Methylphenidate troubles.

[Anonymous]

My psychiatrist is away until next month, and here in Australia we have tight laws around AD/HD medications. He’s the only one who can prescribe it for me, and my partner and I have been evaluating how my medication effects me.

Currently I’m on Ritalin LA 40. It costs an arm and a leg, and it only lasts around five hours (on a good day) for me before I start to feel static-brained. My partner can pick when I’m medicated and when I’m not pretty easily. Previously I’ve been on Ritalin 10s (“Take up to four a day as required”, but my psychiatrist advised me that he’d have no problems with me taking an additional 2 for an afternoon dose when I worked long days). The problem I had was that it was rough coming off them, and I’d spend the day on feeling like I was trying to position an aerial on an old TV – I’d take a pill and hit the sweet spot, then they’d wear off and I’d forget to take the next lot until I started feeling uncomfortable.

Now the times when I’m unmedicated are just frustrating. Sure, the Ritalin LA is smooth-ish and fairly consistant but it doesn’t last long enough for my day and I don’t know if I can afford to continue it. I’m kind of dreading going back on to my old regime, but I’m just wondering if there can be any solution to my problem in short-acting dexedrine?

In Australia, only short acting stimulants are subsidized for adults, while long acting stimulants cost a fortune and there are only two available (Ritalin LA and Concerta). I guess after all my reading, I’d be asking my doctor to try me on Concerta, Adderall XR, or Vyvanse, but I really can’t afford Concerta and I especially can’t afford to get other long acting stimulants imported (which is entirely possible, according to my pharmacist).

I should probably talk to my psychiatrist, but since I can’t until next month, I’m trying to find out all I can. I’d heard that dexedrine isn’t so rough to come off for a lot of people, but I wonder if it may provide the same level of treatment? I don’t really feel any “effects” of ritalin – I just feel kind of balanced while its working. I’m guessing dexedrine can’t be that different. Anyway, does anyone have any experience with this?

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[Anonymous]

I don’t know Dexedrine at all. For you It might work like Ritalin or it might just be another

stimulant. If it doesn’t do the job and last longer then there’s not much point experimenting.

Since Ritalin works for you it’s safest to stick with it. Switching to a drug that doesn’t work

as well could throw off your schedule and you end up missing more doses, throwing off your

schedule even more. Before you realize what happened you’re missing doctor’s appointments

and letting them go because you always have a surplus of unused pills at the end of every month

that keeps growing like magic because you can never remember how often you forgot and the static

is getting louder and (mmmm, that coffee’s good) and you’ve gotta reschedule that appointment but first

you simply must finish the bacon and now the news is on and whoa!-I’m-late-start-the-car-don’t-runoverthecat!…

Yeah. Been there, done that, got the t-shirt, lost it, did it all over again….

After 20 years my doctor’s receptionists are used to losing contact and having me reappear out of the blue. ;]

 

I started getting a generic form of Ritalin SR (APO-METHYLPHENIDATE SR) recently because

it is much less expensive then the brand name version and it lasts all day. There was a patent

on the sustained release part which expired and one of the generics manufacturers was ready.

Ask your pharmacist if the APO generic brands are available to you yet and to watch for them

because any similar patents down there are probably expiring or are about to expire quite soon.

With that patent out of the way your SR version will be as affordable as the little 10mg version.

I had my pharmacist on watch for a generic form and we switched when it became available.

If it helps your pharmacist find it, the catalog number (or whatever they call it) is APX 02266687.

This number may only work in Canada but it’s worth a look because the full price on this version

is probably lower than the subsidized price on the LAs and it does seem to be a 24-hour pill.

Here, it’s subsidized and I don’t know the price because it’s so low I end up paying zero.

The SRs come on so slow and last so long that you’ll probably increase the dosage to cover all

24 hours and never have the up-and-down ride anymore, just smooth sailing all day and good

sleep at night. Don’t be surprised if you eventually end up doubling or tripling your daily dosage

to get a good fit again because the steadier coverage will be just like taking the other pills on a

perfect 24-hour schedule. You won’t be missing a dose anymore because they become a part

of breakfast, a routine you could do even with the heaviest static on the brain. Without the static

at night you’ll probably find it easier to sleep at night too. I’m up to 6x20mg now and am still

ramping it up to get the perfect fit.

 

In the meantime your timing problem could be easily solved with your cell phone, if you have one.

