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Thursday, December 5, 2013
Attention Deficit Hyperactivity Disorder
Taking Adderal at the Right Time
I have changed doctors and he has diagnosed me with ADD in addition to major depresssion.I was taking Lexapro and began to feel very lethargic, tired etc. He prescribes ADD meds on a 24 hour basis. Is this a new trend? Is it healthy? He maintains that the brain needs the meds all of the time for it to heal. I have already tried Focalin and he now has me on Adderal. I am starting on the 5mg. for a week then upping the dose by 5mg every week. Please comment. Thank you.
First, I hope you told your doctor about being tired on escitalopram (Lexapro). There are many antidepressants out and he may want to place you on one that has no negative side effects.
Now, to your specific question. There is not data I am aware of that 24/7 stimulant medication is better for ADD than all waking hours. That is not to say it isn't, we just do not know.
I have two patients who I have medicated that way because it was the only way I could get them good sleep. I had tried many alternatives first. I also have many patients on a dose (often lower than their usual dose) of short acting stimulant an hour before bed because it appears to focus their brain's sleep center and allow them to get to sleep. I try this when adults or children with ADD lay awake thinking about all kinds of different things at night and can't otherwise shut that off. I do not necessarily try that if all their thoughts are worries (that's usually anxiety, not ADD) or racing all around the place and not really making much sense (that could be a mood problem). So, those folks are often medicated about 19 hours each day.
One concern I have is the word "heal." It's important to know that we do not have good evidence yet that any long term physical improvement happens to the brain on stimulant medications. There is a small amount of evidence this may be happening but not enough yet to at all be sure.
On the other hand, when you can learn better, that stays with you the rest of your life. If you sleep better, that helps you learn better. It would be neat to find out that our dreams helped us to deal with life better when they were well focused---but that's shear speculation for now.
Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati