Ritalin dosage - adult

[joklem]

Hello, I have pretty severe ADHD. Diagnosed twice in late childhood and early teen years, severe concentration, wakefulness and focus issues, even in fun things/hobbies. It "ruined" my late high school years (when I was taken off it), and that word is in quotation marks because I am autodidact - I learn very fast and by myself, given I have the motivation and energy. Even though living with ADHD can be a complete hell because it can cause, and even be misdiagnosed as, anxiety and depression (I've gone to docs for depression and anxiety, but they sent me for an evaluation which I didn't even have the motivation to show up for), I've never fell into drug abuse, so I lived with adhd symptoms and social anxiety for most of my life.

I'm going to include all the details I can think of right now.

I went to my family doctor, who prescribed me 10mg Ritalin twice a day for 7 days, then 20mg twice daily in the morning and noon. He didn't ask much because he was the doctor who diagnosed me in my childhood. They are of generic brand (pms-methylphenidate), and instant release. He wrote a prescription for 12 refills (one year).

He told me to mess around with the dosage to find what feels right. I've tried 10 and it didn't do anything noticeable. With 20mg (took one an hour later), I was feeling half-awake, but noticed that my concentration was a little better, but felt like a bit of a "zombie". Since it's a derivative of amphetamine, I know that the effects are supposed to be noticed on the first dose as opposed to some medications that can take weeks to notice any change.

Around four hours and a half later, I tried 30mg, and wow. I wasn't "high" (I know the feeling of a recreational amphetamine dose), but I was fully awake, concentrated, focused, VERY ambitious (got an internship at the local radio station the same day I started the medication, I have no education in the domain but convinced the director that I'm passioned about getting further in the trade (self-learning sound engineering)), more social - I feel more genuinely interested in people, and social anxiety wasn't an obstacle, my head and thoughts are clear as crystal, compared to the feeling of having 20 TV channels open at once before. I actually feel more relaxed, no anxiety at all.

I get very limited side effects, which is loss of appetite (pretty strong, but I eat well) and slightly increased sweating (I didn't sweat much before). The intended effects start around 30 minutes after swallowing the pills, and start wearing off after around 3 hours. After around 3:30 hours, it's completely gone.

I also tend to keep occupied during the evening, and the doses are to be taken in the morning and around noon, which leaves me with a pretty strong rebound effect ADHD in the evening, as early as 6PM. My sleep schedule is normally 1-2AM to 8-9AM, and I need to keep it that way.

Is three doses of 30mg, in the morning, around noon, and around 5-6 for the evening a good (and relatively safe) dosage/schedule to take (generic, if that matters) Ritalin? I will need to ask my doc to change the prescription, but again he gave me the OK to mess with my dosage a little bit, I'm guessing because there's various factors and he can't guess how I feel.

Physical stats: Male, 23, 6'1", 212lb, good heart as far as I know (on 30mg and one ~8oz coffee I had with dinner at 6:30PM BPM is 90, counted at 8PM. Regular, not arrhythmic.). Never had any surgery or severe health problems other than a pneumonia when I was around 12. No family history of heart disease.

Prior medication/drugs:
-Ritalin (forgot the dosage) from around 10 to 15 years old;

-Amphetamine (speed) once at a party two months ago, didn't plan on it but it made me realize that I *needed* to treat my ADHD. When I was offered the pill, I thought that it would increase my anxiety, but it did the opposite. Overall, I felt a stigma with stimulant drugs even with ADHD. Still took me two months to see a doc, though. Worth noting is that I got a very nasty "down period" of 3 full days where I was completely miserable, which permanently put me off abusing drugs, that was no fun at all, but the experience and eye opening probably changed my life for the better;

-Zero alcohol (incl. beer) in years, and it was one time. Don't like the effect at all. Family history of alcoholism (Father and an uncle, but they haven't drank in well over 10 years. I didn't even know until they told me around a year ago), no history of drug addiction;

-Occasional cannabis use.

Might be worth noting:
-stopped smoking the same day I got the prescription. (21mg nicotine patches)

[joklem]

Oh, few details I forgot:
-No insomnia. I go to bed around 1AM and it takes 30 minutes to fall asleep
-Sleep like a brick until I wake up naturally at 8AM.
-Wake up a little groggy but that was always the case. No "hangover".
-I'm still not over the stigma, and I feel like I may be "abusing" and I get a bit of stress about my doctor ending the treatment. But on the other hand, I feel healthy mentally and physically and he gave me the OK to figure out the right dosage.

