View Full Version : Concerta + Paroxetine


andyr
02-06-09, 05:41 AM
Short intro... I'm 37yo male, 5'11, 100kg, diagnosed ADHD-PI in August 2008. Having self-medicated with chocolate most of my life I am now dieting successfully. I started on Ritalin in Sep 2008, titrated from 1x10mg to 3x20mg then switched to Concerta 54mg (didn't work), then 72mg (after some arm-twisting). Some days I need 90mg, but my psychiatrist wouldn't approve. I don't think he believes in the .22 ratio.

Without the Concerta, I'm relaxed and cheerful but unproductive and inattentive. With it, I'm very productive but not very effective and often stressed. We think it's comorbid OCPD and/or GAD. My mother took Prozac for GAD, but my symptoms are mostly OCPD. He prescribed Paxil 20mg 2 weeks ago, and in 2 weeks it goes up to 40mg.

I'm pretty lucky, I had only a few mild side effects in the first week, and I feel relaxed and happy again. The OCPD is better too. But the ADD symptoms are back and he thinks 72mg is already quite high. Yesterday afternoon was a struggle at work, so I took 20mg Ritalin and it was really effective. Now here comes the maths...

Concerta 72mg = Ritalin 3x16mg
Ritalin 16mg + 20mg = 36mg = Concerta 164mg

I don't know all the latest research but I'm pretty sure we're into overdose territory here. And yet it worked and I was able to focus really well. So today I took 108mg Concerta, and actually felt pretty good. Good focus and attention, no fog, no spacing, no distractions. Total control of my productivity.

So here's what I want to know...

1. What's the maximum "safe" dose of Concerta? And what are the possible consequences of 108mg or higher?

2. Is there any formal literature (preferably peer-reviewed) which I can show to my psychiatrist to reassure him that 108mg isn't dangerous?

2. Is it common for Paxil (or SSRIs generally) to counteract Methylphenidates? Is there a formula to balance this? (eg. how much extra methylphenidate to take for each extra mg of Paxil/SSRI ?)

3. Is there another effective OCPD medication that doesn't counteract methylphenidate?

4. Is there another effective ADD/SCT medication that doesn't increase anxiety, and/or isn't affected by SSRIs?

5. Since starting Paxil, I'm also taking supplements (multi-vit, omega-3, B6, Iron, Magnesium, Folic Acid, Calcium, Zinc, Potassium). I take all the pills in the morning when I wake up. Can any of these interfere with either the Concerta or the Paxil?

PS. I know this forum isn't a substitute for a doctor, and I'm also seeking professional advice. If I learn anything new, I'll post back here. Meanwhile thankyou in advance for any advice you can give.

PPS. I also know all about Paxil withdrawal, and if I have to stop it I will taper it over several months. The Paxil is not for depression, as I have always had a sunny outlook.

PPPS. The "Ritalin" I took was generic Methylphenidate Hcl, and the "Paxil" is generic Paroxetine Hcl. The Concerta is the Real Thing (tm).

PPPS. Trust me, I wanted to write more. This is as brief as I can make it :-)

Driver
02-06-09, 07:20 AM
1. Not really known: only guessed. People typically abuse more than 100mg in a single hit; doses of 500mg aren't fatal.
2a. Nope. If you're body can take it - no tachycardia, hypertension, etc i.e., signs of overstimulation, then it's safe.
2b. Yes/No/Maybe. The neurotransmitters are believed to be linked: a change in serotonin may bring a change in dopamine & norepinephrine. Typically though, people find their ADD is more pronounced when they take meds to remove the anxiety (as anxiety stimulates an ADD'er).
3. A different SSRI may help. Your mileage may vary.
4. Some people have success with Strattera.
5. Don't mix St John's Wart with Paxil, and go easy on Vitamin C and food-acids with Concerta.

andyr
02-06-09, 09:57 AM
Strattera is something I've been thinking about for a little while. I know it's better for inattentives than for hyperactives, and I was never hyperactive. But switching would take a few months so it should be an informed decision. Interesting that anxiety works against ADD symptoms. At first I was just demotivated, but when my attention and focus went, I knew it was more than that. I know about VitC, and there's none in my diet at all apart from the multi-vit. Didn't know about St John's Wort, but I don't take it anyway. Sounds too herbal for me... I prefer proper medicine!

hollywood
02-06-09, 12:29 PM
first off in adults off label doses are often the norm and tolerated well. Remember when taking concerta and or ritalin depending on your metabolism and stomach ph we know that different amounts are actually used in your brain than the actual prescribing dose. So , obviously it varies. After looking at your post seeing your math at how you figure 168 quite honestly I don't know how your dosing or coming to that number as 72mg of concerta + 36mg concerta would be 108 and then I lost you on how you methodically got to 168? Seriously break it down so it makes sense , as I can't figure out what the heck your talking about regarding adding ir doses or what. Anyways, if 168 is tolerated then thats the dose, obviously 168mg of concerta would equate to about 36.96mg ritalin titrated into three doses daily. What works works and remember higher dosing in trials approves standard dosing based on children which does not account for adults and their dosing, also clinical efficacy was improved in those that tolerated higher doses of mph in the trials if you can handle the side effects. Although, I do advise to use smaller doses if possible I can say that what works works and what doesn't doesnt. It sounds like your acute or situational anxiety issues most likely interfere with your ability to relax and truly know in a controlled relaxed environment just how much or effective your meds are helping you focus. Of course the real world is not controlled and in your case like others you may require a larger dose.

andyr
02-06-09, 01:01 PM
My personal life is a bit crazy at the moment, for a variety of reasons, so there's an elevated baseline stress that I have to deal with. Although the stress was there before the Paroxetine and is well under control now.

