http://www.news.com.au/dailytelegraph/story/0,22049,22133793-5006007,00.html

I know statistics can be manipulated very easily to fit the objectives of whoever is citing a story. Despite this, I am somwhat perturbed by this story. I am not concerned with the first set of stats, rather I am concerned that meds will lose all effectiveness after a few years. I am looking for specific insights from those of you who have been on meds for 3 years or more. Are you any better off than when unmedicated? I am completely objective, and have yet to form an opinion, simple feedback is what is in order. One more question: how does one respond to accusations to ADD/ADHD critics who contend that ADD was nonexistent as a disorder prior to the 1980's?

I don't take meds myself, but dd does. The article seems to imply that the stims CAUSED the behavior issues. I suggest it's just as likely the stimulants weren't as effective at controlling behavior issues as they should have been (perhaps because the children were older, heavier, more hormones, etc. and should have had a dosage adjustment) OR that the rates of potential to commit crime and abuse drugs were lower than they would have been if the kids hadn't been on stimulants. I wonder what the crime and drug use rates are for stimulant naive AD/HD kids compared to those on meds?

Here ya go, wifeandmom, an answer to one of your questions at least. :)

http://pediatrics.aappublications.org/cgi/content/abstract/111/1/179


Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature

<nobr>Timothy E. Wilens, MD^*^{,http://pediatrics.aappublications.org/math/Dagger.gif}</nobr>, <nobr>Stephen V. Faraone, PhD^*^{,http://pediatrics.aappublications.org/math/Dagger.gif}</nobr>, <nobr>Joseph Biederman, MD^*^{,http://pediatrics.aappublications.org/math/Dagger.gif}</nobr> and <nobr>Samantha Gunawardene, BS^*</nobr>



^* Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, Massachusetts
^{http://pediatrics.aappublications.org/math/Dagger.gif} Harvard Medical School, Boston, Massachusetts

<!--Reprint requests to (T.E.W.) Pediatric Psychopharmacology Clinic, ACC 725, Massachusetts General Hospital, Boston, MA 02114. E-mail: wilens{at}helix.mgh.harvard.edu<script type="text/javascript"><!-- var u = "wilens", d = "helix.mgh.harvard.edu"; document.getElementById("em0").innerHTML = '<a href="mailto:' + u + '@' + d + '">' + u + '@' + d + '<\/a>'//-->

--><!-- ABS --> Objective.Concerns exist that stimulant therapy of youths withattention-deficit/hyperactivity disorder (ADHD) may result inan increased risk for subsequent substance use disorders (SUD).We investigated all long-term studies in which pharmacologicallytreated and untreated youths with ADHD were examined for laterSUD outcomes.

Methods.A search of all available prospective and retrospectivestudies of children, adolescents, and adults with ADHD thathad information relating childhood exposure to stimulant therapyand later SUD outcome in adolescence or adulthood was conductedthrough PubMed supplemented with data from scientific presentations.Meta-analysis was used to evaluate the relationship betweenstimulant therapy and subsequent SUD in youths with ADHD ingeneral while addressing specifically differential effects onalcohol use disorders or drug use disorders and the potentialeffects of covariates.

Results.Six studies—2 with follow-up in adolescence and4 in young adulthood—were included and comprised 674 medicatedsubjects and 360 unmedicated subjects who were followed at least4 years. The pooled estimate of the odds ratio indicated a 1.9-foldreduction in risk for SUD in youths who were treated with stimulantscompared with youths who did not receive pharmacotherapy forADHD (z = 2.1; 95% confidence interval for odds ratio [OR]:1.1–3.6). We found similar reductions in risk for laterdrug and alcohol use disorders (z = 1.1). Studies that reportedfollow-up into adolescence showed a greater protective effecton the development of SUD (OR: 5.8) than studies that followedsubjects into adulthood (OR: 1.4). Additional analyses showedthat the results could not be accounted for by any single studyor by publication bias.

Conclusion.Our results suggest that stimulant therapy in childhoodis associated with a reduction in the risk for subsequent drugand alcohol use disorders.



Key Words: attention-deficit/hyperactivity disorder • substance use • pharmacotherapy

Abbreviations: ADHD, attention-deficit/hyperactivity disorder • SUD, substance use disorders • OR, odds ratio • POR, precision of the odds ratio • SN, standard normal deviate • CI, confidence interval



<hr>

Are you any better off than when unmedicated?Dude, I've been taking stimulant medication for over 15 years now, and I am way better off than I was when I was unmedicated. For example, I flunked out of high school and had to get my GED which then allowed me to go off to college like the rest of my peers. Once I got to college, I flunked out of there too after two semesters. Then at the age of 22 I was diagnosed and put on medication. It changed everything about the way I learn. Anyhoot, I eventually decided at the age of 33 to go back to college and see how I might be able to perform now that I am medicated. Well, I've been on the Dean's list every semester since (fall of 2003), and I am hoping to one day enter medical school. In a nut shell, I am way better off than I was when unmedicated.





One more question: how does one respond to accusations to ADD/ADHD critics who contend that ADD was nonexistent as a disorder prior to the 1980's? My response to people like that would be two fold. First I would probably ask them if they believe if gravity existed before it was discovered by Sir Isaac Newton? Secondly, I would likely explain the "hunter in a farmers world" theory. If you are not familiar with that theory, I would suggest doing a Google search on it, or you might check out this link: http://www.addforums.com/forums/showthread.php?t=1858&highlight=hunter+farmers+world+theory





In response to the article you posted a link to, I would have to say that from my experience it has been extremely important to take periodic breaks from my stimulant medication in order for it to work most effectively over the long haul. However, a break every 3 years? I'm not sure I agree with that per se. These days 3 years is just way too long for me Dude. Nowadays I take a break just about every weekend. Sometimes I might break for just a day, but more often than not it's for two days during the weekend. I used to never take breaks in the first few years of being on the medication, and I remember toward the end of those first few years that the medication seemed to have lost some of it's edge.

