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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by AC75 on April 29, 2005, at 18:51:42
Folks, I'm no conspiracy theorist; I believe in the system. But increasingly I believe the medical community just isn't focusing on side effects of stimulants, they don't fully know what's going on, and that's kind of scary. I'd like us to list and discuss, if possible, our experiences.
I have spent the last 3 years on Ritalin and Concerta (my experience extends only to these two). The stuff is generally efficacious; yet at the same time, I am only 30, and sometimes I really feel as if physically I'm 15 years older than that! So here's been my experience. Please tell me if your experience backs it up.
(1) LOSS OF APPETITE. A no-brainer. They told us this would happen. I went from 185 to 150 lbs. in 8 months, and I'm struggling to keep it now at 155. I'm over 6' tall.
(2) FREQUENT URINATION. This is the one no doctor can figure out. Okay, so I believe them: Ritalin is not a diuretic. But that doesn't mean at peak dosage it can't speed your system up (ever felt your heart beat fast when you're on a stim?) to the extent that everything, including the passage of fluid through the body, isn't working overtime. I try to drink water to offset it; what I drink is immediately flushed out as clear urine and then some. Even when I haven't had any water for a day or two, when the Concerta dosage hits peak level in me, clear urine! Can't be the stim, you say? Then please tell me why the problem disappears 100% a day or two after I stop taking Concerta.
(3) DEHYDRATION and associated side effects. *Amphetamines* are known to cause severe dehydration; why do doctors find it so hard to believe stimulants could too? The urination thing leaves me with constant dry mouth, no matter how much water I drink. Increasingly my knees snap, crackle, and pop, which for a fit 30-year-old with no family history of arthritis really should not happen. Recently my general physician said she couldn't even get a blood pressure reading on me, it was so low -- despite being on Concerta at that moment (it's supposed to increase it, right?), and despite ALWAYS having had perfectly normal readings all my life! She later told me dehydration links directly to low BP. When I mentioned the Concerta & urination link, she looked at me blankly. Just didn't know how this could happen.
(4) BLURRY VISION. This one's in the prescribing information, and it's true. Really weird. When the Concerta hits its second chamber in the latter half of the day, releasing a higher concentration of methylphenidate, it actually becomes harder to focus on signs farther away. Not a big deal in the short run. But does anyone know WHY this happens? Is pressure in the eye being increased by the rise in pulse/BP thanks to the stim? Some other explanation? I'd like to get to the fundamentals of this so I can figure out whether I face a longer term problem.
To wrap up, these questions are only my own, and I'm sure you all have your own. It's important. Kids typically get on it for several years and are off by adulthood. What about those of us on it as adults? I started at 27. I'm taking it at 30. Is this going to go on until I retire at 70? Will I even reach that age hale and hearty? The doctors uniformly say yup, no problem. How can they sound so sure? Either it's because I have problems no one else does, or because this drug is so old no one studies it anymore, and so really no one knows jack. That's why I thought I'd ask all of you.
Many thanks in advance.
Posted by Alejandro on April 30, 2005, at 5:48:12
In reply to Stimulant Side Effects: The Definitive Thread, posted by AC75 on April 29, 2005, at 18:51:42
Hi, AC75! I am on Ritalin too (almost 3 years running on it), and I´m 25. It works great for my ADHD, and I consider it a wonderful drug. However, your comments about s/e seem very accurate:
> (1) LOSS OF APPETITE.Agree. Moderate in my experience.
My strategy: I have lunch and dinner 3 or 4 hours after taking ritalin. Though, you can´t do it on Concerta.
> (2) FREQUENT URINATION.Agree. Very pronounced symptom in my exp.
My strategy: ask gently for the bathroom wherever I am, cause I´ll need to go frequently. :-)
> (3) DEHYDRATION - dry mouthMe too! Hey, why doný you try drinking Gatorade twice a day. ;-) It works.
> (4) BLURRY VISION.
I haven´t experienced that symptom, but sporadically I have to use eye-drops for dry-eye since I take Ritalin.
(5) HEADACHES
Mild in general. This symptom may be related to the dehydration issue (which is a fact), but if a plenty glass of water or a Gatorade don´t help, I may take acetaminophen (350 to 500 mg).
