Hey all,

thanks for all the help so far. I have an appointment to go to a Dr. tomorrow at 3pm who has already told me that he diagnoses and prescribes medicine for ADHD (I asked because I did not want to go to him and then simply be referred to a specialist).

I have researched this a great deal and I believe the two medications most likely to work for me are Adderall first and then Ritalin. Is it dumb to tell the Dr this? Without insurance (my first appointment alone will cost me $120) I don't have the money or the time to try out the lower level meds that have a far less probability of working, only to eventually get to Adderall. I am thinking of requesting to be started on Adderall, because I have done all the research on the drug. I have no history of drug abuse or addiction at all. But will asking for Adderall get me flagged as a potential drug seeker? Or does it depend on the Doctor? I don't know this Dr at all so I cannot say what type he is. Any input given will be great,

THANKS

It's impossible to know how you will respond to any drug until you try it, so to assume what will most likely work is like trying to assume what your favorite beer would be without ever having tasted a beer.

I have taken all of the prescribed stimulant medications for this condition with the exception of Daytrana, and Adderall was the only one that made me feel like I would be better off without medication. Adderall made me feel pronounced sedation, compared to the rest of the stimulants that all stimulated me to one degree of another. Granted this is not a normal response to Adderall, but it just goes to show that it's impossible to tell how you will respond until you take a given drug.

When you say that you "don't have the money or the time to try out all the low level meds that have far less probability of working," all I can tell you is that I understand how you feel, however it's usually a very long path to finding the right drug, and then finding the right dose. I have not had insurance since I was 18 years old, and I was diagnosed in 1992 at the age of 22. I would strongly recommend that since you do not have insurance that you take the time to call around to the different pharmacies in your town before you choose one to fill your prescription. I have discovered that most big chain pharmacies like CVS, Right Aid, and Walgreens are notorious for price gouging on prescription drugs. For example, last year I decided to get the brand name Dexedrine instead of the typical generic version I usually get, so I called around to find out where it was the cheapest. Here are the lowest and highest prices I was quoted on the exact same drug (Dexedrine) and the exact same amount of the drug:

Kmart pharmacy........$210 for 400 Dexedrine 5mg tablets
CVS pharmacy..........$490 for 400 Dexedrine 5mg tablets

It really does pay to shop around when getting a prescription filled.

Who knows, you might find the right drug, and the right dose right out of the gate on your first try. I've just never heard of that actually happening before.

Please keep us posted on how this turns out for you, and don't get discouraged if it does not work out with the first drug you try. I've found the process to be a tedious, boring, and often frustrating thing to endure. However, it's also the most worthwhile thing I have ever done for my health. ;)

Hey all,

thanks for all the help so far. I have an appointment to go to a Dr. tomorrow at 3pm who has already told me that he diagnoses and prescribes medicine for ADHD (I asked because I did not want to go to him and then simply be referred to a specialist).

I have researched this a great deal and I believe the two medications most likely to work for me are Adderall first and then Ritalin. Is it dumb to tell the Dr this? Without insurance (my first appointment alone will cost me $120) I don't have the money or the time to try out the lower level meds that have a far less probability of working, only to eventually get to Adderall. I am thinking of requesting to be started on Adderall, because I have done all the research on the drug. I have no history of drug abuse or addiction at all. But will asking for Adderall get me flagged as a potential drug seeker? Or does it depend on the Doctor? I don't know this Dr at all so I cannot say what type he is. Any input given will be great,

THANKSHave you ever taken Adderall???

What will most likely happen (and what SHOULD happen) is that he'll advise that you try out Strattera for a month.

Adderall and amphetamines are considered 'second line' nowadays - they only use them if non-stimulants don't work, and for good reason. Stimulants are almost 'outdated' nowadays - not quite yet, but almost - it's like giving someone a Tricyclic antidepressant when you could give them an SSRI - Tricyclics were developed in the 1950s; they still work, but they're old/crude compared to whats available now. Stimulants are still relevant, but they're on their way out now that newer, better drugs are being developed.

