![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 44. Go back in thread:
Posted by Leonardo on January 26, 2001, at 5:34:44
In reply to Re: Sources of Ritalin. » Leonardo, posted by JahL on January 25, 2001, at 17:48:15
Thanks Jah
I agree with all you say, which is why I am desperate to do the Ritalin trial even if it is unofficial! So far I've just tried a few tablets from my son's supply, but he needs them of course so I can't keep doing that. Very promising. I haven't been able to get hold of any more yet. My Pdoc is actually more progressive than most in the UK I think, and getting referrals from your doctor is not so easy as in the US I think. I will keep up the pressure, but O don't want to piss him off in case he digs his heels in completely.
Leonardo
>
> > I have quite a good Pdoc who hasn't ruled out stimulants, but wants to try conventional things first, to see if my concentration/attention problems are just due to depression (I don't think so, I've always had them). I'm going on sertraline (Zoloft) next, but have to wait 4 weeks for selegeline to wash out (my fault - I got that from the internet w/o prescription...)
> >
> > I take it you're in the UK too??
>
> YEAH.
>
> How did you get on with your trial of stimulants?
> >
> > Best wishes
> > Leonardo
>
> Hi Leonardo. The stims did nothing for me but the point is it took just 2 weeks (& 2x 11hr flights!) to rule out an entire class of medicine (=peace of mind). I really can't see what the fuss is about; if you're going to 'abuse' ('their' term) drugs there are so many better ones on offer. They actually made me a bit edgy & I couldn't wait to get off them.
>
> It sounds to me like you're unnecessarily denying yourself a treatment that holds obvious benefit. And the fact that yr son's been diagnosed ADHD increases the likelihood that you have some co-morbid ADD/HD.
>
> Why not ask yr pdoc 4 a 2 week trial of Ritalin (@ a conservative dose), working on the basis that yr depression may begin to remit upon resolution of yr cognitive difficulties. My current (US) pdoc had no hesitation in prescribing stims because he has witnessed this happening before in his surgery. Besides, like you, I've *always* had attn difficulties & scored highly on the 'ADD-o-meter'.
>
> Alternatively you could ask to augment one of yr partially-effective SSRIs with a stimulant, a reasonably common/acceptable practise in refractory depression.
>
> 4 week wash-out followed by a, what, 8wk trial of Zoloft sounds an awful long time to me...
>
> Rgds,
> Jah.
Posted by Shell on January 28, 2001, at 21:32:45
In reply to Re: Sources of Ritalin - Adderall easier? » Shell, posted by kazoo on January 25, 2001, at 2:13:10
> ^^^^^^^^^^^
> Greetz to Shell:
>
> CORRECTION: A doctor *can* call in Control II substances but he MUST follow up with a written prescription within 48 hours (or the DEA will get mad, Tsk! Tsk! Tsk!).
>
> kazooThanks for the clarification! Maybe it's just MY doctor that won't call one one in...she probably doesn't want to take the risk of not following up within 48 hours (though I'd guess she'd call one in were it an emergency).
Shell
Posted by Shell on January 28, 2001, at 22:38:58
In reply to Adult ADHD - getting stimulants prescribed (UK) » Shell, posted by Leonardo on January 25, 2001, at 7:53:34
> Hi Shell
>
> Many thanks for your thoughtful responses. I'm not sure if many adults in the UK are getting Ritalin etc for ADHD. I personally know of one adult who gets dexedrine for ADHD (one of my son's teachers, who helped pinpoint that he had ADHD!) I need to do more research on the ADHD web sites, I guess, and try to contact my son's teacher aboout her experience.
>
> But I think it is common for children in the UK to stop getting Ritalin when they reach adolescence, never mind reaching 18! So the question of continuing it into adulthoodprobably doesn't arise much in the UK so far.
>
> I scored 18/20 on one adult ADHD checklist I saw, I don't think it was a proper diagnosis form though. Do you have the URLs of any good sites where I can follow up?I will look. I know I have found a few sites with different rating scales (but all the tests gave me similar results). I will send you the URLs when I find them.
>
> I did have the concentration/attention problems way back into my school days, but mostly I was bright enough to get around them. I didn't have the hyperactivity component, but I did have many of the other symptoms. Proving it back to age 7/8 would be tricky though. In retrospect I think my first run-ins with depression were due to an inability to cope with university/work demands due to concentration problems when I lost the familiar support of my school days.It would be hard to "prove" it. I know that it is recommended that the therapist interview parents, other older relatives, teachers, etc., though the older one gets the more difficult this becomes. Parental interviews were not a part of my diagnosis; it was based on my own recollection of my childhood. I did tell my psychologist about things that had been said about me as a child (my mother has called me the "absent-minded professor" since I was in Kindergarten (age 5) and has also told me I couldn't survive without a "keeper". Pehaps you may be able to recall similar remarks.
School records are another thing often used in diagnosis. They look for comments like "Johnny seems to be a bright boy, but really needs to apply himself, pay more attention, etc". They also look for IQ scores and achievement test scores that are significantly different from grades, i.e., a high IQ with mediocre grades.
However, as you know, the inattentive type of ADD often goes unnoticed. I sent for my school records when I was diagnosed and they were full of comments like "very well-behaved young lady", "model student", "pleasure to have in class", ad nauseum. I suppose I should have been pleased, but I was concerned that the comments would perhaps negate my other symptoms. The only times I received a B (are you familiar with the American grading system?)in school was in penmanship in the 3rd-5th grades and in typing in high school. I was sure that I would be told that I could not possibly have ADD. Instead, I was told that it is not uncommon for for people with above average intelligence to have good grades and no history of behavior problems because of the structured environment of school. I didn't fall apart (academically) until my sophomore year in college (Should I say university? It's strange that it is common for higher education to be referred to as "college" in the US, whether one attends a university (as I did) or a college. Oops, I am way off topic!).
One thing that may (or may not depending on your circumstances) point towards ADD is a history of frequent changes of major while in college (there it is again!) or frequent job changes. People with ADD often find they have lower levels of academic and/or workplace achievement than would be expected by someone with their level of ability.
