- To Change Your Mind - Details Matter
ADHD Medication Answers
ADDA Plans
June 3, 2013Dodson Dysphoria and ADHD
June 25, 2013ADHD Medication Problems Abound
The map is not the territory.
Alfred Korzybski
So why not consider the 3 most elemental medication issues so often missed?
Take a look at this very short, 1 min 32 second video review of basic issues that contain answers for common sense ADHD solutions. Without the science, without evidence, without clear parameters, meds remain in the Dark Ages of speculation and guesswork, with no expectations.
Join me in forward this information on the easily available New ADHD Medication Rules to anyone remotely interested in moving forward for answers that increase ADHD medical predictability.
No, it's not your doc's fault, it's not the pharmaceutical company's fault, problems arise with the rapid advance of science in the context of old concepts. In the significant absence of understandable, practical guidelines – Rules that work – confusion and consternation prevail. While you're at it, take a look at this comment from “Tired” in Europe who read New Rules and found some answers.
Looking forward to your thoughts!
New Rules Trailer from Dr Charles Parker on Vimeo.
Please share to encourage improved thinking.
cp
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18 Comments
[…] ADHD Medication Answers […]
[…] ADHD Medication Answers […]
Dr. Parker, I really need some help!! I’ve been seeing my new doc for over a year. She’s examined my family and my history and we all have ADHD except my mother.
My problem is I’ve tried everything from being treated by a previous doctor who never recognized ADHD and nothing has worked. I was optimistic with this new diagnosis and new doctor b/c it seemed to finally fit. I started with Vyvanse a few months ago, but wanted more flexibility and may have started at too high of a dose so switched to Adderall.
I’m extremely hyperactive and OCD while being extremely perfectionistic, rigid and HATE any disruptions in my routine which leaves me with no balance/life. So I’m now on Adderall. Started with 10xr, nothing. Then 20xr. Complained that wore off too soon and needed a booster when working my night job. I’m not even really sure when it starts working or stops working. I only notice that late night at work the old me comes back with her chattiness, inability to sit still, getting upset when things don’t go as planned. So today she reluctantly prescribed me #90 of 20m IR to titrate my dose accordingly. She trusts me. Honestly, I didn’t ask to increase dose. Just told her my situation and that I’d prefer IR for control and flexibility as well as price. I have not started the IR yet. Just got today.
The problem is yes, it is probably doing what it’s supposed to. I am not as emotional or taking things as personally, no more OCD, not as uptight about things. Still have no motivation (had some recent trauma which caused a mild breakdown in daily routine, feeling lost etc), no drive or desire. I have also noticed that amphetamines have slowed my critical thinking, mental capacity, lucidity and so forth. I have had no “negative” side effects. I’m normally an extremely fast processor so this is causing some “blah-ness”. I don’t know how to function without my OCD to drive me??
I’m still binge eating like crazy. I’m very lucky that I workout and must have a high metabolism b/c I still weigh 113 despite eating 3-4000 calories a day. Part of my OCD involved BDD issues, which I’ve struggled with since the age of 12. Used to be bulimic, but no longer purging.
I don’t know what to think of this reaction. I have a high IQ (140) and just feel kind of slow now. Is this the trade off for no more anxiety or racing thoughts?? Is there any way to have no reduction in cognitive speed, mental clarity while having a boost in energy, motivation, yet no anxiety?
Sorry for rambling and not having any clear thought or structure, but I’m on my meds now…. 🙂
Any advice on a certain direction my doc and I could take, would be so helpful and much appreciated. I do not have insurance right now, and it costs me $700/mo for dr visit and meds so testing for anything is not an option right now. I have been taking 50mg Seroquel for last 3yrs for severe insomnia along with sonata. No other meds except Adderall right now. I’m trying to get off Seroquel and hopefully find another way to sleep. Perhaps Seroquel has an effect on my acute depression?? I HATE SSRI’s. They tend to make me more spacey and anxious while doing nothing for depression.
Do you think the diagnosis is correct or maybe I have underlying depression along with ADHD or something else all together? I’m so frustrated at this point and have been researching for hours a day to try and jump ahead to my maintenance phase whatever that entails.
Thank you in advance!!!
Regards,
MizzLynn
MizzLynn,
Obviously it’s inappropriate for me to consider a second opinion verdict even w this amount of helpful info. – Just too many variables in all of these matters to take an informed guess. I can tell you in general terms, however:
1. Binge eating w/o gaining weight needs medical review and quite likely lives downstream from a malabsorption problem, likely IgG in origin, certainly foods need to be ruled out.
2. Eating disorders frequently reside downstream from IgG issues.
3. Trace element and neurotransmitter imbalances are other avenues of important inquiry. Because of your economic status I would start w TMA [Tissue Mineral Analysis References]
Without these tests you likely will continue to suffer unpredictable results. Consider SSRI w your Adderall – but remember the importance, w your doc, of balancing DA and Serotonin.
cp
Dr. Parker–
Thank you so much for taking the time to reply and for your insightful information.
I will take this info to my dr to see if she can direct me to certain testing.
Funny, I had a feeling you were going to go with the IGG especially after being on your site. I have mentioned this to my doctor before. She seems to dismiss the binge eating as just an impulsive thing that would be under control after taking the meds. Doctors also tend to think (IME) that as long as I’m not under/over weight then it’s not a problem.
