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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Shell on January 7, 2001, at 23:11:19
A few weeks ago, my doctor added 18 mg of Concerta (for ADD) to my daily doses of Effexor and Wellbutrin (for depression). I have noticed a small improvement in attention, motivation and reduction of fidgetiness (is that a word?). However, my family has pointed out to me that after the medication wears off (11-12 hours after taking it), I am worse than I was unmedicated. I am more emotional, more unreasonable, more irritable and less logical. Is this similar to the rebound effect that Ritalin users experience?
I had thought that since I noticed a slight, but less than overwhelming improvement with 18 mg, I would ask my doctor to increase the dosage. Now I am wondering if a larger dose would magnify the end-of-day meltdown effect. Would this necessarily be the case?
I am unsure of the best way to proceed. I like the positive effects of this medication on my ability to concentrate and to screen out things that would normally overwhelm me. However, my family dreads the time when it wears off so much, that they think it might not be a bad idea to discontinue it altogether.
Is there anything I can do to extend the duration of the medication? I really only get ten hours of benefit from it, as it seems to take almost two hours after I take it before I notice any effect. If I take it early (i.e. 6:00 am), it works from aproximately 8:00 am to 6:00 pm, which is a huge help to me at work and with dealing with my children at home. However, this leads to some unpleasant evenings, where my poor husband usually ends up going to bed early to get away from me (which I don't take well!). If I take it later in the morning (i.e. 11:00 am), it will work from approximately (1:00 pm to 11:00 pm). We have a much better evening together, but I don't get any of the effect of the drug until my work day is half over.
I suppose my ideal scenario (however unrealistic it may be!) is a 16-18 hour extended release version that takes effect within a few minutes. Since that is obviously not an option, does anyone have any ideas on what might be helpful? Has anyone else had a similar experience with Concerta? I would be very grateful for any solutions or insight (and so would my family!).
Thanks,
Shell
Posted by Chris A. on January 8, 2001, at 1:24:02
In reply to Questions about Concerta, please help!, posted by Shell on January 7, 2001, at 23:11:19
What about added small dose of regular Ritalin when the Concerta wears off, say five mgs? As long as it doesn't cause insomnia it would seem to a reasonable solution. It's effects usually last 2 1/2 to 3 hours. If one goes to sleep the rebound doesn't come into play.
Hope this helps.Blessings,
Chris A.
Posted by medlib on January 8, 2001, at 19:28:52
In reply to Questions about Concerta, please help!, posted by Shell on January 7, 2001, at 23:11:19
Since you really want to try an increased dose of Concerta, how about asking your pdoc to prescribe a 2nd 18mg Concerta/day to be taken 4 hrs. after your initial dose? That would "cover" the whole day while providing the max. effect during afternoon and early evening hours when most people have the most problems with fatigue and concentration. Hope you have prescription coverage--Concerta averages $2/pill here.
Well wishes---medlib
> A few weeks ago, my doctor added 18 mg of Concerta (for ADD) to my daily doses of Effexor and Wellbutrin (for depression). I have noticed a small improvement in attention, motivation and reduction of fidgetiness (is that a word?). However, my family has pointed out to me that after the medication wears off (11-12 hours after taking it), I am worse than I was unmedicated. I am more emotional, more unreasonable, more irritable and less logical. Is this similar to the rebound effect that Ritalin users experience?
>
> I had thought that since I noticed a slight, but less than overwhelming improvement with 18 mg, I would ask my doctor to increase the dosage. Now I am wondering if a larger dose would magnify the end-of-day meltdown effect. Would this necessarily be the case?
>
> I am unsure of the best way to proceed. I like the positive effects of this medication on my ability to concentrate and to screen out things that would normally overwhelm me. However, my family dreads the time when it wears off so much, that they think it might not be a bad idea to discontinue it altogether.
>
> Is there anything I can do to extend the duration of the medication? I really only get ten hours of benefit from it, as it seems to take almost two hours after I take it before I notice any effect. If I take it early (i.e. 6:00 am), it works from aproximately 8:00 am to 6:00 pm, which is a huge help to me at work and with dealing with my children at home. However, this leads to some unpleasant evenings, where my poor husband usually ends up going to bed early to get away from me (which I don't take well!). If I take it later in the morning (i.e. 11:00 am), it will work from approximately (1:00 pm to 11:00 pm). We have a much better evening together, but I don't get any of the effect of the drug until my work day is half over.
>
> I suppose my ideal scenario (however unrealistic it may be!) is a 16-18 hour extended release version that takes effect within a few minutes. Since that is obviously not an option, does anyone have any ideas on what might be helpful? Has anyone else had a similar experience with Concerta? I would be very grateful for any solutions or insight (and so would my family!).
>
> Thanks,
> Shell
Posted by Chris A. on January 8, 2001, at 23:46:38
In reply to Re: Questions about Concerta, please help! » Shell, posted by medlib on January 8, 2001, at 19:28:52
That was a great idea from medlib. Still another possibility is taking a small regular Ritalin dose (5 or 10 mg) early in the a.m., followed by your Concerta later in the a.m. A bit of overlap should prevent rebound during the day. Perhaps an overlap in the am and pm would work best. You might have to experiment to find the best times and doses. We are paying for Concerta for our daughter. It has been a great med, but is a bit pricey compared to the original Ritalin (same chemical structure without the high-tech delivery system). Our insurance pays some, but it is definitely not on their "preferred" list. Most of my meds aren't either, so the out-of-pocket expeditures can add up quickly. Check me out on solutions.com :) Wish I could come up with some for myself.
Hope you find something that works.
Blessings,
Chris A.
Posted by Shell on January 10, 2001, at 17:24:10
In reply to Re: Questions about Concerta, please help!, posted by Chris A. on January 8, 2001, at 23:46:38
I can't thank both of you enough for your creative solutions. I am definitely going to discuss both with my doctor and see which she thinks will work best for me.
I also have the utmost sympathy for anyone who has to pay for his/her prescriptions. After I read Chris A's post, I looked at all of my prescriptions and realized that without insurance, they would cost nearly $500/month! I am very fortunate that my insurance covers ALL drugs equally, even Concerta! It is just a shame that all plans are not like this (and I won't even get into the fact that not everyone has prescription coverage).
Shell
This is the end of the thread.
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