Expert: Dr Billy Levin - 9/4/2008

Question
QUESTION: Dear Dr. Billy Levin,

Since my highschool i never managed to watch one full class, i can only pay attetion or focus for about five minutes and then rest of the time my mind is wandering... when i realize that, and try to focus again, its too late to understand anything.

I always make plans, but i never finish those plans because of procrastination. I think i may have ADD.

Now im 20 year, weight 75kg and height 1,78, and i want to start taking ritalin. How much dosage do you recommend me? (I never took it before)

Soon im going to see a doctor, but i want you advice because you seem to be one of the best doctors and i trust you. How much Ritalin do you think i should take?

Sincerely
Paulo from Brazil.

ANSWER: Firsty the dose of Ritalin depends on your response and has no relationship to age or weight. The usual method is to start with Short acting Ritalin,  5mg every 4 hours (7am, 11am and 3pm.) Then increase the dose every few days  until you and your doctor  feel the dose is optimal. Any dose between 15mg and 60mg per day is possible.  A monitoring system using rating scales seems to be the `most accurate method.  Once the total daily dose s known it is more convenient to switch to an equivalent long acting product taken once a day. Treament is taken 7 days a week. Good luck.

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

QUESTION: Dear Dr. Billy Levin,

I went to a psyquiatrist, told him about my life, did some tests and then he diagnosed me with ADD. He prescribed a medication called SERTRALINE , and then said that Ritalin is only the last resource medication, because according to him, ritalin can get you addicted.

What is opnion Doctor? Ever heard of Sertraline for ADD?

Sincerely,
Paul.

Answer
This is a very difficult question to answer as I have dual loyalties. One to the Psychiatrist who is a college, and one to you, to know the truth. I will thus tactfully say I disagree with the Psychiatrist totally. I am not discussing your needs as I have not examined you. Ritalin is not addictive ans is the first choice,not the last resort if the diagnosis is ADHD and there is a need to treat medically. This is an accepted approach, and not just my opinion. Setraline, a well known antidepressant,  is a very poor substitute for the very effective Ritalin.