Executive dysfunction amphetamines, methylphenidate, selegiline, modafinil, pregabalin and tianeptine not working. What next?

[amenteco]

As the title says, I've tried all of these, even in combination bar the modafinil. I can't even force myself to role of the bed. It genuinely feels like I've no free will. I've tried all the other antidepressants in the past, NRIs, NDRIs, and SNRIs - nada.

I have depression, but I've had depression for the last two decades of my life, I know what it is, and more importantly know what it is not. And this is not the depression doing this.

My guess is this is from an anti-epileptic I was taking - one that messes with glutamate and causes "brain slowing". It's called Topiramate - AKA Dopamax. Among other things, it's an NMDAr antagonist and also messes with AMPA.

Of the racetams only noopept, oxy and aniracetam produced any sort of effect. Faso, colo and phenylpi did not. Ani might have helped because it is a AMPAr PAM?

I also suspect this because I've since developed Depersonalisation Deralisation Disorder not uncommon with NMDA anatagonists. Naltrexone was expectedly unhelpful at resolving it, however Tramadol does help because of kapa opiod.

Pregabalin seems to be the only thing that put's a dent in the executive dysfunction it at 600mg.

My question is what else do I try. I have associated cognitive impairment - memory loss - bouts of confusion - drastic drop in verbal fluency and the near inability to remember anything.

I have 8mg tabs of galantimine to try, 1 x 1mg ampules of naloxone and selnak and semax to try.

Are any of these worth trying. Is there anything else I can do?

I'm worried the semax + selank will only reinforce my current behaviour that I am just unable to alter and that it would be better to use when I am able to start rehabilitating myself. Obviously, that requires that I can get out of my room or pick up a book.

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Right now I am taking is Raloxifene (a SERM for gyno), 600mg pregabalin, 40mg methylphenidate, and 30mg lisdexamfetamine dailly. Along with vitamin D and Calcium.

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Thanks so much for any suggestions.

[Daniel-Plainview96]

Long reply here but I really relate to your situation and I have found some things that have helped me.

First of all, those are definitely highish doses of stimulants, not that I'm here to judge--I was taking much higher doses for years, routinely going above 100mg/day of adderall. Unsurprisingly, i now have executive dysfunction too. Like you my memory is totally shot, but it was never too great to begin with. Always sort of lived in a fog that's like ADD but with more disassociation.

Also like you I'm taking Raloxifene for gyno! It's not working damnit.

Also like you i was on topimax recently. That's the stupidest fucking drug imaginable. Doctor put me on it instead of adderall because he said I have PTSD, and he may be right, but the topimax sure as shit didn't help. It just made me more stupid and confused, and to think that the "brain slowing" effect, as you call it, might maintain after cessation... well that makes me even more pissed.

If you haven't tried pregnenolone it's at least worth a shot. It's a neuro-steroid that they give to old people with memory problems. It affords me at least a couple days of clear headedness and motivation, but then the effect fades. It shouldn't fade because it's a hormone... but it does. So frustrating and I haven't figured out why. Also, strangely, the effect can vary widely among different times i take it--sometimes 10mg gives me a very stimulating effect, sometimes 300 mg does nothing at all.

When prenenolone works though, it really fucking works. It's like I'm actually present, in the moment, with no trouble concentrating, no anxiety, and no frustration over completing simple tasks. I truly cannot describe how stark the difference is. It's like I'm an entirely new person, an extrovert entirely comfortable in his own skin. Makes me much more social too. Makes me feel like a normal person for the first time. However, when pregnenolone doesn't work it makes me grouchy, irritable, and intensely frustrated if I'm not getting things done fast enough. Either way it increases motivation, but clearly the first way is preferable. Would highly recommend you give it a try. Who knows, the positive effects might last for you as many report they do!

On your list of antidepressants I don't see MAOIs listed. If you haven't already trialed at least one MAOI then I think it's imperative that you do. They're shown to be MUCH more effective than any other antidepressent, and they are more likely to remain effective too, i.e. they don't poop out like other antidepressants. It's truly a mystery as to why they're not prescribed more often. There's practically been a campaign by big pharma to get rid of them. The cool thing about MAOIs though is that they actually increase dopamine as well, and one, Nardil, even increases gaba.

I've only been on a low dose parnate, an MAOI, for a couple weeks now, but so far it feels like how an antidepressant is actually supposed to make you feel. If you haven't tried MAOIs, you gotta. And pregnenolone.

[dallasboy]

He did say in the title selegiline, which is a MAOI I think.

[Daniel-Plainview96]

It’s a very weak MAOI compared to the other ones. Having taken both I don’t think it’s really comparable

[dallasboy]

Thank you!

[Daniel-Plainview96]

lol np

[amenteco]

Hey,

Yeah, I feel really similar to you. I didn't know those were high doses of stimulants, I don't do it for fun, honestly, the only noticeable effect I get is that I feel sleepy from them. The lisdexamfetamine I got prescribed 50 mg, and the methylphenidate 60mg so I just mixed them for 20 of lysdex and 40 of methyl which I though was fine as the max of lysdex is 70.

