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Diagnosis of ADD/ADHD

adhd medication doctors

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#1 JohnnyP

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Posted 03 June 2013 - 01:10 AM


I don't want to seem like a jerk or anything to anybody who may be having difficulties in their daily lives due to ADD/ADHD, but does anybody else feel that it is over diagnosed? Just seeing more and more young people being diagnosed makes me think that assumptions and conclusions are being made way too hastily and being medicated without reason. Am I the only one who feels this way? Or is there a reason that there a more people being treated than there were say 10 years ago that I am missing? Is it just there is more of a broad spectrum of what are considrred signs/symptoms? Or not to sound like a conspiracy theorist is it just drug companies trying to make more money?

Edited by JohnnyP, 03 June 2013 - 01:11 AM.


#2 andrea23

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Posted 03 June 2013 - 08:49 AM

in Italy is like doesn't exist this disase and is cured in very little cases (1500 in the whole country) and only in children, an adult can't be cured with methilphenydate (scheduled like morphine), in society a person with adhd is just a lazy/stupid. :S

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#3 Tom_

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Posted 03 June 2013 - 01:15 PM

I agree ADHD is over-diagnosed/mis-diagnosed in the extreme - in certain countries, mostly the USA & Canada. A see a lot of people angry at there psychiatrist for offering them an SSRI over stimulant when actually it was the best option because they are depressed/anxious/both. That's also another problem, Mild cases of depression, anxiety and ADHD are being offered drug treatment over self help strategies and low to moderate intensity psychotherapies and behavioral interventions.

andrea23 I really struggle to believe only 1500 people in the whole of Italy (a population of about 60,000,000) are being treated with methylphenidate (bearing it mind it has indications for more than just ADHD). Have you got any evidence for that assertion? Also, you can't 'cure' ADHD, you can only treat it with stimulants (and other drugs). I would be very surprised if adults can't be treated with methylphenidate.
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#4 andrea23

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Posted 03 June 2013 - 01:50 PM

andrea23 I really struggle to believe only 1500 people in the whole of Italy (a population of about 60,000,000) are being treated with methylphenidate (bearing it mind it has indications for more than just ADHD). Have you got any evidence for that assertion? Also, you can't 'cure' ADHD, you can only treat it with stimulants (and other drugs). I would be very surprised if adults can't be treated with methylphenidate.


i read it in documents of a university, an adult that want be treat with methylphenidate has to go in Switzerland to buy it and (in a legal way) is considered ad addicted because in Italy the treatment with ritalin exist just for children

Edited by andrea23, 03 June 2013 - 01:55 PM.


#5 magniloquentc0unt

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Posted 04 June 2013 - 11:29 AM

i live in switzerland and ive been diagnosed ADD when to me it was an obvious case of dysthimia but honestly i was happy to receive the methylphenidate because i was quite sure my problem was dopamine. it turned out ritalin didnt do ABSOLUTELY nothing to me. But i was surprised being given it as first medication. ofc i had to have my heart checked and general health assessed before i received it. I'm very surprised ritalin didnt work for me (up to 60mp instant release). now im being given Tianeptine for dysthimia. I think that depression traits can mimic ADD traits.

#6 Tom_

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Posted 04 June 2013 - 11:38 AM

Affective disorders have very little to do with dopamine. At least in that all the effects on dopamine are via other neurotransmitter systems (primarily Sertonergic, noradrenlergic and Ach). If the Tianeptine doesn't work switch to Sertraline.

But yes, I do agree with you depression can present as ADHD.

Edited by Tom_, 04 June 2013 - 11:39 AM.


#7 magniloquentc0unt

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Posted 04 June 2013 - 11:58 AM

i must admit while on fluoxetine i had good improvement on focus and concentration, but the sexual sideeffects are really not worth it in my perspective... are they that common on sertraline? here in switzerland they woull probably give me moclobemide

Edited by magniloquentc0unt, 04 June 2013 - 11:59 AM.


#8 Tom_

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Posted 04 June 2013 - 12:05 PM

Giving someone moclobemide as a first, second or third treatment line for depression is medical negligence in all but severe, chronic subtyped depression IMO. The side effects of that are nearly always more severe than on SSRIs anyway although just not sexual.

Sertraline often has less severe sexual side effects and Mirtazapine isn't assoicated with any at all.

#9 brainslugged

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Posted 04 June 2013 - 11:18 PM

I think it is both under and over diagnosed. Over-diagnosed in hyperactivity, under-diagnosed in inattention. I don't know how bad this is, though(the over-diagnosis). To be honest, stimulant medicines can greatly improve quality of life and aren't as dangerous as they are made out to be. As long as people don't abuse them, they are pretty safe, especially Ritalin. Amphetamine is not quite as safe, but there are ways to reduce harm, and occasional therapeutic doses are probably going to help more by reducing stress than they will hurt with their minimal neurotoxicity.

Mild cases of depression, anxiety and ADHD are being offered drug treatment over self help strategies and low to moderate intensity psychotherapies and behavioral interventions.

