To Medicate, Or Not To Medicate

[Anonymous]

Well, the first day on Ritalin was a success. My son was disappointed not to be allowed more than the one dose, as he really felt “improved” while the Ritalin was in his system. And we noticed an effect too. He was not as easily frustrated – I heard him teach his sister how to do something, and it didn’t dissolve into the usual frustrated yelling match. Also he was calmer overall. His conversation wasn’t all over the place, he interrupted less, and he didn’t constantly barge in to tell me all sorts of useless information. He also listened, and I notice that the one time I asked him to do something, he did it right away without using delaying tactics or getting sidetracked once started. Certainly not the norm for him!!

After looking at his report card today and seeing all C grades, with a D chucked in for good measure, I am so looking forward to a fresh start next term with medication on board. He has a great attitude towards things too, which will help immensely.

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[Anonymous]

Day 2 of Ritalin for my ADHD son today.

He had a dose in the morning, and a second at lunch. He cleaned the car for pocket money this morning, and did really well. He had trouble getting started, so the Ritalin doesn’t improve his motivation to get going, but it certainly helped him stay on task. He spent a couple of hours cleaning the inside of our car, and did an extremely thorough job. No coming inside for breaks, no giving up because it was too hard or taking too long, no asking for help more than a brief question about what he could use to clean the seats. Very different to his usual self. He does get hyperfocussed on things, but still seems to fluff around wasting time, or gets lost in the little details and loses sight of the big picture. Today was a real improvement.

He also had a rehearsal this afternoon, and noticed he was better able to pay attention, was less talkative, and had more energy to put into his performing (probably because he was channelling it better instead of wasting it by jiggling and fidgeting). While on the Ritalin, his conversation still seems rather rambling, but he spends less time pausing to gather his thoughts, and he doesn’t seem to go off on tangents as much (sort of hard to tell after only 2 days though).

He was pretty tired after the lunch dose wore off, though he picked up again once he had eaten tea and had a shower. It’s promising for when he has a later dose though. It seems like he won’t have insomnia from a third dose, as some people do. Actually, he hasn’t reported any side effects at all yet.

Three doses tomorrow (8am, noon and 4pm). And another rehearsal, in the evening, so we have another opportunity to see what improvements occur in a setting that requires concentration etc. I am tempted to delay his 4pm dose a touch, so he is covered fully for the whole rehearsal, as well as to get an idea about how late he can get away with taking it before it affects his ability to sleep. Mostly because he has performances later this year and a 10-12 hour slow release preparation will be wearing off as his performances start, so I want to have an idea about how we could manage it. I want to ask the doc if it’s possible to take a short acting Ritalin on top of the slow release stuff (as the SR is wearing off) so he is covered by medication through to later in the evening (a dose about 6pm to peak around 7-8pm and see him through till 10pm). Just for those nights when he has an important event and the wearing off “slump” happens at a really bad time. I could delay his SR dose till later on non-school days, but I couldn’t do that on school days, as firstly he needs the effect of the meds at school, and secondly, I would have to take the tablet into school to give it to him at the appropriate time (too many hoops to jump through if I want the school to deal with the medication rather than me doing it – alright for a long term, regular dosing regime, but too much work for a once-off change in dosing).

Ugh. I think I need me some Ritalin too. Wanted to have an early night, but have just wasted hours on the computer. It’s now way past the time I had planned to go to bed. Roll on September, when I have my psych appointment!!

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[Anonymous]

Hmmmm. He had bad heartburn/reflux this morning. Plus a major panic attack because he hurt Neither is unusual for him – he often freaks out when he hurts himself or has symptoms that he can’t explain. And heartburn is normal for him, if he eats pizza usually, though it does occur at other times as well. Just not first thing in the morning or as severe as it was today….hence the panic. Calmed him down. Gave him antacids. He’s fine. But now reluctant to take his Ritalin. I think a call to his doctor is in order this afternoon. We might have to get something for his heartburn as it looks like the Ritalin is going to make it worse. Bugger!

