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Old 10-19-2007, 05:49 PM   #1
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Wellbutrin SR for ADD???

Hi all....my 19 year old daughter who has had problems since she was 14 was recently diagnose with ADD Type 6 "Ring OF Fire"/Mood Disorder by one of Dr. AMEN's clinics using SPECT Imaging as well as a thorough psychiatric evaluation and testing. We had lost over 4 years not knowing what was going on and our daughter refusing to accept that something was wrong, that is, until she saw a visual scan of her brain all lit up with hot spots all over the place!!! If anything was going to convince her this was it!!

The treatment plan recommended to us was that she be started on an anticonvulsant (Lamictal) since the mood centers of her brain were involved which would stabilize the ups and downs and irritability that she was experiencing. After she was up to a therapeutic dose of Lamictal and she was still "stuck in having things her own way" or experiencing impulsiveness it was suggested that an antidepressant should be added. And after that if needed an ADD med such as Daytrana be tried.

Our daughter is away at college in her second year. She started the Lamictal at the end of August and has been following up with a psychiatric Nurse Practioner at college. She brought a copy of her SPECT findings as well as her diagnosis using testing, history and a thorough intake as well as the suggested treatment plan for the NP to look over.

She went to see the NP for the second time who had decided to increase the Lamictal the first time they met to 150mgs before adding anything else. I was really happy with this plan.

Meanwhile we have noticed some improvements as has our daughter. When she calls her conversations are not as flighty with her jumping from one subject to another or her talking about something going on in the room at the same time. It was actually pleasant talking to her and we didn't end up in an argument with her hanging up like we had going on last year. She also said that she was not as upset as usual by things people said or did and was able to sleep better too. The biggest thing was that she didn't feel as if she had to be doing something every minute of the day and was able to relax more.

Today the NP decided to start her on Wellbutrin saying that it would help her ADD and wasn't a stimulant. I thought that she was perhaps convincing my daughter that this was an ADD med since I always throught of it as an antidepressant but when I looked into it I did find out that it is used for ADD when I read that it is also sometimes used to treat episodes of depression in patients with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods) and to treat attention deficit disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age). This definitely describes my daughter and I was actually not only surprised but impressed that the NP picked this particular med and was relieved especially since I was concerned about my daughter's drinking habit and use of recreational drugs including Adderall that was not prescribed to her. At this time I am convinced that alot of her alcohol and use of other substances had more to do with self-medicating than anything else.

So.....I was wondering if anybody else was ever on Wellbutrin for their ADD and how it worked and what to expect.

Any insight and advice would be most appreciated.

Thanks ~ Goody

Last edited by goody2shuz; 10-19-2007 at 05:50 PM.

 
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Old 10-20-2007, 04:55 AM   #2
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Re: Wellbutrin SR for ADD???

Hey Goody,

Wellbutrin is used off label for ADHD. The bottom line is if it isn't a stimulant it doesn't work - at least not for ADHD symptoms. Wellbutrin is a stimulating antidepressant in the same class as Strattera but without most of Strattera's nastiness. So it just may do the job.

Better than Daytrana? It depends. The Daytrana patch is hands down the most consistent delivery system. The patient isn't subjected to the ups and downs of most other methylphenidate meds. That significantly reduces its abuse potential because the patient does not feel undermedicated at any time during the day. In my book undermedicated is worse than not medicated.

Wellbutrin SR is also consistent. I would opt for Wellbutrin SR over any methyphenidate med except Daytrana or Concerta. But Wellbutrin isn't as stimulating as methylphenidate.

Is Wellbutrin SR less risky for the bipolar? I haven't read as much but suspect not. Daytrana releases 2.5mg methylphenidate/hour if I'm not mistaken. Methyphenidate is metabolized quickly so blood levels never get too high. My best guess is Daytrana is less risky for the bipolar.

Relevancy: If the Wellbutrin SR works, all is well. If it doesn't work, it'll put your daughter again at risk for self-medication.

If I remember correctly, Amen's clinic recommended Daytrana. If correct, why corrupt a plan that up until now has worked well?

One of the things I had to learn for my work is not to switch technologies in the middle of a project. Best way I can think of to screw up a perfectly good program - code or med.

I wanted to start a thread titled "ADHD Remediation and Reality." The few that I think it would interest will read this post so I'll do it here.

Past couple years I've been experimenting with several "natural" ADHD remedies. Fact is, our pantry is filled with hundreds of dollars worth of "natural" failures.

