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