Hey all, I'm a recovering alkie (3 years - age 32) and my doctor put me on 40 mg Ritalin LA to be taken once a day. Previously I was taking 30 Mg Ritalin LA twice a day and he said that was too much due to long term health implications. However, I'm noticing that 40 mg isn't cutting it...after 8 or 9 hours I'm back to the fog head. I tried taking some of the crystals out of the pill after work and chewing it up so it wouldn't be long acting....it actually worked fairly well. But I'll find myself short at the end of the month.

Problem is, I want to suggest some short acting Ritalin for evening activities but I'm rather concerned that I'm just getting dependent on this stuff. I guess it is what it is but I'm always a bit wary, along with the doctor, of asking for increases in meds.

Is finding the right dosing amounts/timing a normal part of ADD prescription? I've only been on it for 2 weeks by prescription (1 month without).

I don't like the idea (feel like an addict) of crunching up 10 mg or so after work but I don't want to invite trouble/controversy from the doctor this early in the medication.

And, as a footnote, I don't get high off it (I *know* what high is) but I also know what dependence is. I don't like taking a pill to solve my problems but it *******' works like a champ!

Any support would be helpful.

RC

Well, unfortunately talking to your doctor is the only thing that I can suggest. Without his/her help you potentionally will find the need to continue self-medicating and going through your prescription before the allotted time. Many people complain of evening "drops" in extended release medications, and I'm hopeful that if you discuss this with your doctor he/she will be able to find a solution that will be acceptable to both of you. I realize that given your past dependency on alcohol you don't wish to be looked upon as a potential "user/abuser" but I'm sure your doctor will understand your needs...have faith in them :)

Good luck to you.

Yes, finding the right dose could take a month or two. It's usual to titrate up to find a useful dose. Taking long-acting meds makes the titration more difficult.

Asking your doc for evening short-acting ritalin is resonable. Lots of ADDers do this. I found that ritalin rebounded for me in the evening so I needed to take some short-acting in the late afternoon.

Dosage is very individual. Methylphenidate (Ritalin) is poorly absorbed in the GI tract and then gets metabolized rapidly, leaving little to affect the ADHD brain. If you and I ingest the same dose, we may have very different max blood levels of the drug. You may need more or less than me to acheive the same effective presence of the drug where its needed, in the brain.


So if your doc insists on an absolute maximum dosage during titration, you may have a problem. Seems to me, if you were taking 60mg successfully, but were cut to 40mgs (why? do you have high blood pressure?), requesting an additional 10 or 20 mgs a day brings you back up to the proscribed dosage.

Also, crushing up time-release nodules may be concidered druggy behavior and violates your perscription instructions. Spinkling a portion of the nodules on your mashed potatoes with dinner, does not violate the perscription. But, the nodules would then kick in hours later when you don't need the ritalin.

Talk to your doc. You could call and explain that you experience a rebound in the evening and ask what should you do about it.

There's evidence that proper medication use for ADHD can prevent future drug and alcohol abuse in adolescents and does not encourage drug abuse in adults.
see:
http://www.psychiatrist.com/supplenet/v65s03/v65s0307.pdf

Good luck.

RC,

i dont know if you have came off of alcohol yet but check out the book 7 Weeks to Sobriety at healthrecovery.com. i have been on aderal which is similar to ritalin and its a joke man. all psych drugs are going to cause more harm than good 95% of the time. i have been on at least 10 since i was 15 and i am now 20 and off all them. you have to give your body what you need which is nutrition and things your body can process and use. drugs are not the key man. learn about this stuff and dont stay in the dark like i did.

Rustifer,

If the doctor is aware of your history -- and it sounds like from reading your other threads, that s/he is -- then I'm going to join the choir and advocate talking to your doctor about how best to treat your symptoms when they return in the evening.

There are other checks and balances doctors use when prescribing the meds, so, I don't think they'll necesarily leap to the conclusion that you are abusing your meds. And the symptoms you describe are, from what I've read, very common.

If it's a hard subject to approach with your doctor, you might find that printing a copy of the relevent posts from this thread will help you broach the subject. I've found done this in the past and it helped me open up a line of communication.

Good luck,

Wheezie

RC,

i dont know if you have came off of alcohol yet but check out the book 7 Weeks to Sobriety at healthrecovery.com. i have been on aderal which is similar to ritalin and its a joke man. all psych drugs are going to cause more harm than good 95% of the time. i have been on at least 10 since i was 15 and i am now 20 and off all them. you have to give your body what you need which is nutrition and things your body can process and use. drugs are not the key man. learn about this stuff and dont stay in the dark like i did.

Shawn,

I understand that your experience with meds has been negative, however, your experience is not the norm.

