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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by jealibeanz on February 1, 2007, at 15:05:33
Does anyone know of any "alternative" methods to treating adult ADHD?
By that I mean combination of stimulants or off-label drugs.
My prescription plan doesn't even cover stimulants for ADHD for people over 18, only stimulants for fatigue! So this has become a battle. My doc hopefully will change my diagnosis so I don't have to pay $200 a month.
I've tried Adderall and it caused major depression.
I tried Straterra. It was alright at first. I know I was more productive, but thinking back now, I just didn't feel right. Kinda depressed and emotionally blunted, but I have depressive tendencies, so who knows.
I was on Provigil for fatigue, which is also used to ADHD sometimes. It worked great for the overwhelming fatigue for a few months, then stopped. So, then...
I tried Concerta, and it just didn't last very long.
Right now I'm on Ritalin LA, 20mg, b.i.d. It's OK, but not quite stimulating enough.
Has anyone ever combined a stimulant with Straterra?
Maybe I should ask about increasing the Ritalin? I'm 130 lbs, female, so I'm not really at a max dose.
I know Wellbutrin is used off-label. I was on it for depression/anxiety before. Didn't do much but made me gain 20 lbs in 4 months while I was nauseous and couldn't eat much and worked out a lot. Talk about weird! Same will all SSRI/SNRI's too.
Posted by dbc on February 1, 2007, at 15:19:47
In reply to Combination of ADHD Meds..., posted by jealibeanz on February 1, 2007, at 15:05:33
Im so stereotypical and im sure you expect this post out of me.
Dexedrine is incredibly cheap even when buying 250+ 5mg pills at once you wont pay over 50 or so dollars. Despite what you may think its nothing like adderall. Adderall is a poorly conceived cocktail of isomers but you probably know this from my posts. Dexedrube feels soothing in a way and controlled.
Posted by jealibeanz on February 1, 2007, at 15:35:33
In reply to Re: Combination of ADHD Meds..., posted by dbc on February 1, 2007, at 15:19:47
Have you ever tried Ritalin? It's fairly mild in my opinion.
I don't like suggesting meds by name anymore (since I've been in med school for 6 months... don't wanna be a know it all, because I'm not!). But I used to, and still do have a lot of input. My doc and I collaborate very well.
Maybe I'll mention that Adderall seemed to "pack the most punch", so to speak, but also seemed wayyy too over-stimulating. I was up, down, and all over the place, than went into depression. That info could possibly lead him to consider dexedrine.
Posted by dbc on February 1, 2007, at 15:48:52
In reply to Re: Combination of ADHD Meds..., posted by jealibeanz on February 1, 2007, at 15:35:33
Ritalin made me anti-social and weird. Plus the rebound from the drug was like being punched in the face.
I still would try focalin though if given the chance.
Posted by jealibeanz on February 1, 2007, at 16:25:29
In reply to Re: Combination of ADHD Meds..., posted by dbc on February 1, 2007, at 15:48:52
Focalin XR does seem appealing. I wonder if my doc likes that one. They all seem to have their favorites.
Posted by 10derHeart on February 1, 2007, at 16:27:58
In reply to Combination of ADHD Meds..., posted by jealibeanz on February 1, 2007, at 15:05:33
>>Has anyone ever combined a stimulant with Straterra?<<
Yes. When I first started Strattera (Jan '04) I was also rx'd - I think - 10 or 20 mg Ritalin tabs with it. I was previously on a Prozac/Ritalin combo to treat both ADD and depression, for about 18 months. Two pdocs had no problem doing this, and they would pretty much adjust to what I said I needed re: the Ritalin. I'd take 20-40 mgs in certain situations where I knew I'd need more sharp focus than Strattera provides me. After a while, though, I stopped asking for it to be renewed as I just couldn't see that big of a difference any more (Ritalin vs. no Ritalin)
FWIW, 20 mg. of Ritalin BID would never have been effective for me. Before Strattera, I had to use a minimum of 40 mg Ritalin BID to "cover" an average day, and at times I recall using 100mg total. Now I did weigh more than you at that time, for sure, but I still think it's wise to consider increasing the dose. Just to find out at what point it might become too much, kick in SEs you aren't willing to tolerate, etc. Or, maybe it won't do that. Maybe it'll be just right!
Hope this helps. Sorry it's been so tough for you to find one med or a combo that works long term. So frustrating.
Posted by jealibeanz on February 1, 2007, at 16:45:11
In reply to Re: Combination of ADHD Meds... » jealibeanz, posted by 10derHeart on February 1, 2007, at 16:27:58
Isn't it nice when docs actually listen and believe that you know your body better than them?
My doc is like that... and he's also a veerrrrry caring and fairly liberal guy, as far as GP's go... most wouldb't like the idea of rx'ing daily Xanax, 4mg, for and extended period... and stimulants or Provigil and Lunesta for over a year!
