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How to avoid Concerta tolerance?


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Any tips to avoid Concerta tolerance? I feel a boost in my mood the first 2-3 days that dissapear after that, but my concentration keeps improved and I feel less tired even after a week taking it everyday.

I am taking it mainly for negative symptoms of schizophrenia and depressive symptoms.

I was thinking on taking it like this:

Monday: 36mg

Tuesday: 36mg

Wednesday: 0mg

Thursday: 36mg

Friday: 0mg

Saturday: 18mg

Sunday: 0mg

 

I cannot rest from it for more than 2 days or I get totally useless and depressed again....

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The transient improvement in mood is stimulant-induced euphoria (basically an elevation in mood), which is commonly seen for a short period of time alongside generally increased stimulant effects when starting or raising the dose of a stimulant. It recedes along with the increased effects after your body develops an initial tolerance to the stimulant, and a reduced but more consistent set of effects is present when the same dose is taken daily without breaks. Taking a break from a stimulant will reset things in your brain to some degree, effectively causing a partial regression to the starting condition upon resuming the stimulant, with the magnitude of the regression correlating very roughly to the duration of time you were off the stimulant.

When using stimulants to treat ADHD, the stimulant-induced euphoria is generally considered an undesired side effect due to its lack of therapeutic benefit and the fact that it is a tempting gateway to stimulant abuse. Of course, the strength of stimulant-induced euphoria can vary quite wildly depending on your genetics, the stimulant, your tolerance, and the dose taken. It is not always transient, especially at higher doses.

In your case, the best approach depends on what your doctor wants to achieve with the use of the stimulant. Stimulants can produce relatively sustained mood elevations at the right dose, and when used as an antidepressant, the goal of treatment may simply be to slightly elevate your mood in a sustained fashion. In that case, a higher dosage may simply produce the desired effects more consistently without inducing too strong of a mood elevation. However, you can technically cycle on and off of the stimulant (known as taking a "tolerance break" or "drug holiday") to lower your tolerance, although this method comes with a few issues including the rather problematic issue of how to manage your potentially very disruptive day(s) off of the med when you're experiencing stimulant withdrawal on top of no longer treating whatever you were taking the stimulant for. For people with ADHD, the most frequent cycling commonly seen is once weekly, with the stimulant not being taken over the weekend but taken as usual during the week. It is unusual to hear of someone taking tolerance breaks more often than that, and most people take them infrequently or not at all. Although these "tolerance breaks" or "drug holidays" were once routinely recommended by practitioners (with varying durations and frequencies), modern clinical practice guidelines for ADHD based on the current scientific evidence have declared the practice controversial and unsupported by conclusive evidence. On the basis of this they do not advocate for or against the use of tolerance breaks, although it is pointed out that the impact from a day or two off of meds can easily cause a setback or risk greater than the advantage or benefit of a temporarily-reduced tolerance (but it is also pointed out that a break from medication can sometimes be useful for assessing the continued need for medication, undetected subtle psychiatric side effects, and unnoticed beneficial effects).

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That was super informative, @JustNuts! Kind of confirmed everything I thought about taking Adderall, and I've been on and off stimulants (Concetta, Strattera, Klonopin) since I was 12. (I'm about to be 27 next month.) Thanks for posting!

Edited by heilmania
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  • 1 month later...
5 hours ago, Blahblah said:

I read that Namenda is for treating Alzheimer's disease. I've never heard of this before - is this a common Rx for stimulant tolerance?

While memantine has been studied as a direct treatment for ADHD, there is very little evidence to support this use. It is infrequently used off-label as an adjunctive treatment for either reducing stimulant tolerance or reducing stimulant side effects, although not much research on this topic exists and its benefits (if any) are very poorly studied (there's an odd assortment of rat trials with a bunch of different psychostimulant derivatives, and not much else). Its use at this stage is not very advisable due to the extremely limited and poor quality evidence.

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