Strattera (if it works) is the most perfect ADHD medicine available. There are no ups, there are no downs, there is no 'waiting' for it to kick in or anything like that - you take it at night and you're good to go all day for the next day - you wake up ready to go - and it lasts all day, 24/7 actually.

One of the pitfalls of stimulants is that they only last during the day and you have to wait for them to 'kick in' after you take them and then at the end of the day you 'come down' from them - which is different for everyone, but for me it makes me feel really tired in the afternoons and sometimes gives me very *mild* headaches. Also, they're controlled - and they're easy to get addicted to and withdrawal is bad.

Strattera isn't controlled and there is absolutely no withdrawal.

But if you just ask your doctor for Adderall and you aren't even diagnosed with ADHD yet - it sounds like you're doctor shopping:rolleyes:.

My advice - ask him about Strattera first - and if he gives you a sample pack, make sure its not high doses (one of the pitfalls of Strattera is that it's SO new that many doctors don't know how to titrate it properly yet and give out doses that are WAY too high).

The correct titration for Strattera is:

1st week - 18-25mg
2nd week - 18-25mg
3rd week - 18-25mg or up the dose to 40mg if you need to.

From here on out you up the dose each week AS NECESSARY - only if you aren't feeling the effects that you desire.

What I see all too often is people that end up with doses like this:
1st week - 40mg
2nd week - 60mg

and in some cases even 80mg:eek: in the first two weeks.
Strattera is intended to increase your Norepinephrine levels over time; but at these levels it actually DEPLETES your norepinephrine levles - giving you the exact opposite effect of what you're supposed to get.

If you go over to the Strattera forums on ADDForums, you'll see a lot of people complaining about how 'awful' Strattera is and how it has such terrible side effects. Two things you have to keep in mind - First, Strattera will MESS YOU UP if you take too much. Second, it TAKES TIME TO WORK. Usually it takes about two weeks before you feel the full, 'optimal' effects. People used to stimulants expect it to 'kick in' within a couple of hours:eyebrow: - but it's NOT a stimulant and it doesn't work like one. It has to build up in your system (which takes a few days) before you feel at your 'optimal' level. Also, it doesn't FEEL like stimulants do either. With stimulants, you feel them working - you feel 'energized' when they peak, you feel 'strung out' when they come down, and you get that feeling like you're 'on speed' sometimes if you take too much;). Strattera doesn't make you feel like you're on drugs - it makes you feel...absolutely NORMAL. Not super engergized, not distracted/absentminded/hazy/tired - it makes you feel in the middle - NORMAL.
Keep in mind Strattera is BRAND NEW in the United States (it is the first, and still the only NRI available in the country) and a lot of doctors don't get how to titrate it yet. Also, Eli Lily is weird about giving out sample packs - they only give out the 40mg and 60mg mainly and a lot of doctors don't get the 18-25mg packs.

If you get Strattera, INSIST that you get a low starting dosage (nothing higher than 25mg for the first two weeks)

Hope my advice is helpful, and good luck with your doctor's appointment.
And, feel free to ask me any questions about Strattera (or Adderall);)

Ya you sound like someone who should ask your Dr about prescribing Strattera

Wow, Thanks so much. All the advice is really helpful. You seem to really love Strattera. Since it is so new and experimental I think I still prefer the old and most popular (from what I understand) starting-off medicine for ADD which is Ritalin. Maybe I won't request anything and see what the doctor says, but if it's not Ritalin or Strattera I'll mention those to him.

Thanks

Wow, Thanks so much. All the advice is really helpful. You seem to really love Strattera. Since it is so new and experimental I think I still prefer the old and most popular (from what I understand) starting-off medicine for ADD which is Ritalin. Maybe I won't request anything and see what the doctor says, but if it's not Ritalin or Strattera I'll mention those to him.

ThanksIf you're an adult, I would shy away from Ritalin.

The only medicines 'approved' for Adult ADHD are Strattera and Adderall (if i recall correctly). Ritalin can be used for adults, but I think it's primarily for children.;)

Wow. I don't want to start a flame war but I totally disagree with ben72227's advice and comments.

to quote:
"What will most likely happen (and what SHOULD happen) is that he'll advise that you try out Strattera for a month."

