[335i4u2nv]

anyone here have it or have taken the meds for it. Bc supposedly my doc thinks i have it and wants me on Strattera some weak ass gay version of Adderall which i dont want to be on but idk... should i? I liver is already a POS and ive had multiple procedures on it already.

INFO on meds? anything... im bored outta my mind

[inabis]

you know I've been wondering if I have this as well...I just can't seem to remember anything anymore and sometimes when people talk to me the best way to explain it is that my mind becomes lazy and stops listening. I literally have to fight my brain to focus and by the time that happens I missed what the person has said. I thought it was all in my head up till now but I might need to get checked out...did you just go to a normal doctor. I now almost always carry a notepad with me so I dont forget anything...it just drives me crazy. Does this happen to you as well??

sorry I don't mean to

[JoeClothing]

Yup...I was diagnosed with it. Took Adderall for one day and felt like I was going bonkers. I literally didn't sleep for a 24 hour period and hated that my heart felt like it was going to beat out of my chest, so I got off the meds, and well have decided to just live with it.
.

[335i4u2nv]

Originally Posted by inabis

you know I've been wondering if I have this as well...I just can't seem to remember anything anymore and sometimes when people talk to me the best way to explain it is that my mind becomes lazy and stops listening. I literally have to fight my brain to focus and by the time that happens I missed what the person has said. I thought it was all in my head up till now but I might need to get checked out...did you just go to a normal doctor. I now almost always carry a notepad with me so I dont forget anything...it just drives me crazy. Does this happen to you as well??

sorry I don't mean to

hey its cool about the jacking... lol but ya i went to family med doc and then went to a psyc and neuro docs and they agreed but i felt like u did with the forgeting and no paying atten. meds arent doin shit for me even though ive only been taking it for a few days

[TheLegacy]

I'm sorry, what did you guys say?

Don't take meds if you don't feel you need it.

People have been convinced all my life I have ADD

yet never bothered to check into it cuz I don't care... I can pay attention but my mind drifts a lot, plenty to think of lol

[schneid4323]

Ive been debating things like this for weeks.

Aderall is terrible, the fact they give it to children sickens me. It is an enphetamine with the same side affects as speed as well as the same dependency, and parents give this to kids 5+..... Doctors pass this speed out like wild fire, anyone who has taken it, including myself, knows that it helps you concentrate but ruins your appetite and keeps you up just like coke or meth... Giving this to really anyone for daily use, especially growing children must be a joke, i seriously dont understand where people get off doing this.

You see a rise in ADD mainly hitting in my generation, the beginning of the internet. Why is this you might ask? well one measures brain thoughts at mili-seconds and one measures processing in nano, so the need to think quicker has come. Evolution? possibly Adaptation? eventually will become evolution. So why fight progress? I have ADD and i figured out the best way to use that with my OCD. Something called Lateral thinking http://en.wikipedia.org/wiki/Lateral_thinking is what i typically do mixed with logic/reason... controlling your ADD to focus on topics, practicing it, maybe even getting to the point where I am may help you, I can literally use my ADD to think twice as fast as one could in traditional ways, I have stepped outside the boundaries of language into a spiral of thought in which ADD is very useful. The world is changing, we must change to, just as we did when Plato wrote Republic and when the middle east obtained Aristotle, and when Augustine started the dark ages. If you need any help or have any question about how to not suppress ADD but to control your mind with the absence of drugs (pot is useful really though, but way better then speed) im willing to help you with anything that I can. Dont fight it, control it, utilize it, make money...

[335i4u2nv]

Originally Posted by schneid4323

Ive been debating things like this for weeks.

Aderall is terrible, the fact they give it to children sickens me. It is an enphetamine with the same side affects as speed as well as the same dependency, and parents give this to kids 5+..... Doctors pass this speed out like wild fire, anyone who has taken it, including myself, knows that it helps you concentrate but ruins your appetite and keeps you up just like coke or meth... Giving this to really anyone for daily use, especially growing children must be a joke, i seriously dont understand where people get off doing this.

