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Monday, May 20, 2013
Attention Deficit Hyperactivity Disorder
Changes in Medication With Age
I'm 44 and have been on Dexedrine for 30 years. At 14 I took 5 mg 3-4 times a day. I was also prescribed valium PRN for the sudden anxiety attacks that stsrted at the same age. the dex. made me feel normal plus everything became better. In 1981 I self-medicated with cocaine and became a near milliobaire by 28. I had a successful company etc., but I was addicted to the cocaine. I quit the coke as it was too hard to control,dose and illegal. I went back to dexedrine and have been on it pretty consistentially since. My dose is now extremely high ( in my opinion,not my drs)I take 45mg (3-15 mg spasules)in morning-6 a.m.-then go back to sleep til 9 a.m. at 3 p.m. I take 2 more 15mg spansules and one 10mg pill at 6. I take one 15 mg and one 10mg sometimes. At 9p.m. I take 10 mg. again. total max-6 - 15mg 5-10mg. thats as much as 140mg a day. sometimes i dont take but 1/2 or take day off. it seems that it is the only drug that really works and ever since i changed to the 45/30/15 mg doses has it seemed to work like in past. i never had to increase dose. Maybe 3 times in 30 years. Are there others who take doses like this. I seem to be getting worse and more disorganized and am wondering if as I get older am I going to get worse ADD? I'm also on chronic pain meds recently and I was told its ok to mix-diludid. I'm a diabetic and suffer from severe pain in feet from neuropothy. Anyway, I'm wondering if my impolsive behavior and anxiety etc is due to the need for better treatment of ADD or a sign of old age? I'm really worried sometimes and have alot of trouble keeping organized or doing tasks like laundry, listening, etc. I'm getting depressed and was hoping there might be a trial of somesort to get over this.
Thank you for writing. You have raised MANY good, important questions. Unfortunately, I am restricted by the fact that I have never met you and therefore, in spite of all the important and useful information you have shared, I have not had the chance to find out more. I do not even know if you are male or female. A thorough, careful history, and a relationship over time, are two of the most important key elements to helping someone like you. That means you need to work closely with a good clinician/therapist who is an expert in this area to sort things out if you want to get the most help. However, perhaps I can give you some good food for thought.
First, congratulations on getting off the cocaine. That can be difficult for many people to accomplish. Besides the reasons you mentioned to have quit, all good ones, there is another very important one. Ongoing cocaine use appears to burn out brain cells and make ADD worse . . . permanently. I have a few patients at The Affinity Center who need to be on stimulants the rest of their lives, probably because of the three or four years they used a lot of cocaine. Only a few, out of thousands of patients in ten years, but they are there.
If you are female I urge you to take a look at the website attached below on women and ADD. It is superb and it's authors, Patty Quinn and Kathy Nadeau, have excellent books out on the topic that can help you understand yourself. Perimenopause (and, yes, early forties is peri for many of us) dose seem to worsen ADD.
You are taking a stimulant dose that is toward the higher end but it is not too high if it is appropriate for you. In general, it is the appropriate dose if it helps you and more is not more helpful, and it is not giving you problems. Side effects can include anxiety and depression. They can also include sleep, eating, heart and vascular concerns, among others, and you said nothing about that. There is know way for me to know if those symptoms in you result from your stimulant or, in fact, would be worse if you lowered or stopped the stimulant. With your history, I would suspect the latter.
Your dosing is a little unusual but many people need "unusual" dosing. Then again, I am unsure exactly what your dose is because what you first describe is different from the 45/30/15 you mention later and I am unsure what is long acting. Still, it really needs to "work."
If you have any of that "near million" left from your late twenties, or have good insurance, find an expert who will get to know you well and work with you on more than just the dexedrine. You need a holistic approach but you do need more than this column.
I wish you the best.
Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati