@ryansturgiss4115~~I'm so happy that Vyvanse is helping you~~Methylphenedate,(Ritalin) was great for me as I am an adult who was diagnosed with ADD a few months ago even though I had it as a child along with anxiety/panic disorder since I was 8 years alomg with insomnia~~To make a long sad story short a new Dr, put me on Meth/Ritalin and I could finally focus and concentrate again without my head spinning in differet directions~~I don't procrastinate and when I started something I could actually finish it~~But where I live there is a shortage of Methylphenadate/Ritalin so she put me on Vyvanse~~For me it has been a horrible experience~~It only helps my brain work better but only sometimes and for a only for about 4 or 5 hours and then I experienced a Vyvanse crash and many horrible symptoms~~She started me on a low dose and it was like taking baby aspirin~~She uped my dose to 50mg. and for me like I said it was horrible~~But we know that we are all different in how certain medications will work for us~~I wish I could be one of those people that are on Vyvanse and it changed their lives for the better~~Stay well and take care~~Good luck~~😊
I’ve tried all the medications discussed, and have researched them a lot over the past few years, but this video was absolutely the most informative thing I’ve seen. Thank you so much! If you have time, I would love to see a video about Fluvoxamine (Luvox) (SSRI) in the treatment of OCD. Thank you so much ☺️
How many miligrams of methylphenidate did you take? I got myself 10mg pills but noticed they sell it up to 40mg, and taking one pill didn't do anything, I had to try 40mg to feel improvements. Should I take around 60-80mg?
If you only knew, how grateful I am for your Video. English isn't even my native language but I still understood you very well. You have explained the effect of those two medications in an easy way but at the same time you mentioned every important aspect. I truly appreciate this well-made Video and I wish you all the best.
Methylphenidate feels like a far more potent stimulant to me and helps me with my ADHD more than dexamphetamine. Despite being a short acting agent, correct dosage timing can result in methylphenidate being a more flexible and less intrusive (sleep, appetite) medication. But I acknowledge everyone is different.
Did you try using Short acting Dexamphetomine or Vyvanse? Just curious and yeah absolutely everyone is different! I'm on 30mh Dex short acting and it's been amazing.
I started medicating with Concerta and it screwed me up in all sorts of ways with no benefits so tomorrow I am starting Elvanse and hope that works better. Luckily I work at a neurophychiatric clinic so I get help instantly if needed and our patients seem to love that I can relate to them in their struggles and some like the fact that they can see that it is possible to have a career even if you do’nt have a neurotypical brain ❤ I adore most of our patients and it is so lovely to see them feel better and improve their quality of life. Might share this video with them as it is very informative yet simple ❤️🙏🏼
@@PsychiatrySimplified Thank you 🙏🏼 My first day on Elvanse was great! I was more productive and have energy left after work for my four kids and house work instead of crashing at 3pm and just being overwhelmed and irritable with my darling children. I hope it lasts 😁
Concerta and dexamphetamine are very variable in their responses for different individuals. Taking into account pharmacokinetics, individual patient needs, and their mechanisms - there is always a process of dose adjustment needed. Importantly because sleep dysfunction tends to be highly comorbid with ADHD addressing that provides some additive effects.
@@PsychiatrySimplified I think there is some benefit in clonidine with stims like before sleep as clonidine through a2d sorry for misspelling inhibit norepinephrine which can contribute to less anxiety with taking MPH f.e. that is also from my experience but what do you think dr.?
Well explained. My nephew was prescribed MPH today. I want to make sure I explained the mode of action to his mom in the most accurate, clearest way possible, and this really helped. Thank you Sir
Unless it's critical for understanding the timing of something kin which case I watch a normal speed), I watch everything at at least 1.5X and 90% of what I watch is at 2X. About 20% of the time I wish there was a 3X. Listening UA-cam?
LOVE this! I was diagnosed with Multiple Sclerosis in 2018, then recently an ADD/ADHD combined presentation. Still learning about ADHD and figuring out what symptoms are caused by which condition, so that I can treat them in the best way. Have been on Ritalin for a couple of weeks, not sure how affective it is, but will keep trying. This video was really helpful, thank you!
Thank you for helping me understand the medications critical to my life. This has helped me understand more than any provider has been willing to explain to me.
@@PsychiatrySimplified Doctor, what do you think about the dopamine release caused by bupropion? Do you think that its more efficient in the long term to counter SSRI apathy effects, if we compare it with DEXAMPHETAMINE & METHYLPHENIDATE? Thanks!
@@PsychiatrySimplified thanks for your answer doctor. I would like to hear your opinion about these three that we mention. Do you think that bupropion gives less anxiety than the other ones if we compare long term use? Thanks again.
@@samuelsales401 it’s really individual when it comes to medications. It depends on the underlying explanation of anxiety. In adhd for example Rx adhd with methylphenidate and dex may reduce anxiety. In females dex may worsen anxiety. If mixed features is present then even bupropion can increase anxiety. In general bupropion is less ‘activating’ but that’s in general only based on its mechanism of action but does not mean it applies to all patients.
Excellent channel. Such clear explanations. Concerta XL worked to a point but Elvanse seems to suit me better. Elvanse really helps with procrastination and concentration. Videos like this should be recommended by ADHD clinics following diagnosis. Just got yourself a sub and thank you, Doctor Rege. 🙏
@ Charlie Greyfriars . Agreed. Given the medical confraternity is so ignorant currently, distribution of relevant material would be a boon for patients.
Beautiful explanation and differentiation between these drugs. Especially the detail about lysine cleaved in stomach for vyvanse. I have taken adderall for some time but due to drug shortage, my doctor and I decided to try vyvanse and it was NOT a good fit. Ill just say the effects were severe and extremely unpleasant. The effects of vyvanse were actually substantially worse than just quitting adderall cold turkey. I was wondering about the difference in mechanism and any reasons it would affect me so differently.
Many thanks Dr Rege for such a concise but very informative approach towards explaining psychiatry. I find your videos really helpful while preparing for my exams. 👌 Keep up the good work.
Dexedrine IR worked great, however, during Covid Lockdown I quit taking it and started drinking alcohol heavily and noticed an almost immediate effect on my mental health. Amphetamines definitely have their side effects which are not to be taken lightly but compared to alcohol or other drugs are much less severe
🎯 Key points for quick navigation: 01:03 *🧠 Both dexamphetamine and methylphenidate target the prefrontal cortex to improve cognitive functions affected by ADHD, such as attention, concentration, and set shifting.* 02:21 *💊 Methylphenidate inhibits NAT and DAT, increasing levels of noradrenaline and dopamine in the synaptic cleft, enhancing their effects on postsynaptic receptors.* 04:38 *🔬 Dexamphetamine competitively inhibits VMAT, leading to increased dopamine release, and acts as a reverse DAT inhibitor, further pushing dopamine into the synaptic cleft.* 06:01 *⏰ Long-acting formulations like lisdexamphetamine provide more consistent dopamine release, mimicking tonic firing and potentially offering better symptom management for ADHD.* 06:59 *🎯 Optimal dosage of ADHD medications is crucial to avoid both inadequate symptom control and side effects like rigidity and inflexibility in the prefrontal lobe.* 07:53 *🔄 Dexamphetamine exhibits a triple-pronged effect, including NAT and VMAT inhibition, resulting in a more potent action compared to methylphenidate.* Made with HARPA AI
Something anyone new to this needs to know. Adderall is a mix of 4 compounds. Mainly 2 Isomers. Those isomers bind to different receptors sites. If you are prescribed a generic, the ratio of those compounds will be different than brand name Adderall. The issue you may run into as I did, is after a period of time adjusting to, and fine tuning dosage on the medication, your pharmacy can simply change manufacturers of the generic. Generic does not mean "same". It's pretty much a 100% forgone conclusion that the new generic will NOT have the same ratio of isomers. This is bad..Insurance companies will steer you towards generics. And it's totally true they cost less. But your brand name medications composition won't change at the whims of the pharmacy's finance department. In my case I went from a good working dose and frequency medication, to having no fingernails after a month on the new generic. Racing heart. Anxiety. All from getting a drug people would assume was the same, just from a different manufacturer. Now I'm on a non generic.
I have been telling my doctor this for years, she kept telling me no they have to have the same activity ingredient.And I be saying no way they are the same, she says it's in my mind, insurance won't cover it after it is off Brand status so she by default. It's shameful that the doctor and pharmacist don't know this,they can get somebody
I take 72mg of Methylphenidate (Ritalin Long Acting) daily and it was interesting to learn about how it works to help me focus. Unfortunately I'm on quite a high dosage as my ADHD is awful but hey is what it is. But yeah thank you for the video! It's really nice we live in an era where we can learn alot about how people's disorders are treated and break it down scientifically 👍
@@Riku-Leela thank you. I've covered clonidine in another video - sometimes these agents can be used to counteract anxiety - they are also used independently in adhd. Ps not medical advice - discussing this with the doctor can help.
thank you, doctor! Very informative. Much appreciated! I have always wondered if maybe I should switch to Adderal, but I am having success with Ritalin/Concerta so I will stick to that! Note I have some Concerta I never took as I preferred a shorter acting medicaiton and also due to cost, but now that there is a nation wide Ritalin shortage, I am thankfully using the Concerta and very pleased with the results as well.
Thank you! I have been prescribed d-amphetamine and I wanted to know what I'm dealing with. You explained the subject very clearly and I understood everything despite not having a medical background.
I’ve had a love/hate relationship with Adderall the past few years. The insomnia and body crash was not worth the few hours of focus that it gave me 😅 I recently switched to Ritalin and have responded very well to it! I can actually sleep now :) I was curious how the two medications differed & this video answered all questions. Thank you!
Scratch that, I have 2 questions! My psych had suggested taking Wellbutrin along with the Ritalin, for depression and ADHD. I’ve read that both of these medications are NDRIs. Would both medications essentially be doing the same thing? Also, what role does caffeine play when combined with a stimulant like Ritalin? Sorry for the questions! Not looking for medical advice, just very curious lol.
@@rebeccalopez1755 what is the rationale ? You are correct both are NDRIs. Caffeine stimulates wakefulness by antagonising adenosine receptors which may have some indirect effect by allowing wakefulness neurons such as orexin and dopamine to act without the Adenosine somnogenic ( sleep inducing) effect. Here sleep wake neurobiology Neurobiology of Sleep - Circadian Rhythms, Sleep-Wake Cycle and Insomnia ua-cam.com/video/X5KpIoy4wL8/v-deo.html
i love adderall because i dont get a really noticeable comedown but with dexmeth (focalin ir) 90% of the time i end up getting the worst hangover/comedown out of every drug ive ever used. i still use it tho because.. well im an addict but i lowkey hate this
@@delsymdrinker it’s weird I hated focalin XR and Concerta but love Ritalin even though they are the same drug. I take Ritalin IR tho. I like to be able to control the timing better. Haven’t tried Adderall but a high dose of Vyvanse sent me into full on panic mode. I’m pretty sensitive to stims and I like to keep it that way so I don’t absolutely have to have them to not wanna blow my brains out…I do have ADD like a mofo tho and Ritalin helps me power through so I don’t get fired from my job. 🤷♂️
I'm taking Adderall, Buspirone and Sertraline. They switched out the Fluoxetine for the Sertraline. ADHD depression and Anxiety supposedly but I'm super tired all the time. The Adderall works pretty good for a few hours but it makes my hair fall out too much so I stopped taking it. I took myself off Sertraline & Buspirone and just took the Adderall and it seems to make me happier to the point where it seems like the other meds aren't or weren't helping. I just need something to focus and not make my hair fall out.
Hair loss can be a side effect of amphetamine stimulants. However other causes should also be ruled out. There are ways around this - alternatives, other meds that may stop hair loss etc. Please discuss this with your doctor as they can advise specifically.
@@hagridsbeardguy1399 yes that is something many say. One hypothesis is that it reduces striatal and frontal dopamine both if which are already postulated to be affected in ADHD thus worsening cognition. In women it can do this by activating the emotional arousal areas.
I used to want to smoke and get high all the time because of the dopamine release it made me feel like normal people, It felt awesome. But I quit weed recently and used methylphenidate recently it’s helping so far but I wish it would last longer
Great video. Personally I much prefer the short-acting medications as it gives me much, much finer control over my day and I can time precisely when the medications will wear off. I can also opt to use them in such a way that I only get a half-day effect when that's all I need. I try to use the medication as little as possible.
Yes for many the flexibility is an advantage while for others they prefer taking it once because of the schedule etc. Thank you for your feedback. Wish you well with treatment.
My provider mentions her strong hesitancy against IR adderall and I respect that but ER lasts too long and difficulty sleeping ensues. I asked for MPH as it’s lack of “stimulating” properties which I would assume can hinder addiction formation and might be more beneficial.
