Ritalin - does the tiredness go away?

[aularian]

Hi all,

I'd appreciate any feedback from anyone that's had a similar experience. I apologise if this answer can be found in another thread (and please feel free to move this post if need be), I just couldn't really find it.

I was just wondering if the tiredness side effect goes away? My specialist decided to trial me on Ritalin a couple of weeks ago - 20mg long acting dose.

I just feel tired and really up and down all day, also a lot more antisocial than I normally am. I've been struggling with my job for some time now which is why I've sought treatment, but the Ritalin is just making it all even harder.

Some days if I have something particularly important on, I choose not to take it, though I'm aware that should be the other way around. It's a few more weeks til my next appointment. I'm just wondering if it's something I should power through and see if it gets better, or do I stop and wait to return to the doctor?

Has anyone that felt tired on Ritalin ever found that it went away?

Thanks

[XavierQ]

It will get better in time, but to get completely rid of the tiredness, you'll need to keep your lifestyle healthy. I've experienced that when I'm on Ritalin, my body is very unforgiving when it comes to an unhealthy lifestyle.

Here are some quick tips:

1) Make sure you eat properly:
- the right amount calories (Ritalin makes you eat less = less energy)
- no heavy meals
- take in enough fat (your adrenal glands will thank you)
- Avoid sugar and caffeine (they'll help for the first minutes, but cause a crash later)
- Avoid alcohol
- Drink plenty of water

2) Exercise (even when you're tired, but never before bed)
- increases blood flow (Ritalin constricts blood vessels)
- reduces stress
- improves sleep

3) Take a moment when you need it:
- Powernap
- Play on your favorite song on your mp3-player

Supplements that might help: magnesium, fish oil, creatine (I know it sounds bizarre, but it's actually pretty good at reduces fatigue.)

[MADD_MEN]

I haven't personally experienced drowsiness with Ritalin, but I did with Adderall. Everyone's chemistry is a little different, so it may go away or it may not. I'll echo Xavier in saying good sleep and diet are very important. I find that if I don't get enough sleep, I can get very tired.

Magnesium, fish oil might help, or possibly Wellbutrion.

If drowsiness persists, you may want to try a different med, as there is no one perfect med. I think it's good to try different meds anyway to see which one is the most effective for you.

[thomas2names]

I recently started methylin er 10mg (generic ritalin) and found that i also get drowsy after taking it and I have a harder time talking to people or thinking of something to start a conversation. I just started my job two months ago and have only connected with a few people. Anyways Im going to see my doctor in a week so ill see what he has to say. I hope you get an answer from yours and can solve your prob.

[aularian]

Thanks all. Did you figure yours out Thomas? I decided to stop taking the Ritalin, the side effects were killing me and I didn't really get any benefit from it. I'm going to try dex soon so hopefully that will yeild better results...

[mdrider]

I started generic Ritalin (IR) almost 5 weeks ago. My doc had me start with 5mg/2xday, working up to 10mg/2x day.

I actually increased the dosage even more slowly than my doc had said to do (instead of jumping from 5mg to 10mg, I did 7.5 mg), so I only got to the 10mg/2x day ten days ago. This past Tuesday my doc upped me to 10mg/3x day because the ritalin was wearing off midafternoon.

For the last week I have been fighting tiredness and lack of focus, with the last couple of days being the worst. I had a similar experience with Adderall XR (20mg), which turned me into a zombie (that plus lots of side effects was why we switched to ritalin).

Anyway, I think that I've been on too much ritalin the last week -- yesterday I didn't take the third dose. This morning instead of 10mg I took 5mg. I am feeling better -- more focused and I feel more like doing something (I spent most of yesterday sitting on the sofa surfing the internet, totally obsessing over one thing that I should not have been spending time on...ok, I'm on the sofa right now, but I'm actually going to get up after this post and go grocery shopping! ).

I have not had any increased heart rate or bp w/the increased dose of ritalin -- just tiredness & lack of focus. Time will tell, but it seems for me that too much of a stimulant (either adderall or ritalin) makes the ADD worse. (edited to add: I'm the inattentive type, not hyperactive)

[KMiller]

Originally Posted by mdrider

Time will tell, but it seems for me that too much of a stimulant (either adderall or ritalin) makes the ADD worse. (edited to add: I'm the inattentive type, not hyperactive)

Wikipedia mentions that stimulant medications have a bit of a different effect on ADHD-PI, and that people with -PI respond better to lower doses, with less benefit at higher doses. Wikipedia, unfortunately, fails to cite a source - a source of great consternation for me.

