I'm diagnosed ADHD, inattentive subtype. From personal research, I also fit very well into the "Sluggish Cognitive Tempo" criteria, and people who fit this seem to have a high prevalence of co-morbid anxiety disorders. I'm pretty socially anxious, and have a lot of general anxiety as well.

From a 2006 paper (http://jad.sagepub.com/cgi/reprint/10/2/141.pdf):

ADHD With Comorbid Anxiety
David Beck Schatz
Stanford University School of Medicine, dschatz@stanford.edu
...
Recent studies indicate that anxiety in ADHD may a) partially inhibit the impulsivity and response inhibition deficits, b) make working memory deficits worse, and c) may be qualitatively different from more phobic types of anxiety seen in pure anxiety samples. In examining subtypes of ADHD, measures of sluggish cognitive tempo show strong correlations with anxiety measures. Insights into the nature of the comorbidity between ADHD and anxiety may be gained by examining the possible comorbidity between Obsessive Compulsive Disorder and ADHD, shared risk factors for ADHD and anxiety, and the current pathogenic models of ADHD.
Who here matches this Sluggish Cognitive Tempo (http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo) model and/or has ADHD with a co-morbid anxiety disorder? Which treatments have been the most effective for you?

I'm currently on Adderall but I'm going to ask my doctor to let me try Strattera as soon as I get health insurance. Supposedly Strattera is better for ADHD with co-morbid anxiety.

Any feedback is welcome.

Hello Despirit,

I'm diagnosed primarily inattentive and meet many of the standards of SCT. But probably most people would not describe me as daydreamy. I seem to have some H in there somewhere. I do, however, have a LOT of anxiety. I'm risk averse (I like thrill-seeking, but only in a very safe way, if that makes sense), etc.

I'm on 10 mg Adderall XR and 50 mg Luvox. The Luvox knocks the anxiety on its butt, but seems to perhaps contribute to feeling scattered. I'm not sure about the latter observation, yet. The Adderall seems to work best for me in very low doses.

I have not tried Strattera. I've not heard good things about it.

Hello Despirit,

I'm diagnosed primarily inattentive and meet many of the standards of SCT. But probably most people would not describe me as daydreamy. I seem to have some H in there somewhere. I do, however, have a LOT of anxiety. I'm risk averse (I like thrill-seeking, but only in a very safe way, if that makes sense), etc.

I'm on 10 mg Adderall XR and 50 mg Luvox. The Luvox knocks the anxiety on its butt, but seems to perhaps contribute to feeling scattered. I'm not sure about the latter observation, yet. The Adderall seems to work best for me in very low doses.

I have not tried Strattera. I've not heard good things about it.
Thanks for the reply!

I used to be quite a thrill-seeker when I was in my teens. Mostly driving a lot faster than I should've been. I'm chilled out in that respect in the past few years, though. I tend to try to stay away from danger. ;) What activities do you enjoy to fulfill your thrill-seeking, if you don't mind me asking?

That's interesting about the Luvox. I'll definitely research into that. I haven't had much luck for anxiety relief with the two SSRIs that I've tried, Prozac and Paxil. I think the Strattera might be good for me, though. I know there's a lot of bad experiences with it, but it's mode of action(norepinephrine reuptake inhibitor, norepinephrine/dopamine release in prefrontal cortex but not nucleus accumbens) seems like it would be ideal for me, in theory, anyway.

No problem, Despirit. I like thrills that are as close to totally safe as they can be: rollercoasters, water slides, go-karting. I think I'd enjoy rally racing if I had a five point restraint, helmet, roll cage, and the driver was a pro.

I also enjoy horsebackriding.... That's far and away the most dangerous thing that I do and I'm much more aware of the danger now than I was when I was a kid. But I continue to do it just because I love it so much.

I also fit the description of SCT and have been high-anxiety all of my life. Social anxiety included. I was very day-dreamy when I was young. Not so much now - but motivation is always a problem. I also have slow processing speed and very noticeable working memory and short-term memory problems.

Anyhow, my pdoc will not prescribe any stimulant type medications for my ADHD symptoms, because the meds can increase anxiety and agitation in people like me. I've read the same and agree...I certainly don't want any MORE anxiety!!!

I've tried a variety of antidepressants, and even though they're supposed to help with both depression and anxiety - I honestly can't say whether they've ever done ANYTHING for me except for increasing agitation (nervous movement).

I'm currently taking a steady dose of Klonopin (.5 mg 3x/day), which is the first thing ever to help my anxiety. I still feel nervous and uncomfortable about a lot of things, but it's much better than before. I can function much better.

