ADHD Med Tutorials

DR., Could you speak further about the effects of going outside the top of the window. I was on no ADHD meds and started at 45mg Vyvance.... way to much...went down to 30mg... still to much(causing headaches, insomnia, overall feeling of being fried). I was ready to give up on ADHD meds in general, but thought i might try a micro does. I took 15mg.... less fried feeling, but still present and the insomnia persisted...  Today i took 10mg and so far attention is up, brain does not hurt and we will see about sleep tonight. What are your thoughts on very small doses?  or is just not the right medication for me?

Stay tuned over here, posted a comprehensive reply to this important question on the blog dashboard, with refs, and for some reason it's not popping up over here... This question is a big deal for so many!

cp

My latest conversation: CoreBrain Training: College and Goodbye

I'm a 43 yo female treated with 70mg Vyvanse for ~3 years for ADHD.  I would say Vyvanse reduces distractability and it also helped reduce my daytime sleepiness, but I still struggled.  In addition my psychiatrist has treated me for depression with Prozac which was recently increased to 60mg.  I've listened to your video's in which you note the "incompatability" of Prozac and  Vyvanse and brought this information to my psychiatrist who politely denied any problematic interactions with the 2 drugs ( I shared with him your website in case he wanted to hear it from a peer).  Last year, I was also diagnosed with narcolepsy and began medical treatment with a neurologist ~1 yr ago with Xyrem 9mg qnoc and 250 mg Nuvigil qd.  Several months ago, my blood pressure began a steady elevation and I was diagnosed  with HTN.  My IM doctor had me stop Vyvanse in order to get my blood pressure managed.  I remained on Nuvigil for daytime sleepiness and tried Strattera for my ADHD while my IM doctor added/adjusted meds to get my blood pressure down.  This was less than adequate treatment for my ADHD and I had increasing problems at work and ultimately requested FMLA  to focus on getting BP down, until I could safely return to taking Vyvanse again.  I am back on Vyvanse now and have had some improvements, but I'm about to return to work and I worry I won't overcome the challenges I have @ work.  I've had years of counselling and even began seeing someone who specializes in ADD 4 months ago.  I'm concerned about the combination of meds I'm on and disappointed that after months and months of tweeking, this is as good as it gets.  I like my doctors but I feel the complexity of my comorbidities  warrants more collaboration and assessment.  I live in Austin, TX.  Any suggestions, recommendations re: my quest for optimal management if my ADHD would be greatly appreciated.

Jennifer

I am concerned about something you said in your video blog, (the first one about DOE), where you said do not mix methyl amphetamines and amphetamine salts.  My son needs an afternoon dose of a short acting stimulant, which in the past has been adderall- amphetamine salts short acting.  Unfortunately, because of the shortage of this medication, his doctor has prescribed ritalin short acting. What do we do in this situation?

Mcw, This is a problem nationally as the absolutely misinformed are still, after these many years, in a state of panic about amphetamine products. This is why Harvard was years behind common practice as they had no idea about how to use them, feared the word AMP, and simply wouldn't get involved in studies. Out on the frontier we were waiting for comments from the bastions of objective thought, and they simply weren't considering thinking objectively. Politics spin the day. cp

Mcw4rosy, Send them a copy of my "Predictable Polutions for ADHD Meds" if you find it helpful. In only a few pages it outlines why folks are having so much trouble with stimulants and what can be done to correct those issues. Fr^e here at http://www.corepsychblog.com/adhdbook cp

Lin, The food allergies absolutely need identification and correction. We all suggest IgG in our office and that food problem if not corrected will chase you through your middle age years if you don't jump on it and correct it. Type in IgG in to SEARCH and many posts and comments will arise for your review. cp

Micheal, Many big thanks for dropping a note over at Amazon - you will likely enjoy the CoreBrain site when we nail it up - some serious interviews and deeper thinking about all things psych and mind that get lost in the labels. Appreciate,- long distance high five! cp

