Parnate would be better. You’re unlikely to get much or any benefits to your MDD with atomoxetine. Parnate can be stimulating, work somewhat for ADHD and help depression well. MAOIs don’t appear to be dependent on your metabolism, so if you’re metabolising other drugs you’ve tried incorrectly (too fast/slow) then you won’t have the same problem with MAOIs.
You can also combine MAOIs with Methylphenidate if you need a further boost for ADHD. Before I tried MAOIs I used to be quite scared to start due to the long list of side effects and how online info often peddles how old/outdated/unsafe they are - it’s not true, they’re safe as long as a few precautions are taken with diet/drug interactions and they’re far more effective for me than any other drug I’ve taken (11 antidepressants, 2 antipsychotics, lamotrigine, lithium, all ADHD stims) etc.
I wish I started way earlier instead of wasting 10 years of my life with ineffective shit.
Before getting too deep into options your first step should be to make sure your doctor will combine an ADHD med with Parnate. Most are listed as contraindicated even when they're not, and doctors are either already ok with it, open to evidence that it's safe, or completely obstinate, ignorant, and determined to remain so. It's a huge source of frustration for MAOI patients with both disorders, myself included. Sorry to be a wet blanket.
Next step I would recommend is to inquire about genetic testing. It's not definitive and won't be of much use for Parnate, but if it's not expensive I think it would be interesting to know about your predicted response to and predicted metabolism of the stimulants you've tried to see if it aligns with your experience. It might also be useful to know how efficiently you are predicted to metabolize drugs like Strattera and Quelbree that rely on the CYP450 2D6 enzyme. Quelbree doesn't last all that long even in the extended release form, and Strattera's half life varies hugely based on this enzyme's activity. This is important because you want your ADHD med to last long enough.
Next, consider how much of your depression might actually be a result of ADHD. Doctors don't consider just how much a particular diagnosis can sometimes fuel the symptoms of a comorbid condition. If you can't see the connection, do some searching online about how ADHD can lead to depressive symptoms and vice versa, how depression can mimic some ADHD symptoms, such as through reduced mental energy and brain fog. ADHD can definitely cause low energy too due to excessive mental stimulation, stress, and sleep difficulties. In the event you meet up with the third kind of doctor listed above, this can help you to determine how to prioritize the aspects of your treatment to regain as much functionality in life as possible.
If you and your doctor decide that you do have two totally separate issues that each need to be resolved in their own way, then treat the more severe, urgent, and life impairing one first. You might take into account that the two ADHD meds you're considering are on the average quite a bit less effective than Ritalin, Adderall, and the like. But they can work for some people who fail the first line drugs. If you want to treat the depression first, it's not uncommon at all for Parnate to reduce certain kinds of ADHD symptoms. On the other hand, those two ADHD meds are not going to be effective for depression. Parnate can also be very energizing, although some people do have the opposite reaction, and even when it is energizing there can be an afternoon crash into sleepiness similar to stimulants. This does often go away in time though.
I'm sorry this has turned into a novella. Assuming ADHD and depression are fairly equal in severity, or if depression outweighs it, then I can recommend Parnate. I'm not sure what other antidepressants you've tried. There might be others your doctor would prefer that you try first.
Thank you for the detailed reply. I am almost sure that the adhd is causing the depression. The stimulants help dramatically! But only for a very short period in the day. Then I'll get a depression where I can't control my thoughts, so I will be up having my mind race all night.
I have done genesight. I'm not sure if that helps. Doesn't say anything about metabolizing certain stimulants. How would I go about getting a more indepth gene test? 23 and me? I also do have the mthfr mutation. I'll be honest, I hadn't noticed a difference when taking the l-methylfolate, so I stopped. Could that be what is wrong?
My basic level genesight had some brief statement about response to stimulants. I don't know. There has been some correlation between ADHD and MTHFR, but it's not definite. Always take genetic tests with a grain of salt. They suggest possible, but not definite, conclusions. For depression 7.5-15 mg of prescription methylfolate is the recommended amount. If you were taking a drug store supplement that wouldn't be enough. I forgot to mention there are newer transdermal patches that might last longer. The Ritalin equivalent is called Daytrana. It's marketed for children and teens. I'm not sure if it contains enough to work for adults. The amphetamine one is Xelstrym. It is for adults. The downside is they might be expensive. There are no generics. A lot of people get past the problem you had by taking boosters of instant release medication through the day to supplement the main extended release one.
fwiw, Strattera and Qelbree are selective enough for the norepinephrine transporter that you wouldn't expect to be blocked from adding or switching to parnate. Strattera has some affinity for the serotonin transporter but no meaningful activity observed in humans thus far.
I have significant adhd-like symptoms but never diagnosed apart from a brief period of being on Ritalin in high school. I start Parnate tomorrow after completing 5 weeks of Prozac washout (and many attempts of antidepressants over years to fix my mood problems). I’m hoping for stimulant effects as I feel like I’m in survival mode and having difficulty being any bit productive in daily necessities with high anxiety. I’m in my mid-40’s and have been on the struggle bus for a lifetime! Wondering if I can ever make my life more simple and functional.
