Choosing the Initial Medication for ADHD Management - Part 1: Context Matters

[@kikitauer]

I got diagnosed at 41 years old. I also have well controlled high blood pressure and some other health issues. I was already taking indapamide and nebivolol, then some allergy meds and drops for high intraocular pressure. I live in Prague, Czechia, EU. The only meds for ADHD available here are Strattera and fast and slow methylphenidate. So my psychiatrist started me on Strattera but eventually it was obvious that it is making my BP worse and my eye pressure even noticeable worse. I cannot take Ritalin because it contains gluten and I have celiac - frequent comorbidity in ADHD. So we decided to try long form methylphenidate and it work magic. My eye pressure is even lower than without and I have no side effect to speak of. So happy.

[@kiljupullo]

Hello. Adhd here. I got my gluten sensitivity in check with iron, copper and multi b vitamin regimen. I know celiac does not go away once its there, but these defiencies still exists. 😊

[@Shadowarfare117]

That's interesting that celiac is a comorbidity with regards to ADHD. I too have celiac and I have an appointment with my doctor to get diagnosed with ADHD as the symptoms certainly line up. Thank you for your comment. As a side note, I just caught word of a bodybuilding competition in Prague. I thought it interesting enough to share.

[@Lasidar]

Dr. Barkley, I'd love to see you do a lecture on how to find the correct dose of ADHD medication. I find it really hard to determine if I'm at the right dose, or if I would do better on a higher or lower dose.

[@Cattoinbox]

Dr. Russell, Thank you so much. you may not realize how much you've helped my life. Years of despair as an overthinker, yet done nothing at all. I have big goals, but lack the motivation and self-confidence to take actions. I constantly think that I NEED to do a lot of things, yet I can't bring myself to do them. I have wasted years of my life. My unproductivity leads to anxiety and panic attacks. It also affects my physical health. I have had UTIs multiple times because I often forget to drink water on a daily basis if it is not within my visual field. I can spend a whole day without drinking any water at all. The odd thing is, I am also a physician currently working in the intensive care unit. My mind works just fine when I am at work because the tasks I need to do in the hospital has been ingrained/programmed in my body. But when I get home, I feel completely paralyzed. Your videos have helped me manage my ADHD. I started to externalize tasks, do list, and allocate time to do the tasks like you said in one of your video. I am still working on it. at home I get distracted a lot so its has been hard to focus and manage time. Unfortunately, in my country, there is a certain stigma surrounding mental health patients. I am afraid that if I see a psychiatrist, other physicians will look down upon me and hinder any future work possibilities I might have. Thus, so far I have not been medicated.

[@MattThornton-og4xo]

Thank you, Dr. Barkley. Excellent information. I am currently on a controlled methamphetamine medication that has changed my life. As an adult diagnosed at 60, I can say better late than never. You play a big role in my daily routine of self help through listening to your thoughts and peer reviews and talking through the ADD issues. Thank you for your service.

[@paulwilk2854]

On the topic of addiction, I take Vyvanse and sometimes forget to take it. If I had an addiction, I doubt I would be able to forget to take that medication. I used to smoke, and when I needed a smoke it was hard to even think of anything else.

[@OGAngie]

I was taking adderall for almost a decade and quit it cold turkey in February when I was dealing with another medical issue involving my heart. Zero withdrawal whatsoever. It's funny because for years I was scared I might be "addicted" because I needed it to function. That was just the ADHD that was now being treated. 😂

[@Najahfreeman]

Could you do a video about titration? I struggle to assess the effectiveness of my meds due to external factors like (allegedly, yet to disscuss with psychiatrist) burn out, depression and anxiety. I remember at low doses being "content" about my meds and then upping them and realizing that my contentment was below what was realistic to ask for. In other words, I struggle to know what is realistic to ask for in terms of medication effects.

[@noteventrollin9581]

Hey doc, just wanted to say thank you for all your work. I watched a few of your videos mainly the short one containing the idea of the adhd tank etc and i will watch some more and hopefully i can improve. I appreciate you.

