View Full Version : I can only tolerate 5mgs due to the exacerbated anxiety.... anyone else the same?


andy1027
01-02-14, 10:38 AM
Is anyone else in the same boat as me?

I am wanting to go back to methylphenidate long-term because it works wonders for my concentration, but I can only (just about) tolerate 5MGs of the immediate release form. ONLY 5MG!

The reason is that I am very sensitive to the methylphenidate - It makes me very anxious and nervous and my only solution to that is to take only 5mgs as opposed to higher dose extended or immediate release forms. The extended release forms are even worse for my anxiety, making it more chronic.

The advent of this has made me realise that as well as my ADD, I have an underlying, undiscovered and undiagnosed anxiety problem which is clearly exacerbated by the methylphenidate. Years ago, I was on the ER form at 30mgs for 9 years, I took it when needed but it made me feel all TERRIBLE anxiety and nervousness which outweighed the purpose I was taking the medicaiton for.

As I said. I want to take the methylphenidate again, but treating the anxiety too. I am waiting to see a psychiatrist for that. However, until then I am taking the methylphenidate 5mgs along with 80mgs propranolol so as I can finish my web project for college (I cant do it without the methylphenidate, which is a god send). The propranolol certaintly helps a lot for what it can do, but it could be better - a lot better. So I am thinking of perhaps combining propranolol with a benzo or perhaps a benzo on its own. We shall see what the psychiatrist says.

But for now....

The problem with the 5mgs is that it runs out fast. I'd say within 2 hours.
In order to keep it high in my bloodstream as much as possible throughout the day. How often would I need to be topping it up in order to avoid the dip?

Also - Is there anyone else in the same position as me? What medications are you taking to counteract the anxiety effects that are exacerbated by the methylphenidate?

Thanks - All contribution welcome :) I really appreciate everyones help.
My hope is that I can get somthing that will help reduce the anxiety felt whilst I am on methylphenidate so I can concentrate even better!
The methylphenidate is fantastic! I can really feel the dopamine just sitting there in my pre-frontal cortex (lol). Without the medication - I feel nothing there, and I am always tired and restless.

karbouris
01-02-14, 08:28 PM
Yes! Me!

andy1027
01-02-14, 08:45 PM
Yes! Me!

lol But your signature says you take 10mgs IR Ritalin.

PS - I would say I have the same issues as you on top of ADD -> Mild depression and anxiety.

dvdnvwls
01-02-14, 09:02 PM
Regarding the timing: the best way is to check it yourself. Take one as normal, and note the exact time. Note the time again when you feel it starting to take effect, and again note the time when it's starting to lose effect. Using some fake numbers: if you take it at 8, and it takes 20 min to kick in, and then is running out at 11, then 11 minus 8 is 3 hours, minus 20 minutes for kick-in time, means every 2 hrs+40 min. Or however it really works for you. Does that make sense?


When taking consecutive doses, it's probably better to overlap them a tiny bit, so that you don't have up-down-up-down throughout your day, but up once, stay about the same for several hours, and then down once.

karbouris
01-03-14, 02:09 PM
I was on 10mgs 4x. I started 3 10mgs a day, but would take half every few hours. Im perscribed 10mgs 2x daily but I only take half 4x daily. Waiting on my insurance to approve my metadate CD script. I'm too lazy to change my profile. Lol.

Modafinilguy
01-09-14, 08:04 AM
Anxiety is complex. It is both biological and psychological, and should be treated on both fronts.

I would strongly recommend Clonidine, especially in an extended release form. But you have to very slowly increase the dosage week by week, for a few weeks until its at an effective level.

Clonidine is a bit like a beta blocker. except instead of block the beta-adrenergic receptors, it blocks the alpha-adrenergic recepts. Same receptor system, different group.

In simplicity Clonidine counter acts the physical side effects of stimulants, in pretty much all ways. It reduces physical tension, has a general overall relaxing effect, and slows the heart down gently (where as stimulants obviously increase heart rate).

Clonidine is prescribed by some doctors for Panic Disorder.

Also, believe it or not, it actually has direct effects on the prefrontal cortex (the main adhd brain area), and is known to improve various ADHD systems. However you might not have these, as you are ADD, it mostly helps with impulsivity and hyperactivity.

I would suggest this is the first port of call to treat anxiety on stimulants, though you will need to get the dose and timing right for optimal effect.

Having said that, there is more to anxiety than just that. Anxiety can be psychotically reinforcing. You can become anxious that the Ritalin will make you anxious, thus causing the anxiety in a sort of feedback loop.

