SWIM's ADD Adventure

[Beltane]

For most of the usual reasons, SWIM decided to look into ADD/ADHD (hereafter simply referred to as ADD) diagnosis and treatment. What follows are his experiences and bits of SWIknowledge and wisdom he's accumulated on his journey. Topics covered addressed are ADD doctors, ADD testing, and ADD medications.


ADD Doctors

In SWIM's opinion, if a person is serious about getting evaluated for ADD and exploring the different medications and treatments available, it's best to visit a doctor who specializes in ADD for the following reasons:

1. These doctors are very familiar with ADD and are going to be far more knowledgeable than the average general practitioner.
2. ADD doctors are more familiar with the different variations of treatments and medications.
3. These doctors are likely to be more comfortable prescribing the more "serious" ADD medications (amphetamine based medications) that a general practitioner would shy away from.

SWIM would add that in his opinion, a person who goes to an ADD specialist is likely to get an ADD diagnosis. That's what these doctors see all day, and that's the mode in which they think. Just something worth considering.

When SWIM went to the ADD specialist, he was very up front about his past experience with drugs, disclosing prior stimulant and cocaine abuse, IV administration and the fact that he'd been through rehab and had been sober since (about 6 months at the time.) One might think that prior substance abuse would preclude one from ever being prescribed one of the stimulant medications used to treat ADD, but this isn’t necessarily so. It’s well-known that those suffering from ADD symptoms often self-medicate with stimulants prior to seeking treatment. SWIM feels it’s best to be honest with the doctor.


ADD Testing

As for the ADD testing, for SWIM this barely seems worth mentioning. There is no "official" test like a brain scan or biochemical assessment for ADD. Any test SWIM has taken or heard of is just a series of questions to be answered orally or in writing. The ADD symptoms listed in the DSM IV are the closest thing there is to an "official" test regarding an ADD diagnosis.

SWIM finds it hard to believe that everyone couldn't be diagnosed with ADD considering the questions he was asked. His doctor had their own questionnaire, but it was based on the DSM IV diagnostic criteria, which are as follows:

DSM-IV criteria for ADHD

I. Either A or B:

A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.

B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.

Impulsiveness

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

II. Some symptoms that cause impairment were present before age 7 years.

III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).

IV. There must be clear evidence of significant impairment in social, school, or work functioning.

V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

For a person whose sole intent is to convince a doctor that they have ADD in order to get prescribed stimulants, and that's each person's prerogative and not for SWIM to judge, rest assured that even without any research at all this should be an easy task. This is especially true if the doctor is an ADD specialist as they're specifically looking to find ADD.

SWIM answered the test questions he was asked honestly and was told that he definitely was a "member of the club." In actuality, SWIM is not wholly convinced, though he's proceeding with treatment for the time being. SWIM still thinks that ADD is what happens when someone is asked to do something boring. SWIM has no trouble sitting through a good movie that lasts 2 hours. To be fair, he's told that some ADD people could never sit though a 2 hour movie, not matter how engaging.


ADD Medications

SWIM's doctor started him out on Strattera, which he was excited to try, interested to see if he got any positive effects without having to turn to stimulants. SWIM titrated up in dosage over 2 - 3 visits spanning approximately 2 months and built to a dosage of 100mg/day. SWIM noticed no benefits. SWIM never pushed for stimulants and wonders if doing so would have precluded him being prescribed them later on. SWIM was patient and consistently expressed frustration with lack of results. After titrating to a full dosage of Strattera and sticking with it for a bit without encouraging results, SWIM expressed a willingness to try, however cautiously, one of the stimulant medications.

SWIM's doctor told him that the stimulants fall into 2 basic categories: methylphenidate based medications, e.g. Ritalin, Concerta, Focalin, and amphetamine based medications, e.g. Adderall, Dexedrine and Desoxyn. SWIM had used drugs in both categories recreationally in the past. The drug aficionado in him took over at this point and, knowing that the amphetamine based meds were more powerful, told his doctor that when he'd taken Dexedrine recreationally he found himself reading and studying with a high level of focus. There's some truth in this, but he felt similar effects from all stimulants including cocaine. He framed his experience with Dexedrine as a particularly positive one because that's what he wanted to be prescribed.

