graininthegrooves: sertraline, citalopram and undiagnosed ADHD

[graininthegrooves]

I used to have a brain capable of so much fluid thought and analysis. Yes there were low times, but I was quick and capable in my own mind. I am convinced my time on SSRI's has utterly destroyed my ability to think coherently and clearly. It has changed who I am. My internal monologues aren't what they were. They are echoes of the past. I can still write fluidly; so there's a silver lining! Parts of me are still me, but I know that I'm missing more than has remained.

 

This is especially infuriating for someone in my position. I now know that I have ADHD. I struggle daily with the trials of this neurodevelopmental disorder. I've struggled with it all my life, unknowingly. It's only this year that I've gained the awareness that I have it.

 

To those that want to know what it is like to have this condition. Imagine wanting to achieve, yet having a brain that fights you all of the way through any task that doesn't give it easy gratification. Imagine being time-blind. A master procrastinator that can't break through that procrasination without a jolt of adrenaline from an emergency of your own making. Imagine being useless with names and memory in general; yet never forgetting a face. Imagine, constantly being reliant on your subconscious to replace the conscious memory systems you don't have; meaning you have to feel your way through recall which leaves you very open to being gaslit.  Imagine being labelled as lazy your entire life; despite that not being the truth nor what you desire most. Imagine watching all those you grew up with furthering their careers and becoming something; whilst you are incapable of achieving anything without risking quick burnout, trauma and losing pieces of yourself in the process. That's ADHD.

 

Interestingly, it's widely recognised that with us ADHDers, we a have a tendency to develop high emotional intelligence as a coping strategy. We also spend so much time in our own brains that our innate abilities to think, critique and come up with out of the box ideas are our strengths. Our brains become both our best friends and worst of enemies.

 

So with this in mind, imagine the effects of the past nine years on citalopram and later sertraline for someone with ADHD. The effects have been to systematically chip away at the parts of myself that made living with this condition bearable and my adult self even remotely functional. My emotional intelligence is impaired by my inability to experience the broad range of emotions I once had. My thinking impaired in so many ways I can't list them all here.

 

I've bounced in and out of this forum over the years. First to help wean myself off of citalopram and now to begin tapering sertraline. Today, I had enough spare dopamine to join and write an introductory piece. Those of you who contribute and have done hard work and gone before us all; I thank you sincerely from the bottom of my heart. You have paved the way for those that come after you so that we may have a smoother ride on this harrowing rollercoaster.

 

To the CEO's of pharmaceutical companies who've peddled these nightmares in pill form I say: you will lose. There are enough tragic stories on here and ongoing lawsuits around the world to know that this ship is gaining speed. I am so angry with what your likely criminal actions have done to my body and my brain without my consent. If I get through this, I hope to help contribute to in some way to making your working lives hell. To speak more broadly, it is your consistent and flagrant disregard of the rules in favour of profit that have begun to erode the very foundations of evidence based medicine. The time has come to do something about this. Perhaps we can begin by breaking these vast monopolies up into smaller pieces? Anyway, that's a discussion for another day.

 

In the meantime, hello to you all on this forum. My name is graininthegrooves and yesterday I began tapering off of sertraline via a hyperbolic regime of 10%. I am now down from 100mg to 90mg.

[Shep]

Hello, Graininthegrooves.

 

Welcome to Surviving Antidepressants.  

 

Please note we don't recognize ADHD here as a medical diagnosis. We understand that some folks have more trouble concentrating and working within certain boundaries, but we don't subscribe to the chemical imbalance theory that upping dopamine with stimulants is the answer. In fact, the long term studies on this are not good. We have a number of members here who have been harmed by this diagnosis and treatment.

 

I wouldn't attach your identity to a psychiatric diagnosis. Many people who end up with that label have long histories with these drugs and it's a case of "your drug is your problem" or they are simply more gifted in things that our current toxic culture doesn't value. Also, people with trauma, especially childhood trauma, tend to have more trouble with concentration even as adults. But the answer isn't stimulants. You may want to read Robert Whitaker's book Anatomy of An Epidemic.  It comes highly recommended here. 

 

You may also find this link interesting. It's about children and ADHD but it gives a good explanation regarding stimulants that you may find helpful. 

 

Mad in America - ADHD info

 

As you read more, you'll find all sorts of wonderful coping skills besides using drugs, ways that will allow you to use your talents without poisoning your body with drugs. 

 

I read in your "my history" section you wrote "Taking lisdexamfetamine alternating days and as needed."

