27 replies to this topic

[Stacia]

A few months ago I found the cocktail that stabilized my BP. Yay! However, with stability did not come the ability to focus or concentrate so well. I brought this up with my pdoc yesterday hoping to convince her to give me some Provigil since I didn't want to adjust my meds. After briefly describing what's up, she said these weren't med side effects and then proceeded to ask a series of questions for the next 15 minutes followed by a short paper quiz, all of which lead to an ADHD dx and some related discussion. Although she wants to prescribe Strattera, my insurance requires that I first try a couple immediate release meds. I walked out of her office with a 'script for Ritalin and what seems a very slow titration.

I know little about ADHD other than I have traits that go back forever. I could compensate before but the med s/e's I do have now really interfere with compensating. I know that I need to be careful that ADHD meds don't mess with my sleep, but otherwise, I know next to nothing. So, I have many questions.

What is a typical titration schedule for Ritalin?

Is there a build up of the med, or is it, poof, what ya immediately get when ya take it is all there is?

I'm starting at 5mg a day for a week, then 5mg twice a day for another week... up to 10mg twice a day right before my next appt. I took 5mg yesterday and it only did a little more than a cup of regular coffee. So, I think this might be too conservative. ??? I slept fine, btw. I want to call in Monday and ask if I can take more, but want to know a little more before I make that call.

How's Ritalin compare to Adderall, Dex, other ADHD meds?

What's Strattera in particular like?


Heh, actually any info would be appreciated!!!

[bunnyrabbit]

I'm not an ADHD medical guru by any means. However, I tried Ritalin and it sucked! I was dysphoric and it hurt my bunny tummy! So I didn't take it.

Recently, pdoc started me on Adderall. I like it! I take a low dose, so I hear, but it's enough for me. It's not the extended release kind, just regular, so I take it twice a day. I don't get dysphoric. I was extremely irritable recently (thyroid medical reduction) and with a dose increase, I'm quite nice. Pdoc said it could make some people giddy. I haven't experienced that at all. Must be the lithium, klonapin and geodon at play. I think it works better than Ritalin for ADHD stuff. My experience only. I've also never had cycling with it, like the Wellbutrin.

[sunny day]

(Aside: Thanks, bunnyrabbit, for including info about thyroid + Adderall = irritable/giddy. That may help explain some erratic moods in a friend.)

Edited by sunny day, 01 February 2009 - 11:43 AM.

[bunnyrabbit]

[Stacia]

Thanks BR

[rex]

I've been on Vyvanse for 1.5 months now, first Adhd med I've taken. 70 mg lasts all day for me, 9-10 hrs, more or less. Side effects were typical for someone who's not used to amps, but decreased to near nil within 2 weeks. Gives me energy, which can come out as aggressive and snappish at times. Come down is not bad, and sleep is okay as long as I take my other meds and don't drop the V too late in the morning. I've hardly had a seriously depressive thought since I started. I stopped cold turkey for 3 days at my doc's request. Lethargic the first day, and mild depression returned.

I haven't had experience with any of the others, but I don't think I would want anything that might have more side effects or tempt me to abuse.

[justmary]

Is there a build up of the med, or is it, poof, what ya immediately get when ya take it is all there is?

I'm starting at 5mg a day for a week, then 5mg twice a day for another week... up to 10mg twice a day right before my next appt. I took 5mg yesterday and it only did a little more than a cup of regular coffee. So, I think this might be too conservative. ??? I slept fine, btw. I want to call in Monday and ask if I can take more, but want to know a little more before I make that call.

How's Ritalin compare to Adderall, Dex, other ADHD meds?

What's Strattera in particular like?

Heh, actually any info would be appreciated!!!

What you get a few minutes after taking it is what you get. That's all there is. That is assuming we're talking about immediate release Ritalin.

