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Doctors' Answers to "Frequently Asked Questions" - Attention Deficit Disorder

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Attention Deficit Disorder and Bipolar II [posted 1/14/99]
Question: Depakote/Cylert/Wellbutrin/Klonopin Interactions.
I just recently started taking Depakote for Bipolar II. My doctor had been giving me Klonopin, which was not much help. I have always had trouble sleeping and found that the Wellbutrin made me even more restless and edgy than I had been before (I was already a terror). My mood was very unstable and has always been. I was given Cylert for my ADD and have found it does not work nearly as well as the Ritalin I was originally taking. Unfortunately my mood really was affected when the Ritalin was wearing off. Not to mention I had lost over 10 lbs. in less than 3 months (at 5’ 5” I was down to 97 lbs.). My Psychiatrist thought Wellbutrin would help with the ADD. At that time I had gone through two severe losses of my grandpa in December and then my grandma in February. Needless to say I felt terrible and my ADD symptoms were very much there. I was put on Cylert and have been on it now for some time now and am not seeing any real improvement in my ADD. Plus, I had terrible insomnia. About 2 1/2 weeks ago I started taking Depakote first 250 mg/day. After 4 days that was upped to 500 mg and now it is at 750-1000 mg. It seems like a very rapid increase, but it seems to help. My temper and irritability are much better. I am taking these 3 pills all together at the same time 9, 1, and 6. The Klonopin I am gradually weaning myself off of, but I notice I am having trouble sleeping again. I have never taken anything that has made me tired enough that I fall asleep. My Cylert/Wellbutrin combo is not really working for my ADD either. My Psychiatrist is just really at a loss as to what he should do to help me sleep and address my ADD symptoms. I have a fairly serious past of 3 suicide attempts, plus a lot of other destructive behavior. What kind of drug interactions are associated with these medications? Maybe reducing the Klonopin is part of the problem. Also, my short term memory is terrible.

Answer: Well, reducing the Klonopin is probably contributing to the sleep disorder. However, if you can function without this drug you're probably better off. You might try melatonin for sleep, no obvious interaction with your other drugs.

Pamelor for ADD [posted 11/25/98]
Question:  My 9 year old granddaughter has been on pamelor for over a year. Her parents had been told she has ADD and she also had a problem with excessive eye blinking which has iimproved with the medication but I am concerned about long term effects. What is your opinion?

Answer: Long term side effects of pamelor don't appear significant and don't appear to differ from short term effects.

ADD Reactions to Medications [posted 11/24/98]
Question: My daughter was just diagnosed with ADD and Obsessive Compulsive behavior. I feel confident that the diagnosis is correct. The Doctor prescribed Adderal and Luvox. The first week the results were amazing. Then after about 3 or 4 weeks she started getting very irritable and cranky. About the sixth week she was so bad I slowly weaned her off. After one week completely off medication, she seems in much better humor and we can now live with her again but now she is once again very distractible and impulsive. Is this a normal reaction to these medications? I also read lately where these two medicines should not be taken together. Is only one of them responsible for making her unbearable? Thank you.

Answer: I would probably restart the medications one at a time with the Adderal first. It is ok to take the two together if monitored;but, with the reaction it is unclear whether it is a particular medication or the dosage of one/both that is the problem.

ADD [posted 10/2/98]
Question: My son, Ian, is 8 years old and is still having incontinence of bowel and bladder. He has been diagnosed with mild ADHD, but is not medicated for it. The neurologist said he would outgrow this, but is there anything else that can be done?

Answer: ADD I know, what is ADHD? If you are referring to ADD, it would be very uncommon to have bowel and bladder problems with ADD at this age.

ADD - Adderall vs. Ritalin [posted 8/11/98]
Question: Last year my 14 year old daughter was diagnosed with ADD. The psychiatrist who works in the school district put her on a medication called Adderall. Since then she has been on the medication and has been doing great in school. She hasn't failed any subjects and is doing much better with her behavior. The doctor explained that this is a fairly new medication and she prefers Adderall over Ritalin. I don't know much about it and what the possible long term effects are. I did ask my family doctor if he could prescribe it for her instead of going monthly to the psychiatrist who is expensive and far away. He told me he wasn't familiar enough with it and would not prescribe it. Is this medication as safe as Ritalin?