Posted by Phillipa on February 1, 2007, at 23:29:05
In reply to Re: Combination of ADHD Meds..., posted by jealibeanz on February 1, 2007, at 16:45:11
Go to the official site for straterra it is with cymbalta and says it's an SNRI? How can this be? Love Phillipa
Posted by jealibeanz on February 2, 2007, at 4:12:16
In reply to Re: Combination of ADHD Meds... » jealibeanz, posted by Phillipa on February 1, 2007, at 23:29:05
I think people usually leave out a letter when speaking of Cymbalta or Effexor.
Cymbalta and Effexor are Selective Serotonin and Norephinephrine Reuptake Inhibitors = SSNRI
Straterra is a Selective Norephinephrine Reuptake Inhibitor = SNRI
Posted by hugo on February 2, 2007, at 11:27:19
In reply to Re: Combination of ADHD Meds... » Phillipa, posted by jealibeanz on February 2, 2007, at 4:12:16
Provigil was mentioned above as being helpful for a while then pooping out. Intermittent dosing with Modafinil can prevent this, some say. What does intermittent mean? Maybe skipping weekends or using it as needed in combo w/another stimulant.
Hugo
Posted by med_empowered on February 2, 2007, at 12:47:31
In reply to Re: Combination of ADHD Meds..., posted by hugo on February 2, 2007, at 11:27:19
i've read of cases where provigil was added to standard stimulants (ritalin, the amphetamines) for narcolepsy...I imagine you could do the same for adhd. For super-adhd you could try 2 different stims,like ritalin+dexedrine. Sometimes kids end up on odd combos...like buspar+a stimulant, an atypical neuroleptic+ a stimulant, that kind of thing. I imagine with kids there's more emphasis on behavior control with those combos, but maybe they'd help you, too.
Have you considered switching from Ritalin LA to straight-up ritalin? It'd be cheaper and, in my experience, easier to dose out; the LA caps can be kind of unpredictable, so doing generic ritalin 2-3+/- times a day might be smoother. Sometimes adding a low, even sub-therapeutic, dose of an antidepressant can be helpful. And there are always the tricyclics but...they suck.
Have you tried Desoxyn? Its hardcore, its expensive, and the dose titration can take a while, but a lot of people seem to like it. Apparently you can get more bang for your buck--more anti-ADHD effects w/ lower dosages, which can result in fewer side effects (or more tolerable ones) than adderall or dexedrine.
Posted by Phillipa on February 2, 2007, at 19:15:13
In reply to Re: Combination of ADHD Meds... » Phillipa, posted by jealibeanz on February 2, 2007, at 4:12:16
Can you tell me what this means? I really don't know? Pleae? Love Phillipa
Posted by Phillipa on February 2, 2007, at 19:17:32
In reply to Re: Combination of ADHD Meds... » Phillipa, posted by jealibeanz on February 2, 2007, at 4:12:16
I get it there is no serotonin in it right? So this makes it an ADD med? Love Phillipa
Posted by rina on February 3, 2007, at 19:15:14
In reply to Combination of ADHD Meds..., posted by jealibeanz on February 1, 2007, at 15:05:33
> Does anyone know of any "alternative" methods to treating adult ADHD?
>
> By that I mean combination of stimulants or off-label drugs.
>
> My prescription plan doesn't even cover stimulants for ADHD for people over 18, only stimulants for fatigue! So this has become a battle. My doc hopefully will change my diagnosis so I don't have to pay $200 a month.
>
> I've tried Adderall and it caused major depression.
>
> I tried Straterra. It was alright at first. I know I was more productive, but thinking back now, I just didn't feel right. Kinda depressed and emotionally blunted, but I have depressive tendencies, so who knows.
>
> I was on Provigil for fatigue, which is also used to ADHD sometimes. It worked great for the overwhelming fatigue for a few months, then stopped. So, then...
>
> I tried Concerta, and it just didn't last very long.
>
> Right now I'm on Ritalin LA, 20mg, b.i.d. It's OK, but not quite stimulating enough.
>
> Has anyone ever combined a stimulant with Straterra?
>
> Maybe I should ask about increasing the Ritalin? I'm 130 lbs, female, so I'm not really at a max dose.
>
> I know Wellbutrin is used off-label. I was on it for depression/anxiety before. Didn't do much but made me gain 20 lbs in 4 months while I was nauseous and couldn't eat much and worked out a lot. Talk about weird! Same will all SSRI/SNRI's too.The Ritalin La didn't work for me but the generic worked wonders Methalphnidate. Also Focalin XR was a saving grace. It's lasts about 12hours in the day. Wonderful!!
Posted by rina on February 3, 2007, at 19:17:37
In reply to Re: Combination of ADHD Meds..., posted by dbc on February 1, 2007, at 15:48:52
> Ritalin made me anti-social and weird. Plus the rebound from the drug was like being punched in the face.
>
> I still would try focalin though if given the chance.
Focalin XR is truly life on wheels. It worked wonderfully. It lasts about 12hours a day.
Posted by jealibeanz on February 3, 2007, at 19:32:51
In reply to Re: Combination of ADHD Meds..., posted by rina on February 3, 2007, at 19:15:14
When you say Ritalin LA didn't "work", what exactly do you mean? It didn't last long enough? Wasn't stimulating enough? Caused side effects?