Whenever mentioning past stimulant use/abuse, SWIM was quick to point out that he didn't use stimulants to "party" in the traditional sense, but would instead find himself reading, writing and researching, the whole time wishing he possessed the natural focus that made this type of work possible. This is all true, but he did deliberately sculpt that message when delivering it to the doctor.

SWIM's doctor was going to start him on one of the newer drugs such as Vyvanse, a so-called prodrug designed to prevent abuse. This made perfect sense given his history, but he wanted Dexedrine. Luckily, he didn't have insurance and couldn't afford Vyvanse as there's no generic version so that problem took care of itself.

All the stimulant drugs come in instant release (IR) and extended release (XR) versions. SWIM's doctor started him on dextroamphetamine XR (generic Dexedrine) at a dosage of 10mg/day. The next month SWIM went to 30mg/day (2 X 15mg.)

At this point SWIM was seeing some results and wanted a higher dosage. He also wanted the instant release version of the pills. He anticipated some problems with this because of his drug history.

SWIM told his doctor he was feeling SOME results, but was still frustrated. He told her that he found himself taking the 2nd 15mg pill earlier and earlier in the day and running out of gas in the evening, which was true. Next he tried taking both 15mg pills at the same time in the morning and was excited because he finally felt he was "in the zone." Of course then he had nothing left in the afternoon/evening. He told her that next he started taking a 3rd pill in the evenings which helped a little but kept him up at night. SWIM stressed that his most productive hours were between 9pm and 1am, and he needed something that could keep him "in the zone" during that time and still let him get to sleep before 2am. In the end, the doctor suggested a mixture of instant release and extended release pills, which is at least part of what SWIM wanted. For a person wanting their doctor to switch them from XR to IR pills, this may be worth remembering.

One reason SWIM’s doctor had no trouble upping his dosage is that he’s in very good shape, and his blood pressure is very low, 110/70 on average. Dexedrine increases blood pressure, and that’s one of the things his ADD doctor pays attention to when considering larges dosages. Coincidentally, each time SWIM returned to the doctor he was out of his meds and therefore didn’t take them before going in to see her. Because of this, when she checked his blood pressure at the start of each session it remained very low. If he had taken his meds and had elevated blood pressure, it’ possible his doctor would have been more cautious about upping his dosage.

SWIM now takes XR + IR in the morning, 2 XR's in the afternoon and 2 IR's in the evening. That’s what he’s prescribed anyway. On the upside, he finds it easier to focus and concentrate and gets more focus-type work done than he ever could without stimulants of some sort. The downside is that he has trouble sticking to his prescribed dosage schedule and usually ends up taking 5-10 mg more than he should per day. Also, even with the IR pills he has a little trouble getting to sleep and has to fight the urge to just take more and keep working late into the night. A possible solution may end up being to skip the meds on the weekends and continue to take more during the week.

There are 2 other significant downsides to mention. First, SWIM has lost all motivation to workout. He used to be at the gym 4-5 times per week and now is lucky to make it twice. When he's there, he hasn’t yet mustered the drive to lift weights and settles for a 1 mile swim on average, half of his usual distance. He’s eating less though so there’s less of a need for extended cardiovascular exercise. Second, SWIM has smoked cigarettes off and on over the years, especially when drinking or doing any kind of stimulants. He didn’t like it much and never had much trouble stopping when he wanted to. He hadn’t smoked for 6 months prior to going on Dexedrine but soon after found himself at 10 – 20 cigarettes per day. On the days he doesn’t take his meds, he smokes little if any. Along with this his caffeine intake has increased from negligible to 2 – 3 cups of coffee per day. SWIM believes these challenges can be overcome with will power, and if he decides to continue taking Dexedrine long-term the smoking, at least, will have to be addressed.

From a sobriety standpoint, SWIM isn’t one to argue semantics. He’s also not one for recovery groups or meetings so there’s really no one to argue with. But he occasionally wonders if he’s still technically sober. There have been a couple days when he’s gone way over on his medication, but he’s chalking these days up to youthful exuberance and concentrating on staying away from everything else.

So far SWIM has found his ADD treatment a mixed blessing. He’s certainly able to focus and concentrate better, but his physical health has suffered to some degree. In the coming months he’ll watch how things progress and put serious thought into whether the benefits outweigh costs.

