Stimulant Side Effects: How do you Cope?

[APSJ]

I've been taking methylphenidate for about fifteen years, and its been incredibly helpful to me, but has some consistent unpleasant side effects, some of which I manage to deal with effectively, others of which I have not.

I've heard that a lot of the stimulant meds have similar side effects, and am extremely curious about how other people deal with the side effects they experience. What do you do?

Here are my methods:

•Lack of Appetite: I not only have no appetite while on my medication, I actually find eating quite unpleasant. I sometimes end up not eating lunch, which results in me feeling light headed and unfocused in the late afternoon.

The best thing I've come up with is to carry a cliff bar with me, which I can eat quickly, and drink a lot of water. I still feel somewhat light-headed, but it helps a lot. Recently I also started eating Black Black candy, which has menthol and caffeine, which helps with both energy and the dry mouth and bad breath that sometimes result from my not eating for long periods.

•Single-mindedness: This is something that I have a problem with even without the medication, but its much more intense with it. Essentially, once I start working on something, or researching something, it is extremely difficult to stop or be interrupted. At work, this means I will sit at my computer working all day without stopping. I can be quite productive this way, but I think it makes people around me who take breaks to socialize, eat lunch, etc. think I'm very strange(or possibly crazy).

I don't have any really successful methods of dealing with this except to make taking breaks an assignment for myself. Thus, although I have no desire to do so, I try to get up, and walk around a little, stop working while I eat my Cliff bar, and even talk to people about what they are working on.

•Sweating: I used to find that I sweat a lot more when on my medication, and my skin is more oily.

The former was helped by adding another medication, propranolol, the latter is still a problem, but not a major one.

•Crashing: At the end of the day when, the methylphenidate wears off, I am essentially useless. Oddly, some days its very intense, and everything, even sitting on the couch watching TV, is unpleasant, while other days its very mild. I've yet to pin down any factors common to either sort of day. A consequence of this is that my productive time each day is significantly shorter than for most people, since I have to let the medication wear off by 6:00 pm at the latest if I am going to sleep before 5:00am, anything I have not gotten done by that time, I cannot do.

Sometimes, cutting my last dose down a little, so the change isn't so abrupt helps, but that is often impractical as I frequently need to concentrate later in the day. When its very unpleasant, I sometimes have a couple of drinks, but I try not to as I'm not really sure about the health effects of combining alcohol with whatever residual medication is in my system.

•Insomnia: I had insomnia long before I started drinking coffee or taking methylphenidate, but the medication has made it significantly worse. Even though I avoid taking it after 4:00, I still have frequent trouble sleeping.

I've found nothing that helps me with this other than medication, either over the counter:unisom and melatonin, or prescription: doxapin, remeron. These work fairly well, but the former make it hard for me to wake up, and the latter take quite a while to work.
I had a serious adverse reaction to the hypnotic variety of sleep aids(ambien, sonata, lunesta, etc.), after using them successfully for several months, and I already take a benzodiazapene for anxiety during the day so I'm pretty confined in my options. I've often thought about asking for whatever is in a "mickey" as seen in old movies, but I'm not sure I'd get a favorable response.

[supahdupah]

I share all of the same issues except for the insomnia. I can fall asleep no problem, even if I took a dose 4 hours before bed. I do have trouble sleeping in though. I cannot sleep more than 7 hours.

The thing that is interesting to me is the coming down part. Sometimes I barely notice it and feel fine. Some days its horrible and i get a headache and my eyes won't focus properly. I can't put my finger on it either. Is it diet related? Not eating well enough that day?

[APSJ]

Originally Posted by supahdupah

The thing that is interesting to me is the coming down part. Sometimes I barely notice it and feel fine. Some days its horrible and i get a headache and my eyes won't focus properly. I can't put my finger on it either. Is it diet related? Not eating well enough that day?

This is a really frustrating mystery for me. I've been taking ritalin, with occasional breaks, for about fifteen years, and have yet to figure it out. Its such a dramatic difference that I feel it has to be physiological, caused by something I do.

I was beginning to think that it has to do with my not eating much during the day, but I almost never do, and some days I'm fine even if I eat nothing.

I haven't been keeping track of it long enough to see if I ever have a bad crash on a day when I've actually eaten a real lunch.

If you figure it out please post your discovery.

[supahdupah]

One thing so far that has never resulted in a bad come down has been splitting my last dose. I am on 15MGx3. So what i have done a few times is take 10MG for the 3rd dose then 5mg 2.5 hours later and everything is good. Not quite enough data to know if its just coincidence.

[Driver]

•Lack of Appetite:

See a nutrionist to make sure you're on a compatible diet.

•Single-mindedness:

Increase your serotonin: take St John's Wart and/or more carbs.

•Sweating:

Drink more water to thin it out.

•Crashing:

Taper your dose at the end of the day.

•Insomnia:

Don't take your dosage late. Try sleep aids like white noise generators, fans etc.

[APSJ]

Originally Posted by supahdupah

One thing so far that has never resulted in a bad come down has been splitting my last dose. I am on 15MGx3. So what i have done a few times is take 10MG for the 3rd dose then 5mg 2.5 hours later and everything is good. Not quite enough data to know if its just coincidence.