I've been taking it twice a day, and it still doesn't seem strong or long enough. I think the control release/extended release/long-acting mechanisms of drugs are hit or miss with people. I seem to be one of those who doesn't do well with them, plus I think I'm a fast metabolizer in general.
Posted by rina on February 4, 2007, at 15:23:43
In reply to Re: Combination of ADHD Meds... » rina, posted by jealibeanz on February 3, 2007, at 19:32:51
> When you say Ritalin LA didn't "work", what exactly do you mean? It didn't last long enough? Wasn't stimulating enough? Caused side effects?
>
> I've been taking it twice a day, and it still doesn't seem strong or long enough. I think the control release/extended release/long-acting mechanisms of drugs are hit or miss with people. I seem to be one of those who doesn't do well with them, plus I think I'm a fast metabolizer in general.It didn't help with my ADD much and didn't last long enough. My dose was 60mg, spread out through the day. I was encouraged to try coffee once you feel the come down of the stimulant, it wards of the bad side effects. I must also say that Focalin is the best stimulant for ADD ever discovered. Plus it works for a period of 12hours a day, with no withdrawal issues.
Posted by jealibeanz on February 4, 2007, at 18:41:44
In reply to Re: Combination of ADHD Meds..., posted by rina on February 4, 2007, at 15:23:43
Doesn't it seem like doc's push Adderall, Ritalin, and Concerta, but not Focalin?
It's nice to know that there's another option though.
I went to see my doctor and told him the 20 mg Ritalin LA b.i.d. just didn't seem like enough. Adderall was the strongest drug I've ever had, but that I was up, down, hot, cold, allll over the place... he didn't want me to go there again.
So, I've now been increased to 30 mg Ritalin LA b.i.d. I'm having insurance problems right now though, so it wasn't approved.
I haven't been stimulant-free in a year now (went from Straterra to Provigil to Concerta to Ritalin). It's only been two days, but I feel horrrrrrible! I'm not actually falling asleep, just extreeemely tired, achy, cranky, and disconnected. NOT fun!
I normally have to drink caffeine from coffee and diet coke from the time I wake up until the time I go to sleep on top of the meds. This shows how messed up my body really is!
Posted by med_empowered on February 4, 2007, at 22:19:57
In reply to Re: Combination of ADHD Meds... » rina, posted by jealibeanz on February 4, 2007, at 18:41:44
would your doc OK generic ritalin/dexedrine/adderall? I think that might cut your costs down to 50-70 per month (out-of-pocket).
Posted by rina on February 5, 2007, at 0:24:11
In reply to Re: Combination of ADHD Meds..., posted by med_empowered on February 4, 2007, at 22:19:57
> would your doc OK generic ritalin/dexedrine/adderall? I think that might cut your costs down to 50-70 per month (out-of-pocket).
Actually after I pay my 250 deductible each year, most if not all the RX are less than 30dollars.
Posted by jealibeanz on February 5, 2007, at 4:06:02
In reply to Re: Combination of ADHD Meds..., posted by med_empowered on February 4, 2007, at 22:19:57
$50-$70? Is that what you meant? For generic? Whoa! That's still a lot. I was considering asking him because I figured the price range would be in range of benzo's (reallly cheap!).
He probably would write a generic script, but he'd probably also rather see me try the med he was prescribing. I've had a lot of problems with generics of all types too, so I try to stick with brand name for everything.
My insurance will cover it. They don't cover ANY meds for AD/HD for people outside of the ages 5-18. No little kids can have the disorder, nor can adults. Nice for them to make that decision, huh?
But they will cover stimulants for "fatigue related to other medical conditions". This is true for me. My doc actually wrote nacolepsy as the dx time. The reason I started Provigil in September was because I was sleeping 18 hours a day (not good when you have 12 hours of class a day!).
My problem is that the med has to be authorized by the doctor (aka nurse, since the doc isn't the one calling). They have to call the company and get authorization codes to give to the pharmacy.
I'm soo mad right now. This is now the 4th month that it's happened. I've been paying out of pocket ($200 for Ritalin LA and Concerta), assuming I'd be reimbursed when it was straightened out. But no.
I've been there each time when the pharmacist called the office and explained the situation to the nurse and gave them phone numbers. I've called the office several times for each script. My mother went to the office and spoke to a nurse, who we know, and was told "these things can take several days to go through". (in other words... we don't like doing so sometimes we get around to calling a few days later).
The insurance company sends letters to the doctor's office. I've brought my letters in to my appointments, explaining the situation and what they must do. My doctor keeps reassuring me that the problem has been fixed and not to worry about it. I don't blame him. It's poor communication. He doesn't know his nurses are refusing to do the job.
So, my mother, father, and me are all calling them today and telling them it needs to be fixed. My parents are furious! It's completely ridiculous. The nurses just will not call. It's not fair to me, or my doctor, who is under the impression that his orders are being followed for the patient he's treating.
Posted by jealibeanz on February 5, 2007, at 4:08:24
In reply to Re: Combination of ADHD Meds..., posted by rina on February 5, 2007, at 0:24:11
When my insurance covers them, brand name meds are $5 and generics are $3. I can even get this in a 3 month supply for certain meds.
This is the end of the thread.
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