Medication for depression; CBT - any experiences?

[Matej_Blaha]

Hey!

Hope you’re all doing well!

I wanted to ask what experience do you have with medication for depression & anxiety? I don’t really know where is the boundary between ADHD symptoms and anxiety and depression. I am unable to do anything a lot of the time because of low levels of dopamine and associated brain fog and executive dysfunction. I am inhibited all the time and it is socially debilitating as well.

This means for me that I am unable to keep up with my life and studies (2nd-year undergrad) and I tend to withdraw from everything - even leaving my room becomes problematic then. Naturally, I don’t have any stimulation and I am becoming more and more depressed when this happens. I only have a few classes per week, so no one can really notice, and it is hard to even gather the energy and motivation to do something with it (plus the shame).

I am on 5mg methylphenidate 2xday as other medication didn’t seem to help that much and a higher dose came with an increase in heartbeat and anxiety. I have just started a CBT therapy and was encouraged to start antidepressant medication as well.

Can anti-depressant medication improve my symptoms even though they are attributable to ADHD? Is it worth it? If so, which type of antidepressant?

And secondly, does anyone has an experience with CBT? How should I approach the therapy and talk to my therapist when the main cause of my troubles is not maladaptive cognitive schemas, but symptoms of ADHD that have led me into this situation, and thus limited internal resources to cope with my situation?

Thank you!
Matej

[annamaria]

Hi,

as you can assume, I am not the best source for an answer that helps, but I assume I can share my experience and you could talk to a doctor/specialist.

I believe an antidepressant on top of the ADHD medication can/could help. I also believe I waited too long to start with that kind of therapy.

(Again, as I am not very well, this is what I am trying now, you should talk to your doc.)

The ADHD and the extreme impaired stimulus filtering often take more energy as I realize. Or I realize too late that the load I take is too much. Therefore I have problems sleeping or taking a break. It is easy for me to hyper focus. And this is were the circle starts. Being overworked and sleep deprived I slide into a depression not realizing it. And than I sometimes “beat myself up” for still not tackling it and don’t realize that my expectations are too high.

First I believed ADHD medication alone should work and I should just not be so lazy. Than I realized it really gets worse…

So now I take Buproprion (which I am told is mainly and antidepressant) in the morning. It really lightens me up, before I had trouble leaving the house.
As ADHD medication I take Lisdexamfetamin (LDX), both together get me going, but I really at the end of the day am even more sensitive to my non working stimulus filter and hear, smell, see everything. Everything distracts me and keeps me from sleeping.
Here I got melatonin for the evening. Agomelatin.
Now I believe CBT could work instead of the Agolmelatin in the evening. I had some tea once and actually I was gifted a CBT containing body butter which I used yesterday after I was in the woods and a hot shower and I slept as good as I hadn’t slept this year before. Now, I can’t tell you if it was the walk in the nature, the hot shower or the CBT cream.
But I found it very interesting.

I do believe that a higher dose of my Lisdexamfetamin (LDX), would not have helped me the same as the Buproprion seems to help.
And after all, I am not in a good condition. But this is also because of some real fact not good “circumstances” and could also be because I am a woman in the age of hormone changes. Even though my gynocologist says this won’t count in my case.

I don’t know if this helps. But for my case, I would approach it by saying that I would want to see if it calms me down in the evening and helps me to get some sleep and when I sleep I am less anxious.
I personally would “never” take it during the day, for I would be scared that it slows down my brain.
I never took methylphenidate. Can’t tell you anything about that.

[annamaria]

I messed up CBT and CBD

I just realized, when I made myself a tea. Lavender in this case.

Yes, I am opting for cognitive behavioral therapy as well. Haven’t found a therapist yet. I believe it is good also schema therapy.
I had dialectical therapy some years ago… but I really want to give it another try.

Will not cancel the above answer. And really can tell you, this made me laugh out loud. Some ADHD here on this side. Thanks for making me laugh.

[Matej_Blaha]

Thank you very much!

@annamaria

I don’t know if this helps. But for my case, I would approach it by saying that I would want to see if it calms me down in the evening and helps me to get some sleep and when I sleep I am less anxious.
I personally would “never” take it during the day, for I would be scared that it slows down my brain.

