Posted by med_empowered on August 5, 2005, at 8:31:39
In reply to Can Narcolepsy ADHD Co-exist??, posted by NARCOLEPTIC on August 4, 2005, at 22:11:14
Just based on the few people with narcolepsy I've known, and the little bit of stuff I've read about it, it would appear that there are levels of severity. Narcolepsy is commonly associated with varying degrees of depression--usually mild, but not always--that may both result from the disorder AND make the disorder harder to deal with. Antidepressants work OK on the depression; tricylics like Pamelor seem to be pretty popular for taking care of that. Anyway, some people with narcolepsy can take 1 200mg Provigil in the AM and function just fine...on the other hand, I've read case reports where up to **180 mgs** of dexedrine were required just to keep the person functioning at an "OK" (still sub-optimal) level. As for Narcolepsy co-existing with ADHD...I dont think there's a *correlation*, but the two disorders aren't mutually exclusive; so, yeah, one could have ADHD along with narcolepsy. Usually, though, when something like that happens, the physician treats disorders in order of their severity (it seems arbitrary to me, but thats how they do it). So...step #1 would be addressing the narcolepsy. If that goes well, the patient would then be considered for treatment of the ADHD after they'd been functioning for a while. The problem, as I see it, with treating ADHD and narcolepsy at once is that both conditions typically require use of stimulants. Since narcolepsy is a chronic condition, tolerance to the stimulants is a major issue in treatment...if you up the stims to deal with ADHD, you run the risk of getting more side effects (which, if you're doing high-dose stimulant therapy could put you at risk for amphetamine-psychosis) AND you accelerate the tolerance process. I guess Provigil and/or Straterra could be used, but the success w/ ADHD symptoms with those meds are lower than with the old-school stimulants. Assuming side-effects were OK, I imagine you could first try an anti-depressant treatment for the ADHD...its not ideal, but theoretically you could pump up the action of the amphetamines AND treat depressive symptoms AND maybe help the ADHD. Wellbutrin and high-dose Effexor are sometimes used for ADHD...Cymbalta also seems to be catching on (its new and shrinks love new toys...whether or not these uses have any basis in *fact* or proven efficacy remains to be seen). Tricyclics can also be used for ADHD...I think Pamelor is the big one for that application. Theoretically, Tricyclics would boost the amphetamines...having done a TCA+Adderall combo, though, I can tell you: its rough (picture sweating and heart weirdness). Good luck!
poster:med_empowered
thread:537659
URL: http://www.dr-bob.org/babble/20050803/msgs/537791.html