You see a rise in ADD mainly hitting in my generation, the beginning of the internet. Why is this you might ask? well one measures brain thoughts at mili-seconds and one measures processing in nano, so the need to think quicker has come. Evolution? possibly Adaptation? eventually will become evolution. So why fight progress? I have ADD and i figured out the best way to use that with my OCD. Something called Lateral thinking http://en.wikipedia.org/wiki/Lateral_thinking is what i typically do mixed with logic/reason... controlling your ADD to focus on topics, practicing it, maybe even getting to the point where I am may help you, I can literally use my ADD to think twice as fast as one could in traditional ways, I have stepped outside the boundaries of language into a spiral of thought in which ADD is very useful. The world is changing, we must change to, just as we did when Plato wrote Republic and when the middle east obtained Aristotle, and when Augustine started the dark ages. If you need any help or have any question about how to not suppress ADD but to control your mind with the absence of drugs (pot is useful really though, but way better then speed) im willing to help you with anything that I can. Dont fight it, control it, utilize it, make money...

ya thats what ive been doin for the last 12 yrs but right now in my current state with my carrer and everything else i really dont need this right now.

[schneid4323]

Originally Posted by 335i4u2nv

ya thats what ive been doin for the last 12 yrs but right now in my current state with my carrer and everything else i really dont need this right now.

If you could focus your ADD on your career and everything else at your discretion how would it not be beneficial? I think you may be missing what i'm saying, re-read it and check out the wiki page.

[ADHD]

AHAD??? U mean ADHD!!! hmmmm whats that???

[Kev]

If you don't want to take the stimulants, there are alternatives like Atomexetine (Strattera) or buproprion (Wellbutrin) that can help with the ADHD symptoms. They are not as effective as the stimulants though.

Methylphenidate and mixed amphetamine salts are fairly safe medications and oral use of these pills have not been linked to dependence / addiction down the road. The SR formula does not give you the same kind of rush as speed or crystal meth.

[Expired]

Originally Posted by inabis

you know I've been wondering if I have this as well...I just can't seem to remember anything anymore and sometimes when people talk to me the best way to explain it is that my mind becomes lazy and stops listening. I literally have to fight my brain to focus and by the time that happens I missed what the person has said. I thought it was all in my head up till now but I might need to get checked out...did you just go to a normal doctor. I now almost always carry a notepad with me so I dont forget anything...it just drives me crazy. Does this happen to you as well??

sorry I don't mean to

How old are you??

Could be that you have had a people overload..
Try getting away from people for a while and relax, instead of trying to absorb everything?? At least before you start taking medicine.. It seems like doctors have a drug for everything now a'days, even though most of the time it has been normal behavior for centuries.

-Nathan

[Dragonman4]

Originally Posted by Kev

If you don't want to take the stimulants, there are alternatives like Atomexetine (Strattera) or buproprion (Wellbutrin) that can help with the ADHD symptoms. They are not as effective as the stimulants though.

Methylphenidate and mixed amphetamine salts are fairly safe medications and oral use of these pills have not been linked to dependence / addiction down the road. The SR formula does not give you the same kind of rush as speed or crystal meth.

Indeed. To quote the future MD/DO from a future PharmD, Strattera is the 1st non-stimulant designed to treat ADD/ADHD and bupropion has been used for years for antidepression and now in ADD/ADHD. Basically the thought behind ADD/ADHD or most other neurological disorders is the disruption of chemical signals within the brain. Loss or degradation of the number of triggering chemicals that entice the nerves in your brain to depolarize or "fire" is believed to cause most of the psychiatric disorders.

The 2nd part I'd have to disagree with slightly. True that methylphenidate (Ritalin) and mixed amphetamine salts (Adderall) are not as potent as the original compound methamphetamine, they're still considered DEA schedule II for their addictive/abuse potential. What I think you meant to say Kev, and correct me if I'm mistaken in your phrasing, is that proper management of these medications should not lead to dependence/addiction down the road. In reality however, due to gradual receptor hypersensitization, they will downregulate and you will most likely require higher doses. But this is a process that will take years.

Unfortunately, it's pretty easy nowadays to get diagnosed with ADD being the diagnostic confirmatory test is so subjective with minimal sensitivity. If you're really hesitant to start actual stimulant medications, try some caffeine first. Caffeine itself is a pretty potent stimulant. After all, there's nothing like a double-shot of espresso to wake you up.

