View Full Version : "coming down" rebound effect of Ritalin?


Arwen
05-02-09, 05:29 AM
Hi All :)

Just started Ritalin not too long ago and I have a few queries :o, hopefully I can get them answered. At the moment I'm still experimenting with the dose/timing, but Ritalin has been effective in controlling my impulsivity, fidgeting, distraction and ability to focus etc.

I get some nasty rebounds such as headaches, irritability but the one I am most concerned about is the effect of Rtalin wearing off- the 'coming down'. I feel like the world is closing in, and I feel so lonely and down. It was very scary as I was not a very good space. :( It lasted for about 2-3 hours in the evening. Definitely not something I would want to repeat.

At the moment I take Ritalin 10mg 3 times a day with the last dose around 3-4pm. My psychiatrist recommended I take an extra 5mg dose in the evening around 6pm to taper it off... She said that ideally she would want me on the Ritalin LA but it is not subsidised by the government like Ritalin is. At the moment in Australia Ritalin LA is only subsidised for individuals who have been prescribed medications before 18. :confused:

So my question is, how do you cope with a "coming down" effect? Or prevent it in the first place? Please advise, much appreciated! :) Thanks!

kzaro
05-02-09, 05:46 AM
Hello Arwen! I might not be of much help cause I'm also new to ritalin and I also experience these come-downs.

So, first splitting the last dose in two smaller helps I think, then I would suggest you to think and relativize before the come down, I mean, before you're in a bad mood etc, just try to be persuaded that it will happen but in a way it's artificial, and also about the fact that there's a part of that which just comes from ADD or hyperactivity.
I know that's not the perfect solution but that helps me a lot to know that i'm always exagerating things. Also at the end of the day, if you can manage to do something distracting, see a friend, watch a movie etc, and try not to think about that it really helps.
Also, if you're not too tired i'd really suggest you to do some sport, even if it's only running 20-30minuts, that really, really helps!
One last thing I've tried a few time but not since I'm on ritalin, is taking l-theanine, I noticed as I said in the other post that it really helps relaxing when I'm very tensed/stressed.

Arwen
05-03-09, 03:53 AM
Has anyone noticed that if they take only a small dose it makes you tired instead? I took a "last' dose at 7pm last night and still couldn't sleep at 2AM, so I took a 5mg Ritalin and fell asleep in 20minutes. I took a 5mg tablet this morning to get rid of the yuck rebound effects, and have been sleepy... in fact I can't fight it anymore so I will be heading off for a nanna nap... so unlike me.

γ-quantum
05-03-09, 06:57 AM
Has anyone noticed that if they take only a small dose it makes you tired instead?

yes. but even a high dose (10mg) makes me tired. 10mg also gives me some sort of 'buzz' though, its not only tiredness... but i can fall asleep MUCH better even on 10mg of ritalin than without it! i havent ever tried it at night though, so i cant tell if the quality and duration of sleep would improve overall. 5mg makes me sleepy without giving me a buzz though, so i guess i could sleep quite well from it.

i am planning to ask my doctor tomorrow if its okay to take 2.5mg - 5mg to see if i can sleep better from it, as i dont wanna just experiment with the stuff by myself. maybe it interfers with the quality of sleep, same as most sleeping pills - you can sleep better on them, but your brain doesnt get the rest that it needs because the sleep cycles are messed up from the drug.

but maybe ritalin for people with adhd actually improves the quality of sleep... i really dont know, but i'll post what my doctor said about it here on the forum.

Arwen
05-03-09, 09:15 AM
So an update now... as I was too tired to say much before :o

I only took one dose of Ritalin today as I actually wanted a drug free day (or days) and that dose made me sooooooo tired! I had to stop everything and lie down in bed for a few hours. This is the 3rd time this week Ritalin has made me tired... usually it makes me calmer, but sometimes it makes me very tired... like what the heck? Tired on a stimulant???

