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Hoping someone can offer some insight to what is happening with me?

I've been taking Ritalin consistently over a year again. Pulled me out of a bad anhedonia - I'm focused, motivated and goal driven. Mood was great the last 5 months. Now, I'm having intense meltdowns in the afternoon/eve. Stress-related. Internal pressure to succeed. I've lost many years to depression, being unproductive (was even bed-ridden from episodes).I've worked REALLY hard to pull out, and had one of the best 5-month "good periods" in a long time. I'm afraid of going back to that...

I wonder if the Ritalin is in fact causing mood swings now. I get crying spells: stress, perfectionism, anxiety, irritability. I know everyone here will probably suggest adding an antidepressant again, but to be honest the A/Ds increase my apathy and anhedonia (I have Double depression - chronic low mood/no pleasure, with intermittent severe episodes). I don't know what to do, this seems to be stress-related as I've been so focused on Ritalin and wearing myself down.

My main coping mechanism lately is studying, reading, working, writing as much as possible to distract myself from my unrelenting unhappiness with my life and myself. Basically, nothing is fun or enjoyable for me, I can't enjoy going for walks, hobbies or even watching tv series. I think the Ritalin has motivated me (good) but I've become a workaholic robot who only gets satisfaction from output, accomplishing goals and achieving perfection. I feel like a complete FAILURE if I'm not learning or working the entire day until bedtime!!! Is this similar to a Hypo or "Mixed" episode?? I don't want doc to label me as Bipolar and then quit prescribing Ritalin.

Edited by Blahblah

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I have tried this, and I end up in bed sleeping most of the day ? and more depressed. I stopped taking breaks on the weekends because of this. I would lay in bed all weekend.

I take the extended, so I thought I'd avoid the "crashes" and I take the IR afternoon when it wears off. Hmmmm. In fact, lately after taking the IR in afternoon, I get MORE tired. Is this normal??

Edited by Blahblah
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54 minutes ago, Blahblah said:

I have tried this, and I end up in bed sleeping most of the day ? and more depressed. I stopped taking breaks on the weekends because of this. I would lay in bed all weekend.

I take the extended, so I thought I'd avoid the "crashes" and I take the IR afternoon when it wears off. Hmmmm. In fact, lately after taking the IR in afternoon, I get MORE tired. Is this normal??

But do hte meltdowns stop on the day you don't take Ritalin.

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Is it sustained release or IR?  A crash at the end of the day with IR stimulants is common.  My mood usually really tanks for an hour or two after that.  You might want to try a sustained release preparation that wears off more gradually.   

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I took Ritalin years ago, I think it was even sustained release, and I got really crashy in the afternoons. I take (generic) Adderall XR now and have found it to be much smoother in terms of gradually wearing off without my noticing. YMMV.

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4 hours ago, Velvet Elvis said:

Is it sustained release or IR?  A crash at the end of the day with IR stimulants is common.  My mood usually really tanks for an hour or two after that.  You might want to try a sustained release preparation that wears off more gradually.   

I've had this issue with adderall and focalin IR- we retimed the dosing and it mitigated the crash at least partially 

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I have found IR ritalin to have a hard crash - but also that the crash can vary by manufacturer. Any chance your prescription was filled with a different brand? Pharmacies change the brand of generics they provide based on what they can get cheapest.

Maybe talk to your pdoc about trying concerta? Pretty sure it's a longer release than ritalin LA (it's still methylphenidate though), so then you may not need the IR boost in the afternoon.

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I think part of the problem is that I've taken a higher dose the last 2 weeks (my pdoc said I could vary the dose slightly based on my needs). I take sustained release in the morning, and then IR after lunch...maybe the IR is wearing off really fast and causing the crash....I think its the IR that is causing the irritability. And to meet a deadline, I drank a bit of coffee late afternoon (I normally only drink caffeine in the morning).

I've been falling out of my healthy sleep schedule also, lately going to bed around 1-2am, after looking at screens all evening. :-( I need to get back on top off this bad habit!

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I was on Concerta for a month or two and like you, it yanked me out of chronic TR depression brilliantly. I was periodically irritable every day but manageably-so. But then it pooped-out and I switched to Vyvanse which was a life-saver as it was if I'd just started taking a the Concerta from scratch. After a couple of months that too pooped-out and so now I limp from dose to dose on Adderall IR.

4 x 15mg doses a day is my optimal "coverage" where each one takes an hour to kick in and lasts ~ 90 minutes which gives me about 6 hours of feeling human a day. It infinitely better than feeling unrelentingly inhuman all the time, day after day with no respite but it sucks.

BTW my regimen to get these effects even with TRD has been Abilify, then Rexulti with Trintellix. We should communicate on ideas as it sounds like we're in a similar-brain-boat. I'll be up-front that I'm terrible at replying (because of my TR OCD and TRD) but I get round to it eventually.

