Expert: Dr Billy Levin - 8/6/2010

Question
Dr. Levin -- I'm a 41 year old female and have recently been told that I may have ADHD by a psychiatrist.  I am in recovery from cocaine addiction (almost 7 years clean and sober) and so I had concerns about taking Ritalin.  So, I was put on Strattera as I already take 400 mg of Wellbutrin and have been for several years.  I wasn't feeling much of anything from the Strattera until about 5 weeks in and then I started feeling extremely unmotivated, have a hard time getting up in the morning, and as a consequence of getting to the office late, I don't get very much done during the day.  I haven't felt really happy in many weeks.  Not sure if it's the Strattera or not.  What are your thoughts?  Thanks.

Answer
Undiagnosed and untreated ADHD will often result in drug abuse and depression. You have  or had both. This depression will not respond to antidepressants until the ADHD is treated as well. As Ritalin is not addictive it is the drug of choice, not Strattera which is not as effective as Ritalin. More important Ritalin is also an antidepressant. Welbutrin is a good choice but not on its own. If Ritalin is monitored using rating scales to optimal dose you will feel the benefit within 10 to 20 days. If Strattera is gong to work it often takes 8 weeks before you have any benefit. The choice is obvious.