[Wishmouse]

Have been living with depression for many years, but medication never seemed to help, it made my depression extreme. My T, has had a whole re-think and has now diagnosed me with ADHD and a dash of sensory integration issues for good measure. I have not started medicating yet, we are trying a few alternative remedies first.

Is this misdiagnoses common? Have any of you tried AD and found that they made you feel worse? Have you had any luck with the "alternative rememdies"? If you are on meds, how do they make you feel (if i'm not feeling hyper I tend to stress and get anxious ie. Xanax)

[sunrise]

Is this misdiagnoses common?

I think misdiagnosis for ADHD is common (and also for other conditions). ADHD and depression and anxiety often travel together. It can take some effort to tease them out. Sometimes the easiest approach is just to try different things and see what works rather than trying to get an exact diagnosis.

Have any of you tried AD and found that they made you feel worse? Have you had any luck with the "alternative rememdies"?

I tried an "alternative remedy" for depression first, i.e. psychotherapy. My first therapist helped a bit and my second therapist pretty much "cured" me, and rapidly too. Quite some time later I was prescribed Wellbutrin for ADHD symptoms, and I found that it also lifted my mood (Wellbutrin is most frequently prescribed for depression). So even though I didn't consider myself depressed anymore, the Wellbutrin helped me. It made me realize that my "normal" level of being is just typically somewhat "depressed" compared to many people. (I guess I had always known that.) Anyway the Wellbutrin helped with both mood and ADHD symptoms. I have since added a stimulant, Vyvanse, and gotten even more help with the ADHD symptoms and mood. On these two meds, I feel actually great sometimes! And I can definitely focus better, am less disorganized sometimes, can see tasks through to their conclusions sometimes, etc.

Wishmouse, what type of antidepressants have you been taking? If you have been taking an SSRI (e.g. Prozac, Lexapro, Paxil, etc.), then it wouldn't help with ADHD symptoms, as you need something that affects the dopamine pathway for that, and those ADs work via serotonin. Wellbutrin acts on dopamine, so it might be a good thing to try if you have both depression and ADHD symptoms. Stimulants like Adderall, Concerta, etc. also act on dopamine, which will help not also with ADHD but with depression. It's a great "secret" that stimulants help with depression, and you will find very few practitioners who will prescribe them for that unless there is comorbid ADHD (because they are controlled substances and addictive, whereas ADs are not).

As for anxiety, I haven't had good luck treating it with medication. Buspar didn't help. The smallest dose of Xanax makes me fall asleep. So I rely on other strategies, such as controlled breathing, meditation, soothing mental imagery, etc.

Wishmouse, what are sensory integration issues, and how are they managed?

Best of luck to you with finding solutions.

[Wishmouse]

Agreed, the SSRI's and Tri-cyclic made me EXTREMEMLY depressed; I tried Wellburtrin which was great initially, but also made me very weepy and emtional. Had negligable results from Lamictal.

Sensory integration issues means that I experience everything, am not able to filter out "irrelevant imput" and am Overly sensitive to touch, movement, sights, or sounds , Everything to the power of 10. Making it impossible to relax or concentrate as everything is a distraction. Am trying a few things to manage it, mainly cutting down on stimulation ie dimming all the lights, increasing temperature, applying pressure (sitting in a highback chair and wrapping a shawl around my shoulders, like a little caccoon), and playing music that is rythmical and consistant (meditation CD's). Doing this at home and work.

Am more concerned by ADHD than SID, if I could get that under control then life would be peachy

[Simcha]

[quote=sunrise;839777]I think misdiagnosis for ADHD is common (and also for other conditions). ADHD and depression and anxiety often travel together. It can take some effort to tease them out. Sometimes the easiest approach is just to try different things and see what works rather than trying to get an exact diagnosis.

I have since added a stimulant, Vyvanse, and gotten even more help with the ADHD symptoms and mood.

I have heard a lot about Vyvanse, and I wonder how it compares to the stimulant I take (Dexedrine XR). I have a good response to the Dexedrine XR spansules, except that some days when the medicine wears off it can be most unpleasant. I've been told that Dexedrine is rougher on most people when it wears off than the other stimulants, although it reportedly has excellent response rate in adults otherwise.

Wishmouse, what type of antidepressants have you been taking? If you have been taking an SSRI (e.g. Prozac, Lexapro, Paxil, etc.), then it wouldn't help with ADHD symptoms, as you need something that affects the dopamine pathway for that, and those ADs work via serotonin. Wellbutrin acts on dopamine, so it might be a good thing to try if you have both depression and ADHD symptoms. Stimulants like Adderall, Concerta, etc. also act on dopamine, which will help not also with ADHD but with depression. It's a great "secret" that stimulants help with depression, and you will find very few practitioners who will prescribe them for that unless there is comorbid ADHD (because they are controlled substances and addictive, whereas ADs are not).

Excellent points. I've actually only heard of Welbutrin being used in the AD class (for ADHD), but really nothing would surprise me with the lack of education on ADHD (esp. in adults) in our psychiatric/medical community.
I think that you and I are some of the lucky ones in that we both seem to have good providers who are educated in adult ADHD.

The misconception that some people have that stimulants are addictive (vs. having potential for abuse; two diff. things) is widespread enough that it even biases doctors and other prescriber's (including psychiatrists) against prescribing stimulants for ADHD. The ones who think you are a drug addict or that "don't believe in stimulants" oftentimes then prescribe a antidepressant as a first line treatment even if a stimulant isn't contraindicated. I think this can be discouraging if the patient doesn't see a response from the AD, and the patient might then shy away from ADHD treatment and not try anything else. Of course your case is different and you had depression issues and ADHD issues intermingled (as many of us do if we go untreated for most of our life). In my case I have anxiety issues intertangled with ADHD issues. Rarely travels alone is right!

