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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 05-07-05, 06:15 PM
sonowyatellme sonowyatellme is offline
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Asking for advice:Concerta, other stimulants, Strattera, airlines

Hello all,

I'm hoping that some of you might have some input for me. This is a pretty long post and I hope you'll bear with me. I've tried to break it down and make it readable and have put some main stuff in colors. There are lots of questions in here. If you've got any ideas and can help with any of them I'd appreciate it so much. I have appointments soon lined up with my docs, but those are expensive appointments and sometimes I think I go in there and blabber away the dollars without having a good plan. There's so much going on in my head right now that I can't quite sort it all out. Just writing this has helped. And maybe you guys will be able to see a forest while I'm in here examining the trees! Thanks in advance.

About six weeks ago I started taking Lexapro and was to introduce Concerta (36mg) 10 days later. The Lex initially knocked me out. I was completely unproductive for about two days and hated it. But I am glad that I stuck with it, because by about day 4 I definitely felt something. By one week I had noticeable effects and now I feel that it has evened things out a bit for me.

The trouble is the Concerta. A few days after starting the Lex, I left for a three-week trip with two friends and hadn't told anyone about meds. I guess I just wanted to feel like I could get a handle on things on my own--feel strong in my decisions to use meds so that I can support these decisions when discussing it--before others around me started offering me their skepticism or judgement. Here on the forums seems like the best place to discuss all this for now. So thanks for being here! So Concerta. Right. Back to the topic. I started it and it pretty much knocked me out. All I really wanted to do was to nap. And I really wasn't feeling much increase in clarity. So after 4 days of it I quit. It was ruining my trip.

When I got home I called the doc. Already had an appointment for one week later, but I told her of the fatigue and she said, "We'll discuss that further at your appointment. We may not have the right stimulant." Before I'd left for the trip she said the Lex would take a while to kick in but I'd know about the Concerta right away. As I thought about it later, I wasn't quite sure how to define "right away." And, when I picked up the Rx, the pharmacist had said, "This may make you drowsy until your body gets used to it." So decided that I hadn't given it a fair shake.

I went to my appointment with an open mind. I was willing to give Concerta another try as I didn't think that travelling was a good time for a controlled experiment. My doc confirmed that by "right away" she'd meant a week, so I said I'd go for it. Now in the meantime she says that if I decide that it really doesn't work we can go to Strattera. I should mention here that I'd overslept for the appointment (I think the Lex still makes me groggy upon waking despite its benefits...it's like when I awake my brain could instantly and easily return to sleepland...and that morning it just did ) and I was late and not necessarily as alert as I'd like to be for the appointment. So I did not ask, "What about another stimulant, like you'd mentioned on the phone?"

I don't know how to exactly support this, but I have spent many months browsing forums (much of that time here) and reading anecdotes. And for some reason the people whose stories I relate to the best have done well on and sung the praises of Adderall. And next in line Dexedrine. Not that this has any scientific basis for what would work for me, but I kind of thought going into it that Ritalin (which Concerta is the slow-realease form of) was not going to be the one for me. Maybe I've just poo-pooed it before even giving it a chance?

After my first evaluation with the doc, she just prescribed the Concerta, without discussing any other options. (I was referred to her by my psychologist, who is great, so she already had a little of my background). She also said in that first appointment that she had stopped prescribing Adderall because of the "risks" that had been reported. Now I have read a little about the reported deaths and am not sure that I am convinced of Adderall's risks. I have also read of so many people having great success with it.

As I write this I am on day 8 of the second go-around with Concerta. I won't say that I haven't had any benefit from it. There were a couple of days when I could notice (more like as an outside observer than internally if that makes sense) that I made decisions with a bit more ease. That I interacted a bit more and shared my ideas a bit more often with others. Yesterday was a pretty good day. I started my work day at 5:30 am and didn't take it until 8 am. I've found that as it wears off I am pretty much worthless and wanted a few hours to get some stuff done after work too. Work was pretty good, and I managed to get a Mother's Day package in the mail after work (yes, it will be late and I had planned for the previous three days to send it ), but that was really all I was able to accomplish after the work day. A couple of other little things I have noticed that disturbed me. Sometimes i can't find simple information in my brain that is usually there. One of the first days back on Concerta I had to hang up the phone before leaving someone a message because I realized I couldn't think of my own phone number. Another time I was playing Cranium and had to spell something backwards. I'm usually awesome at that but this time I was looking for the word in my brain and I couldn't picture it. And just yesterday I was relaying a story I'd just heard about Rush Limbaugh. I said "Lumbaugh," then said it again as a question because I knew it wasn't right. It's like I'm going to the filing cabinet in my brain that I am used to going to for these pieces of information...I look in there...and someone has taken the file!!! Anyone had anything like this?