I´m on 60 mg/day. What is your dose?
Posted by AC75 on April 30, 2005, at 9:27:16
In reply to Re: Stimulant Side Effects: The Definitive Thread » AC75, posted by Alejandro on April 30, 2005, at 5:48:12
Fascinating. Thanks so much for your post. At least now I know I'm not alone on the topic of urination & dehydration. I have come to find these side effects can be mitigated by taking the Concerta in the morning with a filling breakfast (but low-fat, so that it makes it through the digestive tract more quickly). That way, the medication eases into the system. I've found a high dosage on an empty stomach can be a problem. Anyway, this mitigates the worst of the side effects, but it by no means eliminates them, especially the dehydration.
When you drink all that Gatorade, don't you find the methylphenidate is causing all of it to get flushed out of your system rather rapidly, making it a waste? Or does it actually stop the dehydration in your case? I might try to concoct a more natural rehydration formula, since Gatorade is full of so many chemicals!
You'll be amazed, but I am a full-sized adult who finds that 21 mg/day is enough! I don't know why my system is so sensitive to this stuff, but it is. I also take drug holidays whenever possible to avoid tolerance from developing.
Do you really find you can only get it to work by taking 60 mg? Do you take Conerta, or manually cut Ritalin tablets? Here's what I do: Concerta has two chambers of the drug in it, with the second one containing more of the med under the theory that tolerance begins to develop throughout the day. I find that's nonsense. I need more in the morning, to get the system started, and less during the rest of the day, once the stuff has reached a critical mass in my system. So I take an 18 mg Concerta tablet in the morning along with a 3 mg piece piece I break off of Ritalin. This gives an initial infusion of 7 mg rather than the 4 mg Concerta along would give you. Before I did this, I would have to take more throughout the day, and feel almost nothing in the morning. For some reason, this works great for me.
Let's see what others have to say re: side effects. Thanks again!
Posted by Alejandro on April 30, 2005, at 15:05:21
In reply to Re: Stimulant Side Effects: The Definitive Thread » Alejandro, posted by AC75 on April 30, 2005, at 9:27:16
> When you drink all that Gatorade, don't you find the methylphenidate is causing all of it to get flushed out of your system rather rapidly, making it a waste? Or does it actually stop the dehydration in your case? I might try to concoct a more natural rehydration formula, since Gatorade is full of so many chemicals!The reason of my suggestion is that Gatorade formula contains sodium and potassium, which actually PREVENT dehydration, promoting fluid retention.
> You'll be amazed, but I am a full-sized adult who finds that 21 mg/day is enough! I don't know why my system is so sensitive to this stuff, but it is. Do you really find you can only get it to work by taking 60 mg?
I´m not amazed, because mi mother (who also has ADHD) is full-responsive to 15-20 mg/day of Ritalin IR. Effective dose depends on particular organisms and circumstances of life. I try to avoid taking more than 40 mg, but if the moment require it, I go to 60 or even 80 mg /day.
I take regular Ritalin (immediate release). I made a trial of extended release but It didn´t work for me. I take 10 to 15 mg several times a day. Also, take 5 mg 4 hours before bed-time.
BTW, have yoy tried Adderall/ Adderall XR? I`m curious about how it works (it isn´t available in my country).
Greetings!
Posted by AC75 on April 30, 2005, at 15:10:42
In reply to Re: Stimulant Side Effects: The Definitive Thread » AC75, posted by Alejandro on April 30, 2005, at 15:05:21
Fascinating. I think I should reconsider the Gatorade option! But I'm reluctant to sit on all that sugar all day -- if you drink Gatorade throughout the day, theres this salty-sweet stickiness in the mouth all the time. :-) Better than being dehydrated though. So you have noticed a difference since you started doing that?
I did try Adderall. Started with a small dose, and it immediately gave me severe chest pains. Thinking I'd screwed up my heart, I went to the emergency room, where I found the EKG was normal. So the doctor said most likely I'd had a muscular reaction to Adderall -- it must have tightened my chest wall. Took a week to get over. This is a rare reaction, and it was scary, but thankfully nothing like this has happened with Concerta.
Concerta is so smooth throughout the day. It's a real pleasure when it works, and isn't making me pee all the time!
