View Full Version : Drug flow chart/guidelines?


hyper-not
10-05-16, 08:59 AM
Is there some kind of chart that tells you, if you take ‘this’ and you feel ‘this way’, the next thing you might try could be ‘this’ or ‘that’? I have a Psychiatrist, but he seems not to know what to do next. He explained his approach by using a ‘salt and pepper’ analogy - ‘salt’ being a serotonergic focused drug which tends to be more sedating. And ‘pepper’ is norepinephrine focused drug that is more activating, and that his focus was to find some kind of balance. I know that this explanation is waay oversimplified to the point of condescension. But I’m not sure I could handle the next level of complexity anyway.

Years ago I tried pretty much most of the available serotonergics, generally producing an intolerable dizziness for more than a week or two before I finally had to stop. Most recently I’ve tried Sertraline(again), Duloxetine, Bupropion, Strattera, most in conjunction with Adderall. The Sertraline and Duloxetine produced some temporary dizziness but also made me feel very tired and want to compensate with more Adderall (I’m already at the top end of my Adderall dose). They did seem to help my mood, though.

With Bupropion, I felt cognitively sharper, but it didn't seem to help the depression at all. Trying the Strattera seemed to be heading that way too, but insurance issues stopped that experiment.

Currently I’m on Adderall alone, and just fighting the bad moods and falling back into my usual unhealthy mood enhancement activities. But this is nonproductive and can’t last. I’m thinking of suggesting some combinations to my Psych, like adding sertraline/bupropion with the adderall.Is there some kind of chart that tells you, if you take ‘this’ and you feel ‘this way’, the next thing you might try could be ‘this’ or ‘that’? I have a Psychiatrist, but he seems not to know what to do next. He explained his approach by using a ‘salt and pepper’ analogy - ‘salt’ being a serotonergic focused drug which tends to be more sedating. And ‘pepper’ is norepinephrine focused drug that is more activating, and that his focus was to find some kind of balance. I know that this explanation is waay oversimplified to the point of condescension. But I’m not sure I could handle the next level of complexity anyway.

Years ago I tried pretty much most of the available serotonergics, generally producing an intolerable dizziness for more than a week or two before I finally had to stop. Most recently I’ve tried Sertraline(again), Duloxetine, Bupropion, Strattera, most in conjunction with Adderall. The Sertraline and Duloxetine produced some temporary dizziness but also made me feel very tired and want to compensate with more Adderall (I’m already at the top end of my Adderall dose). They did seem to help my mood, though.

With Bupropion, I felt cognitively sharper, but it didn't seem to help the depression at all. Trying the Strattera seemed to be heading that way too, but insurance issues stopped that experiment.

Currently I’m on Adderall alone, and just fighting the bad moods and falling back into my usual unhealthy mood enhancement activities. But this is nonproductive and can’t last. I’m thinking of suggesting some combinations to my Psych, like adding sertraline/bupropion with the adderall.

20thcenturyfox
10-09-16, 06:29 PM
I have never seen the precise type of flow chart you are describing, and I agree such a chart could be helpful to professionals and patients alike. Even if some of the details were controversial, there must be some principles of first line, 2nd line, etc that are not.

I will say that this med chart from the UK--covering not just depression & ADHD but everything else from Alzheimers to Bipolar-- is the most comprensive I have seen (though not up to date and does not mention bupropion for depression). http://www.sssft.nhs.uk/images/pharmacy/documents/other/MMP-Handy-Chart-October-2011-V2.pdf You have to scroll down to p20 to find the section on depression!

Could this be a starting point for discussion between you and your doc?

Toss4n
10-13-16, 10:04 AM
Really difficult making a chart as some people will react differently to meds than others, so they are in a way unique to each user. But I've been thinking about creating an app that could help figure out which part of you that isn't working and making a suggestion for a medication and or supplement that targets that specific area, but I haven't gotten around to it yet, because everything is so convoluted when it comes to the brain, and we actually don't know how each medication works (or what contributes to its antidepressant effects).

It's not as easy as saying: let's increase serotonin/dopamine/noradrenaline in this specific region, and voilá you're better - you just have to try them one by one (it also takes a long time for most of the to work, and by that period, stopping them could cause other problems as the brain has gotten used to that particular medication messing things up further).

Here's a great summary of what we know about depression thus far (the information is somewhat dated already, but should give you an idea of the complexity behind depression):
http://www.health.harvard.edu/mind-and-mood/what-causes-depression
(http://www.health.harvard.edu/mind-and-mood/what-causes-depression)

hyper-not
10-15-16, 02:14 PM
Thank you Toss4n & 20thCenturyFox for the info. I figured that it was too complex, following the rules of Chaos theory more than anything. I guess my initial question was one of desperation, complicated further by affordability and communication with Psychiatrist. My Dr keeps suggesting non-generics, which I can't afford right now. My expectations are too high, and I really need to work on my communication with him so that he can actually help me.

20thcenturyfox
10-16-16, 12:17 AM
Is there some kind of chart that tells you, if you take ‘this’ and you feel ‘this way’, the next thing you might try could be ‘this’ or ‘that’?...
Trying the Strattera seemed to be heading that way too, but insurance issues stopped that experiment.

Currently I’m on Adderall alone, and just fighting the bad moods and falling back into my usual unhealthy mood enhancement activities...

Thank you Toss4n & 20thCenturyFox for the info. I figured that it was too complex, following the rules of Chaos theory more than anything. I guess my initial question was one of desperation, complicated further by affordability and communication with Psychiatrist. My Dr keeps suggesting non-generics, which I can't afford right now. My expectations are too high, and I really need to work on my communication with him so that he can actually help me.

I have a little experience with combinations I might share in case it might help. We obviously don't have the same brain functioning, though because I have had several brief flings with bupropion and it definitely makes me aggressive. Instead I was on a combo of desvenlafaxine and Adderall for quite a long time until something changed and it stopped working.

But what caught my attention was your statement about Strattera and insurance. Did you know Straterra is now out in a generic, atomoxetine? It may or may not be covered by insurance, but it is definitely cheaper.

I'm now on atomoxetine 60mg plus Vyvanse 50mg (similar to Adderall, but unfortunately not available in generic)--and in fact this "activating" combo was suggested by an internist to my current doc (who is probably not well informed about ADHD, nor as conversant with meds as some I have had previously). I'm very grateful that she did, too, because, although the Strattera did make me feel nauseous, both when I first tried it by itself, and again when I added it to the Vyvanse, that unpleasantness went away after a few days, and the combination is one of the most positive things that has happened recently. I have a long way to go to climb out of this hole I'm in, but I'm definitely encouraged to keep trying...which is something new.

I see no reason why you could not combine atomoxetine (primarily noradrenergic) and adderall (like Vyvanse, primarily dopaminergic), just as well, to see if that achieves the right balance between those 2 systems. I see references on the internet to others doing it, and am considering trying it myself, since I always slept better on Adderall than I have since starting on Vyvanse.

Good luck on your next round of meds.

hyper-not
10-16-16, 12:04 PM
Thanks 20thcenturyfox, This is something I will consider. Did not know that Strattera was generic now.