- Beltane

Reputation Comments on this post:

	Awesome post :)
	Very informative and detailed post. Thanks for taking the time to write this up.
	very good and informative post, thanks
	Great write up on ADD

[Metomni]

Thanks for the account man! From SWIM's experience, SWIY is spot on with everything.

SWIM went to get diagnosed with ADD even before he was interested in drugs and was also prescribed Stratera to no avail. It really does nothing for SWIM. He has thought about going in and getting his medication switched from Stratera to one of the others, but feels there's no chance now that he's 20 and hasn't done anything with it since he was 15. SWIY's account gives my pet some hope that we might actually be able to get it switched.

[Beltane]

Update on the effects of dextroamphetamine on SWIM's cardiovascular system:

SWIM checked his blood pressure today at the gym. He had not worked out at all and was completely relaxed. It had been 3 hours since his last dose of dextroamphetamine and he was exactly on his prescribed dosage schedule and not 1 mg. over. SWIM also consumed a large coffee one hour before taking readings, which certainly bumped up his bp a bit.

SWIM's normal blood pressure hovers around 110/70 and his resting heartrate is usually about 55.

SWIM actually used the machine twice and got the folling results:

1. 150/72, pulse = 70
2. 130/82, pulse=77

An average of the two readings has SWIM's systolic number in the 'Pre-hypertensive' range and diastolic comfortably in the normal range. Still, this is a significant increase in blood pressure and it's SWIM's guess that the bulk of that is due to the ADD meds.

- Beltane

[Beltane]

SWIM thinks it would be easy for SWIY to get his meds switched. If SWIY is on Strattera, then his doctor believes he has ADD. Go to the doctor and say you've been frustrated for years and finally could take no more. Explain how you went online and read about the real benefits people experience from finding an ADD medication that works for them. Then say that what you get from Strattera is nothing like you were reading about, and SWIY is no longer willing to settle for something that's not addressing his problem. SWIM doesn't see how a doctor could refuse such a request. SWIY has definitely given Strattera a chance and found it useless.

If the doctor won't help SWIY get a referral and find one who can. Shouldn't be difficult at all.

- Beltane

[Donmeka]

SWIM tried Strattera as well and found no positive results and when he found out it is somewhat similar to reuptake inhibitors which SWIM is against he called it quits, now SWIM has had his regiment of 20mg Desoxyn and 6mg Xanax daily before but did not have Desoxyn for a couple months to see how it went and his ADHD hindered his ability to live well and his friends even noticed this so SWIM decided to get back on his ADHD meds again.

2 days ago SWIM picked up his Desoxyn 5mg RX which is 10mg 2x daily and he took only 10mg that day with no benzo and he felt better then he has in months. The next day he picked up his Xanax RX and filled up his weekly container and took 1mg of xanax with his 2nd 10mg of desoxyn and the other 1mg an hour or so later.

SWIM has yet to take his BP test but he will be awake tomorrow at 9:30 and will probably take his 1st 10mg dose of desoxyn with his 2mg xanax at 10am so he has time to eat a good breakfast. he will test his BP/HT before he swallows his medication then again at 11 or 12am.

I want to say thanks to the OP for his tale on his adventures through ADD treatment and Beltane for reminding me to test my BP. In the past SWIMs BP has never been that high, never close to dangerous but SWIM has not taken both of his medications together like he is supposed to until now because SWIM is making a lot of life changes for the better. SWIM will report tomorrow on his test results.

[Beltane]

SWIM has been journaling about his experiences on ADD meds and now comes here to add the highlights to this post.


The Positive

- SWIM has the motivation, desire and focus to do and enjoy things that he always did when high on stimulants, but could rarely, if ever, muster without them. Two examples of this are writing and computer work.
- SWIM loves to write when he has the motivation. In the last 2 weeks he's done major work on a Wiki page and minor work on a Wikipedia page, wrote some in-depth posts like this one, wrote and mailed over 10 snailmail letters, journal every day, re-did his resume, answered tons of emails and wrote almost 40 pages of a book that's been outlined in his head for years.)
- Since getting clean (mostly off IV cocaine but also IM Ketamine and a few other minor things,) SWIM can barely go near his computer. It's a symbol to him of a giant pile of work that's never finished considering email, malware removal, software updates, OS upgrades/configuration and tweaking whatever little problems pop up that day when he sits down. He's been at the computer for a couple hours every day, some productive writing and research and others spent dealing with admin stuff, none of which was intolerable and lots of which he enjoyed.
- SWIM has a decent script and takes enough to feel a sort of high he'd thought was unavailable since cleaning up his act. He can't deny enjoying this.