Up until half an hour ago I felt like crap and very down, I'm not sure how much was the drug and how much is my actual emotions. The down lasted 3 hours! :eek: Is this normal? I know that all stimulants have rebounds, but 3 hours of feeling like this is the pits! :mad:

Think I'm ditching the Ritalin, can't stand feeling like this. Is it too early to give up (1 week)? :confused: I mean, the 'cure' is to keep taking the Ritalin, now I know that I can even take it at night and go to sleep... but I want the option of not taking it, if I want to.

kzaro
05-03-09, 01:58 PM
Hello!! I'm experiencing the same thing!!
When I take small doses I'm totally tired and I get no benefit.. For example I tried 4*5mg, so it's 20mg, and I was soo tired all day! And no speed except my heart!
That's why before quiting I'll try I think to take a "significant" dose, I've never tried more than 40mg, I think I'll try 50 and them maybe 60mg and then if it doesn't work well I'll have tried everything!

I really don't unterstand why this stimulant make me feel so tired and stunned...

Honestly, that's strange but like you it's been 1 week, and each day passing I want less and less to take ritalin again...

My only hope is that, with a higher dose I could get the same thing than the first two days : I was really focused so I could work a lot, and then when it wears off I was tired enough to go to sleep fast without being too despressed... I'm in the same case, I don't really know what comes from ritalin and what is symptom from something else, but that's not a good feeling :(

reggi
05-12-09, 03:45 AM
i ve been taking this drug now for a few days and have noticed after about 2 hours (10mgs) i get that "coming down" feeling. its horrid. i dont feel depressed just lost and flat. i hate it. is this the way its gonna be?

when i feel it i take another pill but surely there must be another way of doing this?

i feel like ditching the whole thing...yes, i feel other benefits but geezz..i feel like an addict topping up every two or so hours.

HELP!

Driver
05-12-09, 03:49 AM
I've been taking Ritalin for a few months now and I'm all to familiar with the come-down.

That said, what I've found helps is:
Eat decent regular meals
Avoid refinded carbs - white sugar, white bread, white ...
Take a multivitamin daily.


When I do above, I don't get a bad come-down. :)

andyum
05-12-09, 04:02 PM
A couple of things that have worked for me to reduce the come-down effects:

1) I take a smaller amount but more frequently. I started at 10mg 2x per day. I now do 5mg every three hours (3 to 4 x per day as needed). I don't feel tired doing this like others.

2) I found, mostly by accident, that if I wait a bit in the morning to take my first dose, it seems to go smoother through the day. I used to take my first dose when I was getting ready for work around 7:30AM. Now, I sometimes wait until about 9AM. I have no idea why this would be the case but it seems to help.

3) I do sometimes take a smaller amount of 2.5 mg (instead of 5 mg) later in the afternoon.

4) Above all, getting a good night sleep seems to be the most effective way of reducing the come downs for me. And, eating well like Driver points out.

elizadoo47
05-17-09, 08:33 PM
Not on Ritalin, but Focalin (basically the same thing) my teen daughter does best taking her largest dose (7.5 mg) in the morning, after a good, solid breakfast. Then, about 4 hours later, she does a smaller dose (5 mg) and by mid-afternoon, a small (5 mg); then, around 6-7 pm, a tiny dose of 2.5 mg).

If she is eating very well she can sometimes leave off the tiny dose at the end of the day.

I thnk eveyrone has a different metabolism. My daughter is like a jet: jets use about 70% of their fuel just getting off the ground, the remainder is used in cruising. For my daughter, she needs the greatest "bump" early in the morning, and throughout the day, she just needs small boosters.

Imnapl
05-17-09, 09:28 PM
Your body's reaction to medication is influenced by several things:
hydration, restful sleep, nutrition, exercise, general health and comorbid disorders. How are you doing in these areas?

ridkidLA
05-17-09, 10:29 PM
I just started last Thursday and am experiencing the same thing! I am also taking Klonopin for anxiety/sleep (an absolute miracle drug for me) but mainly just at bedtime and maybe .5 mg during the day. My timing with the Ritalin is about an hour and 45 minutes after the dose, I start to get tired. At 2 hours exactly I feel like I am about to pass out. Now I am taking 1x10mg pill every 2 hours, up to 40 mgs a day. I just need it long enough to last through the work day. I hit the gym after work, so I prefer to have my last dose around 2:30-3:00 in order to keep my heart from racing out my chest. For me, the magic answer has been .5 mg of Klonopin right when my last dose is up at the 2 hr mark. It's easy breezy from there - no weird come downs. I just feel relaxed and able to focus through the rest of the afternoon. My MD is totally fine with this combo as long as I don't exceed his max dosages on either pill, which I definitely stay way under. I really didn't want to try stimulants since low doses of Wellbutrin and Effexor gave me insomnia and I felt like a lunatic. I started with .5 on the Ritalin and it literally was like a tranquilizer. I was shocked at how tired it made me! I see pros and cons of the Ritalin. I am giving myself a few more days to see if I want to continue or not. It sounds like we are all kind of experiencing the same thing. Is Adderall better? I’ve heard some stimulants work better with certain body chemistries than others.

