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Melancholya

What should I expect from methylphenidate to know it's right for me?

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Hey all. I've been taking methylphenidate SR for a week now - 20mg once a day. Today in accordance with my psychiatrist's instructions, I have increased that to 20mg twice a day. My psychiatrist said that if it's not right for me I'll feel high, and if it is right for me I'll feel more calmed and focused. 

When taking once a day, I didn't notice any negative effects except maybe a headache (could have been something else though). The change was subtle but I noticed I have been able to talk more easily with people I don't know well (or anyone really). More conversational and I just find it easier to speak. I also have had a bit more focus and motivation to do things, but not heaps. My fatigue and sleepiness has felt better although I still feel tired at times. 

Now today, after taking the afternoon dose (and remember it's my first one), I feel weird. I have a headache. I feel dizzy/drowsy right behind my eyes. Almost like I'm tipsy and I want to go to sleep. I wrote an email to a friend earlier and had to go back and read it again as I found I couldn't remember what I'd written. 

Is this to be expected upon first starting the increased dose? Will my body adjust or does it not work that way? This is the very first time I've been on a stimulant and I have no idea if this is a sign that it's right for me or if I shouldn't take it. Even writing out this post now I feel a bit scrambled and can't quite feel a grasp on what's in my mind (though I seem to be writing coherently so that's good!). 

Any information or experiences with this med would be greatly appreciated as I'd like to understand it. 😊 Thanks so much. 

Edit: I forgot to mention that despite feeling weird I feel super calm. My daughter had a massive screaming tantrum and it didn't bother me at all when normally it would irritate the shit out of me. But I'm really calm and not bothered by anything. (maybe part of feeling sedated?) 

Edited by Melancholya

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1 hour ago, Melancholya said:

Hey all. I've been taking methylphenidate SR for a week now - 20mg once a day. Today in accordance with my psychiatrist's instructions, I have increased that to 20mg twice a day. My psychiatrist said that if it's not right for me I'll feel high, and if it is right for me I'll feel more calmed and focused. 

When taking once a day, I didn't notice any negative effects except maybe a headache (could have been something else though). The change was subtle but I noticed I have been able to talk more easily with people I don't know well (or anyone really). More conversational and I just find it easier to speak. I also have had a bit more focus and motivation to do things, but not heaps. My fatigue and sleepiness has felt better although I still feel tired at times. 

Now today, after taking the afternoon dose (and remember it's my first one), I feel weird. I have a headache. I feel dizzy/drowsy right behind my eyes. Almost like I'm tipsy and I want to go to sleep. I wrote an email to a friend earlier and had to go back and read it again as I found I couldn't remember what I'd written. 

Is this to be expected upon first starting the increased dose? Will my body adjust or does it not work that way? This is the very first time I've been on a stimulant and I have no idea if this is a sign that it's right for me or if I shouldn't take it. Even writing out this post now I feel a bit scrambled and can't quite feel a grasp on what's in my mind (though I seem to be writing coherently so that's good!). 

Any information or experiences with this med would be greatly appreciated as I'd like to understand it. 😊 Thanks so much. 

 

I don't remember the feeling of starting methylphenyldate now, but when I lost it for a couple weeks, restarting it had me feeling a little sedated and flat as well, but it wore off quickly.  

Edit: I forgot to mention that despite feeling weird I feel super calm. My daughter had a massive screaming tantrum and it didn't bother me at all when normally it would irritate the shit out of me. But I'm really calm and not bothered by anything. (maybe part of feeling sedated?) 

I think that is a part of the psychological effects of this drug, greater frustration tolerance.  

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I don’t remember ever feeling sedated on this drug but I do remember feeling very calm and focussed. I definitely didn’t get any headaches or dizziness. I did get agitation from some other stimulants but the one you’re taking never agitated me. The downside for me was that my calmness and focus came with a flatness of mood. I didn’t laugh as boisterously (I actually found it hard to laugh in general) nor was I able to get excited over things. I just sort of existed. I do think the ADD side of me without medication is much more energized, spontaneous, and fun than the drugged ADD me was. 

I had to stop taking ADD drugs because they started to cause psychotic symptoms. I don’t miss them except recently because quarantine has made focus nearly impossible for me. 

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It sounds like you are already getting benefits from the drug. 

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Those are hallmark signs of methylphenidate dosage being too high, so to me, it sounds like maybe the 40 mg/day is just a tad too much for you. 30 mg might be a sweet spot for you at this moment in time, but I don't think the methylphenidate SR tabs come in anything but 20 mg. I stand corrected: Epocrates says that (at least in the US) there are 10 mg SR tablets, but not sure about in NZ.

The extended release mechanism of the Ritalin SR/Metadate ER tablets is rather unreliable. It ranges from 2-8 hours of duration. If you want an extended release methylphenidate product, there are much more reliable products on the market (though I don't know what's on the market in NZ, admittedly).

