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
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.