@@yasinyildirim4686 yes one can try that and have a discussion with the doctor. Lisdexamfetamine in some lasts a lesser duration . Mph - comes as Ritalin LA or concerta both which have different durations. A discussion with provider is helpful as in long term longer acting versions tend to provide better tonic DA rather than the pulsatile DA.
I initially did a 2x a day IR . They work well but I would frequently after the first dose actually get stuck on a project with that improved focus and blow right by the time I was supposed to take the second dose. Then I got stuck playing the "If I take this too late will I sleep like crap" game.
Dr. I take vyvanse. It helps with more attention type deficit but has helped tremendously with my depression and anxiety more than anything. I would welcome a comment from you about this.
Most definitely. Dopamine in the prefrontal covered plays an important role in depression and anxiety. Dopamine is linked to mood, reward , motivation, drive, attention, concentration and it is also involved in the top down control of the ‘threat area’ which is amygdala and limbic system: so dopaminergic agents are used in Rx of depression. E.g Bupropion, Agomelatine etc. i explained this in another video - hope you find it useful. What Depression and Anxiety Look Like in the Brain ua-cam.com/video/vy97wZQyEr8/v-deo.html
Glad I found you! It’s harder than I think it should be to find information on the mechanistic actions of psychoactive drugs, and it is a useful piece of the puzzle. Pending an assessment, I am trying to understand this, because while I think I have had poor dopamine leveks all my life, I suspect my noradreline may be another story (I’m presently on Clonidine, and will check out your video on that). Assuming a positive dx, I was inclined to look at methylphenidate first, but I’ve started getting the impression that amphetamines might target dopamine a bit more than methylphenidate, and it sounds like that may be the case.
Subscribed! This is such helpful information and very much appreciated!Thank you also for the visuals, really helps to learn alongside audio! Love your style of teaching, gonna be binge watching your videos now! ❤❤
I have found that individuals who suffer with serious depression benefit from the extra dopamine release you get from Adderall…with the downside being that the drug burns out your dopamine receptors and you become seriously dependent on it like you would any amphetamine. Amphetamine withdrawals are no fun at all. Some people really wanna get high though.
I need all day strong all day long😂😂😂 I'm just starting Vyvanse. I'll sacrifice the first hour or two of waking up so I can be set for the rest of the day. Praying it works when Im not on just a starting dosage. 🙏
Very well explained! I have an ADHD question that I will try to keep as short as possible. My daughter (19 y.o) was diagnosed with depression and anxiety 5 years ago. It has been a very long journey. She has treatment-resistant depression and nothing has really helped her - she's tried it all, including Spravato and TMS. She had genetic testing done which shows that she is not a good candidate for SSRI's as well as most other gold standard treatments. She was always an excellent student, until a few years ago. She was not tested for ADHD during high school, but now that she is struggling (badly) in college, her psychiatrist just ordered an ADHD test. I should note that my son (her older brother) was diagnosed with ADHD (inattentive) when he was 8 years old. He took Focalin and it did nothing for him. My daughter mentioned a few times through the years that she thinks she also has ADHD (inattentive), but that surprised me as she had always been a high achieving student. Anyway, we're thinking that her test will show that she does have the disorder. Included in the genetic test was an analysis of how she might respond to ADHD meds. Literally every single one says either "lower odds of response" or "moderately lower odds of response." Adderall and Vyvanse were in the "moderately lower odds of response" category. This is because she is COMT met/met. So, my question(s) after all of this is, do you genetically test your patients and if so, have any with COMT met/met had any response to Adderal, Vyvanse or any of the other amphetamine based meds? My daughter's options are so limited with everything and it's really frustrating. Thank you in advance.
I often see these tests been misinterpreted. The tests are a tool to be used to supplement a thorough ADHD / psychiatric evaluation. The test cannot predict diagnosis or response to meds in this way. ADHD os highly comorbid - patients respond well irrespective of the genotypes . It’s the phenotypic presentation that matters more - that means identifying the specific domains - Cognition, activity , reward sensitivity, behavioural activation, behavioural inhibition and fight and flight. Then going through a ruling out process - when individuals don’t respond it’s often due to comprbidities - e.g sleep disorders are amongst the most comorbid especially in children and adolesacents and adhd treatment goes beyond stimulants only. See this videos for a diagnostic understanding - ua-cam.com/video/Jq0VmCbN6C4/v-deo.htmlsi=boLPaMkc3ypa7pAh
How did your daughter go? I was also a high achieving student in High School with depression and anxiety (among other things) who fell apart during University. And I also had a brother diagnosed with adhd as a child! I had a lot of mental health treatment and nothing helped. We tried everything- all the pharmacological interventions, different therapies like ACT, CBT, DBT, somatic things, lifestyle things, and even tree-hugging things (this was literally prescribed by a therapist)! When I was 27 I came across information about ADHD in women and girls presenting differently. And I knew. I did so much research, checked the DSM-5, took all the tests. It was a lightbulb moment for everything. It took a long time to get diagnosed and start treatment but it has been literally LIFE-SAVING. My depression is gone, anxiety minimal, I sleep better, my ED improved, everything. I am now working on my anger and resentment that it was completely overlooked during 15 years of mental health treatment. Please, please get your daughter tested. Dont let her spend another decade struggling and hating herself. Advocate for her, and if the psychiatrist suggests medication treatment TRY IT. Ignore the gentic testing, the only way to know if treatments will help is to trial them (under supervision), and if one medication helps a little butnot much try others. It took a while to find the right medication and dose for me, and its always being re-evaluated, but it is so worth it. I know this is long but I am so passionate about helping other women cut through the BS that is often medical-misogyny as its so common and causes many issues. ❤
Thank you for this explanation. I have recently been diagnosed with ADHD and prescribed Concerta. My doctor explained it briefly but I have been trying to find out more about ADHD and the different treatments. This was very thorough and hit all of the points I was wondering about.
See I am worrying and overthinking, because my Ritalin does not work for me, and I got worried it may have been a misdiagnoses. But this video shows how different the medications are from one another and why it may not be working for me. I hope the amphetamines work.
When one says medications are not working - it's important to break down not working into 1. What symptoms are not targeted? 2. What effects have been felt. Based on this a targeted plan is made. Wish you well
@@icarus8964 it depends on specific symptoms. Symptom domains in ADHD - include cognition - attention , concentration, organisation , procrastination, executive functioning , goal directed action , motivation 2. Emotion - hyperactivity may occur here , emotional dysregualtion. 3. Sleep . Now adhd can occur with other conditions such as depression in which case low mood, anhedonia ( inability to experience pleasure) negative thoughts, and adhd symptoms are worsened l. Similarly other conditions may coexist. So aim is to identify which Sx are present. Stimulants target - adhd Sx specifically , but if mood Sx are present they may not. Similarly if sleep dysfunction is present or worsened with stimulant that should be addressed. Anxiety is another issue. Females have a different presentation. So once the specific Sx are identified then medication can be used appropriately to target the domains. Hope this helps clarify. Ps not medical advice
@@icarus8964 it is a balance that the doctor is trying to achieve in general. Sometimes other meds are needed for synergy. Other medical conditions should also be treated. See video on diagnostic evaluation of adhd. How to Diagnose Attention Deficit Hyperactivity Disorder (ADHD) in Adults? - Dr Sanil Rege ua-cam.com/video/Jq0VmCbN6C4/v-deo.html
A bit of a taboo subject for many, but would you be interested in comparing & contrasting Desoxyn's active drug to dextroamphetamine & levoamphetamine? Specifically how all three differ in terms of how much they affect the norepinephrine transporter, and how Desoxyn has a greater serotonergic effect. I feel many prescribers reach for Adderall over Dexedrine simply due to its existing ubiquity despite the potentially mitigated physical & anxiety-inducing side effects of pure d-amp, and especially do not consider Desoxyn, a drug with potentially less side effects & better mood improvements that is avoided due to both stigma and neurotoxicity concerns of the serotonergic effects despite a therapeutic dose being much lower than a recreational one (as well as a blanket ban of the medication in many countries).
You raise a good point. Stigma is a barrier and other concerns, as you rightly raised, when seen from a purely medical point of view, Desoxyn as an agent, if used appropriately, has benefits. Not available in Australia for Rx. Thanks for raising this
@@PsychiatrySimplified Dear Dr Sanil Rege this methylphenitade in doses above 60 mg a day doesnt mix good with tramadol.I don t have hypertensia or cardiovascular problems but when i take two concerta pills 36 mg and take tramadol with it i have pulse 155-160...Otherwise i have normal pulse. One 36 a day is just fine.
Hello, I was diagnosed adhd by a Qeeg brain scan at 19 (this was in 2006 and I was never treated, I was prescribed time released Adderall took it literally one day but the dose was too high or looking back i couldn't click my executive function to activate lol. I don't even like Tylenol so I think mentally the idea of a medicine that made me feel ANYTHING was against my nature. Fast-forward, I'm now 35 with four kids ranging 3-10.. the older 3 are diagnosed combined type and suspected but not did dyslexic (specific learning disabilities in reading and writing but school won't call it dyslexic) the baby is undiagnosed but has received early intervention therapy daily since before 2 for sensory stuff, lots of stimming, probably autistic, definitely adhd but his speech and ot therapist use the word hyperlexic, he's an absolute genius - talks about parallelogram quadrilaterals trapezoidal semicircle, knows all the planets, counts by tens to 100 while my older 2 repeated kindergarten (pre diagnosis pre IEP pre mama bear knowing repeating HARMED not helped them so the boys will never repeat and both had ieps as disabled preschoolers. All 3 older have normal iq. I have extreme guilt for waiting this long and basically telling my kids "try harder and you will see that chalk board... try squinting, try moving closer, try taking longer to figure it out. I'm an obsessive researcher and I know the right thing to do is medicate the older 3 who struggle so bad. My 6 year old, number 3 lol, has the hardest time and a complete aversion to learning or trying or anything letters or speech related. My heart breaks. So I decided before medicating them I will try to treat my adhd for the first-time since 19 the one day I tried it lol. The doctor prescribed me 5mg Ritalin once a day. Two weeks went to twice a day. Two weeks later went to 10mg twice a day which I have yet to pick up from the pharmacy so I'll see if its better. Do you have a recommended medication for adults.. my biggest obstacle is the executive function / motivation to begin like where to start and completing tasks without starting 1485843182 more, and working memory is SHOT. Forget forgetting why you walk in a room, I can't remember what I was going to Google, who I was going to email etc when it can be something very important! Also do you have a recommended medication for kids who have adhd but also specific learning disabilities so like maybe more focus or problem solving ? Please help bc both my adhd and the kids neuro will listen to me and try what I ask for but I'm overwhelmed with options and stuck in analysis paralysis so my indecisiveness debilitates me and my days turn into weeks months and literally years and things that are ON THE TOP of my to-do list are still there years later. Ugh. But I have to get it under control for my kids so I can help them manage theirs. Please send me your recommendations and advice 🙏 thank you. Edit to add - my kids father is also adhd, diagnosed as a kid and overmedicated in the early 90s so he is also untreated majority of his life and explains the genetic end of it with our kids lol. Isn't it interesting how 3 struggle so so so so sooo hard learning but are socially strong while the baby is smarter than all of us combined but doesn't have input receptors to questions so he's very one sided and output output output like questions don't register right away or at all sometimes so socially I worry but academically he knows like high-school geometry lol and the other kids are social butterflies so funny and fun, make friends everywhere they go but all struggle s hard.
Very informative! I wanna switch to a extended release. It feels more natural. Taking tentin every few hours is more ''spikey'. Not what I'm looking for.
Brilliantly explained. However regarding my experience with a lisdexamphetamine, Elvanse (UK version), and comparing it to my new dex (initially prescribed as a booster), it works so much better for me in that apart from it being an instant release form, it also lasted way longer and I didn’t get the crash at all that i got on Elvanse, almost like a complete opposite of what both were designed for - And this was done by taking it in it’s own at first, not as a booster, so i could guage the drug by itself and its effects. I now use that on it’s own. One question I have is, are shorter acting meds more harmful for the body than a ‘lisdex’ due to the latter being released slower? I have a overthinking worry and concern that I’m damaging my health somehow? - (taken as prescribed and not in the context of abuse etc)
6:20 According to the paper "Lisdexamfetamine Dimesylate (Vyvanse), A Prodrug Stimulant for Attention-Deficit/Hyperactivity Disorder" the enzymatic cleavage happens mostly in the blood, not in the stomach.
@@PsychiatrySimplified I didn't expect an answer at all to a year-old video, much less a correction! It shows your great professionalism! Thank you for your videos, they are very helpful.