In those early days of being medicated, I rarely if ever missed a chance to take my dose(s) throughout each day, and looking back now I suspect the reason for that had a lot to do with me being so fascinated by how much more functional my brain seemed to operate while on the medication. Well, over the years the thrill of experiencing the "new me" has kind of faded somewhat, but the good news is that the "new me" is still around thanks to the medication still working like it should. That being said, I really do not think the medication would work that great for me anymore if I was to take it non-stop without a break for months at a time, not to mention 3 years at a time. I have actually taken the medication longer than that in the past without taking any breaks, but looking back on it now reminds me of other things I did in my youth as an attempt to be healthier, which in the end turned out to be almost counter productive for me.

PS I forgot to mention that I have also found it very beneficial to change up my medications from one stimulant to another stimulant every so often too. This is something that I typically do once a year or once every other year I guess, and it really has seemed to help keep things fresh for me.

nothing for me to add here, but great advice about changing medication every year.

Secondly, I would likely explain the "hunter in a farmers world" theory. If you are not familiar with that theory, I would suggest doing a Google search on it, or you might check out this link: http://www.addforums.com/forums/sho...rs+world+theory (showthread.php?t=1858&highlight=hunter+farmers+world+theory)C~F the rescue of those who might hate research :D :

The Hunter and Farmer Theory

Not too long ago, the typical traits of a person with ADHD were actually advantageous. People relied often on specific skills needed to bring home meat for the nourishment of the family. These skills are still valued today in hunter gatherer societies around the world. Fleetness of foot, although strong on sprinting and short on marathon running, ability to change course instantly, ability to make snap decisions, creativity in plotting the path of capture, ingenuity in devising traps, the ability to monitor the whole situation with global thinking skills, all contribute to a successful hunt. Successful hunters also have an extraordinary ability to hyper focus on the task at hand if it is extremely important or interesting. This is often a surprising fact for people who do not understand the full range of ADHD-like behaviors.

Imagine the type of individual who would have first explored and then settled this country 300 years ago. It was not only a strength but a necessity to make independent decisions using survival skills in the wilds. Driven by curiosity about an evolving world, a need for physical activity and large muscle activity, and an "every man for himself" mentality, the hunter type flourished. After the industrial revolution, the traditional classroom setting became all important to produce workers for factories with production lines and repetitive work. Suddenly, the need for novelty, individuality, creativity, and spontaneous movement and thought became not only secondary, but actually a handicap which exists today.

Just think for a moment and see if you can answer this question before proceeding. Where in today's society could someone such as Benjamin Franklin appear and feel perfectly at home? I would argue that it would be the traditional classroom, still flourishing across our land. The child sits in the seat and faces a teacher who stands at the front of the room and teaches in a lecture style of teaching. With public education aimed straight for the 50th percentile, many children who have ADHD are at one end of the bell curve, struggling to survive in a world too often devoted to repetitive worksheets, sitting still in a seat, listening to a teacher lecture at the front of the room. While the "farmer" type, who is not bothered by repetitive work, lack of novelty or physical movement, often manages just fine and comes out of the system with a decent education, there are many who fall off the assembly line because they learn differently. They are often smart, even gifted, but they must be taught in a different way.

People with ADHD have difficulty processing incoming information. There is often a strong deficit in the area of auditory processing. These folks often need to learn compensatory techniques to get the information into the brain, store it where it will be accessible, and then be able to retrieve the information and make it useable. This problem leads to serious deficits not only in the classroom, but often in the larger world. These techniques are known, but not generally available to our children who have such deficits. Simple strategies such as visual clues, i.e. the picture above can be a very effective compensatory technique to help get information into the brain where it will be effectively stored for later retrieval.

In spite of the difficulties, many people with ADHD go on to lead productive, full lives. Many hunters struggled to obtain even a rudimentary education in the traditional setting. Yet who can question the value of their individual contributions to the betterment of mankind? Such people as Thomas Edison, Benjamin Franklin, Ernest Hemingway, Albert Einstein were all failures at traditional schooling. (Click here to see Al at work.) (http://www.geocities.com/Athens/oracle/1580/images/einstein.gif)

Other famous hunters are listed at this site under a separate heading. Mr. Hartmann speculates that perhaps the high incidence of ADHD in our country may be linked to our founding fathers, by nature hunters, discoverers, and adventurers.

In order to be successful, the hunter type must be very selective about the field of work he or she chooses. Many hunters are very successful as airline pilots, policemen, investigators, trial lawyers, advertising executives, entrepreneurs, artists, actors, musicians. There is a strong correlation between ADHD and creativity. Also, because their attention wanders easily, hunters can often see a situation from several different directions, arriving and novel and unique problem solving solution. It is not unusual for such people to have a number of careers, sometimes simultaneously. After giving a talk on ADHD, one gentleman approached me and thanked me. He said he had always felt guilty about changing jobs, but after owning a successful business for quite awhile he felt tied down and bored. After hearing my reference to Mr. Hartmann's book, he decided on-the-spot (surprising? :-) to consult a therapist and work out what he really wanted to do next in the way of work. It is important for hunters not to measure themselves by the standards of a farmer society but by their strengths. It is important to choose a profession that showcases those strengths. At the same time, hunters need to realize they live in a farmer society. There are numerous opportunities for hunters to succeed. It is important to weigh the strengths and weaknesses and where the best fit will be in terms of fulfillment and success.

Hunters are often risk takers. Mr. Hartmann talks about the difference between linear problem solving and random problem solving. A vertical problem solver who finds a door that is stuck is likely to bang harder and harder on it, eventually kicking it in if necessary. The random problem solver is more likely to look for other ways, such as trying other doors or windows. The hunter would fall into the later category.

This theory of hunters and farmers is no means meant to put down or belittle the farmer temperament. If a hunter is smart, he or she will team up with a farmer. Farmers are superior at organizing, staying on track, performing all the tasks the hunter is weak at performing. They have important strengths necessary for many fields of endeavor. I think of certain wildly successful trial lawyers who have teams of farmers doing the meticulous research and footwork so necessary in such a field. At the same time, farmers need to recognize the tremendous strengths of the hunter, and value them from early childhood for their potential. They must teach them they way they learn, with methods which have been proven successful for children with ADHD. These strategies have proven successful for all children, not just those with disabilities.

Could this be a result of publication bias?

Either:
Begin the article with:
CHILDREN who use Ritalin for a long period of time could be more at risk of delinquency and substance abuse, a study has found.
Don't bother mentioning other studies.
Then close the article by mentioning a commercial, alternative therapy.

