Expert: Dr Billy Levin - 1/28/2010

Question
QUESTION: My daughter has ADHD and an anxiety disorder. She began on 50 mg of Zoloft and over time she seems to be building an immunity to it. She is now on 125 mg of Zoloft with some relief but we are thinking of adding the new Tenex XR (which has been re-named for ADHD use. I know it  has been approved for children with ADHD and  she still can be very impulsive.
She did not do well at all on any of the stimulant medications! What do you think?



ANSWER: Firstly the body does not develop an immunity to Zoloft. Sometimes to dose needs to increased to obtain an optimal effect as with the stimulants..When you say she did not do well on stimulants, what exactly do you mean? The most frequent reason for them not working is incorrect use! Tenex is not spesific for ADHDS but may be of some value for anxiety, but not anywhere as effective as the correct use of stimulants for ADHD. I think if you give me more and exact details about how you used the stimulants, I might be able to advise you.

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

QUESTION: My daughter is diagnosed with ADHD and an anxiety disorder. She was on Adderal in increasing amounts for a year and a half and methylphenidate just briefly. When she was on stimulants alone, methylphenidate and Adderal, she could not go to sleep at night, became rail thin, her mood was wild at night. At night, she was SOOO irritable/ANGRy/ mad-yelling at all of us-her parents and brother. We could not console her. She was scream and yell at us so badly that we thought we would have to call 911
and she might be hospitalized. Our chewing of food had her in a frenzy-she remains irritated by the sounds that are naturally related to chewing. She was on the stimulants during the week for her impulsivity and distractibility. Teachers thought there was some limited improvement in her focusing.
Zoloft has offered her and us some peace as she is lesss intense. Yet, she still can be argumentative, she is still impulsive and demanding of attention, positive or negative yet it is not nearly as wild as it was when she was on stimulants. Her peer interactions continue to get her into trouble  since her behavior is not always appropriate. And she has still has difficulty accepting no and following directions.
She has put on 17 lbs since going on Zoloft and has grown a few inches.
We are hoping that the Tenex helps her feel calm and better able to focus.
I hope the additional information has been helpful.
What are your thoughts?


Answer
Unfortunately you have not given the information I had hoped for. By exact details I meant what dose, at what times, how many doses and on how many days per week for each medication. Much of what you have described is often when the medication is not monitored with rating scales and adjusted to optimal levels.Were rating scales used on a regular mothly basis? How often did the doctor see, evaluate and advise? It is not my intention to belittle your doctor but without details it would be impossible to advise you. Often when there is severe rebound as the stimulant wears off there is safe effective "add on" medication for the various side effects. Eating and sleeping are never a permanent problem for an experienced doctor to manage with advice and medications. If you wish me to continue please give me more and exact information and I will try and advise you.