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Treatment options for ADD other than medical cannabis - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Mental Health
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1762 Questions
User :   I would like to talk to someone about my ADD.
Doctor :   hi
Doctor :  
how can i help you?
Doctor :  
ok
Doctor :  
since when you have this ADD?
User :   my whole life
Doctor :  
what symptoms do you have now?
User :   who are you?
Doctor :  
are on regular medications?
User :   no, not on any medications...
Doctor :  
I am a General Practitioner, I believe I can help you within my expertise and If required I shall recommend a specialist.
User :   ok
User :   Where are you located?
Doctor :   I am located in India
User :   awesome
Doctor :  
please proceed with your health query
Doctor :  
what do you want to know about ADD?
User :   Well I basically have trouble concentrating on things, and i tap my feet nervously a lot
Doctor :  
ok
User :   and its really hard for me to sit still in general... I'm 26 years old now
Doctor :  
ok
User :   I was diagnosed with ADD when I was 12, and now I run my own businesses, and I am a successful person but I want to see if there are any other treatment options out there
Doctor :  
please provide your gender, location, occupation, height and current weight
Doctor :  
ok
User :   M
Doctor :  
ok
User :   I was on ritilin (spelling?) and aderol when I was a kid
User :   and had very little luck with both. They made me sick and nervous
Doctor :  
ok
User :   I was self treating for a while with medical cannibis but stopped because of the legality issues
Doctor :  
ok
User :   my symptoms completely dissapeared when vaporizing cannibis
Doctor :  
ok
User :   I can work better, and focus longer, and i'm generally happier. I even did it for long periods of time and it still helped, but I stopped because my job is too important now and I cant risk getting in trouble
Doctor :  
see, ADD or ADHD as it is known, is a neurobehavioral developmental disorder
Doctor :   it is characterized by co-existence of attentional problems and the hyperactivity in some form, with each behavior occurring infrequently
Doctor :   it is of 3 types, depending on appearance of symptoms, age at appearance and traits associated with them
Doctor :  
1) Predominantly hyperactive-impulsive ADHD
User :   I was never the type of kid to get in trouble for being too hyper or anything
Doctor :  
2) Predominantly inattentive ADHD
User :   it was mostly staring off into space
Doctor :  
3) combined form of both these above two types
Doctor :  
so your case could be the 2nd type
Doctor :  
and the symptoms can go unnoticed at early age
User :   mostly... but I also have some nervous habbits
Doctor :  
passing off as a "child being nice and quiet types"
User :   as a kid i used to open my mouth in a funny way to stretch sort of
Doctor :  
ok
User :   and I sometime push my finger into my ab muscles
Doctor :  
as the child grows up, more of associated problems start showing up like
User :   and take overly deep breaths sometimes, just out of stress
Doctor :  
depression, anxiety, substance abuse, learning disability etc
Doctor :  
the signs and symptoms can vary from child to child
Doctor :  
Inattention, hyperactivity, and impulsivity are the key behaviors noted in a person affected with this ADD
User :   ive had everything except substance abuse and only very mild depression as a kid
Doctor :  
and sometimes it is hard to tell and draw lines between completely normal and teh ADD levels of the symptoms
User :   Why did the Aderol/Ritelin make me sick but the cannibis seems to help... is there a legal form of drug that works like cannibis?
Doctor :   ok
Doctor :  
i wil ask you fwe more questions reagrding your symptoms in childhood
User :   ok
Doctor :  
which will help us to determine teh type of ADD you are having
Doctor :  
as a child, were you easily distracted, missed details, forget things, and/or frequently switch from one activity to another?
User :   all of those things
Doctor :  
did you have difficulty in focusing on one thing?
User :   yes, except video games
Doctor :  
do you become bored with a task after only a few minutes of starting it, unless they are like doing something enjoyable?
User :   yes
User :   its misserable
Doctor :  
did you find difficulty in focusing attention on or organizing and completing a task or learning something new at any time?
User :   i learn new things very quickly
User :   but only if its something i'm interested in already
Doctor :  
do you have or have had trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities?
