My Forum Comments
Karthik: –First thing you should do, which would seem ‘obvious,’ would be to discuss this with your prescribing doctor!!
Sometimes, the side effects of ‘too much’ methylphenidate are as you describe yourself, tired, sleepy, no energy. Trying 15mg if available (see below) might be worth a trial.
It wasn’t clear whether you ‘are’ in India, are ‘from’ India but not living there now, and are being treated in the USA or another country. This might be relevant as to clarifying which formulation of methylphenidate you are taking. You wrote that you were taking the “sr” form. It’s not clear whether this was just a generic reference meaning “a sustained release form” or referring to the sustained release form of brand name “Ritalin SR.” The names of the various and brand name formulations can be confusing. Ritaln SR is not longer distributed in the USA, but there are other sustained release, or ‘extended release’ formulations, which are. One reason the “Ritalin SR” was discontinued was that it was found to be inconsistent in its extended release, thus providing undependable, uneven blood levels. It was superseded by “Ritalin LA,” a methylphenidate extended release beaded capsule. As mentioned, there are many methylphenidate extended release (AND immediate release) formulations, some still only brand name, others now available also as generics, some only as generics (Concerta, Metadate-CD, Ritalin LA, etc.) so knowing which one you are actually taking might help identify whether the ‘release mechanism’ might be part of the problem. Might also be worth trying an immediate release tablet form, so you can evaluate the effects of the immediate release form, and control the dosing with repeated dosings during the day from 2 to 4 times daily, depending on your age and the response, and then convert to one of the extended release formulations.
agree with some of the suggestions like Tile attachments, a place to dump all her stuff when she walks in the door, etc. Sounded like she wasn’t having so much difficulty finding things at home, but more so losing them when out and about, like forgetting to retrieve her credit cards, bus cards, ID cards, etc. after using them. Wasn’t clear whether she was losing 2 passports during travels abroad, or just in the house, or when used locally (not sure for what). Many of these things might be amenable to trackers like Tile, even passports, even cell phones, too, in case she doesn’t have another computer from which to use the Find-My-Phone app, ID/credit/bank cards,etc., etc., etc, Can confirm with her credit card companies, etc., whether attaching a Tile-type unit would be problematic (shouldn’t be, as long as it’s placed strategically to not interfere with the magnetic strip and the imbedded chip…)
No mention was made as to whether she is taking ADD medication to help manage her dysfunction. If not, this should definitely be considered, and from your description, strongly recommended, as it has definitely been shown to reduce distractability, impulsivity, procrastination,and more !!!!!
If she is, it should be reevaluated as to effectiveness of the dose. This can make a tremendous difference!!!
- This reply was modified 3 years, 7 months ago by ADDdoc.
That’s an interesting complaint. Many sexually active men and women with ADD/ADHD find their sexual experiences are improved when they ‘time’ them to be occurring while their meds are active in their systems! They describe being more focused on the event(s) occurring, more attentive to their partner, and their partner notices a greater intimacy (connection’), etc.
These meds are known to have an opposite side effect called priapism, an erection that lasts tooooo long and can be dangerous if not treated if the erection lasts more than 4 hours!! (While many men can only dream of having this experience, many women are more than thankful that it does not happen!)
As your son proceeds toward independent driving, it is highly likely he will want to drive on weekends. (Different States have different restrictions with regard to hours of the day, or number of passengers, age of passengers, etc., until they’re 18.) Even beyond these restraints, it is important you consider the importance of him being ON his medication when driving, which will impact whether or not he can drive on those weekend days.
Statistics are clear (AAA and other sources) that new drivers between 16-25 have the greatest amount of automobile accidents (per driver), AND that within that age range of new drivers, those with ADD/ADHD who are unmedicated have 25-30% MORE automobile accidents than the other new drivers in that new driver age group!!! Aside from the obvious increase of physical injuries and deaths as a result of the increase in at-fault accidents, don’t forget what will happen to your (his) insurance premiums!!
It may be important to not ignore that the time will be soon upon you, and him, where he may need to ‘choose’ between driving on weekends or masturbating on weekends ;—)
Another possibility could be that, as someone with ADD/ADHD, he may have some impulsivity, needing immediate gratification and no patience to wait, whether it’s waiting in line for something, waiting for a light to change, waiting for a class to end, or waiting for the ejaculation to occur, having not had the experiences of longer periods of foreplay/arousal as being ‘normal’ and impulsively expecting more immediate culmination of the act, therefore concluding that a delay from what he is used to is a problem, rather than just ‘different,’ and if accepted rather than distracted by it, it would not be a distraction to the focus of achieving orgasm.
