My Journey, Input appreciated.

[cj3w]

Hi all, quick overview of my journey..

Current college student and work full time as well, sometimes up to 60 hrs / week.

7 months ago I was diagnosed with depression, started zoloft 50mg / day.. didn’t like the sexual side effects, loss of libido mainly. Switched to wellbutrin hcl 150, then to 300 because my doc said it would be beneficial for troubles concentrating.  I was not diagnosed with adhd until recently.

Started on 18mg concerta, did nothing for me for a month. Went back to the doctor, explained my issues and he said he wanted to up it to 27 mg concerta. I asked him about cheaper drugs because my insurance doesn’t kick in until $2000 out of pocket. I still have a long way to go because I’m generally very healthy. Anyways, he switched me to 10mg immediate release methylphenidate.

The first two weeks, the medication was AWESOME. Zero side effects, extremely productive and focused for 2 1/2 hours after taking the medication. I was not buzzed, high, or anything that you may describe as euphoric. My only complaint was that the prescribed 2x 10mg daily wasn’t enough to cover the 18 hours that I am awake and am expected to perform at my job and at school.

Until 2 days ago (about two weeks on the medication), it worked great. Now, it’s like it has zero effect for me. Zero. I have to call back at the end of the week to let my doctor know my progress. I fully intend on telling them exactly the truth, what I am posting here. What do you think I should do? Any input? Is there anyone else that was in my situation that has any tips for me? Right now, I should be doing homework, but because my meds aren’t working, I’m searching for answers that I can’t seem to find. Any input is appreciated.

Thanks for creating this website, it seems like I have sort of a support group.

Best, C

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[cj3w]

I forgot to add, one thing that has changed is that I am just physically drained and want to sleep a lot more than usual. This happened when I switched from 1st to 2nd shift as well. So I’m usually awake while it’s dark out. It just seems like it is a lot harder to get out of bed than it used to be. This may or may not be an effect of the medication and / or my schedule change.

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[Patte Rosebank]

@Cj3w, I’m not an expert, but I know from experience that instant-release methylphenidate only lasts about 4 hours. So 2 doses wouldn’t be enough for 18 hours.

Concerta may be a better choice for you, because of its extended delivery through about 12 hours (at least, for me). But everyone’s different, so finding the right med & dose takes trial-and-error, under medical supervision.

If cost is an issue, Concerta’s manufacturer has a free co-pay plan that can help. And it makes the only generic brand that really is identical to branded Concerta.

Talk to your pharmacist about all this. Often, pharmacists know more about meds than doctors do. Then, you can have an informed discussion with your doctor about it.

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It sounds like maybe your sleep cycle is an issue here, as well as perhaps the gloom of this winter-without-end. When even neuro-typicals are complaining that it has them feeling tired & miserable, you know it’s a bad winter.

Shift-work isn’t good for anyone, because it messes up our circadian rhythm (the “internal clock” that controls our bodily functions). But its effects are really strong on people with mental or physical health issues like diabetes and metabolic disorders.

When your sleep is messed-up, it affects your brain-functions, mood, digestion, blood-sugar levels, metabolism, and (most dangerously) cardiovascular functions.

Like many daily medications, ADHD meds work best when taken at the same time every day. When you switch your schedule, it takes quite a while for your circadian rhythm to adjust. Until it does, you’re essentially jet-lagged. (As I often am.)

Dr. Roberto Olivardia has done a lot of work on the effect of sleep disruption on ADHD. Google him.

There’s also a video download about sleep issues, in the Shop: http://totallyaddshop.com/products/addeep-sleep

 

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[cj3w]

Larynxa, thanks for your input.

I don’t know about my sleep cycle, it could be more just getting used to 2nd shift work, it doesn’t depress me, but has certainly affected my internal clock. I used to get seasonal depression (more gloomy in the winter than usual) but when I started wellbutrin (buproprion), it doesn’t seem to affect me.

As far as taking my medication for adhd, I can’t take it at the same time every day because of it’s lack of effective time. I need to prioritize when it comes to work and school. What is more important to focus on that particular day? That is something that I try to figure out daily. Sometimes its school, so I take it as I’m leaving work. Sometimes it’s work, so I take it when necessary, sometimes both. I know I need to talk to my doctor about it, and I plan to for sure.

What is the max prescribed dosage of methylphenidate IR per day in adults? If it helps, I’m 5’9″, 165lbs, and 27 years old (male). When do I know it’s time to step up to the next strength drug?

Thanks, C

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[blackdog]

Hi @cj3w, welcome to the forums, aka “the support group”. 🙂

It’s late and my meds wore off long ago, so I probably shouldn’t even try this right now, but here goes.

