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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by theo on September 23, 2004, at 18:06:53
Went to my pdoc today, I'm currently on 100mg Lamictal moving up to 150mg and on 750mg Keppra daily.
My pdoc thinks I have ADD symptoms and may add a stimulant in a month after my Lamictal settles in. She mentioned Adderall XR or Concerta, which one should I push for? I've never taken a prescription stimulant and want something thats smooth. I know some stimulants can smooth you out and some do nothing but make you nervous and anxious. Any input would be greatly appreciated.
Posted by utopizen on September 23, 2004, at 18:12:59
In reply to Adderall XR versus Concerta?, posted by theo on September 23, 2004, at 18:06:53
> Went to my pdoc today, I'm currently on 100mg Lamictal moving up to 150mg and on 750mg Keppra daily.
>
> My pdoc thinks I have ADD symptoms and may add a stimulant in a month after my Lamictal settles in. She mentioned Adderall XR or Concerta, which one should I push for? I've never taken a prescription stimulant and want something thats smooth. I know some stimulants can smooth you out and some do nothing but make you nervous and anxious. Any input would be greatly appreciated.
>I don't think it's appropriate to take a long-acting stim unless there's some reason for it. In kids, the reason is they don't have to be embarassed by going to the nurse at lunch time. In adults, I don't see a legitimate reason. I've heard of the argument that the onset of action can affect the outcome of effects.
In this case, Concerta would be "smooth" and Adderall, just think of that like a low-tech way of getting two doses in one pill. It gives you half of the pill immediately, and the other half 4 hours later, just like as if you took its immediate release 4 hours later.
Posted by anxiety_free on September 23, 2004, at 21:43:58
In reply to Re: Adderall XR versus Concerta?, posted by utopizen on September 23, 2004, at 18:12:59
> > Went to my pdoc today, I'm currently on 100mg Lamictal moving up to 150mg and on 750mg Keppra daily.
> >
> > My pdoc thinks I have ADD symptoms and may add a stimulant in a month after my Lamictal settles in. She mentioned Adderall XR or Concerta, which one should I push for? I've never taken a prescription stimulant and want something thats smooth. I know some stimulants can smooth you out and some do nothing but make you nervous and anxious. Any input would be greatly appreciated.
> >
> Hey! XR formulations of stimulants are big because a) they make $$$ and b) they reduce the likelihood of abuse. Personally, I did Ritalin LA (like concerta, but supposed to be smoother). It was OK. Now I take Adderall XR in the morning, plain old adderall in the afternoon. I like it a lot more.
Posted by theo on September 24, 2004, at 7:10:35
In reply to Re: Adderall XR versus Concerta?, posted by utopizen on September 23, 2004, at 18:12:59
> > Went to my pdoc today, I'm currently on 100mg Lamictal moving up to 150mg and on 750mg Keppra daily.
> >
> > My pdoc thinks I have ADD symptoms and may add a stimulant in a month after my Lamictal settles in. She mentioned Adderall XR or Concerta, which one should I push for? I've never taken a prescription stimulant and want something thats smooth. I know some stimulants can smooth you out and some do nothing but make you nervous and anxious. Any input would be greatly appreciated.
> >
>
> I don't think it's appropriate to take a long-acting stim unless there's some reason for it. In kids, the reason is they don't have to be embarassed by going to the nurse at lunch time. In adults, I don't see a legitimate reason. I've heard of the argument that the onset of action can affect the outcome of effects.
>
> In this case, Concerta would be "smooth" and Adderall, just think of that like a low-tech way of getting two doses in one pill. It gives you half of the pill immediately, and the other half 4 hours later, just like as if you took its immediate release 4 hours later.
>I thought stimulants were the best for ADD? I took Wellbutrin before and it is a "dirty" drug chocked full of side effects such as mild nagging sore throat, headache, ears ringing, etc., and doesn't work well as a stimulant for me.
Posted by Hattree on September 24, 2004, at 10:22:28
In reply to Re: Adderall XR versus Concerta?, posted by theo on September 24, 2004, at 7:10:35
Concerta lasts longer. I personally prefer long-acting stimulants to a couple of doses of short-acting ones because for whatever reason, on the second dose of, say, ritalin, I would feel an increase in anxiety that I don't experience on the long-acting version. I keep both types around and decide what to take depending on what time it is.
Posted by utopizen on September 24, 2004, at 16:00:54
In reply to Re: Adderall XR versus Concerta?, posted by theo on September 24, 2004, at 7:10:35
> >
>
> I thought stimulants were the best for ADD? I took Wellbutrin before and it is a "dirty" drug chocked full of side effects such as mild nagging sore throat, headache, ears ringing, etc., and doesn't work well as a stimulant for me.
>No, I meant to say that a stimulant is appropriate, but for economical reasons, I don't think it's appropriate for docs to prescribe EXTENDED-RELEASE stimulants unless the patient has some sort of schedule in which they're around others 24/7 to the point where they can't discretely access and take a second or third dose (e.g., school children).
