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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by jonquiljo on March 23, 2006, at 17:24:41
I have been concerned about taking adderall or ritalin - mainly beause I worry about developing tolerances, needing more and more - then finding that standard doses don't work any more.
Anyone who has been taking these meds for years like to comment? Can you take them for long periods of time (months, years) and not have to deal too much with tolerance issues? If so, what are "stable" doses that tend not to require more and more?
I'm talking about these meds from an ADD standpoint and not depression. Thanks.
Jon
Posted by Johnny B. Linux on March 23, 2006, at 20:34:00
In reply to Tolerance to Adderall or Ritalin?, posted by jonquiljo on March 23, 2006, at 17:24:41
> I have been concerned about taking adderall or ritalin - mainly beause I worry about developing tolerances, needing more and more - then finding that standard doses don't work any more.
>
> Anyone who has been taking these meds for years like to comment? Can you take them for long periods of time (months, years) and not have to deal too much with tolerance issues? If so, what are "stable" doses that tend not to require more and more?
>
> I'm talking about these meds from an ADD standpoint and not depression. Thanks.
>
> Jon
Hi Jon, good question. The stimulants used for ADD/ADHD are safe, effective and have a good track record. Now, tolerance to Ritalin or Adderall can't be entirely avoided. I've heard of patients and their doctors making use of a drug holiday, switching to a different stimuant or class of medications to deal with tolerance issues. There are pros and cons to becoming tolerant to any medication. The pro is that you may become tolerant to annoying side-effects, such as nervousness or high blood pressure. The con is that you may become tolerant to the therapeutic effects. If you do indeed become tolerant, you and your doctor can take measures to deal with it.You always have the stimulating antidepressant Wellbutrin or the non-stimulant Strattera if you want to curtail the issue of tolerance altogether.
Posted by alohashirt on March 25, 2006, at 6:27:06
In reply to Re: Tolerance to Adderall or Ritalin?, posted by Johnny B. Linux on March 23, 2006, at 20:34:00
Tolerance seems to be a much bigger problem with amphetamines than methylphenidate. I have been on methylphenidate for two years, no tolerance. Important not
to confuse higer expectations with tolerance - For me a day
w/o my ADHD medication is more unfocused than I am
willing to put up with yet for years I put up with it.Focalin allegedly less of a problem than Ritalin because its a single isomer. I wonder if this means dexedrine would be less of a problem than Adderall?
> > I have been concerned about taking adderall or ritalin - mainly beause I worry about developing tolerances, needing more and more - then finding that standard doses don't work any more.
> >
> > Anyone who has been taking these meds for years like to comment? Can you take them for long periods of time (months, years) and not have to deal too much with tolerance issues? If so, what are "stable" doses that tend not to require more and more?
> >
> > I'm talking about these meds from an ADD standpoint and not depression. Thanks.
> >
> > Jon
>
>
> Hi Jon, good question. The stimulants used for ADD/ADHD are safe, effective and have a good track record. Now, tolerance to Ritalin or Adderall can't be entirely avoided. I've heard of patients and their doctors making use of a drug holiday, switching to a different stimuant or class of medications to deal with tolerance issues. There are pros and cons to becoming tolerant to any medication. The pro is that you may become tolerant to annoying side-effects, such as nervousness or high blood pressure. The con is that you may become tolerant to the therapeutic effects. If you do indeed become tolerant, you and your doctor can take measures to deal with it.
>
> You always have the stimulating antidepressant Wellbutrin or the non-stimulant Strattera if you want to curtail the issue of tolerance altogether.
Posted by jonquiljo on March 25, 2006, at 14:24:47
In reply to Different meds (Re: Tolerance to Adderall, posted by alohashirt on March 25, 2006, at 6:27:06
TOlerance is what I am "afraid" of ... I've had ADD for many years and find that stimulants work "miracles". Pretty pathetic that, in my 50's - I'm just figuring all of this out.
Adderall works best for me. It takes 30-40mg of Ritalin about 2X a day to "focus" me to any coherent level.
I just wonder if the tolerances that do develop are as bad as that of opiates, etc. I've seen people for years on those drugs and its a never-ending cycle of needing more and more and more - to the point where it doesn't work at all after that. Now that I've spent 2/3 of my life unfocused - I'd like to focus for the last third.
How does one deal with that? P-docs are more worried about their liability than your "pain".
