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ADD/ADHD: Medication - Start Meds At Bottom of the Therapeutic Window

Posted Oct 27 2008 3:56am

ADD/ADHD Medication Axiom: Start Low and Go Slow - for any Stimulant Med

A couple of quick hint for starting ADD/ADHD meds: Find the Bottom of the WindowADDBottomWindow

  • Underdose the Start: I always recommend carefully, slowly starting the ADD/ADHD medication at the outset - lower than the expected endpoint. Most of the new drugs have different rates of metabolism, and it is quite easy to overdose the patient. This happened with Adderall in the beginning, it happened with Adderall XR, and it happens with Concerta and Vyvanse even today. So start much lower than expected, and move slowly up - about every 2 weeks when close to precision.
  • Start with The Duration of Effectiveness [DOE] in mind.
  • Vyvanse is Especially Tricky: I see many second opinions wherein the docs started with the Harvard study in mind for the 6-12 yr olds. I always carefully ask about the metabolic rates, sensitivity to medications, bowel issues in an effort to predict slow metabolic challenges - that would cause toxicity at the outset.
  • Low Start Requires Bottom Awareness: The axiom for stimulant meds: start low, and go slow, watching for the effect to show. Address the ADD Symptoms: When it is working the focus is better, the impulsivity is down, the worries are diminished and the patient can get going with projects - overcoming avoidance and procrastination.

The Bottom looks easy, - but if you don't see it, it can become quite complicated.

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