Sorry for the long post exploring adhd meds for the last 2 years has been a personal project of mine. I wish someone told me these things to begin with since there really isn’t a great/easy to follow user guide to adhd meds.
You have NRIs Qelbree/Atomoxetine NRIs and Bupropion/Ritalin NDRIs. Which are variations on a theme but have different side effects profiles. The psychoactive effects all feel very unique. I haven’t tried Qelbree/Strattera.
Clonidine and guanfacine which are A2AAs. I just trialed Clonidine and guanfacine for the last year. My conclusions; yeah they quiet the mind but stacking them with sedating APs, not amazing. They, reduces signal noise so you are less hyper and scattered but the sedation over all means you are less active. Better for emotional control then active focus.
Modafinil which is really off label and doesn’t help so much with attention as it promotes wakefulness. Works via histamine theoretically, so should pair great with a sedating antipsychotic. However it keeps me awake on mine. The half life is 15 hours, which personally I find is way to long for practical use.
Amphetamine is great, if you don’t have schizophrenia. It is the one that has the largest mood altering effects. It can make you both mainic and psychotic. It is hard to be productive when you experience positive symptoms so I have stayed away so far. The amount of drug induced psychosis is staggering, quite high risk for a schizophernic. My doctor specifically mentioned not prescribing it to me. I kind of agree that it can at times be borderline/questionable to prescribe it in schizophernia.
Qelbree/Amoxoetine/Bupropion are good options if you want to avoid psychosis.
Clonidine and guanfacine are only useful if you combine them with modafinil/ritalin/amphetamine.
Modafinil/Ritalin/Amphetamine are only good if you have no current sleep issues and or combine with a sedative.
Modafinil is good if you are just looking to counteract the sedation of APs. Worth trying if you are feeling sedated. Combines noticeable well with Amphetamine/Ritalin but obviously you can stack it with other things.
Ritalin and Amphetamine work best but will likey exacerbate positive symptoms.
Guanfacine-Modafinil-Amphetamine/Ritalin will give best results if you dose right. My personal favourite recipe is 1mg Guanfacine/12.5mg Modafinil/5mg Ritalin IR.
It’s not productive if you don’t sleep so you need to take the Modafinil immediately when you wake up and then the Ritalin right before commencing work.
If you redose Ritalin IR your window is really not later then 11am-1pm. Consequently you have a super productive morning and then tail off with the day. This way you’re working with your circadian rhythms instead of against it.
You can’t go on forever with the stimulants. It’s best only to take them when you need to complete large volumes of work or when learning. Otherwise if you take them as a matter of course every day you can wire your brain on the wrong things. They are ultimately very powerful tools but need to be treated with respect and you need to take breaks. You need to work with them not expect them to do the heavy lifiting for you. As a result proper hygiene with stimulants means they have a limited use case. Something good to have lying round in your arsenal but not the be all end all. In the end they mostly don’t make life a more pleasurable experience so if you don’t really need them for a specific purpose they are best avoided to begin with.
To be honest if I could only choose one I’d pick Ritalin, hands down because when you need to GO and get ■■■■ done the other stuff doesn’t compare. In this way I imagine Ritalin again does not compare to amphetamines. That said I have boxes of ritalin and modafinil lying around they are the most effective but personally I’m not in love with taking them nonstop.
Bupropion is my favourite but that’s because it’s an antidepressant. Of the stuff I have tried bupropion is the only thing I would recommend to others. Ritalin and Amphetamine were once antidepressants but abuse profile, dose escalation, dependance they have flaws.
So I would say if you want something you will want to take everyday bupropion, if simply want something that works Ritalin.
Qelbree could work too but it’s pretty new so I haven’t read a lot about it yet. Selegiline, Phenylpiracetam, Bromantane, Sabroxy are things I haven’t tried which are on my list to get around to, they could potentially yield results also.
