I'm sorry this got a so long, but I wanted to include everything that could have importance that I could think of. Any experience, research, ideas etc. could be INVALUABLE to me.

In a couple of months I have an extremely important deadline (one that would change my life), and I've been putting it off so now I have a LOT of work to do. Most of you have probably been in a situation like this before (I know I have, just not this big), PLEASE give your advice, comments or ideas as it could be invaluable to me.

My problems have always been fatigue (even when sleeping 8-9 hours a night, eating healthy and exercising), motivation (keep my focus on the things I SHOULD do/dont give up if I cant comprehend something at once), unable to organize/get an overview, memory, collect my thoughts, be relaxed (anxiety?! I'm probably a bit hard on myself, aka. would like to do everything great, although most things dont), be PRESENT and not in my own world, shyness among others.

Most important is:
1. Fatigue
2. Motivation (be able to focus for longer periods of time)
3. Be relaxed (probably relates a lot to: 2. Motivation and shyness)

I got diagnosed about 1-2 years ago (without hyperactivity although still have a restless feeling mentally), and I've tried:
Ritalin: Some success, seems 20-40 mg works the best in the long run. With 60-100 mg is better in the short run for focus, fatigue, but then after a few days/a week, I get even more tired. Might have something to do with my Gilberts Syndrome?? I dont metabolize the medication fast enough, which makes me unable to enter deep sleep on the higher doses? (I've actually tried Betaine some years ago for Gilberts, and it actually made my eyes white, usually they are yellowish, especially in stressful situations. I wonder if that would help, but I'm afraid to mix it). All in all mostly helped with fatigue, which is great, more talkative in social situations, but also a small euphoria (in stomach?!), and more restless? (more anxiety?)
Citalopram: Didnt seem to help much, just got even more tired (and I dont really think I have a depression).
Mianserine: Was meant for taking at night for better sleep. Just made me even more tired.
Modafinil: 200-400 mg: In a strange way made me less tired, although I still felt tired, I didnt yawn anymore. Didnt notice much else, except I had trouble sleeping when taking 400 mg.
Strattera: Didnt feel much difference...
Dexamphetamine sulphate: 5-25 mg (15 mg morning, 10 midday). Helps with fatigue, but also a bit more restless. Think its a bit better than Ritalin for me.
Klonopin: 0,5-1,5 mg morning. Makes me feel a bit more relaxed and tired, although I can still feel anxious (too focused on people/situation around me - in a constant defensive mental state). Should I try something else, or higher dosage?
Right now I take 40 mg ritalin (LA in the morning) or 25 mg dexamphetamine (15 morning, 10 midday) and 1 mg Klonopin (morning).
I dont feel tired, and a bit more relaxed, but my biggest problem is still motivation (to focus on what I SHOULD be doing) and I have an extremely important deadline in a month.

Regarding the Klonopin, I'm a bit worried about the long term side effects, although I'm not too worried about the addicting part, as I very rarely get addicted to anything. I've read it can have a negative effect on cognition and memory, which would be counterproductive, as these abilities are essential for me the next 1-2 months.

I work well with my psychiatrist, so I'd be able to combine what works best for me.

Other things that could have importance:
As mentioned I have Gilberts Syndrome...
I'm a former member of Mensa. I also took the WAIS, which put my performance IQ at 132 and Verbal IQ at 108, which is a significant difference. As far as I've read, quite a few things can be the cause of this (PTSD among others. Stress/anxiety maybe??)
Been at a Specialist in endocrinology and hematology. I've been screened via blood/urine tests for 50 difference things. All normal, although TSH is about 2-3, the Free T3-T4 looks fine (except the bilirubin = Gilberts)
Neurologist, who took an MRI/EEG and the standard tests. All normal.
Went to a Heart specialist, as I sometimes feel light pressure in the left side of my chest. (Also went to the Hospital for this, they took EKG, BP, Pulse, said everything is normal. They said stress could cause this) He said everything is normal (Took a couple EKG's, scanned my heart with some kinda device: Said major structures of my heart is normal. I have a BP of 93/140 and a resting pulse of 44-46: I run 2-3 times a week/overall fit/BMI 22,5).
Sleep Specialist: Tested for probably everything they can test for. RLS, Sleep Apnea, Lung capacity (7,5 liters: I'm 6,4"), EEG, Sleep patterns (phase 1,2,3, REM etc). All normal.If anyone has a comment on any of it, PLEASE tell me.
Everything from dosages to combinations.
Also feel free to ask for more info, if I've forgotten to write something.

Kind Regards
Wanderingmind

You sound a lot like me.

For some, Adderall helps with motivation (in sort of a weird way, like being compelled to do something -- not great in the long run, but I guess it would be good for an upcoming deadline). But since you're already taking dex and Ritalin, don't know what adding another would do, really.