Edith
05-21-09, 01:55 PM
I have very similar thing - low doses get me really tired. Ive tested now different doses and times, also making notes about all other stuff. But still, im not very happy, that good effects last so little and coming down is very long. Its not normal. Ive tryed 5, 10, 15 and yesterday I took 20 at once. I had great focus about an hour and then I started to feel more and more tired. 5 mg is just a good sleeping pill. Today I took 10 2x (3 hours between) and it was quite as same as 20, just not as jittery. I actually got couple of things done I wanted to get done for some time, so its good. But this sleepiness comes too fast! I wish I could feel so well all day as I feel in those best Ritalin moments. I eat and drink a lot of water, also taking vitamis. My come dows are not that bad as many people describe here. I just feel sleepy and kind of indifferent, like I dont care a thing. Its better than feeling depressed I guess :).
Ive taking it a little over a week and Im also thinking now, that is it worth it if good effects last so little time.

Arwen
05-21-09, 09:21 PM
My experience on Ritalin was that the headaches went away after 5 days on Ritalin, and the sleepiness was mainly if I was understimulated. If I was quite stimulated (I have high stimulus ADHD) then the sleepiness didn't set in. Also if I took too little Ritalin I could feel sleepy.

After 2 weeks on Ritalin I changed to Concerta as the Ritalin rebound of depression was too difficult and dangerous to handle. Not as effective in areas, but at least not causing depression.

SemiColon
07-23-09, 12:46 PM
So happy to find this forum as I'm experiencing similar problems.

I have Crohn's Disease and suffer from a lot of fatigue. I also have depression and anxiety problems.

I finally talked to my primary physician about all of this and he put me on a few medications:

•Wellbutrin (for depression) 100mg twice daily
•Ritalin (for fatigue) 10mg twice daily

When he mentioned the Ritalin, I was confused as to why I would need it...didn't know much about it.

The first few days I took it, I felt great. Then, I started noticing that after my second dose in the afternoon I felt horrible. It was almost as if my depression worsened.

I have a follow up with my doctor on Tuesday but, in the meantime, am scared of the horrible side-effects after my last dose.

As Imnapl mentioned, I am focusing my efforts on getting better sleep at night, drinking more water during the day and watching what I eat.

I feel like I am alive for the 2-3 hours after each dose, but then the bottom drops out and my quality of life is very low.

Without it, I am tired. With it, I have a few hours of energy, but then hit rock bottom.

Not really looking for answers...just curious to read other experiences and if there is a light at the end of this medical tunnel.

Cheers,

SC

Imnapl
07-23-09, 01:05 PM
SemiColon: I love your username! As you well know, fatigue is a symptom of auto-immune disease and, unfortunately, it can fluctuate on a daily, even hourly basis. Depression is also a partner to chronic illness. I'm intrigued that your doctor is that innovative about trying a stimulant to help you. I too have inflammatory arthritis. When my inflammation was at its worst, I could not stay awake for more than a couple of hours at a time in spite of regular doses of both Ritalin and Wellbutrin. I wouldn't wish this disease on my worst enemy. Would it help if we started a social group on ADDForums?

SemiColon
07-23-09, 01:25 PM
I think I'm on a mission to feel "normal" because, after 10 years of dealing with Crohn's, I'm not sure it's possible.

When I first started taking Ritalin (just a week ago), I thought my prayers were being answered because the fatigue went away...I could do great work, clean house, etc. I felt like a normal person not living with a chronic disease. Then, when I found out about (and experienced) the "rebound", then I became discouraged because it really zoned me out.