[unthought]

30mg TID should be fine for most people, the theraputic range for Ritalin is 1.3mg/kg/day upto 2mg/kg/day. I think your dose is even on the low side, and one problem you might find is that for most people it only lasts 2-3 hours. You might get better results with mixed amphetamine salts (Adderall), it usually lasts 4-6 hours, and has twice the potency of Ritalin.

[joklem]

90mg/day is low and the range is actually 96-192? (at my weight) Making sure... (going to the doc monday or tuesday, depending on if he's on guard).

I'm in Canada, and the "approved" dose is 60mg/day (could be for children though, it doesn't say anything about adult dosage), and if that's the max prescription I can get then yeah Ritalin won't work for me... I started a project after 5 years of doing nothing that requires me to not be ADD and be alert/concentrated all day and most of the evening, and I'm a bit worried that I'll go back to the way I was and fail if it doesn't work... Bummer because I don't get any bad side effects either.

When I take one dose, when should the next be taken? Before or after it loses most effects?

*edit* still got the effects and I've been productive tonight, but I'm feeling like a junkie...

[joklem]

Took 30mg around 10 because there was a party at my apartment, had the crappy rebound and sleep wasn't going to be possible until 3-4AM (due to noise, not insomnia). Got the alertness/wakeful effects, no negative effects. I didn't drink (never do), but I puffed on a few joints (not much, enough to be mellow-ish. I don't really consider cannabis as a drug anymore, more like a creativity tool - it's a safe herb, it fits perfectly with music, not addictive, it's better (for me) when used occasionally, blah blah). Then they were all drunk so I withdrew to my bedroom because I was feeling creative. Composed a few things for possible later use in mixing projects.

Right now it's 3:51AM. A few people are still here and dropped speed at 3AM. I was offered a pill, but refused (with disgust). The effects of the meds are gone, but I feel alright. Tired, ready for bed.

An observation I've made about myself is that if I have an obligation or feel "forced" to stay alert, I get bad rebound with racing thoughts, worse than before Ritalin. But once the day is over, the "comedown" is very mild. These kind of parties don't happen very often - the end of the day is usually between 12-1AM. Basically, I don't really feel a need to take Ritalin unless it's daytime/early evening or there's something I need to do. My new more positive outlook on life in general keeps that late evening down mild it seems.

I feel a bit proud that I refused all the stuff being passed around even though that's my normal behaviour, other than a trip every 1-3 months previously. Wouldn't have done speed either way, though.

Right now I'm stressing out because I think my doctor will lash on me and end my treatment.

Thinking of three things, the first one making more sense than the others right now

1) Stop the treatment

2) I wonder if I could take it as needed as long as I eat/sleep well and don't go past that 1.3-2mg/kg limit? On 99% of days three doses should be enough, but sometimes it could be useful. It could help with the stress just knowing that I have freedom, other than making me feel like a junkie because I needed a little boost to function in a task?

3) Can I actually go back to my old tired, demotivated self? My initial thought is F*** that. I'm scared ****less that my dreams will be once again shattered by this soul eating condition.

[peripatetic]

hi joklem,

it sounds like you have a lot going on. these are my impressions (ideally helpful, perhaps useful, hopefully not offensive because certainly not intended to be, but admittedly direct):

let's just get the whole # of mg/day thing out of the way. the right dose is what gives you the maximum benefit without unmanageable/dangerous side effects. you can't just go by weight. on this forum alone there are people taking much lower doses with great results who weigh more than you, and some of us taking much more and weighing a whole lot less. you have to work with your doctor to see what works best.

so, did he tell you to take no more than 60 mg/day? i'm thinking he did and that's why you mention it?

if my math is correct you took:

0:00 10 mg
1:00 20 mg
5:00 30 mg

and that was 60 mg on day 1, correct? and, 60 mg is what your doctor said is the maximum for you per day?

then you started taking 30 mg every 3.5 hours to equal 90 mg/day, correct?

ok, and then last night you took an extra 30 at 10:00 PM, for a total of 120, yes?

you have rapidly increased your dosage and, unless i'm missing some weeks on this timeline, this is not the titration schedule your doctor intended when he said to 'play around' with the dosage. he said to take 20 mg/day for a week, then 40 mg/day for a week, etc.

**side note: i don't give a crap about people doing drugs, and i went to college, too, but you just have to get it together.

