This is terrible! Advice figuring out my IR dosage?

[AWizardDidIt]

Hello! I'm new to the forums! I was recently diagnosed with mild to moderate ADD. I'm 27 so definitely a pretty late diagnosis. I'm more of the inattentive type I'd say, pretty spacy, I daydream a TON.

So anyway, when I was diagnosed, the pdoc wrote me a script for Ritalin IR and told me to play with it for two weeks until I figured out the right dosage. He wanted me to start at 5 mg twice a day, then 10mg, etc. until I figured out the lowest effective dose and also the threshold where the medication is too high.

Sounds easy enough right? Well I am having lots of trouble. I started with 5mg twice a day for a couple days . . . I had some awful side effects at first but after a day or two they calmed down. However I wasn't feeling much of anything GOOD either so I tried 10mg twice a day for awhile. On 10mg, about 20-30 minutes after taking my FIRST dose, I'd have about an hour where my head would feel pretty clear, I could actually focus on things . . . good stuff! However, after that, it would start fading and I'd feel more normal. The weird thing is that taking the second dose didn't really seem to help much and would generally just make me feel side effects! I'd feel very tense and anxious, also somewhat spacy, almost drunk-like? If I was getting benefits too, it was tough to tell around the bad stuff. I did 10mg x 2 for a few days and the side effects were getting better, but I was still only tangibly getting benefit for like an hour.

Yesterday I tried 15 mg x 2 . . . I pretty much just felt crappy all day with the anxiety, spaciness, just generally feeling drugged without really feeling any benefits. Today the side effects were somewhat better, and I didn't feel them in the morning much at all, but it's still been really hard to tell if the drugs are working or not. Maybe for a little while in the morning I could concentrate a bit better, but for the rest of the day and especially after the second dose I mostly just felt crappy and drugged.

Did anyone else experience anything like this? It's been so hard to figure out which dose is right. Does it sound like 15mg x 2 is too much, or not enough? Should I try 20 mg x 2 tomorrow or should I stay put, or even go down? Is Ritalin just not for me? I'm feeling anxious because I'm seeing him on Monday and I want to have a dose figured out by then so we can start the extended release drugs.

Thanks!

[CheekyMonkey]

From my experience, the pdoc is usually pretty specific with building up to the therapeutic dose. I find it kinda weird that your pdoc just let you have at it without any idea of what to do...

[ana futura]

Calm down and have some patience!

I always think it'sfunny to tell people with ADHD that.

Anyway, all this stuff takes a long time to dial in. Don't be in a hurry to switch to long acting meds just yet. It sounds like ritalin might not be a good fit for you, but it's really hard to tell how a med behaves when you keep messing with the dose. I'd go back to 10's, and stay there until there's no more side effects. If you want to switch at this point I'd ask to try dexedrine or focalin at your next appointment. If you don't like Ritalin IR you probably won't like the long acting methylphenidate either. There are differences, but they're slight.

If the "good" part of ritalin is really good, than it might be worth investigating ritalin LA. Concerta is weird. You can't exactly halve the pill, and the unique delivery system means there's no way to figure out the right dose with IR pills anyway, you'll still have to muck around. You can use ritalin to titrate towards an adult concerta dose if you want.

I've been on meds since April, and I still haven't figured out what I'm supposed to be on and how much.

[ana futura]

Originally Posted by CheekyMonkey

From my experience, the pdoc is usually pretty specific with building up to the therapeutic dose. I find it kinda weird that your pdoc just let you have at it without any idea of what to do...

My doctor lets me go with it, but he spent a lot of time educating me about the process. I'm hyper sensitive, so the rules had to be broken a bit for me. I'm still not up to an adult dose of anything.

[CheekyMonkey]

Originally Posted by ana futura

My doctor lets me go with it, but he spent a lot of time educating me about the process.

But, the first time you got meds? I understand after you've been on them and kind of have an idea of what it is going to be like, but to not really know?

I'd want some guidelines!

[ana futura]

Originally Posted by CheekyMonkey

But, the first time you got meds? I understand after you've been on them and kind of have an idea of what it is going to be like, but to not really know?

I'd want some guidelines!

Yeah, I think I had a bit more guidance than Wizard. Maybe he just assumed I had no respect for authority and would do what I wanted to do anyway, which is kinda true

When I was mucking with meds it was with half an adult dose, and it was still too much. Debating between 2.5 and 5 is not exactly like going from 5 to 20. My doc did give me a ceiling.

