Strattera

Ritalin is a Schedule II controlled substance under the Controlled Substances Act:

These drugs are only available by prescription, and distribution is carefully controlled and monitored by the DEA. Oral prescriptions are allowed, except that the prescription is limited to   30 doses, although exceptions are made for cancer patients, burn victims, etc. No refills are allowed. (Wikipedia, emphasis mine.)

Cocaine, by the way, also is a Schedule II controlled drug.

So, while Ritalin works very well on Alan, it's impossible for us to put him on Ritalin.  We can't get more than a 30-day supply at one time, and we would have to get a new prescription for him every month. This may be a hassle but is very doable when you live close to your doctor, and close to your pharmacy that actually stocks Ritalin.  It's less doable when you live thousands and thousands of miles away in a country that, incidentally, has never ever heard of ADHD or Ritalin. You will note that there are no exceptions for Expats in that list above. It's just not feasible for us to fly to the US every 30 days to get a new prescription.  (Although, now I wonder whether our international health insurance would pay for that.  Hm.) 

Now, we can live without Ritalin but it's really a depressing thought that, if we were to depend on it, we had to leave our Expat lives behind and move to the US or to Germany.

Moving right along.  We watched Alan and we had some problems reported back from school.  It's only the beginning, but we feared that without intervention, he might eventually enter a perpetual loop of problems - punishment - more problems.  We are nerdy people and google everything.  I've also written a longish paper on "Adolescent ADHD", so we know pretty much what to expect in the future.  ADHD children have high risk factors for addictive behaviors, criminal behaviors, life-long problems with social and emotional relationships.  We just don't want Alan to enter this loop if we can help it.

So, Ritalin is out.  Strattera is in the game.

The crux of all these meds is that they really ought to be monitored by a doctor.  Progress or non-progress needs to be noted, in order to terminate the drug application if the desired outcome is not achieved. We're lucky enough to have a pediatrician who allows for our unusual life situation.  He was ready to give us a prescription for Strattera for 3 months, and to monitor Alan's progress via weekly telephone calls.  So we keep lists and check off good and bad behaviors.  We gave a list to his teacher, to see whether there is any improvement in the school setting.

This is what we noted after two weeks on the drug:

• He sits through breakfast without getting up, fidgeting around, or not eating.  He eats with a healthy appetite which is great.  He finishes a bowl of cereal or an omelette of two eggs every morning.
  
• We did a craft today where he had to string beads to long chains which we then tied to a little old twig and hung into a tree outside as a mobile.  He sat and strung beads for an extended period of time.  When he knocked over a little container with tiny beads, he spent ten minutes sorting them and putting them back into the container.
• He started making elaborate constructions out of Lego.
• He reads by himself.

They say it takes about four weeks for the Strattera to work its wonders.  So far, so good.  Of course, other than Ritalin which can be taken whenever necessary (allowing to skip "good" days, only using it on "bad" days), Strattera has to be given continuously.  It builds up a depot in the body which needs to be maintained.  Miss a day, and you pay for it.  It's  darn expensive, it's a much newer drug, and little is known about long-term effects.  Let's hope for the best.  So far, the side effects are minimal, and the good effects seem to be coming along.  We shall see.

Comments

[Lorraine]

It sounds like you're on the right track, for sure. I will keep you guys in my thoughts for continued upward swing.

Whenever I feel like whinging about whatever latest Med Drama may be happening to us, I will, from now on, think of y'all and how easy *we* have it. Thank the gods for doctors who know you well enough to trust your reporting and will treat over the phone.

[claudia]

Oh, Lorraine. You really don't need to be bashful, and there is NO comparison between our medical problems. You deserve a badge or a medal or a million bucks for your way of dealing with Alec's sickness. I don't know how you do it (well, I do, sort of), and I admire you deeply for your courage and your strength. It makes me feel ashamed that I'm whining about not obtaining meds when it's really "only" about something harmless as ADHD.
Thanks for the good wishes, and we are keeping you and Alec in our thoughts and prayers, as always.