Drugs, Drugs, Drugs, ADHD

Note: If I remember, and I also feel like it. I will hyperlink to the various research papers I discuss below. If you are reading this, and you want me to update, just leave a comment. Don’t worry about the age of the post, I will see your comment.

This is a semi-private place for me to discuss personal findings. As well as, Maybe, at some level, provide useful information to someone looking for info on the 12th page of a google search.

If you are here, Welcome! I hope my research can help you at some level.

I have ADHD, at least, I have been diagnosed by a medical professional as having the disorder. The currently accepted front line treatment for ADHD are stimulants. Almost the entirety of these stimulants are amphetamines of some type. Methylphenidate(Ritalin) is not a true amphetamine, but instead a dopamine reuptake inhibitor. It works, by preventing the brain from breaking down and removing brain produced dopamine. It has similar if less powerful effects than true amphetamines like Adderall. Adderall a racemic mix of both dextroamphetamine and levoamphetamine, increases concentrations of dopamine as well as noradrenaline. This is why it is often a “drug of abuse”, the dopamine makes life more “fun”, tasks become more enjoyable, and focus becomes easier. The noradrenaline gives that tweaky “rush”. Body metabolism is increased, felt energy is increased, and inhibitions are reduced.

Amphetamines work for ADHD, for this same reason. People with ADHD have less access to brain produced dopamine, either their brain reuptakes the dopamine faster, or they produce less dopamine in the first place. This is why those suffering from ADHD have issues “focusing”, but the problems that stem from the disorder are much more far reaching than this.

People with ADHD, are less interested in everything. They are more likely to be bored and depressed, and they are less likely to be successful in life, for this reason, since success stems, in part, if not almost entirely, from the amount of work an individual is able to perform. Sufferers have to devote more “energy”, across the board, to performing tasks that require attention. Things that are “fun”, such as tv, or video games, are less fun, and things that are “boring” are even more boring for someone with the disorder. Imagine if your job was even more boring than it currently is. Imagine how much more you would be fatigued after work, and how much more you would loathe your work.

Well, that has always been my problem, and Adderall has been a proverbial god-send for these issues. Where I was demotivated, I can perform, in spite of how much I hate a task, mostly because it reduces how much I hate that task, because it reduces how boring that task is. I can read, for hours, I can study, for hours, I can research, for hours. I still have to choose what I focus on, and I still have to fight my desire to focus on more entertaining things over less entertaining ones, but the soul-crushing boredom preventing me from doing necessary tasks, has been solved.

But, I have been very concerned about the long term effects of amphetamine use, and whether it could lead to long term brain changes. Mostly through destroying dopamine receptors, as seen in abusers of methamphetamine(an amphetamine).

But, thanks to the Adderall, I have been able to go on a research binge of sorts. Day after day, in my free time. For these past 14 or so hours I have been on an Adderall fueld research spree.

Though its unhealthy, I am once again trying to fix my sleep schedule by staying up through the night. I woke up around 5pm yesterday, and its about 12am now. I will try to pass out around 8pm tonight. Hopefully I can get that to work without the use of benadryl. I don’t want to use dementia causing anticholinergics, if I can help it.

I know what you are thinking, the Adderall is keeping me up! But no, I have always had insomnia, at least since I was around 15. I blame this, mostly on environmental factors, stemming from my insane parents, and how they handled their rocky divorce, but that is for another post entirely. The characteristics of my insomnia hasn’t changed, beyond a very sleepless first week on the drug.

In any case. I am have been researching options for treating the anxiety and depression I seem to be suffering from. I am currently prescribed generic adderall, at 45mg, 15mg 3 times daily. Along with generic guanfacine ER.

Its been about 3 months now, give or take. The effects of the amphetamines are wonderful. Increased focus, motivation and quality of life. Unfortunately the stress is still there and the suicidal ideation is still there. I hoped that a dopaminergic drug like amphetamine could cure these problems, and it certainly seemed to help for the first month or two. However, I have adjusted to the substance, and it doesn’t help with the depression or anxiety as much anymore.

The guanfacine is barely noticable, it might be helping with anxiety at some level, but it certainly isn’t significant enough to ameliorate the stress, especially stress induced from social interaction.

So I have been researching the use of anti-depressants, opiates, and other options to reach some base level of sanity.

Though I realize that the source of the depression/anxiety is likely tied at some level to my childhood. My shitty parents being what they were. I can’t deal with that right now. I also can’t really afford a quality therapist.

I am searching for an effective medical solution to keep me functional in the meantime.

Surprisingly, in opposition to our current societies collective opinion, and perhaps even the majority of the medical community, I have found that opiates are not really as dangerous as they have been made out to be. At least in regards to addictive potential. Apparently less than 1% of patients, prescribed opiates for treatment resistant pain, become would could be qualified as “abusers”. On top of this, the dreaded tolerance you see spoken of, either in medical papers, or in online opiate user communities, doesn’t seem to be a problem specifically for the treatment of pain. The papers that I have seen state that dosage stabilizes, and even is reduced in many cases, after initial stabilization. This apparently holds for years. With certain patients being on a stable dosage of opiates for decades.

