Early 90s Flashback

March 24, 2011 9:23 AM

I was recently officially diagnosed with ADHD by a great psychiatrist who spent a lot of time with me and seemed very serious about helping me. He ended up prescribing me Ritalin. This was very surprising, and I felt like I was transported back to the early 90s (which was the last time I heard the word actually spoken aloud). What are the possible benefits of Ritalin over Adderall, which may have led him to choose this?

I am very curious, but I certainly don't want to seem suspicious by asking him directly. I don't care what I take as long as it is helpful, but I am at a loss to explain the prescription and am not finding much information when I search via Google.

I'm sort of afraid that this an attempt to weed out seekers of Adderall, and that the possibly more effective drug is being withheld because it is so frequently abused. I'd love to hear alternative possibilities. Maybe my doctor is just a smart guy who isn't swayed by seemingly universal ADHD-treatment-hype. Any ideas guys? Thanks.

posted by wombat stork to Health & Fitness (20 answers total)

I am very curious, but I certainly don't want to seem suspicious by asking him directly.

It's your health. You can and should be asking questions of your healthcare provider! That's also the best way to get an answer to your question.
posted by runningwithscissors at 9:26 AM on March 24, 2011 [6 favorites]

(This is a guess from someone who loves someone who takes Adderall):

Adderall is fantastic for controlling ADHD, but it's a pain to take. New prescriptions (meaning actually having to go to the doctor to pick it up, he can't just call it in, though not seeing the doctor necessarily) every 30 days. Doctor and blood tests every 6 months. Possible serious complications that require those every 6 month blood tests. Coming off it every night sucks. If Ritalin works for you, it's probably way better to take it than to take Adderall. There seems to be little harm in checking first to see if Ritalin effectively manages your ADHD before going to Adderall.

Of course, like runningwithscissors says, seriously you're allowed to ask your doctor questions about the medications he chooses for you!
posted by brainmouse at 9:29 AM on March 24, 2011 [1 favorite]

I know next to nothing about this, but my best friend was also recently diagnosed with ADHD as an adult and was also prescribed Ritalin.
posted by something something at 9:30 AM on March 24, 2011

Ritalin is often a try first sort of medication.
Depending on how you react will tell the psychiatrist what's the best course of medication.
I have a sibling and another loved one who went down this path. The medications are different and adderall has its side effects too (I can take a nap on the low dose no problem, the crash on the longer lasting dose is pretty bad as mentioned up thread).
Its best to just talk to your doctor about questions concerning why this medication as that is always a follow up question to any script a doctor gives me.
My experience with amps/speed (that is what it is) is dexadrine>adderall>ritalin,
Best of luck.
posted by handbanana at 9:36 AM on March 24, 2011

I've never had a blood test for this Rx and I've been taking the generic version of Adderall (slow release) for about 7 years. I skip weekends and sometimes a whole week in the summer, or when I'm not really working. Personally, Concerta is the only drug that did nothing much for me. Ritalin seemed about the same, to me.
posted by Ideefixe at 9:38 AM on March 24, 2011

As part of my job, I talk to psychiatrists fairly often and a number of them have told me they are reluctant to prescribe Adderall, especially for new patients, because of the tendency for people, especially students, to buy and sell it on the black market. From their point of view, there does not seem to be this market for Ritallin. They offer Ritalin instead of Adderall precisely to weed out potential sellers.
posted by pasici at 9:46 AM on March 24, 2011

There is no "universal" medication treatment for ADHD. I am a therapist and I know kids/adolescents/adults on Vyvanse, Strattera, Ritalin, Adderall, Concerta, Daytrana, Focalin, Metadate, and others. There is no real reason to think that Adderall is the "universal" treatment, except that you have heard the name a lot before because tons of high schoolers and college kids abuse it. Also, just because Ritalin's been around for a long time doesn't mean it's less effective or less good a drug to treat ADHD. It's still around because it does work for a lot of people.
posted by so_gracefully at 9:50 AM on March 24, 2011 [1 favorite]

Aside from all the other stuff mentioned above, Ritalin is traditional and old-fashioned and very very well proven in terms of safety. It's the obvious, boring first thing to try.

I still take the stuff once or twice per weekday, after my Concerta has run out.
posted by tel3path at 9:56 AM on March 24, 2011 [2 favorites]

Ritalin is often a try first sort of medication.