The shift work is most likely messing up your internal clock. It could be the medication too, since fatigue is a possible side effect. It could also be something else entirely. You should mention it to your doctor, maybe ask for some blood tests to check to see if everything is okay. You are young and healthy so there is probably nothing to worry about, but it never hurts to check.

It is important to try to stick to a routine with the medication. If you can take it at the same time every day it will work better. But I understand what you’re saying about the short time that it is effective. You could try another slow release medication like the Concerta. Maybe there are some that are less expensive. I really don’t know.

As for the dose, 10 mg is pretty low. If you have been taking it for at least 2 or 3 weeks with no side effects it is probably time to increase it to the next level. But that is up to your doctor.

The general rule with most meds is that you start on the lowest dose for 2-4 weeks and if you are tolerating it well and it seems to be doing some good, then you go up to the next dose, and keep going up gradually, until you find the one that works the best. I believe the maximum recommended for methylphenidate is 60 mg/day, but don’t quote me on that. You want to take the lowest dose possible to get relief of your symptoms. Remember that you will build up a resistance to it over time and it will become less effective. And if you are still taking the IR, it is still going to wear off in about 4 hours.

Weight can have an effect on how some medications work. In some cases people who are overweight require higher doses. Your BMI puts you just barely in that category, but not enough to worry about, in my opinion. There are many other factors that will affect how the medication works and everyone is slightly different. Finding the right dose is usually a matter of trial and error unfortunately.

The easiest way to get the most accurate and up to date info is probably to talk to your pharmacist. They have more detailed knowledge and experience with all the different kinds of meds that are available.

Good luck, and good night. 🙂

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[cj3w]

“As for the dose, 10 mg is pretty low. If you have been taking it for at least 2 or 3 weeks with no side effects it is probably time to increase it to the next level. But that is up to your doctor.”

Thanks for the welcome 🙂 and yes I will be speaking with him directly about this. I have found that I do much better when I take them one after another, as if the therapeutic effect lasted longer and was of more quality. Tonight I did an experiment while doing boring school work and ended up taking 3 10mg, spaced 3 hours apart. It worked very well. I could concentrate on my work, get the things done that I needed to, and I feel accomplished at the end of the day.

I have kept an adhd journal to help communicate the way that I react and feel to my pdoc. It includes time at work, at home, with schoolwork, and the like. I would have forgotten half of the things if I didn’t write them down.

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[Patte Rosebank]

They used to believe that height & weight were factors in calculating dosage. Today, they know that how each person metabolizes meds is far more important.

Dr. Charles Parker has done a lot of work on this. His latest book is an easy read, and full of information. (http://www.amazon.com/New-ADHD-Medication-Rules-Science/dp/1938467221)

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[blackdog]

Good job keeping a journal. I keep trying to but I never remember to write in it for more than a couple of days.

I have to say please be careful experimenting on your own with the meds. Anyone who knows me would know that’s a bit like the pot calling the kettle black, but it really isn’t a good thing to do, even if we do know everything. 😉

When I said “everyone is slightly different” I was mostly thinking metabolism, as Larynxa said. I was just too tired. Still am, since I was bad and stayed up way past my bed time. Anyway, since metabolism affects weight, a persons weight is often a visual indicator of their metabolism. Higher weight typically means slower metabolism, and vice versa. There is more to it than that of course. But everyone is different and stimulants can have a radically different effect on different people.  What is too low for you could be too high for someone else, even someone the same height/weight/build etc. There really is no way to tell until you try and it is best to be cautious and take it slow to avoid any adverse effects that might come with taking too much to soon. It will take time to figure out what works best.

 

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[g.laiya]

it sounds like with your schedule you would be better off with an extended release type med, and may also benefit from an IR or a cup or two o java for the gap.

but it also sounds like second shift work may not be a great thing for you. like pp have mentioned, shift work – it’s not really good for anyone, messing with circadian rhythm, but i imagine far more challenging for those with physical/mental/emotional difficulties…neurotransmitter issues….

something else to keep in mind that i experienced, and may be related:
if you are under a lot of stress emotionally or physically – even fighting off a virus like the common cold – it can feel like your medication stopped working. so yes it also might be worth it to get a basic blood panel run, see if anything else is going on.

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[cj3w]

I hate shift work, luckily I only have to do it for two weeks, every 6 weeks (rotation with others). I am very much looking forward to going back to day shift next week.

I spoke with my doctor, he is upping me to 15mg morning / 10 mg early evening. I didn’t really want that, but I figured I’d give it a shot.

