View Full Version : Switched from Adderall to Focalin


cloud1
12-28-08, 11:04 PM
I just switched from Adderall to Focalin IR today(after I finally found a pharmacy that had it). It didn't impress me the way Adderall did the first time I took it. I was getting to spacey on Adderall and it didn't seem to work like it used to so doc wanted to try this. Anyone had a good experience switching? He said I could change in like a week or two if I want Adderall back.

Hudson
12-31-08, 09:40 PM
Yeah. Adderall didn't really do much for me. Gave me some energy but also fueled my symptoms. I became more distracted, the chatter in my head was faster and I didn't have the *ah, let's focus on what's important right now...okay* mental clarity and powers to execute tasks the way I did when ritalin was (briefly) working.

Tried 5 mgs of Focalin XR for like 10 days. Again, maybe the energy/mood boost one might get from perscription-grade coffee but the mind kept wandering off after each sentence of the book I was reading. Also my grasp of time seemed to be WORSE than normal.

So far the only thing that's really helped has been ritalin - but the IR wears off in an hour and then makes me super distracted (great! paid my bills and then an hour later I lock the keys in the car.) The LA stuff and the patches just made me feel amped up. And the IR gives me chest pains after a while.

Will try concerta or dex next I hope - and maybe see if adding an anti-depressant helps. Just gotta be patient and accepting....

hollywood
01-02-09, 12:34 PM
ritalin ir has always worked wonders. I have been on all the marketed time released meds since they have come out. Honestly ritalin ir probably works the best as far as symptom control is concerned, if we are talking about all the ritalin based meds. You simply titrate your dosage upwards until you have positive symptom control... "Far easier than guessing when the time released meds will kick in. I think that concerta in combination with ritalin ir as needed should be effective. I think in many ways the ir meds are far better in general.

phenyl
01-13-09, 10:17 PM
Focalin is the only ADD medication I've ever been on, and it's been great for me.

However when I was abusing drugs for a period, I tried Adderall several times, but they were recreational doses -- so that's a poor gauge of therapeutic effect. I did once take a therapeutic dose of 20 mg though, and don't remember it being superior to focalin for me, but I was also strung out on oxycodone and morphine at the time.

I started on 2.5 mg of the IR kind 2x a day, and recently got boosted to 5 mg focalin IR 2x a day because we (my doctor and I) thought I could receive more benifit from a slightly higher dose, and this does seem to be the case.

I'm also still SLOWLY tapering off of opioids, but since I'm not abusing them anymore they're no longer having detrimental effects on my life because I'm not constantly having to worry about withdrawals, money issues, supply to feed the habit, etc etc.

I got put on 15 mg phentermine once a day too to counteract the nasty weight gain my anti-d, remeron, causes. Since this is also a stimulant (more similar to adderall than focalin, but weaker than adderall. meaning, phentermine has the same mechanism as adderall of reversing the flow of the dopamine transporer and norepinephrine transporter and also diffusing directly accross the neuron membrane to push both of those neurotransmitters into the synapse; focalin is a DN reuptake inhibitor -- a different mechanism of action with a similar end result. Some just respond better to one mechanism over the other. With phentermine I guess I've got a little of both going on), I have no doubt it boosts the effects of focalin too.

Contrapunctus
01-15-09, 09:50 PM
^^^Are you tapering off opioids with duragesics? That sounds like it could be a bit tricky. Do you have chronic pain? I would imagine methadone would work better (although probably not if you do have chronic pain).

In regards to Focalin, I find it superior to d-amphetamine, and even superior to Desoxyn (at least, in certain areas).

phenyl
01-18-09, 02:52 PM
^^^Are you tapering off opioids with duragesics? That sounds like it could be a bit tricky. Do you have chronic pain? I would imagine methadone would work better (although probably not if you do have chronic pain).

In regards to Focalin, I find it superior to d-amphetamine, and even superior to Desoxyn (at least, in certain areas).

I know it sounds incredibly unorthodox, but it honestly makes more pharmacologic sense than using methadone to taper. Here's why:

With benzodiazepines, tapering is best done with benzos that have a very long half life because benzodiazepine withdrawal can have deadly complications, and long half life benzos reduce the severity of the w/d symptoms. It's a painful process, but it has to be done that way, because the consequences of benzodiazepine w/d in their more severe manifestations can be life threatening.

