Hi. I wrote an earlier post about whether to try Concerta or Adderall for my 8 year old. Received some helpful replies. Thank you. We started the methylphenidate XR LA 10 mg yesterday (which says compare to Ritalin on the bottle). Intentionally started on the weekend so i could observe him closely. He had a great morning at basketball, was cheerful, focused and in a good mood all day. Had lots of energy as usual so we went to the trampoline gym. Good appetite all day.. in fact extra hungry as the day went on.
But then around 2pm his stomach started to hurt. By 4pm he started getting very irritable and yelling at me and his laptop. And asking for more and more food like he could not get satiated.
By 8pm he was absolutely melted down. Screaming and punching the bed. Yelling at me to get away from him and not wanting to be touched or cuddled. Then crying and feeling guilty for losing his temper. He cried about how he can't control his emotions for some reason and how sorry he was. He said he doesn't like feeling like this.
It was devastating to witness and it makes me not want to give again. I know there are these potential sites effects which was what I was so worried about. But I don't know if the benefits outweigh the risk. Will it get better? I don't know if he will even cooperate to take it today. I feel like I'm hacking his brain and it doesn't feel good :/
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My 11 yo had rough crashes from this and we reduced his dosage by half which has seemed to help.
Previously he struggled to perform tasks and was overly emotional.
We now work together when his meds are wearing off and give him space to relax. I’m not a fan of this prescription but after two different meds and changes in dosage I think we are in a somewhat manageable spot until summer break.
Thank you. I was wondering if maybe the dose was too high. Still waiting to talk to doc. Yesterday was the second day and the same thing happened. The worst part is how badly he feels about raging out afterwards. He feels lots of guilt which is so hard to see because we both know that's not the norm for him.
coming off of a stimulant can be hard. Talk to your doc. They can usually add a smaller dose mid day so coming off is a bit slower. Also, I recommend Tami g a gene sight test. It will tell you if high meds will have adverse effects like this .
If you don’t have insurance, it’s like $6k. Our Medicaid covered it, though my doc didn’t see any need… even though it’s been a godsend for me and my partner. It won’t tell you which meds will work for your kid, just the strength of adverse effects (though it won’t say what the side effect will be). Just wanted to clarify.
Thanks! I did some research and Genesight looks like it would be around$330 for self pay. So I will continue to look into that. Have an appt with pediatrician tomorrow to discuss.
Similar emotional crash happened last night after they wore off. Very angry and frustrated, then feeling super sad and guilty for calling me a jerk. He was worried about taking today because he doesn't want to rage out on us again later he said...because he knows that's not him.
But he was willing to try again, and i made the mistake today of giving the meds (day 3) before a big breakfast. We have the day off from school and it was getting later in the am so I wanted to get them in him. He only ate a few spoonfuls of yogurt with it (pills going down easy with the yogurt thankfully!) ..which was not enough protein.
Shortly after he started getting a bad stomachache, nausea, lack of hunger, and just feeling "weird" and uncomfortable. I tried to get him to keep eating but he was uninterested all day.
I took his temp and he has a low-grade fever. Not sure if it's related to the meds or if he's fighting something unrelated (Also reason we're headed to doc tomorrow).
But.....despite all that today was the first time we sat and tried to complete 4 pages of writing for his research project. UNBELIEVABLY he finished writing all 4 pages in less than 10 minutes! It took one hour for him to complete 2 pages of the writing the day before we started the meds with me right by his side constantly redirecting.
He was exceptionally proud of himself! He wanted me to give him a spelling test right after so he could keep testing himself. He's said he's happy this might help him in class.
So the meds clearly work as intended. It's just the crappy side effects that I'm hoping we can minimize somehow. Really hate seeing him so uncomfortable and irritable.
[Of course, consult their therapist and/or doctor before supplementing]
Ritalin is just the brand name for immediate release methylphenidate (generic drug name). Concerta, is the brand name for a specific extended release version of methylphenidate.
