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Duloxetine (Cymbalta) for ADHD
Рет қаралды 1,145
3 ай бұрынDuloxetine (Cymbalta) is a relatively balanced serotonin/norepinephrine reuptake inhibitor (SNRI), approved for depression, fibromyalgia, and a number of chronic pain syndromes. It is used off label for ADHD. Only a few studies support its efficacy in treating ADHD in children and adults.
Other relatively pure norepinephrine reuptake inhibitors (atomoxetine/Strattera), and SNRI (venlafaxine/Effexor, milnacipran/Savella/Fetzima, tricyclic antidepressants) have been shown to reduce both inattentive and hyperactive/impulsive symptoms of ADHD.
I tend to use far more duloxetine for treating ADHD than these other options, because the side effects of duloxetine tend to be more tolerable, predictable, and safer than those with the other SNRI AND NRI. This is a generalization, and there are certainly individuals who do not have good responses to duloxetine or have great responses to these other agents.
Overdoses (which can be fatal) with tricyclics can occur at doses only slightly above the therapeutic range; most individuals have constipation, weight gain, lethargy, and cardiac side effects from this class of drugs. Venlafaxine often creates withdrawal effects with missed doses, and its norepinephrine action is relatively weak. Side effects with atomoxetine tend to be less predictable than those from duloxetine, and most individuals need to titrate upwards for weeks before reaching effective doses. In the US, milnacipran is not available as a generic, making prohibitively expensive for many.
References:
Duloxetine May Improve Some Symptoms of Attention-Deficit/Hyperactivity Disorder (2010)
www.psychiatri...
Effects of selective serotonin reuptake and dual serotonergic-noradrenergic reuptake treatments on attention and executive functions in patients with major depressive disorder (2010)
pubmed.ncbi.nl...
Efficacy and Adverse Effects of Venlafaxine in Children and Adolescents with ADHD: A Systematic Review of Non-controlled and Controlled Trials (2013)
www.eurekasele...
Serotonin Norepinephrine Reuptake Inhibitors: A Pharmacological Comparison (2014)
www.ncbi.nlm.n...
Tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD) in children and adolescents (2014)
www.cochraneli...
General:
Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions. Subscribe if you're curious about how neuro-atypical brains can optimize their functioning in our shared, and somewhat strange, world.
Dr. Kruse has posted talks in both the "live" and the "video" sections of this channel. Thumbnails on ADHD topics have a pink background, and those on more general mental health topics have a purple background. A small collection of ADHD-Trump videos have an orange background.
You're welcome to email him with topics you want discussed, people you think he should interview, or if you would prefer a time for the weekly KZfaq Live option other than Tuesdays at 6:00 pm (Pacific Standard Time).
drjohnkruse@gmail.com
@Heather_Michelle Ай бұрын
I'm currently taking Cymbalta for generalized anxiety, fibromyalgia pain and ADHD. While I've only been taking it for three weeks I can tell a marked improvement in all three. Thank you for this thorough breakdown of it's effects and treatment uses, very helpful.
@DrJohnKruse Ай бұрын
You're welcome, and I hope that it continues to help you.
@larauforesicrowther6954 3 ай бұрын
thank you, very interesting
@johnp.3225 3 ай бұрын
Dr John, thanks so much for your videos, you're helping our ADHD community with useful information and suport. Let me ask you: my dilema is between Vyvanse 50mg and 70mg, the 50mg gives great internal concentration, I can read, it calms my brain and no rarely I feel sleepy, while the 70mg wakes me up, gives me some extra energy but I cant read for long time, its like I'm little hyper. Since I'm inattentive ADHD, maybe CDS/SCT, which dosage seems correct to you? In my country there are only 30, 50 and 70mg Vyvanse dosages.
@plymix8389 3 ай бұрын
Hey, I’m not the doctor but i can offer my advice since im in a similar dilemma. My max dose of effective vyvanse is 40mg but I take 20mg since 40mg makes my impulsive. I’ll explain my thoughts to you. Basically, your body has only a certain ammount of dopamine it can actually regulate, too much dopamine above that ammount without any other drug to increase regulation such as Guanfacine and you will become impulsive. Even though 40mg feels so much nicer of an amp for me, I have come to enjoy the peace of not being impulsive at my 20mg I take. Same as you I feel very sleepy usually? But the 20mg takes care of that but I kinda do feel like I want a little more. But yeah, It gets better overtime and once you start beliving in it, you will love it more. That extra amp for a trade off in impulsiveness is not worth it bro. There is 30mg of Vyvanse. You can try 30mg x2 for a total of 60mg a day aswell if you can afford the extra pills. Edit: another option you can try it’s taking the low dose of Guanfacine extended release. 1mg is the lowest. Take that and 70mg of vyvanse. It should be able to weaken the 70mg down a bit. The issue is that it might overweakn it to feel like 50mg. But yeah just giving you another option. (I actually take 1mg 2x daily with my 20mg 1x daily of vyvanse and it works amazingly)
@DrJohnKruse 3 ай бұрын
Vyvanse capsules can be opened to get intermediate doses, so that might be an option, if you're "open to it". My general advice is always to get by with a lower dose than a higher one, if possible, just to reduce the likelihood of any long term problems.
@enigmab8978 3 ай бұрын
Heard this one already,good one.Can you do one on Venlafaxine?
@DrJohnKruse 3 ай бұрын
Everything I would want to say about venlafaxine (Effexor) is in this video on Cymbalta. When venalafaxine was the only SNRI available, it made sense to use it. It really doesn't anymore for most individuals, since it is so relatively weak on the norepinephrine reuptake transporter. Even though there are more studies on venlafaxine for ADHD than there are for duloxetine, I think any direct head to head study of the two would be a hands down winner for duloxetine.
