View Full Version : Ritalin "tolerance" after 4-5 weeks?


anaidi
10-12-14, 06:43 PM
I was diagnosed with ADHD last month, and was given IR Ritalin to try. Initially, it was amazing. I felt so much calmer, clear headed, and could focus on work, uni lectures etc. The dose was slowly increased from 5mg 3 x a day to 15mg 3 x a day (now taking 45-50mg per day spread over 4 doses as I work long 12 hour shifts). Anything more than that I get headache-y.

BUT.... after about 2 weeks I started feeling TERRIBLE at the end of the day, like super-tired. The doc said it was the Ritalin "crash". We adjusted dose and times... Basically it's continuing.

But the worst thing is that the Ritalin has virtually stopped working with regards to concentration, focus and motivation.

It still is amazzzzing in keeping me calm and my mood is definitely much better. Also, my impulses are kept in check with the Ritalin. So there is definitely a positive effect. But I cannot get any work done! I procrastinate even worse that I used to, I can't get anything done. I do full time uni and full time work, so my days off work are precious because I have so much uni work to do, and I just spend days in my room watching TV, and basically doing anything BUT uni work. I am so concerned. What started as the best thing that has happened to me in my life (getting a diagnosis finally that made sense, and starting to feel better) I basically am just back to pre-diagnosed ADHD in terms of the inattentiveness. I am combined type ADHD so it's like the Ritalin is ONLY working on the impulsivity and hyperactivity, but not working on the inattentiveness.

I have an appointment next week with the doc who has suggested "tolerance" already. She said it is uncommon but not unheard of.

She thinks that this 'tolerance' in addition to the 'crash' I feel at the end of the day means that I should probably give dexamphetamine a try (I am in Australia so there is only dex - no Adderall or anything).

Has anyone here had the same problem with Ritalin and/or tried dex too?

I know that mx is a very very personal thing, so what works for one person will be completely different for another person.

Guess am just looking for some reassurance that the Ritalin doesn't work for everyone, because the happiness I felt last month is slowly disappearing because I am so worried that it's all going to come back and I won't ever get my life under control... :(

Cyanide
10-12-14, 08:19 PM
So far I've had a similar experience with Ritalin (started about a month ago). Initially I found a reduced reluctance to do basic things like cleaning up after a meal and a slight improvement in general motivation, overall calmness, reduced impulsivity and increase in patience. These positives persisted for most the day once I reached 30mg (3 x 10mg).

Unfortunately I've yet to experience any noticeable improvement in focus or distractibility. Even at the best of times I'm still ferociously jumping between tasks at work and trying to read things that aren't taking my interest is still next to impossible. I started on 10mg daily increasing by 10mg every couple of days and have leveled out at around 60mg for the last week or so. I've played around with dosage every which way (less more often, more less often) to figure out what works best.

The duration of the positive effects now is frustratingly brief (1-1.5 hours) which means that even when spacing my doses out I still have very limited coverage, with constant ups and downs. Once I went upward of 30mg per day I started getting very jittery when the Ritalin wore off, and though I'm getting better at dealing with this, initially it was keeping me wired all evening and making it very hard to sleep.

I've also noticed the "rebound" effect many have mentioned where my symptoms are a little worse than usual once it wears off (attention, anxiety, irritability). The rebound is worse with higher doses, and better when I have the next dose in time for it to start working before the previous has worn off.

Given the limited benefit I've experienced and how frustratingly brief the coverage is when it does work, I hope my psychiatrist will be happy to try dex soon too. I'm also from Australia and it sucks we don't have Focalin here as I'm very curious to see if that works better without provoking as much anxiety as the Ritalin seems to.

I suspect your doc is right that it's probably tolerance, I think it's the same in my case. If our dosages were significantly higher we might eventually get the benefits we're hoping for, though I suspect the side effects would continue to worsen and outweigh the positives. It definitely seems sensible to see if dex works out better.

Pilgrim
10-13-14, 01:00 AM
That initial high you get doesn't last. You have to find ways to motivate yourself.
I would try Dex though.

sarahsweets
10-13-14, 04:47 AM
I'm a believer that when we think its tolerance its actually that we are focusing too much on feeling it work.

Cyanide
10-13-14, 06:21 AM
I'm a believer that when we think its tolerance its actually that we are focusing too much on feeling it work.

That's a bit of an oversimplification (and I wish it were true). I stopped obsessing about the effects of the medication about a week ago so it's not that. Also I experience obvious physical symptoms that reliably indicate when the medication is wearing off; when they start I sometimes check the time and it's always about 1.5h after my last dose.

Maybe it's not tolerance, we all know people can have very different responses to the same meds. The consistent decrease in effectiveness sure feels like tolerance though.

Pilgrim
10-13-14, 10:35 AM
Another way of putting it is your body is becoming less sensitized to it.
I think certain core functions still stay the same.

palmtree_23
10-13-14, 10:45 AM
I'm a believer that when we think its tolerance its actually that we are focusing too much on feeling it work.

This. I completely agree. 80% of people search for the euphoria. Thats why i just dont get how people can use the IR forms of medication exclusively. Its like a constant up and down feeling all day. Wouldnt everyone rather just have an extended release and forget that they've even taken a medication?

If you take a perfectly normal, fully attentive person, they are still tired and fatigued at the end of a long day. They dont come home full of energy for no reason. SO why do we all thing that we deserve to have a head full of constant stimulation?

This is just my opinion tho but I think we all focus on the drugs way too much when we should be more focused on feeling normal with ER medication because thats as close to the natural mechanism as possible (but not really lol)

Cyanide
10-13-14, 07:03 PM
With all due respect palmtree_23 did you read OP's post? It's pretty obvious that OP is not chasing euphoria.

