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Dr. Harriet
Dr. Harriet, Doctor
Category: Mental Health
Satisfied Customers: 117
Experience:  Board Certified Family Practitioner with 25 years of psychiatry medication management experience
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I had asked you a question yesterday about adderall and ritalin

Customer Question

I had asked you a question yesterday about adderall and ritalin being taken at the same time. I was just wondering if you could elaborate on the interaction between the two. I think my doctor is a moron and he doesn't really answer my questions. Would they cancel each other out? Which do I take first and why? Anything you can give me for more information I would appreciate it. I am a 26 yr old single mom, full time student, and I work. There are no resources for women with ADD in my area and I am kinda alone here in trying to figure it out. Also I have looked into dexedrine, anything you know about that? I can pay you for these answers, send me an email and let me know how much for some advice I am desperately in need of.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Harriet replied 5 years ago.

Hi again,

I don't think they would cancel each other out, you just wouldn't know which one or what dose of either one was helping or not. If you feel comfortable with the diagnosis and if you feel comfortable taking one of these meds, it probably doesn't matter which one you pick; they have similar side effects and are both effective. But I would choose one only and not take the combination, at least to start. Dexedrine is also another form of stimulant. It is also effective for some people. It is not better or worse than the other meds. It has about the same rate of effectiveness and the same kind of side effects as the others. It generally is reserved for a third-line option behind the others, like ritalin and adderall, as it is quite addictive and not readily available any more...

 

Basically, the standard is to start with one medication only, and adjust the dose until you've gotten a good effect or decided it just isn't working. If it doesn't work for you, then you abandon that medication and try another. If that doesn't work after dose adjustments, then you abandon that drug and try another. There really is no evidence that supports using more than one drug simultaneously.

 

If you don't feel confidence in your doctor, though, you might want to hold off on all medications and get another opinion on the diagnosis and treatment. Many adults find that therapy, especially cognitive/behavioral therapy is helpful for treatment of ADD in adults without the use of medications. If you find a therapist with experience with adult ADD that might be a good thing, especially if you have not tried this form of treatment in the past or have concerns about the diagnosis.

 

And finally, there is a newer medication called Strattera which works really well for adult ADD without any of the addiction issues that ritalin, adderall, dexedrine, and all the other ADD medications have. It is started at a low dose, is taken once or twice a day, and can be safely increased until the effect holds you all day. Its main side effect is nausea, which happens in maybe 20% of people who try it, so it isn't a miracle by any means, but it is nice to have a very different option. Also, some people respond well to an antidepressant called Wellbutrin, which is actually the first line treatment for adults with ADD. It does not have the potential for addiction that the stimulants do, as it is an antidepressant and not a stimulant. ...

 

Sometimes patients feel more comfortable talking with a psychiatrist about these kinds of medications rather than a primary care physician, as they have much more expertise in using these medications... I've seen adults who have anxiety or other issues that cause them to have difficulty with concentration be given high doses of stimulants like ritalin and become dependent on them and have a terrible time ever stopping them. At your age, the side effects like high blood pressure aren't that much of a worry, but over time they become a big concern. We really don't like to give these stimulant drugs to adults for the rest of their lives. Some people with clear ADD limit them only to working hours, if work requires a lot of sustained concentration, then have them not take the medications on weekends so that they don't get tolerant to them... Other people take them if they are in college and need to be attentive for classess and homework, but are able to stop them once the college courses are over. Hopefully, you and your doctor can develop a strategy for what to take, when to take it, and how long to take it for, so that you aren't saddled with being dependent on these drugs forever...

 

Hope this is helpful. Sorry for making you wait. Didn't get on the computer today until now...

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