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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by alohashirt on August 19, 2005, at 20:10:59
I am puzzled:
My doc tells me that the controlled studies for Provigil showed an improvement for children but not for adults. A number of people on this board have posted that they had better results from Provigil than Concerta or Ritalin. Controlled studies for Ritalin consistently show a measurable improvement.
I believe people are accurately repporting their experience so what should I make of this?
1) Provigil is more effective than Ritalin for a minority of people?
2) Provigil improves optimism so people think they are more improved with Provigil
3) the controlled studies of Provigil were brokenRemedyFind shows people preferring the Feingold / diet approach ""http://remedyfind.com/hc-ADD-ADHD.asp"" yet research doesn't seem to support Feingold at all. Should I assume that parents who are guilty/fearful of Ritalin are latching onto "No Coca Cola" as a treatment?
Posted by theo on August 19, 2005, at 23:59:51
In reply to Provigil for ADHD (cf Concerta), posted by alohashirt on August 19, 2005, at 20:10:59
Are you still taking Concerta?
Posted by alohashirt on August 21, 2005, at 0:08:21
In reply to Re: Provigil for ADHD (cf Concerta) » alohashirt, posted by theo on August 19, 2005, at 23:59:51
Yes - with dexedrine & strattera
Posted by theo on August 21, 2005, at 13:47:29
In reply to Re: Provigil for ADHD (cf Concerta), posted by alohashirt on August 21, 2005, at 0:08:21
> Yes - with dexedrine & strattera
I forgot to ask, what dose of Concerta?
How do you like the Strattera?
Posted by alohashirt on August 21, 2005, at 23:27:10
In reply to Re: Provigil for ADHD (cf Concerta) » alohashirt, posted by theo on August 21, 2005, at 13:47:29
> > Yes - with dexedrine & strattera
>
> I forgot to ask, what dose of Concerta?
>
> How do you like the Strattera?
>
>
My doc has been titrating the meds each month and right now we are reducing:Currently
36mg Concerta., 30mg dexedrine
50 mg StratteraI often think the Strattera does nothing but when I stop taking it I get worse.
I think that it could be worth trying the new Focalin XR.
Posted by Bill LL on August 22, 2005, at 12:19:41
In reply to Provigil for ADHD (cf Concerta), posted by alohashirt on August 19, 2005, at 20:10:59
I wonder if the dose used in the study for adults was lower than that used for children. For children, most had the best ADHD relief at 410 mg.
The tablets currently come in only 100 mg and 200 mg. But in the study for children, the manufacturer prepared pills that are 410 mg (for some strange reason).
I personally am having very good results taking 400 mg Provigil along with 15 mg Lexapro. It's helping my ADD symptoms more than when I took 72 mg Concerta. In addition to better results during the day, I'm getting good results through the evening and night also whereas the Concerta started to fade out at night. When I took only 200 mg of Provigil, it was not enough as I still had too much anxiety. But 400 mg has lessened my anxiety.
But since I also take Lexapro, it's hard to determine how Provigil would do for me on it's own.
> I am puzzled:
>
> My doc tells me that the controlled studies for Provigil showed an improvement for children but not for adults. A number of people on this board have posted that they had better results from Provigil than Concerta or Ritalin. Controlled studies for Ritalin consistently show a measurable improvement.
>
> I believe people are accurately repporting their experience so what should I make of this?
>
> 1) Provigil is more effective than Ritalin for a minority of people?
> 2) Provigil improves optimism so people think they are more improved with Provigil
> 3) the controlled studies of Provigil were broken
>
> RemedyFind shows people preferring the Feingold / diet approach ""http://remedyfind.com/hc-ADD-ADHD.asp"" yet research doesn't seem to support Feingold at all. Should I assume that parents who are guilty/fearful of Ritalin are latching onto "No Coca Cola" as a treatment?