So yes, as I sit here writing this on day 8 of Concerta I am in my room that is cluttered to the point of few footpaths. I have unpaid bills piling up, loads of laundry to do, the closet door fell off (it's easy to put back on, as soon as I can make a footpath to it ) and all I feel like doing is typing this out to you guys! I've got the Concerta headachetoday and I'm in a state of total lethargy. So I'm thinking it's not really working. Does that sound like a fair assessment? While it has on occasion given me the energy to be more quickly decisive and more interactive with others I don't think that it has done a darn thing for executive function tasks of prioritizing and not procrastinating. If anything, it seems that the lethargy/fatigue have made these things worse as all my non-work hours (and sometimes at work too) I'm just wiped out.

Is it possible that a change in dose would change things? Does anyone know if too much or too little can just make you tired? Have I given it enough time? Do the slight improvements indicate that with more time or a different dose I might do better?

And onto the next possibilities. I am wondering why Strattera is the next option. From things I've read it has made many people really sleepy initially. And others have gotten sleepy in about the third week. And it involves a gradual increase in dose. As you can imagine (remember the state of my room?) the last thing I need right now is another drug to make me tired. I've already fallen so behind in day-to-day tasks! The thought of this just makes me want to turn and run from the idea of meds altogether.

Here's one thing I'm considering. This doc does not really know me. On the phone she mentioned trying a different stimulant. At my appointment she suggests Strattera. Now, I have shared with her that an ex of mine was a heavy cocaine user. I also worked in an environment where this was fairly prevalent. I have never tried it. I have never had any interest in trying it. I talked with my ex til I was blue in the face and from every angle and with every strategy to try to talk him out of using it. Obviously talking to a user til you're blue in the face does not stop them from using it. Obviously he is very much an ex. Lives far far away from here. No communication. I don't work in that environment anymore. It's possible that my doc has the mental link from me to drug abuse and may not see past that at the moment. For this I am wondering if she chose to change her course of action to Strattera. Even at the end of the first appointment she emphasized that I was not to combine the Concerta with any other stimulant drugs, "...like don't use any cocaine." To me this was laughable. A given. I shrugged it off. Looking back I think now that it may be playing into her prescribing choices. Okay, so she doesn't believe in Adderall. Why would she skip over Dexedrine? What other stimulants might she have been referring to in the phone call?

There's another thing I'll mention here. And this is playing a big part in my desire to sort all this out sooner rather than later. I work as a flight attendant, though I have been furloughed (laid-off, but in this case by choice) for three years and was to remain off for another two years. I have just learned that I am being recalled early. I will return to flying in two and a half months. We are subject to random drug tests. My doc says as long as I have a prescription for whatever I'm fine. But I don't think it quite works like that. After multiple web searches the best I could come up with was that testing positive for amphetamines or methylphenidate would be followed up by contacting my physician. If they must contact my physician then all confidentiality goes out the window. The medical review officer of the test would then (if it was a drug which might be considered to affect performance in safety-related duties) question whether other alternatives had been considered. And without confidentiality, I don't know how the airlines view ADD to start with. Not sure that this wouldn't be a sort of "black mark" on my record. So for all this I am thinking Strattera could be a good choice. It's not a stimulant and should not affect a drug test. If it doesn't work (and it might take those two and a half months of dose increases to decide that) then moving to another stimulant might be justified and well-supported if the need to justify it ever arose (as in a drug test). Anyone know any other ADD airline employees? I can't find much info on this at all and how they handle it. This is another reason I don't want to stick with Concerta. Sometimes shifts are incredibly long hours. I could not deal with the comedown from Concerta that I am feeling these days and be in the middle of a workday.

So what this all boils down to, I guess, is this:
  • Is it time to ditch Concerta or just adjust it?
  • I'd like to try another stimulant next. It would take less time than Strattera to know the effectiveness. If it works, I might get some stuff done now, rather than just be falling asleep all the time. That's not really a question, is it? So how 'bout: does this sound like a good idea?
  • I am willing to try the Straterra, but not right now. If I can first discover a stimulant that works for me, then I think I could put it aside and try the Straterra. If Strattera works, fabulous! That's all the drug-testing angst put aside. If it doesn't and I have already found a stimulant that does, then I can immediately return to it and have the proof that alternatives have been tried to back it up in the event of a drug test. Whadya think?
  • Do you know any airline employees with ADD and how do they deal with it?
Thanks to all who have made the time to get through this. Reading all the posts here has been so helpful to me (encouraged me to consider medication in the first place) and everyone is so supportive that this is the place I turn to feel less isolated in this whole ADD experience. I have only told three people that I am pursuing this medication and they are all scattered in places far from here. So in my day-to-day life nobody really knows what's going on (except the docs...but that's different). So sometimes just the daily coping with the side effects and even deciding if the meds are working is proving a real challenge.