I'm interested that your experiences tend to reinforce Wikipedia's assertion.

[mdrider]

Would be nice to see some studies that look at this issue. I searched a bit thru pubmed but didn't find anything.

Got my grocery shopping easily done this morning and will shortly head out for a hike -- a far cry from yesterday's sluggish couchpotato experience.

Originally Posted by KMiller

Wikipedia mentions that stimulant medications have a bit of a different effect on ADHD-PI, and that people with -PI respond better to lower doses, with less benefit at higher doses. Wikipedia, unfortunately, fails to cite a source - a source of great consternation for me.

I'm interested that your experiences tend to reinforce Wikipedia's assertion.

[mdrider]

O.k., this is interesting -- a study published in June 2009 which looked at the effect of genotype & MPH treatment/side effects in children:

http://bit.ly/2a9Bp3

"The dopamine transporter locus (DAT1) has been studied as a risk factor for attention-deficit/hyperactivity disorder (ADHD) and in pharmacogenetic studies of stimulant response. Several prospective studies have reported an association between the homozygous 9 repeat allele of the DAT1 3' untranslated region (UTR) variable number tandem repeat (VNTR) (DAT1 3') and decreased efficacy of methylphenidate (MPH). We hypothesized that children with the 9/9 genotype would display higher rates of specific stimulant side effects. Data on adverse events and DAT1 3' genotypes were combined from two, double-blind, placebo-controlled, crossover studies of MPH conducted in child psychiatric outpatient clinics in Montreal and Washington, D.C. There were 177 participants, 5-16 years old (mean age = 8.99, standard deviation [SD] = 2), with ADHD. Parents completed the Stimulant Side Effect Scale (SERS) after a week of placebo and a week of MPH treatment. Principal components analysis of the SERS resulted in three factors: Emotionality, Somatic Complaints, and Over-focused. Children with the 9/9 genotype displayed higher scores on the Emotionality factor during placebo than children with the 9/10 and the 10/10 genotype, and their Emotionality scores increased further during MPH treatment (F[2,151] = 3.24, p < 0.05). Children with the 10/10 genotype displayed a significant increase in Somatic Complaint factor scores during MPH treatment relative to the other genotype groups (F[2,150] = 3.4, p < 0.05). These data provide suggestive evidence that DAT1 variants are differentially associated with specific stimulant side effects. Children with the 9/10 genotype displayed less severe stimulant side-effect ratings than either of the homozygous groups, who each displayed increased susceptibility to different types of adverse events. Preliminary evidence suggests that pharmacogenetic analysis using DAT1 variants shows promise for identifying individuals at increased or decreased risk for poor tolerability."

And this, published just a week ago (ahead of print publication) -- "Carboxylesterase 1 gene polymorphism and methylphenidate response in ADHD."
http://bit.ly/ZUhUx

"Methylphenidate (MPH) is the most frequently prescribed drug in the treatment of attention deficit hyperactivity disorder (ADHD). Several pharmacogenetic studies suggested that catecholamine candidate genes influence individual MPH-responses, but these results are mostly contradictory. Genetic analyses of MPH metabolizing carboxylesterase 1 enzyme (CES1) have not been carried out, whereas, meta-analysis of CYP2D6 genetic variants has been already indicated significant pharmacogenetic differences in atomoxetine treatment. Here we present an association analysis of the CES1 Gly143Glu functional polymorphism in a Hungarian ADHD group (n = 173). The genotype frequencies were similar to that of the general population (5.8% vs 4.1% of Gly/Glu heterozygote). Pharmacogenetic analysis was conducted among 122 ADHD children treated with MPH. Neither the categorical analysis comparing 90 responders vs 32 non-responders, nor the dimensional analysis of Inattention and Hyperactivity/Impulsivity score reduction showed a significant main genotype effect. However, analyzing the daily dose, we observed an association with the rare 143Glu-variant: 5 patients in the responder group carrying the Glu-allele required lower doses of MPH for symptom reduction (0.410 +/- 0.127 vs 0.572 +/- 0.153 mg/kg, t(1,88) = 2.33, p = 0.022). This result warrants for further investigations of the CES1 gene in larger ADHD samples."

Originally Posted by KMiller

Wikipedia mentions that stimulant medications have a bit of a different effect on ADHD-PI, and that people with -PI respond better to lower doses, with less benefit at higher doses. Wikipedia, unfortunately, fails to cite a source - a source of great consternation for me.

I'm interested that your experiences tend to reinforce Wikipedia's assertion.