Stims with MAOIs

[Geek]

I recently started Emsam. My pdoc had me stop taking Vyvanse at that time. She has said, though, that once I got up to and settled on the 12mg/24h dose we could talk about adding Ritalin.

I'm really, really missing the Vyvanse. OMG the world is so distracting and hard to focus in!

Here's the thing though... I really don't like Ritalin. I don't like that it's so short acting - I have to remember to take it 3x/day, set alarms, carry doses with me, etc. I also just don't like how it feels. I don't feel as focused on it, and I find it can be really... peak-y, if that makes sense. I know there's Ritalin LA and Concerta, which are longer acting... do they feel different than IR Ritalin?

Are the amphetamines really contraindicated that much more than the methylphenidates with MAOIs? I don't have much experience with IR versions of the amphetamines either, but I figured they might "feel" better than Ritalin.

Looking for thoughts/experience/advice/studies to take to my pdoc...

[mikl_pls]

Some will say that amphetamines are contraindicated with MAOIs, but my pdoc prescribed Adderall and Dexedrine with my MAOI prescriptions.

Methylphenidate is probably safer than amphetamines, but I personally had no problem with amphetamine with my MAOIs.

In addition to Ritalin LA and Concerta, there's Metadate CD, which IMO is a better option than Ritalin LA. Concerta works for many people, but it didn't work for me (nor did Ritalin IR).

The key to titrating up on a stimulant with a concomitant MAOI is to start low and go slow though. You may have to use an IR stimulant to titrate up and then switch to an ER stimulant.

Of all the methylphenidate products I've tried, Metadate CD was the only thing that felt like it was doing something, and I only took 20 mg.

[Blahblah]

@mikl_pls What exactly is the difference between Ritalin LA, Concerta and Metadate? Are they basically the same thing but one lasts longer? Or is the release mechanism completely different?

I've only taken RitalinIR and RitalinLA...IR dosing is a huge pain, I like the initial effect (it works quickly also), but like @Geek mentioned, it is so short-acting & peak-y and I always crash from exhaustion. Ritalin LA is OK I guess, but it also wears off too soon (afternoon) so it's like if I have anything important to do, I must rush to get it all done by 2pm, because after that I am fairly useless.

In my case it's also probably different, because I'm not treating ADD as much as apathy, lack of motivation/interest, residual depression symptoms.

[mikl_pls]

1 hour ago, Blahblah said:

@mikl_pls What exactly is the difference between Ritalin LA, Concerta and Metadate? Are they basically the same thing but one lasts longer? Or is the release mechanism completely different?

I've only taken RitalinIR and RitalinLA...IR dosing is a huge pain, I like the initial effect (it works quickly also), but like @Geek mentioned, it is so short-acting & peak-y and I always crash from exhaustion. Ritalin LA is OK I guess, but it also wears off too soon (afternoon) so it's like if I have anything important to do, I must rush to get it all done by 2pm, because after that I am fairly useless.

In my case it's also probably different, because I'm not treating ADD as much as apathy, lack of motivation/interest, residual depression symptoms.

Their releasing mechanisms are different, mainly. Ritalin LA is 50% IR/50% DR and while it's supposed to have a duration of action of up to 8 hours, it tends to fall very short of that for most people such that they have to dose it twice a day. Metadate CD is 30% IR/70% ER, and also is supposed to last up to 8 hours. Concerta, if I'm not mistaken, starts releasing as soon as it gets in your stomach, and continues to release throughout the day with a duration up to 12 hours. The thing about Concerta is that the dosages don't quite tell how much Ritalin is in it. 18 mg = 12 mg, 27mg = 18 mg, 36 mg = 24 mg, 54 mg = 36 mg, 72 mg = 48 mg, and 108 mg = 72 mg. (72 mg is the official highest dose, 108 mg is the "unofficial" highest dose, especially for adults.)

I've tried Concerta and Metadate CD. Metadate was the only one I could feel anything on. Concerta and Ritalin IR were nothing at all for me. That's just my experience though.

There are several newer Ritalin products... I don't know if they'd be available where you are, but Aptensio XR is one that is 40% IR/60% ER and lasts up to 12 hours. Adhansia XR is 20% IR/80% ER, don't know about it's duration of action though. It can be dosed up to 100 mg apparently. Jornay PM is, I believe, a very slow release version that you take in the evening in order for it to be effective by the next day.  It too can be dosed up to 100 mg instead of the usual max of 60 mg. Quillichew ER are ER chewable tablets that are 30% IR/70% ER. Quillivant XR is an extended release liquid that lasts up to 12 hours I believe.