On Beyond Ritalin....
By Carol Watkins, M.D. and Glenn
Brynes, Ph.D, M.D.
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Said Debra Ann Dilly O’Malley
Who had AD/HD and wow was it was bad,
“I’ve tried Ritalin in the morning and night
Doses low, doses high and it just isn’t right.
I’ve altered dose intervals; tried the SR.
I’ve gone on-line lots; talked to friends near and far.
I’ve learned all there is on this darned ADD.
But my mind still can’t focus, just how can this be?
My children and husband are ready to bust
I think I’ll just give up and say I’m a klutz.”
Then she almost fell out of the chair on
When I booted my laptop, showing symbols galore.
The chemical structures appeared on the screen
Next to pills red and yellow and capsules of green.
And I said, “You can stop if you want, leave it be,
Because some people stop and give up, but not me!”
“Now your Ritalin’s great with, say, 60 percent
(Or 50 or 80) we get improvement.
In people I meet there are things we achieve
That we never could get if we just let things be.
It may take some work, but you really can mend.
A consultant’s work starts where the first-line stuff ends.
My bag of tricks starts with these stimulants three.
Amphetamine, Desoxyn, and Cylert they be.
But most times just one ‘cause I’m wary of two.
If Desoxyn’s abused, the Feds might call on you
And the maker of Cylert warns of livers quite yellow:
‘If your patient takes Cylert, draw blood from that fellow!’”
vary on how long they go
Adderall, Spansules: from fastest to slow.
Some kid told me Adderall’s sweet going down.
I’m not sure I believe it; that kid was a clown.
Dex Spansules are nice: cover homework and sports.
And let you down easy; less rebound of sorts.”
still feel so mad and I snap at my spouse.
Though I concentrate well, it’s still bad at my house.
I’m impulsive and jumpy, and sometimes quite mean—“
But I said, “All’s not lost; we can
I’ll check your blood pressure and EKG too.
But don’t stop it too quick--BP might hit the roof.
Tenex may be milder; it may last all day;
We like it in Baltimore; what else need I say?”
“Way back in the eighties when you’d just learned to walk.
Adults got tricyclics so the Feds wouldn’t squawk.
They’re not Schedule II, and they do work OK
So you won’t be distracted through the night and the day.
But you’d best eat your veggies
Kiss your contacts goodbye.
Your ‘water’ may slow and your mouth will be dry.
You maybe will faint when you stand to get dressed
But you’ll keep right on task and you won’t get depressed.”
in the late ‘90s and Y2K too
We’ve lots of keen antidepressants for you
Some may help, some may not tame your ADHD
I’ll give you a list of them now and we’ll see
I’m afraid they’re so many, each can’t have a verse
So we’ll put them in groups; and attempt to be terse.”
“Wellbutrin looks like Dex if you check out
a great many folks, It may soon be the norm.
It can help you stay focused, treat your saddest moods too
And you won’t wonder where your dear love-life has flew.
It lasts many hours and plus, I’m not joking
If you take it a while, It can help you stop smoking.”
SSRI’s in the past 15 years
the answer to all (or a menace to fear?)
For ADD’s core, they don’t do very much
But they help irritation, depression and such
So if you are angry, distracted, and sad
Then she said, “I’ve
been noticing moods up and down
First I’m so sad and guilty, but then, I’m a clown.”
I said, “I can fix that, it may be much wiser
To give you a trial of a mood stabilizer!”
“But if Depakote helps, am I manic-depressive?”
“I don’t know. If it works don’t ask
“There was Lithium first and it
may be a shock
The stuff is so natural, it comes from a rock!
But it can cause shakes; make your acne come back
And for rapid mood cyclers,
Might not put you on track.”
“Neurontin, or Depakote can be quite
And they can help lots for a grown-up or child”
But she said, “They help
some, but I still don’t feel great.
My weight’s ballooned up to three hundred and eight.”
I said, “Let’s be patient; there’s more to this tale
A consultant continues
When the third line drugs fail.”
“I know what I’ll do and it really
Let’s mix a few up, make a custom cocktail.
We’ll mix and we’ll match from these drugs on my plate.
Polypharmacy’s good for those comorbid states.”
“On the far horizon with my
special spy glass,
I watch and I wonder what may soon come to pass.
I see troops of new compounds,
Each may be my new buddy
Pending FDA blessing or multi-site study.
Methypatch, Atomoxetine, Estrogen too.
We’ll soon have more choices
To add to this crew.”
“But what if
your big bag of pills doesn’t work?
Now I focus and see that my husband’s a jerk.
I interrupt people at home and at work.
I forget all my
appointments and lose all my friends…”
I did mean to mention
there’s therapy too.
For groups and for couples and maybe just you.
There’s coaching, day planners all here in my hat.
Don’t expect me to rhyme them…
don’t pay me to talk about that.”
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