(an aside within the side note: if by 'speed' you mean that your friends are sharing adderall/dexedrine, ...actually, seriously, just reflect on that for a moment; i'm at a loss for words...)

anyway, if you're smoking randomly, whatever, but if you're doing it while you're taking 120 mg/day after just a few days, um, either stop taking more than the amount of a reasonable titration schedule, lose the pot and regroup or, if you cannot rein it in and take no more than 60 per day (if that's what your doctor said is your maximum daily dosage), call your doctor because it sounds like you could be courting disaster.

i'm going to go out on a limb, here, and suppose that your doctor gave you somewhere in the vicinity of:

week 1: 140 mg (20 mg/day)
week 2: 280 (40 mg/day)
week 3: 420 (60 mg/day)
weeks 4-52: 20,160 mg possible (420/wk at 60 mg/day)

this schedule is more aggressive than i recall mine being, but it could be totally standard; i have no idea.

anyway, so, he's thinking, roughly, that you're using about two bottles of 100 pills per month (1000 mg/bottle). i don't know if canada actually allows refills, but there are states that allow a 100-day supply, you can call in to your doctor and have it left at the pharmacy, etc. however, i'm thinking *if* he gave you one prescription for a 12-month supply, he probably rounded up, just to ensure you would be covered, and he could have given you a prescription of up to 24 bottles of generic 10 mg ritalin, right? did you get all of the bottles at once?

how many weeks have you been taking the medication and how much have you taken, total (or how much is left)?

you seem preoccupied with drug use and abuse and concerned both that you are abusing your medication *and* that your doctor might take it away. my initial reaction is that this outlook is troublesome. if you 'feel like a junkie' because you're taking way more than prescribed and at all hours of the day and night, stop taking more than 60 mg/day and if you cannot, then call your doctor. please.

if you end up taking ritalin to treat your symptoms at whatever prescribed dosage you and your doctor work out, i would be happy to answer any and all questions you have about taking, at least in my experience. there are lots of us here who have taken it for a pretty extended period of time, so you might want to look at the threads in the 'ritalin' section. you can also feel free to message me if you have any questions at all.

i wish you the best of luck and success and hope you are well.

please take care,

[joklem]

No, it was:
8:00 20mg
13:00 30mg
18:00 30mg
22:00 30mg

The day before:
8:00 20mg
13:00 30mg
18:00 30mg
Which felt "just right" to me. Very effective at treating symptoms with only one side effect, which is loss of appetite. Don't have trouble eating, I'm just not hungry. Haven't lost weight either and slept like a brick. I couldn't sleep before 4AM before I started the treatment.

I have zero problems stopping if I feel that it's getting out of control (if it stops helping and only causes problems, I'm not stupid - quit tobacco 4 days ago and there were 15+ smokers in my apartment last night, resisted the temptation rather easily). I skipped the morning dose(woke up at noon), and skipped the afternoon dose. I felt fine when I woke up after a coffee, but I was dead tired ALL DAY before Ritalin. No negative effects at all other than being ADD (and stressed over figuring out my dosage), but I don't have tasks to do today.

The speed was "street" amphetamine. It's pretty pure (good chemist), but I had no problem whatsoever not taking it even though the medication's effects were gone.

The prescription is 10mg morning/noon to ease my system into it and look for adverse effects, but it didn't do anything noticeable at all, not even the loss of appetite (he said I'd probably jump straight to 20mg). 20mg gives me that "zombie" feeling some people seem to complain about with too low dosage... (and the effects wear off after barely 2:30 hours) I know how stimulants feel and know what effects I'm looking for (focus, concentration, more social, etc... I get the happy feeling from accomplishments - no euphoria (other than that 5-10 minutes rush alot of people seem to report, which is pleasant (anyone who says it isn't is most likely a liar), but I have no desire to chain that) even when I went straight to 30mg).

He knows that I've tried amphetamines before, and my pot use which is very occasional anyway out of personal preference - and I'm not a huge fan of the effects of the combination, so it will be even more occasional. I live in Montreal and I literally don't know anyone who doesn't smoke at least occasionally, including older adults who are successful, etc. No anti-marijuana brainwash here. :P

The prescription is 12 bottles of 60 20mg (refill once a month, lifelong treatment so that will be renewed in a year also). The 14 10mg pills were extras, and he said I could use them to experiment and find the right dosage but obviously I'll have to see him when I do to fix the supply thing.

30-30-30 feels right, but since it's higher than most people report, I'm stressing over incertainty that I will be able to use it to treat my symptoms (higher than health canada's "approved" dosage, but AAFP says 40-90mg daily), which are a very, very huge obstacles everyday for well, my entire late teen and adult life. I basically did nothing for over 4 years. It's only been less than a week since I started the treatment and made great progress.

