And, of course, a good physical exam and metabolic workup are important. And, as "funone" suggests, a Vitamin D level check is not a bad idea, either.
While even excellent nutrition, good sleep, and adequate Vitamin D are not "cures" for ADHD or depression, they can help to minimize the need for medication, and help the medications you might take to work as well as possible.View Thread
Adderall is the stimulant most likely to be abused, so that's a problem.
Still, when you tried it, you say, "I could concentrate, focus, make sense, and be a generally nice person."
That should be a critical clue to any physician who is attempting to treat you.
Many people with undiagnosed ADHD develop addictions, often with the sole initial motivation of "feeling better" and stopping the noise in their heads. But then the addiction presents a secondary diagnosis to ADHD -- a dual diagnosis.
Most physicians are not prepared to treat ADHD adequately. Add a prior substance abuse issue, and some are doubly hesitant.
The good news is that some newer stimulant formulations are non-abuseable (with some caveats). Which one might work for you will require some trial and error. It is impossible to predict on the front end which one is best suited to your individual neurochemistry.
There are two classes of stimulants, and it's good to try each, in case one is significantly better.
In the amphetamine class, the stimulant that is marketed as non-abuseable is Vyvanse. It is a form of Dexedrine, and is somewhat similar to Adderall. But without the problematic side effect profile.
Vyvanse is a "pro-drug" -- meaning that the active ingredient (the stimulant) is not released until it reaches a certain point in the gut, where a chemical reaction takes place.
The other class (methylphenidate) has an option that has been marketed as non-abuseable, too: Concerta. It is a laser-drilled osmotic pump that releases the medication steadily as it travels through your GI tract. You actually excrete the capsule. There is also a patch, called Daytrana.
So, really, your doctor should work with you on this.
I don't blame the doctor for being cautious. Some people with abuse even "non-abuseable" drugs, by taking too high a dose, for example. And they will doctor shop in order to get the supply they want.
See if you can talk to him/her and attempt to address these concerns with him. Make it a short-term trial, if that increase the doc's comfort level. And agree to keep a log of the amount you took each day, and how you felt.
You really deserve to see if legitimate ADHD treatment works for you. If not this doc, keep trying.
Meanwhile, keep reading information on ADHD and substance abuse, including this WebMD link, excerpted below:
"One of the longest-term studies, which followed 100 boys with ADHD for 10 years, showed no greater risk for substance abuse in boys who took stimulant drugs compared to those who didn't take the drugs. An earlier study by the same authors even suggested that stimulant use might protect against later drug abuse and alcoholism in children with ADHD by relieving the ADHD symptoms that often lead to substance abuse problems. The earlier the stimulants are started, the lower the potential for substance abuse down the road."
These are all great topics of discussion. The power of the group!
Melatonin: It's not for everyone. Not everyone is affected by the circadian rhythm problems increasingly being associated with ADHD. So, not everyone will be helped by melatonin, and some will be harmed (e.g. potentially people with bi-polar and some types of depression).
Melatonin is a powerful hormone, and you don't want to mess around with that, especially in children. You want to eliminate other issues before resorting to melatonin.
Sunrise Alarm Clock: A great idea for many people, because it intensifies the signal to the brain's circadian signal that it's time to get up. Again, won't work for everyone but won't hurt to try.
Cortisol: If possible, have your cortisol levels tested. This typically involves spitting into a little tube at several points during the day (and shipping off to the lab). This tracks the trajectory of your cortisol. Many people with ADHD have lived with years of stress, which can really affect cortisol levels.
Relora: I've heard others report good effects with this, particularly in stress relief. I know nothing about safety studies, which are always a concern with "natural" products.
Electronic usage: Many people with ADHD "self-medicate" with screen type (computers, videogames, TV, etc.). Some use them to fall asleep. The problem is that this can create a secondary addiction. That is, after you finally fall asleep, a part of your brain is saying, "Want more screen time!" and awakens you to fulfill that wish.
Try to stay off the electronics for several hours before bedtime. Lower all the lights in your house in early evening (cue to circadian rhythm).
Eye relaxation: Many of us who work via computer monitors will have eye strain from always staring straight ahead. This can create a type of muscle fatigue that prevents us from relaxing. I'm sure if you search online, you can find specific directions. But basically, you can just do circles with your eyes, and look side to side. Also, a warm compress on your eyes can help to relax the muscles.
Magnesium: Magnesium is the mineral that, among many other functions, can help us to relax. Many American are deficient, and are consuming too much calcium in ratio to magnesium. Unless you have kidney disease or some other contraindicating factor, magnesium is safe to try. For many, the citrate form is best absorbed, but there are other choices.
I hope this is helpful.