Schedule II prescription drugs have potential for abuse, which can lead to addiction(s), but in itself it isn't addictive. It sounds like a semantic distinction, but it really isn't as abuse and addiction are different clinical terms. Anyone who takes a Schedule II prescription drug to abuse it is likely not a person with ADHD. It's not like taking methamphetamines (commonly compared to legal stimulants due to similar chemical compounds), and there are many extended release versions that virtually eliminate the abuse factor. Multiple longitudinal studies have actually shown that children and adults with ADHD who take stimulants are actually LESS likely to become drug addicts if they are treated with a stimulant than if those with ADHD who go without.

[sunrise]

Originally Posted by Wishmouse

Sensory integration issues means that I experience everything, am not able to filter out "irrelevant imput" and am Overly sensitive to touch, movement, sights, or sounds

I think I might have some of that too. It has gotten worse as I've gotten older. For example, if I'm watching TV, I sometimes have to put up my hands to each side of my face to block my peripheral vision so I can focus on the TV. Anything going on to either side of me is too distracting. Likewise, sounds. The changes you are making to your environment sound like a really good idea.

Originally Posted by Simcha

I have heard a lot about Vyvanse, and I wonder how it compares to the stimulant I take (Dexedrine XR). I have a good response to the Dexedrine XR spansules, except that some days when the medicine wears off it can be most unpleasant. I've been told that Dexedrine is rougher on most people when it wears off than the other stimulants, although it reportedly has excellent response rate in adults otherwise.

Dexedrine is dextroamphetamine, which is the same drug that Vyvanse is metabolized to in the gut. So they are basically the same drug, once they get going. Because Vyvanse is basically inert until it goes to the gut and gets activated, it has very low potential for abuse. Addicts don't get that instant buzz they like from it. It is the only stimulant I have ever taken so I can't compare how it feels to others. My PNP told me that her patients describe it as very "smooth." I do not feel a strong coming onto it or coming off of it. It is just seamless. I take one in the morning and it lasts a long time. I take a Wellbutrin in the afternoon for a little extra help keeping that dopamine in the synapses. If you are having trouble when the dexedrine wears off, it might be worth investigating Vyvanse.

The misconception that some people have that stimulants are addictive

I thought that too! I didn't know they weren't addictive. I had heard you can develop tolerance to stimulants (need more to get the same effect) and I equated that with the drug being addictive.

[chaotic13]

I think misdx's happen all the time with ADHD. Mainly because ADHD is not well defined and often causes or is a comorbidity with other disorders such as depression and anxiety.

I do not believe I am currently suffering from depression, but I believe I was experiencing a depressive episode that made my ADHD symptoms no longer manageable with innervention. Now that I've experienced the benefits of medication, I decided to continue with this treatment for now.

I think at times (like this week) I experience intermittent sensory integration issues. Wheither these are considered pathological or not... I don't know. Not sure if this is because of my ADHD; but when I am not on medication for my ADHD it is definately harder for me to deal with them.

I am on Adderall and I feel... what I consider normal now. When off this medication I tend to zone out and get very agitated when presented with a busy environment. My patience is much improved while on the Adderall.

Occasionally I will take a low dose of short-acting Propranolol when I know I am going to face a particiularly stressful situation (like therapy this week). I really don't feel any major difference when I combine these medications. Other than... I don't feel the racing heart and throat restriction as much. I don't feel mentally impaired, more talkative, or more emotional. I don't know if this is a real benefit or just a placebo effect--but whatever--I think it helps.

[Simcha]

Originally Posted by chaotic13

Originally Posted by chaotic13

I am on Adderall and I feel... what I consider normal now. When off this medication I tend to zone out and get very agitated when presented with a busy environment. My patience is much improved while on the Adderall.

Occasionally I will take a low dose of short-acting Propranolol when I know I am going to face a particularly stressful situation (like therapy this week). I don't feel the racing heart and throat restriction as much. I don't feel mentally impaired, more talkative, or more emotional.

(((((((chaotic)))))))

That's interesting... I had never heard of Propranolol before (I had to look it up!). Was the Propranolol prescribed on an "as needed basis" to augment your Adderall for your ADHD treatment, or is it for calming you down?
Either way, how does the Propranolol affect you after you've taken it (I couldn't tell if you were saying the Propranolol calms you down or what-not). Is your Adderall the sustained release variety?

I'm always looking for something better. I like the Dexedrine XR Spansules (for those who might not know, the XR is extended release), but I'm a fast metabolizer, and about half the days of the week it doesn't feel good when it wears off (I can get very hyper and/or slightly agitated). I find it takes about an hour and a half during for the period where it wears off to have those negative symptoms go away. Mostly I try to stay away from people during that time period, but it's not always possible. I take the Dexedrine XR Spansules 30mg in the morning and I can augment with 30mg in the late morning/early afternoon as needed (and usually I do). When I take it, I feel calmer, more able to make decisions, able to prioritize, and my focus is definitely improved. My mood is also better and more even. I am far less impulsive. It doesn't hurt my creativity either. However, I'm a fast metabolizer, the maximum time the benefit from them seems to last is 4-5 hours at best , which is frustrating. I'm much more "emotional" when I'm not on the medicine, and I also will get incredibly annoyed at loud noises, especially at things like the T.V. (mostly commercials). I get frustrated easier at things that just don't matter. I have noticed that the longer I am on the medication (almost two years now), the more I improve over time.