Set the scheduler (they all have something similar) to ring at the right times of the day, using a ring

tone or beep that only those schedules use or even vibrate only. Since you’re setting specific times like

0800, 1200, 1600, etc. you’ll have to set several, one for each time, and set them to run every day.

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[Anonymous]

Good ideas and nice support.

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[Anonymous]

I haven taken Mdidate er or sr that was substituted, both were time released and found a great place with this medication. I have taken it for 8 years at 20 mg 2-3 times a day. I work 12 to 14 hrs a day and on those days took the third dose but often felt I didn’t need it and was not compelled to take it.

I the fall of this year I could not find a pharmacy that could keep this medication in stock. I found myself playing the call every pharmacy in town to see if they had it and would have to rush in to get it if they did. Most did not. Since I have top pick up the medication, the Dr. will not give me the prescription more than a day before it’s needed, it turned into a real hassle. The pharmacies indicated it was real hard to get now. I went to my Dr. (family practice) and shared my problem. I had taken concerta long ago when my daughter was diagnosed but it was very expensive so I went to the generic. My daughter chose not to continue meds.

I was prescribed 20 mg of concerta substituted with methylphenidate hcl the first month, then went to 36mg. I had many ups and downs so the Dr put me at 54mg. He did not know anything about either drug and went from a print out I got on the internet about concerta as a possiblitity. It works for the add, but I too get irritible in the evening. I find it very hard to go to sleep and stay asleep I have restless leg syndrome also. I have used 1mg of lorazapam for some time instead of ambian. I sleep walked on ambian so another dr put me on lorazapam. I find myself suplementing with pm or sleep aid drugs like advil pm if I have a head ache or benedryll if not.

I also have COPD, quit smoking 4 yrs ago and have continued to take bupropion for mood stabilization. I have had respiratory issues lately and use assorted inhalers for that. I also go on and off steroids. I have had significant (unlike any before) depression episodes and suicidal thoughts, not wanting to be dependent or ‘disabled’ with a breathing problem. The asthma Dr. says I need to go get anti psychotic advise and medicine. I feel the changes in all the meds in the last few months has changed my body chemistry so much I am a mess. After my last visit on Friday to the respitory doctor, I was put back on steroids, went back to an original long acting inhaler combined with rescue inhalers and nebulizer. My mood is more stable the last few days. I still have crying jags but not suicidal thoughts.

I have seen a counselor (social worker) who was helpful but the ups and downs with meds is a real problem. I am a special ed teacher and have to go back to work tuesday and am worried about my ability to manage my work. Any suggestions? I would really like to have medidate er back but it appears I can’t get it any more.

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[Anonymous]

I am taking this (methylphenid.–10 mg. It doesn’t seem to have a lot of effect (I was hoping it would immediately make me feel like tacking some of the large tasks I’ve been putting off, but no, it didn’t) . I’ve not been taking it long. I’m supposed to take two a day but have to work out for myself when. Most days I just took one in the a.m. but today I took two for the first time, one at 9 a.m. and one at 1:30 p.m. because I thought perhaps the reason I wasn’t noticing it helping was that I was only taking it once. I just don’t feel much different–it does seem to make me feel really tired after awhile. Is this common? Does the fact that I don’t notice much effect mean it’s not working for me or that I’m taking too little? The nurse practitioner I am seeing is worried about it causing a stroke although I don’t have high blood pressure even though I am 68. I’m just wondering if I will notice a difference after being on it longer or if this is as good as it gets? I feel as if I’m feeling my way along without a lot of help. If I’d known the clinic I went to was going to put me with a PA, I think I’d have just gone to my family doc. It’s an almost 2 hour (each way) drive to get to this clinic. I thought I would see a psychiatrist. Now I feel more confused than ever and my house looks just as bad as ever or worse. HELP!!

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[Anonymous]

Hi monkeybarb, I am not a doctor, but as far as I know, unless you’re taking a slow-release version, methylphenidate should act right away (or perhaps within the hour), and it will only last for about 4 hours (I did a trial of ritalin earlier this year) Being tired might be the crash after it stops working. Why don’t you go to the manufacturer’s website and see what they say about it? If the NP thinks there’s a risk for you then it might be wise to consider that. What does your family doc say?

About taking on a large task, that’s not the best idea, especially if you are new to your meds. They are not magic bullets that transform your life – billd here is famous for saying they are just like a key that unlocks a door for you – you still have to work on getting through the door and facing the challenges. Ari Tuckman has a good book that talks about strategies for the different kinds of issues that we face. Meds may make it easier to implement some of these strategies, but in my experience, you still have to work at it.

