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I'm not quite sure where to put this post... I know CB is a first person site, and I post pretty regularly about my own brain crap, but my main question is about my 15 yo son. He's just been officialy Dxd as having ADHD (which is like, duh, we've known it for years). He is also in therapy for some anxiety and depression issues. My bipolar disorder was very early onset (7 or 8), so of course I am worried that he might also be developing a mood disorder. Initially, we are going to be doing more organizational work with him, get him an IEP, and a daily coach at school, but if things aren't going well in about 5 or 6 weeks, we will be considering medication.

So here is the question-- if he has a developing mood disorder, which ADHD meds are least likely to exacerbate it? At one point, a shrink Dxd me as having ADHD and put me on Dexedrine-- it only took me about 6 doses before I was gone out of my mind manic for over three months, withOUT more Dexies. His aunt became psychotic on Adderall. He comes from a long line of coke heads... Um, yah, this whole thing freaks me out.

The pdoc we saw said that she wouldn't recommend Strattera initially because it needs to be used daily, and she would prefer that we start him with something PRN.

Thanks!

Oh, funny side note-- we had been trying to figure out how to get him more quiet study time at school, and when he would be able to meet with his coach, but there just wasn't any time during the day. Then he conveniently broke his leg and got moved from gym to a study hall where the kids with IEPs go! :)

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Any doc who thinks that an ADD person shouldn't take stimulants every day doesn't understand how crippling ADHD can be and what a relief stimulants can be. I live in a total confused haze without stimulants and the idea that there are some days that I should be denied mental clarity seems cruel. Stimulants aren't addictive, but once you realize how much better you can function on them you realize how much being off them sucks. Without them simple things like fixing a meal for myself without fucking something up is difficult. Communication is difficult. Socializing is difficult.

Anyone with ADHD should have the right to use their brain for as much of their waking time as possible. It's cruel to withhold that.

If anti-depressants were short acting would it be advised that some people only take them when they need them, or take drug holidays on weekends when they can be afford to be miserable?

I was going to recommend strattera because it has the least chance of inducing mania.

There's also intuniv, a relatively new med that should have no chance of inducing mania.

If any drug is going to induce mania it's going to be a stimulant and it's going to do it pretty quickly. Taking weekends off or taking it only when needed won't stop that. If you want to avoid the mania risk, drugs like Strattera are exactly what you need to be looking at.

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My son also has the risk of co-morbid mood problems but we keep him at a very low dose of concerta (18 mg daily). He does extremely well on it.

You absolutely and positively need to treat the ADHD if it's making the kid miserable. If mood problems surface or develop, treat them then...

I don't see a huge problem starting with a stim (it hasn't activated my kiddo at all) but I do think that strattera and intuiv are rational, reasonable options and your pdoc for your son shouldn't be ruling anything out at this point without knowing what and which meds your son is likely to respond to.

the problem with strattera more than anything is that it simply isn't that effective for many people with ADHD, so it may not be your best option in that realm.

I am BP and get manic as fuck, and have been taking provigil for years with absolutely no ill effects on the right mood stabilizers so it genuinely can be done. I've been on adderall too, which I did not like for a variety of reasons, but which also did not make me manic. plenty of people with comorbidity are treated for both, and do very well.

Anna

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Any doc who thinks that an ADD person shouldn't take stimulants every day doesn't understand how crippling ADHD can be and what a relief stimulants can be. I live in a total confused haze without stimulants and the idea that there are some days that I should be denied mental clarity seems cruel. Stimulants aren't addictive, but once you realize how much better you can function on them you realize how much being off them sucks. Without them simple things like fixing a meal for myself without fucking something up is difficult. Communication is difficult. Socializing is difficult.

Anyone with ADHD should have the right to use their brain for as much of their waking time as possible. It's cruel to withhold that.

If anti-depressants were short acting would it be advised that some people only take them when they need them, or take drug holidays on weekends when they can be afford to be miserable?

I was going to recommend strattera because it has the least chance of inducing mania.

There's also intuniv, a relatively new med that should have no chance of inducing mania.

If any drug is going to induce mania it's going to be a stimulant and it's going to do it pretty quickly. Taking weekends off or taking it only when needed won't stop that. If you want to avoid the mania risk, drugs like Strattera are exactly what you need to be looking at.

I agree with most of what you're saying here, although, I do think stims can be addictive, for some people, in some situations. And I can't agree that straterra's the least likely to cause mania, both because of my own experience, and because of the dearth of research.

As bad as ADHD is for many, it isn't that bad for everyone. For you, or for me, the idea of PRN meds wouldn't work. But for some people, it does. It's not unreasonable to want to consider that option when beginning treatment.

