View Full Version : Quit smoking and now Ritalin does not work anymore


BlackLotus
03-18-10, 06:12 PM
Background

OK, so i quit smoking (and also pot) 2.5 months ago by going on the patch (big/21mg nicotine/24h) and additionally by using lozenges (2mg nicotine) every time i have a craving. After 1 month i switched to the medium/14mg nicotine/24h patch and after yet another month to the small/7mg nicotine/24h patch.

This strategy has worked wonders regarding the not-smoking part, i don't want to smoke again - ever. When i'm out with friends that smoke, i might take quite a lot of lozenges but never really considered lighting a cigarette.

Current Situation

BUT there is a catch. I am right now feeling quite depressed and am constantly procrastinating instead of working. Nothing really gives me any joy anymore. Everything seems boring and i cannot focus. It feels like my head is clear but everything is fuzzy at the same time. This week i just surfed the net all day instead of getting work done. Ok, there were like a couple of hours last Tuesday when i really was excited about something i had to do and then i was easily able to focus and stay on track. But then that exciting thing was done and i was back at misery. I probably haven't felt that depressed for years.

Looking back, i believe that the intensity of my current symptoms is more or less linked to the lowering of the dosage of nicotine (by switching to smaller patches every month).

So, like 15 minutes ago i decied to use a big nicotine patch instead of a small one and that cloudy/fuzzy feeling already starts to go away. Still feeling a little depressed, though, but that might be related to the "oh ****, i didn't get any work done this week and my boss is gonna be mad when he finds out" part.

I haven't change my dosage of Ritalin LA since i quit smoking. My current dosage is the same since i began taking it like 3 or 4 years ago: 80mg per day, one Ritalin LA 40mg in the morning and one in the afternoon (this is equivalent to taking 4x 20mg of regular Ritalin).

Questions

So, i am right now wondering what the best next steps would be (assuming that increasing the nicotine dosage really makes the depression/procrastination/lack-of-motivation go away for good).

Stay with the large nicotine patches (possibly forever)


Is this a health concern to use nicotine patches for a long period? Any known skin or other problems?


Adding some other medication to the Ritalin


As mentioned, i am thinking about trying Wellbutrin XR instead of using nicotine patches to keep a clear head. I am just a bit worried about two things:

a) Will it have any negative effect on me?
b) Will this combination stop to work over time (as some forum members have experienced)?

What about taking L-Tyrosine to enhance the Ritalin? Does this affect the same parts of the brain as nicotine and bupropione?


Try some other medication and quit the Ritalin


Amphetamine (Adderrall) -> Is not readily available here in Europe, i could probably get a prescription and have a pharmacist custom make some Amphetamine-syrup for me, but it might raise some issues with the doc or the insurance. (This custom made Amphetamine-syrup here normally is only prescribed for children which cannot swallow pills)
Bupropione (Wellbutrin) -> Some forum members have mentioned that the stimulant effect of Wellbutrin alone is not as strong as the Ritalin, so I kinda doubt that this would be sufficient.
Atomoxetine (Strattera) -> This med kinda scares me with all the warnings (liver damage, suicide, increases depression, etc.) that come with it.
Other medications -> Well, Wikipedia and Google provide a list of a whole lot of different drugs to try, but i am a bit at a loss on what else might work. Right now it seems that i am looking for a drug which does the same thing to my brain that nicotine does. Suggestions anyone?


Play with the Ritalin dosage


Is it possible that the lack of nicotine makes the Ritalin act more/less effective so that the only change would be an in-/decrease in dosage? (80mg/day is quite a high dosage already, at least that is what the specialists and the "FDA" here in europe say)


Any thoughts and inputs on those questions would be greatly appreciated. :)

(And please excuse the length of this post, i just kinda had to do a "full brain/thought dump" right now).

ADHDTigger
03-18-10, 07:36 PM
First, congratulations on quitting smoking! Quitting is very difficult for ADHDers to actually do.

You may need to change your Ritalin dosing- here's why. Nicotine produces 'happy brain' in ADHDers. This is probably why ~80% of people with ADHD are smokers. Since you have discontinued that source, the Ritalin may not be adequate.

The long term fix is to discuss this with your doctor.

Nicotine through transdermal patch CAN cause rashes. It is best to move the patch so it is not in the same place every day.

Nicotine patches are considered to be safer from a health perspective than smoking.

Wellbutrin might be a good adjunct to Ritalin for you but probably not what you need all by itself. I personally had an awful time with it and avoid it.

Google ADHD and Smoking. There is a LOT of research on the subject.

BlackLotus
03-21-10, 07:04 PM
Meet the doc

OK, so i talked to my doc and i got a prescription for Wellbutrin XR 150mg but was advised that it might be a better idea to increase the Ritalin dosage and see if that alone helps before trying the Ritalin(80mg)+Wellbutrin(150mg) combo.

Trying Ritalin @ 120mg/day

Already being at a high dosage of 80mg (20-20-20-20), i was a bit hesitant at first, but gave it a try and took 120mg of Ritalin today (30-30-30-30). Unfortunately this had little to no effect on the ADHD, but i kinda had the "i'm high on drugs" feeling but without any improvement in attention. I also disliked being in places with a lot of noise, sitting at a crowded cafe i kinda had audio overflow by all those other people talking. Interestingly, going to the movies was not an issue, as the movie we watched might have triggered hyperfocus mode.

Theory: 80mg/day too much?