[Kev]

Originally Posted by Dragonman4

Indeed. To quote the future MD/DO from a future PharmD, Strattera is the 1st non-stimulant designed to treat ADD/ADHD and bupropion has been used for years for antidepression and now in ADD/ADHD. Basically the thought behind ADD/ADHD or most other neurological disorders is the disruption of chemical signals within the brain. Loss or degradation of the number of triggering chemicals that entice the nerves in your brain to depolarize or "fire" is believed to cause most of the psychiatric disorders.

Well, if you read up on ADHD literature, you'll find that the mechanism of action of the stimulants on ADHD is not known. It is paradoxical that a stimulant medication can be used to treat attention deficit and hyperactivity. It is true that chemical imbalance in the brain is thought to be part of the cause of psychiatric disorders (e.g. low serotonin = depression, high dopamine = psychosis) and forms the basis of pharmacological intervention in psychiatry. However, we cannot undermine the effectiveness of psychotherapy on these illness. Take depression as an example, psychotherapy is as effective as SSRIs in multiple RCTs.

Originally Posted by Dragonman4

The 2nd part I'd have to disagree with slightly. True that methylphenidate (Ritalin) and mixed amphetamine salts (Adderall) are not as potent as the original compound methamphetamine, they're still considered DEA schedule II for their addictive/abuse potential. What I think you meant to say Kev, and correct me if I'm mistaken in your phrasing, is that proper management of these medications should not lead to dependence/addiction down the road. In reality however, due to gradual receptor hypersensitization, they will downregulate and you will most likely require higher doses. But this is a process that will take years.

You are partially right. The stimulants are DEA Schedule II for its abuse potential because the pills can be crushed and smoked, not because the po form has addictive potential. With numerous RCTs published, none was able to link the use of po stimulants under the supervision of a physician to substance dependence down the road. I also suggest you to read up on the mechanism of action on these stimulant drugs, they act as Dopamine / Norepinephrine reuptake inhibitor, thus increasing the effective concentration of dopamine across the synaptic cleft. They do not actively bind to the post-synaptic dopamine receptor and thus have no direct agonist effect on the receptor. Therefore, these medications, unlike the opiates, will not cause severe receptor hypersensitization or down regulation even after years of use. The tolerance that you are describing are more related to the people that abuse amphetamines, i.e. they need to use more to achieve the same high as before. Worse case is that you use too much and deplete all your dopamine store, which would result in the infamous "crash" as seen in a cocaine binge.

Originally Posted by Dragonman4

Unfortunately, it's pretty easy nowadays to get diagnosed with ADD being the diagnostic confirmatory test is so subjective with minimal sensitivity. If you're really hesitant to start actual stimulant medications, try some caffeine first. Caffeine itself is a pretty potent stimulant. After all, there's nothing like a double-shot of espresso to wake you up.

The neuropsych testing for ADD is actually pretty robust and is pretty much standardized AFAIK. However, I'm not an expert in psych testing so I'll refrain from commenting on the sensitivity and specificity of the testing (I don't even know the gold standard of diagnosis).

[Dragonman4]

Originally Posted by Kev

Well, if you read up on ADHD literature, you'll find that the mechanism of action of the stimulants on ADHD is not known. It is paradoxical that a stimulant medication can be used to treat attention deficit and hyperactivity. It is true that chemical imbalance in the brain is thought to be part of the cause of psychiatric disorders (e.g. low serotonin = depression, high dopamine = psychosis) and forms the basis of pharmacological intervention in psychiatry. However, we cannot undermine the effectiveness of psychotherapy on these illness. Take depression as an example, psychotherapy is as effective as SSRIs in multiple RCTs.

Agreed. Many MOA's of neurological medications are not known for certain, they're merely "thought to work by this mechanism". I also agree with your comment about SSRIs and psychotherapy. If I remember, the treatment protocol for MDD is usually psychotherapy along with the initiation of an SSRI or TCA to maximize efficacy.

You are partially right. The stimulants are DEA Schedule II for its abuse potential because the pills can be crushed and smoked, not because the po form has addictive potential. With numerous RCTs published, none was able to link the use of po stimulants under the supervision of a physician to substance dependence down the road. I also suggest you to read up on the mechanism of action on these stimulant drugs, they act as Dopamine / Norepinephrine reuptake inhibitor, thus increasing the effective concentration of dopamine across the synaptic cleft. They do not actively bind to the post-synaptic dopamine receptor and thus have no direct agonist effect on the receptor. Therefore, these medications, unlike the opiates, will not cause receptor hypersensitization or down regulation even after years of use. Worse case is that you use too much and deplete all your dopamine store, which would result in the infamous "crash" as seen in a cocaine binge.