5mg is a tiny dose of Ritalin. Itty bitty, tiny. If you felt little more than a cup of coffee, I'd say that's about right. I don't believe it builds up. I'd make the call because IMHO, 5mg is a waste of time. Maybe if you're super sensitive to meds or if you're 5 years old it would work, but I wouldn't spend a week at 5mg, if it were me.

I take Adderall XR, 30mg. It works well for me. I used to be able to tell the minute it kicked in but not any more. I've gotten sort of used to it. All I notice now is that when I don't take it I have a lot of problems concentrating and such.

Hope this helps some and good luck.

[Stacia]

Thanks, Rex.

Yes, Mary, that helped if in no other way than making me feel a little better about calling my pdoc tomorrow.

[creepy]

Recently, pdoc started me on Adderall. I like it! I take a low dose, so I hear, but it's enough for me.

Thats a small dose for someone on lithium. Most of the people on lithium that take adderall seem to be on large amounts of it compared to others.
15mg for me would make me unbearably speedy and too fidgety to get any work done

[elegy]

20mg Adderall XR put me straight to sleep. So did 40 and 60. Vyvanse made me groggy, as well as depressed and flat.

Focalin IR has been the only med out of the ones tried that has worked. I've bitched about it before, but after trying the others, I realized I was taking it for granted. Big time. So I'm on 70mg daily - 30mg in the AM, 30mg in the afternoon, 10mg late afternoon. It works well for me, but since Focalin IR tabs only go as high as 10mg, there's a ridiculously large amount of pills monthly. Insurance wont pay for brand name, so I'm stuck with generic - upsets my tummy more than brand, and feels different overall. I can't quite pinpoint what exactly feels different, but all in all, I'm content with it.

Educating yourself about ADHD in general as well as the medication options will be a hugely beneficial step to take. I know how hard it is to find straight forward, comprehensive information about ADHD/ADD. And the vast amount of resources on the internet can be extremely overwhelming, at least it was for me.

So, here's a few resources I've collected from my own quest for info...
About adult AD/HD, from CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder). This site also has links to other helpful sites.

Another immensely useful site is ADD Resources and their articles. They also have a free newsletter, and the archive has all the back issues.

Finally, ADDForums is an awesome message board with a very large community . Any question you have, you will likely be able to find the answer just using the search. I suggest browsing the boards, because you'll probably learn more about ADHD than you ever knew you wanted to learn. The members are also amazingly friendly, welcoming, intelligent, and knowledgeable about all things ADHD/ADD. There's also a whole forum on medications, with subforums for each ADHD med out there. There's also a bi-polar board with answers to many questions regarding co-morbid bi-polar and ADHD and medication options

Good luck with everything, I hope you can find some answers from these sites. If you would like some more links or book suggestions, feel free to PM me.

Edited by elegy, 02 February 2009 - 03:04 PM.

[mj1127]

Hi Stacia,
Long ago when I was first dx'ed, I did a titration similar to yours. Slower is probably better to make sure it doesn't mess with your mood, but if it's really driving you crazy, you probably can go a little faster. Of the IR drugs, I actually liked Adderall and Dexedrine better - I'd say Dex is the smoothest, Adderall the most effective. However, Adderall does not work at all with Lithium for some people (I can take it but need more than w/o Li). Focalin is another form of methylphenidate (Ritalin).

As far as the longer acting stuff goes, I would say Adderall XR and Vyvanse are probably the best. I take Vyvanse (my pdoc is in love with it, silly woman) but it is pretty good. Adderall XR may be better, but then there's the question of the Li factor. Concerta is the long acting methylphenidate that is usually prescribed, though there's also a Ritalin LA, which my son took (comes in a capsule; he can't swallow pills). Where Adderall and Vyvanse make me feel calm and focused, Concerta always made me feel a little charged up. I could feel very clearly when it was kicking in and when it was wearing off. There is a Dexedrine ER, though I've never taken it. However Vyvanse is essentially a long-acting Dex - it is converted to Dex in your gut. Then there's Provigil, which I don't know much about.

