not responding to starting doses | ADHD Information

About a month back, my doc prescribed me 5 mg. short-acting ritalin to help me wake up in the morning. that did nothing for me. I only took the ritalin 3 mornings, and then stopped, since it was doing nothing and I was chnging docs anyway. Now, my new doc, who I think is great, btw, rx'd concerta 27 mg. I took that today at 7:40 AM (I was supposed to wake up early today as a deal w/ my doc )but I fell back asleep an hour later until 10:30 AM. So, it is probably still in my system right now (3:45 EST, 8 hours later), but I don't know if it's even doing anything. Sine I woke up, I felt the same as when I drink a cup of coffee (which I do nearly every day)--kinda jittery, mind racing, and my appetite is the same. But the caffeinated feeling I've had all day may just be psychological.

Aren't stims' dosages based on the severity of the disorder? If so, I must have ADD really bad! My doc said the 27 mg. concerta is like 10mg. short acting ritalin, but this week he was about to start me on only 18mg. until he realized the 5 ritalin did nothing. I thought I'd notice at least a little bit of an effect, with no questioning that it might be psychologcal. Does the med having no effect mean it's not working and I should look for a new med, or does it just mean I have a greater tolerance when starting new meds, or does it mean I must have really bad ADD, which means the imbalance in my brain is pretty bad and it takes more med before I'll notice a change? What usually happens when the med isn't the right one for you--does it do absolutely nothing?

sorry if I rambled a little and confused anyone soberxinsanity39157.5373611111

27mg is a relatively small dose, my 10 year old whose ADHD is inattentive (and I am not thinking it is a horribly  bad case...) had to take 54mg a day.  And that eventually quit working....Just talk to the doctor and see if you can titrate up to 36mg....that may do the trick, or you may need to up the dose again. 

Stims are not dosed by the severity of the disorder, but by the response to the meds once begun.  A doctor will start a med, titrate the dosage up until the benefits continue, then stay at that dose, as long as there are not unwanted side effects.

chasesmom7939157.5533796296

I have a question for you both.  Are children rx'd higher doses becasue they have so much less impulse control than adults?

I was rx'd 10mg twice a day of Addrell, and the 10 worked for the first day then started to ware off quickly. 

I uped my own dose to 15 in the afternoon today, and I feel calm, and focused.

Very good question...that could very well be the truth.  As an adult that has developed coping skills over the years, you would maybe need less medicinal aid, because of those coping mechanisms.

That is one of the beauties of being an adult on the meds...you are the one that can tell how it is affecting you...and adjust your dose accordingly......we parents have to depend on observing....of course the children have input especially the older ones, but you have to have very sharp observational skills as parent of a medicated ADHD child...

My mom tells me that it must be making me irritable and giving me insomnia, but I think it's in her head. I get crabby with my mom all the time because we just don't get along well, pretty much every day. And I have insomnia anyway--just because I went to bed much later doesnt mean I went to sleep any later. If I go to bed early, I'll stay up until I get tired, sometimes 3 hrs. +.
Thanks for the advice!

Try melatonin for sleep.  You can buy it at GNC or dollar general, or any drug store.....try 1mg an hour or so before bed, and if that doesn't work try 2mg.  My son takes a 3mg tablet from time to time when he needs it, the lower doses seem to be the most effective, higher doses can have the opposite effect (no sleep) and can cause nightmares. 

I know that the 1mg sublingual (melt under the tongue) tablets are at GNC---60 tablets for about or so. 

The irritability may diminish as you get more sleep, and as you adjust to the meds.

Good luck, and keep us posted!

I think I've heard here on other threads that melatonin can actually make you feel more rested and better able to wake up in the morning? Is this true? I am very drowsy and spacey in the morning and I'm trying to figure out why. Maybe it's just an ADD thing?--I hear a lot about how someone with ADHD has insomnia at night and can't wake up in the morning...

I don't remember the post too well it was a while back, but I think the poster mentioned that melatonin helps to sleep better at night, so when morning comes, you are more well-rested.

Well that makes perfect sense.  If you get to sleep earlier, and sleep longer, you will be better rested and ready to face the day.

Try it, it is not an expensive supplement, and if it works you have so much to gain!  Not the least of which is your mom off your back about the insomnia issue.

To go back to the original question, response to stimulants has much more to do with metabolism and individual body chemistry than it does with dosage.  Never make the mistake of thinking that worse ADHD = need more meds.  I have far worse ADHD than a friend of mine: I take 15mg of adderall at a time, and he takes 25mg.  He has no real response to my dosage, and his dosage would make me explode!  Yet, I'm severely ADHD with particularly bad hyperactivity/impulsivity problems for an adult, and he's "merely" moderately inattentive. 

And, as someone else pointed out earlier, a good doctor will titrate you slowly with stimulants.  Too often doctors thrust someone right into the normal theraputic range on stimulants, and people have a horrendous few weeks trying to adjust.  Personally, I metabolize stimulants VERY quickly, and so I get a lot of side effects from too much hitting me at once even in smaller doses.  You can imagine what those first few weeks were like with a doctor who immediately pumped me full of 25mg XR.  Take your time, you'll likely find that you have a very small window for theraputic dosing.  A few miligrams too few, and you'll get very little benefit and a few miligrams too high, and you'll be in stimulant side effect hell.  12.5mg does very little for me, but 17.5mg can't be taken at once, or I get too jittery and overfocused.  Be patient!  You'll get there!

Many adults and children have a very slight benefit until the dosage is titrated up.  The reason that doctors start patients on the smaller dose is so the body can adjust slowly to the effects of the med.  As the doses are raised, you should notice benefits that are more lasting.I don't have any side effects, I can't even tell when it's leaving my system b/c I don't notice a difference! I timed it to wear off 10-12 hrs. after taking it, but I feel the same, I don't know if anything is happening at all. I hope raising the dosage will make a difference, I don't hear too many people here saying they stopped a med because it wasn't doing anything..maybe I worry too much. I have a reason though: my therapist and I have been suspecting ADHD since Sept 2005, and I'm just now starting meds/treatment. It just took me so long to get this far and I don't want to have worked so hard to get to this point for 1 1/2 yrs and then find out nothing will work for me.

Well don't despair!  Even if concerta is not the med for you, there are so many others to try!  I could never tell either when the med was leaving my son's system and when hubby was on the low dose of concerta, we all noticed a change in him even as he protested that he felt no different. 

Have others around you mentioned any changes in your mood, or demeanor?  We all noticed that he was calmer, and in a generally better mood on the concerta at a low dose, and he didn't notice a change until he went to the higher dose.  He had to switch to dexedrine due to crappy insurance coverage (concerta too expensive) and the dex has a generic.  If they come out with a generic for concerta, he will switch back I am sure.

I know that it is a pretty small dose, but what I'm really getting at is, is it normal to not notice anything at all, even on the first day? Like I said, I felt a little like I was caffeinated for the first half of the day, but that may just have been a psychological effect of me being excited to start the meds. My appetite is also the same, as is my level of attention (or should I say, inattention?)