Hi - my first post here, figured I'd jump right into the fracas. =)

A few weeks ago I was officially diagnosed ADD (after an all-day-long testing session with a neuro-psychologist). This was definitely not a surprise to me.... although I still suspect there's something more going on than just ADD.

I have a question that I know can't actually be definitively answered but I'd be very grateful for shared insight and suggestions!!

The question is: how should I approach my primary care physician when I see her on Monday (in two days)? Bottom line is: I want to start meds NOW. I'm 41 years old. It's TIME!

I would like to go to this appointment armed with a specific medication to request, a suggestion for a starting dose AND a dose to work up to if necessary, along with an alternate (or two or three???) to try if the first one doesn't work. It'd also be great to know from you fine folks if there is any sort of guideline out there as to just how long to stay on one medication before concluding it doesn't work and switching to another. (I'm aware she may outright refuse to prescribe some of the stimulant meds, but for now I'd like to proceed as if she will.) Basically, I don't want to be my usual meek, afraid-of-authority figures self!!!!!!

There are a few caveats, though, that I'm thinking will affect everything:

1) She is a very, hmmmm, lackadaisical physician. I could go so far as to say negligent. Basically, if I don't arrive armed with information and a plan, and if I don't "push," then she doesn't do too much. (Yes, I need to change physicians - but she's who I have now and I just don't want to wait.)

2) I've been on a 20 year long + quest for relief of severe fatigue and sin the past 15 or so years I have been on just about every medication known to the ADD world --- ALL without any significant effect on the ADD symptoms! (sadly, all without any significant effect on the fatigue, either)
My guess is that actually treating ADD (rather than trying to use the meds off-list to treat fatigue) would involve different dosing amounts and schedules.

3) As an added bonus, I'm a veteran special education teacher - 15 years of intense experience with, guess what? Kids with behavior difficulties!! Needless to say, it's a whole other ball game when it's yourself you are attempting to diagnose and treat. =)

Any suggestions on what information to bring with me to my appointment?

For anyone who is interested (and is still with me at this point, after all my rambling, LOL) I'm including the list of medications that I've tried - along with the effects at the time.

Thank you in advance to anyone who would like to share ideas,
Rebs
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- Adderall is "too much" and I end up just flitting around focusing on everything - for about 3 seconds at a pop. Might have been on doses too high.

- Ritalin/concerta makes me feel I'm getting "kicked in the pants". I'm super-aware of everything but can't settle down to any semblance of concentration. Might have been on doses too high.

- Provigil causes me to be scatter-brained and hyper with no additional positive effects. (I have pills that are 200mg but I cut them into 8ths. Still too much!)

- Neurontin and other anti-convulsants helped considerably with the sleep issues but nothing for ADD

- Strattera (up to 120mg) was very helpful for the fatigue but not for ADD, and this only for a couple years - then all symptoms got much worse and I discontinued.

- Omega3 supplements are noticeably helpful, but in a very minimal way.

- A long, long list of various anti-depressants, none of which had effects on anything, neither fatigue nor ADD symptoms nor mood.

I found Adderall and Ritalin too powerful too, side effect wise. Sweats, headaches, headrushes, falling asleep upright when they wore off, yikes!

Ask to try Dexedrine. Tell them that you come to the Boards here and have read many posts by users concerning Dexedrine. It is quite 'mild and smooth', as my Doctor says.

Sorry for the late response but I wanted to thank you for your reply. When I approached the doctor with the possibility of dexedrine, desoxyn, etc., she replied that she has only prescribed ritalin, adderall, concerta, and stratterra. I got the "gut instinct" that if I wanted to try something outside of HER comfort zone, I'd have to go through the motions of trying something on her list first.

Okay by me, I know everything changes and who knows - what didn't work 8 years ago might work now.

Still, it would have been nice to potentially skip some of the trial-and-error! I'm thinking positively though - I have a doctor. She seems to be willing to work with me on this. I have decent insurance. Things could definitely be worse!

Thanks again - the dexedrine is the way I think I'll eventually need to go.

Rebs

Hey Rebs..a belated welcome :-)

Hey, thanks! I have only about a zillion questions/comments but I'm holding back for now, trying to do more reading and searching to see if those questions are out there already.

=)

Rebs,

You are 41. You say you have been dealing with this for 20 years.

For diagnosis, ADD has to start by age 6 (DSM criteria), IIRC.

I don't necessarily 'agree' with this age limit. (LOTS of inattentive types are missed in Childhood; exp FEMALES), but it is something to keep in mind when talking to your Doctor, Psychologists, etc.


It was probably there before you noticed all it's symptoms.

[Puberty and high school seem to bring 'hidden' Female ADDers' symptoms out moreso, too.]