So just now i suddenly had an idea: Maybe the sudden lack of nicotine caused "80mg=All Good"(Have been stable at 80mg since diagnosed 4 years ago) to become "80mg=Too much" and what i thought to be "Ritalin won't work" is actually "Ritalin overdose". One would expect it to be the other way round, but is it possible that i might have to reduce my dosage for the Ritalin to be effective again? It sounds paradox, but the whole "Stimulants calm you down" thing is a paradox, too, isn't it? ;)

Any thoughts and inputs on those questions would be greatly appreciated. :)

Josh_kelly
03-22-10, 07:55 AM
my suggestion:

discontinue batch and ask your doctor about 150-300 wellbutrin sr (brand). good for smoking, depression, and adhd.

first two weeks are no good. after you will notice effects. I dont think you will need ritalin any more.

But if you don, divide your ritalin dose by two and switch to focaline brand novartis. (say 10 mg ritalin = 5 mg focalin but start with 2.5 mg cause sometimes its enough). much smoother, no jitters like ritalin, last longer and works well with wellbutrin.

or you can go with (wellbutrin + low dose of dexedrine spansule brand). that's a good combination too.

BlackLotus
03-23-10, 01:34 AM
Suggestion of Focalin / Dexedrine

Dexedrine is not available where i live, so not really an option. Focalin is not yet available at pharmacies but has gotten governmental approval last December, so it should be available in pharmacies soon. Might give it a try some time.

Todays experiment: Ritalin @ 40mg/day

OK, so today i decided to try a lower dose of 40mg (10-10-10-10) of Ritalin. Also, i did not apply any nicotine patches in the morning. The morning was spent procrastinating, surfing the net, etc. In the afternoon i kinda got hyperfocused on some "this is unjust and i need to write some emails" political issue. Way-too-crazy. In the evening i went to see my mom at her house and all i talked about was this political issue. We then got into an argument, me being in total ADHD-talk-about-life-the-universe-and-everything-mode and her being in i-dont-understand-you-at-all-but-am-suggesting-all-kinds-of-things-you-should-do-because-i-am-scared-that-you-might-go-crazy-and-i-want-to-help-you-mode. I had to leave, as i felt that she is not taking me seriously. Oh, did i mention that throughout the day i consumed like 4 or 5 cans of caffeine energy drinks and when at my moms i was dropping nicotine lozenges like they were candy?

I need my Nicotine patches

So, when i was driving home, i noticed my aggressive driving and then it somewhat hit me: The last time i was acting crazy like today, was when i tried to quit smoking cold turkey. So when i got home, i applied 3 nicotine patches and started to read a book. Overall, i was able to focus on the book, even though i had to read some "boring" sections a couple of times to actually understand them. The "interesting" sections i grasped at first reading.

To Wellbutrin or not, that is the question...

So, now i am wondering what kind of pharmacological experiment shall be tried next. I already have Wellbutrin XR at my disposal (thanks to my doc giving me the prescription even though she said that this should be the last resort - i should try playing with the Ritalin dosage first). Hmm, OK, so i know that the nicotine patches play an important role in all this, which means that tomorrows experiment will probably be like this:


Ritalin 80mg/day (20-20-20-20), my regular dose for the last couple of years
3 small Nicotine patches (Equivalent to smoking a cigarette every hour)
If i do not notice any ADHD improvement within 4 hours of getting up in the morning:

Take 150mg of Wellbutrin XR and see what happens.


Wellbutrin + Nicotine patches: Good or bad?

If i go with Wellbutrin tomorrow, should i keep the Nicotine patches on or should i remove them? Scientifc method (and my experiences from debugging Java code) would mean that i should only modify 1 parameter (= leave the patches on), but i am unsure if combining nicotine patches with Wellbutrin might pose a significant health risk. Any thoughts?

Josh_kelly
03-23-10, 05:13 AM
You cant combine patches with wellbutrin. i think it says that on prescribing info.

after two weeks at the right dose. you will stop or greatly reduce smoking. wellbutrin is much more than patches. because it blocks source that gives your pleasure from smoking nicotine. you will feel like blowing air.

BlackLotus
03-23-10, 06:31 AM
Hmm, so is it likely that i will experience nicotine withdrawal symptoms when switching from patches to Wellbutrin? Or will it be a smooth transition?

I haven't smoked a cigarette since new years eve, so the "need cigarette in hand / act-of-smoking-as-a-reward / behavioral" part of the addiction is totally gone but the "i need nicotine or i will get VERY VERY angry" part is still a big issue.

Maybe "Ritalin doesn't work anymore" actually means "Ritalin still works, the ADHD is under control, but it's actually the nicotine withdrawal that makes me behave like a total psycho"?

tired tired
03-23-10, 08:41 AM
I didn't experience withdrawal.

john410
02-25-11, 12:53 PM
I'm interested on the closure of this. What happened, BlackLotus?

abooth3
02-28-11, 03:41 AM
This happened with me too, only I quit when I was taking Vyvanse.

Still trying to figure out how to make my meds effective......not sure. Taking Dexedrine IR/Spansules now, did trying Wellbutrin help?

I'm totally off Nicotine for a good month now, and I still don't feel like my medications are doing all that much......

batuhanb85
03-03-11, 05:11 PM
Same here, and Wellbutrin didn't help (made worse). Nicotine has complicated neurophysiological mechanism, and I really wonder what makes ritalin work when I smoke. Nootropics like piracetam that increase acetylcholine activity may work. Any thoughts?