>
> I don't think DSM-IV is applicable in the UK, and like I said, I don't think adult ADHD is yet recognised as a real condition in the UK. My Pdoc seems sufficiently switched on to accept it in principle and bend the rules - he has already let me continue taking deprenyl as trial AD, even though that also is not approved in the UK for depression (I bought that on the net).If he is willing to try new things, he's a keeper! Have you considered asking your son's teacher about the possibility of a consultation with his/her doctor?
>
> I am worried that I might nevr get to try stimulants for the reasons you describe (ie he might always argue its related to the depresion). Which is why I wanted to do trial of Ritalin to see if it is worth stepping up the pressure!The more I read about ADD, the more I think it is likely that the depression symptoms are a result of living with untreated ADD.
>
> I am personally convinced that I always have had ADHD-inattentive, but I guess I will never be sure unless I get to trial the drugs. It is possible as you say that the positive boost I had to the few tablets I took was just the same buzz anyone gets out of taking a stimulant. But the fact that it works so well for my son, and that ADHD would explain so many of my problems, makes me think it was a real response.I have read somewhere (I will REALLY have to go back and find theses references) what percentage of the parents of ADD children have ADD themselves, but I can't remember it. I think it was something likee 25-50%, but don't hold me to that...I will check to be sure.
I would agree that a family history of ADD (your son) and definite ADD-type symptoms would make it seem that your response to stimulants was indeed a good response (reduction of your symptoms). I only meant to anticipate (you know, devil's advocate kind of thing) any negative response you might receive.
>
> I love your theory about why ADHD is more common in the US than the UK (apparently), that it was proportionately more ADHD people who emigrated because of novelty seeking! I don't imagine it accounts for the whole difference, but it could well be a real effect. I read somewhere that ADD would not necessarily have been a disadvantage to ancient man - sitting round the fire otside your cave etc, it would be an advantage to be distracted by the noises of fierce beasts prowling nearby. So its not surprising that the tendency has been passed down the generations.
>
> If your theory is true, it may account for another puzzle I have - my real surname is much more common in the US than it is in the UK! So if ADHD runs in my family line, maybe a lot of us emigrated to the US when we had the chance!I wish I could take credit for the theory about why there is a higher rate of ADD in the US, but I read that somewhere...I just can't remember where (this is getting to be a pattern)! I suppose it is probably just one possible factor among many...though it is intriguing. Perhaps my ancestors had some ADD-type symptoms which made it more difficult for them to adapt to whatever social system was in place, so they left. Knowing my family, that would not be unlikely!
Posted by Leonardo on January 29, 2001, at 10:53:49
In reply to Re: Adult ADHD - getting stimulants prescribed (UK) » Leonardo, posted by Shell on January 28, 2001, at 22:38:58
> > I scored 18/20 on one adult ADHD checklist I saw, I don't think it was a proper diagnosis form though. Do you have the URLs of any good sites where I can follow up?
>
> I will look. I know I have found a few sites with different rating scales (but all the tests gave me similar results). I will send you the URLs when I find them.
>
>
Thanks for the good info. I too went to pieces as soon as I started University... I'm having a really bad day today, so hope to reply more when I feel better.Leonardo
Posted by Leonardo on February 27, 2001, at 6:16:16
In reply to Re: Adult ADHD - getting stimulants prescribed (UK) » Leonardo, posted by Shell on January 28, 2001, at 22:38:58
Hi Shell
I can identify with a lot of what you said about early experiences probably due to undiagnosed ADHD, I too did OK at school, but fell apart in my first year at university (sophomore, right?)
Good news - I now have a private appointment to see a specialist in the UK who can diagnose adult ADHD and prescribe stimulants. Wish me luck! I feel like I need it at the moment..
Best wishes
LeonardoPS I thought that a university in the US was often called 'school', which seems really bizarre from the UK perspective (school is for kids...) We do have colleges in the UK, they are either less academic type of universities, or even '6th form colleges' (ie age 16-18). That is high school in the US? Yes? No? Now I'm rambling...
> I didn't fall apart (academically) until my sophomore year in college (Should I say university? It's strange that it is common for higher education to be referred to as "college" in the US, whether one attends a university (as I did) or a college. Oops, I am way off topic!).
>
Posted by Shell on February 28, 2001, at 10:01:13
In reply to Re: Adult ADHD - getting stimulants prescribed (UK), posted by Leonardo on February 27, 2001, at 6:16:16
> Hi Shell
>
> I can identify with a lot of what you said about early experiences probably due to undiagnosed ADHD, I too did OK at school, but fell apart in my first year at university (sophomore, right?)First year is freshman, second is sophomore, third is junior, fourth is senior. If you don't finish "on-time", we have fifth-year senior, sixth-year senior...etc, but that is another issue! Acutally, the class designation is determined by the amount of work successfully completed. They work that way on the recommended schedule, but it can vary. I once had a roommate in her third year who was still technically a freshman (but that was a sore point...no one ever mentioned it!).
> Good news - I now have a private appointment to see a specialist in the UK who can diagnose adult ADHD and prescribe stimulants. Wish me luck! I feel like I need it at the moment..I DO wish you luck! I hope you have finally found the person who can help you. Let me know how it goes.
>
> Best wishes
> Leonardo
>
> PS I thought that a university in the US was often called 'school', which seems really bizarre from the UK perspective (school is for kids...) We do have colleges in the UK, they are either less academic type of universities, or even '6th form colleges' (ie age 16-18). That is high school in the US? Yes? No? Now I'm rambling...University is often called school or college. I guess that one is supposed to be able to tell by context (maybe the person's age?) whether the school is high school or university.
High school in the US is usually 9th-12th grades (sometimes 10th-12th), which correspond roughly to the ages 14-18. This is free (though you can pay for a private school)and compulsory until 16. One can drop out after 16, but it is hard to get a job without a high school diploma.
After high school graduation, the options are usually: get a job, join the military, or attend higher education. We have technical and community colleges (two-year programs that are job oriented or can be transferred to a four year school) which award an Associate (AA,AS) degree. Colleges and universities both award bachelor's (BA, BS) degrees (four-year). The difference is that universities also offer graduate and/or professional degrees, i.e., masters (MA MS), doctorate (PhD), medical (MD, DO), law (JD), business (MBA), etc. Unfortunately for clarity's sake, all institutions of higher education are referred to as "college" or "school".
Talk about digression...I'm really sorry! Maybe that is why it is called Psycho BABBLE.