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[Anonymous]

Well, I got some ranitidine tablets for my son to take at bedtime, so he doesn’t get reflux/heartburn through the night, and it helped last night, so he was happy to take his Ritalin today. Sitll reluctant to take the third dose, as he couldn’t see why it was necessary, but I explained that the paediatrician wanted to see how it went with regards to effect and side effects and he couldn’t do that effectively if my son wasn’t taking the dose he would normally take on a school day. So he took a third dose. He said he didn’t have any trouble getting to sleep last night, which was good, so we’ll see how tonight goes.

I worked last night, so slept today, but I didn’t hear the kids, so things must have been calmer. I got a few interruptions from my son in the “between dose” phase, but once the next dose kicked in he was less impulsive and kept out of my room and solved his own problems. The kids also had the neighbour’s young boys over, and managed to keep them quiet and occupied for the whole day, so I am impressed. I would usually have to remind them to be quiet and stay at the other end of the house. And the house doesn’t look much messier, so they have done some tidying up, or kept things under control at least, so another thing to be happy about. I don’t think it’s all due to the Ritlain, but I think it certainly has had an effect on my son’s self-control, frustration levels, and forethought, to say the least.

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[Anonymous]

Thought I had better give an update….

After a successful trial of Ritalin 10mg three times a day, my son has now been put on Concerta 27mg. Here in Australia the doctors have to show success with the short acting drugs before prescribing the long acting ones. Having to only take one tablet per day is a huge bonus, as my son is not the best at remembering to take pills, and we also don’t have to arrange for him to have medication administered at school. He is really thrilled with the effect of the medication. Not only has it helped him with focus and stuff, but it has also seemed to allow him to think more about what his needs are and how to manage his learning issues. He has negotiated with his teachers and is now allowed to do his class work on a laptop, which has made a huge difference to his ability to complete his work and not lose it. He has had no real side effects other than the gastric reflux in the first few days, which we treated with a Ranitidine tablet before bed, which we were able to cease after a week or so.

I still have to wake him up in the morning. He doesn’t get up with his alarm. In the holidays, we trialled giving him his medication before he had to get up, and it made a big difference in his ability to wake up and get moving. But with his school and my work times, I can’t give him the meds before he gets up. He tried doing it himself, but one morning he had his drink but not his tablet, and another morning he couldn’t remember if he had taken his tablet or not, so he now has it once he is up out of bed. Needless to say, mornings are hell. He is angry and irritable. He is always rushing, as he lingers in bed without the meds on board, and he is never organised and takes his frustrations at not being able to find things out on me. But he is much happier at school, and he is expressing fewer frustrations and is more tolerant and calmer when he comes home from school.

Overall, with the medication he has gone from almost failing at school to being accelerated in some classes and doing very well in the others. He is better able to take a step back and look at himself critically. He is more patient and tolerant, and gets much less angry. And when he does lose his temper, he is better able to calm himself down and deal appropriately with the situation that made him angry. The medication has made a huge difference and we are very happy that we decided to give it a go.

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[caper]

Did the doctor say 27mg concerta is equivalent to 10mg 3x daily? I would have expected them to use 36mg concerta instead, as I’ve read it’s equivalent to 8mg 3x daily.

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[Anonymous]

If the Concerta is the equivalent to 8mg x3 daily, then that would make the 27mg the corresponding dose, as 8×3=24. But the doctor did say that while the 27mg is probably the most suitable dose for my son, given the success of the 10mg 3x/day, if he has a growth spurt then he may need to move up to the 36mg dose. So maybe the 10mg 3x daily could correspond to either the 27mg or the 36mg Concerta depending on other factors such as the person’s weight, and their severity of symptoms. I don’t know what the corresponding Ritalin 10mg dose would be for the 36mg Concerta if it’s not 10mg three times a day.

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[caper]

Supposedly not all the MPH in Concerta is released, so from a 36mg Concerta you don’t get it all.

Here’s one of the pages I read regarding dose equivalence.

http://www.addadhdblog.com/concerta-getting-the-right-dose/#30fc2

I also read some clinical reports that showed 36mg Concerta is equivalent to 10mg MPH 3x daily.

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[Shadow Nexus]

Read my blog posts on the topic of “first time on adhd meds”

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[Author]

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