@@georgH No, it means a lot to have an audience like you contributing. Many themes that I cover are covered because of the comments and, of course, for me to learn as well. So appreciate the feedback and your input.
Thank you. Can you please make a video regarding all three possible ways of treating adhd? Atomoxetin, mph and Amphetamine group of meds. Please, it would be great, if you can make video about comparison between amph and methamph, because I read and hear a lot” you are using medical meth, nothing else”
Will keep that on list. Although not gone in detail I've covered a summary of ADHD rx here. Attention Deficit Hyperactivity Disorder(ADHD) Simplified | How to Diagnose ADHD | How to Treat ADHD ua-cam.com/video/AyNKTHwM3f0/v-deo.html
I do get mine from the name look up ⬆️ ⬆️⬆️ they are the best I know that helped me with products when I suffered Adhd, depression and anxiety and I get mine from them
The difference in my case, is that one works and one doesn't LOL I switched from Adderall to dextroamphetamine sulfate and it is like a whole new drug. All of the jitters and nasty side effects of the Adderall are completely gone. I also found Vyvanse very ineffective the disadvantage of dextroamphetamine however is that it seems to be much more difficult to find than the other more common drugs.
I used to do loads of speed back in my day it was the only time in my life i ever read a book from couver to couver in one night jhon liveington seagel it was good book
I went from Adderall, Auvelity, Trintellix, and Rexulti to Azstarys, Trintellix, Wellbutrin, and buspar. I like the change much better but dont think I'm quite dialed in yet. Im thinking about going back on Vraylar. 😅
Hello. I’ve been on methylphenidate for a month now - used it 5-years back as a youngster and it worked like a charm, or so i remember. However now that i got it again, my heart is pounding, my jaw keeps clenching and i’ve been experiencing severe arrhytmia from it. What’s your opinion, do you think dexamphetamine would suit me better? Methylphenidate works for 4-6 hours after taking it but after the effect is gone, life becomes even harder. Barely lasts through the work day.
Very difficult to predict. LA versions are trialled if activating side effects are present in general. They also have a longer duration of action. psychscenehub.com/psychinsights/diagnosis-and-management-of-adult-adhd/
No that's not how it is. Dexamphetamine increases / releases Serotonin, Dopamine and Noradrenaline. MPH - NA and DA but no serotonin. Dex is generally more potent when it comes to DA release. But the differences in repsinses differ from individual to individual
Ive been taking adderall and it makes me very flat and totally spaced out im pretty much a zombie. i can hardly function and im taking the starting dose for adults. I was just given 10mg of ritalin 2x a day hoping it works well. Just did a test 5mg piece before i take it going to work tomorrow. I just feel happy energized and focused thats what i want. I also take guanfacine 1mg at night.
@curtiskarner2190 it turned out to be more than just adhd. In my own research and opinion, and my new phychiatrists words. I lack both serotonin and dopamine. Increasing dopamine can decrease serotonin. I take prozac 20mg, and I can take stimulants fine now. There are no issues at all. I plan on increasing to 40mg of prozac she is wanting me to take focalin once I adjust to my antidepressant. Prozac has made my life so much better. I was taking 20mg of adderall xr and then I went up to 30mg xr which made me a zombie but I think it would be fine now if I were to take it again because of prozac.
As someone who experiences both anxiety and ADHD, I've personally tried both Concerta and Vyvanse. After conducting a week-long trial, switching between the two medications each day, I've found that Concerta is a better option for those who also struggle with anxiety. During my time on Vyvanse (Lisdexamfetamine), I noticed an increase in my nervousness, euphoria, and physical agitation. Based on my experience, I would recommend Concerta as a more effective option for those with both ADHD and anxiety.
Thank you sharing your experience. It is very individual dependent. The responses are very varied and your description could also hold true for vyvanse in some. Hence in ADHD treatment it's important to consider appropriate trials and not rule out a medication if one hasn't worked.
Ha ha! Those seem like interesting analogies; however being in Australia - don't know what Chik-Fil-A, Popeye's, Cane's/ Zaxby's are? Could you describe in fast-food terms what's the difference? Wonder if someone can do an Australian version (:
I do get mine from the name look up ⬆️ ⬆️⬆️ they are the best I know that helped me with products when I suffered Adhd, depression and anxiety and I get mine from them
Hi sir, Thats was a great informative video explained clearly doctor👌🏻. I'm having a doubt, instead of using stimulants like amphetamine, methylphenidate or Atomoxetine to treat ADHD. Can we use the below mentioned medicines as an alternative. Like * Armodafinil or Modafinil * Yohimbine * Bupropion * Rauwolscine Will there be any better efficacy or improvement compared to classic stimulants. Asking this out of curiosity and for information purpose only sir. One more kind suggestion doctor - Can you please make a video on comparison between Modafinil, Methylphenidate, Rauwolscine or Yohimbine and amphetamine. Thanks in advance doctor
Modafinil , Armodafinil and Bupropion are used in the treatment of ADHD and have evidence . The other two - no evidence and not used in clinical practice . Modafinil, Armodafinil and bupropion can be useful depending on the level of deficit and the comorbid symptoms. Use of agents depends on what are the symptoms that one is looking to target .
For me Methylphenidate had a whole range of negative side effects like a intense constant anxiety and nervousness while 60mg of (Lis)Dexamphetamine had all the positive without the negatives and has been a life saver ever since, im on it for like 7 months now hopefully it stays working since i heard tollerance starts kicking in after a while. I also tried Bupropion but that did nothing besides give me headaches and the feeling of a knot in my head that i couldn't untie
Methylphenidate immediate release or extended ? Extended release medications like Lisdexamfetamine do not have the pulse DA release like immediate release dex or methylphenidate so is more tolerable for many.
@@PsychiatrySimplified Hey thanks, i have to admit in the first few weeks Methylphenidate felt like a wondermedicine (even tho i felt jittery and unnatural ). During that time i switched from immediate to a extended release dose of 54mg after asking my psychiatrist (for ease of use since i had this comedown effect in waves throughout the day). But over the next couple of months the negative effects where setting in badly and the positive effects all but flattened and i started feeling incredibly unstable so i just couldn't commit to using it daily anymore. After this he advised Bupropion for a while but it didn't do much for me besides make me more lazy and depressed while giving me a headache, so i asked my psychiatrist about Dexamphetamine and he eventually gave me a buildup to 60Mg of Lisdexamfetamine and even tho it doesn't give the same drive as Methylphenidate and took a few weeks to get used to it feels incredibly natural and makes me able to focus and continue working even during moments when i am battling some internal things ( It does at certain moments increase my social anxiety a bit but besides that it does wonders for me ) Contrary to most taking Dexamfetamine throughout the day compared to M helps me sleep better at night somehow, my psychiatrist wanted to give me Venlafaxine after Bupropion first but since i asked about dex myself we went with that and i am happy we did. Sorry for the long reply lol
@@LAKXx good to know. In clinical practice the stimulants tend to have varied responses for patients - so just because one doesn’t work doesn’t mean the other shouldn’t be tried as in your case. Glad it worked . Thanks for sharing. 🙏🏻. Always good to know how individuals respond.
Thank you! I have one question: my psychiatrist prescribes Dexamphetamine as an alternative treatment for depression. I have severe sleeping problems since I started using Dexamfetamine. My psychiatrist says the same as you about this stimulant: it works about 4-5 hours. I disagree. Half life of Dexamphetamine (not XR) is about 10-12 hours. In the Netherlands it is forbidden to drive for 30-40 hours after using Dexamfetamine or speed due to its long half life. After 2 x the half life (about 20h-24h) there’s still a too high blood level of amphetamine (1/4 of the initial dose). 30%+ of Dutch patients experience sleeping problems. My psychiatrist says this is not possible because it works just short (4 hours). So my question: are you both wrong? Given the half life of Dexamphetamine, I think you both are. Methylphenidate IR has a half life of about 2-3 hours. Much, much shorter. I know that. Thank you for reading and hopefully answering my question! ❤
Thank you for your comment. With psychostimulants half life and duration of action are two different things. Because with immediate release the D1 receptors get stimulated more significantly when extracellular DA concentrations rise. This is responsible for the burst phasic D1 activation that results in euphoric effects or activation and when beneficial the cognitive benefits. However the D1 receptors do not keep getting stimulated for 10-12 hrs - these receptors require significantly high levels of DA ti be activated. On the other hand the XR version provides this but the aim is to have a steady basal level of endogenous DA to maintain good D2 activation,NA and target the goal directed learning areas and habit forming areas. Once individuals find that they are experiencing rewards because of the ability to plan better etc then the D1 receptors gets stimulated through unexpected rewards. So in summary ‘ duration of action ‘ is not linked to the half life - it's linked to the amount of plastic burst of DA provided by the medication rather than the tonic DA. Too much burst is not beneficial. Hope this helps
Great Video. You made it easy to follow. How does dexmethylphenidate compare between the two compounds you mentioned? Is it kind of like a middle ground?
Good question. Dexmethylphenidate is the more potent isomer of Methylphenidate( d isomer - active form). dexmethylphenidate does allow for a lower dose to be used and increases the duration of action by 1-2 hours. Thanks for the feedback 🙏🏼
Dr. what do you think, first great Video btw!, taking ndri like bupropion or DNRI like Concerta with amphetamines first: if fe focuse on concerta as noncompetitive reuptake inhibitor and taking amphs as competitive which release additional dopamine into synaptic cleft, from that video shouldn't they work in synergy?
The combination results in significant DA & NA release which should be justified - it’s not usual practice . In treating ADHD significant phasic DA is detrimental - it’s only essential in early phases of learning and improving reinforcement sensitivity - constant phasic DA can worsen cognition.
Dear DR Rege, My name is Thomas and I am 22 years old. I got diagnosed with ADHD last year. I have tried Ritalin, Concerta, Adderal and Vyvanse. I find Vyvanse to be the best for me; it completely relaxes my mind and body. But it only works about 7 hours for me, so I take 10 mg at 7 AM and 10 mg at 1 PM. My question to you is: will the pill of 1PM disrupt my (deep) sleep, because of the half life of 10-12 hours? I usually go to bed at around 10 PM. Thanks in advance. Yours sincerely, Thomas
The dosing of vyvanse is extremely individual - the variation from person to person is huge. so sometimes the only way is to trial and find out and then adjust. Your doctor will be able to do this with you. Wish you well.
Interesting that you mention methylphenidate binding to the *transport* for reuptake. What makes it different from Atomoxetine, if one is a stimulant and one is an antidepressant?
Methylphenidate is NAT and DAT ( also antidepressant properties) at more significant levels than atomoxetine which is only a NAT ( NAT Inhibition increases NA and DA ( mild via diffusion - see video on SNRIs ) . The labels stimulant vs antidepressant is only semantic. Best to think of functions that one is targeting in treatment
I have five question (plsss I need awnsers plsss): 1.How can DAT And NAT be able to transport the Dopamin out of the presynapse eventhough its blocked by Dexamphetamine ? 2. When Dexamphetamine is inhabiting VMAT2 does it then block the pathway for DA to go in the vesikel ? or does its simply take up space so that DA isnt able to be in there, or does it do both? 3. When the action potential reaches the synapse, what does happen with the vesikel if they are filled with Amphetamin? and what does happen with Amphetamine? 4. Does DAT need the action potential to be able to transport DA out of the presynapse ? 5. Do you have any good sources where the neurobilogical effect of Dexamphetamine is very detailed explained? (Sry for my english I am German desprate student who is desprate for information that cant be found in german and I also don't find anything in english)
2. Dexamphetamine acts on transporters so simply increases extracellular synaptic DA and NA . However it does have reverse transport so will directly release DA from presynaptic as well and via release from VMAT. This is the extrusion . 2. Yes DA uptake into presynaptic neurons and subsequently in vesicle is prevented via DAT inhibition and will also release DA from presynaptic neuron through reverse transport. 3. Don’t understand the question . Action potential is at post synapse so different process 4 . Presynaptic and post synaptic is present to keep a balance - presynaptic is negative feedback so if too much in synaptic space presynaptic will increase uptake ( like vacuum cleaner) but presence of amphetamine will change this as release and extracellular DA is > Uptake. 5. psychscenehub.com/psychpedia/dexamphetamine-and-lisdexamfetamine-mechanism-of-action-side-effects-and-dosing/
I'm here because I've been on methylphenidate for a while and I am having side effects, I feel absolutely terrible and it's not helping like it should. I have a new prescription to start dexamfetamine tomorrow, so I'm just learning. I hope it will help me
Awesome analysis. Why do we consider MPH to act on PFC when DAT inhibition can increase D levels in limbic system and nucleus accumbens? It is not like a D1 agonist to be sure it acts on PFC mostly. Wouldn't that make sense to give a D2 antagonists too so you block limbic dopaminergic overactivation but keep D1 activation in PFC? Thanks.