This was my experience. When I was diagnosed (ADD, definitely no H in my life at the time) about 5 years ago, my doctor started me on Ritalin. After a few weeks and gently increasing doses, I didn't feel any difference. We went to Adderall next and it was like having the world go from black and white to color.

I would expect any good doctor to explore a range of options where options exist, though as pasici notes, for better or worse some bias may exist if you're a certain demographic (I'm well beyond (typical) student age, FWIW).
posted by jalexei at 10:02 AM on March 24, 2011

New prescriptions (meaning actually having to go to the doctor to pick it up, he can't just call it in, though not seeing the doctor necessarily) every 30 days. Doctor and blood tests every 6 months. Possible serious complications that require those every 6 month blood tests. Coming off it every night sucks.

All of these are also true of Ritalin. Source: husband, diagnosed in his mid-30s.
posted by desjardins at 10:25 AM on March 24, 2011 [1 favorite]

You know, this is metacommentary, but it's really easy to get unnecessarily paranoid about your interactions with your doctor when you're taking something Schedule II.

And it really is unnecessary. I've never been thrown out of anyone's office for asking "Why this amphetamine and not that one?" or "What are the pros and cons for sustained release?" or "I think we should talk about changing my dosage" or whatever. I've definitely worried that showing any sort of preference would get me labeled as a drug-seeker — but it hasn't actually happened. So I mean, your doc is not my doc and your mileage may vary, but it sounds like you've got a lot of room to be more up-front about your concerns without making any extra trouble for yourself.
posted by nebulawindphone at 10:32 AM on March 24, 2011 [2 favorites]

When I was diagnosed and prescribed my psych at the time said "Okay, let's try medication. Do you want Ritalin or Adderall?"

I had already decided I wanted to try Adderall for many reasons, the biggest being that it was often prescribed off-label to people with depression who have had problems with SSRIs.

I've never needed a blood test for it. (What's the blood test supposedly for, anyway?)

And I don't notice much of a come-down from it either, other than some hardcore drowsiness around 3pm that goes away pretty quickly. But I also take the IR, not the SR/XR.
posted by elsietheeel at 11:10 AM on March 24, 2011

Ritalin was also my first-try medication. Worked great, but the side effects (feeling like I was constantly short of breath) made it ultimately a no-go for me. The med that works the best for me turns out to be an extremely low dose of extended release Dexedrine.

Another possible reason - it's so old that health insurance will almost always cover the generic version at generic prices, something they may not do with other ADHD medications. (My old insurance, for instance, would only cover name brand Adderall, and with a $50 monthly co-pay.)
posted by spinifex23 at 11:46 AM on March 24, 2011

I was put on Ritalin. It seems to be the first one they put you on, since it is the safest (been around the longest) and they can put you on a generic (which is cheaper).

A note about generic Ritalin, it is not the same non-generic Ritalin. My husband first took regular Ritalin, he was then given generic Ritalin. He was not aware of the change. The generic version made him feel very strange. He told his psychiatrist that he felt odd. The doctor confirmed that generic Ritalin sometimes does this. The doctor then showed us the molecular structure of Ritalin as compared to the molecular structure of the generic version. They were not the same. I also had the same experience with regular Ritalin and generic (prescribed the branded version at first, then given the generic when I refilled, but not told of the change). The doctor then wrote a script prescribing only the branded version.
posted by fifilaru at 12:59 PM on March 24, 2011

fifilaru, research bears out your and your husband's experience re: generic and non-generic medications.

"An overall review of this issue found several generic psychoactive medications to be less effective than their brand-name counterparts," according to a journal article cited on the informational website crazymeds ("By crazy people, for crazy people"). If you're interested, crazymeds goes into more detail on this point.

wombat stork, crazymeds also has an article on the different ADD meds/central nervous system stimulants, their side effects, and other stuff to keep in mind.

I could go on -- and if it weren't for Adderall reining in the hyperfocus that is the signal trait of my ADHD, I probably would -- but it's suppertime here on the Upper Right Coast of the U.S., so I'm going to sign off. You sound like you're on the right track, wombat stork. Good luck with it all.
posted by virago at 3:37 PM on March 24, 2011

"An overall review of this issue found several generic psychoactive medications to be less effective than their brand-name counterparts," according to a journal article cited on the informational website crazymeds

I don't have a dog in this fight but that article (and the generics-vs-brand Crazymeds page in general which you link to) are ridiculously weak in terms of support for the claim. Really, that the journal article linked to is the best they can find is practically evidence against the claim. To be clear, it's quite possible that some generics are more different than the brand name stuff than they should be, but I think it is wrong to represent that article with the statement "research bears out...". Anyway...

