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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by BLPBart on March 11, 2002, at 11:11:03
I have a question for any of you who can shed some light for me. I've been on ADs for a couple of years now. Started on celexa, then prozac, then prozac + wellbutrin, now wellbutrin SR 300 mg/day. This works pretty well for the depression although I'm a bit moodier than I was on the prozac. Recently, my doctor and I discussed adding a pstim to my AD because I was feeling very lethargic. I was doing some reading about Adderall, started reading about ADD, and just about fell over when I realized they were describing me. I fall into the category of inattentive, definitely not hyperactive. When you read the descriptions about girls who are quiet and unobtrusive, often depressed and have a difficult time staying on task and focusing, but somehow manage to get through life despite all of the difficulties-that's me. Anyway, I took the survey, my doc said I met the diagnostic criteria and we started down the stim path. He started me on dex spansuls 10 mg/day. I upped that each week by 10 mg. When I got to 30 and felt nothing he decided to try something different. Initially he was going to give me Adderall, but since it's fairly close to dexedrine in composition, he decided to go totally different and put me on concerta. So far I've been taking 36 mg/day, I just doubled that dose this morning and still can't tell I'm taking a stimulant. What I'm wondering is what would be a typical adult dose of Concerta? My usual self-doubts are starting to creep up on me and I'm wondering if being ADD is all in my head. Maybe all of the things that have occurred in my life that I finally thought had an explanation might be just me looking for excuses for my poor grades in college, etc. My doc told me that ADD types don't get hyper from stims, rather they don't have any response to them until they hit the right dosage and then it's like a light switch being flicked on. What I'm wondering is since my ADD (if I really and truly have it) is not severe enough to be noticeable to other people, i.e. I'm not hyper and doing a lot of things people associate with ADD, that maybe the effects of the drugs will be much more subtle than I've been led to believe. Does anybody out there have any words of wisdom for me?
Posted by fachad on March 11, 2002, at 18:48:06
In reply to ADD Med Dosage?, posted by BLPBart on March 11, 2002, at 11:11:03
There are two factors going on with your "took a pstim and felt nothing" symptoms.
The first factor is that your pdoc has given you timed release formulations of the pstims. They are DESIGNED for you not to feel them.
A problem with immediate release pstims is that you feel them "coming on" and then later you feel them "wearing off" Both aspects can be somewhat dysphoric, but wearing off is always dysphoric.
With the timed release formulations, they are designed to "sneak up" on you, take effect, then wear off gradually so you do not feel them wearing off. They are "transparent" to the user by design.
The other major benefit of the time-release meds is that you do not have to keep taking pills all day over and over. No "roller coaster" and no multiple dosing.
This is really a GOOD thing, but usually pdocs start with the immediate release pills, find the correct dosage and then switch to the sustained release pills.
Maybe you could suggest to your pdoc that he prescribe the immediate release pills (they are much less expensive) and then when you are familiar with the effects and have found the right dose, you can switch to the sustained release pills.
The other factor that might be in play here is your expectations. Stimulants may help you to a greater or lesser degree, but they are not a universal panacea that will make you feel super good all the time.
You may never feel the "light switch" effect, but immediate release formulations may help you become familiar with how the meds affect you and learn to be realistic about what to expect.
For your reference, here are drug names and dosages:
Ritalin - immediate release methylphenedate (MPH)
Concerta - Sustained release MPH
Metadate - Sustained release MPH
Ritalin SR - older technology SR MPH
MHP doses are usually 15 - 60mg/day, sometimes 80mg/day or more.Dexadrine - immediate release dextroamphetamine
Dexadrine Spansules - Sustained release DX
Dextrostat - immediate release DX
DX doses are usually half of the MPH dose. Usually 5 - 30 mg/day, sometimes up to 60mg/dayAdderall - mixture of different forms of amphetamine. 1/2 of it is DX. Even though it is an immediate release med, the different salts take effect and wear off at different rates, so it acts like a sustained release med.
> I have a question for any of you who can shed some light for me. I've been on ADs for a couple of years now. Started on celexa, then prozac, then prozac + wellbutrin, now wellbutrin SR 300 mg/day. This works pretty well for the depression although I'm a bit moodier than I was on the prozac. Recently, my doctor and I discussed adding a pstim to my AD because I was feeling very lethargic. I was doing some reading about Adderall, started reading about ADD, and just about fell over when I realized they were describing me. I fall into the category of inattentive, definitely not hyperactive. When you read the descriptions about girls who are quiet and unobtrusive, often depressed and have a difficult time staying on task and focusing, but somehow manage to get through life despite all of the difficulties-that's me. Anyway, I took the survey, my doc said I met the diagnostic criteria and we started down the stim path. He started me on dex spansuls 10 mg/day. I upped that each week by 10 mg. When I got to 30 and felt nothing he decided to try something different. Initially he was going to give me Adderall, but since it's fairly close to dexedrine in composition, he decided to go totally different and put me on concerta. So far I've been taking 36 mg/day, I just doubled that dose this morning and still can't tell I'm taking a stimulant. What I'm wondering is what would be a typical adult dose of Concerta? My usual self-doubts are starting to creep up on me and I'm wondering if being ADD is all in my head. Maybe all of the things that have occurred in my life that I finally thought had an explanation might be just me looking for excuses for my poor grades in college, etc. My doc told me that ADD types don't get hyper from stims, rather they don't have any response to them until they hit the right dosage and then it's like a light switch being flicked on. What I'm wondering is since my ADD (if I really and truly have it) is not severe enough to be noticeable to other people, i.e. I'm not hyper and doing a lot of things people associate with ADD, that maybe the effects of the drugs will be much more subtle than I've been led to believe. Does anybody out there have any words of wisdom for me?