* * * * *

Or:


Results.Six studies
Additional analyses showedthat the results could not be accounted for by any single studyor by publication bias.

Conclusion.Our results suggest that stimulant therapy in childhoodis associated with a reduction in the risk for subsequent drugand alcohol use disorders.



* * * *
There's a choice.

I think I've been on Concerta for over a year, but I can tell you it is less effective and has gotten so progressively over time. This was exactly what I was afraid of. I did have the initial period when I started that everyone talks about where you feel great and it seems nothing can go wrong. That lasted for a few months, I believe, and then I stabilized at 72 mg. For a few months, it'd last for 9 hours a day. Then.. seven hours a day... then six, five, and it now lasts four hours a day IF I'm lucky.

I can really relate to what you are describing selby. In fact, that is what motivated me to start switching things up initially.
When that first happend to me I was taking Ritalin, and so what I did initially was to start trying out different generic versions of Ritalin each time I got a prescription filled to see if maybe the generics might perform better.

Since then, I have gone through the same ritual with all the stimulants (that had an available generic). I found that for me it was very worthwhile to do that, because I found some generics to be great performers, while others seemed like a rip off and waste of time.

Oh yeah? I did try switching to Adderall but it made me more tired, spacey and daydream more often. However, it gave me more capability to experience emotion (on Concerta I'm kind of an unfeeling zombie).

But what's more important--how you deal with family and friends or whether you succeed in school and work? It was a trade off for me but I picked Concerta. Yes, I'm short with people more often, quiet, withdrawn and ruminate all the time, and it kind of seems to be getting worse... but I have much better attendance and can actually get things done (sometimes).

I'm trying "natural cures" for the time being, I'm still on Concerta (I need those precious four hours in the morning..!) but the whole experience of going on a miracle medication only to have it work less and less has made me pretty depressed..

I can relate. I found Adderall to be very sedating. In fact, it made me feel like I had been hit with a tranquilizer dart. It's the only stimulant drug to ever cause me to experience the paradoxical reaction. I never really believed the paradoxical reaction to stimulants was a real thing until then.

For me, Concerta (or any other methylphenidate product) & Adderall were about as bad as it got concerning the prescription stimulants. The three that I found worked so much better, and were also much more therapeutic were Desoxyn, Dexedrine, and Focalin.

Each of those three drugs are each just single isomers. For example, Desoxyn is the dextromethamphetamine, or the right handed isomer of methamphetamine. Dexedrine is the dextroamphetamine, or the right handed isomer of amphetamine. Lastly, Focalin is the dexmethylphenidate, or the right handed isomer of methylphenidate. In each case, the right isomer of these three drugs is much more active in the central nervous system, and not so active in the peripheral nervous system.

In contrast, the left handed isomer (levo) is much more active in the peripheral nervous system (PNS), and not so active in the central nervous system (CNS).

CNS stimulation usually equates to things like increased attention span, focus, motivation, euphoria, etc. While PNS stimulation usually equates to things like increased heart rate, blood pressure, sweating, twitching, etc.

I have had much success by switching these drugs up over the year periodically, and I really do not think I would be where I am academically right now if I had not done that considering that this past Febuary was the 15th anniversary of starting these prescription stimulants. Like you said, things start off great in almost all cases (except Adderall for me), and then the effects would gradually get weaker and weaker over time.

Anyhoot, sorry to ramble on and on. I'm currently suffering from a bad case of insomnia, and I am very sleep deprived but unable to drift off at the moment. :o

http://www.news.com.au/dailytelegraph/story/0,22049,22133793-5006007,00.html

I know statistics can be manipulated very easily to fit the objectives of whoever is citing a story. Despite this, I am somwhat perturbed by this story. I am not concerned with the first set of stats, rather I am concerned that meds will lose all effectiveness after a few years. I am looking for specific insights from those of you who have been on meds for 3 years or more. Are you any better off than when unmedicated? I am completely objective, and have yet to form an opinion, simple feedback is what is in order. One more question: how does one respond to accusations to ADD/ADHD critics who contend that ADD was nonexistent as a disorder prior to the 1980's?As far as it not being a disorder prior to 1980 -- that's ridiculous -- they just called it something else. Back when I was a kid in the 60's it was called simply hyperactivity -- I was diagnosed with that and offered Ritalin; later it was changed to minimal brain damage; later still to minimal brain disorder; and then to Attention Deficit Disorder. This condition was first treated with stimulent mediction over 70 years ago.

As far as meds maintaining their effectiveness -- I don't know a definitive answer. The body has an amazing ability to compensate for what we regularly give it. I found with my meds that when I took med holiday's it was more effective, but it never totally stopped working either -- but I was on for less than 3 years.

Scattered

I'm trying "natural cures" for the time being, I'm still on Concerta (I need those precious four hours in the morning..!) but the whole experience of going on a miracle medication only to have it work less and less has made me pretty depressed..I ended up getting off medication because I developed facial tics. The funny thing was that I actually ended up doing better off meds. I'm not saying at all that the meds didn't work -- they did. My ADD symptoms were definately worse off meds, but I finally started taking responsibility for my ADD. In other words, I stopped hoping some medication would "fix" me. I started doing those things that could help me get better organized (a book called Mastering Your Adult ADHD by Spricy, etc was very helpful with practical solutions that have been research tested on ADDers); exercising daily; taking supplement that ADDers have been shown to be shy on (magnisium, zinc, Omega III's); attending to my spiritual needs, and getting more support from others. I'm actually in a better place now than I was on meds with these changes. The stimulents helped me focus, but made me pretty obsessive and I tended to hyperfocus on the computer or whatever and still didn't get much done.

Anyway, I just wanted to encourage you that there are other options even if the meds effectiveness dwindles. Exercise and some of the other things I mentioned can also help the meds work better.