Posted by Katz on February 28, 2001, at 15:18:13
In reply to Re: Adult ADHD - getting stimulants prescribed (UK), posted by Leonardo on February 27, 2001, at 6:16:16
>Leonardo,
I'm keeping my fingers crossed and wish you the best of luck in obtaining the stims. I've been wondering how you've been doing, the last time we talked you were about to embark on two new AD trials. Since you're still trying to get stims I guess they didn't work out. BTW, I have an appointment with a pdoc on Monday (thanks to a fellow babbler) in which I will be trying to obtain some ritilin. Here's hoping we will both be successful in our endeavor.
With prayers,
Kathy
Hi Shell
>
> I can identify with a lot of what you said about early experiences probably due to undiagnosed ADHD, I too did OK at school, but fell apart in my first year at university (sophomore, right?)
>
> Good news - I now have a private appointment to see a specialist in the UK who can diagnose adult ADHD and prescribe stimulants. Wish me luck! I feel like I need it at the moment..
>
> Best wishes
> Leonardo
>
> PS I thought that a university in the US was often called 'school', which seems really bizarre from the UK perspective (school is for kids...) We do have colleges in the UK, they are either less academic type of universities, or even '6th form colleges' (ie age 16-18). That is high school in the US? Yes? No? Now I'm rambling...
>
> > I didn't fall apart (academically) until my sophomore year in college (Should I say university? It's strange that it is common for higher education to be referred to as "college" in the US, whether one attends a university (as I did) or a college. Oops, I am way off topic!).
> >
Posted by Leonardo on March 4, 2001, at 8:46:54
In reply to Re: Adult ADHD - getting stimulants prescribed (UK), posted by Shell on February 28, 2001, at 10:01:13
> > Good news - I now have a private appointment to see a specialist in the UK who can diagnose adult ADHD and prescribe stimulants. Wish me luck! I feel like I need it at the moment..
>
> I DO wish you luck! I hope you have finally found the person who can help you. Let me know how it goes.
>
Hi ShellNice to hear from you again! I got a cancellation appointment at short notice, and saw my new ADHD specialist on Wednesday. He was great! I could have had either Ritalin or dexamphetamine, so I plumped for the dex. I had heard that it was often better for adults, though the doc thought there was no way of knowing which is best without trying them. I have to start at a low dose (2x a half tablet per day) for 5 days, and then go up. So far so good! I will try 2 tablets for the first time tomorrow.
I got a very strong response to the first dose, but it has been tailing off since. The first day I managed to do as much work in 5 hours as I had done in the previous week through lack of concentration. Now I feel OK-ish, but reckon I'll need a much higher dose to really tell. For the last few weeks I was really struggling at work, the odd dose of my son's Ritalin helped, but when I tried the Ritalin alternative Equasym it made me worse and very anxious. Scary.
So I just hoping it will turn out OK as I crank up the dose. It is certainly much more effective than any of the antidepressants I tried before.
I can't remember now what you are taking and how well it is working?
Best wishes
LeonardoPS the education system in the UK seems to be changing quite quickly at the moment, not sure what will be there when my kids get to university/college/school/whatever!
Posted by Leonardo on March 4, 2001, at 9:05:32
In reply to Re: Adult ADHD - getting stimulants prescribed (UK) » Leonardo, posted by Katz on February 28, 2001, at 15:18:13
> >Leonardo,
>
> I'm keeping my fingers crossed and wish you the best of luck in obtaining the stims. I've been wondering how you've been doing, the last time we talked you were about to embark on two new AD trials. Since you're still trying to get stims I guess they didn't work out. BTW, I have an appointment with a pdoc on Monday (thanks to a fellow babbler) in which I will be trying to obtain some ritilin. Here's hoping we will both be successful in our endeavor.
>
> With prayers,
>
> KathyHi Kathy
Many thanks for your thoughts, I can see that you know what its like to go through this dreadful quest of finding someone who can help you! I told my new doc it was like trying to fiond the Holy Grail. He agreed and is annoyed because it shouldn't be so hard.
I was off meds altogether for about 3-4 weeks (quit selegeline), and had a very hard time coping at work, hence I haven't been posting much. I then tried the Zoloft which my SAD specialist recommended, but it was hopeless, made my head go into a real spin, worse than anxiety, just spinning racing thoughts that wouldn't settle down. My GP gave me diazepam (Valium) which calmed me down, but the zoloft obviously wasn't working for me so I quit after about 10 days.
As I just replied to Shell, I got my consult with the ADHD specialist quicker than I thought (my insurance agreed to pay for this guy, I took a cancellation appointment at 24 hours notice and drove half way across the country!) He was great, I'm on the 5th day of dexamphetamine. It is early days, but very promising.
I seem to remember that you didn't think you had ADHD? I found that the symptoms are not always that obvious, it took me 2 years to recognise it in myself after I recognised it in my son. Good luck with your new doc. Have you tried Ritalin before? My new doc is very stricy about the startup regime. For the dex it is a half tablet only, twice a day for 5 days, before going up to 1 tablet am, half at lunch, and half at 4pm. Then its reviewed after 2 weeks. He reckons that people who try to start up too quick can get a bad response which never settles down properly, and they have a lot of trouble later on. This may explain my variable response to the Ritalin I took. I went straight in at a full tablet, taken just occasionally. I got some very good responses, but some bad ones too, so I'm following orders from the doc this time. I think he has about 500 ADHD patients, so I take him seriously!
Best wishes
Leonardo
Posted by Katz on March 4, 2001, at 9:46:15
In reply to Re: Adult ADHD - getting stimulants prescribed (UK) » Katz, posted by Leonardo on March 4, 2001, at 9:05:32
Leonardo,
I'm sooooo happy for you! I'm thrilled that you have finally gotten the right diagnosis and are well on your way to a treatment stratery that will help. I'll be keeping my fingers crossed that all goes well.
As for me, I don't believe that I have ADHD but ADD is a possibility. I was on Ritilin approx. three years ago for 6 months. I was on 20 mg/day, never increased my dose and had amazing results. Dysthmia, Anhedonia and especially Social Phobia, all greatly improved. The med was discontinued when I was no longer able to travel 3 states away every month to obtain a prescription. My attempts to find a pdoc in my area to prescribe ritilin have been futile up until now.
