My official diagnosis is Adult ADD accompanied by Schizoid-Defective Disorder (Depressed Type.) I'm a 24 year old male, and roughly around 150 lbs. (5'9") and have been perscribed Ritalin 20mg. 3-4 times a day by my Psychiatrist. It is the only medication I have been perscribed eventhough I have serious behavioral problems such as accute depression, violence/aggression issues (unfortunately aquired 2 felony assault charges as a result when I was younger), social anxiety, and obsessive/compulsive features caused by the other diagnosis. In the past I have tried Zoloft (50 mg. twice a day) and Risperdol (antipsychotic, 4 mg. in the evening), Depakote, and many others. Anti-depressants, antipsychotics, and anti-anxiety medications seem to have no effect on me irregardless of the dossage or analogs of the meds. I tried 20mg. of Ritalin and it seemed almost miraculous (at-first) though I still have issues with paranoia, violence, and inability to adhere to any task/schedule.

Despite what I have been perscribed I have discovered that ritalin wears off extremely fast (causes a frustrating and depressing crash), and requires larger amounts to generate any continual, theraputic effect in me. As a result, I now take around 140-160 mg. within a 24 hr. period to get even the smallest benefit from them (20 mg. about every 2/3 hrs. or so.) Unfortunately, I am rather certain this constitutes some form of abuse or addiction and sadly, this seems to be the only thing that really even works for me. I may not have completely cured my other problems, but I am FAR less violent, and FAR less anxious than what even Depakote or anti-anxiety medications could do for me. Needless to say, I am upset and feel at a loss. I may have formed a serious chemical dependency and there seems to be no other meds with any benefit to me.

What's worse is I have 2 small heart murmurs apparently produced by anxiety/stress. I had deliberately witheld this information from both my Psychiatrist and my therapist, in order to prevent any hesitations when it came to getting perscribed Ritalin. As it is a CNS stimulant, it causes accelerated heart rate, excitation, etc. and this would endager my chances. Being aware of the risk, I had still determined I would rather not be suicidal and violent than potentially giving myself a stroke or heart-attack. It was a choice of certain death brought on by my behavior and something only slightly less certain. It's very dificult for me to express this dilema and how frustrating it is.

How badly can 140 - 160 mg. hurt me internally? What is the realistic amount of danger I am in for a heart-attack or stroke? In all honesty, I do not think I will be able to stop taking them without serious professional help/rehab brought on by another party as I am too aggressive/defiant to actually cooperate in such a situation. Even now I am SURE I would not make it an easy process for those unfortunate enough to try.

So what should I do? Continue using this amount or become hospitalized, incarcerated, or worse? And yes, it *is* as bad as it sounds. I need help, and the internet is the only way to get advice discretely. I have no intention of triggering a confrontational event in the office of my doctor.

Jeepers. Don't you worry about having a stroke or heart attack? That is a lot of Ritalin.

I think you may be posting this information here (including your Doctor's name) b/c you know you are in a bad way, and need intervention.

I hope you can come clean with your doctor. As you say -- you may wind up in trouble, medically, or legally.

That would be really tragic for you.

Ideally, your Doctor would hospitalize you (voluntarily) until he can get your Meds ideally figured out, so you are not a danger to yourself, others, or to your health (high-medication-wise).

Can a friend or loved one help Advocate for You? (EG Give them a CUT & PASTE of everything your wrote above, so they can know how to help you.)

I know what I am doing is dangerous, of course. I am now finally forced to only be able to look at the specific degrees of danger as I am no longer willing/able to anything else at this time. Yes, I am very concerned for my life, but irregardless of what I do it is still comprimised. With the medication - believe it or not - there is actually less of a risk than there would be without it.

That's the challenge I am faced with.
I'll take risk of a heart-attack over a sociopathic spree/suicide any day.

Jason,

If you're having to increase your dosage that fast, you won't be able to sustain it and then what you fear may happen anyway and you're putting yourself at great risk. Talk to your doctor -- let him know about how effective this has been and find a solution and combination of medications that doesn't put you or anyone else at greater risk. Remember a heart attack or stroke doesn't always end in death -- you might survive with lifelong disability. Take care of yourself -- that dosage is very high, especially with a heart murmur and it sounds like you're developing tolerance quickly.

Scattered

As everyone said, please talk to your doctor, or go to a hospital. Even though you think you need this high of a dosage for relief, many times, if you treat other symptoms with different meds, you can then take a lower dose of stimulants with the same results.
You are on a very dangerous road, and at this rate, as Scattered said, you will just have to continue to increase your dose. You will eventually get to the point that you will get aggressive, paranoid, etc, for the simple fact that you are abusing a stimulant and that never ends well.
I don't understand why you are only on Stimulants when you are violent? What is your doctors reasoning for that? Have you ever been put on mood stabilizers? They may help you a great deal and many people have great results with a cocktail of mood stabilizers, anti-psychotics and stimulants.
Your doctor is there to help you. Please rely on him to guide you through this.
Good luck!

Sounds good, thanks.

I have an appointment next month on the 7th. (quite a ways a way.) I will try my best to slow it down and use as much ol' fashioned willpower as I can. It's very hard because the stuff triggers so much of a dopamine rush and prevents its uptake again - making it extremely pleasureable/addictive. I did not expect something like this to happen and am a little shaken by how self-reinforcing it is. It seems to grant a false sense of "mental effeciency" and what can be percieved as energy.

If anything I will refrain from taking any if my heart rate gets a little above 114, etc. and wait about 4-6 hrs. Perhaps even having the pills into 10mg. and smaller would even work. Strangely it does not seem to have an effect on my blood pressure. (Thank god my mom's a nurse!)

I have tried depakote and some of its analogs for anger, but because I still possess an intense distractability and inability to follow a single train of thought, I would still become gradually frustrated which would lead to aggressiveness.

I am in therapy now so we can try to figure out how to resolve this without medication as it's something I've never really tried yet.

Just one more question before I go though: How would ritalin react to diphenhydramine (Tylenol PMs) as it is a hypnotic/tranqulizer? Are there any dangerous interactions there? It seems to have a very sedating, relaxing quality not all that euphoric in proper doses which I used to use as a sleep aid. I am thinking about using this again to balance out the addictive/pleasurable feelings ritalin seems to cause, and I don't want to risk any more trouble seeing as diphenhydramine can cause tachycardia and arythmic beating as well in higher doses. But it can come in handy as well for forming a regular sleep schedule and managing a lot of the more destructive side-effects.

(As a COMPLETELY unrelated side-note: Wouldn't it be great if people could actually learn to control their heart rate and breathing through concentration and mental effort? I hear in some remote Buddhist, Hindu, and Yogic disciplines that this is actually possible and is even trained to monks who adhere to those particular faiths.)

I wouldn't try any mixing without checking with my doctor. Certain combinations have sent my heart racing and made the beat irregular too.

Exercise whenever possible (walking or some other exercise that's not going to stress your heart murmur) can help release dopamine and serotonin helping calm your emotions and focus your thoughts.

Scattered

Are you scripted 140mgs daily? Doctors are always right? as we know. This is not unheard of, and indeed i have read of 5mgs-200mgs daily (narcolepsy) being used, a fellow on Remedyfind takes 3, 20mg tabs 3x daily=180mgs, and reports feeling fine. Report your experiences with yr Doc, and don't settle for less.

Thanks

Jason, I have Mitral Valve Prolapse, my doctor's know, and I take Concerta 54mg 1x day and Ritalin 20mg, 3x day. No heart problems.

Yest the ritalin wears of quickly, I never liked the crash. My cocktail keeps me going pretty well all day and evening and wears off before bed.

Adderall was horrible and really wrecked havoc with my heart rate. Tell your doctors, just say you forgot rather nonchalantly-or I am wondering, could Ritalin affect my heart murmurs? Some heart murmurs mimic anxiety attacks, just so you know.

It takes time to find the right drug "cocktail" keep working with your doc, and keep a daily record of your mood, symptoms, and cognitive function. It will really help the doc understand what is going on.

Best wishes, and take care.

