HELP! - After 15 years Ritalin not cutting it!

[joshua1160]

I was diagnosed with ADHD in 2nd grade. I was started on Ritalin IR at that time and it worked miraculously for me for many years. I did incredibly well through school, college, and even made it to medical school. But, now in the past year I've entered an increasingly worsening ADHD hell!

3 years ago, I switched from Ritalin IR to Ritalin LA to extend coverage so that I wouldnt have to pop pills so frequently. I had been taking Ritalin IR 15 MG every 3-4 hours. The Ritalin LA at 40 MG worked well for about 6 hours so I would usually take it twice a day. This worked great for a couple years.

Then, I started noticing that it was working for shorter periods of time...more like 5 hours. I also started to notice that after the second dose of Ritalin LA sometimes I would get those "zombie" symptoms. I put up with this all for many months.

Then, I started noticing something else. After about 2-2.5 hours after taking the Ritalin LA, I would start losing focus. If I waited long enough, I would get another boost of focus a couple hours later. However, this was not acceptable. Therefore, I said screw this stuff, I'm going back to good ol' Ritalin IR that worked for me for 10+ years.

So, I started taking Ritalin IR again. However, I was dismayed to discover that it didn't work as well for me now as it had in the past. I began to realize that it would only work for about 2 hours as opposed to the 3-4 hours like it used to. Additionally, I started experience severe rebound and withdrawal symptoms when it was wearing off. When it starts to wear off I completely lose focus and can't concentrate on ANYTHING, my head hurts, and I become incredibly tired and irritable.

Because of the rollercoaster with Ritalin IR, I frantically started trying other medications

Concerta - experienced a drop in focus after 2 hours just like LA,

Daytrana- didnt do anything until 6 hours in. and then i was plagued with anorexia and a too drugged feeling

Metadate CD - at 40 MG it was WAY too much. 30 MG still perhaps too much. 20 MG - I don't think as sharply as usual for the first 3 hours. Then for the next 3 hours its decent. However, taking anything else at 6 hours when it starts wearing off makes me feel too drugged. But, maybe theres still some tinkering to do with this drug

Focalin - I thought this would work great. I couldn't believe it: 15 MG hardly did anything for me! Pharmacologically this makes no sense but I'm not making this up.

The other aspect of my story is that through this past year with all the trouble with my ADHD medications and anxiety about getting a grip on things before starting residency training, I have started to exhibit signs of depression. I have lost interest in things including medicine, I have lost motivation, I am ambivalent about my future, I don't enjoy things anymore. Part of me feels like this is all a result of the rollercoaster of NE and Dopamine levels in my brain caused by the medications that seem to effect me more than they used to. When I feel well medicated my mood is usually better. It's hard for me to sort out what's causing it but I've never felt like this before.

I'm worried about whether or not I will be able to handle the rigors of residency and a career as a physician.

Has anyone experienced anything like this before? I've done my literature search and unfortunately there's hardly been any research on effectiveness of methylphenidate after long-term use (i.e. 10+ years). I'm hoping someone else may have similar experiences and perhaps some insight into medications or strategies that helped them. I'm considering trying wellbutrin next to help with my depressive symptoms and perhaps theoretically it could help with the rebound and withdrawal symptoms of the stimulants....maybe it can smooth things out? any other ideas?

[FunnyHead]

Joshua1160
Have you ever stopped taking any medication for a week or so. Then start it again.
I overstand that as a medical student this could be hard but if you could find a time to get away from the stress and take a break from the medication. Works well for my tolerance. Check with your doctor though as everyone I encounter like pharmacists and other doctors besides mine, seem to find it hard to understand when I do this.
There is herbs and teas that I can use that last for short time periods. Yerba Mate works well to take of the edge or B complex, ginko biloba, american ginsing(cold FX)
Flax, Hemp, sunflower, and pumpkin seeds, all work short term.
Raw carrots and avocado really help aswell.
FunnyHead

[peripatetic]

joshua,

i can relate. seriously.

i really don't know how much i can go into it at this exact moment, and i think there are some points of our experience that are dissimilar, but i, too, successfully took ir ritalin for over 15 years. i casually stopped for a few weeks after an error in coordination, etc. by the time i got my prescription refilled i'd ruined two specific things in my life that i'll likely never fix.

i've spent the last 10ish months seeing my psychiatrist every two weeks, minimum, and trying to get my sh*t back together. i ended up having to add dexedrine because the ritalin no longer does much for my inattentiveness, but it's the only thing that quells my hyperactivity/impulsivity. this doubling up on already high doses of stimulants isn't comforting for me.

i don't have any physical side effects, but i'm feeling rather superlative in some sense.

you know how you do something really well and you just feel so elated; for me, this is in writing or speaking on philosophy. sometimes, i'll write something for a journal or give a lecture and think, 'YES! that's exactly what i wanted to say and i think i really said something useful; NAILED IT!'

the superlative i feel about my current situation is the inverse of that feeling. and, i have a pretty firm grasp on the concept of 'dread'. so much so, that i have to stop for tonight very soon because it just doesn't do anyone any good to think about how f*cked i feel.

the combo is working, though, for now. i can only hope it continues to do so.

i'm sure your circumstances have nuances that distinguish our experiences significantly and i wish you the best. if you want more info on the various 'alternatives' i've tried these last months and such, let me know. i'm not opposed to sharing, but i'm kind of spent on it at the moment because i was just so shocked to see your post.

shocked because i'm scared sh*tless and so i mostly avoid thinking about how precarious a perch i'm sitting on right now.

i have the greatest sympathy for your concern and i hope you find a workable solution soon.

[Fima]

dude, have you raised your dose since 2nd grade?
as far as I know, most people gain some weight, and more wight= higher Ritalin dose... that could be your problem,
but when you talk about the "Rebound" thing, its reminds me of something that happens to me lately too, maybe I am overreacting, but I think they changed the medication, I have the same situation as you have, but unlike you, I used ritalin for 4 months only.