Newly medicated, concerta, now Ritalin.

[FishermanT]

Hi, first post here. I am 35, always had ADD symptoms but Seems to scrape bye previously. Life has gotten increasingly more difficult since my daughter has been born and taking on a very stressful and complex business. Earlier this year my general practitioner evaluated me for ADHD, I checked all the boxes so they had me meet with a psychiatrist over zoom whom also diagnosed me as ADHD. The zoom psychiatrist visit was very rushed and not very in-depth unfortunately. I was prescribed 18 mg of Concerta Which I have taken for about two weeks. Initially the first few days I felt very productive and more able to focus on my family and work. After that the positives became less apparent and more negative side effects which seems to have the same consistent pattern every single day. I felt like the medication released doses or spikes at three points throughout the day which gave me on feelings.Around noon I get a very amped up adrenaline feeling which wears off mid afternoon then sort of stoned/high feeling around four or 5 o’clock, even stumbled on words some. The last three days there’s feelings have mostly gone away but today I felt pretty scatterbrained at times. Had a check in with the Psychiatrist and they said that the symptoms were not normal and they want me to switch to 10 mg slow release Ritalin. After a little bit of research I see Ritalin is also methylphenidate which has me wondering if it’s going to make me feel exactly the same way as Concerta?

[Gettingittogether]

The 10 mg would be immediate release, not slow release. Concerta is the slow (extended) release version of Ritalin (methylphenidate).

The answer to your question is not really. You would think that the same med--extended and short term--would have the same effect. But it's not that simple.

Some people like it and feel more control about when to take it. I started on Concerta and now I'm on the immediate release and I like it. So try out the short-term version.

BTW: there are other versions of extended release methylphenidate (Focalin for example) and some people have better results with a particular extended release formulation (even though again it's the same active ingredient.

[FishermanT in reply to Gettingittogether]

Ok thank you for replying. It was described to be by the DR. as though it is a extended release version and I am supposed to take once daily in the AM. I am frustrated with the Zoom Dr visits. They are so short there isn’t enough time for back and forth dialogue. I quickly described my symptoms, pros and cons and the doctor said that was not normal and I shouldn’t be having those symptoms after three weeks. I had only been on the medication for eight days though and I don’t think I was heard when I tried to correct that statement. So they switched me to 10 MG’s Ridellan once per day And scheduled the next appointment for one month out. Reading everyone else’s posts it sounds like they have much more frequent doctor visits and much sooner adjustments in medication’s then one month apart

[PilgrimA in reply to FishermanT]

Hi.

Where are you located? I am in the UK and it’s very similar here… very patchy follow up and not easy to get really heard and understood while adjusting meds .

[Gettingittogether]

Actually no, medication management visits (which is the name of these visits where the doctor checks on your adhd medication) are usually like 4 times a year. I've had three psychiatrists and one psychiatric nurse practitioner prescribe my ADHD meds over 15 years. The schedule was the same with all of them--every three months, four times a year.

If your psychiatrist takes insurance, usually those visits are short--usually ten to 15 minutes in my experience. My first psychiatrist would have two quick appointments where he wouldn't even think of changing the med and then every third or fourth, he would ask me about the medication in a way that indicated he was ready to make a change if I wanted it.

The only psychiatrist who gave me lots of time was the one who was out of network and he was a lot more expensive than the two in-network psychiatrists (like $130 a visit vs $25 copays--and these days that guy would be like $300 a visit). This out of network guy gave me more like 30 minutes and the conversation was much more relaxed. I'm now with a psychiatric nurse practitioner (in network) and maybe she's not under the same time pressure as the psychiatrists who take insurance, but she gives me as much time as I need, usually 20 to 25 minutes, sometimes 15 minutes if everything is all right.

One thing I did find is that is over time these folks trusted me more and more. At the start, they were more distant. Providers are trained (seems to me) to be on the lookout for people who use these medications abusively.

But keep pressing like you're doing!

BTW: what symptoms did she say you were NOT supposed to be having. In fact, the first three weeks are when side effects are the highest level.