The Negative

- SWIM is consistently taking 5-10 mg. too much every day.
- SWIM is sleeping terribly, going to bed between 4 and 6am and sleeping badly until noon. Once he gets out of bed and starts taking his meds, he feels a growing aversion to slowing down and going to sleep. Similar to when he did a lot of meth 10 years ago.
- SWIM takes 3 Tylenol PM's every night to sleep.
- SWIM has gone back to smoking, which he doesn't even like. 1 pack a day.
- SWIM's gym attendance is dropping precipitously.
- SWIM eats in the morning before meds and at night when they finally wear off, that's about it. He's added some meal replacement shakes as a precaution.
- SWIM finds himself isolating in a kind of tweaker/alone-and-writing-working kind of way. He's normally supremely confident and seems to lose a huge chunk of this when on his meds.
- SWIM still does OK sexually, but he's a bit off his game due to the mixture of decline in physical health, lack of sleep and med side effects.
- SWIM finds himself often fighting the urge to take more meds in a quest to get higher or something.
- SWIM has a tendency to let his newfound motivation and focus get wasted by slipping into a 2 hour research project to look at every single different external hard drive option for his laptop upgrade instead of just picking one that would work and getting on with his life.


Conclusions

Looking over that list, there's an awful lot of things in the negative column. But SWIM feels like a new man being able to put energy and focus into writing projects and the other things that used to pile up endlessly on his desk and weigh him down like an anchor.

After moving this weekend and going back to work, SWIM will take a comprehensive look at his notes (he documents meds, sleep time, etc.) and attempt to formulate a dosage, eating, working and working out schedule that he could conceivable stick to. Then he'll see if he can do it and re-evaluate.

If SWIM get his life working while taking his meds every day, his next option will be skipping them on Mon - Thr and eating a bunch while tweaking and writing on the weekends.

More to come, so long as SWIM keeps eating Dexedrine that is-

- Beltane

[Donmeka]

since SWIMs last post SWIM did not even sleep last night even with 2 bars of xanax, he probably could have but his friend showed up to spend the night at nearly 3 then gave SWIM an 80mg oxycontin and by the time the adventure was over it was 5am so SWIM said screw it he will stay up. SWIM doesnt know if its just because of the nonsense or him getting used to his desoxyn since it was his 2nd day and his 1st day taking 10mg 2x daily like told by his psych. things like this are natural at first. tonight SWIMM should sleep fin he believes.. he will eat breakfast soon, take his 10mg and 1mg of alprazolam and test his HR. He wll then do it after 1 hour then 2 to see the change. SWIM is nearly borderline hypertension naturally.

To Beltane Your COns worry me, not terribly but they still worry me a bit. you shoud forccccce yourself to eat a meal atleast 3-4 tiimes a day and drink water all day. not non stop but still keep a a bottle with you always. eat a big meal before taking your medicine.

from the looks of it SWIM hinks you shouldnt be taking your med or atleast you should take a break and see how u feel. because from what SWIM has read the negatives highly outweigh the positives and ur really risking your health by not eating properly. plus the fact u take 10mg more than advised is not good and also the fact u feel the urge to take more is also not good.

SWIM would suggest bringing all these points up to your doctor ASAP.

[eltimmy]

Desoxyn will probably have less of the peripheral sides you are suffering, as the adrenergic affinity is much lower and the BBB penetration better. Also, you should really stop the smoking.

Directing the focus instead of engaging in tweaky behavior: lower the dose or get a coach. Do what you need to.

[Beltane]

SWIM would like to at least try Desoxyn, but is curious as to how to bring it up with the doc. SWIM doesn't want to lean too heavily on the negative sides of current meds, lest the doc see fit to switch him to some ritalin variant.

May write more soon, but taking doses at prescribed times and taking weekends off has got SWIM closer to on track. Still some bugs to work out.

