Concerta vs Ritalin

[Anonymous]

Could someone enlighten me on the differences between these two meds (and any others)? I’ve tried Ritalin so know what it feels like for me. I would like to know the differences or similarities between Ritalin and other ADHD meds.

I took Ritalin 10 mg for about 3 weeks, 2-3 times a day. One day I took 15 mg and that was ok during the day but the evening dose of 15 mg was different, I didn’t feel quite right and was very drowsy.

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[Bibliophile]

Ritalin is Methylphenidate, which is classified as a psycho-stimulant drug (see http://en.wikipedia.org/wiki/Methylphenidate for more information).

Concerta is a long acting Methylphenidate that uses the osmotic-controlled release oral delivery system (Oros) technology (basically a pump) to gradually release the methylphenidate throughout the day.

Biphentin is another long acting Methylphenidate, but it uses suspended release capsules whose dissolve rate is different so that it is released throughout the day as well.

Biphentin can be sprinkled, Concerta cannot.

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[Anonymous]

Thanks, librarian_chef.

What do you mean by sprinkled? And if you know, when would a doctor prescribe one over the other? I like the control I have over taking the Ritalin, I can spread the dose out if I want or not take it in the evening.

I haven’t been assessed yet (process starts next week) but I did do a three week trial with my husband’s Ritalin.

When I told my family doctor that yesterday, she pretty much freaked out and said that Ritalin was a stimulant and addictive and that she would never prescribe it but (once assessed) she might prescribe Concerta, Adderall and Focalin (I think that’s what she said). So if what I am reading on the wiki article is true, she was full of baloney since they are the same drug.

Susan

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[Bibliophile]

Yes, they are both methylphenidate. I believe she is in favour of the long acting ones as you take one capsule in the morning that is released throughout the day. Ritalin is an addictive substance and can be abused so she might be reluctant to have you manage the dosage yourself. Unfortunately, just because you saw a positive benefit with the stimulant does not necessarily mean that you need to take it to compensate for executive function deficiencies, e.g. inattentiveness and impulsive behaviour.

Sprinkled means that you can open the capsule up and sprinkle the globules onto yogurt or something else that you don’t chew. This is good for young kids and adults that cannot swallow a capsule.

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[Anonymous]

Thanks for all the explanations. But isn’t Ritalin non-addictive at properly supervised dosages for people who have ADHD (or narcolepsy)? Perhaps the lack of trust by the doctor is an issue that I need to address with the psychiatrist I will be seeing for assessment.

When you talk about exec function deficiencies, are you suggesting behavioural techniques/training vs meds? I have been working with a psychologist for almost 2 years now and the therapy is not managing the issues.

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[Bibliophile]

There is a theory that ADHD is actually an impairment of the brain’s executive functions. Executive Function (EF) refers to brain functions that activate, organize, integrate and manage other functions. It enables individuals to account for short and long term consequence.

Barkley breaks executive functions down into four areas:

1. Nonverbal working memory

2. Internalization of Speech (verbal working memory)

3. Self-regulation of affect/motivation/arousal

4. Reconstitution (planning and generativity)

Brown breaks executive functions down into six different “clusters.”

1.Organizing, prioritizing and activating for tasks

2. Focusing, sustaining and shifting attention to task

3. Regulating alertness, sustaining effort and processing speed

4. Managing frustration and modulating emotions

5. Utilizing working memory and accessing recall

6. Monitoring and self-regulating action

source: National Research Centre on ADHD, http://www.help4adhd.org/faq.cfm?fid=40&varLang=en

Here is an article from blogspot on ADHD treatments and their addictive nature (http://adhd-treatment-options.blogspot.com/2008/10/how-addictive-is-ritalin.html). What I think your doctor is worried about is that with Ritalin in a non-long acting form, you are going to have to take multiple pills throughout the day. This could lead to you taking too much. Remember that Ritalin is also ground up and injected or snorted for a high by drug users too.

