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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I'm 29 years old and suffered with ADHD my whole life. I

Customer Question

I'm 29 years old and suffered with ADHD my whole life. I took concerta 54 mg for 15 years between the ages of 10 & 25. As I got older it became less effective, disrupted my sleep and made me very edgy in social settings. I got off the concerta under a doctor's supervision. I'm a professional musician in NYC and while I was on the concerta (my first 5 years living in NYC and having a scholarship to music school) I excelled and was very productive & self-motivated. I now feel after having been off Concerta for almost 5 years that I suffer from adult ADD with no hyperactivity and this presents with emotional problems in my relationship, an inability to handle nagging and minor criticism from my boyfriend, frequent fights with him, constant procrastination & doing things last minute, feeling overwhelmed by my work & being self-managed, feeling like I'm doing he bare minimum to get by financially, impulsive over-eating, a lack of self esteem & generally feeling like I'm not living up to the potential I once had. My sister is a psychiatrist at Penn in Philadelphia and spoke to me about trying a non-stimulant like Guanfacine after we had a conversation about my therapist thinking I would benefit from a low dose of lithium for my emotional difficulties & agitation with my romantic partner; my sister has known me my whole life vs. my therapist who has known me off and on for a couple years and I met her when I decided to discontinue the concerta. I feel as though her recommendation for lithium would only cover up one of my symptoms and possibly make me more content to accept things as they are and be less motivated to be a more organized & productive individual. On the flip side, I am afraid to be dependent on any prescription medication due to the cost & logistics of being monitored as I have a very unpredictable international travel schedule with my work at times, and I also fear the potential side effects and withdrawal. My memories of missing a concerta dose were so epically horrible; I could not get out of bed, experienced pain in my extremities & a complete inability to function. I am also a heavy recreational cannabis user. I have extraordinarily high executive function through being a heavy user for the past decade & while I'm willing to cut back on using, I'm not willing to stop completely & worry about the interactions of occasional use with guanfacine, particularly during the daytime. Wondering if this can be mitigated by using at night before bed, which is not only a relaxing source of enjoyment but helps me sleep well, since I'm assuming this medication is taken in the morning?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

*This website DOES NOT constitute treatment and only provides information and advice in a Q&A format. For treatment (therapy and/or medications) you must go to a licensed professional in your area. Please note that anything said here is not private or confidential, as this is a public forum.

Hello and thank you for using JustAnswer. I am very sorry that you are struggling with these symptoms of ADHD Inattentive Type, I can understand how distressing this can be for you. I do want to mention that Guanfacine is typically used to treat children ages 6-18, so your insurance may not cover this medication since it is outside its intended use. Another non-stimulant medication that I would like to recommend would be either Strattera or Wellbutrin. Strattera is officially approved to treat ADHD symptoms and Wellbutrin is an atypical antidepressant that has a secondary use of treating ADHD. Also Wellbutrin may help lessen your emotional difficulties too instead of the Lithium. I am surprised Lithium was the first recommendation because it is considered very powerful and has the potential for a lot of side effects, even at low doses. Also you have to get regular blood tests to make sure the Lithium is not causing any internal damage. Given that your emotional issues and agitation with your partner are not very serious or severe mood symptoms, it would be better to try an antidepressant first (either Wellbutrin or possibly a SSRI antidepressant) as these have low rates of side effects compared to the Lithium.

So regarding the Marijuana use and these medications...unfortunately there are no firm studies showing interaction effects with Marijuana and the Guanfacine, Wellbutrin, or Strattera and really this is because of federal law that limits the use of marijuana in testing. Even though there are no interaction effects listed, does not mean you will not have an interaction because there is just a lack of research in this area. Given that you realistically want to take the medication and use marijuana 12 hours a part (give or take a couple hours) seems reasonable, but I would recommend that you try to lower the use of your marijuana at first to see how you react while one of these medications.

I hope this helps and I truly wish you all the best with your continued treatment.

Customer: replied 1 year ago.
Re: the Wellbutrin, I took this as a child and had horrible side effects. My therapist did not want to revisit this in adulthood due to that. As far as straterra, was told that it is non-stimulant but has stimulant-like side effects. My issues with my partner are not severe on a good day but have spiraled out of control before into very severe conflicts. Does straterra require frequent blood testing? Does it have withdrawal symptoms if you miss a dose?
Customer: replied 1 year ago.
does Straterra mitigate any of the emotional edginess or is it mainly for focus & attentiveness?
Expert:  Dr. Z replied 1 year ago.

Strattera does have some stimulating properties as it causes an increase in Norepinephrine, but not nearly as much as Wellbutrin or as Concerta. Strattera does not require regular blood panels and there are no withdrawal symptoms associated with it. In fact the manufacturers will state that you do not need to taper off Strattera and you can just stop the medication entirely without fear of withdrawal. Strattera can help lessen "emotional edginess" if it is associated with ADHD, but it is not an antidepressant or mood stabilizer, so it will not lessen mood symptoms outside of ADHD.

Customer: replied 1 year ago.
Does the increase in norepinephrine from straterra have an effect on appetite & sleep in the way concerta does?
Expert:  Dr. Z replied 1 year ago.

It will not have a significant effect on your appetite and it will not effect your sleep cycle if taken in the morning.

Expert:  Dr. Z replied 1 year ago.

I hope this answers your questions and gives you some guidance on this issue. Please let me know if you have any questions or concerns as I am happy to assist and support you regarding this issue.

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