Anxiety is often associated with various perceptions (especially of your senses) that TRIGGER it. For example Ritalin may increase your pulse, you may hyper focus on this, and it makes you anxious. Because you are more anxious, one of the main effects of anxiety is to increase heart rate (and many other physical symptoms). So because your heartrate further increases, you become more anxious, then your heartrate increases. The symptoms of your actual anxiety can aggravate and worsen the actual anxiety over and over, the end result can be a massive PANIC ATTACK.

A drug like Clonidine to stop the physical side effects, in conjunction with understanding the psychological elements of an anxiety reaction, identifying triggers, well this is the best strategy.

If Clonidine is not effective or partially effect. A normal doctor would usually suggest an Select Serotonin Reputake Inhibitor antidepressant like Prozac. Such drugs from my experience help some people with anxiety, but many do not benefit. Indeed initially many of these drugs can WORSTEN anxiety until you get used to them.

You could try an SSRI, if Clonidine and psychological techniques are not enough.

A benzodiazepine in a moderate dose may be of assistance but BEFORE. Benzodiazepines are very seductive drugs in terms of being tempting to abuse, they are HIGHLY addictive, and if you get dependent suddenly stopping them causing AWFUL withdrawal symptoms. Taking too much is worst than being drunk, you will think you are fine, but have no idea at all, and some people become aggressive or suicidal on higher than your supposed to have doses.

If you try a benzo you MUST keep in complete control, and take it in a very controlled way, and do EXACTLY as the doctor says, and not muck around with it.

I actually- many years ago- had some anxiety problems on Ritalin. I took an antidepressant like the ones I mentioned, called Aropax. In hindsight, I think it significantly aggravated the anxiety on the Ritalin.

Such antidepressants as the SSRI's are VERY hit and miss. Its a bit like roll a dice. In some people they can worsen ADD, anxiety and depression symptoms!

There are more advanced drugs available. You want drugs that have specific effects on specific Serotonin receptors, not just flood the whole system like standard SSRI's. Because some of these receptors, when activated by Serotonin actually have NEGATIVE effects and reduce the ability of the brain to function. Other Serotonin receptors have the OPPOSITE effect and have good effects when activated. There are drugs available (a couple) which block most the bad receptors (stopping them from reducing brain function activity), and active most the good ones!

The 5-HT1a, and 5-HT2A receptors are highly implicated in anxiety, as are others. You want a drug which at least activates 5-HT1a, and BLOCKS 5-HT2a. It complex but they work in unison in having a positive effect when modified this way, yet they have opposite effects, that why you turn the first one on, and the second one OFF.

There actually are quite a lot of medication options available for anxiety these days.

Don't forget to always address the psychological side and identify triggers and incorrect (irrational) assumptions which may cause you worry.

Best of luck!

avjgirsijdhtjhs
01-09-14, 02:37 PM
andy1027: I noticed in your sig that you said that methylphenidate makes you physically anxious. So looks like you're talking about sympathetic nervous system stimulant physical anxiety panic-fest stuff like described above:

Having said that, there is more to anxiety than just that. Anxiety can be psychotically reinforcing. You can become anxious that the Ritalin will make you anxious, thus causing the anxiety in a sort of feedback loop.

Anxiety is often associated with various perceptions (especially of your senses) that TRIGGER it. For example Ritalin may increase your pulse, you may hyper focus on this, and it makes you anxious. Because you are more anxious, one of the main effects of anxiety is to increase heart rate (and many other physical symptoms). So because your heartrate further increases, you become more anxious, then your heartrate increases. The symptoms of your actual anxiety can aggravate and worsen the actual anxiety over and over, the end result can be a massive PANIC ATTACK.

Okay read this about levoamphetamine (http://wiki.answers.com/Q/What_is_levoamphetamine?#slide=1) (looks like they changed to page from regular text to some idiotic "click the left and right arrows ********" - anyway, read the stuff by clicking on the right arrow), which makes up about 25% of ADDerall, with the rest being the CNS stim dextroamphetamine (the good stuff). See why a person that dislikes the physical anxiety from levo would want to take dextro only?

