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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Festus on April 23, 2006, at 23:18:20
Hi Folks,
I may be directed elsewhere,but that's cool,if it's where I should go.I'm looking for knowledge of Dr.s and the dosage amounts they work with,involving treatment of ADD/ADHD with Stims.
My 10 year old is ,currently,at 72mg SR Methylphinadate(Concerta,2 36mg caps in the AM).She's been on Ritalin for 5 years,and she's worked up from 1 18mg Concerta,daily to the current 72mg.and then wanted her to be on 108 mg Concerta(two 54mg SR caps)and we said NO!She only weighs 50 lbs.,at 5'2".I was finally diagnosed ADD,at the age of 46.My Daughters Doc asked me if I'd ever been tested.I guess he detected symptoms when I would come to the Appointments with my kid.I went to another Psych Doc that I knew a bit more.He asked for my old Report cards from school.After looking them over,he shook his head.Anyway,I'm now on Dexedrine 10 mg tabs,taking 4,twice a day.I just began this Stim Therapy,about 40-something years went by before I knew what I was really doing.Adderrall only made me angry and nervous,Ritalin did,nt cut it,so,Dex was next.I was thinking that there was a Format they had to go by,for dispensing Stims for ADD,but I am not sure if it is a stae-to-state deal or what.I have ,also,seen Docs that did not seem to be concerned about the dose size,but what size would WORK.Does anyone know of these things?I have read conflicting info on health issues and long-term or big dosages,with Stims.Anyone know the RealDeal?Thanks,Festus
Posted by med_empowered on April 24, 2006, at 6:20:17
In reply to ADD Meds and Tolerance:Where to draw the line..., posted by Festus on April 23, 2006, at 23:18:20
hey! The only guidelines I've seen are from the FDA, and they're kind pointless--the ideal is to max out at 40mgs/amphetamine (or ritalin equivalent, which would be about 60mgs) per day for ADHD, or about 60mgs amphetamine (or equivalent) for narcolepsy. Now..I know lots of people with ADHD and a few with narcolepsy, and I have to say: those guidelines are ridiculous, and I'm glad docs disregard them. Some people do well on very little, some people need more, and some people can do nicely w/ combo therapy--stims plus "awareness training" or other psychological interventions appropriate to ADHD and related issues.
It does sound like your doc is loading your kid up on Ritalin. I don't know you or your child, and I'm not a doc but...WOW. That's a whole, whole lot of Ritalin. If nothing else..maybe you could try a switch? Its not prescribed a whole lot, but there is Desoxyn (its RX meth)...the big benefit with Desoxyn is that its super-potent (even more potent that dexedrine, and much more potent than Ritalin), so you can use less. The benefit there is that after your child adjusts (assuming this works and is even an option), she might have fewer stimulant-related side effects, since desoxyn is pretty "efficient" in terms of dosing. Another option might be to just give her a break off the stims during the summer (or reduce the dose) and try some psychological treatment, maybe neurofeedback, meditation, a new diet...there are lots of add-on therapies you can try instead of bumping up the stims.
Posted by scatterbrained on April 26, 2006, at 3:07:27
In reply to ADD Meds and Tolerance:Where to draw the line..., posted by Festus on April 23, 2006, at 23:18:20
I would suggest getting a second opinion from another doctor. That amount of stim is a lot for a 10 year old child, maybe it's ok, but I'd be careful. As for adult ADD, I have found that doctors that specialize in ADD tend to have a higher prevelence of quackery(someone should do a study). Umm, if you feel you need stims go for it but if you have gone this long without them and survived, why go through drug trials. The danger is that it might start the ball rolling on something.
Posted by ed_uk on April 26, 2006, at 9:45:15
In reply to Re: ADD Meds and Tolerance:Where to draw the line. » Festus, posted by scatterbrained on April 26, 2006, at 3:07:27
>I have found that doctors that specialize in ADD tend to have a higher prevelence of quackery
That wouldn't surprise me.
Ed
Posted by alohashirt on April 27, 2006, at 21:32:29
In reply to ADD Meds and Tolerance:Where to draw the line..., posted by Festus on April 23, 2006, at 23:18:20
A few points - just my personal opinion based on the literature I've read (I've obsessively read everything I can on ADHD but I have no medical training of any kind.)
The stimulants are clearly extremely safe drugs. There are a handful of unexplained deaths that have occurred in children who tool stimulants. Some of these deaths may have resulted from medication. others not. This is less than 0.1% the death rate attributable to any of aspirin, tylenol or penicillin. Clearly the stimulants can cause hypertension reduce appetite and reduce sleep.
Recommended doses seem irrelevant. I have a friend who takes 18mg of Concerta, I needed 108mg, and I know someone who takes 126mg. I think that many doctors will stick to FDA limits out of fear, ignorance. The US context is oen of fear and hysteria about ritalin, most of it seemingly unfounded.
What is your daughter like when she is off meds? Have you considered trying a differenbt med and seeing if her bodyweight increases? Do you trust your doctor? It may be worth getting a second opinion. I would be worried.
> Hi Folks,
> I may be directed elsewhere,but that's cool,if it's where I should go.I'm looking for knowledge of Dr.s and the dosage amounts they work with,involving treatment of ADD/ADHD with Stims.
> My 10 year old is ,currently,at 72mg SR Methylphinadate(Concerta,2 36mg caps in the AM).She's been on Ritalin for 5 years,and she's worked up from 1 18mg Concerta,daily to the current 72mg.and then wanted her to be on 108 mg Concerta(two 54mg SR caps)and we said NO!She only weighs 50 lbs.,at 5'2".I was finally diagnosed ADD,at the age of 46.My Daughters Doc asked me if I'd ever been tested.I guess he detected symptoms when I would come to the Appointments with my kid.I went to another Psych Doc that I knew a bit more.He asked for my old Report cards from school.After looking them over,he shook his head.Anyway,I'm now on Dexedrine 10 mg tabs,taking 4,twice a day.I just began this Stim Therapy,about 40-something years went by before I knew what I was really doing.Adderrall only made me angry and nervous,Ritalin did,nt cut it,so,Dex was next.I was thinking that there was a Format they had to go by,for dispensing Stims for ADD,but I am not sure if it is a stae-to-state deal or what.I have ,also,seen Docs that did not seem to be concerned about the dose size,but what size would WORK.Does anyone know of these things?I have read conflicting info on health issues and long-term or big dosages,with Stims.Anyone know the RealDeal?Thanks,Festus
Posted by Caedmon on April 29, 2006, at 7:08:44
In reply to ADD Meds and Tolerance:Where to draw the line..., posted by Festus on April 23, 2006, at 23:18:20
I agree with med_empowered, maybe try Dexedrine to see if you get better results at a lower dose. Or, I'm curious, are there specific symptoms that warranted the higher dose e.g. hyperactivity vs. inattentiveness? Good luck, it's surely a difficult issue for any parent!
- C
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