Medication outside the US

[John_White1992]

Hi guys, I'm an Italian man who's currently living in Italy and I started taking Ritalin. Here there's no many options about ADHD medication and other then methylphenidate there are only non stimulant medications. You guys that are from the US with a huge amount of medication available and also decades of researches on ADHD, what do you think about Ritalin? It is just something that reminds you the 80s so something obsolete or it is still largely used and effective? I heard most of the people use Vyvanse, Adderall and Concerta. Are those medications WAY BETTER then Ritalin or is Ritalin still a valid option? I'm using Ritalin guys but taking it 2/3 times a day is a joke. Thanks in advance for your help guys

[STEM_Dad]

Concerta and Ritalin are both the same kind of medication, methylphenidate. The difference is that Concerta is extended release. It is supposed to be taken once per day, instead of 2-3 times per day.

So, you might ask your doctor if an extended release medication is available.

~~~~

As for non-stimulant medication, I was on atomoxetine, which is known by the brand name Strattera. According to my Google search, it is also available in Italy. It works differently from Ritalin. It is typically taken once per day, but works continuously. It does not wear off the same day.

The downsides are that you have to keep taking it every day. Many people with ADHD might be helped by it (about 70%, I think). But according to the research, stimulants work well for most people with ADHD (at least 90%). Atomoxetine can have some unpleasant side effects, but I was lucky that I could prevent the side effects just by taking it when I eat. If I took it on an empty stomach, it made me nauseous for a little while, but then the upset stomach would go away.

[John_White1992 in reply to STEM_Dad]

Thank you STEM_Dad for the answer. Yeah we do have Strattera in the non-stimulant options but talking about stimulants we don't have things like Vyvanse or Adderall that apparently works differently in your brain compared to Ritalin. Are Adderall and Vyvanse way different and more effective compared to Ritalin? Is Ritalin something obsolete or something just for kids? Thanks again

[STEM_Dad in reply to John_White1992]

Ritalin is not obsolete or used just for kids. It is still considered one of the first choices for treating ADHD.

I think that Adderall and Vyvance do get a lot more attention in the news media and social media. Some people with ADHD might be better treated by this type of medication, but other people might be better treated with Ritalin or Concerta.

From information put out by ADHD experts like Dr. Edward Hallowell and Dr. Russell Barkley, I have learned that:

• Methylphenidate (Ritalin, Concerta, etc) can help treat about 90% of patients with ADHD

• Amphetamine-based medication (Adderall, Vyvanse, etc) can help treat about 90% of patients with ADHD

• Atomoxetine (Strattera) can help treat about 70% of patients with ADHD

Some people will respond well to more than one medication. Others will respond much better to a particular medication.

Adderall and Ritalin are chemically different, but if I understand correctly they work similarly. Some people will be more sensitive or resistant to one or the other. Other people will be similarly sensitive or resistant to both.

Also, sometimes a change of dosage will make a big difference. Likewise, a change from instant release formulation (e.g. Ritalin) to an extended release formulation (e.g. Concerta), or vice versa, can make a big difference.

~~~~~

The doctor to diagnosed me with ADHD first started me on Adderall, but it only helped me a little. I asked him to try Strattera, and it worked much better for me.

That doctor started me on Adderall because he said that most of his ADHD patients responded well to it, and because in his experience atomoxetine (Strattera) was more likely to cause unpleasant side effects. Obviously, I was the exception to most of his other ADHD patients. (I think he gave me a chance to try Ritalin first, but I started with Adderall because it was the doctor's recommendation.)

~~~~~

How well does Ritalin seem to be doing for you? Is it an improvement? Any bad side effects? How long have you been on it?

Have you talked with your doctor about adjusting your dosage, or about trying an extended release stimulant (since you complained about having to take it 2-3 times a day)?

[John_White1992 in reply to STEM_Dad]

Thanks again STEM_Dad for replying me. I started 2 weeks ago with Ritalin. First week I started taking 10mg twice a day. Now I'm taking 20mg twice a day. During the first week I didn't feel much. First couple of days was like drinking couple of Expresso coffees. Now with 20mg it kicks a little bit more, yesterday was my first day on 20mg per time and in the morning I felt full of energy but I don't see much improvement on my focus and behavior. I see a bit of improvement on my motivation but I think it's quite normal. Should I wait a bit more to see if Ritalin works for me or not? Like a month or two?

[STEM_Dad in reply to John_White1992]

One of the reasons that stimulants are usually the first choice is because it doesn't take as long to figure out whether they are working or not.

I was on Adderall for about 6 months at different dosages, a month on each dosage (going up, taking a break, going down, and then back to the starting dosage). I think that I could tell within 2 weeks how it affected me, but my doctor insisted on each dosage trial for a full month.

• With stimulants, I've heard some people say that it's possible to know within the first 2 hours of it's working. I know that within the first 2 hours I knew that it was doing something...but it took a couple of weeks to get used to how it made my feel different.

I'm not an expert. I'm not a doctor. So, I would recommend that you keep a daily journal of your experience with your meds. Bring the notes with you to your doctor's appointments.

Like I said before, when I switched from Adderall to Strattera, it worked twice as well for me. But from my conversations with other people, I've found that for many others the stimulants worked better (or they had more severe side effects from Strattera than I did).

