A Response to a Reader's Question about ADHD Medication Treatment

I got a comment just now from a reader which included questions about their medications. They take methylphenidate and Strattera and are wondering about the length for duration, or of the overall effectiveness of their medication.

As a non-professional, I responded as follows, and hope that it clarifies my own understanding of medication as it relates to ADHD treatment. I would be very interested to hear from readers their thoughts on my perspective, and the advice I gave...

I wrote (I have modified it slightly for clarification below):

"Have you spoken with your doctor or psychiatrist? Methylphenidate and the amphetamine class of psychostimulants work for some and don't work for others - it can't really be predicted, depends on the individual. There are dosage aspects, metabolism issues, concurrent medication useage, and a host of other factors involved, not to mention your own personal level of change or stress due to situational factors (New job, school, city? Change in relationship status? Problems in your personal life? Are you getting sufficient sleep?)

Strattera didn't really work for me by itself, and I no longer take it. But I do take another NSRI class medication - buproprion (trade name Wellbutrin). Some of the NSRI meds can be useful in reducing some of the anxiety which may be brought on by taking the stimulants and may assist executive function, or so I understand.

What form of methylphenidate are you taking? Long release like Concerta or Adderall XR, or short release, like short release Adderal or Ritalin?

A good psychiatrist with a clear understanding and training in psychopharmacology should help you tweak your medication. I would definitely speak with your doctor about this, though.

To get the most out of your appointment, I'd recommend the following:

Try to track your cognitive senses throughout a few days in a notepad - i.e. Your focus level between 1 and 10, attention.

Track your emotions also - and your reactivity, irritability, grumpiness, ability to manage transitions or to shift out of hyperfocusing without being too pissed off(!). Basically, your level of attention self-regulation.

Track impulsive behaviors - interrupting, acting out, moving on to an inappropriate task or activity, when you should be sticking with the one you're already on.

Also try to document your ability to get priority items done, your ability to be organized, your level of overall 'effective functioning' in various arenas of your life. That is, how well you are managing at work, home, school, parenting, relationships, hobbies, sports, personal care, etc...

Bring this tracking information to your doctor / psychiatrist and it should help them better understand how to help you find an effective medication regime. Hope that helps.

Note that I'm not a medical professional, so just take my advice as you see fit. All the best, and let me know how it works out!"


Mungo