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General Medication Discussion This section is to be used for general medication discussion and other medications not broken out in their own respective forums.

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Old 01-31-12, 06:33 PM
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Arrow "Long term, antidepressants are just as effective as stims for ADHD"...really?

When I got diagnosed with ADHD combined type, my psychiatrist asked me which type of treatment I would like, stimulant (adderall) or antidepressant. Adderall would work immediately, but he said in his experience, antidepressants work just as well if you give them time, and it is a matter of trial and error, and patience.

I had tried effexor before for a couple of years. It was prescribed for "sluggishness" and low motivation and depression. At first it was ok, but then it stopped working after about a year, I started having panic attacks for no reason, and then the withdrawal was one of the worst things I've ever experienced. So I was all for trying something else. It improved motivation & "sluggishness", but also improved mood, attention, memory, learning, and concentration, I was more organized, overall I think it was much better.

So is there any truth to what he mentioned? Does aderall lose alot of its strength over time? I was only able to stay on it for a few months due to insurance issues. Or was I just on the wrong antidepressant (effexor)? I've taken SSRIs and I know they don't work for me or most people. Was he just giving me treatment options and over generalizing? I thought he was a great doc, I just have wondered about this statement for a long time, and am considering going back on some kind of medication.

BTW, I think he may have had some minor selfish motivation, his office was really busy and he specifically mentioned the scheduled II nature of adderall as a "con", meaning I would have to come monthly to his office. But I agree this is a hassle.
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Old 01-31-12, 06:44 PM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

"Long term, antidepressants are just as effective as stims for ADHD"

I don't think that this is true, at least for a significant proportion of those who have ADHD (please correct me if I'm wrong) in terms of being validated with peer-reviewed research. I do know that there are some antidepressants indicated for ADHD and that work for some people, without being used in conjunction with a stimulant. Straterra (atomoxetine) is the most commonly used antidepressant for ADHD. I've read/heard of Wellbutrin (bupropion), Effexor (venlafaxine) and some tricyclics and MAOIs (rarely) used but I cannot say anything in regards to how effective they are. I don't think I've heard of an SSRI used ONLY for ADHD, but they are often used to treat co-morbid depression or anxiety.

There is a lot of (mis)information out there about medications for psychiatric or neurological conditions, and a lot of this is put out by a group that may have some kind of motive, whether it is a pharmaceutical company, people who oppose stimulant therapy, government, whatever. In general, I think that antidepressants, especially the newer ones, are more expensive and profitable for the pharmaceutical companies, compared to generic formulations of psychostimulants.
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Old 01-31-12, 06:54 PM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

Here you have Effexor (venlaxafine), vs. Adderall XR:


Quote:
Abstract

BACKGROUND:

Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders beginning in childhood that may continue to adulthood. The purpose of this study was to evaluate the possible therapeutic effect of venlafaxine in adults with ADHD.
METHODS:

In a double-blind setting, drug-nave adults with a diagnosis of ADHD based on DSM-IV-TR criteria were randomly selected to receive either venlafaxine (up to 225 mg/day) or a placebo for 6 weeks. The Conners Adult ADHD Rating Scale self-report screening version was administered before and during the treatment at 2-week intervals to measure the therapeutic effects.
RESULTS:

The mean age (SD) of patients was 30.5 (8.1) years. Eleven out of 20 patients receiving venlafaxine and 13 out of 21 patients receiving the placebo were male. The two groups were not significantly different in terms of age, educational level, weight, or blood pressure. Significant decrease was observed in both subscales (inattentive, hyperactive/impulsive), total ADHD symptoms score, and ADHD index in both the venlafaxine and the placebo groups. Seventy-five percent of treatment group versus 20% of placebo group met treatment response criteria when defined as a 25% drop in total ADHD score (p = 0.001). No serious adverse effects were reported during the trial.
CONCLUSIONS:

In this double-blind trial, the symptoms of adult ADHD decreased after a 6-week trial of either venlafaxine or a placebo with no significant difference. However, a significant treatment response defined as a 25% drop in ADHD index (measured by a self-report scale) was achieved by venlafaxine. The interpretation of these results is limited by the short duration of follow-up in this study. Copyright 2012 John Wiley & Sons, Ltd.
Copyright 2012 John Wiley & Sons, Ltd.