One thing you can try is supplementing with l-phenylalanine or l-tyrosine . They are both amino acids. tyrosine is a metabolite of phenylalanine. Tyrosine gets turned into dopamine and norepinephrine by our bodies, which is primarily what is increased in synapses by ADHD stimulants. So, if neurotransmitter depletion is a factor, then this would likely help. If not a part of the problem, then this shouldn't do any harm. Protein is made up of chained together amino acids. So, these are primarily ingested when we eat protein. Our body separates them out for use.
One of the potential factors in stimulant crash is neurotransmitter depletion. Like vitamins and minerals, there is an RDA for l-phenylalanine. According to this link, an 8 year old boy's RDA for phenylalanine and tyrosine (they are added together) is 41 mg per kg of weight. So just throwing out some numbers, if they weighed 50lbs, that would come to 932 mg per day. (RDA is amount that is good enough for the needs of 97% of the population).
It can be purchased on Amazon.com easily enough. Capsules are usually 500mg. But, they can be opened for a lower dose or the powder can be purchased and measured instead and mixed with water or in a drink. phenylalanine would take a lot longer to metabolize so can try that in the morning or up to several hours after they take their medication. Tyrosine, I'd guess 2 or 3 hours before they have symptoms would be plenty enough. If it does help, you may want to look into their diet to be sure they get enough protein throughout the day. Getting enough protein should be good enough for most people. If it doesn't help, then maybe you can rule neurotransmitter depletion out as an issue.
You can look into something called integrative psychiatry. All that means is they usually have various professions involved in a holistic approach to treatment. In addition to a psychiatrist they may have a neurologist and nutritionist on staff for example. Who contribute to a more comprehensive therapy. A friend who is a psychiatrist has had good results referring some of the children she treats to that type of therapy. Just watch out for the ones trying to upsell you on things like their line of supplements etc. Some places are more professional than others. There is an integrative psychiatry accreditation I think. So look for places with it. Basically, do some research and ask others for references and results before choosing a place if you try it.
A factor in stimulant (or non stimulant) crash can be "acute tolerance". Basically, our bodies try to counter the effect of things that change our brains functions. To get back toward what our brain thinks is its homeostasis. Simply put, our brains start down regulating neurotransmitter receptors (literally, pull them back into the cell so they can't be triggered) which reduces the total receptor density. Reducing the signal strength. So, at the end of the day, the meds stop doing their thing, we may be left with the reduced receptor density, but nothing boosting the neurotransmitters. So, we end up below our normal baseline in cells signalling, which can increase symptoms from baseline. Or cause some new ones. Getting enough rest and time off the medication allows those receptors to upregulate back into play for the next day.
The below link shows how they determined the dosing strategy for Ritalin, and the extended release design of concerta, (also shows Adderall (amphetamine) and the design of Adderall XR based.) Which is all based on managing acute tolerance. The article is older and claimed to not be sure what acute tolerance is caused by. But it is known. I had learned about it in college years before the article was published. (I don't have any professional credentials, just a bachelors in general psychology that I never used career wise. Hence the reference at the top to discuss things with real doctors first.).
Simply put, the stronger the dose, the faster and more the downregulation. But, still needs to be high enough for therapeutic effect. Hence the balancing act.
Thank you for this detailed reply and explanation. We have the extended release type, so it's the equivalent to Concerta. I actually had some L-tyrosine gummies that I bought a little while ago with the intention of giving to him. But he didn't like the taste so I didn't continue at that time. They are 500mg a piece, so I nibbled off a little for him to try about 3 hours before the 12hour mark last night.
I can't tell if it made a difference. He still called me an asshole when I tried to change the TV. I ignored it because if I respond, he breaks down in sobs apologizing with guilt. It's really so unlike him, and we're headed to doc today to see about lowering the dose.
The intended effects are amazing with getting his work done, but I don't know if its worth it if it continues to affect him emotionally like this. I'll talk to doc about adding some supplements to counteract the crashes. But I'm hoping maybe a lower dose will help, or maybe even something more short acting. I don't know if he needs 12 hours of coverage as he doesn't have major behavior problems; it's more just the lack of focus and organization.
