Remember the 'Top of the Window' is ranging too high in dosage, the
'Bottom of the Window' is too little dosage. The worst thing that can
happen when you are working to carefully correct stimulant meds: an
overdose upwards because that apparent 'bottom,' the apparent under
dose, was actually too much meds and the patient was actually coming
out of the 'top.' Here is how that looks clinically using these 7
When the Med Dose is too High: it can look like the patient is no longer focused,
they are hyper, confused, and cognitively not as sharp. Every visit,
every medication review, every question in medication adjustment must
consider the possibility that these symptoms mean the drug dosage is
OverFocus Looks Like UnderFocus: This single oversight is the absolutely biggest problem with stimulant medications today:
New medications work so well the top actually appears to be
insufficient dosing. Clinically it appears as if they need more
medication. The big problem: More meds in this situation can make the
patient much worse, perhaps dangerous, certainly more unable to focus, due to that over-focusing.
Side Effects are in Evidence: This phenomenon, actually going out the top - while looking like the
bottom - always has side effects. Side Effects are often subtle, so
inquiry must carefully review these: appetite is down, weight loss
occurs, agitation is higher, compliance appears worse. angered more
easily, sleep is disturbed significantly when no sleep problems
The Patient argues that It Works Well and Can't See the Side Effects. They are so happy to have a new focus they push to have the dose up because they do, so desperately, wish to improve.
The School Is Pleased - In A Structured Setting Side Effects Are Less Obvious. This report often throws off the Treatment Team, because the team is
not trained to look themselves for these details, but relies to heavily
on what the teachers say, ignoring thier own personal concerns.
Peer Relationships Suffer.
People closest to the patient see odd changes and feel put off by the
pressures and new, overbearing attitude that has slowly emerged.
Malevolent Odd Actions, Never Before Experienced, Occur. The patient becomes more destructive in odd ways. A manager who never gossips begins to gossip. A child decides to hit his favorite pet, and
never did before. A child may start a fire in the back yard, or try to
drive the family car... 'just for fun.' The symptoms at first seem
quite innocent but in the overall are maladaptive.
Do review these seven tips carefully. Dropping the medication down,
even a small amount, under these circumstances will often reveal the
person who is evenly focused, who is emotionally more on track, and
performing better throughout the day. Dropping the medication down will
take them out of the 'Top' and put them back within the best
therapeutic dosage, back in the targeted 'Therapeutic Window.'
Bottom Line By following simple guidelines and the metaphor of the 'Therapeutic
Window' you will be more able to adjust dosing correctly, and
effectively - so you and yours don't feel like treatment failures. I
invite you to sign up now for the early bird special set of gifts for
my new book " Fixing the ADD Madness: A Patient's Guide to Stimulant
Medication Details," [upper right sidebar here]-And enjoy the bonus gift on the thank you page for signing up early
-- simply to express your interest in the book: a 1200 word article on
The 10 Biggest Problems With ADD/ADHD Medications, and a 17 min audio
review of the article.