Good question. D1 family of receptors are considered excitatory and d2 inhibitory. Broadly - its the predominance of their presence that differs - so D1 predominant in PFC ( does not mean not there in other areas) and d2 striatum - nucleus accumbens and dorsal striatum. So yes when DAT is inhibited along with release DA acts on receptors in these areas. It is about modulation so any excitation is balanced by autoreceptors to uptake excessive DA from the synaptic cleft to maintain balance. So one doesn't need to give D2 antagonists if there is no vulnerability or clinical expression of DA overactivity in striatum - e.g psychosis, mixed features, bipolarity as the brain’s homeostatic mechanisms should kick in. But for some patients we have to provide a buffer to prevent this as you state. I cover dopamine in the other video on Dopamine in more detail - ua-cam.com/video/uo9nI-U7QXo/v-deo.htmlsi=AuHN2-WRcLoFGPrz
If you ever have the time, I would really like to see a comparative explanation of modafinil as a supplement to this explanation of dex & methylphenidate.
It is a milder agent in relation to DAT inhibition. But has orexin and histaminergic activity in addition as well which the two others don’t have . Will add video to the list
@@PsychiatrySimplified Have a pharmacology background. Struggled with postgrad studies (different discipline) as an adult, began with modafinil then moved to the enantiomerically pure armodafinil, began to develop a reaction that was likely erythema multiforme, so discontinued use. Few years later, formal diagnosis with adult ADD (somewhat cathartic) and began treatment with dex. I tolerate it well and it has helped a LOT. I give my body breaks from it (lower dose on weekends, occasionally a few days to weeks without use) but it just isn't as effective as armodafinil, which can only be described as "clean" in contrast. Have been considering asking my specialist to trial methylphenidate to see if it is more effective in my case. The resources you have provided to people are informative and quite valuable.
Dr. I recently got diagnosed with ADHD which I truly believe I have however I also have suffered from severe depression and anxiety most of my life. I have never "enjoyed" the feeling several SSRI's have provided for me and even the NDRI Wellbutrin wasn't good for me as it caused agitation. I knew from past experiences that Adderall was basically the cure to everything for me especially because of the euphoric effects. I have been prescribed Adderall and it was amazing just like I thought it would be but after a week of Adderall it seems that it is having a opposite effect and not only do I not have a euphoric feeling but I am considerably more depressed but the medication is holding its abilities to treat my ADHD by stimulation. I'm curious if maybe my dopamine is being depleted somehow. I'm not abusing my medication. I'm wondering if another ADHD medication would be better. I've even considered ketamine therapy for depression but it would be way too expensive. I have no intention of abusing any medication but I just feel strongly that dopamine increasing medications might be what I need in life to help, not only with ADHD symptoms but also severe depression and anxiety
sorry to hear. The diagnosis of ADHD should include a comprehensive assessment to rule out comorbidities. Stimulants treat specific symptoms - they improve cognition and can reduce hyperactivity. This allows for the prefrontal cortex then to engage in activity. However in many individuals esp adults there are other comorbidities. So a stimulant on.its.own may not address all aspects. It becomes important to look at all symptom domains. E.g mood dysregulation, mixed features, sleep issues, specific Sx of depression, anxiety etc. As individuals may require a synergy of medications with complementary effects to provide a beneficial outcome. For example many a time if anxiety rises with stimulant and individual also has sleep difficulties, augmentation with clonidine provides a synergy addressing all Sx. Similarly if individuals have mood dysregulation, mood stabilisers with stimulant provide optimal outcome. This allows for the dose of the stimulant to also be kept optimum and lowest effective dose. There is also the possibility of dose adjustment with stimulants required I.e does increases. this it is important to discuss this with your doctor. Ps not medical advice ua-cam.com/video/Jq0VmCbN6C4/v-deo.html
Hi Luke, when treating ADHD I don’t think it is a doctor’s intention to provide a “euphoric” feeling by putting you on medication. Rather what they seek to do is find balance. Euphoria is not a natural state of being it is only induced by drugs or certain life circumstances such as achieving goals or having something happen in your life that makes you really happy like graduating college or falling in love. If you are chasing euphoria you are on a DANGEROUS path. settle for balance. Balance is real. Humans do not experience euphoria daily and it is not how we are meant to live. If that’s what you’re looking for then I’m afraid you will not find it without substance abuse.
Kratom helping me with ADD like only one substance. I take Ritalin, Methylphenidate, Adderall, Wellbutrin, Vyvanse and other stimulants, other drugs, but nothing work for me as good as kratom. I dont know why, if because kratom agonist noradrenaline and serotonin receptors i dont know. And the euphoric effect of kratom i like it, help me to motivate. Sorry for my english :D
d-amphetamine seems to be more specific in reducing overactivity, and impulsiveness and improving sustained attention. l-amphetamine shows a relatively greater effect in improving sustained attention compared with its effect on reducing overactivity and impulsiveness.
I have questions. 1) neurotransmitter is released into the synaptic cleft when the presynaptic neuron fired as a way to pass the signal on. In the normal brain the synaptic cleft gets cleaned again, neurotransmitter gets recycled. The synaptic cleft has to be freed of neurotransmitter or else the next signal (aka release of neurotransmitter) can't get through. Like a reset. Correct so far? Well, what happens when you inhibit reuptake and the reset doesn't happen as normally? Are the meds effectively slowing down the frequency of signaling because the neurotransmitter lingers longer in the synaptic cleft? Aka, is all the dopamine that stays in the synaptic cleft inhibiting new signals coming through? 2)how does reuptake eventually happen? I mean, the cleft does have to get cleaned before a new signal can pass through, no? Or does it mean that as long as the meds last there just lingers a constant amount of dopamine in the synaptic clefts where ever dopamine is the neurotransmitter and the clean up only happens after the meds wear off? And wouldn't that effectively block neuronal pathways? 3)are you depleting all dopamine all at once because you empty the vesicles completely and inhibit reuptake and will that dopamine linger so long on the synaptic cleft that it diffuses somewhere into the extracellular space away from the synapse and away from recycling? 3) Is the rebound effect such a drag because you depleted all dopamine for a while so you function even less well than if you hadn't taken meds to begin with? 4) a) what kind of long-term architectural changes are known to happen in the Synapses once you have taken your meds for years? b) I read that people have to increase dosage because there is some tolerance. Is tolerance related to architectural changes, like maybe the body builds more reuptake mechanisms to counter the effect?
I do get mine from the name look up ⬆️ ⬆️⬆️ they are the best I know that helped me with products when I suffered Adhd, depression and anxiety and I get mine from them
I’ve childhood to severe adulthood ADD .. short action Ritalin helps a lot yet sometimes is too much of a speedy feeling.. it also is a positive mood lifter and motivater for me.. what should I do? Thank you
It's a question for the doctor. In general the Long acting / slow release version avoids the speedy feeling by providing a steady tonic release of DA. Ps not medical advice.
@@PsychiatrySimplified Just experimental in clinical studies maybe. Also 4-methylaminorex comes in mind. Do you know what is interesting Dr. Rege,this phenmetrazine was even slightly less potent stimulant than methylphenitade,but many users from that era prefered it oved amphetamine sulphate,d-amphetamine ,or d-methamphetaine in terms of abuse and euphoria.I wonder why,there must be sth behind this.
@@sidka8435 thank you for sharing, very interesting. it says was withdrawn due to widespread abuse. you are right re the less potency. very interesting.
@@PsychiatrySimplified Why was that,Dr Rege? Slightly less cns stimulant effects than methylphenitade,but more euphoric and more aphrodiisiac than d-amphetamine,or even d-methamphetamine for many ppl.Especially when abused I.V. Also problem with psychosis similar to methamphetamine,more than with amphetamines or mph.Does it also work on another receptors,or some neutrontrasmiter? What i ve read people describing phenmetrazine feeling like low dose oxycodone+ medium quality cocaine.
Dr. Rege, listening to how Vyvance slows the release of the dex, I’m just curious about something. I take lysine tablets daily as a prevention for cold sores. Would this have any affect if when I take dex (or Vyvance, or even Ritalin/ Concerta)? Thank you for all the information you give us, Elle
By far the best explanation of these medications I could find anywhere.
This was brilliant.
Thank you 🙏🏼
Thank u very much. My Vyvanse is a life changer. Grateful to psychiatry everyday now.
@ryansturgiss4115~~I'm so happy that Vyvanse is helping you~~Methylphenedate,(Ritalin) was great for me as I am an adult who was diagnosed with ADD a few months ago even though I had it as a child along with anxiety/panic disorder since I was 8 years alomg with insomnia~~To make a long sad story short a new Dr, put me on Meth/Ritalin and I could finally focus and concentrate again without my head spinning in differet directions~~I don't procrastinate and when I started something I could actually finish it~~But where I live there is a shortage of Methylphenadate/Ritalin so she put me on Vyvanse~~For me it has been a horrible experience~~It only helps my brain work better but only sometimes and for a only for about 4 or 5 hours and then I experienced a Vyvanse crash and many horrible symptoms~~She started me on a low dose and it was like taking baby aspirin~~She uped my dose to 50mg. and for me like I said it was horrible~~But we know that we are all different in how certain medications will work for us~~I wish I could be one of those people that are on Vyvanse and it changed their lives for the better~~Stay well and take care~~Good luck~~😊
Wdym?
I’ve tried all the medications discussed, and have researched them a lot over the past few years, but this video was absolutely the most informative thing I’ve seen. Thank you so much! If you have time, I would love to see a video about Fluvoxamine (Luvox) (SSRI) in the treatment of OCD. Thank you so much ☺️
Thank you for your feedback. 🙏🏼. Really appreciate it. Will keep this request on the list.
I love your videos!
How many miligrams of methylphenidate did you take? I got myself 10mg pills but noticed they sell it up to 40mg, and taking one pill didn't do anything, I had to try 40mg to feel improvements. Should I take around 60-80mg?
If you only knew, how grateful I am for your Video. English isn't even my native language but I still understood you very well. You have explained the effect of those two medications in an easy way but at the same time you mentioned every important aspect. I truly appreciate this well-made Video and I wish you all the best.
Thank you for your feedback 🙏🏻
Methylphenidate feels like a far more potent stimulant to me and helps me with my ADHD more than dexamphetamine. Despite being a short acting agent, correct dosage timing can result in methylphenidate being a more flexible and less intrusive (sleep, appetite) medication. But I acknowledge everyone is different.
It's the other way dextro is more potent as far as dopamine
Why are they saying this drug is the same family is psychedelics
Did you try using Short acting Dexamphetomine or Vyvanse? Just curious and yeah absolutely everyone is different!
I'm on 30mh Dex short acting and it's been amazing.
methylphenidate is for me the best medication for adhd and i know what i'm telling
Yes me to! Im glad i was prescribed this drug after 10 years untreated
I started medicating with Concerta and it screwed me up in all sorts of ways with no benefits so tomorrow I am starting Elvanse and hope that works better. Luckily I work at a neurophychiatric clinic so I get help instantly if needed and our patients seem to love that I can relate to them in their struggles and some like the fact that they can see that it is possible to have a career even if you do’nt have a neurotypical brain ❤ I adore most of our patients and it is so lovely to see them feel better and improve their quality of life. Might share this video with them as it is very informative yet simple ❤️🙏🏼
Good luck. And wish you well. Thanks for sharing. Appreciate it 🙏🏻
@@PsychiatrySimplified Thank you 🙏🏼 My first day on Elvanse was great! I was more productive and have energy left after work for my four kids and house work instead of crashing at 3pm and just being overwhelmed and irritable with my darling children. I hope it lasts 😁
@@IamTheMom Good to know! wish you well for the ongoing future
Concerta and dexamphetamine are very variable in their responses for different individuals. Taking into account pharmacokinetics, individual patient needs, and their mechanisms - there is always a process of dose adjustment needed. Importantly because sleep dysfunction tends to be highly comorbid with ADHD addressing that provides some additive effects.
@@PsychiatrySimplified I think there is some benefit in clonidine with stims like before sleep as clonidine through a2d sorry for misspelling inhibit norepinephrine which can contribute to less anxiety with taking MPH f.e. that is also from my experience but what do you think dr.?
Well explained. My nephew was prescribed MPH today. I want to make sure I explained the mode of action to his mom in the most accurate, clearest way possible, and this really helped. Thank you Sir
I'm glad it was useful. 🙏🏼
This is gold, we need more channels like this 🙌
Raise your hand if you’re watching this at 1.5x speed or higher.
