On Beyond Ritalin

On Beyond Ritalin….

By Carol Watkins, M.D. and Glenn

Brynes, Ph.D, M.D.

Return to managed care humor page

Said Debra Ann Dilly O�Malley

O�Clad

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

the floor

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!��

  

�Amphetamines

vary on how long they go

 Dex,

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.�

 

�But I

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

try Clonidine!�

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.� 

 

 

�Now

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

its form

For

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.� 

 

�Came the

SSRI�s in the past 15 years

As

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

Try CeLuvoPaxiProZolo-Kazad� 

 

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

questions excessive!� 

 

 

�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

mild

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

can�t fail

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��

 

�Oh�…

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

They

don�t pay me to talk about that.�

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