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Old 01-13-2013, 08:25 PM   #1
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concerta vs adderal - dependency, mood swings, etc.

Hi-

Recently been diagnosed with ADD. was put on concerta because my brother was on it and they say that if that worked for him it would for me.

im on 27mg right now.

is this stronger than adderall?

my friend is on 15mg of M.amphet salts

is that the same thing as adderall? they say it works pretty well for them overall. i havent asked them about mood swings yet. i notice i get pretty grumpy sometimes from concerta

i also decided not to take it on the weekends to avoid dependency if i can. is this a good strategy? ive heard cases on both sides.

i also notice sometimes on the weekends without it - i am EXHAUSTED. like cannot move, cannot wake up... during the week i sleep a normal amount on it. i dont think i lack sleep.... can anyone help educate me a bit on all this

 
Old 01-14-2013, 01:28 AM   #2
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Re: concerta vs adderal - dependency, mood swings, etc.

Welcome! There's a lot here, so I'll try to break it down on a point by point basis. If I come off as harsh at any point, please forgive me, I tend to ask pointed questions or make specific recommendations, but bear in mind I am not a mental health professional, I am simply working from my own experiences/research with ADHD.

Quote:
Originally Posted by ludear View Post
Hi-

Recently been diagnosed with ADD.
Welcome to the club. What sort of process did you go through for your diagnosis? How long have you had symptoms of ADHD? Did you have a physical to rule out a physical basis for your focus issues? I ask because there are a plethora of non-ADHD issues, both physical and mental/emotional that may present as, and be misdiagnosed as ADHD. Because these may be treated differently, it's important that your doctor or mental health professional rule these out.

Quote:
Originally Posted by ludear View Post
. . . was put on concerta because my brother was on it and they say that if that worked for him it would for me.
Unfortunately, that's simply not true. Even if you were twins, there are a huge number of biological and environmental factors that can lead to people receiving different effects from different medications. While Concerta may indeed work for you, the fact that it works for your brother is meaningless.

Quote:
Originally Posted by ludear View Post
is this stronger than adderall?
Concerta is a long acting formulation of Methylphenidate, which is best known as Ritalin. Although they are extremely similar, there are slight chemical differences between Methylphenidate and Amphetamine (Adderall) which render direct comparisons of strength impossible. Some people get better effects from Methylphenidate than from Amphetamine and vise-versa.

That said, perhaps the best way to compare is to consider where you are in your medications' respective therapeutic ranges. The therapeutic range for Concerta is 18-72mg/day, which would put you slightly above 1/3 of the maximum recommended dosage. 15mg of Mixed Amphetamine Salts (which is the generic version of Adderall) is likewise roughly 1/3 of the daily recommended maximum for treatment of ADHD (40mg/day).

It's important to note, however, that there is no way to predict how different dosages of different medications will affect you. It's impossible to accurately compare your doses, as you're different people.

Quote:
Originally Posted by ludear View Post
. . . is that the same thing as adderall? they say it works pretty well for them overall. i havent asked them about mood swings yet.
Again, their experience with Adderall may be different from your own. I tend to describe Adderall as a 'shotgun' approach to ADHD management, they threw in pretty much everything in hopes that one or more type of amphetamine will help. The blend of amphetamine salts provides efficacy in a wide range of individuals, but the potential for side effects with Adderall is likewise often much higher. Most people tend to receive benefits from Adderall, but side effects like mood swings/crashing tend to be more pronounced than with more targetted medications like Concerta.

Quote:
Originally Posted by ludear View Post
. . . i notice i get pretty grumpy sometimes from concerta
What part of the day do you find that you're grumpy when you take the Concerta? If it's early in the day it may be the medication itself. If it's late in the day, you're more likely crashing. Both cases may indicate that your dosage is too high.