My pdoc has not had much success with Strattera and does not usually prescribe it. Neither did my old pdoc. My son's pdoc prescribes it on occasion - in fact we were going to try it for him before he decided he didn't want to take meds anymore - but I didn't get the sense he had stellar results either.

As I'm sure you can tell, between my son and me, we have taken a pharmacy full of ADD meds, so if you have any other questions, please ask.

I hope you find something that works for you soon.

Edited by mj1127, 03 February 2009 - 09:47 AM.

[Stacia]

Elegy, MJ, thanks so much for the info! The links are great in that I recognize myself and feel a little more like this dx makes sense beyond just coping with the effects of meds. The info on different perscriptions is good to know, too. I may take both you up on those PM offers at some point when I'm not so tired. Really, thanks.

[Anna]

stacia, since you are on lithium, you may find that traditional stimulants don't work, or don't work as well. There's some wacky interaction thingy, I think? (Correct me if I am wrong, please...)

If you don't find relief with either ritalin or adderall, you may need to try WB/Provigil/strattera. I'd go for the provigil first, if it were me, if you can ever get your insurance company to pay for it.

strattera did JACK for my kid. However, the things seems to be that you either respond really well to it for ADHD, or get nothing, and there's no way of predicting which you will be without trying it.

Anna

[Stacia]

Thanks for the heads up, Anna. I think I'll post a separate question under Lithium on that.

As said, my pdoc wants me to trial Strattera so it is in my future. Still, I think I'll see if I can get her to okay a higher dose of Ritalin or Adderall to see if those do work before I try Strattera. Heh, maybe that will be futile.?

[mj1127]

I think that the med Li patients most often have trouble with is Adderall. I can tell you, however, that it is not everyone, because I can still take it with 1200mg Li. I need a little more than w/o Li to get the same effect, but it does still work. I also believe that fewer people have a problem with Ritalin and Li. If you are having some effect from it, it probably works for you.

I wonder why she is so set on you trying Strattera. Maybe she's concerned about stims messing with your mood? Of course, sometimes pdocs have their pet meds (mine loves Depakote and Vyvanse). Maybe it's that.

I always found it interesting that WB is supposed to help ADD. I took it for years, and it never did anything for me.

I agree with Anna about Provigil - if the others don't work, it's probably your best bet.

[Stacia]

The day I took 10mg of Ritalin I had a little improvement, mostly noticed it when the med wore off. So, Ritalin seems to work. Not sure what dose I'd really need and already know that these immediate release pills are not for me. When I go back next month, I'll ask for extended release Adderall or maybe Dex. Might as well try the alterntives, heh.

I think my doc is speed adverse just as she is benzo adverse. However, we will have a long talk about how Effexor set me off. I'm really not thrilled (okay, I'm a little scared) to try Strattera.

Wellbutrin is off limits for me. I'd have to do okay on a lot of Mirapex w/o any signs of mixed or hypo/mania before my pdoc or I would consider taking it. ADs haven't been very kind to me.

Provigil if nothing else works, but I think something else will. We'll see.

Thanks MJ.

[elegy]

Well, if you noticed improvement on the 10mg Ritalin, maybe pursuing the methylphenidates would be something to try. There's long acting methylphenidate(Concerta) as well as Ritalin SR. In addition, there's Focalin(dexmethylphenidate) and Focalin XR.

There's really quite a selection out there for ADHD meds, in regards to formulations, combinations, and duration of action.

[Stacia]

How do Concerta and Ritalin SR compare?

[Anna]

Ask your pdoc about trading in Tegretol and Lamictal for Trileptal. Trileptal is the newer formulation of Tegretol and shows greater efficacy with less side effects. Its also known to be as effective as Lamictal with treating depression in bipolar patients.

References please?

I would EAT my hat if trileptal were as effective as lamictal in bp depression. I have taken both.