A note about Dexedrine: The doc the prescribed the ritilin had me on dexedrine first. I eventually got up to 30mg/bid with absolutely no effect. I could take it, rollover and go back to sleep. I think the dex was possibly making me depressed also. But, as the saying goes, "everyone's mileage is different."
Unfortunately, my appt with the new pdoc is tomorrow and it appears it will be cancelled due to what is being hailed "the snowstorm of the century". Predictions are that it may dump 3' of snow here in New England before all is said and done. Looks like the gods are conspiring against me. Aughh! Anyway, I'm glad things worked out for one of us. Keep us posted on your progress.
Best wishes,
Kathy
> > >Leonardo,
> >
> > I'm keeping my fingers crossed and wish you the best of luck in obtaining the stims. I've been wondering how you've been doing, the last time we talked you were about to embark on two new AD trials. Since you're still trying to get stims I guess they didn't work out. BTW, I have an appointment with a pdoc on Monday (thanks to a fellow babbler) in which I will be trying to obtain some ritilin. Here's hoping we will both be successful in our endeavor.
> >
> > With prayers,
> >
> > Kathy
>
> Hi Kathy
>
> Many thanks for your thoughts, I can see that you know what its like to go through this dreadful quest of finding someone who can help you! I told my new doc it was like trying to fiond the Holy Grail. He agreed and is annoyed because it shouldn't be so hard.
>
> I was off meds altogether for about 3-4 weeks (quit selegeline), and had a very hard time coping at work, hence I haven't been posting much. I then tried the Zoloft which my SAD specialist recommended, but it was hopeless, made my head go into a real spin, worse than anxiety, just spinning racing thoughts that wouldn't settle down. My GP gave me diazepam (Valium) which calmed me down, but the zoloft obviously wasn't working for me so I quit after about 10 days.
>
> As I just replied to Shell, I got my consult with the ADHD specialist quicker than I thought (my insurance agreed to pay for this guy, I took a cancellation appointment at 24 hours notice and drove half way across the country!) He was great, I'm on the 5th day of dexamphetamine. It is early days, but very promising.
>
> I seem to remember that you didn't think you had ADHD? I found that the symptoms are not always that obvious, it took me 2 years to recognise it in myself after I recognised it in my son. Good luck with your new doc. Have you tried Ritalin before? My new doc is very stricy about the startup regime. For the dex it is a half tablet only, twice a day for 5 days, before going up to 1 tablet am, half at lunch, and half at 4pm. Then its reviewed after 2 weeks. He reckons that people who try to start up too quick can get a bad response which never settles down properly, and they have a lot of trouble later on. This may explain my variable response to the Ritalin I took. I went straight in at a full tablet, taken just occasionally. I got some very good responses, but some bad ones too, so I'm following orders from the doc this time. I think he has about 500 ADHD patients, so I take him seriously!
>
> Best wishes
> Leonardo
Posted by JahL on March 4, 2001, at 13:38:33
In reply to Re: Adult ADHD - getting stimulants prescribed (UK) » Shell, posted by Leonardo on March 4, 2001, at 8:46:54
> >I got a cancellation appointment at short notice, and saw my new ADHD specialist on Wednesday. He was great! I could have had either Ritalin or dexamphetamine, so I plumped for the dex. I had heard that it was often better for adults, though the doc thought there was no way of knowing which is best without trying them. I have to start at a low dose (2x a half tablet per day) for 5 days, and then go up. So far so good! I will try 2 tablets for the first time tomorrow.
> > I got a very strong response to the first dose, but it has been tailing off since. The first day I managed to do as much work in 5 hours as I had done in the previous week through lack of concentration. Now I feel OK-ish, but reckon I'll need a much higher dose to really tell. For the last few weeks I was really struggling at work, the odd dose of my son's Ritalin helped, but when I tried the Ritalin alternative Equasym it made me worse and very anxious. Scary.
> >So I just hoping it will turn out OK as I crank up the dose. It is certainly much more effective than any of the antidepressants I tried before.> Best wishes
> LeonardoHi Leonardo.
Glad to see you're finally getting the treatment you're due. I'm amazed it was that easy. B4 I flew 2 the US to get stims, my UK pdoc referred me 2 an adult ADD clinic (in Cambridge). The letter I received from them (after *6* weeks) was accompanied by a 15 page questionare. I was told I would also be expected to undergo extensive psychometric testing & various interviews. If after all this, it was decided that I was ADD, I would be given a *single* dose of 1 med, the implication being that a non-reaction means you don't have ADD (!?!). I declined.
My US pdoc recommends test-driving as many stims as possible, to find the one that gives the best results. Why settle for good when you can have great? Something 2 think about.
Anyway, sounds like you've found a good'un-keepahold of him! Good luck with the trial,
Jah.
Posted by Leonardo on March 5, 2001, at 8:12:27
In reply to Re: Adult ADHD - getting stimulants prescribed (UK) » Leonardo, posted by Katz on March 4, 2001, at 9:46:15
Hi again Kathy!
Sorry to hear about the snow in New England, hope you managed to get to the appointment. If so how did it go, will he prescribe the stuff? We have been having some snowstorms here in Olde England too, but where I am in the south we get off pretty lightly.
I was interested to hear you say you don't think you have ADHD, but may have ADD. I don't have much of a hyperactivity component, so reckoned I have the DSM-IV category of "ADHD - primarily inattentive type". DSM-IV no longer uses the old term 'ADD' which means the same, but I now notice that most people on PB still talk about ADD rather than ADHD. I think I'll start saying ADHD/ADD to make sure I'm covered!
Anyway, it is certainly possible to have ADHD under the new criteria without ever having been hyperactive. The clincher for me was reading an adult ADD/ADHD checkilist at http://adders.org/info7.htm - give it a go! I scored a good 19 out of 20 and felt sure I was onto something. There are many other checklists around, some bring out problems with relationships and dealing with other people which might be relevant to your social phobia. I too have had low level depression always, and difficulty getting any fun out of life. ADD and depression seem to be closely linked, for me I think the ADD caused the depression because I could never get round to getting my life under control and solving my problems.
