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Old 11-30-2005, 01:57 PM   #1
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Should I ask to increase dosage of ritalin?

I am 29 years old, been on ritalin for about 3 months. Started taking 10 mg twice a day for just a few days then increased to 20mg twice a day and felt like that worked the best. But the last week or so I've been feeling like it has just stopped working, so I increased my dose to 30mg twice a day. Also, on long, busy days, I take 3 doses. I am wondering this is normal...should I be feeling like I need to increase the dose after just 3 months when it was working fine at first, or is the way I am feeling a warning sign of being addicted or something? Thanks for any advice!

 
Old 12-02-2005, 04:32 PM   #2
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Re: Should I ask to increase dosage of ritalin?

Based on anecdotal evidence, it seems like the 3 month mark is when Ritalin loses some effectivity for alot of people.

You really must talk to your doctor. Although short acting Ritalin, taken orally, is not generally considered addictive, there can be issues of tolerance.
Sometimes tolerance is mysteriously acute (ie. one day it just doesn't work then it does again the next day) while more rarely it is lasting.

Due to this and because of the wide variety of possible side effects, you should never ever change your dosage without talking to your doc (unless of course he/she asks you to experiment with a limited range of dosages to find the one that works best for you.)

Also, be aware that there are a number of posters on this board with beliefs about stimulant medications that are not scientifically proven. Some of these claims can be very scary. Don't let them get to you - a trained physician or psychiatrist will be able to give you the most reliable info about the drug.

Good luck.
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Old 12-05-2005, 12:18 PM   #3
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Re: Should I ask to increase dosage of ritalin?

Thank you for the feedback Sodawater! I do have some background in pharmacy so am a little aware of the basics and know enough to disregard any "hype" I may come across :-) Of course I know I should talk to my doctor, I just wondered if my experience seemed atypical or not. I guess I am a little afraid that if I appear addicted, he may stop the treatment altogether, and I have just been SO happy and calm and just, a different person, that stopping treatment altogether is not something I want to do! Thanks again!

 
Old 12-06-2005, 06:40 AM   #4
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Re: Should I ask to increase dosage of ritalin?

I took Ritalin when I was first diagnosed with ADHD, but it wore off very quickly from the start, and didn't seem to help me too much at all. My doctor switched me to Dexedrine, which he said is stronger and longer-lasting, and it has worked very well. Not to say you need to switch meds, but there are others out there that you might ask your doc about at some point, instead of having to keep increasing your Ritalin dose. Good luck, Sue

 
Old 12-06-2005, 10:54 AM   #5
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Re: Should I ask to increase dosage of ritalin?

Similar to Sue quoted below, switching meds worked well for me. In my case, though, Adderal XR did the trick.

Bob

Quote:
Originally Posted by Suecat3
I took Ritalin when I was first diagnosed with ADHD, but it wore off very quickly from the start, and didn't seem to help me too much at all. My doctor switched me to Dexedrine, which he said is stronger and longer-lasting, and it has worked very well. Not to say you need to switch meds, but there are others out there that you might ask your doc about at some point, instead of having to keep increasing your Ritalin dose. Good luck, Sue

 
Old 12-06-2005, 01:38 PM   #6
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Re: Should I ask to increase dosage of ritalin?

Sorry if I came across as patronizing or what I wrote seemed simplistic - you never know how experienced someone is, so I often wind up erring on the side of spelling out the obvious.....

I personally noticed after a few weeks on Ritalin that I stopped being as aware that I was *on a drug*. Although when I looked at myself more clinically - asking how much I was actually getting done - the effects remained clear.

Yet when I raised the dosage by 5 mg, I was again aware of being *on a drug* but too jittery to get as much done. My doc urged me to stick with the higher dose to feel it out, but after a whole week or so I really couldn't get comfortable on it and went back to the lower dose which has worked nicely.
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Old 12-06-2005, 02:11 PM   #7
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Re: Should I ask to increase dosage of ritalin?

I have had the exact same experience as sodawater with ritalin. For a while I really felt that it had "stopped working" but eventually I realized that it was just the side effects that were gone (that "speedy" feeling), but that my concentration was still vastly improved. Well perhaps it worked a little less dramatically then it did in the very beginning, but I didn't feel like I needed to change anything.
I am also a 29 year old female, I take 30mg/day. I believe that 60mgs is about the limit of what they'll want you to be taking, so maybe switching to a new one like the others did would be the best way to go if the ritalin isn't working.
Good luck!

