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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Laree on March 4, 2004, at 11:44:08
Hi, I was diagnosed with (adult) ADHD in the fall of 2002. I was put on Adderall XR (20 mg./day) & was quickly switched to immediate-release Adderall (40, then 50 mg./day); however, appx. 2-3 months ago, it began pooping-out at that high of a dose. So it was decided that i would switch to Ritalin (immediate-release), 30 mg./day. Well, for the first few days i was on it, i thought it was pretty lovely. it calmed me down and really improved my focus. however, the dosage was nowhere near sufficient. as a result, my grades began to suffer in a big way. the dosage was doubled appx. a month later & i am now taking 60 mg./day in total. i am not doing well on it at all. i want to go back on the Adderall or else try something else. does anyone have any suggestions about this??
any help would be appreciated greatly! does anyone have any experience with the ADHD med(s) Desoxyn / Dexedrine?? Thank-you!
--L.
Posted by utopizen on March 4, 2004, at 18:55:22
In reply to ADHD meds FRUSTRATION!!! pls help!!, posted by Laree on March 4, 2004, at 11:44:08
First of all, you should breathe =)
I've been down the same road. From the start, my doc would simply switch me from Ritalin to Dex, then to Adderall (where I lingered on it for about 9 months) and finally to Desoxyn, which I've now been on for about a year.
Desoxyn was great when I first started, but after several months it just sort of makes me super anxious, emotionally liable, and sort of depressed. Keep in mind I also have narcolepsy as well as ADD, so I also take this to stay awake. Reading is impossible, whereas I remember just a year ago that wasn't an issue with Adderall (I've tried Adderall a few months ago, and it's just slightly less effective than Desoxyn).
You can ask about Desoxyn, but it sounds like you're the type, like me, who needs to switch around every few months to a different stim anyhow.
Why don't you talk about slowly trying out Straterra, and adding Provigil to it (especially if you get tired when you strain your attention-- and if so, please do insist on getting a sleep study!)
I now see two psychiatrists-- one to focus solely on my social anxiety disorder (Klonopin for now). And one who's a sleep psychiatrist, who will focus on my sleep and ADD (they're very related when you have them at the same time).
My other sleep doc, who's a pulmonary specialist, suggested I talk to my sleep psychiatrist about combining Provigil and Straterra.
I've tried Provigil for sleep at 400mg and felt nothing. But he claims he sees ADDers with sleeping disorders who's failed Provigil like me but when taking it with Straterra it works.
Trust me, you initially see the benefits to these stimulants at first, and then eventually as the months pass you realize you still can't manage your time, convince yourself to eat lunch 1/2 the time, have trouble sleeping on a regular schedule, and still have trouble with your ADD.
For me, I also can barely read a book or read notes even without suddenly getting tired.
You can always try augmenting a stimulant like Desoxyn or Ritalin with Straterra while you wait the month or two to see how it goes, but I suggest also trying to combine it with Provigil if you have any problems related to your attention and sleepiness.
And it's not because Provigil alone is likely to work, it's because the combo itself-- Provigil+Straterra-- has seen better results than either one alone, even when Provigil fails alone.
If it helps you, even a little, you can always combine it with your stimulant and it could reduce your anxieties and such from the side effects of the stims, and possibly let you lower your dose of the stim to a point where it's more tolerable while remaining just as-- or more- effective.
But Desoxyn is cute, but I'm on it now, and I'd prefer to have an appetite again and not feel so anxious....
Posted by EscherDementian on March 5, 2004, at 3:25:47
In reply to Re: ADHD meds FRUSTRATION!!! pls help!! » Laree, posted by utopizen on March 4, 2004, at 18:55:22
i've been on Adderall for more than a year now, with changing mixed sucesses. It was a godsend to me in the beginning. The PMHNP was a blessing in her skilled recognition or my condition, but unfortunately provided an "almost" but less than adequate useful dosage for me ---choosing instead a 'milktoast'safety covering her a*ss somehow, and disintegrating our repoir and my confidence in her actual abilities, OR in my salvation.
New Pdoc with vast more experience and is someone with better 'personal'"connections" with me, philosophical, life meanings, medical discovery, etc.etc. and an authentic interest in ME, not BOOKs as BIBLES to his gifted work, has been SAVING MY PAINFUL AND CONFUSED LIFE here....
