Hello.  My name is Chuck and I am new to this board.  I am a 23 year old male who has a very long story about my past a present situation.  I am seeking help/information on what I should potentially use to help my doctor.  Here is my story up to this point.

Last year, after many trials and tribulations, tests and therapy, my doctor finally diagnosed me with having what he calls a "Dopamine Deficiency" coupled with adult ADHD.  In the past this was mistaken by him and others as depression, generalized anxiety, and social anxiety.  They had me on a wheel of meds then ranging from paxil to effexor XR all of which did nothing but leave me as an emotional shell.

About a year ago or more I was placed on Wellbutrin XR 150mg twice a day.  After a month of this, any issues I had with communicating and keeping thoughts linear were solved as my "dopamine deficiency" was cured somewhat.  However, the medication had the wonderful side effect of bringing forward and focusing my ADHD.  Taking me off of the wellbutrin did not do anything but put me back into a state of stuttering and unable to think straight at all.

Enter concerta into the picture.  After a month on the wellbutrin I was placed on Concerta 36mg once a day.  For two months I was on this and wow the change was increadible.  I could focus, came out of my shell, and felt what I think most people dub as "normal."  All through this I am also in therapy for non-medicated ways to deal with the ADHD.

After two months I returned to my doctor to mention that now that I knew the way things could be, I noted that things were not exactly the way I wanted.  My hyperactivity, inability to sit through a class let alone a shift at work, and even to stay focused at home was more than just a 8-12 hour problem.  It was a whole day, whole life problem.  My doctor opted to put me on 54mg of concerta once a day having the theory being that the higher dosage would last longer throughout the day.  And for the most part it did.  However, I work full time and go to school full time or at least I do now that I can focus somewhat.  And I work at night exclusively.  While the focus and the ability to function during the day was extroadinary, the ability to focus and function properly at work was diminished as soon as the conerta would wear off.

But I dealt.  After about 6 months of concerta, and furthered entrance into a social world that had years ago left my hyperactive self behind, I was becoming unhappy with the way the coctail of the wellbutrin and the concerta was working.  I once again retunred to my medical doctor on the advice of my therapist as the therapy was not furthering my ability to focus.  This time I asked, on the suggestion of the therapist, to try regular ritalin since I could dose it myself based on when I would need it.

One thing i found over time was that my ability to be goofy and silly and bouncy was obviously diminished by the concerta due to the nature of the medicine.  It was designed to take those things away so I could focus.  I like being that way when it doesn't affect some function of my normal life.  I wanted to have the ability to dose the medicine when I needed it and opt not to take it when I didn't need it.  My doctor agreed and switched me to 20mg of straight up ritalin prescribed for 3 times a day.

Wow.  The ritalin was what I had been looking for all along.  Though the concerta essentially is ritalin, just time released, the immediate release ritalin in 20mg pills was notable because it took my focus and concentration to a level that I actually liked.  Much stronger and effective than the concerta.  However, no nicety comes without a price.  The down side to the ritalin, as well as to my being able to dose it at will or forget to dose it at will as the case sometimes was, was that while the UP part of the medication was great and allowed me to function properly, the down portion was horrible.  I became very moody and as my fiance puts it, b**chy (sorry for the language, that's just what she says).

So for 6 more months I use this ritalin suffering through the daily mood swings.  I found that it would work well for about 1-2 hours and then taper off so fast I didn't know what to do.  You can only safely take it every 4 hours, and since I only had 3 for my 16 hour functioning day, I would try to space it out about every 5 or 6.  Those nights I had to study with others or in groups didn't go too well b/c I was always up and about and not able to sit still and in general very annoying to those trying to study with me in a group.  My grades dropped, and my performance at worked failed again.

So that pretty much brings me to now.  I have done research and talked with therapists and others and have found that medication is something that I have to accept as part of my reality due to the severity to which this condition aflicts me.  However, the type of medication is up for debate.  The wellbutrin 150mg tid has remained a constant throughout my treatement and is deemed necessary by all parties to keep the dopamine levels up in my brain.  But the ADHD medicine is something up for debate.