Take care,
Scattered

Lars,
I am in no way implying that stimulants cannot be beneficial; obviously they can be. I simply believe that one must always question accepted beliefs, and be willing to objectively study the issue. My question to you Lars is how is your physical health after 15 years of stimulants? Do you have hypertension or other cardiovascular side effects while on the meds? Do you smoke tobacco or drink alcohol? If I may be so frank, what is your blood pressure, and have you ever had it taken while on the meds, as many people will not take the meds the day they have a doctors appointment. I respect your right to privacy, and you are obviously not obligated to answer this question. The reason I ask is that I never had any signs of hypertension until I had been on stimulants for a couple of years; prior to that my blood pressure was exceptionally healthy. I concede that this could be a case of mistaken causezation; maybe some other factor i.e. stress, etc., could have been the real culprit; however, I have a nagging suspicion that Adderall was the reason. Today many cardiologists contend that stimulant use could cause permanent hypertension. I wish I had a link for this, but it's true. Being a history major it is essential to have facts.

...as many people will not take the meds the day they have a doctors appointment.You're kidding? Why would anyone want to sabotage their health? That's like lying about how much you smoke.

Being a history major it is essential to have facts.This is a good point...of course, its also interesting what Lars himself is studying to be. :)

I for one will take my meds on the day of the test, and have objectively concluded that my blood pressure is about the same whether or not I take my meds. It is slightly high in the pre-hypertension stage when on the Adderall, but normal or slightly above normal when unmedicated; however the question remains as to whether the Adderall does raise blood pressure, and if so could it be permanent even when unmedicated for years? This is a legitimate concern that must be addressed.
As to your assertion about people lying on such things being comparable to lying about the amount one smokes, I would contend that one has to lie in order to survive in a for-profit uber alles medical system that puts profit over people. Sorry to get in a political diatribe, but it is essential to the point I'm trying to make. I'm actually very conservative, despite the name dude which is my favorite film, but if one watches the film "Sicko" and isn't disgusted by the state of for-profit health care in this county where corporate bigwigs would see someone die to increase profit for share holders in hmo's than one is not paying attention.
If one ever has ever had a high blood pressure reading or a common medical problem than one could be excluded from ever having private health insurance again under our current system, based on a so-called "pre-existing" conditon which does preclude the vast majority of Americans from receiving adequate medical care. By the way ADD is a preexisting condition.
The problem is the system: one has to lie in order to maintain health insurance. The HMO's will screw you over any way they can.

My question to you Lars is how is your physical health after 15 years of stimulants? I am healthier now in almost every respect, which by the way I do not attribute to my ADHD medication. It is the result of healthy choices, and some effort.




Do you have hypertension or other cardiovascular side effects while on the meds? Only when taking methylphenidate based drugs like Ritalin, Concerta, Methyln, etc.





Do you smoke tobacco or drink alcohol? I used to.





If I may be so frank, what is your blood pressure, and have you ever had it taken while on the meds, as many people will not take the meds the day they have a doctors appointment. Sorry, but I do not lie to my Dr, or try and decieve him like that. It's my health at stake, and since I have no insurance I want the best healthcare possible. My Dr takes my blood pressure each and every time I go in for a visit. I saw him one week ago today, in fact one week ago at this exact same time as I am writing this oddly enough. My blood pressure was 118/72. Additionally my Dr has me take an EKG at least once a year, and blood test about once every other year.






The reason I ask is that I never had any signs of hypertension until I had been on stimulants for a couple of years; prior to that my blood pressure was exceptionally healthy. I concede that this could be a case of mistaken causezation; maybe some other factor i.e. stress, etc., could have been the real culprit; however, I have a nagging suspicion that Adderall was the reason. That seems like a logical assumption about the Adderall. I have come to the conclusion that the racemic stimulants (Adderall, Ritalin, Concerta, Methylin) were not good for me. The incorporation of the levo isomer in each of these respective drugs seemed to be the culprit.

How can I be sure about this? Well, I can be sure because in each case I have been prescribed the single dextro isomer of these drugs (like Dexedrine, and Focalin), and in each case my response went from not good (with Adderall and Ritalin, Concerta, Methlyn), to about as good as it gets (with Dexedrine, and Focalin).






Today many cardiologists contend that stimulant use could cause permanent hypertension. I wish I had a link for this, but it's true. Being a history major it is essential to have facts. Simply saying "but it's true" means nothing without being able to support what it is you're saying is true. It's certainlly very convenient to do that. However, when something is true in the field of medicine, the facts are usually not very difficult to find support for something that is "true" as you claim. Especially in an era that allows the use of search engines like Google Scholar (just to name one), which usually takes just seconds to assemble the links to the facts you need. When you find a link to that "truth," I sure would love to read it.

PS BTW, we are not interested here at this forum in what cardiologist contend concerning stimulant abuse and permanent hypertension, because we at this forum are only interested in, and only discussing the therapeutic use of stimulants for treating our ADHD. Drug addicts take huge doses of stimulants compared to those of us who are taking them therapeutically.

First of all, I would like to concede that I think Lars is a very intelligent and articulate individual who I have enormous respect for. I am very glad that you have been able to obtain good results by switching up your medication from time to time

Simply saying "but it's true" means nothing without being able to support what it is you're saying is true. It's certainlly very convenient to do that. However, when something is true in the field of medicine, the facts are usually not very difficult to find support for something that is "true" as you claim. Especially in an era that allows the use of search engines like Google Scholar (just to name one), which usually takes just seconds to assemble the links to the facts you need. When you find a link to that "truth," I sure would love to read it.

Good, you caught me in a logical fallacy. I disagree with your assertion that it was, "very convenient to do that," I was simply advancing an alternative viewpoint, and have repeatedly asserted that I am absolutely objective regarding this question and simply believe that everyone should routinely question their beliefs and deeply held biases. Thank you for enlightening me about google scholar, but I can come up with a legitimate article, but unlike many on this forum, I have a life to lead, and that is not my primary concern in life right now.

PS BTW, we are not interested here at this forum in what cardiologist contend concerning stimulant abuse and permanent hypertension, because we at this forum are only interested in, and only discussing the therapeutic use of stimulants for treating our ADHD. Drug addicts take huge doses of stimulants compared to those of us who are taking them therapeutically.

On this statement you completely misconstrued me, I never stated anything about sitmulant abuse and the link between permanent hypertension, rather I stated stimulant use (yes, thereapeutic legitmately prescibed use), and the link between permanent hypertension. Read the original quote. Could not legitimate use also cause problems, you immediately assumed I was talking about abuse, which is not the case.

