View Full Version : Recently diagnosed and a few questions about dosage.


Rickyrick258
02-14-17, 02:18 AM
Hey there everyone!!

Ill try and keep this short and condense everything. I will probably leave out information so I will add anything if asked.

I was diagnosed with ADHD-PI a couple months ago. I was a bit skeptical at trying medication at first because of the negative connotation towards ADHD and stimulants. Not to mention my upbringing and my families view on ADHD not being a real mental health disorder. I tend to separate from my families ideology as we don't agree on much. I was diagnosed after seeking out a therapist just to talk about my life, stressors and to get some outside perspective. After a few sessions and explaining my life's history, my therapist diagnosed me with ADHD-PI, saying that it is often gone unnoticed or misdiagnosed when hyperactivity is not present. This would've explained a lot of my problems, why no medications for antidepressants or anti anxiety ever seemed to help my supposed "major depression, general and social anxiety". Anyways I was hesitant at first about his suggestion to try stimulants along w/therapy but after a couple sessions decided to give it a shot.

I was put on 10mg/ twice a day. This seemed to help a little but didn't notice much after the first couple days once my body got used to the medication. Therapist worked with PCP to increase to 20mg/twice a day. Therapist said original dose was very low. The 20 twice a day definately seemed to help a little bit more but again, still didn't seem effective to the extent others: my therapist described it should. My therapist said on long work days, if I've taken weekend off from the medication that I could take a total of 60mg throughout the day as I see fit. I tried 30mg twice a day a few times and that dose seems to do exactly what it's suppose to. Most of the symptoms I've struggled with all my life are improved and my overal life is much improved from work to family and friends.

After doing a bit of my own research, I was a bit disappointed and confused that the dosage I am currently on is consider high/max dose. I was confused how I went from a very low dose to the maximum dose in one increase. And why would I be told I could take 60mg somedays. I was considering talking with my doctor to increase to 60mg a day but not I'm not sure what to do? I didn't know I was on a high dose but the 20mg twice a day just isn't effective enough for me to want to continue treatment at that dosage. Not to mention the possibility of tolerance in years to come, if I'm already on the highest to start where do I go from here.

Do I have a naturally high tolerance or something. Would a doctor even consider more than 40mg total in a day? It just seems to be beginning true effectiveness around 60mg in a day. Does anyone have a suggestions on a medication that might work better? Or is anyone else prescribed 60mg a day or more for therapeutic reasons. Is doses above 40mg really that unhealthy/toxic for you? I was unaware I was already at the highest as of now. I thought I had quite a bit of wiggle room to find the right dose. I'm just really confused about dosage, why my body responding to such high doses for initial treatment. Not to mention I have little to no side effects and have not experienced this "comedown" people speak of even at 60mg days. Any help with any of these questions would be much appreciated.

Thanks,
-E

sarahsweets
02-14-17, 04:17 AM
My therapist said on long work days, if I've taken weekend off from the medication that I could take a total of 60mg throughout the day as I see fit. I tried 30mg twice a day a few times and that dose seems to do exactly what it's suppose to. Most of the symptoms I've struggled with all my life are improved and my overal life is much improved from work to family and friends.
Is your therapist managing your medication? Therapists are not doctors so I was confused. And why would taking a weekend off mean you could take 60mg?

After doing a bit of my own research, I was a bit disappointed and confused that the dosage I am currently on is consider high/max dose. I was confused how I went from a very low dose to the maximum dose in one increase. And why would I be told I could take 60mg somedays. I was considering talking with my doctor to increase to 60mg a day but not I'm not sure what to do? I didn't know I was on a high dose but the 20mg twice a day just isn't effective enough for me to want to continue treatment at that dosage. Not to mention the possibility of tolerance in years to come, if I'm already on the highest to start where do I go from here.

The daily recommended max for adhd is 40mg and for narcolepsy its 60mg but these are recommended, not necessarily whats considered effective. Many of us are on higher doses. I am prescribed 60mg a day- 20mg xr three times a day with 10mg dex boosters twice a day. My feeling is that if the 20mg three times a day works, you dont need to worry about tolerance because it hasnt happened yet- I am not a big fan of worrying about what hasnt happened yet. And when they daily recommended doses are made they are not always based on what works, just on what works most of the time based on studies that usually involve children. 60mg is on the high end, but its not ridiculous.