Don't know about Klonopin, but an anti-anxiety med would probably help.

As for this deadline, I only wish I knew what to say. The smarts will help you, definitely. Is it a month's worth of work?

Sorry I can't help, but I sure do sympathize.

Here's my combo of choice:
Exercise + Strattera + Adderall (XR)+ lots of water + never skipping a meal even when I don't feel like it.

Please do not underestimate the effects of exercise. Even 15 minutes of getting your heart rate up to 75-80% of max has an intense effect throughout the day. Lack of exercise is often the reason your body doesn't respond well or doesn't feel quite right. It totally helps with sleep, insomnia, regularity, palpitations/heart rate and other side-effects that adhd meds are notorious for.

Can i just be really nosey and ask what Gilberts Syndrome is? I don't have any advice, its way beyond me and i know very little about med combo's. Xersize can help produce more energy, have you found it makes any difference for you?

Thanks all for the comments and advice!

I can probably make it, as I usually do well in these situations (Like the thread in the Adult ADHD forum: http://www.addforums.com/forums/showthread.php?t=47685)

The difference is, that normally the amount of work would be 1-2 weeks. This is work for more or less 2-3 months for normal working hours/working intensity.
I've tried splitting the bigger project up into smaller fragments, which is probably one of the most frequent given advices in that situation (when you cant bare to look up at the mountain/flight of stairs you have to climb). The impact isnt big enough though.


Thanks for the advice on exercise. At the moment I'm probably only running twice a week, and would like to get that to at least 4 times.
I've tried running 3-5 times a week (20-30 minutes) for close to a year, or weightlifting 3-4 times a week (for years).
It probably have a small positive effect (compared to only twice a week like I do now), so I'll get started on that again :)



Gilberts Syndrom: In general it's described as an inherited (3-10% of US population!) mild liver disorder. They are still unsure about the symptoms.

I'll borrow a bit from Mayoclinic, which have a good description:
http://www.mayoclinic.com/health/gilberts-syndrome/DS00743/DSECTION=1

"Gilbert's (zheel-BAYRZ) syndrome is a common, mild liver disorder in which the liver doesn't properly process a substance called bilirubin, which is produced by the breakdown of red blood cells.
In fact, Gilbert's syndrome is usually not considered a disease because of its benign nature. Most people who have the disorder find out by accident, when they have a blood test that shows elevated bilirubin levels.
Gilbert's syndrome affects 3 percent to 10 percent of the U.S. population. More males than females have the condition.
A number of factors may increase bilirubin if you have Gilbert's syndrome. These may include:

Illness, including infections, such as the cold or flu
Menstruation
Fasting or skipping meals
Dehydration
Overexertion Some people with Gilbert's experience episodes of fatigue, weakness and abdominal pain. However, it's not known if Gilbert's actually causes such symptoms, or if they're related to stress or other conditions.
..."

Dexamphetamine sulphate: 5-25 mg (15 mg morning, 10 midday). Helps with fatigue, but also a bit more restless. Think its a bit better than Ritalin for me.


I have heard of betablockers being prescribed with stimulants to take some of the edge off.

http://www.neuropsychiatryreviews.com/march02/adhd.html

Problem: A 20-year-old college student responded well to methylphenidate but experienced edginess. Changing to a long-acting form was not helpful; tricyclics were poorly tolerated and bupropion was only partially effective.
Solution: Return to methylphenidate but add propranolol (20 mg/d). Make sure that the patient doesn’t have asthma, which can be severely aggravated by propranolol.

Thanks Theta!

I actually have tried propranolol too (only med I didnt describe before). I might have felt a bit less edgy, and 2 mornings (out of a week) I woke up refreshed (which I never do).
It would also help with my relatively high Blood Pressure (BP).

I'll have to check the interaction between klonopin and propranolol. There seems to be a bit, seems like mostly synergetic effects: http://www.drugs.com/drug-interactions/klonopin_d00197_propranolol_d00032.html
I'll check with the doc before trying it.

Only reason I'm hesitant to continue using it, is because I already have Bradycardia, and I think thats a contraindication (as applied to adult medicine, is defined as a resting heart rate (http://en.wikipedia.org/wiki/Heart_rate) of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min).
During night it can go down into the high 30's, and with propranolol who knows, maybe into the 20's (it lowers the BP and heart rate).

I know that when I take Rit or Dex my heart rate increases 15-20, and Propranolol lowers it with a similar amount. If my heart rate gets lowered with 15 at night (when rit/dex has stopped working) it could probably go below 30...

There's actually one thing I dont really get. How can I have a BP in the 93/140 area, resting heart rate of approx. 46 and be relatively fit (in the Cooper running test. I'm actually in the "Very Good " category: 2800 meters in 12 minutes).