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Old 06-07-18, 01:46 PM
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Over medicating? Or do I really need this much?

Hey guys, I'm 31 years old and my wife and I have been working on getting some treatment for my hyperactive 7 year old son.

I had no idea about ADD until that point and once I began to learn about the conditions it literally began to make my own life make sense to me. So I make myself an appointment and low and behold doc says not a doubt in my mind you're primarily innattentive. So he starts me on metadate ER 20 mg and I'm supposed to check in weekly.

First week does nothing, so he prescribes dexmethylphenidate ER 10 mg. Second week maybe I felt something maybe not, so I tell them, they say double the dose, so 20 mg er. All I could say was jackpot! Worked wonderful! Made me a complete believer. About 5 days in and I started getting quite a bit of side effects, mainly fogginess and some possible depression, not to mention it's not really working as long as it was before, maybe 2 good hours in the morning and a good hour in the afternoon.

So fast forward to now about 5 weeks in and I go to talk to the doctor about the past month and I tell him no more ER for me I would like to have the IR. He tells me that we probably need to raise the dose slightly but they don't make 15 mg IR tablets. He prescribes me 10 mg IR tablets 3 times daily and cut one in half and take it as 15 mg twice daily. Boy was that dose wrong! Way too much, so I've been taking a 10 mg in the morning, followed by 5 mg 2 1/2 hours later followed by a 10 mg 2 1/2 hours later followed by a 5 mg 2 1/2 hours after that. I've noticed taking it like this does get rid of the side effects but I'm not seeing any effectiveness accept for after my 10 mg dosing.

I've looked at the charts and understand how it works and the peaks. I really feel like I need 10 mg 4 times a day and 5 mg in the evening to counteract the sides. I know this seems absolutely crazy and make me feel like a junky honestly but I'm not seeing a great deal of benefit currently. The doctor is willing to prescribe Adderall I just don't know what to do. I've never taken pills or had any addictions in my life, I just know my body, and am trying to be honest. I'm not looking for a rush or anything like that, any advice would be appreciated

Last edited by peripatetic; 06-07-18 at 02:40 PM.. Reason: added paragraph breaks to ease reading. no other edits
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  #2  
Old 06-07-18, 05:08 PM
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Re: Over medicating? Or do I really need this much?

I am sorry for the very long post, I guess maybe a better question would be since more than 10 mg seems to be too much, is it really possible for the medicine to be metabolizing so quickly to wear off? I've never been heavily overweight but keep a few pounds to spare and have never considered myself to have a high metabolism. Like I said in the above post, the doctor is willing to let me try other avenues if I feel I need to, I just don't have much experience and would hate to start from square one.
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Old 06-07-18, 06:25 PM
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Re: Over medicating? Or do I really need this much?

Quote:
Originally Posted by Welds363 View Post
I've looked at the charts and understand how it works and the peaks. I really feel like I need 10 mg 4 times a day and 5 mg in the evening to counteract the sides. I know this seems absolutely crazy and make me feel like a junky honestly but I'm not seeing a great deal of benefit currently.
d-MPH has a fast elimination time, so it'd make sense that you'd have to constantly re-dose. And 45 mg/day seems on the high end, but not extreme by any measure.

Quote:
Originally Posted by Welds363 View Post
The doctor is willing to prescribe Adderall I just don't know what to do.
Adderall is from amphetamine class of stimulants. Some people do better on amphetamine, and others do better on methylphenidate. It might be worth trying out. Stimulants have their effects right away, so you might be able to tell right away which one is better for you.

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I've never taken pills or had any addictions in my life, I just know my body, and am trying to be honest. I'm not looking for a rush or anything like that, any advice would be appreciated
Addiction occurs when people try increasing the dose the maintain euphoria. That's not what you're doing.
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Old 06-07-18, 06:43 PM
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Re: Over medicating? Or do I really need this much?

Quote:
Originally Posted by Welds363 View Post
I've looked at the charts and understand how it works and the peaks. I really feel like I need 10 mg 4 times a day and 5 mg in the evening to counteract the sides. I know this seems absolutely crazy and make me feel like a junky honestly but I'm not seeing a great deal of benefit currently.
That doesn't seem unreasonable.