For me, I also find that maybe a day or two out of the week the Dexedrine XR Spansules isn't as effective. I don't know if that is normal or not. I've never taken anything else for ADHD other than the Dexedrine immediate release tabs (at a lower dose). The immediate release tabs were intended to work faster in the morning (it takes 30-45 minutes for the Dexedrine XR Spansules to kick in), but they made me feel agitated more than increase focus. I think that too, is because I'm a fast metabolizer. I have thought about trying another medication in place of the Dexedrine XR Spansules. I do not want to increase the dose of Dexedrine XR that I take, as I'm not sure that would extend the timeframe the beneficial effects work anyway. I also do not want my body to start to need higher doses for the same beneficial response.

Questions for chaotic (and everyone else who is on meds for ADHD):

Do you ever have some days where the ADHD medication doesn't work as well as others (include the name of med) ?

What other medications have you tried to treat the ADHD, and if so, what works and what doesn't?

Does the medication for ADHD you take have any noticeable side effects, and how does it feel when it wears off and leaves your system?

How long does the beneficial response to the medication last?

What other treatment strategies (including alternative and psychotherapy) have you tried that works/helps?

Maybe I'll write another thread post to explore this topic more too. Thanks for your input!

[Simcha]

Originally Posted by sunrise

I think I might have some of that too. It has gotten worse as I've gotten older. For example, if I'm watching TV, I sometimes have to put up my hands to each side of my face to block my peripheral vision so I can focus on the TV. Anything going on to either side of me is too distracting. Likewise, sounds.

(((((((((((((sunrise))))))))))))))

I can remember having problems with sensory issues ever since I was three-four years old. In what I've read and in discussions with my T, problems with sensory integration issues are quite common with children and adults who have ADHD.

Clothing tags, loud sounds, TV (the sound from commercials are torture for me), tightness/looseness of shoes, collars, clothing and bedding materials, too many people in the same room, etc. are some of the more common stimuli that are agitating to people with sensory issues relating to ADHD. Some people with ADHD also have full blown Sensory Integration Disorder comorbid to the ADHD (that must be pure hell--ack!).

Tags on the collar are horrifying for me. As an FYI to those who have the same problem, the Hanes clothing company now makes their clothes TAG-FREE!! WOOHOO!

[laurajames22]

Hi. I just found this site. Yes, I was underdiagnosed with anxiety/depression for more than 15 years. Zoloft was very helpful but I continued to get and loose jobs due to all kinds of behaviours not explained by anxiety/depression. I never accepted the depresssion diagnosis, I just clung to the anxiety part to explain my crazy happy then scared behaviours. It took poverty and an astute prescribing nurse to actually take the time to observe how I interrupt other speakers, go down long, interesting paths of tangential conversation before returning to the answer to the question originally asked of me. I could not be diagnosed by the HMO doctors I'd been paying for 15+ years AS LONG AS THEY ONLY SPENT 9 MINUTES OF A 15 MINUTE annual appointment speaking with me. So, I continued to take Zoloft for the anxiety/depression as well as the ADHD. Then I was switched to Adderall XR to participate in freebie program, which worked well once we upped the dosage. And now I've just been switched to Vyvanse when the Adderall XR freebie program was discontinued and the Vyvanse program began. I also take Celexa (generic is Cetalopram) for OCD (obsessive compulsive disorder) that was diagnosed once the ADHD was treated. I also take Seroquil at night in order to get a full nights sleep without interruption. I do a good deal of sleeping during the day to compensate and have to use an alarm to wake up and take the Vyvanse (for ADHD & Anxiety/Depression) and Celexa (for the OCD) then go to sleep for awhile until those meds wake me up. Needless to say I applied for SS Disability Insurance and received it within 9 mos of my application. I'm working to overcome past issues with a psychotherapist and I continue to work at my art and writing fully expecting to earn a living within 3-5 years. BRIGHT SPOT: Now that my mind and nervous system have evened out and I'm learning to live a non-chaotic life, I have really come to appreciate my artistic abilities and honor them by continuing to learn new techniques. After 35 years working in an office environment--corporate, small business, non-profit--I appreciate the ability to live within my own mental emotional cycles (the moon, the stars, menses) and NOT the 9-5 that never, ever worked for me no matter how hard I tried. Time for this ADHD'er never adds up and plays out the way it does for other folkes. I've lost a few friends who didn't believe ADD/ADHD was REAL but. after reading great books and receiving links to ADD sites through ABOUT.com, I KNOW it's very real and I'm doing the very best I can every single day to live this life as I've been given it. DID THIS HELP?

[chaotic13]

Originally Posted by Simcha

(((((((chaotic)))))))

Thanks Simcha.I had to include this... my inner feral child needed to feel some no-touch love this week.

Was the Propranolol prescribed on an "as needed basis" to augment your Adderall for your ADHD treatment, or is it for calming you down?

Yes, the Propranolol (a fast acting version at a low dosage 30mgs, I think) was Rx'ed for use "as needed." It is not really part of my treatment for ADHD. During one doctor’s appointment…after dismissing the perky PA, I told my neurologist/Pdoc/Candyman that I was struggling with chilling out during therapy (elevated BP, knot in throat, racing heart, muscle tension, and the feeling of someone sitting on my chest). He recommended that I take 1or 2 tables an hour before a stressful event. Propranolol is a beta-blocker and in higher dosages is used to lower BP and heart rate and to treat tremors, angina (chest pain). Unofficially it can be used to treat…short-term anxiety symptoms and migraines.