Dr. Parker, I am new to this world. My 6 year old son very clearly has ADHD with only the inattentivness portion. He is so "out of it" during school that he produces no work. He takes 10-20 times the amount of time needed plus many many re-directions just to do the simplest of tasks. He is just thinking of interesting things, telling stories, examining other things, creating art etc. Obviously this has led to big problems at school as he can't produce any work.  Yesterday we tried our first medication, the Daytrana patch. We put it on at 9am, and had a few hours of nothing noticeable. Then at about 3pm our sweet polite child became a raging violent monster. He raged, sobbed, screamed, hit, destroyed things and was generally out of control from 3pm to 2am! We took the patch off at 4pm and anxiously waited the 2 hours for it to leave his system. We thought the hysterical rage would then end, it didn't. He was literally out of control for 10 full hours after removal of the patch.  So obviously we do not want to try another stimulant! We talked to our doctor today who wants to start him on Intuniv tomorrow. I've read up on it and it seems like it's designed for children with the hyperactivity component more than anything. I'm wondering if this type of drug alone, will benefit our son. I would so welcome your thoughts on this. I feel very alone with no one to talk to and very guilty for putting my son through the chaos of yesterday. Thank you

Dr. Parker. It’s been six months since I last wrote you. I’m 49 years old. About 5 years ago I realized I was mentally exhausted; a lifetime of being miserable and unable to make decisions. I couldn’t stop my racing thoughts. I went to a few Phychiatrists and they prescribed antidepressants (SSRI’S). None of them worked. They actually made me feel worse. Then I found a great Neuro-Psychiatrist. He started me on Stimulant medicine. I tried most of them. I found your website and watched the ADHD med tutorial videos. The eight videos are a great addition to my ADHD knowledge. My next decision was to take Vyvanse. Now I’ve finally purchased your book ADHD Medication Rules. The books is a MUST READ for anyone with ADHD - or anyone seeking knowledge regarding ADHD, Serotonin, Dopamine and much much more. I have no medical background but I’m able to read and re-read the Rules book. My notes are streamlined - allowing me to laser focus on my ADHD. I want to thank you and encourage you to continue your open and bold work in the area of ADHD. Michael

Many thanks Mike. The details do make a considerable difference - and it puzzles me why we simply haven't made that important change with all the extant info out there! cp

Dear Dr Parker I have a 5 year old boy (almost 6) who has recently been on Strattera over the last 2 months (this is the first time on any adhd medication), he started on 18mg, then after 5 days 25mg and then after another 5 days 40mg and at which we decided to stay with this dosage.  We thought at the time this was right as he did seem to improve and pre-school agreed, however looking back the first two dosages seemed to work better, now I feel he is even worse, moody, grumpy and after 7 weeks he started with stomach pains and occasional vomiting.  After consulting with his doctor, was told to stop for 1 week and try again, if the problem continued then it was obviously the medicine and they would try something else.  Today I started him back on 40mg and after his breakfast he started feeling sick (always give him the medicine after his breakfast). So having read/listened/you tube editorials that you have on your blog, I am now wondering if he had reached his top of the window on 40mg, so it's not the medicine but incorrect dosage. He went see a neurologist at CHKD. He was also diagnosed with Tourette's (vocal) and Sensory Processing was diagnosed almost 3 years ago for which he sees an OT twice a week.  I am a little lost with his conditions and not knowing what the right thing to do is, not sure if the OT is doing any good, his vocal noises did stop for a while, but have definitely come back. I would be very grateful of any advice you could offer for when I contact them again about the sickness on Monday, thinking to ask for a lower dosage? Kind regards Vicki