There is even an unofficial definition of 6 subtypes of ADD/ADHD including Depressive Subtype, which fits me closest I think. See:
http://user.cybrzn.com/~kenyonck/add/add_legal_public.htm
and also:
http://www.amenclinic.com/ac/addtests/default.asp
Interesting that you didn't respond to dex, but it doesn't mean that you definitely don't have ADD/ADHD. As you say, everyones different in response to meds. The book I read said that about 50% of people respond equally well to Ritalin and dex, but 50% have a markedly better response to one or the other. I hope that Ritalin works again for you this time!
I have found from my limited expereince so far a very similar response to Ritalin and dex, though the dex does seem to be smoother and gentler acting than the Ritalin as others have said. It may be worth keeping an open mind, as I have found different response to taking the same drug at different times, also some different brands of the same stuff seem to be unreliable. I found the Equasym version of Ritalin made we decidedly worse. The dex I have is Dexedrine by Medeva Pharma Ltd.
Well I took a whole 5mg dex pill this morning for the first time, I'm feeling a bit woozy and tight-headed, but it's not much compared to most AD side effects. Otherwise I'm feeling pretty good, despite work crises!
Best Wishes
Leonardo> Leonardo,
>
> I'm sooooo happy for you! I'm thrilled that you have finally gotten the right diagnosis and are well on your way to a treatment stratery that will help. I'll be keeping my fingers crossed that all goes well.
>
> As for me, I don't believe that I have ADHD but ADD is a possibility. I was on Ritilin approx. three years ago for 6 months. I was on 20 mg/day, never increased my dose and had amazing results. Dysthmia, Anhedonia and especially Social Phobia, all greatly improved. The med was discontinued when I was no longer able to travel 3 states away every month to obtain a prescription. My attempts to find a pdoc in my area to prescribe ritilin have been futile up until now.
>
> A note about Dexedrine: The doc the prescribed the ritilin had me on dexedrine first. I eventually got up to 30mg/bid with absolutely no effect. I could take it, rollover and go back to sleep. I think the dex was possibly making me depressed also. But, as the saying goes, "everyone's mileage is different."
>
> Unfortunately, my appt with the new pdoc is tomorrow and it appears it will be cancelled due to what is being hailed "the snowstorm of the century". Predictions are that it may dump 3' of snow here in New England before all is said and done. Looks like the gods are conspiring against me. Aughh! Anyway, I'm glad things worked out for one of us. Keep us posted on your progress.
>
> Best wishes,
>
> Kathy
>
Posted by Leonardo on March 5, 2001, at 8:27:29
In reply to Re: Adult ADHD - getting stimulants prescribed (UK » Leonardo, posted by JahL on March 4, 2001, at 13:38:33
Hi Jah
Well finding out how to get the appointment was not that easy! As you may recall my previos Pdoc was trying everything else first, and I'm not sure that he would have prescribed stims in the end anyway. My GP refused to prescibe without a specialist diagnosis, not surprising I guess. I found the NHS waiting list at the Maudesley hospital in London was 14 months! There is a London clinic called Integrated Neurocare (Dr G Hosking), which charges £775 for a comprehensive diagnosis, but my insurance wouldn't pay. So eventually I found the Bristol Priority Clinic (Dr P Cosgrove) who charges £250 for a diagnosis in a 1.5 hour consultation, and no problem with prescibing stims if diagnosed. Follow ups are by phone.
I had the choice of Ritalin or dex, I'm trying dex, but I think I can switch if it doesn't pan out. He is trying to get Adderall imported, but hasn't got it yet. He is keen on starting at a low dose and working up gradually, and also knows that a 'good' response is not necessarily the best achievable. I think he prefers to exhaust the possibilities of the first trial by upping the dose as far as possible before switching though.
What did you try, did you find a winner? Do you think you have ADD/ADHD or something else?
> Hi Leonardo.
>
> Glad to see you're finally getting the treatment you're due. I'm amazed it was that easy. B4 I flew 2 the US to get stims, my UK pdoc referred me 2 an adult ADD clinic (in Cambridge). The letter I received from them (after *6* weeks) was accompanied by a 15 page questionare. I was told I would also be expected to undergo extensive psychometric testing & various interviews. If after all this, it was decided that I was ADD, I would be given a *single* dose of 1 med, the implication being that a non-reaction means you don't have ADD (!?!). I declined.
>
> My US pdoc recommends test-driving as many stims as possible, to find the one that gives the best results. Why settle for good when you can have great? Something 2 think about.
>
> Anyway, sounds like you've found a good'un-keepahold of him! Good luck with the trial,
>
> Jah.
Posted by Katz on March 5, 2001, at 11:18:14
In reply to Re: Adult ADHD/ADD - getting stimulants prescribed » Katz, posted by Leonardo on March 5, 2001, at 8:12:27
Hi Leonardo,
Thanks for all the info. I took the test and scored 13 out of the twenty. Seems to still leave me up in the air about the right diagnosis. The crux of the problem (as I see it) which is hindering a diagnosis of ADD is that I don't have *disorganizational* problems even though I do *tune out* and have many other ADD symptoms. The medical establishment seems firmly entrenched in the belief that ADD/ADHD *must* be accompanied by "an inability to get organized" and a propensity toward *multi-tasking*, as their main criteria for an ADD/ADHD diagnosis. Since I have neither one, an ADD diagnosis is automatically thrown out. I believe it's time for the "experts" to reevaluate the current ADD criteria. I truly believe that I am ADD w/o the current gold standard components. In any event, it is theorized that ADD/ADHD may be caused by hypoactivity in the frontal lobe region of the brain. I believe whatever label is put on my condition, it is also probably caused by the same inactivity of the frontal lobe and that is why I had such a robust reaction to the ritilin. I know for a fact that my brain needs to be stimulated and not sedated! The fact that we have to struggle in vain to get a stim is ludicrous! While addiction is cause for some concern, this simple little pill has far less serious side effects than any of the tradtional AD's on the market.
My appt with the pdoc was cancelled and rescheduled for next week. I'll let you know what happens.
Best wishes,
Kathy
Hi again Kathy!
>
> Sorry to hear about the snow in New England, hope you managed to get to the appointment. If so how did it go, will he prescribe the stuff? We have been having some snowstorms here in Olde England too, but where I am in the south we get off pretty lightly.
