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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by jealibeanz on January 4, 2007, at 7:41:40
I'm getting frustrated... I've been on Concerta for about 6 weeks now. Even with an increase in dose to 54 mg, it doesn't seem very effective after the first day of the increase. Obviously I could go higher to get more of a stimulant effect, but for some reason it seems to only last for 4 hours or less, not the 12 that the company claims.
I was on Provigil for this fall, and it worked OK for a while then stopped. Last summer and spring on took Strattera. It was OK, but I think slightly depressing and very nauseating. I never felt like myself. I took Adderall a year and it caused major depression.
I disappointed... I need the stimulants for concentration and energy. I sleep non-stop without them and do poorly in school. I wouldn't say that none of the medications have been effective, but I don't currently have anything that's helping, except for drinking coffee all day.
My doctor would probably rather have me on medication that he's monitoring, instead of me drinking gallons of coffee. That doesn't seem like a good idea. I hope he feels the same. I just worry that I'm running out of options.
Posted by lymom3 on January 4, 2007, at 8:52:36
In reply to ADHD meds... What next?, posted by jealibeanz on January 4, 2007, at 7:41:40
Focalin XR? Worked for my son when none of the other stims have,. He's been on it almost 2 years now.
Posted by laima on January 4, 2007, at 9:44:26
In reply to ADHD meds... What next?, posted by jealibeanz on January 4, 2007, at 7:41:40
How about regular ritalin instead of Concerta? I tried Concerta briefly, but it didn't do much for me, either. Regular, short acting ritalin seemed both more potent and longer lasting. Go figure!
Posted by jealibeanz on January 4, 2007, at 10:13:33
In reply to Re: ADHD meds... What next?, posted by laima on January 4, 2007, at 9:44:26
Nope, never Ritalin. It may work, since Concerta does seem to have some very minimal stimulant effects, and no adverse effects. I think my dose is too low, but also think somehow by body is metabolizing the triple release formulatoin properly. It's like I only get that initial burst, and not the other 2 later releases of medication.
Is focalin one of the racemates of ritalin, or is that dexedrine? I get confused.
Posted by laima on January 4, 2007, at 10:54:10
In reply to Re: ADHD meds... What next?, posted by jealibeanz on January 4, 2007, at 10:13:33
Focalin's got something to do with ritalin...how is it different?
Posted by Edwin Ransom on January 4, 2007, at 13:43:33
In reply to ADHD meds... What next?, posted by jealibeanz on January 4, 2007, at 7:41:40
Jealibeanz,
You could try Selegeline. It's a stimulting anti-depressant. An EMSAM/Modafinil combination is what I take for narcolepsy/ADD. It isn't an endless amphetamine honeymoon, but it's been worthwhile for 5 months.
I use exercise to keep anxiety down, 4-6 miles of running a day or 90 minutes of Yoga. The adrenalin rush of aerobic exercise helps me with motivation and focus as well. Also seems to help with sleep.
I think that, with ADD, one has to take a multi-modal approach. Diet, exercise, sleep, and trial-and-error lifestyle modifications. I've taken all kinds of different drugs (everything for ADD except desoxyn and pemoline, I think), and they've all frustrated me in ways similar to what you describe. I've also tried a bunch of non-drug therapies. Nothing really seems to solve the problem by itself, but lots of little things can add up.
I hope this helps. There are so many things to try alongside the drugs. And the best things I've found were also the cheapest (like running, drinking green tea, and meditating).
Posted by med_empowered on January 4, 2007, at 13:46:52
In reply to Re: ADHD meds... What next?, posted by Edwin Ransom on January 4, 2007, at 13:43:33
if you're going to do adhd meds and provigil and ritalin have been let downs, you may as well try out the amphetamines. Adderall is effective and I tolerated it better than ritalin...if Adderall is effective but you need something a little different, you could try dexedrine and (maybe) desoxyn.
Posted by jealibeanz on January 4, 2007, at 13:49:26
In reply to Re: ADHD meds... What next?, posted by med_empowered on January 4, 2007, at 13:46:52
I've never tried Ritalin.
I did try Adderall and it caused extreme depression.
Posted by jealibeanz on January 4, 2007, at 13:50:49
In reply to Re: ADHD meds... What next?, posted by Edwin Ransom on January 4, 2007, at 13:43:33
I'm afraid of taking any more antidepressants. They have not been good to the waistline. :/
Posted by hugo on January 4, 2007, at 14:05:05
In reply to Re: ADHD meds... What next?, posted by jealibeanz on January 4, 2007, at 10:13:33
Ritalin and Concerta are forms of d,l-methylphenidate. Focalin is d-methylphenidate. Different isomeres of the same compound, but what does this really tell us? Either one might be the perfect stimulant for somebody, but the only way to find out is a trial. And the nice thing about stimulant trials is that you can get an idea about benefits/side effects relatively quickly.
As for me, this morning I asked my pdoc to agree to a trial of Adrafinil, a chemical cousin of Modafinil.
Good luck to you.