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My kid has the risk as well. We've had the problem more of the stims making him flat than anywhere near manic, this was worse with Ritalin LA than with Adderall in any form. He currently (age 12) is not on regular meds (his choice) but takes Adderall IR prn for testing and homework when he needs good concentration or organization (which he lacks naturally). He only gets away without meds because he is so damned smart, but his grades are far from what they should be, and I suspect he may have to go back to full-time meds by high school. Not really what you asked, but our experience.

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My kid has the risk as well. We've had the problem more of the stims making him flat than anywhere near manic, this was worse with Ritalin LA than with Adderall in any form. He currently (age 12) is not on regular meds (his choice) but takes Adderall IR prn for testing and homework when he needs good concentration or organization (which he lacks naturally). He only gets away without meds because he is so damned smart, but his grades are far from what they should be, and I suspect he may have to go back to full-time meds by high school. Not really what you asked, but our experience.

IMHO you're being neglectful by not providing him with what is required to be a full human being except for when he has to take a test.

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My kid has the risk as well. We've had the problem more of the stims making him flat than anywhere near manic, this was worse with Ritalin LA than with Adderall in any form. He currently (age 12) is not on regular meds (his choice) but takes Adderall IR prn for testing and homework when he needs good concentration or organization (which he lacks naturally). He only gets away without meds because he is so damned smart, but his grades are far from what they should be, and I suspect he may have to go back to full-time meds by high school. Not really what you asked, but our experience.

IMHO you're being neglectful by not providing him with what is required to be a full human being except for when he has to take a test.

That's not really fair, given that the current PRN plan is the kid's choice. Given that he's functioning reasonably well, not engaging in self destructive impulsivity, and doing ok in school, I think it's perfectly reasonable to let him make that choice. I can't imagine you'd think a well functioning 12 year old should be forced to take meds he doesn't want.

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Thanks for the responses.

Any doc who thinks that an ADD person shouldn't take stimulants every day doesn't understand how crippling ADHD can be and what a relief stimulants can be.

Well, this pdoc is a researcher in the field, and has written and co-written several books about ADHD/executive skills. She's been in the field for over thirty years and works at a center specializing in learning disabilities, so I believe that she does understand. She is not rejecting the idea of using meds daily if necessary, but wants my son to work on other skills in conjunction with med use. My son has been having trouble, but he isn't at a point in which he is crippled by his attention problems. He has the ability to maintain concentration for extended periods without making mistakes if he is interested in what he is doing (stop motion animation for instance).

Stimulants aren't addictive

If you mean that a person's body doesn't become addicted (physiologically), then I suppose for most stim. meds, you are right. However, considering the number of people I have seen addicted to stimulants (ranging from Ritalin to meth), it doesn't matter whether it's physiological or psychological- it's still an addiction.

I was going to recommend strattera because it has the least chance of inducing mania.

There's also intuniv, a relatively new med that should have no chance of inducing mania.

Thanks for the recommendations. If it gets to the point that my son feels the need for medication, I will ask our doctor about those.

I don't see a huge problem starting with a stim (it hasn't activated my kiddo at all) but I do think that strattera and intuiv are rational, reasonable options and your pdoc for your son shouldn't be ruling anything out at this point without knowing what and which meds your son is likely to respond to.

the problem with strattera more than anything is that it simply isn't that effective for many people with ADHD, so it may not be your best option in that realm.

Oh, she wasn't totally ruling it out, but saying that because it isn't as effective as other meds, it wouldn't be the first one to try.

As bad as ADHD is for many, it isn't that bad for everyone. For you, or for me, the idea of PRN meds wouldn't work. But for some people, it does. It's not unreasonable to want to consider that option when beginning treatment.

Yes, that's exactly it. In the same way that I sometimes have extreme anxiety and need to use clonazepam, but other times I don't. Then there are times when I need to use it daily. I really like that it can be used that way, so it was good to hear that my son may not need daily meds for his issues. Thus far, he is able to function pretty well, and before starting on medication, we will be putting other supports in place so that he doesn't feel that medication is the only thing that keeps him organized and focused. We want him to feel that most of his success is due to his own efforts, because he is sorely in need of confidence building.

IMHO you're being neglectful by not providing him with what is required to be a full human being except for when he has to take a test.

I know that is your opinion, but it seems a bit harsh to call a parent neglectful because she makes different decisions than you do.

For our family, we need to weigh all choices very carefully because of various issues (genetics, environment, etc.). For instance, what if he truly does have a mood disorder and is given a stim that activates him and puts him on the fun rollercoaster of bipolar disorder years earlier than he might have? We will have put him into a much worse situation than he's in now, which isn't that bad.

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My kid has the risk as well. We've had the problem more of the stims making him flat than anywhere near manic, this was worse with Ritalin LA than with Adderall in any form. He currently (age 12) is not on regular meds (his choice) but takes Adderall IR prn for testing and homework when he needs good concentration or organization (which he lacks naturally). He only gets away without meds because he is so damned smart, but his grades are far from what they should be, and I suspect he may have to go back to full-time meds by high school. Not really what you asked, but our experience.