Posted by BLPBart on March 12, 2002, at 9:43:44
In reply to Re: ADD Med Dosage? » BLPBart, posted by fachad on March 11, 2002, at 18:48:06
Thanks for taking the time to send me such a detailed answer. I appreciate your suggestion about trying the non-timed release formulations and it makes sense why I'm not running around feeling like I'm on speed or something. Along that note, I read your earlier post about SSRI induced anergia and I had a horrible time with that after taking prozac. I turned into a complete zombie and did nothing but sleep on it. That's the main reason why I'm now on wellbutrin instead, although I'm still not exactly a bundle of energy which is part of the reason for the pstims. Anyway, one of the things I'm wondering about is that it might not be as obvious to me as the light bulb switching on when the ritalin kicks in because of the type of ADD that I have. I'm not bouncing off the walls or doing a lot of the really obvious ADD type things. My case is very subtle and is primarily a problem in organization and focusing on things. I told my doc I wanted to try the stims to see if it would help me at work because I am so unfocused and disorganized and I'm very inefficient at using my time. I'm one of those people who has to stay late to get work done because I can't get it done in a normal work week. However, I'm also realistic enough to know that I'm not suddenly going to walk into work one day and be Miss Efficient and the Queen of Organization, primarily because those are actual life skills that I've never acquired. So, I guess I'm afraid I'm going to keep going back to my doctor and telling him that it's not working, only because I can't recognize when it might be helping. I have no idea if any of this makes any sense.
> There are two factors going on with your "took a pstim and felt nothing" symptoms.
>
> The first factor is that your pdoc has given you timed release formulations of the pstims. They are DESIGNED for you not to feel them.
>
> A problem with immediate release pstims is that you feel them "coming on" and then later you feel them "wearing off" Both aspects can be somewhat dysphoric, but wearing off is always dysphoric.
>
> With the timed release formulations, they are designed to "sneak up" on you, take effect, then wear off gradually so you do not feel them wearing off. They are "transparent" to the user by design.
>
> The other major benefit of the time-release meds is that you do not have to keep taking pills all day over and over. No "roller coaster" and no multiple dosing.
>
> This is really a GOOD thing, but usually pdocs start with the immediate release pills, find the correct dosage and then switch to the sustained release pills.
>
> Maybe you could suggest to your pdoc that he prescribe the immediate release pills (they are much less expensive) and then when you are familiar with the effects and have found the right dose, you can switch to the sustained release pills.
>
> The other factor that might be in play here is your expectations. Stimulants may help you to a greater or lesser degree, but they are not a universal panacea that will make you feel super good all the time.
>
> You may never feel the "light switch" effect, but immediate release formulations may help you become familiar with how the meds affect you and learn to be realistic about what to expect.
>
> For your reference, here are drug names and dosages:
>
> Ritalin - immediate release methylphenedate (MPH)
> Concerta - Sustained release MPH
> Metadate - Sustained release MPH
> Ritalin SR - older technology SR MPH
> MHP doses are usually 15 - 60mg/day, sometimes 80mg/day or more.
>
> Dexadrine - immediate release dextroamphetamine
> Dexadrine Spansules - Sustained release DX
> Dextrostat - immediate release DX
> DX doses are usually half of the MPH dose. Usually 5 - 30 mg/day, sometimes up to 60mg/day
>
> Adderall - mixture of different forms of amphetamine. 1/2 of it is DX. Even though it is an immediate release med, the different salts take effect and wear off at different rates, so it acts like a sustained release med.
>
>
> > I have a question for any of you who can shed some light for me. I've been on ADs for a couple of years now. Started on celexa, then prozac, then prozac + wellbutrin, now wellbutrin SR 300 mg/day. This works pretty well for the depression although I'm a bit moodier than I was on the prozac. Recently, my doctor and I discussed adding a pstim to my AD because I was feeling very lethargic. I was doing some reading about Adderall, started reading about ADD, and just about fell over when I realized they were describing me. I fall into the category of inattentive, definitely not hyperactive. When you read the descriptions about girls who are quiet and unobtrusive, often depressed and have a difficult time staying on task and focusing, but somehow manage to get through life despite all of the difficulties-that's me. Anyway, I took the survey, my doc said I met the diagnostic criteria and we started down the stim path. He started me on dex spansuls 10 mg/day. I upped that each week by 10 mg. When I got to 30 and felt nothing he decided to try something different. Initially he was going to give me Adderall, but since it's fairly close to dexedrine in composition, he decided to go totally different and put me on concerta. So far I've been taking 36 mg/day, I just doubled that dose this morning and still can't tell I'm taking a stimulant. What I'm wondering is what would be a typical adult dose of Concerta? My usual self-doubts are starting to creep up on me and I'm wondering if being ADD is all in my head. Maybe all of the things that have occurred in my life that I finally thought had an explanation might be just me looking for excuses for my poor grades in college, etc. My doc told me that ADD types don't get hyper from stims, rather they don't have any response to them until they hit the right dosage and then it's like a light switch being flicked on. What I'm wondering is since my ADD (if I really and truly have it) is not severe enough to be noticeable to other people, i.e. I'm not hyper and doing a lot of things people associate with ADD, that maybe the effects of the drugs will be much more subtle than I've been led to believe. Does anybody out there have any words of wisdom for me?
This is the end of the thread.
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