But i want to ask him about Desoxyn. Something intuitive calls to me. I have more that a few hunches. i'd like to try this.
Any suggestions ?
Exploring Metamorphose for the better and All i can relaxe finally and "BE", wholly and productive,
Escher Dementian
hopefulness
Posted by utopizen on March 5, 2004, at 13:19:01
In reply to Re: ADHD meds FRUSTRATION!!! pls help!!, posted by EscherDementian on March 5, 2004, at 3:25:47
You'll likely get results from Desoxyn, but my experience with it is that while I've not developed any tolerance, the tolerably to the side effects appear to increase after prolonged (several months) use.
I'm trying Straterra+Provigil now for my sleepiness soon... missed my sleep doc's appt. by 1/2 hour, and got re-scheduled for May, so hope my other psychiatrist that I see for social anxiety and ADD will give it to me or at least put me back on Adderall to finish the semester!!
Posted by Laree on March 5, 2004, at 22:56:05
In reply to Re: ADHD meds FRUSTRATION!!! pls help!!, posted by utopizen on March 5, 2004, at 13:19:01
Here is my dilemma: I do not think my psychiatrist will prescribe me Desoxyn. you see, I am also in college, and the abuse w/stimulants at schools nowadays is rampant as i'm sure you're well aware of...
i think maybe they will fear they may get "evaluated" by the state for rx'ing this drug (esp. to someone my age??). it bums me out that i have this problem & the meds i have to take for it seem to be so scrutinized & often difficult to obtain!! ugh! does anyone else out there feel that frustration? haha...
So this is where i'm at: taking 60 mg. of Ritalin (immediate-release)/day. it wears off faster than the Adderall did (it lasts about 2 hrs., if i'm LUCKY) & I developed a tolerance to it MUCH sooner than i did to the Adderall. as i understand it, 60 mg./day of Ritalin is the highest dose given for ADHD. well, i'm pretty miserable on it most of the time. i feel quite zombie-ish, that my quirky personality has been stinted, and i really enjoy that part of my personality. so i feel as though that has been ripped from me & i want it back!! at first i could read for hours & could sleep at night (i sometimes experienced difficulty falling asleep when i had to take Adderall in the late afternoon); now, the Ritalin seems to have little effect. i feel very discouraged...i have a lot of work to catch up on, so i cannot wait a month or more for straterra (my pdoc suggested that before the switch to Ritalin) to "possibly" become of some aid to my ADHD...besides, i do not think i have heard a good word about it from anyone. sorry for the long message, but if someone could please help me formulate a way to bring the desoxyn/dexedrine possibility up to my pdoc without having them think i'm looking for trouble instead of medical assistance, that'd be great...
thanks!
-L.> You'll likely get results from Desoxyn, but my experience with it is that while I've not developed any tolerance, the tolerably to the side effects appear to increase after prolonged (several months) use.
>
> I'm trying Straterra+Provigil now for my sleepiness soon... missed my sleep doc's appt. by 1/2 hour, and got re-scheduled for May, so hope my other psychiatrist that I see for social anxiety and ADD will give it to me or at least put me back on Adderall to finish the semester!!
Posted by utopizen on March 6, 2004, at 0:15:31
In reply to Re: ADHD meds FRUSTRATION!!! pls help!!, posted by Laree on March 5, 2004, at 22:56:05
It doesn't sound like you'd want Desoxyn. It doesn't come in sustained release form (it use to until 200).
It will feel like it lasts for like 2 hours or 3 if you're lucky.
And forget tolerance. You go outside the avg. daily range your doc will read in the PDR stating "20-25mg/day" and you'll never get any again if you even suggest it's "not working like it use to" or "perhaps the dose is too low." I never got tolerance, and have been on it for a year now, but it sounds like you get tolerance to your simulants. For me, the side effects just get gradually more and more annoying.
So it's an annoying drug. Your pharmacy won't stock it, and that means I have to wait a week just to get the prescription filled after seeing my doc. I'm also bored with it. I want to go back on Adderall, but soon start Straterra+Provigil. I hate all the stims, but Adderall seemed better about getting me in dork mode enough to go to the library.