Posted by Alejandro on April 30, 2005, at 15:56:07
In reply to Re: Stimulant Side Effects: The Definitive Thread » Alejandro, posted by AC75 on April 30, 2005, at 15:10:42
>I think I should reconsider the Gatorade option!
yup, give it a try! ("cool blue" is the one I like most; in fact, I´m drinking one right now.)
I also tried to exclude coffee from my diet, it is undoubtedly diuretic and can induce dehydration if taken along with Concerta. And may affect methylphenidate absorption as well. Actually, caffeine is rarely necessary if you take a strong stimulant like Concerta. Don´t you think so? ;-)
Posted by theo on April 30, 2005, at 17:12:20
In reply to Stimulant Side Effects: The Definitive Thread, posted by AC75 on April 29, 2005, at 18:51:42
What dose of Concerta are you taking? I was on 18mg and today made the jump to 36mg. It felt like a bit to much and don't know if that initial rush will were off or if I should drop back down to 18mg? What's your experience in increasing Concerta dose?
Posted by AC75 on April 30, 2005, at 17:26:57
In reply to Re: Stimulant Side Effects: The Definitive Thread » AC75, posted by theo on April 30, 2005, at 17:12:20
Read my posting a couple of posts up on this topic. By the way, there is a 27 mg dosage in between. I could never do 36, although 18 on its own (without the morning booster) isn't enough either. The 27 mg starts out fine but then is too much in the latter half of the day (you do know Concerta has a two-phase release of the med, right?).
Posted by theo on April 30, 2005, at 18:12:45
In reply to Re: Stimulant Side Effects: The Definitive Thread » theo, posted by AC75 on April 30, 2005, at 17:26:57
> Read my posting a couple of posts up on this topic. By the way, there is a 27 mg dosage in between. I could never do 36, although 18 on its own (without the morning booster) isn't enough either. The 27 mg starts out fine but then is too much in the latter half of the day (you do know Concerta has a two-phase release of the med, right?).
I knew it was two phase, but not until today when I took the 36mg did I feel the intensity of the second phase about 5 hours after I took it. It was to much and I guess I just blew $100.00 on 29 pills I won't be taking. I haven't messed with my insurance yet because they will flag it and have to get the form from the doctor and it could take up to 72 hours etc., but will be patient and do this so if I do try a strength that doesn't work, I won't be out so much. I tried to get a partial fill but they said they wouldn't do it with a stimulant.
Posted by AC75 on April 30, 2005, at 18:21:54
In reply to Re: Stimulant Side Effects: The Definitive Thread » AC75, posted by theo on April 30, 2005, at 18:12:45
I hear you. This is precisely the pain in the a** about the over-regulation of stimulants. First, they tell us that figuring out the right one for you is a matter of trial and error. Then, they add, "Sorry, we don't have samples because it's a controlled substance." So what choice do you have? Pay huge amounts of money to get various vials of stuff you may never use. I still have the early Adderall trial -- 30 really pricey tablets that I couldn't take beyond the second day due to chest pains (see above). Then when 27 mg of Concerta was too much, I got stuck with a vial of that. In hindsight, the best thing is to buy 2-3 tablets at full cost to yourself to try it out. You'll know in just a few tries.
I'm in a good spot in terms of efficacy right now, it's just the myriad side effects that are on my mind. I can help you figure out the optimal balance for you, because I've done a lot of trial and error with Concerta that no doctor ever has. They're usually clueless.
A couple of questions:
(1) Did the second phase of the 36 mg really hit you noticeably? But did the first phase feel just right?
(2) How do the two phases of 18 mg compare?
A funny thing happens to me with Concerta: after a meal (depending on how heavy it was), the effect goes away for an hour or two! Then it stays an hour or two (or more) longer into the night. Usually I take Concerta at 7 AM and the darn thing isn't out of my system until past midnight! I think I might metabolize it very slowly...
Posted by theo on May 1, 2005, at 9:14:41
In reply to Re: Stimulant Side Effects: The Definitive Thread » theo, posted by AC75 on April 30, 2005, at 18:21:54
> A couple of questions:
>
> (1) Did the second phase of the 36 mg really hit you noticeably? But did the first phase feel just right?