 

Please note we don't recommend alternating doses for any psychiatric drug, especially while someone is tapering. 

 

And there's a MAJOR drug interaction between lisdexamfetamine and sertraline. See:  Drug interaction report

 

Please be sure you're taking these two drugs at least 2 hours apart to help reduce the likelihood of a dangerous drug interaction. 

 

We can help you taper off sertraline in order to lower your drug burden, but the alternating doses of the stimulant may cause problems. People taking stimulants will sometimes increase their use in order to mitigate withdrawal symptoms from their other drug. The fluctuating levels of the stimulant in your blood stream may also cause upticks in symptoms. It may even lead to kindling. 

 

Hypersensitivity and Kindling

 

If you develop insomnia from the sertraline withdrawal, being dependent on a stimulant is one of the worse things possible, as it makes insomnia worse. 

 

Ideally, you would want to come off the lisdexamfetamine first. The half-life of this drug is 10 - 12 hours. So it's possible you could become dependent on it by alternative days with as needed use, as you mention. That means that some days you're either doubling up your dose or you're taking it on your off days. 

 

I can leave you some links to read about tapering sertraline and I'll also provide one for the stimulant, as it has important information about that drug, whether or not you decide to taper it: 

 

Tips for tapering off sertraline (Zoloft)

 

Tips for tapering off lisdexamfetamine dimesylate (Vyvanse)

Why taper by 10% of my dosage?

 

The Windows and Waves Pattern of Stabilization

Taking multiple psych drugs? Which drug to taper first?

 

Please set up a signature. Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature:  Account Settings – Create or Edit a signature.

Please continue to use this thread to document your taper and to ask questions. 

 

 

[graininthegrooves]

I very much appreciate the length of this post and the time it as obviously taken you to collate this information. So I have taken my time to follow this up with a detailed post. I also understand why some hold the view that ADHD isn't a valid diagnosis. That's their choice and experience. I respect their view. I'm also very aware of sertraline's interaction with lisdexamphetamine, and my psychiatrist has taken me through how to keep an eye out for serotonin syndrome. However, I personally have struggled the entirety of my childhood and adulthood with ADHD. There are so many reasons why this is obviously a part of who I am that I'm not going to list them here. So thank you for the information, but I've fought hard to get to where I am, have now experienced for the first time in forever some level of functionality and so I'll be keeping on the amphetamines.

 

What concerns me is the blanket statement in your post about the entirety of psychiatry. Does this reflect the attitude of the entirety of this forum? Because it seems to be if I may use the word, dogmatic, rather than nuanced. If we ask ourselves what psychiatrists do fundamentally, the best analogy is to call them engineers of pathological brains. They have various tools at their disposal in the form of pharmaceuticals; these tools give them the means to do good as well as harm. As such, people's experiences are going to differ depending on many variables such as: who treated them, how appropriate the drug choice was, how their bodies reacted to that drug, how the pharmaceutical companies manipulated the trials, after-care, drug reviews etc. In the same way that psychiatrists and medical professionals at large have a tendency to over pathologise because that's how they've been trained, this forum must realise that all it sees are those who've been dissaffected and let down by psychiatry. The success stories have no reason to visit here and contribute. So it's important to recognise that if one solution is a bad one you don't then discard all other unrelated solutions for all problems. This isn't a logical approach to any discipline and it concerns me that this forum has adopted this as policy. Each one, whether that be a class of drugs, or a single drug should be examined individually.

 

To speak more broady. From my perspective, there are multiple conflicting forces at play affecting mental health services. A lack of sufficient funding is a major one. Pharmaceutical monopolies, both their direct influence on healthcare systems (the USA being the worst of the bunch) and their influence on evidence based medicine, is another. The youth of psychiatry as a discipline when compared with others such as modern medicine shows a comparitive lack of a wealth of evidence.

 

I've had a look through the evidence of "ADHD - Mad in America" in your post. I'm really not impressed. It's a clever piece of misinformation. The vast majority of the broad and well researched evidence base that exists for ADHD outcomes, directly conflicts with much of the ideas in this articles' select pieces of evidence. Unsurprisingly, the pieces of research referenced are misquoted and cherry-picked.