[AWizardDidIt]

Wow, thanks for the great response!

Yes, I haven't been on meds before. His specific instructions for the titration were to start on the lowest dosing ( 5mg x 2), give it a day or two, and then try the next one up until I hit a point where I was not getting any more benefit. He WANTS me to go too high so we know where that is . . . although how I'm supposed to know what "too much" feels like vs. regular side effects is a mystery to me.

Knowing that, should I probably try 15mg x 2 for one more day or should I just drop back down to 10mg x 2?

[ana futura]

Originally Posted by AWizardDidIt

Wow, thanks for the great response!

Yes, I haven't been on meds before. His specific instructions for the titration were to start on the lowest dosing ( 5mg x 2), give it a day or two, and then try the next one up until I hit a point where I was not getting any more benefit. He WANTS me to go too high so we know where that is . . . although how I'm supposed to know what "too much" feels like vs. regular side effects is a mystery to me.

Knowing that, should I probably try 15mg x 2 for one more day or should I just drop back down to 10mg x 2?

It's my understanding that you should not go up until side effects have leveled off on your current dose. That's why I think you should go back to 10 until you see the side effects go away. Then you go up to 15. You may feel side effects every time you increase. The point of titration is to make the side effects bearable. Baby steps means you won't have to deal with as many side effects as you would starting out at a full dose.

Too much = too many side effects. You have already hit your ceiling for now.

[ana futura]

It sounds like ritalin is really not for you. It's not supposed to be painful. You probably would do better on an amphetamine. Although I felt ritalin was not for me, but now I like it. That's after I started getting a little manic on dexedrine though. I think the dexedrine broke me in a bit, and made the ritalin easier to deal with when I revisited it. I like it ok now, hated it at first.

[AWizardDidIt]

Originally Posted by ana futura

It's my understanding that you should not go up until side effects have leveled off on your current dose. That's why I think you should go back to 10 until you see the side effects go away. Then you go up to 15. You may feel side effects every time you increase. The point of titration is to make the side effects bearable. Baby steps means you won't have to deal with as many side effects as you would starting out at a full dose.

Too much = too many side effects. You have already hit your ceiling for now.

That makes much more sense than "a day or two" which is what he said. At least since I was at 15 today I probably won't have any side effects tomorrow at 10.

Not really digging this pdoc so far . . .

I'm not sure Ritalin is for me either . . . Maybe the extended release versions will be OK though? I know at least one person who does fine on stuff like Concerta but who feels awful on Ritalin IR.

[Drewbacca]

I'm feeling too lazy at 3am to give a detailed answer, but the OP response to ritalin sounds a lot like mine. I've had much better luck with amphetamines (adderall/vyvanse/dex).

[Verile]

If you're really diagnosed as inattentive then I don't know why the Pdoc gave you Ritalin, especially the instant release version.

Ask for a low dose of extended release. Something like 30 mg of Vyvanse or 10 mg of Adderal XR.

[Drewbacca]

Originally Posted by Verile

If you're really diagnosed as inattentive then I don't know why the Pdoc gave you Ritalin, especially the instant release version.

Ask for a low dose of extended release. Something like 30 mg of Vyvanse or 10 mg of Adderal XR.

Dr. Verile in the house.
This is what I'm talking about when I say stating your opinion matter-of-factly.

[Verile]

Don't be mean. It's just my style of talking. It's still just an opinion like anyone else's. She can take my suggestion or leave it. It's what I would do in her position.

[ana futura]

IR Ritalin should always be the first option in ADHD, according to Dr. Futura. It's the mellowest, and if you respond well to it you should stay on it as long as possible. Sometimes MPH konks out, and you have to switch to amps. If you start with amps, you might lose out on future effectiveness.

If you start with mph, you lose nothing. If you start with amps, you might over respond (ticks, manic thoughts, etc.) and your doc might take you off stims altogether. I clearly should not have started with dex, but I liked it so much when it worked that I kept taking it, even though it was probably a really bad fit for me.

The reason most people who start on amps stay on amps is because amps are always effective. Ritalin may or may not work. Amps will always work, but they often aren't the right fit. It's hard to realize whether they're a good fit unless you try mph first.

A large chunk of people with PI respond great to ritalin.