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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 02-17-06, 03:42 AM
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Observations on the use of stimulant medications

Seeking treatment for ADD myself, I discovered this forum in an effort to better inform myself about medication treatments - particularly in regards to the stimulants, and primarily Adderall. What I’ve found in the posts here has been very informative and useful. I’ve summarized a few of my observations about stimulant medications, and have posted it below. Are my observations generally accurate? Or am I way off? Comments are most welcome.


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The postings on this forum paint a far more subtle and detailed picture of stimulant treatment than anything I’ve found in ADD books for general readers. Typically, in the treatment chapters of those books, a few cases are briefly described, and they often conclude with something like this: “After appropriate treatment, Susan was able to start putting her life together...” End of story.

I have no doubt that initially the treatment was effective, even highly effective. But I’m left to wonder about things like side effects, how long efficacy lasted, and if there were any consequences from long term use. The only place I’ve been able to find some sort of answer to these questions is on this forum.

Importantly, these forums are not biased against the use of stimulant medications. They’re openly discussed. This is not, for example, a forum where you’ll find strident anti psych-med advocates grinding their axe. (At least I haven’t run across this so far.) The postings on this website are first person accounts from the frontlines of treatment. They are, in short, the word on the street. As such, they are both believable and highly informative.

Remarkably, I’ve found way more red flags regarding stimulant meds on this website than anywhere else. This posting, by an addforum member named oracle, is an example of what I call a ‘red flag’ posting. http://www.addforums.com/forums/showthread.php?t=25496

Who could possibly read a post like oracle’s and not conclude that some kind of cellular damage has taken place (since her symptoms have increased when she doesn’t take the drug), and that, by remaining on the drug, damage continues to accrue?

It would be one thing if posts like her’s were rare or unusual - but this is not the case. I’ve read a number of other posts on this forum and elsewhere that describe similar experiences with stimulant medications. Here are a couple from this website:
http://www.addforums.com/forums/showthread.php?t=25490

http://www.addforums.com/forums/showthread.php?t=25152

Even when the experience with a stimulant medication (after a year or more of regular use) is more benign, you often see comments like “Overall, it’s been very helpful - but when I’m off the med, my symptoms are worse (less motivated, focused, etc.) than they were before I started treatment.”

Oracle’s experience (albeit considerably milder) has noticeable similarities to descriptions of meth abuse. This is hardly surprising if you spend a little time researching the amphetamines. Briefly: “Amphetamine, dextroamphetamine, methamphetamine, and their various salts are collectively referred to as amphetamines. In fact, their chemical properties and actions are so similar that even experienced users have difficulty knowing which drug they have taken.”

Meth abuse and its consequences have been extensively studied, of course. In an effort to learn more about the amphetamines, I've done a bit of research on meth. A standard description of meth abuse reads something like this: “...users experience a sense of euphoria, as well as increased energy, focus, (and) confidence... users require more and more of the drug to reproduce and maintain those feelings. ... With repeated use, methamphetamine robs users of their physical health, cognitive abilities, and their ability to experience pleasure.” Compare these statements regarding meth to posts like oracle’s, and you’d have to be blind not to see the similarities.

Amphetamines are like a high-octane fuel for the brain’s 'dopamine engines'. To produce their positive (or theraputic) effects, these drugs substantially rev these cellular 'engines', greatly increasing dopamine release. Repeated over-stimulation through chronic amphetamine use, however, causes the cellular structure involved in dopamine tranfer to degenerate.

“...research (has shown) that methamphetamine damages the nerve endings of brain cells containing dopamine, a chemical messenger that plays a role in movement and pleasure. ... The damage, which affects dopamine nerve endings located in the brain structures that make up the striatum, is similar to but less extensive than that caused by Parkinson's disease.”

Among the results (surprise, surprise):“...chronic doses of methamphetamine in drug abusers have been associated with increased impulsivity, and impairments in learning and attention.”

