Coping with the Dark Side of Ritalin/Concerta

[alexthecannibal]

Hi everyone. I'm looking for some advice and I really hope some of you can help.

Ok, so, anyone who is familiar with and/or has experience with Ritalin/Concerta knows what I mean when I say the term "comedown" is a major understatement. Personally I would describe it as "plummeting to rock bottom and falling flat on your face", but hey, that's just me. Anyway, the point is basically that it's just a bitch.

So here's the deal. I've been prescribed Concerta for almost a year now, and I'm currently on 56mg a day. Surprisingly enough, I don't have ADHD. I was put on the meds for a sleeping disorder similar to narcolepsy. Over the past year I've grown used to crashes. With it being an extended release pill, I'll begin feeling the negative effects throughout the day, but they will quickly fade as the next dose sets in. However it isn't the same if I am abusing it. I've been snorting it for several months now. It's not severe, because I really do need the medication and can't just burn through it all in a week. Otherwise I'll be a zombie for the next 3 weeks. I don't abuse it daily by any means. I do it when I feel I need a boost for a specific task (which isn't often) or sometimes just for the social aspects on the weekends.

Here lies the issue. Today had to be one of the worst days of my entire life. And for absolutely no good reason. I had nothing bad happen to me today at all! It was a completely normal Sunday, and yet I lied in bed for most of the day having a mental breakdown over a damn comedown. I mean it was like no other. It was unbearable. I think I took too much too fast and I got a lot of anxiety from it, and when I crashed it was like getting hit with a truck. Just awful. I really can't put it into words.

I am desperate for ANY advice to even remotely make these situations less excruciating. This is the first time in like 12 hours that I haven't felt like complete shit. I finally couldn't do it anymore and took 30mg oxy to just chill the hell out. It worked, but taking that amount of any opiate to ease every comedown seems a bit extreme, don't ya think? Other than cutting back on the abuse (which I'm definitely doing now), does anyone have any tips at all that have helped you or someone you know? I know this question has been asked before... but it seems on every thread I find there's no specific points given and the topic always gets changed. Any help is truly appreciated.
Also, sorry for the novel I just wrote. I get carried away with these things.

*Other info:
- I'm on 40mg Prozac daily for mild depression. Only severe during the crashes.
- I don't smoke.
- Any other drugs I use are occasional and not very often.

 

[Smoky]

Hi Alex,

I'm so sorry you are going through this. Good description about the crashing, that describes it perfectly. The plummeting. 8(
I've been on stimulants prescribed and non prescribed in my past for a long time, starting when I was 11 years old. I even used to take Black Beauties.
I wonder if a drug similar to an amphetamine type would work for you. Like Stattera, or an snri.
I never tapered off these types of drugs you are on, but I do remember the crashes I went through… and very deep depressions. Have you thought about quitting? Or tapering down over a period of time? Does the drug help with your sleeping disorder?

When doctors have worked with me when on multiple medications with incentive to discontinue one ... I would gradually taper off one and slightly increase the other. I think with the specific meds you are on you would gradually taper down and hold the dosage without skipping days or increasing amount for a couple weeks then taper down again. The idea is to allow the body to stabilize before you drop again.

I have more experience with cns tapering, but know a little about stimulants so wanted to chime in.
And 30 mg is a lot, I use to abuse the 30 mg Roxy 215s but I didn't start at 30 to begin with, so yes … it's a high amount without a tolerance to opiates.
Perhaps the comedowns won't be so horrible if you started reducing the amount, adjust your body to a lower amount. OF course since you have a sleeping disorder, I am not sure how to guide you on that cos I don't know the type.
And I can only speak from my minimal experience specific to and some knowledge.

I want to add that atypicals really helped me after stimulant medications, and sometimes during.

~ Smoky

 

[alexthecannibal]

Hi Smoky! Thank you for the reply, I really appreciate it. As far as quitting, I'd love to. I don't enjoy having to rely on this stuff just to keep me functioning. However, my sleeping disorder is quite severe unfortunately. Last year I was sleeping 12-23 hours straight and it was very difficult for anyone to wake me. I saw several specialists and had a number of sleep studies done. They told me there was no way to confirm between Narcolepsy or a similar disorder that's less common, unless I did a spinal tap. I wasn't curious enough to take it that far. Either way I knew I would be given close to the same treatment. I started on Ritalin and after 2 months or so, I told my doctor hell no. Trying to correctly time the doses while avoiding the crash was not working for me. That's where the Concerta came in. To answer your question, yes, it does work. But it seems like I'm only given 2 options at this point... neither of them a good balance. If I take the meds, I'm not tired. I'm awake, and I have energy. But I'm extremely sad, and really just empty. OR: I can not take the meds, and only take my Prozac which definitely helps my previous depression issue. So I'm happy...and exhausted. And all I can manage to do is sleep. It's a lose/lose to be honest with you. My doctor is... a mess, so to speak, and I'm considering switching to someone with more experience with my issue. My current one refuses to put me on adderall (I haven't asked him for it specifically but he never lists that as an option) and I really have no idea why because I've heard the comedowns are far less harsh than methylphenidate. Actually, he doesn't give any other stimulant as an option. Last time he told me we could try some anti-depressant that also had stimulant properties (forgot the name) but he didn't think it would be strong enough so I took his word for it and stuck with what I have. It's just one big catch 22 and I've dealt with it for far too long. If I get nothing efficient from this thread I will have no other option but to switch doctors and hope for something that works without ruining my life. Anyways, thanks again for the message. I'm glad I can talk to someone who knows first hand the dreadful feeling of depression, and not just going off a description. And It really does mean a lot to me when someone takes their own time to help me out.

 

[Smoky]

Hi Alex,

I hope someone will respond. I'm surprised no one has. Probably because BL shouldn't give advice due to your undiagnosed sleeping problem. I would do a spinal tap if I were you. I know they are dangerous but you gotta rule everything out. Is your doctor a pcp?

I would see a psychiatrist perhaps (not cos you need one for mental purposes), but because of where you are with the medications 1, and
2.
A psychiatrist will be much more knowledgable about drug combos. You mention your doctor being a mess. Also, Prozac is an older drug. I took it and had an awful experience, it helped somewhat but I got on a new ssri once and it worked tremendously better for me for some time. You really are in a Catch 22. Has he mentioned any mood disorder meds to help cope with the stimulant crashes? That helped me, although they can sometimes have side effects and lethargy, and make one more tired, especially the older ones.

I actually had my thyroid gland removed via a primary doctor that couldn't regulate my #'s right when it could have been prevented. I now see an Endocrinologist specific to my disorder which has made all the difference in the world. I guess my point is, and maybe some will jump in on this thread, but ask for a referral to a specialist again… It's so difficult to keep looking sometimes for a solution but don't give up. And if you don't want to do that push your doc to try something different. He seems conflicted and unsure of what to do, but anything might be better than where you are now.

Best,
Smoky