need help with balancing meds and supplements

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    • #50871
      microfish
      Participant

      Hi everyone,

      I’d like advice on the most optimal and sensible way to balance my meds and supplements. Which ones might interact, which should be taken together, which ones might benefit from being taken at a particular time of day, and so on. First a little background on me, in case it helps:

      I’m a 38 y.o man who very recently discovered he had ADD. It had never crossed my mind that I might have ADD/ADHD (mainly because of ignorance, and the misleading name of ADHD – I’ve never been hyperactive and, having a tendency to hyperfocus, “attention deficit” never sounded like me). But when I learned about the actual symptoms of ADD a month or so ago, almost by accident, it was like a thousand jigsaw pieces from all parts of my life just suddenly came together and fit. I’ve since been diagnosed, and have responded very well to Ritalin (no side effects, increased focus, mental calmness, can much better handle mental/social discomfort). I’m on 15mg x3 times a day, which appears to be a good dosage for me (10mg was pretty good but occasionally didn’t seem enough…15mg hasn’t felt much different, but appears a little more reliable.)

      I’ve had all the hallmark symptoms and problems of ADD (except hyperactivity) throughout my childhood and youth: impulsivity, underachievement, restlessness, difficult relationships, low self-esteem, disorganisation, chronic lateness, etc. However, by this stage of my life, I’ve done pretty well in minimising many of the worst offenders, through a combination of good fortune, learning the hard way through trial and error, a successful treatment with Zoloft (for depression/anxiety), and an amazingly supportive wife.

      After many rocky early years and a lot of mutual hard work, my marriage is great, as are most other relationships. My brooding temper and spiraling negative thoughts are under control, thanks largely to Zoloft and good counselling therapy. My self-esteem is good. I’m still messy in some areas of life, but have taught myself to become impressively organised in other ways, despite having spent my teens and 20s in chaos. For example, I eventually learned in my 30s that I can handle tasks much better when I first break them down into tiny subtasks, which as I’m learning is ADD 101. And after being chronically late to every job I’ve ever had, and struggling immensely with motivation once I was there, I eventually found a way to work for myself, doing something I really love, which solved both the lateness and motivation problem.

      So, the main areas that still give me a lot of grief are inattentiveness and distractibility. As I mentioned, I work for myself – on a large project that will only provide income once it’s complete…so there’s no time to waste! But despite loving what i do, I’ve always struggled with distractions, focus, and motivation, which is particularly stressful since much of my family’s livelihood depends on whether I can pull this project off or not. I’d estimate that in a given work day, I fight with distraction every 2 minutes on average. Sometimes I win the fight (which still throws off my focus) and sometimes I end up spending two hours on Wikipedia reading up about Pee Wee Herman. Ritalin has helped in this department, though not entirely, and I seem to hit a slump in the afternoon.

      So please keep this mind – my ADD treatment needs to really optimise the focus/attention aspect most of all. If possible, I’d like to hit a balance of meds and supplements that can sustain my focus for the whole working day (and evening, when I also often do work…I need to work around my 2 young kids’ needs), without the afternoon slump that often hits me.

      OK, so here’s what I’m taking at the moment:

      Ritalin LA 30mg (7:00)
      Ritalin IR 10mg: (14:30) (may increase this one to 15mg…also tempted to take another one at 18:00 so that I can have an ADD-free evening)
      Zoloft 150mg
      Multivitamin
      Zinc

      After doing a bit of research, I’ve also ordered a bunch of other supplements, which haven’t arrived yet. I’ll gradually incorporate these one by one into my routine.