Answer: Sounds like you need a new primary care physician. If he/she is not familiar with the drug, it is easy to check with the referring physician for things that need to be observed. In reality, there are few problems with this drug and you won't know until you try it. However, you already have and haven't seen any effects. Compared with Ritalin - in terms of long term side effects, there shouldn't be a major difference. Palpitations, rapid heart beat, elevated blood pressure, restlessness, dry mouth, diarrhea, constipation are the usual side effects.

Attention Deficit Disorder [posted 8/6/98]
Question: My son has been having a lot of problems in school. In science, he seems to get up and walk around class, can't seem to stay on tasks, and talks when he should be listening. When he plays sports, if he looses, he gets really upset. He seems to be very bright. When he does get into trouble, I take things away from him, and this upsets him a lot. I was wondering if this could be a problem with being hyperactive. He had a lot of problems in kindergarten. They put him in with children that had to start at the beginning, and he complained everyday that he was bored. He has always been very active. When he would loose a baseball game, he would scream and cry like it was only him who lost the game. He was evaluated by a doctor recently, and the doctor stated that he had anxiety attacks. Could you est something to help him?

Answer: Further testing or a trial of Ritalin or something equivalent. Ask his physician about this. If the physician is not interested, get a second opinion. Testing by a qualified psychologist can also show the problem if the physician is unwilling to try a short trial of medications. Don't use the school psychologist unless you cannot afford it. My experience with them is dismal in diagnosing Attention Deficit problems. It might be anxiety, but sounds a lot more like ADD.

Treatment [posted 7/31/98]
Question: My son Carlos, 6, has problems due concentration failure. The problem is much more in school than in home. A neurological physician recommends Ritalin, but our family physician recommends us not to use any kind of drugs. He thinks only with therapy he can improve his behavior in school. We are agree with the latter. What do you think about this issue?

Answer: Try the ritalin, you will see an immediate response if it is the correct diagnosis. These children were treated with counseling for years with no improvements. Ritalin is a wonder drug for these children in the correct setting. There are pros and cons you should know about, but you should see his response first and then judge what the appropriate course is.

ADD Medications [posted 7/27/98]
Question: Can anyone tell us why neither Ritalin or Dexedrine helps our daughter? Her behavior gets ten times worse from it so we just had to take her off it. She is 4 years old and seems much better to us without medication. The doctors we see have never heard of such a reaction to both.

Answer: If it works keep doing it, if it doesn't work stop doing it.

Catapress and Adderall for ADD [posted 7/23/98]
Question: My son has been diagnosed with ADD, he has an IQ of 116, he has very low math and writing scores. He has bad side-effects from ritalin. Would adderall or catapress patch be better? I would like information on how these work and their side-effects.

Answer: Sorry, but I have not experience using these drugs for ADD. There is an extensive support network available in most communities and a national ADD organization. I suspect a discussion group on the internet would be the place to discuss this with other parents.

Attention Span
Question: Other than using drugs, is there anything to be done, or a specialist to go to help a 10 year old girl increase her attention span so that her mind does not wander in class? She also has problems memorizing and retaining information.

Answer: She should be tested by a psychologist with a specialty or interest in attention deficit disorder. This is common and fairly easily treated. Formal testing is required and you should do it sooner rather than later.

Attention Span
Question: My 10 year old has a very low attention span which I was told she would outgrow. Her mind wanders during class and she has no idea what is going on. Her hearing has been tested fine. Her grades are suffering. Her long term memory is also very poor. Is there a specialist that can train her to focus her attention and increase her memory?

Answer: I would have you daughter tested by a clinical psychologist who is a specialist in attention disorders. Do this privately if you can afford it. The school system will have a bias. If she has dyslexia or ADD this needs to be determined to get the special type of teaching necessary for these children.

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