Quote:
Clin Ther. 2006 Feb;28(2):266-79.
Efficacy and safety of mixed amphetamine salts extended release (Adderall XR) in the management of attention-deficit/hyperactivity disorder in adolescent patients: a 4-week, randomized, double-blind, placebo-controlled, parallel-group study.

Spencer TJ, Wilens TE, Biederman J, Weisler RH, Read SC, Pratt R.
Source

Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114, USA. tspencer@partners.org

Abstract

BACKGROUND:

The ability to recognize and diagnose attention-deficit/hyperactivity disorder (ADHD) has increased in recent years. The persistence of ADHD symptoms puts adolescents with ADHD at risk for long-term adverse psychosocial outcomes.
OBJECTIVE:

The primary goal of this study was to assess the efficacy and safety of mixed amphetamine salts extended release (MAS XR) in the management of adolescents with ADHD.
METHODS:

This was a 4-week, randomized, multicenter, double-blind, placebo-controlled, parallel-group, forced-dose-titration study. Adolescents aged 13 to 17 years with ADHD were randomized to 1 of 4 active treatments (MAS XR 10, 20, 30 or 40 mg/d) or to placebo. All doses were given in the morning. This study used a forced-dose-titration design in which patients randomized to the 10-mg/d group received 1 dose of 10 mg/d for 4 weeks. Patients randomized to the 20-mg/d group received 1 dose of 10 mg/d for the first week and 1 dose of 20 mg/d for the remaining weeks; patients randomized to the 30-mg/d group received 1 dose of 10 mg/d for the first week, 1 dose of 20 mg/d for the second week, and 1 dose of 30 mg/d for the remaining 2 weeks; and patients randomized to the 40-mg/d group received 1 dose of 10 mg/d for the first week, 1 dose of 20 mg/d for the second week, 1 dose of 30 mg/d for the third week, and 1 dose of 40 mg/d for the fourth week. The primary efficacy measure was change from baseline to end point in the ADHD Rating Scale-IV (ADHD-RS-IV) score. The secondary efficacy measure was the score on the Clinical Global Impressions-Improvement (CGI-I) scale for ADHD. ADHD-RS-IV total scores were analyzed post hoc in patients with low baseline ADHD-RS-IV severity (ie, patients with baseline ADHD-RS-IV total scores less than the median) and high baseline ADHD-RS-IV severity (ie, patients with baseline ADHD-RS-IV total scores greater than the median). Safety was assessed by recording adverse events, vital signs, and body weight at all study visits and 30 days after drug discontinuation.
RESULTS:

Of the 287 randomized adolescents, 258 completed the study. The intent-to-treat (ITT) population included 278 patients. The majority of patients were male (65.5%) and white (73.7%) The mean weight (57.8 kg [127.1 lb]) at baseline and the mean height (163.8 cm [64.5 in]) at screening were comparable across all MAS XR treatment groups. Patients in the placebo group had a mean weight of 59.8 kg (131.6 lb) and a mean height of 166.1 cm (65.4 in). Most (56.5%) of the patients had ADHD combined inattentive/hyperactive-impulsive subtype. Two hundred nineteen (78.8%) patients were treatment naive, and 59 (21.2%) had received treatment for ADHD within 30 days before screening. ITT analysis of the ADHD-RS-IV revealed statistically significant (P < 0.001) improvement in mean ADHD-RS-IV total scores in all 4 MAS XR treatment groups, compared with placebo, at all weeks throughout the 4-week study; the mean change from baseline to end point was -17.8 in the MAS XR 10- to 40-mg/d groups and -9.4 in the placebo group. Significant treatment effects were observed in both the ADHD-RS-IV inattentive (P < 0.001) and hyperactive-impulsive (P < 0.001) subscales from baseline. In patients with low baseline ADHD-RS-IV severity, statistically significantly (P < or = 0.01) greater improvements were observed in the MAS XR 20-, 30-, and 40-mg/d groups than in the placebo group; in patients with high baseline ADHD-RS-IV severity, statistically significantly (P < or = 0.02) greater improvements were observed in all active treatment groups compared with placebo. On the CGI-I scale at end point, a higher percentage of adolescents in all MAS XR treatment groups were considered improved (MAS XR 10 mg/d, 51.9% [P < 0.01]; 20 mg/d, 66.0% [P < 0.001]; 30 mg/d, 70.7% [P < 0.001]; 40 mg/d, 63.9% [P < 0.001]) compared with adolescents receiving placebo (26.9%). The most common adverse events in patients receiving MAS XR versus placebo were anorexia/decreased appetite (35.6% vs 1.9%), headache (16.3% vs 22.2%), insomnia (12.0% vs 3.7%), abdominal pain (10.7% vs 1.9%), and weight loss (9.4% vs 0%). Most adverse events were mild or moderate in intensity (97.5%); no serious adverse events were reported.
CONCLUSIONS:

The adolescents with ADHD treated with 10- to 40-mg/d MAS XR up to 4 weeks had significant improvements in ADHD symptoms compared with those who received placebo. Results of this study suggest that once-daily dosing with MAS XR up to 40 mg was effective and well tolerated for the management of ADHD in these adolescents.
By large, Adderall and in general stimulants, are first-line treatment for ADHD because their effectiveness is so damn straight-up appealing. There is some limited efficacy to SNRIs, TCAs, NRIs, and such as well, but not nowhere near the same efficacy seen by stimulants.
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Old 01-31-12, 07:03 PM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

epic fail by me--was going to attach a poll but I was too slow
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Old 01-31-12, 07:22 PM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

Wow, that effexor study was designed to succeed no matter what. A 25% improvement, I mean that's significant statistically, but compared to my personal experience with adderall (80% improvement), very different, and overall a really low hurdle. I wonder who sponsored that study. I can drink some coffee and notice at least a 10% improvement in my symptoms. And 6 weeks, that's not very long. Thanks kassem. Maybe my psych was just listening too much to drug reps and reading studies like these, and somewhat misinformed.
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Old 01-31-12, 08:15 PM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

I've been on antidepressants (various ones) for over 10 years and have yet to notice them help my ADHD symptoms in any way!
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Old 01-31-12, 08:33 PM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

I have tried lots of different meds for anxiety and depression.
Ironicly I forgot the name for most of them,
but one of them was effective;
Effexor. (against axiaty,but it made me a bit more agressive,and if I forgot to take them it felt truely horrible with like electrisity/"zzz"-feeling in the brain for like,ages,maybe its called paresthesia,Im not sure (!) )
Other meds that has helped me is Ritalin.
No other meds has helped me with ADD other then that.
I also think it helps to keep a potentional depression/feeling of hopelessness in check.
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Old 02-01-12, 01:47 AM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

Quote:
Originally Posted by oneup View Post
BTW, I think he may have had some minor selfish motivation, his office was really busy and he specifically mentioned the scheduled II nature of adderall as a "con", meaning I would have to come monthly to his office. But I agree this is a hassle.
It could be. However, your having to come to his office once a month shouldn't be a big deal. He doesn't have to see you every time. All he has to do is write/print off the prescription and leave it at the reception desk for you to pick up. I have been doing this for years. I consider the minor hassle to be well worth it for effective treatment, and I'm sure you would too. He does sound like he was being lazy. LOL
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Old 02-01-12, 09:43 AM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

No, it's not true.

A poor attention span can certainly lead to depression, but I don't think depression itself leads to a poor attention span.

