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General Parenting
Developed Tolerance to Stimulant, Now What?
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<blockquote data-quote="smallworld" data-source="post: 17236" data-attributes="member: 2423"><p>Hi and welcome. I was talking with my son's neuropsychologist recently, and he indicated that doctors are finding Focalin XR is actually lasting only about 6 hours. So what you're seeing with your son may atually be "normal" with that medication. You could ask your doctor for a "booster" dose of regular Focalin for the afternoon.</p><p></p><p>Having said that, I really don't think what your son is experiencing is out of control ADHD. I'm really wondering if your son has ADHD with a mood overlay. That's my son's diagnosis. He has ADHD, but it's not his biggest problem. He really has huge mood issues that have been much more difficult to get under control than the ADHD. My son's history is similar to yours: He was diagnosed with inattentive ADHD and anxiety at age 9 and did well on Concerta for about a year and a half. When he went to middle school, his anxiety increased, and we took him off Concerta and tried Zoloft. After 3 weeks on Zoloft, he had a prolonged intense manic reaction that we could not get under control until his psychiatrist put him on a mood stabilizer. He is now doing much better (although not perfect by any stretch of the imagination). With the mood stabilizer in place, my son is now able to tolerate a low dose of Focalin XR (10 mg) and a low dose of an antidepressant (2.5 mg Lexapro) to target symptoms the mood stabilizer doesn't cover.</p><p></p><p>The atypical antipsychotics (Risperdal, Abilify) help with anger and aggression, but they do not have long-term mood-stabilizing properties like mood stabilizers, and they tend to poop out over the long haul. Furthermore, stimulants like Concerta and Focalin XR can fuel anxiety and mood lability, which Risperdal and Abilify cannot offset. </p><p></p><p>You might want to consider an evaluation by a neuropsychologist (found at university or children's hospitals) to figure out what is what. My son has had two neuropsychologist evaluations (one at age 9, one at age 13). Both times we gleaned invaluable information about how to guide both medications and therapeutic interventions.</p><p></p><p>This is not an easy road to travel. Best of luck to you.</p></blockquote><p></p>
[QUOTE="smallworld, post: 17236, member: 2423"] Hi and welcome. I was talking with my son's neuropsychologist recently, and he indicated that doctors are finding Focalin XR is actually lasting only about 6 hours. So what you're seeing with your son may atually be "normal" with that medication. You could ask your doctor for a "booster" dose of regular Focalin for the afternoon. Having said that, I really don't think what your son is experiencing is out of control ADHD. I'm really wondering if your son has ADHD with a mood overlay. That's my son's diagnosis. He has ADHD, but it's not his biggest problem. He really has huge mood issues that have been much more difficult to get under control than the ADHD. My son's history is similar to yours: He was diagnosed with inattentive ADHD and anxiety at age 9 and did well on Concerta for about a year and a half. When he went to middle school, his anxiety increased, and we took him off Concerta and tried Zoloft. After 3 weeks on Zoloft, he had a prolonged intense manic reaction that we could not get under control until his psychiatrist put him on a mood stabilizer. He is now doing much better (although not perfect by any stretch of the imagination). With the mood stabilizer in place, my son is now able to tolerate a low dose of Focalin XR (10 mg) and a low dose of an antidepressant (2.5 mg Lexapro) to target symptoms the mood stabilizer doesn't cover. The atypical antipsychotics (Risperdal, Abilify) help with anger and aggression, but they do not have long-term mood-stabilizing properties like mood stabilizers, and they tend to poop out over the long haul. Furthermore, stimulants like Concerta and Focalin XR can fuel anxiety and mood lability, which Risperdal and Abilify cannot offset. You might want to consider an evaluation by a neuropsychologist (found at university or children's hospitals) to figure out what is what. My son has had two neuropsychologist evaluations (one at age 9, one at age 13). Both times we gleaned invaluable information about how to guide both medications and therapeutic interventions. This is not an easy road to travel. Best of luck to you. [/QUOTE]
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