Posted by KaraS on August 5, 2004, at 12:59:38
In reply to Re: Ritalin's Diminishing Returns » KaraS, posted by Ktemene on August 5, 2004, at 3:45:17
> Hi Kara,
>
> It was a few months ago that my pdoc mentioned to me that my reaction to Adderall (feeling calm and collected rather than wired and euphoric) was typical of ADDers. Another aspect of my response to Adderall he considered typical is that I never feel the need to increase the dosage and I never have any withdrawal symptoms when I don't take Adderall for a few days- I'm just less focused. Some people have proposed this "paradoxical" reaction to amphetamines as a marker for ADD, but most doctors are unwilling to accept this as a definitive test. This may be partly because so many doctors make so much money providing an ADD Dx on the basis of high-tech brain scans and labor-intensive evaluations of written tests. But it is too cynical to claim that this is the only reason. ADD is a complicated condition and there is no reason to expect that a single simple amphetamine-reaction test will neatly distinguish all ADDers from all non-ADDers. At any rate, there is no such simple test for Depression or OCD or GAD etc.
>
> But it does seem to be the case that most people who have ADD also respond to Adderall and Ritalin the way you responded to Ritalin. So this should at least provide a strong suspicion that you do have ADD. As I am sure you know, ADD is often hard to recognize in girls and women because many of us lack the most noticeable ADHD trait: hyperactivity. Many of us fall into the inattentive ADD category and that is hard to spot. I found a description of the difference between ADHD and ADD without hyperactivity that sounded so much like me as a child that I became convinced that I had ADD. On the chance that it might be useful to you, I'll include the URL: http://www.ldpride.net/addsub-types.htm
>
> One of the problems with determining the right Dx is that it is possible to have Depression and ADD as independent conditions. But it is also possible to have ADD as the primary condition, which then generates so much stress and trauma over the years that it causes Depression. And of course Depression can cause one to have most of the symptoms of ADD.
>
> Many doctors seem to think that ADD/ADHD is a dopamine dysfunction of some sort. I think it is a good strategy for people who are depressed and fit the ADD/ADHD profile (and aren't helped by SSRIs) to try a med that targets dopamine, at least as an augmentation strategy.
>
> By the way, on another thread you mentioned a poster who had argued in response to Todd (King Vulcan) that Selegiline's amphetamine metabolites were not responsible for its antidepressant effect. I think that poster was me. I wasn't arguing that when Selegiline metabolizes to l-amphetamine and l-methamphetamine there is never any antidepressant effect. I am sure that Todd is right to say that there is, especially when the Selegiline dose is large. But I am also sure that the l-amphetamine metabolites from my tiny 5 mg dose of Selegiline could not be the cause of the antidepressant effect Selegiline has produced in me, because if it were, then the 20 mg of Adderall (which is mostly the more powerful d-amphetamine) I used to take should have produced a vastly greater antidepressant effect, but Adderall had almost no antidepressant effect on me. And there are a few other posters here who have had the same very positive response to low dose Selegiline. In our case at least there must be some other explanation for Selegiline’s antidepressant effect.
>
> Ktemene
>
> > Ktemene,
> > Forgive me for barging in here. You said above:
> >
> > "My pdoc told me that your reaction to
> > Ritalin, being able to fall asleep after you have taken it, is typical of people who have ADD."
> >
> > Is this something that your pdoc told you recently? I may have had this conversation with you earlier (I'm sorry but I can't remember if it were with you or zuegma) about my falling asleep after taking 5 mg. of methylphenidate. Other things that people find stimulating also tend to make me drowsy. I don't know if i have ADD or not. I took the Strattera test and it didn't seem to suggest that I have it but I still have my doubts. Maybe what you or z said to me earlier was that those with ADD or ADHD tend to fall asleep from stimulants but the fact that you do fall asleep from them does not in and of itself prove that you have ADD.
> >
> > -K
>
>Thanks so much for that comprehensive response. I read the chart from the address you gave me and a lot of the ADD descriptions match me but plenty of it doesn't. I guess you were right earlier (I think it was you anyway) when you said that the diagnosis per se is less important that the treatment. If Adderall or another medication helps me, then it really doesn't matter what the actual diagnosis is.
Several months ago my pdoc said that I should increase the Ritalin and see if I have that response at 10 mg. Sometimes people react one way to the smaller dosages and a different way as the dosage is increased. I was just too scared to try a larger amount. Sounds foolish I know. It's not a bad thing for you not to develop tolerance or have withdrawal symptoms from stopping the Adderall - if there's a silver lining here... (I haven't seen my doctor in months because of lack of health insurance so I can't really follow up on it right now.)
I'm really surprised that current thinking holds that dopamine is implicated in ADD. I would have thought it was NE or at least both of them.
I have tried selegiline in 5 mg. and taken it for a couple of days at a time. I haven't tried it steadily. How long before you got an antidepressant effect from it? Was it right away or did it take weeks?
poster:KaraS
thread:373827
URL: http://www.dr-bob.org/babble/20040805/msgs/374377.html