Regarding meds, I would just like to say that different generics are different---at least for adderall IR. Below are my individual responses corepharmaceuticals -- correct dose for me = 25 mg...lasted 5 hrs to the T, effective within 30 minutes, had heart palpitations in what I call my "quieter moments" barr/teva ---- correct dose = 20 mg....lasted about 4 1/2 I think?  I only took it a couple times, because it made me feel very just dull I guess.  I was achy all over and had a bad headache.  Later learned they put saccharin in theirs, and that is my best guess as to why I felt that way. sandoz --- correct dose = 30 mg...lasts 5-6 hrs, effective in about an hour or so...it has a more gentle on and off so it's harder to tell.  more like vyvanse in that regard. you can guess which one I'm on now.  My dr's (psychiatrist) still trying to tweak other stuff; I doubt that it'll ever pan out, but I'm hopeful.  ugh.  don't like all the trials and side effects though.  But he's a great dr and they're aren't any other red flags in terms of other non-psych problems.

Hello Dr. Parker, It's your friend Ibrahim. I just wanted to say "hello" and to let you know how impressed I am with your blog and the quality of content you have put out there. I'm sure this is an excellent resource for people out there who are looking for the services you provide, or to learn more about this health topic. Ibrahim

Hi Dr. Parker, I was logging on today to ask you a question and what I watched was and and is my question, as we have talked about before about a year ago the adderall had changed my life. I am taking a 20 mil. in the morning at 6 am then at 10 am and the third at 2:30 and now I feel like i am back in 5 th grade I just can't seem to pull the trigger and its getting worse my mind is always full now and have noticed this slide for about 3 months, due to the economy I don't have insurance and nobody to talk to and I think I am on a roller coaster and seems as it only works for a couple hours or so and now my mind is worring about when is it going to wear off and this is robbing my quality time of work and family function. Dr. please help me im falling back to 3 rd grade and I don't like it there. Thank You Dr. Parker for all you do in caring and understanding this gift Ron

I look forward to that new book! :)

Dr. Parker, So I had read your book and watched some of this videos before you actually posted them here directly. I'm wondering what your comments would be on a few thoughts/questions I have --- 1) Regarding the current constructs of ADHD -- a) we have the DSM: inattentive, hyperactivity/impulsivity (which really aren't the same...but doesn't matter anyway because its vague), and combined. b) construct as deficits in executive functions c) your construct as thinking ADHD, acting ADHD, and avoiding ADHD...each with similar subsets d) we have Amen's 6(+) subtypes which I don't remember at all Obviously the first is too vague and purely descriptive, which is why other constructs have developed. What I'm wondering is what your view as far as the executive function construct is? Also if, according to your construct, individuals could struggle with some combination of thinking, acting, and avoiding...? And any comments in general on these various constructs. 2) Research shows (with any aspect of psychiatry) that the most beneficial treatment is usually a combination of therapy/skills training/counseling/education and medication as needed. What I'd like to know is if the severity of difficulties is high despite good lifestyle habits/management strategies etc and a patient is also taking medication....is it viable that someone could re-train their brain so to speak? Through skills training/education/therapy etc, can people really change their brains so that the targets of the medicine are met that way instead and just as easily? (even though obviously it takes more work upfront) an example could be lack of clarity in thinking, or not being able to remember or access what you're trying to communicate... 3) Research also shows that ADHD (particularly in adults; though obviously this research is limited) is rarely on its own. It's not just a question of attention or thinking, but regulating so many things and therefore affects so many other areas that can have other diagnoses - especially if the ADHD is severe. That really, if considering the executive function construct, these other diagnoses also show a lacking in some of those same functions -- but perhaps not as many? Obviously if there's major depression that should be treated first, which you emphasize in your book. But what about other areas? (I'm thinking anxiety, obsessive and compulsive tendencies w/o actually really matching ocd, low energy in AMs or early PMs/high energy other times, perfectionism, mood swings within a day, autism/aspergers, sensory and/or auditory processing, ..........and so forth). What are some things that you see? What advice and/or treatment options are there? How good do you/your patients try to get things? I had more, but can't remember it now, and I need to sign off for the day. Looking forward to your insight though! :) Thanks.