(As a COMPLETELY unrelated side-note: Wouldn't it be great if people could actually learn to control their heart rate and breathing through concentration and mental effort? I hear in some remote Buddhist, Hindu, and Yogic disciplines that this is actually possible and is even trained to monks who adhere to those particular faiths.)
Jason,

You have received good advice already so I want to address your side note.

Here in the West, people use biofeedback to control heart rate and even blood pressure. You can relax your mind and control your breathing without adopting the "religious" Eastern components. Do a search on biofeedback and pulse rate.

I got a cheap gizmo from Radio Shack that one connects to one's fingertips; it measures your "stress" levels as you think different thoughts; it helps to make a connection between thoughts and physial reaction.

There are tapes that will guide you in a relaxation journey - the effects are usually correlated to lower blood pressure and heart rate.

IN MY OPINION:

Methylphenidate (ritalin) is of value in that the user can get an effect late in the day and still get a nights rest. It is also, again my opinion, the only stimulant on the market that is at least marginally safe as medication. Ritalin is the only adhd stimulant you have to work with. Work with it and get the most for it. Master it. This means keeping in mind that, as in all aspects and activities of life, there is a point of diminishing returns. There a dosage at which you will attain the maximum overall life style effect. This is rarely over 15mg a day. This level of dosage will not result in eternal bliss but correctly titrated, ritalin is a valuable tool. There are additional tools which may provide additional help. Consider the following appropriately small dosages: an SSRI (prozac 1mg/day), weak stimulant (caffiene 50mg/day, phetermine 10mg/day, provigil 20mg/day), ESRI (strattara 10mg/day). These dosages may seem laughable small, but in concert and at the ratio they can be made to provide benefit to most anyone.

You were not born into this world for the purpose of revealing all to your doctor. Physicians are perceptive by experiece and willl ask specific questions is they find a need to do so. However, unless you are willing and able to research medications on you own, you must rely on you doctor to sort out these issues. Explain to your present primary care physician that you are only interested in small dosage medication for your psychiatric issues. Most doctors will prescribe multiple medications if they believe that there is a good chance of a positive outcome. Come to their office with your act together, knowing what you want and why. Suck it up and get it together, remember that there is always tomorrow, there is always another good laugh and there is always, for damn sure, another physician ready and anxious.

Finally and again in my opinion. antipsychotics, pain relievers, tranquilizers, sleep aids and related medications are for those who are unable to work out their life style issues otherwise, and if needed at all, can be make to work at small dosage. Also, they are (and resperidol for sure) very likely to interfer with stimulates and related medications.

Have a great day friend,

ubar

This is a tough situation especially with the psychotic tendencies you described. When dealing with habituation/addiction it should always be a given that one day you will be without the drug which is hard for most people to deal with. But with you...it could be a catalyst for something very bad, maybe something you didnt think you were capable of.

There is no need to lecture you as you are an intelligent person who is aware, and not in denial of having a substance abuse problem. Weening yourself off a substance that powerful is not easy to say the least, been there done that. But I do have a few suggestions.

It seems like you dose so frequently is because you hate the crashing feeling. What if you didn't crash so hard or quickly? Would you being willing to try products that work that way?

There are several extended release Ritalin (methylphenidate) drugs on the market.
-Ritalin LA: Combination of immediate release and extended release beads
-Concerta:Intial dose within 1 hr the rest is released as tablet absorbs H2O from your GI tract so it can vary person to person.
-Metadate CD: 30% immediate release & 70% extended release
(There is also Ritalin-SR and Metadate ER but they have fallen out of favor and been replaced with the aboved mentioned formulations.)

One of these may delay the crash and intensity but we both know why you might be opposed to trying one of these. You won't get the "high" as strongly as you do right now. Unfortunately I found the biggest deterent being availablility/access. Unless your doc is irresposibly writing for that much and/or you have some very generous friends I could see slowing down your useage. Then again everyone who really wants something will find a way to get it...

Will power is not enough when you have an addiction hence the addiction. Listen to the other peoples advice. My suggestions for a quick fix are only deflecting your underlying problem and not treating the root. I just figured at this point...