>
> (2) How do the two phases of 18 mg compare?
>
> A funny thing happens to me with Concerta: after a meal (depending on how heavy it was), the effect goes away for an hour or two! Then it stays an hour or two (or more) longer into the night. Usually I take Concerta at 7 AM and the darn thing isn't out of my system until past midnight! I think I might metabolize it very slowly...
Yes, the initial phase of the 36mg was strong but didn't bother me that much, but when the second stage kicked in, I felt like I was blasting of, jittery but off balance and mentally fuzzy. Physically stimulated but mentally fuzzy, if that makes any sense. It also made me feel uncomfortable in that I didn't want to be around people. I took it at about 7:30am and I looked at the clock when I sarted to get a massive wave and it was about 12:30pm for stage two.The 18mg is completely different. No uncomfortable feeling and I really don't even feel a second stage kick in, smooth transition. The only reason I wanted to try something above 18mg was because the 18mg seems to wear off about 4:00pm when taken about 7:00-7:30am. It is funny though because some days the 18mg feels more intense than others and seems to last longer, so maybe I ought to give it more time, maybe I jumped the gun thinking more might be smoother, some meds are like that. The more I think about it, Concerta does build up in the blood and I think is actually more effective after taken 2-3 weeks. What's your opinion on that?
I'm stuck with the debate now of either sticking with the 18mg or trying the 27mg dose? As intense as the 36mg was though, I don't know if a 9mg drop will make that much difference. Could you tell a big difference between the 18mg and 27mg dose?
Posted by alohashirt on May 2, 2005, at 0:38:38
In reply to Stimulant Side Effects: The Definitive Thread, posted by AC75 on April 29, 2005, at 18:51:42
>
> (1) LOSS OF APPETITE. A no-brainer. They told us this would happen. I went from 185 to 150 lbs. in 8 months, and I'm struggling to keep it now at 155. I'm over 6' tall.I get an increase in appetite.
> (2) FREQUENT URINATION. This is the one no doctor can figure out. Okay, so I believe them: Ritalin is not a diuretic. ButI'm too busy to pee.
> (3) DEHYDRATION and associated side effects.
absolutely - confirmed by recent blood tests as well as a dermatologist.>
> (4) BLURRY VISION. This one's in the prescribing information, and it's true. Really weird. When the Concerta hits its second
sometimes - but other times I get sharper vision, especially if I go outside at night and its very, very cold.> To wrap up, these questions are only my own, and I'm sure you all have your own. It's important. Kids typically get on it for several years and are off by adulthood. What about those of us on it as adults? I started at 27. I'm taking it at 30. Is this going to go on until I retire at 70? Will I even reach that age hale and hearty? The doctors uniformly say yup, no problem. How can
It's all relative. Whilst noone knows jack about how the mind works, there is a lot of information about the effects of methylphenidate. It;s prossibly the most well tested psychoactive medication. I know that withoyt Concerta I
would weigh an extra 30lb - not because my appetite is suppressed but because the Concerta lets me exercise three times a week instead of once a month.
Posted by Chairman_MAO on May 2, 2005, at 9:56:12
In reply to Stimulant Side Effects: The Definitive Thread, posted by AC75 on April 29, 2005, at 18:51:42
The blurry vision is probably from excess norepinepherine. Are you on any other ADs, etc? Dry mouth is not as intimately tied to thirst as you may realize. You can have dry mouth without being dehydrated, and you can be dehydrated and have a very moist mouth. The dry mouth comes from activation of the sympathetic nervous system, which also probably induces rapid voiding of the bladder as well in order to make you lighter so you can fight or flee. :)
If the urniation thing is REALLY bothering you, get some vasopressin nasal spray. I would to Desoxyn if possible; that has the least peripheral side effects out of any stimulant. failing that, try Focalin; that will probably give you significantly fewer side effects like the ones you're talking about.