My memory problems are still there, but I'm trying a variety of other things to see if they'll help. I use a bright-light therapy light, take Omega III Mood and have been using an online program www.lumosity.com every day to see if that will improve my memory and processing problems. I've been using it for a couple of weeks and I really do see a difference in my working memory already! So I'm excited about that.

Despirit:

Great topic and article. ADHD-combined plus co-morbid anxiety/dep.

Focalin XR (too up), Strattera (no perceived effect on ADHD ... extreme drowsiness on weaning off), Wellbutrin & Prozac (not good 4 me).

Vyvanse (30mg), Lexapro (20mg) & Deplin (1/day) -- excellent feel so far. Vyvanse is very steady and long-lasting. Lexapro is calming. Deplin apparently boosts the Lexapro.

Need to get exercising, though. Heard or read somewhere that John Ratey MD's book Spark claims that exercise will do more for anxiety than any med. Haven't read it or seen his sources for the claim.

Keep us posted.

Oh yea - exercise (cringe). Guess I blocked that one out - sounds like I really need to try it! Could be I'm missing something important there.

I'm 56 years old, and have had inattentive ADD all my life, but didn't know I had it until about 3 years ago. Before my diagnosis of ADD, I had to quit a demanding job because I could not keep up with its frantic pace. I had already discovered by then that I had sleep apnea, and I was using a CPAP machine, with great success, to help me sleep at night. But despite getting plenty of rest, I was still in a fog, still very confused, and unable to do my work.

I then went to a neurologist for some testing of my brain functioning, and her report led my primary care doctor to realize that I was probably suffering from ADD. He prescribed Adderall XR, which helped quite a bit, but was expensive and pooped out on me by 5 p.m. each day. It took a couple of years to figure out that the generic Adderall tablets actually worked much better than the Adderall XR, and that I did best on a on a daily dose of about 30 mg/day, taking half a tablet at 6 a.m. and the other half around 1 p.m. I also learned to stay away from caffeine after lunch and to avoid chocolates late in the day, because they interfered with my sleep, and I also started taking the dietary supplements recommended by Dr. Amen at his Brain Place web site for inattentive ADD (L-Tyrosine, ginkgo biloba, grape seed extract, a multi-vitamin, and fish oil capsules).

However, despite making substantial progress in clarity of mind, and overall happiness, I was still unable to motivate myself to find another job, or to take any decisive action to put my life back in order. I would make a list of things I needed to do, but would then ignore the list, and indulge in activities which gave me immediate relief, comfort, or distraction. I spend my days reading, working crossword puzzles, playing solitaire, surfing the Internet, sending e-mails to my friends, doing volunteer work, and hanging out in bookstores. I borrowed money from firiends and family to meet my living expenses, but I completely failed to take any action to look for work. No resume, no plan, no employer contacts of any kind. It was totally baffling to me that I could not find the motivation to do anything to help myself.

Eventually I realized I was probably suffering from some sort of hidden depression or anxiety in addition to my ADD. And so, in a moment of panic, I called up my primary care doctor, and met with him in his office. He recommended I take Wellbutrin in addition to the Adderall. And so, two weeks ago, I started taking Wellbutrin SR at 100 mg twice a day (the standard introductory dose). I'm no expert, but it's my understanding that Wellbutrin is a dopamine reuptake inhibitor, whihe Adderall is a dopamine production enhancer. Apparently the two medications together are what I've needed all along.

It's amazing how much easier it is, now that I've added the Wellbutrin, to get going, set priorities for the day, and actually accomplish things. My thoughts are more organized, I take action confidently, without much second-guessing, and I've even been able to add regular exercise to my routine. I'm looking forward now to finding new work, because I know I can handle it now. I feel employable, competent, and hopeful for the future.

So if you're discouraged about the slow pace of your recovery, and the many setbacks along the way, keep working on it. Keep trying, until you find a combination of therapies that works for you. A good relationship, reliable friends, regular exercise, attention to diet and sleep habits, volunteer work in your community, they're all important. But it's also vitally important to patiently work with your doctor to develop the right diagnosis, identify any co-morbidities, and take the right medicine or combination of medicines for your situation. I had no clue I was suffering from anxiety and depression until I started taking the medicine my doctor recommended. It seems obvious now, but at the time I had no idea how much I had been suffering from these additional problems. As they say, 'the fish are aways the last to discover water".

Excellent post, dusk2don!

Thanks for your inspiring story dusk2don! You may find this article interesting: http://www.princetoncme.com/pdf/programs/2006-190.pdf