      Omega 3 with EPA and DHA
      Rhodiola Rosea
      Magnesium
      L-Tyrosine
      L-Carnitine

      I’d appreciate any advice you might have regarding these, and figuring out what the most effective way of staggering them out through the day would be. Here are a few concerns/questions/remarks I have:

      Zoloft> This has been very successful for me when I first went on it, and was a godsend. After a few days when it started working, I woke up one day and felt *pleased to be alive*. Not euphoric, or dreamy. Simply content to be alive and actually looking forward to the day ahead. After experiencing this feeling, I realised that I’d not felt it since early childhood! I’ve been on Zoloft for 6 years, and it’s greatly improved my life, and I had no intention of ever going off it. Though since learning more about ADD and experiencing the calmness that I get with Ritalin, I think that some of my anxiety came from ADD, and once I get fully settled in with the ADD treatment, I’ll try lowering the Zoloft. For now, I’m wondering if I can take Ritalin and Zoloft at the same time, or if I should stagger them.

      Multivitamin> I’ve read that you shouldn’t take Ritalin at the same time as ascorbic acid (synthetic vitamin C) as it can reduce the effectiveness of the Ritalin. I’ve also read that this is an overblown myth, and that it wouldn’t have any adverse effect. Just in case though, I’ve been taking them separately, even though my multi doesn’t contain ascorbic acid but calcium ascorbate and acerola fruit extract.

      Rhodiola> Since ordering it, I’ve read that it’s an MAOI, and that MAOIs shouldn’t be combined with SSRIs (like Zoloft), due to potentially life-threatening effects. So I guess that one’s out.

      L-Tyrosine, L-Carnitine> I’ve read that as these are the building blocks of norepinephrine and dopamine, they can help sustain pre-frontal cortex activity even after Ritalin wears off, helping to stave off the post-Ritalin rebound/slump. If so, when would be the most optimum time to take these? And should I take them together, or staggered throughout the day?

      Thanks for reading, and for any advice you might have.

    • #50884
      Penny Williams
      Keymaster

      You definitely need to work with your doctor on adding supplements to your medication regimen. Ideally, you’d work with an integrative medicine doctor, as they are more versed in natural treatments. There can be interactions with medication, or interactions among supplements, so you must work with someone knowledgable on this.

      Here’s more information about supplements commonly used by those with ADHD:

      Vitamin Power! 8 Best Supplements for ADHD

      Adult ADHD Treatment Options – An Overview

      It very well could also be that you just aren’t on the right stimulant for you. There are many others to choose from.

      Penny
      ADDitude Community Moderator, Author & Mentor on Parenting ADHD, Mom to teen w/ ADHD, LDs, and autism

    • #50903
      microfish
      Participant

      As I said, the ritalin is working pretty well. I don’t have anything to compare it to of course, not having tried others, but it’s certainly a big improvement compared to pre-treatment. And promising enough that I wasn’t compelled to ask for a new medication.

      The main downsides are that I don’t feel ‘fully covered’ all day. The effectiveness seems to come in patches, and there’s often a late-afternoon slump. But from what I’ve read, that’s very common, and even normal. I may try Concerta once my current ritalin prescription runs out in 3 months, since it’s more slow-release than Ritalin IR and LA, but until then, I’ve heard that these sorts of ADD rebounds can be mitigated somewhat with well-timed supplements.

      Thank you for the links, but I’ve already seen them when I was researching about what I should consider taking – in particular, the “Vitamin Power!” one, which is a good summary, though contains only cursory information. Of the ones recommended there, I’ve gone with Zinc and Magnesium, though not with iron (I probably have enough from the copious amounts of broccoli, beans and greens I eat, and the form of iron in most supplements is mildly toxic). I’ve started drinking green tea for the theanine. Pycnogenol appears useful, though studies seem to suggest that it only makes about a 5% improvement, so I skipped that one. Valerian and Lemon Balm seemed less relevant to me, as I’m not hyperactive and I don’t have bad insomnia. Inositol is something I may look into one day, but it usually comes in a B complex multivitamin, which is a turn off for me because they almost always contain folic acid, which has been shown in studies to increase the risk of cancers (unlike folate, which is the healthy, non-synthetic form that’s found in food).

      So I feel that I’m beyond the “what should I take?” stage, and onto the “when should I take it?” stage.

