Expert: Dr Billy Levin - 2/18/2011

Question
QUESTION: Hi Dr.-

Last year I was diagnosed with Adult ADD at a 98 percentile. And ever since then my PCP and I have been trying to figure out the correct dosage for me. A few months ago he Rx me 20mg Ritalin SR 1 tab 3x a day but I was still having a hard time focusing on my classes (I just recently returned to college) and also multi-tasking at work. My blood pressure is still pretty much normal, I don't have any trouble sleeping but he doesn't want to up my dosage of Ritalin but instead this week with my f/u appt with him he Rx me the same dosage of 20mg Ritalin SL 3x a day and 50mg of Sertraline 1x a day to be taken in the AM. I know Sertraline is an antidepressant. I don't have any history of depression and my PCP knows this but I'm just curious how Sertraline would help with my ADD verses just uping my dosage of Ritalin. The side effects worry me and scares me that it'll worsen my mental state instead of improving it. I started taking the Sertraline 2 days ago and it seems to be working ok but I'm scared of the long time effects. Please advise. Thank you.

Jonee

ANSWER: I cannot advise as you have not given me enough detail. Do yo take the SR all at once or in devided doses. In my opionion SR shoul not be used as it has major inconsistencies, In My country it was taken off the market. To evaluate an optimal dose the short acting Ritalin should be used 4 hourly and the dose gradually increased until optimal using Conners rating scales.Then only should a longer acting product be introduced to give at least 12 hours cover. If a Hamilton scale for depression suggests depression only then should an antidepressant be introduced with the stimulants. Ritalin on its own is a mild antidepressant anyway!

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

QUESTION: I don't take the SR all at once. I take 1 tab at 7am, another at 11am and the last dosage of the day at 3pm. I wasn't prescribed the 20mg SR right away. I started with 5mg once a day. My doctor gradually increased my dosage and am now taking the 20mg SR with a 50mg Sertraline. What are the inconsistencies that you're referring to about the Ritalin SR?

ANSWER: I am confused. You state you take them all ot once and them you tell me you take them at 7,11 and 3. Ritalin SR (sustained release) works for 8 hours. Then why would you take them every 4 hours. It  makes no  sense! Are you not taking short acting 10mg tablets ,2 at 7am 2 at 11am and two at 3pm.  Ritalin SR is a capsule and Ritalin 10mg is a tablet.  

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

QUESTION: I never once said that I took them all at once and I never once said I am taking short acting 10mg 2 @7am 2 @ 11am and 1 @ 3pm. Please read my original question again as it clearly says it. I'm not depressed so I don't care that Ritalin is an anti-depressant. All I'm asking is why Sertraline was prescribed to me when I'm not depressed nor do I have a history of depression. The Ritalin and the Sertraline was prescribed to me for my ADD and I just wanted to know why Sertraline was prescribed to me, does it actually help with ADD?

Answer
I think you had best ask you own dotor for advice. I would clearly never prescribe 20mg SR which works for 8 hours, every 4 hours. Moreover I am  surprised anybody uses SR  as the company has replaced it with   Ritalin LA, a much better product. As to why you are on Sertraline it is impossible to say without examining you. It is not a treatment for ADHD. This matter is now closed. I wish you good luck!