 

The article cherry-picks from the abstract rather than demonstrating comprehension of the entirety of each piece of research. For example: https://www.madinamerica.com/wp-content/uploads/2011/12/Mta at 8 years.PDF in this article the "impairment in adolescence due to medication" quoted is actually due to teens not adhering to taking their medication. Rather than the drugs causing the impairment as the article presents it, it is the lack of drugs / yoyoing of on an off again treatment that causes the impairment. Another piece of evidence is the "canadian study". This isn't even a study at all, it's a working paper. Which is a fancy name for a literature review loosely discussing other people's research rather than conducting its own or collating it into a statistically analysed systematic review. Also, the Australian 10 year study was misquoted as well, this is the relevant quote required for context, "This is consistent with previous research and suggests that children diagnosed with ADHD have an underlying condition that impacts negatively on a range of long-term life skills." So rather than the medication causing depression and anxiety, the study actually concluded what was already widely accepted, that ADHD kids struggle with many issues long-term, including depression and anxiety!

 

"Mad in America" is an atrocious piece of writing, designed to make you believe a narrative at a glance, but under inspection its arguments fall apart. The entirety of the article hinges on its proving that long-term outcomes are negatively effect by ADHD medication. As I have demonstrated above, it doesn't just fail to do that, it outright misrepresents findings.

 

The article conveniently omits the more recent pieces of research that have a larger population or are systematic reviews or meta-analyses. Here's a good example: https://pubmed.ncbi.nlm.nih.gov/23698916/. There's also vast amounts of research done showing how ADHD is genetically inherited. As well as demonstrating the physical differences to neurotypicals at dopamine receptor sites: https://pubmed.ncbi.nlm.nih.gov/22610946/. What struck me as particularly enlightening when conducting my research into this subject, is that the ADHD brain is measurably physically different to a neurotypical one. It is literally viewable on an MRI! The caudate and putamen are smaller in those with ADHD: https://pubmed.ncbi.nlm.nih.gov/7977887/.

 

The dopamine theory of ADHD has yet to be undermined in the literature base. Whereas the serotonin theory of depression has been found to be false in recent research.

 

To talk about where we are right now in terms of the research base, the most recent pieces of research into the direct changes to the youth brain on ADHD medication suggests that, whilst their are long-term permanent changes, these effects are likely positive in nature. This also coincides with many users extensively reporting outgrowing their ADHD medication in adolescence. We however have no idea if this is also true of the adult brain. If I were to gamble I would say likely not; so my lack of medication as a child will always haunt me to some degree!

 

Nuance and an open mind is what's required when approaching any scientific discipline. How can we seperate CPTSD and ADHD when the current evidence base only demonstrates a relationship and nothing else? We can only have opinions about what has not been studied. I agree that cultural values are a possible cause of poor treatment for ADHD, but again that's yet to be studied properly. I also have the opinion that things such as ADHD and OCD exist on a complex spectrum with other yet to be discovered ideas. I'd guess that the research is heading towards a complex inter-relation between trauma, ADHD and genetics. But again, it's only an opinion.  

 

This is why fundamentally, it pains me and worries me to see yet another line being drawn here on this forum. Interestingly, the opposite end of the scale exists at the r/ADHD subreddit. I think there's room for nuanced opinion in the absence of reliable research. There's strength in admitting what we don't know. There's also strength in being humble about being fooled by articles misrepresenting pieces of research.

 

In the mean time I'm going to continue taking the medication for people with ADHD like symptoms. As the research supports, it is the best treatment currently available. Without it, I am severely disabled 95% of the time. This is no way to live a life.

 

[Shep]

On 10/26/2022 at 11:19 PM, graininthegrooves said:

In the mean time I'm going to continue taking the medication for people with ADHD like symptoms.

 

Thank you for taking the time to write out your position.

 

As we're a site for coming off these drugs, this forum is not the best fit for what you need. 

[bunchesofoats]

Hi @graininthegrooves, thanks for sharing your story. I'm also a sufferer of ADHD and relate greatly to your experience. Managing ADHD symptoms while experiencing SSRI withdrawal has been a whole new world of challenges. It sounds like the Vyvanse is successfully helping you manage ADHD symptoms, so I wouldn't change what's working. You also don't want to make too many changes at once. If you haven't already read about the basics - get some omega 3 and magnesium daily. Omega 3 to help your brain heal and magnesium to help with relaxation. These are the only two supplements I've seen recommended across the board and have been helped by myself. I take a magnesium supplement at bedtime and omega 3 with breakfast.

 

How is tapering the sertraline going?

[Altostrata]

We don't argue with people if they want to continue to take their drugs. Hope it all works out for you.

[Twilly]

Hey @graininthegrooves, I found your post last night and looks like we have a lot in common. I was also diagnosed late as an adult. I, too, went through really difficult experiences trying to keep a job before I even touched any meds or even recreational drugs.

