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Prescribed Adderall Again; Thinking About Switching to Daytrana or Focalin XR


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I was recently prescribed Adderall by my PDOC. I have been treated for ADHD with it in the past with a previous PDOC, and I have been on Strattera, Intuniv, Vyvanse (lisdexamphetamine) and Concerta (methylphendidate ER). 
 
My moods have been all over the place lately. I feel less depressed, but I still have "The Sadness", especially when my mood is down. My PDOC says it's best to tackle the ADHD first and then maybe the anxiety, depression and mood will be alleviated. 

She prescribed me Aplenzin 522mg. (brand-name bupropion in the form of its hydrobromide salt [not hydrochloride] equilavent to Wellbutrin XL 450mg.) that I've had before with and well-tolerated. I was taken off it to try Pristiq. Bupropion had no side effects which is good, but it might be because it didn't do anything all in the past. She says that it might be good for my ADHD, however.

She asked me what ADHD treatment worked best for me under the prior PDOC. I was on Concerta with her and then on Nuvigil which she says is doing nothing for my ADHD.  I told her #90 and she then prescribed me #60 amphetamine salts 10mg. PO saying that I may not need as much since we have the bupropion on board. 

I am thinking about upping the dosage to #90 like she advised or switching to a different a medicine. There's a catch to her: she refuses to prescribe over 40mg. of Adderall because that's the max written under her guidelines by the state for psychiatric nurse practitioners. She is fully aware that I may require a higher dose but Louisiana doesn't allow her to write it. Around two years ago, I responded well to 20mg. in the morning with the 10mg. booster in the afternoon. I have no response to 20mg., not even an increase in blood pressure from baseline. I've experimented. It takes 40mg. of IR in one dose for me to at least to have a therapeutic response, and I need a booster later on. I'm not chasing after euphoria either. That's ridiculous. 

 
I can only come up with one reason why it isn't working: The Abilify is attenuating the effects due to being a dopamine partial agonist. I was not on aripiprazole in the past with Adderall. I now need a higher dose to break through this blockade, but she will only write 40mg. At the current dosage, it is identical to the 54mg. of Concerta I was on earlier this year in that it did absolutely nothing. Nothing. 
 
Now, my only option appears to be Focalin XR 40mg. (she will write 30mg. to start off with because I would do the same as a PDOC since I understand it's a different time release system from Concerta 72mg.) It seems to be the highest dosage of any ADHD drug there is when taken in consideration the maximum recommended dose on her guidelines.  
 
I am now taking:

Abilify (aripiprazole) 10mg. 

Adderall (amphetamine salts) 20mg. [10mg. BID]

Aplenzin (bupropion hydrobromide) 522mg. 

Lamictal (lamotrigine) 200mg. 

Nuvigil (armodafinil) 250mg. 

Neurontin (gabapentin) 1,800mg. [400mg. QID] 

Pristiq (desvenlafaxine) 50mg. 

 
What exactly is the conversion from Ritalin --> Concerta --> Focalin? 
 
Do you think that methylphenidate may be more effective with anti psychotics since it is a reuptake inhibitor instead of releaser?  

Also, I really like the idea of the Daytrana patch -- it's what the PDOC uses herself. She gave it a glowing review. How would you convert Daytrana to Concerta or Ritalin? I understand the highest dose is 30mg. but it gives the methylphenidate a 100% bioavailability. At max, methyphenidate bioavailability is 52% so it seems that Daytrana would be ~= 60mg. or more of Ritalin which would be equal ~= 72mg. of Concerta? 

 
Thanks for any advice!
 
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According to this 30mg Daytrana = 45mg Ritalin = 54mg Concerta

 

Personally, I don't find the idea of getting my methylphenidate through a patch appealing. I believe they are similar to nicotine patches which are a pain in the ass to use. I have to go through a whole routine to get it to stick to my skin.

 

I have to shave the area, wash with harsh soap before some rubbing alcohol and applying the patch, which I then have to press with my hand for 2 minutes. It still comes off around the edges during the day. I would much rather just swallow a pill.

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When's the last time you went an extended period of time without any stimulants? For me, drug holidays (as much as doctors think they're BS) are key, especially with Vyvanse. If going without stimulants puts you into a non-functioning state, it's possible you're simply tolerant. Taking a good week or two off from them helps.

 

Stimulants help me a lot too but I try not to get to the point where I -need- to take one to function throughout the day. Unfortunately after years of messing around with all those different formulatons, you might have developed a dependance and need basically to detox yourself to get the same effect. The worst of it is a week.

 

Can't the PRN though rx both XR and IR amphetamine as if they're seperate medications?

 

im useless though this is why its my 2nd post

 

ppox

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