Stim to non-stim?

[starsallover]

Hi everyone. For those who went from a stimulant to a non stimulant, how did you know when you had had enough of the stimulant? I think I'm about done with generic concerta 18mg and the resulting insomnia. No bueno. I noticed some positive things happening in the last 5 days, but I need to sleep! And yes, I've been taking sleep aids also.

[STEM_Dad]

First, how effective is your medication at treating your ADHD?

If it helps your ADHD a lot, then consider asking your doctor to switch you from Concerta, an extended release form of methylphenidate, to an instant release form (such as Ritalin).

~~~~~

I did switch from a stimulant (Adderall XR) to a non-stimulant (generic Strattera), but there were two reasons for doing so. First, the stimulant did not treat my ADHD symptoms well enough. Second, it caused me to have tachycardia (elevated heart rate).

Those were the two reasons for switching that convinced my doctor to try something other than Adderall, because in his experience it was the most effective ADHD medication for most of his patients with ADHD.

.....

As for me, I had a third reason, which was that due to the research I had done into ADHD, Strattera was effective at treating the symptoms that I was experiencing which Adderall was not treating well enough. (I had binged on ADHD information videos, and that included several featuring Dr. Russell Barkley. In one or two, he talked about a similar, often comorbid condition called SCT - Sluggish Cognitive Tempo; the symptoms he listed sounded just like me. The best treatment, according to studies, is Strattera, aka atomoxetine. Adderall only treated half my symptoms, compared to how well atomoxetine does for me. --- Note: research validates the existence of SCT, but it is not yet included in the DSM - the Diagnostic and Statistical Manual of Mental Disorders.)

[starsallover in reply to STEM_Dad]

as always, thank you for the wonderful information. It's hard to tell how well this medication treats the ADHD. I've only taken it about five days total, and those days I felt like I was on top of the world. So easy to do things! So motivated! Wonderful mood and hopeful! You get the drift. But today is the total opposite. I think that something with blood pressure or heart rate is being affected. My chest just felt funny. I have a blood pressure and heart rate cuff and meant to use it several times, but didn't for some reason.

I'll try to answer this more at another time. Feeling foggy headed and DGAF today. Just sad. Having a terrible day and I'm alone. Was optimistic and happy yesterday. Too much of a difference. I don't like it at all. I don't like having such a dramatic shift because of a pill.

[STEM_Dad in reply to starsallover]

Stimulants can affect sleep and appetite. How are you doing with those? Have you found it harder to get to sleep at night? Are you eating well enough? Also, make sure that you are drinking enough fluids. ... It does take time for the body to adjust to the meds, which might include ups and downs while your body is attempting to reach a point of homeostasis.

[starsallover in reply to STEM_Dad]

Little sleep but better appetite. I actually had the desire, energy and EF skills to put together a good meal. Lots of fluids. Yes, I understand it takes time to get used to new meds, but no more concerta for me.

[STEM_Dad in reply to starsallover]

It's absolutely good to recognize which medications do not work well for you, or cause side effects that are bad enough to warrant getting off them. So, if you know that Concerta is not for you, then hold the line on your position. Doctors can sometimes be very insistent.

There might be a different formulation of methylphenidate that would work for you, but given your response about Concerta, if your doctor wants to you try one, I'd recommend asking for an initial trial of a few days instead of a month. With stimulants, it is usually obvious within the first few days if there are concerning or bothersome side effects.

(My initial dosage of 10mg Adderall didn't have any side effects that I can recall, except for feeling irritable when it wore off every day. When it was increased to 20mg, I noticed no increase in the benefits, but it introduced tachycardia, i.e. elevated heart rate, plus an even more pronounced irritability when it wore off. I haven't tried any methylphenidate medications, only Adderall XR and atomoxetine, and the latter one has worked better for me between the two.)

Try working on getting better sleep, or even non-sleep deep rest (NSDR). Stanford professor Dr. Andrew Huberman is an advocate of NSDR. I've tried it on occasion, and it seemed to help most times I did, but haven't gotten into a regular practice with it. hubermanlab.com/topics/nsdr...

It might be that your body & brain just have to get used to the medication you're taking, in order to adjust your sleep cycle accordingly. Or, maybe you will need a different medication or dosage strategy. Some people on stimulant meds respond better and sleep better with the short acting version (sometimes referred to as IR, for "instant release"), and take it 2+ times during the day, instead of the long acting (XR, extended release) formulation.

[starsallover in reply to STEM_Dad]

I don't think even an immediate release would be good for me. Today I am so irritable and short tempered. So difficult to get through basic tasks. It's a major contrast to how I felt two days ago on Concerta. Honestly it's scary to me. Yes, maybe things would get better with a different formulation or medication, but this is very bothersome. I don't think I want to have any part of stimulants again after this. I don't know, I may change my mind. But right now I don't like how this feels.

[Mamamichl]

what time of day are you taking them? Maybe extended release is not leaving your body before the end of the day. You can also have a gene site test to see what meds your specific genetics do t work well with.

[starsallover in reply to Mamamichl]

I took them as soon as I woke up, no later than 8 am. Definitely not leaving my body in the intended time frame. I noticed that the days I didn't take a pill and I had the previous day (because of no sleep), I often had noticeable lack of motivation and drive. I literally didn't want to do much but flip through things on the Internet. I had to talk myself into eating and caring for myself. Such a dramatic difference. I figure all this is because of the drop in dopamine.

I did look up a gene test and there's one I think my insurance will cover. I might look into that further.

[Mamamichl in reply to starsallover]

Did you have the immediate release (ir) or the extended release (er)?

[starsallover in reply to Mamamichl]

extended release, estimated to be 10 to 12 hours

[Mamamichl in reply to starsallover]

some people burn through er in like 4 hours while others it lasts 24. It’s just how bodies are processing differently.

[starsallover in reply to Mamamichl]

They seemed to help me focus and the good stuff for several hours, but then the insomnia/hyped up state lasted longer despite good sleep hygene. Whatever is happening, no bueno!

[Mamamichl in reply to starsallover]

Check if it’s Er or ir

[starsallover]

I said that it's extended release, ER

[samami]

Your dosage seems very high. I am on instant release Methylphenidate. I just take half a tablet of the 5mg tablet in the morning. If I crash too much in the afternoon, my doctor said to take the other half, but only if it is before 6pm. I do suffer from brain fog, memory problems, lack of motivation etc and am just starting to figure the out how to use the Methylphenidate. My doctor just added Atomoxetine but I haven't had the courage to start it yet.

[KentuckTD in reply to samami]

ER and instant release are dosed differently.

[starsallover]

update: I started taking generic Strattera about a week ago. So far so good. I can tell it's making a difference. Very gentle though, which is exactly what I want. I started off at a low-dose and I'm going to increase it overtime. I see my doctor in two days to talk about it.