I'm 20. While I'm a pro at charming my docs and allaying their concerns for prescribing me controlled substances, let me give you some advice: just because it's challenging to get or is obscure to your docs doesn't mean it's a wonder drug. Your doc sees patients fail drugs all the time, and he knows what to do when that happens. Listen to him, and remain skeptical, but not too much. I wish I had gone on Straterra a year ago when it came out-- maybe I could have combined it with some Provigil and Adderall and would actually have time management during the day.
You know what ADD means for me when I'm on a stimulant? I have all my clothes cleaned and folded, my bed's made, I made it to class, my sleeping machine for my sleep disorder is cleaned out, I've got all my meds filled or refilled, I'm making my doc appts., and I read up a lot on boards like this and search Medline for the next great drug.
Well guess where I am? One of the top schools in the country, one you'd go "oh, you must be smart" if I named it. And I've slaughtered my GPA, I've got 2 incompletes I have about a week to start completing in time, I've got one course that could fail me out of a shot at rooming with my friends next year as a senior, no friends beyond my roommates from last year still because of my social anxiety disorder,
Last April, I saw a new psychiatrist and he continued my recently switched to Desoxyn script from my first psychiatrist and added Klonopin 1mg 3x/day for my social anxiety--- I thought I hit jackpot.
I didn't realize taking it everyday after a few months means you aren't as brazen to speak to strangers as you were back when you took it as needed at parties.
And the Desoxyn?
It hasn't changed the underlying problem about me, that I put off work because I can't actually read anything for school b/c it'll put me to sleep, which means I can't do anything unless I put it off until midnight of the day it's due, start the 7 page paper then, do the research, write it up, and pray you'll have something witty and clever and coherent while you feel half dead and are on far too much amphetamine just to stay awake and coherent enough for the paper.
Bear in mind my time management issues are a worst case scenario, but I am not the only one out there. I also have a sleep disorder, which I've taken 4 separate tests for at night and a daytime one just to prove I have and have seen a slew of sleep specialists who have yet to agree on a single diagnosis for why i'm so sleepy if I want to do anything like read for class.
I have a breathing machine that blows air at night. The Desoxyn will make your appetite disappear so much it's pathetic, like you can force feed, but even that's hard because you have to remember to force feed and not space out and clean out your kitchen cabinets or whatever the heck else those stimulants possess you to do instead.
So long story short, Desoxyn was cute at first, until I realized after a couple of months it still wasn't even helping me with my sleepiness very much.
If you can try out Straterra, I'd do that first. Tell your doc you don't like the side effects of the Adderall, and would like to combine it with Straterra and then down the road see if it's possible to stop altogether and stick with Straterra.
Provigil 400mg+Straterra at 80mg is an excellent combo if you fail to respond, and you can still take Adderall if your doc's cool with that.
Why exactly do you conclude you have tolerance to the stim? It takes me a few months after getting a new stim to realize I'm just as messed up as before, but I have side effects now. Maybe you gradually realize that the burst of energy you had in the start of a class for a few weeks or months had more to do with your optimism for the med, not the med itself?
I don't know how you can actually tell you have tolerance to it-- unless you were to say, take a higher, unprescribed dose to determine this, but it doesn't sound like the people on this site would even do that. So how do you know you have tolerance, and don't just simply need to switch to Dexedrine or Concerta or Adderall XR or a med that use to work but you haven't tried for a few months???
Anyway, listen to me-- I HATE not feeling the desire to eat, having trouble sleeping, rambling in my writing like this, having no sense of time, feeling tense, anxious, worrying about irrelevant things while ignoring important exams and papers until the last second---
if you can try Straterra at 80mg for your target dose, you might have a shot at not getting this same feeling. Many fail it, but you can try combining it with Provigil at 400mg as well (it has a synergyistic effect, and no, not just for sleepy heads).