I take 15 mg x 4, and taking ten for my last dose usually at least reduces the the come down, but there are still many days when i take four full doses and am fine, even better than some days when I took only three, or took a reduced final does, so I'm convinced there's some factor I'm missing.

Originally Posted by Driver

Try sleep aids like white noise generators, fans etc.

I'll have to try this. Before I had air conditioning I used to use a fan in the summer, and it always helped me sleep. It never occurred to me to that it could be a year round solution for some reason.

[novagal]

I second the fan suggestion. I cannot sleep in perfect quiet. I can't sleep with unexpected outside noises either. Our fan goes with us on vacation even. Something to note about fans - some might have a pitch that can make things worse. Recently, our trusty fan that we'd had for over five years took a dump and we replaced it with a newer fancier model. After a couple of weeks of very little sleep, I realized there was a sound to it that was irritating the heck out of me. We took it back and got the same model we'd been using prior, and had a great sleep that night.

I also sleep better with the cool air on my face, but when it's really cold we'll just point it away from the bed.

[APSJ]

Originally Posted by novagal

I second the fan suggestion. I cannot sleep in perfect quiet. I can't sleep with unexpected outside noises either. Our fan goes with us on vacation even. Something to note about fans - some might have a pitch that can make things worse. Recently, our trusty fan that we'd had for over five years took a dump and we replaced it with a newer fancier model. After a couple of weeks of very little sleep, I realized there was a sound to it that was irritating the heck out of me. We took it back and got the same model we'd been using prior, and had a great sleep that night.

I also sleep better with the cool air on my face, but when it's really cold we'll just point it away from the bed.

I also like to have a fan or A/C blowing directly on my face when the temperature allows for it, but my significant other hates it, so its tricky.

For the sound, I'm thinking of leaving my computer set to this site at night as an experiment some time http://simplynoise.com/ Again, my significant other may be an issue.

I actually sleep better with some outside noise. I moved from the city to the country when quite young, and ever since I've found the city sounds somewhat soothing. As odd as it sounds, the noise from cars, horns, sirens, shouted obscenities, and garbage trucks, provided its not directly outside my window, is far more conducive to sleep for me than the dead silence I had in the country at night. In the winter it was particularly bad, as the crickets and peepers provided some background noise in the spring and summer.

[Featherhead]

All of Driver's suggestions are on-target, but a continued problem with any of these side effects may suggest a need for a lower dosage or different med. As for single-mindedness, that's what stims are supposed to do for ADD sufferers, but again, extremes may require a change in dosage/med.

[APSJ]

Originally Posted by Featherhead

All of Driver's suggestions are on-target, but a continued problem with any of these side effects may suggest a need for a lower dosage or different med. As for single-mindedness, that's what stims are supposed to do for ADD sufferers, but again, extremes may require a change in dosage/med.

Unfortunately, my dose is already quite precariously balanced between too small to be effective and too large to keep the side effects manageable.

The single-mindedness I'm referring to isn't just a matter of being able to focus on a single thing, its a matter of not being able to stop. Sometimes at work, if I've been writing/researching furiously for an hour or so and someone asks me a question, I'll literally be dumbfounded and just sort of stammer while I try and transition my thinking from work mode to interaction mode.

Even a simple thing, responding to a queston like "Hey, [APSJ], there's a call for so and so, is she here today?"
will result in a response like
"huh? uh wuh..so and so..um she sits over..uh..i don't know if she's..wait i saw her ..no that was yesterday..um I don't know."
Its particluarly embarassing if "so and so" is sitting within earshot at the time.

[Driver]

Originally Posted by APSJ

The single-mindedness I'm referring to isn't just a matter of being able to focus on a single thing, its a matter of not being able to stop.

This is overfocus, and stems from not enough serotonin.

[APSJ]

Originally Posted by Driver

This is overfocus, and stems from not enough serotonin.

That's not a term I've heard before, but it makes sense. I used to take prozac, and low serotonin seems to run in my family. Can you point me to any research on this?

[Driver]

Originally Posted by APSJ

That's not a term I've heard before, but it makes sense. I used to take prozac, and low serotonin seems to run in my family. Can you point me to any research on this?

SSRIs are used in the treatment of OCD.

[APSJ]

That seems to support the idea further...I took Prozac for depression, but I do have OCD as well, although its never been a big enough problem to seek treatment for it. It never occurred to me that being unable to shift focus was connected to what I considered OCD symptoms(like a compulsion to rearrange the bottles in the medicine cabinet in descending order of height)

[Driver]

Originally Posted by APSJ

That seems to support the idea further...I took Prozac for depression, but I do have OCD as well, although its never been a big enough problem to seek treatment for it. It never occurred to me that being unable to shift focus was connected to what I considered OCD symptoms(like a compulsion to rearrange the bottles in the medicine cabinet in descending order of height)

Obsessions can be thoughts as well as actions. Being unable to shift focus is no different to being unable to ignore that the medicine bottles are not sorted in descending order of height.