ADHD Medications - Part II - Stimulants
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- เผยแพร่เมื่อ 25 พ.ค. 2023
- The past 10-15 years have witnessed a number of major developments in the medications and delivery systems available for the management of ADHD. Dr. Barkley here discusses the types of medications now available to ADHD management and the various delivery systems developed to extend the effectiveness of the medications across the day. For each medication, he will present the major beneficial effects and side effects. He will also discuss various issues clinicians should consider in selecting particular medications to use with a patient with ADHD, such as those issues related to the social context, the patient’s characteristics, and any comorbid conditions that may exist.
Part II discusses the stimulant medications, far and away the most prescribed drugs for ADHD
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Dr. Barkley, I´m a huge fan of your work, your information has helped me in my clinical work and as an adhd patient. Thank you so much.
I really appreciate your thorough break down
Wow wow re the delayed overnight / extended release. That’s a game changer! We need that here in the UK
Wow. I wish we had these options in the UK. I set an alarm to take my meds an hour before my ‘main’ alarm. So the delayed release formulation would be amazing for me. As I was suffering severe fatigue from 30 years untreated and the meds make getting up actually not torture!
Oh wow I will try that, thank you for the idea !
@@Wintermute909 yes. We have those medications. I’m on lisdex. What I meant is the release options.
I believe Vyvanse is available in the UK as Elvanse.
Oh sorry, I thought you meant delayed=extended release.
I too would love a delayed release medication. Waking up is the hardest part of my life.
Thanks so much for this Dr. Barkley! I just got diagnosed at 29 a week ago and have been taking Adderall XR for 5 days now. I've been very curious about how the engineering of these pills work so I can try to find the ones I want to try. I'm an engineer myself so the tech is what counts :) (Well of course my response too lol)
You are most welcome
Hello. Why do I have lower blood pressure (95/60 instead of 120/70) on methylphenidate- 10mg a day extended release? Should I do something about it? Thank you!
I am 49 years old, and I’ve been using conserta for nearly 25 years. I’m curious about dosage. My first prescribing doctor pretty quickly landed me on a pretty high dose, 90 mg. This worked great for me. I have moved several times and changed health insurance and each time my new psychiatrist wanted to lower my dosage. I always resisted. I’ve never met anybody else on more than 54 mg. I’ve also never seen any research on the risks of taking higher doses. I eventually gave in and lowered my dose to 54 mg which is not as effective. I am getting by but it’s not as easy as it was. There is also heart disease in my family, so at nearly 50 years old I am being cautious, but I’m really not sure if it’s worth it. None of my psychiatrists or my cardiologist has been able to point to any actual science. Can you help me find good infromation?
You said she should compete in speed eating. I kind of wish she would. It could be content.
Hello Dr Barkley, my 8 year old son recently started Biphentin and started presenting a vocal tic (coughing) within a week of starting. I do see some improvements in his ADHD symptoms with his inattention. Will these tics go away after a while or is there a risk that the tic may become permanent? No prior history of tics prior to medication.
Hello Dr.! Thank you for all these videos; your channel is incredibly insightful. I wanted to ask if you can address whether long-term stimulant use to treat ADHD can make the underlying issue worse? I was diagnosed as an adult and started treatment once I entered the professional world as I was able to cope my way through school and recently attempted to go off medication after switching from Adderall to Vyvanse. The latter gave me terrible side effects however after I attempted to go off it I found that I simply could not think at all; it felt impossible to do anything. I do not remember being this way prior and was wondering if my brain had become dependent on the medication or if this was just a matter of contrasting perspective. I've been having difficulty finding literature on the matter and would love to hear your thoughts.
I am not aware of any evidence that this is the case where long term use leads to a worsening of ADHD. Thanks so much for watching the channel.
@@russellbarkleyphd2023 Thank you so much for your response, Dr. 🙏 Your time and attention is truly appreciated!
Does Russell Barkley have any clues to non prescription / natural based solutions that target the executive and related brain areas to solve this problem?
Dr Russell, thanks for your great content! I'm from Brazil and I follow all your videos. Could you please help me with a big question? I am very afraid of taking Ritalin or Vyvense in the long term, because I am afraid of desensitizing my neurons or having some very strong side effect in the long term. I am 28 years old and I have been taking the drug for 1 year. I have moderate/severe ADHD and would need to be on medication for life. God bless you and thank you for sharing your content with us.
Thank you for watching. I am not aware of any research showing that long term problem with the medications.
Methylphenidate and atomoxetine increase my resting BPM from 60 to 90-100 and I constantly feel my heart beating.
I’m aiming to try vyvananse next. Hopefully it does not have this side effect.
Hello Dr. Barkley! I really need your opinion on bupropion. I live in Greece and got diagnosed with adhd a few days ago at 22 years old and my psychiatrist prescribed me strattera at first, but it’s in short supply and I can’t find it anywhere. Then he recommended concerta or Ritalin but we have the same problem here in Greece with adhd meds in general and I’m really worried I won’t be able to get proper treatment due to that. Could you share some thought on bupropion? My psychiatrist told me it can help with adhd as well but it’s an antidepressant.
Thank you so much in advance I really hope you read this comment because I’m really frustrated and I’d really value your input.
It has been used often here in the us with adults with ADHD, even though off label, meaning not approved for it by our FDA. There is research showing it to be of benefit to some adults. Talk with your doctor about your concerns.
