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Goody,

This post may appear to be an attempt to hijack your thread but you'll find it relevant at end.

KjRunner,

You and I are very close psychological twins. I find that interesting because we differ from gender to upbringing to every other psychological property. I can only conclude that you and I are part of an psychological pattern that is rooted in biology not environment.

You may be able to replace Wellbutrin and Adderall with concerta.

What follows is my Concerta recommendation basis.

The two years following my diagnosis was very difficult for me med wise. I must take part of the blame. But the balance I am going to place right where it belongs - on the medical "profession."

The short of it: I resisted stimulants for about six months after a doctor suspected ADHD. During those six months I was losing money faster than the Feds. My deficit budget was because to I couldn't work and I can't raise taxes. Brain problems were between me and a paycheck. I went to my family doctor and told him I need speed. Honestly I said it just like that. He knows me. He says "adult ADHD is a very complex disorder that requires a specialist. I don't want to prescribe because I don't know what I am doing. You need a shrink." I said "ok." The HMO I had at that time would not allow my doc to refer a shrinK. I was livid. My brain is more important to me than my liver. Can refer a liver guy. Can't refer a shrink. What gives?

So I go to my HMO's web to find their shrinks - zillions of them. I picked the one that was geographically closest to me. That is not a good way to choose a doc that will work on my brain. I called and his girl says, three months for an appointment. I took it.

Three months? I'm desperate. I go back to fam doc and tell him it's three freaking months till I see the shrink and I am going broke. Give me a speed prescription so I can get off the ground. I hounded him and he acquiesced. He writes a script for two 10mg generic ritalins AM/PM because my HMO won't pay for any ADHD med other than generic - not Strattera, Adderall, Ritalin LA, Concerta, etc. Generic or pay out of the pocket. With my deficit budget I took the generic.

So I get my generic Rit (methylin) and take my AM dose. The lights came on for about two hours. I was wonderful. I was "cured." But had to wait another couple hours for my noon dose. Same deal - for about two hours the lights were on - then off again. So I go on the net and find that the generally accepted max for Rit is 60 mg per day. Well, this is a no brainer - I'll fill in the blanks to determine how many pills I need, tell doc and he'll write me an update. I tell doc that 5 10mg pills per day is pay dirt. He went ballistic. He was screaming at me "how dangerous what I did was." He carried on like a lunatic. I told him I looked it up on the net and 60 mg is max. I only need 50. He kept on ranting. Then he writes me a script for 2 20mg Ritalin SR. Please note that SR is old technology that doesn't work well.

I take the AM 20mg pill and about 2 hours later the lights went out [U]and [/U]an overwhelming depression came over me. Two years later I discovered that 20 mg in one shot is too much for me. How I wish that I hadn't hounded family doctor. He was right. I was wrong. ADHD meds should not be managed by a family doctor.

Finally I get my shrink appointment. The guy is a bozo. He knew less about ADHD than my family doctor.

I find another shrink that shingled ADHD. I got an appointment in two weeks. I tell him that the two 20mg pills isn't enough. No problem. He upped it sequentially to 80mg. I kept getting worse and worse. So I fired him too. And found another family doctor that I knew has ADHD kids. She prescribed Adderall maxing it at 40mg / day. I got worse. Damn.

Back to the web. I discovered that 20mg at a shot is too much for me. And that is why 5 10mg spread out over the course of the day worked so well. Beginners luck. I called the second shrink that I fired for an appointment. We hashed it out. When I said two 20mg Rit isn't enough he interpreted that to mean that 40 mg does not control my ADHD symptoms. He understood me that way because that is what I meant. I wasn't able to distinguish between lack of efficacy and a depressive reaction. Now that he understood, he knew what to do - prescribe Concerta. Well, at that time financially I am doing better but just barely making ends meet. So we went with 3 20mg generic cut in half taken every 1.5 hours or so. Works but is a pain taking 6 doses per day and frequently I screw up on the timing.

I am calling tommorow to request a Concerta script. I can afford the Concerta now and could have afforded it three years ago if I only knew then the direct relationship between a meds efficacy and my ability to function.

Goody,

Don't let that college psychiatric Nurse Practioner over-ride Amen's recommendations. Someone just posted how important it is to get - not just a shrink - but an ADHD specialist shrink. Dr. Daniel Amen is the preeminent ADHD specialist. All other shrinks need to catch up. Anyway I felt the details I provided were necessary for substantiating my "don't do that recommendation."

Bob





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