My overall concern is that those who wish to present a dissenting opinion are instantly ostrasized from the community, and I'm not even doing that, I'm simply sharing alternative points of view. Also, I found your posts somewhat condescending and arrogant, just because I don't know as much as you concerning stimulant meds doesn't mean I should be treated disrespectfully. I find a continual pattern of bullying and abuse thrust upon those who don't seem to hold the party line adequately, which will eventually alienate those who turn to this forum for information and are rebuffed.

<!-- / message --><!-- sig -->
__________________

First of all, I would like to concede that I think Lars is a very intelligent and articulate individual who I have enormous respect for. I am very glad that you have been able to obtain good results by switching up your medication from time to timeThanks Dude, I appreciate your kind words.





Simply saying "but it's true" means nothing without being able to support what it is you're saying is true. It's certainlly very convenient to do that. However, when something is true in the field of medicine, the facts are usually not very difficult to find support for something that is "true" as you claim. Especially in an era that allows the use of search engines like Google Scholar (just to name one), which usually takes just seconds to assemble the links to the facts you need. When you find a link to that "truth," I sure would love to read it.

Good, you caught me in a logical fallacy. I disagree with your assertion that it was, "very convenient to do that," I was simply advancing an alternative viewpoint, and have repeatedly asserted that I am absolutely objective regarding this question and simply believe that everyone should routinely question their beliefs and deeply held biases. I agree that everyone should routinely question their beliefs and deeply held biases very much. I've been doing that since I was diagnosed over 15 years ago on this issue.

Curiously, I am confused how someone can claim to be "somewhat perturbed," and then claim to be "completely objective" about the same thing as you proclaimed in your initial post. I always thought that the word "perturbed" was defined as "being thrown into a state of agitated confusion," and that the word "objective" was defined as "undistorted by emotion or personal bias." Based on the terminology you chose to use, I assumed you were somewhat perturbed more than you were objective since you created a thread concerning what it was that perturbed you in that article.

You asked for anyone with 3 plus years of experience to share their viewpoint, and that is what I was doing.





Thank you for enlightening me about google scholar, but I can come up with a legitimate article, but unlike many on this forum, I have a life to lead, and that is not my primary concern in life right now. You're welcome Dude.

I'm glad that you have a life to lead, but there's no need to use sarcasm concerning how you feel about other people here who are leading their lives differently than you. Every member of this site has a life to lead whether you believe that or not, and everyones time is precious, and sacred, just like yours is Dude. Some of the lives people here are leading are the lives of parents, some are the lives of students, some are the lives of teachers, some may be unemployed stoners sitting around laughing at the rest of us, etc, etc. You seem to think that having "a life to lead" means that you are too busy to be bothered with unimportant details like supporting a claim of "truth" with a source to back that "truth" up. Whether you want to admit it, or believe it, it's certainlly very convenient to claim a truth and not provide a source to substantiate it.

On a personal note, I would like to share something with you concerning the whole I have "a life to lead" thing. Based on the appearant sarcasm in that statement I am left to assume that you likely think that those who spend a lot of time providing sources to their claims here don't have "a life to lead" like you do. I find that line of thinking sad, but at the same token I can relate to that because there's a fairly big chunk of time from my past when I used to think along those very same lines. In fact, I used to say things like "my time is money" among other rediculous phrases in an effort to let others know that I was not going to allow them to "waste" my "valuable" time. I have since learned that my time is worth more to me than any amount of money in the whole world Dude, and I believe that everyone elses time is priceless too, including yours brother. Unfortunately most people (not all) come to this realization a little too late in life, like when they are on their deathbeds for example, and they suddenly realize that they would give any amount of money in the world for just one more day, or one more hour, or maybe even one more minute of their valuable time.

Here's a couple of quotes that I would like to share that struck a cord in me concerning my former egocentric beliefs of how I had "a life to lead" in comparison to others around me who I thought were wasting their time.

"Life is what happens to you when you're busy making other plans." ~John Lennon

"Time you enjoy wasting, was not wasted." ~John Lennon





PS BTW, we are not interested here at this forum in what cardiologist contend concerning stimulant abuse and permanent hypertension, because we at this forum are only interested in, and only discussing the therapeutic use of stimulants for treating our ADHD. Drug addicts take huge doses of stimulants compared to those of us who are taking them therapeutically.

On this statement you completely misconstrued me, I never stated anything about sitmulant abuse and the link between permanent hypertension, rather I stated stimulant use (yes, thereapeutic legitmately prescibed use), and the link between permanent hypertension. Read the original quote. Could not legitimate use also cause problems, you immediately assumed I was talking about abuse, which is not the case.I was not implying that you were stating that. However, what I was implying was that the "many cardiologists" that you claimed "contend that stimulant use could cause permanent hypertension" appear to be alluding to the link that exist between those who abuse these drugs, because the link to those who use these drugs therapeutically over the long term has yet to be clinically shown. That is not to say that their is not anectdotal evidence to support their claim, but the thing is, there is anectdotal evidence to support a host of claims surrounding these drugs (and most drugs for that matter) that have little to do with the way in which the majority of patients taking these drugs therapeutically respond to them.





My overall concern is that those who wish to present a dissenting opinion are instantly ostrasized from the community, and I'm not even doing that, I'm simply sharing alternative points of view. I'm sorry you feel that way Dude. Please try and consider that there might be those who have been questioning their deep held beliefs about this issue a little longer than you have been, and as a result they have heard claims like those presented in the article time and time again, only to find out that those claims are unable to be confirmed with clinical data, or if their is clinical data it turns out to be from short term studies, or to find out that the claims are simply referring to anectdotal evidence. There is certainlly clinical data involved with that research, however the part that gets a little fuzzy is when it pertains to the "long term."

What's odd about this misunderstanding we have here, is that if you read my response, I was much more in agreement with what the Dr's in that article were saying about taking a break from medication than I was opposed to what it was they were suggesting. In fact, I was saying that I felt that waiting 3 years before taking a break was too long to wait, for me. If I ever do achieve my goal of becomming a Dr, I will be sure to encourage all of my patients that are ever taking chronic doses of prescrition stimulants to take periodic breaks, because I know after 15+ years of taking these drugs that by doing that I actually help the way in which these drugs are able to do what they were intended to do, and that is provide me as much relief as possible from my ADHD symptoms.