Posted by AC75 on May 2, 2005, at 12:16:46
In reply to Re: Stimulant Side Effects: The Definitive Thread » AC75, posted by theo on May 1, 2005, at 9:14:41
Yes, there is a substantial difference between the 18 and 27. I would advise you to try two different things: First, see if you can find individual Ritalin tabs, either 5 or 10 mg. If it's 5, break it in half to get 2.5 mg, and take that WITH the Concerta 18 mg in the morning. This starts you off with 6.5 instead of 4 right off the bat, and this has an elevating effect for the bloodstream level throughout the day. If you still start to feel a run-out by mid-day, take the second 2.5 mg chunk with or after lunch. This is the best way I have found to supplement that natural, smooth flow of Concerta with a little boost (of the same drug, of course) during the day. I still think the 2-chamber theory is crap: it should start out stronger and stay reasonably flat all day. Oh well.
If this fails, try 36. I am sensitive to every 1 mg difference, let alone 9! Methylphenidate works within very narrow tolerance thresholds. Your jump from 18 to 36 was ill-advised.
Posted by AC75 on May 2, 2005, at 12:17:13
In reply to Re: Stimulant Side Effects: The Definitive Thread » theo, posted by AC75 on May 2, 2005, at 12:16:46
Sorry, I meant try 27 not 36.
Posted by AC75 on May 2, 2005, at 12:19:05
In reply to Re: Stimulant Side Effects: The Definitive Thread, posted by alohashirt on May 2, 2005, at 0:38:38
Thanks. I have a blood test scheduled in 2 days myself.
I don't do cardio exercise on Concerta. My heart's already pounding a bit too much on the med, last thing I want is a heart attack at age 30.
I'm pretty fed up with tailoring my life around this med, actually...
Posted by AC75 on May 2, 2005, at 12:21:49
In reply to Re: Stimulant Side Effects: The Definitive Thread » AC75, posted by Chairman_MAO on May 2, 2005, at 9:56:12
Chairman, your post was exceptionally helpful. No, not on anything else. It was big enough of a deal for me to get onto Concerta, since I'm so opposed to this unnecessarily unnatural kind of stuff. I therefore don't want to take any more drugs to assist in bladder control. Maybe at age 80, not today. I'll talk to the doctor about other methods -- maybe decreasing the dosage of the Concerta. But your sympathetic nervous system explanation checks out on Google, and it's scary that no doctor has ever come up with it before.
I question your evolutionary theory, however. How is human flight from danger assisted by having to stop and pee every couple of minutes? ;-)
Posted by Chairman_MAO on May 6, 2005, at 11:00:31
In reply to Re: Stimulant Side Effects: The Definitive Thread » Chairman_MAO, posted by AC75 on May 2, 2005, at 12:21:49
The idea is not to stop and piss every few minutes. the idea is for the system to be activated, for you to piss to be lighter on your feet and subsequently fight or flee. Then, the system is supposed to take a back seat and let the parasympathetic nervous system dominate once again.
It is downright frightening that your doctor did not know this. Find a new doctor; I'm serious. Any shrink that doesn't understand this should not have a license. A first year, second semester biology student should know this stuff.
Stimulants keep this system continually activated. As my psychopharm prof. wrote in the textbook I used to have, "[stimulants] pepare the mind and body for an emergency that does not exist."
That's why the pupils dilate from high doses of stimulants; dialated pupils increase the "depth of field" of your visual system, thereby allowing you to bring both distal and proximal objects into focus simulatenously as well as letting in tons of light to improve night vision. Eye doctors use sympathomimetic drops to dilate your eyes during examination. Sympathetic activation also causes appetite suppression and sometimes nausea to prevent food intake which would take energy away from the muscles. The extremities become cold because all of the energy is shunted to muscles, the cardiovascular system, and the brain. Problems with the GI tract also can happen because it takes a lot of energy to digest food, and stimulants take energy away from that system. Parasympathetic activation, on the other hand, increases salivation, excretion, constricts pupils, etc. There are actually two seperate systems of nerves that each innervate all the body's organ systems, etc., corresponding to the symp. and para. systems. They counterbalance each other. Isn't all of this fascinating? That's why I love this subject so much.
Posted by AC75 on May 6, 2005, at 11:10:37
In reply to Re: Stimulant Side Effects: The Definitive Thread » AC75, posted by Chairman_MAO on May 6, 2005, at 11:00:31
Cold extremities too! I have all these effects you're talking about. I need to look into this more. Thanks.
This is the end of the thread.
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