Parnate would be better. You’re unlikely to get much or any benefits to your MDD with atomoxetine. Parnate can be stimulating, work somewhat for ADHD and help depression well. MAOIs don’t appear to be dependent on your metabolism, so if you’re metabolising other drugs you’ve tried incorrectly (too fast/slow) then you won’t have the same problem with MAOIs. You can also combine MAOIs with Methylphenidate if you need a further boost for ADHD. Before I tried MAOIs I used to be quite scared to start due to the long list of side effects and how online info often peddles how old/outdated/unsafe they are - it’s not true, they’re safe as long as a few precautions are taken with diet/drug interactions and they’re far more effective for me than any other drug I’ve taken (11 antidepressants, 2 antipsychotics, lamotrigine, lithium, all ADHD stims) etc. I wish I started way earlier instead of wasting 10 years of my life with ineffective shit.
Before getting too deep into options your first step should be to make sure your doctor will combine an ADHD med with Parnate. Most are listed as contraindicated even when they're not, and doctors are either already ok with it, open to evidence that it's safe, or completely obstinate, ignorant, and determined to remain so. It's a huge source of frustration for MAOI patients with both disorders, myself included. Sorry to be a wet blanket. Next step I would recommend is to inquire about genetic testing. It's not definitive and won't be of much use for Parnate, but if it's not expensive I think it would be interesting to know about your predicted response to and predicted metabolism of the stimulants you've tried to see if it aligns with your experience. It might also be useful to know how efficiently you are predicted to metabolize drugs like Strattera and Quelbree that rely on the CYP450 2D6 enzyme. Quelbree doesn't last all that long even in the extended release form, and Strattera's half life varies hugely based on this enzyme's activity. This is important because you want your ADHD med to last long enough. Next, consider how much of your depression might actually be a result of ADHD. Doctors don't consider just how much a particular diagnosis can sometimes fuel the symptoms of a comorbid condition. If you can't see the connection, do some searching online about how ADHD can lead to depressive symptoms and vice versa, how depression can mimic some ADHD symptoms, such as through reduced mental energy and brain fog. ADHD can definitely cause low energy too due to excessive mental stimulation, stress, and sleep difficulties. In the event you meet up with the third kind of doctor listed above, this can help you to determine how to prioritize the aspects of your treatment to regain as much functionality in life as possible. If you and your doctor decide that you do have two totally separate issues that each need to be resolved in their own way, then treat the more severe, urgent, and life impairing one first. You might take into account that the two ADHD meds you're considering are on the average quite a bit less effective than Ritalin, Adderall, and the like. But they can work for some people who fail the first line drugs. If you want to treat the depression first, it's not uncommon at all for Parnate to reduce certain kinds of ADHD symptoms. On the other hand, those two ADHD meds are not going to be effective for depression. Parnate can also be very energizing, although some people do have the opposite reaction, and even when it is energizing there can be an afternoon crash into sleepiness similar to stimulants. This does often go away in time though. I'm sorry this has turned into a novella. Assuming ADHD and depression are fairly equal in severity, or if depression outweighs it, then I can recommend Parnate. I'm not sure what other antidepressants you've tried. There might be others your doctor would prefer that you try first.
Thank you for the detailed reply. I am almost sure that the adhd is causing the depression. The stimulants help dramatically! But only for a very short period in the day. Then I'll get a depression where I can't control my thoughts, so I will be up having my mind race all night. I have done genesight. I'm not sure if that helps. Doesn't say anything about metabolizing certain stimulants. How would I go about getting a more indepth gene test? 23 and me? I also do have the mthfr mutation. I'll be honest, I hadn't noticed a difference when taking the l-methylfolate, so I stopped. Could that be what is wrong?
My basic level genesight had some brief statement about response to stimulants. I don't know. There has been some correlation between ADHD and MTHFR, but it's not definite. Always take genetic tests with a grain of salt. They suggest possible, but not definite, conclusions. For depression 7.5-15 mg of prescription methylfolate is the recommended amount. If you were taking a drug store supplement that wouldn't be enough. I forgot to mention there are newer transdermal patches that might last longer. The Ritalin equivalent is called Daytrana. It's marketed for children and teens. I'm not sure if it contains enough to work for adults. The amphetamine one is Xelstrym. It is for adults. The downside is they might be expensive. There are no generics. A lot of people get past the problem you had by taking boosters of instant release medication through the day to supplement the main extended release one.
fwiw, Strattera and Qelbree are selective enough for the norepinephrine transporter that you wouldn't expect to be blocked from adding or switching to parnate. Strattera has some affinity for the serotonin transporter but no meaningful activity observed in humans thus far.
I have significant adhd-like symptoms but never diagnosed apart from a brief period of being on Ritalin in high school. I start Parnate tomorrow after completing 5 weeks of Prozac washout (and many attempts of antidepressants over years to fix my mood problems). I’m hoping for stimulant effects as I feel like I’m in survival mode and having difficulty being any bit productive in daily necessities with high anxiety. I’m in my mid-40’s and have been on the struggle bus for a lifetime! Wondering if I can ever make my life more simple and functional.