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ADD and Phentermine
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An_191275 posted:
I was a Ritalin kid and took Dexedrine time release thru college & law school other wise I could not stay awake in class or study. I always had trouble with Dexedrine. It ws too much and addictive. Your teeth ground together and depression resulted from the come down. Fortunately, I was a type of person who valued their health and could get off of it ( I was on the Olympic biathlon team (didn't make Olympics)). The relief it granted toward my ADD was certainly there, but the side effects were awful and you formed a love/hate relationship toward Dexedrine. It also lost effectiveness. I sort of grew out of it by being self employed and stimulated by my job and family. I took a job for the World Bank in Brazil where I gained 45 lbs I returned the the US & went to a weight loss clinic where they used Phentermine to help control weight. The stuff worked very well at reducing weight, but it also worked better than anything else I had ever tried at controlling my ADD. It had few side effects, its effectiveness stayed and it did not seem to affect by health. I could come off of it without side affects, except my ADD would return and I would get disorganized and forgetful, it began threatening my livelihood and self esteem. I forgot appointments, dates, papers, keys, cell phones, trouble with money.

I went to my family doctor and fessed up and told him what the situation was, he prescribed the same dosage and bingo: all the ADD problems went away. Like a magnet with iron filing they now lined up.

I search Web MD for Phentermine and ADD: nothing, nada. If you look at the reviews for patients taking Phentermine, they to a person are 4-5 stars. If you look at feed back from other meds for ADD, it is a real marginal return with a lot of bad Juju and few are happy about their meds. I am a member of Mensa, very high on the creative end of the spectrum, and my mind does not seem to stagnate as I get older, but without Phentermine I lose it. I had the most thorough physical of my life and the Doctors reported I am in perfect health with a very strong heart and circulatory system. I am over 65 years old, and I can tell you that ADD does not go away; it is your constant companion and If conquered, a benefit. But it will turn on you in a heartbeat.

My question is why isn't Phentermine prescribed for ADD? What is it is different than straight amphetamines? Why do you get the stimulation without the side affects of Dexedrine. Why is it not a recommended medicine for ADD by the Feds. RTK
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bkarcher responded:
I know this is an old post but I'd like to respond to these questions for anyone that might happen upon this page in the future. I'll take the questions one by one.

Why isn't phentermine prescribed for ADD?

Sometimes it is. Mainly, I think doctors are hesitant to prescribe meds for off-label uses if there's a drug specifically designed to treat a condition. That said, phentermine is being investigated as a potential treatment for ADD so it may be more widely prescribed in the future.

How is it different than amphetamines?

Phentermine works predominately by increasing levels of norepenephrine in the brain. Amphetamines increase the levels of dopamine (predominately). The two neurotransmitters are very similar (one actually converts into the other, I believe) but their effect on alertness/cognition are different.

Why... without side effects...?

There are quite a few side effects associated with Phentermine, including many of the side effects of Dexedrine. However, the difference in mechanism of action probably has something to do with the lower incidence of side effects.

Why not recommended by the feds?

The "feds" rely on research to make recommendations. Since there hasn't yet been much research on the efficacy of phentermine in treating ADD, they can't make any suggestions. Maybe in the future...
 
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estralia replied to bkarcher's response:
I just found your post, maybe you can shed some light on questions I have about my treatment. I am 42 and was taking adderall for 2 years with few side effects and general success. 1 1/2 yr ago I had to leave a 5 year relationship and move into a different house. I became depressed but was getting by. My Dr prescribed prozac for my depression but it didn't help at all. Adderall became unavailable so I have been taking ritalin. I feel hopeless to feel like I used to. Nothing is working. I have been reading and am considering why adderall worked better and the anti depressants do not help. I am considering asking my doctor to try a selective serontonin norepenephrine reuptake inhibitor. Could I be on the right track with this? I have no structure in my home right now and while I know I need to get my environment working in my favor I have been so depressed that I just can't climb out of this hole. I am a single mom of two and I am the only one who can fix my "unfriendly home". The two anti depressants I have been on have only addressed serontonin which led me to think maybe my norepenephrine level needs addressed too. I would appreciate your opinion. I live in a small town and the doctors here try but do not specialize in ADD or ADHD.
 
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Patricia Quinn, MD responded:
Your question is a valid one. Phentermine is a sympathomemitic amine and is similiar to the psychostimulants, but not exactly the same. It also works on different neurotransmitter systems (primarily norepinephrine and some on dopamine and serotonin) and....it works in the hypothalamus (not the striatal-prefrontal cortex). So, as you can see, it is similiar, but not the same.

Phentermine has been approved as a weight loss medication for the treatment of obesity. It's primary effects are dry mouth and appetite decrease - hence the use in obesity, but it can also increase BO and heart rate. Adderall was initially tested as Obitrol (for weight loss but was not particuarly effective) and brought out again and retested for ADHD.

Everyone with ADHD is not the same and thus have differing involvement of the various neurotransitter systems. It seems that you do better with medications that affect norepinephrine.
Perhaps you shoudl discuss this with your physician and see about one of the non-stimulants like Strattera.
 
