Reply To: Too old for Concerta?

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Hello! I’m a med student and I take both bupropion and methylphenidate for my ADHD. So here’s what I know based on taking these meds and taking classes on them 😉

Neither bupropion nor methylphenidate (concerta) are SSRIs (selective serotonin reuptake inhibitor). Bupropion, like SSRIs, is an antidepressant, but as an NDRI (norepinephrine-dopamine reuptake inhibitor) it has significant stimulant properties – so it is very often used off-label for ADHD. Methylphenidate is a stimulant.

Many psychiatrists think that antidepressants can cause suicidal thoughts in depressed people because, before taking the stimulant, they literally didn’t have the mental energy to contemplate suicide. As they begin to feel better, they ironically feel well enough to make serious plans to kill themselves but not well enough not to want to do so. Bupropion is not generally a medication you would worry about regarding suicidal thoughts, and especially if it’s not being taken for depression.

A lot of psychiatrists do feel uncomfortable prescribing stimulants for adults, but there really isn’t data suggesting that we shouldn’t do that. According to UpToDate, a website that a lot of docs use as reference for treatment guidelines, methylphenidate is perfectly appropriate to be prescribed for adults, and geriatric dosing and guidelines are identical to adult guidelines. There IS a concern in people with heart conditions such as structural heart defects, problems with your heart rhythm, heart failure, and heart attacks. A lot of doctors will do an EKG on you before starting a stimulant to make sure this isn’t more likely. And, of course, heart problems are more likely as you get older.

As for docs taking money from drug companies…in the US, at least, I’m pretty sure it’s illegal for doctors to make any sort of agreement with a drug company about what drugs they’re going to prescribe. They can accept free stuff from the drug company, like going to dinners where the merits of the drug are discussed, and…pens with the name of the drug they’re selling and stuff, but even if they take advantage of that stuff, they are under no obligation to prescribe the drug. Anyway, the vast majority of docs I’ve met are really altruistic people who care more about helping their patients than getting on the good side of a drug company. I think it’s more likely your doctor was uncomfortable prescribing a stimulant because she rarely does it for adults.

Bupropion MIGHT work very well for you, but personally I think it makes more sense to keep with the meds you were on, if they were working well and side effects were minimal. Can you see if another doctor in your area is willing to prescribe? Or talk with your doctor about having a psychiatrist prescribe the stimulant instead?