Do I have a naturally high tolerance or something. Would a doctor even consider more than 40mg total in a day? It just seems to be beginning true effectiveness around 60mg in a day. Does anyone have a suggestions on a medication that might work better? Or is anyone else prescribed 60mg a day or more for therapeutic reasons. Is doses above 40mg really that unhealthy/toxic for you? I was unaware I was already at the highest as of now. I thought I had quite a bit of wiggle room to find the right dose. I'm just really confused about dosage, why my body responding to such high doses for initial treatment. Not to mention I have little to no side effects and have not experienced this "comedown" people speak of even at 60mg days. Any help with any of these questions would be much appreciated.

Thanks,
-E
I dont think you can jump to you having a naturally high tolerance. Most doctors will go low and slow so to be fair, it is unusual that you would go from 20 to 60 but I still cant wrap my head around the part about taking a weekend off first? Why was that mentioned? Does your doctor know your therapist is managing your medication?

Rickyrick258
02-14-17, 09:30 PM
Thanks for replying, I appreciate it. Sorry if I wasn't clear. My therapists office is in the same building as my Primary care physician who prescribes the medication.
After being diagnosed, my therapist told me to schedule an appt w/ my PCP and he would have a talk with him about suggesting medication as a part of treatment. My pcp had no problem with this. After initially being prescribed the adderall at 10mg/twice a day by my primary, I saw my therapist about 2 weeks or so after (would've been sooner but his sched was a bit full). Anyways I was talking about how I was feeling and how everything was going and he said that it was a very low dose and I would have better results from an increase dose. During my appt, he ran downstairs to ask my PCP to see if it would be okay for me to double up. My PCP said that was fine but to just schedule an appt for a week later to get the new 20mg/twice a day prescription as I would run out of the 10mg tablets in a week if I doubled them. I thought this to be a bit strange but I didn't really question it as much as I should've. At the beginning of the appt w/ my therapist he asked how the medication was working and how long the duration of effects I was getting. It was still early on at this point and hard to tell but seemed about 4, 4 1/2 hours max. I had told him that during my long work days, I can be working anywhere from 12-14hours and that I was having difficulty getting coverage for most of work and was trying to spread my doses out 7 hours but it wasn't working very well. That's when he said the dosage was low and I most likely needed a higher dose and should double up on what I had. He then said that if I also don't feel like I need it every day, I could take breaks and weekends off, and whatever extra I had I could use on my longer work days as a 3rd dose. But then he exclaimed that he shouldn't be telling me how to take my medication and to hold on while he went and asked my PCP if the dosage increase was okay. I just assumed he would've mentioned the idea of taking breaks/extra when needed but now I'm not so sure. I didn't think much of it at the time but after reading (and actually somewhat comprehending what I read lol) many articles and forums about ADHD and medication treatment, I began to feel a bit uneasy about everything. I was suppose to see my therapist a few days ago but we had a big snowstorm and the appt was cancelled. I rescheduled but it's almost 2 weeks away. My insurance isn't great and only allows a certain number of therapy appts per cycle so I have to spread them out a bit. I will also be seing my PCP in a little over a month and will mention my concerns then. I didn't think my situation was any different than others. However, now it seems to be a bit different as most people get psychiatrists, titrate much slower and such as well as weekly therapist appts (I would go weekly if insurance allowed). It didn't dawn on me to question my PCPs dosages as I've been seeing him for many years and any medication he's ever given for any reason has always been on the low end of the spectrum.

I would like to thank you again for responding Sarah. You definitely helped put my mind a bit at ease, as I was more under the impression that it was very unheard of and unhealthy to go above 40mg a day for ADHD. I suppose I will just explain this whole situation to my PCP as he is the prescribing physician.
If he doesn't not feel comfortable or agree with higher dosages, where should I go from here? It just isn't effective enough at 40mg a day for me to continue treatment at that dose. Any recommendations on another medication to try? I know every med effects everyone differently, but I'm seriously trying to avoid try a slew of medications to find one that works. Suggestions would be nice. Im jumping the gun a bit but from most things I've read this isn't very common to receive about 40 a day. Just trying to be proactive and have a plan for the next steps to take if things don't work in my favor. Thanks again, Have a great week!!

