March 28, 2013

A Response to a Reader's Question about Medication.

I got a comment just now from a reader which included questions about their medications. They take methylphenidate and Strattera and are wondering about the length for duration, or of the overall effectiveness of their medication.

As a non-professional, I responded as follows, and hope that it clarifies my own understanding of medication as it relates to ADHD treatment. I would be very interested to hear from readers their thoughts on my perspective, and the advice I gave...

I wrote (I have modified it slightly for clarification below):

"Have you spoken with your doctor or psychiatrist? Methylphenidate and the amphetamine class of psychostimulants work for some and don't work for others - it can't really be predicted, depends on the individual. There are dosage aspects, metabolism issues, concurrent medication useage, and a host of other factors involved, not to mention your own personal level of change or stress due to situational factors (New job, school, city? Change in relationship status? Problems in your personal life? Are you getting sufficient sleep?)

Strattera didn't really work for me by itself, and I no longer take it. But I do take another NSRI class medication - buproprion (trade name Wellbutrin). Some of the NSRI meds can be useful in reducing some of the anxiety which may be brought on by taking the stimulants and may assist executive function, or so I understand.

What form of methylphenidate are you taking? Long release like Concerta or Adderall XR, or short release, like short release Adderal or Ritalin?

A good psychiatrist with a clear understanding and training in psychopharmacology should help you tweak your medication. I would definitely speak with your doctor about this, though.

To get the most out of your appointment, I'd recommend the following:

Try to track your cognitive senses throughout a few days in a notepad - i.e. Your focus level between 1 and 10, attention.

Track your emotions also - and your reactivity, irritability, grumpiness, ability to manage transitions or to shift out of hyperfocusing without being too pissed off(!). Basically, your level of attention self-regulation.
Track impulsive behaviors - interrupting, acting out, moving on to an inappropriate task or activity, when you should be sticking with the one you're already on.

Also try to document your ability to get priority items done, your ability to be organized, your level of overall 'effective functioning' in various arenas of your life. That is, how well you are managing at work, home, school, parenting, relationships, hobbies, sports, personal care, etc...

Bring this tracking information to your doctor / psychiatrist and it should help them better understand how to help you find an effective medication regime. Hope that helps.

Note that I'm not a medical professional, so just take my advice as you see fit. All the best, and let me know how it works out!"



  1. That's great advice, Simon. (And I'm glad to see you back in action, blogging-wise!)

    The medication selection and monitoring process is so important, and yet many MDs just give it very short shrift. That means folks with ADHD need to be very pro-active.

    I encourage people to recruit a friend, spouse, or other family member to hep with the "teamwork" aspects of establishing a good medication routine. Even to the point of going to the doc with you. Because sometimes two heads are better than one, including in assessing the doc's knowledge and expertise and taking note of follow-through points.

    One of my main reasons for writing my book was to provide a medication protocol that readers can follow to get the best results from medication. The basics are not rocket science, or even neuroscience. They simply require a step-by-step method. And too few MDs know this.

    Some people with ADHD will find the issue more complicated, such a when there is co-existing anxiety, depression, substance abuse, or bipolar. Or when funds are tight and access to reasonably priced medications limited.

    But self-advocacy is definitely the start of getting the best results from medication.

  2. Wonderful insight,
    being in a region where ADD is not recognized and CBT is not available, I am now looking for ways to improve myself.
    I was just wondering about the same issue the past few days, Ive been on Ritalin for the last 1 month but of late I notice the effect is falling. Will also raise the issue with my psychiatrist next week.



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