IF I WAS YOUR DOC:Reasons why I wouldn't prescribe Desoxyn:
1. You don't seem eager about Straterra
2. You don't seem concerned over the side effects of the amphetamines
3. You develop "tolerance" quickly at prescribed doses
4. You complain of repeated dosing, even though you need to take Desoxyn more often than Ritalin
5. You may not be actively seeing a therapist for your ADD
6. Your ADD's severity may not be documented comprehensively enough through a neuropsychological evaluation to warrant a med change
Posted by Laree on March 6, 2004, at 14:15:30
In reply to REAL help ISN'T Desoxyn... » Laree, posted by utopizen on March 6, 2004, at 0:15:31
Utopizen:
I see a therapist at school who specializes in ADHD. She is also my ADHD coach. We have both agreed that I need something that kicks in at least a half-hr. after I wake up so I can get organized for my day right away. Thus, I definitely do NOT want an "S-R" or "XR" version of a stimulant. The first stim. i was ever put on for ADHD was Adderall XR. it was great at first but afternoon/evenings soon became very difficult for me, so I was switched to regular Adderall (imm.- release). I am also "savvy" with my docs (or however you want to put it) & have always been very good at getting my man, if you know what i mean. Now, i am not "eager" about Strattera because they wanted to put me souly on Strattera; i also have incompletes from last semester as well as class work from this semester that i have to make up, so it's a sort of 'crunch time' for me...and since we know stims work for my ADHD, it would be a big risk to POSSIBLY see some benefits a month + down the road when i am in a crucial time period in school. That idea (as you can probably imagine) makes me very, very uneasy and anxious. I don't know where you get off assuming that I am not concerned about the side effects of amphetamines; but actually, i had less side effects with Adderall (which, as i'm sure you are WELL aware of, is a mixture of amphetamine salts) than with Ritalin. As i said, i did not develop "tolerance" to Adderall until i was on it for over a year. And on Adderall, dosing was 2x per day. And obviously, the "severity" of my ADHD DID recently warrant a med change. my pdoc said that some people need to cycle (switch) ADHD meds (stims.) a few times a year (ie: being on Adderall for half of the year, Ritalin for other half, etc.). While I do appreciate the information you have provided, I certainly do not appreciate you undermining me. Your assumptions about me (as well as my condition and the care i am under for it) were way off base. Maybe the Desoxyn makes you feel cocky, because that's exactly how you come off. I am 21 years old and do not need to be chided by someone younger than I. Oh, and I never said Desoxyn in & of itself was "REAL help". That's a bunch of B.S. You should be careful of any & all assumptions you decided to voice to/about a person you do not REALLY know at all. You NEVER know what they have been through, what they are currently going through, or where they are coming from. to make completely blind assumptions is immature, unfair, and ignorant.
> It doesn't sound like you'd want Desoxyn. It doesn't come in sustained release form (it use to until 200).
>>
> IF I WAS YOUR DOC:
>
> Reasons why I wouldn't prescribe Desoxyn:
>
> 1. You don't seem eager about Straterra
> 2. You don't seem concerned over the side effects of the amphetamines
> 3. You develop "tolerance" quickly at prescribed doses
> 4. You complain of repeated dosing, even though you need to take Desoxyn more often than Ritalin
> 5. You may not be actively seeing a therapist for your ADD
> 6. Your ADD's severity may not be documented comprehensively enough through a neuropsychological evaluation to warrant a med change
>
>
Posted by scott-d-o on March 6, 2004, at 17:21:19
In reply to Re: ADHD meds FRUSTRATION!!! pls help!!, posted by Laree on March 5, 2004, at 22:56:05
> Here is my dilemma: I do not think my psychiatrist will prescribe me Desoxyn. you see, I am also in college, and the abuse w/stimulants at schools nowadays is rampant as i'm sure you're well aware of...
> i think maybe they will fear they may get "evaluated" by the state for rx'ing this drug (esp. to someone my age??). it bums me out that i have this problem & the meds i have to take for it seem to be so scrutinized & often difficult to obtain!! ugh! does anyone else out there feel that frustration? haha...
> So this is where i'm at: taking 60 mg. of Ritalin (immediate-release)/day. it wears off faster than the Adderall did (it lasts about 2 hrs., if i'm LUCKY) & I developed a tolerance to it MUCH sooner than i did to the Adderall. as i understand it, 60 mg./day of Ritalin is the highest dose given for ADHD. well, i'm pretty miserable on it most of the time. i feel quite zombie-ish, that my quirky personality has been stinted, and i really enjoy that part of my personality. so i feel as though that has been ripped from me & i want it back!! at first i could read for hours & could sleep at night (i sometimes experienced difficulty falling asleep when i had to take Adderall in the late afternoon); now, the Ritalin seems to have little effect. i feel very discouraged...i have a lot of work to catch up on, so i cannot wait a month or more for straterra (my pdoc suggested that before the switch to Ritalin) to "possibly" become of some aid to my ADHD...besides, i do not think i have heard a good word about it from anyone. sorry for the long message, but if someone could please help me formulate a way to bring the desoxyn/dexedrine possibility up to my pdoc without having them think i'm looking for trouble instead of medical assistance, that'd be great...