I am aware of their MOA, but would constantly increased plasma concentrations of amines within the synaptic cleft eventually not lead to post-synaptic receptor hypersensitization due to repeated sensitization and thus leading to downregulation?

With regards to the Schedule II, if I remember reading the package inserts correctly, physical dependence does develop with amphetamine-derived products. Granted that may not be true for all of them, but for instance Vyvanse, the new lisdexamfetamine dimesylate product has a Drug Abuse and Dependence section describing the euphoric effect of amphetamine analogues and hence their abuse potential. While this may be just a formality, isn't there a dependence syndrome seen in psychiatric patients regarding methylphenidate?

The neuropsych testing for ADD is actually pretty robust and is pretty much standardized AFAIK. However, I'm not an expert in psych testing so I'll refrain from commenting on the sensitivity and specificity of the testing (I don't even know the gold standard of diagnosis).

If I recall from the AAFP journals, they use the DSM-IV criteria for diagnosis. However, if you actually look at the symptoms list, they would be fairly easy to fake. Hence why I would say off the record that the tests are pretty useless in terms of specificity.


I wish I had access to UpToDate or MDConsult right now lol, but seeing as how I'm home, I can't access them. In any case, you make some interesting points. I actually plan on going to medical school after my 1 year contract with CVS is over. Retail Pharmacy just pays too well lol.

[Kev]

Originally Posted by Dragonman4

Agreed. Many MOA's of neurological medications are not known for certain, they're merely "thought to work by this mechanism". I also agree with your comment about SSRIs and psychotherapy. If I remember, the treatment protocol for MDD is usually psychotherapy along with the initiation of an SSRI or TCA to maximize efficacy.


I am aware of their MOA, but would constantly increased plasma concentrations of amines within the synaptic cleft eventually not lead to post-synaptic receptor hypersensitization due to repeated sensitization and thus leading to downregulation?

With regards to the Schedule II, if I remember reading the package inserts correctly, physical dependence does develop with amphetamine-derived products. Granted that may not be true for all of them, but for instance Vyvanse, the new lisdexamfetamine dimesylate product has a Drug Abuse and Dependence section describing the euphoric effect of amphetamine analogues and hence their abuse potential. While this may be just a formality, isn't there a dependence syndrome seen in psychiatric patients regarding methylphenidate?



If I recall from the AAFP journals, they use the DSM-IV criteria for diagnosis. However, if you actually look at the symptoms list, they would be fairly easy to fake. Hence why I would say off the record that the tests are pretty useless in terms of specificity.


I wish I had access to UpToDate or MDConsult right now lol, but seeing as how I'm home, I can't access them. In any case, you make some interesting points. I actually plan on going to medical school after my 1 year contract with CVS is over. Retail Pharmacy just pays too well lol.

No doubt stimulants cause tolerance, but only if you consume large amounts of it, as in substance abuse / dependence. The doses used to treat ADHD (20-60mg po qday for methylphenidate, sustained release prep, or 10-30mg po qday for amphetamine mixed salts, sustained release prep) are not likely to cause hypersensitization and downregulation of the receptor.

My honest opinion about medical school vs retail pharmacy is "stay with pharmacy, it's really not worth while to go to medical school." Too much investment (money, time, effort), too little return. 47K / year salary for a PGY-1 in a big city and you work about 100 hours a week.

[Dragonman4]

Originally Posted by Kev

No doubt stimulants cause tolerance, but only if you consume large amounts of it, as in substance abuse / dependence. The doses used to treat ADHD (20-60mg po qday for methylphenidate, sustained release prep, or 10-30mg po qday for amphetamine mixed salts, sustained release prep) are not likely to cause hypersensitization and downregulation of the receptor.

My honest opinion about medical school vs retail pharmacy is "stay with pharmacy, it's really not worth while to go to medical school." Too much investment (money, time, effort), too little return. 47K / year salary for a PGY-1 in a big city and you work about 100 hours a week.

