ADHD and FATIGUE

[Anonymous]

Dr. Jay if you get a chance can you explain what you meant by “CBT deals with the accumulated negative noise.” I have done CBT before but it has been specifically for mood disorders and I’ve been thinking of ways to apply the CBT that I know of to help with the noise but I haven’t come up with anything.

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[Anonymous]

I was officially diagnosed as having ADHD combined subtype on September 30th and was prescribed Concerta. I took 18mg of Concerta in the morning, before 9 am, and began noticing an improved ability to ignore that “I’ll do it later” attitude and my mood swings pretty much disappeared. I also noticed a big improvement with my ability to schedule my day and I have been getting many things done around the house.

This past Friday, after a week of taking the initial dose, I began taking two 18mg pills before 9 am, as per my doctor, and I didn’t notice that much of an improvement in symptoms over the one 18mg pill I was taking before. I did notice a slight improvement with my energy levels but I noticed that it still took a while to get going in the morning. It seems as though I feel “normal” between 11am and about 2-3pm on both the 18mg and 36mg of Concerta. After 3pm, however, I feel an overwhelming ‘crash’ and I’m back to my old pre-ADHD diagnosed self (drowsy, fatigued, foggy-minded, sluggish).

I should mention I’m taking 40mg of Fluoxetine (generic Prozac) and I believe that the Fluoxetine is interacting in some way with the Concerta and causing that horrible drop in energy in the mid-afternoon . I am also sweating A LOT. I am thinking of working with my doctor to drop the Fluoxetine to 20mg.

I wanted to get some input from those of you who are taking Concerta on:

1. How many pills you take on a daily basis and at what times?

2. Do you ‘crash’ at a particular time of day?

3. What do you do to overcome that ‘crash’?

4. What has been your experience with SSRIs and Concerta?

If Dr. J could weigh in or any of you guys taking Concerta with SSRIs that would be great.

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[Anonymous]

Hi,

a) first, if you are taking generic Concerta, it doesn’t last as long and, in my experience, drops at the end very suddenly

b) the ascending curve of real Concerta is slow so you won’t get an effect until, yes, about 11 am. Try adding some short acting methylphenidate to the morning to get the kick.

c) You can smoothe out the crash by taking a little bit of short acting methylphenidate at 3 pm

d) the combo of an SSRI and Concerta should be no problem.

Always speak to your doctor before making any changes to medications. Dr. Jain provides advice generically and not for any one person. Advice does not constitute a therapeutic relationship or promise of care. Please consult the privacy policy for more information

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[Anonymous]

Thanks Dr. J. The Concerta is not generic as per the instructions on the rx from the doctor and from what my pharmacist says. The bottle says Concerta and the pills themselves have ‘alza 18’ printed on them.

Even before the Concerta, and for a while now, I have suffered from chronic sinusitis and, from what I read, this condition can lead to drowsiness and fatigue. I have my SECOND sinus surgery scheduled for November 10th. I was thinking that I was feeling down and low on energy because of an infection and this morning it was pretty much confirmed that I do have an infection since I woke up feeling like Mike Tyson was using my face as a punching bag while I was sleeping.

I guess this just shows the importance of having a full medical evaluation to treat any other medical conditions that might be aggrevating symptoms. I believe the infection is playing a role in the drop in energy over the past couple of days and I look forward to the surgery. Chronic sinusitis SUCKS. I still want to reduce the Fluoxetine though.

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[Anonymous]

I have nine patients I have seen who had motor restlessness whose teachers-mothers thought they had ADHD but later found out that mom changed the laundry soap and the kid had itchy underwear. Totally. A physical examination is always a first step.

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[Anonymous]

It’s me again. I was advised by my doctor to take 54 mg of Concerta and I started the new dose yesterday, 3x18mg pills in the morning.

Yesterday I noticed increased aggression to the point of wanting to go out there and have someone cross me the wrong way to get into a fight, very strange stuff. I was also more talkative but I was still able to get my daily tasks done. Today however I took the 3x18mg pills again in the morning and I became more mellow, a lot more mellow. It’s 4:22 pm right now and haven’t done any chores, gotten out of my pyjamas or done my workout. I had breakfast at 8 am and had to force feed my lunch at 3:15 pm. I should mention that I am on antibiotics for a pretty bad cold and I am also doing group work to address past abuse issues (I was sexually abused as a child.)

I’m not sure at this point if it’s the medication increase that caused the aggression yesterday and the “I don’t give a **** about my chores” attitude today. I was advised to try the 54 mg for 3 days and see how it goes but so far I feel very bad. I feel that ‘zombie-like’ feeling that I’ve heard other people talk about.

Can some talk about nagative side effects that can be encountered with too much Concerta. Should I expect these side effects to decrease over time?

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[Anonymous]

Fernando, there are times when your medication is not as effective as other times. There is no point getting angry at the medication (you ask whether the medication increase that caused the aggression).

My husband’s medication is inadequate when he has a cold or some other illness. He takes short acting methylphenidate through the day to top up the Concerta but cannot take more on these occasions because he has high blood pressure and would have a stroke if he did. In the meantime it’s the family who has to put up with him until he gets better.The other occasion that this occurs is through high stress work situations. Lacking insight at the time, he cannot see the problems he is causing at home (and I shudder to think about his staff at work) until later when he feels fine again.

Talk to your doctor about increasing your medication, or taking a wonderful drug strattera which helps the ADHD symptoms and reduces anxiety, obsessionality etc. Some of my children are on that and it works a treat!