> thanks!
> -L.
>I don't think a pdoc would have much objections with trying dexedrine.. after all, adderall is like 3/4 d-amphetamine anyways. I was on adderall first, then ritalin. Ritalin was making me anxious so I told my pdoc I'd like to try the dexedrine spansules since they were now available in generic and much cheaper than adderall XR. he had no problems with this. It ended up that I didn't care for the ancient release mechanism of the spansules and went back to the adderall XR after all. There really is not much difference between adderall and dex except the adderall may have a few more peripheral side effects since the l-isomers of amphetamine tend to act more in this fashion (this is why l-methamphetamine is still the active ingredient in vick's inhalers.)
It's funny how vick's misspells levo-methamphetamine on the package (they spell it "Levmetamfetamine"). I guess they think people are less likely to realize it's related to the evil street drug crystal meth?)
scott
Posted by Laree on March 7, 2004, at 19:06:59
In reply to Re: ADHD meds FRUSTRATION!!! pls help!!, posted by scott-d-o on March 6, 2004, at 17:21:19
Scott,
I need something in an immediate-release form; do they make Dexedrine in immediate-release form?? I have an appt. w/my pdoc tomorrow. do you have any other helpful suggestions for me? I fear that when I tell them about the problems I've had with Ritalin (along w/the minimal effect it has on my ADHD, it also gives me marked anxiety, stomachaches, nausea, etc...) they may yank me off of Ritalin, not put me back on Adderall, and then goodness only knows what will happen! To be honest, they do not seem that well-versed with ADHD meds anyway...maybe it is time for me to find a new pdoc...pls. write if you can currently think of anything that may be helpful to my situation, though! thank-you so much!
Best,
L.
> I don't think a pdoc would have much objections with trying dexedrine.. after all, adderall is like 3/4 d-amphetamine anyways. I was on adderall first, then ritalin. Ritalin was making me anxious so I told my pdoc I'd like to try the dexedrine spansules since they were now available in generic and much cheaper than adderall XR. he had no problems with this. It ended up that I didn't care for the ancient release mechanism of the spansules and went back to the adderall XR after all. There really is not much difference between adderall and dex except the adderall may have a few more peripheral side effects since the l-isomers of amphetamine tend to act more in this fashion (this is why l-methamphetamine is still the active ingredient in vick's inhalers.)
>
> It's funny how vick's misspells levo-methamphetamine on the package (they spell it "Levmetamfetamine"). I guess they think people are less likely to realize it's related to the evil street drug crystal meth?)
>
> scott
Posted by scott-d-o on March 7, 2004, at 23:57:57
In reply to Re: ADHD meds FRUSTRATION!!! pls help!!, posted by Laree on March 7, 2004, at 19:06:59
> Scott,
> I need something in an immediate-release form; do they make Dexedrine in immediate-release form?? I have an appt. w/my pdoc tomorrow. do you have any other helpful suggestions for me? I fear that when I tell them about the problems I've had with Ritalin (along w/the minimal effect it has on my ADHD, it also gives me marked anxiety, stomachaches, nausea, etc...) they may yank me off of Ritalin, not put me back on Adderall, and then goodness only knows what will happen! To be honest, they do not seem that well-versed with ADHD meds anyway...maybe it is time for me to find a new pdoc...pls. write if you can currently think of anything that may be helpful to my situation, though! thank-you so much!
> Best,
> L.
>yes they make 5 and 10mg immediate-release dexedrine in both generic and brand name. the only advice I can give is be assertive and make sure they know that the adderall was a marked improvement, at least for a while. i dont see any reason to be fearful they will not put you back on a certain med if you are insistent that it was helping you. tell them you just want to experient with other stims to make sure you have the best one possible for you.
scott
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