The proper way to start any stimulant medication is with the minimum dosage, which with Concerta is 18mg. Your doctor should have started you there and worked up slowly. Are you finding that you have more energy when you take your Concerta? If so, I recommend that you try a lower dosage, as any rush of energy or increased feeling of self worth is euphoria, which will not only wane late in the day which can lead to depressed mood, but also cannot be maintained long term, as your body/brain will adjust to the stimulant effect, and you will have to increase the dosage on a regular basis to get that euphoric feeling.

Quote:
Originally Posted by ludear View Post
i also decided not to take it on the weekends to avoid dependency if i can. is this a good strategy? ive heard cases on both sides.
I have also heard from people on both sides of this issue. For what it's worth, because Concerta is a short acting stimulant, you should not suffer any ill effects from skipping days. Stimulant-based meds are not like reuptake inhibitors that take time to build up an effect, so you should be able to retain maximum efficacy even if you take them inconsistently.

Often, people skip doses in hopes of avoiding tolerance, where the body becomes so accustomed to the effect that you no longer feel it. Dependence is usually more a matter of becoming addicted to the euphoric feeling, which you shouldn't have at proper doses anyway.

That said, my psychiatrist always strongly encourages me to avoid missing days, so maybe there's something to it.

Quote:
Originally Posted by ludear View Post
. . . i also notice sometimes on the weekends without it - i am EXHAUSTED. like cannot move, cannot wake up... during the week i sleep a normal amount on it. i dont think i lack sleep....
Once again, I feel like this is an indication that your dosage is too high. You should not receive an energized feeling from the meds. Ideally, you shouldn't notice anything but an increased capacity for focus and perhaps a more organised train of thought.

Another question, have you ever been tested for or diagnosed with clinical depression? The inability to get out of bed can sometimes indicate that diagnosis.

Quote:
Originally Posted by ludear View Post
can anyone help educate me a bit on all this
I hope some of this helped. Finding the right medication/combination/dosage for treatment of ADHD can be a difficult process. Take your time and work with your doctor to ensure that it's done right. In the short term, I would recommend getting in touch with your doctor and see how they feel about a dosage reduction to 18mg for a week or two, to see how you feel at the lower dose.

Best of luck.

 
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Old 01-23-2013, 11:17 AM   #3
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Re: concerta vs adderal - dependency, mood swings, etc.

Thunor-

Thank you so much. This was beyond helpful. Process was a lot of surverys, behavioral type questionaires, etc.

I actually started out on antidepressants and those were of no help after a few months. I was told by the psychiatrist that if antidepressants didnt make a difference after a few months, to come back and get tested for ADD. Again, I dont think I have depression - usually when I dont get out of bed, its not because I dont want to. Its just because I am a complete flop for the day. I usually force myself to go for a run or something by at least 4pm so I dont feel like a complete waste of space.

I tried the mixed salts one day just to see if I found a difference. I found that it kicked in fast with a rush but then seems to die down. Concerta seems longer lasting. It was hard to tell about the mood part though. That may be in large part more due to my current job situation than the medication itself.

Again, thank you. This was very helpful. I have been reading some very terrifying things on the boards so sometimes I wonder if it is better to stop cold turkey than to try to figure out what my body works best with.

 
Old 01-25-2013, 12:10 AM   #4
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Re: concerta vs adderal - dependency, mood swings, etc.

ludear,

It sounds like you have a pretty strong handle on what your symptoms are; I'm glad to know you're so self aware.

It sounds like the Concerta is working for you, at least somewhat. That's a good thing, stick with it. Your sense about the amphetamine salts is probably correct. Amphetamine and Methylphenidate (the active ingredient in Concerta/Ritalin) lasts roughly 4 hours in your system. The way Concerta is formulated, however, is such that your body has to break down a more complex molecule to access the active ingredient--this way it can be released more slowly throughout the day, so it's a smoother uptake and lasts a lot longer. It's likely that your friend's amphetamine salts is an instant release formulation, which means you get the full shot of the med immediately and it will be gone within 3-4 hours.

