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Mental Health (Expert Forum)
ADD meds and treatment advice
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
ADD meds and treatment advice
by RogerT, Feb 03, 2005 12:00AM
I'm a 44 year old male and currently a nursing student. I have been taking Zoloft 100mg and imipramine 50mg for about 9 years for depression. Ever since I was young, I knew I had some sort of a learning disability, but such things were largely undiagnosed in public schools in the 60's and 70's. I also had struggled with depression from that time. I only agreed to medication after exhausting other attempts at treatment such as counseling and psychotherapy. The dosages I'm now on do very well for me with virtually no side effects.
I have been attending a local community college for several years part time and am employed in health and human services. I decided from the company I often kept that I wanted to become a nurse. I finished the prerequisites with a very good GPA and was accepted into my school's RN program. When classes started last fall, I was immediately overwhelmed. There seemed to be so many assignments, projects and research to plan and complete that I could hardly open a book. The effort to focus went from mildly difficult to almost impossible. I did some research both online and from texts, including taking the WHO adult self-report scale for attention deficit disorder. I told my psychiatrist my situation and asked to be put on Strattera. It has had a marginal effect overall; we've slowly moved up the doses to the current 80mg. I understand that this is still only a moderate dose for this medication, but my hope for it having any lasting effect has faded. I barely passed through my first semester and immediately see trouble coming in this one. I've begun trying supplements such as piracetam, choline citrate, and omega 3 (fish oil), and while I've begun experiencing good effects, its too early to tell. I still have most of the classic symptoms, including disorganization and difficulty concentrating and completing projects.
My question, at long last, is what other medications can you suggest? I purposely chose Strattera and the other medications
because of their low side effects. How bad would side effects typically be with the amphetemine based meds such as Concerta
under proper dosages? Can you suggest any good educational sources to help me overcome this disorder? I appreciate any advice you can give me. I've worked hard to get this far, but I know I'm not going to make it if I can't get these symptoms under control. Thanks.
I have been attending a local community college for several years part time and am employed in health and human services. I decided from the company I often kept that I wanted to become a nurse. I finished the prerequisites with a very good GPA and was accepted into my school's RN program. When classes started last fall, I was immediately overwhelmed. There seemed to be so many assignments, projects and research to plan and complete that I could hardly open a book. The effort to focus went from mildly difficult to almost impossible. I did some research both online and from texts, including taking the WHO adult self-report scale for attention deficit disorder. I told my psychiatrist my situation and asked to be put on Strattera. It has had a marginal effect overall; we've slowly moved up the doses to the current 80mg. I understand that this is still only a moderate dose for this medication, but my hope for it having any lasting effect has faded. I barely passed through my first semester and immediately see trouble coming in this one. I've begun trying supplements such as piracetam, choline citrate, and omega 3 (fish oil), and while I've begun experiencing good effects, its too early to tell. I still have most of the classic symptoms, including disorganization and difficulty concentrating and completing projects.
My question, at long last, is what other medications can you suggest? I purposely chose Strattera and the other medications
because of their low side effects. How bad would side effects typically be with the amphetemine based meds such as Concerta
under proper dosages? Can you suggest any good educational sources to help me overcome this disorder? I appreciate any advice you can give me. I've worked hard to get this far, but I know I'm not going to make it if I can't get these symptoms under control. Thanks.
Doctor's Answer
by Roger Gould, M.D., Feb 04, 2005 12:00AM
, Feb 04, 2005 12:00AM
I don't have any medications to add,but I think that if you and your psychiatrist want to try Concerta at a small dose, that would be your best bet.
I would also encourage you to discuss another psychological aspect of the problem. You are making a big mid life change..this is an identity change. Its one thing to be a nurse, but its a lot harder to be a student at this age, so think more about the kind of normal conflict I would expect you to have. Doing the assignments is the trigger for that conflict..do I really want to do this with my time in life. Surfacing the conflict may help you, and it doesn't mean you would have to stop being a student, only that you might have to make the decision again with a greater degree of information and consciousness.
I would also encourage you to discuss another psychological aspect of the problem. You are making a big mid life change..this is an identity change. Its one thing to be a nurse, but its a lot harder to be a student at this age, so think more about the kind of normal conflict I would expect you to have. Doing the assignments is the trigger for that conflict..do I really want to do this with my time in life. Surfacing the conflict may help you, and it doesn't mean you would have to stop being a student, only that you might have to make the decision again with a greater degree of information and consciousness.
As far as meds go, sadly to say there aren't that many to even get confused about. Everytime I see anything about ADD and the dreaded "AMPHETEMINE" treatment I get upset, because of the attitudes of both patients and doctors, both are so scared of the drug and all of the possible side effects, they won't take it or won't prescribe it. I'm here to say that if you really have ADHD/ADD to the severity that I have it, none of that will scare you one bit, because my life was a horror story before I started the treatment, and if you don't understand what I mean then you don't have ADD/ADHD to the point that you require the most adequate treatment we have, which in my opinion is amphetemine's. When prescribed by an informed M.D. and taken properly, they can make the difference between life and death. Addiction? I was addicted to everything before I started on Dexedrine 13 years ago and I haven't abused any alcohol or drugs since. I was going to 12 step meetings before I started on Dex. I can't get back those years, I am not willing or able to go back to nursing school now, but at least I was given a chance to. When your life is like a jigsaw puzzle in a box, that someone keeps shaking, and all of a sudden you can actually see the pieces fitting together making a recognizable image it is indeed a beautiful thing. I use the puzzle as an example because it also shows that the drug doesn't FIX you instantly, and won't work without you doing much behavior modification with it. It is a slow process but at least you have some direction. No longer living like a runaway train.