User :   its really hard for me to memorize things that my brain doesnt tell me are important
Doctor :  
ok
User :   terrible short term memory problems (except while on cannibis, strangly enough)
Doctor :  
do you sometimes seem to not listen when spoken to?
Doctor :  
ok
User :   yes, people talk to me all the time and i dont even know they said anything
User :   and its not because i couldnt hear them its just that i diddnt notice. But if they say certain key words I will tune in
Doctor :  
i wil explain why is that after finishing my questions regarding ADD
Doctor :   ok
User :   ok
Doctor :  
do you often daydream, become easily confused, and/or move slowly in doing any task?
User :   yes
Doctor :  
do you feel difficulty processing the information as quickly and accurately as others when faced with stresful situation?
User :   yes
User :   but in certain things, much faster than others
User :   its really strange
Doctor :  
do you struggle to follow instructions?
User :   its really hard for me to follow step-by-step instructions
User :   less of a problem as I get older, and also not a problem on cannibis
Doctor :  
i will need to ask you few more questions and it might take some more time
User :   take your time
Doctor :  
your time limit of 30 minutes may not be enough to complete our discussion hence i am asking you to allow me time
User :   can I pay an extra 2 dollars and extend it?
Doctor :  
i can provide you a coupon code to avial discount on your next payment, you can quote this code 'CRM374'
User :   i have to go to bed so i wont be up long
Doctor :   you can continue the live chat with me anytime again either today or tomorrow
Doctor :  
i will be available at same time tomorrow again if you want to discuss with me
User :   but you diddnt even help me
Doctor :   else my collegue will carry on with the discussion
User :   what will we talk about tomorrow? do you know much about ADD?
Doctor :  
we can continue the discussion now
Doctor :   i need to ask few more questions to determine what type of ADHD you have to be able to guide you with the treatment options
Doctor :   shall we continue our discussion now?
User :   sure but i dont want to go through the trouble of paying again
Doctor :  
i was worried that time will not be enough so i wanted to give you a coupon code since your case requires undivided attention
Doctor :   so i diverted from the discussion
User :   haha ok
User :   what do you need me to do
Doctor :  
right now answer few more questions that i need to ask
Doctor :  
and then we will proceed with the treatment options
Doctor :  
once we are sure of what type you are affected with
Doctor :  
so shall i proceed with the questions?
User :   yes
Doctor :   do you fidget and squirm in your seat when stresed?
User :   even when not stressed haha
Doctor :  
do sometimes tend to speak/talk non-stop?
User :   CONSTANTLY squirming and fidgeting
User :   yes... that too...
Doctor :  
Do you tend to dash around, touching or playing with anything and everything in sight?
User :   i dont really do that much

Doctor :   when as a child did you have trouble sitting still during dinner, school, and story time? or even now at ofice or meeting?
User :   i'm back
Doctor :  
hi
User :   yeah I constantly have to sit on my leg
User :   or i'll shake it
Doctor :  
ok
User :   and sometimes i compensate for taking really deep breaths
Doctor :  
ok
User :   but i constantly feel the urge to move my leg or something
Doctor :  
so do you constantly tend to be in motion?
User :   yes
Doctor :  
and do you feel difficulty in doing quiet tasks/activities?
User :   depends on what it is
User :   reading for fun would be out of the question
Doctor :   the answers that you have given to my questions point towards the 3rd possibility of ADD/ADHD type, i.e, of a combined type
Doctor :   Predominantly hyperactive-impulsive ADHD combined with Predominantly inattentive ADHD
User :   what causes it?
User :   why does cannibis seem to help so much?
Doctor :   have you ever identified these in yourself? or has someone commented on these behaviors like stubbornness, aggression, frequent temper tantrums, deceitfulness, lying, or stealing?
User :   all of the above
User :   wait
User :   no not those
Doctor :  
i will come to the cause and your cannabis related question. kindly give me some more time.
Doctor :   ok
User :   I thought you were talking about your earlier questions
User :   stubbornness, for sure
Doctor :  
do feel changes in moods? like as mood swings?