I don't have any advice, I'm actually following along to see what kind of solution your doctor suggests. We had a similar reaction with my 8yo son when trying stimulants. We didn't see the dramatic benefit during the day though so I stopped it. But the rebound melt downs were the worst we'd ever had. An hour of screaming, crying, hitting, saying he hated everyone and everything, trying to punch the wall... I decided it wasn't worth it.
Also-we just did the genetic testing. We did Tempus- it was about $200. His wasn't super helpful, it did show he has the MTHFR gene mutation so we're supplementing with methylated B viamins, but not too much else to help. He's a bit of a fast metabolizer too. I need to make a more in depth follow up with our pediatrician but we decided we're not going to mess with the ADHD meds til summer so he's not a guinea pig at school. We had several bad experiences with med attempts earlier in the school year and we've just gotten him more stable and cooperative again. I don't want to keep messing with it.
Thank you so much for the reply. Well...the doc prescribed adderall instead. My child tried it today for the first time (5mg amphetamine salts xr) and it was an absolute nightmare!
Although his teacher said he got his work mostly done without being prompted, his stomach hurt all day, and apparently he started feeling terrible about himself when he wasn't to help a friend in need. This turned into relentless self-berating (I'm so dumb and stupid and my brain is broken) which then resulted in him banging his head against the wall repeatedly at recess. Even though it hurt he couldn't stop apparently. No adults saw or intervened. He just suffered silently all day. He said the only reason he's taking these meds is so he can make more friends, and so people stop thinking he's annoying.
I'm devastated he went through this mental torment, and had such a strong negative reaction. He said he really feels like there's something wrong with him because we keep making him try all these things. He said was happy with his school work progress on the concerta, but the crashes were too much. Regardless, he said he prefers that to this.
Just spoke to the pediatrician again who admitted this is now beyond her pay grade, and referred us to a ped psych. She said they can be reeaaaaally hard to access in our area. The place she suggested is well over an hour away. Fingers crossed we can get in soon. I won't be giving him anything in the meantime.
I know that I'm doing the right thing by taking all these steps. At least that's what people tell me. But I can't help feeling completely guilty and horrible for subjecting him to this extreme reaction today by coercing him to take these strong meds
If we could send him to a school that was better suited for his learning style we wouldn't be taking this route. Like most of us probably, I feel kinda forced to conform and stuff him into a box that he doesn't fit in.
Oh my goodness, I feel exactly the same way with my son. We tried adderall too, and it was a disaster. But Straterra was the worst for us. The Dr encouraged us to keep him on it for 6 weeks to get to full therapeutic value even each week he got worse and worse. I finally said "enough" and we took him off of it. He was cursing, melting down, and suicidal by the end. I was heartbroken and so mad that I listened to that stupid Dr! It took us weeks to get it completely out of his system and he's still suffering the consequences for his behavior while on it. The bright side is that he has A LOT more support at school (an aide constantly, even at recess) and is doing well. I tried to explain to them that the escalation in his behavior was that medication, but they put the services in place and they're still there. He is doing better - is not really on any medication for his ADHD (he has other challenges like anxiety that he's medicated for). He never really saw the benefit to the stimulants - not sure if the dose was too low or what, but I am not going to experiment with him anymore this school year. I will try again in the summer. Hundreds of dollars to the Dr and Rx, and he still suffers with the process.
But like you said, the social emotional side is where we struggle. I hate to see him upset and lose friends because he can't control himself. I hate to see him feel bad because he can't sit still and stay on task. I even toy with homeschooling him so he doesn't feel so bad about himself. The momma bear in me wants to protect him from himself and the kids around him, from the labels and artificial metrics schools use to test for tax dollars. I substitute teach, I'm compassionate toward the kids who struggle - a little patience and reinforcement is helpful. Redirecting and reminding kids to stay on task isn't a big deal (to me) but it's a big deal to the school.
It's really not the most important thing in the world to sit quietly and do worksheets etc. But that is the requirement at school. Being creative and energetic is a valuable way to be when you're not in school. He's so friendly and a natural leader. Those qualities will serve him well in adulthood I just don't like this in between phase.
Hope the Ped Psychiatrist can see you guys right away. Keep us posted!!
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