Opioid withdrawal on the other hand isn't deadly, just extremely unpleasant. They don't call methadone "liquid handcuffs" for nothing... tapering from it results in a continuous state of mild w/d symptoms for a VERY prolonged period.

Fentanyl on the other hand has a short half life, so w/d symptoms are only experienced for the first week after each dosage drop, after which your body readjusts to the new dosage. It's much easier (provided you have the self control to not abuse the short acting med) to taper from a short acing opioid because the w/d symptoms last for a shorter period with each drop. The self control issue can be solved by having somebody else hold the drugs and doing the taper under the watchful eye of a competent doctor.

With methadone, you'll experience low grade withdrawal symptoms CONTINUOUSLY until you're totally off, and then face low grade symptoms for another few weeks after that.

The government may say / claim whatever that methadone is best for detox, but that's just not the experience of most people, frankly. It wouldn't be the first time the government was wrong about the best way to go about ending a drug dependency.

Increasing numbers of doctors who are extremely confident in their skills in psychiatry are willing to taper with short acting opioids, knowing the discomfort is less with the shorter half life. I know that goes against the protocols for antidepressant and benzodiazepine discontinuation, but this isn't antidepressant or benzodiazepine discontinuation. It's a different beast, and increasingly doctors are waking up to that fact.

Methadone is NOT to be taken lightly. It's better suited for indefinite maintenance at a stable dose IMO and in the opinion of some well educated and confident physicians (at least that's what mine has told me) than it is for tapering.

A methadone taper is miserable the WHOLE time, while tapering from a short half life opioid with an extended release system involves only punctuated discomfort with periods of relative comfort.

So far I've been quite successful with this admittedly controversial method of quitting opioid use. We have had to slow down the rate of tapering as the dosage gets closer and closer to zero. The first few drops (from 112 mcg per hour to 100 mcg per hour to 75 mcg per hour to 50 mcg per hour to 37 mcg per hour) were a breeze. It's that drop from 37 mcg per hour to 25 mcg per hour where the one month at 37 was not long enough and we had to go back up to 37 mcg per hour and switch to three month intervals. As zero is approached more closely the body takes longer to readjust... we've discovered (doc and I... and the three other patients he took on after me... I was the first he tried this method on, and ALL three of us experienced issues at that same spot in the taper). So it's gonna slow down from now till zero. But so far, so good...

Based on what I've heard about tapering methadone, this seems like a breeze. It takes a little self control, a little desire to quit, but more importantly a support system... to do it this way ... but IME so far it seems like a FAR better alternative than methadone for TAPERING. Methadone may be great for indefinite maintenance, but for tapering short acting opioids make more sense due to shorter periods of w/d symptoms and relative comfort after the body adjusts to the new lower dose.

Is this technically illegal... what my pdoc is doing... technically yes, but he'd never get in trouble for it, because there are more and more docs that support this method and if the gov't decided to get ****y there'd be plenty of expert defense for any doc using this method.

It's about time, in my opinion, that doctors were allowed to perform opioid tapers for ADDICTS too and not just CP patients. This is the first step.

The next step is to allow doctors to do maintenance in their OWN PRIVATE PRACTICE with some safeguards in place (family who will monitor / dole out meds, attention to progress by the doctor).

I firmly believe that a HUGE part of the reason that methadone fails to help a large chunk of opioid dependent patients is becuase of the clinic structure. Impersonal, degrading, inconvenient... are all words that come to mind when I think about clinics that dispense methadone for maintenance or tapering purposes. That isn't even considering methadone's major flaw too: it has a disproportionately severe incidence of side effects compared to almost all other opioids.

Buprenorphine can be prescribed by a doc in their own practice if they take the class for it, but I personally see buprenorphine as having little value for people already hooked on opioids, unless the habit is small (a hydrocodone habit of say 100 mg daily might be a good fit for 1 mg / day bupe maintenance, but for higher tolerances, it just doesn't alleviate cravings as well as full agonists like methadone... not anywhere NEAR as well... but it comes with side effects that give 'done a run for its money).

It's really time for the government to give doctors back their right to use their own best judgement with regard to treating addiction to drugs that cause physical dependence.