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shboogie replied to Patricia Quinn, MD's response:
I originally started taking Phentermine for a short term weight loss medication but, I have continued taking it for my ADHD. I am not severely overweight ( I could always lose ten pounds and look better ) I have my blood taken every 3-6 mos. I have never had blood pressure problems or any additional side effects. I am definitely more focused and capable of staying on track with the medication. I was concerned about the long term effects and asked my pharmacist who assured me I should be fine. Is there a reason for me NOT to take this longterm?
 
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StephG responded:
I know this post is older but I am really glad I found it. For the last 20 years they have changed my meds continuously but nothing every really worked. When something did work it didn't for very long. My last med change my doctor put me on phentermine, I was shocked and confused by his choice. Turns out this is the medication that fits. I truly never knew this is how the rest of the world lives. It is nice to finally be able to focus!
 
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GinaPera replied to bkarcher's response:
Thank you for the explanation. I found more good information on Phentermine at Wikipedia, including this:

Phentermine works on the hypothalamus portion of the brain to stimulate the adrenal glands to release norepinephrine , a neurotransmitter or chemical messenger that signals a fight-or-flight response , reducing hunger. Phentermine works outside the brain, as well, to release epinephrine or adrenaline, causing fat cells to break down stored fat, but the principal basis of efficacy is hunger-reduction. At clinically relevant doses, phentermine also releases serotonin and dopamine , but to a much lesser extent than that of norepinephrine.[4>
 
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MitchyChick responded:
Oh my goodness, thank you so much for posting this! I was so scared! I started taking Phentermine for obesity a few days ago and I feel so much better than I have in a very long time. I really can think more clearly, I haven't had problems with feeling jittery, I am more organized, I handle stress better, and most of all I am really a lot happier. I couldn't understand it and it was really scaring me because I have known so many people who became addicted to different drugs and I'd rather be obese than be one of them, but I really like feeling better. I am even getting through my test books faster, without getting bored and distracted all the time. I looked to the internet to find out if how I am feeling means I am getting addicted and it turns out, these are signs I have untreated ADD! That's okay, both of my sons have ADD and I've known I might have it but have always been able to do well without medication. If medication can make me feel like this though, I am going to look into it. Thank you so very much for posting this!
 
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Sumguynobuddynoes responded:
I have gone through the gammit of all the ADD drugs with very little or no effect on my ADD. So I gave up and was content to live my easily distracted self, happy to be in a job that is constantly full stimulus to mask my distractive tendencies. However, I was obese and had a voracious appetite that would not be satisfied, so my doctor prescribed Phentermine. I turns out that I may have high blood sugar and that was the cause of my abnormal appetite, but the side effects allow my feeling of normality and hope have returned. My focus has never been better. My mind feels like a fog has lifted. If this is how normal people feel, I have been sorely missing out. It feels great to be able to concentrate and focus like a normal person. I never experienced such clarity.

I understand that ADD may be the results of several different causes, so each person will respond differently, but this Phentermine has had the greatest impact on my life. And not for it's intended use.

I dread the day when my prescription runs out and I have to return to the normal ADD fog I have lived with all my life. Until this medication, I did not understand how much of the world I have passed over because of my ability to concentrate and think. It is amazing that I have been able to be as successful as I have with this unseen handicap. It is insulting to have person treat you like you are deliberately trying not to learn or not concentrating. I was punished for this many times in the Navy. Therefore I was also not respected because I was considered slow. However, I did not know that I had ADD.

I hope the FDA will look into allowing Phetermine to be used as an ADD treatment.
 
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DenverADD replied to bkarcher's response:
I'm take Adderall for my ADD. Other than afternoon irritability and the breaks I need to take to keep my tolerance down I'm happy with the drug.

Recently, I got a prescription for Phentermine as a weight loss aid. Of course, I don't take the two together.

I was hoping the Phentermine would ease my ADD and help me lose weight.


What I've found is that the Phentermine actually diminishes my concentration ability to a point even lower than when I'm not taking anything.


On the positive side, Phentermine physically motivates me, whereas Adderall is all mental stimulation, keeping me glued to a chair working all day.

I've ditched the Phentermine since it was counterproductive for work and it's appetite suppressing effects were nonexistent for me.
 
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Barliman replied to DenverADD's response:
A simple observation.
Dopaminergic pathways ORIENT attention. They are NOT exclusively associated with the reward pathways. They are just as much associated with the punishment pathways.

Dopaminergic neurones lock our attention onto the most relevant stimulus in our environment. If that stimulus happens to be a teacher or a boss with a bad attitude- then the results of taking stimulants may not be desirable.

Furthermore, Left brained, analytic attention drives a sympathetic response in and of itself.

Try taking your stimulants and doing a right brained meditation exercise like body scanning or a hypnosis/guided imagery exercise and all those "sympathomimetic" effects will evaporate.

Stimulants are well known to enhance learning in ANY population. If you have access to a legal prescription, then have the sense to use it to train in the most refined and stable attention that you can learn. The schools of thought that teach these attentional skills are thousands of years old, and will probably still be here long after modern psychiatry has been forgotten.


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