User :   but nothing else
User :   never deceitfulness, lying or stealing or agression
User :   i have a lot of self control
Doctor :  
ok
Doctor :  
that is good
User :   ive never even gotten a speeding ticket
Doctor :  
there were asked to see if there are related problems that could make the condition worse to treat
Doctor :   now coming to the cause
Doctor :  
the exact or specific cause is still not known.
Doctor :   there is a possibility of genetic factors playing a role that is being looked upon
User :   maybe too many video games as a child?
Doctor :  
other factors include diet, social settings, and physical environments
Doctor :  
that play a role in making a child develop these
User :   i was always the kid that wouldnt eat
User :   picky as hell...
Doctor :   there are theories proposed to the cause too
Doctor :   like eg: the AD children tend to be like hunters, being good in searching and finding things.
Doctor :   rather than being quiet and managing complex tasks
User :   thats amazingly accurate haha
Doctor :  
there can be environmental causes like during pregnancy or early chilhood, infections can lead to developing these
Doctor :  
alcohol and tobacco smoke exposure during pregnancy and environmental exposure in very early life also tend to lead to these
Doctor :  
others include premature birth, pregnancy time infections
User :   ok, not aware of any pregnancy issues
User :   i used to "spit up" a lot as a child
Doctor :  
chilhood infections of measles, varicella, rubella, enterovirus 71, streptococcus infections etc.
User :   thats the only abnormal thing that I know about
Doctor :   ok'
User :   i had chicken pox
Doctor :  
in diet, the use of most artificial food colors increases the risk of developing ADD
User :   I mostly ate peanutbutter and jelly
Doctor :  
these include sunset yellow FCF (E110), quinoline yellow (E104),
Doctor :   carmoisine (E122), allura red (E129), tartrazine (E102) and ponceau 4R (E124) which are responsible
Doctor :  
using more of packaged foods also on one of risk factors
Doctor :  
included in dietary causes
User :   i ate a ton of candy
Doctor :  
ok
Doctor :  
now coming to social causes, any family dysfunction, or educations dissatisfaction, relationships issues with caregivers, violence and emotional abuse in early age tend to push children into ADD.
Doctor :  
so all of these including physicians, parents, teachers, and others who have in some or other way caused the child to be withdrawn can be part of causative factors
Doctor :   did you have any of these social factors playing a role in your early life?
User :   i had an awesome childhood
Doctor :  
these people tend to have reduced brain volume predominantly the left-sided prefrontal cortex
Doctor :   which reflects in inattention, hyperactivity, and impulsivity of the ADD
User :   My parents were amazing, and nothing bad ever really happened to me
Doctor :  
even the blood supply to these areas controlling the various emotional and other motor aspects recieve reduced blood supply
User :   I hated school so much though, and it caused my parents and I to fight a lot about school work, and I was up all night doing school work at an early age
Doctor :  
resulting in higher concentration of dopamine transporters in brain
Doctor :  
when you take cannabis, these effects are somewhat counteracted making you feel better
Doctor :  
and produce more dopamine
User :   i'm left handed by the way
User :   and almost all of my friends are left handed... as weird as that is...
Doctor :   have you followed what i have said uptil now?
User :   yes
Doctor :  
ok
Doctor :  
is your sleep adequate? do you feel that you are able to sleep well?
User :   wait- I want a little more clarification about the dopamine transporters
Doctor :   ok
User :   so people with ADD have a reduced left side of the brain in the frontal cortex?
Doctor :  
predominantly those areas, but in general the entire brain is reduced in size
User :   So when the brain creates dopamine, thats bad?
Doctor :  
dopamine transporters are in charge of "planning ahead" and making brain ready to respond adequately to any stimulus.
Doctor :  
but when they are increased in numbers with less of dopamine around, the symptoms of ADD result
Doctor :  
lower levels of dopamine with high tranporters
Doctor :  
lead to teh resulting symptoms with a person not knowing what to do, but keep doing something
Doctor :  
leading to learning problems and fidgeting etc.
Doctor :   now coming to treatment part
User :   I totally understand
Doctor :  
treatment involves combination of behavior modification/therapy, life-style changes, counseling, and regular medication use.