How does the Propranolol affect you after you've taken it?

I don’t notice any major difference, however when I was testing it out over the summer I took it once before doing my daily walk, and I felt like I was dragging a bit at the end. …Not a good idea to take a beta blocker and then go out an exercise… It was low level exercise…and I knew I could stop anytime if I wanted to.

I’ve only used my Propranolol anxiety treatment a few times, one being last session. It does seem to help with my physical symptoms. They don’t totally go away but they seem more manageable. The last time I tried to talk about a particular issue in therapy…I thought my heart was going to bust right out of my chest and I was dry heaving in the parking lot afterward. Last week I still felt very anxious…but not where near this ways.

I will caution people though…at one point in the management of my BP we tried switching me to a long-lasting –higher dose of Propranolol. My candyman figured… hey why not address both your anxiety and your BP issue with one medication. This worked well for me, EXCEPT for two occasions when I drank some alcohol (1 glass of wine, and the other time it was a large glass of Foster’s Lager). For me Propranolol and even just one glass of alcohol DO NOT MIX. I crashed hard about 30 minutes after drinking… felt like MAJOR depression. I would not recommend doing this.

Is your Adderall the sustained release variety?

Yes, I take 60 mg of the Adderall XR in the morning.

I'm always looking for something better. I like the Dexedrine XR Spansules

Actually the whole reason I visited this forum today was because …somehow the pharmacy companies have gotten my email address…(hopefully not from PC!) and I was sent an article/advertisement from Medscape.com on DAYTRANA. This apparently is a “once-daily transdermal patch formulation of methylphenidate, available in 10 mg, 15 mg, 20 mg, and 30 mg dosage strengths, provides day-long symptom control.” I know nothing about this medication but thought I would check to see if anyone was using it.

[sunrise]

Originally Posted by laurajames22

Hi. I just found this site.

Welcome to PC!

Simcha's Questions: (my answers in red)

Do you ever have some days where the ADHD medication doesn't work as well as others (include the name of med) ?
Mine seems to work every day, at least the stimulant (Vyvanse).

What other medications have you tried to treat the ADHD, and if so, what works and what doesn't?
Wellbutrin -- quite helpful but didn't get me to where I wanted to be.
Vyvanse -- I added this to the Wellbutrin (decreasing the dose), and this combo works very well for me.

Does the medication for ADHD you take have any noticeable side effects, and how does it feel when it wears off and leaves your system?
Wellbutrin -- at 300 mg/day, I developed a tremor in my hands. Fine motor tasks such as turning the pages of a book could be really hard. Thank goodness I'm not a surgeon. I am now down to 150 mg/day, and the tremor is improved somewhat but is sometimes still problematic. I have not been able to tell if the tremor is worse when my body is low in Wellbutrin (withdrawal?) or when the Wellbutrin is high. I also was very energetic when I first started taking it, but this wore off.
Vyvanse -- no bad side effects whatsoever. Very smooth, no sense of coming on or off of the drug. Is supposed to last up to 14 hours. It is so smooth I find myself unable to time its effects. A great side effect is it keeps me from falling asleep during the day. I had a real problem with that, no matter how early I went to bed, and I could fall asleep at the drop of a hat during the day, and often did. Sometimes I would fall asleep at driving (while at stop lights). I would use the pause in driving to catch some winks. Oddly, I also dream during these brief nod-offs. My PNP says I may have a form of narcolepsy (minus the cataplexy) and stimulants are a treatment for that, so that is great. I found that by accident. I just love being able to get through the whole day without falling asleep. It's a miracle!

How long does the beneficial response to the medication last?
Wellbutrin -- I don't think it really wears off if you take it every day. It becomes stable in your system.
Vyvanse -- It lasts a long time, I'm not sure how long. I don't feel it wearing off. It is supposed to last up to 14 hours, which is significantly longer than Adderall XR. On my prescription plan, it is also a lot cheaper than Adderall XR.

What other treatment strategies (including alternative and psychotherapy) have you tried that works/helps?
I have read some self-help books on strategies for coping, focusing, organizing, etc. I have not tried psychotherapy for ADHD.

[sunrise]

Originally Posted by chaotic13

DAYTRANA. This apparently is a “once-daily transdermal patch formulation of methylphenidate, available in 10 mg, 15 mg, 20 mg, and 30 mg dosage strengths, provides day-long symptom control.” I know nothing about this medication but thought I would check to see if anyone was using it.

I think I read in another forum that someone tried it but couldn't stay on it because they had a bad reaction to the adhesive in the patch.

[Simcha]

Originally Posted by chaotic13

Thanks Simcha.I had to include this... my inner feral child needed to feel some no-touch love this week.

I always knew you were really a feral child at heart, chaotic!

Yes, the Propranolol (a fast acting version at a low dosage 30mgs, I think) was Rx'ed for use "as needed." It is not really part of my treatment for ADHD. During one doctor’s appointment…after dismissing the perky PA, I told my neurologist/Pdoc/Candyman that I was struggling with chilling out during therapy (elevated BP, knot in throat, racing heart, muscle tension, and the feeling of someone sitting on my chest). Propranolol is a beta-blocker and in higher dosages is used to lower BP and heart rate and to treat tremors, angina (chest pain). Unofficially it can be used to treat…short-term anxiety symptoms and migraines.

