If a stimulant medication is too low, is the outcome always "no effect"?

In other words, does the reaction of "there is no real therapeutic response" mean you experience nothing at all, or can other experiences occur?

I am careful NOT to say just FEELINGS, but both how you feel and the experience of being on the medication and its dosage evaluation.


If not, what might one experience, outside "it was like i took a placebo"?

Thanks in advance.

chaz

I was just reading this on Dr. Parkers blog, and then switched over to ADDF. Anyway it explains and is very interesting,




The Therapeutic Window (http://en.wikipedia.org/wiki/Therapeutic_window) represents the body's ability to metabolize the medication effectively. Several easy rules apply here:

If the medication is just right in dosage and duration you will feel that you are simply floating through that effective opening - no problem, and no, or very few, "side effects."
If the medication is too much, too high a dosage, you will have signs of toxicity, and will hit the top of the window - bump your head on the top of that window.
If the medication is too little, too low in dosage, it doesn't appear to be working at all, you can't get into the window, and your chin keeps hitting the sill at the bottom.
Notes on pain at the top of the window - dose too large for the metabolic landscape:

Simply feels like you are toxic, it's just too much. You shouldn't feel stoned or drugged.
Confusion, disorientation, cognitive stress, anxiety, self expression diminishes.
With some stimulants you can feel moody and depressed all day - and relieved in the evening as they have a shorter 1/2 life with an expected duration of less than 12-14 hrs. If you feel better when they are gone from your system, - this is a big hint.
With stimulants too high, especially some of the stimulants, you might feel buzzed, an uncomfortable intensity, too overly attentive, with angry and sad mood swings. With the methylphenidate ['Ritalin-like'] products you may feel "stoned" if they are beyond the top of the window.
If you feel these kind of symptoms for the first couple of days after starting a new med, usually no problem. If symptoms continue, urgency is called for and an adjustment is very likely necessary, - see your doc.
Read on for notes on the bottom of the window:
Down at the bottom:

The medication simply isn't working - no side effects, no therapeutic effects, no effects whatsoever.
Sometimes you may feel just a hint of progress during a portion of the day, but then loose the effectiveness in the PM. - Even with SSRIs at an insufficient dose they may show improvements only a brief portion of the day. Dose and expected duration of effectiveness [DOE] (http://www.corepsychblog.com/2007/08/addadhd-treatme.html) are inseparable measurements. Appropriate dosing will often determine duration of effectiveness through the day.
Expect to loose effectiveness when the medication is only set to deliver effect over a portion of the day, as most stimulants.
The objectives, the targets for treatment, spelled out in that first interview, show no improvement.
Brief notes on metabolism, metabolic rate, and other conditions that react poorly to the medication in question:

New genetic studies show that many do not metabolize drugs at the same rates (http://www.healthanddna.com/professional/pharmacogenetics.html). Studies show that less than 50% of the population metabolizes medications at an average rate.
Pharmacogenetic studies (http://www.healthanddna.com/professional/pharmacogenetics.html) [regarding, in this case, 2D6 metabolic pathways] show that 5-7% of the population are very fast metabolizers and require more than expected doses to turn the therapeutic tide.
Metabolism is not completely dependent on body size, and the old adage that body size, larger weight or height, suggests a need for more medications, is outdated.
Also outdated is the cookie cutter dosage suggested by some based upon age. Each dose for each person must be reviewed at every medication check - Each individual's Therapeutic Window will tell the tale. Drug dosing, sometimes suggested on preliminary reports, can be misleading. Simply go low and slowly with everyone at the outset. Often psych medications are under and overdosed through the process of not establishing specific improvement criteria.
With stimulant medications used for ADD: the top of the window can look like the bottom of the window, creating an apparent need for more medications in the real context of too much. Said another way, too much medication can diminish focus and attention.
Noted repeatedly at CorePsychBlog: Drug interactions (http://www.corepsychblog.com/2006/12/kids_and_antide.html) clearly effect the therapeutic window.
As we have been regularly reporting here at CorePsychBlog: Metabolic issues, such a gluten sensitivity (http://www.corepsychblog.com/2007/09/glutenceliac-se.html), bowel and liver problems (http://www.corepsychblog.com/2006/12/bm_number_2_poo.html) also challenge the expected rate of metabolism.
And see more here at Genelex (http://www.healthanddna.com/professional/depression.html) on pharmacogenetics for antidepressants and antipsychotics

This sounds a lot like Dr. Jones as in Ask Dr. Jones. Excellent info btw. To the OP, if you are questioning whether or not your dose is too low you probably should be offered a slight increase from your doctor.

When you get in your therapeutic range you will hopefully know- it's like the fog is lifted or being able to finally see after trying on glasses....

I am experiencing a low dosage situation also. I have been diagnosed with adhd for about 10 years, impulse controle being my worst symptom. Two years ago, I stopped taking Adderall altogether. I was taking two 30mg XR a day. Five days ago, I went to a new doctor who prescribed the 10mg XR. The first couple of days I felt great, outgoing, attentive, ambitiouse, calm, and in controle over my thoughts and feelings. Now, Im on day five, taking only the 10mg in the morning, and having trouble just typing this post. My anxiety is rushing right back in again. Its kind of painful to get a glimps of so much clarity, and then wake up and all of a sudden, I'm right back in the fog again. So now, I'm trying to navigate myself through the day with constant and differing thoughts and impulses once again. Although, Im not going to take anymore than prescribed. I just will have to wait it out until my next appointment because this doctor seems to be impossible to get on the phone. Any advice or comments are greatly appreciated. Trying to get off my pitty pot =P.