True

Regarding med school vs pharmacy. Yea it's a cushy job, but I've always seen myself being an MD. Yes, the pay scale for residency sucks, but 47k for a PGY1 is actually higher than it used to be no? I remember hearing when you'd be lucky to get 35k. At least you get some bumps as you progress through your years. I find it more fulfilling being a doctor. Everyone always says you have to want to be a doctor to actually be one. It's true to an extent I suppose or else everyone would have given up during internship. I give props to all med students/interns/residents, I round with them every morning. You know what you want to specialize in? I'm hoping to go into oncology w/ a further sub-specialty in oncogenomics.

edit: saw your sig lol. divinum est sedare dolorum. blessed are those that relieve pain if my latin serves. I'm guessing anaesthesia?

[Kev]

Originally Posted by Dragonman4

True

Regarding med school vs pharmacy. Yea it's a cushy job, but I've always seen myself being an MD. Yes, the pay scale for residency sucks, but 47k for a PGY1 is actually higher than it used to be no? I remember hearing when you'd be lucky to get 35k. At least you get some bumps as you progress through your years. I find it more fulfilling being a doctor. Everyone always says you have to want to be a doctor to actually be one. It's true to an extent I suppose or else everyone would have given up during internship. I give props to all med students/interns/residents, I round with them every morning. You know what you want to specialize in? I'm hoping to go into oncology w/ a further sub-specialty in oncogenomics.

edit: saw your sig lol. divinum est sedare dolorum. blessed are those that relieve pain if my latin serves. I'm guessing anaesthesia?

Man, I admire your aspiration. If that's the case, I'd say follow your heart and don't look back. I agree that you have to want to be a doctor to actually become one, but the other part of the harsh reality is that you have to finish your training in order to make enough money to pay off your loans. That's the frequently undisclosed side of the harsh reality in medicine. A lot of us walk out with a mortgage without a house. As I said, 47K for PGY1 is on the high side, e.g. schools in Manhattan, and is not the norm.

Oncogenomics sounds like a fun and promising field for the future, especially with the development of therapeutic monoclonal antibodies. It'd be cool if the treatment of a patient is tailored specifically to the genotype of the tumor cells.

For me, I'll most likely end up in anesthesiology with fellowship in critical care or pain. I'll have to start applying this June.

[Dragonman4]

Yea, oncogenomics, metagenomics, the future is in targeted hormonal compounds. The burden of med school is rough, but pharmacy school isn't a joke either. If it weren't for scholarships and grants, I'd be 225k in debt. It's a 6-year doctor of pharmacy program here, I started off at 28k my 1st year, and every year it went up. This current year, which is my last is 42k for tuition and I'm basically just out doing rotations/rounding. I know a few of my friends who have had to borrow the whole way and for them it's close to 200k just for tuition minus housing/food.

Best of luck to you though. Maybe you'll get Mass Gen. That would be sweet to have on your resume. =)

[Year's_End]

Originally Posted by inabis

you know I've been wondering if I have this as well...I just can't seem to remember anything anymore and sometimes when people talk to me the best way to explain it is that my mind becomes lazy and stops listening. I literally have to fight my brain to focus and by the time that happens I missed what the person has said. I thought it was all in my head up till now but I might need to get checked out...did you just go to a normal doctor. I now almost always carry a notepad with me so I dont forget anything...it just drives me crazy. Does this happen to you as well??

sorry I don't mean to

You definitely have ADD. Trust me, I would know.

[335i4u2nv]

ohh well all i know is this Strattera crap doesnt do much for me and leaves me feeling sick all day

[335i4u2nv]

but thanks for all the input and all the smart talk! i learned alot reading these posts. And i guess Adderall isnt as bad as long as the doc watches u and dont abuse it. But my liver is crappy already so does this effect it? i know this Strattera crap is bad for it but the doc insists i take it first

[Dragonman4]

Adderall has no issues with the liver that I know of, mostly cardiac. Strattera does have a caution in patients with liver injury as in rare cases, it may cause your liver enzymes to shoot up, but the incidence really is rare. Basically if your doc feels comfortable with you on it and you already have a bad liver, he will most likely do a baseline LFT for you before you start it. As long as he's watching your labs, you should be ok.

Regarding your feeling sick, if you have any side effects that last longer than a week or that affect you to a point where you don't want to deal with it or it actively affects your life, then tell your doc and he should switch you to something else.