Side effects of Concerta? Yes. You’ve already said you have difficulty eating lunch until 3:15. Same for my husband and children. That’s when the meds are starting to wear off. That’s when you take your lunchbreak, not get upset about it. My family also eat like ravenous horses at about 8pm. I just put out a big supper and they get on with it. The other one is going to sleep late because the drugs are a stimulant. The trick is to go to sleep with enough still in your system that they won’t keep you awake, but that the drugs have not worn off alltogether so you are lying awake until the small hours with a racing mind. That’s also what I have to judge every night getting four children and a husband into bed. These side effects are not cumulative. Stop the drugs (and live in chaos) and you instantly stop the side effects.

Since it’s easy to work with the drugs’ side effects, why would you stop taking them? This is only about accommodating a different lifestyle now. Be open minded and keep smiling. At least you have adiagnosis and you’re getting help.

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[Anonymous]

Well it seems as though the aggression has gone away but I am noticing that after being very depressed yesterday I am VERY mellow today. I am reminded of when I used to smoke weed when I was younger and feel spaced out and just very lethargic and mellow. It is to the point where I have no motivation to do much and just want to lounge around and do nothing.

I found a chart on the CADDRA website (see link below) that shows that Concerta increases the effects of SSRI. The chart also shows that antibacterial medication should be avoided and I am currently taking Novamoxin 500MG 3x per day. I am feeling really drowsy and just out of it and I am also sweating A LOT. These are symptoms that I remember feeling when I started the SSRI and went away in time but these past 3 days have been really bad.

I won’t be taking the 54 mg of Concerta tomorrow but will go back to the 36 mg dose until I see the doctor. I could not get a hold of the prescribing doctor today and won’t be able to talk to anyone until Monday so if someone has more info on this, or could suggest something, I would appreciate it.

http://www.caddra.ca/cms4/index.php?option=com_content&task=view&id=96&Itemid=141&lang=en

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[Anonymous]

Slowly wind back the SSRI NOT the Concerta!

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[Patte Rosebank]

When you’re sick (or even when you have PMS), it makes any mental condition or mood disorder symptoms get worse.

You should discuss this with your doctor or pharmacist, because he/she is much better equipped to advise you on adjusting dosages to take this into account.

Do NOT try doing it yourself.

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[Clive]

Hi Everybody ,

I had a vist with my doctor yesterday( ADD virgin ) to have my BP checked , 130/85 and we agreed that 30mg biphentin was working .

We also talked about some help with those day when i get totally overwelmed .,is there any body out there that know somebody the councils ADDers in the Hamilton / Burlington area.

Cheers

Clive

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[Anonymous]

I haven’t had time to read all the posts, will at a later time, but had to put my 2 cents in. Extreme fatigue runs iny family. My mother had it and my son has it. My son Matt had to be changed from afternoon to morning kindergarten because he was still taking a 2 to 3 hour nap in the afternoon. When he started 1st grade I know he still struggled. He is now 40 and has never been diagnosed ADD but may very well have it.

I’m 66 and wasn’t diagnosed until about 15 years ago. I was an elementary teacher and when I told the other teachers that I had been diagnosed ADD, they said that they could have told me that years ago. I also have struggled with clinical depression, besides fatigue. I have been on ritalin and prozac for about 14 years and it seems to help quite a bit. Ritalin metabolizes slowly for me so I usually can’t take it after 2:30 or so. Consequently, in the evening I begin to drag. Exercise and meditation are the other things that work for me.

Good luck and keep on trucking.

Janet

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[Anonymous]

This thread has been HUGELY helpful for me!! I have ADD predominantly inattentive type and the fatigue issue is HUGE for me. The uncontrollable urge to nap, the crashes, the inability to complete time managed tasks due to low energy, inability to initiate and sustain task. I get it!

It’s not depression in my case. I’ve taken prozac for years and am not currently depressed. I know that fatigue well. This is different and I believe tied very much to my ADD. I take Concerta which helps with focus(almost TOO well since I struggle with hyperfocus a lot), but not does seem to help at all with the energy crashes.

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[sylvie]

Good evening! I just read this discussion (it took me 90 minutes!) and almost feel like crying … It describes so well how I feel. The extreme fatigue both mental and physical, the randown and sluggish feeling, the running mind, etc. I’ve just been diagnosed and I’m on the trial process to find the right medication for me. I tried Concerta up to 90 mg and it doesn’t do anything. I just started Adderall 10 mg. I usually wake up feeling ok but the symptoms strike me about 1 to 2 hours after and for the rest of the day. I most of the time eat very well and take Omega 3. I’ve tried meditation, yoga, exercise, etc but it’s almost impossible! It wears me out more than anything. I’m able to walk outside every 2-3 days. Thank you all so much for writing. I could not have write it but I relate to it. Let’s hope I’ll be able to write like this when the medication kicks in. ciao fow now.

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[Deborah]

Hi everyone! I don’t know if my experience will help anyone, but I’d rather play it safe and mention it just in case it might. I had trouble for years with fatigue, and it seemed to get worse over time. A mom of one of my son’s friend’s told me she’d recently re-hydrated with water and felt much better. Once I started drinking enough water, the immediate effects of it nearly caused me to stop! After a bit, other than a constant headache like someone smashed two cymbals on my head for months, I felt better when I drank enough. On days I didn’t, or was out in the heat too long, I started to fade out again mentally and physically. I talked to my medical Dr. and he suggested Gastrolyte which I tried. WOW! I found I wasn’t as unhappy either. My Dr. explained it was the electrolytes I needed. Take care everyone, Deb

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