Posted by theo on September 24, 2004, at 18:19:26
In reply to Re: Adderall XR versus Concerta?, posted by utopizen on September 24, 2004, at 16:00:54
I see, I misread your post.
Posted by theo on September 24, 2004, at 18:27:25
In reply to Adderall XR versus Concerta?, posted by theo on September 23, 2004, at 18:06:53
What's the difference between methylphenidate (Ritalin) and d- and l- amphetamine (Adderall)?
Which one is a smoother stimulant? What's the difference?
Posted by watergirl on September 24, 2004, at 20:19:49
In reply to Re: Adderall XR versus Concerta?, posted by utopizen on September 24, 2004, at 16:00:54
Hi. I would like to say that my pdoc preferes me on EXTENDED-RELEASE meds. I already have a problem with mood swings and the EXTENDED-RELEASE forms have less ups and downs, "smoother", I guess. He also does not feel like I should "be my own nurse". So, extended-release meds are more than just for conveince and $$$$ for the mfgs. is some cases.
Best Wishes,
Cindy>
> No, I meant to say that a stimulant is appropriate, but for economical reasons, I don't think it's appropriate for docs to prescribe EXTENDED-RELEASE stimulants unless the patient has some sort of schedule in which they're around others 24/7 to the point where they can't discretely access and take a second or third dose (e.g., school children).
>
>
>
Posted by zeugma on September 24, 2004, at 20:33:52
In reply to Re: Adderall XR versus Concerta?, posted by utopizen on September 24, 2004, at 16:00:54
>
> > >
> >
> > I thought stimulants were the best for ADD? I took Wellbutrin before and it is a "dirty" drug chocked full of side effects such as mild nagging sore throat, headache, ears ringing, etc., and doesn't work well as a stimulant for me.
> >
>
> No, I meant to say that a stimulant is appropriate, but for economical reasons, I don't think it's appropriate for docs to prescribe EXTENDED-RELEASE stimulants unless the patient has some sort of schedule in which they're around others 24/7 to the point where they can't discretely access and take a second or third dose (e.g., school children).
>
>
> Studies have shown that compliance with a med decreases if a three-times-a-day or greater dosing schedule has to be adopted. I take ritalin LA twice a day which is equivalent to taking the IR version four times daily. It would be difficult to maintain this schedule consistently if I needed to remember to swallow the four pills within the space of ten or so hours. Ritalin's effects wear off VERY fast for me and I find even the LA version frustratingly short-lived. The IR version would be absolutely impractical.As a side note, I find provigil to be a far more effective stimulant than Ritalin, but its side effects are much worse.
-z
Posted by theo on September 25, 2004, at 7:51:22
In reply to Re: Adderall XR versus Concerta? » utopizen, posted by watergirl on September 24, 2004, at 20:19:49
Which stimulant are you taking?
Posted by utopizen on September 25, 2004, at 10:47:15
In reply to Re: Adderall XR versus Concerta? » watergirl, posted by theo on September 25, 2004, at 7:51:22
All it does is this: releases 1/2 of the pill to your metabolism immediately, and then again 1/2 of the pill 4 hours later.
Anyone claiming this is "smoother" either hasn't taken Adderall Immediate Release in two divided doses 4 hours apart from one another or is getting a placebo effect.
Concerta is different: it releases a portion of Ritalin in your system immediately, and then gradually releases more over a 12 hour period. It's a very sophisticated pill, and is seen as one of the more sophisticated pills designed. A biotech company that does nothing but enhance pills was outsourced for it.
Ritalin LA is very primitive, and I've only heard bad things on this board about it. It's not like Concerta, although I've only had Ritalin in immediate release form. Concerta may, in some, decrease Ritalin's side effects because the onset of action is slower and thus your body is more apt to be more resillent of its side effects.
Posted by theo on September 25, 2004, at 11:23:05
In reply to Adderall XR is a primitive drug, posted by utopizen on September 25, 2004, at 10:47:15
So would Concerta be your first choice for someone trying a stimulant for the first time?
Posted by theo on September 25, 2004, at 18:01:06
In reply to Adderall XR vs Concerta, posted by anxiety_free on September 23, 2004, at 21:43:58
So if you had to pick, do you think Adderall is smoother than Ritalin or Concerta?
Posted by anxiety_free on September 25, 2004, at 21:11:06
In reply to Re: Adderall XR vs Concerta » anxiety_free, posted by theo on September 25, 2004, at 18:01:06
> So if you had to pick, do you think Adderall is smoother than Ritalin or Concerta?
I definitely think Adderall is smoother than Ritalin, and Adderall XR is smoother than Concerta or Ritalin LA.
Posted by utopizen on September 26, 2004, at 12:25:11
In reply to Adderall vs Concerta, posted by anxiety_free on September 25, 2004, at 21:11:06
> > So if you had to pick, do you think Adderall is smoother than Ritalin or Concerta?
>
> I definitely think Adderall is smoother than Ritalin, and Adderall XR is smoother than Concerta or Ritalin LA.
>I think it's best to use the immediate release version of adderall rather than something like XR or Concerta. Saves $.
This is the end of the thread.
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