Posted by alohashirt on March 26, 2006, at 20:11:23
In reply to Re: Different meds (Re: Tolerance to Adderall, posted by jonquiljo on March 25, 2006, at 14:24:47
> How does one deal with that? P-docs are more worried about their liability than your "pain".I have heard of people taking between 15mg and 144mg of Concerta a day. I don't have personal experience that confirms "p-docs are more worried about liability than my pain." However I live in NYC one of the doctors I have seen is an ADHD specialist and so he is well aware that different patients require different doses. My impression is that *with the right doctor* tolerance need not be a problem.
Three points:
1) ADHD is a special case - there is all teh hysteria about overdiagnosis, "drugging our children" plus the treatment of choice are drugs that can be abused. Two threads of hysteria!
2) A pdoc with real ADHD experience will understand that people respond differently.
3) Some people see the world in black&white. Others see the shades of gray. The black&white guy will stick closer to recommeneded doses and think twice about "non-standard doses" This isn't a pdoc issue - its just a reflection of humanityBottomline - find the right doctor for you.
Posted by jonquiljo on March 26, 2006, at 22:01:05
In reply to Re: Different meds (Re: Tolerance to Adderall, posted by alohashirt on March 26, 2006, at 20:11:23
Well, P-docs aren't easy to come by in my neck of the woods. I guess I've been disillusioned over the years, but I find most Dr. in general to very much be concerned with covering their *sses, and avoiding the patient. I'll be pleasantly suprised if I find one who really does the "right" thing. Unfortunately - I've met very few.
I think medicine pays so poorly now, that it has become kind of a "stale" institution. More Dr.'s are complacent or worry about what can happen to them - rather than the good of the patient. I live in the SF Bay Area - and most of the Dr.'s here complain that they can't afford to even live here. Given that, I can't blame them for not even caring.
> 3) Some people see the world in black&white. Others see the shades of gray. The black&white guy will stick closer to recommeneded doses and think twice about "non-standard doses" This isn't a pdoc issue - its just a reflection of humanity
>
Posted by scatterbrained on March 27, 2006, at 21:06:25
In reply to Re: Different meds (Re: Tolerance to Adderall, posted by jonquiljo on March 25, 2006, at 14:24:47
I actually just wrote a post sort of similar to this. From my understanding, tolerance is less likely to develop if you don't have a comorbid mood disorder.
Posted by ADDmom32 on March 29, 2006, at 23:51:05
In reply to Re: Different meds (Re: Tolerance to Adderall, posted by jonquiljo on March 26, 2006, at 22:01:05
I am a 40 year old single mother of three. I was diagnosed ADD over 2 years ago and have been taking Adderall XR 30mg in the am since. I'm not ADHD (sometimes wish I was - joke) but I have struggled with depression for many years. I do take Cymbalta 60mg every am as well.
I have not noticed a tolerance and do not feel a dependency on the Adderall because I have taken a couple "breaks" from it - like for a weekend or as long as a week before and did not feel like I crashed.
But if I mess up and forget about my antidepressants for 2 days in a row - then I CRASH!
Being diagnosed ADD and beginning Adderall was one of the greatest gifts I have ever been given.
I am in group therapy and I have filled my library with every book I can find on the subject.
Of course I haven't read any of them front to back. (BIG smile)I consider myself a highly addictive personality and work very hard at monitoring my behavior in that regard.
Adderall has only been a blessing to me.
But I think learning as much as I can about this "condition" - ADD/ADHD - diet, behavior changes (some more slowly than others) and talk therapy has all played a part in my making the 2nd half of my life completely different from the 1st. I can truly say that for the 1st time in my life ... I like myself.How cool is that? very
Posted by jonquiljo on March 30, 2006, at 3:37:07
In reply to Re: Different meds (Re: Tolerance to Adderall » jonquiljo, posted by ADDmom32 on March 29, 2006, at 23:51:05
> How cool is that? very
Yes it is very very cool. Our situations sounds very similar, though I feel that I don't want to take a break from Adderall - too much lost time already in my life. And life is short. I crash w/o adderall or RItalin, but not with LExapro - which I take for the depression which acompanies my ADD. I am not hyperactive either. And yes, it seems that these meds (along with my diagnosis) have been a true blessing - although I had to dianose myself - and then talked to shrinks and MD's about it - who concurred wholeheartedly.
I will continue on Adderall. My Dr. has prescribed me 40mg XR per day - and I'll start with that. IF I need vacations, I expect that Ritalin may help with the "off" times - therre seems to be much debate about cross-tolerance. I suspect there is very little.
THanks for your reply - and I wish you all the best. Its nice to be "reborn" - isn't it??
Jon
Posted by ADDmom32 on March 30, 2006, at 13:17:18
In reply to Re: Different meds (Re: Tolerance to Adderall, posted by jonquiljo on March 30, 2006, at 3:37:07
You diagnosed yourself and then had to talk all the MD's into it? while you were not well!?!
