Jump to content
CrazyBoards.org

Time for a new stimulant??


Recommended Posts

Started back on RitalinLA & it might as well be a sugar pill because i notice nothing....It worked for me in the past. I'm not sure if it is not working now because I am on Lamictal? I thought Lamictal could be making in ineffective.

Will ask my pdoc, but should I go up in dose or try something else? What should I try? This is for focus issues but more for motivation, interest & general apathy (depression symptoms)

Link to comment
Share on other sites

I take Ritalin and Lamictal, and I have no problems with Lamictal interfering with the Ritalin. As an observation, 20 mg of Ritalin is a somewhat small dose. I take 30 mg which is still on the smallish side. I've seen people on 60 mg or more. Also, Ritalin is not a miracle med. It helps me to wake up and gives me a little more energy and better concentration, but it does nothing for my apathy and lack of  motivation. That's where Abilify helps. But I notice you are on 5 mg of Abilify. Abilify did nothing for me until I hit 10 mg.

In my experience, Ritalin is a milder stimulant than the amphetamines. The amphetamines also did nothing for me to pull me out of my depression. I had to give up on amphetamine because I couldn't handle it. It was like racing the engine of a car with the brake on for me.

  • Like 1
Link to comment
Share on other sites

10 hours ago, jt07 said:

I take Ritalin and Lamictal, and I have no problems with Lamictal interfering with the Ritalin. As an observation, 20 mg of Ritalin is a somewhat small dose. I take 30 mg which is still on the smallish side. I've seen people on 60 mg or more. Also, Ritalin is not a miracle med. It helps me to wake up and gives me a little more energy and better concentration, but it does nothing for my apathy and lack of  motivation. That's where Abilify helps. But I notice you are on 5 mg of Abilify. Abilify did nothing for me until I hit 10 mg.

In my experience, Ritalin is a milder stimulant than the amphetamines. The amphetamines also did nothing for me to pull me out of my depression. I had to give up on amphetamine because I couldn't handle it. It was like racing the engine of a car with the brake on for me.

Interesting. Yeah, I tried to go up to 10mg, but had a ravenous appetite, getting up to eat everything in the middle of the night. Increased appetite & weight gain are deal breakers for me. My pdoc had me do blood sugar, kidney & liver tests before starting Abilify. A/P's and the metabolic & TD side effects really worry me...these things sneak up on you over time (or sometimes immediately). I've tried the gamut of them and they really screwed me up in the past.

I also read (drugs.com) that the typical dose for Abilify is 10-15mg, and it has not been clinically shown as more effective in doses above 15mg. I know, YMMV.

Do you think that an increased dose would take effect within a few days? Or dose it take weeks to be noticeable? I wish they would hurry up and come up with some new atypical antidepressants that work more on dopamine. :-( I am running out of good options.

 

Link to comment
Share on other sites

12 hours ago, Iceberg said:

Adderall could be a logical option ...or vyvanse 

Getting a script for Ritalin was a bear - I think it will be near impossible to get Adderall. I don't even know if it would work for apathetic depression. Ritalin does help with focus and seems to help with energy a bit, but I'm afraid my main problem symptoms are the lack of interest/pleasure/motivation.

I'd be afraid to start any heavier duty stimulants.  I don't have major energy issues or narcolepsy or anything. I can focus if it's something I am interested in (problem is, nothing is interesting to me)

Sometimes I just want to scratch all the meds. I am more likely to experience more severe, sad moods without medication, but in contrast, i also had more good moods and some interest in things so it's a catch-22. Now I just feel a bit flatlined, not completely numb, just blah & bored beyond words. Is this what "healthy" is?

12 minutes ago, Blahblah said:

Interesting. Yeah, I tried to go up to 10mg, but had a ravenous appetite, getting up to eat everything in the middle of the night. Increased appetite & weight gain are deal breakers for me. My pdoc had me do blood sugar, kidney & liver tests before starting Abilify. A/P's and the metabolic & TD side effects really worry me...these things sneak up on you over time (or sometimes immediately). I've tried the gamut of them and they really screwed me up in the past.