I felt so much calmer, clear headed, and could focus on work, uni lectures etc. The dose was slowly increased from 5mg 3 x a day to 15mg 3 x a day (now taking 45-50mg per day spread over 4 doses as I work long 12 hour shifts). Anything more than that I get headache-y.

...

I basically am just back to pre-diagnosed ADHD in terms of the inattentiveness. I am combined type ADHD so it's like the Ritalin is ONLY working on the impulsivity and hyperactivity, but not working on the inattentiveness.


I've never felt nor am I searching for euphoria on Ritalin either. I'm perfectly capable of experiencing euphoria without drugs by listening to music, reading/watching things I find compelling, discussing topics I'm passionate about, etc.

Recreational users may take the amount anaidi and I spread out over a day in a single dose (not to mention via dubious routes of administration).

If you take a perfectly normal, fully attentive person, they are still tired and fatigued at the end of a long day. They dont come home full of energy for no reason. SO why do we all thing that we deserve to have a head full of constant stimulation?

I would be more than happy to come home tired and fatigued if I could function with the consistency of my peers throughout the day. Most of us are simply trying to get closer to what is normal for other people.

anaidi
10-14-14, 07:55 AM
Initially I found a reduced reluctance to do basic things like cleaning up after a meal and a slight improvement in general motivation, overall calmness, reduced impulsivity and increase in patience.

This is exactly how I felt/feel! The patience is a big one - I used to blow my fuse all the time, and the Ritalin is definitely helping me control that. That was an added benefit that I had not expected :-)

Given the limited benefit I've experienced and how frustratingly brief the coverage is when it does work, I hope my psychiatrist will be happy to try dex soon too.

Frustration is one word for it, I feel like I get a good half hour in every 4 hours, and I'm either clock watching to see if my next dose is due, or it wears off and I only realise when I get snappy at someone or something like that, that I'm like an hour or more past when my last dose was meant to be.

Thats why i just dont get how people can use the IR forms of medication exclusively. Its like a constant up and down feeling all day. Wouldnt everyone rather just have an extended release and forget that they've even taken a medication?

Yes, I would definitely prefer an extended release form, but only got diagnosed last month, and my doc said that the IR Ritalin is the only one available to me under the PBS (government subsidised), so I would need to pay $100+ every 3 weeks if I wanted ER (compared to $15 for IR). And as far as I know, dexamphetamine is ONLY (happy to stand corrected if this is wrong) available in 5mg IR tablets in Australia, so I don't think we really have much of a choice here unless we can afford to pay for the ER :-(

If you take a perfectly normal, fully attentive person, they are still tired and fatigued at the end of a long day. They dont come home full of energy for no reason. SO why do we all thing that we deserve to have a head full of constant stimulation?

I agree, I don't expect to be able to be focused and attentive 24/7. My two concerns, though, which I may not have explained properly, are:

1) I don't get the benefit of focus or concentration on the Ritalin, so I am just as bad on the medication as I was off it, and
2) Tired at the end of the day is one thing, but every night I feel like I've not slept the night before, even though I have. Like extreme tiredness. Apparently this "crash" is common with Ritalin, hence doc's suggestion we try the dex.

With all due respect palmtree_23 did you read OP's post? It's pretty obvious that OP is not chasing euphoria.

Thanks Cyanide, and no I am definitely not chasing euphoria. I have never been big on medication of any type. Experimented once or twice in my late teens (literally once or twice!) with a couple of things, but have never had the need to medicate to 'feel' something. For me, medication is/has always been purely for taking pain/feelings/thoughts away.

No, for me, this is about feeling like I can clear my head and focus and feel calm, and get through a day of work without saying or texting or emailing or doing something impulsively that I know I will regret but do anyway. Or worrying constantly about what will come out of my mouth next. This is what I had hoped for anyway, and it's not all bad news but it's only treating half the problem. I don't want to feel like I am on medication. I just want to function.

How do people take so much in one go anyway!? I think I mentioned above that I get headaches... anything over 1.5 tabs at a time - I'd never be able to handle more than that. It's just trial and error with the IR unfortunately but I will discuss with the doc next Tues at my next appt and see what she says. I am not eager to switch from one to another (I guess I am concerned that the dex will be worse) but we will see. Basically, after 33 years, I am willing to give anything a shot :-)

palmtree_23
10-15-14, 11:54 AM
With all due respect palmtree_23 did you read OP's post? It's pretty obvious that OP is not chasing euphoria.

Yes I did read it. I take "feeling the medication" as euphoria. Maybe I'm wrong by that statement but in my opinion if your constantly searching for the drug to "feel" then your never going to get anywhere. You'll just start to obsess at every minute of the day about how stimulated you feel and in my opinion that's not the point.

Would you really keep reading those books or have discussions about passions if you didn't "feel it" no you wouldn't. So you can argue that people searching to constantly feel the drug are seeking euphoria. Thats why id advocate a long acting medication as it takes away the huge ups and down to a much better degree then the IR medications.

Just my opinion

Cyanide
10-15-14, 08:18 PM
Thanks for the clarification, I get where you're coming from now.

In regards to the ups and downs, you're right that ER would probably make things a lot smoother - I've had the least trouble when taking 5mg every hour instead of larger amounts less frequently. However this isn't very useful when 10-20mg at once doesn't do a great job of treating my symptoms as it is.


Would you really keep reading those books or have discussions about passions if you didn't "feel it" no you wouldn't. So you can argue that people searching to constantly feel the drug are seeking euphoria.

I'm sure my passions are driven somewhat by the rewarding experiences they provide, these are obviously things I find intensely stimulating. For the most part I'd say these are healthy sources of stimulation. I agree that chasing these feelings with chemicals is probably not healthy. I don't want to feel my medication though, I just want it to work!