The maximum manufacturer-recommended daily dose (not a hard and fast rule, but what's been tested for FDA approval) is 60mg, and you'd be well under that at 45mg total/day.

(Inconvenient, yes, in terms of having to remember 5 doses a day...but not unreasonable if you have strategies for remembering to take it.)

Quote:
Originally Posted by Welds363
The doctor is willing to prescribe Adderall I just don't know what to do. I've never taken pills or had any addictions in my life, I just know my body, and am trying to be honest. I'm not looking for a rush or anything like that, any advice would be appreciated
If you're seeing benefit in terms of reduction of ADHD symptoms, and you're not chasing a euphoric high or constantly increasing your dose, and you're working closely with your doctor to manage your symptoms, then it doesn't seem like a problem.

Have you run your dosing idea past your doctor yet?
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Old 06-07-18, 06:57 PM
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Re: Over medicating? Or do I really need this much?

No, I haven't discussed the thought of 4x10mg and 1x5mg since we just decided the end of last week to start 3x10mg a day. He specifically told me that there is no right answer that he can give and that as long as I'm checking in and keeping them updated to split it up however I find it effective. I will say it is very inconvenient trying to split it up at the right time, but we have scheduled breaks and lunches at work so I've pretty much just been taking a whole or a half dose every break. I used to get pretty bad hyperfocus on certain things that I was interested in working on but on the other hand some projects were so unbearably boring that I didn't know how I was gonna make it through the day. More than once I have just dropped what I was doing and just left work because I couldn't stand one more minute, this seems to really level the playing field between wanting to do and being forced to do. As troublesome as taking 5 doses a day would be that's what gets me wondering what if an amphetamine class may suite me better and hopefully get by with just twice a day.
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  #6  
Old 06-07-18, 07:08 PM
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Re: Over medicating? Or do I really need this much?

Quote:
Originally Posted by Welds363 View Post
No, I haven't discussed the thought of 4x10mg and 1x5mg since we just decided the end of last week to start 3x10mg a day. He specifically told me that there is no right answer that he can give and that as long as I'm checking in and keeping them updated to split it up however I find it effective. I will say it is very inconvenient trying to split it up at the right time, but we have scheduled breaks and lunches at work so I've pretty much just been taking a whole or a half dose every break. I used to get pretty bad hyperfocus on certain things that I was interested in working on but on the other hand some projects were so unbearably boring that I didn't know how I was gonna make it through the day. More than once I have just dropped what I was doing and just left work because I couldn't stand one more minute, this seems to really level the playing field between wanting to do and being forced to do. As troublesome as taking 5 doses a day would be that's what gets me wondering what if an amphetamine class may suite me better and hopefully get by with just twice a day.
Yes, it may also be worth trying something from the amphetamine family if you've never tried it. It may work better or last longer; it may not. If it helps, that would give you some long-acting options to try that you haven't tried already.

People vary enough that there's really not a reliable way to predict who will respond best to which medication.

If an amphetamine helps, and doesn't cause bothersome side effects, great! If not, maybe the methylphenidate 10mg, 4x/day + 5mg 1x/day could work.

The important thing is that you're working with your doctor to figure this out -- and that your doctor seems reasonably knowledgable and willing to help you find the most helpful treatment.

Best wishes!
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Old 06-08-18, 04:32 AM
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Re: Over medicating? Or do I really need this much?

Personally I would give amphetamines a try.
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Old 06-08-18, 08:02 AM
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Re: Over medicating? Or do I really need this much?

I plan on going back to school for a couple of classes soon which is why I originally wanted to talk to the doctor. Concentrating on bookwork has always been a down fall of mine, like reading a whole page and zero comprehension or retention.

While I try and get this dosage right it's really just to be ready for school. I like to try to keep in the back of my mind that I made it a pretty successful 30 years without medicine. When and if I can get dosage figured out I believe that I'll end up scaling back to only during school, studying, and anytime I need to make it over a hump or rough patch at work.
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Old 06-11-18, 11:41 AM
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Re: Over medicating? Or do I really need this much?

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Originally Posted by namazu View Post
That doesn't seem unreasonable.

