Can I Get My Medication ‘Well Done’?

“I had a horrible piece of steak at that restaurant, and will never go there again!!”

steak-001We’re supposed to learn from experience, so this response is entirely reasonable.  If you have more than one good restaurant nearby, there’s no need to repeat a blunder, so pick a different steak joint next time.

On the other hand, it would be surprising to hear someone say, “I had a ghastly meal at Restaurant A, so I’m never going to another restaurant.” Most of us know better than to extrapolate so broadly from one lousy experience to all future occurrences. Many people recover from a bad meal with soggy French fries or over-cooked burgers to live a long, productive life filled with perfectly acceptable fast food.

A similar over-reaction often appears when treating ADHD, but it somehow sounds more plausible:

“He became anxious on the drug he tried, so we’re sticking with all natural treatments.”

“The medicine was great at first, but then it seemed to quit working so we gave up on it.”

“My friend’s brother couldn’t sleep for a whole night on that drug, so don’t try to prescribe it for me.”

“We gave it to her for a couple days and didn’t notice anything, so we’re not going to use medicine.”

These statements would make sense if doctors could read minds, predict the future and know everything there is to know about both brains and pharmaceuticals. I apologize if this bursts anyone’s bubble, but doctors are not remotely that good.

Medication for almost any condition requires trial, error and adjustment. It’s similar to buying a dress suit off the rack. You might have to try on several to find the best one for you, then spend even more time with the tailor nipping and tucking to get the fit just right.

A few things to remember if you are ready to begin trials of medication for ADHD:

1. Be ready to try more than one medication. There are three first-line medications for ADHD and several more that are almost as good. Genetic testing may one day determine the perfect medications for each person, but that day is not here yet. The state of the art in 2014 is individual trials that include the potential for failure. In ADHD the success rate of a single trial is about 70%, but that rises to 90% with a second trial and 97% with a third trial. Not everyone gets a solid hit on the first pitch.

2. Side effects are the rule, not the exception. Most get better or disappear with time, like muscle soreness when you begin a new exercise regimen. Side effects should prompt you to ask your doctor for guidance, but not to stop the medicine without specific direction.

3. Some side effects indicate that you need to adjust the dose, not stop the medicine. Nervousness and over-talkativeness might prompt a decrease in stimulant dose. Grumpiness can signal that the dose of a nonstimulant like Strattera or Intuniv is too high.

4. Fine tuning takes time. Medications for the brain can work surprisingly well in a narrow range and work very poorly outside the range, so several dosages of each medication will usually be prescribed.

5. Manufacturers can’t make every necessary dose. Many of my patients need dosages that aren’t commercially available. Compounding pharmacies are one of several workarounds we commonly use to make unique, individual dosages available.

6. It can take several months for the body to adjust to a new medication. Small tweaks in dosage are usually needed in the first year.

pad thaiThe search for the “best” medication — or combination of medications in many cases — can take anywhere from a few weeks to a few months. Like the search for the best steak (or pad thai or sushi or crabcakes), the early trials, failures and successes become worth it when you emerge at the end of the search with the confidence that comes from personal experience, not just from your friend’s brother.

 

 

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

Posted in ADD, ADHD, medications, side effects
8 comments on “Can I Get My Medication ‘Well Done’?
  1. chaddgr says:

    Great analogy! It would be interesting to know if resistance to taking medication can simply be addressed by education…

    Is it more common among folks with AD/HD compared to other psychiatric diagnoses, men vs. women, children vs. adults, people who have to “fail first” before being made eligible, insurance coverage, our “NO EXCUSES!” culture, “denial,” or not being able to connect cause and effect when not appropriately medicated? Whatever the reason, though, it would seem that education should be as important as treatment. How tragic if we know what works, -but people don’t use it, feel ashamed for needing it, or can’t access it.

    After all, there is help for this now!

    Liked by 1 person

  2. […] Can I Get My Medication Well Done? (ADD-doc Oren Mason) […]

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  3. […] Can I Get My Medication Well Done? (ADD-doc Oren Mason) […]

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  4. Just found this. I LOVE your analogy and this article. I have already pinned it, and linked it to a couple of meds & non-pharm articles on my own WordPress blog, ADDandSoMuchMore dot com — and will be linking to others as I have time (watch for pings, if you have them enabled). I hope you’ll have time to jump over to take a look at what I write about.

    YOU are one of what I refer to as the “good” ADD/EFD docs – well informed, great communication skills – on and on and on – which you may or may not know is relatively rare. I wish we could clone you (and that you lived down the street from ME!)

    Now that I have vetted you, please feel free to leave a “clickable” link to ANY article I write that makes sense with one of yours and I will approve it post haste (with gratitude), even before I’ve had a chance to check it out. In MY world, that’s an endorsement of the highest order! (Keep it to one live link per comment, tho’ or you’ll be autospammed and I’ll never see it TO approve – multiple comments perfectly okay).

    Pleased to meetcha’
    xx,
    mgh
    (Madelyn Griffith-Haynie – ADDandSoMuchMore dot com)
    – ADD Coach Training Field founder; ADD Coaching co-founder –
    “It takes a village to educate a world!”

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  5. […] Can I Get My Medication Well Done? (ADD-doc Oren Mason) […]

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  6. […] Can I Get My Medication Well Done? (ADD-doc Oren Mason) […]

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  7. […] Can I Get My Medication Well Done? for another meds-trial analogy from a doctor who treats ADD (and related) […]

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Oren Mason MD
Oren Mason MD

Oren Mason MD

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

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