As of Friday, my doctor has put on something called Metadate CD 20mg once a day.  It works much like the concerta.  It does however, take me up to the same concentration level as the ritalin did initially.  And the dropoff when it wears off is not near as harsh as the standard ritalin.  It is much nicer than the concerta and much much nicer than the standard ritalin.  However, it still does not go the distance and does not last near as long as the concerta and does not have the capability to be dosed twice a day like the ritalin.

So my question is, are there any other options?  I have heard from many in my situation that adderall is a nice alternative to the ritalin and that it lasts about 5 hours and can be dosed three times a day without near as bad of mood swings and down feelings as with the standard ritalin.  I have also heard that dexedrine is similiar in function.

I know that adderall and dexedrine are a slightly different chemical than ritalin, concerta, and metadate (dextro/levo amphetamine vs methylphenedate respectively).  I have also heard about Straterra but as of now that is not supported by my insurance.  Are there any options out there on either side of the medication divide, ritalin/adderall, that comes in any form or in any brand name, that any adult out there with a similar long day work schedule might be able to recommend?

I've found that as I originally anticipated, this is a whole day, whole life problem.  The idea of only dosing myself when I need it is not very feasible seeing as how I don't go out and party any more at this stage in my life and my goofyness/funnness is inherent in my personality now and is not only attributed to my adhd.  I'll always be a bouncy, spunky young man, but I need something to take me down to a level of functionality with the rest of the world.

Any suggestions or observations about other medications other than those listed here that I can take into my doctor?  I would love any help anyone can offer.

Thanks,

Chuck

The sad fact is is that I did cut back on my hours before I was diagnosed and it really didn't do me much good except for making me not graduated yet while most of my peers are.

I am a chemistry major which most people think is nutty.  My full time job that I use to support myself and my future wife (only 11 days remaining!) is as a movie theatre manager.  I've been doing it for 5 years.  I MOSTLY (and I stress mostly) work in the projection booth which gives me ample time to stay mobile and/or to sit and do homework and whatnot. 

Work is a necessary evil unfortunately and I've found that this schedule works well for me.  I must admit that now that school is out that I am significantly less stressed, but what I have discovered is that with the lack of stress, deadlines, and responsibilities resulting from school, my distractability has increased and my productivity at work is decreasing.  It's like before I had so many things to do with school and work that it at least gave me multiple options of what to work on.  Being hyperactive sometimes does have the added ability to focus on multiple goals at once.  Motivation...well that's something different.  My motivation IS negatively affected by the school work which in turn gives me poor grades.

It's rather a viscious cycle.  If I don't do school or only do a small portion of school, I never get anything done b/c I'm too busy occupying myself with thoughts and actions of no importance to work or my home life.  When I'm in school, the stress resulting from it makes me focus more on work and home life and everything else because there is less ability for distraction b/c I know I don't have time for other things.

Like right now I should be working, but I'm typing this.  If I was in school I would never have even thought of getting near this computer but would instead be staring at a book (staring, not reading mind you) at the desk in the projection booth.

Anyway, long story short, the medicine does help...signficantly.  No matter what dosage.  It helps.  But it's when it wears off or it's lack of going the distance of my day that sucks.

The more I research, the more I want my doctor to at least let me try adderall (not XR, just regular) for 30 days in a dosage equivalent to my 20mg of ritalin.  That, with the wellbutrin, while still riddled with side effects I'm sure, seems as if it is the least of the evils available.  Some random mood swings I can deal with, constant mind shattering depressing ones every day from the ritalin and especially this metadate I can not.

Thanks for listening,

Chuck

Nightshade,  Why can't you take the Wellbutrin and Concerta or Metadate and then have the regular Ritalin or Adderall as an alternative when the other med where's off.  That way you can take it only when you need it in addition to your other meds.  This is exactly what my sons physician suggested for him when his Adderall XR didn't last long enough.   Or for days like Saturday/Sunday when he got up much later than on a regular school day and we didn't want the Adderall XR to keep him up at night. 