You are a strong, courageous, wise person. You have my admiration.
You just GO!!!
God, what a blessing to find someone who thinks our "situations are similar". I have spent sooo much of my life feeling like I was on the outside looking in.
Thank you.
Posted by jonquiljo on March 30, 2006, at 13:50:00
In reply to Re: Different meds (Re: Tolerance to Adderall, posted by ADDmom32 on March 30, 2006, at 13:17:18
No, no, no - it sounds very much like we are quite the same. I have ALWAYS been on the outside looking in. I haven't even had a job in the last 15 years - I "retired" only because of fortunate circumstances that were no merit of my own.
I just "happened" into figuring out my ADD. I took someone elses Adderall to give myself some energy to clean the house - and I found that it didn't energize me, but rather focus me. It was truly eye-opening.
At 52 - you think I would have figured it out. I was a clown in school at a young age. I had trouble in high school,college, and graduate school because I couldn't study. I became a scientist who couldn't keep a notebook and therfore couldn't ever get anything done. And so on, and so on. I know thats a bit too much information, but it should tell you how others can falter too.
One of the "telltale signs" of ADD is lack of self esteem - perhaps you suffer from that as well as me? Oh well, I've rambled long enough. TIme to take my Adderall and get on with the day. Good luck.
Jon
Posted by ADDmom32 on March 30, 2006, at 14:22:07
In reply to Re: Different meds (Re: Tolerance to Adderall, posted by jonquiljo on March 30, 2006, at 13:50:00
> No, no, no - it sounds very much like we are quite the same. I have ALWAYS been on the outside looking in. I haven't even had a job in the last 15 years - I "retired" only because of fortunate circumstances that were no merit of my own.
>
> I just "happened" into figuring out my ADD. I took someone elses Adderall to give myself some energy to clean the house - and I found that it didn't energize me, but rather focus me. It was truly eye-opening.
>
> At 52 - you think I would have figured it out. I was a clown in school at a young age. I had trouble in high school,college, and graduate school because I couldn't study. I became a scientist who couldn't keep a notebook and therfore couldn't ever get anything done. And so on, and so on. I know thats a bit too much information, but it should tell you how others can falter too.
>
> One of the "telltale signs" of ADD is lack of self esteem - perhaps you suffer from that as well as me? Oh well, I've rambled long enough. TIme to take my Adderall and get on with the day. Good luck.
>
> Jon
I just fell in love with you.
(joke - don't worry not a stalker)Thank you
Posted by jonquiljo on March 30, 2006, at 18:22:30
In reply to Re: Different meds (Re: Tolerance to Adderall, posted by ADDmom32 on March 30, 2006, at 14:22:07
> I just fell in love with you.
> (joke - don't worry not a stalker)
>
> Thank you
Well, you sounds like my kind of person! And, no - I'm not a stalker either. Lets say we're both "soulmates in confusion" - or rather the new-found lack of confusion.I'm suprised you aren't angry at the lack of diagnosis for so many years. I certainly am! I've been to therapists, shrinks and psychopharmacologists for over 30 years and NO ONE has ever had a clue - especially with all the wierd (almost thrill seeking things I have done in past years). It doesn't say much about the medical/psychiatric profession.
I recently read "Driven to Distraction" (and no --- not from front to back either). It described me as well as my three siblings all of which apparently have ADD - and NONE have ever been diagnosed. Pretty pathetic, huh???
Jon
Posted by ADDmom32 on March 30, 2006, at 21:08:49
In reply to Re: Different meds (Re: Tolerance to Adderall, posted by jonquiljo on March 30, 2006, at 18:22:30
I AM ANGRY. That's a huge part of my depression.
But I am a southern woman and have been trained to be have an obnoxiously cheerful disposition.
Learning to cry or express anger has been one of my hardest life lessons.
Check out "Delivered from Distraction" it's new this year, written by the same guys as a follow up to "Driven". I had a lot of AHA! moments from it as well.
Posted by jonquiljo on March 30, 2006, at 22:44:38
In reply to Re: Different meds (Re: Tolerance to Adderall » jonquiljo, posted by ADDmom32 on March 30, 2006, at 21:08:49
I will check out Delivered from Distraction. I'm just a Northern boy with really bad anger issues too. I've had a little bit od California rub of on me in the last 25 years. My personal situation is difficult, and it makes it hard for me to even try now.
ANGRY! YES, I am pissed at the morons who take your money and pretend to be doctors. Oh well.
This is the end of the thread.
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