Top Ten Questions about ADD meds
Wednesday, June 1, 2011 3 Comments
— Updated legacy post -orig. 09/12/99- from Madelyn Griffith-Haynie, CTP, CMC, A.C.T., MCC, SCAC —
Considering ADD Medication?
First Things First: Doctors are only human — OVERWORKED humans. They also have a lot of patient information to keep track of. On top of that, it may take a change or three to titrate meds for each patient (find the right medication, the right dosage, the right timing, etc.).
So it’s always wise to double-check your prescription EVERY time. Make sure the medication, dosage and timing are the same as last time, and point out anything that’s different before you leave the office.
When you pick up your medication at your pharmacy, check it again.
So that means you’re gonna’ write down the information the FIRST time, right?
THEN you’re gonna’ transfer it to something you will keep in your wallet – or to your PDA or cellphone – something you always have with you, right?
(while you’re waiting for your very first prescription to be filled is an excellent time to do this, by the way!)
NOW, on to those Ten Things . . .
1. What TYPE of medication is it?
In addition to the NAME of the medication (and it’s generic, if you will be taking a Brand), you want to know the meds class — what TYPE of medication is it? Stimulant? Antidepressant? Anti-anxiety medication? Beta Blocker? Mood Stabilizer? (For antidepressants you need more info still: SSRI, Tricyclic, MAO Inhibitor, other?)
2. What is the medication designed to do?
WHAT area of functioning is the medication supposed to be helping me with? If the answer is broadly generic, like “help you focus,” or “pay attention,” respond with simple questions like the ones below:
Can you say more about that?
How will that show up in my functioning?
What might that look like to someone who knows me well now?
What kind of tasks might I be able to do that I struggle to accomplish currently?
3. WHY this particular medication for me?
Why this type of medication, and why this particular one.
4. WHY this medication AT THIS TIME.
The most current thinking is that stimulants are the first-line medication of choice for ADD. This contrasts from older approaches that had “let’s rule out other diagnoses first” thinking behind it. Many doctors are still prescribing one of the anti-depressants first and adding stimulants later, “if necessary.” There are good reasons why a doctor might go this way with YOU. Some, however, are still basing their choices on the older thinking about ADD. Your doctor needs to explain his treatment approach so that you understand it.
Even if your doctor prescribes a stimulant, you still need to ask question number 4!
Listen for answers like the following to let you in on the doctor’s thinking — and to let you know that it is not simply a formula approach to medicating ADD.
• Dexedrine Spansules generally require less overall medication than Ritalin to get the desired results and it is easier to titrate dosage.
• Adderall generally has a slower, more sustained action throughout the day that may help even out some of the functioning swings you report.
• Methelphinidate (generic “Ritalin”) tends to work better with audial processing disorders and, from what you tell me, that seems to be part of what is going on with you.
By the way, I have personally heard the statements above “straight from the horses mouth.” Your doctor may not AGREE with them, and may well say something quite different. That’s OK – different docs have different approaches tied to different clinical experience with ADDers.
The important thing is that they HAVE a treatment philosophy and that they are willing to explain it to you.
There is no need for them to defend it — so be aware of your tone of voice and the way you frame your questions so that you don’t, inadvertently, put them on the defensive.
As long as you have a good feeling that your doctor is not defending some cookie cutter approach explained to you as THE way it’s done, you have to be prepared to trust your doctor’s advice, regardless of what you read on some webpage (ahem! including this one).
5. How will I know if it’s working?
What is our “end-game?” What functionality or behavioral/emotional control will be available to me with the addition of this medication that is not available now?
6. How soon might I notice the effect of the medication?
What might I notice first? What side-effects might show up, and how long do they generally last?
7. What precautions do I need to be aware of?
• Is there anything to watch out for that would mean I should call you immediately?
• Is there anything I am supposed to do (or not do) while this medication is in my system?
• Why or why not?
Why or why not?
You’re not being a smart-alec, you REALLY need to ask that question! You must know what you are risking to know how carefully you have to monitor yourself.
For example . . .
there are certain over-the-counter cold remedies as well as certain foods that MUST be avoided when talking a type of antidepressant known as an MAOI (MonoAmine Oxidase Inhibitor) – many of the cocktail party foods, by the way.
• Most people know not to mix milk with antibiotics.
Why not? Milk reduces the effect of the medication.
• Some medications must be taken with food.
Why? The medication will upset your stomach if you don’t.
• Don’t drink and drive.
Why? Even ONE drink impairs reaction time and increases the chance of an accident involving others.
ALL good to know.
What could happen if you drink a fizzy cold remedy, pop a sinus pill
or drink a glass of wine and have a few peanuts
when an MAOI is still in your system (up to 3 weeks later, btw)?
Stroke or heart attack.
VERY different risk.
If you don’t ask, what’s the likelihood you’re going to understand it THAT clearly and succinctly?
Don’t rely on the patient insert that comes with most medication – that’s for backup! ASK this question and make sure you get an answer that makes sense to you.
Most ADDers struggle with reading (concentration, not literacy!), and those inserts are deadly dull reading. I don’t even read the darn things half the time, and I’m an avid reader. But I always ask question #7 for any change in medication (even if I think I already know the answer)!!
8. What do I do if I don’t like the effect of the medication?
How long do you generally give the titration process before we stop working with this medication in ANY dosage and switch to another medication?
What signs will we be looking for to tell us that this is or is not the best medication for ME? If this doesn’t work well, what will we likely try next?
9. What is our next course of action if this works well?
Will we be adding anything else? What? When? In what circumstances?
10. Can someone in your office help me with a titration log?
A titration log is a type of chart that allows you to track some specifics of your medication history. Titration log documentation captures some specifics day-to-day, and really helps to shorten the time it takes to find a treatment plan that works well for you.
Not all doctors offices offer this service, and those that do offer varying levels of support. Your goal is simply to find out what’s available through the office and what’s up to you to find another way to handle.
If you don’t track it, you really don’t think you will remember, do you?
ADDers tend to remember the highlights, not the specifics – and then only the most recent or the most dramatic. Your doctor needs more than that to be able to do his or her best job.
Related Content here on ADDandSoMuchMore.com
- 10 Questions to Ask to find a GRRRRreat! ADD Doc
- The Top Ten Stupid Questions from [supposed] ADD Professionals
- ADD Meds Info for Moms
- ABOUT Non-Medical Alternatives
Related articles ’round the ‘net
- Can I Get My Medication Well Done? (ADD-doc Oren Mason)
- How ADHD Stimulant Medications Work | Laurie Dupar Coaching for ADHD (blueandgreenblog.wordpress.com)
- ADD and Medication (counselorcarmella.wordpress.com)