Because the actions of the various amphetamines on the dopamine transmission system are virtually identical, it’s not difficult to extrapolate from what is known about the consequences of chronic meth abuse, and apply it to long-term amphetamine use for the treatment of ADD. Though the symptoms of cellular degeneration are milder and slower to appear when dosage is regulated by a doctor, I find it difficult not to conclude that identical damage begins to occur. Posts like oracle’s - which describe the negative consequences of long term Adderal use - appear to corroborate this.

I don’t believe - not in the least - that doctors, psychiatrists, or even the drug companies are in on some kind of evil conspiracy to generate profits or get people to conform to regimented behavioral norms. (And I’ve read some eye-roll worthy theories along these lines.) I think that they really do have the best interests of their patients in mind and are using the best treatments currently available in an effort to alleviate symptoms.

However... what do you tell someone who is 24 - has been on Adderal for 5 or 6 years - is currently taking a far higher dose than originally prescribed in an effort to maintain any degree of efficacy - and yet the medication’s effectiveness continues to diminish? Continued drug therapy appears increasingly problematic, and likely to cease being effective altogether. And when the drug is stopped, the symptoms originally being treated have noticeably increased. At 24, the patient is worse off than they were prior to treatment, their treatment options have obviously decreased, and they’ve still got a lot of life yet to live. Do you tell them this?

“After 14 month of abstinence from the drug, users have regrown most of their damaged dopamine receptors; however, they showed no improvement in the cognitive abilities damaged by the drug. After more than a year's sobriety, former users still showed severe impairment in memory, judgment and motor coordination...”

Therapy - if it’s to be called that - should not involve damaging precisely those areas one is seeking to treat. It appears to me, however, that the use of stimulant medication runs the risk of doing just that.

Last edited by timh; 02-17-06 at 11:03 AM..
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Old 02-17-06, 05:35 AM
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I have a few comments:

1 Methamphetamine is not a drug for ADD. The very reason is the fear for addictiveness and maybe also the possibility of long term nerve damage.

2 It's too simple to say some medications are wrong. It really depends on what dosage you take. If you take a very overdose the risk of having bad side effects is high. But taking low doses should avoid this. Your research did not quote the med dosages that were used and caused damage to neurons. If you did that then we can compare these dosages to normal, therapeutic dosages.

3 AD(H)D is a very serious psychiatric disorder. I lived with it all my life. It has very profound effect on how I lived my life. You can't say meds are wonderfull, but someone with AD(H)D can profit very much from meds even if there are some side effects. Ofcourse you should stop medication if you experience severe tachycardia or any other bad side effect. Nobody asked you to risk your life to treat AD(H)D. Everybody is a different situation and what works well for one person may be a nightmare for another person. For one person adderall may be a "lifesaver", but for the other person it's a poison.

4 If you find a good, safe med then the benefits of it with treating AD(H)D are very good. But safety is more important ofcourse. That's why I don't use adderall, because I think it is much too potent. The combination of amphetamine and dextroamphetamine is too much for me I think.

5 Tolerance is something you are discribing (needing more meds to obtain the same result), but this does not always occur. For example with my usage of methylphenidate (not amphetamine/ dextroamphetamine) I don't get tolerance. But every person is different ofcourse. If somebody develops tolerance he should switch to another med or be off meds for a while.


Quote:
Therapy - if it’s to be called that - should not involve damaging precisely those areas one is seeking to treat. It appears to me, however, that the use of stimulant medication runs the risk of doing just that.
Then go to therapy! Hope it works better then meds...
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Old 02-17-06, 08:06 AM
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None of your links work, all that you say is suspect.
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Old 02-17-06, 09:21 AM
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Nice antipsych post there spoonbits. Be very careful what you read on the internet. Groups like Scientology have an axe to grind and have been proven wrong countless times. It can be done one more time if you wish.

For the record, therapeutic levels of stimulants have a long history of effective use for the treatment of ADHD. Stimulants are considered to one of the safest classes of drugs out there and also of the most effective. What more could you ask from a medication?
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Old 02-17-06, 11:55 AM
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I fixed the link issue in "spoonbits" post.

I don't think this post is a slam on the use of medication. Actually, I am glad "spoonbits" is doing research before making a decision to try medication as a treatment plan.