Math... it depends whether you're looking at mg/day or mg/third.

72mg (Concerta) * 0.22 = 3x16mg (Ritalin from Concerta)

3x16mg + 3x20mg (Pure Ritalin) = 3x36mg (Pure Ritalin)

3x36mg / 0.22 = 164mg (Concerta).

It's really a large dose, and I'd rather explore Strattera first.

hollywood
02-06-09, 04:23 PM
Andyr-
paxil has been shown to slow reaction time and those taking paxil versus those who were not taking paxil in blind and double blind studies who were taking paxil had slower reaction time and lower overall performance for solving math equations than those subjects not taking paxil. Also, you should not be concerned with dosing if side effects are not present, seek your doctors advice, metabolism varies

bluewaterbob
05-15-09, 01:20 PM
I'm 47 y.o. male with ADD (not Hyperactive), diagnosed 11/2008. I started with Ritalin generic, titrated from 2 x 10mg/day to 2 x 20mg/day, but then it wasn't working well, so the doc had me try Concerta 54mg/day for 3 days then 72/mg day.

Concerta initially releases 22% of the Ritalin, but delivers a steady stream of it through the 8-10 hours (less if you have a higher metabolism or more acidic stomach). Doctors tend to start with a lower dose of Concerta because its a steady release through the day. When you take Ritalin (not extended release SR or LA versions) it metabolizes into your system in an hour or two then slowly wears off, then you usually take a 2nd and sometimes a 3rd dose to carry you through the day. So the amount of it in your system rises and dips through the day.

Its thought that a steady stream like Concerta provides can be lower than the prescribed Ritalin, but personally I think that isn't the case, and too many people that move from Ritalin or its generic to Concerta end up thinking Concerta doesn't work for them, when all they needed was a higher dose. Also, the Concerta manufacturer, and many older documents show max dose of Concerta should be 72mg, but many docs have found larger doses are safer and needed for some with ADD. Even Canada, with its government health plans cover up to 108mg/day, and many docs in the US do too.

Another option to making Concerta and any time released meds work better is to keep your stomach less acidic so they don't metabolize and leave your system too quickly. You can do that by avoiding juices and acidic foods and with some supplements and foods to make your system more alkaline.

Personally I've found taking a multi-vitamin an hour before Concerta, some odorless Omega 3/Omega 6 fish oil pills from Natures Bounty (Walgreens), and exercise aerobically every day (jogging, treadmill, whatever works for you). If you hate to exercise start out slow, even walking a 100 yards, then each day add to it. It works. And exercize and other activities that get the heart pumping for 20+ minutes is a natural way to raise the dopamine in your brain (one of the 2 chemicals low in ADD/ADHDers.) This helps your ADD and any depression that comes from low dopamine levels.

That's why many are prescribed Wellbutrin with Concerta. Wellbutrin raises dopamine levels. I thought my doc wanted to add it for depression. I'm not depressed, I was just frustrated the meds weren't working and didn't want an anti-depressant making me not care about my lack of focus and productivity. Still I'd rather exercise which is good for your sex life too. Wellbutrin, for guys (don't know how it affects women, but I was on it for a month a few years back) will improve sex/arousal for about 2 weeks, then it kills it! (My gf wouldn't like that and neither would I) Then you'll need viagra... I'd rather get a good night sleep and exercise so the seratonin and dopamine in my brain stay at their best possible levels.

(When I was going through a very stressed time I considered St Johns Wort extended release, but read too much about other anti-depressants causing problems when taken with Concerta, and the manufacturer specifically recommends not taking it. Wellbutrin is widely prescribed with Concerta so try it if the doc suggests it, you can always stop if its not for you. If you are depressed and not taking a conflicting med St Johns Wort extended release might work great for you. It did for me. Depression is proven to change the level of chemicals in your brain, that don't go back to normal even when what was depressing you goes away. Taking something for it can get you back to who you used to be, and usually you won't have to take it forever, but don't quit as soon as you feel better - give it time to get everything back to the right levels.)

In case this might help, when I was drinking too much juice everyday, instead of water, the Ritalin and then Concerta didn't work. Not realizing the problem I tried Adderall. I'm ADD not ADHD (no hyperactivity) and Adderall didn't work good at all. I would feel drugged and irritable when it wore off. I thinks its more suited to ADHDers. I was going to try Vyvanse, which is the same med but a much smoother time release than Adderall or Adderall XR, but it has the same med so wasn't right for me. I did find out that Vyvanse is the least expensive time released ADHD drug in the US, and different doses are all pretty close in price so those needing larger doses aren't paying a fortune. ($120 - $160/month).

I just wish Concerta was more reasonably priced so everyone that needs it could afford to use it and get their life turned around. Ritalin works similar, but gives you more peaks and valleys and often ADDers forget to take the 2nd dose.

One place to check and compare drug prices is the online site: http://www.drugstore.com/pharmacy/drugindex/ its usually 10-30% lower than your local pharmacy, but you can compare prices then decide if you want to buy online or local. (for ADD meds online you have to mail in your prescription).