Stimulants for ADHD

[marissa]

We went to the psych for our youngest son today. She suggested Focalin to start for him. I'm reading the info and it says to not use if there is a history of vocal tics and or glaucoma. My son has vocal tics and an eye condition called abnormal eye cup pallor. The suggestion was to do a stimulant before we more to anything else. Has anyone had experience with this medication?

[auntie]

A lot of docs like to start with stimulants- they have a long record of study and safe use, they're relative inexpensive, they are the class that is most effective across symptoms and age and they're easy to trial because they are effective immediately.

They can exacerbate tics as well as ramp up the complexity and frequency of them. They can also increase anxiety in individual prone to it, so there may be some cause and effect on that front. Still, some physicians and families feel that the benefits of the medication outweigh this side effect. Some doctors wiwll prescribe something to lower the tic threshold along with the stimulant. I'm seeing a lot of kids taking a stimulant along with Clonidine or Tenex/Intunive.

Given his eye issues, I would consult with his opthamology team. I'd want the most expert opinion regarding the impact of medication on his eye condition. You might even run it by a pharmacist at CHOP for a second opinion.

We've not done Focalin. But we've trialed similar meds- the Ritalin group and the Dexedrine group. Focalin is the 3rd of the cousin group. They're very similar but seem to effect individuals slightly differently. DS does best of Adderall or Dexedrine SR; he's a hot emotional mess on Ritalin or Concerta. You have to trial to see how they work for your child.

The stimulants seem to be most effective, especially past age 12. But there are meds like Strattera and the antihypertensives (Tenex/Intunive and Catapres/Kapvay are the commonly prescribed ones) that could be used as well if his eye issues or tics make stimulants a poor choice.

[marissa]

My friend last night said her son does well on Concerta and a few others. I need to put in a call to his eye doctor anyway. He didn't complete his exam last month and I need to reschedule it for him. Chris couldn't get past the light in the eye part.

My cousin is a pharmacist so I might ask her as well.

[auntie]

It's all so individual.

Some kids do really well on Concerta which is just Ritalin in a special packaging that makes it time release and less easily abused.I was diappointed DS couldn't tolerate it because it's the longest lasting of the stimulants. With older kids and adults- you need all day coverage for classes, homework, activities and now work and driving.

One thing you can always ask to do is to trial a shorted acting version of the extended release you hope to end up with- Dexedrine for Adderall and Vynace or Ritalin for Concerta. That way, if the med is a really bad fit, it'll clear his system in about 4 hours.

Get some input from your cousin. A good pharmacist is a valuable resource around this sort of thing.

[auntie]

marissa

Just wanted to share this update.

I've mentioned my adult niece living with me before, mostly at that other place. She's a bright capable "kid"- great job, MPA, etc, but living with her I started to get deja vu. It was like living with my mother to some degree- the poor time management, the uncompleted tasks, the debris fields around the house. Holy shit, I invited another scattered ADHDer into my home.

We had a conversation about this a while back because the executive function stuff was making her miserable. She had been seeing a therapist for 7 years and basically spinning her wheels. She and the therapist thought maybe some meds for anxiety/low level depression made sense. I showed her some stuff about ADHD and shared what I saw. When she was ready to see a psychiatrist, I suggested the one DS sees because he's great with young adults- conservative but sympathetic.

Of course, the day of her first appointment I found her beloved long term boyfriend dead in his basement. They'd had plans and he wasn't answering his phone or emails so we went to check on him. The ME says he must've fallen on his steps a few days prior. The psych had to go into dealing with grief, anxiety and depression and only today were they able to move forward on the ADHD thing.

He gave her Focalin. He described it as "gentler" than Adderall and more reliable than the generic Concerta. He would have been OK with Concerta but warned her that it would be ridiculously expensive with most insurance. I'm curious to see how it goes. She's still waiting on precertification. 

[marissa]

Thank you! My cousin said the literature said tics were higher in 1% of kids. She was more concerned about his eye issues. He has enlarged optic nerves and if you don't know enough about them it looks like glaucoma. She suggested we call his geneticist.

[auntie]

I lied anyway.

Grrr. The insurance company wanted a precert and med trial for other stimulants before approving Focalin. So he wrote brand name Concerta. Weird because they're about the same price retail.

[marissa]

Had to share this gem...I've been sick since Tuesday morning. I have bronchitis and a sinus infection. Hubby had been on parental duty *which really means it's me with a bit of him in there* but he took all three boys to Chris' Boy Scouts last night. Up until last night he was not convinced Chris needed anything. The child was out of control and apparently running all around the room, not listening, and doing his own thing the entire meeting. One hour and a half time period all alone with just him parenting and he's convinced himself we need to do this, like in "Why didn't I think of this sooner?" thing. UGH! If only he would have listened to me a year ago...

[auntie]

My DH is an experiencial learner as well. As I recall it was a Pack meeting that finally got him on Team Auntie. TBH, I still find cubs hard- I'm the district PR person and I have to cover them a cocuple times a year- they're cute but yikes!!

My niece finally started the Concerta. OMG- what a difference. She stayed focused on getting ger "to do" list done and even packed for 6 hours without falling down the rabbit hole. DH noticed that she even read an article in C&E News straight through in one sitting which is a first.

[ktzmoh]

Curious if you wound up trying the Focalin? We just started our 7yo on a low dose (in combination with Intuniv he's been on for a while) and we've been underwhelmed with the results.

[marissa]

We were to gather our info and she'd write the script in January because my husband had been so against it at the appointment.

[auntie]

ktzmoh

Did you see any improvement with Intuniv? We did Tenex when DS was 7 1/2 and it was worthless for him. 

When DS moved next to Dexedrine, we saw little impact at 5 mg (the lowest dose) but big changes at 10 mg. Like night and day. What does his psychiatrist say about this?

[ktzmoh]

Dec 17, 2014 16:14:26 GMT -5 auntie said:

ktzmoh

Did you see any improvement with Intuniv? We did Tenex when DS was 7 1/2 and it was worthless for him. 

When DS moved next to Dexedrine, we saw little impact at 5 mg (the lowest dose) but big changes at 10 mg. Like night and day. What does his psychiatrist say about this?

We did at first - and at 3mg. But the side effects were hard - he would go through this energy low in the afternoon that was just not okay. So we dialed it back and the sleepiness went away, but it was less effective . That's when she switched us to this combination. The lowest dose of Focalin isn't making a night and day difference, but we are going slow. We may wind up trying out a little bit of a higher Focalin dose over the holiday break when we can closely observe him. 

We haven't tried Dexedrine. Is that similar to Focalin? There are so many drugs and drug combinations possible. It's very confusing

[auntie]

The active ingredients are similar, but not identical. Dexedrine and Dexedrine XR are more like Adderall.

Trialing over a break when you can shake out temporary sleep issues is always best.