ADHD and fibromyalgia and nortriptyline

Yesterday I finally met with a new psychiatrist (having lost access to my previous one back in, oh, March), with the intention of figuring out what to try next in terms of ADHD medication.

As a recap, the first medication I tried (Concerta) just made me irritable and gave me tachycardia, and the second one I tried (Adderall) worked really well for my brain but also made my blood pressure skyrocket.

Anyway, on Tuesday I had also met with my pain doc and the decision we came to was that we should try increasing the nortriptyline again, since 20mg is doing something but not enough, and I couldn’t really remember why I felt like 30 was too much. He wants me to target 40-50mg for my eventual long-term dosage.

And the new psychiatrist and I discussed medications and she said that while there’s a few non-stimulant meds I could try, what’s a much more likely successful thing is to just increase my nortriptyline dose, since treating ADHD is actually an off-label use of it (which I knew already, and which makes sense since fibromyalgia and ADHD are believed to have the same underlying cause, namely poor dopamine regulation). So, while nortriptyline isn’t as effective against each of the five or so things it treats (pain, depression, anxiety, attention, insomnia) as a single targeted medication, it’s effective at all of those things and only has the single set of side-effects. And it means having a lot less crap to balance between other treatments.

So, she’s going to coordinate with the pain doc to figure out what the best target dose should be, and she’s going to let him drive the prescription/dosing so they’re not talking over each other.

She does want me to avoid using cannabis for a while, which is fine, since I basically only use it to fill in the gaps that nortriptyline wasn’t covering for me.

Anyway, I’ve been at a 30mg dose for two days and holy crap I forgot how drowsy this makes me, not to mention forgetful and having trouble with my procedural memory (like, having trouble even performing basic, routine tasks). Also my sense of time is even more messed up than 2020 made it already. But I should adjust to it soon enough. Hopefully before my trip to Port Angeles in November! I’ll probably opt to hold off on any further dosage increases until after that, anyway. Driving 2.5 hours each way while brainfogged isn’t a great idea.


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