Hi Chuck,

I know the full-time job and going to school routine well. I think most ADDers can handle the mental activity required if we are studying something we like, under one condition. It is really important to get enough sleep on a regular basis. I have read that sleep deprivation hits the same frontal lobe that is affected by ADD. I also know from experience that lack of regular sleep makes my ADD symptoms much worse.

Hang in there buddy!

I try to always get enough sleep, when I was younger I had some terrifying experiecnes with sleep deprivation, I am not sure if I can explain it well enough.

Would start out having troubled dreams, that usually pulled me right out of my sleep, just to realize that I was paralized, could not move at all. The mind woke up, my the body did not! Really scary feeling, I even went to the doctor to get a ekg, but the tests never produced anything... I have only meat 2 people at most that could atest to having the same exact thing happen.

There is more to it then just this, I could hear and feel things moving around me, like if my cat walked over me, I would usually fight to move (would have the feeling that I even fell off of the bed, but when ever I pulled out of this, would find I was still right where I started), when others where around I would start to hyperventilate (and few knew me enough to help by jerking me awake). and it usually upset me enough, I would forget about sleeping for quite awhile after that.

Since I have made sure to get sleep more regularly - this has not been a problem in quite a while, but I know it can still happen, last incedent was maybe a year back, and prior to that was maybe 5 years or more. Use to be a frequent problem when I was a teenager.

I'm supposed to be on medication but I'm not. All the ADHD medicines have an effect on the heart. Many people like Adderall but I think there should be something safer on the market and Strattera isn't it.

Wile E

I don't want to shake anyone up, so don't feel bad for me it is in the past and I can say with great relieve over to me now.

I had had at least 3 people between the age of 6 and 8 that on multiple occassions sexually abused me (combined with emotional and physical abuse), and for a few years following that put me in the greatest fear for my life and resulted in a lot of nights of lost sleep.

Nights that I would stay up, and just be locked over and over reviewing my life trying not to forget anything of what happened, I was so hyperfocused at that time, that I know I was hallucinating on a few occassions. I think this set the stage for the problems I had with sleep depervation years later (that did not actually happen at that time).

Yes, matter of fact it would start as a bad dream, or maybe earlier before I even fell asleep that I was scared. I would start to come up from the dream in utter darkness and feeling like I was falling down and that I had to wake up otherwise I had the intense feeling that I would die, then once my mind would awake I would still feel intense fear, because it would transfer to actually feel like someone was in the room, or if not someone more of a presence.

Now, I can say I had one incident where in my mind during a dream I killed my attacker and since then I have felt released, and might be due to the ADD the details of my actual encounters years ago is but a foggy memory. I know it happened, I just don't remember specifics (know feelings associated) I am completely detatched from any of that).

Now it is just a rare thing if I encounter this other lagging problem, it is like just a backlash (echo) of the past. Least the way I think of it.

I usually don't remember my dreams since they are always so dark in color, no bright colors... if I think of a color before going to sleep I might remember to see it. But my dreams are not worth seeing or remembering since they are usually graphic about death and such, usually totally detached from them like I am just an observer.

I can set my own internal sleep alarm though, that is neat, if I go to bed at 11 and want to wake up at 7 then I count how many hours that is, and also count off 11 to 7 and do this 3 or 4 times. Guarenteed I can wake up by 6:30 that way. Always thought that was interesting.

Yes, I do pace in my office usually when I am on the phone trying to focus on a particular problem for consumers when they call in... like if I walk around in a circle I can force my thoughts to circle around to see what I need to draw from to help them. Sometimes after I catch what I needed I actually will just lay down on my back on the floor and try to repeat everything I can from memory. Not often that I do that, but maybe a time of two per week.

hey nightstar:

i believe what you and wile e are both discussing is called 'sleep paralysis'

i have had that happen to me and it is terrifying...you should if anyone is having problems with it look it up.

i am not discounting your sexual abuse as a cause..just trying to let you know what you were experiencing probably was...

sumi

http://www.stanford.edu/~dement/paralysis.html

hey guys..here's a brief explanation from stanford on the sleep paralysis.

sumi

Oh thank you so so very much, all these years and no one could tell me what was wrong. Just makes me all the more pissed at my doctor for having no followed through to at least tell me what was wrong!

