Bad Ritalin crashes despite increased dosing :-(

[Blahblah]

Pdoc FINALLY upped Ritalin (LA) to 30mg in morning, and I take 10mg (IR) in afternoon. Been on consistently about 1.5 years (note, it’s a real pain to get it here, they treat it like street meth & it’s the most benign stimulant!!)

I have bad energy crashes within 5 hours, then crave chocolate (which I usually dislike), I have more coffee. The IR 10mg in afternoon seems to do nothing. Trying the 20mg IR in afternoon, which might be better, but wears off in 2 hours, I don’t want to mess up my sleep or jack up my heart rate.

Note, I’m not taking for ADD (but for depression add-on) my physical energy, alertness & motivation just crashes now. I just get tired & need to nap.

Any ideas? (I’m 50kg) Pdoc says they dose per kg, usually 50mg-60mg max for me. If I increase again, I’ll quickly be screwed (it initially worked so well!). I know Adderall is more potent, but worried about neurotoxicity and irreparable brain damage when I eventually go off (don’t plan on being on forever). I’ve heard Adderall is more “speedy” and can be agitating as well.

Edited July 17, 2019 by Blahblah

[DammitJanet]

It’s too bad you can’t try Vyvanse. 😐 I never even get a crash time with it and it helps my depression as well as everything else. 

Have you thought of asking doc?

[Blahblah]

Vyvanse is not available here 😞  seems it is much less preferred over methylphenidate and apparently in 2014, Shire did some clinical trials showing it was not an effective treatment for depression, (but maybe that was just in monotherapy)...Is it an amphetamine similar to Adderall? I read somewhere that it was developed to have less potential to be abused, but its still a controlled drug. I'll continue to work on my pdoc to find other suggestions. Did it give you any bad insomnia or other side effects (other than typical nausea & dry mouth?)

Is Viibryd an antidepressant? I've never tried that...don't know if that's available or would be similar to ritalin?

Edited July 17, 2019 by Blahblah

[DammitJanet]

3 hours ago, Blahblah said:

Vyvanse is not available here 😞  seems it is much less preferred over methylphenidate and apparently in 2014, Shire did some clinical trials showing it was not an effective treatment for depression, (but maybe that was just in monotherapy)...Is it an amphetamine similar to Adderall? I read somewhere that it was developed to have less potential to be abused, but its still a controlled drug. I'll continue to work on my pdoc to find other suggestions. Did it give you any bad insomnia or other side effects (other than typical nausea & dry mouth?)

Is Viibryd an antidepressant? I've never tried that...don't know if that's available or would be similar to ritalin?

Vyvanse is much better than adderal (sp) as far as my experience and others I’ve read here...also many others here have noted it helped their depression more than others. 

Viibryd is not a stimulant. It is a stimulating AD though. 

Good luck on your increased Ritalin!

Edited July 17, 2019 by DammitJanet

[notloki]

Adderall is amphetamine.

[Geek]

Vyvanse is a variant on Adderall - longer acting, same base stimulant.

[DammitJanet]

I read vyvanse is a med that breaks down to dextroamphetamine. I could be wrong, but I’m pretty sure I also read Michael and browri sayin that too.  @mikl_pls?

Edited July 18, 2019 by DammitJanet

[Geek]

42 minutes ago, DammitJanet said:

I read vyvanse is a med that breaks down to dextroamphetamine. I could be wrong, but I’m pretty sure I also read Michael and browri sayin that too.  @mikl_pls?

Yep!

Adderall is a mix of dextroamphetamine and levoamphetamine (source). The ratios vary for the IR and XR formulas.

Dextroamphetamine and levoamphetamine are variants/forms of amphetamine.

 

[DammitJanet]

Gotcha!

[Blahblah]

19 hours ago, notloki said:

Adderall is amphetamine.

I'm aware of that.

My question was whether Vyvanse is also. I was curious how it is different from Adderall regarding side effects and efficacy. Maybe it was not clear. Thanks @Geek for clarifying.

