hi
I have now completed a week on 18mg slow release methylphenidate and to be honest I have not noticed anything different other than that I’ve had a really bad week with my anxiety! My consultant psychiatrist says to continue with the plan of another week of 18mg and then increase to 27mg for weeks 3&4. Has anyone else had similar experience of starting meds?
It makes sense to have questions at the beginning of treatment. I recently started taking regular blood pressure measurements. Like you, I'm also in a healing place in my life. It's really to dive into being an observer of my own experience.
Wishing you peace as you navigate the new routine. 🙏🏼
Hi, welcome to the forum Lfc3910 !
Everyone's experience is different. I haven't tried any type of methylphenidate. I've tried Adderall XR (not helpful enough for me) and a non-stimulant called atomoxetine (generic Strattera). The latter treats my ADHD symptoms very well.
With stimulants, you should be able to tell quickly if they are doing anything. The standard approach is a method called titration: a doctor plans a strategy of increasing the medication dosage over time until the most therapeutic effect of that medication is reached.
So, unless you are experiencing any negative side effects, I would recommend following the doctors plan to increase the dosage. You should know within a few days it's working.
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For some people, the IR (instant release) version of a stimulant might work better.
For others, switching to the other stimulant might work better. (In your case, that would be switching to an amphetamine based medication, such as Vyvanse or Adderall.)
And for still others, changing to a non-stimulant such as Strattera, Wellbutrin, &/or Guanfacine might be more beneficial. (Like me, with my generic Strattera.)
It can take months to figure out what works well for you.
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I recommend keeping a daily journal when your start on a new medication or new dosage. Notify your doctor about any side effects. Notify your doctor ASAP about any concerning side effects (don't wait until your next appointment).
Thanks for your reply. I’m definitely going to contact the doctor again.
I got instant relief from my crazy internal monologue, with the very first dose. I think mine went up to 27mg and then 36mg slow release. I would discuss with your psychiatristTo me , that first week,reminded me of the weird peace or silence you can sense when you wake up and its snowed but you've not looked out the bedroom window yet. Some folk describe it as feeling stoned.
I know certain people respond better to the fast release.
Do you take meds for anxiety or drink a lot of caffeine. Ive cut back on caffeine
Hello Lfc3910,It sounds like your psychiatrist is taking a long slow approach to this.
My understanding is that you can tell in a couple days if the meds are working.
My husband's first trial was a few of days at one dose, increase for a few of days, increase again if needed, not weeks at each dose. He takes Adderall which comes in 5mg increments.
And if your anxiety is increased it may not be a good fit. Is your Dr open to discussing options? Are they well versed in ADHD? Dr can perscribe meds but that doesn't always translate into deep knowledge of what they are treating.
Is the anxiety like usual anxiety or a hyper awareness that you are taking a new med that is 'supposed' to have a big impact? In other words, is the anxiety fueled by ideas and expectations surrounding the meds or is it "regular" (not discounting your anxiety at all, just groping for good terminology) anxiety at a heightened rate? I hope that makes sense.
If your usual anxiety is up I recommend talking to your doctor.
Another thought is that prescriptions have a minimum and maximum dose allowed under FDA. Sometimes the lowest dose is too much but the prescription can't be made any smaller. So then that med "doesn't work"
See if your doctor will be creative with you so you don't suffer with heightened anxiety for an extended period.
I am NOT a medications expert, the above is my understanding from personal experience and some study of the topic.
I hope that helps,
BLC89
Full disclosure: I am an ADHD Parent Coach. I have been married to ADHD for nearly 30 years and raised two kids who have ADHD.
Hi, LFC!
It's too bad the doctor wants to wait so long to increase the dose. STEM_Dad is right; you can tell within hours what effect a stimulant will have on you. They don't have to build up in your system to work like the non-stimulants do. Sure, it may take a few days of living with it to experience its benefits, but if you don't notice anything after a week besides anxiety, then he should kick it up a notch (says me, your armchair non-MD! 
It sounds counter-intuitive, but for some people the anxiety improves with a higher dose. They get to a place where it provides real improvement in how they function, not just improved self-awareness of how bad things are.
Other people, like me, don't get much improvement from stimulants, but Strattera (or one of the other non-stimulants) makes a difference.
And many, many people who do respond to stimulants, need a MUCH higher dose than the published recommended amount. For example, our 16-year-old son has done well on 144 mg of Concerta when he wakes up, and 72 mg in the mid-afternoon. Because he apparently metabolizes it quickly, the morning dose is already wearing off by the time he gets home from school. It's marketed as once-daily, all-day, but for many people it doesn't last that long.
But it's tough to find providers who understand this reality and are willing to push through until they get to a therapeutic dose. Most don't have enough experience to know that the higher doses are safe, and they just stick with what they know. And sadly, a lot of people give up on medication before reaching that "sweet spot" because their provider has told them that's all there is.
So if you don't see the kind of improvement you want, keep trying. And if this provider isn't familiar with the newer medications, consider another provider.
Good luck!
Dad
For me Ritalin instant release works much better maybe you should consider that as well.
Yes you should notice reduction of ADHD symptoms like reduced brain fog, better concentration, quieter mind etc.
If it feels like absolutely nothing has changed bring it up with your doctor.
thank you
Your dosage sounds extremely high to me. A few months ago, I started on 5mg a day instant methylphenidate. I take 1/2 a pill (2.5mg) in the morning, then 1/2 a pill (2.5mg) four to five hours later. I sometimes (rarely) take another half late afternoon if I know I need to function that evening.
The effect has been very subtle but I am able to get things done which is a bit of a miracle. I have less brain fog for sure. And my mind is quieter, although I can still be scattered if I have too much on my agenda!
I have had a lot of anxiety in the past and I have not found it to be worse at this dosage. I'm anxious but it is not out of control.
I asked my doctor about the extended release methylphenidate - but she said I was better off controlling my dosages by myself during the day.
you definitely have to give it some time because your system has to get used to the medication but about the anxiety unfortunately its a common side effect not much too be done if it gets too bad you will have switch the medication
ADHD meds not available in Pakistan
Help with talking to dr about meds
thoughts on non-stimulant meds?