In terms of the OP's question I don't think it matters in any case. It would only be an issue (if it exists) for someone switching from a brand name to a generic because they may experience a change in the amount of bioavailable drug. That could produce sub-optimal results. But the OP would be starting the medication fresh, so a small difference in bioavailability would not be a big deal. The drug would either work or it wouldn't. If it works, it doesn't matter if the formulation is slightly different than some others.

OP: It is my opinion you are overthinking this. If your doctor thinks you should try Ritalin, by all means try Ritalin. It'll either work or it won't. If it doesn't work you can try something else. Have you read something (or heard, etc) which makes you reluctant to try Ritalin? As far as I know it's at least as safe as Adderall.

Honestly, I think you're just working off a false assumption. That is, I don't think Ritalin is nearly as outdated or deprecated as you think it is. Lots of people still take it. For some it works better than the alternatives. For some it works the same. For a lot it doesn't work as well, and they change to a different med. I think you're more worried than is warranted under the circumstances.
posted by Justinian at 5:35 PM on March 24, 2011

So that it doesn't get lost in my comment, OP, I'll reiterate the major point; my understanding is that Ritalin a perfectly normal and standard first treatment for a newly diagnosed ADD person and that I think you are mistaken in the idea that Adderall is significantly more effective and thus preferred. But asking your doctor why he prefers to start with Ritalin is perfectly reasonable, although I would phrase it more along the lines of "What advantages does Ritalin have?" and not "Why didn't I get Adderall?" 'cause the latter is, uh, sketchy.
posted by Justinian at 5:41 PM on March 24, 2011

Easy answer: the doctor presumably has had a number of patients, and seems to think Ritalin is a better choice.

I don't have a dog in this fight but that article (and the generics-vs-brand Crazymeds page in general which you link to) are ridiculously weak in terms of support for the claim. Really, that the journal article linked to is the best they can find is practically evidence against the claim. To be clear, it's quite possible that some generics are more different than the brand name stuff than they should be, but I think it is wrong to represent that article with the statement "research bears out...". Anyway...

Just as a point of fact, generic Adderall and the real thing are different. Not all generics are identical.
posted by gjc at 6:03 PM on March 24, 2011

They both do pretty much the same thing to you. It unlikely that you will notice anything other than the duration. Getting the dosage right is more likely to be the issue. Your doctor may prefer Ritalin because the are more familiar with how to dose it more closely asa they ramp up a patient. Still there is nothing wrong with asking about alternatives or sharing your specific concerns. Since these are both schedule 2 drugs with all the paperwork that goes along with it, it isn't like you are suspicious because you ask about one or the other. The doctor should be keeping close tabs on the number of pills and frequency of prescriptions.

Expect the following. You will feel great the first week or two. That's just the euphoria, as your body adjusts to the stimulants. You should also notice a marked improvement in your executive function. You will find after a while that the euphoria fades, this is normal. You may also think that because you don't feel as awesome, the medication isn't working anymore, but it is. However it won't work very well if you don't get a good nights sleep, focus on building your executive function skills and setup some consistent daily patterns. Best thing I've done for my ADHD was swap therapy for a coaching session and have my psychiatrist do a monthly dosage review.

I've taken generic and real Adderal depending on what the pharmacy has in stock and I can't tell the difference.
posted by humanfont at 6:36 PM on March 24, 2011

Just as a point of fact, generic Adderall and the real thing are different. Not all generics are identical.

Nobody has claimed they are identical. But this statement is still misleading. The active ingredient should, in theory, be identical. They can have different fillers and such. So long as the different fillers do not result in a hugely different bioavailability of the active ingredient. Generally speaking, the difference in bioavailability between generics and brand names is on the order of 3% although the limit is higher than that. So the statement "generic Adderall and the real thing are different" is technically true but misleading because the generic and branded form will both result in roughly the same bioavailability of dextroamphetamine.

And, again, even if that weren't the case it doesn't matter for the OP because she is not considering switching between a branded and a generic, where a slight change in bioavailability might be at all relevant.

OP, I don't think you should care about the generic -vs- branded. I don't think it is at all relevant to your situation and I hope you won't worry about it.
posted by Justinian at 8:00 PM on March 24, 2011