Edited July 18, 2019 by Blahblah

[CrazyRedhead]

21 minutes ago, Blahblah said:

I'm aware of that.

My question was whether Vyvanse is also. I was curious how it is different from Adderall regarding side effects and efficacy. Maybe it was not clear. Thanks @Geek for clarifying.

Adderall and Vyvanse are both considered amphetamines......Vyvanse takes longer to be broken down by the body, so it's longer lasting.....Studies have shown that Vyvanse is just as effective as Adderall, and that side effects are similar with each one.

https://www.drugs.com/medical-answers/adderall-vs-vyvanse-3013810/

Edited July 18, 2019 by CrazyRedhead

[Iceberg]

1 hour ago, Blahblah said:

I'm aware of that.

My question was whether Vyvanse is also. I was curious how it is different from Adderall regarding side effects and efficacy. Maybe it was not clear. Thanks @Geek for clarifying.

Depends what you need too. Many feel That vyvanse is “smoother” and lasts longer than the the adderall (especially the comparable adderall XR) throughput the day. However, I take instant release adderall, because it has a bit more punch, and also offers more dosing flexibility as far as doese timing. But if you’re looking for all day coverage with just one pill, vyvanse might be the way to go 

[Blahblah]

18 minutes ago, Iceberg said:

Depends what you need too. Many feel That vyvanse is “smoother” and lasts longer than the the adderall (especially the comparable adderall XR) throughput the day. However, I take instant release adderall, because it has a bit more punch, and also offers more dosing flexibility as far as doese timing. But if you’re looking for all day coverage with just one pill, vyvanse might be the way to go 

Good to know. I pray that in the near future (upcoming official/annual med review by special hospital doc) I can maybe get my hands on some Adderall. Sheesh I sounds like an addict..but honestly after 2 years, super compliant on the same dose (which has been sub therapeutic for months) I'd like to tweak some things. Other antidepressants really aren't cutting it, they all cause anhedonia.

I guess I was hoping that there was another med (along the lines of Ritalin) that wasn't in the amphetamine class. Basically, something of a DRI. I've trialed Wellbutrin several times up to 350mg and it didn't do much but give me sweats & tinnitus 😞 low dose Abilify I've even tried & I hate A/Ps didn't have desired effect, made me hungry and my legs restless.

@Iceberg Can I ask how long you've been on the 60mg per day? I'm curious whether a certain dose can be effective longterm, or if most people just need to keep increasing every 6-12 months (or take long breaks?)

Edited July 18, 2019 by Blahblah

[DammitJanet]

2 minutes ago, Blahblah said:

Good to know. I pray that in the near future (upcoming official/annual med review by special hospital doc) I can maybe get my hands on some Adderall. Sheesh I sounds like an addict..but honestly after 2 years, super compliant on the same dose (which has been sub therapeutic for months) I'd like to tweak some things. Other antidepressants really aren't cutting it, they all cause anhedonia.

I guess I was hoping that there was another med (along the lines of Ritalin) that wasn't in the amphetamine class. Basically, something of a DRI. I've trialed Wellbutrin several times up to 350mg and it didn't do much but give me sweats & tinnitus 😞 low dose Abilify I've even tried & I hate A/Ps didn't have desired effect, made me hungry and my legs restless.

Straterra?

[notloki]

2 hours ago, Blahblah said:

I'm aware of that.

My question was whether Vyvanse is also. I was curious how it is different from Adderall regarding side effects and efficacy. Maybe it was not clear. Thanks @Geek for clarifying.

They both contain d-amphetamine, eventually. Adderall is largely d-amphetamine but contains some l-amphetamine. Vyvanse is pure d-amphetamine eventually. Vyvanse starts off in the capsule as a prodrug of d-amphetamine. In your gut this is changed to d-amphetamine. About 35% of the prodrug is changed into d-ampheramine.