 

I really hope your taper is going well. I also hope you haven't abandoned this forum because it is the best place for guidance on tapering out there. We all have different perspectives and backgrounds. It is true that the best harm reduction advice is not to put any psychotropic medications (and even supplements) into your body. At the same time, I see people here who have held onto their doses or even bumped back up to their full dose based on their needs. There is no need to argue over a diagnosis if you feel a medication helps you at this moment.

 

Honestly, even though there are brain commonalities across (most) people diagnosed with ADHD, we still cannot diagnose ADHD through a brain scan. That alone is telling to me. At one time, I really hoped a Dr. Amen SPECT brain scan would be the answer, but it is still controversial and HIGHLY speculative. I personally think a diagnosis has some limited usefulness as a guiding entity to match a person with a possibly effective set of treatments. Even if a person gets a quality diagnosis, though, none of the best practice treatments for that diagnosis may work for the person at all. I worked as a child therapist prior to COVID and have seen the occasional child who would have a very slow response to best practice treatment, with a lot of backtracking. I remember even reading a study showing that stimulant effectiveness in people with ADHD is not significantly effective in improving quality of life for the group studied long-term. I've actually worked as a part-time researcher myself (in a slightly different area though) and do enjoy compiling my own research lists on this.

 

I feel like maybe I could offer you a bit of insight from pretty much the last year of really strange things happening to me and my body as I've been tapering from my SSRI. I've muddled through hours, days of researching relevant aspects and consulted with a bunch of people, including several doctors. This is not medical advice, but I spend quite a bit of time around people who work in harm reduction and who regularly work with medical professionals.

 

First off, I've only been on my SSRI for two years, but the brain fog you describe will get lifted over time. It may take months or even years depending on your biology, circumstances, etc. I started noticing huge improvements in my mental clarity several months into my taper. I am realizing I can only leverage this improvement if I keep my taper very slow, which you are hopefully still doing!

 

Second, Shep's advice of keeping your Vyvanse consistent while you are tapering off is absolute key. Here, consistent not only means taking the same dose each day, but taking it at the exact same time each day. It has a pretty long half-life. If, say, you took it later one day and earlier the other day, there will be more drug in your system at the time than your body is used to. Because your nervous system is sensitized from every change you make to the SSRI, a slightly higher dose might hit its sensitivity limit and send you into an adverse reaction.

 

I say don't worry about tolerance. It takes months to develop tolerance to taking a therapeutic dose of a stimulant as I mentioned at a consistent time daily. I thought I was developing a tolerance in the past, but am now wondering if that was the SSRI dampening its effect. I am not noticing tolerance anymore ever since I started an ongoing taper. I do notice the dampening effect when I take my SSRI - part of why I take it close to bedtime - more on this later...

 

Throughout my own taper, I've learned how crucial it is to pay attention to the half-life of all medications I take. It is important to re-dose in a way that either keeps its level as consistent in the body as possible. In the case of stimulants, where you want them to wear off at least somewhat before you go to bed, I suggest getting a small booster dose later in the day to "soften the blow" of sudden reduction of it in your body. Keeping levels of all other meds consistent will help your body reach homeostasis faster and easier as you reduce your sertraline dose. 

 

Third, you are taking a stimulant, which means it's adding stimulation for your body. Again, when you are already de-stabilized by your sertraline dose change, you want to keep all stimulation to a minimum - no overly intense exercise, limit stress and major life changes, etc. For those of us who cannot avoid the extra stimulation, like you and I (I work a physically demanding job as well), I think it is even more crucial for us to make sure to make everything else consistent, too. Sleep and food are natural medicines for the body and also need consistency, especially in the first couple weeks after a dose change. I went to bed an hour later last night, woke up with a headache, and all of my biological functions were completely thrown off. I felt less motivated and more "blah" overall. My responses to my daily dosing were not as good, either. Just yesterday, my night and morning went exactly according to routine and it was a very smooth day. Depending on where I am at, this disbalance can even take more than one day to recover from.