>
> I was interested to hear you say you don't think you have ADHD, but may have ADD. I don't have much of a hyperactivity component, so reckoned I have the DSM-IV category of "ADHD - primarily inattentive type". DSM-IV no longer uses the old term 'ADD' which means the same, but I now notice that most people on PB still talk about ADD rather than ADHD. I think I'll start saying ADHD/ADD to make sure I'm covered!
>
> Anyway, it is certainly possible to have ADHD under the new criteria without ever having been hyperactive. The clincher for me was reading an adult ADD/ADHD checkilist at http://adders.org/info7.htm - give it a go! I scored a good 19 out of 20 and felt sure I was onto something. There are many other checklists around, some bring out problems with relationships and dealing with other people which might be relevant to your social phobia. I too have had low level depression always, and difficulty getting any fun out of life. ADD and depression seem to be closely linked, for me I think the ADD caused the depression because I could never get round to getting my life under control and solving my problems.
>
> There is even an unofficial definition of 6 subtypes of ADD/ADHD including Depressive Subtype, which fits me closest I think. See:
>
> http://user.cybrzn.com/~kenyonck/add/add_legal_public.htm
>
> and also:
>
> http://www.amenclinic.com/ac/addtests/default.asp
>
> Interesting that you didn't respond to dex, but it doesn't mean that you definitely don't have ADD/ADHD. As you say, everyones different in response to meds. The book I read said that about 50% of people respond equally well to Ritalin and dex, but 50% have a markedly better response to one or the other. I hope that Ritalin works again for you this time!
>
> I have found from my limited expereince so far a very similar response to Ritalin and dex, though the dex does seem to be smoother and gentler acting than the Ritalin as others have said. It may be worth keeping an open mind, as I have found different response to taking the same drug at different times, also some different brands of the same stuff seem to be unreliable. I found the Equasym version of Ritalin made we decidedly worse. The dex I have is Dexedrine by Medeva Pharma Ltd.
>
> Well I took a whole 5mg dex pill this morning for the first time, I'm feeling a bit woozy and tight-headed, but it's not much compared to most AD side effects. Otherwise I'm feeling pretty good, despite work crises!
>
> Best Wishes
> Leonardo
>
>
>
> > Leonardo,
> >
> > I'm sooooo happy for you! I'm thrilled that you have finally gotten the right diagnosis and are well on your way to a treatment stratery that will help. I'll be keeping my fingers crossed that all goes well.
> >
> > As for me, I don't believe that I have ADHD but ADD is a possibility. I was on Ritilin approx. three years ago for 6 months. I was on 20 mg/day, never increased my dose and had amazing results. Dysthmia, Anhedonia and especially Social Phobia, all greatly improved. The med was discontinued when I was no longer able to travel 3 states away every month to obtain a prescription. My attempts to find a pdoc in my area to prescribe ritilin have been futile up until now.
> >
> > A note about Dexedrine: The doc the prescribed the ritilin had me on dexedrine first. I eventually got up to 30mg/bid with absolutely no effect. I could take it, rollover and go back to sleep. I think the dex was possibly making me depressed also. But, as the saying goes, "everyone's mileage is different."
> >
> > Unfortunately, my appt with the new pdoc is tomorrow and it appears it will be cancelled due to what is being hailed "the snowstorm of the century". Predictions are that it may dump 3' of snow here in New England before all is said and done. Looks like the gods are conspiring against me. Aughh! Anyway, I'm glad things worked out for one of us. Keep us posted on your progress.
> >
> > Best wishes,
> >
> > Kathy
> >
Posted by Shell on March 5, 2001, at 12:54:08
In reply to Re: Adult ADHD/ADD - getting stimulants prescribed » Katz, posted by Leonardo on March 5, 2001, at 8:12:27
That's fantastic! I'm so glad you FINALLY found someone who can help you. It's just a shame it took so long to do so. Someone less determined to find a solution would have given up long ago and as for the unfortunate person with ADHD who didn't even know to look for a diagnosis....
It's not quite that difficult in the US, but from what I've read here, it is more difficult than I'd realized. I had no problem at all being diagnosed and medication prescribed at my first appointment with my regular family doctor. I wish it could be that simple for everyone.
So how is it going with the Dexedrine? I have a cousin who prefers it to the Ritalin because of the smoothness you described. I am taking Concerta (54 mg in combination with 300 mg Wellbutrin) and I really can't compare it to any of the others since it is the only medication I have tried. I noticed that the first few weeks the effect was much more noticeable, now it is very subtle. I wonder if that is normal?
I am really glad you finally received the diagnosis and treatment you needed. Can your records now be transferred to someone closer to home or do you need to continue your cross-country treks for treatment? I don't know what your laws are, but here we must pick up the written prescription in person every month; I hope that's not the case for you.
Keep me updated!
Shell
Posted by sorcha on May 2, 2001, at 20:24:31
In reply to Re: Adult ADHD/ADD - getting stimulants prescribed » Leonardo, posted by Shell on March 5, 2001, at 12:54:08
Sorry to barge in on a dead (last post two months ago) coversation like this but I thought I'd try and revive it as I'm interested in more information.
I've encountered many of the same problems you speak about regarding diagnosis and prescriptions and am feeling very frustrated right now.My younger brother was diagnosed at 13 as ADHD. My father tried Ritalin for a while when they were thinking of it for my brother and found it worked fantastically for him. My brother never did get it and was expelled from school at 15.
Personally I never had much problems with school although I never did homework (from the age of about 6), was always disorganized and inattentive and never 'fulfilled my potential'.
I have been trying to get my bachelor's degree for the past 10 years or so, have switched majors several times, can't hand in anything on time (if ever), never study for exams more than a few hours before when I feel extremely pressured and have great difficulty writing papers. I have also switched 5 jobs in the past 6 years and am currently unemployed (as of January - the last company I worked for folded).There is no doubt in my mind that I am ADD (I am willing to forego the H) particularly since I recognize all the symptoms I see in my brother and my father in myself. There is no doubt in my parents minds that I am ADD either.
The medical establishment here (in Israel), on the other hand, does seem to have doubts. It is very difficult for my to find someone who will diagnose me, let alone get a prescription for something that might help.