- Beltane

[IntrepidTraveler]

Originally Posted by Beltane

SWIM would like to at least try Desoxyn, but is curious as to how to bring it up with the doc. SWIM doesn't want to lean too heavily on the negative sides of current meds, lest the doc see fit to switch him to some ritalin variant.

May write more soon, but taking doses at prescribed times and taking weekends off has got SWIM closer to on track. Still some bugs to work out.

- Beltane

SWIM has been perscribed to adderall for a long time and the pros have certainly outweighed the cons, but he also wants to try desoxyn after all of the good things he has heard about it, especially on D-F. Seems like it has fewer negative side effects with all of adderall's benefits. That said, SWIM also has no idea how he would bring this up with his doctor--how does a 22 year old guy ask his doctor to perscribe him methamphetamine? SWIM thinks his doctor would be very startled by this question, and it seems like most doctors are not too keen on it. In fact, my mom has worked in retail pharmacy for the last 30+ years, and she confirms that it is rare to see anyone bring in a script for it and that, even when they do, many of the pharmacies she has worked at don't even carry it.

[Beltane]

ADD update:

It's been a while since SWIM's been tinkering w/ his ADD meds. He's taken them as prescribed for as long a a month straight, experiencing the pros and cons mentioned thus far. For the last 6 weeks or so, SWIM has started using the meds more episodically rather than every day.

On the days he takes them, he takes them as prescribed but with a lower tolerance usually gets pretty wired. He's using them mostly as needed for specific kinds of work he has trouble with normally, e.g. writing first draft copy of a current book project, extended Internet research and any paperwork-intensive task in general. These days are still a little uncomfortable, but this is outweighed by what he gets accomplished on these days. He's taking them 2-3 days in a row usually about twice per month.

Additionally, SWIM has found 2 activities that help alleviate some of the negative side effects. The first is meditation, which he does daily regardless but goes for longer periods of time when taking meds and fighting agitation.

The second is any strenuous, physical activity. When SWIM goes for a 45 minute job as soon as the meds start getting on top of him, usually 3-4 hours after first dose, he is much calmer the rest of the day and usually sleeps better too.

SWIM still plans to talk to doc about trying desoxyn to see if the side effects are any easier to deal with. His next appointment is in 6 weeks and he'll bring it up then.

- B

[roman6886]

Swim started on 20/20 mg dexadrine IR and wow talk about staying up for 3 days smoking like crazy and if swim even touched caffiene it would add 3+ hours of no sleep, swim lost 20 lbs, very edgy, much less social, and resting heart rate of 120 (swim has normally high heart rate of 80-100, docs said was fine).

Went to 40 mgs regular adderal, during which was given full $1200 legal adhd test for college percs, they found that the adderal was no better than caffiene

Next ritalin ~ nothing
Next concerta ~ nothin
next Straterra ~ good for things like work and driving ( not good to day dream while driving )

had to go back on Dexadrine but XR this time and only 15 mgs
works good but swim has to take according to lunch and dinner

roman6886 added 23 Minutes and 2 Seconds later...

now to Beltane comments, I have several back

- a ripoff general doct test is a joke but the legitimate test that cost more than a grand is filled w/ many diff test all diff kinds and really thorough, swim tutored learning disabled kids for years and many have been rejected, confirming swims belief

- Never say you take more than the recommended dosage, especially w/ a history (swim has been dropped by practitioners) if you feel like it stops working after a certain time and you could probably benefit from re-dosing but you wanted to check with the doctor first ~ this would be ok

- swim doesnt know how tolerant SWYouK is or his/her weight or what the specific dose is but "takes XR + IR in the morning, 2 XR's in the afternoon and 2 IR's in the evening." this seems pretty extreme and dangerous

- it sounds like the stims have become a pretty big crutch, given swim is not a psycologist. and the fact that SWYK had a prob w/ coke and stim abuse is very troubling, it seems like SWYK is nudging closer and closer to an older problem so the transition back into that life is easier

- Swim has worried alot about his/her heart getting worn out, it may be healthy and ok by docs standards but if the avg persons heart beats XXX beats in their life that means that SWIM or SWYK will reach that point that much faster,,,,SWYKs may not be as bad as SWIMs but 20 beat difference is still significant

Dont take anything 've said personally, its easier to see flaws from the outside

Reputation Comments on this post:

good and informative post, thanks