Some of these substances namely DMAE and most recently phosphatidyl serine seem to help. Both are cheap and relatively low risk. But neither are as effective as Ritalin.

It would be my pleasure to quit the Rit and go hug trees. But I can't.

I get paid well for my work - when I can work. The funny thing about our society is no one gets paid well unless they produce well. I can afford very little inattention and hyperactivity while I'm working. My production goes down the toilet.

I'll quit the Rit the day someone gets the rest of the world to accomodate me.

OR ---

I'll quit my job as soon as I find someone to pay our bills. Then quit the Rit.

Bob

 
Old 10-20-2007, 06:33 AM   #3
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Re: Wellbutrin SR for ADD???

I use Wellbutrin in conj with Adderall. I tried WB first, it works great as low level coverage. When I went on Adderall, it seemed to lose something when I stopped WB. So, we added it back. I believe that is smooths out the peaks and valleys with Adderall

 
Old 10-20-2007, 11:55 AM   #4
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Re: Wellbutrin SR for ADD???

Quote:
Is Wellbutrin SR less risky for the bipolar? I haven't read as much but suspect not.
I would say that it is definitely NOT less risky in BPD - it is MORE risky. Wellbutrin flipped me into hypomania.

Wellbutrin is being prescribed more frequently for ADD, especially since many ADD'ers have comorbid depression. But, it's tricky with BPD, so be careful.

 
Old 10-20-2007, 07:01 PM   #5
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Re: Wellbutrin SR for ADD???

Thanks everybody for your posts!!!

Bob...once again your experience and knowledge is much appreciated. You are right in regard to the AMEN Clinic's recommendations, however, I had failed to mention that in the treatment plan it was suggested that we start with an anticonvulsant and once it was at a therapeutic level if still experiencing the "getting stuck" (stubborn hardheaded behaviors) that adding an antidepressant may be beneficial. Our daughter was started on Lamictal which is also a mood stabilizer. The treatment plan also mentioned that the pdoc would be interested so see if she would also benefit from one of the classic ADD meds suggesting the Daytrana patch.

I guess that with our daughter's history (she provided the NP a copy of the diagnosis and suggested treatment plan from the AMEN clinic) the NP felt that trying the Wellbutrin SR might be worth a try in the sense that it would serve as both an antidepressant as well as an ADD med and not a stimulant that could be abused (although the patch probably has a low chance of being abused). I thought that it might be worth a try and with the mood stabilizer on board the chances of it inducing a mania are signifcantly less. If our daughter could significantly improve with one med such as Wellbutrin rather than two I figured it was worth a try.

One thing that I found while looking into a site that had personal accounts of people's experiences with Wellbutrin SR in treating their ADD was that...

1) It was quite effective and surprisingly so in treating their ADD

2) It took away the urge to use drug and alcohol that they had bee using to
treat the symptoms of ADD that they were having. One person actually
mentioned how she smoked alot of marijuana and after starting Wellbutrin
she had no need to. Wellbutrin also was successful in allowing some of the
people to quit smoking (which is something our daughter has been trying
to do especially since having bronchitis multiple times in the past year.

3) Some had even said that it worked even better than the other ADD meds
that they had tried such as Adderall and Ritalin.

4) It is also a great med used to treat SAD (seasonal affective depression)
which our daughter feels that she has. She hates the winter and states
that her mood is definitely down during the winter months.

Kjrunner & Fine&Dandy ~ thanks for sharing your positive experience with Wellbutrin and for you genuine concern about the possibility of it triggering mania. Fine&Dandy....were you on a mood stabilizer when that happened with you??? I know that was my first concern but when I looked at the info the Wellbutrin is not a SSRI but rather is a NDRI (Norepinephrine Dopamine Reuptake Inhibitor) and less likely to trigger mania....but still there is a chance that it will in somebody who is truly BP. With the Lamictal as a mood stabilizer I feel as if we have an extra safety net in place.

I have spoken to my daughter about the things to look out for and am confident that she will call me if she has any problems.

Thanks again for your wonderful posts and I will try to keep you updated with how things go. I am glad to have heard that others have heard that Wellbutrin can be used for ADD since I wasn't aware of that.

((((HUGS)))) and thanks ~ Goody

 
Old 10-21-2007, 01:28 AM   #6
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Re: Wellbutrin SR for ADD???

