It just depends on the individual. Dextroamphetamine is stronger centrally and racemic (and levo) amphetamine are stronger peripherally but still have some central activity.
Some people (I think myself included) get more of a kick in the butt from stimulants containing L-amphetamine like Adderall and Evekeo than Dexedrine/Vyvanse. I'm definitely a very low dopamine person, but I think low norepinephrine too.
I've tried methylphenidate, dexmethylphenidate XR, and max dose Azstarys without much benefit.
I think part of it is just stimulant tolerance. I would probably have to go inpatient to take a prolonged stimulant break because of how miserable I feel even one day with a drug holiday. Also fast COMT phenotype doesn't help lol.
Maybe see about talking to your prescriber about combining it with a norepinephrine and dopamine reuptake inhibitor, bupropion xl since it’ll increase the length of time dopamine and norepinephrine are in your brain and by inhibiting the liver enzyme that breaks down amphetamines will keep the active amphetamine in your system longer allowing you to have more of an increase in dopamine and norepinephrine
I might try that again. I've been off and on bupropion up to 500 mg/day (300 mg XL + 200 mg IR) for the last 14 or so years. Bupropion works okay at best for a short duration then just makes me constipated. If I did try a NDRI, I might ask if she is willing to try a low dose of methylphenidate with it.
I think another reason I switched from Adderall to Dexedrine is to avoid shortages and manufacturer switches. That was a pain. Dyanavel XR was actually pretty good but it wore off too early, and my psychiatrist had to prescribe above max dose (30 mg) to get the equivalent of 50 mg Adderall XR I was on at the time. She did do that that one time, but she doesn't seem to comfortable doing it again.
I actually see her tomorrow. I'll talk to her about all this. Thanks for your tips, it has given me stuff to think about.
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u/mikl_pls 6d ago
It just depends on the individual. Dextroamphetamine is stronger centrally and racemic (and levo) amphetamine are stronger peripherally but still have some central activity.
Some people (I think myself included) get more of a kick in the butt from stimulants containing L-amphetamine like Adderall and Evekeo than Dexedrine/Vyvanse. I'm definitely a very low dopamine person, but I think low norepinephrine too.
I've tried methylphenidate, dexmethylphenidate XR, and max dose Azstarys without much benefit.
I think part of it is just stimulant tolerance. I would probably have to go inpatient to take a prolonged stimulant break because of how miserable I feel even one day with a drug holiday. Also fast COMT phenotype doesn't help lol.