No mention was made as to whether he had tried other ADD medications, like Mydayis, or Vyvanse or Adderall XR, (with/without Adderall immediate release). The side effects may be different enough and the benefits as good or better.
Too many different issues to try to address in a post, I think. Many variables.
Your first complaint seems to be that the med wears off too early, so you experience the ‘crash’ from the absence/withdrawal of the medicine.
Might talk to your doctor, who I hope is a psychiatrist who is knowledgeable about ADHD (not all are), about trying Mydayis, an extended-extended release variation of Adderall XR. It lasts the longest of the extended release ADHD meds now available, and you might be able to be medicated until you go to sleep, which might get around your current tail end crash. If it interferes with getting to sleep, there are meds that could cut off that continuing stimulant effect, for example clonidine.
You referred to Dex tablets, which is a short acting amphetamine, which, tho successful treating ADHD, can have more intense side effects as you describe, that some others don’t, plus the crash at end of it’s length of action, etc. It was originally used to treat obesity/eating disorders, since it often has stronger side effect of appetite suppression.
Dexedrine Extended Release might help by lasting longer, similar to reasons above, tho remembering that it is not among the first choices any more, because of some of the side effects — like appetite suppression and sleep interference and end of day crash.
You mentioned trying Adderall, but again not clear whether the immediate release tablet which has 5-7 hr duration med thus requiring 2-3 doses per day, or the extended release capsules, which only last approx 7-9 hrs, with similar effects as above, but possibly not as great, since milligram for milligram, it is only 87% as active, but may carry you till bedtime and not interfere with sleep, eating, at end of day, etc.
With all of these, there are meds that can counteract the interference with getting to sleep at the end of the day, which may be necessary to be able to keep you on medication for the duration of your ADHD functional time awake, to avoud that crash.
Your psychiatrist should be able to sort out with you whether you are having obsessive or compulsive thoughts and/or actions, which may require an additional treatment with an OCD (or antidepressant) medicine. There are those with ADHD who also show some OCD symptoms, and upopn treating the ADHD, the OCD symptoms reduce or disappear, but if not, an OCD med is added….
As mentioned, there are a lot of variables raised in your question, and without even your age being provided, not enough info to fine tune any comments……March 13, 2018 at 5:37 pm in reply to: Concerta does not work with single 36mg but works on two 18mg capsules? #78919
It’s important to know whether you are comparing the brand name product to the brand name product of each strength, rather than brand of one strength to generic of the other, and also, if using generics, comparing generic to generic of the same generic manufacturer! Concerta® (brand) is one of the rare medications where the FDA issued a warning a few years ago (but did not order a recall) that the generic “Concerta” of 2 of the 3 generic manufacturers did NOT meet the bioequivalency specifications of the brand name!! Even insurance companies agreed to cover the brand, in light of this, rather than have to deal with complaints of ineffective or inconsistent clinical effectiveness from differences among the generic products.
The immediate release portion of Concerta has been stated to be 22% of the total dose, and is in the “overcoat” of the tablet, the surface.
One possible consideration to explain your differences in effectiveness of the 2 18mg tablets vs. the 1 36mg tablet, “might” be that the surface area of 2 tablets is greater than the surface area of one tablet, thus, the amount of immediate release coated surface area exposed to immediate dissolving in the stomach “might” be why it is dissolved sooner, and thus absorbed more quickly than the same total amount of immediate release medication on the surface of the single 36mg tablet. Just a thought ;—)
Your question seems to be addressed by the manufacturer (of the brand name product) in the second paragraph below, where they describe the equivalence of 2 27mg tablets and 3 18mg tablets.
“5.2. Pharmacokinetic properties Absorption
Methylphenidate is readily absorbed. Following oral administration of CONCERTA to adults, the drug overcoat dissolves and plasma methylphenidate concentrations increase rapidly reaching an initial maximum at about 1 to 2 hours. The methylphenidate contained in two internal drug layers is gradually released over the next few hours. Peak plasma concentrations are achieved at about 6 to 8 hours after which plasma levels of methylphenidate gradually decrease. CONCERTA once daily minimises the fluctuations between peak and trough concentrations associated with immediate-release methylphenidate three times daily. The extent of absorption of CONCERTA once daily is generally comparable to conventional immediate release preparations given three times daily.