Hugo
Posted by laima on January 4, 2007, at 14:05:33
In reply to Re: ADHD meds... What next? » Edwin Ransom, posted by jealibeanz on January 4, 2007, at 13:50:49
Selegeline doesn't cause any weight-gain...I would vote for a ritalin trial, or selegeline, or perhaps even selegeline with small amount of ritalin (depending on what your blood pressure looks like).
Posted by jealibeanz on January 4, 2007, at 14:10:08
In reply to Re: ADHD meds... What next?, posted by laima on January 4, 2007, at 14:05:33
I think it can, especially if serotonin is even slightly involved with me, I will be that 1 in 1000 to get an odd side effect!
Posted by jealibeanz on January 4, 2007, at 14:12:04
In reply to Re: ADHD meds... What next?, posted by hugo on January 4, 2007, at 14:05:05
That is the nice thing about stimulants, as opposed to antidepressants. I guess I haven't exhausted all options, but I'm getting pretty close.
Posted by blueberry1 on January 4, 2007, at 15:18:11
In reply to ADHD meds... What next?, posted by jealibeanz on January 4, 2007, at 7:41:40
There are always options. Don't give up. :-)
Sometimes the right option is actually something ridiculously simple and cheap.
Want to take something instead of gallons of coffee? More energy, without jitters, improved mood, improved concentration...all that good stuff? There is a food that is known to do all that. Without going into details, go to the net or go to the health food store and buy some Maca. There is a lot of research on it. I know it sounds whacko when we all talk about these heavy duty drugs all the time and then some friek says to try a South American food. But when all the heavy duty drugs let you down, commen sense logic tells me that trying something cheap and easy is not a bad thing. It sure beats tons of coffee and has tons of benefits as well.
Other than that, I've heard Desoxyn is the gold standard in stimulants. Try Maca first. Make sure to take enough...at least the full dose, maybe double or triple what it says. Give it 4 days to 30 days.
Weird I know. But continuing to try things that have proven not to work is weird too. Some of these great foods were put on earth for a reason. If you think coffee is ok, you will likely find Maca 100 times better, and without the jitters that usually come from stimulative things.
Posted by hugo on January 4, 2007, at 17:56:02
In reply to Re: ADHD meds... What next? » hugo, posted by jealibeanz on January 4, 2007, at 14:12:04
Keep on keepin on!
Hugo
Posted by peddidle on January 5, 2007, at 20:31:11
In reply to ADHD meds... What next?, posted by jealibeanz on January 4, 2007, at 7:41:40
I currently take 54mg concerta also. Before I started taking it, I could have fallen asleep at any given moment and slept all day.
When I first started taking concerta a couple years ago, I was told that it would work instantly, and that I wouldn't have to wait to get the full effect. However, I think the benefits really only kicked in a few weeks after. Maybe that's just me, but I would suggest that you give it at least two weeks to work before you try something else.
Incidently, my pdoc put me on Strattera first, too. Among other things, I also found it to be depressing, and of course, the unbearable nausea was no picnic. :P
Posted by Edwin Ransom on January 6, 2007, at 17:29:55
In reply to Re: ADHD meds... What next?, posted by peddidle on January 5, 2007, at 20:31:11
I did some research, and found three new ADHD drugs in the pipeline:
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guanfacine extended release (GXR, also referred to as SPD503)"a selective alpha-2A-adrenoceptor"
http://ihealthbulletin.com/blog/category/adhd/
(search within the site for 'guanfacine')'I believe that this drug would be in a totally new class of ADHD meds.
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Lisdexamfetamine Dimesylate (NRP104/LDX)
"a new ADHD medication in which d-amphetamine is covalently linked to l-lysine, a naturally occurring amino acid"'d-amphetamine? is that adderall or ritalin?
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SPD465"SPD465 has the same active ingredient as ADDERALL XR(R) (mixed salts of a single-entity amphetamine product), but is designed to provide ADHD symptom control for up to 16 hours."
http://www.medicalnewstoday.com/medicalnews.php?newsid=47879
'this reminds me of 'focalin' I tried focalin, which is ritalin but without the inactive isomer. I don't think it did anything different. I was never able to find any evidence that it had a lower side-effect profile either.
Posted by jealibeanz on January 6, 2007, at 20:09:41
In reply to Re: ADHD meds... What next?, posted by Edwin Ransom on January 6, 2007, at 17:29:55
Yeah, I've heard of all those pipeline drugs. They take a while to actually get to market.
For now I'm going to try Ritalin LA. My doctor just gave me the script yesterday. I won't be able to fill it til the end of next week due to insurance authorizations.
But it may be OK. I told him that Concerta was only only working for four hours and he was baffled. So he started rambling off the ADHD meds and I had to remind him I'd taken them before. He was about to give me Adderall! I hated that stuff.
But luckily one of the drugs mentioned was Ritalin, so he prescribed Ritalin LA, 20 mg. Does that seem low or high? Is it a starter dose? Remember I've been taking 54 mg Concerta with little effect, so I'm not new to stimulants.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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