Meds increase causing cognitive impairment

[Eligee24]

Has anyone experienced cognitive impairment if their stimulant medication is slightly too much? As the doc raises my meds my feelings of cognitive impairment increase, but he keeps telling me that just means I need more meds 😩

[DefinitionReclaimed]

No, but I've heard that blunting of emotions can occur with stimulants. I don't suppose this is what you're referring to? Here's what Dr. Russell Barkley has said on this (starting around 59:37) :youtu.be/hzhL-FA2v10?t=3577(Not working as expected?)

Transcript of relevant part:

"For instance, let's take the stimulants. The stimulants work in controlling emotion by suppressing the limbic system. The higher the dose you give, the less activity in that system. Okay, well that's certainly one way to skin a cat, isn't it? I can control your affect by eliminating your affect, but remember, the limbic system was not impaired in ADHD. It's not part of the ADHD neuroanatomy, but one way to control emotion is to prevent it from occurring to begin with. And that's what the stimulants do. And now you know why one in five patients complains to you of emotional blunting; that the patient becomes like almost an automaton. They begin to lose their affect. Yes, they're compliant. Yes, they're productive. Yes, they're obedient. But that's all they are. Parents in particular very concerned about this side effect, and often stop their stimulant medication because they don't like what this child has become. They don't see the joie de vivre affection of the child. We want this kid to be poking his sister once in a while, to be getting a little upset. I don't need a bland robot that sits at a computer. And that some of these kids can get that way, so we have to be careful with stimulants because if you push the dose too high, you can get blunting of normal emotions, which really isn't the goal after all, is it? "

According an ADDitude magazine readers survey (source: additudemag.com/adhd-medica... ), the percentage of parents reporting dampened personality varied by ADHD medication, but was around 20-25% for most of them:

ADDitude magazine readers survey - medication effects

[DefinitionReclaimed in reply to DefinitionReclaimed]

p.s.--I just remembered something else that might be relevant here (source: adhdrollercoaster.org/adhd-... ):

"7. Hey, Gina, why are you making a big deal? By law, generics are the same as brand. My pharmacist assures me the generic is exactly the same as brand.

No, sorry. Generics are not the same as brand. No matter what some misguided pharmacists—and even physicians—might tell you. The generics are more precisely “bioequivalent” but that’s not “exactly the same.”

There are three key differences, and they are particularly relevant to psychiatric conditions because the best results typically come within a precise dosing range (the “therapeutic window”):

1. Variable dose of effective ingredient:

In the U.S., the FDA requires the “bioequivalence” for the generic product to be between 80% and 125% of the original product. Yes, that’s roughly 20 percent up or down—a huge window of variance. Even that number will not be constant; it might vary each time the prescription is filled because pharmacies often switch suppliers.

This variability alone can wreak havoc for many people with ADHD. They might do best with a specific dosage; taking much more or less than that dosage is not as effective—and can even be very problematic. Especially when you’re not expecting it. And especially when you question the pharmacy about the different-looking pill and you’re told that generics are the exact same as brand. Wrong."

[BlueDaydreamer]

I think you need to tell him that you are not comfortable with this stimulant and the way it makes you feel. If he refuses to change you to another medication, see another psychiatrist, but do ask your current doctor how you would be able to get off the medication safely. If he refuses to tell you, then you need to find another doctor immediately, if that is possible on your insurance. I would not take a medication that was impairing my cognitive function. And I don't know how he can expect you to!