I'm now at an impasse because I know there is a very productive person inside me, but this auto-immune disease and medications are suppressing what I am capable of.

Does that make sense?

I appreciate your quick response to a thread that's been slow for a few months.

Oh yeah, I had a 1/4 of my colon removed in 2000...hence the user name. :)

Imnapl
07-24-09, 12:14 AM
Oh yeah, I had a 1/4 of my colon removed in 2000...hence the user name. :)Well, you definitely haven't lost your sense of humor. :D

selby
08-07-09, 05:04 AM
I've been searching forever for ways to deal with the rebound of stimulants. Seems like Zoloft has eliminated it. Of course I wouldn't recommend something so drastic, but the rebound I was experiencing was severe, like full-blown depression/irritability, it was unbearable. The fact that Zoloft helps whereas Wellbutrin didn't makes me wonder WHY it helps??

crucialminutia
08-07-09, 11:15 PM
I've taken four to five 10mg doses of Ritalin each day for more than 12 years, and even though YMMV, I thought I'd share a few very subjective, semi-scientific observations:

I usually feel sleepy between 10 to 35 minutes after 1) taking my first dose of the day, and after 2) taking any dose more than about 30 minutes late.

If I remember to space my doses about 3 hours apart early in the day, and about 3.5 hours apart later in the day, I almost always avoid rebound until late in the evening (which is an ideal time for me to go to sleep).

When I mess up the timing, and therefore experience an unplanned rebound, I usually just finish the day med-free, or every once in a while, I'll treat myself to one more dose at bedtime (to get to sleep more easily, and dream better).

And you probably won't believe it, but...

At almost exactly 37 minutes after taking a dose, IF I'm feeling sleepy, relaxed and undistracted, I often literally feel a chill up my spine as the Ritalin kicks in, which immediately and dramatically clears my mind.

Has anybody else had similar (or contrary) experiences?

peripatetic
08-08-09, 12:08 AM
crucialminutia, well, welcome, first of all:)

i make a plan and set timers every day to space out my doses if i know i'll need coverage for a full 12-16 hours. when i decide to take a 'half day' for whatever reason i don't *usually* have problems.

i only end up with it if i take all of my doses for the day and haven't eaten enough (sleeping at night isn't a problem for me, especially if i take all possible doses, so i know it isn't a result of sleep deprivation). if i skip lunch, though, and don't eat any snacks, it's a problem.

it might also be useful to note that for me, the 'rebound', takes the form of frustration because i become completely incapable of maintaining one train of thought for the amount of time required to formulate a sentence--a short sentence. and then i get pi**y about it...really pi**y...like, i need a nap and a diaper change asap before i start strangling.

my 'solution' is 1. a few tablespoons of ice cream (the one food i can eat *anytime*), 2. a cigarette (yes, i keep a couple of 'emergency cigarettes for this purpose and this step is also why i've avoided posting about this because *i know* how bad smoking is, etc, etc), 3. a shower (ideally very cold turning to very hot), 4. a meal, 5. going to sleep.

this 37 minute thing is something i don't think i've ever experienced! i'll have to watch for it:) how long have you been monitoring it? does it usually happen only once if those conditions are met, or every time that day?? i'm definitely going to try to pay attention--i can't believe i just typed that... well, i *am* going to try to remember to look out for it:D

in case dosage would make a difference, i'm allowed to take a up to 6 20 mg ir daily, but i usually take 3-5. that's been my prescription pretty consistently since 1993.

best,

crucialminutia
08-08-09, 03:47 PM
***
this 37 minute thing is something i don't think i've ever experienced! i'll have to watch for it:) how long have you been monitoring it? does it usually happen only once if those conditions are met, or every time that day??...
***
Thanks for the welcome, peri!

I don't think I've ever noticed my "37 minute chill" except after a lapse in "coverage" (i.e., after the 1st dose of the day, or following a dose which was late enough to trigger a rebound -- conditions under which the dose almost always makes me sleepy). I've never noticed it on subsequent, properly timed doses.

I'll actually have to watch for it myself though, because it's probably been several years since the last time I noticed one --

I first noticed the chill during a time when I was pretty severely depressed, unmotivated, alone, and homebound -- not doing much (or even thinking very much) at all.