Pretty much spot on, except I don't think that mild ADHD should be treated by just CBT, but maybe CBT and a non-daily prescription of ritalin (maybe 10 x 5mg pills/month). Similarly, I think that mild depression and anxiety should be tried to be solved with nootropics before CBT, and then SSRIs as a 3rd line. CBT should be a lot more common than it is, though.

A see a lot of people angry at there psychiatrist for offering them an SSRI over stimulant when actually it was the best option because they are depressed/anxious/both.

I don't know what you are talking about never heard of anyone doing that before. Certainly I have never done that before and made a thread that partially revolved around it, lol :happy:
I really am afraid to take SSRIs, no kidding. Too crazy to take crazy medicine, I guess, lol.

Edited by brainslugged, 04 June 2013 - 11:21 PM.


#10 NeuroNootropic

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Posted 06 June 2013 - 01:13 AM

Giving someone moclobemide as a first, second or third treatment line for depression is medical negligence in all but severe, chronic subtyped depression IMO. The side effects of that are nearly always more severe than on SSRIs anyway although just not sexual.

Sertraline often has less severe sexual side effects and Mirtazapine isn't assoicated with any at all.


Huh? What are you talking about? Moclobemide is a reversible MAO-A inhibitor, it does not carry the risk of having a hypertensive crisis like with the irreversible MAOIs. And Moclobemide does not negatively affect sexual function, in fact, it was found to improve it.

#11 Reformed-Redan

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Posted 06 June 2013 - 01:57 AM

Ritalin works great for me in the low doses I take and the rather short duration of activity (1-1.5h). I've never taken more than 2.5 mg of methylphenidate IR (depends on how I break the tablet.) I try not to take it daily and am very cautions with dosing. I try to avoid it as I thought it might be not worth the acclaimed harm it does in terms of addiction, to the already prone to addiction, and evnetual tolerance. Fortunately, I'm not after any high and just want to get away with as little of methylphenidate I can. I haven't tried any amphetamine salts and don't really want to as there is more of a euphoria associated with it. Might go with dex-methylphenidate IR as the t1/2 is longer. Only, thing at the moment I worry about is tolerance. But, rather than increasing the doeses I'll try and counteract the tolerance by exercise or other beneficial methods.

My regimen is .5mg deprenyl morning with 1500mg Green Tea Extract if I feel like it for COMT inhibition through EGCG, 50mg zinc for tyrosine hydroxylase, and 2.5mg methylphenidate at 4PM (occasionally.) DLPA in the morning. I prefer DLPA over NALT as NALT makes me feel weird. I also try and refrain from masturbation as it does wonders to dopamine upregulation. Also, exercise would be a great idea; but, don't hit the pavement often enough. I would never recommend my regimen to anyone else as everyone differs. Also, please never combine a MAO-B inhibitor with a DRI or releasing agent, this could lead to hypertension and destruction of DA neurons.

Edited by yadayada, 06 June 2013 - 02:04 AM.


#12 Reformed-Redan

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Posted 06 June 2013 - 02:08 AM

This is also a great blog by a psychiatrist on how to take Ritalin or stimulants. This should be mandatory reading for any new ADD sufferer about to receive stimulant medication.

http://thelastpsychi..._correctly.html

I'll just post the content here because it's just pure gold.

How To Take Ritalin Correctly


This is a post about Ritalin, Adderall, Dexedrine, and others-- it is meant for those for whom it is written. You know who you are.


I've written three textbook chapters and a couple of articles on stimulants, and I may or may not have taken them at one time or another, so I'm an expert.

Because I work in a university hospital, and because I'm, well, different, I get approached by college or med students at least once a week for Ritalin or amphetamine prescriptions. Every one claims to have "ADD." (NB: I don't give them out.)

They want the Ritalin to help them study. I get it. I'm not advocating it, but if you are going to use Ritalin you should probably do it intelligently, to maximize the gains.

First, a disclaimer: you should only get Ritalin for indicated disorders by prescription from a physician. Ok? Because the doctor will rigorously apply artificial and unreliable diagnostic categories backed up by invalid and arbitrary screens and queries to make a diagnosis. So after this completely subjective and near useless evaluation is completed, your doctor should be able to exercise prudent clinical judgment to decide if Ritalin could be of benefit. In other words, he will ultimately decide based on little else but his own prejudices and/or consult the Magic 8 Ball. That'll be $250, please. Cash appreciated.

That said, the key to amphetamines and Ritalin is to stop thinking of them as stimulants, and to think of them as reinforcers.

Let's conceptualize how these drugs work. Imagine getting a brain scan while you are performing a task. The parts of your brain you are using for the task will light up, brighter than those you aren't using.

Now you drink coffee (1). The whole brain lights up brighter, proportionally.

Now you take amphetamines. The parts of your brain that you are using light up brighter, but the parts you aren't using go darker. Get it? Caffeine is a global brain stimulant, while amphetamines focus your attention, reducing distraction.