When I first started the Vyvanse (40mg), it was amazing!! For 4 whole days I had never felt better or more clear headed in my life. Suddenly, it was like I could see the world without my negative obsessions stopping me or holding me back. Then it started to feel weird. I felt a little toxic and stoned. So I told her I wanted something a little different as far as the way Vyvanse is absorbed. I think she thought I was crazy when I told her that I thought I wasn’t metabolizing the Vyvanse and told me my dose was probably too high which would make sense from her point of view.
Thanks again!!! I’m really glad to have found your sight. For years, I never would have thought that IGG played a role in psych meds!! But, yes, all of last year I was in remission from any ED and was eating cleaner than ever! I felt amazing and had more energy during that time period. I think my culprit might be sugar…
Thanks again!
ML
mizzlynn,
The informed must always make the effort to be patient, indeed understanding, with the uninformed. With respect and consideration we will set a tone of group acceptance over on the informed side, and make it less clubby, less negative and less polemic. Those few additional details firm up my recommendation. Stay the course, you can turn this around – hang tough.
Details matter,
cp
Dr. Parker,
I am in my mid thirties and have just started being treated for ADHD. (I have also suffered from OCD in the past.) The first medication I tried for ADHD was Vyvanse which I was very happy with at first, but after a few months my OCD got out of control. I then tried Wellbutrin which helped me with sticking to tasks but made me less alert. I plan to try Strattera next, but am not optimistic about it. I am thinking that Vyvanse combined with Zoloft (which has worked to control my OCD in the past) may be my best bet. Would you recommend Vyvanse/Zoloft or is there another stimulant/SSRI combination you have seen more success with for patents with ADHD and OCD?
Thanks very much for your help.
Brian
Brian,
There is no interaction between Zoloft and Vyvanse, so not a problem, and you are likely right on with that consideration as a reasonable trial. Agree on Wellbutrin, good if it works, but less efficacious than Vyvanse. Strattera likely will disappoint. If Zoloft doesn’t work try any one of the Effexor products for the best SNRI coverage.
Beyond that, w refractory OCD, if that combo works for awhile then peters out you do need a biomedical workup: IgG, Tissue Mineral Analysis, possibly Neurotransmitters as well to jump on contributory causes vs symptoms.
cp
Thanks very much.
Dr. Parker,
I hope you will permit me to ask a couple of follow-up questions:
1. Are some stimulant medications more likely than others to cause obsessive thoughts? (My Doctor has put me on Concerta which does not seem to be effective in controlling ADHD symptoms, but so far has not caused OCD thoughts. Ineffectiveness and lack of OCD symptoms may be a function of dosage because I am only taking 18 mg/day)
2. Based on your previous response would you recommend that I try Effexor/Vyvanse before I try Zoloft/Vyvanse?
Best Regards
Brian
Brian,
1. Yes, different stimulant meds show idiosyncratic side effects on the side of excessive “mind stimulation” independent of dosage. But the first consideration on any stimulation with excessive thinking is not the med itself, but the med dosage, the Therapeutic Window.
2. Eff/Vy is my favorite combo, but doesn’t work for everyone. Yes, I do start there, – but don’t get frozen in expectations. No harm w Zoloft and sometimes less money.
cp
Dr. Parker,
Thanks so much for your help. Your book and especially your advice have been very valuable.
My goal is to be able to control my ADHD/OCD symptoms with the smallest hammer possible. Before I move on to a stimulant / SSRI (or SNRI) combination, I want to make sure I have explored all appropriate options with stimulant only treatment. Concerta does not seem to help my ADHD symptoms. I have tried both 18 mg and 36 mg dosages. Vyvanse is excellent at controlling my ADHD symptoms. I started on Vyvanse 30 mg which caused OCD symptoms to appear, but these subsided within a few weeks. Vyvanse 50 mg caused major OCD symptoms and a feeling of being very stressed out. Reducing the dose back to 30 mg did not relieve the OCD even though I stayed at 30 mg for several weeks.
Before I go on to try a stimulant / SSRI (or SNRI) combination, do you have any suggestions as far as a stimulant only approach?
Thanks Again
Brian
Brian,
Start all over and get the IgG testing and then the Therapeutic Window will open with a breath of fresh air.
cp
Dr. Parker,
I was finally able to meet with an Psychiatrist today. (Until now I have been working with my family doctor.) The Psychiatrist confirmed that I fit the criteria for ADHD and OCD and suggested that I try a combination of Vyvanse and Luvox. Do you have any thoughts on this?
Best Regards
Brian
Brian,
No drug interactions between Vyvanse moving through 2D6 and Luvox which is clean on that path. A good, reasonable choice.
cp
Thanks Dr Parker. The Psychiatrist I saw feels that Luvox should have less side effects than Zoloft but from what I have read Luvox is likely to have more side effects. I am concerned about tiredness, weight gain and sexual problems. What has been your experience?
Best Regards
Brian
Brian,
Luvox is not first line w me for those reasons, – but honestly w adults Zoloft can also be a weight gainer, more often w women than men. The simple reason I didn’t get more specific is that one never knows what actually will work as so many variables are at play. The main thing I watch for in all psych meds is that Phase 1, CYP 450 metabolism. Luvox blocks 1A2 and 3A4 and if a person is on any other meds that run up thru those pathways, problems can occur. Unfortunately those facts are often too much info for the average doc to respond to, so I leave that to your discretion.
Bottom line: of the two, I would go for Zoloft, but my favs are Effexor/venlafaxine and Luvox/celexa for these reasons.
cp
Thanks Dr Parker