 
Old 12-06-2005, 02:19 PM   #8
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Re: Should I ask to increase dosage of ritalin?

Oh I also meant to say that part of the reason I decided not to up my dosage was that because the effects were more subtle, I didn't have to deal with that "roller coaster" effect that came at first, where it's working working working, everythings great then BAM - I'm suddenly useless, stupid and confused. At 30mgs, I feel relatively consistent throughout the day. Not performing at a ten, but I don't need to worry about falling to a zero either, if that makes any sense. But it's all a process of trial and error, I'm sure your doctor is willing to work with you to find the right thing. Just tell him your concerns, I don't think he will think you're addicted to it. Me, I'm trying to get pregnant, and worry that I'm psychologically addicted because I don't take it if I think I'm pregnant and everything falls apart! But like a doctor told me, you're supposed to feel better when taking it, that's why it's prescribed. There's nothing wrong with that.

 
Old 12-06-2005, 08:43 PM   #9
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Re: Should I ask to increase dosage of ritalin?

Quote:
Originally Posted by christin0215
Thank you for the feedback Sodawater! I do have some background in pharmacy so am a little aware of the basics and know enough to disregard any "hype" I may come across :-) Of course I know I should talk to my doctor, I just wondered if my experience seemed atypical or not. I guess I am a little afraid that if I appear addicted, he may stop the treatment altogether, and I have just been SO happy and calm and just, a different person, that stopping treatment altogether is not something I want to do! Thanks again!
Sounds like tolerance, which is a scientifically proven occurance in the brain due to downregulation. If you look up downregulation, drug tolerance and tachyphylaxis in medical dictionaries or encyclopedias, that will clarify a bit.

Tolerance can lead to many problems including downregulation is basically where the brain decreases the amount of receptors due to continued exposure to an activating drug.

Tachyphylaxis is the diminution of a pharmacological response during the continued or repeated administration of an activating substance. Tachyphylaxis or receptor desensitization is counterintuitive because the addition of more of an activating ligand lessens the wanted response.

Eventually, higher doses will be needed and with higher doses comes more risk of adverse effects or too large of a dose needed which wouldn't be ethically prescribed. That's worst case but can happen.

Certainly, a person should NOT increase on their own without consulting a doctor. I'm not sure, but doing so on your own would appear to be abuse to a doctor so he needs to know you are developing tolerance and he will decide how much more to give.

 
Old 12-07-2005, 03:52 AM   #10
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Re: Should I ask to increase dosage of ritalin?

Tolerance to stimulant meds is a reality. However, I apparently have learned how to, if not eliminate tolerance altogether, at least slow its progress.

1. Don't expect ADHD meds to do it all. Coping skills must be utilized. ADHD work-arounds are simple but hard for us to implement. Writing everything down (so I don't forget it), careful scheduling (realistic time management) and as regular a routine as practical are my prime skills. Routine/structured-life is a friend but only if it is leading to well defined goals. Think of routine as a thought-out system to produce a specific result.

2. Take med holidays. I appreciate that many advocate taking stimulant meds every day. But I can function without meds as long as either the work or play does not require much sustained focus or is something I really enjoy doing. I notice the med seems more efficacious after a day off. Two days off (that is difficult for me) and the med feels much like the first dose.

I think it has something to do with half-life. For instance, the mixed salts of amphetamines that make up Adderal have a half life of 5 hours. But they can be detected in the blood a few days after last taken. Taking days off allows our bodies to bring blood levels of the drug down to near zero helping to prevent tolerance. The days off force me to pay more attention to my coping skills - another advantage.

3. That being said, being undermedicated is as frustrating as can be. It is amazing how many ADHDers will not ask for ligitimate med increase for fear of being perceived as drug seekers. Self experimentation is dangerous because the meds are extremely addictive. Addiction happens once we prefer the "feel good" of the med over dealing with daily emotionally difficult situations common to all humans. Addiction can insiduously hook us even when our intentions are good. I think more addicts are self-medicating than hedonistically seeking pleasure.

The only safe way I've found to get the optimal meds and dosage is a doctor that fully understands ADHD and is emphathetic to our plight. FINDING SUCH A DOCTOR IS NO EASY TASK. Ask around. RN's are the best professionals to ask about physician qualifications if you can get an RN to talk. The medical profession is like the moffia. You risk getting "hit" for opening your mouth.