Hi Goody,

Interestingly, of the 2 antidepressants that clearly flipped me into hypomania, neither was a SSRI. Wellbutrin did it and Effexor did it. They are both very stimulating. So, do warn your daughter to watch for the signs - especially insomnia!

And no, I wasn't on mood stabilizers at the time.

I agree with you that Wellbutrin is worth a try, just warn your daughter to be hyper-alert to the signs that she is getting into trouble.

Good luck!

 
Old 10-21-2007, 03:26 PM   #7
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Re: Wellbutrin SR for ADD???

Goody,

This post may appear to be an attempt to hijack your thread but you'll find it relevant at end.

KjRunner,

You and I are very close psychological twins. I find that interesting because we differ from gender to upbringing to every other psychological property. I can only conclude that you and I are part of an psychological pattern that is rooted in biology not environment.

You may be able to replace Wellbutrin and Adderall with concerta.

What follows is my Concerta recommendation basis.

The two years following my diagnosis was very difficult for me med wise. I must take part of the blame. But the balance I am going to place right where it belongs - on the medical "profession."

The short of it: I resisted stimulants for about six months after a doctor suspected ADHD. During those six months I was losing money faster than the Feds. My deficit budget was because to I couldn't work and I can't raise taxes. Brain problems were between me and a paycheck. I went to my family doctor and told him I need speed. Honestly I said it just like that. He knows me. He says "adult ADHD is a very complex disorder that requires a specialist. I don't want to prescribe because I don't know what I am doing. You need a shrink." I said "ok." The HMO I had at that time would not allow my doc to refer a shrinK. I was livid. My brain is more important to me than my liver. Can refer a liver guy. Can't refer a shrink. What gives?

So I go to my HMO's web to find their shrinks - zillions of them. I picked the one that was geographically closest to me. That is not a good way to choose a doc that will work on my brain. I called and his girl says, three months for an appointment. I took it.

Three months? I'm desperate. I go back to fam doc and tell him it's three freaking months till I see the shrink and I am going broke. Give me a speed prescription so I can get off the ground. I hounded him and he acquiesced. He writes a script for two 10mg generic ritalins AM/PM because my HMO won't pay for any ADHD med other than generic - not Strattera, Adderall, Ritalin LA, Concerta, etc. Generic or pay out of the pocket. With my deficit budget I took the generic.

So I get my generic Rit (methylin) and take my AM dose. The lights came on for about two hours. I was wonderful. I was "cured." But had to wait another couple hours for my noon dose. Same deal - for about two hours the lights were on - then off again. So I go on the net and find that the generally accepted max for Rit is 60 mg per day. Well, this is a no brainer - I'll fill in the blanks to determine how many pills I need, tell doc and he'll write me an update. I tell doc that 5 10mg pills per day is pay dirt. He went ballistic. He was screaming at me "how dangerous what I did was." He carried on like a lunatic. I told him I looked it up on the net and 60 mg is max. I only need 50. He kept on ranting. Then he writes me a script for 2 20mg Ritalin SR. Please note that SR is old technology that doesn't work well.

I take the AM 20mg pill and about 2 hours later the lights went out and an overwhelming depression came over me. Two years later I discovered that 20 mg in one shot is too much for me. How I wish that I hadn't hounded family doctor. He was right. I was wrong. ADHD meds should not be managed by a family doctor.

Finally I get my shrink appointment. The guy is a bozo. He knew less about ADHD than my family doctor.

I find another shrink that shingled ADHD. I got an appointment in two weeks. I tell him that the two 20mg pills isn't enough. No problem. He upped it sequentially to 80mg. I kept getting worse and worse. So I fired him too. And found another family doctor that I knew has ADHD kids. She prescribed Adderall maxing it at 40mg / day. I got worse. Damn.

Back to the web. I discovered that 20mg at a shot is too much for me. And that is why 5 10mg spread out over the course of the day worked so well. Beginners luck. I called the second shrink that I fired for an appointment. We hashed it out. When I said two 20mg Rit isn't enough he interpreted that to mean that 40 mg does not control my ADHD symptoms. He understood me that way because that is what I meant. I wasn't able to distinguish between lack of efficacy and a depressive reaction. Now that he understood, he knew what to do - prescribe Concerta. Well, at that time financially I am doing better but just barely making ends meet. So we went with 3 20mg generic cut in half taken every 1.5 hours or so. Works but is a pain taking 6 doses per day and frequently I screw up on the timing.