Do I think that what works best for me will work best for everyone else? No, I don't. However, in the case of a patient taking voluntary periodic breaks from chronic stimulant therapy like I have done, I don't see (nor my Dr for that matter) how any harm can be done by doing that, however I can see (first hand) how much benefit can potentially be achieved by doing that.

The fact is I am not a Dr (obviously), and since I am not all I can do is share what has worked best for me over the years in the hopes that another person might consider talking to their Dr about the possibility of it helping them too. Maybe some might read or hear what I say about my experience and think that it's something that they would never want to even consider. That's ok too. I would never think of telling anyone else what they should or should not do concerning their prescription drug therapy (unless I was a Dr), but I often do encourage others to consider speaking to their Drs about this or that due to what has, or has not helped me over the years.





Also, I found your posts somewhat condescending and arrogant, just because I don't know as much as you concerning stimulant meds doesn't mean I should be treated disrespectfully. I apologize for anything I posted that might have allowed you to feel that way Dude, and I hope that you accept my apology. I am very sorry that my post came off in that light, and I will re-read them to see what it was that might have come off like that.

My intention was not to be condescending or arrogant. However, what I was intending to convey was that claims like these about these drugs are often times associated with anectdotal evidence, short term studies, and what is known to occur concerning the long term side effects with addicts who abuse these drugs. I would hope that you would consider forgiving me for anything I said that you did not take in the manner in which it was intended.

I am not perfect by any means, and I like most others here, have stong personal views about ADHD, and about what we know worked after years and years of trial and error. That being said, I will say that what works best for one person does not always work best for another person, so please know that I am not so extreme in my feelings about one medication over another, or whether medication is better than no medication. It boils down to the unique individual in question.





I find a continual pattern of bullying and abuse thrust upon those who don't seem to hold the party line adequately, which will eventually alienate those who turn to this forum for information and are rebuffed. I can appreciate what you're saying Dude, and I do want to thank you for taking the time needed to write this long post explaining how you feel about all of this. First I would like to say that this is the medications forum, and as such there are many who come here often who are very pro medication. That being said, I can see how one might recognize a pattern. However, I am not so sure about the bullying part, although I am not doubting your claim that you felt that you were bullied. I think what appears to be bullying is often times people wanting to know whether someone if referring to medical fact, or just ones opinion. A good example of this would be where you spoke about the "many cardiologists" who "contend that stimulant use could cause permanent hypertension." Then following that with, "I wish I had a link for this, but it's true." When someone says something is true, that strikes a cord in the hearts & minds of those who develop a deeper understanding of the scientific method.

Peace,

Lars

Thanks for the reply Lars. I am giving you ample warning that this post is going to be rambling, frequently swithing subjects, etc.

Like I have previously stated I am glad that you have benefited from changing medications when one has proved to be less than beneficial. Unfortunately for many of us, our doctors know little to nothing about ADD, and often persist in prescribing the same type of meds. Going even more radically, dare I state the hearasy that we are more informed than the average pdoc on issues of ADD, some certainly but not all. The cost of consulting a psychiatrist is often out of reach for many of us, and I have had some rather bad experiences with them. I would much rather go to a a regular doc who is somewhat liberal in their views, and trusts a well informed patient to suggest new ways of treating their illness, and is open and suggestive of that. In my opinion, which is anecdotal, far too many shrinks and pdocs have been interested in pushing their own medicines of choice (for whatever reason) and often leave the well educated patient out of the equation.
How did you finally find a doctor that would allow you to switch off meds and pursue your own strategies? I have a doctor who is pretty good, who I think would allow me to suggest alternatives and be open and receptive to them, but I have yet to bring up the adverse side effects of Adderall on social interaction and the occasional rapid heartbeat. I think there are better alternatives to Adderall out there, but how do you think I should bring it up with my doctor. After all, adderall after five years has definately been better than nothing at all, but in recent months, some side effects have increased not to an unbearable level, but definately uncomfortable, and I think something else would be better. I earnestly believe that many people would benefit enormously from switching off meds from time to time. It is such a simple solution, but it is easier said than done.

Lars wrote, Curiously, I am confused how someone can claim to be "somewhat perturbed," and then claim to be "completely objective" about the same thing as you proclaimed in your initial post. I always thought that the word "perturbed" was defined as "being thrown into a state of agitated confusion," and that the word "objective" was defined as "undistorted by emotion or personal bias." Based on the terminology you chose to use, I assumed you were somewhat perturbed more than you were objective since you created a thread concerning what it was that perturbed you in that article.

You got me there, I simply put up that story to elicit debate, as you and I both conced that one should question one's beliefs, and I believe that the article helped stimulate healthy debate. If we only put up articles that supported our own deeply held biases, than this forum would be boring. I maintain my objectivity.

Lars wrote I'm glad that you have a life to lead, but there's no need to use sarcasm concerning how you feel about other people here who are leading their lives differently than you. Every member of this site has a life to lead whether you believe that or not, and everyones time is precious, and sacred, just like yours is Dude. Some of the lives people here are leading are the lives of parents, some are the lives of students, some are the lives of teachers, some may be unemployed stoners sitting around laughing at the rest of us, etc, etc. You seem to think that having "a life to lead" means that you are too busy to be bothered with unimportant details like supporting a claim of "truth" with a source to back that "truth" up. Whether you want to admit it, or believe it, it's certainlly very convenient to claim a truth and not provide a source to substantiate it.

This forum is very beneficial and enlightening to me, as well as countless others, and I didn't mean to be sarcastic or rude. My point is that everything in life is good in moderation, and one should not spend all of one's time on the forums while excluding everything else.


I was not implying that you were stating that. However, what I was implying was that the "many cardiologists" that you claimed "contend that stimulant use could cause permanent hypertension" appear to be alluding to the link that exist between those who abuse these drugs, because the link to those who use these drugs therapeutically over the long term has yet to be clinically shown. That is not to say that their is not anectdotal evidence to support their claim, but the thing is, there is anectdotal evidence to support a host of claims surrounding these drugs (and most drugs for that matter) that have little to do with the way in which the majority of patients taking these drugs therapeutically respond to them.