Here is what we have in the US, anyway. Perhaps you could use this as a reference to look up what might be available to you?

  • The regular old instant release methylphenidate (Ritalin), which you could take 10 mg 3x/day for 30 mg
  • There's an instant release liquid formulation of methylphenidate called Methylin, which comes in two concentrations, 5 mg/5 mL and 10 mg/5 mL. I'm not sure about its availability outside the US. IIRC, it's mint flavored... It would seem like I would be drinking mouthwash to me... bleh... lol
  • The two biphasic release ER capsules
    • methylphenidate LA (Ritalin LA) (50% IR/50% DR (which sucks according to what I've read and heard), lasts 6-9 hours, 30 mg
    • methylphenidate CD (Metadate CD) (30% IR/70% ER, much better and more effective, it even works for me, and methylphenidate doesn't do anything for me!), lasts 6-9 hours, 30 mg
      • There are actually more biphasic release ER products, but they're brand-name only, and I don't know if they're available outside the US...
        • Aptensio XR: 40% IR/60% ER biphasic release capsules, lasts about 12 hours, 30 mg
        • Adhansia XR: 20% IR/80% ER biphasic release capsules, lasts 16 hours..., 25-35 mg (I suppose this is methylphenidate's answer to Mydayis?) Can be dosed up to 100 mg, but currently they don't make a 100 mg capsule. They highest they make is 85 mg for some reason.
        • Cotempla XR-ODT (currently only approved for pediatric patients): 25% IR/75% ER biphasic release orally disintegrating tablets, lasts 12 hours, 25.9-34.6 mg (?) (dosing is weird with this one...)
        • Quillichew ER: 30% IR/70% ER biphasic release chewable tablets, lasts for 8 hours, 30 mg
  • methylphenidate OROS (osmotic-controlled release oral delivery system) (Concerta): getting the dose right (and convincing prescribers to get it right) is tough... The dosage of Concerta doesn't directly equate to the amount methylphenidate in the tablet that gets absorbed by your body since, well, not 100% of it is absorbed by your body... I think about 22% of it is not absorbed or something like that. There's are basic formulas to determine dosage conversions.
    Ritalin → Concerta = (Ritalin * 18) / 12
    Concerta → Ritalin = (Concerta * 12) / 18
    So 30 mg Ritalin = 45 mg Concerta, which can actually be achieved by taking a 27 mg + 18 mg tablet. But if that's too much of a hassle, you could go for 36 mg (24 mg methylphenidate) or 54 mg (36 mg methylphenidate).
    Concerta generally lasts for 12 hours.
  • dexmethylphenidate (Focalin) and dexmethylphenidate ER (Focalin XR): this is the dextrorotatory enantiomer of methylphenidate and is supposedly twice as potent as methylphenidate, meaning you can dose at half the dosage and it be just as potent. For some reason, the instant release Focalin max dose is 20 mg/day (equivalent to 40 mg Ritalin), but the Focalin XR allows you to go up to 40 mg/day (80 mg Ritalin). It's a mystery. Pharmacodynamically, they're both roughly about as dopaminergic as each other (Focalin actually slightly weaker at inhibiting dopamine reuptake inhibition, surprisingly), but Focalin is much more noradrenergic (inhibits norepinephrine reuptake inhibition significantly more than Ritalin). For 30 mg Ritalin, 15 mg Focalin would be the equivalent dose. So Focalin 5 mg 3x/day, or 10 mg in the AM and 5 mg in the afternoon... Focalin XR comes in capsules in doses from 5 mg to 40 mg in increments of 5 mg doses, so 15 mg is an easy dose to get with it, and it lasts up to 10-12 hours.
  • Brand-name only products (unsure about availability outside US
    • Jornay PM: A rather interesting product... You take this in the evening and it supposedly is already working by the time you wake up, so no need to wait for it to start working while you get up and get ready for your day. It lasts "all day," no idea what that means... But like Adhansia XR, you can go up to 100 mg/day with this one. They're actually developing a methylphenidate product that will allow you to dose up to 240 mg/day supposedly...
    • Quillivant XR: An extended release liquid solution (25 mg/5 mL). That's about all I know about it. I think it lasts for 12 hours.
    • Daytrana: A transdermal patch version of methylphenidate. The dosing is funky and doesn't correlate with oral dosing. You titrate up on it all over again with the patches as there is evidently no "equivalents" between the patch doses and oral doses... comes in 10 mg, 15 mg, 20 mg, and 30 mg per 9 hours. You wear the patch for 9 hours, then take it off, and it will continue to work for anywhere from 3-5 hours after you remove it. You can take it off sooner if you wish.

