View Full Version : Minimum vs Maximum Dosing


TheHammer
03-11-17, 07:12 PM
Hello fellow ADHDers, I'm a new person here. Diagnosed ADHD about 4yrs ago and I'm 48 now. As with most ADHDers I've lived the life of the "could have been a contender." Lots of potential but....

I'm taking 40mg of Vyvanse once daily assuming that I should take the smallest effective dose seeing as how it's an addictive substance 'n all. However, after listening to a Dr. James Dobson on a podcast, he suggested that patients should take the maximum effective dosage. Meaning that if a 40mg dose is effective but 70mg dose is more effective (and the side effects tolearable) patients should take the 70mg dosage.

Am I wrong in assuming that the higher dosage I take the higher the risk of addiction?

dvdnvwls
03-11-17, 08:33 PM
What does your own doctor think about this topic?

Lunacie
03-11-17, 08:39 PM
If you really have ADHD the risk of addiction is very, very small. Your body will
get used to having the meds on board and there can be withdrawal effects if
you stop taking it suddenly. But the same is true of anything else we stop, like
caffeine giving headaches. Even being unable to wear eyeglasses after several
months is likely to cause eye strain and headaches. Still not addiction.

What you do is start at a low dose and slowly (like every week or two) increase.
When the side effects are too bothersome or unwelcome, you go back down to
the next lowest dose from that as long as side effects are minimal.

Dr. James Dobson is a psychologist with a slant towards right-wing religion.
Psychologists have neither the training or the license to prescribe or monitor
medications.

Dr. Russell Barkley is a much better source for information on ADHD.

BellaVita
03-11-17, 09:03 PM
My opinion is if you find something that works, don't mess with it.

dvdnvwls
03-11-17, 09:16 PM
Dr. James Dobson is a psychologist with a slant towards right-wing religion.
Psychologists have neither the training or the license to prescribe or monitor
medications.

Dr. Russell Barkley is a much better source for information on ADHD.
It's clear from Dobson's writing that religious topics are his real specialty, and that the rest of what he does is something he's added on.

Lunacie
03-11-17, 09:26 PM
It's clear from Dobson's writing that religious topics are his real specialty, and that the rest of what he does is something he's added on.

You may be right. Either way he's not the best reference for stimulant meds.

aeon
03-11-17, 09:39 PM
Am I wrong in assuming that the higher dosage I take the higher the risk of addiction?

Based on the data from peer-reviewed clinical research, yes, you would be wrong to make such an assumption.


Cheers,
Ian

TheHammer
03-12-17, 05:13 PM
I haven't had a chance to speak with my Dr. about it. I will though, first chance I get.
Anyone else feel guilty when Vyvanse (or whatever medication they take) makes them feel good? I wonder, if the way I feel on Vyvanse is how I'd feel if I didn't have ADHD? Or is the effect of feeling "good" only a pleasant side effect?

maple17
03-13-17, 09:07 PM
However, after listening to a Dr. James Dobson on a podcast, he suggested that patients should take the maximum effective dosage. Meaning that if a 40mg dose is effective but 70mg dose is more effective (and the side effects tolearable) patients should take the 70mg dosage.

I didn't listen to the podcast, but I don't quite understand the logic. If someone is seeing benefits and the medication is effective with little to no side effects on a lower dose, why would you increase? I guess I don't see the variations of effective vs "more" effective...

My kid's behavioural paediatrician recommended 30mg, but start with a titred dose, and then increase it, if needed. We experienced really good results with the titred dose and almost no side effects after the first 10 days or so, so there was no reason to increase it and we still haven't gone up to the full 30mg, six months on.

TheHammer
03-14-17, 05:08 PM
maple17]I didn't listen to the podcast, but I don't quite understand the logic. If someone is seeing benefits and the medication is effective with little to no side effects on a lower dose, why would you increase? I guess I don't see the variations of effective vs "more" effective...