Yeah, I'd be scared to take it myself, but I'm hesitant with most pills that can affect my cardiac system. Since I don't have cardiac problems, I don't want to create one either. I've had some physician experiences that I didn't care for (regarding asthma that was diagnosed in May). I'm not so sure they all take the time to properly evaluate you, as they tend to prefer the "hurry up rush rush" appointment these days. IMO, they don't always know what is best. I usually run things through with my T to evaluate if I should take something or not. I don't always think logically when it comes to trusting physicians.

I’ve only used my Propranolol anxiety treatment a few times, one being last session. It does seem to help with my physical symptoms. They don’t totally go away but they seem more manageable. The last time I tried to talk about a particular issue in therapy…I thought my heart was going to bust right out of my chest and I was dry heaving in the parking lot afterward. Last week I still felt very anxious…but not where near this ways.

Have you made your T aware of the extent to which you get these anxiety reactions after difficult sessions? It sounds like you are experiencing a panic attack during these episodes. I would tell him in detail if you haven't already. Talking about the symptoms and precipitors to panic attacks can be very difficult, but must be done in order to overcome them. I have Panic Disorder myself; not everyone who gets panic attacks has Panic Disorder, as they can happen as stand-alone episodes, or due to a specific phobia or medical condition (probably other reasons as well). Hopefully you don't have Panic Disorder, but either way, panic attacks are terrible. Every time you experience one, it reinforces the tendency to get one (physiologically and mentally). Better to get to the source and kill it altogether---have you talked to your T about this?

Yes, I take 60 mg of the Adderall XR in the morning.

How long does the beneficial effects of the Adderall XR last for you? Do you have negative side effects that are notable? Do you have negative side effects when the drug wears off for the day?

Actually the whole reason I visited this forum today was because …somehow the pharmacy companies have gotten my email address…(hopefully not from PC!) and I was sent an article/advertisement from Medscape.com on DAYTRANA. This apparently is a “once-daily transdermal patch formulation of methylphenidate, available in 10 mg, 15 mg, 20 mg, and 30 mg dosage strengths, provides day-long symptom control.” I know nothing about this medication but thought I would check to see if anyone was using it.

LOL--- that is really crappy about the pharmacy companies now spamming you. I doubt it was PC; I imagine the spam came from one of Medscape.com's advertisers (or affiliate's advertisers).

I haven't known anyone on Daytrana, but I hear that it is optimal for children who have a hard time taking pills for one reason or another. All I really know off the top of my head about it is that methylphenidate is the drug in Ritalin (and one of the drugs in Adderall), and it is a stimulant. If the ad said "day long symptom control", I would assume that it might be a long-acting extended release form of the methylenphenidate, but don't take my word for it. I'll have to look it up now when I'm done browsing on PC (I try to do one activity at a time now--sometimes it works, sometimes not). I'd be hesitant of it as I wouldn't want it to come off or accidentally be absorbed by someone else (and have my kitty eat it). I also wouldn't like the risk of skin irritation. The plus I see with the patch versus a traditional pill form is that you can control to a certain degree--how much of the drug gets released at once (because you can always take off the patch if you are experiencing negative symptoms).

[Simcha]

[/quote]

Originally Posted by sunrise

Vyvanse -- no bad side effects whatsoever. Very smooth, no sense of coming on or off of the drug. Is supposed to last up to 14 hours.

Dexedrine XR is supposed to last up to 8-10 hrs (some publications I read said up to 6 hrs), but I really don't think the drug manufacturers can support their claims. There is no way to measure the timeframe the beneficial effects last (not the withdrawal when the drugs wear off or the side effects), as everyone's response to stimulants is trial and error, making the responses quite variable. Since the response is variable (and that fact is well known), how is it they came up with this magical timeframe?

Stimulants are also used for treatment of Narcolepsy. ADHD and Narcolepsy are markedly different disorders; that being the case, are the drug manufacturers saying that the timeframe the drug will work on both ADHD --and Narcolepsy is still 8-10 (or however many) hours, even though they recommend different dosages for Narcolepsy and ADHD? How is this knowledge possible? Secondly, in ADHD the drug hasn't been studied for responsiveness to ADHD in adults to the same degree it has been studied for responsiveness in children. Children and adults metabolize quite differently from each other.

This only really bothered me when I had to deal with changing the dosages of the drug I take (Dexedrine XR), which was a challenge. The manufacturer can't tell the doctor how much to prescribe, but they can recommend dosages---which are usually followed. This is quite a hinderance when you are an adult and taking medication that is more than likely prescribed at dosages and strengths etc. that are not really designed for you, but for a child (only in the last 10 years has ADHD in adults began to be scientifically studied and recognized as being different in adults--or even existing at all).

Because stimulants are a controlled substance (like Xanax etc. are) on the Schedule II drug list, doctors are very careful to not prescribe anything different than what the manufacturer recommends. Dextroamphetamine is the active ingredient in Dexedrine. Different manufacturers make generics of Dexedrine, and all have different medicine guides to it. I've also noticed that different pharmacies also have their own guide, which they give you alongside the manufacturers drug guide. All different! Who are we supposed to believe.

I hope I didn't make anyone's head spin on this tangent of mine. /rant

It is so smooth I find myself unable to time its effects.

Do you ever notice a return of ADHD symptoms, or are you unable to tell a difference (other than the increased wakefulness related to the narcolepsy issue)?

A great side effect is it keeps me from falling asleep during the day. Sometimes I would fall asleep at driving (while at stop lights). I would use the pause in driving to catch some winks. Oddly, I also dream during these brief nod-offs. My PNP says I may have a form of narcolepsy (minus the cataplexy) and stimulants are a treatment for that, so that is great.

