![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Ashley B on October 15, 2007, at 8:47:11
I'm wondering if anyone can answer this. I've taken 72 mg. of Concerta for a year and a half, and am trying to wean myself off of it. Through fish oil, a multivitamin, NDAH, l-tyrosine and 5-HTP, I'm now down to 36 mg.
Does anyone know why it became less and less effective? It worked beautifully when I first started taking it, and lasted for ten hours. Gradually, it lasted 8- then 6- now 4 hours. Also, upon taking it, I'd get a "euphoric" feeling in which I could talk normally and socialize with other people for an hour or so. Usually, I'm very shy and have some social anxiety. This extra kick gave me motivation to talk to people, enjoy the presence of others and even make new friends. I wish I could feel like that all the time.
I do notice that it seems more effective after a drug holiday. If I don't take any on the weekends, Concerta seems to last for longer and is more effective on Monday.
1. Why do they stop working? Do they deplete the adrenal glands, or the supply of dopamine?
2. Is there anything I can do to prolong their efficacy? Will any supplements help? I'd give anything to feel like I did after I first started taking it. My grades and work performance have declined.
Thank you.
Posted by cumulative on October 15, 2007, at 9:51:05
In reply to Why do ADD stimulants stop working?, posted by Ashley B on October 15, 2007, at 8:47:11
As was discussed in a thread above, I wish I could bottle up that euphoric feeling and summon it when I like as well.
But that effect, related to dopamine activity in the nucleus accumbens, develops tolerance incredibly quickly. It's not something you can chase for long before getting problems.
Now, as for the therapeutic effect, which is what is now fading for you, 1.5 years in ... well, this takes a lot longer to happen, because the dopaminergic effects in other brain ranges (which comprises most of the "therapeutic" effect) takes much longer to develop tolerance, and can even display <i>reverse tolerance</i> or <i>sensitization</i>, ie you need less of the same drug to produce the similar effect. So for this reason many people take their medications for years.
Where the point is that the medications lose their effectiveness seems to vary incredibly, on god knows how many factors in play. There's a woman on addforums.com posting right now whose dexedrine just pooped out for her after 15 years.
But if you've hit that point where not just the initial euphoria of the early days, but the therapeutic range of effects (*improved focus, concentration, executive function, and yes, the pleasant non-euphoric mood boost) then it's time to look at options.
What Dr. Hallowell of Delivered From Distraction notes is that the cross-tolerance between methylphenidate and amphetamine is not high, so when they hit that brick wall, it's time to the next interval with a different mechanism of treatment. A few people switch them every month -- I wouldn't advise that for a number of reasons, but if it works for them then that's great.
Lars from addforums.com also switches from a methylphenidate to an amphetamine about every year or two. I think he's in his thirties, re-doing college, Dean's List, considering medical school.
>1. Why do they stop working? Do they deplete the adrenal glands, or the supply of dopamine?
Probably a bit of these and more. Probably powerfully downregulated activity of Tyrosine hydroxylase and dopamine receptor functions. Glutamate toxicity ---> tolerance? Psychological tolerance? It's such a nebulous concept, and so much goes on.
2. supplements
Magnesium gets drained from your body by psychostimulants anyway -- and this should certainly ease anything that might be going on with glutamate toxicity via Ca++ overflow. I take 400mg Magnesium citrate 4x daily -- this might be too much for some people.
Search some articles on zinc supplementation increasing the effectiveness of ADD meds.
Also, there's this glorious little piece of our Chairman's:
http://www.dr-bob.org/babble/20060304/msgs/616992.html
Good luck Ashley!
Posted by Ashley B on October 15, 2007, at 10:39:19
In reply to Re: Why do ADD stimulants stop working?, posted by cumulative on October 15, 2007, at 9:51:05
Thank you so much. I've been looking for that answer forever! And the Tolerance Prevention post is great.
You said "A few people switch them every month -- I wouldn't advise that for a number of reasons" Why is this?
Posted by Racer on October 15, 2007, at 16:47:38
In reply to Why do ADD stimulants stop working?, posted by Ashley B on October 15, 2007, at 8:47:11
>
>
> Does anyone know why it became less and less effective? Also, upon taking it, I'd get a "euphoric" feeling in which I could talk normally and socialize with other people for an hour or so. Usually, I'm very shy and have some social anxiety. This extra kick gave me motivation to talk to people, enjoy the presence of others and even make new friends. I wish I could feel like that all the time.
>This is a sort of side topic, but I've never felt euphoric on Concerta, or any other psycho-stimulant I've taken. Part of my symptomology is a sort of Calvinistic fear of addiction, so I've talked to my doctor about tolerance, addiction, etc, with Concerta. He says that, since I'm not aware of when it kicks in -- although I can tell when it has worn off -- addiction probably isn't a risk for me. In general, it's not supposed to produce euphoria at therapeutic doses. It may be that it's been working, but you haven't been aware of it because you've been looking for that good feeling, rather than for what it really offers?
Good luck, whatever you do.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.