This is entirely selective and controlled by you. You have to decide what you want to focus your attention on. If it's reading, the reading parts of your brain will be brighter. But if you stop reading and decide to talk to your friend on the phone, you know, the hot one with the hotter roommate, then you'll be more focused on that (obviously). Attention is always decreased when it is split among several tasks. In other words, you can only concentrate on one thing at a time, even though it may feel like you are doing two things at once.

While amphetamines and Ritalin do stimulate you and keep you awake, using them to pull an all nighter completely subverts their awesome power. If you want a stimulant, drink coffee or Red Bull. Amphetamines should be saved for reinforcement.

You want to set up a study situation that as closely as possible resembles your testing context. Do you take tests in the middle of the night? Using multicolored highlighters? With The Daily Show on in the background and eating Doritos? Then you're a pig, and you deserve to fail. You're dead to me.

You should study in the morning, at a desk, under the same "fed" conditions as on test day. (So you would have eaten before taking the test, not snacking at the test.) Quiet room, no distractions. Remember, attention is decreased with multiple stimuli in normal conditions, but on amphetamines, this will be be greatly magnified. Studying while talking to your friend means your "talking to friend" parts of the brain are brighter while your ""studying" parts of the brain are darker. Same thing with listening to music and studying.


Take the amphetamine (takes about 30 minutes to "kick in.") Study, straight, with no distractions or interruptions, for about four hours. Quit. You're done. Amphetamines give you about 4 hours tops of great concentration. Go to lunch, the gym, watch a movie, etc.

The power of amphetamines is this: you take them again, in the same dose, 30 minutes before your test.

In a metaphoric sense, taking the amphetamines during the test, under the same circumstances as you had been previously studying, will "remind" the brain of that context. If you see a question that "resembles" something you studied, your mind will be primed to recall it better.

Remember I said you can only concentrate on one thing at a time, that attention decreases when it is split? The trick here is to make everything about studying into one large "thing."

Here's an example: if you listen to a symphony, you will hear music. Musicians, however, hear both the music and every single instrument. They can attend to each instrument individually and simultaneously hear how each instrument fits into the larger context. A non-musician can't do that. If he's concentrating on the oboe, he doesn't "hear" the violas.

Studying has to become a large symphony, everything doing its part correctly, expectedly. So on performance day (testing) you play the same symphony. You're not trying to concentrate on each part, if you've practiced enough it should be second nature. The amphetamine helps facilitate this.

Addicts can get physical feelings of withdrawal or "high" simply by being presented with the cues-- the environment-- of their drug use. And theykey into these cues much faster than non-drug related cues. That's what you're looking for here. The amphetamine feeling "reminds" you of what you studied.

For example, what you don't want to do is NOT take amphetamines at testing if you had used them to study; or take them at testing if you didn't use them to study. Or change the dosage, or change anything else you eat. (2)

Similarly, you should only be taking one pill a day. Don't take amphetamines to study AND later to do other things (like go out at night.) You are destroying the context specific reinforcement. Additionally, tolerance to amphetamines happens pretty quickly-- if you take them every day, you're going to need higher doses as time goes on. Ideally, you'd use them only for the last stretch of time before the test. For example, maybe you'd take them only the last week or so before the test, when you are studying from back tests as opposed to a textbook. (See the context?) And you'd stop using them after the test, give yourself a break, etc.

As a public service announcement, don't worry too much about grades. This is America, not Germany, where success is determined by the solidity of your goal and the amount you are willing to work. I know you don't believe it now, but it's true. Go have a drink.'



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#13 Tom_

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Posted 06 June 2013 - 09:24 AM

Huh? What are you talking about? Moclobemide is a reversible MAO-A inhibitor, it does not carry the risk of having a hypertensive crisis like with the irreversible MAOIs. And Moclobemide does not negatively affect sexual function, in fact, it was found to improve it.


There is some weak evidence it improves sexual function. I suspect this is true.

Severe and obviously rare side effects include: bone marrow suppression, hypersensititivity (angioedema, urticaria, hypotension, anaphylaxis), severe exacerbation of schizophrenia, induction of psychosis, increase in suicidal behavior, peripheral neuropathy, proconvulsant, much higher risk of Serotonin syndrome than normal antidepressants - especially when combined, Hyperprolactinaemia, hypertension (over 140/90), peripheral edema, a much worse withdrawal syndrome...

Common side effects; headache, mental status changes, hypomania, nausea, sedation/over activation, migraine, the shitts, insomnia, worsening of depressive symptoms, hyper/hypotension (>140/90), sexual side effects, this list goes on with the usual.

The drug has an important place in the pharmacotherapy of depressive disorders and is much safer than dual MAO-Is. The side effects are however not entirely begin. It DOES carry the possibility although thank god much reduced risk of severe hypertension - cases certainly have been reported - its efficacy in studies is rarely above significance vs first/second treatment (SS/NRI's), although a lot of studies examine it as a second or third line and this might explain reduced efficacy. It should only be prescribed for ADHD (without depressive disorder/anxiety) after evidence based treatments because it only has two pilot studies - co concomitant therapy with a psychostimulant is potentially very dangerous. I am all for use of rational polypharmacy even with the older MAO-I's but they all come with inherent and significant risk.





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