Anti-depressants will certainly make you feel better about your life, but it won't actually improve it in anyway.
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Old 02-01-12, 10:00 AM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

Quote:
Originally Posted by Fraser_0762 View Post
No, it's not true.

A poor attention span can certainly lead to depression, but I don't think depression itself leads to a poor attention span.

Anti-depressants will certainly make you feel better about your life, but it won't actually improve it in anyway.
Yeah, depression can cause difficulty concentrating, remembering details,
and making decisions. But it usually causes a whole host of other
symptoms that don't look quite so much like ADHD.
from: http://www.webmd.com/depression/guid...ing-depression
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Old 02-01-12, 12:12 PM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

Celexa helped me remain calm, but I'm confused about how to use it and it's effects. I get calm and in the morning when I take stimulants I seem to be okay, but then I crash and I'm pretty fatigued and this seems to happen with alot of the antidepressants I've noticed. I think I may stop them all. I think you can get too used to them and I've noticed zero help while using them in regards to my adhd. I'm at my wits end with them . I keep saying there is a problem and I'll be doing pretty okay . I take an antidepressant and just feel worse. Yes there are a few days that you feel calm and good but it's not consistent whatsoever personally and my attention and memory worsen. If I had to pick one thats mild and has worked best I guess I'm like everybody else because celexa and lexapro seem to work the best as far as feelings of being calmer and relaxed. Problem is being too relaxed and there really is no fine tuning , adding or putting in wellbutrin doesn't dramatically alter this effect. I'm learning it seems the more meds , the worse the outcome.
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Old 02-04-12, 04:44 PM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

Quote:
Originally Posted by hollywood View Post
Celexa helped me remain calm, but I'm confused about how to use it and it's effects. I get calm and in the morning when I take stimulants I seem to be okay, but then I crash and I'm pretty fatigued and this seems to happen with alot of the antidepressants I've noticed. I think I may stop them all. I think you can get too used to them and I've noticed zero help while using them in regards to my adhd. I'm at my wits end with them . I keep saying there is a problem and I'll be doing pretty okay . I take an antidepressant and just feel worse. Yes there are a few days that you feel calm and good but it's not consistent whatsoever personally and my attention and memory worsen. If I had to pick one thats mild and has worked best I guess I'm like everybody else because celexa and lexapro seem to work the best as far as feelings of being calmer and relaxed. Problem is being too relaxed and there really is no fine tuning , adding or putting in wellbutrin doesn't dramatically alter this effect. I'm learning it seems the more meds , the worse the outcome.
Hollywood, this was pretty much my experience with antidepressants in general. I've tried effexor and SSRIs, and they would work well for some stuff initially (effexor-motivation and depression, SSRIs-low mood/ anxiety/ stress / anger related issues), but then the effect would plateau and slowly decline, to the point where the benefit is inconsistent, side effects are still there, and then stopping them be faced with discontinuation syndromes. Maybe they work better or cleaner for some people, but to me it seemed like my doctors weren't aware of this, or choose to ignore it, or not tell me. After 2 years of effexor, I was having withdrawal symptoms every night (brain zaps, panic attacks, headaches, insomnia, agitation), but the pdoc kept trying to convince me to stay on it. I decided to stop it on my own, and after tapering down and going through the withdrawals, I started feeling better.

So when the different pdoc mentioned that, that "Long term, antidepressants are just as effective as stims for ADHD", I felt like he had to be messing with me. But I started to wonder if I would have a similar response to stimulants, that after a while they would stop working, and my brain would get desensitized to them.
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Old 02-23-12, 06:56 PM
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Re: "Long term, antidepressants are just as effective as stims for ADHD"...really?

"Long term, antidepressants are just as effective as stims for ADHD"...really?

I keep thinking about this, maybe my doctor meant ritalin/ concerta, that since these are DRI's, they fall under the umbrella of antidepressants? Was thinking about this because am getting a referral to psydoc again, and maybe trying concerta.
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