Why? Strattera has more side effects, is less effective and has not been studied and documented for over 50 years like the stimulants have. I've seen one study that showed most adults would prefer no ADHD medication at all to taking Strattera.

"Adderall and amphetamines are considered 'second line' nowadays - they only use them if non-stimulants don't work, and for good reason. Stimulants are almost 'outdated' nowadays - not quite yet, but almost - it's like giving someone a Tricyclic antidepressant when you could give them an SSRI - Tricyclics were developed in the 1950s; they still work, but they're old/crude compared to whats available now. Stimulants are still relevant, but they're on their way out now that newer, better drugs are being developed."

What are you basing these "second line" "out dated" statements on? In fact Strattera should be considered a last line treatment according to every comparison study that has been published. Even your comments on Tricyclics aren't accurate. The main problem with trycyclics was dietary restrictions. The new trans-dermal trycyclics have shown to outperform SSRI's which are themselves "crude" if you consider blocking serotonin has very little to do with solving the complex problem of depression and only works after months or years of treatment and even then only works on 50% of those who take them. Compaired to stims working on 80% of ADHDer's.

"There are no ups, there are no downs, there is no 'waiting' for it to kick in or anything like that"
Well that's certainly not true. Strattera is an SNRI and can take several weeks to start working for ADHD symptoms, if it works at all. You might not have to wait for it to "kick in" in the morning but there is a less than 40% chance that it will ever "kick in" for you, even if you can stand the side effects. It does work 24/7 however since, again it's an SNRI, but that also means that it's working when you don't want it to, including when you would rather be sleeping or taking a weekend off.

"One of the pitfalls of stimulants is that they only last during the day and you have to wait for them to 'kick in' after you take them and then at the end of the day you 'come down' from them - which is different for everyone, but for me it makes me feel really tired in the afternoons and sometimes gives me very *mild* headaches. Also, they're controlled - and they're easy to get addicted to and withdrawal is bad."

I don't know who would care if their ADHD medication only works during the day. Most people don't care if they have ADHD symptoms while they sleep. Yes, you will have to wait 15 minutes to an hour for a stim to start working, depending on the type and dose etc, and you may "come down" from them, again depending on the type or dose or time of dose or release mechanism of the drug. But the fact that they are "controlled" is meaningless and you are no more likely to become "addicted" to them than Strattera if you take them as perscribed (IE don't snort them or overdose). "withdrawl is bad". Actually any withdraw symptoms from stims happen very quickly, often a day or two if at all. And people on stims frequently stop and start them, such as take them on weekdays only, with no problem at all. Some only take them on certain work or study days. Withdraw from Strattera can be much worse and more dangerous than stim withdraw and can last for weeks. It is recommended that you slowly decrease your dose over a course of two weeks, as with any SNRI or SSRI. Also Strattera has NOT been studied for long term use. The longest published study is for 9 weeks, while studies have documented people on dextroamphetamine for 50 straight years.

"Strattera isn't controlled and there is absolutely no withdrawal."
Again, controlled is irrelevant and "absolutely no withdrawl" is not a true statement. Controlled doesn't mean the drug is un-safe, it means it can be abused or chemically converted into a recreational or "street" drug. There are controlled substances at your hardware store. Strattera on the other hand has a BLACK BOX WARNING: http://en.wikipedia.org/wiki/Black_box_warning

I'm glad Ben has found a medication that works for him but the truth is that Stratterra (Atomoxetine) consistently rates as one of, if not the worse ADHD medication on the market. It has the highest side effect profile and is the least effective. Studies have shown that children who start on Strattera are 4.2 times more likely to switch to a stimulant medication and that number is believe to be much higher in adults.

Here is the RXList link on Strattera: http://www.rxlist.com/cgi/generic/strattera.htm

And Wiki: http://en.wikipedia.org/wiki/Strattera


Good Luck!

I'm glad Ben has found a medication that works for him but the truth is that Stratterra (Atomoxetine) consistently rates as one of, if not the worse ADHD medication on the market. It has the highest side effect profile and is the least effective. Studies have shown that children who start on Strattera are 4.2 times more likely to switch to a stimulant medication and that number is believe to be much higher in adults.
I agree.