It is considered to be neurodevelopmental.

(Although I've met a lot of people, esp. women with Fibromyalgia, who have some sort of ADD or [as they call it] "Fibrofog" -- going on!. And, I tend to think they deserve assessment (neuropsych testing) and a trial of meds as much as the next person. When our brains don't work, our lives don't work!)


If you want to try Dexedrine (for some reason, despite being MUCH milder than ADDERALL, it has a bad reputation), ask for a referral to a Psychiatrist who deals with Adult ADD.

The chain of prescribing seems to be: 'ritalin first', for some reason. Desoxyn, I have never seen prescribed. At least not here in Canada. It sounds like a drug of last resort.

I would first try telling your psychiatrist that you want to treat your ADD and tell her all the things you've tried first, and see what she says. If she tries to give you something you don't want, THEN I would push her for something else.

Nothing screams druggie more than a patient that comes in and says "Give me these pills."

As for Desoxyn, it is a drug of last resort as it's the most likely to be abused as it's basically methamphetamine.

http://www.askdrjones.com/2005/09/07/desoxyn-vs-adderall-and-dexedrine/

REBS--Welcome from another newbie!

I wasn't diagnosed til I was in my early fifties. I have been consulting with psychologists and or psychiatrists most of my life. I just "fired" one of the few psychologists in my area who performed all of the appropriate tests, and gave my psychiatrist the results.

I found my "shrink" after my wife (non-ADD) prodded me to seek help--she was observing some unexplainable ""stuff" that was happening, and kudos to her...in some ways I don't believe that I would be "here" if it weren't for her!

YOU are, or need to be (become) the point person and develop the best team possible to assist you. Since you describe your "doc" as docile (?) and will only prescribe those meds with which she is familiar...if I were in your shoes, I would go back to the neuro-psych who performed the tests and ask for a referral to the best psychiatrist who knows/understands ADD in your area. S/he would be the "prescriber" of meds after speaking with you about your history, present symptoms, etc. Ask that doc to refer you to the best psychologist who knows and understands ADD in your area.

You didn't indicate length of time on the listed meds/supplements, but it struck me that perhaps you had not been on anything long enough, or with appropriate professional guidance, interpretation, to have had appropriate/desired results. Example: while you mentioned Omega 3, I didn't see the mg or length of time taking it. In my case, mass doses (4000 mg) of omega 3 daily over the last 4 years has helped smooth out mood swings, helped in blood flow, and the mechanics of the heart.

Everyone on this forum is different, and if you don't find the correct team members that work in your best interests, you will not be able to make the progress that you are looking for.

When you do find the right team members for you, you will know it. The search may take awhile but it is well worth the effort!!

Dexedrine is more commonly prescribed in Cananda than in the United States. It's quite common for doctors not even to think about trying Dexedrine. It's also very common for it to take at least 3 trials of medication before finding the correct medication or medications.

Thanks SO much to all who replied!

I want to try to make some clarifications - was trying to be succinct but ended up only being brief!

The neuro-psychologist who recently assessed/diagnosed me is brand new to the area and explained that she was unable, at this time, to make recommendations.

It has been a very long haul to get this ADD diagnosis. The signs have been there since I was very young, no question about it. Up until now, since those symptoms were not alleviated by ADD meds (periodically prescribed in attempts to treat chronic/acute fatigue), I was told that I was therefore NOT a person with ADD. Frustrating! I was never successful in my requests for ADD testing and, frankly, was too weary to fight much.

As a side note - the fatigue symptoms I experienced from the age of about 8 on, inexplicably vanished about 4 - 5 years ago. No idea why, but I'm not complaining!

The medications I have taken (listed in my first post) were, to the best of my judgment, prescribed, titrated, and monitored correctly. (I am in the field of special education and have become familiar with appropriate medication management.) They were always prescribed by a psychiatrist, and/or neurologist, and/or a neuro-psychiatrist. Many of these medications were helpful to varying degrees with the fatigue but none of them affected the ADD symptoms that have always been present.

So now that I'm in a new state/new job, and was able to get a referral for the testing, and am correctly (I truly believe) diagnosed with ADD, I was hoping I could skip the expected "try this, try that, then try the other" steps. Because I HAVE tried them. Kept logs/journals (albeit sporadically) of any changes/benefits. TRUST ME, I'd have known if they had relieved the ADD symptoms.

My current doctor is not willing to refer me to anyone else, as she says she is comfortable prescribing the "big three". She is also very laid back tends not to be assertive in treating things. However, if I make a solid case she is generally amenable.

I will just have to keep plugging away, take the medications she offers, record my reactions, report back to her, and not give up. I live in a fairly rural area – and will continue to look for appropriate and qualified medical professionals.

Thanks again to all who responded!