Okay now a quote on methylphenidate form Wikipedia:

ChemistryFour isomers of methylphenidate are known to exist. One pair of threo (http://en.wikipedia.org/wiki/Threo) isomers and one pair of erythro are distinguished, from which only d-threo-methylphenidate (http://en.wikipedia.org/wiki/D-threo-methylphenidate) exhibits the pharmacologically usually desired effects.<sup id="cite_ref-Heal_DJ.2C_Pierce_DM_2006_713.E2.80.9338_124-0" class="reference">[124] (http://en.wikipedia.org/wiki/Methylphenidate#cite_note-Heal_DJ.2C_Pierce_DM_2006_713.E2.80.9338-124)</sup><sup id="cite_ref-125" class="reference">[125] (http://en.wikipedia.org/wiki/Methylphenidate#cite_note-125)</sup> When the drug was first introduced it was sold as a 3:1 mixture of erythro:threo diastereomers (http://en.wikipedia.org/wiki/Diastereomer). The erythro diastereomers are also pressor (http://en.wikipedia.org/wiki/Pressor) amines. "TMP" is referring only to the threo product that does not contain any erythro diastereomers. Since the threo isomers are energetically favored, it is easy to epimerize (http://en.wikipedia.org/wiki/Epimerize) out any of the undesired erythro isomers. The drug that contains only dextrorotary (http://en.wikipedia.org/wiki/Dextrorotary) methylphenidate is called d-TMP. A review on the synthesis of enantiomerically pure (2R,2'R)-(+)-threo-methylphenidate hydrochloride has been published.<sup id="cite_ref-Prashad_126-0" class="reference">[126] (http://en.wikipedia.org/wiki/Methylphenidate#cite_note-Prashad-126)</sup>


So anyway, dexmethylphenidate (referred to above as d-threo-methylphenidate) would likely work better for you than regular methylphenidate.

andy1027
01-12-14, 09:52 AM
andy1027: I noticed in your sig that you said that methylphenidate makes you physically anxious. So looks like you're talking about sympathetic nervous system stimulant physical anxiety panic-fest stuff like described above:



Okay read this about levoamphetamine (http://wiki.answers.com/Q/What_is_levoamphetamine?#slide=1) (looks like they changed to page from regular text to some idiotic "click the left and right arrows ********" - anyway, read the stuff by clicking on the right arrow), which makes up about 25% of ADDerall, with the rest being the CNS stim dextroamphetamine (the good stuff). See why a person that dislikes the physical anxiety from levo would want to take dextro only?

Okay now a quote on methylphenidate form Wikipedia:

ChemistryFour isomers of methylphenidate are known to exist. One pair of threo (http://en.wikipedia.org/wiki/Threo) isomers and one pair of erythro are distinguished, from which only d-threo-methylphenidate (http://en.wikipedia.org/wiki/D-threo-methylphenidate) exhibits the pharmacologically usually desired effects.<sup id="cite_ref-Heal_DJ.2C_Pierce_DM_2006_713.E2.80.9338_124-0" class="reference">[124] (http://en.wikipedia.org/wiki/Methylphenidate#cite_note-Heal_DJ.2C_Pierce_DM_2006_713.E2.80.9338-124)</sup><sup id="cite_ref-125" class="reference">[125] (http://en.wikipedia.org/wiki/Methylphenidate#cite_note-125)</sup> When the drug was first introduced it was sold as a 3:1 mixture of erythro:threo diastereomers (http://en.wikipedia.org/wiki/Diastereomer). The erythro diastereomers are also pressor (http://en.wikipedia.org/wiki/Pressor) amines. "TMP" is referring only to the threo product that does not contain any erythro diastereomers. Since the threo isomers are energetically favored, it is easy to epimerize (http://en.wikipedia.org/wiki/Epimerize) out any of the undesired erythro isomers. The drug that contains only dextrorotary (http://en.wikipedia.org/wiki/Dextrorotary) methylphenidate is called d-TMP. A review on the synthesis of enantiomerically pure (2R,2'R)-(+)-threo-methylphenidate hydrochloride has been published.<sup id="cite_ref-Prashad_126-0" class="reference">[126] (http://en.wikipedia.org/wiki/Methylphenidate#cite_note-Prashad-126)</sup>


So anyway, dexmethylphenidate (referred to above as d-threo-methylphenidate) would likely work better for you than regular methylphenidate.

I will defnitly check this out! Hopefully it is available here in the UK. If its not... I dont know what to do lol

Fraser_0762
01-12-14, 09:57 AM
Focalin isn't available in the UK.

Dexamphetamine (Dexedrine) is an option however.

avjgirsijdhtjhs
01-12-14, 11:09 AM
I will defnitly check this out! Hopefully it is available here in the UK. If its not... I dont know what to do lol

Yeah, anyone (no prescription needed, or age restrictions) can go walk in a pharmacy in the US, and get some levomethamphetamine (often spelled on the bottles as levometamfetamine :lol:), since it's a decongestant. Nobody wants that stuff.

Anyway, good luck, and hope it works out.

roflwaffle
01-12-15, 10:34 PM
Lexapro worked great for my anxiety. Totally brought it back to normal levels.