ADD Medications / CNS Stimulants

Medications discussed on this site include:
Adderall
Desoxyn (methamphetamine)
Dexedrine (dextroamphetamine sulfate)
Focalin (dexmethylphenidate hydrochloride)Ritalin / Concerta (methylphenidate hydrochloride)
Cylert (pemoline) (Brand being discontinued, generic still available for now)
And the non-stimulant Strattera (atomoxetine HCl), which is also covered in the section on SNRIs.
While this site is primarily for adults, the ADD/ADHD market is primarily for kids. Although the advertising blitz for adult ADD/ADHD is now in full force, led by the two meds approved for adult use: Strattera and Adderall. There are plenty of adults in the ADD/ADHD spectrum, including the vast majority of people in the bipolar spectrum. That’s right, the latest research has shown that people in the bipolar spectrum have less dense prefrontal cortices than the non-bipolar, and that’s going to give you ADD symptoms.
We are a bit concerned about the aggressiveness of the marketing of ADD meds towards parents of kids who may or may not need meds. Now you people with kids who obviously express the hyperactive part of ADHD who have tried everything else, we’re not telling you to once again question your decision about meds. Kids who are really hyperactive as part of ADHD probably need meds, and just like any other psychiatric disorder it’s merely a question of finding the right medication or cocktail of medications. What bugs us is the marketing of drugs as the solution for children not paying attention to boring, irrelevant school that competes with exciting TV and video games. Are children being medicated unnecessarily? Maybe. But there are plenty of kids who are not hyperactive who certainly need drugs. It’s tough to figure it out.

ADD medications are all stimulants of a sort, even Strattera. Although sold as the only non-stimulant ADD med currently on the market, Strattera does have a stimulating effect for some people. It sure as hell woke me up in the morning, and I’m not the only one reporting that.
Now if you have ADD/ADHD, these stimulants tend to calm you down and help to focus your attention, whereas if someone without ADD takes a recreational stimulant they’re physically and mentally jumping all over the place. This is not a paradoxical reaction as seen in people with bipolar disorder. The ADD/ADHD brain has areas of under-activity primarily in the prefrontal cortices. Anyway, the lack of activity in the prefrontal cortices is the reason why our train of thought is always jumping tracks, if not crashing outright. Nature abhors a vacuum, right? So the brain makes up for that under-activity with extra activity elsewhere, thus the hyperactivity part of ADHD. The ADD meds go right to the prefrontal cortices and generally boost the activity everywhere, but mainly, when they work correctly, where there’s not enough activity. Thus activity in the brain is smoothed out and regulated and there’s no need to be hyperactive in one place because you’re not under-active anywhere else. And with normal brain activity you can keep a train of thought going.
To use a somewhat flawed analogy of a car with a misfiring cylinder, the one or two cylinders that aren’t firing correctly are the under-active parts of the brain, while the ones causing the annoying backfires, knocks and bangs are the hyperactive parts of the brain. The ADD meds smooth out the activity of your brain so everything runs at the same level of activity. The trick is just making sure you’re not revving too fast all the time.

To help you decide if it’s bad enough to require an ADD-med, you should be seeing a therapist or counselor and you should belong to a support group. A psychiatrist is basically going to figure out the right meds for you and that’s going to be about it. Sometimes they’ll do counseling, but often not. For more information on, and reasons why you should be seeing a talk therapist/counselor and belong to a support group, take a look at my page on support groups. Both will help you determine if you really do need meds. And if you do, the services of both therapist and support group are vital to complete what the meds do, because meds alone are not going to fix your problems! You’re going to have to learn coping skills no matter what. So everything that all the people who try the non-med way to deal with ADD – the people who take meds need to be doing that stuff as well. You can’t be lazy and expect the meds to do it all for you.

The effects in common to the ADD meds:
Because these are stimulants, they all have a common side effect that is just the thing everyone all the other meds is looking for – weight loss. As such they are not for people who have any sort of eating disorder. They also tend to raise your blood pressure and mess with your heart rhythms one way or another. So if you have any history of cardiac weirdness, it’s time for a long talk with your psychiatrist and whoever is looking out for your heart before taking any of these medications.

The sleep thing is weird, while insomnia or just a general need for less sleep is common, yet with some forms of ADD/ADHD some of the speedier ones like Desoxyn, Adderall and especially Dexedrine can actually help people sleep better. Again this is not an example of the paradoxical effect but just a smoothing out of brain activity, I just wish I knew what the deal was with Dexedrine and sleep. I keep getting and reading more reports

(you know, anecdotal evidence) of people getting really sleeping on Dexedrine.
They interact with other drugs (especially MAOIs (which interactive with everything on the planet), other antidepressants and anticonvulsants) and some foods. You absolutely cannot wash these meds down with orange juice or other citrus products, else you’re wasting your money. It’s in some of the older PI sheets for these meds. But not some of the newer ones. Conspiracy by the drug companies? Maybe they were just happier that some kids weren’t bouncing off of the ceiling after breakfast.

Anyway, the short reason is here. A longer, and somewhat kinkier answer is here. No OJ. For the same reason no meds for tummy troubles (indigestion, diarrhea, whatever). You’ve got to have perfectly balanced pH levels in your stomach. The newer flavor of Adderall XR may not be so touchy about this, with it’s high-tech coating. The same goes for Concerta. And Strattera doesn’t give a rat’s ass one way or the other, as it’s not technically a stimulant. But all the others – wash them down with water on an either an empty stomach or the blandest food you can eat.

Plus there’s aggravation of anxiety and nervousness, tics and tremors (including “unmasking,” to use the term of art, of Tourette’s syndrome), an increased chance of seizures for those of us in the epilepsy spectrum, that pesky cottonmouth, increased sweating; and the usually transitory stuff of headaches, dizziness and tummy troubles that will accompany each introduction to a new med or increase in dosage.

Oh, and they’re addictive and can be abused. And once you get into abuse, or just having too high of a dosage under doctor’s orders, you might find yourself in the realm of paranoia, hallucinations and general psychotic behavior. Some of them require a triplicate prescription and Desoxyn in particular is a real pain in the ass to have filled. The growth and weight of kids always has to be monitored.

Because of FDA scheduling you can’t buy most of these meds from an overseas pharmacy. Even buying them from a domestic Internet pharmacy can be tricky sometimes and I wouldn’t trust buying any CNS stimulant through the mail. If it takes a triplicate prescription, you really should to go someone in person to buy your meds and that’s all there is to it.

Because it is possible to misdiagnose bipolar as ADD/ADHD, or vice versa, watch out for mood swings and really nasty mania reactions like rages or their feeling just too good and doing something patently crazy. We always recommend if there is a known or suspected bipolar condition, or even known clinical depression, that all credit cards and firearms be put in the hands of a trusted friend or relative prior to taking any of the stimulant-based ADD medications for the first time, and that that friend or relative have bail money handy. You don’t want to find out if you’re bipolar the hard way. And if you are bipolar, you had better have a damn good reason for taking these medications.

Otherwise, stimulants don’t tend to have a lot of side effects. Well, the non-methylphenidate class. I.e. everything except Ritalin / Concerta and Focalin. That crap I’m not too fond of. Everything else – they’re basically a safe class of medication for adults. As usual I’m clueless about kids, so I can’t really tell you one way or the other. But for adults, as long as you’re not prone to abusing stuff. I.e. you don’t have a history of partying too much and/or too often and/or OCD tendencies, then the amphetamine class of stimulant can be a useful and relatively safe class of meds for a variety of applications.

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