@FLAMENCOTIME1 3 ай бұрын
, thank you dr. john I wonder why parkinson disease meds like sinement or stalevo usually not use in treatment of ADHD?
@DrJohnKruse 3 ай бұрын
I agree, these dopamine boosting agents would seem like logical options. There has not been a lot of research on these drugs, and what l little there is did not show large enough benefits to encourage further research. Here is more on amantadine, one of the mainstays of Parkinson's treatment. kzfaq.info/get/bejne/pKyHkt2KlqyVoJs.html
@ihague4568 26 күн бұрын
The activity of drugs like methylphenidate and other stimulants for ADHD are complex and not completely understood. Did you know that mice lacking the dopamine transporter have elevated dopamine and are particularly hyperactive. Not only that, stimulants like ritalin still calm this particular breed of mice down. It can't be because of actions at the dopamine transporter because these mice don't have any. Also, the drug reverses the hyperactivity caused by the hyperdopaminergic state. Direct dopamine agonsts can actually increase impulsive behavior and risk taking. In some theories, drugs like ritalin do more to stabilize the tonic and phasic activity dopamine rather than just boost dopamine. Also, dopamine precursors don't really help ADHD. So, it's way more complex than we know.
@DrJohnKruse 23 күн бұрын
@@ihague4568 thanks for the reminder about the tendency to oversimplify. I talked about some of that in earlier video: kzfaq.info/get/bejne/m86iebCXvdiqfqM.html
@plymix8389 3 ай бұрын
Have you gotten much better results with cymbalta over strattera? The reallly scary thing about seritonin reuptake inhibitors is how hard they are to get off of them, and if if duloxotine is that much stronger Ron serotonin than it would seem that duloxotine would have a bigger withdrawl effect. Does the benefits overweight the risks over strattera?
@DrJohnKruse 3 ай бұрын
The vast majority of people I have worked with tolerate Cymbalta with minimal problems, and all of them have been able to stop, with a gradual (two month or more) withdrawal, without any lingering problems. More on antidepressant withdrawal is here kzfaq.info/get/bejne/rrSSdtKQ3rXLlWw.html In contrast, almost everyone I have worked with has had trouble starting or continuing on Strattera. If you look at the comments on this video kzfaq.info/get/bejne/ld50hsmivKuXc4E.html it seems that while some people have had good success with Strattera, it is more common to have a miserable experience. In my clinical experience Cymbalta's benefit/risk ratio for treating ADHD is much better than Strattera's.
@FrankieOver50 9 күн бұрын
I've been on duloxetine for GAD and Fibro for 3 years. My ADHD however is markedly worse. I cannot concentrate at all. It's like it worked too well on my anxiety and I have no urgency or stress that I need to get things done.
@DrJohnKruse 9 күн бұрын
Some people who feel too calm on duloxetine feel more attentive on another SNRI, milnacipran (Savella and Fetzima) which has also been shown to be helpful with fibromyalgia. It has relatively greater strength on norepinephrine than on serotonin.
@FrankieOver50 9 күн бұрын
@@DrJohnKruse thank you. I’ll speak to my doctor. I’m so calm I feel like I’ve also lost my personality 😅
@carltonlassiter7724 2 ай бұрын
thank you so much for sharing your knowledge with these videos! i have 2 quick questions, if you don't mind: do you think duloxetine is more effective for treating adhd than bupropion? and, do you have an opinion on combination treatment with a non stimulant + amphetamine? i am sometimes taking low dose ritalin in the evening, after my dextroamphetamine during the day. it seems to calm me in a way the amphetamine doesn't, and helps me to just relax before bed. i would be interested in adding a non stimulant to the amphetamine, in hopes that it could add a similar calmness like ritalin does for me, and to provide some additional stability in between the d-amp doses.
@DrJohnKruse 2 ай бұрын
I've seen both buproprion and duloxetine work well for ADHD, but I have not been able to pinpoint any patient characteristics that identify who will respond better to one than the other - except if there is substantial co-occuring anxiety I would very likely try duloxetine first. I have worked with many individuals who have had good results from a combination of either duloxetine and stimulants or bupropion and stimulants, and usually it allows them to take a lower dose of stimulant than they otherwise might have.
@carltonlassiter7724 2 ай бұрын
@@DrJohnKruse thank you for the reply, much appreciated!
@angeloselarja Ай бұрын
@dr.johnkruse6708 would combining duloxetine with bupropion be a good idea?
@DrJohnKruse Ай бұрын
@@angeloselarja I've seen it help some individuals, and others where it either didn't add value, or contributed to anxiety and over arousal. If it is an option you pursue, I would start with a low dose, and see what your personal results are, good or bad.
@sarahtaher1531 Күн бұрын
I am taking Cymbalta and I was considering adding wellbutrin too. Did you try it? @@angeloselarja
@afser1533 3 ай бұрын
Is amantadine anticholinergic? I have been taking it for ADHD. It has a very subtle effect, I noticed I can focus better while reading and my mind doesn't wander after every couple of lines. But I heard that it's anticholinergic and I think maybe I am a little dumber on it. Does Duloxetine help with the motivational aspects of ADHD? Task initiation, productivity, executive function?
@DrJohnKruse 2 ай бұрын
Amantadine appears to have some anticholinergic side effects in humans, but in animal studies the molecule doesn't seem to bind to acetylcholine receptors. I've had some patients report improvement from duloxetine with motivation, task initiation, and productive
@richwilson5969 27 күн бұрын
Hard to understand your voice.
@FlynnaYoutube 24 күн бұрын
He is in the process of transferring all his live videos into edited videos with better audio, you can already see the first ones being uploaded in the last few days. The edited version of the Duloxetine video will come out at some point. Have a good one
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