At that time, I probably had high blood sugars (from undiagnosed Type II Diabetes) and untreated high blood pressure, with no meds other than Ritalin.

I have Obstructive Sleep Apnea (OSA), so I tend to doze off when sleepy, and then sporadically wake up, gasping for breath -- especially between 10-35 minutes after my 1st dose of Ritalin.

But this "chill" thing isn't quite the same -- I haven't ever noticed a connection between gasping for breath and feeling the chill.

When I first noticed the chill, my Dr had asked me to log my reactions to Ritalin, so I was using the stopwatch function on my wristwatch to time my reactions to each dose. It must have happened 4-5 times in one week before I realized what was happening, and then began entering the chill into my log.

Over the next 2-3 years, I must have recorded hundreds of chills in that log, each one noticed only while sleepy, relaxed and undistracted, in a sitting position.

They'd start with a faint, cold sensation in the small of my back, and rapidly shoot up my spine, causing my shoulders to tighten, my head to shake gently, and sometimes inducing a brief tingly feeling inside my skull -- before dissipating rapidly. (The entire process probably takes less than 2 seconds.)

And every chill which I noticed was amazingly consistent and punctual -- it almost always arrived in the 37th minute following my first Ritalin dose of the day.

lunajune
10-08-10, 12:38 PM
I had this problem too.. I would recommend doing what andyum said and taking smaller and more doses. or try a different time release medication such as focalin.
I started scaring myself with ritalin. I started taking too much in my opinion because of the fear of crashing afterwards, I felt like an addict! I told my dr and he recommended a time release and I had done my own research talking to a friend who took focalin and looking it up online. I would recommend taking either a 5mg or 10 mg time release focalin.
For me it lasts longer throughout the day and once I am ready for bed there's no problems falling asleep. I also have not had any problems with crashing.
hope this helps!

hereditary
10-23-10, 10:25 AM
Interesting reading peoples experiences here... though I am afraid to say I seem to be in the extreme minority when it comes to this medication

Whenever I would come down from ritalin... I would get an enormous surge of energy and motivation, would start sorting and organising, cleaning my possessions, polishing bits of glass, cleaning the kitchen floor by hand, you name it.

Sometimes, if the come down was really bad I would resort to walking around in circles in my living room, muttering to myself furiously like some kind of deranged drug addict lol. I might have even been scared were it not so clockwork and predictable. I'm not sure exactly what I talked about... I think it was mainly rehearsing future conversations, delving into interesting theories and concepts, improvising grand speeches about my life's experiences.

When this phase wore off, I got an intense desire to exercise and would normally sprint 2 miles as fast as I could, literally to the point of collapse... and then I would be ostensibly 'back to normal' and go about the rest of my evening in peace.

Interesting that is kind of behaviour is commonly seen in recreational stimulant users, but when they are peaking their high, not crashing. I did not at all find the crash to be unpleasant, often it was the most interesting and enjoyable part of my day, though the need to socially quarantine myself combined with the dawning realisation that what I was experiencing was essentially a temporary state of insanity eventually drove me to lower my dose to the point of ceasing medication all together.

I can certainly say I have no capacity to empathise with this all-too-common "walls crashing down" feeling - if it feels anything like waking up to an alarm clock then maybe I can guess though :p

Jimdyer93
11-03-10, 06:18 PM
Hello, i'm 17 and i just started taking Concerta slow release 36 mg about a month ago. its become a lot better but i still get some nasty rebounds at night occasionally. my problem is that i ONLY need the medicine for school- i really don't need it on the weekends. My doctor said i should try Ritalin 5MG tablets in the evening to reduce the rebound. i have heard they cause sleep loss and im not into that at all. My other question is, theoreticly, if i take a ritalin 5MG on a weekend just to get some homework done, how are the effects going to differ from my Concerta? could really use some help im kinda scared to try, will i rebound the same way?

Arwen
11-03-10, 08:58 PM
Hello, i'm 17 and i just started taking Concerta slow release 36 mg about a month ago. its become a lot better but i still get some nasty rebounds at night occasionally. my problem is that i ONLY need the medicine for school- i really don't need it on the weekends. My doctor said i should try Ritalin 5MG tablets in the evening to reduce the rebound. i have heard they cause sleep loss and im not into that at all. My other question is, theoreticly, if i take a ritalin 5MG on a weekend just to get some homework done, how are the effects going to differ from my Concerta? could really use some help im kinda scared to try, will i rebound the same way?