      Apart from the Rhodiola, which I’ve already ruled out, the other supplements on my list (omega 3, L-Carnitine, L-Tyrosine, magnesium) are all things that I’m already eating every day in food, so I’m not overly concerned about adverse interactions. Though I am interested in perhaps fine-tuning their intake to optimise their effects.

      I know that if I ask my current psychiatrist about this stuff, he’ll look at me blankly and then go to his computer to google it. And I’m reluctant to seek out another expensive professional just to ask about what time of day to take my supplements, as I can imagine that the answer may well be “um, whenever it says on the bottle”. Though I guess an integrative medicine doctor would probably help.

      Would a neuropsychologist be likely to have expertise on these areas? My psychiatrist is from the old “do a quick assessment then hand out prescriptions like a vending machine” school, and I feel like I’m missing out on the benefits of getting actual therapy and counselling. A counselling psychologist would be good with the therapy, but would be unlikely to know enough about the chemical side of things and unable to prescribe meds. Finding a type of clinician who was well versed in both areas would be very helpful. Would a neuropsychologist perhaps be a good option?

      • This reply was modified 3 years, 4 months ago by microfish.
    • #50928
      Lys
      Participant

      I’ve been digging into the supplement world at length since I got to the point that the anti-depressant does more harm than good, and I’m phasing it out. If you cut yours, do your research and taper down very slowly (10% drop, hold for a month). Anti-depressant withdrawal (or, in doctor-speak, “discontinuation syndrome”) can be N-A-S-T-Y.

      So here are my thoughts:
      – Magnesium is very helpful, but I would advise not to take magnesium oxide unless you suffer from constipation. The best are the high-bioavailability forms of magnesium. Also take enough vitamin D.
      – Careful with dopamine support. Unless you suffer from a motivation drop across the board (nothing is interesting), too much dopamine will simply give you more motivation to do interesting things, not uninteresting but important ones.
      – Usually people with ADHD are suggested to look into support for acetylcholine, which would be particularly useful if you don’t eat enough animal products.
      – For anxiety generally GABA support is recommended. But not the GABA supplement itself — in normal circumstances it shouldn’t cross the blood-brain barrier.
      – Do not take 5-HTP, St. John’s Wort and the like with Zoloft. You might have figured that one already.
      – Avoid or drop PPIs (proton-pump inhibitors for stomach acid reduction). They interact with SSRIs, they are prescribed like candy, and have other undesirable side effects.
      – Try some vitamins with the methylated forms of B-12 and folic acid, in case you have a MTHFR mutation. For some people it makes a big difference.
      – I found the best results to be coming from general body support. Maintaining the blood sugar steady (that meant a low carb diet in my case, your mileage may vary) and supporting blood circulation and oxygenation of the brain (if your extremities are cold, your brain probably doesn’t get enough blood) were really half the battle. I add to that a supplement against inflammation (the famous turmeric, although even here some combinations are better than others), which really helped my focus and “pep”, and I’m considering some liver support. If you have troubles with the digestive tract, or you have taken antibiotics in large doses, some support there might be useful.
      – Whatever supplement you try, try it in the lowest possible dosage first (if it says take two capsules a day, take one) and avoid the high dosage supplements at first. Up the amount if all goes well. Sensitivity varies, and a pleasant burst of energy in a low dose can become severe agitation at a super-high dose.

      • #125446
        alienbunnyx
        Participant

        Hey Lys,

        I am taking ritalin 10mg/20mg depending on the day but I’ve taken some 5htp last night for the first time, thought it would help,may I ask why iys not good to take 5htp with ritalin?

    • #50964
      microfish
      Participant

      Thanks for the helpful thoughts, Lys! 🙂

    • #51175
      Exhausted Mum
      Participant

      My 12 year old has been on Concerta for the last six years. With her Concerta (once daily) she takes​ a high dose fish oil tablet to bump up the effects of the Concerta (to keep the dose low). She says it makes a noticeable difference for her at school. There’s never been any side effects.

    • #99480
      nickh401
      Participant

      Hi Microfish,

      I’m just bumping this comment to ask how this is going for you?