 

More research is needed of course. And anxiety/depression is different than chronic pain. But it is surprising to see peer reviewed research flying in the face of commonly accepted medical knowledge.

On top of this, I have discovered that the use of a “speedball” is generally safe. Namely, the mixture of either amphetamines such as dexamphetamine, or methylphenidate, can be mixed with opiates with minimal risk, at least in the short term treatment of cancer patient’s pain. The risks of speedball use, is primarily seen among users who take excessively high doses. Using the stimulant effects of the amphetamine to allow an even higher dose of opiates, without risk of respiratory depression, and ensuing coma. When the amphetamine wears off, however, if the opiates remain in the blood at sufficient level, the user will go into respiratory depression if amphetamines are not re-administered. As a side note, if you have taken too much of an opiate, say, heroin in the form of IV, taking a significantly large dose of any amphetamine is likely to keep you alive, stimulating your CNS system and overcoming the CNS depression caused by the opiates. It is less safe than using something to block the opiates, say Narcan, but its better than dying.

As an aside, interestingly, this is known as a Brompton cocktail. A mixture of a stimulant and an opiate. It was popular apparently during the 18th and 19th centuries for various treatments. But, with our current Western society’s and government’s very strict view on both narcotics and stimulants, it is unsurprising that this has fallen out of favor.

At lower doses, the amphetamine treats the somnolence (daytime sleepiness) of the opiate, reduces the “mental fog” caused by the sedative effects, and also reduces the required opiate dose needed for therapeutic effect, due to boosting the analgesic properties of the opiate.

From what I can tell, the two drugs do not counteract in other, or cause deadly or even problematic symptoms in the vast majority of patients.

Once again, the negative stigma tied to a “speedball” seems to be due to the relatively small percentage of drug abusers who fail to measure dosage, and cause either opiate toxicity or amphetamine toxicity due to overdose. This seems to be the cause of most stigma tied to “hard” drug use. A small percentage of morons, cause over-anxious moral busybodies to limit the freedoms of the rest of the populace. Both amphetamines and opiates seem very safe to both the brain and other organs, as long as dosages are kept lower than what might be considered “recreational”. This seems to be at least under 2mg/kilogram for the amphetamines. For the opiates, I am unsure of dosage rates, as it is currently outside of my interest. But, opiates in the studies I have seen, are kept at a low enough dose to treat felt pain. Dosages for euphoria are much different than doses for reducing pain, at least according to my current understanding. This is possibly why pain patients have much lower rates of addiction than those seeking euphoria from opiates.

On top of this, several studies have shown that the use of Buprenorphine(suboxone, but without naloxone which “kills the high”)  is incredibly effective at treating treatment resistant depression (TRD). As well as reducing suicidal ideation in those at high risk of suicide. This isn’t particularly surprising. Opiates generally make you feel good. But buprenorphine in particular is unique in its safety profile. It can not be overdosed on like heroin, since it doesn’t seem to cause respiratory depression, even at very high dosages.

However, this gives me a sort of nuclear option, that is relatively safe. If I am prepared for some level of dependency and I have a “stack” of sorts to treat withdrawal if cessation is needed, I can use a combination of buprenorphine and either methylphenidate or dextrooamphetamine to simultaneously keep me active, alert, calm, and happy.

I will write a post on treating withdrawal symptoms later perhaps. If I do I will link it here.

It is risky at some level, I am mixing two separate classes of drugs known for their addiction and abuse potential. But if I use dosage schedules taken from research papers as well as publicly available titration tables from places like http://www.pdr.net or UpToDate.com. I can stay at safe levels, and probably use this longterm.

There is some concern for amphetamine toxicity as mentioned in the paper detailing treatment of cancer patients with both amphetamines and buprenorphine. However, according to the paper, the toxic symptoms were only found in the first trial that used a non-amphetamine stimulant. Methylphenidate was found to be safe, and caused no toxicity among the tested population. However, if toxicity occurs, I can simply cessate use.

The largest issue at this point would be getting a reliable supply of the buprenorphine. It is only schedule III, so I am less likely to be targeted by law enforcement if I went with DarkNet options. But I would prefer to follow the legal route to minimize both cost and risk. However, I find it unlikely I could find a doc that would be comfortable with prescribing an opiate off-label, even if it is a safe-ish one like buprenorphine. Especially alongside an amphetamine. There is a reason the paper discusses cancer patients. Good luck getting prescribed the combo without having a painful, chronic and likely fatal condition like cancer.

However it could be possible. Though it would probably be worth getting my hands on a supply of bupe first to test efficacy, and then going from there. Once again this is the nuclear option. I should try an SSRI or SNRI first, and then maybe progress to Tianeptine, which is unscheduled and easily purchased online. It probably would even be better to get a prescription of benzodiazapines before I went with opiates as a treatment option.

However, buprenorphine or another opiate is probably the most powerful solution to my anxiety and depression issues, though it also carries the most risk. Either in the form of a jail sentence, or addiction and abuse.

It is frustrating to me the lack of research on opiates in the treatment of depression and anxiety. If addiction and abuse rates truly are so low, then the aversion of the medical community as a whole to the use of opiates in treatment is irrational at best.

 

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Drugs, Drugs, Drugs, ADHD

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