember the most balanced that I felt was at the 50mg to 75mg mark. I could get a full 7 hours out of the medication and felt two distinct releases. Convinced I was on the right track, we kept lowering and now I require 3x a day dosing because I only get the benefit of the initial release before my body appears to metabolize it completely and the rest becomes useless.

I am in Canada and there is no Adderall IR otherwise I am just I would be fine with that.

Thanks for any suggestions you may have! I am meeting with the med psych team on September 9th, and would like to have some suggestions to bring to the table.

Once I get the results of the genetic study, I will post them up to add further insight.

Thanks for taking the time.

10-04-14, 06:04 PM
OK, I couldn't get through the whole post (sorry ADHD) but I am on mirtazapine with adderall IR along with other meds and I lost that sinking depressed feeling I get while I can be active with adderall.

10-07-14, 05:33 PM
I notice you're on Effexor + Adderall according to your signature, how are you liking this?

10-08-14, 01:31 AM
I would recommend Lexapro as it is metabolized through the P450 pathway

10-08-14, 01:33 AM
When I was on that combo - did not like it one bit

Do not remember the reason for my negative experience but I just did not like it. I'm pretty sure it had to do with nausea

10-08-14, 11:43 AM
I notice you're on Effexor + Adderall according to your signature, how are you liking this?

To be honest, it was great until I reached 187.5 mg and then I guess the norepinephrine started to kick in and now the Adderall is almost intolerable. It was becoming less and less effective and now I'm seriously considering a switch to dexedrine to unload on the norepinephrine stimulation, since dexedrine only works on dopamine I believe....

Any thoughts? Thinking about calling the doc and asking to discontinue the Adderall XR until I can switch.