Posted by zeugma on August 22, 2005, at 13:55:47
In reply to Re: Provigil for ADHD (cf Concerta), posted by Bill LL on August 22, 2005, at 12:19:41
Provigil targets different symptoms than Ritalin/Concerta. The symptoms Provigil targets may be less common than the ones the approved meds treat. That may mean it is statistically a less efficacious med for ADHD, but overlooks the fact that ADHD is an umbrella term (a 'wastebasket diagnosis', someone around here once said) for what might be a vastly different set of underlying pathologies.
-z
Posted by theo on August 22, 2005, at 16:36:20
In reply to Re: Provigil for ADHD (cf Concerta), posted by alohashirt on August 21, 2005, at 23:27:10
> > > Yes - with dexedrine & strattera
> >
> > I forgot to ask, what dose of Concerta?
> >
> > How do you like the Strattera?
> >
> >
> My doc has been titrating the meds each month and right now we are reducing:
>
> Currently
> 36mg Concerta., 30mg dexedrine
> 50 mg Strattera
>
> I often think the Strattera does nothing but when I stop taking it I get worse.
>
> I think that it could be worth trying the new Focalin XR.
What's the difference between methylphenidate (Concerta) and dexmethlphenidate (Focalin XR)?
Posted by alohashirt on August 22, 2005, at 21:51:28
In reply to Re: Provigil for ADHD (cf Concerta) » alohashirt, posted by theo on August 22, 2005, at 16:36:20
> >
> > I think that it could be worth trying the new Focalin XR.
>
>
> What's the difference between methylphenidate (Concerta) and dexmethlphenidate (Focalin XR)?
Ritalin (Concerta) is d,l-methylphenidate HCl
whereas Focalin is only the d isomer that is said to be more
active. The theory is that this means half the dose can be used
which means less side effects on appetite or sleep.
The tablet is D shaped.I don't believe that controlled studies or clinical reports fully support the 2 for 1 concept. It's a shame that there has been no research that compares teh stimulant medications. It's evident that they are different and different people prefer different ones.
Posted by Bowtie Bob on August 26, 2005, at 13:34:56
In reply to Re: Provigil for ADHD (cf Concerta), posted by alohashirt on August 22, 2005, at 21:51:28
> > >
> > > I think that it could be worth trying the new Focalin XR.
> >
> >
> > What's the difference between methylphenidate (Concerta) and dexmethlphenidate (Focalin XR)?
>
> Ritalin (Concerta) is d,l-methylphenidate HCl
> whereas Focalin is only the d isomer that is said to be more
> active. The theory is that this means half the dose can be used
> which means less side effects on appetite or sleep.
> The tablet is D shaped.
>
> I don't believe that controlled studies or clinical reports fully support the 2 for 1 concept. It's a shame that there has been no research that compares teh stimulant medications. It's evident that they are different and different people prefer different ones.
>
The big differences between the Concerta and Focalin XR are twofold: 1) Focalin/XR is the active isomer of the Ritalin/Concerta compound--the L-isomer is pretty much inactive, and 2) The release system of Focalin XR allows a 50% release upfront, whereas it takes 2-4 hours for the Concerta to hit. I am a working adult who begins the day early. As such, I cannot wait 2-4 hours for my med to kick in. Unfortunately, I need a short acting med mid-day to carry me through the day. I guess we have to look at the trade offs. By the way, I have not had any stomach upset with Focalin/XR like I did with d,l methylphenidate. Good luck!
Posted by alohashirt on August 26, 2005, at 22:36:43
In reply to Re: Provigil for ADHD (cf Concerta), posted by Bowtie Bob on August 26, 2005, at 13:34:56
> The big differences between the Concerta and Focalin XR are twofold: 1) Focalin/XR is the active isomer of the Ritalin/Concerta compound--the L-isomer is pretty much inactive, and 2) The release system of Focalin XR allows a 50% release upfront, whereas it takes 2-4 hours for the Concerta to hit. I am a working adult who begins the day early. As such, I cannot wait 2-4 hours for my med to kick in. Unfortunately, I need a short acting med mid-day to carry me through the day. I guess we have to look at the trade offs. By the way, I have not had any stomach upset with Focalin/XR like I did with d,l methylphenidate. Good luck!
