Attention Deficit Hyperactivity Disorder Information from the "ADD ADHD Information Library"

Medications for Attention Deficit Hyperactivity Disorder - ADD or ADHD

Your Attention Deficit Disorder information source for

Ritalin (Methylphenidate)

Our opinion is that Ritalin is a good medication. But it can cause problems, and must be used with caution.

Tip for Parents: The short-acting pill is better than the timed-release pill. Also, the brand name "Ritalin" is much superior to the generic "Methylphenidate." Always begin your "trial" of medication with the real stuff. If that works, then feel free to see if the generic will work as well as the "real stuff."

Ritalin begins to work in about 15 or 20 minutes. It peaks in effectiveness at 1.5 to 2.5 hours, and lasts for about 3.5 to 4.0 hours.

Some kids have "withdrawals" or a "trough period" from coming off of the dose at about the 4 hour mark. They may become irritable, tearful, emotional, or bratty. This lasts for about 15 minutes, and tends to be worse with doses of 15 mg. or more. The best remedy for this that we've found is a 12 oz. Mountain Dew at about the 3.0 hour mark. The caffeine "deflects" or "flattens out" the angle of withdrawal. This trick works well.

We have seen hundreds of kids benefit greatly from Ritalin. But doctors and parents must be observant and conservative. We have also seen some horror stories with Ritalin. Start slowly and cautiously. It is not a toy.

Ritalin works somewhat differently in the brain than do the amphetamines like Dexedrine or ADDerall. Ritalin seems to primarily impact on longer term vesicular storage of Dopamine, while amphetamines impact primarily the pool of newly synthesized Dopamine. It also has a different effect on Norepinepherine.

To be fair, here is a link to a site that is strongly opposed to Ritalin use, as the author, Mr. Lawrence Smith, states that his child died as the result of its use. He claims that there are about 20 deaths reported each year to the FDA's MedWatch program. Although it is hard to believe everything that is on the internet, I do think that you should at least take a minute to look over his site and consider the information. Here is a copy of the email that Mr. Smith sent to me in 2002.

 

Mythology and Ritalin

From the Physician's Desk Reference (PDR) 1997, page 867

"Drug treatment should not and need not be indefinite and usually may be discontinued after puberty."

"Start with 5 mg twice daily, before breakfast and lunch."

"Administration of amphetamines for prolonged periods may lead to drug dependence and must be avoided."

None of these statements is supported by research.

Most children with ADD ADHD will still benefit from medications through their teenage years, and more than 50% of children with Attention Deficit Hyperactivity Disorder - ADD ADHD will still benefit from stimulant medications into adulthood.

Studies show that the medications work better if taken with or after meals.

Studies show, over and over again, that (1) ADD ADHD kids who are never treated will have higher rates of drug use than non-ADHD kids, (2) ADD ADHD kids that ARE treated, whether with medications, or biofeedback, or with anything, will have LOWER rates of drug us than non-ADHD kids. There is no evidence that using stimulant medications increases rates of drug use among adolescents or adults. Rather, the opposite is true.

Dexedrine (d-amphetamine)

Dexedrine is not prescribed much here in California, but those patients that we've seen on it have done well. Typically it is prescribed to patients who have not responded to Ritalin very well. It has the advantage of having a very nice long-lasting product (one dose per day). Usually it will not be prescribed to teenagers, as it can have retail value in the high school parking lot.

Cylert (Sodium Pemoline)

Cylert seems to be prescribed most by neurologists and by the few pediatricians who are afraid of Ritalin.

We don't recommend Cylert.

It works about half the time only. We have been told that it causes hepatitis in 1/1000 of patients. We cannot verify this, but it's good enough for us to not recommend it to patients anyway. Even the manufacturer recommends against it as the first medication tried in treating Attention Deficit Disorder - ADD ADHD.

Besides Attend works as well or better and is much healthier and safer.

ADDerall

This is a fairly new drug in the treatment of Attention Deficit Disorder - ADD ADHD. The doctors that we know who have tried it really have come to like it.

It is a "cocktail" drug, or a mixture of four drugs, all from the amphetamine family. As a result it has a broad spectrum of symptom coverage. It also tends to last for about six hours per dose, so it can cover the entire school day. It can be less "harsh" than Ritalin. ADDerall might be worth talking to your doctor about as either the first or second medication to try.

ADDerall tablets come in 5, 10, 20, and 30 mg doses offering great flexibility to a physician in targeting the optimum dose for any patient. Even greater flexibility is offered because the tablets are double-scored so they can be accurately split into halves or quarters. This means that ADDerall can be administered in increments as low as 1.25 mg, or adjusted in 1.25 mg increments.

ADDerall begins to work more gradually than Ritalin, or Dexedrine, and the "drop-off" slope is also much more gradual, meaning that there is less of a "trough" time at the end of the dose.

Read more about ADDerall at this site: http://www.pslgroup.com/dg960222b.htm

Expectations and Drawbacks

Either Ritalin or Dexedrine or ADDerall can be expected to work very well for the "space cadet" ADD kids. Stimulants (including caffeine) are great for "inattention" or "brain fog" symptoms. We would estimate that 75%-80% of Attention Deficit Disorder - ADD ADHD Inattentive Type kids would respond to low doses of Ritalin very nicely. For them, Ritalin is a very easy treatment intervention.

Hyperactive-Impulsive kids respond less well to the stimulants. Maybe 60-65% will benefit.

Kids with impulsivity or temper outbursts either do very well, or they do very poorly. These kids may also need something like Extress for temper, or Clonadine for extreme outbursts.

We recommend the Extress nutraceutical medicine first. We have seen Extress work very well in reducing temper outbursts. You can buy it at from VAXA International. The Clonadine is like a "sledgehammer," but use it if you need to.

The main drawbacks of stimulants that we have observed are loss of appetite (feed a protein shake twice a day to help keep weight up), some irritability or anger (as when you have had too much caffeine), possible short term growth inhibition (though long-term this may not be a problem). Remember, every medication has possible bad side effects, so always closely monitor your child when taking medications!

If there is a problem, don't give the next dose, and call your doctor right away.

 

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