Hi,

I was a regular visitor here a while back, and have since been diagnosed with Asperger Syndrome with "attentional dysfunction".

My problems with attention seem to be predominantly with shifting attention, both away from something that preoccupies me and towards something new. In particular switching back and forth is something I struggle with (which leads to trouble with eye contact in conversations, driving etc.).

The neurologist decided that a trial of Ritalin should be worthwhile, and I started yesterday on a very cautious course as follows:

5mg mornings (5 days)
5mg mornings & midday (5 days)
10mg mornings, 5mg midday (5 days)
10mg mornings & midday (5days)

With a potential for adding another dose (first 5 them 10 mg) around 4:30 pm.

The first reactions have been very positive, I felt calm, as if that eternal "hamster wheel" had quietened down a bit (I had been worried about anxiety side effects) as opposed to the usual restlesness (inner, mostly, with quite a bit of fidgeting but no overt hyperactivity) and for once it seemed my conscious thoughts were not limping two steps behind my actions and movements.

No "speedy" or "high" feeling, just calm, collected, able to get into my work without the usual fogginess or constant self-distraction.

However, the noticeable effects only seemed to last for maybe 1 - 1 1/2 hours, starting about 20 minutes after taking the medication.

This seems awfully short, although I realise this may just be due to the low starting dosage.

(Although at least there was not much of a rebound effect - however I did become a lot more aware of the inner restlessness once the dosage wore off!)

So my questions are as follows:

- How normal does this suggested course sound? It sounds very cautious to me but then I prefer that to the side-effect fuelled full-on approach

- Is the duration (as opposed to strength) of the noticeable effects likely to increase as the dosage is increased?

- In the long run, should Concerta not be an option (it does not get prescribed as often here in the UK), would medication every ~3 hours be feasible?

Thanks for any input!

Your Dr's approach is cautious, but prudent. The ideal amount of ritalin will vary from person to person, so a slow increase in dosage is a good idea.
The duration of the drug is short - usually in the 3-4 hour range - but that too depends on the person. You may find that the noticable effect last longer at a higher dosage, but you may not.
If you do metabolize that drug quickly, Concerta may be a good choice for you. It is a time release version of Ritalin that releases the drug continuously over about a 12 hour period. Concerta is fairly expensive - that is the draw back - but it does work well, by most accounts.
Good luck,
Greg

Thanks, I will try taking it just before setting off to work tomorrow, and see how long it works. I should start with adding 5 mgs at noon on Monday - although this still leaves me with about 1/2hour extreme fuzzyness around 10 (rebound I guess) and 1 1/2 hours of average fuzzyness, this will at least mean that I should get 2 consistent periods of concentration until I start upping the first dose of the day to 10 mg. saturday in a week's time.

As I have said above, Concerta is not as redily available in the UK as it is in the USA, but I will certainly bring this up with the neurologist at the follow-up on 23rd April.

There are a number of other time release versions of Ritalin. Ritalin SR, Metadate CD and possibly others. They differ in the way they deliver the drug, but both do in in sustained release.

Thanks, I am aware that there are many different time-release versions of methylphenidate available, but Concerta appears to be the most reliable and evenly-spaced of them from what I've read. I will definitely bring this up at the next check-up though.