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I'm wandering into unknown territory here, but I didn't see any threads that specifically dealt with this. My 7yo son has been dx'd with add, inattentive-type. We were given the choice of focalin or strattera. For various reasons we chose to try the strattera first. Now I come here and am reading that apparently strattera isn't very affective? Or at least I'm seeing that for adults. Does anyone have any experience on its effectiveness with kids? I'm also a little concerned (ped downplayed this s/e a bit) about weight loss? He's already in the 5th percentile, all my kids are very very slender (but healthy), weight loss would NOT be good.

I'm very confused, and there was a mountain of information discussed at the office today. I wish I would have thought to bring a tape recorder, now my addled seroquel-infused brain isn't remembering a whole lot. My husband was there, and absorbed the info, but now I'm just looking for some real-life answers.

Thanks.

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The side effects are worse, it can take months to get up to working doses and in most cases it does not work nearly as well. They keep trying to come up with new killer drugs for ADD but none of them ever work as well as the ones that have been around for over fifty years.

I liked focalin better than any of the other methyphenidate type stimulants but came back to Dexedrine because it just worked better for me.

There are two classes of stimulants and all the drugs inside them are pretty much the same btw. You've got amphetamine derivatives and you've got methylphenidate derivatives. Most people find one significantly better than the other. There isn't a whole lot of variation between the drugs of the same class. For the most part they are just the same drug reformulated with minor tweaks in order to keep patent coverage.

One main advantage of stimulants is that they come to full effect within an hour or so of having taken them so you don't have to waste weeks and months to find out if they are going to work. IMHO, this is a good reason to try them first. Plus, they have been used for over fifty years and are about as well studied as it gets.

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Well, I'll be honest, that wasn't what I had hoped to hear. It really was a toss-up between the two meds... and what the details are is that the pediatrician took a couple of days after the eval, and ultimately, in our last consultation, came to the conclusion that one of the two would be good for him. One of the reasons we chose strattera is its long life. It's not only school problems, but intense emotional problems after school, and there were concerns about giving him a stimulant too late in the day. Our concerns were pretty much from sun-up to sundown. Plus, like I mentioned, this kid CANNOT lose weight. We have a hard enough time getting him to eat, and then getting him to eat nutritionally.

I'm not trying to argue, just laying out some of the reasoning. I'm glad you posted, VE, you gave me a hard time about not getting him medical treatment. So, here I am, and we are now, and I just hate to think of putting him through the med-go-round. As we all know, it sucks.

thanks for your reply, that'll be a big help if we don't see results. He's starting sub-therapeutic level, then titrating up next week. What worries me is the timeline... if it takes months to sort this out and get to a right dosage, there goes 2nd grade. His grades are good, but it's a real battle to keep it there, and after school is a nightmare most days.

<sending info to husband, he might want to go ahead and switch now>

Thanks.

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"Everyone knows" that stimulants rev a person up, increase metabolism, and cause weight loss, and are highly addictive - because that's how they usually affect people who do not have ADHD.

However, it's uncommon for stimulants at a therapeutic dose to affect people with ADD the same way they do the rest of the population. If you do see someone with ADHD losing weight without trying, losing more of his appetite than he had before, etc. - then he's taking too much (and probably won't tell anyone after all the praise for getting better grades and conduct scores, not that anyone listens to kids and troublemakers)

Strattera's a real crapshot for ADHD and depression, because - like many other noradrenergics - it is most effective if started at well below the maintenance dose and only slowly increased if at all. Also, while ADHD can involve both noradrenaline and dopamine, Straterra can only affect the former, not the latter. Stimulants hit both, and so almost always work. Wellbutrin hits noradrenaline and also dopamine to a minor extent, so it can work when the others are too little, too much, or just not right (It does have its own dangers, but that's beside the point here, as it's more of a fall-back position.)

BTW, inattentive ADHD folks may not always need the same medication levels that their hyperactive and mixed siblings, cousins, and parents need in order to get by.

Unless there's an immediately compelling reason, start low, go slow. Most people on the receiving end really only want *just* enough to get their brains working effectively. More than that is almost always counterproductive.

