| Dear Mr. Gazley:
I am so excited to see your article on ADD. Yours is the first article that addresses the emotional component that I have been asking about for quite a while. I have described my son, who is 15, as unable to empathize with others and the impact he has on them, and if we do seem to get through, he doesn't seem to have the ability to feel or express needed emotions to cause change in behavior. Just recently, I was able to verbalize what I observed, but nowhere did I see anyone aknowledging it or discussing it.
Almost all the characteristics you list describe him. He has been on Ritalin since age 6. Currently, (for the past 2 years approx) he has been taking 54mg Concerta, which the doctor told me is maximum dosage (he weighs 150 lbs). He still is extremely active (more so than my other 3 kids), but it makes him tolerable. Evenings are tough, because the meds have worn off. He is just so mean and onery to his siblings (and we are very strict on any name calling and put downs).
Sincerely,
D.J.M.
Testimonial by M.A.
I have felt for a long time that something within me was sabotaging all my endeavors. But I could not put my finger on it. I have had problems controlling my anger in family situations since I was a child causing untold suffering in my relationships. I had problems with depression and obsessive behavior that had derailed many well planned and executed schemas.
I had been successful at achieving intermediate objectives primarily through intellectual work. I can deeply concentrate on intellectual tasks. I willed my way through many situations by forcing myself to compensate for things that at the time I did not understand. The internal pull for compulsive behavior and lost of equanimity were the immediate causes of the sabotage. But the root caused remained hidden.
It was unexpected when I was told that Attention Deficit Disorder (ADD) could be, partly, the cause of my anger problem (rage) in particular. And the cause of the sabotaging force within me in general. After reading Amen’s book on ADD I accepted this possibility. We started to look at alternatives for dealing with the ADD on a physical level by balancing the brain function through the use of medication.
There were two main general symptoms areas. One area was the depression and two my anger. I took an antidepressant that worked well in alleviating the depression symptoms. But I could not find a medication that would turn on my higher level thinking centers. I tested several stimulants without success. This is very much an understatement. The stimulants not only did not bring the desired results but they made me irritable, hyper-alert, more compulsive and in general they made me feel worst.
Jef recommended “Provigil” and I was hesitant to test it because of my experience with the other stimulants. I did some research about Provigil and among other things I found the following picture and write-up which were very useful in making a decision to try “Provigil”.
Here is a write-up on Provigil (Modafinil) from www.modafinil.com:
" ...modafinil ('Provigil', 'Alertec', 'Vigicer', 'Modalert', etc) is a memory-improving and mood-brightening psychostimulant. It enhances wakefulness and vigilance, but its pharmacological profile is notably different from the amphetamines, methylphenidate (Ritalin) or cocaine. Modafinil is less likely to cause jitteriness, anxiety, or excess locomotor activity - or lead to a hypersomnolent 'rebound effect' - than traditional stimulants. Subjectively, it feels smoother and cleaner than the amphetamines too. The normal elimination half-life of modafinil in humans is between 12 - 15 hours. So it's worth fine-tuning one's dosage schedule accordingly.
Current research suggests modafinil, like its older and better-tested analogue adrafinil, is a safe, effective and well-tolerated agent. It is long-acting and doesn't tend to cause peripheral sympathetic stimulation. Yet its CNS action isn't fully understood. Modafinil induces wakefulness in part by its action in the anterior hypothalamus. Its dopamine-releasing action in the nucleus accumbens is weak and dose-dependent; the likelihood of a euphoric response ('abuse potential'), dose-escalation and tolerance is thus apparently small. Modafinil has central alpha 1-adrenergic agonist effects i.e. it directly stimulates the receptors. Modafinil inhibits the reuptake of noradrenaline by the noradrenergic terminals on sleep-promoting neurons of ventrolateral preoptic nucleus (VLPO). More significant, perhaps, is its ability to increase excitatory glutamatergic transmission. This reduces local GABAergic transmission, thereby diminishing GABA(A) receptor signalling on the mesolimbic dopamine terminals.
Modafinil is proving clinically useful in the treatment of narcolepsy, a neurological disorder marked by uncontrollable attacks of daytime sleepiness. Narcolepsy is caused by dysfunction of a family of wakefulness-promoting and sleep-suppressing peptides, the orexins. Orexin neurons are activated by modafinil. Orexinergic neurons are found exclusively in the lateral hypothalamic area, but their fibers project to the entire central nervous system. Genetically modified orexin-knockout animals offer a model of human narcolepsy. Selective orexin receptor agonists of the future may prove useful both to narcoleptics and the population at large.
Experimentally, modafinil is also used in the treatment of Alzheimer's disease, depression, attention-deficit disorder, myotonic dystrophy, multiple sclerosis-induced fatigue, post-anaesthesia grogginess, cognitive impairment in schizophrenia, spasticity associated with cerebral palsy, age-related memory decline, idiopathic hypersomnia, jet-lag, and everyday cat-napping. Depressives who feel sleepy and fatigued on SSRIs can augment their regimen with modafinil. In September 2003, an advisory panel to the FDA endorsed its use for treating shift work sleep disorder and obstructive sleep apnea.
The US military are interested in modafinil too.
Modafanil is marketed as 'Alertec" in Canada - and over the Net. 'Alertec' is less expensive than 'Provigil'. Cheap generic modafinil should be available from 2006. But Cephalon is vigorously litigating to defend its patents.
In March 2005, Cephalon filed a New Drug Application (NDA) with the FDA for "Nuvigil" (r-modafinil, armodafinil) - a single isomer formulation of modafinil. Nuvigil will be marketed aggressively to offset the loss of revenue from Provigil.
Modafinil is increasingly used as a 'lifestyle drug' - a lucrative 'off-label' market its makers have not been unduly keen to discourage. Some prescribing physicians have reportedly been surprised at a previously hidden epidemic of narcolepsy among hard-working young professionals attending their surgeries.
Prudence, however, should be exercised in drastically curtailing one's sleep. Prolonged sleeplessness weakens immune function. Animals tortured in sleep-deprivation experiments eventually die from massive bacterial infections of the blood... "
I tried it. Provigil
worked very well for me. It was a great relief but it was not a big bang
experience. What I have experienced is more subtle. I can move from task
to task with more ease. I am less irritable and more rational in what
used to be difficult situations. I am more willing to contemplate my fallibility.
I am willing to integrate the disowned parts of the ego to be able to
transcend the ego.
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