Ciao,
Sonowyatellme
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Old 05-07-05, 10:25 PM
sweetmama sweetmama is offline
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Whew, I cannot believe I read you whole post word for word but I did. (must be that dang Adderall) I have no idea about the flight attendant drug testing but I do know that ADD/ADHD is considered a mental disorder and is covered under the Americans with Disabilities Act. That said, I dont know if you would have a case being on amphetamines and doing this line of work. I recomend googling Disablity or Americans with Disability and finding out what you are up against, there has been research done on this in this site as well and you could search just this site with the word disability.
Totally honest, I havent tried Straterra but I havent heard alot of positive stuff about Straterra. You might try reading some posts under the Straterra section to get a better idea. As for Concerta, yes I would think that you would feel something alot more positive than you have felt. After going on AdderralXR 20 mg I feel like a new person, immediate positives. I have my bad days but in general preety good stuff. If your psych feels Adderall is dangerous she will probably feel that Dex. is as well. I would advise you to find a new psych, I know thats difficult but you might need someone more educated on the meds that help with ADD/ADHD. I had to switch Drs. a couple of times to find the right fit. Its a pain in the rear but it is wonderful when all works well.
I know this probably answered nothing you asked but I gave it a shot
Good Luck on your endeavors, I wish you the best.
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Old 05-08-05, 12:24 AM
sonowyatellme sonowyatellme is offline
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Hey Sweetmama,

Thanks! I know that took some slogging. Obviously that Adderall does way more for you than Concerta does for me! It's the end of day 8 now and all I wanted to do was nap. I think the Concerta has had its chance. Your reply helps me to confirm this. And you've given me some things to consider...like maybe the psych is not as experienced in ADD drugs as I need. And I'll do some research on the Americans with Disabilities Act. That's an angle I haven't tried yet. I really appreciate your help.
-Sonowyatellme
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Old 05-08-05, 03:00 AM
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Wheezie Wheezie is offline
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wow! reading your post was like visiting my own brain-in-action! we tend to think too much, i think....

the hardest part is trying to picture how a conversation is going to go. i tend to freeze when i'm verbalizing, so, maybe that's just me.

anyway, by adjust the concerta, do you mean adjust the dose?

i think i'm more fatigued when i take too much dexedrine. lately, when i take it, i take just 5mg of the short acting/ dose. ~ every 4 hours. it's worked better than 10mg and 7.5 might be ideal, but, splitting the pills is a pain.

this probably wouldn't help you much though because time-relesased pills are *not* supposed to be split. so, trying a lower dose would probably require a new prescription/visit with the p/doc, if a lower dose is even available....

i'm not familiar with concerta, but, you mentioned that it was the ritalin version of adderall.... from what i remember (take this with a grain of salt, my memory is fallible!) ritalin tends to be more effective when treating children and dexedrine more effective when treating adults. it'd be helpful if i could remember where i read that, eh?

is your p.doc cautious about adderall because *(s)he* is concerned, or might it be a reaction to her patients' concerns??? maybe letting her know that the Adderall scare doesn't concern you greatly may let her see that avenue as open??? might be worth a try anyway.

i took the same approach you did when "picking out" the med i wanted to try. it made sense in my head that if the people whose stories i could see myself in found something that worked for them, it might work for me too.

and i recognized not wanting to talk about it until i was more sure about it (in regards to discussing the meds thing with your friends while on your trip). i was very cautious about who i talked to about ADD dx and meds at first. still am, actually, just slightly less so as i gain confidence.

my p.doc (at the time, i've since switched ... long story) wanted to start me on strattera, but, because my insurance wouldn't cover strattera unless a stimulant wasn't effective first, he suggested adderall. i said i wanted to try dexedrine instead, mainly because i knew i could adjust the doses and find the right combination *for me*, dexedrine being a bit more flexible, i guess.... anyway, he never asked "why?" just mentioned he had samples for adderall, but, if i wanted to try dexedrine, that was fine. actually, now that i'm thinking about it, i had just started taking several other meds - all non-generic - and it was getting expensive because my co-pay is higher on the newer drugs. so, he did ask why and i told him i wanted to try a generic rather than a name brand because of the $$$ ....

right! so, not in the airline business.... can't help you out. glad you have a new lead to follow though.