🤣
Raise you’re hand if this while reading comments
Unless it's critical for understanding the timing of something kin which case I watch a normal speed), I watch everything at at least 1.5X and 90% of what I watch is at 2X. About 20% of the time I wish there was a 3X. Listening UA-cam?
Great 😂
LOOOOOOOOOOOOOOOOL 🙌🏾🙌🏾🙌🏾
Dr. Rege, thank you for fulfilling my request for an MPH vs. AMP comparison!
Pleasure. Hope it meets your expectations. 😁
@@PsychiatrySimplified It sure does.
@@DennisBolanos thanks for your feedback 🙏🏼
LOVE this! I was diagnosed with Multiple Sclerosis in 2018, then recently an ADD/ADHD combined presentation. Still learning about ADHD and figuring out what symptoms are caused by which condition, so that I can treat them in the best way. Have been on Ritalin for a couple of weeks, not sure how affective it is, but will keep trying. This video was really helpful, thank you!
Thank you for the feedback. 🙏🏼. Wish you well with treatment.
@@PsychiatrySimplified thank you 🙏🏻 hope you’re well.
I know that it is the norm for a GOOD ms doctor to prescribe ritalin to their ms patients. It improves one's life. improves quality of life.
Thank you for helping me understand the medications critical to my life. This has helped me understand more than any provider has been willing to explain to me.
Thank you for that feedback. Appreciate it.
@@PsychiatrySimplified Doctor, what do you think about the dopamine release caused by bupropion? Do you think that its more efficient in the long term to counter SSRI apathy effects, if we compare it with DEXAMPHETAMINE & METHYLPHENIDATE? Thanks!
@@samuelsales401 in terms of a hierarchy of dopamine effects - lowest to highest- bupropion
@@PsychiatrySimplified thanks for your answer doctor. I would like to hear your opinion about these three that we mention. Do you think that bupropion gives less anxiety than the other ones if we compare long term use? Thanks again.
@@samuelsales401 it’s really individual when it comes to medications. It depends on the underlying explanation of anxiety. In adhd for example Rx adhd with methylphenidate and dex may reduce anxiety. In females dex may worsen anxiety. If mixed features is present then even bupropion can increase anxiety. In general bupropion is less ‘activating’ but that’s in general only based on its mechanism of action but does not mean it applies to all patients.
Excellent channel. Such clear explanations. Concerta XL worked to a point but Elvanse seems to suit me better. Elvanse really helps with procrastination and concentration. Videos like this should be recommended by ADHD clinics following diagnosis. Just got yourself a sub and thank you, Doctor Rege. 🙏
@ Charlie Greyfriars . Agreed. Given the medical confraternity is so ignorant currently, distribution of relevant material would be a boon for patients.
Completely agree on procrastination and concentration
I KNEW I WASNT CRAZY!!!! Just a difference in meds that really hit me hard
You're a gifted communicator and educator. I'll be sharing your channel to others like me.
Thank you for your feedback. I appreciate it 🙏🏻
Beautiful explanation and differentiation between these drugs. Especially the detail about lysine cleaved in stomach for vyvanse. I have taken adderall for some time but due to drug shortage, my doctor and I decided to try vyvanse and it was NOT a good fit. Ill just say the effects were severe and extremely unpleasant. The effects of vyvanse were actually substantially worse than just quitting adderall cold turkey. I was wondering about the difference in mechanism and any reasons it would affect me so differently.
Wow! This is an incredibly detailed yet simple video that thoroughly explains the difference between both! Amazing work!
thank you for your feedback
Many thanks Dr Rege for such a concise but very informative approach towards explaining psychiatry. I find your videos really helpful while preparing for my exams. 👌 Keep up the good work.
Thank you for your feedback 🙏🏻
Dexedrine IR worked great, however, during Covid Lockdown I quit taking it and started drinking alcohol heavily and noticed an almost immediate effect on my mental health.
Amphetamines definitely have their side effects which are not to be taken lightly but compared to alcohol or other drugs are much less severe
🎯 Key points for quick navigation:
01:03 *🧠 Both dexamphetamine and methylphenidate target the prefrontal cortex to improve cognitive functions affected by ADHD, such as attention, concentration, and set shifting.*
02:21 *💊 Methylphenidate inhibits NAT and DAT, increasing levels of noradrenaline and dopamine in the synaptic cleft, enhancing their effects on postsynaptic receptors.*
04:38 *🔬 Dexamphetamine competitively inhibits VMAT, leading to increased dopamine release, and acts as a reverse DAT inhibitor, further pushing dopamine into the synaptic cleft.*
06:01 *⏰ Long-acting formulations like lisdexamphetamine provide more consistent dopamine release, mimicking tonic firing and potentially offering better symptom management for ADHD.*
06:59 *🎯 Optimal dosage of ADHD medications is crucial to avoid both inadequate symptom control and side effects like rigidity and inflexibility in the prefrontal lobe.*
07:53 *🔄 Dexamphetamine exhibits a triple-pronged effect, including NAT and VMAT inhibition, resulting in a more potent action compared to methylphenidate.*
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Something anyone new to this needs to know. Adderall is a mix of 4 compounds. Mainly 2 Isomers. Those isomers bind to different receptors sites. If you are prescribed a generic, the ratio of those compounds will be different than brand name Adderall. The issue you may run into as I did, is after a period of time adjusting to, and fine tuning dosage on the medication, your pharmacy can simply change manufacturers of the generic. Generic does not mean "same". It's pretty much a 100% forgone conclusion that the new generic will NOT have the same ratio of isomers. This is bad..Insurance companies will steer you towards generics. And it's totally true they cost less. But your brand name medications composition won't change at the whims of the pharmacy's finance department. In my case I went from a good working dose and frequency medication, to having no fingernails after a month on the new generic. Racing heart. Anxiety. All from getting a drug people would assume was the same, just from a different manufacturer. Now I'm on a non generic.
I have been telling my doctor this for years, she kept telling me no they have to have the same activity ingredient.And I be saying no way they are the same, she says it's in my mind, insurance won't cover it after it is off Brand status so she by default. It's shameful that the doctor and pharmacist don't know this,they can get somebody
I'm having a hard time adjusting
Very informative. I am about to add dexamphetamine to my antidepressant meds. It’s good to understand how this drug works. Thank you.
Gonna switch tomorrow from methyl to dex, thanks for the clear explenation!
Good luck!
I take 72mg of Methylphenidate (Ritalin Long Acting) daily and it was interesting to learn about how it works to help me focus. Unfortunately I'm on quite a high dosage as my ADHD is awful but hey is what it is.
But yeah thank you for the video! It's really nice we live in an era where we can learn alot about how people's disorders are treated and break it down scientifically 👍
Thanks for the feedback. Glad it's helping you. Wish you well 👍🏼
@@PsychiatrySimplified thank you! I do get quite anxious but other than that it works perfectly! Keep up the great videos 😊
@@Riku-Leela thank you. I've covered clonidine in another video - sometimes these agents can be used to counteract anxiety - they are also used independently in adhd. Ps not medical advice - discussing this with the doctor can help.
@@PsychiatrySimplified oh interesting thank you, I'll watch that definitely and perhaps speak to my psychiatrist if it seems helpful! 👍
Awwww
thank you, doctor! Very informative. Much appreciated! I have always wondered if maybe I should switch to Adderal, but I am having success with Ritalin/Concerta so I will stick to that! Note I have some Concerta I never took as I preferred a shorter acting medicaiton and also due to cost, but now that there is a nation wide Ritalin shortage, I am thankfully using the Concerta and very pleased with the results as well.
Thank you for your feedback. Good that you find it beneficial. Wish you well.
Thank you! I have been prescribed d-amphetamine and I wanted to know what I'm dealing with. You explained the subject very clearly and I understood everything despite not having a medical background.
Thank you for your feedback 🙏🏼
Thank you for this video. Very helpful and very clearly explained. Super appreciated.
🙏
Glad you found it useful
Great video I've got ADHD and I'm on vyvanse great tablet
Thank you! This was extremely helpful! Appreciate it! Great evidence based channel 🏆
Thank you for your feedback. 🙏🏼
I’ve had a love/hate relationship with Adderall the past few years. The insomnia and body crash was not worth the few hours of focus that it gave me 😅 I recently switched to Ritalin and have responded very well to it! I can actually sleep now :)
I was curious how the two medications differed & this video answered all questions. Thank you!
Scratch that, I have 2 questions!
My psych had suggested taking Wellbutrin along with the Ritalin, for depression and ADHD. I’ve read that both of these medications are NDRIs. Would both medications essentially be doing the same thing?
Also, what role does caffeine play when combined with a stimulant like Ritalin?
Sorry for the questions! Not looking for medical advice, just very curious lol.
@@rebeccalopez1755 what is the rationale ? You are correct both are NDRIs. Caffeine stimulates wakefulness by antagonising adenosine receptors which may have some indirect effect by allowing wakefulness neurons such as orexin and dopamine to act without the Adenosine somnogenic ( sleep inducing) effect. Here sleep wake neurobiology Neurobiology of Sleep - Circadian Rhythms, Sleep-Wake Cycle and Insomnia
ua-cam.com/video/X5KpIoy4wL8/v-deo.html
i love adderall because i dont get a really noticeable comedown but with dexmeth (focalin ir) 90% of the time i end up getting the worst hangover/comedown out of every drug ive ever used. i still use it tho because.. well im an addict but i lowkey hate this
@@delsymdrinker it’s weird I hated focalin XR and Concerta but love Ritalin even though they are the same drug. I take Ritalin IR tho. I like to be able to control the timing better. Haven’t tried Adderall but a high dose of Vyvanse sent me into full on panic mode. I’m pretty sensitive to stims and I like to keep it that way so I don’t absolutely have to have them to not wanna blow my brains out…I do have ADD like a mofo tho and Ritalin helps me power through so I don’t get fired from my job. 🤷♂️
Great explanation of the inverse agonism of DAT by dexamphetamine!
I'm taking Adderall, Buspirone and Sertraline. They switched out the Fluoxetine for the Sertraline. ADHD depression and Anxiety supposedly but I'm super tired all the time. The Adderall works pretty good for a few hours but it makes my hair fall out too much so I stopped taking it. I took myself off Sertraline & Buspirone and just took the Adderall and it seems to make me happier to the point where it seems like the other meds aren't or weren't helping. I just need something to focus and not make my hair fall out.
Hair loss can be a side effect of amphetamine stimulants. However other causes should also be ruled out. There are ways around this - alternatives, other meds that may stop hair loss etc. Please discuss this with your doctor as they can advise specifically.
SSRIs make my ADHD symptoms 1000% worse.
@@hagridsbeardguy1399 yes that is something many say. One hypothesis is that it reduces striatal and frontal dopamine both if which are already postulated to be affected in ADHD thus worsening cognition. In women it can do this by activating the emotional arousal areas.
I used to want to smoke and get high all the time because of the dopamine release it made me feel like normal people, It felt awesome. But I quit weed recently and used methylphenidate recently it’s helping so far but I wish it would last longer
Discuss the longer acting versions with your doctor. Wish you well.
Congrats! Ritalin helped reduce my desire for all of my toxic dopamine seeking behaviors…sex, drugs, and alcohol.
@@JB-qt3wo Vyvanse seems to have fixed my SUD too. Been on it about a year and a half and have no desire for drugs anymore and rarely drink alcohol.
Great video.
Personally I much prefer the short-acting medications as it gives me much, much finer control over my day and I can time precisely when the medications will wear off. I can also opt to use them in such a way that I only get a half-day effect when that's all I need. I try to use the medication as little as possible.
Yes for many the flexibility is an advantage while for others they prefer taking it once because of the schedule etc. Thank you for your feedback. Wish you well with treatment.
@@PsychiatrySimplified Thanks doc :)
My provider mentions her strong hesitancy against IR adderall and I respect that but ER lasts too long and difficulty sleeping ensues. I asked for MPH as it’s lack of “stimulating” properties which I would assume can hinder addiction formation and might be more beneficial.
@@yasinyildirim4686 yes one can try that and have a discussion with the doctor. Lisdexamfetamine in some lasts a lesser duration . Mph - comes as Ritalin LA or concerta both which have different durations. A discussion with provider is helpful as in long term longer acting versions tend to provide better tonic DA rather than the pulsatile DA.
I initially did a 2x a day IR . They work well but I would frequently after the first dose actually get stuck on a project with that improved focus and blow right by the time I was supposed to take the second dose. Then I got stuck playing the "If I take this too late will I sleep like crap" game.
Dr. I take vyvanse. It helps with more attention type deficit but has helped tremendously with my depression and anxiety more than anything. I would welcome a comment from you about this.
