Expert: Dr Billy Levin - 5/4/2008

Question
QUESTION: I am an adult who was diagnosed a.d.h.d as a child but parents would not allow meds. At 15 I demanded I be put on something and was prescribed ritalin. I hated it, I had a headache all the time and was constantly crashing. I dont remember any benefit. As an adult I became very against medication and thought if I just "tried harder" my add problems would go away. I finally realized I need help so requested strattera, not wanting a stimulant. Big mistake, horrible side effects and nothing helpful. Now I am on focalin and I experience minor side effects but nothing that seems helpful at all. I almost feel sedated in an odd way. I  just cant understand it...I do not feel like I am stimulated in any way and my brain feels to foggy to concentrate. The weird pressure in my head makes me want to sit on the couch and not move or talk. (and not doing things is one of my main problems!) My Dr has had me adjust the dose but all I get is either more or less of a head-ache. Now I am terrified that I finally decided to help myself...but its not working. Could someone with add really not feel ANYTHING from these meds? I am so confused and sad. I will talk to my Dr about this some more but I have no insurance and am seen at a local clinic. There isn't much of a relationship there. I just want to if there is any hope...

ANSWER: As difficult as it is to believe you I accept all you have told me and you have my sympathy. However in many many years I have never had one single patient who was correctly diagnosed and correctly treated , not respond. Sometime dose adjustments or medication switch overs or combinations. If I had exact types of medication you took including the times and the doses per day I might make some sense of you predicament. If you do have ADHD, it is a very treatable condition. I truly believe there is no such thing as a non responder.

---------- FOLLOW-UP ----------

QUESTION: Why is it difficult to believe? I have been reading forums dedicated to adhd and find many people complain of side effects...but they do seem to be getting some sort of benefit as well. But you were right on the money...after posting this question is desperation I just phoned the Dr who called me back pretty quickly to say he did not this methlyphenidate products were right for me and asked me to come in that day for a new prescription for adderalXR. The difference is amazing, there has been some discomfort but it has diminished and I absolutely see the benefits. It is not at all what I had expected and was afraid of, being "high" all the time, in fact I feel very much like myself only far more "present". Thank you for the answer, it was encouraging to hear that there IS treatment but you might have to work a bit to find the right one. (I still don't get why anyone would take either of these drugs for "kicks".)

Answer
You have hastily misunderstood my intention. My suggestion is if you do have ADHD there is a medical treatment that will succeed. The most important cause of troublesome side effects are incorrect use or dosage. Monitored titrated adjustments done by an expert doctor  using rating scales will succeed. You hardly mentioned titration and did  not even mention rating scales. These are the most important instruments to success. Obviously you are not aware of the use of rating scales on a regular basis to optimise doses. Only optimal doses work and are unique for each patient.