Hi there,

First of all everyone gets different responses to the different medications, even the different types.

For example, I personally had problems with Ritalin... at the end of the day I would crash so bad I was so depressed I just wanted to shoot myself. My psychiatrist recommended that I take an extra Ritalin in the evening. I thought the same as you, "HUH! Won't I stay up all night? I gotta go to work the next morning!" But I was so desperate to not feel like shooting myself I took it. And you know what? I had the best sleep in my entire life (bar pre-operative drugs).

I did that for a while until I got sick of constantly popping pills throughout the day and switched to Concerta. It only lasts about 7-8 hours for me and my work day is 9-12 hours. I used to take meditation holidays on weekends and occasionally if I know I will need to be able to control my impulsivity and attention over the weekend I will take concerta or a ritalin depending on the time required.

I don't seem to get any rebound from taking just one Ritalin. But then everyone is different. So you might have to try because you can get many responses, but none of them will answer your personal situation.

Good luck! :)

String
11-04-10, 01:15 PM
I've taken four to five 10mg doses of Ritalin each day for more than 12 years, and even though YMMV, I thought I'd share a few very subjective, semi-scientific observations:

I usually feel sleepy between 10 to 35 minutes after 1) taking my first dose of the day, and after 2) taking any dose more than about 30 minutes late.

If I remember to space my doses about 3 hours apart early in the day, and about 3.5 hours apart later in the day, I almost always avoid rebound until late in the evening (which is an ideal time for me to go to sleep).

When I mess up the timing, and therefore experience an unplanned rebound, I usually just finish the day med-free, or every once in a while, I'll treat myself to one more dose at bedtime (to get to sleep more easily, and dream better).

And you probably won't believe it, but...

At almost exactly 37 minutes after taking a dose, IF I'm feeling sleepy, relaxed and undistracted, I often literally feel a chill up my spine as the Ritalin kicks in, which immediately and dramatically clears my mind.

Has anybody else had similar (or contrary) experiences?

This is actually very, very similar to my experience. I've been taking 4 to 5 doses of 10mg methylphenidate all this year (except for 3 months with concerta and a 10mg IR for evenings). When I take the medication every 3 to 3.5 hours, I don't experience a come down. The come down at night, however, can help me fall asleep. I sometimes feel a little chill when it kicks in (doesn't often clear my mind too quickly, but sometimes). I often feel a bit of a chill or tingle when it's wearing off, too.

For those who are having troubles, I'll share a bit of my own personal experiences that go along with crucialminutia's note:

I think the medication itself can even help me fall asleep at times. Without a late afternoon dose, like a 10mg dose around 5 or 6 pm, I can sometimes have medication related insomnia. I think what happens is that I have a come down early in the evening and then get wound up and irritable and have a harder time sleeping later in the evening. When I didn't have access to my medication one day, I didn't sleep a wink that night. I was tired and in bed and didn't sleep.

The other thing I would recommend is to be consistent. My Doctor drove me crazy at first titrating me up slowly with set times each day, but now I'm super grateful because it allowed me to understand the medication. We started with 5mg x 2 and added 5mg a day each week until I said stop. It allowed me to figure out schedules. Consistency and schedules are important, even if you're going for the smallest dose or smallest coverage possible. The one thing I did ask my doctor to change during the titration process was the frequency. He was having me take the medication every four hours. I asked him to change it to every three or 3.5 hours because I found that if I waited four hours, I would crash a little before the second dose and then the second dose felt weird.

If you aren't consistent with regular daily doses while testing the medication, how will you ever know if your insomnia, or headaches, or whatever won't just go away after a few days or a couple of weeks?

LAST THOUGHT: Changing doses and schedules and skipping days, or thinking it doesn't work after taking it two days, can sabotage what might be a good therapy for you.

Scorpio1988
11-07-10, 08:37 PM
Maybe you'll just get used to it,i did in only a week.;) though I do get abit of anxiety irritability. It's nothing really serious though, nowhere as noticable as the beginning of the week.