He has some good points, as well as, specific situations of people experiencing issues with medication usage.

Quote:
Therapy - if it’s to be called that - should not involve damaging precisely those areas one is seeking to treat. It appears to me, however, that the use of stimulant medication runs the risk of doing just that.
Based on the threads you posted your observation is very possible. But, also take into consideration these are only 2 or 3 instances out of thousands of posts and members of this forum. In no way am I down playing these individual's issues. They are real, very serious and I feel bad for them.

Any medication you take has a risk. Look at over-the-counter aspirin. In reality, it is a very dangerous medication that kills thousands of children and adults per year. It causes serious medical conditions that include bleading ulcers and strokes. Yet, we don't see anyone raising a fuss about getting it removed from the market.

The key is a combination of medication, therapy and self-improvement. While on the medication take steps to make positive changes and build processes. Make those processes into habits. Then when/if the time comes to reduce or stop the medication, those processes "may" stay.

I feel, many people view medication as the "magic pill" that can be used as a crutch. Medication should be use only as a tool.

Quote:
A standard description of meth abuse reads something like this: “...users experience a sense of euphoria, as well as increased energy, focus, (and) confidence... users require more and more of the drug to reproduce and maintain those feelings. ... With repeated use, methamphetamine robs users of their physical health, cognitive abilities, and their ability to experience pleasure.”
This is true. Most people report that they do not experience the euphoric feeling when taking a prescribed dose. I know I can take my prescribed dose and take a nap within 30 min. I do not speed up, I slow down. I feel good because of my improved self-esteem. I get stuff done, stay on track and not struggle to get my thoughts and ideas out of my head. I don't stumble when I talk, my numbers don't get reversed, I don't make careless mistakes and I don't get that "flooded" feeling mid-thought.

My son is in 2nd grade now. He was diagnosed in kindergarten. All of the signs were there. This was observed by us, his teacher, school psychologist and the doctor. His grades were a couple A's, mostly B's and S's. We started medication and he has completely turned around. He is a straight "A" student now. He is also reading at a 5th/6th grade level. We are also very in-tune with his behaviors and dispense his medication.

You have made some very legitimate observations, "spoonbits". Unfortunately, this topic has been brought up so many times in the past that it is a sore spot among the veterans. The veterans also have to remember there are a lot of people just starting their ADHD journey. Sorry to sound so "reality TV".
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Old 02-17-06, 02:14 PM
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Quote:
Remarkably, I’ve found way more red flags regarding stimulant meds on this website than anywhere else. This posting, by an addforum member named oracle, is an example of what I call a ‘red flag’ posting. http://www.addforums.com/forums/showthread.php?t=25496
REMEMBER: it is not the med that is bad, but it's how the person taking it uses it (and his doctor). For example, if one takes a overdose of a med he will suffer the consequences and he may even find himself in hospital, but if one monitors himself well he will most likely benefit from it. Treatment with meds for AD(H)D involves constantly looking for the best and safest med and dosage.

Maybe for oracle, adderall is not "his" med. But fortunately, he can use other meds and they may prove to be much better.
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Old 02-17-06, 04:52 PM
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Scientology just loves the personal story. "Man kills his pet after taking Ritalin", or something like that. They loath to use Science or any sort of statistical study, in fact they never do. This is why I'm highly suspicious of any post that draws general conclusions based on individual and personal observations. It is very dangerous to base any conclusion on your own personal observation or that of others. Yet, that is what TV has trained us do. We get sucked in and have an emotional reaction. "Isn't horrible that John lost a limb after taking prozac. How will he ever play football again"? Once we have an emotional response our thinking can easily become influenced and biased. Yet we as a society continue to draw unsupported conclusions. This is such a basic premise to avoid yet so few do it.
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Old 02-17-06, 05:00 PM
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Quote:
Originally Posted by spoonbits
...Who could possibly read a post like oracle’s and not conclude that some kind of cellular damage has taken place (since her symptoms have increased when she doesn’t take the drug), and that, by remaining on the drug, damage continues to accrue? ....
I could.
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Old 02-17-06, 05:03 PM
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Quote:
Originally Posted by spoonbits
....It would be one thing if posts like her’s were rare or unusual - but this is not the case. I’ve read a number of other posts on this forum and elsewhere that describe similar experiences with stimulant medications. Here are a couple from this website:
http://www.addforums.com/forums/showthread.php?t=25490