[@JWildberry]

Is there a difference between what type of meds work best on a certain type of symptoms? My biggest problem is what I believe you call self motivating (I struggle to do things), while my brother's biggest struggle is emotional control, and my nephews biggest struggle is attention. Are some medications better at treating certain types of symptoms?

[@TSpoon823]

The biggest frustration I've had is the impact insurance plays on all of this. The generics of some meds are cheaper, especially the methylphenidates. I was able to try a week or so of a med, titrate, change, or whatever pretty easily for the first month or two. My pharmacist even said how glad he was to see us going that route while we figured it out. But even though generics admre cheaper,, insurance isn't covering a 7-10 day trial. It's a month or nothing. So, once I ended up moving all the way to Vyvanse, it's so costly even in generic that it's not realistic for me to titrate at a quick enough pace. So if 40mg isn't working, I have to put up with that for a month until insurance will cover more. Except I end up using coupons anyway... Sorry for the rant, but the point is insurance here in the US really makes this process much more frustrating, expensive, and slow than I feel it should.

[@Kwells92]

This is America, the health insurance company chose for us… it’s a disgrace. We had to go through 3 other medicines with multiple different doses before even getting to the medication that we initially expected would be best. It turned out to be the best, but we had to put our son through unnecessary bad or not as good medications. But the insurance company had chosen based on price from cheapest first to more expensive. It sucked, because we asked the doctor to not do certain drugs. He said that he couldn’t do otherwise. Called the insurance company and they basically confirmed…

[@pedrogorilla483]

I’m an adult male diagnosed 3 years ago. Started with Vyvanse and it changed my life. Over time it started to work for a shorter period, then I got a second dose at lunch time but I’d often take the second one too late or by the time it would come into effect I’d already be so tired. Now I’ve got a second dose of Attentin which is dextroamphetamine and starts working after about 30m instead of 1:30-2:00h like vyvanse. It works really well and even feels better. I wonder if I lose some of the medication in the process of converting lisdex into dextro because the equivalent dextro dosages are much more effective for me.

[@OGAngie]

How does one balance the risks and benefits of stimulant medication when you have another condition like hyperthyroidism/Graves' disease (which can stress the heart)? Stimulant medication changed my life and took me from almost failing out of high school to graduating from a top university cum laude. I had to quit after a diagnosis of Graves' disease and my life is now in shambles again. The ER doctors and my endocrinologist managing my Graves disease all say I should restart my stimulant medication, but my PCP never wants me on a stimulant again. I can't find great literature on overlap of Graves disease and ADHD treatment but my thyroid levels are back to normal levels, and my resting heart rate is back to 50's 60's with no arythmias, so I'm really not sure why my PCP is the only one to disagree with stimulant medication. I'm a research scientist in pediatric neurogenetics and feel like I can't do my job anymore and it's humiliating. Luckily people are chalking up my lack of work ability to leftover illness from my Graves disease which I took FMLA off for, but this isn't sustainable. My life is in ruin.

[@Alex-js5lg]

Hi Russ! What are your thoughts on Wellbutrin/bupropion in general as an option for ADHD treatment, particularly in cases of parents being resistant towards stimulants or of a patient finding stimulants intolerable? Given its classification as an antidepressant, it might be an easier sell (both literally - given its comparatively low cost - and figuratively) than a stimulant while still primarily targeting the same neurotransmitters.

[@russellbarkleyphd2023]

There is some evidence for its effectiveness in ADHD likely due to it affecting multiple neurotransmitters including dopamine. While not FDA approved in the US it is often used off label with adults with ADHD.

[@kevinwhite6176]

@@russellbarkleyphd2023 As an adult, I decided to try medications again (diagnosed at 10yrs, stopped ritalin at 15 due to getting TMJ from it) and went back on Ritalin. My primary care physician didn't like that it was possibly raising my blood pressure (I have high BP). So I thought, let's experiment. First, I tried Strattera. It worked, although it raised my blood pressure, caused painful ejaculation (people might laugh but I'm not kidding when I say *PAINFUL*), and started causing auditory hallucinations (apparently a known side effect; I kept hearing people saying my name when I was listening to things while wearing headphones). Then, I tried Wellbutrin, which seemed promising since I also have anxiety. Unfortunately, that caused me to have rapidly escalating anxiety and I had to discontinue it before having a mental crisis. So, if you ever want some anecdotes of some unfortunate side effects of atomexotine and buproprion, there you go :( I intend to try going back on stimulants since I could possibly add in clonidine for blood pressure and its synergistic effect anyway.