I have gone to a psychologist, who claims it's not her responsibility and suggested I go to a private facility specializing in learning disorders. They won't see me since they only diagnoze children. My appointment with a neurologist yielded little result as he said he can diagnoze me but it won't be recognized by my medicare for prescription matters. The psychiatrist I saw sent me back to the psychologist saying he will have no problems prescribing ritalin when I come back with a psychologist's diagnosis.
It's like catch22
He did, however, prescribe an antidepressant (parotexine) after a 10 minute conversation. I do not believe I am depressed and I do believe I could benefit greatly from Ritalin but have no idea what to do anymore.Any suggestions?
Posted by Bill L on May 3, 2001, at 8:57:09
In reply to Re: Adult ADHD/ADD - getting stimulants prescribed, posted by sorcha on May 2, 2001, at 20:24:31
Sorcha- maybe you could call or write a letter to the psychologist and tell him or her that the psychiatrist said that he will give you Ritalin but needs the psychologist's diagnosis. Ask the psychologist to therefore write the diagnosis on a piece of paper and mail it either to you, or directly to the psychiatrist. Good luck!
> Sorry to barge in on a dead (last post two months ago) coversation like this but I thought I'd try and revive it as I'm interested in more information.
> I've encountered many of the same problems you speak about regarding diagnosis and prescriptions and am feeling very frustrated right now.
>
> My younger brother was diagnosed at 13 as ADHD. My father tried Ritalin for a while when they were thinking of it for my brother and found it worked fantastically for him. My brother never did get it and was expelled from school at 15.
>
> Personally I never had much problems with school although I never did homework (from the age of about 6), was always disorganized and inattentive and never 'fulfilled my potential'.
> I have been trying to get my bachelor's degree for the past 10 years or so, have switched majors several times, can't hand in anything on time (if ever), never study for exams more than a few hours before when I feel extremely pressured and have great difficulty writing papers. I have also switched 5 jobs in the past 6 years and am currently unemployed (as of January - the last company I worked for folded).
>
> There is no doubt in my mind that I am ADD (I am willing to forego the H) particularly since I recognize all the symptoms I see in my brother and my father in myself. There is no doubt in my parents minds that I am ADD either.
>
> The medical establishment here (in Israel), on the other hand, does seem to have doubts. It is very difficult for my to find someone who will diagnose me, let alone get a prescription for something that might help.
> I have gone to a psychologist, who claims it's not her responsibility and suggested I go to a private facility specializing in learning disorders. They won't see me since they only diagnoze children. My appointment with a neurologist yielded little result as he said he can diagnoze me but it won't be recognized by my medicare for prescription matters. The psychiatrist I saw sent me back to the psychologist saying he will have no problems prescribing ritalin when I come back with a psychologist's diagnosis.
> It's like catch22
> He did, however, prescribe an antidepressant (parotexine) after a 10 minute conversation. I do not believe I am depressed and I do believe I could benefit greatly from Ritalin but have no idea what to do anymore.
>
> Any suggestions?
Posted by Carl Nolan on May 10, 2001, at 7:10:08
In reply to Re: Adult ADHD/ADD - getting stimulants (UK) » JahL, posted by Leonardo on March 5, 2001, at 8:27:29
Hello all!
I have for the first time bagan reading about ADD after suspecting for some time that I am affected by it. The psychiatrist that my GP referred me to has no doubt that I was probably diagnosed with something compatible to ADD as a child, whatever that means. I live in London and at my local hospitals, The Royal London and St Bartholomew's, the adult mental health department has no experience of diagnosing adults. In order to establish if there is a depressive component, I have been prescribed Venlaxafine (Efexor). The medicine is ineffective and causes side effects also, nor am I depressed. Please can somebody tell me more about the Maudesley. A friend of mine told me that there is a unit there, but I thought perhaps they saw a poster on the wall or something. I have been told that if I find a specialist I can be referred. At 27 I am despairing. I have had many jobs, no idea what to do next, am easily distracted, thoroughly disorganised, know the score? Something that I have noticed, not once have I read anything, from anyone talking about ADD, about the dangers of ADD. Does anyone not cross roads without realising? Do you know if a response to Ritalin would be treated as part of a diagnostic aid? I am going to try and acquire some. Are there any ADD groups meeting here in London? Will write more soon.
Posted by katz on May 10, 2001, at 9:00:09
In reply to Re: Adult ADHD/ADD - getting stimulants (UK), posted by Carl Nolan on May 10, 2001, at 7:10:08
Hi Carl,
Leonardo would be the one with the information you are looking for. Unfortunately he has not been posting lately. He finally succeeded in getting an ADHD diagnosis and subsequent treatment after a very long & difficult struggle with the medical community in England. Hopefully, he will get these posts in his email and respond to your questions. Leonardo, if you're reading this, please let us all know how you're doing.
Good luck,
Kathy
> Hello all!
>
> I have for the first time bagan reading about ADD after suspecting for some time that I am affected by it. The psychiatrist that my GP referred me to has no doubt that I was probably diagnosed with something compatible to ADD as a child, whatever that means. I live in London and at my local hospitals, The Royal London and St Bartholomew's, the adult mental health department has no experience of diagnosing adults. In order to establish if there is a depressive component, I have been prescribed Venlaxafine (Efexor). The medicine is ineffective and causes side effects also, nor am I depressed. Please can somebody tell me more about the Maudesley. A friend of mine told me that there is a unit there, but I thought perhaps they saw a poster on the wall or something. I have been told that if I find a specialist I can be referred. At 27 I am despairing. I have had many jobs, no idea what to do next, am easily distracted, thoroughly disorganised, know the score? Something that I have noticed, not once have I read anything, from anyone talking about ADD, about the dangers of ADD. Does anyone not cross roads without realising? Do you know if a response to Ritalin would be treated as part of a diagnostic aid? I am going to try and acquire some. Are there any ADD groups meeting here in London? Will write more soon.
Posted by Noa on May 10, 2001, at 10:44:42
In reply to Re: Adult ADHD/ADD - getting stimulants (UK) » Carl Nolan, posted by katz on May 10, 2001, at 9:00:09
I am not sure using venlafaxine to DIAGNOSE a depressive component is such a great strategy. To me, a med trial is to see if the med is effective for you, not to establish a diagnosis. Afterall, a lot of these meds are used cross-diagnoses.