>I began Focalin XR three days ago and so far it is an improvement on Concerta. Subjectively it feels sharper. What do you take in teh afternoon? Do you also take Strattera?
Posted by ed_uk on August 27, 2005, at 13:35:32
In reply to Re: Provigil for ADHD (cf Concerta) » Bowtie Bob, posted by alohashirt on August 26, 2005, at 22:36:43
That's very interesting. Please keep us updated.
What do you mean when you say it was sharper?
~Ed
Posted by theo on August 27, 2005, at 16:43:47
In reply to Re: Provigil for ADHD (cf Concerta) » Bowtie Bob, posted by alohashirt on August 26, 2005, at 22:36:43
> I began Focalin XR three days ago and so far it is an improvement on Concerta. Subjectively it feels sharper.
My doc gave me a scrip for Concerta, which I've tried before, but I'm tempted to ask him for a trial of Focalin XR instead. If you are taking 18mg Concerta, would you start at 10mg Focalin XR? What dose are you taking? Is it a pretty smooth release compared with Concerta? By "sharper" do you mean more on your toes, clearer thinking? Please explain.
Posted by alohashirt on August 27, 2005, at 22:22:31
In reply to Focalin XR » alohashirt, posted by ed_uk on August 27, 2005, at 13:35:32
> That's very interesting. Please keep us updated.
>
> What do you mean when you say it was sharper?
>
> ~EdIt's hard to explain. Instead of 36mg Concerta I am taking 15mg of Focalin. (Also taking 45mg dexedrine XR) I have previously taken up to 72mg Concerta so have a sense of how it affects me. The Focalin feels different - if it were a piano it would eb a higher note. It should be having identical effects through same mechanisms. I'll see how it feels after a few weeks.
Posted by Bowtie Bob on August 28, 2005, at 14:43:19
In reply to Re: Provigil for ADHD (cf Concerta) » Bowtie Bob, posted by alohashirt on August 26, 2005, at 22:36:43
> > The big differences between the Concerta and Focalin XR are twofold: 1) Focalin/XR is the active isomer of the Ritalin/Concerta compound--the L-isomer is pretty much inactive, and 2) The release system of Focalin XR allows a 50% release upfront, whereas it takes 2-4 hours for the Concerta to hit. I am a working adult who begins the day early. As such, I cannot wait 2-4 hours for my med to kick in. Unfortunately, I need a short acting med mid-day to carry me through the day. I guess we have to look at the trade offs. By the way, I have not had any stomach upset with Focalin/XR like I did with d,l methylphenidate. Good luck!
> >
>
> I began Focalin XR three days ago and so far it is an improvement on Concerta. Subjectively it feels sharper. What do you take in teh afternoon? Do you also take Strattera?I take a Focalin tablet--the short acting one--in the afternoon. No, I prefer not to take Strattera; the PI states that it goes thru the P-450 system in the liver...possible drug interactions. My preference is to go with that is tried and true first, then to something else if I have problems. Between the Focalin XR and Focalin, I am covered for about 14 hours--the whole work day, and part of the evening with my family. So far, after about 2 months I still do not have any trouble sleeping or eating. Everyone is different and reacts differently.
Posted by Bowtie Bob on August 28, 2005, at 14:45:42
In reply to Re: Focalin XR, posted by alohashirt on August 27, 2005, at 22:22:31
> > That's very interesting. Please keep us updated.
> >
> > What do you mean when you say it was sharper?
> >
> > ~Ed
>
> It's hard to explain. Instead of 36mg Concerta I am taking 15mg of Focalin. (Also taking 45mg dexedrine XR) I have previously taken up to 72mg Concerta so have a sense of how it affects me. The Focalin feels different - if it were a piano it would eb a higher note. It should be having identical effects through same mechanisms. I'll see how it feels after a few weeks.I assume that your are taking the Focalin XR. If so, remember that you get 50% of the Focalin upfront as opposed to about 22% of the methylphenidate from the Concerta. This explains the quicker effect. Concerta hits you on the back end of the release.
This is the end of the thread.
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