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stimulant doses seems to be wearing off after about 3 or 4 days at each dose


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I have been taking methylphenidate for depression and adhd symptoms the past month or so; first in the form of ritalin then concerta.. after several days with ritalin it wore off at 10 mg, then 20 mg. this was about the time i first noticed the feeling of mental clarity that i hadn't experienced before trying stimulants.

but each time after several days the foggy feelings would resurface, difficulty forming sentences, etc. i would also become irritable. once i got to something like 30 mg of ritalin i noticed myself feeling even more irritable and anger-prone. So we figured i might need a stimulant that isnt IR and doesn't have too much of a "kick". so we tried concerta. great results once i started noticing it kicking in 18 mg worked really well for at least 2 days. at about the 4 or 5 day mark foggy feelings resurfaced, had difficulty forming sentences, etc. i asked to be put on a higher dose. 27 mg worked well for a short time, but once again, symptoms would shortly return. so i asked to be put on 36 mg, and instead of feeling focused and calm i felt a clouding of consciousness, it was very disturbing and i quickly stopped taking it with pdoc permission.

i have been on 27 mg of Concerta now for a while but it seems i'm not getting 100% relief from my adhd symptoms: overly fast thought processses, difficulty forming sentences, difficulty with word choice, foggy feelings. Today i found myself unable to read sheet music during piano lessons as well as i normally do. rather embarrassing.

this seems to be the pattern with all the stimulants iv tried so far (ritalin and concerta): initial relief and clarity.. followed by fogginess after 3 or 4 days. However too much of the medication produces intolerable symptoms. What's the solution? If anyone has suggestions i would greatly appreciate your input. Would amphetamines work better than methylphenidate perhaps? there must be a way of scheduling and dosing these meds so that i may get maximum symptom relief or at least have some input the next time i see my pdoc.

Edited by Nullo
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Dexedrine spansules are very consistent for me.  I take it in the AM and Afternoon.  Taking it for depression mainly. 

I used to take Ritalin, never tried an extended release version.  It made me angry sometimes as well, which is why I quit taking it. 

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Dexedrine seems to be very popular here and in other forums. I'm curious as to why, not that i see any problem with it. I wonder if Focalin XR would be a reasonable option given that it's a variant of methylphenidate, which i'm currently taking, and in light of the issues mentioned above.
 

Edited by Nullo
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If I were having the problems that you are with methylphenidate, I'd try going with one of the amphetamine-based formulations such as Adderall or Dexadrine if I could get my pdoc to agree. Dexadrine turned out to be too much for me to handle, but YMMV.

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Is there any reason a stimulant might be more effective than methylphenidate? I ask because it seems to me that most stimulants have the same mechanism of action: boosting dopamine and norepinephrine, roughly speaking. is it possible that the issue is not so much whether its methylphenidate or amphetamine but rather how it's dosed, at what times it's dosed and how the drugs is formulated (when the effects peak and when they subside)

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10 hours ago, Nullo said:

Is there any reason a stimulant might be more effective than methylphenidate?

Possibly. It is possible that amphetamines may be more effective for those who didn't respond well to methylphenidate/dexmethylphenidate. We don't exactly know why, it has just been clinically demonstrated, and vice versa.

10 hours ago, Nullo said:

I ask because it seems to me that most stimulants have the same mechanism of action: boosting dopamine and norepinephrine, roughly speaking.

While their end results are the same (increased dopamine and norepinephrine), their mechanisms of action are actually quite different.

(From Wikipedia, YES I KNOW it's a bad place to cite from, but this is the only place that explains this in a clear manner...): Both amphetamine and methylphenidate are predominantly dopaminergic drugs, yet their mechanisms of action are distinct. Methylphenidate acts as a norepinephrine-dopamine reuptake inhibitor while amphetamine is both a releasing agent and reuptake inhibitor of dopamine and norepinephrine. Methylphenidate's mechanism of action in the release of dopamine and norepinephrine is fundamentally different from most other phenethylamine derivatives, as methylphenidate is thought to increase neuronal firing rate, whereas amphetamine reduces firing rate, but causes monoamine release by reversing the flow of the monoamines through monoamine transporters via a diverse set of machanisms, including TAAR1 activation and modulations of VMAT2 function, among other mechanisms. The difference of action between methylphenidate and amphetamine results in methylphenidate inhibiting amphetamine's effects on monoamine transporters when they are co-administered.

Basically methylphenidate causes things to speed up, while amphetamine causes things to work in retrograde, pulling monoamines back into the synapse, from my understanding, as well as causing release from the synaptic vesicles.

So while they don't have the exact mechanisms of action, they do produce the same end result.

An amphetamine-based stimulant may be worth a try.

10 hours ago, Nullo said:

is it possible that the issue is not so much whether its methylphenidate or amphetamine but rather how it's dosed, at what times it's dosed and how the drugs is formulated (when the effects peak and when they subside)

If you want to continue to give methylphenidate a try, you might consider giving one of the biphasic release versions a try, like Metadate CD (30% IR + 70% ER) or Ritalin LA (50% IR + 50% DR), or the newer Aptensio XR (if your insurance covers it, which is 40% IR + 60% ER). Focalin XR is also biphasic, but I can't remember if it's 50%/50% or what. There are so many options when it comes to methylphenidate. There are way more that I didn't list. There's an extended release liquid solution too if that interests you (Quillivant XR).

 

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mikl, thank you so much! Once again, your input is very helpful and i intend on showing this to my pa. it has been unusually difficult to find this kind of information explained in simple terms via internet search

Edited by Nullo
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On 11/10/2018 at 8:29 PM, gb84 said:

Dexedrine spansules are very consistent for me.  I take it in the AM and Afternoon.  Taking it for depression mainly. 

I used to take Ritalin, never tried an extended release version.  It made me angry sometimes as well, which is why I quit taking it. 

This is exactly what happened to me on Ritalin. I got so damned crazy moody and angry. Couldn’t tell what was happening, just felt like a really weird angry crazy mind. 

Now im on vyvanse and it’s a wonder drug. 

Edited by DammitJanet
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