I still think you misread my original quote, I saw the story on a television news program, the old media and don't have a link. Maybe the tv was biased when they asserted that, "many cardiologists feel," and than proceed to interview one guy.

I respect your objectivity and also believe that everyone should question their deeply held beliefs. I simply think that there are some on these forums who act somewhat dictatorial and seem to know everything, which could be dangerous if taken seriously by the uninformed public.

Please excuse the unlogical flow of this information, I'm tired, my meds wore off hours and hours ago, and I need to get some sleep. The last point I have to make is that imagine that everyone's words were taken at face value and used to scrutinize the individual. I have made some rather ignorant statements on these forums, but imagine if everyones words were used against them. I'm sure you, as well as nearly everyone on this forum has contradicted themselves at one time or another. A smart, free thinking individual is willing to admit that he doesn't have all the answers and flip-flops from time to time. Anyway, it is officially time to go to bed, and I probably forgot something, but thanks for taking the time to respond to a sleep-deprived contrarian, it is certainly not a waste of time!

How did you finally find a doctor that would allow you to switch off meds and pursue your own strategies? Well, actually I did not "finally find" my Dr, he was the first and only Dr I ever went to concerning this issue. I never realized how fortunate I was in that respect until I became a member here.

When he and I first crossed paths in 1992, he had just become a psychiatrist, and was not that much older than me. Being so fresh out of medical school, and psychiatric residency, he was very up to date on the current knowledge concerning this condition, and that combined with my quintescential ADD history, and sypmtoms probably made it a "match made in heaven" so to speak.

It saddens me that other people do not have the same experience with their Dr as I have had with mine. I can understand how that feels though. For example, in 1991 I herniated two lumbar disc in my lower back, and the pain was excrutiating. For about 6 weeks, I was unable to even walk to the bathroom or anywhere for that matter due to the intensisty of the pain.

I eventually had an MRI which confirmed the herniated disc as my diagnosis, and as such helped to outlined the different options available for the those Dr's treating me at that time. There were two surgeons that wanted to operate, and yet other Dr's who told me that surgery might not be the best option for me. Whether I chose this therapy, or that therapy did not matter nearly as much as the chronic pain I was having to live with every moment of my life until the proper therapy was found.

Well, this eventually led me to a Dr to try and get something for treating the pain. I went to see the Dr with my fresh MRI in hand, and I will never forget what I what happend next. After describing how none of the OTC pain relievers were helping me, this Dr prescribed me 800 mg tablets of Motrin. When I looked at the prescription, I immediately said, "I tried taking 800 mg of ibuprofen on my own already, and it did not help me at all." It was then that the Dr looked at me and yelled, "Well, I'm not going to prescribe you any narcotics mister!" She screamed that at me in a tone suggesting that the only reason I was there was for narcotics. Yet there I was barely able to walk due to the pain with a MRI in hand clearly showing the problem in my back.

Sorry to ramble on about that, but the reason I point that out is because it caused me to lose complete and total faith in all Drs at that point in my life. So, when 1992 roled around, and I was trying to find an answer to the ADD symptoms I was suffering from, I was convinced that it was a completely futile attempt on my part to try and get a Dr to help me for ADD. I remember describing this situation to my Dr, and telling him all about the situation from the previous year about how the other Dr assumed I was exhibiting drug seeking behavior instead of seeking legitimate pain relief. I went on to tell him (with a defeated attitude) that I saw little hope that he would believe me due to the fact that there is no way I can go get an MRI, or an X-ray to show him that there in my brain was ADD, so I assumed that since it was not something he could confirm the presence of in my brain there would be no way that he would prescribe me a stimulant drug.

His response was to say, "well, its not like I'm prescribing you a lifetime supply of Ritalin here ya know?" "This is just a one month supply, and its a very low dose at that." I almost cried due to the fact that I could not believe that he was actually willing to listen, and trust me as being sincere.

So I really do understand what its like to have a Dr that is not flexible concerning drugs that might actually help a patient very very much. One of my goals in wanting to become a Dr is the hope that I can maybe prevent another patient from going through that same mistrust that I experienced.






I still think you misread my original quote, I saw the story on a television news program, the old media and don't have a link. Maybe the tv was biased when they asserted that, "many cardiologists feel," and than proceed to interview one guy.

I respect your objectivity and also believe that everyone should question their deeply held beliefs. I simply think that there are some on these forums who act somewhat dictatorial and seem to know everything, which could be dangerous if taken seriously by the uninformed public. Sorry if I misread your original quote man.






Please excuse the unlogical flow of this information, I'm tired, my meds wore off hours and hours ago, and I need to get some sleep. I understand.






I'm sure you, as well as nearly everyone on this forum has contradicted themselves at one time or another. A smart, free thinking individual is willing to admit that he doesn't have all the answers and flip-flops from time to time. You are correct, I have contradicted myself at one time or another, and I suspect that most people have too.






Anyway, it is officially time to go to bed, and I probably forgot something, but thanks for taking the time to respond to a sleep-deprived contrarian, it is certainly not a waste of time! Thanks Dude, I appreciate you taking the time to respond as well.

I can relate. I found Adderall to be very sedating. In fact, it made me feel like I had been hit with a tranquilizer dart. It's the only stimulant drug to ever cause me to experience the paradoxical reaction. I never really believed the paradoxical reaction to stimulants was a real thing until then.

For me, Concerta (or any other methylphenidate product) & Adderall were about as bad as it got concerning the prescription stimulants. The three that I found worked so much better, and were also much more therapeutic were Desoxyn, Dexedrine, and Focalin.

Each of those three drugs are each just single isomers. For example, Desoxyn is the dextromethamphetamine, or the right handed isomer of methamphetamine. Dexedrine is the dextroamphetamine, or the right handed isomer of amphetamine. Lastly, Focalin is the dexmethylphenidate, or the right handed isomer of methylphenidate. In each case, the right isomer of these three drugs is much more active in the central nervous system, and not so active in the peripheral nervous system.

In contrast, the left handed isomer (levo) is much more active in the peripheral nervous system (PNS), and not so active in the central nervous system (CNS).

CNS stimulation usually equates to things like increased attention span, focus, motivation, euphoria, etc. While PNS stimulation usually equates to things like increased heart rate, blood pressure, sweating, twitching, etc.