 

I've realized that cortisol starts rising after midnight, which is why I have trouble sleeping if I go to bed then. Amphetamine can exacerbate cortisol (https://www.nature.com/articles/1395751) and SSRI w/ds exaggerate natural fluctuations in cortisol throughout the day (e.g., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267127 but a lot of research on this), so we need to be extra careful of aligning ourselves with our natural cortisol rhythms: 

 

Lastly, I've had to be mindful of the stimulant-SSRI interaction when dosing. For me, the interaction sensitizes my system similarly to the sleep thing I described above. I get jittery, disoriented, start feeling a dull headache, and generally just get "thrown off". I found that dosing my SSRI at night about two hours before sleep, when there is probably less stimulant in my body, has worked best. The two hours is because I do find it a bit activating at first. It is also an SSRI and I try to do something serotonin-boosting in that two-hour window to make it more effective in helping me dose off. I am no longer taking it for its "therapeutic effect" anyway, so why not leverage its drowsiness-inducing properties?

 

This is all. I really hope this gets to you and, if not, to whomever else is still struggling and looking for answers. I really wish I could have some of this advice readily available to me when I first started, rather than putting my body through so many stressful adjustments in trying to find what worked. If only the doctors would actually provide us the information we need on all this from the get-go...

 

I will be chatting with a psychiatrist next month, too. Hoping to get a few further answers, confirmations, and maybe leads to some more nifty research on any of this. Open to any questions, too!

[graininthegrooves]

Thank you all for your responses. I respect your opinions, lived experience and knowledge and appreciate everyones input. Especially the research papers (thank you @Twilly) I'll be having a read of those in the next few days, if not after christmas. I have to admit I was little put off by some of the initial responses as it made me feel pretty invalidated despite how much I've researched and how hard I've fought to get where I am with all of this. But, having taken some time to reflect, I now realise it was coming from a place of love and concern so, thank you. There was also some advice in there I probably should have listened to, but I'll get to that in a minute.

 

At first my withdrawal symptoms from sertraline were pretty much limited to a small bump in anxiety the day or two after taper and exceptionally vivid dreams. I had one day of weird sexual arousal at things that wouldn't usually get me aroused! But that subsided very fast. I've been taking my heart rate and blood pressure regularly to keep an eye on my cardiovascular system and this wasn't abnormal in anyway for the first three tapers.

 

I continued tapering roughly every two weeks or so. However, in the past few weeks I've been noticing heart palpitations, they kind of feel like little burps and a few days ago I had around 5 seconds of tachycardia and atrial fibrillation. It was the most odd sensation. I am familar with heart palpitations and these are one of the first symptoms I get when I've missed my dose of sertraline. As I take it first thing when I wake up I often know immediately upon waking if I'm withdrawing.

But this sensation was new. My blood pressure is in normal range, a little variable but normal, however my heart rate has been on the higher side for quite a lot of this past month. Always below 90, usually between 76 and 85. For me that is slightly higher than usual, I am normally between 65 and 75 as a rough average. I've also noticed the stimulants when I take them have started giving me tension headaches half way through their active time.

 

I have a feeling that this is due to what some of you have warned me about. But of course I didn't listen. Definitely eating that humble pie right now. I've been taking my stimulant medication intermittantly as required, rather than regularly at the same time every day. Whilst this has been great for my productivity, organisation and general life stuff, I am guessing that the bouncing and yoyoing occurring is having a negative physiological effect on homeostasis as you explained above @Twilly. On top of this there was some family drama prior to christmas which has massively triggered my CPTSD and I feel that all of this has taken its toll on my heart to some degree. I am much calmer now though, and have decided space from the family issues is the most important thing for my health for the time being. Luckily I am in a position where I am not reliant upon them for financial or emotional support.

 

I also keep getting left jaw pain, stiffness and what feels like gunk and discharge into my sinuses/throat from this area. I've had this investigated by an ENT who did a dreadful job. All he did was check my hearing and then discharge me. Hearing was borderline, yet I had excellent hearing at previous test around ten years prior. I didn't get a chance to discuss this result with the ENT. Overall it was pretty dreadful care. However, I've noticed this pain sometimes gets worse when I have the tension headaches. However it doesn't seem limited to when I'm on the stimulants. And it predates the start of using stimulants.

 

One thing I wanted to mention in this post was that I was for most of the pandemic really dreadful with being consistant with taking the sertraline at the same time every day. I can now say that was because of my ADHD. I've since instituted a system that allows me to as consistant as I possibly can. However, before this I would on some days, forget I had taken the pill and and no doubt accidentally double dose. Looking back at this I realise this was stupid. I wish I hadn't done it. But my brain was unable to keep track of the medication at the time. I thought this might be useful context so it's why I mention it.

