Hi folks, first post but been a lurker for a while. Quick rundown. Im early 20's in college, m, 200lbs. Ive had ADD since birth, started Adderall and Ritalin back in late 90's. To many behavioral side effects so i stopped for several years and now Im back and need help to get through college. In the past year ive tried Adderall, Lexapro, Concerta, Paxil, and various vitamins/herbs to combat ADD and general anxiety. Im a terrible zoner and procrastinator. Concerta and Adderall do a decent job of getting me focused but they make my anxiety bad and they give me terrible stomach pains, especially when i work out. I drink plenty of fluids but my diet has been supressed obviously. So ive tried Paxil, lexapro, SJW, and 5-htp to combat the anxiety/loos of appetite but no success. SSRI are a nightmare for me so those are out. Adderall made me too angry so thats out. SJW seems to help some so ive stayed on that. I now take Concerta 36mg, SJW and my multivitamins.
So like i said, the concerta 36 works somewhat but not as well as i know it could. Ive been on it for over a couple months not much change. So should i try adjusting dosage or going with a new med? There are a lot more out now than i remember 10 years ago. I like the feeling of stimulants and they help a lot with my focus but the anxiety is bad and my appetite needs to come back. What do you guys think?

I suggest trying either focalin, or dextroamphetamine. These are probably less likely to make you anxious, but they will probably still kill your appetite. If your ADHD symptoms responded better to concerta, than try focalin. If they responded more to adderall, then try dex. If neither of these work, then desoxyn might be a good choice. It's just too bad that desoxyn is much more difficult to get, otherwise I would recommend trying it first.

If none of that works, then maybe add guanfacine with your existing stimulant treatment. This might help with the anxiety some.

From my own personal experience, I notice that a small amount of acetyl l carnitine and alpha lipoic acid to help bring be back to normal somewhat, and help with appetite. I've not heard much about others using them though for this purpose. You'd want to take these apart from the ADHD medication because they might interfere with absorption.

Well, i dont like the idea of amphetamines, aside from health factors, they make me angry. I have not heard anything about Focalin.
How does it work? Same as concerta?
I guess my plan now is to find a balance of a tolerable level of anxiety, some sort of appetite and obviously concentration. I assume going up in dosage of concerta would only make the side effects worse or create new side effects. And i know it wont help to go down. I cant use a SSRI or anti-anxiety med to kill the side effects so im left with trying to find the right dose of a single ADD med. Im sure its out there somewhere.

Focalin works the same way as concerta. The only difference, is that focalin has the "inactive" l-methylphenidate molecule removed, leaving only d-methylphenidate. I have tried ritalin, and I can say it made me quite anxious. Focalin doesn't do this for me.

Given how you seem to prefer concerta, then my first choice would be to try focalin. If that helps, but not enough, then you may want to add guanfacine.

Desoxyn appears to be generally the smoothest of all of the ADHD meds. This might even help combat anxiety. But, it is difficult to obtain (depending on your doctor). If you try focalin first, then you might "earn" the right to try desoxyn so to speak, as it would probably be considered more of a 2nd line treatment. Desoxn is dextromethamphetamine, so I think you get the idea of what your doctor is going to think.

If desoxyn is not an option, then I would proceed to dextroamphetamine, which also might help with anxiety. I have a slight anxeity problem, and dex really brings my anxiety down. Unfortunately for me, dex seems a bit too sedating, and I need something to pick up my mental energy level. I may try adderall for this purpose. Dex will likely have a different effect than adderall which is composed of dextroamphetamine sulfate, in addition to 3 other amphetamine salts.

Another option is effexor (venlafaxine). Amu_d has some interesting comments, and research posted here, though keep in mind that it is not approved for ADHD by the FDA:
List of ADHD Medications - On-label and Off-label #33 (http://www.addforums.com/forums/showpost.php?p=641467&postcount=33)

So in summary, here's exactly what I would try if I was in your situation; take it for what it's worth because I don't have as much information about you as your doctor:
1. Focalin, if too much anxiety, than add guanfacine
2. Desoxyn, if too much anxiety after trying 1.
3. Dextroamphetamine, if 2. is not an option. see how anxiety/anger compares to focalin, and possibly add guanfacine if needed
4. Effexor, might help treat both anxiety and ADHD
5. Strattera, I put this last because of your existing physical sides. But, this may be worth trying before 4.

Again though, this is purely what I would do given what information I have available, if I had your condition, and response to the meds you mentioned. I am not an ADHD specialist, nor a medical professional.

Hi,

Whenever I have stomache problems I tend to take several capsules of Psyllium Husks. I actually got the idea when trying out a low-carb diet. Taken in the morning/night or before meals, it will slow digestion too. Pretty cheap and worth trying IMO.

To add to the list mystery gave you, there's also Wellbutrin--a different kind of anti-depressant which has an effect on norepinephrine (like Effexor) but usually with less side-effects than Effexor.

-hth

Thanks a lot for the help guys. Im going in to ask about Focalin with the doc this week.
One weird question:
I was reading up on guanfacine for hypertenstion/anxiety and saw that it "reduces vascular tone." Does this mean my muscle veins will become less pronounced? Im VERY athletic and i like my tone. But if it curbs the anxiety I guess its worth it.

Hey Ampu,

Maybe this dosage will work for you. It gives me a longer period of efficacy,
less anxiety and I can make sure I eat well before the loss of appetite kicks in.

I take 45mg of Concerta by taking One pill of 18 mg then one pill of 27, or the other way around.
The 36mg didnt work well enough for me, and the 54 mg was too strong, then I found out on the net that others have tried splitting the dosage between two pills.

So in the morning, Either before or during my breakfast I take a pill of 27 or 18.
This gets me clear-headed in the morning and doesn't kill my appetite too much.
Then about 2 hours later, after starting work, I take the other pill.

This helps me keep the clear-minded-ness going for longer into the day, doesn't
suppress my appetite too much before my breakfast, and because I don't take all
45mg all at once, I don't get hit by a rush of anxiety.