concerta dosage

[Hope498]

I was diagnosed with attention deficit disorder 30 years ago. Doctor Is.... Specialized in attention deficit disorders in adolescents and adults. He prescribed 2 Concerta 54 mg in the morning / 20 mg Ritalin in the afternoon. I have taken this dosage for 30 years. It improved every aspect of my life. A year ago doctor Is... retired a year ago .

I had to go to a new Doctor. Doctor Pe... Initially prescribe the same doses as my former doctor and than began decreasing the doses so I am now taking less than half of the formally prescribed dosages. This has decreased my quality of life drastically. Now age 73, I can only live normally half of the time.*

I have ADD and I've had it since I was seven years old untreated then among other things I didn't learn to read until 2nd grade . In addition my brother, son and daughter have ADD. In addition my daughter also has bipolar illness.

in addition if a person with cerebral palsy is in a wheelchair you do not take the wheelchair away the wheelchair is a necessity not a crutch. The same is true of medication for someone that has ADD. An attention deficit disorder does not go away it is a lifetime disability!

I am 73 and want to live the quality of life I deserve. Due to this reduction in the medication I need currently I am in bed half the time and have to schedule everything around when I have enough medicine.

Please help me find a psychiatrist that specializes in attention deficit disorder and would prescribe me with the correct medicine. My zip code is 06896 Fairfield County Connecticut

*He stated he could not prescribe the same medication my original doctor had successfully prescribed for 30 years because he would lose his license. As the patient this makes no sense.

[BlessedLady]

Do you have any condition that affects your blood pressure and/or heart rate ? It is common for doctors to no longer prescribe stimulants like Ritalin to those 65+. Some doctors do but more and more are stopping it. Of course for patients that have cardio and/or b/p issues it is understandable but more amd more are no longer prescribing stimulants to those 65+ across the board. I know there is no law against prescribing stimulants to patients 65+. Unfortunately, some doctors lie to their patients.

Personally, I wonder if Medicare Part D plans have started sending out warning to doctors when they prescribe stimulants to those 65+. I know some Medicare Part D Plans cover stimulants (Ritalin, Adderall, Dextroamphetamine, etc) and some do not. Medicare Part D increased their oversight over Schedule II drugs several years ago. I know stimulants for those with ADHD and opiates for pain are completely different situations. But like it or not stimulants are Schedule II and that is not going to change.

The way we metabolize medications changes as we get older. Have you talked with your doctor about the decrease ? Has he told you he will no longer prescribe Ritalin and/or Concerta at some point in the near future ? Have you asked your doctor about other non stimulant medications for ADHD ? I do not think you will find a doctor that will continue to prescribes medications your old doctor did, especially at the same dosages.

[Gettingittogether]

Your dose was way way beyond the recommended dose. Doctors can go beyond the recommended dose, but they need to be awfully confident to do so. The more they go outside the recommended dose, the more the DEA is likely to check on them and the more their insurance companies will raise questions. Your previous prescription was way way way out there--and I mean way way way high.

If you cannot get out of bed, then that's not ADHD. That's depression. In fact methylphenidate (The Concerta & Ritalin you took are forms of methylphenidate) are prescribed sometimes for treatment-resistant depression. Methylphenidate can be a good treatment for some severely depressed people.

People with ADHD can get out of bed, that's not the problem. The ADHD problem is impulsiveness and lack of focus and attention control once we're out of bed.

Sounds to me like you need to get your doctor thinking about treating depression. That high dose (and it is wildly high) in the past probably treated your ADHD and your depression.

Did you tell your current doctor you're in bed half the time? That's task #1. No doctor will ignore that a patient is in bed half their lives. Reporting this should get the doctor focused on depression. You need some help with the depression. Yes, people with ADHD do often have depression as well. There's a chance that once you get focused on depression the doc may raise the methylphenidate, but in the past 30 years there have been developments in anti-depressants.

[psychtech]

Hi Hope,

I was in the same situation where I was once on a good combination of Stimulants and then I moved to Rhode Island and had to find new psychiatrist/neurologist to treat both my Bipolar I disorder and my ADHD . The specialists here would not prescribed the these two stimulant medications that was so effective in treating my Bipolar depression as well as in treating my ADHD . None of the f***in doctors here would prescribe Adderall or Vyvanse; and the quality of my liffe was extremely poor. Please, write to me if you want to get a consultation with my neurologist ; he is the best of the best, but he does not take health insurance. The initial neurological consultation fee is $ 645. 000. He spends approximately 45 minutes where he is able to provide assessment, accurate diagnosis , and effective treatment plan for your ADHD. He is a live saver for me!

Please email me at [e-mail]

[BlessedLady in reply to psychtech]

Doctors that do not accept insurance. Do not have to deal with "advice" from insurance companies when it comes to treating and prescribing for patients. This is especially true when it cones to patients that have Medicare. The friends I have that use Direct Pay doctors. Never have the problems with prescription my friends do that have Medicare

[Gettingittogether]

I'm talking about malpractice and liability insurance. Doctors have to fill out a bunch of forms and abide by a bunch of guidelines to get approved for malpractice insurance. And these days, when many doctors practice as part of larger healthcare organizations, there is more strictness on doctors following recommended prescribing guidelines.

I have been to three psychiatrists and one psychiatric nurse practitioners. None of them would prescribe anything close to the dose you got in methylphenidate.

I'm not trying to be rude, but to say you're facing a real problem. You will have to search long and hard to get that dose that you used to get. But tell the doctor about depression and not being able to get out of bed. They do have more room if the patient has a complicated condition.

And get to the best psychiatrist you can afford. Really confident and well known people sometimes are bolder than less confident providers.

[Phianoposis33]

I'd look into something else..Have you tried another ADHD med? Non stimulent? My son was on 60 Mg of XR adderal and I don't even want to begin to tell you the problems he had being on that high of a dose. Good luck!

[Shinja88]

Dear Hope498, your doctor is afraid of the DEA. The only thing I can say is that at least he has been honest with you regarding why he has reduced your dosage.

I have had my meds reduced considerably and am struggling to make it through the day. The excuse that providers give is that it’s a heart attack or stroke risk. But the peer-reviewed literature is inconsistent on that topic. My old psychiatrist, who passed away suddenly, prescribed what others considered “a lot” of medication. It was a dose that we arrived at through careful observation and care. One time I forgot my meds while on vacation and needed to get them replaced. That is when she told me about the pressure doctors were under in regards to stimulant medication and the DEA. Each provider is given a DEA number.

The DEA “controls” the manufacture, distribution, and prescription of certain drugs that are considered risky. There are different levels/categories. (My apologies for forgetting them.) anyways, the DEA basically can take away the right to prescribe and (I think) can make it very hard to renew a medical license or have it taken away completely. So that’s why your current provider said that.

With the fentanyl epidemic, the perception by medical providers is that there is a crackdown. If there is an actual crackdown, who knows. But there is certainly a fear among providers about this.

I hope that answers your question. I’m so sorry you have to deal with this. I know what it’s like. But I hope that explains why he said that. Kind regards, Shinja