”Methylphenidate (MPH), a stimulant chemically related to amphetamine, works by inhibiting dopamine uptake.6 Its mode of action is not completely understood, but presumably it activates the brainstem arousal system and cerebral cortex to produce its stimulant effect. It has been used as an adjunct for depression and apathy in various medical illnesses.7,8 MPH has also been shown to increase the motor effect of levodopa in PD.9 It has a short duration of action and is usually given every 4 hours. It begins to act almost immediately, and its effects should be evident within the first couple of days.7 We report a patient with Parkinson's disease and apathy who did not respond to antidepressant treatment but was successfully treated with MPH.”
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My son has just been diagnosed with ADHD and prescribed slow acting Ritalin. He was displaying similar apathy and procrastination anxiety and inability o start doing something that hubby always has and just a few doses has made a big difference to him so far. He sat all day and did his study which is unheard of as he normally is up and down mucking around.
It made me wonder if it would work on the apathy for hubby. Is it a dumb idea ?
Could be appropriate. It might be in a bit of a gray area in your husband's case or meeting a definite need and serve some value, but that is not something I could determine. You could, along with your prescriber. And it depends how well informed your prescriber is, and also how legitimate the need is.
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People with ADHD have "insufficient cortical arousal," especially in their ascending reticular activating system (ARAS). A fair analogy might be with a car that has an insufficient throttle or fuel pump or dirty fuel or insufficient spark plug charging system or weak idle. Ritalin is just the thing to provide such arousal, and so alertness, ability to focus, reduction of anxiety, and perform mentally higher functions such as learning, self-control, application, things that you generally have in your temporal lobes and frontal cortex. It matters a great deal for children and adults who need to be able to study and focus and maintain their behavior, as they acquire what it takes to develop through childhood.
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For an adult, it matters if the adult needs to live a productive life in the sense of providing a living, performing activities and duties as a contributing member of society, behave without impulsiveness or explosiveness or disruptiveness or violence, providing a living for himself and others, etc etc etc. ..
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It's probably not the greatest idea to prescribe for somebody who wants a better personal life experience, alertness energy and consciousness for example, but it might indeed help in that area and so that's a matter for you and your doctor. In a disabled adult who perhaps is not expected to provide self support or support to others or perform or exist in a social environment, maintain lawful behavior and participate in various social activities out of necessity, it is probably more of a voluntary thing than a necessary thing, and so in that case, it's a personal question whether apathy ("lack of motivation") is something that should require treatment. In such a situation what is to be gained is a personal benefit, not strictly a medical disease benefit.. for example, you might obtain the same or similar benefit if you use cocaine or methamphetamine. That's because methylphenidate is not without its downsides and side effects, especially if you are already using other medications that are psychotropic...
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But that in itself does not necessarily preclude proper use of methylphenidate even if you are taking other things, such as depression or even anxiety for example. There is a certain cost to methylphenidate, which is as a stimulant it tends to generate reactive oxygen species and sometimes it can bring you nearer the border between acceptable and agitated states. So I'd say it could be into the territory of a personal judgment call and if you can get your doctor to go along then it might be worth trying it out. If prescription turns out to not be a good idea, coffee and strong tea is a social substitute that's very commonly used just for that, does a lot of what you might use Ritalin for, although agitation may come quicker with the strong coffee, so lower doses of that might also do the trick, caffeine in coffee and caffeine and theobromine in black tea... In which case adding milk would provide a buffer for one's stomach against acid and tannins, but would come at the cost of the benefit of the phytonutrients you get with tea and coffee, as the proteins in milk tend to lock up those nutrients. (With both coffee and tea, without milk, you also get some very nice helpful antioxidants and phytonutrients). But it certainly can't hurt to inquire and discuss.
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In any case, if you wanted to test the hypothesis that a stimulant would help, try giving him a few of those "4-Hour Boost" or "Red Bull" energy drinks that are basically caffeine, you know the kind that the kids buy . Or a half-liter of Mountain Dew soft drink or Diet Coke. I used to take cans of Diet Coke on me when I would drive for 24 hours on college holiday and whenever I do have a long drive Diet Coke does it just fine for me and actually the effect is quite comfortable, rather mild as far as side effects go, just keeps my focus and alertness up. Works better than coffee.
