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ADHD meds

I am a male in my 20's with ADHD.  

A few years ago I tried Ritalin for a period.  It worked very well for my symptoms but caused chest pain, pretty severe actually.  (10 milligrams 2-4x/dy)

I then tried Adderall.  It also caused some minor and fleeting chest discomfort--but much less than Ritalin.  However it caused my heart to really race and beat hard (at around 5 mg) in addition to insomnia.  Like Ritalin, it also worked very well for my symptoms.  

Next I tried Strattera which did not worked and only caused side effects (80 mg/dy).  

I thought perhaps I had an underlying heart condition making me so sensitive to stimulants, so I stopped all medications for nearly 2 years and was checked out by a cardiologist (2 actually).  

Both cardiologists said my heart is fine except for mitral valve prolapse (with minimal regurgitation).  My thyroid is also normal.  I even had a stress echocardiogram which was normal.  They said it would be ok to use stimulants "as tolerated".  

I've tried so hard to do without meds, using fish oils and exercise, avoiding alcohol and getting proper sleep.  However, this is simply just not cutting it and so recently I decided to try Dexedrine at a very low dose.  At 1.25-2.5 mg it was easier on my heart rate than Adderall, but still I could notice a definite, although fleeting chest discomfort (like a little bit of pain and pressure).  

I do not want to try a TCA or MAOI nor add a beta blocker to a stimulant.  

From the research I've done I think that leaves me with about 3 options.  The first is Provigil, but it is contraindicated with mitral valve prolapse.  The other 2 are Focalin and Desoxyn.  

Although Desoxyn is supposed to have the best CNS vs PNS activity, I can just imagine the song and dance I'd have to go through to get someone to prescribe it.  

So, I'm considering Focalin.  My understanding is that methylphenidate has the least peripheral actions of the stimulants and that focalin contains only the active "d" isomer whereas Ritalin is a racemic mixture of "d and l".  

My question is whether Focalin would really present an advantage over Ritalin in terms of peripheral side effects (heart primarily).  Although it's marketed under the premise that it only contains the active "d" isomer, thus allowing for half the dosage and theoretically half the side effects, I've read that the "l" isomer is actually very poorly absorbed.  

What I really liked about Ritalin was it's fast onset and short duration (no insomnia, flexibility of dosing).  Obviously I could not tolerate the chest pain.  

Getting to the point, I have 3 questions:

1. Is the L-methylphenidate isomer very peripherally acting (heart, lungs), or just "inactive"?

2.  Do you think Focalin would truly be a reasonable alternative to Ritalin for me?

3.  What are my other options?

Sorry for the long-winded post. I'm just very frustrated that I won't be able to find an effective and tolerable tx.  Thank you.
28 Responses
242532 tn?1269553979
You have certainly done your research, you now know more about the chemistry of Focalin than I do.  But from my experience, here is my advice.  You can't figure these things out in advance.  You are very sensitive to stimulants, so you have to be cautious and systematic about how you experiment.  I would recommend that you retry ritalin, but at an even smaller dose, and less frequently.  If that doesn't work, then do the same for Focalin.   That's the only way to find out...the advertising is not the answer.
Avatar universal

Thank you, sounds very reasonable...I'll talk to my Dr. about giving that a shot.
Avatar universal
ADHD doesnt exist-

Avatar universal

I wouldn't believe in ADHD either if I didn't have it.
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Avatar universal
Thought this was interesting...
Children on fish oil capsules showed improvements in attention, behaviour and vocabulary.  

If your child has attention deficit hyperactivity disorder or ADD, the solution may be as simple as giving your child fish oils.

An Australian study suggests daily dose of fish oil helps calm children with attention deficit hyperactivity disorder.

Children in the study were given a commercially available dietary supplement containing a combination of fish oil and evening primrose oil, in a ratio of four to one. They were given just under a gram of fish oil a day.

The results showed that children on the active fish oil capsules, rich in omega-3 fatty acids, had improvements in attention, behaviour and vocabulary. They were able to concentrate better, they were calmer, less impulsive.

The reason why fish oils are important is possibly because 60 per cent of our brain is composed of fats, the most important being omega-3 fatty acids, such as those found in fish oil, and omega-6, like those in evening primrose oil. And as many people are deficient in the omega-3 fatty acids, it can cause several problems.

There's a growing body of research that's finding evidence of links between omega-3 deficiency and mental health problems like depression and schizophrenia. And research is also suggesting that some children with developmental problems, including dyslexia, can benefit from taking omega-3 supplements.

The fish oil conducted in this study had higher concentrations of EPA and DPA. Researchers are starting to think that perhaps EPA is the important one of the two. So when you
Avatar universal
yea, i got 14 yrs old daughter who has a.d.h.d. since age 7 yrs. she had been on different mediciens changed since 7 yrs. Right now, she dont take a.d.h.d. medicine anymore. just  medicne called Ablify to take at bedtime everynight to help her to think clear. doing well. wait til she gets older , it gets better or worse? who knows? . it is very hard thing on adhd medicines or not on people.
Avatar universal
Is there a fish oil available that is easy for a child to consume and are there guidelines for dosage on a child?  I, too, have heard of this from a friend who is extremely knowledgeable about alternative and homeopathic medicine.  Any info is appreciated.
Avatar universal
i have had adhd all my life but did not start taking medication for it till 2000. it has changed my whole life. no more obsessing, i can pay attention, i can sit still...it is wonderful. i wish i could have taken these meds when i was a young child..i wouldn't have made so many bad choices. there IS such a thing as adhd.
Avatar universal
I tried 60 mg of Ritalin for 8 months and am now on Adderall, 20 mgs. twice a day.  I think the Adderall will need to be upped when I see my doctor again.  I recently got off Effexor, which was the worst withdrawal I've ever experienced.  I had no problem switching from Ritalin to Adderall. Does anyone have any Adderall withdrawal knowledge?
Avatar universal
My daughter, 11 years old, is ADD. Not hyper. She was failing in school. We tried Adderall and within a year her scores were at level, up 2 grade levels. She doesn't care to take it, but has helped her so much to consentrate. She make A honor society this year in 6th grade, she was so excited, she was livid. This has also helped her anxiety of not being accepted due to her poor grades.
Avatar universal
I recently started adderall.  I am 41 years old and have been hyper my whole life.  I obsess and hardly ever finish a project I start.  I have distroyed a lot of relationships due to my obsession to run over peoples words. I find it hard to stay focused while someone is talking. I can forget a major task as easy as walking out of a room.  I dont want to believe I am ADD.  I dont like taking this medicine.  I have been taking it for 1 week.  I have never taking any meds until now.  I am on zoloff and adderall.  My feet are cold and my hands are sweaty.  I went to the hospital because my left foot went blue.  I did not know the meds caused this till now. The hospital diagnoised me with phelbitis.  But its not its the result of adderall.  I wonder why the dr didnt put two and two together.  Anyway, I wanted to know if anyone out there knows when  I will stop climbing the walls.  I was told it would take one week for it to calm me if I was ADD.  Its not working.  Although I am staying up all hours of the night doing different tasks.  Please help with some info.
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