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Mental Health (Expert Forum)
ADHD meds
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.
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ADHD meds
by windbeat, Nov 12, 2005 12:00AM
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.
Doctor's Answer
by Roger Gould, M.D., Nov 14, 2005 12:00AM
, Nov 14, 2005 12:00AM
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.
Thank you, sounds very reasonable...I'll talk to my Dr. about giving that a shot.
• Psychology professor Diane McGuinness, PhD: "Methodologically rigorous research indicates that ADHD and hyperactivity as 'syndromes' simply do not exist"
Neurologist Fred A. Baughman, MD: "We are not mis-diagnosing or over-diagnosing, mis-treating or over-treating ADHD. It has been a total, 100% fraud throughout its history"
The Australian National Association of Practising Psychiatrists (NAPP): "[ADHD] is not an inherited genetic disorder or organic disease" and "scientific evidence to support ADHD as a disorder is unproven".
• Author Beverly Eakman: "These drugs make children more manageable, not necessarily better. ADHD is a phenomenon, not a 'brain disease'. Because the diagnosis of ADHD is fraudulent, it doesn't matter whether a drug 'works'. Children are being forced to take a drug that is stronger than cocaine for a disease that is yet to be proven"
• Psychologist John Breeding, PhD: "The diagnosis of ADHD is, itself, fraudulent"
• The Consensus Development Conference, held by the US National Institutes of Health, came to this conclusion: "[W]e do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction
Barry Turner ,medical ethics lecturer at university of Lincoln october 2005 -
"ADHD is a behavioural disorder not a disease.I consider that it is wrong to give children powerful central nervous system stimulants for this.There is no evidence of any etiology of disease in this condition.
Therapy ,psychology and nutrition have all been demonstrated to work for this condition.It is a learned behaviour and it can be unlearned"
I wouldn't believe in ADHD either if I didn't have it.
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’re looking for fish oil supplements don’t just look at the volume of fish oil, but the amount of EPA and DPA in it as well.
Fish oils have been shown to be safer than Ritalin – a drug commonly used to treat ADHD. As this drug has been linked to suicidal thoughts, hallucinations, aggressive and violent behaviour and heart problems.
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