The fact that your doctor Will prescribed Concerta is not necessarily a bad thing as it may help you the same way. It is the same thing as Ritalin, just in a controlled release form.

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[Anonymous]

Thanks. Couldn’t wrap my head around Barkley but the Brown clusters make more sense to me. I’ll try and have a look at the links.

Yes, I have read from that wiki link that ritalin can be abused by drug users as it’s similar to cocaine. Strange that my doctor would think this my motivation, again indicating a trust issue there.

I use timers with alarms during the day to remind me to do certain things (one of my problems is that I cannot estimate time and get totally absorbed in one activity to the detriment of others), and one of them was set for 4 hours to indicate the time for the next dose of Ritalin. We both would make a conscious decision at that point, did we want to take another dose (10 mg) or not, or wait a bit. If I had a timed-release dose, I wouldn’t be able to make those decisions. I’ve had issues in the past with insomnia (I used to take a low-dose of amytryptyline) so I am concerned about something that stays active tor the 10-12 hours you quoted. At least with the Ritalin, I could stop after 8 hours and it would not affect my sleep, actually it helped me get to and stay asleep for the whole night.

I’m a self-employed work-at-home entrepeneur, so I don’t need something to keep me alert and focused during a regular workday in someone else’s environment. With Ritalin, some days I will need two doses and sometimes three. I need to have the control so it fits to my personal schedule. The Ritalin is in and out in 4 hours and my experience verifies that.

What if you’ve taken the Concerta dose (at 7 am, for example) and then you take something else at 5 or 7 pm because you have a meeting or whatever at 7 pm and you need to be alert and focused. What then? No options with Concerta or even Ritalin because you’ll be up well past your bedtime and have trouble getting to sleep.

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[Anonymous]

My children and I have been taking Concerta 36mg for about 2 years now and have the Ritalin 20 mg (short acting) for back up or other matters that may come up. I administer it about 6am get my day going. My 17 yr says it kicks in about 7am and my 10 yr daughter I see it working about the same time (when she gets her dose she goes back to sleep for a while until my son leaves for school). My daughter and I don’t really have any sleep issues but on occasion my son does. I have learned that we all need to take it before 9am or it is not going to be a good day. The Ritalin I keep spare doses in my purse for when someone has forgotten or needs it twords the end of the day no later than 4pm for something (ex: sports-game or focused activity). If sleeping is a problem ocassionally I give him benedryl or something like that.

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[Anonymous]

Thanks pixiegirl. Sounds like this will need to be discussed with the assessing psychiatrist to take into account my level of activities and need for flexible scheduling.

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[Anonymous]

let me know if you have anymore questions. like I said my 2 kids and I have the ADHD/ADD and each day can be an adventure(LOL) and they and I have tried different meds in the past. Having the Concerta as the primary meds early in the morning and the Ritalin short acting (for 911 situations) seems to be a good system for us. Good Luck.

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[Anonymous]

I’m taking my last 10 mg of Ritalin now and then I’m going to stay off it until after my assessment is complete (3 appointments and last one is near end of June). That way I can really see what’s going on. But I do have a better idea of what options there are, thank you both!

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[Anonymous]

Why so long for assessments? My kids were evaluated at Childrens Hosp. Boston in 2 appts and I had my eval at Mass Gen Boston in 2 appts within 1 month.

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[Anonymous]

I’m north of Toronto in Barrie, Ontario, and fortunate enough to have an ADHD clinic right in Barrie. Dr. Timothy Bilkey is supposed to be a top Canadian expert on adult ADHD, and from his website and other searches, I guess he must be travelling and giving seminars, etc as well as doing his clinic work (he also has a Stratford, Ontario clinic). He’s also writing a book.