By effective I mean, it allows me to minimally do what needs to be done but, my daily life is still taxing. With a low dose I feel I function at 60% of my capability, as opposed to 30% without any at all. In other words, a low dose is better than none at all. However, if I took a higher, more effective, dose I wonder if I could function at 80%-100%.

dvdnvwls
03-14-17, 06:36 PM
100% never happens - it's a true impossibility. You can certainly discuss with your doctor whether a small increase seems warranted, but you need to know that hitting only 75% and ending up with unacceptable side effects is quite possible. If it's helping 60%, there's also a good case to be made for not rocking the boat. Up to you whether you ask your doctor or just leave it as is.

Cyllya
03-15-17, 02:31 AM
I think if it doesn't help you as much as you're hoping for and you can afford to raise the dose, it's worth a try. If the result is no good, you can always go back down.

However, it "maximum effective dose" doesn't make much sense.

erikfig
03-15-17, 03:04 PM
Every person is different. If 40 mg is working for you keep taking 40. If it ain't broke don't fix it. I take 40 mg everyday and I have no reason to go any higher. Just my 2 cents. :)

aeon
03-15-17, 03:19 PM
If someone is seeing benefits and the medication is effective with little to no side effects on a lower dose, why would you increase? I guess I don't see the variations of effective vs "more" effective...

“Effective,” for me, is not binary, or an absolute.

For example, I know for me 30mg/day of dextroamphetamine sulfate provides a degree of efficacy in addressing my presentation of ADHD, with a tolerable level of side-effects.

That said, I know for me 60mg/day of dextroamphetamine sulfate provides a much greater degree of efficacy in addressing my presentation of ADHD, with a still-tolerable level of side-effects.

I can appreciate that if you don’t see effectiveness/efficacy as a gradated spectrum, the above will not make sense to you.

I take the maximum amount of medication I can that provides the maximum benefit to me, which stays within a tolerable level of side-effect presentation, and risk/benefit ratio. Simple as that. :)


Cheers,
Ian

maple17
03-17-17, 01:33 AM
“Effective,” for me, is not binary, or an absolute.

For example, I know for me 30mg/day of dextroamphetamine sulfate provides a degree of efficacy in addressing my presentation of ADHD, with a tolerable level of side-effects.

That said, I know for me 60mg/day of dextroamphetamine sulfate provides a much greater degree of efficacy in addressing my presentation of ADHD, with a still-tolerable level of side-effects.

I can appreciate that if you don’t see effectiveness/efficacy as a gradated spectrum, the above will not make sense to you.

I take the maximum amount of medication I can that provides the maximum benefit to me, which stays within a tolerable level of side-effect presentation, and risk/benefit ratio. Simple as that. :)


Cheers,
Ian

Well explained, thanks Ian. :goodpost: Makes sense now. I don't have ADHD and I'm just parenting a kid with it and she's never expressed any desire to increase her medication to see if it works "better." But then we're still early days. She's getting results on the reduced dose and that's good enough for her (and us), so that's all we have to base our experience on. That obviously might change as she gets older and is able to perceive these variations in effectiveness.

Pilgrim
03-17-17, 03:46 PM
Take the lowest dose possible always. Adders are prone to overdo. Life's a marathon.

mildadhd
03-18-17, 03:03 PM
Hello fellow ADHDers, I'm a new person here. Diagnosed ADHD about 4yrs ago and I'm 48 now. As with most ADHDers I've lived the life of the "could have been a contender." Lots of potential but....

I'm taking 40mg of Vyvanse once daily assuming that I should take the smallest effective dose seeing as how it's an addictive substance 'n all. However, after listening to a Dr. James Dobson on a podcast, he suggested that patients should take the maximum effective dosage. Meaning that if a 40mg dose is effective but 70mg dose is more effective (and the side effects tolearable) patients should take the 70mg dosage.

Am I wrong in assuming that the higher dosage I take the higher the risk of addiction?

In my experience (with methylphenidate), the higher the dosage the worse side effects, even when the higher dosage works better.

I prefer 20 mg (SR), takes longer to reach peak and wares off slower over a longer period of time. (better sleeps)

10 mg works better for me but I choose not to take it because I get irritable when it wares off.

20 mg (SR) is not covered by insurance and I pay a lot more, than 10 mg (IR)





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mildadhd
03-18-17, 03:09 PM
The higher the daily dosage of methylphenidate (SR), the more I can remember my dreams. If I wake up to go to the bathroom or something, if I go back to sleep, I sometimes continue having similiar dreams.




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