The medications prescribed for ADHD *are* effective in managing symptoms of ADHD for the majority of us diagnosed with ADHD. Period. Nutrition, exercise, and education are all improtant tools as well.

That being said, this is Rustifer's thread and any further discussion along these lines will only get us further off topic. If you'd like to address any of the points I've made, please do so via pm or start a new thread.

Thanks,

Wheezie

Rustifer, I do understand your dilemna, as I am in a similar situation myself. My doc started me out at 10mg LA, telling me that I might want/need 20mg (he prescribed 60 - 10mg to last the month).

Except for a brief period the first day when 10mg 'woke me up' for a bit, 10mg or 20mg didn't do a thing; I tried 30mg, which was a bit better...but it wasn't until I took a leap and tried 40mg that I actually was able to concentrate and focus and think clearly. 50mg was a bit too much.

Since he only told me to try the 10 or 20, I am a bit reluctant to tell him I tried 30, 40 and 50....as if that might imply that I am a bit too willing to experiment with drugs. Alcohol was always my problem, not drugs. And for years I would tell him that I was troubled by the fact that I could never get motivated to do what needed doing, procrastinate until the last minute....and get so focused on the book I was reading that hours would pass before I realized it. I could never remember to do things...appointments, deadlines...so I simplified my life to me and the bottle.

Didn't mean for this to get so long, but I see my doc today, and I think I need to be 'rigorously honest'. And include my concerns as well as the experimentation. I just can't see waiting several months until he comes to the conclusion on his own that I need more than 20mg....and that 40 is not unreasonable, given what I've read here.

Good luck & keep us posted.

I'm in recovery as well. I have been clean and sober since 3/25/88= 17 +years. I also work a daily program of NA;including a (daily) written 10th Step and 2-3 meditation books.

I'm on Adderall as well. Right now, I think that this is my 3rd med change in as many months.

Before trying stimulants, I spoke with the world's leading authority on ADHD;Russell Barkley.

What he told me was that the only way Ritalin could be addicitve for someone with ADHD, was if I grinded it and snorted it;which I wouldn't do.

Just to be on the safe side, we tried Straterra first.I had an allergic reaction to it and ended up in the hospital.

Ritalin worked ok for me for abut a year. I didn't have any cravings and didn't feel wired. It did make me feel like I was in a fog tho. At some point it quit working and we went with Adderall XR.

I just saw my doc yesterday to discuss my meds.I've been keeping a daily log of how my days have gone; especially at work. I've really been struggling for the last several months now.

I'm a licensed (Clinical/Child ) psychologist at a rural non-profit community mental health center.My practice is 90-95% ADHD kids between 6-19/20 yrs old.

I've spent the last 17 years making ADHD my primary area of expertise.

PSYCH MEDS ARE NOT A JOKE.

If you go to the NA Big Book,there is a chapter entitled "More Will Be Revealed." What it says that if an addict takes a legitimate medication for a legitimate medical condition from an "informed" physician, then it's okay.

My sponsor is a judge. He is probably the most knowledgable person on Recovery issues I've ever seen.We talked about this at lenght,and continue to talk.

Right now, I need my meds to work in order to do my job. Hopefully, this newest round will get the job done. I still havent had any cravings and/or felt wired.

My drug of choice was cocaine.

If you go to the ADDERALL section of the Forum, you'll see some posts in the now closed "Adderall omg" thread.

Please ignore the BS part and look at my postings around July the 4th or so.
What you'll see is that I posted a summary of 3 research studies covering 13 years, that show a REDUCTION IN RISK FOR SUBSTANCE USE DISORDER'S FOR PEOPLE WITH ADHD TAKING (ANY) STIMULANT.

The last study showed an 85% decrease in risk.

These are all unrestricted research grant studies published in peer reviewed jornals by some of the most well respected researchers in the world.

One of them is the man I spoke with;Russell Barkley. One of the other researchers is a psychiatrist from Harvard Med School, Joe Biederman.

I actually went back further than the 13 years covered here,and could find NOTHING to contradict these data.

This is a serious subject that requires a lot of thoroughness. I wish you luck and hope you "Keep Coming Back."

take care
mctavish23 (Robert)

<title></title><meta name="GENERATOR" content="OpenOffice.org 1.9.125 (Linux)"><meta name="AUTHOR" content="Andrew York"><meta name="CREATED" content="20050917;18582200"><meta name="CHANGED" content="16010101;0"> <style> <!-- @page { size: 8.5in 11in; margin: 0.79in } P { margin-bottom: 0.08in } --> </style> I have an addictive personality, and have been prescribed straterra. When I switched from taking the medication from afternoon to morning I ended up taking 1/2 dosage more than I should have in a 24 hour period. Dumb mistake! The bright side of the story.... I can't see how someone could abuse straterra, it was not pleasant.