Thank you! I wish learning didn’t bring symptoms of anxiety crashing over me. Particularly learning information I need to know or if I did know it could help me? It’s like I fear for that time space when I will now have information but no way to carry it out/implement or I will have the cloud of “this explains everything” or “you have suffered so much more than you needed to…..”. It’s traumatic. But when I *can* learn information about my health or people I care about without shutting down - it is always a good thing. Thank you for these videos. I hope you are successful on here. The world needs you!
My video on anxiety as an attention problem may be of some help. I hope that science and medicine keep learning new things. Which means that there were always be new information. Rather than scolding yourself for not having learned x, y, or z earlier, I would try to focus on what you can do with this information now. And if there is really no way to implement any of it, then it is just amusing, not useful information.
Informative video! It's a bit validating to hear there are other people who take a stimulant at bedtime. I did that for a while and found that I was actually _awake_ in the morning. I didn't have an hour-long period of grogginess like I usually do.
It'd be interesting to have scientific studies on combinations of long-release + immediate-release maybe for people that are particularly resistant to meds for whatever reason but that don't react well to the immediate release alone
I should have been clearer at the onset that my focus here was on combining medications from different classes, rather than mixing and matching stimulants with different durations of action. There is some research on that topic which I did not get into.
@@markmuller7962 anecdotal self-study: bupropion was p ineffective for me until i started doin this (as inspired by other great info vids on this channel, tyvm) more than 75mg iR gives me migraine auras for days & 200mg SR doesnt peak high enough to be adequate support when i most need it, but bc they metabolize at v different rates for me so they actually work p well together currently: single morning dose guanfacine 1mg ER & bupropion (75mg iR & 200mg SR) started guanfacine a couple months in advance of bupropion bc i needed help w stabilizing intense emotional regulation & establishing consistent dose adherence. later added bupropion to target other adhd symptoms. its taken attempting several combos over the last year before finding more evident success w my symptom management thru the current dosage & deliveries its worth tryin different release deliveries esp, ime, so this comment is just gentle encouragement for readers to ask their dr if theyre curious about whether it may be helpful for them to try somethin similar 👍
There are certainly people who safely combine these medications. There is a slightly increased likelihood of anxiety, agitation, and blood pressure/heart rate effects, which are generally dose dependent and minimized by starting with a low dose and only titrating upward as tolerated.
Hi, I am taking atomoxetine 80 mg in the morning and guanfacine 3 mg at night. There is symptomatic improvement for ADHD but there is a room for improvement. I still have depression though. Is it a good idea to add bupropion 150 mg to the above regimen to help with depression and improve ADHD symptoms? I understand that the dosage of atomoxetine will have to be reduced due to effect of bupropion on cytochrome P450. Should it go down to 40 mg from 80 mg? I don't see any other drug interactions for this regimen ( atomoxetine+ guanfacine + bupropion). May be adding bupropion to guanfacine can lower seizure threshold a bit? Can you please guide regarding this situation? As a background, I am a doctor myself but don't have a license to practice yet in the country I am in. My psychiatrist doesn't know much about prescribing and combining non stimulants for ADHD but the good thing is that he listens to me and has started me on non stimulants first. Thanks in advance.
Introducing bupropion would probably include decrease the atomoxetine not just because of the drug/drug interaction but also because there would be some replication of norepinphrine reuptake action. But starting low and monitoring for side effects makes what you suggest a reasonable approach. More often I have used duloxetine rather than atomoxetine, because I think it is as effective for ADHD, and more tolerable, and more likely to help with associated depression or anxiety.
Very interesting thank you sir! Can you make a follow up video regarding the combination of an anti psychotic + stimulants? Due to a psychotic episode in the past I am prescribed risperidon 2mg + currently vyvanse after ritalin which didn't work + an SNRI to battle my comorbit depression. It's working like a Charme now. And the SNRI will be taken off soon. Most promising would in theory be aripripazol as anty psychotic which I can't take due to side effects.
I read some studies that point that atomoxetine tends to reduce tics in contrast to stimulants, so can it be used in combination with stimulants to combat this adverse event, especially if the patient has underlying tic disorder?
I've been taking vyvanse 40 mg since February. I have been having a problem with daytime Bruxism. Can this be a side effect? If so, Would something else with the vyvanse 40 help with this?
As someone else commented, magnesium (which the body utilizes in muscle function) supplementation is often helpful for bruxism. Zinc supplementation can help strengthen the enamel of your teeth, which may reduce the impact that grinding has on your teeth. A nightguard/mouthguard is also helpful for that as well.
Yes, bruxism (tooth grinding) can be caused by stimulants. As others have stated, lowering the dose, reducing caffeine and stress, or adding mouthguards at night, or magnesium, can all help.
I'm aware that some find my voice better suited for ASMR than for informational videos. ruclips.net/video/I_9xzJLVii4/видео.html For some it works just to listen at a faster speed. But no single style will work for everyone; there are plenty of more dynamic presenters on the internet, some with good information about ADHD.
Most Important Chapters:
19:26 Mr. Cupcake Arrives
22:35 Open the Door Please
I think u might have ADHD if that is what you're focusing on 🤔😅
Thank you!
I wish learning didn’t bring symptoms of anxiety crashing over me. Particularly learning information I need to know or if I did know it could help me? It’s like I fear for that time space when I will now have information but no way to carry it out/implement or I will have the cloud of “this explains everything” or “you have suffered so much more than you needed to…..”. It’s traumatic. But when I *can* learn information about my health or people I care about without shutting down - it is always a good thing.
Thank you for these videos.
I hope you are successful on here. The world needs you!