Posted by JahL on May 13, 2001, at 22:51:35
In reply to Re: Adult ADHD/ADD - getting stimulants (UK), posted by Carl Nolan on May 10, 2001, at 7:10:08
Hi Carl.
I'm UK also. Don't think a great deal of the Maudsley.
I recently got an appt for ADD @ ADDENBROOKE'S NHS TRUST (Adult ADHD Clinic)
HILLS RD,
CAMBS,
CB2 2QQ.They have a specialist Adult ADHD Clinic. The psychatrist destined to treat me has written 3 times; I am impressed by his persistence; it makes a refreshing change!
I couldn't suffer the NHS waiting lists (not *too* long) & hopped on a plane to the US where I was offered 4 different stims. You'll most likely only be offered Ritalin & then only if you satisfy their dx criteria by way of filling out reams of questionaires.
Don't be disheartened tho'-definitely worth asking yr GP for a referral. Go private if you can afford it. Good luck.
J.
(just ask if you need any more details)
Posted by Carl on May 30, 2001, at 9:22:40
In reply to Re: Adult ADHD/ADD -this might help... » Carl Nolan, posted by JahL on May 13, 2001, at 22:51:35
Jah, hello there!
Thank you for your reply and the Cambridge address. It will, most likely be my last resort though. I am unsure at the moment. Then again I have only just begun the trek on this railway track of a journey, and I mean the one my mind has to make. Should not be that difficult, my mind takes more directions than the London Underground map. I guess it is all the red tape, or rather red lights, that I think make getting an ADD diagnosis problematic.
So what happened at the Addenbrooke NHS Trust? I hope you don't mind me asking. Did you manage to keep your appointment?
You say thet you could not suffer the NHS waiting list any longer. How long is that? Are you north or south of England?
What of the Maudesely (sp?) then? What was the dissapointment there?
I am unable to go private. Costs you see. I might have to make provisions to do so later on in the game, I might end up having to. I am studying at the moment, yet again, and difficult as it can be psychologicaly I am going to have to sit most of the year again. For me though, being such a laid back never mind do it tommorrow type of person I don't think it will bother me to much.
Jah, have you any idea of the cost involved in getting a private consultation, treatment, and repeat prescriptions? More interesting is your visit to the States. Where did you go exactly, and how did you get on? East coast is obviously cheaper to travel to. Did you have any problems with the medical establishment or the medicines. Also, how did you obtain your diagnosis? Was it through your US trip or is an American diagnosis not recognised here?
The latest I have heard is that there is a unit at Kings COllege London, you the hospital medical school? Well I am told that are doing research into ADD. In particular they are researching possible links between ADD and Dyslexia.
I am trying not to be disheartened at the moment. Anxiety, I feel is becoming an issue. Probably this is because of the long and drawn out process that I am going to have to endure. Another thing that is of great concern to me is the fact I might never be diagnosed at all. Is this a fear you had at times? I am absolutely certain that Attention Deficit is my problem, right back to the age of birth so my mum tells me.
Please would you explain what you mean about dx. The 'reams of questionaires also'. I have recently been referred for a psychotherapy appointment. The waiting list is approximately fourteen months. However, they are not going to send me date until I return a fifteen page questionaire. No problem, I'll do it tonight when I've done my census form!
I apologise for the delay in replying. All the above I wrote a couple of weeks ago. I've just added to it today. I have been hospitalised for Epilepsy. Another problem. Can you believe that they are trying to put ADD down to Epilepsy. I suppose you can. I know different. After all my fits are quite infrequent. Anyway, I'll not go into the realms of that now. I have given you enough to read about. Never before have I written something so questioning. Forgive me.
Carl.
Posted by Sulpicia on May 30, 2001, at 23:46:07
In reply to Re: Adult ADHD/ADD -this might help..., posted by Carl on May 30, 2001, at 9:22:40
> Hi--
forgive me for barging in. You mention UCL, ADD and dyslexia:
might this have been Oxford instead [people rolling in their graves
no doubt :)]?
Have a look at these links:
http://www.dyslexic.org.uk/abstracts.htm#AJR-FAMetabhttp://www.dyslexic.org.uk/images/ajr_doc_efa.pdf
I don't know if you'll find them of any use but they appear
to have had some success using essential fatty acid supplements.
No prescription needed, essentialy harmless, and who knows?
Perhaps something to try while you figure out how to get a proper
diagnosis and treatment?
I have ADD myself and I certainly feel for you -- and I'm a grad student.
I *believe* that were it not for diagnosis and treatment [w/adderall],
I would have performed dreadfully on my comprehensive examinations...
Best of luck.
S.
Posted by Carl on May 31, 2001, at 8:29:00
In reply to Re: Adult ADHD/ADD -this might help..., posted by Sulpicia on May 30, 2001, at 23:46:07
Thanks Sulpicia for the links.
I will check them out sometime. For the moment I have a lot of emails to reply to. Dyslexia itself is not a problem I have. Perhaps I sounded as if it was.
It wasn't UCL I mentioned but Kings College Hospital, part of St Thomas's and Guys. Oxford does sound like a good bet, however. I shall look into it.
Thank you again for the links. Are you new to this thread? If you return can you let me know if there are any decent English websites.
Regards
Carl.
Posted by XYZ on August 21, 2003, at 5:58:51
In reply to Re: Adult ADHD/ADD - getting stimulants (UK) » JahL, posted by Leonardo on March 5, 2001, at 8:27:29
Hello everyone. It seems that this thread has died a death, which is a pity. First of all thanks to all -Leonardo especially - for giving me the low-down on Dr Cosgrove and the Bristol Priority Clinic. I've just been diagnosed with the hyperactive form of ADHD and been put on Dex. Despite only taking 2.5mg twice a day at first and now 5/2.5./2.5 I'm amazed at the improvement. At the moment I do feel a definite crash when the level in my system drops, but I suppose I have to work out dosing over time.
I'd like to know what other people have found it like and how it compares to Ritalin. I am also interested to know if there's a "theory of gravity" involed - i.e. must what goes up come down. I know Paul Erdos (the Hungarian mathematician) took benzedrine for the last 25 years of his life and was the most prolific (and one of the most talented) mathematicians of last century. He stopped for a month and apparently couldn't work, so it does seem to have long term potential.
Back again soon
XYZ
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