I luckily don’t have that much trouble with sleep now, and CBD with melatonin and a walk outside seem to do the work. Anxiety and depression are quite unpredictable for me, it can get really bad sometimes and then it completely disappears. I am sorry, what is it that you wouldn’t take during the day? Buproprion?

I hope you feel better soon!

[Matej_Blaha]

Well, that happens, CBD does help too!

In addition to what you’ve mentioned, Lions Mane seems to be beneficial for memory… or at least I feel like it is

[annamaria]

No, I meant CBD. As much as I don’t like to be anxious, I really don’t like anything that makes me too calm.

[Dawnslayer]

My therapist isn’t the best at ADHD stuff (she tries but I get the feeling I know more than her sometimes), but I have done CBT with her. Basically, it’s a lot of talking about the thing and then going over (repeatedly) what I’ll do differently to cope with whatever the problem is. It’s all about hitting the pause button and then starting your coping method.

[j_d_aengus]

@Matej_Blaha

what experience do you have with medication for depression & anxiety?

I was diagnosed with anxiety at the same time as I was diagnosed with ADHD. I took an SSRI medication for a few months, until my doctor and I both agreed that I didn’t seem to need it anymore. (I had already left the circumstances which had caused the anxiety, when the anxiety didn’t go away, I knew I needed help.)

I also was going to counseling for the anxiety, and for my first steps in treating my ADHD. About a year later, I met with a different counselor who taught me some CBT techniques and reinforced that what I already knew and was practicing for mindfulness meditation is correct.

@Matej_Blaha

I am on 5mg methylphenidate 2xday as other medication didn’t seem to help that much and a higher dose came with an increase in heartbeat and anxiety.

The first ADHD medication I was on was Adderall XR, but because higher dose increased my heart rate, yet did not improve my ADHD traits over the starter dose. I felt like Adderall was not the right prescription for me, and so I asked my doctor for a change of medication. I specifically asked for atomoxetine (a non-stimulant, known by the brand name of Strattera), and I’ve been doing well on it ever since.

I do admit that I functioned pretty well on the combination of the SSRI to treat anxiety and the low dose of Adderall XR. I was doing better and I ever had before in my life, but the addamoxetine works better for me than Adderall ever did, and it has its own mild SSRI properties. Since starting on the atomoxetine, I have not needed any supplemental SSRI medication.

• (I have gone through depression and through anxiety since starting this medication, but between the counseling, therapy skills, and medicine, I have not needed anything stronger to rise again to feeling like my normal self again.)

[Matej_Blaha]

Thank you!

It is great that she tries to understand!
I don’t think that there would be many therapists that know a lot about ADHD since there is a lot of variation in symptoms and a lot of controversy and stereotypes in research, this is my main worry since some experiences are impossible to explain. And if this would turn out into yet another frustration, I am not sure where it would take me. Luckily my therapist seems to be quite understanding so far.

[Matej_Blaha]

Thank you!
This gives me some hopes.

That sounds like worth the try, both the SSRI and atomoxetine perhaps. I have actually started on atomoxetine as this is the only prescribed drug over 18 in the Czech Republic, it didn’t seem to work so I’ve stopped taking it and then started lisdexamfetamine some 2 years later in the UK, I was a bit disappointed with it so I’ve switched to methylphenidate, but higher dose than 5mg 2x day really didn’t do me well and 5 mg is nearly nothing. Perhaps I would respond differently to atomoxetine as it is some time since I’ve tried it and it was a low dose. What seemed to perhaps bring some more clarity over time is Lion’s Mane.

Glad you’re better now!

[j_d_aengus]

I understand that the stimulant medications treat a dopamine deficiency (increasing available dopamine in the brain).

Atomoxetine is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). It primarily works like an SNRI, plus has mild SSRI effects. (Note: norepinephrine is made from dopamine.)

Both dopamine and norepinephrine stimulate various parts of the brain to action, but they do so in different ways. Epinephrine (aka adrenaline) is related to norepinephrine.