Anna

[bunnyrabbit]

Ask your pdoc about trading in Tegretol and Lamictal for Trileptal. Trileptal is the newer formulation of Tegretol and shows greater efficacy with less side effects. Its also known to be as effective as Lamictal with treating depression in bipolar patients.

References please?

I would EAT my hat if trileptal were as effective as lamictal in bp depression. I have taken both.

Anna

Whatever the research, there is no FDA approval for the use of Trileptal for BD for any phase of the illness.

[elegy]

I feel obligated to share my unfortunate experience with ADHD medication. I was diagnosed when I was 7, but I refused to take medication until I got to college and could not keep up. I had one episode of Mania when I was 15, but it was precipitated by cannbis use, so a diagnosis of bipolar could not be made. My dad prescribed me Lexapro (he is an oncologist) shortly afterwards. It fucked with my moods so much that I had no idea what was going on.
Anyway, there has never been any episode of mania or hypomania that was not triggered by some substance, so mood stabilizers were not really considered.
When I got to college I was given Wellbutrin and Adderall (both at high doses). I started having mild hypomanias, and my pdoc didn't know what was going on. She gave me Lexapro! She also increased my Wellbutrin!
Needless to say I switched pdocs because I couldn't sleep, and had lost 35 pounds and looked like I was anorexic.
I continued taking Adderall but at a lower dose. To make this shorter the hypomanias began increasing in intensity, until I switched to Concerta. When I was switched to Concerta I started getting the most intense euphoria since I was snorting cocaine. I didn't tell my pdoc about this. I eventually had to go on Depakote. Ever since then the Hypomanias have continued to be triggered. I am currently on a combo of Depakote, Lamictal, and Seroquel, and we just tentatively added Vyvanse a week ago, and my hypomania was again triggered! Be careful about what and how much stimulants you take. I am one of those very rare people for whom taking stimulants is a one-way ticket to hypomania.

Uhmm... I'm thinking this situation has less to do with the Adderall/Concerta, and more to do with some of the other things described in your post. A lot to do with them, actually.

Concerta + cocaine = euphoric feelings(in most people). Lexapro + Wellbutrin + Adderall = hypomania-like reactions(in most people).

Oncologist prescribing psych meds? Another bad idea.

[CER]

A few months ago I found the cocktail that stabilized my BP. Yay! However, with stability did not come the ability to focus or concentrate so well. I brought this up with my pdoc yesterday hoping to convince her to give me some Provigil since I didn't want to adjust my meds. After briefly describing what's up, she said these weren't med side effects and then proceeded to ask a series of questions for the next 15 minutes followed by a short paper quiz, all of which lead to an ADHD dx and some related discussion.

Wow. This is exactly what happened to me about a year and a half ago.

I tried Strattera first, but it was a big failure for me. I'm on Adderall now and it works quite well with my cocktail, but it probably wouldn't work with Stacia's due to her taking Li.

[creepy]

Concerta + cocaine = euphoric feelings(in most people). Lexapro + Wellbutrin + Adderall = hypomania-like reactions(in most people).

Oncologist prescribing psych meds? Another bad idea.

I know my flavor of MI lies somewhere close to BPII. Some of the reactions I have to my meds seem hypomanic, but I just dont fit the whole description. Once in awhile I get really irritable. Sometimes I get in a rush to do things but most of the time Im apathetic due to the celexa.
I think im going to take a nap instead of going out for lunch... z_Z

Anyhow, do be careful with stims and bipolar. Some folks are sensitive to them and some arent. Different stims may work... its hard to know until you try.
Bipolar is often comorbid with ADD if I remember right.

[racingmind]

you guys that are BP and take stims that work for you are really lucky. I'm on my first stim, dex, and it only helps focus and energy for a few hours then I crash real hard at the end of the day. I only take 10mg IR and I already notice this crash, and at this dosage, it's not nearly enough to get me through class, activities, homework, etc.

Hopefully other meds wont be as harsh.