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Attention Deficit Hyperactivity Disorder

Drugs for ADHD

05/25/2010

Question:

I`m 55 and in good health and I have been treated for ADHD (they called it "minimal brain damage") when I started treatment 30 years ago. A bunch of dugs were tried, but ritalin 20mg twice daily totally worked. Within a week of starrting treatment, I went from being on the verge of flunking out of college to a solid "B" student. I went on to get a professional degree, got married and had a sucesssul career on the ritalin. I always felt a stigma the the minimal brain damage moniker and was glad when they told me that I had a sleep disorser, like narcolepsy just milder. I never had trouble with the ritalin, except for 2 weeks each year when I went on reserve duty as a militray officer and had to stop the drug for fear of a drug test. I found temporary ways to cover my ADHD symptoms, at least for 2 weeks) and I had a job with almost no contact with people, so I got away with it. Five years ago, I retired (at 50) and stopped taking the ritalin because I knew that I would have to buy medical insurance and my history would make that difficult. So I went off the drug, got the insurance, but the ADHD returned with a vengence. I just saw a psychiatrist and he wants me to take Strattera; which I have started and ralize that it will take a while to work, but reading the side-effects and many negative patient experiences with Strattera, I feel that the ritalin 20mg twice is much better, safer and less expensive therapy. I never abused the ritalin and this is documented. The new doc is a great guy, but seems adamant about the Strattera instead of stimulants. He did give me a small rx for 10mg ritalin to take only when I had something that required a lot of concentration (for me this is from wake up to bedtime) and he says that the Strattera should kick in within 2 months. I know that the side effects of Strattera are supposed to be temporary; I got a lot fo suggestions about taking it with food in the evening to reduce the nausea and drowsiness. I feel like I constantly have the flu, am about to throw up and whe I take a ritalin the ADHD disappears in 20 minutes. I`m a biochemist and understand that the side-effects on the package insert report EVERY side-effect every reported, but this drug has 2 problems for me: it makes me sick and it doesn`t work. Is there any reason that docs today shy away from stimulants like ritalin (especially in a patient who has never abused it)? I printed out the significant side-effects of ritalin and Strattera and put them side by side and it`s a no-brainer(for me); if you don`t abuse stimulants ritalin is safer, especially if it worked for you for nearly 30 years. If you can give me any opinion, I woudl appreciate it. Thanks

Answer:

You don't know yet whether Strattera works because you have not tried it for 2 mo., but you also say it makes you sick, which is a more important consideration. If you have not discussed all this with your psychiatrist, you should. 

You imply that you think the reason he doesn't want to prescribe Ritalin is that he suspects you may abuse it. Have you asked him for clarification of that issue? If that is the concern, there are some formulations of methylphenidate (generic name for Ritalin) that he may have less concern about, such as Concerta or the Daytrana patch, or even Ritalin LA or Focalin XR. Perhaps he would be willing to try one of those. Has he seen your medical records to confirm that you were taking methylphenidate before? 

It's not clear from your statement whether you have narcolepsy, but if you do, Strattera would not be a good choice. 

For more information:

Go to the Attention Deficit Hyperactivity Disorder health topic, where you can:

Response by:

L Eugene Arnold, MD, MEd L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University