Adderall / Possible ADD § Depression...Not sure if I am on the best medication

[Dewpoint]

Depression has been with me a few years, (I'm a 43 year old male) but significantly worse the last year. Back on November 13th, I was sent to the hospital for a one month / 7 hour a day Mental Health Outpatient program. Upon my departure, they put me on Remeron. I simply haven't had any luck on any of the standard SSRI's. I went off Remeron on Thursday of last week after one month of Remeron 30mg, due to unmanagable sedation and puffiness around the eyes. Hamilton score last Thursday, 38. GAF 50.



My P Doc discussed that I might also be displaying some symptoms of ADD, that Adderall XR would be worth a try. My possible ADD symptoms are:



a) Lose my keys every single day. Always find them in a new, unique location.

b) Often have a hard time talking. My mind is racing on multiple tasks at any given time.

c) If I am talking, and someone interrupts me, it is almost as if I am startled. By this I mean, instead of being able to respond to another person's comments, I am knocked off my track..and have to really fight to keep the conversation flowing.

d) Start many projects. Never finish any. Always looking for the rush from planning and starting, but not finishing. Although, as the depression has depended, my drive to start anyhting has also pretty much disappeared.

e) Difficulty concentrating in meetings. During my school & Univ. years, I was also always bored in class. I would take what I could from the class...often falling asleep. Then learn the material on my own, after class.





My Adderall XR dosage has been 10 mg on the first day, 5 mg second day, 10mg 3rd day, went to approx 7.5 mg today. I feel quite edgy & jittery. Depression seems to be even more severe. Cried twice yesterday. Although a couple of collegues say that I sound "crisp".



If Adderall XR could work, it will be worth the side effects. I have read numerous forums where people have said that they too experienced some of these side effects, but then the drug seemed to work 2 weeks or so down the line. My BIG concern is that in these cases, as in mine, the body may simply get use to the drug, hence the disappearance of side effects. But, if ADD is not present, then the chemistry in the brain in being unnecessarily altered, and perhaps permanently damaged due the effects of this amphetamine.



So, here's my questions:

Is it normal to experience the side effects mentioned above when starting Adderall XR. or is this most likely a sign that I don't have ADD and I am simply experiencing the Amphetamine effect on a normal mind?



And, if this drug doesn't work, the doctor has given me a prescription for Aventyl. I believe it's called Pamelor in the U.S. How many days should I allow for the Adderall XR to leave my system before starting on Aventyl.



As a side note, I also tried Dexadrin approx. 4 months ago for 3 days at very low dosage, and experienced almost identical side effects. (2.5 mgs every hour for 4 hours)



Thanks

[Roger Gould, M.D.]

Adderall is worth a good two to three week trial, given your probable add diagnosis( your description of the symptoms). Pamelor is potentially dangerous in combination with any other drug so wait a good six weeks in between.  Re permanent damage there is no research that suggests that, but it is always a slight risk with any of these kind of cns drugs.  Better to use them as temporary stop gap and do most of your change work in a therapy counseling situation.