Just a question on pharmacokinetic differences between dexidrine and vyvanse: I see from studies that the curve for vyvanse is basically the same for an equivalent dose (1:3 ratio) except that it lags dexidrine by an hour. Is that right?
That may be true of peak effects but I think therapeutic levels remain in the blood longer than with Dexedrine as best as I recall.
Hello Dr Barkley, your videos are very informative and I greatly appreciate your research and sharing it with us in an informative yet easily understandable format!
I do, however, take one issue with a comment you made regarding simulant medication's loss of appetite being "not really a side effect" in adults and possibly even desirable.
I am 30 and have been taking methylphenidate for almost a year since my diagnosis (as both Medikinet XR and Concerta at various doses), but my psychiatrist and I are actually planning on discussing switching to another drug. This is largely because the loss of appetite and nausea are affecting me negatively enough that I've come to dread taking the medication on days I know I'll need to eat lunch.
I do not feel any active nausea when not around food, but for about 2-6 hours after taking the drug, the mere smell or thought of eating can leave me gagging, or I'm only able to eat a few small bites before I can physically eat no more. This understandably leaves me feeling hungry, light-headed and irritable during the middle of the day, especially since I've never been able to a large breakfast either, thus I basically have to wait for the stimulant effects to start wearing off in the late afternoon before I'm finally able to satiate my gnawing hunger. So between the hunger and inability to eat, and my light-to-moderate ADHD symptoms, I'd often rather deal with slightly greater inattentiveness and distraction than the unavoidable hunger pangs.
All this is to say that I felt a bit hurt at your lighthearted insinuation that adults like me shouldn't mind the loss of appetite and rather be glad we can "lose some weight". I hope you will take this into consideration and perhaps in the future make less light over side effects that your own research numbers show can affect over 50% of stimulant medication users. Thank you.
He said most adults don't mind the loss of appetite, not that you shouldn't mind it, not that you are experiencing it anyway since what you described is nausea and not loss of appetite.
Hi Dr, I’m a 35 year old woman who was diagnosed with ADHD last year. I started Adderall a few weeks ago, I was taking it for 2 weeks before my dr switched my medication. Unfortunately Vyvanse is out of stock so I went about a week with being medicated, which is fine, I’ve done it my entire life. But I have severe withdrawals. Mainly being sick, like feverish. Does Vyvanse have the same possible withdrawals? I’m terrified to start another medication. The withdrawal was HORRIBLE. I’d rather continue living with my issue than ever feel that way again.
I have a friend who’s 8/9 year old daughter had hallucinations after starting methylphenidate. They then tried her on a different brand of it (for some reason ) and the parents had to stop the medication when the hallucinations got bad again. The medication made huge improvements in her quality of life outside of that one severe side effect.
The problem is that the hallucinations continued (though not as severely) several months after cessation of the medication. They now want to start her on straterra until the hallucinations stop completely. I can’t find any research on them extending beyond the cessation of methylphenidate and in the mean time this child is struggling with every aspect of life (quite a severe case). Can you offer any advice/research?
Apologies for all the comments! I’ve been watching your videos all morning 😆
I don't know of any research showing that the hallucinations continued after cessation. Try using Google Scholar to search the journals for any new cases I may have missed.
@@russellbarkleyphd2023 yeah I couldn’t find any either! (My background is neuropsych).
#TomCruise is wrong.
Adult male age 73. Placed on every known (?) stimulant & non-stimulant w/o an impact!
Historically with meds dosage has little to no effect. Reaching max dosage levels w/no impact, do doctors move on too quickly to the next medication?
Not a doctor, but IIRC, although you should see the benefits of stimulants immediately, non-stimulants take ~ 30 days before the benefits become noticeable. Past that delay, the effectiveness (for most people) is equivalent.
So if stimulants don't work for you, to give some buffer, you'd benefit from trying non-stimulants ~ 60 days before moving on.
I may misremember, however. :-\
What, if any medications are used(?) in neurodivergent brains
That depends on what you mean specifically by that phrase as well as the presenting symptoms producing impairment.
How can we counter act the weight loss, need the kid to gain weight.
Physicians I know recommend weekend and summer drug holidays if the weight loss is a significant problem, as well as being more flexible about when children can eat.
@@russellbarkleyphd2023 Thank you, we are flexible and let him eat whenever he wants. For example, he eats dinner and then again in about an hour. he eats again. We can see the medication (VyVanse) is winding down and when he gets hungry. The comment about not eating lunch is nothing but true with this kid. ha I am really Enjoying your videos and couple of books. Thanks your information has helped us so much.
I have a few tricks up my sleeve. We provide medication later on non-school days and offer BIG weekend breakfasts full of preferred foods before Vyvanse kicks in those days (bonus is avoiding early evening rebound); I slip snacks next to kiddo and touch his shoulder so he notices they’re there when he’s hyperfocused on gaming or coding; on days calories seem too few we do “bedtime smoothies” with loads of fresh and frozen fruits plus full fat, high protein Greek yogurt, and a splash of OJ; and we pad calories wherever we can slip them in (butter, olive oil, avocado oil, cream, nut butters, an extra serving of favorite fruit…) It takes daily vigilance but it seems to be helping.
@@yarntoast Hey thanks for the tips, do appreciate this. great tips!
Wow wow re the delayed overnight / extended release. That’s a game changer! We need that here in the UK