   
3 Keys to Mindful Medication
Q:
"I have been on Adderall for several months, and I don't think it's working. Do you think I need to try Ritalin?" 
A:
When we use Ritalin, Dextroamphetamine, or Adderall there are three clinical problems that must be answered. Possibly your doctor has not addressed them yet. Before you change medication, go over these three with him/her: 1. What dose is needed? The dose is not based on age or body weight but on how fast each person metabolizes the medication. Thus, we usually start at 5 mg per dose. If no improvement, we go to 10 and then 15 and then 20 until we find what dose works best; 2. How often is the medication taken? Adderall lasts about 4 to 5 hours. But, for some, it may last longer. If it lasts 5 hours and you take the first dose at, say 7 A.M., it will wear off at about noon. Thus, you may feel it is not working in the afternoon or evening; and, 3. When should you be on the medication? The answer is, whenever the ADHD behaviors interfere with your life. For example, if you take it only during school hours and can not sit or focus on homework, you need a dose for the evening. Or, if you take it Monday through Friday and have difficulty over the weekend with family, friends, or school work, you may need it over the weekends. Discuss these questions with your doctor. It may be that Adderall will work but that you are not taking the proper amount at the proper times.
Larry Silver, M.D., is the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities. He is also a clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C.
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