Most definitely. Dopamine in the prefrontal covered plays an important role in depression and anxiety. Dopamine is linked to mood, reward , motivation, drive, attention, concentration and it is also involved in the top down control of the ‘threat area’ which is amygdala and limbic system: so dopaminergic agents are used in Rx of depression. E.g Bupropion, Agomelatine etc. i explained this in another video - hope you find it useful. What Depression and Anxiety Look Like in the Brain
ua-cam.com/video/vy97wZQyEr8/v-deo.html
Great info. Knowledge pouring out in an understandable way!
Thank you for your feedback 🙏🏼
Glad I found you! It’s harder than I think it should be to find information on the mechanistic actions of psychoactive drugs, and it is a useful piece of the puzzle. Pending an assessment, I am trying to understand this, because while I think I have had poor dopamine leveks all my life, I suspect my noradreline may be another story (I’m presently on Clonidine, and will check out your video on that). Assuming a positive dx, I was inclined to look at methylphenidate first, but I’ve started getting the impression that amphetamines might target dopamine a bit more than methylphenidate, and it sounds like that may be the case.
wikipedia has all the info you need. Erowid is a great user experience website
Subscribed! This is such helpful information and very much appreciated!Thank you also for the visuals, really helps to learn alongside audio! Love your style of teaching, gonna be binge watching your videos now! ❤❤
Thank you. Suggestions welcome 🙏🏻
I have found that individuals who suffer with serious depression benefit from the extra dopamine release you get from Adderall…with the downside being that the drug burns out your dopamine receptors and you become seriously dependent on it like you would any amphetamine. Amphetamine withdrawals are no fun at all. Some people really wanna get high though.
I need all day strong all day long😂😂😂
I'm just starting Vyvanse. I'll sacrifice the first hour or two of waking up so I can be set for the rest of the day. Praying it works when Im not on just a starting dosage. 🙏
Very well explained! I have an ADHD question that I will try to keep as short as possible. My daughter (19 y.o) was diagnosed with depression and anxiety 5 years ago. It has been a very long journey. She has treatment-resistant depression and nothing has really helped her - she's tried it all, including Spravato and TMS. She had genetic testing done which shows that she is not a good candidate for SSRI's as well as most other gold standard treatments. She was always an excellent student, until a few years ago. She was not tested for ADHD during high school, but now that she is struggling (badly) in college, her psychiatrist just ordered an ADHD test. I should note that my son (her older brother) was diagnosed with ADHD (inattentive) when he was 8 years old. He took Focalin and it did nothing for him. My daughter mentioned a few times through the years that she thinks she also has ADHD (inattentive), but that surprised me as she had always been a high achieving student. Anyway, we're thinking that her test will show that she does have the disorder. Included in the genetic test was an analysis of how she might respond to ADHD meds. Literally every single one says either "lower odds of response" or "moderately lower odds of response." Adderall and Vyvanse were in the "moderately lower odds of response" category. This is because she is COMT met/met. So, my question(s) after all of this is, do you genetically test your patients and if so, have any with COMT met/met had any response to Adderal, Vyvanse or any of the other amphetamine based meds? My daughter's options are so limited with everything and it's really frustrating. Thank you in advance.
I often see these tests been misinterpreted. The tests are a tool to be used to supplement a thorough ADHD / psychiatric evaluation. The test cannot predict diagnosis or response to meds in this way. ADHD os highly comorbid - patients respond well irrespective of the genotypes . It’s the phenotypic presentation that matters more - that means identifying the specific domains - Cognition, activity , reward sensitivity, behavioural activation, behavioural inhibition and fight and flight. Then going through a ruling out process - when individuals don’t respond it’s often due to comprbidities - e.g sleep disorders are amongst the most comorbid especially in children and adolesacents and adhd treatment goes beyond stimulants only. See this videos for a diagnostic understanding - ua-cam.com/video/Jq0VmCbN6C4/v-deo.htmlsi=boLPaMkc3ypa7pAh
How did your daughter go? I was also a high achieving student in High School with depression and anxiety (among other things) who fell apart during University. And I also had a brother diagnosed with adhd as a child!
I had a lot of mental health treatment and nothing helped. We tried everything- all the pharmacological interventions, different therapies like ACT, CBT, DBT, somatic things, lifestyle things, and even tree-hugging things (this was literally prescribed by a therapist)!
When I was 27 I came across information about ADHD in women and girls presenting differently. And I knew. I did so much research, checked the DSM-5, took all the tests. It was a lightbulb moment for everything. It took a long time to get diagnosed and start treatment but it has been literally LIFE-SAVING. My depression is gone, anxiety minimal, I sleep better, my ED improved, everything. I am now working on my anger and resentment that it was completely overlooked during 15 years of mental health treatment.
Please, please get your daughter tested. Dont let her spend another decade struggling and hating herself. Advocate for her, and if the psychiatrist suggests medication treatment TRY IT. Ignore the gentic testing, the only way to know if treatments will help is to trial them (under supervision), and if one medication helps a little butnot much try others. It took a while to find the right medication and dose for me, and its always being re-evaluated, but it is so worth it.
I know this is long but I am so passionate about helping other women cut through the BS that is often medical-misogyny as its so common and causes many issues. ❤
I wish her the best in finding help...I too had I in college
@@PsychiatrySimplifiednow I can read my results better...thanks
Dude that wall is perfectly in focus.
This is amazing! Thanks for putting out this information on your channel.
Pleasure. Glad you found it useful.
For a very long time I was looking for such a comparison video
Most informative video, saved me so much time doing tedious research! Thank you!!
Please create more content!!
Thank you for your feedback. Will do. Hope you have explored some of our other content which you may find helpful.
Thank you for this explanation. I have recently been diagnosed with ADHD and prescribed Concerta. My doctor explained it briefly but I have been trying to find out more about ADHD and the different treatments. This was very thorough and hit all of the points I was wondering about.
Thats a sort of methylfenidate like ritalin. Hope it works well. If not, try ritalin before adderral.
Beautifully explained, concise and clear video. Thank you
Thanks you for your feedback
See I am worrying and overthinking, because my Ritalin does not work for me, and I got worried it may have been a misdiagnoses. But this video shows how different the medications are from one another and why it may not be working for me. I hope the amphetamines work.
When one says medications are not working - it's important to break down not working into 1. What symptoms are not targeted? 2. What effects have been felt. Based on this a targeted plan is made. Wish you well
@@PsychiatrySimplified And what if no symptoms are being reduced? Does that more than likely mean I dont have ADHD
@@icarus8964 it depends on specific symptoms. Symptom domains in ADHD - include cognition - attention , concentration, organisation , procrastination, executive functioning , goal directed action , motivation 2. Emotion - hyperactivity may occur here , emotional dysregualtion. 3. Sleep . Now adhd can occur with other conditions such as depression in which case low mood, anhedonia ( inability to experience pleasure) negative thoughts, and adhd symptoms are worsened l. Similarly other conditions may coexist. So aim is to identify which Sx are present. Stimulants target - adhd Sx specifically , but if mood Sx are present they may not. Similarly if sleep dysfunction is present or worsened with stimulant that should be addressed. Anxiety is another issue. Females have a different presentation. So once the specific Sx are identified then medication can be used appropriately to target the domains. Hope this helps clarify. Ps not medical advice
@@PsychiatrySimplified Thank you so much. I have all symptoms, so ill just keep trying tablets.
@@icarus8964 it is a balance that the doctor is trying to achieve in general. Sometimes other meds are needed for synergy. Other medical conditions should also be treated. See video on diagnostic evaluation of adhd. How to Diagnose Attention Deficit Hyperactivity Disorder (ADHD) in Adults? - Dr Sanil Rege
ua-cam.com/video/Jq0VmCbN6C4/v-deo.html
A bit of a taboo subject for many, but would you be interested in comparing & contrasting Desoxyn's active drug to dextroamphetamine & levoamphetamine? Specifically how all three differ in terms of how much they affect the norepinephrine transporter, and how Desoxyn has a greater serotonergic effect.
I feel many prescribers reach for Adderall over Dexedrine simply due to its existing ubiquity despite the potentially mitigated physical & anxiety-inducing side effects of pure d-amp, and especially do not consider Desoxyn, a drug with potentially less side effects & better mood improvements that is avoided due to both stigma and neurotoxicity concerns of the serotonergic effects despite a therapeutic dose being much lower than a recreational one (as well as a blanket ban of the medication in many countries).
You raise a good point. Stigma is a barrier and other concerns, as you rightly raised, when seen from a purely medical point of view, Desoxyn as an agent, if used appropriately, has benefits. Not available in Australia for Rx. Thanks for raising this
@@PsychiatrySimplified Dr, What i v read Australia has scheduled Xanax to the most restricted cathegory .So Xanax has also very bad stigma ?
@@sidka84 Issue with Xanax has been misuse and dependence as it is very short-acting. Short-acting benzodiazepines have a higher risk of dependence
@@PsychiatrySimplified Dear Dr Sanil Rege this methylphenitade in doses above 60 mg a day doesnt mix good with tramadol.I don t have hypertensia or cardiovascular problems but when i take two concerta pills 36 mg and take tramadol with it i have pulse 155-160...Otherwise i have normal pulse. One 36 a day is just fine.
@@sidka84 because tramadol is an snri plus opioid. The combination leads to significant NA and Dopamine which can increase blood pressure
Another awesome video. Thank you for this clarification.
Hello, I was diagnosed adhd by a Qeeg brain scan at 19 (this was in 2006 and I was never treated, I was prescribed time released Adderall took it literally one day but the dose was too high or looking back i couldn't click my executive function to activate lol. I don't even like Tylenol so I think mentally the idea of a medicine that made me feel ANYTHING was against my nature. Fast-forward, I'm now 35 with four kids ranging 3-10.. the older 3 are diagnosed combined type and suspected but not did dyslexic (specific learning disabilities in reading and writing but school won't call it dyslexic) the baby is undiagnosed but has received early intervention therapy daily since before 2 for sensory stuff, lots of stimming, probably autistic, definitely adhd but his speech and ot therapist use the word hyperlexic, he's an absolute genius - talks about parallelogram quadrilaterals trapezoidal semicircle, knows all the planets, counts by tens to 100 while my older 2 repeated kindergarten (pre diagnosis pre IEP pre mama bear knowing repeating HARMED not helped them so the boys will never repeat and both had ieps as disabled preschoolers. All 3 older have normal iq. I have extreme guilt for waiting this long and basically telling my kids "try harder and you will see that chalk board... try squinting, try moving closer, try taking longer to figure it out. I'm an obsessive researcher and I know the right thing to do is medicate the older 3 who struggle so bad. My 6 year old, number 3 lol, has the hardest time and a complete aversion to learning or trying or anything letters or speech related. My heart breaks. So I decided before medicating them I will try to treat my adhd for the first-time since 19 the one day I tried it lol. The doctor prescribed me 5mg Ritalin once a day. Two weeks went to twice a day. Two weeks later went to 10mg twice a day which I have yet to pick up from the pharmacy so I'll see if its better. Do you have a recommended medication for adults.. my biggest obstacle is the executive function / motivation to begin like where to start and completing tasks without starting 1485843182 more, and working memory is SHOT. Forget forgetting why you walk in a room, I can't remember what I was going to Google, who I was going to email etc when it can be something very important! Also do you have a recommended medication for kids who have adhd but also specific learning disabilities so like maybe more focus or problem solving ? Please help bc both my adhd and the kids neuro will listen to me and try what I ask for but I'm overwhelmed with options and stuck in analysis paralysis so my indecisiveness debilitates me and my days turn into weeks months and literally years and things that are ON THE TOP of my to-do list are still there years later. Ugh. But I have to get it under control for my kids so I can help them manage theirs. Please send me your recommendations and advice 🙏 thank you. Edit to add - my kids father is also adhd, diagnosed as a kid and overmedicated in the early 90s so he is also untreated majority of his life and explains the genetic end of it with our kids lol. Isn't it interesting how 3 struggle so so so so sooo hard learning but are socially strong while the baby is smarter than all of us combined but doesn't have input receptors to questions so he's very one sided and output output output like questions don't register right away or at all sometimes so socially I worry but academically he knows like high-school geometry lol and the other kids are social butterflies so funny and fun, make friends everywhere they go but all struggle s hard.
Very informative! I wanna switch to a extended release. It feels more natural. Taking tentin every few hours is more ''spikey'. Not what I'm looking for.
Thanks for the feedback. Something you can discuss with your doctor.
Ritalin used to work great , now it only gives me anxiety , took months off , still nothing , no other alternative drug , any idea how to fix this ?