Oh crap that's scary!! Your PNP should have prescribed something for the narcolepsy related disorder a long time ago!! Your lucky you haven't fallen asleep while actually in motion.!!!!!

I have read some self-help books on strategies for coping, focusing, organizing, etc. I have not tried psychotherapy for ADHD.

Have you discussed it with your T? Self-help books about ADHD actually don't help me implement the strategies, but I find that the actual learning about the disorder on an academic level is very helpful.

My T has a dedication to ADHD treatment (in adults), and takes a lot of patients with this particular problem (be it comorbid to something else, or uncomplicated) as a specialty. He's studied ADHD and how therapy applies to it for quite some time now. He enjoys it, and it is also a personal interest (he actually has a son with ADHD who is around my age). Therapy is only successful for people with ADHD if the therapist is able to modify their approach to get through to the ADHD dx'd person, as having ADHD makes therapy more complicated.

Let's face it--we don't think like other people do (I don't think that's a bad thing either). It's extremely difficult to have a coherent, topic oriented discussion with us at times, and that can affect therapy. I find I have a difficult time describing problems with clarity, so sometimes items don't come up in therapy for quite some time. My T knows how to deal with my ADHD way of relating to others and the world, and he is better equipped to help me because he understands ADHD in a deeper, meaningful way that a lot of T's can't. Fortunately, more and more T's are being trained and learning more about adults and ADHD. Most T's can't even keep up with us!!!

[sunrise]

Simcha, you are a wealth of information on ADHD.

There is no way to measure the timeframe the beneficial effects last... Since the response is variable (and that fact is well known), how is it they came up with this magical timeframe?

The data tables my PNP showed me were based on chemical half life of Vyvanse, on average. They were not based on time of effectiveness for treating specific conditions. That you would have to figure out on your own by trial and error since everyone differs in how they metabolize drugs, and also because ADHD is a heterogeneous condition--it may be caused by different things in different people. When I see my PNP again, I'll ask to see the tables/graphs again, so I can tell you what is on the Y axis. By the way, I take 30 mg Vyvanse, which my PNP calculated (with me watching) to be equivalent to about 13 mg of Adderall (not in terms of effectiveness but in terms of active ingredient). We did discuss switching me to Adderall, and she would have started me at 10-15 mg, she said, which, I believe is quite low for people with ADHD. She is conservative, however, and likes to start low and work up.

are the drug manufacturers saying that the timeframe the drug will work on both ADHD --and Narcolepsy is still 8-10 (or however many) hours, even though they recommend different dosages for Narcolepsy and ADHD?

No, I don't believe they are saying anything about how long the drug works on the condition. It is just chemical half life they are reporting on (at least the data my PNP showed me). The effective dosages are determined during clinical trials, and remember, everyone varies, so you and your practitioner have to find out what works best for you.

The manufacturer can't tell the doctor how much to prescribe, but they can recommend dosages---which are usually followed. This is quite a hinderance when you are an adult and taking medication that is more than likely prescribed at dosages and strengths etc. that are not really designed for you, but for a child

A good doc will use the recommendations as a starting point and make modifications after the patient reports on his/her response. So if the first trial dose isn't a good fit, you can adjust to what works for you.

On the subject of different manufacturers of the same drug, it is good to stick with the same one. For example, my PNP won't allow me to get buproprion (generic wellbutrin) from a particular manufacturer, as there are many reports of it being ineffective. She writes this into the prescription. I have been getting only bupropion made by Watson, and this works well for me. If I were to switch to a different manufacturer, I might have to start from square 1 on finding the right dose, and I don't want to hassle with that. It's not only time-consuming, but it's my health!

Do you ever notice a return of ADHD symptoms, or are you unable to tell a difference

I notice I can get sleepy in the evenings. I don't monitor the ADHD symptoms closely. I am helped with them when I need it most, during the daytime. I take my Vyvanse in one dose at about 8 am.

Your PNP should have prescribed something for the narcolepsy related disorder a long time ago!!

She didn't know I had it, lol. My first visit she asked about sleep but I thought that meant how do I sleep at night, not do I fall asleep during the day. I never thought to mention my trouble staying awake because it has been my way of being for so long, I didn't consider it a problem, if that makes sense. It was "normal" for me. It is just a coincidence that the drug she prescribed for ADHD happened to help with my sleep problem. But now it feels wonderful not to fall asleep during the day and I realize this is the way it is "supposed to be." I have fallen asleep briefly while driving quite a few times, actually, but I always wake up in time. It's very brief. Stop lights were great, because I could actually close my eyes and get some winks in. Of course, there are always those times I don't wake up when the light turns green, and then people honk at me. I know this sounds awful, and I am kind of ashamed/embarrassed I didn't realize this was abnormal. Now it seems really irresponsible and dangergous to me.

Have you discussed it with your T? Self-help books about ADHD actually don't help me implement the strategies

Yes, he has ADHD himself, so he knows where I'm at. It was something he said in session once, that made me consider I might have ADHD symptoms. It was like a lightbulb went off. Quite some time later I asked him about it (had to work up the courage), we discussed it, and he referred me to the PNP. He also recommended a psychotherapist for ADHD, if I wanted to go that route. It is a guy he went to school with (same T training program) who works in the same building as him and specializes in individual and group therapy for ADHD. I looked at his website and it looked good, but I decided to see the PNP and not go the therapy route at this time. I have read some self-help books and have found some of the strategies they describe to be helpful. Even if I don't always implement them, at least I know of their existence, which is more than before. My PNP has also made some behavioral suggestions.

