Posted by alohashirt on January 30, 2005, at 0:59:31
In reply to STIMULANT OPTIONS, please!, posted by CareBear04 on January 29, 2005, at 22:43:33
some qns:
What is your pdoc like?
Do you exercise?
How old (set in your ways) are you? As a 40something I can see that medication will only be one part of improving.
Have you had a thorough blood workup ( including hormones, liver function? )
Do you have a support group / collection of other distracted people? My fantasy is that this would help me enormouslysome data:
0) Music really helps jump start me when i am flagging. See http://www.kidloco.com/radioloco/meta_mix03.ram and scroll to 20'45" for a French lounge remix of Chicago hip-hop that is stunningly effective.
1) dosage of stims is not weight dependent but rather personal. See the paper on www.johnratey.com for a great review of adhd medication choices.
2) amphetamines & methylphenidate work differently. For me, I can stay focused longer
on methylphenidate (ritalin family.) and Concerta is by far the smoothest in that family, 72mg being the "right dose." Amphetamines seem to subjectively feel like a sharper focus but more distraction.
3) Most adhd don't get enough sleep, which means impaired intellectual function regardless of meds.
I routinely sleep < 6 hours and am fuzzy because of it.
4) If I go > 4 hours without food I get sleepy.
5) Focalin is one of the two Ritalin isomers and allegedly smoother and more effective. Made me grumpy as hell.
6) When I exercise regularly (and Concerta can give me the focus to actually get up and do the exercise.) I have much more energy, even when I'm sleepy.
7) Strattera seems to help me more when combined with Concerta.
8) Danger of Concerta is getting stuck in a mental rut ( a mediocre version of "flow" .) When something jogs me into changing my environment for ten minutes, being around people with some urgency, I suddenly remember what I am supposed to be doing.
9) I am told that medication just enables the body, but for adults especially, coaching is vital to help us get beyond a lifetime's bad habits. I ahven't been able to afford coaching and writing lists has been a crappy support system so far.
10) I am way, way, way more productive when working in a structured environment with others who nag me me "when will X be done?" In my current quiet, beautiful office with enough time to easily complete my open work assignments I fritter away time.
11) Drinking water helps me.
12) Bonnie Mincu (see google) recommends getting a personal timer to remind you to do stuff. I planned to set this up in my Blackberry but have procrastinated on it!
13) Titration is very difficult. I have noticed that when I have too much meds I get sluggish.
14. As well as tolerance there is a tendency to adjust one's expectations upwards as medication improves things.
15. Methylphenidate & amphetamines are two of the most widely and long tested drugs in use and have extremely safe records. My understanding is that "safe doses" are are much, much greater than recommended max doses, which is very different from, say, tylenol. Rely on your pdocs for titration and if you're not happy, get another pdoc.Good luck.
> hey all--
> this is my story regarding stimulant-like drugs. i started on high-dose 450mg of wellbutrin for inattention, then moved to strattera, then strattera plus provigil, then adderall, then adderall xr. provigil was somewhat helpful, but it made me such a zombie where i would do the same thing for a whole day and seclude myself from the rest of the world. straterra and wellbutrin didn't do much.
>
> i've been on adderall xr since early september and adderall in general since august. adderall was awesome for me at first, except that it contributed to a significant amount of weight loss. i switched briefly to concerta and found that it helped, but it wasn't as helpful as adderall. now, about five months later, adderall doesn't seem to do much of anything for me anymore. i take 30-40mg of the XR in the morning, and though it's supposed to last a long time, it wears off usually within 4 hours. i feel tired and sluggish and inattentive, not focused and able to work like before. i take 20mg of regular adderall in the afternoon.
>
> when i was on concerta, my dose was 3 x 27mg tablets in the morning and i took regular adderall in the afternoon. does anyone know what the conversion factor is between adderall and ritalin? concerta used to be weaker for me than adderall, but today, it seemed to pick me up and get me going in a way that adderall hasn't in awhile. is it possible that the drugs are different enough that a tolerance to one of them doesn't necessarily mean tolerance to the other?
>
> i've read many of the more recent posts on stims, but i still have some questions. for example, can anyone tell me more about focalin? i just know that hardly any pharmacies carry it.
>
> can anyone suggest a stimulant regimen that would get me going again? i've been so wiped out tired and haven't been productive at all. should i switch to concerta and supplement with regular adderall in the afternoon or with regular ritalin? should i add back provigil instead of adderall in the afternoon? what is the max dose of ritalin and adderall per day?
>
> thanks everyone! please respond if you have answers or advice!
poster:alohashirt
thread:449994
URL: http://www.dr-bob.org/babble/20050128/msgs/450039.html