The maximum manufacturer-recommended daily dose (not a hard and fast rule, but what's been tested for FDA approval) is 60mg, and you'd be well under that at 45mg total/day.

---SNIPPAGE---
My understanding of the OP is that he is taking Focalin (generic or otherwise). IIRC Focalin is only reviewed for 20mg/d. I always thought that was strange since MPH is reviewed for the 60 mg/d of which the dex isomer would be 30mg/d.

Of course if I misunderstood any/all, I would appreciate the clarification. -LN
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Old 06-11-18, 12:43 PM
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Re: Over medicating? Or do I really need this much?

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IIRC Focalin is only reviewed for 20mg/d. I always thought that was strange since MPH is reviewed for the 60 mg/d of which the dex isomer would be 30mg/d.
All that means is that the pharma company that submitted Focalin for original FDA approval did not submit data to support usage of 30mg/day. Why? Who knows.
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Old 06-11-18, 01:13 PM
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Re: Over medicating? Or do I really need this much?

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My understanding of the OP is that he is taking Focalin (generic or otherwise). IIRC Focalin is only reviewed for 20mg/d.
Ah, good catch! (I misread the post and thought that the OP was taking IR methylphenidate/Ritalin, rather than dexmethylphenidate/Focalin.) Thanks.

You are correct that the manufacturer's recommended daily maximum dose of IR dexmethylphenidate/Focalin is 20mg -- which, as CharlesH pointed out, means that the manufacturer did not submit data supporting higher daily doses for evaluation by the FDA.
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Old 07-20-18, 02:40 PM
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Re: Over medicating? Or do I really need this much?

Update: Since starting Focalin I gave up trying to take it so often and I stopped trying to keep everything so regulated. I ended up most of the time just taking one when I got to work to get the ball rolling and depending on how the day went, maybe take one or two more, and sometimes just my morning dose and that was it. Still had anxiety from it sometimes and I'd just tell myself in the back of my head everything is fine it's just the medicine and just deal with it.

My doctor ended up starting me on 10 mg Adderall IR up to 3x daily, but as needed. He only gave me about a weeks worth, but I was fed up with it after about 3 days. Hated it, just intermittently made my heart rate spike for no reason and made me more tired and sluggish than I already was. Spoke with the doc again, he wanted to try Vyvanse 50 mg. Same outcome as the Adderall took it for about a week and nothing improved, so I called and told them I was done with the amphetamine class. So going back to Focalin as needed because aside from the anxiety it really seems to have the most benefit.

Any and all suggestions are appreciated guys. I hate taking all this different stuff, makes me feel a little bad about myself and kind of like saying to hell with it.
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Old 07-21-18, 01:14 AM
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Re: Over medicating? Or do I really need this much?

Perhaps try focalin xr
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Old 07-21-18, 01:52 AM
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Re: Over medicating? Or do I really need this much?

Thanks for sharing your situation so openly. I know (as everyone else here does) that its frustrating to find the right method of treatment. Especially when you're in school!


I understand that you are frustrated with stimulant variants. I just wanted to suggest an option of approach that i (maybe didnt recognize suggested but) didnt notice in this thread.

It is not uncommon to have a primary extended release stimulant, and have a moderately to very low dose of an instant release stimulant. Personally ive found that extended release variants often last, but then crash out hard and fast. And instant relese meds, require alot of upkeep and regulation.

What has worked for me in the past (as well as the other men in my family), is to have an XR, to take in the morning, and then a low dose IR to take once, maybe twice throughout the day. I imagine this to be like a balloon being held in the air (by the XR medication), then when the balloon starts dropping, the low dose IR is like a puff of air that puts it back into the jetstream. The combination might be something to look into, if you have an further tolerance for that direction.

Other suggestions..



Antidepressants (specifically Wellbutrin), can help greatly (by themselves) for things like impulse control and thought stopping. As well as craving response. Ive known many ADDrs without depression (though its commonly comorbid for obvious reasons), who exclusively take Wellbutrin (or Buproprion [sp?]) to manage their internal symptoms, and often it seems thats all they need. Depending on the light availability, and the season, sometimes i stop stims, and just take my Wellbutrin.