I also read (drugs.com) that the typical dose for Abilify is 10-15mg (as an adjunct for major depression, the dose is only 2-5mg), and it has not been clinically shown as more effective in doses above 15mg. I know, YMMV.

Do you think that an increased dose would take effect within a few days? Or dose it take weeks to be noticeable? I wish they would hurry up and come up with some new atypical antidepressants that work more on dopamine. :-( I am running out of good options.

 

 

Link to comment
Share on other sites

  • 3 weeks later...

Can't say I've taken Ritalin, but I do find that Vyvanse helps a bit with anhedonia and finding pleasure in tasks. I feel more task reward which stimulates me to complete tasks. Completing my work FEELS GOOD. And Vyvanse is relatively strong so you don't need much. I was on 20mg of Adderall XR, cut over to 40mg of Vyvanse and felt it was too much so we just dialed it back to 30mg. Helps with motivation a bit but that effect generally goes away after you adjust to it. Stimulants are only a part of the solution when you're dealing with ADHD AND depression.

Link to comment
Share on other sites

On 6/4/2017 at 0:53 PM, Blahblah said:

Started back on RitalinLA & it might as well be a sugar pill because i notice nothing....It worked for me in the past. I'm not sure if it is not working now because I am on Lamictal? I thought Lamictal could be making in ineffective.

Will ask my pdoc, but should I go up in dose or try something else? What should I try? This is for focus issues but more for motivation, interest & general apathy (depression symptoms)

I've generally heard nothing but bad things about Ritalin LA, and my pdoc said she rarely prescribes it and says it poops out in the middle of the day often.

If you want to stick with an extended release methylphenidate stimulant, you could try:

  • Metadate CD (generic, similar duration to Ritalin LA, but performs better generally speaking, 30% IR/70% ER)
  • Aptensio XR (brand-name, 12 hour duration, 40% IR/60% ER
  • Concerta (not sure if there's a generic yet, longer ER mechanism I think)
  • Daytrana (transdermal patch you wear for 9 hours and when you take it off continues to work from 2-4 hours for a total of 11-14 hours!! Problem is the dosing is kinda screwy when you try to convert from oral Ritalin, and I think the highest dose comes nowhere near the highest dose of oral Ritalin)
  • Quillivant XR (brand-name, liquid ER solution)
  • Quillichew ER (brand-name, ER chew tabs)
  • Focalin XR (D- enantiomer of Ritalin molecule, supposedly stronger than Ritalin. I felt no difference, but Ritalin does nothing for me, even above 100 mg...)

If you want to try an amphetamine stimulant (if you can manage to get a prescription for one...)

  • Adderall XR (50% Dextroamphetamine, 50% Racemic Amphetamine = 25% levo + 75% dextro, I think 50% IR/50% ER, ~12 hours duration)
  • Adzenys XR-ODT (orally disintegrating ER tablets, amphetamine base = 23.81% levo + 76.19% dextro, ~12 hours duration?)
  • Dexedrine Spansules (100% dextroamphetamine sulfate, generic, 6-8 hours duration)
  • Dyanavel XR (brand-name, only indicated for pediatric patients, liquid ER solution, ~12 hour duration?)

I would not ask about Desoxyn if getting a prescription for Ritalin was as hard as it was for you... lol...

Link to comment
Share on other sites

26 minutes ago, Iceberg said:

For me focalin was useless...I've never actually heard one focalin success story 

My doctor had contradictory things to say about methylphenidate products as well. He said they generally give methylphenidate to the little kids and amphetamine to the adults but then later on he described Focalin as being "too strong". Yet he'll prescribe me Vyvanse. I don't get it.