I am calling tommorow to request a Concerta script. I can afford the Concerta now and could have afforded it three years ago if I only knew then the direct relationship between a meds efficacy and my ability to function.

Goody,

Don't let that college psychiatric Nurse Practioner over-ride Amen's recommendations. Someone just posted how important it is to get - not just a shrink - but an ADHD specialist shrink. Dr. Daniel Amen is the preeminent ADHD specialist. All other shrinks need to catch up. Anyway I felt the details I provided were necessary for substantiating my "don't do that recommendation."

Bob
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Old 10-21-2007, 07:11 PM   #8
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Re: Wellbutrin SR for ADD???

<removed>

I understand what you are saying regarding Dr. Amen....from what I see we are going by his recommendations being that the next step suggested was to add an antidepressant to help my daughter through that "getting stuck" periods. The NP received an entire copy of Dr. Amen's findings and treatment recommendations and even had my daughter sign a release form in order to obtain any copies of her medical records. I am glad because I really don't know what my daughter handed over to her and what she didn't.

Anyway the way I see it the NP's adding the Wellbutrin doesn't go against Dr. Amen's suggestion for treatment now that I have learned that it is used not only as an AD but also to treat ADD. It may even eliminate the need for the Daytrana patch which would be the next step so we will see if the Wellbutrin does the thing and if not re-evaluate.

Also ~ We are entitled to one followup appointment with the pdoc at the AMEN clinic and he suggested that we line up a conference call with me, himself and my daughter and her pdoc which I think that I am going to do when my daughter next meets with the NP. That way the NP should have the medical records in hand and we all can get on the same page in regard to how my daughter is doing and if he agrees with the treatment.

I checked in with my daughter today and she said that the Wellbutrin seems to be making her more tired. I know that there is an adjustment period and told her to hang in there and we would give it a few weeks and if it still posed a problem we would call the NP. I told her if things got worse to call me and that I would in the meantime be checking in with her since this is a new med we are trying.

I so appreciate everybody's input and will keep you all posted with how things are going.

Thanks again for your wonderful support.

~ Goody

Last edited by mod-anon; 10-21-2007 at 10:46 PM. Reason: do not discuss moderator decisions

 
Old 10-24-2007, 07:16 PM   #9
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Re: Wellbutrin SR for ADD???

Well when they say it's too good to be true it probably is....right??? I noticed the past few times by phone that my daughter was back to her jumping from subject to subject. One day she had admitted (as I had guessed ) that she had forgotten to take her Lamictal.

Well the other day when we spoke and was only on the Wellbutrin for less than a week she started telling me that her roommate told her that she was on it and it made her all emotional. I told her that everybody is different and that it was too soon to tell what the med could do. Well today when we were talking she said that she had already tried increasing the Wellbutrin (which is before the NP told her too) and that it wasn't working like the Adderall did. I told her that she should give it a chance and even the NP would agree that it was too soon to consider another med before giving this one a fighting chance. She went on to say that she knows what she is doing and that she should be able to do what she wants to do regarding meds and that she went to get her own doctor because she didn't want me interfering with her. I was hearing all the same argumentiveness and the "getting stuck hardheadedness" all over again that seemed to be better when she wasn't on the Wellbutrin. It is difficult to tell how things are going while she is away but I couldn't help but be concerned about her playing with the meds and not taking them as prescribed and thinking that she knows what is best for her. Everything I told her she cut down and she said that she new that the Adderall worked and that nothing else would...I told her that by Dr. Amen's treatment plan that it was decided to do the anticonvulsant (Lamictal) and then try to add an antidepressant and then the Daytrana. She said that she knew that Adderall was the #1 ADD med and that was what she should be on....I told her that I had my concerns because it was addictive and that with her use of alcohol and drugs that I had my concerns about that and that there were just as effective meds such as the recommended Daytrana patch. She said that she needed the Adderall and I told her that since she was 14 she used caffeine and any stimulant that she could get her hands on such as Ephedra(diet pills).....she said that was what worked for her and that she needed it. I told her to talk to her NP and that she probably would agree with me, that she knew more than her roommate and wouldn't be pleased that she was not following her prescribed instructions. She said that she didn't care, that she knew what was best for her and that she wasn't going to tell me anything anymore and didn't have to. This was a complete turn around than before she started the Wellbutrin and it is almost as if it is making her worse in terms of behavior. I could tell by how argumentative she was being on the phone.