http://www.addforums.com/forums/showthread.php?t=25152

Even when the experience with a stimulant medication (after a year or more of regular use) is more benign, you often see comments like “Overall, it’s been very helpful - but when I’m off the med, my symptoms are worse (less motivated, focused, etc.) than they were before I started treatment.”....
Conclusions totally based on personal observation.
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Old 02-17-06, 05:11 PM
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And then the kicker. From personal observation of ADHD meds to making a direct connection to factual knowledge of meth abuse.

[quote=spoonbits]
...Meth abuse and its consequences have been extensively studied, of course. In an effort to learn more about the amphetamines, I've done a bit of research on meth. A standard description of meth abuse reads something like this: “...users experience a sense of euphoria, as well as increased energy, focus, (and) confidence... users require more and more of the drug to reproduce and maintain those feelings. ... With repeated use, methamphetamine robs users of their physical health, cognitive abilities, and their ability to experience pleasure.” Compare these statements regarding meth to posts like oracle’s, and you’d have to be blind not to see the similarities.


To factual and unfactual.
Quote:
Originally Posted by spoonbits
Amphetamines are like a high-octane fuel for the brain’s 'dopamine engines'. To produce their positive (or theraputic) effects, these drugs substantially rev these cellular 'engines', greatly increasing dopamine release. Repeated over-stimulation through chronic amphetamine use, however, causes the cellular structure involved in dopamine tranfer to degenerate.

“...research (has shown) that methamphetamine damages the nerve endings of brain cells containing dopamine, a chemical messenger that plays a role in movement and pleasure. ... The damage, which affects dopamine nerve endings located in the brain structures that make up the striatum, is similar to but less extensive than that caused by Parkinson's disease.”

Among the results (surprise, surprise):“...chronic doses of methamphetamine in drug abusers have been associated with increased impulsivity, and impairments in learning and attention.”
Quote:
Originally Posted by spoonbits
Because the actions of the various amphetamines on the dopamine transmission system are virtually identical, it’s not difficult to extrapolate from what is known about the consequences of chronic meth abuse, and apply it to long-term amphetamine use for the treatment of ADD.
Why would you even try to extrapolate? These are two different delivery systems and the dossages are not the same either. Try injecting 80% alcohol into your veins and see what happens.
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Old 02-17-06, 05:18 PM
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Quote:
Originally Posted by spoonbits
......I don’t believe - not in the least - that doctors, psychiatrists, or even the drug companies are in on some kind of evil conspiracy to generate profits or get people to conform to regimented behavioral norms. (And I’ve read some eye-roll worthy theories along these lines.) I think that they really do have the best interests of their patients in mind and are using the best treatments currently available in an effort to alleviate symptoms.....
What is really being said here?
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Old 02-17-06, 05:25 PM
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Quote:
Originally Posted by spoonbits
However... what do you tell someone who is 24 - has been on Adderal for 5 or 6 years - is currently taking a far higher dose than originally prescribed in an effort to maintain any degree of efficacy - and yet the medication’s effectiveness continues to diminish? Continued drug therapy appears increasingly problematic, and likely to cease being effective altogether. And when the drug is stopped, the symptoms originally being treated have noticeably increased. At 24, the patient is worse off than they were prior to treatment, their treatment options have obviously decreased, and they’ve still got a lot of life yet to live. Do you tell them this?

“After 14 month of abstinence from the drug, users have regrown most of their damaged dopamine receptors; however, they showed no improvement in the cognitive abilities damaged by the drug. After more than a year's sobriety, former users still showed severe impairment in memory, judgment and motor coordination...”