One of the simplest is to just break down a task into smaller steps. If you have a mountain of clutter in your livingroom (as we did, until recently), start small – I just decided to tackle the DVDs, for example, and found a home for them. Then I tackled the old grocery receipts that were sticking out everywhere. And then something else. Eventually my husband went on meds as well and i got some help. But meds are not the whole solution, just part of it, and they don’t always work for everyone.

I’ve found that the NPs and nurses spend more time with me and give me more info than my GP, whose time is very limited. I do find that frustrating too.

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[Anonymous]

Yeah, I DO have a “mountain of crud” in my living room, funny you should mention it, NoDopa!! How did you know?! Yes, I’ve heard that “break it down” advice a lot, and I’m going to have to try harder to do that. For days, I’ve promised myself to just SORT the #$#@@# stuff, for starters, but even doing that seems so hard. I will try harder, though. I also will go to the manufacturer’s website and see what it said. The PA I saw at the clinic was nice, but I only see her once a month and I wish I could email her in between when I have questions. I’m wondering if the “coming down” part will get better after awhile? I wouldn’t care if it happened in the evening instead of the afternoon. Afternoons are my “Low/lazy/whatever” times anyway, so I guess I should time it so I don’t come down then, for sure.

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[Anonymous]

I suspect that many of our living rooms look alike

“Try harder” might not do it – even with the meds. The stuff that has accumulated didn’t appear overnight, it crept in gradually, so you may need to be gentle with yourself and approach it differently. We got into the habit of ignoring stuff. Eventually after months of tripping over stuff and having nowhere to put new stuff, I blew my stack for the umpteenth time and we slowly started to work out a plan to get it done.

I posted about this elsewhere, but basically it was like this:

– We set a firm deadline (done by Dec 23rd at midnight) – that gave us a few days

– We got real about how much we could do in that amount of time – only ONE room, not two

– We divided up the tasks by person and by what that person would be best at doing, so they’d be better motivated to do it

– We agreed to stay off the computer and not do anything else until we’d finished a substantial portion of it (it took several days)

– We decided to work on it when our meds were at their peak, rather than later in the day when they’d worn off (sounds like you are figuring this part out)

– I started with the small stuff, wanted to clean along the way, but my husband forced me to wait until the end to clean, he was right, it’s easier to clean when there’s no clutter (or less)

– Celebrate your progress, even if it’s only a small amount OR celebrate your effort, even if you seemingly failed (I like celebrating)

I would try emailing the NP and see. You might also see if there’s a toll-free health number in your area, we can call TeleHealth in Ontario, not sure what they would say about my stimulant meds, but you might get some general advice about it, then you could follow up with your GP.

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[Scattybird]

Sorry – can’t work out how to delete a post and not sure why I have 2 out of order. Bed time I think!

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[Scattybird]

Hi MonkeyBarb – re the methylphenidayte; I take 10 mg three times a day but need to take my last one so it wears off before I want to go to bed so I crash when going to sleep because like you it makes me tired. I have noticed that is a bit less of a problem now so maybe it will go for you?

I am still at the sorting out my dose stage. The first time I took it I felt wonderful. It did everything I imagined it would. A few weeks in and I wonder if it is working.

I think it is good for my emotional regulation. It slows me down so I have time to think before I offend anyone which is a bonus for me. I am not sure about the concentration side of things anymore. I think it works but it just helps me to focus by slowing my brain. I feel quite dull when I take it to be honest – a bit too grown up!

Oh yeah – it lasts 3 hours.

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[Anonymous]

monkeybarb, I also took a small dose of ritalin about 5:30 pm and it helped me with alertness through the evening, but i have a sleep disorder so not sure how it affects the quality of sleep. I slept better, but my pattern is to wake up spontaneously hundreds of times during the night, so maybe it was just a recovery night from a previously bad night. Hard for me to tell without lab studies.