So what I have is called: hypnopompic or postdormtal form; complete skeletal muscle paralysis & hypnogogic hallucinations are present, people feel that someone is in the room with them. (That is always how I feld that someone was in the room with me).

Episode is often terminated by a sound or a touch on the body (I could only be jarred awake) I could hear sound but that did't help me wake up.

A study found that 35% of subjects with isolated sleep paralysis also reported a history of wake panic attacks unrelated to the experience of paralysis (that is interesting that one does not have anything to do with what follows).

So in my case I was doing the only thing other then medication to staff of my problem and that was insuring to get enough sleep.

I tell you it is a scary experience and I am just happy that it has not been so common for me since my younger years when I was a teenager (but it is one thing looking back as an adult - but to not know as a child what was going on)!

Mine last minutes at a time, I would say 2 or 3 minutes at a time, least it feels like forever to me, but that might also be counting the time that I am coming up from sleep into being awake -

I agree with you, easier said then done not to panic (especially when you have the overwhelming feeling that someone is in the room with you) - kind of makes you desperate no matter what.

I remember one time back when I was 13, was in a new home, and the lady who I was staying with was down stairs and I had one of these attacks (might have been the firsts as far as I can remember) but it scared me so bad - I absolutely did not want to get off the bed. I screamed and cried for what seemed like forever hoping that she would hear me - but unfortunately she did not. My fear for staying in the room, finally got the better of me and I ended up running to the door and down the stairs. I spend the rest of the night down stairs in the living room on the couch. That was the worse one that I remember the most, cause I actually believed I was going to die.

You would think something that can scare you that bad would be harmful in some way, least I am glad to finally know the answer to this problem.

I have only met two other people with this problem, they did not know either why or what it was. One lady, her cat always come up by her and comforted her during these periods - said the cat would actually paw her face until she came out of it. I still know the one lady and will be sharing this information with her as well.

I had never suspected myself prone to panic attacks, I do avoid watching scary movies or any movies that will make me jump, cause I do actually get chest pains when startled, so I figure I am likely a good canidate for a stroke or heartattack.

Maybe you ought to print that information out for your friend and show her so she can see the information for herself and consider if this is what is happing to her.

Myself I love the feeling of just laying down at the end of the day and stretching out just relaxing. I am a tense person all the time, massages don't affect me.

I have a fastination with mystical stuff, but don't see myself as so. I like studying concepts like handwriting analysis, tarot cards, astrology, even took up reading a bit on white magic once. I find a fastination with information about indian tribe rituals. Things like that really grab my attention. Oh forgot to mention on thing, my favorite color is black and I have personally had people ask me if I was a witch! lol I don't wear any other colors if I can help it. You can just imagine my interview abilities looking like I do in black. I like what they call broomstick skirts - had never thought about the connection until you said that.

Also have fastination with fantasy movies and games, use to play Dungens and Dragons all the time, even like video role playing games alot, I have to stay away from the games, otherwise next thing I know 8 hours or more passed and I didn't do a damn thing the whole day.

I forgot about the screaming, I have tried that before, and came up to the same results that no one can hear you - BUT I do know you can control you breathing - least I could - SO if you ever find yourself in that situation again and you know someone is near by to help you, start hyperventulating - that will most times get their attention if they are close by.

I use to have it stuck in my mind that I could FORCE my body to move, I had focused so strongly that I actually thought I had fell on the floor, but once I came out of it realized nope - didn't budge one bit!

Wile E

Hey just wanted to link this site for you to check out, I went ahead and took the survey they had here on Sleep Paralysis, real interesting.

http://watarts.uwaterloo.ca/~acheyne/S_P.html