User :   so does the cannibis somehow make it worse in the long run? because I used for 1.5 years every day and diddnt notice any real negative side effects
User :   (other than being happier and much more productive every day).... and eating and sleeping better
User :   what kind of behavior modification?
Doctor :   no cannabis makes more dopamine produced, so the transporters are engaged, leading to absence of those symptoms
Doctor :  
and dopamine is responsible to feel good, happier and this leads to being much more productive
User :   I used a vaporizer instead of smoking
User :   and I'm convinced its better for you.
Doctor :  
the medications include the amphetamines derivatives like Ritalin, Metadate, Adderall, Vyvanse etc
Doctor :  
others include antidepressants and antipsychotic drug groups
User :   ive never tried metadate, or vyvanse
User :   I'm really concerned with taking something that is going to make me addicted or more prone to problems in the future
Doctor :  
these are prescription medications, you should try them on your own
Doctor :  
no usally these wil not happen when used in adjunct with the behavior modification/therapy, life-style changes, and counseling.
Doctor :   what i would suggest is that you should go in for counselling sessions with the psychologist for few weeks
User :   if cannibis is legalized, would you recommend that i just go back to using that?
Doctor :  
where it will be determined whether behavioral therapy is required or not
Doctor :  
no , not on the long run, as it has its own side effects on the brain and heart making prone for heart attacks and stroke
User :   isnt that only if you smoke the product? i dont smoke it
Doctor :  
coaching or counselling to overcome and avoid the symptoms along with, positive changes in diet, such as using low sugar/carbohydrate, low additives and packages foods, and no caffeine usually help.
Doctor :  
no, not needed to be smoked, even when you vapourised and inhale it stil gets inside you
User :   what makes it increase my chances of stroke?
Doctor :  
and gets absorbed causing the positive effects that you feel while taking it
User :   or heart attack ?
Doctor :  
either way it gets absorbed through the mucosa
Doctor :  
and it will lead to these risks on long term use
Doctor :  
have you followed what i have said?
User :   yes but i'm curious - what makes the heart more prone to heart attack?
Doctor :  
it increases heart rate and may cause arrythmias leading to heart attacks
User :   so it makes my heart weaker over time because of the increased heart rate?
Doctor :  
due to load on the heart
Doctor :  
yes it does
Doctor :  
Is there any thing else I can help you with?
User :   does working out increase your heart rate?
User :   does doing jiujitsu every night reduce the health of my heart? because i get my heart rate up very high in jiujitsu
User :   What medicine do you recommend? or do you think I just need to go see a psychologist
Doctor :   yes it does, but it does not have sustained effects, with the heart rate coming down to normal after stopping the activity
Doctor :  
but with cannabis use, it does not happen
Doctor :  
there is sustained increase in the heart rate over the time
User :   i had my pulse checked the other day at the dr.
Doctor :  
laeding to increase in basal hear rate itself
User :   it was 59
Doctor :  
*heart
User :   53 actually
User :   106 systolic and 71 diastolic
User :   is that good?
Doctor :  
i would recommend you to go in for a psychologist to first analyse your needs
Doctor :   BP is fine, heart rate is on lower side as of now
Doctor :   and once the needs are confirmed, the further traetment can be initiated
User :   what does it mean if its too low?
Doctor :  
including the counselling sessions and how many you need them
Doctor :  
if you are regular in doing work outs then heart rate between 50-60 s considered as normal basal heart rate
User :   basal?
User :   so do you think my blood pressure and pulse is so low because of cannibis?
Doctor :   basal heart rate means the normal resting heart rate
Doctor :   blood pressure is fine.
User :   ?
Doctor :  
pulse being low also can be due to the work outs also if you are regular with them
Doctor :  
Is there any thing else I can help you with?
User :   what happens if your pulse gets too low?
User :   does that mean my heart is too weak or too strong?
Doctor :   you will feel giddy, blood supply to vital organs reduce
Doctor :  
making you to feel tired or fatigued
User :   can it kill you?