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Thank you, NullO... again, another one to forward to my scientist husband, who should have from the start been all over this. It was until we found out - can't believe neither of us checked - that strattera AND focalin are on the "non-preferred" list for our insurance. The reasoning listed is that it's not proven to be effective. Then he started seriously looking at s/e, not just the crap on the PI, but real-life complaints, and wanted to immediately pull him off. After doing much research last night, at least on paper, it seems that concerta is the one we want to ask for first? Any experiences/thoughts on that?

I understand that too high of a dosage can result in stronger s/e, but it does still worry me that concerta lists that weight loss/blunted appetite is still listed as an initial side effect on low doses. Anyway, this is all being brought to the ped's attention... having cousins who were both reps for the big pharms, it really doesn't surprise me now that he would push something like that, I'm sure he was given many perks and kickbacks. I hate that we were given his interpretations of these meds in the office, and asked to make a choice at that time. Thank god we were given samples.

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I understand that too high of a dosage can result in stronger s/e, but it does still worry me that concerta lists that weight loss/blunted appetite is still listed as an initial side effect on low doses.

Once again, the catch with side effects is that the drug companies are expected to list all of the reported side effects, regardless of the population being reported on.

That does not mean that your kid will have them: for me, the PI sheet for Adderall reads like a bad joke - I'm not the only one here who gets a calmer mood and improved sleep from the stuff. And if I take it on an "empty" stomach (it's absorbed better that way) there'd better be food available half an hour later when it hits the bloodstream. Preferably doughnuts.

If your kid always has a stuffed up runny nose that seems more sensitive to the phases of the moon, weather, and other random input than real allergens and colds ... he might do better on Adderall. Otherwise, methylphenidate has a good track record for ADHD as well.

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That's interesting that you say that about stuffed up noses... he does. I don't think it's allergies; I grew up with those, and I don't see it. He gets very upset, not being able to sleep with it.

Adderall was another on the "non-preferred" list, but I don't remember the price. That could dictate a lot. It's not that we're not willing to spend the money on a drug that works... but with husband and I both on expensive name-brand drugs, I'd really like to keep it reasonable. "Non-preferred" means double the co-pay, $100/month, or $250 for 3 month supply. Still trying to figure that out, how the scripts work if it's a class II drug.

Heh, I remember when I first was offered zoloft. I looked at the PI sheet, and FREAKED. refused to take them, and of course sunk down into deep depression, and quickly didn't care what side effects would be. Ha, joke was on me, because it caused a heavy mania, which led to my dx as bp. I've quit caring about reading mine beforehand... I just wait to see how I react to it, and go from there.

Thanks,

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That's interesting that you say that about stuffed up noses... he does. I don't think it's allergies; I grew up with those, and I don't see it. He gets very upset, not being able to sleep with it.

Adderall was another on the "non-preferred" list, but I don't remember the price.

Not cheap out of pocket, even for the generic "amphetamine salt combo" but it's a very, very good decongestant even at lower doses. I've read that methylphenidate can have "dry mouth" as a side effect (many noradrenergic meds do) so it's possible to get some benefit anyway.

From what other people have reported, this is one class of medication for which it can make a big difference whether you're on the generic or the brand name medication, or on one specific stimulant or another. So try what's on-plan and generic first, then try the approved alternates.

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Hi Rabbit!

My son is on ritalin LA as well as clonidine for sleep. He had to repeat kindergarten, but he was one of the youngest in the class and had a first year teacher who was clueless. This year he has a great teacher, an improved IEP, and he is progressing well.

He did initially have a decreased appetite, but we fed him filling, nutritious foods such as oatmeal & now that really isn't an issue.

We saw the most results from being consistent and having a set routine. Structure is important, as is plenty of time outside (as you probably already know!) I had to organize his after school and weekend time to be like a camp- arts n crafts, sports (even indoor mini golf is good), water play (he LOVES the tub!) Of course he gets down time but if he has too much and isn't guided towards something to do...well, you can probably guess the result.

Good luck with his meds, we just got lucky that the first meds that were prescribed worked. By the way, where is your blog? I miss reading it.

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Hi Scatty!

Yesterday was so-so. He was very talkative and calm, which of course is good, but sometimes he's like that when it's just the two of us, so I don't know if that was an actual effect. I was a bit worried because a couple of times he said he didn't want to do anything, and looked confused... he didn't want to play, no legos, no playstation, no reading, or laying down and resting. It didn't last long tho. Physically, he complained of stomach pains all day. He's hard to feed, but I think even he realized that he needs to eat before taking it.