I am in the process of getting a formal ADHD diagnosis right now, but my psychiatrist put me on Adderall after our first 1 hr. appointment. I didn't really ask for any drug in particular-- I actually thought he might put me on a mood stabilizer (I've been on them before and they work). I also told him that I have bizarre reactions to SSRI's, so that could be the reason he prescribed Adderall. I started on 10 mg. 1X/day. After a week, I was at 10mg. 2X/day. That stopped working, so I take 20 mg. 2X/day. (I increased to the 20mg. twice daily slowly-- he told me to "double it" when I told him it did nothing, but I was more cautious).

I've just been taking it for 2 months, sure it takes about an hour from the time I take it for me to feel calmer and more focused. The only thing I notice when it "wears off" is that I get hyper and disorganized again, and I stop feeling as thirsty. For me, there's no crash-- I do not feel like I'm on speed or anything like that. I feel like I'm on speed when I don't take it! I skip at least one day a week with no ill effect whatsoever. My experience with ADHD meds is very limited, but I think that my doctor figured that a stimulant would be effective for me. I read that adderall works fairly well for people that have the hyperactive type of ADD. I'm sure that he noticed when I met with him, so that may be the reason he tried that first.

Good Luck! Hopefully your psychiatrist is decent and will do a good job of determining what med works for you.

ps. If you tell him/her that you don't have insurance, he/she might be more inclined to prescribe you a generic medicine (adderall IR is available generically-- I have insurance, but I know that the pharmacy where I get it charges $79.99 for 60 generic 20 mg. pills-- a small price to pay for functionality!)

I think the best thing to do is to discuss this with your doctor. See what he suggests...maybe it will fit with what you want to try. Then tell him what you would like to try. If it is a good doctor they will listen to you and if you have done the research and you would like to try an adhd drug to treat adhd then there should be no problem.

That being said, it is only a starting point. If you had to convince your doctor to let you try something and it turns out that it really doesn't help you at all, don't be afraid to go back and try another med.

If you only try one med you won't know if another one is more effective, you need a comparison...so feel free to work with your doctor and try a couple different types of meds...maybe stimulants work well for you...but maybe the non-stim meds will be even better, or maybe even no meds work well for you...you don't know until you try it :)

edit: just wanted to add that I tried adderall first...it worked great but the side effects were awful for me...now I'm on dex...which is doing pretty good, but not great...I am going to try strattera or another non-stim soon as I have never tried that type of med before and it is what my doc originally suggested before I told him I wanted to try adderall first.

I've been blessed to have a doc who has been very helpful at trying different meds and who respects my attempts to do research.
One of the things we tried along my path was using a combination of Strattera and a stimulant. This was after trying each separately at some point. I didnt find the combo any better than either separately. However, I hear it does work for some.
Doing both from the outset might be efficient in that you'll be feeling what, if any, effect you get from Adderall, while waiting for the Strattera to build in your system. Then, if you eliminated just the Adderall after 2-4 weeks, maybe the Strattera will be built up enough to let you know what it's gonna do for you.
Best luck to you.

I see nothing wrong with going in and asking for Adderall, it shouldn't make you look like a drug user. If people weren't supposed to ask, pharmaceuticals shouldn't advertise medications. Also, it's not like people live in a vacuum where they're not going to be exposed to this information in some form or another. Such as hearing from someone else that they have ADHD and take Adderall and it works great for them... that sort of thing. You really should not live in fear of coming off like a junkie by simply requesting what you believe will work for you. It's great you've taken initiative to research this for yourself and figure out your options.

Personally speaking, I opted for taking an amphetamine-based medication before I would take anything else. Amphetamines have been around for 120 years, they have by far the most research behind them, and we have a very well-developed understanding of how they work, what they do, and why. The unknowns here are minimal, so I feel safer and more confident with them than I would anything else.

Also, great post by GL GL.

I agree, the info for Adderall and other stimulants (particularly the LA forms like Concerta and Adderall XR) is readily available. I myself did my own research and offered my input to my doctor and he respected that.