“Pharmacokinetic equivalence has been demonstrated for two 27-mg CONCERTA tablets with three 18-mg CONCERTA tablets. The mean values of the treatment ratio (2 x 27 mg fasted/3 x 18 mg fasted) of the log- transformed pharmacokinetic values for Cmax, Tmax and AUCinf were 101.1%, 104.3% and 100.3% respectively. The 90% CIs for the treatment ratios were within the pre-specified 80% – 125% range.”
Some people feel the immediate release portion of the tablet is insufficient to give an initial, immediate, adequate clinical response. This is sometimes treated by taking a small dose of an immediate release methylphenidate tablet (Ritalin or generic) with the Concerta, which gives a stronger immediate effect, beginning 20-30 minutes after administration, while the extended release Concerta is ‘catching up.”
Hope this is helpful.
“…constant bombardment from my senses makes it impossible for me to think critically and clearly, and the
physical and emotional strain of always guarding against sensory input is exhausting.” (Laura1974)
Frequent, if not constant, bombardment by thoughts not related to the task at hand, being very distracting and even disruptive to functioning, is a very common symptom in ADD, as is impairment of executive functioning, cognitive functioning, etc.
It is also not uncommon for those with ADD/ADHD to have some symptoms of OCD (or depression —see below) also!! With adequate treatment of the ADD/ADHD, many of the OCD symptoms and the depression disappear or greatly decrease. If the depression is because of the ADD/ADHD, the antidepressants won’t really ‘fix’ it, because the cause of the depression is still there, until that is treated! (see below)
The gold standard for treatment of ADD/ADHD is trials of the central nervous system stimulants, which come in various release forms (immediate release, extended release, capsules, tablets, liquid, patch, etc., etc.), in the 2 major central nervous system medicine groups (methylphenidate —like Ritalin, Concerta, Metadate; and dexmethylphenidate – Focalin; and several dextroamphetamine – like Vyvanse: and mixed salts of amphetamines (e.g., Adderall, Mydayis). There are many different ones out there, many generic now, some only brand name, each with some differences in length of action, and other differences.
You (Laura) didn’t mention what the specialty is of the doctor you see. It’s worth just keeping in mind that until about 10-15 years ago, ADD/ADHD was considered “a children’s disease” that kids “grow out of” (NOT!!) and even psychiatrists who did not also subspecialize in child and adolescent psychiatry, but only treated adults, were not even taught about the presence of ADD/ADHD in adults!! Ten years ago, I knew a mom who took her 16 year old daughter to her pediatrician’s appointment to get her ‘regular’ refill of her ADD medicine, as they had been doing for years with successful results, and the pediatrician shocked the mom by saying he could no longer prescribe the ADD medicine for her daughter, because she was “now an adolescent” and kids grow out of ADD/ADHD once they reach adolescence!! Mom was panicked, frightened for her daughter, found a child psychiatrist, and the girl’s medicine was continued, and her grades went back up, mood improved, etc.!!
It’s very common for the major complaints of college students and adults being referred for evaluation, to be “depression and anxiety” or “anxiety and depression.” For many of those, they are found to be struggling for years with undiagnosed and untreated ADD or ADHD!! Their depression was “due” to their struggling to succeed, knowing they are capable of doing better, but not knowing “why” they continue to do poorly, not knowing what’s “wrong” with them, whether in school or at work, becoming increasingly hopeless and feeling they are a failure, and the anxiety increased because they become increasingly afraid they will fail the exam, and the next, and the next, not get the project (or homework) done in time, etc., or mess up at work and get reprimanded or fired, etc., because they couldn’t perform as well as they ‘knew’ they should be able to. For those who end up actually having undiagnosed ADD/HD, these symptoms disappear or become greatly reduced once they are on the right dose of the right ADD/ADHD medicine, and they then become ‘functional’! (and very often do not need to continue taking the antidepressants)
Laura, if your doctor isn’t knowledgeable about how to diagnose ADD or ADHD, or how to treat it, it might be worth making a trip “to the big city” to see someone who is experienced and knowledgeable about ADD and ADHD in adults. Once diagnosed and started on an effective medicine, perhaps you local doctor would be willing to follow you and prescribe your refills, etc.