I undestand the need to structure... I keep a routine around here during the week, but I need to work onthe weekends a bit more.

Thanks for asking.

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I'm glad that you are really working on this at his age. I'm a teacher (and a med taking ADD-er) and I've seen kids that had a terrible time learning really be successful once they were put on meds. Of course, they also need parents and teachers that are willing to make the necessary environmental adaptations and are willing to teach the child coping strategies.

I know quite a few kids that have had issues with the weight loss, however, and Adderall knocked 10 lbs off of my weight, but for me that was a blessing.

I hope you have a lot of success.

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Hi Rabit!

my pdoc started me on Adderall last spring. When I hit the dosage just right, I would get quite calm and was able to concentrate wonderfully on my schoolwork. Unfortunately, I didn't do well with the ups and downs of 4 hour dosing. We went to extended release which was smoother but it had only about an 8 -9 hour effective range and then I crashed again. Not good for night classes.

I switched to Strattera and have been on it for about 8 months. It does give me just a little lift an hour or two after taking it (though my pdoc denies this is possible). It does help clear my sinuses! Yay. It is slow to kick in taking weeks to build up, I think. I don't get the laser focused concentration that Adderall can yield, but rather feel that it has lifted my tide and given me overall improvements. I wouldn't give it up. The only side effect that has sometimes affected me is a bit of dizzy headedness right after dosing, but that was tolerable and has improved after the first few months.

Good luck, a.m.

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Essentially you don't know what will work for whose system until you try.

Nothing works for my nephew EXCEPT a combo of Concerta and Wellbutrin SR.

Not Ritalin IR, NOT Adderall and definitely NOT Strattera.

(he said that Strattera slowed down his body but left his mind "whirring" and it made him paranoid as FUCK)

But that's my nephew and not everyone reacts the same way.

I know my nephew is unique and had to have this combo found for him while he was being stabilized in the hospital.

(he has SEVERE ADHD + bipolar)

It's a strange combo, but it's also the only thing that keeps him on an even keel.

ETA:

btw, my nephew is almost 15, is in the UPPER % for his weight/height after being in the lowest % for weight/height for most of his childhood. (he's 6' 0' and 163 lbs and STILL growing!)

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Thanks for the continuing replies! I'm so thankful that the teacher is so willing to help... she moved around the desks in the classroom, but she kept his desk by hers, giving him the reason <with a wink> that she liked him so much she wanted him to stay there. Yay for a kind teacher.

I can definitely tell when the concerta's wearing off, his mood goes to shit. We had a horrible meltdown this morning, I just keep wondering if there shouldn't be something else added. He's just so angry. After bouncing around on AD's, and continually be thrown into mania/mixed states, I've finally started lexapro myself, still on a low dose (10mg), and I swear, it's taken out a lot of anger. I feel calmer, yeah, a little more revved, but a gentle hypomania would be nice. So, I'm kinda wondering if there isn't a second med that could be worked in to help that with him. He's only been on concerta for a week, and his dosage may still need to be adjusted, so that comes first.

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  • 1 month later...

Just thought I'd toss out an update. We've pulled son off of concerta... the headaches were awful, and he had pain behind his eyes, all day, every day. Talked to the ped today, and he said we may as well just get out of the methylphenidate range, and move toward the dexetrine. So, he's starting dexedrine salts, 5mg to start, which he said IS sub-therapeutic, but at least we can see if there's any effect. I'm starting him on Saturday, so I can monitor him.

Oh, and the teacher had to periodically fill out the Vanderbilt form as well, and she commented this last time that any small improvements are now gone.

Same story... call him in two weeks, and see if dosage needs to be upped. I'm hoping we'll see more positive results this time. Damn, this poor kid was having a hell of a time with the headaches, I feel we gave him enough time for the s/e to subside, but they didn't waver. And then the nurse at the school reminds me that ibuprofen is hard on the liver and kidney. No, really? I thought the shit was candy.

Wish me... him, that is... luck.

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  • 1 month later...

