Posted by Toby on August 31, 1998, at 8:56:09
In reply to Re:Thanks for your help Toby, here is my ADD inf , posted by Comp on August 29, 1998, at 16:23:49
The extra info was very helpful. Sounds like ADD for sure. Let me give you some basic info about the medication treatments.
About 85-90% of people respond to stimulants. Ritalin and Dextroamphetamine are the first choices. If one of these drugs fail, there is a 25% chance the other drug will work. If a short-acting stimulant lasts only 3-4 hours with abrupt return of symptoms, consider the sustained-release form, or Cylert. Dextroamphetamine spansules (long-acting) can have uneven effects with early intense activity and a significant decline thereafter; the long action form of Ritalin works well. When a stimulant works, it works within 2-3 days, the effects persist and there is little to no tolerance over months to years. When a stimulant works, 30% of patients get marked improvement, 40% get some benefit and 10-30% are refractory. **** If the drug is tolerated well (no side effects) but gets only minimal or partial improvement, higher doses are likely to increase improvement.**** That sounds like what has happened for you. A simple increase may do the trick. The usual maximum dose for Adderal is 40-60 mg per day and about 80 mg per day for Ritalin. Different problems related to ADHD may respond at different doses so you have to keep track of what's happening with you, balance benefits with side effects, and decide whether you feel comfortable with your daily functioning at a certain dose, even if every single symptom isn't completely gone.
If the stimulants end up not helping even at the maximum dose, there are some other meds to try. Cylert is good because it has once a day dosing. A drawback is that you have to get blood drawn every 6 months or so to keep a check on your liver because it can (uncommonly) cause some elevation in the enzymes in the liver (catch it early and stop the Cylert and the liver does OK). Wellbutrin is an antidepressant that has been shown to work in some unknown way to improve ADD and the dose is 150-300 mg per day (good for depression, no sexual side effects and well tolerated but you can't take it if you have a history of seizures). Tricyclic antidepressants like imipramine, desipramine and nortriptyline have also been used for years for ADD with good effect (these work best on impulsivity and attention problems and I personally like nortriptyline best because it has fewest side effects). Side effects include some weight gain, and have to get EKG's once a year to monitor the heart. Clonidine and guanfacine are blood pressure medications that are usually used to augment other medications (works only so-so alone). Most common side effect is sedation that goes away in 2-4 weeks. Guanfacine better tolerated than clonidine (less effect on blood pressure, less sedation) and works well on hyperactivity, inattention and immaturity but doesn't do much for mood or aggression.
Since you are currently taking a stimulant, it's best to stick with it until the dose is maxed out. You will need to talk with your psychiatrist about this at length, because many docs are hesitant to prescribe higher doses because of potential abuse. I'm assuming you don't have a history of any major drug abuse since the doctor likely wouldn't have even started a stimulant in that case, so have a good talk with him about carefully increasing the dose and mention the fact that partial responders often get better effect with an increase in dose (dazzling him with your research) and discuss what his plan will be if you don't get any real long-lasting benefit from the stimulants. If he doesn't have any options except Cylert (i.e., doesn't know about Wellbutrin, the tricyclics, or clonidine), time to look for a second opinion.
poster:Toby
thread:391
URL: http://www.dr-bob.org/babble/19980901/msgs/463.html