Watch this one. When stimulants stop working. ua-cam.com/video/Baqzy3L3TjA/v-deo.htmlsi=3UldhrxiCZV97JVu
Efficient, clear presentation. Thank you
Thank you for your feedback. 🙏🏼
Question. Is methylphenidate not considered an snri? And if so, why not? Something I’ve been wondering. Great video. Thank you so much!
No methylphenidate does not have SERT inhibition. So it’s an NDRI but not SNRI
Brilliantly explained. However regarding my experience with a lisdexamphetamine, Elvanse (UK version), and comparing it to my new dex (initially prescribed as a booster), it works so much better for me in that apart from it being an instant release form, it also lasted way longer and I didn’t get the crash at all that i got on Elvanse, almost like a complete opposite of what both were designed for - And this was done by taking it in it’s own at first, not as a booster, so i could guage the drug by itself and its effects. I now use that on it’s own. One question I have is, are shorter acting meds more harmful for the body than a ‘lisdex’ due to the latter being released slower? I have a overthinking worry and concern that I’m damaging my health somehow? - (taken as prescribed and not in the context of abuse etc)
6:20 According to the paper "Lisdexamfetamine Dimesylate (Vyvanse), A Prodrug Stimulant for Attention-Deficit/Hyperactivity Disorder"
the enzymatic cleavage happens mostly in the blood, not in the stomach.
Yes that’s correct- I’ll add a correction. Thanks for picking it up
@@PsychiatrySimplified I didn't expect an answer at all to a year-old video, much less a correction!
It shows your great professionalism! Thank you for your videos, they are very helpful.
@@georgH No, it means a lot to have an audience like you contributing. Many themes that I cover are covered because of the comments and, of course, for me to learn as well. So appreciate the feedback and your input.
Thank you. Can you please make a video regarding all three possible ways of treating adhd? Atomoxetin, mph and Amphetamine group of meds.
Please, it would be great, if you can make video about comparison between amph and methamph, because I read and hear a lot” you are using medical meth, nothing else”
Will keep that on list. Although not gone in detail I've covered a summary of ADHD rx here. Attention Deficit Hyperactivity Disorder(ADHD) Simplified | How to Diagnose ADHD | How to Treat ADHD
ua-cam.com/video/AyNKTHwM3f0/v-deo.html
I do get mine from the name look up ⬆️ ⬆️⬆️ they are the best I know that helped me with products when I suffered Adhd, depression and anxiety and I get mine from them
Thank you so much doctor for making this video! I was looking forward to it
Pleasure. 👍🏼
Thank you for the explanation!
The difference in my case, is that one works and one doesn't LOL I switched from Adderall to dextroamphetamine sulfate and it is like a whole new drug. All of the jitters and nasty side effects of the Adderall are completely gone. I also found Vyvanse very ineffective the disadvantage of dextroamphetamine however is that it seems to be much more difficult to find than the other more common drugs.
This is great and well explained information!!
Thanks for the feedback 🙏🏻
Ah thank you for clear and simple explanation
Thanks for the feedback. 🙏🏼
I used to do loads of speed back in my day it was the only time in my life i ever read a book from couver to couver in one night jhon liveington seagel it was good book
I went from Adderall, Auvelity, Trintellix, and Rexulti to Azstarys, Trintellix, Wellbutrin, and buspar. I like the change much better but dont think I'm quite dialed in yet. Im thinking about going back on Vraylar. 😅
Have a look at the videos on ADHD not equal to stimulants and when stimulants stop working.
Hello. I’ve been on methylphenidate for a month now - used it 5-years back as a youngster and it worked like a charm, or so i remember. However now that i got it again, my heart is pounding, my jaw keeps clenching and i’ve been experiencing severe arrhytmia from it. What’s your opinion, do you think dexamphetamine would suit me better? Methylphenidate works for 4-6 hours after taking it but after the effect is gone, life becomes even harder. Barely lasts through the work day.
Very difficult to predict. LA versions are trialled if activating side effects are present in general. They also have a longer duration of action. psychscenehub.com/psychinsights/diagnosis-and-management-of-adult-adhd/
Many thanks! So easy to understand!
Pleasure
the way I’ve always understood it. MPH makes dopamine last longer and feel more potent. While Dex more so releases extra dopamine
No that's not how it is. Dexamphetamine increases / releases Serotonin, Dopamine and Noradrenaline. MPH - NA and DA but no serotonin. Dex is generally more potent when it comes to DA release. But the differences in repsinses differ from individual to individual
@@PsychiatrySimplified Ah okay. That makes sense. thank you
Ive been taking adderall and it makes me very flat and totally spaced out im pretty much a zombie. i can hardly function and im taking the starting dose for adults. I was just given 10mg of ritalin 2x a day hoping it works well. Just did a test 5mg piece before i take it going to work tomorrow. I just feel happy energized and focused thats what i want. I also take guanfacine 1mg at night.
@curtiskarner2190 it turned out to be more than just adhd. In my own research and opinion, and my new phychiatrists words. I lack both serotonin and dopamine. Increasing dopamine can decrease serotonin. I take prozac 20mg, and I can take stimulants fine now. There are no issues at all. I plan on increasing to 40mg of prozac she is wanting me to take focalin once I adjust to my antidepressant. Prozac has made my life so much better. I was taking 20mg of adderall xr and then I went up to 30mg xr which made me a zombie but I think it would be fine now if I were to take it again because of prozac.
As someone who experiences both anxiety and ADHD, I've personally tried both Concerta and Vyvanse. After conducting a week-long trial, switching between the two medications each day, I've found that Concerta is a better option for those who also struggle with anxiety. During my time on Vyvanse (Lisdexamfetamine), I noticed an increase in my nervousness, euphoria, and physical agitation. Based on my experience, I would recommend Concerta as a more effective option for those with both ADHD and anxiety.
Thank you sharing your experience. It is very individual dependent. The responses are very varied and your description could also hold true for vyvanse in some. Hence in ADHD treatment it's important to consider appropriate trials and not rule out a medication if one hasn't worked.
Oh thank you!! I have been on vyvanse after being on Ritalin for almost a year.
But thank you!!
Thank you for the explanation.
for me dexamphetamine has a weaker mental effect but stonger body effect, whilst methylphenidate works more mentally but is lighter on the body
Interesting . Individuals experience such a range of reactions with these meds .
Same for me also
Adderall - Chik-Fil-A
Ritalin - Popeyes
Concerta - KFC
Vyvanse - Cane's/Zaxby's
I've did them all, trust me
Ha ha! Those seem like interesting analogies; however being in Australia - don't know what Chik-Fil-A, Popeye's, Cane's/ Zaxby's are? Could you describe in fast-food terms what's the difference? Wonder if someone can do an Australian version (:
I do get mine from the name look up ⬆️ ⬆️⬆️ they are the best I know that helped me with products when I suffered Adhd, depression and anxiety and I get mine from them
Hi sir,
Thats was a great informative video explained clearly doctor👌🏻. I'm having a doubt, instead of using stimulants like amphetamine, methylphenidate or Atomoxetine to treat ADHD. Can we use the below mentioned medicines as an alternative. Like
* Armodafinil or Modafinil
* Yohimbine
* Bupropion
* Rauwolscine
Will there be any better efficacy or improvement compared to classic stimulants. Asking this out of curiosity and for information purpose only sir.
One more kind suggestion doctor - Can you please make a video on comparison between Modafinil, Methylphenidate, Rauwolscine or Yohimbine and amphetamine.
Thanks in advance doctor
Modafinil , Armodafinil and Bupropion are used in the treatment of ADHD and have evidence . The other two - no evidence and not used in clinical practice . Modafinil, Armodafinil and bupropion can be useful depending on the level of deficit and the comorbid symptoms. Use of agents depends on what are the symptoms that one is looking to target .
For me Methylphenidate had a whole range of negative side effects like a intense constant anxiety and nervousness while 60mg of (Lis)Dexamphetamine had all the positive without the negatives and has been a life saver ever since, im on it for like 7 months now hopefully it stays working since i heard tollerance starts kicking in after a while.
I also tried Bupropion but that did nothing besides give me headaches and the feeling of a knot in my head that i couldn't untie
Methylphenidate immediate release or extended ? Extended release medications like Lisdexamfetamine do not have the pulse DA release like immediate release dex or methylphenidate so is more tolerable for many.
@@PsychiatrySimplified Hey thanks, i have to admit in the first few weeks Methylphenidate felt like a wondermedicine (even tho i felt jittery and unnatural ). During that time i switched from immediate to a extended release dose of 54mg after asking my psychiatrist (for ease of use since i had this comedown effect in waves throughout the day). But over the next couple of months the negative effects where setting in badly and the positive effects all but flattened and i started feeling incredibly unstable so i just couldn't commit to using it daily anymore.
After this he advised Bupropion for a while but it didn't do much for me besides make me more lazy and depressed while giving me a headache, so i asked my psychiatrist about Dexamphetamine and he eventually gave me a buildup to 60Mg of Lisdexamfetamine and even tho it doesn't give the same drive as Methylphenidate and took a few weeks to get used to it feels incredibly natural and makes me able to focus and continue working even during moments when i am battling some internal things ( It does at certain moments increase my social anxiety a bit but besides that it does wonders for me )
Contrary to most taking Dexamfetamine throughout the day compared to M helps me sleep better at night somehow, my psychiatrist wanted to give me Venlafaxine after Bupropion first but since i asked about dex myself we went with that and i am happy we did. Sorry for the long reply lol
@@LAKXx good to know. In clinical practice the stimulants tend to have varied responses for patients - so just because one doesn’t work doesn’t mean the other shouldn’t be tried as in your case. Glad it worked . Thanks for sharing. 🙏🏻. Always good to know how individuals respond.
@@PsychiatrySimplified Aye keep up the good work Doc your a lifesaver :) It is strange how the subjective experience varies so widely yea
Very good simple explanation Dr
Thank you for your feedback
Thank you!
I have one question: my psychiatrist prescribes Dexamphetamine as an alternative treatment for depression. I have severe sleeping problems since I started using Dexamfetamine. My psychiatrist says the same as you about this stimulant: it works about 4-5 hours. I disagree. Half life of Dexamphetamine (not XR) is about 10-12 hours. In the Netherlands it is forbidden to drive for 30-40 hours after using Dexamfetamine or speed due to its long half life. After 2 x the half life (about 20h-24h) there’s still a too high blood level of amphetamine (1/4 of the initial dose). 30%+ of Dutch patients experience sleeping problems. My psychiatrist says this is not possible because it works just short (4 hours).
So my question: are you both wrong? Given the half life of Dexamphetamine, I think you both are.
Methylphenidate IR has a half life of about 2-3 hours. Much, much shorter. I know that.
Thank you for reading and hopefully answering my question!
❤
Thank you for your comment. With psychostimulants half life and duration of action are two different things. Because with immediate release the D1 receptors get stimulated more significantly when extracellular DA concentrations rise. This is responsible for the burst phasic D1 activation that results in euphoric effects or activation and when beneficial the cognitive benefits. However the D1 receptors do not keep getting stimulated for 10-12 hrs - these receptors require significantly high levels of DA ti be activated. On the other hand the XR version provides this but the aim is to have a steady basal level of endogenous DA to maintain good D2 activation,NA and target the goal directed learning areas and habit forming areas. Once individuals find that they are experiencing rewards because of the ability to plan better etc then the D1 receptors gets stimulated through unexpected rewards. So in summary ‘ duration of action ‘ is not linked to the half life - it's linked to the amount of plastic burst of DA provided by the medication rather than the tonic DA. Too much burst is not beneficial. Hope this helps
Thank you very much for your answer! ❤
"The Prefrontal Cortex. They are known as *The Seat of Good Manners*".
- Lector H. (M.D.).
😋
Great explanation, thank you
Great Video. You made it easy to follow. How does dexmethylphenidate compare between the two compounds you mentioned? Is it kind of like a middle ground?
Good question. Dexmethylphenidate is the more potent isomer of Methylphenidate( d isomer - active form). dexmethylphenidate does allow for a lower dose to be used and increases the duration of action by 1-2 hours. Thanks for the feedback 🙏🏼
@@PsychiatrySimplified Thanks for the quick response!
Dr. what do you think, first great Video btw!, taking ndri like bupropion or DNRI like Concerta with amphetamines first: if fe focuse on concerta as noncompetitive reuptake inhibitor and taking amphs as competitive which release additional dopamine into synaptic cleft, from that video shouldn't they work in synergy?
The combination results in significant DA & NA release which should be justified - it’s not usual practice . In treating ADHD significant phasic DA is detrimental - it’s only essential in early phases of learning and improving reinforcement sensitivity - constant phasic DA can worsen cognition.