I was reading another forum, and here’s a podcast by an ADD coach, talking about project overwhelm. If you can get through the first few minutes where the two speakers pat themselves on the back about how wonderful they are, there might be a few useful tidbits. For one, she says tackle a small project first, a small room. Don’t go for the big stuff. Get a little accomplishment under your belt. I didn’t listen to the whole thing, I rarely do, but I often pick up something useful. Here’s the link http://www.blogtalkradio.com/add-adhd-coaching/2012/01/10/project-overwhelm-and-add-adhd

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[Anonymous]

I am thinking that I am not taking enough of the methyphenidate. I am only prescribed 10 mg, but if I take more, then I will run out before my next appt. I haven’t been taking it because I’ve been sick and didn’t think it would do me any good anyway, but today, since I’m feeling about 50% well, I decided to take some, but now I’m noticing the headache that I think had subsided as I got used to the meds. Boy, seeing a dr only once a month is hard. Wish we could email them when we’re wondering what to do!! It would make life so much simpler. She started me on only 10mg because she was worried about blood pressure rising, since I’m 68, even though I don’t have high blood pressure. Would this, my age, make it a bad idea to experiment by taking more (20 mg)?

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[Anonymous]

I will listen to them, no-dopa, the link you posted, I mean. I have a really hard time breaking things down, and tend to pick up a thing, stop and think if I want it, if I do, decide where it should “live,” take it there. Usually, in that process, forget what I was doing in the first place and start something else. I know inside that the way I’m sorting is slow and cumbersome and not efficient, but I can’t seem to shift myself into another mode. Often, I find half-finished projects and start working on one of those. I have tried not to bring more stuff/supplies home, so at least I’m not adding to the mess—-much. The PA wants to see a picture of my mess–not sure I want her to see it!!!

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[Robbo]

I know how you feel about pictures of your “mess” MonkeyBarb, It’s humiliating. If you could do better you WOULD, you’d gladly do better huh?. I live in a small apartment complex with disabled and/or retired, low income folks. We use to have many (up to 5) inspections each year. It was harassment. Investors, property management, owners, and an apartment manager that had severe control issues, hated seniors, very abusive with most of us. She got fired after we got a lawyer from the Sentinal Project (good, human rights lawyers) here in ca. The inspections have toned way down. Our new apt. mgr.’s are much better. There is an inspection coming up at the end of the month. I’m a nervous wreck trying to find decent help getting my place organized, it is safe and sanitary, just cluttered. I can’t really afford it, but my credit is good, so I can get an ADD coach to help me get organized. That may be my only option. I’m not getting help with medication as soon as I need to. Just yet another support group. I’m posting on another thread about the medication dilemma/frustration. It feels like failure to get a coach… sorta embarrassing… pride sux.

Have you considered getting an ADD coach? is it an option for you? I’ve made some calls, but keep finding dead ends. I’m real close to having my cards payed off and it feels great to have em all down to zero at least once every few years or so. It sucks having to spend money for help with what most normal people have no problem doing.

I’m gonna print out some of the practical, non medication advice about getting organized from these pages. Somehow, having it on paper helps more. As long as I keep it handy, not lost. yeah right, huh? I gotta try… Not giving up is so dang hard sometimes.

PS, I don’t know why, but I always get a kick out of your name and picture, it just cracks me up. (in a good way) Maybe because some of us seem to have brains like a monkey (hopping all over the place, into everything, never slowing down)… does that make sense? hehe. The look on the dogs face is priceless too. He looks like he knows my pain…

Got banana’s?

Gone banana’s? hehe, I’m getting there. Already there, actually… I don’t like it there!

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[Anonymous]

I love bananas and always had one in my brownbag lunch in high school, and my friends dubbed me “Monkey.” My grownup friends (those I have now who didn’t know me in my younger days, don’t know I ever had that name. I’m just Barb to them.)

I was really hoping the meds I’ve tried (Ritalin 10mcg 2 X a day) and now generic Adderall XR, would improve my motivation, but so far, no luck. Disappointing. If the side effects of the Addrerall don’t go away pretty fast, I’ll stop taking it. Being sick from it and not seeing any improvement is discouraging.

I found a book from a thrift store called Time Management from the Inside Out, and reading the book jacket, the author said she’d also written a book called Organizing from the Inside Out. I ordered that from a used book seller online, and am just starting to read it. She has you identify your goals, list what’s working now and what is not working. Then from the “Not Working” list, you see what you need to fix. She has lots of ideas, and it’s not a one-size-fits-all prescription like most organizing books are. I also got another (used) copy of Organizing on the Right Side of the Brain–I either loaned or lost my first copy.(Sigh) But I was sure hoping the meds would help me more. And maybe they will, yet. I know I’m being impatient…….As for a coach, I live in a small town near the coast, about 50 miles from an interstate highway. There are good things about being far from a city, but also bad things, as I had to go to Seattle twice to get diagnosed. That’s about a 3 hour drive each way.

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[Author]

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