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General Medication Discussion This section is to be used for general medication discussion and other medications not broken out in their own respective forums.

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Old 12-31-05, 02:41 PM
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Lightbulb Info: Dose & Effectiveness

I've been thinking about dosage/effectiveness lately, trying to assess my meds. Reading posts and posting last night in the Concerta forum got me thinking more. This morning I've been reading about meds in several books. Some of it was highlighted so I've read it before, but I think it makes more sense in some ways now that I've been trying meds.

Since a lot of us are new to meds and have similar questions about finding the right one and the right dose, I thought I'd post what I've found in case others find it helpful. I've tried to organize and chunk it for easier reading.

Disclaimer: Below is a limited amount of info (by no means exhaustive) pertaining to my current questions, your doctors, the books themselves or other resources have additional information you may want to check into.

Books referenced:
"Driven to Distraction" by Edward Hallowell and John Ratey
"Women With Attention Deficit Disorder" by Sari Solden
"Attention Deficit Disorder: The unfocused mind in children and adults" by Thomas E. Brown (2005).

Possible side effects (I've only tried 2 meds that I have info for):

Concerta:
The printout from my pharmacy lists possible side effects: "decreased appetite, stomach upset, difficulty falling asleep, headache, nervousness, or dizziness. If they continue or are bothersome, check with your doctor. Check with your Doctor as soon as possible if you experience vision changes or blurred vision, weight loss, or irregular heartbeat. Contact your Doctor immediately if you experience involuntary muscle movements, seizures, or changes in mood or personality."

Adderall:
The printout from the pharmacy lists: Side effects that may go away during treatment include dry mouth, unpleasant taste, upset stomach, nausea, diarrhea, loss of appetite, weight loss, constipation, nervousness, restleness, dizziness, or difficulty sleeping. If they continue or are bothersome, check with your doctor. Check with your doctor as soon as possible if you experience vomiting, stomach pain, fever, unusual weakness or tiredness, severe headaches, or change in sexual ability or desire. Contact your doctor immediately if you experience unusually fast heartbeat, mental/mood changes, blurred vision, uncontrolled muscle movements (e.g. tics, tremors), or chest pain.

On recognizing too high of a dose:
Brown (p 261-262) says it's important to notice if symptoms are during the "active" phase of the drug or during it's drop off to make sure it's not rebound. Too high dose may lead to: feeling wired, edgy or anxious (like drinking too much coffee), irritable, feeling very tired, sad, or "blunted" emotionally, serious, loss of usual "sparkle". Says that you should be able to be your "regular self". If tense, irritable or zombie like the dose should be reduced and if that doesn't help try a different med.

On finding right med/dosage:

Brown (253-255) states sometimes the first stimulant tried will work well with only minor adjustments, but often multiple adjustments are needed or the initial stimulant does not work at any dose or produces adverse effects so an alternative is tried. Sometimes stimulants don't work well and so non-stimulant meds are tried, but an ADD individual has an 80% chance of responding positively to one of the stimulants with careful fine-tuning. You can't really tell by age or body weight what will work best, more is not necessarily better, and some people need only a very small dose. On increasing the dose: He says it's preferred to start at a low dose and gradually increase allowing 3 to 7 days on current dose before going to a larger dose if the current dose is not producing an adequate response, only after checking weight and vital signs and side-effects.

Hallowell (p. 237 & 239-240) says finding the right med, dosage, and schedule can take weeks or months of trial and error, and it can seem tedious like trying on shoes, but suggest it's worth being patient and not giving up. Often an increase or a change in med will make a dramatic difference, or adding a med will help the first work better (such as an antidepressant or beta-blocker).

Solden (p. 183) says it's important to stay with a trial of med long enough to find out what the proper optimal dose without side effects is for you, and suggests keeping a diary to observe yourself and how the med affects you.

On Determining Effectiveness of your Med:

Hallowell (p. 240) says often the person taking the med will not be aware if it is working, but spouse, boss, friends, teachers may notice an improvement in focusing and productivity, so it helps to have the input of an additional person.

Solden (p. 183-184) says that some experience a positive dramatic result and know within a few hours the med is making a difference. But some may not feel dramatically different. "You may have to look back over a course of several months to see that your life has improved in significant ways. For instance, you may have accomplished more, you may have stayed on track, or your relationships may have improved. Some people may need input from others to check on their improvement."

Says women might notice they can fold clothes and put them in drawers, they can pick out clothes or go to a department store or grocery store without feeling overloaded/bombarded by stimuli and information. That meds don't increase your willpower but reduce some of the onslaught by helping you block and filter information.

Hallowell (p. 236) says to determine "target" symptoms (and try to be concrete when you define them) to help you assess how the med is working. Some to consider are: distractibility, staying focused (on a task, reading, homework, etc.), impulsive acts/words, attention during conversation, frustration tolerance, outbursts, mood swings, organization, procrastination, prioritization, worrying instead of acting, inner feeling of noise/chaos, hopping from topic to topic/project to project.

Hallowell says (p. 237) when med is effective it can: help a person focus better, sustain effort, reduce anxiety and frustration, reduce irritability and mood swings, increase efficiency because of increased concentration and decreased distraction, and can increase impulse control.

Brown (p. 262-263) says improvement of symptoms in someone more hyperactive or impulsive may be more obvious to others than inattention symptoms, but it should be noticeable to the patient when an effective dose is obtained. Changes might include: reduced distractibility, improved attention to task, better short-term memory, more effective completion of work, etc. A person may not feel different but may notice improvement in how they function (such as a student taking more detailed notes or getting more assigned reading done).

Solden (176-178, Hallowell 241-242 and Brown 269-270) notes that some need to be treated for depression along with ADD and that might require an additional med such as an antidepressant, and also that some women notice increased ADD symptoms and decreased med effectiveness during PMS, and it's good to be aware of that and pro-active.

I hope this is helpful to others out there with similar questions.
~~bythesea
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Old 12-31-05, 02:49 PM
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P.S. I hope the different colors aren't too distracting. I thought they might help people to focus on key points and break it up a little.
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Old 12-31-05, 04:44 PM
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The different colors made it easier for me to 'p****' a long post like this. I do it when I write, and it's probably not 'proper' from an editorial standpoint, but it DOES make it easier.
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Old 12-31-05, 04:45 PM
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haha.....is P A R S E a bad word???
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Old 11-01-10, 09:51 PM
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Re: Info: Dose & Effectiveness

thank you for your information bythesea!
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