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What's a normal ramp up of Ritalin for someone with bipolar?


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I was just dx'd with ADHD by my pdoc who wants to prescribe Strattera. My insurance, however, requires that I try two immediate release meds. So, I'm starting with Ritalin only the start schedule seems rediculously low and slow - 5mg a day for a week, 10mg for a week, 15mg for a week, and 20mg for a week at which point I'll see my pdoc again.

The 5mg has efficacy on par with a cup of regular coffee, which isn't saying much! Unless my sleep is somehow effected between now and Monday, I will call to ask for more. Meanwhile, I'm curious how people usually start off on this med.

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I was just dx'd with ADHD by my pdoc who wants to prescribe Strattera. My insurance, however, requires that I try two immediate release meds. So, I'm starting with Ritalin only the start schedule seems rediculously low and slow - 5mg a day for a week, 10mg for a week, 15mg for a week, and 20mg for a week at which point I'll see my pdoc again.

The 5mg has efficacy on par with a cup of regular coffee, which isn't saying much! Unless my sleep is somehow effected between now and Monday, I will call to ask for more. Meanwhile, I'm curious how people usually start off on this med.

Actually, I think your pdoc is being reasonable. I took Ritalin once. I don't remember the dose, but by the end of the day my pulse was 155! Probably I started with the 10mg or something. I think if I'd worked up to it I might have been able to use it ok, but I was switched to Adderall. Even working up slowly, I had some pretty odd effects from the Adderall for a while. (I was taking Dexedrine later, recently had to drop it.)

Have you tried anything to specifically test your attention? On the ideal ADD med, you wouldn't really notice much at all, except that you had better concentration, were less distractable, etc. Maybe try something you've had trouble with and see what happens.

If you really like crawling around on the ceiling, holding on by your fingernails, ramp up faster. ;-p

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  • 3 weeks later...

I think I started with 20mg/day but it might be a good idea to titrate slowly to the effective dose to avoid the weird shit you go through when your not used to it yet. The first time I took it I felt really zonked out and strange. I felt like I couldn't think so I just sat there on the bus. When I got to my friends' house I found I could talk normally it was just the thinking that was slow. It was like starting a thought then being to lazy to finish it.

The few times I took it after that I felt like I was on speed. I really wanted to work and I ran around doing everything really fast and felt very organized and on top of it all. Now I don't notice much except that when I'm at school I will actually listen to the teacher for as long as they talk even when I'm not really interested. Normally I'd start listening and lose focus and go to la-la-land pretty quickly.

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I was just dx'd with ADHD by my pdoc who wants to prescribe Strattera. My insurance, however, requires that I try two immediate release meds.

5 mg is a good startup dose, even though if your local pharmacy stocks it they're used to the higher doses that a hyperactive teenaged boy might use for maintenance.

MY preference, leans toward 2x-3x dosing of the immediate release. The reason is that a working adult's commute times are often too far apart for an SR version to really cover, while an IR dose taken an hour before starting the ignition puts you at peak function about when you really need it. The 3x might be needed if you're running into problems with fading out mid-day, or needing that extra help to make sure you do go to bed at a reasonable hour.

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The IR version set my mood a little wobbly so I switched to Concerta... which started making me tired within a couple days, and then *more* tired. Pdoc said to stop.

Next week I'll try Adderall XR, which I again know nothing about! Any input on Adderall would be great.

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MY preference, leans toward 2x-3x dosing of the immediate release. The reason is that a working adult's commute times are often too far apart for an SR version to really cover, while an IR dose taken an hour before starting the ignition puts you at peak function about when you really need it. The 3x might be needed if you're running into problems with fading out mid-day, or needing that extra help to make sure you do go to bed at a reasonable hour.

That's assuming you can drive unmedicated. My ADD is bad enough I might as well be intoxicated as unmedicated when I'm driving.

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I was started on Ritalin at 10 mg/day, 5 in the morn and 5 in the aft.

After 2 months and no improvement of concentration, distractibility, disorganization etc. it was increased to 20 mg sustained release. that lasted for 3 mths and I have just now stopped taking it (with pdoc's ok).

I've been having horrible panic attacks for months- since starting the ritalin- at the end of the day, early eve. with racing pulse, light-headedness, weak legs, churning gut.....and again, no improvement with the problems the Ritalin was supposed to address.

So it wasn't the ramping up too fast, I don't think. It's just not the drug for me. I think pdoc doesn't think I have ADHD after all, as all those symptoms seem to be mood/emotion driven anyway.

I haven't had a panic attack since stopping the Ritalin 4 days ago. Before that it was almost daily.

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I was started on Ritalin at 10 mg/day, 5 in the morn and 5 in the aft.

After 2 months and no improvement of concentration, distractibility, disorganization etc. it was increased to 20 mg sustained release. that lasted for 3 mths and I have just now stopped taking it (with pdoc's ok).

I've been having horrible panic attacks for months- since starting the ritalin- at the end of the day, early eve. with racing pulse, light-headedness, weak legs, churning gut.....and again, no improvement with the problems the Ritalin was supposed to address.

So it wasn't the ramping up too fast, I don't think. It's just not the drug for me. I think pdoc doesn't think I have ADHD after all, as all those symptoms seem to be mood/emotion driven anyway.

I haven't had a panic attack since stopping the Ritalin 4 days ago. Before that it was almost daily.

That sounds really unpleasant! I'm glad you figured out what the cause was.

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MY preference, leans toward 2x-3x dosing of the immediate release. The reason is that a working adult's commute times are often too far apart for an SR version to really cover, while an IR dose taken an hour before starting the ignition puts you at peak function about when you really need it.

That's assuming you can drive unmedicated. My ADD is bad enough I might as well be intoxicated as unmedicated when I'm driving.

I can, but my driving record suggests that I really shouldn't drive unmedicated if I can avoid it.

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