Pete

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10 hours ago, sming said:

I was on Concerta for a month or two and like you, it yanked me out of chronic TR depression brilliantly. I was periodically irritable every day but manageably-so. But then it pooped-out and I switched to Vyvanse which was a life-saver as it was if I'd just started taking a the Concerta from scratch. After a couple of months that too pooped-out and so now I limp from dose to dose on Adderall IR.

4 x 15mg doses a day is my optimal "coverage" where each one takes an hour to kick in and lasts ~ 90 minutes which gives me about 6 hours of feeling human a day. It infinitely better than feeling unrelentingly inhuman all the time, day after day with no respite but it sucks.

BTW my regimen to get these effects even with TRD has been Abilify, then Rexulti with Trintellix. We should communicate on ideas as it sounds like we're in a similar-brain-boat. I'll be up-front that I'm terrible at replying (because of my TR OCD and TRD) but I get round to it eventually.

Pete

Thanks! super helpful. Yes , sounds like we are in the same boat. I have double depression (intense episodes have lessened) but I have a daily chronic low-mid grade depression isn't helped by much. Ritalin is the only thing that has even come close to making a dent in my daily symptoms.

The effectiveness seems to be decreasing (i'm more tired and irritated). pdoc wont increase or switch me to anything else at the moment. Accessing stimulants has been like trying to break out of prison. No pdoc wants to prescribe them. I can't jump around to different pdocs because then you get flagged as a "drug seeker" It's sad I really want to stockpile them because I'm afraid of getting cut-off eventually.

I don't have ADHD. So sick of explaining to pdocs why Ritalin (and not antidepressants). It works, and is helping, ok? Now just let me be! I also must pay completely out of pocket, my insurance does not cover stimulants used in depression. What if my dose increased (or I switch stimulants) I will continuously need to keep upping or switching over time? I don't know. My family already thinks I'm "addicted" (eyeroll). I've really seen a noticeable improvement. It is so frustrating.

 

Edited by Blahblah

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On 2/21/2019 at 6:08 PM, Blahblah said:

The effectiveness seems to be decreasing (i'm more tired and irritated). pdoc wont increase or switch me to anything else at the moment. Accessing stimulants has been like trying to break out of prison. No pdoc wants to prescribe them. I can't jump around to different pdocs because then you get flagged as a "drug seeker" It's sad I really want to stockpile them because I'm afraid of getting cut-off eventually.

Totally. Even though experienced PDoc's often have patients on stims long-term and it's the only thing that helps them, in the eyes of the 99% and the government, they are super dangerous and only serve to harm society. It's tragic. It's a bit like the backlash that Chronic Pain patients (like me) are facing due to the Opioid Crisis. People who are legitimately only helped by opioids can no longer get them at all or only a fraction of the dose they need and guess what? They're committing suicide. It's not hard to see why.

Quote

I don't have ADHD. So sick of explaining to pdocs why Ritalin (and not antidepressants). It works, and is helping, ok? Now just let me be! I also must pay completely out of pocket, my insurance does not cover stimulants used in depression. What if my dose increased (or I switch stimulants) I will continuously need to keep upping or switching over time? I don't know. My family already thinks I'm "addicted" (eyeroll). I've really seen a noticeable improvement. It is so frustrating.

Same here. It's really, really hard to find a PDoc who will accept it at face value. My family berate me. I pay OOP as well. If you actually look at the symptoms of inattentive ADD and dysthymia/depression there is an awful lot of common ground so it's pretty ridiculous that you have to have the ADD "sticker" to get covered instead of being judged, lectured-at and sneered-at. Fuck this.

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On 2/24/2019 at 5:21 PM, sming said:

Totally. Even though experienced PDoc's often have patients on stims long-term and it's the only thing that helps them, in the eyes of the 99% and the government, they are super dangerous and only serve to harm society. It's tragic. It's a bit like the backlash that Chronic Pain patients (like me) are facing due to the Opioid Crisis. People who are legitimately only helped by opioids can no longer get them at all or only a fraction of the dose they need and guess what? They're committing suicide. It's not hard to see why.

Same here. It's really, really hard to find a PDoc who will accept it at face value. My family berate me. I pay OOP as well. If you actually look at the symptoms of inattentive ADD and dysthymia/depression there is an awful lot of common ground so it's pretty ridiculous that you have to have the ADD "sticker" to get covered instead of being judged, lectured-at and sneered-at. Fuck this.

So when the current med regimen starts failing, what will you do next? I see you've already tried ECT (quite courageous).

I suppose I will just force myself to take longer breaks in hopes that when I re-instate, some of the efficacy returns a bit longer.  The increased irritability and transient mood swings I'm having are pretty crappy. I have no patience or resilience to stress. Not much else to do. I'm sick of re-trialing meds that have already failed the first time.

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