It's extremely difficult to have a coherent, topic oriented discussion with us at times, and that can affect therapy

I don't really have this symptom (at least not much or enough to impair therapy). I do have some ADHD symptoms, but I don't think my symptoms are as serious as for some people. (I know, I am lucky.) For example, I am being helped by a fairly low dose of stimulants and I don't have the coherent discussion problem. My main problems I work on in therapy are not related to my ADHD-like symptoms. I am content to do meds for them with my PNP at this time. Because of my falling asleep problem, it's possible that even if I surmounted the ADHD-like symptoms with behavioral strategies, I would still stay on the stimulants.

Fortunately, more and more T's are being trained and learning more about adults and ADHD.

Yes. It took me ages to bring my problem with this up with my T because I was very embarrassed about it and thought he would dismiss it. But he was very responsive, even though he isn't an ADHD therapist, and he had all the right names for referrals (ADHD therapist and PNP). I think it helped he has ADHD himself and so knows how it is. I believe he takes just 10 mg Adderall a day. He does the rest (behavioral) himself for optimum functioning. His office makes me feel at home because it might be considered typical of a person with ADHD (it looks just like my office!!!).

[chaotic13]

RE: Anxiety issue

Originally Posted by Simcha

Have you made your T aware of the extent to which you get these anxiety reactions after difficult sessions?

Yes and No. Yes I have told her about the anxiety I experience during and after sessions. I've even mentioned once that my doctor gave me something to take if I want to. However, I have never disclosed to her when I've medicate for a session.

I also don't tell her when I feel my throat tightening or my heart start racing. I think I avoid disclosing this because I'm afraid. I know it is irrational to be afraid ..but I am.

Every time you experience one, it reinforces the tendency to get one (physiologically and mentally). Better to get to the source and kill it altogether...

I'm not sure if my session anxiety has gotten worse... but it certainly hasn't gotten much better. The feeling that I should probably tell my T when I am feeling anxious enough about the upcoming session that I am considering medicating has gotten a bit more intense though.

Simcha your point about getting to the source is well taken though.
I don't think I have a Panic disorder.... I think I have mental disorder that then causes me to panic.

RE: Adderall XR:

How long does the beneficial effects of the Adderall XR last for you?

For me I do not notice a sudden change when it wears off. I take it around 7AM, it seems to be at maximum efficiency in the afternoon, and for the most part can settle down and sleep by 11 PM.

I will say though that if I skip a dose...I usually can function fairly well for most of the next morning. By the afternoon though is when I start floating off, struggling to stay motivated or focused on one thing, or notice that my tolerance for things is diminished.

Do you have negative side effects that are notable?

The only side effect that I've noticed...and I am to completely sure if it is the Adderall. It could be just an unrelated hormone issue...but in the afternoon my face gets really flushed, especially my nose, cheeks, and ears. It isn't really a hot flash because I don't feel hot. Like I said..I am not sure it is even related to the Adderall use but it does usually happen when I am off it. It is not a raise rash or anything, just looks like mild wind or sun burn.

[Simcha]

((((((((((chaotic-feral child))))))))))))

Originally Posted by chaotic13

RE: Anxiety issue
Yes and No. Yes I have told her about the anxiety I experience during and after sessions. I've even mentioned once that my doctor gave me something to take if I want to. However, I have never disclosed to her when I've medicate for a session.

I wonder if the medication affects the quality of your sessions? I'm not saying it does, just something I was wondering.

I also don't tell her when I feel my throat tightening or my heart start racing. I think I avoid disclosing this because I'm afraid. I know it is irrational to be afraid ..but I am.

I COMPLETELY understand the fear in discussing it. It's relatively common that discussing panic attack symptoms can sometimes trigger a panic attack, but that DOES go away. If you ignore the subject, it can make it worse as time goes on (it's pretty self-reinforcing). In my world view, "worse" can also mean the time the disorder goes on existing---I hated how panic attacks even started making me avoidant of stuff (I even stopped running and exercising). Anxiety bites, but even if you have setbacks they are always temporary.

I'm not sure if my session anxiety has gotten worse... but it certainly hasn't gotten much better. The feeling that I should probably tell my T when I am feeling anxious enough about the upcoming session that I am considering medicating has gotten a bit more intense though.

I have faith that you can be direct with him. Your T seems to be really decent from what you've described of him---I'm sure he can make it safe to talk about so that you don't go into a full blown panic attack (and even if you do, that's okay). I had a panic attack once or twice in T's office. It's no big deal (having been through it before). It's lost a lot of it's power over me now that I recognize it for what it is.

I'm sure you've noticed by now how the anxiety symptoms makes the ADHD exponentially worse.

Simcha your point about getting to the source is well taken though.
I don't think I have a Panic disorder.... I think I have mental disorder that then causes me to panic.

LOL-- Well said. Panic attacks come in all shapes and sizes. In my case, Generalized Anxiety Disorder compounds with the ADHD and environmental stressors, which lead to having panic attacks that fit the criteria for full blown Panic Disorder (without Agoraphobia). Panic attacks don't discriminate amongst us though.

RE: Adderall XR: For me I do not notice a sudden change when it wears off. I take it around 7AM, it seems to be at maximum efficiency in the afternoon, and for the most part can settle down and sleep by 11 PM.

I dream of this scenario!!!!!!!! Of course, I think the anxiety has interfered with the effectiveness of my prescription to some degree. It's something I'm going to talk about on Monday with my T. Dexedrine is rather expensive to justify not getting a complete response, and I don't want to up the dosage.