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So no, I would not call it a"dumb" idea. Maybe first it all around with the caffeine, maybe try a half a Red Bull, or a strong cup of tea... and if well tolerated, a full Red Bull, if it works real well, bump some more.
If you go for Ritalin, caution about interaction because of methylphenidate's action though, it is in the dopamine and noradrenaline realm.
Methylphenidate: Primarily works by increasing levels of dopamine and norepinephrine in the brain, which are neurotransmitters that play a role in attention, focus, and motor control.
Caffeine: Primarily works by blocking adenosine receptors in the brain, which are responsible for promoting relaxation and sleepiness.
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And if you do get to looking at Ritalin (methylphenidate) you might be even better served by looking at Vynase.
Also another caution: if you do look into the ritalin or the vynase, your husband is pretty complex, I would ease in with low dose immediate release formulation, because if for some reason he should develop some side effects or problems, the low dose immediate release will wear off much earlier than the long-acting version. Or your doctor can add a script of something like Valium etc. to get through the side effects until the stimulant is done. It can be total torture if you are having problems with a dose and you can't turn it off and that's the problem with the long acting, if you count a problems you're stuck with them far longer, and I could be seriously difficult torture for longer.
Thanks Marion, it’s probably almost impossible to get here anyway as the queue for psychologist then psychiatrist is long and expensive and the chances of getting them to prescribe off label is possibly non existent especially with current shortages for adhd kids.
But it does make me wonder if he has always had something his whole life. He has always tended to overfocus on things that interest him to the exclusion of anything else and when anxious like he is now his brain is on continuously worrying about everything and nothing. He is overstimulated by too many people and noise and heat and mess. Maybe a touch of Asperger’s or autism. 😕
Use for adult ADHD is not really off label anymore... Actually in his case it would be ADD subgroups, or mild depression. All the prescriber has to do is look it up in the literature. And I'll tell you what what he's really looking for is a mild cocaine style bump, and as a cultural thing Colombians have been chewing raw coca leaves for 1500 years. Never hurts to ask. Sigmund Freud's first Fame was in early application of cocaine for depression and as far as he could tell and report and he believed it was a serious treatment in cure for many many things. His main fault was in bad timing, in the 1880s they didn't really know very much about psychopharmacology and potential for addiction except for opium and laudanum. If he'd known to apply it judiciously he might have gotten a Nobel prize. Instead the equivalent went to the guy in Atlanta who put it into his cola drink, which then he named Coca-Cola and the rest became history. I think it wasn't until 1903 that they finally took it out of his soft drink but he did keep the name and now that company runs the world. Yes properly controlled the stuff is probably safer than modern marijuana variants than just about every one of the psychotropic medications for depression and psychiatric disorders. And where you are, if you're lucky enough to have any Maori shamans around maybe they have a connection to get you mailed some raw coca leaves to chew on or maybe they have a recipe to make it into a tea or something. Unprocessed like that they would be very weak and mild.
Depends on the lens you are using, what some people refer to as a touch of autism or asperger's, looked at from the other side of the elephant the proper word might as often be CEO or rocket scientist genius inventor billionaire. In fact those traits are very much heavily overrepresented among those classes which we commonly refer to as massive overachievers.
Have severe apathy due to PD. Had a 2 hour psy. evaluation, conclusion was I need a stimulant. My neuro does not want to give it to me. Psy. sent info for local treatment but due to apathy I have not followed up. I'm very inactive, in the past year I've lost 20+ lbs. of muscle due to sitting around all day. I just do the bare minimum to survive.
matt832 My neurologist prescribed an SNRI, Venlafaxine, to try to counter my apathy. Unfortunately that turned out to drastically lower my blood sodium levels, so I had to stop it.
In its place he has suggested Duloxetine 60mg. I will let you know how this goes...
All this is in addition to the usual carbidopa/levodopa tablets
My question was has anyone tried Ritalin because to me some of the symptoms of adhd are the same as Parkinson’s. My son has just been diagnosed with adhd and I’m wondering if maybe my husband had a version of it with his apathy as they both behave the same way at times. Procrastinating and refusing to do stuff.
Sorry to hear about your apathy. I find it hard to do things, although perhaps not to such an extreme. I think of it as "executive dysfunction", which to me sounds classier than "apathy".I talked to my neurologist about it and he suggested a change in medication - I 'll post the details later this morning..
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