Thanks for this input. My son is almost 16, and was able to pull off good grades until 8th grade, but only because he was in a crappy school that didn't expect anything of him and he's wicked smart (all four of my kids had the highest testing scores in that district every year- the schools begged us not to transfer them because the school's overall scores would drop- bah!). Even in that crappy school, though, his grades started to go down, in part because he was bored out of his skull, but also because he had more work to do. When he transferred, the other school hadn't prepared him for real work and he just nosedived. Which is why we are now intervening-- his obvious attention issues weren't a problem until now.

The pdoc we saw said that many bright kids with ADD can get away without meds until they get to high school...

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My kid has the risk as well. We've had the problem more of the stims making him flat than anywhere near manic, this was worse with Ritalin LA than with Adderall in any form. He currently (age 12) is not on regular meds (his choice) but takes Adderall IR prn for testing and homework when he needs good concentration or organization (which he lacks naturally). He only gets away without meds because he is so damned smart, but his grades are far from what they should be, and I suspect he may have to go back to full-time meds by high school. Not really what you asked, but our experience.

IMHO you're being neglectful by not providing him with what is required to be a full human being except for when he has to take a test.

If we were talking about me, I'd say absolutely, full-time meds or bust. But then I've never suffered much in the way of side effects from my stims, and I was 20 when I first started taking them. Not so for my kid.

When what he did was more my choice, he did take meds full-time. He was dx'ed at age 7 after his second grade teacher called me the first week of school to tell me he was so distracted that he was unable to keep up with the class, despite being able to read at the middle school level. The change when he started on meds was nothing short of remarkable, and there were no more complaints from the school (other than lack of organizational skills, but we're stuck with that). However, he always had a big problem with appetite suppression, which was made worse by the fact that he needs to eat frequently or he becomes irritable. There was the flat feeling (even with Adderall, just not as bad), and sometimes a low energy level, which he also didn't like. Additionally, I think that taking meds made him feel different, and few kids want to feel different. When he was turning 10 and was by that time a fairly rational little person, he expressed a desire to go off his meds. With the support of his teacher and his pdoc, we settled on the prn scheme we are using now, and he has done well enough to continue with it since then. But as he grows, we reevaluate how he is doing, and the minute things start to go south beyond his control, we will do the best we can to get him back on daily meds. I hope it doesn't happen, but I recognize that it may.

Anyway, there's no neglect going on here. The child functions pretty well without meds, and he's not a danger to himself or anyone else, so I do not currently feel compelled to force meds on him. Maybe he's not entirely fulfilling his academic promise, but in some ways he's happier than when he was on meds all the time, and I can live with that.

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My kid has the risk as well. We've had the problem more of the stims making him flat than anywhere near manic, this was worse with Ritalin LA than with Adderall in any form. He currently (age 12) is not on regular meds (his choice) but takes Adderall IR prn for testing and homework when he needs good concentration or organization (which he lacks naturally). He only gets away without meds because he is so damned smart, but his grades are far from what they should be, and I suspect he may have to go back to full-time meds by high school. Not really what you asked, but our experience.

Thanks for this input. My son is almost 16, and was able to pull off good grades until 8th grade, but only because he was in a crappy school that didn't expect anything of him and he's wicked smart (all four of my kids had the highest testing scores in that district every year- the schools begged us not to transfer them because the school's overall scores would drop- bah!). Even in that crappy school, though, his grades started to go down, in part because he was bored out of his skull, but also because he had more work to do. When he transferred, the other school hadn't prepared him for real work and he just nosedived. Which is why we are now intervening-- his obvious attention issues weren't a problem until now.

The pdoc we saw said that many bright kids with ADD can get away without meds until they get to high school...

The more work to do does get to be a problem, especially since many of these kids just can't get organized and it's nearly impossible to handle a heavy workload when you don't know where anything is. That's the problem my son is having now - he doesn't know what or where the assignment is, and even if he does it, half the time he leaves it home or forgets to hand it in. I'd be even more frustrated if I hadn't been just like him at his age. Actually, your son's story sounds a lot like mine, except my parents knew nothing about ADD and I wasn't diagnosed until I saw a pdoc for mood issues when I was in college. Remember that however it works out with the meds, you are doing so much better for him getting him treatment now rather than later or not at all. I hope you and the pdoc can figure out just what he needs.

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The more work to do does get to be a problem, especially since many of these kids just can't get organized and it's nearly impossible to handle a heavy workload when you don't know where anything is.