Brings me to another point. You might do well by getting a SAD light. 20 minutes a day, maybe 40 (morning and evening). The lack of vitamin D.. (which is suggested that you cannot get anymore by regular outdoor activity), has always been a point of issue with me and the men in my family.

On that, you can look into vitamins such as the Omegas, and B's, Potassium. But at this point im sure im not telling you anything that you havnt heard.

And on your initial perscriptions.. i do have to say. Even though 45mg of adderall is the standard cap for men, per day... starting at 30 seems a bit high. You might be sensitive to stimulants? Maybe explore what half of that would do for you. You could also talk with your Pharmacist about those specific medications and how you are responding to them. Remember.. they are doctors too.. just specifically with medications and interactions; Doctors of Pharmacology. Perscribing doctors dont necissarilly have all of the nuances and intimate details that pharmacists do.

Hope these thoughts help, best of luck.

iDTour
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Old 07-21-18, 02:39 AM
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Re: Over medicating? Or do I really need this much?

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Originally Posted by Welds363 View Post
I plan on going back to school for a couple of classes soon which is why I originally wanted to talk to the doctor. Concentrating on bookwork has always been a down fall of mine, like reading a whole page and zero comprehension or retention.

While I try and get this dosage right it's really just to be ready for school. I like to try to keep in the back of my mind that I made it a pretty successful 30 years without medicine. When and if I can get dosage figured out I believe that I'll end up scaling back to only during school, studying, and anytime I need to make it over a hump or rough patch at work.
One thing i wanted to add.. ADHD is a disorder which is one half neurobiological, and one half behavioral/developmental. The point i wanted to address is coping mechanisms and strategies.

You mentioned you're going to be taking more classes at school. As an engineering student i can attest to how much medication by itself, will likely not be the "ultimate answer".

ADHD is typically something that someone (whithout a TBI) has be dealing with all of their life (often unknowingly). The ramifications often affect strategies to deal with.. Stress (a HUGE trigger for ADD symptoms). For instance.. you look at the 100 page chapter you have to read in your textbook, for the next morning.. and it can make me struggle REALLY hard to get through it, just because of the Overwhelm.

ADHD also often (by its lifelong development), can mean that students have already been managing with poor study habbits, rituals, and time management strategies. A pill isnt going to solve this. Truth be told, you might have to approach alot of the incoming material.. differently than anyone else: Over elaborate charts.. drawings.. something to trigger that "catch" that will at least move you into a position to memorize, but ideal to intuitively internalize the material. Your methods might be completely unorthadox.. i just want to encourage you to think outside of the standard "learning box" that generally applies.. cause it might not. Though with you.. it might. I just wanted to suggest an open mind to alternative strategies.

When i was in school (im on a break; life circumstances), not only did i have my psychiatric nurse providing perscriptions, but also 1.. sometimes 2 different on campus therapists to help with the stress factor. IE: Talk therapy.. memorization strategies .. etc.

Additionally.. i highly encourage looking into school resources.. such as a TRiO program. Which if you qualify for, will provide an additional Academic Advisor, who deals specifically with (litterally) "you" and your life situation. For me, my TRiO advisor helped with locating childcare, developing study strategies, organizational strategies, locating financial resources (scholarships/grants and even banking/investment opportunities which would benifit me specifically for my senior year, in addition to its on proprietary scholarships/grants). Also working in tendem with my other Academic Advisors to find the best methods for me to "ingest" the material.. and even to locate private tutors, which were paid for by the program.

The bottom line i guess im trying to make, is that its brutal for anyone with ADHD to go to school, regardless of the level. And the environmental factors of just being in school (with a family... that struggle is VERY real - i know), are often very challenging triggers to an ADD response to fluidly navigate without being pulled into a whirlpool of chaos.

ADHD is a 2 factor thing. 1 part neurochemical, 1 part behavioral/developmental.. thats all im trying to say. Medication and Therapy are more often than not, a tandem approach.. just by the nature of ADHD.

Thats something i know hasnt been address on this thread yet, that as a student, i needed to voice. Being in school is hard, being in school with a developmental/cognitive disorder is.. super hard.

Word to the wise: dont sell yourself short just because other people in the class seem to be just .. "gliding along". ADHD frustration.. is a million times worse than normal frustration.

All the best.

iDTour
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