If you decide to investigate an amphetamine-based option, Vyvanse is formulated in a similar way to Concerta, and will take the edge off the ups and downs you'll get from an instant release med. You can get amphetamine salts in formulations that break down more slowly in your stomach, but they tend to be less effective than those that are bound at a molecular level.

Quote:
Originally Posted by ludear View Post
I have been reading some very terrifying things on the boards so sometimes I wonder if it is better to stop cold turkey than to try to figure out what my body works best with.
Can you tell me what sorts of things you've been reading? I have seen many fear mongers on the boards, and have seen many claims--most involve abuse of ADHD medications. If you're not getting what I call the 'euphoric effect' from your meds, which means that the meds give you an increased feeling of self worth or a rush of energy, you will not become addicted; most cases of abuse/addiction stem increasing one's dose in an uncontrolled way to chase this euphoria. If you are depending on the meds to wake you up or to make you feel like a decent person, your dose is too high and addiction becomes a very real possibility. When taking ADHD meds, you should have a better ability to focus, and an increased ability to follow through on what you start. Anything more than that is an effect that you won't be able to maintain without increasing your dosage on a regular basis, and may well lead to addiction.

As to warnings of permanently damaging side effects, tics, behavioural changes, psychosis, or brain damage--these are generally the result of abusive doses; tens, hundreds, or even thousands of times higher than therapeutic doses. Also, many stem from use of medications in small children; I'm always ambivalent about messing with the brain chemistry of a child, their brains aren't fully developed yet and more suceptible to damage from changes in biochemistry. It's always important to understand that taking any medication at any time does involve risks, but then so do things you would never think about like herbal tea and coffee (did you know that as few as 5 cups of coffee a day can lead to auditory hallucinations?).

It's important to note that the first amphetamine was formulated in 1887, and methylphenidate has been used to treat ADHD since the 1950s. Amphetamine has been used extensively to battle somnolence in the military and trucking industries since at least the 1930s (it's still used in military circles, but banned for truckers). These are not new and experimental drugs--their effects, properties, and long term effects have been very well studied and observed for decades (as opposed to many drugs that you will be prescribed for other maladies which might have been fabricated for the first time 5 years ago).

A couple of notes, though, if I may:

Quote:
Originally Posted by ludear View Post
. . . feel like a complete waste of space.
I have often been diagnosed with depression because on surveys I would admit to feelings of worthlessness or discuss not being able to get out of bed. I am similar to you in that I don't feel that I suffer from Dysthymic Disorder (clinical depression), I always described my depression as situational--I get depressed because I fail at something, I don't fail at things because I'm depressed. That said, I think it's important to work on altering your ways of thinking to avoid thinking of yourself as worthless or bad in some way, because internalizing some labels (bad, worthless, hopeless, pathetic, etc.) can lead to diminished motivation.

One of the biggest changes to my own self image over the last few years has been to judge my actions rather than myself. Simple alterations in thinking: "well that was stupid" instead of "god! I'm such a retard!" or "gah! what is wrong with me? I never do anything right!" can make a world of difference--despite the fact it sounds much the same. I'm to the point now where I even take the edge off the value judgement about my actions, it's amazing how much better 'silly' feels than 'stupid.' That's not to say that I don't continue to have high expectations of myself, but telling myself I was worthless had no motivational value, and actually served to erode my motivation by making me feel like there was no use trying.

Similarly, try to figure out why you struggle to get out of bed. Is it lack of physical energy (I interpret "complete flop" to mean this, but may be wrong)? Is it that you just don't have the mental/emotional energy to face the world or your job? On this same note, a few years ago, I felt trapped in a job that I couldn't face at least 2 or 3 times a month because my relationship with management was so dysfunctional. You wouldn't believe the difference it made to my outlook on life when I left and found something new, even though it paid me less.

Best of luck!

Last edited by Thunor; 01-25-2013 at 12:17 AM. Reason: Noticed a nonsensical sentence.

 
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