I have had much success by switching these drugs up over the year periodically, and I really do not think I would be where I am academically right now if I had not done that considering that this past Febuary was the 15th anniversary of starting these prescription stimulants. Like you said, things start off great in almost all cases (except Adderall for me), and then the effects would gradually get weaker and weaker over time.

Anyhoot, sorry to ramble on and on. I'm currently suffering from a bad case of insomnia, and I am very sleep deprived but unable to drift off at the moment. :o
How did you like Dexedrine and Focalin? Which worked better? How did they work compared to Concerta? If you don't mind me asking. And, how often did you change up medications?

I ended up getting off medication because I developed facial tics. The funny thing was that I actually ended up doing better off meds. I'm not saying at all that the meds didn't work -- they did. My ADD symptoms were definately worse off meds, but I finally started taking responsibility for my ADD. In other words, I stopped hoping some medication would "fix" me. I started doing those things that could help me get better organized (a book called Mastering Your Adult ADHD by Spricy, etc was very helpful with practical solutions that have been research tested on ADDers); exercising daily; taking supplement that ADDers have been shown to be shy on (magnisium, zinc, Omega III's); attending to my spiritual needs, and getting more support from others. I'm actually in a better place now than I was on meds with these changes. The stimulents helped me focus, but made me pretty obsessive and I tended to hyperfocus on the computer or whatever and still didn't get much done.

Anyway, I just wanted to encourage you that there are other options even if the meds effectiveness dwindles. Exercise and some of the other things I mentioned can also help the meds work better.

Take care,
Scattered
I'm working my way to where you are -- it's been such a pain trying to eat right because I crave carbs and dairy and sugar, but I've been off all of them for a week and I can notice a change in my energy level. And I got my neurotransmitter and hormone levels tested so maybe I can adjust my diet accordingly. I really do hope one day that I can "function" off of meds without being a sloth.

"CNS stimulation usually equates to things like increased attention span, focus, motivation, euphoria, etc."

Wait -- which medicine does this? I want whatever one does. LOL!! I'm so spacey today. :(

How did you like Dexedrine and Focalin? I like them both very much.



Which worked better?I was only on Focalin one month so it's hard to say how it would work for me over the long haul, but considering how I responded to it I would say that the Focalin worked a little better for me than the Dexedrine.



How did they work compared to Concerta?They worked much better than Concerta for me. Less negative side effects, and more pisitive benefits.



And, how often did you change up medications? Whenver my Dr and I felt like it seemed like something which would be a good thing to do. Usually the idea to change up medications was initially based on me feeling like I needed a change after being on a given medication for at least 6 months to a year.

Wait -- which medicine does this? I want whatever one does. LOL!! I'm so spacey today. :(Unfortunately there is no single medication that does this for everyone. We each can and do respond differently to these drugs more often than not.

Until you try a drug for yourself you will never really know which drug will provide you what your looking for or not.

That being said, the medicines that provide me the most CNS stimulation were/are Desoxyn, Dexedrine, and Focalin.

In response to the original post about meds being beneficial after years of use...I have this to say.

I was on Ritalin for about 7 years. There seemed to be minimal reduction in their effectiveness...but there was enough to notice a drop. I switched to Concerta which seems to have been fairly consistent in effect until recently I notice that its effects wear off sooner.

There was a book I read by Dr. Amen on brain function (more than one) that explained it this way.
I'm paraphrasing:

Medications that treat ADHD help move neurotransmitter(s) from one area of the brain to the area where this neurotransmitter is deficient. The medication does NOT generate more neurotransmitters it just moves them around.

Therefore, over time these neurotransmitters can become depleted in your brain. When that happens the meds become less effective.

What I've found, after reading his books, is that there are supplements you can take, and diet and exercise changes you can make that help increase these neurotransmittters.

In fact, when I noticed the Concerta was falling short I started taking
L-Tyrosine as recommended in the book (based on my ADHD subtype and other stuff). The effectiveness improved and lasted longer.

Unfortunately, I ran out of the L-Tyrosine and just haven't remembered to go buy more....it's like I have ADD or something.

I really appreciate Lars for his posts in this thread, and others who are chiming in. Very spiriting.

Oops, old thread but I'm replying anyway...

My dad has taken methyphenidate for about 20 years, and it still works for him. He seems to switch a lot between flavors... Ritalin, then Concerta, then Metadate, then Ritalin again... not sure why (keep forgetting to ask).

I could be wrong, but believe he's tried Adderall and Strattera as well, but seems to come back to methylphenidate.

And he hasn't reported any decline in effectiveness to me. Again, I should ask him...

(The same molecule is exactly right for me, and I'm thinking my doc prescribed it because I told him that's what my dad was taking. I think I got really lucky to get the right med on the first try. Anyway, encouraging to think I might never have to switch.)

In response to the original post about meds being beneficial after years of use...I have this to say.

I was on Ritalin for about 7 years. There seemed to be minimal reduction in their effectiveness...but there was enough to notice a drop. I switched to Concerta which seems to have been fairly consistent in effect until recently I notice that its effects wear off sooner.

There was a book I read by Dr. Amen on brain function (more than one) that explained it this way.
I'm paraphrasing:

Medications that treat ADHD help move neurotransmitter(s) from one area of the brain to the area where this neurotransmitter is deficient. The medication does NOT generate more neurotransmitters it just moves them around.

Therefore, over time these neurotransmitters can become depleted in your brain. When that happens the meds become less effective.

What I've found, after reading his books, is that there are supplements you can take, and diet and exercise changes you can make that help increase these neurotransmittters.

In fact, when I noticed the Concerta was falling short I started taking
L-Tyrosine as recommended in the book (based on my ADHD subtype and other stuff). The effectiveness improved and lasted longer.

Unfortunately, I ran out of the L-Tyrosine and just haven't remembered to go buy more....it's like I have ADD or something.
That only worked very slightly for me. I took L-Tyrosine supplements for a while. I'm thinking I should just switch around the meds or something.

I could be wrong, but believe he's tried Adderall and Strattera as well, but seems to come back to methylphenidate.

And he hasn't reported any decline in effectiveness to me. Again, I should ask him...


Please do!!! :)