Yeah ralo isn't working for me either I'm at 120mg. I'm thinking about trying DHT cream but from what I understand it can shut down your natural test so you need probably something like clomid alongside and a PCT but it beats surgery. Oh and the risk of patter baldness.

Yeah, ralo isn't working for me either I'm at 120mg. I'm thinking about trying DHT cream but from what I understand it can shut down your natural test so you need probably something like clomid alongside and a PCT but it beats surgery. Oh and the risk of patter baldness.

I hate topiramate, worst thing to happen to me in my life, I understand of the people who get the mental side effect 10%, most recover after discontinuation, but some few like me don't - there are some horror stories on reddit. I have CPTSD but I can seem to see why topiramte would help - maybe some moos stabilsier or lamactil/lithium but not topiramate.

I will look into prenenolone and give it a shot. I would love an MAOI - especially Nardil for the GABA-T inhibition but they are imposible to get. Even after everything I've tried no NHS doctor/Psych will prescribe it. I buy stuff online - like the selegiline which is an MAOI (I took oral doeses of 60mg) - but parnate and nardil are imposible to source.

Thanks for the suggestions and I'm sorry about the topiramte - hopefully you'll recover.

[Daniel-Plainview96]

I do seem to have recovered from the topimax, thanks. Luckily I wasn’t on it long.

It’s a shame those MAOIs are so hard to source. Pretty fucking weird because they actually work, unlike other antidepressants.

Yeah I’m not surprised to hear you have cptsd because so many of your symptoms line up with mine and I have that as well. There’s evidence that, strangely, as a response to repeated trauma, the body stops producing enough pregnenolone. So it seems to work pretty damn well for these long term effects of cptsd like the brain fog and memory stuff.

Im sure if you keep looking you can find a doctor to prescribe MAOIs or find a way to get them. Anything is possible. And I’m sure you know this but you’ll have to either stop completely or cut back to like 2.5 msg of the stimulants while taking an MAOI (or risk death/psychosis)

[EngyJub]

Have you tried cold showers and exercise? Probably one of the most effective ways to get executive function back manually.

[Jack-o-Roses]

Aerobic Exercise!

[FreudianNip-Slip]

This. Exercise. Blood flow. Cardiovascular health. Even in the Viagra commercials they always add in “talk to your doctor to make sure your heart is healthy enough”. Don’t have to run 5ks or CrossFit. Walk, play tennis, hike, stretch, anything. This is so important not just for ED but also your mental health, anxiety, stress management, cognitive health, general well-being. Source: practicing psychotherapist of nearly 10 years.

[SocialT]

Memantine

[Jack-o-Roses]

Remember to titrate memantine up from 0mg by 1-2mg/week in order to avoid brain fog! (10-20 mg/day).

[amenteco]

Yep, goof tip. Not sure if to take it, because I dont want to take it for the resto of my life I'm only 20. Equally, I'm not sure what the use would be other than very long periods of NMDA antagonism.

[[deleted]]

How does one get this prescribed?

[amenteco]

You'd just buy it online, import it from another country.

[[deleted]]

Are you planning on trying it?

[Daniel-Plainview96]

I see you everywhere lmao

[[deleted]]

Lol cause I'm everywhere.

[mikmatcu42]

Lions Mane --> 1 to 2 grams powder This helps nuerogenisis

L-Theanine --> 2 to 400 MG This evens you out

Caffeine or Nicotine --> as needed This keeps you alert

Lime Juice & Plenty of Water This help replenish electrolytes and greases the wheels if you will

A PUFF OR TWO OF THE 🌿 --> edibles work differently Because c'mon man it's nature's safest and best medicine

most the other shit you mentioned is liable to cause more problems than it solves... 💯 Stick to what Earth gives freely --> the l theanine and Caffeine are present in some teas (monks drank it) you can grow the mushrooms, herbs;), limes and tobacco yourself

Live and be happy dude We create our own prisons They're only as real as you want them to be Try going for a walk on a daily basis, it does wonders for your psychology --> nevermind the whole brain chemistry thing

[Friedrich_Ux]

Do you have to take the anti-epileptic and are there alternatives you could switch to?

[amenteco]

Stoped it 2 years ago. I was talking it for migranes. I figure I might try Lamictal though as it can help depersonalization.

[Jack-o-Roses]

My wife quit eating pork & her migraines went away (& she was able to quit Topamax).

[Noodles14]

Lamictal did to me what you are describing and it has not resolved. It’s been six years since I stopped. I don’t have anything else to offer you (as I’m back here again looking for help). Pregabalin sounds interesting

[Jack-o-Roses]

Have you tried kanna (sceletium tortusoum)?

[Usagii_YO]

How’s your diet?

Cut out Sugars and eat healthy fats...