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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by petters on April 29, 2002, at 13:41:15
Hi.
Anyone out there know how to combat ADD?
What type of medication, dosage ?
Does ADD often coexist with bipolar II ?
Sincerely...//Petters
Posted by Kelty on April 29, 2002, at 22:26:05
In reply to Treatment of ADD, posted by petters on April 29, 2002, at 13:41:15
From what I read this is not necessarily typical, but my adult daughter seems to be doing well treating her ADD with Wellbutrin alone. She also has a dianosis of depression/possible bipolar II. My husband, who has no issues with depression, takes ritalin and has for about 5 years with no intolerable side effects.
There are lots of other options, I am sure, but these are the ones I have experience with.
Good luck.
Posted by 3 Beer Effect on April 30, 2002, at 2:02:29
In reply to Treatment of ADD, posted by petters on April 29, 2002, at 13:41:15
The two most popular treatments are Ritalin (methylphenidate) & Adderall (mixed salts of amphetamine). Ritalin lasts about 3 to 3.5 hours and is normally given 2-3 times a day, while Adderall last about 6 hours and is normally given 1-2 times a day. If you decide on Ritalin, keep in mind the name brand is probably more effective considering it lasts about a half an hour longer than any of its generics (methylphenidate, methylin, metadate). Often times, a person will respond great to one of these medications- either Ritalin or Adderall, but not both, but the only way to find out is a one month trial.
All of these first-line ADD medications are Schedule II medications meaning that no refills are allowed, a DEA triplicate prescription form is required, which must be filled within 7 days, & only a one month supply can be dispensed at a time.
The third most popular treatment is Dexedrine/Dextrostat (dextroamphetamine) which was formerly very popular but has been losing alot of ground recently probably because Dexedrine is only available in 5 mg tablets, while Dextrostat is only available in 5 & 10 mg tablets. Dexedrine/Dextrostat lasts about 4 hours, & arguably causes less anxiety than Adderall but doesn't last as long. Dexedrine & Adderall seem to be good choices if you also have social phobia/shyness along with ADD.
There are 3 newer medicines that are rapidly increasingly in sales. They are Concerta, Adderall XR, and Focalin.
Concerta is a controlled release form of Ritalin/methylphenidate that lasts about 11 or 12 hours and is very consistent in its effects. It comes in a OROS advanced technology time-release capsule. Most people seem to like Concerta, while the only other available controlled release Ritalin, Ritalin SR is quite erratic & best avoided.
Adderall XR is the controlled release form of Adderall with a duration of 12 hours. Adderall XR is not as advanced as Concerta, it basically releases one dose immediately & one dose about 6 hours later & so is fairly similar to just taking Adderall twice a day, but is much more expensive.
There is a brand new form of Ritalin called Focalin. Like Ritalin, Focalin is an immediate release medication that has a similar duration of action (3-3.5 hours). Focalin is different than Ritalin in that half of Ritalin is an active isomer, while the other half is inactive. Focalin is a refined form of Ritalin that contains only the active isomer, & so absorption may be more efficient/extensive & your liver does not have to metabolize as much medication. Focalin is given in half the dose of Ritalin but has the same potency/efficacy.
There are many dosage forms of these medications available, all of which can be found in the official prescribing information at www.rxlist.com or on the websites of their manufacturers (Novartis= Ritalin, Focalin; Shire Pharmaceuticals= Adderall, Dextrostat; GlaxoSmithKline= Dexedrine; Concerta= ?). You can also find the available dosage forms at walgreens.com & clicking on drug prices/info & then entering in the name of the drug.
Your doctor will probably decide the starting dose for you & will titrate it according to response. Many doctors are reluctant or atleast wary of prescribing these medications to adults for fear of abuse & liability because of their Schedule II status, especially if you have a history of alcohol or drug abuse. You might have better luck by asking for one of the controlled release stimulants, Concerta or Adderall XR, which are subject to less abuse & more difficult to abuse than the other stimulants, which may put your doctor at ease.
Sometimes your doctor may make you take a test, to see if you really have ADD or not. The symptoms of Bipolar II and ADHD overlap in many areas & it is sometimes hard, even for psychiatrists, to distinguish between the two. One way to tell is that ADHDers usually do not respond well to mood-stabilizers, & Bipolar IIs either don't respond to stimulants or become manic from them. Neither group seems to respond well to SSRIs, particularly Prozac & Zoloft, which often cause mania in Bipolars & impulsive or disinhibited behavior in those with ADHD.
A second line treatment that is sometimes effective for Adult ADD is Wellbutrin SR. It appears that Wellbutrin SR is usually not as effective as the first line psychostimulants, but often works well if depression is present with the ADD. Wellbutrin SR is also not a controlled substance, so you can have refills & your doctor can call in prescriptions- so it is less of a hassle than traditional ADD psychostimulants. The normal effective dose is 300 or 400 mg/day, while the starting dose is typically 150 mg/day. Wellbutrin SR cannot be taken by anyone who has a history of seizures, because at higher doses its propensity to induce seizures is four-fold the other newer anti-depressants (SSRIs etc.).
3 Beers.........
Posted by Raga on May 1, 2002, at 11:14:47
In reply to Psychostimulants are usual first-line treatment, posted by 3 Beer Effect on April 30, 2002, at 2:02:29
Stimulants are first line, but there are reasons why someone may wish to avoid them.
Wellbutrin only worked for a very short time for me.
But I'm on a desipramine trial now, and it seems to be working quite well for my inattentive ADD or whatever the heck my diagnosis really is...
I highly recommend it.-Raga
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