I opted at first for Concerta and it worked great, until it gave me bipolar issues. I now take Dexedrine and all my choices were my choices and approved by my doctor.

For the record, when I so much as mentioned Strattera, he went :eyebrow: and told me that in his opinion, its a later choice option, since stimulants are proven and widely used and known to work.

Thanks for the well-worded reply GL GL. :)

For the record, when I so much as mentioned Strattera, he went :eyebrow: and told me that in his opinion, its a later choice option, since stimulants are proven and widely used and known to work.
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Mine said the same thing about stimulants and said he always employs them as the first line of defense in light of this. And apparently won't even bother prescribing Strattera, as he believes it unsafe and largely ineffectual.

Thanks for the responses everyone! I just got back from the Doctor and he started me off on Ritalin LA 20mg tablet. I believe Ritalin LA is the 12-hour formula. He said take one a day for the time being and if it's not working see him in a month. I feel like this is a long time to wait if it's not working when the problem could simply be I'm not getting enough of it. Also the Ritalin LA isn't available in the generic yet!!! I had to pay so much.

The Doctor wanted to send me off to be evaluated from a specialized place, but I told him I didn't have insurance right now and couldn't do that. So he said he'd start me off like this and see how it works. I understand starting off slowly, I just feel like 30 days is a long time to not have results.

Does anyone know if it's true that the more you weigh, typically the more Ritalin you'll need in order for it to take effect?

THANKS

Thanks for the responses everyone! I just got back from the Doctor and he started me off on Ritalin LA 20mg tablet. I believe Ritalin LA is the 12-hour formula. He said take one a day for the time being and if it's not working see him in a month. I feel like this is a long time to wait if it's not working when the problem could simply be I'm not getting enough of it. Also the Ritalin LA isn't available in the generic yet!!! I had to pay so much.

The Doctor wanted to send me off to be evaluated from a specialized place, but I told him I didn't have insurance right now and couldn't do that. So he said he'd start me off like this and see how it works. I understand starting off slowly, I just feel like 30 days is a long time to not have results.

Does anyone know if it's true that the more you weigh, typically the more Ritalin you'll need in order for it to take effect?

THANKS

30 days is a long time, yes. If it doesn't work after a week or so, call the office and his nurse can probably set you up with something else. That's usually how these things work in my experience. Hopefully it will work for you though and you won't have to go through this and blow another wad of cash on a new med. I know how being uninsured is a painfully sucky process when trying to get treatment for ADHD.

As far as weight and medications go... it's probably a factor. But there's a lot of things that influence medication effectiveness though. Your diet, your lifestyle, etc. Some people are just naturally more or less sensitive to certain things than another for no apparent reason. 20mg of Ritalin LA could effect someone who weighs 400 pounds 2X as much as it does someone who weighs 120.

Ritalin LA--isn't it a capsule containing spansules that release on a 50%-50% mechanism, lasting 8 hours max (supposedly)? The 12 hour (supposedly) form of methylphedidate is a tablet called Concerta.

If its the 50%-50% mechanism like I think it is, you will get 10mgs methylphenidate initially and then another 10mgs after 4 hours. Some people start off even smaller than that, and others start a bit higher, so it seems like a middle-of-the-road option, to me anyway.

Weight really does not determine dosing, degree of severity of symptoms typically does. I am a smallish female and took much more than many a large male, of several different meds. So its all in the relief required by the patient as far as I know.

Adderall and amphetamines are considered 'second line' nowadays - they only use them if non-stimulants don't work, and for good reason. Stimulants are almost 'outdated' nowadays - not quite yet, but almost -Hmmm.... I disagree with this. If stimulants were considered "second-line" and nearly "outdated," then why do these big drug companies (i.e. Shire) spend millions of dollars developing new ways of delivering stimulants that are proven to work? For example, the most recent I can think of being Daytrana (Ritalin patch) and Vyvanse (Long acting dextroamphetamine)...

