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Treatment options for ADHD (Combined Type)

Hi.

I have been diagnosed with ADHD, multiple times in my life. As a child, again as an adult.

I suffer from the combined type. I have been told I am on the more severe end of the spectrum.

Firstly a brief description of my situation as an adult: I am hyperactive and over talkative. I constantly fidget, I mean this is really pronounced, I never really stop. When seated, besides fidgeting, I constantly shift around, and change the position of my legs. Various friend's I know, have a long history of making jokes regarding my "stupid distractibility and inattentiveness" to situations. Various friends often have to let me know I am talking too much. I have a serious problem with making careless errors with things, massive problems with persistent and motivation, and I regarded by other specifically as a person that avoids things that require "concentration" and "effort". I could write a lot more, but I will also mention that I am really extremely impulsive. I consider myself to have an exceptionally addictive personality, even compared to other people that are "addiction prone". I am absolutely chronically disorganized, no long term planning skills whatsoever (I am "wired" to live in the short term), I constantly lose and misplace things, I am very messy, I have low stress tolerance, a quick and explosive temper (that I have been working to improve for years), people consider me very lazy in regards to doing any tasks/chores yet i am hyper, and one thing I have read that is absolutely true: I have massive difficulty delaying reward, and absolutely can't stand waiting for things that I want or are "rewarding". Also I have very bad time management skills, and am unfortunately known to be notorious when it comes to keep appointments (former or social). Well I will leave that.

I also have had (in the past in particular) big problems with panic attacks (developed at age 20+), problems with depression, alcoholism, and binge eating.

When I was 22 I went on Ritalin, and ended up on the dose of 60mg per day. Ritalin had miraculous, life changing effects. It initially elevated my mood, but only for the first week or so. I noticed I could focus on things basically for the first time ever. Not only that but I was able to actually spend time doing things, concentrating, and constructively focusing on activities and completing them. For the first time in my life I felt motivated towards life, even daily chores. Every time I would take the Ritalin, it felt like in my head "the noise was quieting", and made the constant thoughts and "noise" in my head quieter. It was like putting on a pair of glasses which correct your vision.

However even from the beginning I had some side effects. I felt physically tense, and at time anxious. My pulse rate was often high. After a year on the drug I started to experience horrific, acute panic attacks. They were so severe that on some occasions I passed out due to hyperventilation, lost control of my bowels, and call the ambulance in a state of utter terror.

I also started experiencing worstening symptoms of tachycardia, especially "Orthostatic tachycardia". These problems became so significant that I was eventually forced to discontinue the Ritalin, and I left treatment altogether.

Unfortunately I had a very bad reaction in later years to the drug Reboxetine, which I believe is similar in action to Strattera. Reboxetine- while not helping with my ADHD- made me feel extremely psychologically disturbed, in dark, depressed state of mind. Everything seemed profoundly negative, even horrific. Because of this reaction, and some of the side effects, I am scared to try Strattera.

Do I have any ADHD treatment options left? Can anything be done to control potential panic and tachycardia on Ritalin or other stimulants? (I can't take beta blockers, I am asthmatic).

I am currently taking a medicine without doctor's approval. It is called Modafinil, and I am taking the MASSIVE dose of 2000mg per day, and have been doing so for over 3 months. I know that dose is massive, but I have experienced no side effects, no tachycardia, and I have verified my blood pressure is totally normal (120/80). It helps a lot with many, but not all symptoms.

A quick note: Known data suggests Modafinil has a very low toxicity in high doses. In ADHD trials in children, the dosage on a milligram vs kilogram of bodyweight ratio is essentially identifical to the dose I am taking. Higher doses on a mg:kg ratio were found to provide best symptom relief in children. In general Modafinil was found to be well tolerated in children. though not approved by FDA for complex, controversial reasons. My dose according to mg:kg is pretty much the same as mg:kg dose the children took, when you consider I weigh 123kg. No fatalities or dangerous, unexpected effects have been observed in overdoses and large doses of Modafinil. LD50 in animals indicate likely fatal human dose is MASSIVELY higher than what I am taking. In clinical trial 150 patients took up1200mg up 21 days, 35 up1600mg. No dangerous/unexpected effects. I have read 30 anecdotal accounts (via internet) of other people taking similar doses, no dangerous adverse events mentioned whatsoever. Yes I know it is experimental.

Advice please?
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replied January 23rd, 2019
Thank you for asking at Ehealth forum!

I read your question and I understand your concern.
You can take modafinil. I would suggest you to have psychotherapy sessions like CBT as well.
I hope it helps. Stay in touch with your healthcare provider for further guidance as our answers are just for education and counselling purposes and cannot be an alternative to actual visit to a doctor.
Take care
Khan
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