Doctor :  
we cannot say until we do a ECHOCARDIOGRAM to see the functioning of heart
User :   ok
Doctor :  
usually, not, but if heart is also weak, in terms of the ejection fraction of blood pumped at each beat then it wil lead to in sufficient blood supply
Doctor :   causing vital organ damage
Doctor :  
and slow complications to arise
Doctor :  
Is there any thing else you would like to ask?
User :   sometimes i feel like i cant get enough air
Doctor :  
ok
User :   like i cant breathe big enough
Doctor :  
ok
User :   i think its stress related
Doctor :  
it could be cannabis related, i suggest you to stop using it
User :   i stopped a few weeks ago
Doctor :  
also it could be due to the stress and teh likely depression due to teh stress
User :   my dad got upset over it
Doctor :  
ok
Doctor :  
that is good
Doctor :  
that you have stopped
User :   but now my ADD is back haha
Doctor :  
so now to control it
User :   and I'm in the middle of a startup so I need to be on my A-game
Doctor :  
you will need multiple approach
User :  
Doctor :  
including teh psycholgist consultaions, counselling, behavioral modifications
Doctor :  
and diet changes as suggested
Doctor :  
and lifestyle changes as suggested by the psychologist
User :   ive been eating mostly steamed vegitables
User :   and whole meats
User :   i've been eating mostly organic recently, and no processed foods
Doctor :   ok
User :   I drink a ton of milk
User :   is that bad?
User :   and does steaming vegitables ruin its nutritional value?
Doctor :  
it does to some extent
Doctor :  
and no, your diet is not bad
Doctor :  
as long as you avoid high carbohydrate containing foods
User :   i eat a lot of fruit too
User :   in the morning i blend up blueberries, blackberries, bananas, yogurt, and milk
User :   and scramble some eggs
Doctor :   Please fill the feedback form comment box, and say done when done while i answer your other queries regarding diet.
Doctor :   your diet part is good, continue taking what you are already taking making sure that it is a high protien and low carb diet
User :   its harder to eat the good food now that the cannibis is gone
Doctor :  
with catching up on the psychologist consultations, counseling, behavioral modifications and other lifestyle changes as advised by them
Doctor :   slowly you will get into the habit of taking the good foods, its matter of time, do not be discouraged.
Doctor :   have you filled the feedback form?
User :   yes
User :   I gave you high marks
Doctor :  
is there anything else you would like to ask?
Doctor :  
thanks
User :   yes- do you guys have a video chat option?
Doctor :  
we are there to help you 24/7
User :   have i used up my 1.5 hours?
User :   why cant i see how much ive used up
Doctor :  
not right now, we will soon be coming up with that in about the next quarter of the year
Doctor :  
you could see it by going to the chat history
Doctor :  
i will help you
Doctor :  
just give me a moment
Doctor :  
you still have another 10 minutes more for 1.5 hours to expire
User :   ok
User :   Also - I have wrinkled thumbnails
Doctor :  
ok
User :   and its been that way since i was a kid
Doctor :  
usually its due to nutritional and essential vitamins deficiency, but you seem to have a good diet
Doctor :  
so it should have reversed unless it is heriditary
User :   yeah its really strange, maybe i have a tapeworm
User :   noone else in my family has had it
Doctor :  
have you dewormed yourself?
User :   you know... i used to have "worms" when i was a kid
Doctor :  
ok
User :   my mom had to shine a light up my butt or something haha
Doctor :  
was deworming done for you ?
User :   but i dont know what deworming is
User :   i mean, i assume they fixed it when i was a kid haha
Doctor :  
when did you last deworm yourself?
User :   i dont know how to deworm myself haha
Doctor :  
in case of doubts, you can do it again and repeat it once every year
User :   what do i do?
Doctor :   the deworming tablets are available which your PCP can prescribe.
Doctor :   you have to take them as instructed
Doctor :  
to avoid reinfection, repeat the process once every year
Doctor :  
is there anything else you would like to ask me?
Doctor :  
are you there?
Doctor :  
have you followed what i have said?
Doctor :  
Thanks for consulting HealthcareMagic. Bye for now. Please chat with our doctors 24/7 for medical queries. Please refer your friends to our service.
Doctor :   It seems you have moved out of the chat window. Please log in back if you have medical queries.
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