I got in early because of some appointment cancellations. His office visits are fortunately covered by our provincial health-care plan (OHIP) but the testing (computer and questionnaires) are not. If I want to wait for a fully OHIP covered assessment done at our local hospital, it could take months. My family doctor explained that Dr Bilkey would assess for other issues like depression, anxiety, bipolar, etc. and also provide her with treatment recommendations (specific meds) whereas the regular hospital assessment wouldn’t give recommendations. So it seemed more helpful in terms of guiding my doctor, who clearly doesn’t want that responsibility of diagnosing/assessing. As for the fee I will have to pay, I might be able to claim it on my husband’s private healthcare pension plan, or I will be able to claim it as a medical deduction on my income taxes. I figure it’s worth the extra $ to get a comprehensive assessment from someone who is an expert.

Dr B’s approach is apparently different than most other assessments for adult ADHD. He doesn’t use just the standard questionnaires but has a series of profiles that he uses for assessment. As it was described to me, the first visit will be computer testing and probaby an interview with Dr Bilkey – I am supposed to bring along a “collateral historian”, someone who knows me well and can corroborate or dispute my responses – that will be my husband (who also has ADD). I’m not sure what the second visit will entail, but I have homework from the first visit in the form of an extensive ratings/questionnaire package. The third visit is the “feedback visit”, where he will give me his findings and within two weeks of that visit, will provide a complete written report to my family doctor.

I tried to book a followup visit with my family doctor based on her receiving the report (since I have already booked that final visit in June), but her receptionist refused, saying “let’s see what happens”. I pushed her, saying I knew the date, but she repeated the exact same words. I really wonder what that means. I am having a tough time with my family doctor, her body language says I’m a bother and it’s as if she would like to be rid of me. It’s impossible to switch doctors here, you can’t get a new doctor if you already have one, and we have a shortage of doctors so if I give mine up, it’s unlikely I will get another. Very poor situation.

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[Anonymous]

Wow, that’s a tough situation, but it is what it is. So you need a strategy when you go in there to not let it bother you. First, you may be feeling overly sensitive and emotional because of all that’s going on, that’s perfectly normal, so tell yourself its not that she wants to be rid of you, she might just be having a bad day or had a fight with her husband, it doesn’t necessarily have to be about you. Besides that, all you really need her for is to write your prescription(s) that the other doctor is going to recommend, and the other doctor sounds very thorough, so that’s good news.

The thing about the receptionist refusing to schedule your June appointment isn’t really that surprising. Lots of doctors in the US will only open their appointment schedule for patients a month or two at a time. The receptionists response saying “lets see what happens” makes me wonder what she knows that you don’t know yet, like maybe your doctor is moving or something like that, or maybe she means that she wants to give the doctor as much time as needed to read the report, so she’ll wait until they have the report to see how busy the doctor is at that time and how long she needs to read the report. If she schedules your appointment now, she’s locking the doctor into a deadline of when she has to be ready.

Hope this helps…

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[Anonymous]

Hi LindaLouWho,

It’s not the first time my doc has been this way. She didn’t used to be so difficult. And i didn’t used to be so prepared, although I do have trouble with getting what I want to say across in a very short time frame. My nurse friend in the USA says it’s hard to balance our needs to be a partner in our healthcare with our doctor’s egos.

When I saw her this past Tuesday, she hadn’t read the letter that my psychologist had sent her, at my request, suggesting that over the year and a half that I’d been seeing him, I had consistently displayed symptoms consistent with ADHD, that they behavioural work we were doing wasn’t helping completely, and that he encouraged me to ask her for a physician-supervised trial of meds. I was shocked when I asked the receptionist if they’d received the letter and she said “yes, i scanned it and it’s on her [[the doctor’s] computer. The receptionist knew what I wanted to come in to see the doctor about, so why wouldn’t the doctor have read the letter or known what I wanted to talk about? She didn’t even try to open it up on the computer before escorting me out of the exam room.

I’ll try to be more open-minded, unfortunately the doctor is in control of the med-giving, and the receptionist has a bit of an attitude problem, so I am trying to play nice, but it’s very, very frustrating, as you can imagine.

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[Author]

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