:)

Just thought I'd add my personal experience as a side note for the OP.... During my first ever psychiatrist appointment (in 2004), he prescribed Adderall XR 20mg. I didn't request any drug and actually, I wasn't sure what he was going to do. I never had to do any extensive testing for ADHD, either. I believe in 2004, Adderall XR was (one of) the latest/newest stimulant meds out there. Luckily for me, I responded well to Adderall XR and didn't have to switch around. To this day, it is STILL my favorite med. I've added Adderall IRs as boosters and more recently had to try out Dex spansules and Dex IR because they have generic equivalents. I am without insurance right now and couldn't afford anymore Adderall XR. :( However, I take the original short acting Adderall at this time, 10mg 3 times daily, and it seems to be working out fine for me. :)

Good luck! :)

I'm on my eighth month of trying to find the right medication, and I'm pretty sure that it's Ritalin. No amount of research could have told me that or even narrowed it down. It's an expensive process, I know. If you're near a major university, you might try looking into whether they have a low-cost psychology clinic and medical center, which would probably save you a lot. Also, given that you don't have insurance, Ritalin LA is an expensive drug to be paying for out-of-pocket. Immediate-release methylphenidate would probably be a lot cheaper, and if you have a membership to Costco or Sam's, even cheaper.

The first drug I was prescribed was Adderall, which only made me anxious. Since then, I've been prescribed 2 other kids of stimulants with no complications. I'm pretty sure that if you present yourself in a way that shows that you're serious about treatment, there's no reason for a doctor to be skeptical. But I understand worrying about things like that. I certainly did before my first appointment.

As for Strattera, I know I'm not in the minority when I say that it felt like an SSRI antidepressant for me (it's an NRI). That wasn't a bad thing at all, because it was a very good AD for me, but it didn't do a lick for my ADD. In fact, because it got rid of the little anxiety I had, I wasn't as driven to complete tasks or take deadlines seriously. I don't know if everyone feels this way, but the sentiment that it acts as an antidepressant moreso than an ADD medicine is common.

Good luck with everything, and I hope that you can find a way to make this more affordable and effective!

Strattera felt more like an anti-depressant for me too. It completely killed my anxiety by making me apathetic about everything, so I no longer cared enough about anything to worry, and made me even less productive and less able to concentrate.

Now, the only options left are Ritalin and dextroamphetamine, since there's only 3 ADHD meds available in the UK. I think dextroamphetamine is more likely to work for me than Ritalin, since Ritalin increases norepinephrine more than it does dopamine, while the reverse is true of dextroamphetamine, and Strattera is a pure norepinephrine reuptake inhibitor, which didn't agree with me at all.

Actually Ritalin only blocks the re-uptake of norepenphrine for a very short amount if time (I've read 15 minutes per normal dose) and blocks dopamine re-uptake for hours. Dex will dump dopamine instead of preventing it's reuptake. That's a simple explanation but some people's dopamine "glands" arn't robust to begin with, so they won't do as well on Dex over time.
The other advantage of preventing re-uptake is that you may develop more nor. and dop. receptors and actually "cure" your ADHD to some degree, the same way anti-depressants can "cure" depression (for up to 10 years) for people with depression only.

Good Luck!

Actually Ritalin only blocks the re-uptake of norepenphrine for a very short amount if time (I've read 15 minutes per normal dose) and blocks dopamine re-uptake for hours. Dex will dump dopamine instead of preventing it's reuptake. That's a simple explanation but some people's dopamine "glands" arn't robust to begin with, so they won't do as well on Dex over time.
The other advantage of preventing re-uptake is that you may develop more nor. and dop. receptors and actually "cure" your ADHD to some degree, the same way anti-depressants can "cure" depression (for up to 10 years) for people with depression only.

Good Luck!

I thought Dex both dumped dopamine AND blocked reuptake? And did the same thing w/ norepinephrine as well.

The Doctor wanted to send me off to be evaluated from a specialized place, but I told him I didn't have insurance right now and couldn't do that. So he said he'd start me off like this and see how it works. I understand starting off slowly, I just feel like 30 days is a long time to not have results.

Does anyone know if it's true that the more you weigh, typically the more Ritalin you'll need in order for it to take effect?

