So, in anticipation of my new job starting next week I’m trying to figure out what the right balance of medications should be for my various neurological issues, and I’m not sure where the balance point should be. I’m mostly thinking out loud here, but I am going to try to walk through it and maybe folks with more experience can comment, or something.

The two core issues are fibromyalgia and ADHD, both of which are rooted in dopamine dysregulation. Theoretically, medication which helps one should help the other, but that hasn’t been my experience so far.

For the fibromyalgia I’ve been taking 20mg/day nortriptyline (which helps with dopamine production) and 2x100mg/day gabapentin (which helps with pain downregulation). I take the nortriptyline at 9 PM, and the gabapentin at 9 AM and 9 PM.

For the ADHD I was taking 10mg Adderall XR, but it was staying in my system longer than expected and last Wednesday it got to the point that my blood pressure skyrocketed, to 160/100. Apparently I should have gone to the hospital for that. Oops. Anyway I stopped taking the Adderall (and a few days later I finally felt the full crash from it), and my psychiatrist prescribed me 5mg to try instead. This is my second day on that and it doesn’t really feel like it’s having an effect on my focus (certainly not as profound as 10mg had), but maybe it’s too soon to tell.

Anyway. Because of the new job, I’m getting different insurance, which means I need to get new doctors, and right now I’m sort of in limbo. I worry that changing my meds around will cause a medical emergency while I’m starting out at a new job (which is not a great way to start on the right foot), but I also worry that if I don’t have my ADHD under control that will make the job more difficult to get going with as well.

One of my working theories is that nortriptyline (being a tricyclic antidepressant) is interacting badly with the Adderall, so last night I tried taking just 10mg of nortriptyline to see if I could taper off from that and possibly go back to 10mg of Adderall. Today I’m feeling a lot of pain and not feeling great in general, which is to be expected. But the basis of my experiment is kind of faulty. There’s still the possibility that it might just be Adderall on its own which causes problems (especially with how low my nortriptyline dose is). And it’s foolish of me to try experimenting with dosage without real medical supervision.

Right now I’m tempted to just go back to my previous regimen (i.e. dropping the Adderall entirely) and then wait until I am established with a new doctor to figure out what my next steps should be. But I think I’ll just stick with the current recommendation from my psychiatrist — 5mg Adderall, 20mg nortriptyline, 200mg gabapentin. Hopefully at this dosage, I’ll get enough of the focus benefits of Adderall (especially if it does build up in my system as 10mg seems to do) without it ever getting to the point that my heart nearly explodes.

Why can’t brains and bodies have user manuals?


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