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Successful recovery of ADHD through medicines and therapy - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: ADHD
Answered by

General & Family Physician
Practicing since : 2009
Answered : 681 Questions
Doctor :   Hi
Doctor :   How can I help you?
User :   Yes I have questions about ADHD and medications usage with it, I am in the XXX and am diagnosed with ADHD an take Adderall for this
Doctor :   Ok
User :   I am 24 year old male, I take 20 mg Adderall XR once a day. The medication used to do just fine but now no longer works as well. Before I talk to my XXXdoctors I would like informed advice about other medications and uping the dosage of this med or a combo of meds that might work. I am still having trouble staying on task unless it is something that I enjoy doing, as well I am still highly impulsive making descisions that I later regret and my wife says that I act like a little kid when Im not on the medicine or when it starts too wear off
Doctor :   The treatment of ADHD is by combination of medications and therapy.
Doctor :   There are various groups of psychostimulant that are effective in the treatment of this condition.
Doctor :   The commonest are the dextroamphetamine containing drug (adderall and others)
Doctor :   Other drugs containing Methylphenidate, Dexmethylphenidate are also useful.
Doctor :   Apart from this, other drugs such as atomoxetine, other class of antidepressants are also widely used.
User :   I am doing counseling for the anger management and organizational counsleing. I take the adderall 20 mg xr but it is no longer working. I have tried ( I know your not suppossed too) using more than the daily dose of about 30 mg of xr but anything after 25 mg really effects my blood pressure. It runs from 113/68 hr 42 when I wake up to up to 140/85 while sitting. If i take blood pressure immediatly after sitting down it can be in the mid 145/85 then go back down. It fluctuates very much throughout the day but I have no heart conditions.
Doctor :   Since all these medication are prescription only drugs, they can only be prescribed by a doctor who will be able to monitor you during the course of treatment.
Doctor :   Since the treatment is going to be gradual
Doctor :   if you find that the symptoms are persisting, other groups of psychostimulants/ non stimulants/antidepressants can be started instead.
Doctor :   I would suggest you to report to your treating doctor, who will be able to do the necessary modifications.
Doctor :   Have you followed what I have suggested?
User :   I tried antidepressants but they did no work what so ever, thats why they moved e to the adderall. I did report, he wants me to monitor too see if a blood pressure med needs to be added. I did some research and seen that they can tread aggression and impulsiveness of adhd with catapress. Would the doctor be able to increase the dosage of adderall say maybe the 20 mg xr in the morning and 10 mg instant in the afternoon with a catapress for adhd as well
User :   yes i am tracking
Doctor :   The dosage of the medication are modified depending on its effects on the blood pressure and its effects on your symptoms.
Doctor :   The doctor who is monitoring you, will be the best person to answer this.
User :   Can adderall and catapress which are both adhd medications be prescribed to treat adult adhd as a combo medication?
Doctor :   If there are no drastic effects on the blood pressure, then yes, they can be tried along with the antihypertensive medications.
User :   what do you condisder drastic effects of blood pressure too be sir
Doctor :   Any blood pressure above 140/90mg of Hg is above normal.
User :   now when taking blood pressure how long should you wait after you have sat down to take your blood pressure as I know everyone has there opion on when to take resting blood pressure
Doctor :   catapress are effective in both treating the ADHD symptoms and do not cause rise in the blood pressure.
User :   as weill the catapress could be used to treat the symptoms that the adderall does not correct and lower blood pressure as well correct?
Doctor :   The rise in blood pressure can be noticed in about an hour or two and can last for 3 to 4 hours depending on the dose prescribed.
Doctor :   Yes,
Doctor :   Catapress as you have rightly pointed out, can correct the blood pressure as well.
Doctor :   However, since these medication are needed to be monitored, you need to use them with continued monitoring.
User :   If the adderall raises the blood pressure above that 140 systolic point for those few hours is that still dangerous>
Doctor :   And lastly, since medical drugs are only supportive, you would need to continue strictly with the psychotherapy.
Doctor :   An acute rise of blood pressure above the normal range are not dangerous, however over a period of time, they can induce changes in the blood vessels and lead to complications.
Doctor :   Hence adequate treatment of the blood pressure, either by the use of antihypertensive or by change of medications is needed.
Doctor :   Have you followed what I have suggested?
User :   yes
Doctor :   Do you have any other query?
User :   so with that said would the catapress be a good medication for me to ask my doctor about adding too the adderall to treat the impulsiveness that I still have and assist with blood pressure
Doctor :   Its a good option of using the combination of drugs, if the symptoms of ADHD are persisting and the effects of blood pressure are significant with a single drug alone.
User :   Are there any stimulants that have a less effect on blood pressure than adderall does that would maybe be a better choice for me? Like I said the adderall used to work perfect, however the dosages needed to get the same results greatly effects blood pressure for a few hours
Doctor :   and as suggested earlier, your doctor who has been monitoring your progress as well as recording the blood pressure will be the best person to decide upon.
Doctor :   Apart from the adrenergic blockers such as clonidine (catapress) and the antidepressants, other class of drugs can cause rise in blood pressure.
Doctor :   However, the effects of each drug on the blood pressure may vary depending on the dosage.
Doctor :   Hence with proper monitoring and regular follow up, they can be kept under control.
Doctor :   Have you followed what I have suggested?
User :   yes
Doctor :   Do you have any other query?
User :   yes one more i believe
Doctor :   Please proceed.
User :   when I go to check my resting blood pressure, how long should I remain seated before taking the blood pressure, and if I have been up moving around working, ect what should that blood pressure be when taken?
Doctor :   A resting blood pressure, recorded after a period of an hour or 2 following the medications and recorded in the lying posture
Doctor :   are to be considered.
Doctor :   If you have been, moving around or anxious or under the effects of stress your blood pressure readings may not be right.
User :   how many minutes should you wait after positioning yourself to take your blood pressure should you wait too take that reading
Doctor :   Hence you need to be completely calm and no severe physical activity before recording your blood pressure.
Doctor :   If you are completely calm, and the medications were administered before an hour or two, you can record your blood pressure after 2 minutes of positioning.
Doctor :   Have you followed what I have suggested?
User :   Yes sire
Doctor :   Do you have any other query?
User :   one last, is there any stimulants that could possible last longer than the adderall o3r would a additional dose probably be the best route for treating that ADHD throughout the entire day. (I take at 4:30 am before work and work till 3 pm) medication is wore off by lunch time.
User :   because when I get home all I want too do is watch tv then go to bed. If there is still work to get donw I blow it off and it never gets done till the weekend
Doctor :   Almost all medication are given, once or twice daily depending of the dosage.
Doctor :   And further higher dosages can be done depending on the effects on your symptoms and its effects of the blood pressure.
Doctor :   Hence your doctor will be able to help you in changing the dosage and frequency as needed.
Doctor :   Have you followed what I have suggested?
User :   An if the higher dosages treat the pressistant symptoms then a anti-hypertensive can be added to aid in the treatment correct? As I have read several articles of adults suffer from the influx in blood pressure from stimulants and sometimes require the anit-hypertensive
Doctor :   Yes.
Doctor :   Its necessary that you do not depend on the medications for treating your symptoms alone.
Doctor :   Be regular with your therapies and your symptoms will improve with it.
Doctor :   Have you followed with that?
User :   Yes I have sir
Doctor :   Do you have any other query?
User :   no that is all i believe
Doctor :   Thanks for consulting me.
Doctor :   Bye for now.
User :   thank you for your advice sir
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