THANKSI sympathize with your frustration. For lack of a better way to phrase it, it sucks to know that things could be better but still feel like you can't get there. I had a series of unfortunate exchanges with my insurance company & my local pharmacy this past spring. Consequently, I went three weeks without any meds. Like others, I cannot do my job unmedicated. By the end of the third week, I was so frustrated and so behind in my work that I called my pdoc in tears and asked for an IR ritalin script. This was two months ago, and things have been *so much better* since then. Hang in there, because you'll get there too.

You'll probably know whether it's working for you well before 30 days have passed. In fact, if you haven't noticed anything in a week, you might want to call your doctor and tell him that. I understand your concerns about medicaiton cost (and doctors' concerns about prescribing stims), but psychiatry is anything but an exact science. Be assertive -- it's your life, not your doc's!

To my knowledge, weight doesn't determine the effectiveness of stimulant doseages. I know that there are "optimal" doses of strattera in terms of mg/kg, but I don't think the same exists for stims. I could be wrong, though.

Some evidence if your a smoker that Ritalin should be your first choice. Especially if you have combined type ADHD. If your a non-smoker with inattentive type ADHD then
amphetamines might be best.

Some evidence if your a smoker that Ritalin should be your first choice. Especially if you have combined type ADHD. If your a non-smoker with inattentive type ADHD then
amphetamines might be best.can you elaborate on what you mean and how you came to these conclusions? also, what does smoking have to do with it? thanks

can you elaborate on what you mean and how you came to these conclusions? also, what does smoking have to do with it? thanks

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1474811

Most children with ADHD (perhaps as high as 90%; Barkley, 2001; Barkley et al., 1991; Milich et al., 2001; Weiss et al., 2003) respond positively to methylphenidate (Ritalin) and over two-thirds of such children respond positively to methylphenidate in moderate to high doses (Barkley, 2001; Barkley et al., 1991; Milich et al., 2001; Weiss et al., 2003). In contrast, a significant percentage of children with ADD are not helped by methylphenidate and those who are helped often do best at low doses (Barkley, 2001; Barkley et al., 1991; Milich et al., 2001; Weiss et al., 2003). Many individuals with ADD are helped by amphetamines, such as Adderall. There is considerable overlap in the mechanisms of action of methylphenidate and amphetamines, but there is a significant difference. Although both methylphenidate and amphetamines inhibit reuptake of dopamine and norepinephrine, only amphetamines also promote release of those neurotransmitters. Recent research also suggests that low doses of methylphenidate (the dosages likely to be efficacious in treating ADD) preferentially release norepinephrine in the rat brain (Ishimatsu, Kidani, Tsuda, & Akasu, 2002). Possible problems with the neural release of norepinephrine in ADD are relevant to motivational issues discussed later.

There is also some evidence for differential responsivity to nicotine. There are marked similarities in the neurobiological and psychological effects of nicotine and methylphenidate (e.g., Pomerleau, 1997). It has been hypothesized that individuals with ADHD who are not taking stimulant medication may try to self-medicate by smoking. Certainly, unmedicated adolescents with ADHD smoke far more than do their medicated ADHD peers and their non-ADHD peers (Whalen, Jamner, Henker, Gehricke, & King, 2003). Krause, Dresel, Krause, la Fougere, and Ackenheil (2003) report that individuals with ADHD are far more likely to smoke than are individuals with ADD: “It was striking how many of the 20- to 40-year-old patients in our group, who had shown symptoms of hyperactivity and impulsivity in childhood, were smokers: nine smoked and only three were non-smokers … The opposite was shown in the patients with only inattentive symptoms throughout their whole life: only two smoked, seven were non-smokers” (pp. 610–611; although note that Tercyak, Lerman, & Audrain, 2002, report the opposite).