[@stephensmith1461]

Hi doctor russ , what do you think of Modafinil and Armodafinil for the treatment of ADHD ? if we overlook the fact that it can very rarely cause some serious skin rashes , do you think it could be used long term when stimulants like Ritalin and Adderall are not available ? thank you very much for your effort !

[@FeliciasWorld]

😂 I tried Modafinil when I was very first diagnosed and learned I am deadly allergic. Hives all over and lips and tongue started to swell by the time I got to the ER. This started on the second day of taking a quarter of a pill.

[@ASpaceOstrich]

I notice Ritalin working within a very short time of taking it. I can feel it in several places in the body. Less than ten minutes. Probably less than five, but I've not timed it.

[@PoppiJuly11]

Thanks a lot for all that you do for us 🌸 I live in Italy and Strattera is no longer available. Would you know if and when another atomoxtine medication will be on the market ?

[@JM-cf5yn]

Great video ! Thank you 🙏🏼

[@lisatutler-jones5992]

Great info! Is there a med for those who are managing blood pressure. I was receiving tx from a psych nurse, 10 mg adderall xr. She went on maternity lv and the MD convinced me to try 15mg. Bear in mind that my BP was beyond controlled at this point where I hadn't used amlodipone 5mg in months. A month after using 15mg I was a shitshow. I lost a ton of weight, I was emotionally wrecked, had headaches and my blood pressure shot to 160/90. I downgraded back to 10mg but I've been reluctant to take anything. Now my GP wants me to hold off altogether and wants to add another BP med. I decided against that as I try to work with a dietician and increase sleep and activity. I still have some of the 10mg of adderall xr but I only take it if I'm struggling really hard. Even then I don't take the entire 10mg, I split the capsule in 2.

[@nickm2677]

Question Dr, if I ever want to wean off my current meds (concerta) can i slowly integrate norepinephrine meds? So for example, if I reduce the dosage of my concerta (currently at 54mg) and then also take a norepinephrine meds.

[@The_Codstero1]

Nice shirt!

[@Brutuscomedy]

Crisis? God, I've gone through countless. Trying to simply get an appointment and formal diagnosis is a huge challenge. Plus any medication won't translate in to a harassment free workplace, living wage, and affordable housing.

[@hanskraut2018]

30 yeras old and tiltration for yeras mega discomfort while strattera/atomoxetin had to wait 4-6 weeks between every change and then Clinitian does not respond what has been tested. Some medication dosages wehre awesome but unresponsive people here in switzerland basel so it seems at least

[@ASpaceOstrich]

Something wild I've discovered is that antihistamines at high dosages have a massive stimulant effect.

[@neithere]

Interesting. I have to take 5-10mg cetirizine a day rather often due to seasonal allergies and usually feel a bit drowsy when I do (1st gen AH are even worse). What substance and dosage are you talking about?

[@ASpaceOstrich]

@@neithere 20mg of cetirizine taken by accident (I double dosed) had such a strong stimulant effect that the only reason I'm not currently using it to self treat is that I could feel my heart beating so strongly in my chest that it was concerning. Histamines have a modulating effect of neurotransmitters in the brain. Antihistamines reduce the amount of histamines, thereby increasing the amount of neurotransmitters. There are some studies showing this, though I was not at all aware of it at the time I did this. It may be that in order to get the effect, you need to be taking stimulant medication already.

[@ASpaceOstrich]

@@neithere I was taking Ritalin and Certirizine at the time. I think I accidentally took 20mg of Certirizine and that was what did it. KZbin ate my first reply for some reason. There are studies that back it up, but I wasn't aware of them at the time I took it. And it came with a bad side effect. I'd go into more detail but I'm assuming some of those details are what made the comment get eaten.

[@johnnyarenas6697]

why though

[@ASpaceOstrich]

@@johnnyarenas6697 histamines modulate neurotransmitters. Antihistamines prevent that.