      Cheers,

    • #125455
      mia_green_eyes
      Participant

      Hello, I am no expert, but I was on Zoloft for 8 years for anxiety (and originally depression). I slowly tapered off Zoloft (which took me about a year as it needs to be done slowly). Now they think I have always had ADD, and I am trying Adderall XR. I find that the Adderall XR lowers my anxiety (I was very surprised) similarly to what the Zoloft did. I wondered when reading your post, if lowering your Zoloft slowly might be something to try … to see if you still need the zoloft / need that much zoloft … now that you have ADD medicine (and if you are no longer depressed?). Maybe lowering the Zoloft will help your ADD problems. Zoloft’s “job” is to increase serotonin basically … which, at least for me now… too much serotonin seems to worsen my ADD symptoms and make me groggy / sleepy. Hence I started thinking “dopamine” … which led me to the ADD med.

      When weaning the Zoloft, I found that when I lowered zoloft by 25 mg it took two weeks for withdrawal symptoms (increased anxiety unfortunately) to go away. I would think it was telling me I wasn’t on “enough”. After doing this repeatedly I was not fooled…and waited two weeks, at least, to assess…and yep each time anxiety went back down.
      I reduced Zoloft too fast, at the end, by 50 mg to 0 mg, and suffered vertigo for two weeks (I have heard worse stories).

    • #182737
      sherim06
      Participant

      I don’t know if this will be helpful to you as I am also trying to figure this puzzle out. My son is 12 and has been on Ritalin well now concerta for many years. I just recently discovered hopefully a way out of this hell through vit and supplements. I got him the omega 3 fish oil which was the main one I kept hearing about, a multivitamin for teens since he is now overweight from the last time I tried to take him off concerta and did not go well because he ate so much he was so skinny and is just now going through puberty so if I would have kept him on it his puberty spike and weight gain wouldn’t have happened so drastically so I ended up putting him back on it because he started having uncontrollable episode of very bad mood swings. I got him back on the 20 mg for a couple months but now down to 10 mg but he seems like he’s barely holding on so I’m trying supplements to help him anyways moving forward iv also got him taking protein shakes with fiber in the mornings and I’m pretty sure his liver is not doing so well after being on them for so long also he still wets the bed and I think it’s because when he finally passes out he is out like a light but it could also be how the Ritalin has effected his Diuretics. So I got Him kidney support for healthy urinary tract and bladder control but have not introduced this one yet as I need to look into more how directics effect blood pressure and or if it acts as a blood thinning agent. Which leads me to my next supplement called mood support which is filled with things to lower blood pressure as concerta is known to raise blood pressure and increase heart rate. The other one is a brain support that is filled with things that act as a blood thinner and I read you should not take concerta and warfarin(Mao) “a blood thinner” together Because the concerta will rise the effects of the Mao leading to possible bleeding. So now iv been trying to find the correlation blood thinners have with blood pressure so I can figure this out because it can get very complicated. I too am trying to figure out which ones to give him during the day with his Ritalin and which one at night for the renowned effect to be easier on him. The mood support actually seems to be helping with that a lot there are also adrenal supports that promote healthy stress respons and lowers cortisol levels allowing other hormones to function and not be taken over. I wanted to give him the brain support one during the day with his Ritalin but if they act like an Mao I don’t want him to have too thin Of blood and be at risk of bleeding but I don’t know if these herbs are strong enough to do that. I gave him one today as I am slowing introducing each one at a time to see how he reacts and he seemed fine on it today. Eventually I want to add in the kidney and liver support but not there yet. I feel he needs a mood or adrenal support During the day as well with his Ritalin to reduce the stressful tension he gets while he’s on it. But again that one is for lowering blood pressure so I don’t know if giving both the mood and brain is a good idea together. Anyways I don’t know if you’ll get anything out of this maybe you hadn’t considered factoring in these pieces or not I don’t know but hope this helps and if you have any info for me maybe we can help each other

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