Filipek, Semrud–Clikeman, Steingard, Renshaw, Kennedy, and Biederman (1997) report that individuals with ADHD who respond favorably to stimulant medication have the smallest caudate nuclei. There is now converging evidence for a primary disturbance in the striatum in children with ADHD. Both structural and functional neuroimaging studies report striatal abnormalities in children with ADHD. Structural magnetic resonance imaging studies consistently find smaller caudate volumes and reversed caudate asymmetry in those with ADHD (Aylward, Reiss, Reader, Singer, Brown, & Denckla, 1996; Castellanos, Elia, Kruesi, Gulotta, Mefford, Potter, Ritchie, & Rapoport, 1994; Castellanos et al., 1996; Filipek et al., 1997; Hynd, Hern, Novey, Eliopulos, Marshall, Gonzalez, & Voeller, 1993; Mataro, Garcia–Sanchez, Junque, Estevez–Gonzalez, & Pujol, 1997; Schrimsher, Billingsley, Jackson, & Moore, 2002), although the laterality of the differences and direction of left–right asymmetry have not always been consistent across studies. Functional neuroimaging studies report less striatal activity in ADHD children while they are performing response–inhibition tasks compared to age-matched controls (Durston, Tottenham, Thomas, Davidson, Eigsti, Yang, Ulug, & Casey, 2003; Lou, Hendriksen, & Bruhn, 1984; Lou, Hendriksen, Bruhn, Borner, & Nielsen, 1989; Teicher, Ito, Glod, & Barber, 1996; Vaidya, Austin, Kirkorian, Ridlehuber, Desmond, Glover, & Gabrieli, 1998; Zametkin, Liebenauer, Fitzgerald, King, Minkunas, Herscovitch, Yamada, & Cohen, 1993). Hyperactivity is more typically found after structural damage to the striatum than after structural damage to frontal cortex. Motor hyperactivity is not a prominent characteristic of frontal patients, although an impulsive, manic type of activity (such as marked verbosity) can sometimes be seen in frontal patients. In contrast, patients with Parkinson disease (where the primary disturbance is in the striatum) can show a kind of motor restlessness (called “akathisia”; Lang & Johnson, 1987).

Dopamine transporter (DAT) is the principal mechanism for reuptake of released dopamine. DAT is abundant in the striatum (Garris & Wightman 1994), where it is widely distributed and strategically located (Sesack, Hawrylak, Matus, Guido, & Levey, 1998). It is far less abundant and less well situated in the prefrontal cortex (Sanchez–Gonzalez & Cavada, 2003; Sesack et al., 1998). Hence, it plays a more important role in striatal function than in prefrontal function. DAT is the product of the DAT1 gene. Several studies report that commonly found polymorphisms in the DAT1 locus are associated with ADHD (Barr, Wigg, Bloom, Schachar, Tannock, Roberts, Malone, & Kennedy, 2000; Cook, Stein, Krasowski, Cox, Olkon, Kieffer, & Leventhal, 1995; Daly, Hawi, Fitzgerald, & Gill, 1999; Gill, Daly, Heron, Hawl, & Fitzgerald, 1997; Swanson et al., 2000; Waldman, Rowe, Abramowitz, Kozel, Mohr, Sherman, Cleveland, Sanders, Gard, & Stever, 1998). In a meta-analysis of 11 family-based studies, Cook (2000) found the association between the DAT1 gene and ADHD to be highly significant (p < .0001). It is important that levels of hyperactive–impulsive symptoms are correlated with the number of DAT1 high-risk alleles but levels of inattentive symptoms are not (Waldman et al., 1998). A role for polymorphisms of the DAT1 gene in ADHD is consistent with the centrality of the striatum in ADHD because DAT plays a particularly important role in the striatum. It is also consistent with the efficacy of methylphenidate in treating ADHD, because methylphenidate acts directly on DAT function (Dresel, Krause, LaFougere, Brinkbaumer, Kung, Hahn, & Tatsch, 2000; Seeman & Madras, 1998; Shenker, 1992; Volkow, Gur, Wang, Fowler, Moberg, Ding, Hitzemann, Smith, & Logan, 1998). Further, there is evidence that nicotine may act directly on DAT in a way similar to that of methylphenidate (Krause et al., 2003; Krause, Dresel, Krause, Kung, & Tatsch, 2000; Krause, Dresel, Krause, Kung, Tatsch, & Ackenheil, 2002). Indeed, DAT binding specifically in the striatum has been found to be related to motor hyperactivity but not to inattentive symptoms (Jucaite, Fernell, Halldin, Forssberg, & Farde, 2005).