Dear DR Rege,
My name is Thomas and I am 22 years old. I got diagnosed with ADHD last year. I have tried Ritalin, Concerta, Adderal and Vyvanse. I find Vyvanse to be the best for me; it completely relaxes my mind and body. But it only works about 7 hours for me, so I take 10 mg at 7 AM and 10 mg at 1 PM.
My question to you is: will the pill of 1PM disrupt my (deep) sleep, because of the half life of 10-12 hours? I usually go to bed at around 10 PM.
Thanks in advance.
Yours sincerely,
Thomas
The dosing of vyvanse is extremely individual - the variation from person to person is huge. so sometimes the only way is to trial and find out and then adjust. Your doctor will be able to do this with you. Wish you well.
Interesting that you mention methylphenidate binding to the *transport* for reuptake. What makes it different from Atomoxetine, if one is a stimulant and one is an antidepressant?
Methylphenidate is NAT and DAT ( also antidepressant properties) at more significant levels than atomoxetine which is only a NAT ( NAT Inhibition increases NA and DA ( mild via diffusion - see video on SNRIs ) . The labels stimulant vs antidepressant is only semantic. Best to think of functions that one is targeting in treatment
Thanks Doc! Perfectly said
So concise. Thank you.
I have five question (plsss I need awnsers plsss): 1.How can DAT And NAT be able to transport the Dopamin out of the presynapse eventhough its blocked by Dexamphetamine ?
2. When Dexamphetamine is inhabiting VMAT2 does it then block the pathway for DA to go in the vesikel ? or does its simply take up space so that DA isnt able to be in there, or does it do both?
3. When the action potential reaches the synapse, what does happen with the vesikel if they are filled with Amphetamin? and what does happen with Amphetamine?
4. Does DAT need the action potential to be able to transport DA out of the presynapse ?
5. Do you have any good sources where the neurobilogical effect of Dexamphetamine is very detailed explained?
(Sry for my english I am German desprate student who is desprate for information that cant be found in german and I also don't find anything in english)
2. Dexamphetamine acts on transporters so simply increases extracellular synaptic DA and NA . However it does have reverse transport so will directly release DA from presynaptic as well and via release from VMAT. This is the extrusion .
2. Yes DA uptake into presynaptic neurons and subsequently in vesicle is prevented via DAT inhibition and will also release DA from presynaptic neuron through reverse transport. 3. Don’t understand the question . Action potential is at post synapse so different process 4 . Presynaptic and post synaptic is present to keep a balance - presynaptic is negative feedback so if too much in synaptic space presynaptic will increase uptake ( like vacuum cleaner) but presence of amphetamine will change this as release and extracellular DA is > Uptake. 5. psychscenehub.com/psychpedia/dexamphetamine-and-lisdexamfetamine-mechanism-of-action-side-effects-and-dosing/
@@PsychiatrySimplified Thank you very much for your answer !
I'm here because I've been on methylphenidate for a while and I am having side effects, I feel absolutely terrible and it's not helping like it should.
I have a new prescription to start dexamfetamine tomorrow, so I'm just learning. I hope it will help me
Some individuals find dexamphetamine suits them better than methylphenidate. There is a huge variation in the responses. Wish you well
@@PsychiatrySimplified thank you so much, I'm off to collect my script now ☺️
@@alwaysdead89 wish you well
Awesome analysis. Why do we consider MPH to act on PFC when DAT inhibition can increase D levels in limbic system and nucleus accumbens? It is not like a D1 agonist to be sure it acts on PFC mostly. Wouldn't that make sense to give a D2 antagonists too so you block limbic dopaminergic overactivation but keep D1 activation in PFC? Thanks.
Good question. D1 family of receptors are considered excitatory and d2 inhibitory. Broadly - its the predominance of their presence that differs - so D1 predominant in PFC ( does not mean not there in other areas) and d2 striatum - nucleus accumbens and dorsal striatum. So yes when DAT is inhibited along with release DA acts on receptors in these areas. It is about modulation so any excitation is balanced by autoreceptors to uptake excessive DA from the synaptic cleft to maintain balance. So one doesn't need to give D2 antagonists if there is no vulnerability or clinical expression of DA overactivity in striatum - e.g psychosis, mixed features, bipolarity as the brain’s homeostatic mechanisms should kick in. But for some patients we have to provide a buffer to prevent this as you state. I cover dopamine in the other video on Dopamine in more detail - ua-cam.com/video/uo9nI-U7QXo/v-deo.htmlsi=AuHN2-WRcLoFGPrz
@@PsychiatrySimplified Thanks alot for your detailed answer Doc!
If you ever have the time, I would really like to see a comparative explanation of modafinil as a supplement to this explanation of dex & methylphenidate.
It is a milder agent in relation to DAT inhibition. But has orexin and histaminergic activity in addition as well which the two others don’t have . Will add video to the list
@@PsychiatrySimplified thank you, looking forward to it! I found it more effective in adult ADD than dex, but developed the notorious rash reaction.
Have you tried armodafinil instead? Not advice
@@PsychiatrySimplified Have a pharmacology background. Struggled with postgrad studies (different discipline) as an adult, began with modafinil then moved to the enantiomerically pure armodafinil, began to develop a reaction that was likely erythema multiforme, so discontinued use. Few years later, formal diagnosis with adult ADD (somewhat cathartic) and began treatment with dex. I tolerate it well and it has helped a LOT. I give my body breaks from it (lower dose on weekends, occasionally a few days to weeks without use) but it just isn't as effective as armodafinil, which can only be described as "clean" in contrast. Have been considering asking my specialist to trial methylphenidate to see if it is more effective in my case. The resources you have provided to people are informative and quite valuable.
@@PsychiatrySimplified Not taken as advice. information only. still very much appreciated.
very informative!!! thank you!!
Glad you found it helpful 👍
Dr. I recently got diagnosed with ADHD which I truly believe I have however I also have suffered from severe depression and anxiety most of my life. I have never "enjoyed" the feeling several SSRI's have provided for me and even the NDRI Wellbutrin wasn't good for me as it caused agitation. I knew from past experiences that Adderall was basically the cure to everything for me especially because of the euphoric effects. I have been prescribed Adderall and it was amazing just like I thought it would be but after a week of Adderall it seems that it is having a opposite effect and not only do I not have a euphoric feeling but I am considerably more depressed but the medication is holding its abilities to treat my ADHD by stimulation. I'm curious if maybe my dopamine is being depleted somehow. I'm not abusing my medication. I'm wondering if another ADHD medication would be better. I've even considered ketamine therapy for depression but it would be way too expensive. I have no intention of abusing any medication but I just feel strongly that dopamine increasing medications might be what I need in life to help, not only with ADHD symptoms but also severe depression and anxiety
sorry to hear. The diagnosis of ADHD should include a comprehensive assessment to rule out comorbidities. Stimulants treat specific symptoms - they improve cognition and can reduce hyperactivity. This allows for the prefrontal cortex then to engage in activity. However in many individuals esp adults there are other comorbidities. So a stimulant on.its.own may not address all aspects. It becomes important to look at all symptom domains. E.g mood dysregulation, mixed features, sleep issues, specific Sx of depression, anxiety etc. As individuals may require a synergy of medications with complementary effects to provide a beneficial outcome. For example many a time if anxiety rises with stimulant and individual also has sleep difficulties, augmentation with clonidine provides a synergy addressing all Sx.
Similarly if individuals have mood dysregulation, mood stabilisers with stimulant provide optimal outcome. This allows for the dose of the stimulant to also be kept optimum and lowest effective dose. There is also the possibility of dose adjustment with stimulants required I.e does increases. this it is important to discuss this with your doctor. Ps not medical advice ua-cam.com/video/Jq0VmCbN6C4/v-deo.html
Hi Luke, when treating ADHD I don’t think it is a doctor’s intention to provide a “euphoric” feeling by putting you on medication. Rather what they seek to do is find balance. Euphoria is not a natural state of being it is only induced by drugs or certain life circumstances such as achieving goals or having something happen in your life that makes you really happy like graduating college or falling in love. If you are chasing euphoria you are on a DANGEROUS path. settle for balance. Balance is real. Humans do not experience euphoria daily and it is not how we are meant to live. If that’s what you’re looking for then I’m afraid you will not find it without substance abuse.
Kratom helping me with ADD like only one substance. I take Ritalin, Methylphenidate, Adderall, Wellbutrin, Vyvanse and other stimulants, other drugs, but nothing work for me as good as kratom. I dont know why, if because kratom agonist noradrenaline and serotonin receptors i dont know. And the euphoric effect of kratom i like it, help me to motivate.
Sorry for my english :D
Excellent video with truthful content. Love you sir
I was looking for a video explaining how to use dexamfetamine and was too curious to not click on this instead. The irony
Hey what is dexamphetamine ? I've only heard of dextroamphetamine and I cant find anything called dexamphetamine
@@JamesJack-f2f they're all the same thing.
Raise your hand if you had to keep rewinding the video because you stopped listening
Ahh hah lol, not on purpose, but always with anything 😂
Would be useful to know about levo-amphetamine, which is a component of adderall.
d-amphetamine seems to be more specific in reducing overactivity, and impulsiveness and improving sustained attention.
l-amphetamine shows a relatively greater effect in improving sustained attention compared with its effect on reducing overactivity and impulsiveness.
Very helpful and informative
Thank you for your feedback
I have questions.
1) neurotransmitter is released into the synaptic cleft when the presynaptic neuron fired as a way to pass the signal on. In the normal brain the synaptic cleft gets cleaned again, neurotransmitter gets recycled. The synaptic cleft has to be freed of neurotransmitter or else the next signal (aka release of neurotransmitter) can't get through. Like a reset. Correct so far?
Well, what happens when you inhibit reuptake and the reset doesn't happen as normally? Are the meds effectively slowing down the frequency of signaling because the neurotransmitter lingers longer in the synaptic cleft? Aka, is all the dopamine that stays in the synaptic cleft inhibiting new signals coming through?
2)how does reuptake eventually happen? I mean, the cleft does have to get cleaned before a new signal can pass through, no? Or does it mean that as long as the meds last there just lingers a constant amount of dopamine in the synaptic clefts where ever dopamine is the neurotransmitter and the clean up only happens after the meds wear off? And wouldn't that effectively block neuronal pathways?
3)are you depleting all dopamine all at once because you empty the vesicles completely and inhibit reuptake and will that dopamine linger so long on the synaptic cleft that it diffuses somewhere into the extracellular space away from the synapse and away from recycling?
3) Is the rebound effect such a drag because you depleted all dopamine for a while so you function even less well than if you hadn't taken meds to begin with?
4) a) what kind of long-term architectural changes are known to happen in the Synapses once you have taken your meds for years?
b) I read that people have to increase dosage because there is some tolerance. Is tolerance related to architectural changes, like maybe the body builds more reuptake mechanisms to counter the effect?
I do get mine from the name look up ⬆️ ⬆️⬆️ they are the best I know that helped me with products when I suffered Adhd, depression and anxiety and I get mine from them
I’ve childhood to severe adulthood ADD .. short action Ritalin helps a lot yet sometimes is too much of a speedy feeling.. it also is a positive mood lifter and motivater for me.. what should I do? Thank you
It's a question for the doctor. In general the Long acting / slow release version avoids the speedy feeling by providing a steady tonic release of DA. Ps not medical advice.
Dear Dr Rege,and what You think about phenmetrazine or methcathinone for add/adhd?
Not part of the regulated medical treatments for adhd. Any reason why these as opposed to available and approved ones?
@@PsychiatrySimplified Just experimental in clinical studies maybe. Also 4-methylaminorex comes in mind. Do you know what is interesting Dr. Rege,this phenmetrazine was even slightly less potent stimulant than methylphenitade,but many users from that era prefered it oved amphetamine sulphate,d-amphetamine ,or d-methamphetaine in terms of abuse and euphoria.I wonder why,there must be sth behind this.
@@sidka8435 thank you for sharing, very interesting. it says was withdrawn due to widespread abuse. you are right re the less potency. very interesting.
@@PsychiatrySimplified Why was that,Dr Rege? Slightly less cns stimulant effects than methylphenitade,but more euphoric and more aphrodiisiac than d-amphetamine,or even d-methamphetamine for many ppl.Especially when abused I.V. Also problem with psychosis similar to methamphetamine,more than with amphetamines or mph.Does it also work on another receptors,or some neutrontrasmiter? What i ve read people describing phenmetrazine feeling like low dose oxycodone+ medium quality cocaine.
Dr. Rege, listening to how Vyvance slows the release of the dex, I’m just curious about something. I take lysine tablets daily as a prevention for cold sores. Would this have any affect if when I take dex (or Vyvance, or even Ritalin/ Concerta)? Thank you for all the information you give us, Elle
There is no known interaction. Of course also discuss with pharmacist and doctor specifically