ADD/ADHD medication

[evercleared]

Hi everyone, this is a long post so bear with me! I was diagnosed with ADHD last year, my 3rd year in college. The psychiatrist at the school clinic started me off on ritalin, and I was taking 40mg/day for a few months until it wasn't as effective. So I asked for different meds, since I heard great things about adderall.
The psychs here are really cautious, it's almost ridiculous. Anyway she gave me concerta (18mg) which I didn't like (stomach problems, didn't seem to do anything for concentration). When that didn't work she finally gave me adderall (reluctantly), at the lowest dose (up to 10mg/day). I found my tolerance for it to build rather quickly and finished my 5mg pills(60 of em) in almost 2 weeks, but noticed it was great for my ADHD.
Anyway, I came back to see if I could get more (I was takin about 25mg/day), but the psychs at my school hate adderall and she didn't want to give me more than 10mg/day. Instead I got 20mg extended release ritalin and more regular ritalin. Im finding that after adderall, it's not as effective--is this the case for other people? Not only that, but hte extended release forms of ritalin I find have awful and increased somatic side effects (palpitations, stomach pain, etc) and less efficacy on concentration.
Anyway, I was wondering what people's advice would be about the somatic effects..I've been taking ritalin again (40mg/day) because I have 2 tests this week, but now I am so nervous and antsy, feeling edgy and cold and getting palpitations...it sucks. Im definitely gonna switch back to adderall..but I need some advice for right now about how to deal with ritalin's bad somatic effects?

 

[CrescentFresh]

Hehe, your post reminds me of the old "Scripting ADD Meds" Thread, You seemed to deal with everything perfectly, and if I used your post as a script to a doc id switch if he/she didnt award me with Adderall by then...
Anyways, One possible solution i was thinking about - what would happen if you combined the adderall with benzos? This would make one less jittery/anxious im assuming, but the concentration effects should still hold...of course this assumes you can easily get valium or xanax etc...
Other than that, just try to tell your Psy. the same stuff you wrote down - how it makes you sick and the normal adderall is better...she might think your trying to "score some pills" but if you keep acting sincere she should hopefully cave.
Good Luck

 

[fairnymph]

That's why I hate Ritalin, it totally makes me jittery etc and is nowhere near as effective as adderall for studying purposes. The extended release/concerta stuff is even worse IMO...
It completely makes sense that if you were using something more effective (i.e. Adderall) for your ADD, that going off that med and back on a less effective med (i.e. ritalin again) would only make the less effective med seem even LESS effective than before. This it completely logical.
I think you need to go back to your psych and reaffirm that the adderall was really working and that the ritalin just isn't cutting it. If you psych is unwilling to work with you on this then I suggest you seek out a new doctor, one that doesn't work for your school (hopefully you can afford this or talk to your parents about it?).
If you do get the adderall from a new doc, one way that you could limit building a tolerance so quickly would be by not using the adderall every day, but only using it on the days that you really need it to study for or take a test. You could alternate days of taking adderall with days of taking ritalin. Also, try to not take any meds (if you can help it, I don't know how bad your ADD is) on the weekend and days that you dont' need to do any schoolwork.
As for taking benzos, I have heard that some people find that this prevents them from developing a tolerance to adderall as quickly. Personally, I think it might slow down your thinking a bit and be too sedative for studying purposes. Of course, it probably would help your anxiety so it might be worth the trade off. You'd have to experiment a little to see how you personally would react to the combo.
[ 01 April 2002: Message edited by: fairnymph ]

 

[AnDx]

Originally posted by fairnymph:

If you do get the adderall from a new doc, one way that you could limit building a tolerance so quickly would be by not using the adderall every day, but only using it on the days that you really need it to study for or take a test. You could alternate days of taking adderall with days of taking ritalin. Also, try to not take any meds (if you can help it, I don't know how bad your ADD is) on the weekend and days that you dont' need to do any schoolwork.

Alternating days of adderall and ritalin would not be very effective because there's a cross tolerance between the two drugs.

 

[AbraMontague]

"Alternating days of adderall and ritalin would not be very effective because there's a cross tolerance between the two drugs."
There is no cross tolerance between the two (and I speak from experience.) They have different mechanisms of action in the brain and the chemical structures look nothing alike. The only "tolerance" you might notice is the realization (as fairnymph noted) that ritalin is naturally weak in comparison to adderall or dexedrine.

 

[fairnymph]

Actually, there IS cross-tolerance between d-amphetamine (adderall) and methylphenidate (ritalin) but it is low enough that alternating between the two drugs will still help decrease overall tolerance somewhat.
See:
Pearl RG. Seiden LS. The existence of tolerance to and cross-tolerance between d-amphetamine and methylphenidate for their effects on milk consumption and on differential-reinforcement-of-low-rate performance in the rat. [Journal Article] Journal of Pharmacology & Experimental Therapeutics. 198(3):635-47, 1976 Sep.
Leith NJ. Barrett RJ. Self-stimulation and amphetamine: tolerance to d and l isomers and cross tolerance to cocaine and methylphenidate. [Journal Article] Psychopharmacology. 74(1):23-8, 1981.

 

[yaesutom]

I do find that ritalin sometimes makes me a little jittery, and taking a benzo along with it gets rid of this, but i am still wide awake and able to focus very well, also the ritalin (or adderal, or whatever other stimulant) seems to kill the coordination problems (sometimes klonopin makes me almost bump into things by itself) of the benzo.