It's actually the first time ever feeling clear headed without racing thoughts.

[joklem]

Sorry for double post again :P

He didn't tell me a maximum dosage, just that I can fiddle around until it feels right. I called a pharmacist for information and she told me that the maximum is 60mg/day. Seems like that maximum approved dosage is for children, which makes sense since stimulants for adult ADHD is off-label (I think). Either way, the AAFP, which seems credible also, says that the limit is 90 so I'll trust them for now.

I'll keep up the 30-30-30 schedule and go see my doctor on Monday.

[peripatetic]

joklem,

ah, math was obviously not my forte; thanks for the clarification

i have no idea what the 'maximum' dosage is listed as here in the US, but i do know that doctors prescribe at their discretion, not necessarily based on the 'maximum'. i would imagine canadian doctors could prescribe at their discretion, too, and 90 isn't even close to the highest prescribed dose i know of, so i don't think it's unreasonable that your doctor would go with what works for you.

in answer to your question about scheduling the doses: yes, you want to slightly overlap your doses. from what you've said i would try taking your pills at 3.25-hour intervals and adjust from there to get the right amount of overlap.

with the pot thing, i'm not suggesting you never smoke pot again. i'm saying that it is difficult to gauge response to medication when you're combining it with something else. i suggested you relax on the weed until you stabilize your medication.

regardless, it's certainly not because pot smoking is unheard of where i live. on the contrary, you can easily get a medical card that enables convenient online ordering of your desired sativa/indica blend, delivered to your door within the hour--that is, if you don't want to leave your house and go to a dispensary to select your purchases.

back on topic, it sounds like the medication is providing considerable relief with respect to concentration and i hope it continues to work well for you!

best of luck and do let us know how it goes

[joklem]

I'll just ask him if he can give me freedom with it, so I can stop thinking that I have to finish all I need to do in 3 hours. That's my problem with the treatment right now. Something in the line of 90mg/day as needed, fourth dose if absolutely required. Need to stay up late occasionally, and if I do then I wake up around noon - don't take the morning dose obviously so it evens out even if that happens several days in a row. Today I only took 30mg at 6:00PM.

I thought this tonight: it's better to be a "stim addict" than a lazy unmotivated person. Better to not be able to function without a medication than not being to function altogether. Interested if others think like that also.

Sorry, still working out the feeling of stigma.

[joklem]

So far so good, it seems like my reward center is finally working properly. I'll look back at something I did (cleaning, which is still boring but easier to do :P) and get that "feel good", happy and proud of myself feeling. And I can read, play games or watch a movie without getting bored of them within 5 minutes.

I'm happy to have finally seen a doctor about this.

[andyum]

Originally Posted by joklem

I'll just ask him if he can give me freedom with it, so I can stop thinking that I have to finish all I need to do in 3 hours. That's my problem with the treatment right now. Something in the line of 90mg/day as needed, fourth dose if absolutely required. Need to stay up late occasionally, and if I do then I wake up around noon - don't take the morning dose obviously so it evens out even if that happens several days in a row. Today I only took 30mg at 6:00PM.

I thought this tonight: it's better to be a "stim addict" than a lazy unmotivated person. Better to not be able to function without a medication than not being to function altogether. Interested if others think like that also.

Sorry, still working out the feeling of stigma.

I guess I am a med "wimp." I am prescribed 20mg per day and often don't even take that much. I can't imagine taking 90+mg per day. Your statement about being a stim addict gives me pause for concern and that you also are using ritalin to stay up late. I know we all react differently to meds but ritalin does not give me more energy nor do I use it to stay up late at night.

I don't mean to preach but just urging that you to be careful and make sure to keep working with your doctor.

[joklem]

Originally Posted by andyum

I guess I am a med "wimp." I am prescribed 20mg per day and often don't even take that much. I can't imagine taking 90+mg per day. Your statement about being a stim addict gives me pause for concern and that you also are using ritalin to stay up late. I know we all react differently to meds but ritalin does not give me more energy nor do I use it to stay up late at night.

I don't mean to preach but just urging that you to be careful and make sure to keep working with your doctor.

I stopped taking them until I can see a doctor for the record.