First time I took 15mg, I was anxious. Anxious beyond any anxiety I’ve ever had. It was about nothing, but about everything at the same time. Hard to concentrate, weird sexual craving. After two hours it started wearing off, but didn’t seem to leave. I took my 10mg later on that day and it didn’t have the effect that it used to. Still difficult to concentrate, couldn’t nail down my school work. Second day, same thing. I decided I didn’t want to do 15mg again today, so I took 10mg, then 5 mg a few hours later, and then 10 again at the normal time. It seemed to go okay. I know the community doesn’t condone experimenting, however, this is what I did, at it seemed to be more smooth. But at the same time, none of the doses had the therapeutic effect that they did in the first 2 weeks.

My question is – where do I go from here? I hate the feeling that the 15mg dose gives me. I’m afraid it will take away from my productivity instead of allowing me to focus. Is there an adjustment period? I didn’t experience this at all going from zero ritalin to 10mg IR.. and I don’t want to do extended release because I haven’t had good luck with it and it is literally 3x more expensive due to my insurance than several IR per day.

One thing I’d like to add – my doctor switched me from zoloft to wellbutrin several months ago, before my adhd was diagnosed. I went off of zoloft due to decreased sexual cravings and disappointment (maybe perceived) from my girlfriend. Without going into to much detail, I see her once per month (long distance) and she feels ‘randy, baby’ all weekend when I see her. It was a struggle to perform several times just due to the physical inability to maintain an erection by the 4th day. Otherwise it hadn’t been an issue. However, 50mg zoloft kept me more mellow, easy to communicate with and overall more happy than 150 or 300mg wellbutrin ever did. If anything, the wellbutrin increased my anxiety (I’ve read it does that to people). I noticed it more when I ran out of wellbutrin due to my insurance company screwing with me. When I finally got it refilled and started taking it again, my anxiety has been at least twice what it usually is. As far as energy and depression, the wellbutrin seems to do well. But anxiety wise, the zoloft takes the cake. Should I ask to trial a low dose of zoloft again along with my current meds?

Any other suggestions?

Thanks 🙂
C

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[Patte Rosebank]

@Cj3w, why do companies force their employees to switch between day & night shifts? It makes a lot more sense to hire night-owls for night shifts, larks for day shifts, and keep them on those shifts.

Otherwise, employees’ circadian rhythms are constantly in a state of flux, which actually makes them LESS productive and MORE prone to mistakes. Like the Exxon Valdez and the recent Chicago train-wreck.

What if you asked your boss about staying on the shift where you’re at your best? Not mentioning the ADHD, but just saying something like, “You know, I seem to do my best work in the afternoon. Any chance I could stay on the afternoon shift for a while, instead of switching?” Employers are a lot more open to ideas that’ll increase productivity, than they are to requests for accommodations for a disability.

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As for your medication issues, they’re something to discuss with your pharmacist first and then your doctor. If your current meds aren’t helping you (and are actually hindering you), then your doctor needs to adjust them.

About the Wellbutrin: Is it a generic? They’re notorious for the kind of side-effects you describe…which are not caused by actual branded Wellbutrin.

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Another factor is how many things you’re juggling, that are in flux: shift-work, college, trying to find the right meds, a long-distance relationship…

Try to take each thing one at a time, if you can.

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Maybe you and your girlfriend need to discuss your relationship. Relationships are partnerships, and they’re about a lot more than sex.

You said you feel pressured when the two of you get together, because she always feels “randy”. Have you told her how you feel about it, or do you just give her what she wants? We’re not mind-readers, but we keep expecting other people to be. (Aren’t we silly?)

How would she feel if it were the other way round, and you were the one constantly pressuring her for sex, when she didn’t feel like it?

What if it wasn’t a long-distance relationship, and you two had all the time in the world to be together? What would you do together, then?

What if, the next time you got together, you just focussed on the romance, not the sex…just enjoyed each other’s company, and talked…really, really got to know each other? That depth of connection is the most incredible feeling, and it makes sex even better.

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[cj3w]

@larynxa thanks for the input. I know what you mean about shift work, but it is required for my job. It’s temporary duty for the next few months so I won’t complain too much about it.

As far as speaking with my girlfriend, I know she’d be okay with it but I just don’t want to disappoint her. However you never really addressed my question if I should ask to go back on Zoloft with my current meds or something else. im assuming you would recommend that due to your response.

I think it’s easier for an outsider looking in to give advice such as take  each thing one at a time but for me, I have to juggle all of these things and my current meds aren’t helping like they should. My doctor switched me to 15mg ritalin just a few days ago and wanted me to update him within 2 weeks but I don’t think this will work for two weeks. Id rather take lower doses such as 10mg it x4 daily. Not sure what to do at this point. I know general practice says switch one drug or dosage at a time but I stand firm on my belief that adding Zoloft and taking away the 15mg dose of ritalin would work.

C

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