Good luck! Gina Pera author, Is It You, Me, or Adult A.D.D.?View Thread
It's aggravating, to say the least, that your prescribing MD is not the one who is helping you.
Here is the problem for many adults with ADHD: They also have depression or anxiety -- that is, "serotonin" issues.
The stimulants, by boosting dopamine efficiency in parts of the brain, can backsuppress serotonin in parts of the brain.
So, if the adult with ADHD already has a co-existing challenge with depression and anxiety, the stimulant can make it worse, even if it helps with ADHD symptoms.
It is sometimes hard to know what is causing apparent "anxiety" or "depression." Sometimes it is the ADHD itself. So, when the person starts taking the stimulant, they no longer feel as anxious and depressed, because their ADHD symptoms have been diminished.
But sometimes, due to neurogenetics, the person has ADHD as well as depression/anxiety. Two separate conditions in the same person.
Many adults with ADHD will combine the stimulant with a medication that addresses serotonin issues, such as an SSRI. Or they will take Strattera in addition to a stimulant (Strattera targets norepinephrine, a "cousin" of serotonin.)
Necessarily, I am vastly simplifying the situation with neurotransmitters. In reality, this is an extremely complex system. But I am trying to give you information that you can use now. I hope this is clear.
One last thing: Sometimes when people with ADHD take a stimulant, they are suddenly aware of everything around them that they must do. They suddenly "see" the mess on the living room floor, etc. With untreated ADHD, there can be a tendency to ignore or not see these things -- so less stress.
So, I hope you can think about if this is a possibility for you, and if you might need help with organizational strategies to help you keep up with domestic responsibilities. Sometimes a professional organizer is just the ticket.
Good luck! Gina Pera, author Is It You, Me, or Adult A.D.D.?View Thread
Ritalin doesn't produce an "energy boost." It's an entirely different medication than the steroids, including prednisone.
Ritalin and other stimulants act to normalize dopamine transmission at the synaptic level. Specifically, they generally work as the SSRI antidepressants work on serotonin: they slow the re-uptake (or recycling) of the dopamine molecule in the gap between neurons.
What commenters here might have been experiencing with the prednisone is "mania" -- which might feel like improved focus, but is not sustainable. In other words, you really don't want to mess around with this.View Thread
After a horrible reaction to poison ivy a few years ago, I, too, was given Prednisone—and felt like I was sitting on rocket boosters. Lots more energy. It felt like adrenaline, though -- made me a little shaky at times.
A while later, I heard about some celebrity—I think it was Jane Pauley—whose prednisone use acted as a catalyst for bi-polar disorder. Apparently, that is not a rare effect. The rapid onset of psychiatric symptoms is a well-known risk of prednisone usage, apparently.
Prednisone is a steroid. The neuropsychiatric effects have been observed, but there is no consensus of opinion. My sense is that there are a multitude of factors that make clear answers impossible.
Here is one paper from the Dana Foundation, a few summarizing what is known of the psychiatric effects from prednisone usage:
I would not use prednisone unless I had to. If you have ADHD, there are evidence-based treatment methods. The stimulants, the first-line medication for ADHD, are FAR less risky than steroids.View Thread
Hi mom, I guess better late than never. I'm just seeing your reply two months later.
It's interesting that the pain medication makes him easier to deal with. I wonder at the widespread epidemic of pain-medication addiction, and wonder how many of those people have underlying psychiatric issues. (I know that many are having legitimate pain issues, but there are others...).
If he can't "see" the problem, perhaps there are ways of trying to make it more clear. It is not easy, I know. But one method is called the LEAP strategy, developed by Dr. Xavier Amador. I interviewed him for my book ("Is It You, Me, or Adult A.D.D.?) and explained the strategy there.
He also wrote a book, "I'm not sick! I don't need help!"
I am sorry to hear that your physician did not follow a more cautious approach, in starting you at a low dose of Adderall and increasing only slowly, at each visit checking against rating scales to see what symptoms are improving and which might be worsening.
Yes, please do not ingest nicotine of any type when taking a stimulant. It can exacerbate the effect.
Personally, I recommend against starting with Adderall. I recommend starting with non-amphetamine stimulants, such as Ritalin, Concerta, etc. If those do not work, then try the amphetamine class, but opt for the smoother delivery, such as Vyvanse.
It might be that, in the end, Adderall will still work the best for you. That happens in a minority of people, who get more benefit than side effects from it.
But it nothing to fool around with, 20 mg starting especially. And it can fool people with ADHD into thinking that only the sensation of rocket boosters attached to their behind will "clear the fog." Medication can still be effective without this visceral "proof" -- which is often proof that the dosage is too high.
Caution. Follow your instincts. Find a new doc, if you can. If not, please read my book's chapters on medication (title: Is It You, Me, or Adult A.D.D.?)