another thought, hyperfocus can get kicked in when you start on stimulants. so, you might want to do a search on "hyperfocus" and "dexedrine" i know you'll hit some results with that, i suppose "ritalin" or "concerta" would be even more relevant, but, i'd think any stimulant would exacerbate hyperfocus ... could *very* possibly be wrong about that though!!!!!

anyway, there was more, but, i lost my train of thought, or maybe it de-railed.....

i look forward to reading more of your posts. this was fun for me!

take care,

wheezie
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Old 05-12-05, 01:26 AM
kgro555 kgro555 is offline
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Hey there,

I find it odd that they started you on a long acting stimulant at that dose when you had never tried anything in the past. Being in pharmacy school, they have taught us that for all drugs that have both a short acting and long acting form, you need to start with the short acting form so you can titrate to the dose you need. Once you figure out that you tolerate the medication well and get a total daily dose required, you start the long acting form.

So what I recommend to you at this point is to try the regular release methylphenidate (Ritalin). Maybe 36mg isn't the dose you need. If you have the regular release Ritalin, you can try 5mg 3x/day, then try 10mg in teh AM, and 5mg later on, etc. You will just have more control. The disadvantage is that you need to take it more then once a day, but it will allow you to experiment with doses (under doctors orders, of course).

Ok, thats all I have. Its 1:30am, and I should get to bed since its finals week. Good luck!

~KGro
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Old 05-12-05, 03:29 AM
sonowyatellme sonowyatellme is offline
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Hi to Wheezie and to Kgro555. Just want to say thanks for the replies.

Wheezie...glad you could relate to the kinda random thought patterns. And I appreciate that you understand the ways I felt like going about choosing an appropriate drug and my desire to pretty much keep it to myself at first.

Not feeling like getting into such an in-depth post this time..."Whew!" you all say after getting this far in the thread. I'm just tired of thinking about all of it, and I'm taking a few days to just live.

I did quit the Concerta. Haven't called the doc yet because I want to decide exactly what I'd like to propose before I do. Since quitting the Concerta I've felt like myself again. So yeah, still not getting much done, misplacing the keys several times at work, etc. I DID, however, get the closet door hung back up (and its not quite as easy as I'd remembered). And I've gotten back into working out for the last four days (something that had been put on hold for several weeks).

Kgro555...I agree completely with your thinking. Especially since I noticed glimmers of positive effects on the Concerta. When I first considered meds I expected that it would start with a shorter-acting stimulant. I also expected to have some say in the decision-making. I had done a fair amount of reading on the available meds and thought I was pretty well-informed, but then I didn't want to assume I was any expert when obviously that's the doc's role. So I took her words at face value. Her comment on the Concerta was that she liked it better because you only had to worry about it once a day.

But I'm with you, Kgro. If it means having some control over an appropriate dose then I've got no problem carrying around some pills and dealing with it throughout the day. At this point it's not like I'm gonna forget that I'm medicated and it's time for another pill considering when I take the Concerta it's at the forefront of my thoughts all day long.

Yeah, I'm not so sure about this doc's philosophies. She has a very booked schedule, but I'm suspecting that her ADD experience might be more with kids than with adults. This could explain just deciding on a prescription without getting so much patient input, as well as thinking that a once-a-day dose is more convenient. I like her and don't expect to look for anyone else just now, but I think I need to see if she can understand that I want to be much more involved in the decisions made for my own treatment.

I've also been reading up on Strattera threads I've seen that those with the most success have started on extremely low doses (i.e. 10mg) and gradually increased over the months. I've had a look at the Strattera samples she gave me and they are 40mg capsules. No splitting those! So 40mg of Strattera is definitely not going to be MY next course of action. So as I said, I want to have some feeling of what I do want before I get in touch with her again. I like your idea, Kgro, of trying regular Ritalin. As I said, the Concerta plan surprised me at first too. Wish now that I'd spoken up about it.

And Sweetmama, I've done a little investigating on Americans with Disabilities and haven't come up with anything concrete, yet, but it's got me thinking of some other angles to research.

Guess this post ended up a little longer than I was expecting. But thanks again all as you gradually help me to climb out of the trees and look back and see a forest there . And good luck with finals, Kgro!

Later,

-Sonow
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Old 05-12-05, 07:46 AM
jazzper jazzper is offline
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I'd just tell your doctor what your experience has been, what your employment situation is - and that you need to have all this worked out before you go back to work, and your concerns about the Concerta and Strattera. You might also mention this online community, mention how many people participate, what you've read about the various medications, and tell her you'd like to try the Adderall, and are willing to take the risk, esp. given the clear evidence that it's safer than the media has made it out to be.
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