Rickyrick258
02-14-17, 09:41 PM
Thanks for replying, I appreciate it. Sorry if I wasn't clear. My therapists office is in the same building as my Primary care physician who prescribes the medication.
After being diagnosed, my therapist told me to schedule an appt w/ my PCP and he would have a talk with him about suggesting medication as a part of treatment. My pcp had no problem with this. After initially being prescribed the adderall at 10mg/twice a day by my primary, I saw my therapist about 2 weeks or so after (would've been sooner but his sched was a bit full). Anyways I was talking about how I was feeling and how everything was going and he said that it was a very low dose and I would have better results from an increase dose. During my appt, he ran downstairs to ask my PCP to see if it would be okay for me to double up. My PCP said that was fine but to just schedule an appt for a week later to get the new 20mg/twice a day prescription as I would run out of the 10mg tablets in a week if I doubled them. I thought this to be a bit strange but I didn't really question it as much as I should've. At the beginning of the appt w/ my therapist he asked how the medication was working and how long the duration of effects I was getting. It was still early on at this point and hard to tell but seemed about 4, 4 1/2 hours max. I had told him that during my long work days, I can be working anywhere from 12-14hours and that I was having difficulty getting coverage for most of work and was trying to spread my doses out 7 hours but it wasn't working very well. That's when he said the dosage was low and I most likely needed a higher dose and should double up on what I had. He then said that if I also don't feel like I need it every day, I could take breaks and weekends off, and whatever extra I had I could use on my longer work days as a 3rd dose. But then he exclaimed that he shouldn't be telling me how to take my medication and to hold on while he went and asked my PCP if the dosage increase was okay. I just assumed he would've mentioned the idea of taking breaks/extra when needed but now I'm not so sure. I didn't think much of it at the time but after reading (and actually somewhat comprehending what I read lol) many articles and forums about ADHD and medication treatment, I began to feel a bit uneasy about everything. I was suppose to see my therapist a few days ago but we had a big snowstorm and the appt was cancelled. I rescheduled but it's almost 2 weeks away. My insurance isn't great and only allows a certain number of therapy appts per cycle so I have to spread them out a bit. I will also be seing my PCP in a little over a month and will mention my concerns then. I didn't think my situation was any different than others. However, now it seems to be a bit different as most people get psychiatrists, titrate much slower and such as well as weekly therapist appts (I would go weekly if insurance allowed). It didn't dawn on me to question my PCPs dosages as I've been seeing him for many years and any medication he's ever given for any reason has always been on the low end of the spectrum.

I would like to thank you again for responding Sarah. You definitely helped put my mind a bit at ease, as I was more under the impression that it was very unheard of and unhealthy to go above 40mg a day for ADHD. I suppose I will just explain this whole situation to my PCP as he is the prescribing physician.
If he doesn't not feel comfortable or agree with higher dosages, where should I go from here? It just isn't effective enough at 40mg a day for me to continue treatment at that dose. Any recommendations on another medication to try? I know every med effects everyone differently, but I'm seriously trying to avoid try a slew of medications to find one that works. Suggestions would be nice. Im jumping the gun a bit but from most things I've read this isn't very common to receive about 40 a day. Just trying to be proactive and have a plan for the next steps to take if things don't work in my favor. Thanks again, Have a great week!!

sarahsweets
02-15-17, 04:53 AM
Something I should have asked you was if it was ir or xr that you were taking. If its ir then it would only last about 4 hours. XR is supposed to last 6-8 hours but mine doesnt. I also have absorption issues so that could be why. If take ir and work more than 4 hours then you would need a dose every 4 hours or so. Are you taking 20mg twice a day? a solution would be to take 10mg four times a day and that should help you have consistent coverage. Sometimes its not about total amounts , it can be about dose timing. The weekend and breaks thing is not something that personally I support because for me, adhd is a 24/7 issues and requires daily consistent treatment. Taking breaks is not feasible for me. Something doesnt feel rignt about having your therapist manage your meds, and in particular the way you say its been being done by running to ask the doctor, but I cant put my finger on why.