A good doctor will ask questions. Honest answers will give him/her the info needed to recommend the correct starting med and dose and then tweak the formula until optimal levels are reached. You should never have to ask for a higher dose or a med switch. A good doctor tweaks meds including increasing dose, adding or switching meds based on our honest answers to their querys.

Tough business this ADHD med optimazation is!

Bob

Just thought of another coping skill: Including three hours of driving I will be out on the road today working for about 14 hours. Tommorow my med will not work. The reason is simple. It can NOT overcome exhaustion and ADHD together. I know that doubling or tripling the dose and I'd have no problem but that would drive my body beyond its normal physical and mental limits. Tiredness is the signal that we need rest. It is not wise to override valid signals. Tommorow I scheduled a light day with no meds. I follow heavy work days with lighter ones. Because of recent illness, my wife and I lost $100K - rounded down. I have to fight myself to not overwork in a vain attempt to recover the irrecoverable. The dough is gone forever. Dang!

 
Old 12-07-2005, 03:52 AM   #11
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Re: Should I ask to increase dosage of ritalin?

Thanks so much everyone for the feedback!!! I went ahead and saw the doctor yesterday, a week early, and while I didn't confess that I had started taking 1 and 1/2 each dose, I did tell him that I had been taking it 3 times a day. I told him that my day starts at 5:30am and I don't get to bed until 10-11pm, and he said that increasing to 3 times a day seemed logical. Anyway, I had stopped the extra 1/2 a pill for a day and seemed to be fine...like someone said, I think some days for whatever reason it just seems to work better than other days, regardless of the dose. So, my new directions are 20mg 3 times daily, and that is how I am going to take it. :-)

Thanks for telling me about switching meds...next month if I am not happy with the new regimin I will ask him about that. He had mentioned the longer acting (XR?) ritalin before, but we decided that I liked having the flexibility of taking more on longer days and less on shorter days. Now that I am employed though, seems like almost every day is a longer day, so the longer acting ones might be a good idea.

Thanks again everyone!!

 
Old 12-10-2005, 05:12 PM   #12
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Re: Should I ask to increase dosage of ritalin?

Aderal seemed to work great for me but aderal is NOT a long term drug! I became very ill (unhealthy) because I wouldnt eat but maybe half meal a day while on it. And its near impossible to force.

be careful god bless
Dchild

 
Old 12-11-2005, 10:42 AM   #13
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Re: Should I ask to increase dosage of ritalin?

Thanks for the advice, Bob! Everything you said makes a lot of sense...I did take one day off after I took 5 pills in one day trying to overcome exhaustion...it scared me that I would do that so took the next off completely. I still haven't told the doc that I sometimes take 1 and 1/2 for one dose, b/c from what I've read, the generally accepted limit for ritalin dosing is 20mg at a time, and my doc doesn't strike me as the kind of doc who would stray from the "norm" for dosing. Anyway, he did agree to up the dose to 20mg 3 times a day, so the past week I have tried doing that, and also tried taking 30mg twice a day. The total daily dosage is the same, and sometimes I don't know why, but I feel like taking a little extra and cutting out the 3rd dose.

Anyway, what you said has really got me thinking...meds are supposed to help us cope with our normal life...not give us "boosts" in order to accomplish more than is reasonable. And that's what I think I have fallen into. Thanks for giving me something important to think about!

 
Old 12-12-2005, 03:59 PM   #14
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Re: Should I ask to increase dosage of ritalin?

Christin, be very careful with that. Seriously, I highly, highly recommend that you talk to your doctor before you change anything about your dose. He or she is looking out for you and wants to help you, and knows what is safe. For example, to take five in a day to deal with exhaustion, rather than your ADD symptoms, is embarking on a slippery slope and believe me, you do not want to go there. I've suffered substance abuse problems and it is hell, please don't go there.
I know how annoying it is to be tired and to feel that a little boost would help, but that's what espresso is for and the only thing more annoying than exhaustion is untreated ADD. If you build a tolerance to your meds (and you will by doing that), they will eventually stop working for your ADD symptoms. I imagine that is not something you want. I don't mean to lecture, really, but there are many people who have gotten into trouble that way. Good luck and continue to post!

 
Old 12-13-2005, 03:53 AM   #15
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Re: Should I ask to increase dosage of ritalin?

I know you are right Sylvia...and I am not taking more than the total daily amount prescribed anymore...but I do sometimes take in 2 doses instead of 3 doses. As long as I can stay with it like this without further self adjusting doses, I will consider the ritalin a success I guess. Thanks for thinking of me :-)

 
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