Cymbalta (Duloxetine) for ADHD

[@slemanbisharat6390]

At 60mg/day , Cymbalta worsened my adhd symptoms. It is good for anxiety though

[@macezillamayfield2882]

Are you taking on any more patients or have an online clinic ? I would love someone with your knowledge and expertise to assist in helping find a good adhd combo that works for me

[@DrJohnKruse]

Unfortunately I have not been taking any new patients since moving to Hawaii two years ago. My hope was to keep using what I learned over the last 30+ years by sharing it in these videos and with my writing on Medium.

[@macezillamayfield2882]

Not asking for medical advice just your educated guess. Diagnosed ADHD as a kid and been on stimulants for it . I hate the way they make me feel as a adult and the quick tolerance I build to them is very discouraging - not to mention I was on amphetamines for a long time and when I stopped my natural mental energy and motivation never came back (probably fried my dopamine center’s) So doc put me on bupropion and I’ve had great results I have been on bupropion for 10 years now , I’m at the highest recommended dose of 450 mg xl… It helped out great with energy just to get things done at first but now I find myself struggling again mentally with energy and focus , it’s extremely bad … I would like a non stimulant to add to my protocol. I’m looking into stratterra or cymbalta …. What you guess (not asking for advice ) would be the better one to try first ?

[@DrJohnKruse]

I've seen many more positive results for ADHD with duloxetine (Cymbalta) than with atomoxetine (Strattera) - but that doesn't tell us how an individual might respond. With bupropion the upper limit is recommended because of an increase in seizure risk at higher doses. But the risk was reported with the immediate release form, not extended release forms (where the blood levels are considerably lower for a similar number of milligrams), and the absolute risk was still less than 1%. I've had a few individuals who came to me having been on 600 mg bupropion for several years without adverse events, but that is clearly not standard medical practice.

[@macezillamayfield2882]

@ that’s really interesting…. I was initially taking 600 mg for all those years - (self prescribed and I didn’t realize the seizure risk then and was just young and dumb obviously ) That’s when I felt the best , had the best results with no bad side effects …. But then finally read up on it about the seizure risk at the off label dose I was taking of 600 mg xl … not to mention feeling guilty for not following my doctors orders of only 450 … that’s not what adults do … it’s been 4 years and I’ve tried every alternative I can think of besides cymbalta and stratterra combo …

[@DrJohnKruse]

@macezillamayfield2882 Some of my thoughts on this general topic are in my video on high dose stimulants: kzbin.info/www/bejne/aGi0m2Zme92UmdE Every medication has risks, and potential benefits. The precise benefits and potential risks vary for each individual. Having tolerated a "high" dose of a medication for years without problem is moderately reassuring, but not a guarantee of continued success.

[@macezillamayfield2882]

@@DrJohnKruse thank you DrJohnKruse , love your videos and how educating they are. I’m going to listen to this now

[@bethanyrose8956]

Wow! I was taking this for years for depression symptoms, would definitely say my possible adhd symptoms have increased since i stopped. But i feel more like myself.

[@DrJohnKruse]

I've worked with other individuals who only became aware of their ADHD or ADHD symptoms after they stopped a medication like Cymbalta.

[@bethanyrose8956]

@DrJohnKruse it definitely makes sense! My daughter has shown some obvious symptoms of both ADHD and autism, this mixed with my symptoms resurgence and realizing my previous symptoms before medication has been a catalyst for me to seek diagnosis for both also! Thanks for the info!!

[@PatrickWhite1]

You mention avoiding further amphetamine use in those with past episodes of amphetamine induced psychosis. What about stimulant/amphetamine use in those with past episodes of psychosis from other causes such as schizophrenia or bipolar with psychotic features?

[@DrJohnKruse]

I wouldn't feel comfortable using a stimulant in those situations.

[@stevenjames4497]

Thank you for your very informative and interesting videos. I’ve found them really helpful. I’m really keen to get your opinion on whether you think Cymbalta is better for ADHD than taking Sertraline with Strattera. I’m currently on Sertraline 50 mg in the morning and Mirtazapine 15 mg at night but I’m considering adding in Straterra to more directly treat my ADHD or stop sertraline and switch to Cymbalta. My main symptoms are anxiety and adhd symptoms. Your advice would be hugely appreciated

[@DrJohnKruse]

Neurochemically the two approaches should be very similar. The advantage of taking them separately is that the dosages of each can be individually adjusted and optimized. However, if the ratio of norepinephrine and serotonin reuptake works for you, then Cymbalta simplifies the number of pills to consume and manage.

[@stevenjames4497]

Thanks 👍🏼

[@MaidenLoaf]

Duloxetine made me feel like a zombie and worsened my ability to be motivated for anything. I'm not entirely certain about my current medication, but at the very least Vortioextine has less side effects for me and I actually feel functional.

[@meeerdock]

Iam diagnosed with asd/adhd and fibromyalgia/ibs , after a failed treatment with ssri(cypralex),i started cymbalta at 60mg last year, it literaly decreased my pain from fibromalgia to 40 %. Now since i also have high blood pressure i avoid taking medication for adhd(stimulants) , i noticed some minor decrease in adhd symptoms and thought i was my idea.

[@plymix8389]

Does the benefits of cymbalta outweigh the risks of cymbalta? There are many stories reguarding people who have taken it and are now have seemingly permanent brain damage. Like severe akathisia. Have you seen anyone have this effect from cymbalta?

[@DrJohnKruse]

I've certainly had people who didn't like the ongoing side effects of Cymbalta, and a few others who disregarded warnings and stopped it cold turkey and had horrible withdrawal effects. I've used it for depression more than most psychiatrists and I haven't seen anyone with long term detrimental effects or problems with brain functioning or akathisia.

[@plymix8389]

@@DrJohnKruse that’s really intresting. There is also one more choice when it comes to Norepinephrine reuptake inhibitors btw. It’s the purest norepinephrine reuptake inhibitor out there, it’s called reboxetine. It’s not approved in the US but you can get it form a Canadian pharmacy. Strattera, and Cymbalta have functions besides Norephren, so who knows if it will be as good. But it’s definitely another option if you didn’t know of it. Possibly cleaner due to it not effecting serotonin at all.

[@DrJohnKruse]

@@plymix8389 Yes, I'm familiar with it. I think I even mentioned it in one video recently, because it is a good example of how drugs can get close to the market and never make it. For almost a decade, every year at the annual US psychiatry conference, the makers of reboxetine had a booth, because they thought it was on the verge of approval. They kept promising and it never arrived (here).

[@plymix8389]

@@DrJohnKruse have you prescribed it from a Canadian pharmacy or had any patients try it? I was thinking about trying it, but I realized that it might not control symptoms as-well as Strattera because of the various functions Strattera has that probably play an important role.

[@DrJohnKruse]

@@plymix8389 I don't have any direct clinical experience with it, and I haven't seen any head to head trials comparing it to atomoxetine.

[@truth-hurts3089]

Doesn't work for depression, axiety or adhd. Was on top dose and nothing. Seemed to help pain or sensation but nothing else.

[@stevenjames4497]

Thank you for your very informative and interesting videos. I’ve found them really helpful. I’m really keen to get your opinion on whether you think Cymbalta is better for ADHD than taking Sertraline with Strattera. I’m currently on Sertraline 50 mg in the morning and Mirtazapine 15 mg at night but I’m considering adding in Straterra to more directly treat my ADHD or stop sertraline and switch to Cymbalta. My main symptoms are anxiety and adhd symptoms. Your advice would be hugely appreciated