 

Getting an ECG and a doctor to listen to my heart would probably be the sensible move wouldn't it? I'm going to try and do that this morning, but I am number 27 in the call queue. I am in the UK so getting a checkup right now is the opposite of easy. Every GP is overbooked and overworked. Healthcare workers are on strike. I am also massively triggered by approaching GP's or emergency workers for this kind of support. I've had nothing but bad experiences with them for a very long time. It's not their fault, they are overstretched and worked, but I am concerned approaching them will do me more harm than good. I do feel a bit trapped.

 

What I am tempted to do right now is to quit the stimulants entirely for the time being and see how my symptoms are in the next few weeks moving forward. If they improve overall then I'll stay off of them and continue on with the taper. If they don't I'll seek more urgent medical support. Some reassurance and any thoughts and experience you might have would be most welcome.

 

With regards to supplements I'll definitely have a look at those @bunchesofoats thanks for the recommendation.

 

@Twilly I will respond to your incredibly detailed and well thought out post soon. Right now though I am out of dopamine and am going to try and meditate for a bit. What you've said makes a lot of sense and I want to do it justice and will no doubt have some questions for you.

 

[Altostrata]

You have been tapering sertraline too fast, and you have withdrawal symptoms. Please re-read

Why taper by 10% of my dosage?

 

Tips for tapering off sertraline (Zoloft)

 

If I were you, I would stop tapering for a good while and let your nervous system settle down. Do not further upset it by suddenly quitting any other drugs.

[graininthegrooves]

So I did manage to see a doctor and have an ECG done. They found a single ectopic beat along with my RBBB although the doctor said he wasn't concerned and in his experience this is a normal reaction of the body when withdrawing from certain drugs. Same with the atrial fibrillation event. That said I've been referred for a ECG week long monitoring, but it's a six month wait. Overall Doctor was actually pretty attentive which makes a welcome change. I also asked him to lower my ADHD meds down to 30mg (I have been off of these since 20/12/22) and have not taken any over the christmas period.

 

@Altostrata A good piece of advice. I'll take another month at 65mg and see where we're at. And yes, I was trying to skip ahead with those doses! I need to get used to eyeing the long game during decision making on this. This is not and ADHD person's natural instinct so please bear with me :). If I do reinstate I'll do so slower at every four weeks and see how that goes. It's a shame, as I was planning on quitting smoking this week. But I guess I need to think about organising that for when I've stabilised my taper at a certain level rather than doing both at once.

 

@Twilly Thanks for your wonderfully detailed and interesting post. I devoured it. Very useful and well written! I'm coming around to all ya'lls way of thinking on this. Balancing the nervous system is top priority. The only issue is I can see a rather large barrier immediately in front of me. First of all I have a non-24 hour sleep-wake cycle. Which essentially means I have 26 hour days and my sleeping pattern goes around the clock every 12 days or so. I've been this way since puberty and it has many drawbacks. One of these is taking my pills consistently every day like clockwork. My sertraline dose has been rotating around with me. And this has been working at 95% effectiveness or so. Do you think I should continue doing the same with the stimulants when I start back on them? I will need to push the sertraline towards bed time as currently I take it when I wake. I'll try to get a booster dose from my psychiatrist, unfortunately my medication review isn't due for a while and I can't really afford to pay for a review at the moment. But, I'll pop it on the list.

 

Also what you've mentioned about cortisol sounds interesting. Is there any further research you could point me towards or tips on how to navigate the cortisol rhythms of the day effectively? I find that, the latter part of my day is always the most productive. I'm at least partially assuming as my body has run on cortisol and adrenaline for a long time in the place of healthy dopamine receptor sites.

 

Thanks for sharing some of your personal research on ADHD as well. It's always good to hear other view points. I'm curious what area of research your specialty was? Have you seen this meta-analysis discussing the identification of ADHD in children via structural abnormalities? https://pubmed.ncbi.nlm.nih.gov/31014101/ I agree that imaging diagnoses haven't yet been proven reliable enough to use clinically. But just to be clear, the way I use this particular piece of information in a debate is to try and get the other person to see that there is a literal structural disability in the brain. Not to convince them that diagnosing ADHD via imaging is a good idea. I'm sure we can both agree that this is another beast entirely!

 

And finally, thank you all, and especially @Twilly. That was some post. I've saved it and may return to it for future reference as I will inevitably forget about it in five minutes time. If only I could get a RAM upgrade...

 

 

 

 

 

[Altostrata]

You also quit lisdexamphetamine while tapering sertraline? That's another drug that can cause withdrawal symptoms, as well as cardiac symptoms on its own.