Link to comment
Share on other sites

Focalin is dexmethylphenidate, which is simply the active isomer in racemic methylphenidate. It is completely indistinguishable from equipotent doses of racemic methylphenidate in terms of effects, side effects, or any other outcome measures (10 mg methylphenidate = 5 mg dexmethylphenidate). A very disturbing number of doctors do not seem to understand that dexmethylphenidate is simply twice as potent by weight and by weight alone than methylphenidate, does not differ in any other observable way from methylphenidate, and should always be dosed with the 50% conversion rule in mind (which is just yet another part of the ridiculous situation that the FDA has created and continually worsens via their horribly poorly designed and communicated guidelines on maximum doses for different stimulant drug formulations), something that has led to widespread misconceptions about it being more potent than (or otherwise different than) methylphenidate in areas other than the dosage equivalence.

Note that Ritalin LA and Focalin XR use an identical extended-release mechanism (Elan's SODAS (Spheroidal Oral Drug Absorption System)), so there is zero reason to try the other if one failed to work - instead, try a dose adjustment, a different formulation, or a different stimulant altogether.

Edited by JustNuts
Link to comment
Share on other sites

On 6/21/2017 at 10:17 PM, Iceberg said:

I took it at like 10x3 ir and literally didn't feel a thing. Maybe I'm just weird

Split or concurrent? If split, then that's only the equivalent of 20mg methylphenidate per dose, which isn't enough for some people, although to be fair the vast majority (80%) of MPH responders will respond in some way to that dose. Some people also don't respond to methylphenidate at all (either not at all or with a universally poor response), although it's much more common to respond poorly than to not respond at all.

Link to comment
Share on other sites

On 6/24/2017 at 6:25 PM, Iceberg said:

It might have actually supposed do be 20x3 but the pharmacy said that was to high 

Eh, I'm not that surprised, it's equal to 40 mg MPH TID or 120 mg daily, that's pretty high.

On 6/24/2017 at 7:44 PM, notloki said:

I do 30 mg X3 and no one has blinked an eye. Did need a PA.

60 mg MPH TID, 180 mg MPH per day. Wow. IDK how people can tolerate such high per-dose levels of IR, I doubt I could handle serum levels going that high. I mean my old Concerta+Ritalin combo was maybe equivalent to 40 mg IR at absolute peak, but normally more like 32.5 mg, and peak levels were more than adequate anyways on that combo - definitely wouldn't want them to have gone higher than that (the dropoff from the Concerta was another matter entirely though). Yours is certainly the highest d-MPH dose I've ever heard of someone being on -- I think 80 mg was the highest dosage of d-MPH I'd heard of someone taking before this, and I think that person was taking 40 mg d-MPH XR BID, which is a bit different from pure IR.

My insurer asks for a PA anywhere past 40 mg d-MPH XR // 20 mg d-MPH IR daily. Their MDL on racemic MPH is 60 mg for IR and roughly the same for all extended release formulations (72 mg for Concerta though). However their Adderall MDL is really quite annoying - 60 mg per day, and despite calling the pharmacy twice on two different occasions to ask about their requirements for overriding the MDL ("just send in a PA request and it'll get approved, no problem"), when I asked my pdoc to send in a PA for overriding that (which took a little while due to the insurer repeatedly managing to forget to fax the required form to my pdoc's office when asked to do so) the insurer just denied it, citing their MDL as the reason for denying it. Circular reasoning much? And after telling me it'll be no issue at all to be approved and all we need to do is send in a simple PA request not once but twice (and from different reps)! We never bothered appealing the decision since I can just refill at the 75% mark (every 22.5 days) and have my pharmacist submit the RX as a partial modified fill for 60 mg daily over a 30 day period each time to get the full 80 mg covered by insurance anyways, but that leaves no room for flexibility and half the time I end up missing a half or full day when refilling.

They'll cover outright stupid combinations of multiple different doses of XR, or mixing XR and IR, at higher total doses and/or greater expense to them - but those combos have poorer therapeutic effects for me so it's not helpful for those to be covered. But ask them to cover the cheapest amphetamine med at 80 mg daily instead of 60 mg daily, even though you could take more than that with numerous other combos and they'd be completely fine with it - all of a sudden that's a huge issue. Insurers. Bah.

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...