I stayed up late because I wake up late also, except that one time which was the first time I woke up early so it evened out and everything. I'm more of a night person, I've always woken up at 11 and went to bed at 3AM. I could drink 12 cups of coffees by noon and I'd still be tired, unfocused and daydreaming (racing thoughts, often "creative"). I'm just not an early bird. Tried to change it but some things just can't be changed. :P

It's not so much giving me a boost of energy (ie: weaker than 2 coffees in that department, but I still drink coffee as well), but it keeps me from "daydreaming" all day and being a bit drowsy despite sleeping for 8 hours and staying up for 16.

Oh and yes, dosage seems to be drastically different from person to person. 20mg actually made me a bit drowsy for about two hours and a half, then tired. 30mg made me alert for 3 hours.

The problem is that the effects only lasted 3 hours and after those, the ADHD symptoms would rebound and I would just stare in the distance and be a zombie (sometimes, a mood swing in the middle of something). Which really made me want to sleep. Isn't insomnia a possible side effect of Ritalin? I swear I can sleep like a brick within the hour it wears off.

The stim addict comment was more meant to mean that I've never not had a stimulant in my system (I used to drink coffee and smoke (alot), both stimulants, so I was self medicating without really realizing it ). In a sense, they don't make me escape reality, they bring me back to it if that makes sense.

In retrospect, the huge boost to ambition seems to have been from the novelty of feeling that I'm not ADHD for the first time in my life... and just knowing what the "problem" (is it really a problem? ) was with me helped a little. Being told that I'm just lazy my entire life took a toll on the self-esteem a bit (I thought I was lazy and "forgot" that I had been diagnosed ADHD - try not to laugh at that one :P), but I've been looking back at events in my life which could have been avoided if I had treated my symptoms. My only regret though is that I was bored even in my personal life. Sometimes I could think and stress for hours over what movie to watch. Things like that. With the Ritalin, I could just start one and not really think about what I'm missing during those two hours. I had planned to entertain myself for that period of time, and everything else could wait.

I wasn't lazy, either. From the outside it looked like it. I couldn't stand any job for more than a week. I would literally burn out and quit, or get fired because I didn't perform... But here is my professional interests progression from 2006 to this day:

Electromechanic -> electric engineering -> civil engineering -> EMT -> mathematics -> physics -> quantum physics -> sound engineering (this summer) -> I'm not sure!

I was passioned and learned quickly in everything I had touched in each, but somehow I would get bored and start looking at something else, then make the switch. Some I went to school, some I spent entire days reading about, but I have an amount of education in all of those either from school or self-teaching.

Just to give you the spectrum of that boredom, I never fell into drug abuse because they got boring after the first time. I got drunk for the first time 3 years ago (around 20) and it was boring - I went straight to LSD and well that was a thrill to say the least. I basically did most of the safe non-addictive psychedelics once (LSD twice, but it was "boring" the second time) and then moved on. I wasn't drawn to the hard stuff. I don't get high other than cannabis which I still enjoy from time to time, and pot isn't an "escape from reality" either, it opens a door in my mind and lets the creativity flow, or helps me think about a life problem from "outside the box". :P. So, I'd say I'm not really in danger of falling into drug abuse. The problem is what others see as abuse maybe? I mean, how is wanting to be ADHD-free for 14 hours on some days considered abuse? Hope my doc understands. :P

Maybe Ritalin isn't the right medication for me. Maybe the ~1200mg of caffeine (seems like alot but it gradually got there) I was drinking in the afternoon to barely function made me more tolerant to stimulants in general.

Sorry, set out to write a small reply but I ended up writing a novel about it, haha :P

[hollywood]

I have taken 144mg concerta daily for 7 years. I only respond to larger dosing and if in the past I dosed with ir 30mg would last me only about 3 hours . I would rather be on a low dose but my behavior and things I do impulses loses me friends and relationships.

[Matthew20]

Are there any long term side effects from dosing ritalin at high dosage ? say about 30mg and 80mg

I normally take 5mg or 10mg or 20mg, I've never tried 30mg or 80mg, I've been experiencing drone like effects, zombie effects, hyperfocusing effects (not focusing, just in some sorta hypnotic daydream), inattentiveness, hard to retain what im reading also having problem slowing myself down to read it, my reaction time to things is really slow i'm assuming i'am not alert and all those side effecs are happening to me while on ritalin 20mg LA.

So basically any low dose does not work for me, also I've noticed Ritalin Short acting 10mg makes me sleepy I have not tryed taking 30mg of short acting ritalin or higher. I also have Ritalin LA (long Acting) 20mg last for 8hours.

What should I do ? I need help to feel motivated, alert and be able to retain and retrieve information so i can complete my assigments.

Any advcie will be great thanks