Personally, I'm way more partial for the amphetamines. They're more potent and don't have that zombifying effect that methylphenidate apparently does. Way more brightening, motivating, and energizing. I don't know if amphetamines are available/legal in NZ though. Other countries have funky laws about amphetamines. I know they're 100% illegal in Japan. Like, you can't even bring them with you from your home country to travel over there. If you take an amphetamine for any condition, too bad. Switch to something else if you're going to Japan... :( 

 

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@mikl_pls, thank you! You are amazing. Here's what we have available (all ADHD medication) in NZ: https://www.pharmac.govt.nz/wwwtrs/ScheduleOnline.php?code=A223101 So I see there are other options for methylphenidate. 

I emailed my pdoc to tell him about my response to both 20mg and 40mg. He has instructed me to just stick to 20 for now, until our next meeting (which thankfully is in a couple of weeks). He mentioned possibly adding another 10mg somehow so I guess it might mean switching to Ritalin LA which I know we have here in various doses. We only have SR in 20mg (from what I can see. I could be wrong. I get very confused about all this stuff). I think pdoc wants to avoid IR at this time because my response to bupropion was so crazy. 

I am glad at least that this med is not amping me up (as he said that people who don't need it just get stimulated) and that I am experiencing the beneficial effects I hoped for, just not enough. So now I guess we just keep tweaking until I get something that works well enough. I am a bit hesitant to try an amphetamine. Again because of my horrible bupropion experience. Methylphenidate does increase my heartbeat but without the insane thumping I had on bupropion. So I can cope with it. 

Thanks everyone for your input and help. :)

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58 minutes ago, Melancholya said:

@mikl_pls, thank you! You are amazing. Here's what we have available (all ADHD medication) in NZ: https://www.pharmac.govt.nz/wwwtrs/ScheduleOnline.php?code=A223101 So I see there are other options for methylphenidate. 

I emailed my pdoc to tell him about my response to both 20mg and 40mg. He has instructed me to just stick to 20 for now, until our next meeting (which thankfully is in a couple of weeks). He mentioned possibly adding another 10mg somehow so I guess it might mean switching to Ritalin LA which I know we have here in various doses. We only have SR in 20mg (from what I can see. I could be wrong. I get very confused about all this stuff). I think pdoc wants to avoid IR at this time because my response to bupropion was so crazy. 

I am glad at least that this med is not amping me up (as he said that people who don't need it just get stimulated) and that I am experiencing the beneficial effects I hoped for, just not enough. So now I guess we just keep tweaking until I get something that works well enough. I am a bit hesitant to try an amphetamine. Again because of my horrible bupropion experience. Methylphenidate does increase my heartbeat but without the insane thumping I had on bupropion. So I can cope with it. 

Thanks everyone for your input and help. :)

For what it’s worth, bupropion shot me off the wall but I get along with amphetamines pretty well 

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Maybe if the ir is a big concern you could do 20 sr and like 5 ir to see if that’s tolerable 

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2 hours ago, Iceberg said:

For what it’s worth, bupropion shot me off the wall but I get along with amphetamines pretty well 

I have read that bupropion works more on norepinephrine than dopamine and that stimulants work more on dopamine so maybe that's why. I'm hoping I'll be fine if I try IR. 

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On 6/24/2020 at 6:32 AM, Melancholya said:

I have read that bupropion works more on norepinephrine than dopamine and that stimulants work more on dopamine so maybe that's why. I'm hoping I'll be fine if I try IR. 

I've been on 20mgLA and then I take either 10mgLA or 10mgIR in the afternoon after lunch. I have never felt "wired" or had any difficulty sleeping (actually on Ritalin, I sleep MUCH better, its as if all my focus/drive/concentration is maxed out after dinner, by the time it wears off)

Seems to usually work well, but the tolerance thing sucks. It's wierd, sometimes I actually feel more tired after taking my afternoon dose, not sure why.

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With the stims like ritalin and amphetamine most just know when they have hit the right pill/dose. The difference is that big for those who it is going the work for. SO start with a low dose and if no joy in a while increase. Wash, rinse, repeat until it gets better noticeably. It is worth it to keep on increasing a bit after it starts working. These meds have a range that they work for each individual person so there is no way to know how much is enough until you try. Stop if side effects start or are unmanageable. Or if you don't just feel right. Drop back to whatever dose you felt best on. You are aiming for the lowest dose with the most good effects.

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On 6/27/2020 at 3:07 PM, notloki said:

With the stims like ritalin and amphetamine most just know when they have hit the right pill/dose. The difference is that big for those who it is going the work for. SO start with a low dose and if no joy in a while increase. Wash, rinse, repeat until it gets better noticeably. It is worth it to keep on increasing a bit after it starts working. These meds have a range that they work for each individual person so there is no way to know how much is enough until you try. Stop if side effects start or are unmanageable. Or if you don't just feel right. Drop back to whatever dose you felt best on. You are aiming for the lowest dose with the most good effects.

Agree with @notloki... slow and steady is the best approach for stim dosing. I went through at least 5 different dosing strategies before finding what works, and I learned that the extended release meds don’t do much for. Me 

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