I have no idea if anyone is interested in these updates, since they concern an 8yo, but I just spoke with his ped, and he feels like there's room for more improvement (still lots of 2's and 3's on the Vanderbilt forms), so he's upping the dose from 5mg to 10mg. I'm a *little* worried, because so far he's shown no side effects... no headaches or stomaches, and he sleeps - and falls asleep - just fine. I'm picking up the script this afternoon, so I can see what the effect is this weekend.

He *has* shown some improvements in the attention dept. And (um, not bragging... okay, yeah it is) he's been tested for screening for the gifted program.

Fingers crossed.

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  • 1 month later...

First of all, I'm not giving him "speed pills". Amphetamines hve a different reaction in children. He's not "cracked out"... man, wtf is your problem? I'm not just slapping some pills down his throat, you have no fucking idea of what we have been through, getting him diagnosed, and figuring out proper medication that would allow him to concentrate. I'm sorry, is concentrating a bad thing for you? Just because YOU failed horribly doesn't mean we're allowing our son to do the same. FYI, we've tapered his dose back down to sub-therapeutic levels, he concentrates well in class, participates, and comes out smiling.

You didn't medicate your add - severe add - and yet you didn't graduate til you were 22? I don't think I get your point.

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Seeing that you have bi-poler and ocd, your son is probablly genetically predisposed to those disorders too, and stimulants could activate those disorders.

While I think I've run across evidence to suggest inheritance in bipolar disorder, I do not recall seeing the same for OCD.

Moreover, I've seen no evidence whatsoever that stimulants "activate" OCD, nor have I seen any studies showing activation of bipolar disorder by stimulants used as prescribed for ADHD. Could you provide references to some of the studies that back up your concerns?

Still, the experience of several people on this board is that untreated ADHD tends to sabotage treatment for bipolar disorder and depression, while the judicious addition of an appropriate ADHD medication (not always a stimulant, BTW) can improve both sets of symptoms.

Having severe a.d.d. myself, I know it is very hard to concentrate on anything but id rather not be able to concentrate than be cracked out on speed.

The response of children and ADHD patients to stimulants is the primary basis for the term "paradoxical response." In some cases, activating ADs and stimulants at the wrong dosage can be dangerously (as in "do not drive or operate heavy machinery") sedating.

As to the "special ed" suggestion - in many schools, the "special ed" classes are geared to children with severe learning, development, or behavioral deficits. That is likely to be the *worst* learning environment for a student with controllable ADHD. Your experiences tend to confirm that.

FYI, we've tapered his dose back down to sub-therapeutic levels, he concentrates well in class, participates, and comes out smiling.

If that's the outcome, the dose isn't sub-therapeutic.

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If that's the outcome, the dose isn't sub-therapeutic.

You're so right. The change in attitude and behavior was significantly different between the two dosages. He's very thin to begin with, so the "sub"therapeutic might be stronger than for the average child.

As an aside, what I worried about most - it affecting his appetite - has been no problem. Eating doesn't particularly interest him, but it's been like that for years.

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Guest lostwhileracing

Hi

i wanted to ask how come you switched from Focalin VE? I tried adderall and it worked well but gave me heart palpitations. I am thinking of trying dexedrine because so far Ritalin and Focalin seem to not work as well. Focalin seems a bit better then the ritalin as I don't get tired as much but my mood sucks.

I have never had depression but i feel miserable and I am not sure if that is the cymbalta or the focalin or both.

i have anxiety which has a bit of the obsessive worrying/thinking and then new diagnosis of a BIG case of ADD.

The adderall made me have my energy back i lose when taking the ssri's or cfymbalta but the focalin xr at 15mg doesn't do that.

the pdoc doesn't want me to give up on the focalin yet as I am not having any terrible problems but I don't see staying on it is doing a ton of good either. I don't know how the adderall wasn't giving me the palpitations the first month I took it but then I was getting them along with the PVC, PAC beats and we tried adderall xr but of course no luck asey once I got to 15mg I believe they started cominng back. how is dexedrine for energy and the add?

If that's the outcome, the dose isn't sub-therapeutic.

You're so right. The change in attitude and behavior was significantly different between the two dosages. He's very thin to begin with, so the "sub"therapeutic might be stronger than for the average child.

As an aside, what I worried about most - it affecting his appetite - has been no problem. Eating doesn't particularly interest him, but it's been like that for years.

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