We started him this school year in a charter school that supposedly focuses on arts & technology, thinking that he would be getting more individual attention because the classes were small. But the way the place is set up, it was a nightmare for him. Firstly, they required that almost all work was done on a laptop (look at all the other cool things on the internet! wheee!) with a very confusing website, he had seven classes, barely any individual attention at all (and then only if we set up an appt. w/teacher for after school), and some very strict rules for how work was completed. The school has only been around for about 5 or 6 years, and they are trying to make sure to get State funding without mandatory testing, so they make the kids jump through a billion hoops.

At any rate, he started floundering, and by the end was nearly drowning. We've moved him to a very good regular high school, which is set up with block scheduling, so he only has four 90 minute classes. Yay! His work is done on paper, which may not be environmentally sound, but is tangible and helps him keep track of what he needs to do. One of his classes was gym, but he broke his leg and has been moved into a study hall, where he can get his daily coaching. So everything seems to be falling into place, and maybe we can get him through this year without meds...

Thanks again.

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  • 4 months later...

I am adding to this thread rather than starting a new one because I put a lot of relevant information in previous posts. Sorry to be lazy, but I am in a huge rush and need to get this out.

We started my son on 30 mg of Vyvanse about 5 weeks ago. He did just fine, no signs of a crack up, though he did have some days of Great Ideas that he wanted to Talk about. He also lost 18 pounds because he just wasn't hungry-- though he had put on a bit of weight from breaking his leg, so he wasn't worried about it. We are now making sure he eats more.

At any rate, he didn't feel that the Vyvanse effect was lasting long enough, so the pdoc increased his dose from 30 mg to 40 mg. The increase happened after he had spent about a week not sleeping much (first week of summer vacation) and on the heels of some major family upheaval, so he was already under stress.

The first day of the increase, he was at his father's house. During that day, he had some major conflicts with his siblings, and according to his father, he hit two of them (my son denies this, saying that they were hitting him while he was cornered and he pushed them away). His father flipped out, said that son was acting crazy, that he actually IS crazy, he might need to call the police, that he needed to protect the younger kids from him, he had "crazy eyes" etc. Much of this he told my son directly, as well as passing some of it on to me.

Basically, it was a clusterfuck.

I don't know what to believe, but I am pretty sure his dad was overreacting. He is under a huge amount of stress (self imposed) and currently reading "Anatomy of an Epidemic" so he went from insisting on medication to deciding that it is the Devil's work and had caused my son to have a mental breakdown. The pdoc said that it is unlikely that a small increase would cause this kind of behavior and we could continue to give it while monitoring his behavior. Or we could lower his dose to the original dose until we could get in to see our regular pdoc (he's on vacation).

His father wouldn't give him his medication again, telling my son that the pdoc said it had made him crazy and he needed to stop taking it. I didn't today because he got up really late, but of course I am somewhat concerned. My son is convinced that the medication made him "go crazy" and I have a feeling he might play that up if I give him the medication again. PLUS, if I give it to him when he is at my house, but his father doesn't, will the yo-yo'ing be a problem?

GAH. Any advice would be most welcomed. I am having trouble thinking rationally about this because I am seeing red after hearing what his dad was saying to him.

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Why does his father need to give him his meds? Can he not be allowed to keep track of them himself?

I think that if I gave him his meds to take to his father's house, his father would just flip out and take them away. The things his dad was telling him were pretty awful- that he is a danger to the family, that he needs to stay away from his siblings, that he will call the police if he acts angry, that he is crazy.... Sheesh, I know I'm repeating myself, but it's fucking unbelievable.

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Does he even want to go back to visit his dad?

Well, he doesn't have much choice (unless custody agreement is changed), but regardless, he likes to see his friends in that town, and most of the time, he doesn't have this kind of conflict with his dad.

I have been getting more information about what happened with his siblings from them. It does sound like he went kind of psycho being physically aggressive towards his little brother (burly 16 vs. puny 9). I don't even know what really happened at this point, because not one of the five people telling me about it has said the same thing.

Is it possible that an increase of 10 mg would cause such a big shift in his behavior? I guess the only way to know is to start his meds again tomorrow and see how he acts. He's starting summer school on Tuesday, so I want to make sure he gets the help he needs without going postal at the school. Someone tell me what to do! My thinking parts are all thunked out! :blink:

(GAH! I want to pack up and move by myself to Tahiti! I'm hiding in my room so I don't have to hear any more about it. Yah, like I'm 12. I've been feeling pretty stable the last few days, and this has sent me running to Ativan and cigarettes. Sigh.)

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A dose increase shouldn't make it last that much longer so I'm not sure I see the point of the increase.

If anything the medication should improve impulse control and make him less likely to act out.

If his father is saying that kind of thing and refusing to treat him for a diagnosed medical condition you may indeed have grounds for a change in custody.

Perhaps his father could visit the psychiatrist with him and get things explained to him?

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