The only side effect that I've noticed...and I am to completely sure if it is the Adderall. It could be just an unrelated hormone issue...but in the afternoon my face gets really flushed, especially my nose, cheeks, and ears. It isn't really a hot flash because I don't feel hot. Like I said..I am not sure it is even related to the Adderall use but it does usually happen when I am off it. It is not a raise rash or anything, just looks like mild wind or sun burn.

Hmm, if it's hormonal---is it normal hormonal flutuations, or related to "the change"? I don't think it's the Adderall---Anxiety disorders can cause that to happen for no obvious reason whatsoever, and I've noticed it time to time with me. It's strange. I don't have it happen very often anymore.

[Simcha]

Originally Posted by sunrise

Simcha, you are a wealth of information on ADHD.

Aww.((((((((sunrise)))))) Thanks. I find it evidence that I just like to babble a lot. It makes it difficult to deal with physicians who actually do the prescribing, as often I find their education in this area is lacking.

The data tables my PNP showed me were based on chemical half life of Vyvanse, on average. They were not based on time of effectiveness for treating specific conditions. That you would have to figure out on your own by trial and error since everyone differs in how they metabolize drugs, and also because ADHD is a heterogeneous condition--it may be caused by different things in different people.

A good point I noticed here between the lines---treatment should always be individualized. No two people are exactly the same, so how can we expect everyone to respond the same way? Are we carbon-copies of each other? Highly unlikely. I wish physicians would recognize that more.

No, I don't believe they are saying anything about how long the drug works on the condition. It is just chemical half life they are reporting on (at least the data my PNP showed me). The effective dosages are determined during clinical trials, and remember, everyone varies, so you and your practitioner have to find out what works best for you.

Then their time frames they give (that are assumed to indicate efficacy) don't mean anything at all. Half life of the chemical is sooooo unimportant in determining efficacy. Those tricksters.

On the subject of different manufacturers of the same drug, it is good to stick with the same one.

Interesting; I read something to that effect (and discussed it with my T) not too long ago. When I asked the pharmacist about it, he denied there was any difference between manufacturers of the same drug.

It's not only time-consuming, but it's my health!

Your unlike most people, and to your benefit----you take a proactive approach to your own health. If more people were active partners in their own healthcare like you are, then people would see better responses to medical (and by extension, psychological) interventions.

Yes. It took me ages to bring my problem with this up with my T because I was very embarrassed about it and thought he would dismiss it. But he was very responsive, even though he isn't an ADHD therapist, and he had all the right names for referrals (ADHD therapist and PNP). I think it helped he has ADHD himself and so knows how it is.

Him being a therapist who also has ADHD (that is under control) is the added benefit. His insight is invaluable, and I highly doubt that you would need to see a separate therapist to address the ADHD issues. All therapist SHOULD be well trained in this area too, but... meh, you know how that goes. At least you don't have to worry about your therapist.

I believe he takes just 10 mg Adderall a day. He does the rest (behavioral) himself for optimum functioning. His office makes me feel at home because it might be considered typical of a person with ADHD (it looks just like my office!!!).

Haha! I'm sure his office is warm and welcoming.

[chaotic13]

I'm sure you've noticed by now how the anxiety symptoms makes the ADHD exponentially worse.

YES, when I am not on medication and the world gets really busy my anxiety worsen. I tend to get agitated and aggressive more so than fearful.

Now that I think of if my T sessions are usually in the afternoon when the Adderall is likely at its highest level. This probably helps me mentally but I wonder if this contributes to my physical symptoms? Hmmmm I might try changing when I take it this week to see if it has any affect on my anxiety symptoms during therapy.

[Simcha]

Originally Posted by chaotic13

YES, when I am not on medication and the world gets really busy my anxiety worsen. I tend to get agitated and aggressive more so than fearful.

Now that I think of if my T sessions are usually in the afternoon when the Adderall is likely at its highest level. This probably helps me mentally but I wonder if this contributes to my physical symptoms? Hmmmm I might try changing when I take it this week to see if it has any affect on my anxiety symptoms during therapy.
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I used to get (and admittedly sometimes STILL do from time to time) very AGITATED as a result of the ADHD and anxiety. The less sleep I had, the more disconnected from the real me I became, and the more agitated I would get--of course insomnia is often a part of both ADHD, and anxiety disorders. ADHD causes a low tolerance threshold for frustrations (and the frustrations are as individual as the person--something to do with sensory input overload), which makes many of us experience frustration and agitation easier and faster (although we all express it and experience it in different ways).

The Adderall probably doesn't contribute to your anxiety if the anxiety predates the anxiety symptoms, but it is a possibility. Usually for us ADHD people, the stimulants make us actually able to slow down our minds long enough to complete thoughts and follow through, also making us physically calmer and more awake. The only problems I have with the stimulants during session is if the stimulants are wearing off for the day. I purposefully try not to schedule appointments when I know it will be during that timeframe. The Adderall in your case is pretty new (if I remember right), so I really don't think it agitates your anxiety per se, but as I understand it, Adderall can have a side effect of giving stomach upset symptoms and nausea (commonly). Interesting... maybe give it a try without the Adderall--but I'd first ask your T what he thinks.

I really should try a different drug to see if it is smoother for me, but I'm always afraid to mess around with a medication that actually works on more days than not. I've also been on it for about two years now, and I'm sure there would probably be some minor withdrawal symptoms involved due to the length of use. I'm writing myself a note to talk to my T about that.

[HLB74]

Wow, I've learned so much just from this line of postings - definitely am visiting the dr. soon concerning my very obvious ADHD issues - Thanks so much.