Therapy - if it’s to be called that - should not involve damaging precisely those areas one is seeking to treat. It appears to me, however, that the use of stimulant medication runs the risk of doing just that.
I reject all of the conclusions drawn in the final paragraphs.
http://www.addforums.com/forums/showthread.php?t=17742
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Old 02-17-06, 06:20 PM
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Exclamation

Quote:
I don’t believe - not in the least - that doctors, psychiatrists, or even the drug companies are in on some kind of evil conspiracy to generate profits or get people to conform to regimented behavioral norms. (And I’ve read some eye-roll worthy theories along these lines.) I think that they really do have the best interests of their patients in mind and are using the best treatments currently available in an effort to alleviate symptoms.
evil conspiracy? generate profits? get people to conform? :soapbox: :soapbox: that's GOEDE TIJDEN, SLECHTE TIJDEN or AS THE WORLD TURNS :soapbox: :soapbox: :soapbox:

Don't know where you read those theories.

I think you got brainwashed.
Are you brainwashed by watching too much soap or are you brainwashed by scientology?

Here a few advices:

Don't look too many soaps.

Don't read too much scientology stuff, you see what happens.

Don't think about evil conspiracies too much.

instructions how to get the "scientology" stuff out of your head:

http://members.aol.com/opsgreen/

Right now I am more worried about you than I am worried about adderall spoonbits.
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Old 02-17-06, 07:17 PM
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aaahhh I understand. I read some scientology. For a "scientologist" the world is "controlled" by psychiatrists who plan to control people throught psychiatric meds (brainwash) and then the only ones who can stop that from happening is them, the scientologists ofcourse.

And the CIA conducted experiments ultra secret "mind control". To control people's mind.

And eli lilly produces mind control meds together with CIA.

Get the point? (STATTERA)

Yeah it looks pretty stupid, but if you really believe in it and you read the stuff over and over you can become pretty much brainwashed.

So don't read it. Don't even look at it.
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Old 02-17-06, 11:33 PM
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Steven,

I think you missed the important word "don't" in the OP.


Scuro,

Chill, baby!


Spoonbits,

Interesting points, but my points have already been made by Tim & Scuro. However, let me just summarize it in a more direct way than Tim and a more *eHem!* tactful way than Scuro (no offense, friend).

Quote:
Who could possibly read a post like oracle’s and not conclude that some kind of cellular damage has taken place (since her symptoms have increased when she doesn’t take the drug), and that, by remaining on the drug, damage continues to accrue?
I'm sure you realize that anecdotal evidence does not produce reliable conclusions. These stories certainly illustrate what could happen, but so does the package insert that comes with the meds. We all know the risks. Fortunately, however, the piles of research that led to FDA approval demonstrates that benefits FAR outweigh those risks for the majority of ADDers.

I would certainly never prescribe Adderall to a patient with a heart condition or epilepsy, but that in no way indicates that it should not be prescribed to others.

Quote:
Meth abuse and its consequences have been extensively studied, of course. In an effort to learn more about the amphetamines, I've done a bit of research on meth. A standard description of meth abuse reads something like this: “...users experience a sense of euphoria, as well as increased energy, focus, (and) confidence... users require more and more of the drug to reproduce and maintain those feelings. ... With repeated use, methamphetamine robs users of their physical health, cognitive abilities, and their ability to experience pleasure.” Compare these statements regarding meth to posts like oracle’s, and you’d have to be blind not to see the similarities.
As both Tim & Scuro have pointed out, methamphetamine is not Adderall. Adderall clearly warns of the possibility of tolerance and, while tolerance is less likely for ADDers on a theraputic dose, it is possible. With respect to the possibility of addiction, these two amphetamines are similar in that they both carry a risk. With respect to nerve damage, however, they are NOT similar.

There is no evidence to my knowledge that Adderall causes nerve damage in even the highest theraputic doses. Just about any psychoactive med will in high enough doses, but of course that's not in question. If you have a credible source to support that your "extrapolation" is accurate, please post it. I'm sure we'd all benefit from this knowledge.

In the meantime, please know that your view is welcome by members such as myself. But, I will refute what the evidence disputes. If you can support your claim, I WILL look into those arguments and/or studies with an open mind. I don't want to harm myself any more than anyone else, but my current view, based on the literature, is that Adderall is safe when taken as prescribed.
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