Hi, I recently had my official ADHD diagnosis. Today I have been prescribed Rubifen SR, which I think is basically Ritalin SR under a different name.
I am upping my dose in a staged manner, 20mg for the first 2 weeks, then 40 mg etc.
I took my first pill today and felt nothing. Is that normal? Should I just wait or should I contact my Dr about upping the dose? Does it accumulate in the system and I will feel more tomorrow?
Thanks in advance.
Welcome!
As I understand it, you shouldn’t experience some sort of magical effect from medication. The goal is a slow sustained improvement in managing your life. Medication isn’t a magic bullet that instantly makes your ADHD symptoms disappear.
The general suggestion is that you should monitor your ability to manage tasks over a long period of time. What’s one thing that you struggled with before medication? Look at it again after a week and see if you are better able to manage it. This could be creating and sticking to a routine or keeping your bills under control or regulating your food intake or paying attention in conversations.
The earliest days are really just about seeing how your body responds to and tolerates the medication. Be patient. This is a marathon, not a sprint.
Welcome to the community!
The medication dosage strategy (starting small, increasing gradually) is called "titration". It's a pretty standard practice, especially when you've never taken the medication before.
It can take anywhere from several days, to weeks, or perhaps months to experience the full effects of a particular medication. First of all, your body and brain have to adjust to being on the medication. Then, you and your prescribing doctor or psychiatrist need to assess how well the meds are doing for you.
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When I first started taking ADHD medication, I kept a journal...a note on my phone to record my experiences. I noticed that I felt a little different on the first day, but it wasn't distinct. It took me at least 2 more days to start feeling the slightest bit more focused. I think it might have taken 2 weeks for me to feel the full effects.
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After 6 months on Adderall XR, and not getting enough help from it (but developing a concerning side effect on higher dosage), I asked my doctor to try me in a non-stimulant (atomoxetine, aka Strattera).
It worked twice as well for me as the first medication, and I think was about 90% of the full effectiveness for me by the 5th day. It may be that I am just particularly sensitive to this medication.
Try to be patient. Again, I suggest keeping a journal of your medical trials, especially during the first few days on a new medication or new dose. And bring your notes to your doctor appointments.
Thank you very much for your detailed response. I will continue to let the course run to its plan. I think I was a little deflated as i had watched a lot of youtube anecdotal accounts on how the first dose was quite an eye opener and life changing, so had my hopes up but I hear ya, be patient and take one day at a time.
Not everyone experiences that fast of a response. Some do, and report clarity of thought, sense of calm, ability to focus, and maybe even euphoria.
Some people have little or no reaction, and some only negative side effects. Fortunately, those numbers are much in the minority.
Stimulant medications help the vast majority of people who have ADHD, from a little to a lot.
Stimulants won't make you feel like people think you should feel. They often will make someone with ADHD tired. I'm curious if the doctor had you take a DNA test before prescribing medication. A simple DNA test prevented me from my current psychiatrist discovered that my previous one was prescribing the wrong medication for my DNA type. Ritalin doesn't always work, nor does Adderall. In my case I was on Ritalin...and not thriving. Once it was figured out that it doesn't work on me, I was prescribed Adderall and the difference was amazing.
No, that's not something we do in New Zealand. I haven't heard of a DNA type for different medication before.
Ah! New Zealand. I guess you are kind of at the mercy of the government there. I would just do it on my own and give the paperwork to the Dr. If my first psychiatrist would have done this, I wouldn't have wasted 6 years thinking I was doing something wrong.
Here's a link to Genomind. Maybe your Dr. can get approval for this or knows of something similar in NZ: genomind.com/who-we-support...
An article on a NZ company that's doing this: stuff.co.nz/national/health...
And here is a link to a website for a company in NZ. mydna.life/en-nz/
I know people diagnosed with ADHD who report feeling it kick in and then they say they feel great, like a different person and suddenly able to focus. I don't feel any change at all, but when I run out and go a few days without, my ability to make decisions is absolutely awful again. It's not amazing with the medication, but I can see a difference in certain situations. Part of me wonders if these other people don't actually have ADHD and they're reacting to the medication like a neurotypical person would, but we're all different, which is why different medications and doses are an individual thing. Coffee makes me sleepy, whereas it seems to have the opposite affect in most people.
They'll tweak the dosage until you find what works best for you, so try not to worry too much about feeling a difference right away. I do remember starting though and thinking "do I feel different?" all the time throughout the first few days.
Thank you for that insight. I was hoping for an epiphany but I'll play the long game! Given that you said it takes a few days to notice your ability to focus is bad, do you think this medication needs to accumulate in your system to feel affects?
I think for me it does need to build up a bit, but that will likely be a very individual thing. I noticed it was very bad when I went to a supermarket after I'd been off it about 5 days. I was just pacing around, unable to make decisions and stressed! Part of that I have an eating disorder, but one of the most noticeable changes in me generally has been that my diet is a bit less chaotic. I have autism too, which makes things a bit more complicated. Sometimes it feels like the two conditions are working in opposite ways at the same time.
A couple of things here. First off I am wondering if the dr. had you take a DNA test before prescribing medication. It saves so much time knowing what medications will and won't work on you. I spent 5 years on Ritalin before going to another doctor that did the DNA test and discovered it won't work. Adderall, however, would and was a great change.
Secondly, you may have expectations that simply don't happen for those with ADHD. For most of us, stimulants won't make us feel jittery or amp'ed up. What we get is fatigue. The stimulant medication fills up your Reward Center (Opiate Receptors) and when that's filled up, your brain neurons will have an easier time flowing to your pre-frontal cortex. That's what medication, exercise, meditation, etc... is supposed to do for you.
A simple thing to observe is your sleep patterns. Are you sleeping better or worse? The same means that you may not be getting effects yet.
So far I'm sleeping better.
Medication and prescriber advise please! 
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