Posted by Elizabeth on May 22, 2002, at 13:56:30
In reply to Re: psychostimulant treatment for former abusers, posted by katekite on May 17, 2002, at 22:22:05
> Apparently Wellbutrin is only effective for about 30% of adult ADDers, whereas the stimulants work for 80-90 % depending on the reference.
That's interesting, although it comes as no surprise that WB doesn't work. (What's the placebo response rate?) Can you provide sources for me to look at? Also, do you happen to know what the stats are for kids?
Lately Effexor has been pushed for ADD. I doubt it's any better than WB, but who knows? Imipramine and other TCAs used to be considered options as well, but I'd hesitate very much to give those to kids (plus I'm skeptical as to whether they even work).
> I'm off of ritalin for a week right now for a medical test. I hate it. My functional status just sucks. I don't think I should take weekends off... maybe a week once a year, but not every weekend. ADD is a pervasive condition that affects all of life, it is not a work-disorder.
For a long time ADD was considered a childhood disorder, and lately stimulants have been thrown at any kid who's "difficult" for teachers. Because of the "treatment first, diagnosis second" methodology that has become so common lately (especially in amateur psychiatric diagnosis!), the assumption is that if stimulants help, then ADD must be the cause of their bad behavior. Stimulants do sometimes decrease the behavior, but I don't think that childhood violence and other serious misbehavior are necessarily (or even usually) indicative of ADD.
Anyway, that was a sidetrack, but the point I was going to make was that a lot of these kids who are a handful in school are fine when they're at home, which is a clear sign that they probably *don't* have ADD -- the problem, whatever it is, only manifests in one area of their lives, not in a variety of settings. It's more likely that this school-limited mishbehavior is related to a difficulty adapting to the requirements of a school environment, I would guess.
> I barely can organize myself to pee before I burst -- pretty basic issue that doesn't go away at night or on weekends.
Well, *that's* something that imipramine could help with, at least!
> Yes, people with ADD who are past drug users should try Wellbutrin first. But not only Wellbutrin, if it doesn't work.
There are other options, too, such as clonidine (and of course the TCAs and Effexor). I don't know if they've ever been studied, but I'd expect MAOIs to be very effective in ADD, more so than the TCAs and the newer ADs. And as Zo points out, modafinil is an option...if you have good insurance!
(Zo: why do you not consider Provigil to be a "pstim?" It's not a phenethylamine, but I'd call it a psychostimulant. And no, I don't know who is getting high on Dexedrine etc. A sometime-professor of mine said that when he tried amphetamine as a med student, he became "quasi-psychotic," although others used it for staying-awake purposes.)
> The new non-stimulant atmoxetine should be out this year as an alternative for past addicts. No one will know until its been out for a while whether it actually works.... but the option is good to have.
Do you mean atomoxetine? AFAIK, it's just another monoamine (NE) reuptake inhibitor. I know that it's been found effective for ADD in several studies -- we'll see if that result is borne out in "real life." :-)
-elizabeth
poster:Elizabeth
thread:83085
URL: http://www.dr-bob.org/babble/20020517/msgs/107295.html