Question:
I'm 47 years old and just put together
that I may have ADD. It is not a new
onset. I've always had it and it was never
diagnosed until recently.
The physician put me
on Concerta. She started at 18mg, then
36mg, now 54mg. I'm not sure if the 54mg is the
right dose either. I get headaches almost
everyday and get fatigued in the afternoon. 36mg
helped but wasn't sure if that was really
enough to help.
How can I tell which is the right
dose for me? I've done lots of research and
I'm having trouble finding the answer to this
one. I would appreciate your input.
Thank you.
Dr. Heller's Answer:
Dr. Biederman, Professor of Psychiatry
at Harvard advises higher doses of stimulants when
needed for successful ADHD treatment in
adolescents and adults. In "Today’s Therapeutic
Trends" 20(4):311-328, 2002, Dr. Biederman
wrote: "It should be reiterated that stimulant
medications are considered to be very safe,
and, and that dosage titration should continue until
an adequate dose is reached, if tolerated.
The large therapeutic window associated with these
agents indicates that there is a wide dosage range
for their safe use...under-dosing in older
adolescents and adults is a significant problem...."
- page 324.
Not knowing your weight makes it difficult to
estimate, but 54mg is rarely enough for most
adults.
I usually prefer Adderall XR or Vyvanse in adults
as it is much more effective. The dose of
Adderall XR is 0.5-1mg/kg in adults (to
calculate kg, divide your weight in pounds by 2.2).
70mg of Vyvanse is equivalent to 30mg of Adderall XR.
A big problem is that ADHD is usually associated
with other neuropsychiatric disorders. The
other diagnoses will affect treatment. Diagnoses
like the cognitive generalized anxiety
disorder, depression, the borderline disorder
and others will be affected by the medications
and a comprehensive approach is necessary:
http://www.BiologicalUnhappiness.com/screen.htm.
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