 

[CrazyRedhead]

10 minutes ago, Blahblah said:

 I'm curious whether a certain dose can be effective longterm, or if most people just need to keep increasing every 6-12 months (or take long breaks?)

This is just my personal experience.........When I tried Adderall for my depression, I started out at 30 mg/day, and when tolerance built to that dose, increased it again to 60mg.....I finally ended up on 90mg/day, and when that dose stopped working, pdoc said she would not go any higher, so I just stopped it.

YMMV, though.....Everyone's different.

[notloki]

You asked about side effects. Adderall , because l-amphetamine affects norepinephrine some there will be the possibility of rapid heart beat, pulse, and sweating.   Formulations that are pure d-amphetamine, like vyvanse, should have less of these side effects. I find less teeth grinding on pure d-amphetamine.

[Blahblah]

14 minutes ago, DammitJanet said:

Straterra?

Forgot about that one, doesn't work on dopamine though, seems more like Cymbalta without the serotonin effect. I've heard some pretty bad reviews on this one - I know, YMMV, but I also think its strange that no one on this board seems to be taking it? hmmm, something to maybe consider though once the ritalin completely poops out altogether.

[DammitJanet]

6 minutes ago, Blahblah said:

Forgot about that one, doesn't work on dopamine though, seems more like Cymbalta without the serotonin effect. I've heard some pretty bad reviews on this one - I know, YMMV, but I also think its strange that no one on this board seems to be taking it? hmmm, something to maybe consider though once the ritalin completely poops out altogether.

Yes I’ve heard the same...but you asked about the adhd med that isn’t an amphetamine, and that’s the only one I know of, so I mentioned it.

Edit: I swore it was non-stimulant, but I looked it up again at rxlist and it’s saying it’s an amphetamine?? And said concerta was non? That sounds totally backwards...but I’m so so out of it with my stress level, I’m gonna run the other way right after I apologize! Ha! Sorry!

Edited July 18, 2019 by DammitJanet

[Blahblah]

8 minutes ago, notloki said:

You asked about side effects. Adderall , because l-amphetamine affects norepinephrine some there will be the possibility of rapid heart beat, pulse, and sweating.   Formulations that are pure d-amphetamine, like vyvanse, should have less of these side effects. I find less teeth grinding on pure d-amphetamine.

OK, true, I'd expect the increased HR, sweating etc which I also get a bit on Ritalin (but never had teeth grinding or insomnia on it)

How long have you been taking it? I see you're on a super high dose (90mg?) has it been effective a long time? You've had no high-level tachyardia, arrythmias or anything being on that & high dose Wellbutrin? Does it exacerbate your insomnia?

Edited July 18, 2019 by Blahblah

[DammitJanet]

11 minutes ago, notloki said:

You asked about side effects. Adderall , because l-amphetamine affects norepinephrine some there will be the possibility of rapid heart beat, pulse, and sweating.   Formulations that are pure d-amphetamine, like vyvanse, should have less of these side effects. I find less teeth grinding on pure d-amphetamine.

Yes this was my experience. My crash was also significantly smoother on vyvanse. Like, pretty much unnoticeable! And I personally felt more irritable on adderall and less depressed on vyvanse, for whatever reason. 

[Blahblah]

3 minutes ago, DammitJanet said:

Yes this was my experience. My crash was also significantly smoother on vyvanse. Like, pretty much unnoticeable! And I personally felt more irritable on adderall and less depressed on vyvanse, for whatever reason. 

That's great to hear. I have heard people can get pretty irritable on Adderall... How did you get your pdoc to RX Vyvanse? (I ask bc it's mentioned in your sig that they wouldn't RX Adderall, Dex, or Ritalin anymore...) and from what I hear pdocs are always beyond cautious with a BP1 diagnosis. They don't want to be liable for triggering a psychotic/manic episode

[notloki]

1 minute ago, Blahblah said:

OK, true, I'd expect the increased HR, sweating etc which I also get a bit on Ritalin.