~~~~~

It can take just hours, days, or weeks to know how well an ADHD stimulant like Ritalin is working for you.

It can take days, weeks, or months to know if atomoxetine (Strattera) is working for you.

• It took only 5 days for me to reach full effect (and was at least 75% effective by the end of the second day). But I think I'm uniquely sensitive to that medication. It takes most people weeks or months to experience the full effect.

• The difference is the nature of the medicine. Similar to certain antidepressants, Strattera has to build up gradually in the body before it is fully effective.

Another factor is that the body and brain have to adjust to the medication. It is not uncommon for some people to have a big initial effect from a stimulant, but then it settles down into a more moderate effect. For other people, the effect starts small, but grows to be more effective over time.

It's also possible to develop a tolerance to an ADHD medication, requiring an adjustment to a higher dosage after months of years on the medication.

[Mamamichl in reply to STEM_Dad]

Hey! I’m on stratera now. They recently upped my dose and I had some serious sleep side effects and it made me agitated. I went back down and seem to be doing fine.

[wtfadhd]

hey John White,

in a nutshell- ritalin used to be the most popular med used back in the day when only hyperactive little boys had ADHD diagnoses. Fast forward today when adults n females n even elderly are diagnosed with ADHD. in USA most prescribers who decide to prescribe a stimulant to treat ADHD, they prescribe adderrall xr. its a mix of a few different active ingredients( i think 3) and makes it more effective, longer lasting, less “ sharp”, fewer side effects, etc etc. i think the generic name for adderrall in USA is something like dextro- amphetamine salt combo. its something like that. i can tell you the exact name if that would be helpful. depending on pharmacy- my generic adderrall has different but similar names.

based on common sense not google, lol i would say back when ritalin was used to treat hyper little boys- those little boys likely didnt have the ability nor awareness to articulate about pros n cons of ritalin. fast forward to now when ADHD diagnosis was extended beyond hyper little boys… then other more complex stimulants were developed.

[Mamamichl]

Ritalin is not talked about. These days, docs use the general term more:methylphenidate. It is still an option, and when I discussed my concerns, docs said the 80s zombie kids were just over medicated. We use smaller doses and know what we are looking for more now. However, I tried all of the stimulants and no stimulants work better for me. I would say each of the stimulants are used equally and it takes about 4 meds to try before we find the right one. My partner is on vyvanse because it has less of the side effects.

Another thing that helps in the us is that we have gene sight tests that tell us which meds will have adverse side effects (react to our specific genetics within the liver). My whole family has taken it and it helped us find meds to stick away from. I hear Wellbutrin is over the counter in Mexico.

[StanleyThyroid]

Great posts here. I would say its country specific as Elvanse/Vyvanse is the first choice in the UK.

The other point I would make is none of them fix ADHD - they just enable your brain so you still need tools and methods to function

[Adamadam]

Hello,

Ritalin is certainly still largely used and effective. Some people do better on it than on amphetamine options some don't. It's trial and error similar to how it is with for example SSRI's.

I also live in europe and in my country, from stimulant options, we have only methylphenidate on the market but it is possible to import a medication from abroad despite it not being approved for general sale (for example vyvanse) - a doctor has to fill out a request form, it's sent to the ministry of health, then it has to be confirmed by a specialty consultant and then the health minister has to approve it.

Once the medication is shipped you just buy it as normal with a prescription. This costs around 5-12x a month compared to methylphenidate medication so it is not common but the ministry confirms it is done.

Maybe there is some possibility like that also in Italy. You can try calling places - ministry of health, pharmacies, pharmaceutical wholesalers etc..

If you feel like another stimulant could work better for you than methylphenidate and you have the possibility and money to try it, I think it's a good idea.

Also I'd say, what might seem controversial, but I think it's better to find out whether it is possible to get this treatment in your country from someone else than your doctor because for example they might say "I can't prescribe it" when maybe the reality is they just never did before and the conversation might go very differently if for example started with "I was wondering about trying a different medication and I found out that although it isn't generally available there is a mechanism in place to get it" - I think you know what I mean

[John_White1992 in reply to Adamadam]

This would be an amazing alternative but still complicated, considering that some doctors in Italy has no idea about what ADHD is. Imagine talking about the whole process to request another medication 😂. But appreciate your help tho. Thanks

[WriterG]

Hi John, I've been taking Ritalin (the generic methylphenidate) since the year 2000, with very positive results. My greatest achievement and something I couldn't even consider doing was going back to school and earning a bachelor degree, with a 3.8 out of 4.0 grade point average! Shortly after graduating I launched my home-based, freelance writing business. I haven't tried or taken any other medication for ADD. As the saying goes, "If it's not broken, don't fix it!!"

[John_White1992 in reply to WriterG]

"if it's not broken, don't fix it". I love this. Thanks for replying. I really appreciate