Any advice...she is 19 now and pointed that out.....I was about to schedule an appointment with the doctor from the AMEN clinic to conference in with the NP, my daughter and myself as a followup and was discussing this with my daughter when she brought this all up.

I am open to any suggestions.....

Thanks for listening ~ Goody

 
Old 10-25-2007, 03:28 PM   #10
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Re: Wellbutrin SR for ADD???

Goody,

Don't even think about Adderall. Amen recommended Daytrana for very good reasons.

Bob

 
Old 10-25-2007, 07:10 PM   #11
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Re: Wellbutrin SR for ADD???

Bob ~ Any suggestions on how to go about keeping my 19 year old daughter from obtaining a script for Adderall besides praying and tying her down???

I am laying low (for now )....my instinct tells me that the Wellbutrin isn't doing what it is suppose to do and has worsened things and if I lay low my daughter may call me and share this with me. I am confident that the NP will not do anything rash because ....1) My daughter handed over a copy of DR. AMEN's report and treatment plan to the NP(she may have removed some pages but they are numbered and it would be noticeable if she did, and, 2) The NP had my daughter sign a release to get records from Dr. AMEN at her last visit (so if anything IS missing she will get a good picture because in the history it is CLEARLY stated how we {her parents} are concerned about her abuse of alcohol and drugs including those not prescribed to her.)

I was thinking that my daughter probably does need the stimulant but as you suggested, I would definitely feel better if it were the Daytrana patch. But how do I make sure of that when/if my daughter will not allow me to talk with the NP????? I suggested that she call me at her last appointment so we could conference but she didn't so how am I to do anything??? I was thinking that perhaps I can research where my daughter is going for counselling by calling the college (she did say it was through the counselling services at the college) and then sending an email sharing my concerns. I know that the NP is not allowed to disclose information but I don't see a problem with my voicing my concerns as a mother. I may have a problem with getting through the red tape but it may be worth a try.

When I looked back at AMEN's plan it said that use of an serotonin-type agent such as Lexapro could be used if the "getting stuck" (stubborn hardheaded) behaviors were not reduced. I could possibly email the pdoc at AMEN clinic and discuss my concerns with him and set up that conference call but if my daughter decides she doesn't want me included in that there is nothing I really can do since she is 19. But yet, even if I weren't included my email could definitely play a role in how the overall followup goes when the AMEN doc could share his reasons about using Daytrana rather than the Adderall. So I will keep my fingers crossed that my daughter will allow for this conference call so we can have a smooth transition of her being followed up by the NP at school.

Also, Bob, IF my daughter wants to get Adderall she can make an appointment with any doctor until she gets it but I am doing my darndest to make sure that doesn't happen. But there is only so much I can do since she is away at college and also 19 where legally I have no right to intervene in her overall health care.

So....I must hope that she comes to her senses...she has been cooperative and showed significant improvement when on the Lamictal. There was even a day on the phone that I noticed that she didn't take her Lamictal by the way she was jumping from one thought to another.

I first noticed a change in our conversing by phone this past week which is when she started the Wellbutrin. I notice that the Wellbutrin is a NDRI (Norepinephrine an Dopamine reupdake inhibitor) and not a serotonin-type med as suggested by AMEN so that may be the culprit and perhaps my daughter is right.

I am torn between trusting my daughter (who has yet to earn that trust but seems to feel that she needs the help) or continuing to see how she does on the Wellbutrin since it has only been a week.

This really stinks....how I wish that I had known what I know now 3 years ago when I could have helped her. Now I have to hope that she wants to help herself. Oh and I hear that tomorrow is a full moon and that the few days before and up to a full moon may worsen ADD/BP behaviors....is that true??? Perhaps that has a little bit to do with how things went over the phone last night.

Later...and thanks for the input ~ Goody

Last edited by goody2shuz; 10-25-2007 at 07:34 PM.

 
Old 10-26-2007, 05:09 PM   #12
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Re: Wellbutrin SR for ADD???

Goody,

A difficult concept for all except those afflicted is ...

ADHD screws-up our life - BAD.

We so desperately want to be well that we often make bad decisions.

Your daughter wants to be well. I am sure of that. She thinks Adderall will make her well. Maybe, then again, maybe not. Experimenting with drugs or "natural" scat that does not work is awful. Been there. Done that. Don't subject her to it.

Get her on Daytrana and see what happens. We need to feel that we are living up to our God given abilities. That lack is the real ADHD tragedy and why many will turn to street remedies.

Go from there.

Bob

 
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