My video on anxiety as an attention problem may be of some help. I hope that science and medicine keep learning new things. Which means that there were always be new information. Rather than scolding yourself for not having learned x, y, or z earlier, I would try to focus on what you can do with this information now. And if there is really no way to implement any of it, then it is just amusing, not useful information.
Informative video! It's a bit validating to hear there are other people who take a stimulant at bedtime. I did that for a while and found that I was actually _awake_ in the morning. I didn't have an hour-long period of grogginess like I usually do.
It'd be interesting to have scientific studies on combinations of long-release + immediate-release maybe for people that are particularly resistant to meds for whatever reason but that don't react well to the immediate release alone
I should have been clearer at the onset that my focus here was on combining medications from different classes, rather than mixing and matching stimulants with different durations of action. There is some research on that topic which I did not get into.
@DrJohnKruse Oh yes I was saying in general
@DrJohnKruse *To one day have scientific studies on that matter done by the scientific community
@@markmuller7962 anecdotal self-study:
bupropion was p ineffective for me until i started doin this (as inspired by other great info vids on this channel, tyvm)
more than 75mg iR gives me migraine auras for days & 200mg SR doesnt peak high enough to be adequate support when i most need it, but bc they metabolize at v different rates for me so they actually work p well together
currently: single morning dose
guanfacine 1mg ER & bupropion (75mg iR & 200mg SR)
started guanfacine a couple months in advance of bupropion bc i needed help w stabilizing intense emotional regulation & establishing consistent dose adherence. later added bupropion to target other adhd symptoms. its taken attempting several combos over the last year before finding more evident success w my symptom management thru the current dosage & deliveries
its worth tryin different release deliveries esp, ime, so this comment is just gentle encouragement for readers to ask their dr if theyre curious about whether it may be helpful for them to try somethin similar
👍
Excellent content!
So grateful for you and your very helpful videos!🙏
I agree, he makes very comprehensive content!
Excellent! Thank you
Plz
Can atomoxetine combine with wellbutrin? Thank
I have adhd and depression
Or ritalin with welbutrin
There are certainly people who safely combine these medications. There is a slightly increased likelihood of anxiety, agitation, and blood pressure/heart rate effects, which are generally dose dependent and minimized by starting with a low dose and only titrating upward as tolerated.
@@DrJohnKruse
Thank dr 🙏 john
Hi, I am taking atomoxetine 80 mg in the morning and guanfacine 3 mg at night. There is symptomatic improvement for ADHD but there is a room for improvement. I still have depression though.
Is it a good idea to add bupropion 150 mg to the above regimen to help with depression and improve ADHD symptoms?
I understand that the dosage of atomoxetine will have to be reduced due to effect of bupropion on cytochrome P450. Should it go down to 40 mg from 80 mg?
I don't see any other drug interactions for this regimen ( atomoxetine+ guanfacine + bupropion).
May be adding bupropion to guanfacine can lower seizure threshold a bit?
Can you please guide regarding this situation?
As a background, I am a doctor myself but don't have a license to practice yet in the country I am in. My psychiatrist doesn't know much about prescribing and combining non stimulants for ADHD but the good thing is that he listens to me and has started me on non stimulants first.
Thanks in advance.
🍩 curious about this combo, too
Introducing bupropion would probably include decrease the atomoxetine not just because of the drug/drug interaction but also because there would be some replication of norepinphrine reuptake action. But starting low and monitoring for side effects makes what you suggest a reasonable approach. More often I have used duloxetine rather than atomoxetine, because I think it is as effective for ADHD, and more tolerable, and more likely to help with associated depression or anxiety.
Thanks you. I really appreciate you taking the time to reply.
Serotonin makes me sick.
Very interesting thank you sir!
Can you make a follow up video regarding the combination of an anti psychotic + stimulants?
Due to a psychotic episode in the past I am prescribed risperidon 2mg + currently vyvanse after ritalin which didn't work + an SNRI to battle my comorbit depression.
It's working like a Charme now. And the SNRI will be taken off soon.
Most promising would in theory be aripripazol as anty psychotic which I can't take due to side effects.
I do have a video about antipsychotics used to treat ADHD, focused on aripiprazole and risperdone.
@DrJohnKruse thank you!
I read some studies that point that atomoxetine tends to reduce tics in contrast to stimulants, so can it be used in combination with stimulants to combat this adverse event, especially if the patient has underlying tic disorder?
That seems to be true for some individuals.
I can personally attest to atomoxetine, reducing ticks, after only a few days on it so far. It became apparent immediately
What about combining stimulants xD?
I've been taking vyvanse 40 mg since February. I have been having a problem with daytime Bruxism. Can this be a side effect? If so, Would something else with the vyvanse 40 help with this?
Try to not stress or try lower dose make sure to not have caffine
Magnesium helps! So does mouth guards.
As someone else commented, magnesium (which the body utilizes in muscle function) supplementation is often helpful for bruxism. Zinc supplementation can help strengthen the enamel of your teeth, which may reduce the impact that grinding has on your teeth. A nightguard/mouthguard is also helpful for that as well.
Yes, bruxism (tooth grinding) can be caused by stimulants. As others have stated, lowering the dose, reducing caffeine and stress, or adding mouthguards at night, or magnesium, can all help.
yippee!
You have really good content but your voice is so monotone I zone out often.
I'm aware that some find my voice better suited for ASMR than for informational videos. ruclips.net/video/I_9xzJLVii4/видео.html
For some it works just to listen at a faster speed. But no single style will work for everyone; there are plenty of more dynamic presenters on the internet, some with good information about ADHD.