How long have you been taking it? I see you're on a super high dose (90mg?) has it been effective a long time? You've had no high-level tachycardia, arrhythmias or anything being on that & high dose Wellbutrin? Does it exacerbate your insomnia?

5 years at 90 mg, always effective. Keep in mind I metabolize amphetamine quickly. No tach, afterall I take propranolol. However without it my HR is 111, 95 on just Wellbutrin.

I have been an insomniac all my life, treated since 20 (I'm 56). The insomnia predates starting taking amphetamines by 10 yrs. I'm not taking all that Lunesta because I take all that amphetamine. I was taking all that Lunesta for 10 yrs before I started treating ADHD. I can take amphetamine up to  3 PM and be asleep by 10-11 pm. I also boze on the couch after dinner. So no it does not make my insomnia worse.

 

[DammitJanet]

16 minutes ago, Blahblah said:

That's great to hear. I have heard people can get pretty irritable on Adderall... How did you get your pdoc to RX Vyvanse? (I ask bc it's mentioned in your sig that they wouldn't RX Adderall, Dex, or Ritalin anymore...) and from what I hear pdocs are always beyond cautious with a BP1 diagnosis. They don't want to be liable for triggering a psychotic/manic episode

The only one they’re not prescribing anymore is the straight out dextroamphetamine, or Dexedrine. Your doc should actually be more inclined to prescribe vyvanse as it’s supposed to be less addictive. Stimulants can cause mania, but so can AD’s. I’ve been on it for something like two years and the only time I’ve gotten full blown manic is after taking krill oil for a month or more. Can’t remember exactly how long though. My pdoc was happy to switch me and said she prescribes it to several patients. 

[Iceberg]

1 hour ago, Blahblah said:

Good to know. I pray that in the near future (upcoming official/annual med review by special hospital doc) I can maybe get my hands on some Adderall. Sheesh I sounds like an addict..but honestly after 2 years, super compliant on the same dose (which has been sub therapeutic for months) I'd like to tweak some things. Other antidepressants really aren't cutting it, they all cause anhedonia.

I guess I was hoping that there was another med (along the lines of Ritalin) that wasn't in the amphetamine class. Basically, something of a DRI. I've trialed Wellbutrin several times up to 350mg and it didn't do much but give me sweats & tinnitus 😞 low dose Abilify I've even tried & I hate A/Ps didn't have desired effect, made me hungry and my legs restless.

@Iceberg Can I ask how long you've been on the 60mg per day? I'm curious whether a certain dose can be effective longterm, or if most people just need to keep increasing every 6-12 months (or take long breaks?)

It’s a little different for me, because while we did start it (and got up to 60 mg) to help with depression, once the clozaril kicked in it handled lots of the depression symptoms. So now it’s more to combat brain fog from the cloz. So that means I can often back off the whole 60 on days when I don’t need 100% focus. Ex I mostly take 60 on long class days, exams, long drives, when I have to write without getting distracted every five minutes, and days where I will be working/busy all day 

[mikl_pls]

On 7/18/2019 at 8:27 AM, DammitJanet said:

I read vyvanse is a med that breaks down to dextroamphetamine. I could be wrong, but I’m pretty sure I also read Michael and browri sayin that too.  @mikl_pls?

Yes, this is correct. It is dextroamphetamine bound to the amino acid L-lysine that is cleaved from each other during digestion, so the medicine is "activated" by digesting it and provides a natural extended release mechanism. This was intended I believe to keep people from injecting it intravenously.

 

@Blahblah, if regular old dextroamphetamine (Dexedrine, Dextrostat) is available in your country, you could try that. To me, it's less "speedy" than Adderall. 

Also, if you have any longer-acting methylphenidate products available to you, like Concerta, Metadate CD, Ritalin LA (I recommend one of the former two over Ritalin LA), that might be worth pursuing...

IR Ritalin does nothing for me either, nor does Concerta really, but just 20 mg Metadate CD actually had some effect on me.