![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by Krazy Kat on June 1, 2002, at 15:25:34
Second day on Concerta - absolutely more 'even' than Ritalin. I am taking the starting dose - 18 mg in the morning. Also, remember, I'm on a somewhat high dose of Depakote - 2000 mg. I have switched to taking 1000 mg at night, and 1000 in the morning as Mitch suggested - I do believe it keeps me more even. Thanks Mitch! (was taking all at night).
Still an ocassional bought of irritability that I attribute to the stimulant. Yesterday, I felt it beginning to drop after about 10 hours. Slept well last night, though. Better energy and focus last two days.
I'll add to this post as it progresses.
I am having a slight fall into depression - nothing "serious" but I mentioned it to pdoc. He feels Concerta might be enough to help with that (AD's make me manic) but if not, we'll a tiny dose of Welbutrin (maybe).
- kk
Posted by Ritch on June 1, 2002, at 18:35:14
In reply to Concerta Update - Mitch and Anyone, posted by Krazy Kat on June 1, 2002, at 15:25:34
> Second day on Concerta - absolutely more 'even' than Ritalin. I am taking the starting dose - 18 mg in the morning. Also, remember, I'm on a somewhat high dose of Depakote - 2000 mg. I have switched to taking 1000 mg at night, and 1000 in the morning as Mitch suggested - I do believe it keeps me more even. Thanks Mitch! (was taking all at night).
>
> Still an ocassional bought of irritability that I attribute to the stimulant. Yesterday, I felt it beginning to drop after about 10 hours. Slept well last night, though. Better energy and focus last two days.
>
> I'll add to this post as it progresses.
>
> I am having a slight fall into depression - nothing "serious" but I mentioned it to pdoc. He feels Concerta might be enough to help with that (AD's make me manic) but if not, we'll a tiny dose of Welbutrin (maybe).
>
> - kk
Hi,Glad that is working fairly well! Keep us tuned in. Your writing definitely seems bright and clear (I can tell a difference). I am on a little Imipramine, I am going the cheap-ass route! I won't be able to tell diddly for another week or so how it will work-if it works as well as desipramine did with less anxiety I will be happy with it.
good luck,
Mitch
Posted by Krazy Kat on June 2, 2002, at 16:43:34
In reply to Re: Concerta Update - Mitch and Anyone » Krazy Kat, posted by Ritch on June 1, 2002, at 18:35:14
thanks! what do you think about Converta wearing off after about 10 hours? I know its half-life is 12 hours, but I will need something that lasts a good 12-14 hours to handle "real life" eventually. :) If I up the dose to 27 mg., does that extend the half-life as well?
Thanks. Your comments are so appreciated, Mitch.
Posted by IsoM on June 2, 2002, at 17:54:57
In reply to Re: Concerta Update - Mitch and Anyone » Ritch, posted by Krazy Kat on June 2, 2002, at 16:43:34
KK, it's just an idea but if you'd like it to last that long, you could try what I did with Dexedrine. I would feel the benefit kick in SO nicely when I took Dexedrine, but the wear-off would happen fairly quickly too & I didn't like the whoosh up & then down again.
I would break my tablet in half, take that piece, then about 1 1/2 hours later, take the second piece. The rise was gentler & lasted about 1 1/2 hours longer & they taper was gentler. Mind you, I'd rather feel fully awake & energised all the time, but this was a good enough alternative for me.
Posted by Ritch on June 2, 2002, at 18:25:09
In reply to Re: Concerta Update - Mitch and Anyone » Ritch, posted by Krazy Kat on June 2, 2002, at 16:43:34
> thanks! what do you think about Converta wearing off after about 10 hours? I know its half-life is 12 hours, but I will need something that lasts a good 12-14 hours to handle "real life" eventually. :) If I up the dose to 27 mg., does that extend the half-life as well?
>
> Thanks. Your comments are so appreciated, Mitch.
You could increase to 27mg and that might take care of it. OTOH, do you think you might get by on a couple of strong cups of espresso or something for the first four hours of the day, and then take your Concerta-say at noon with your 2nd Dep. dose? The reason I say that is you mentioned you got some mild irritability that you could attribute to the stimulant. Does the irritability happen within the first six hours of taking it? Also, don't forget the influence (or lack thereof) of Depakote. If you are getting grouchy the last few hours before your bedtime dose of Dep., it *might* be a Depakote blood level *dip* or mild withdrawal instead of a "crash" on the Concerta. If you are getting the grouchies when you are peaking on the stimulant-I don't think it would be a good idea to increase the dose. Just some ideas, but try delaying the Concerta by four hours and see what happens first (keep everything else the same). If that doesn't help, you might then try spreading your Depakote dosage out even more: say 1000mg at nite, and 500mg when you wake up and then 500mg 8 hrs later (in the afternoon), and *then* see what happens.Mitch
Posted by Chris A. on June 2, 2002, at 20:50:37
In reply to Concerta Update - Mitch and Anyone, posted by Krazy Kat on June 1, 2002, at 15:25:34
One trick to extend the hours of stimulant benefit is to add 5 or 10 mg of regular Ritalin when the Concerta is wearing off. Concerta can't be broken up due to it's high-tech Gortex like delivery system. My 16 yo has had excellent response to Concerta (inattentive ADD). We've never had to do the add-on, but have had it available as a back up. Most people (excluding myself) need to function more than 10-12 hours a day. BTW, my daughter just received an award for having the highest GPA in her high school. Eighteen months ago we weren't even sure she would make it through high school. She was unhappy because she couldn't concentrate enough to do her work. Talk about medical miracles. I don't have anything to say to people who are down on prescribing stims for kids who need them. Look at the results!
Sorry for getting off of the subject, but we do need a few sucess stories to keep us going.Blessings,
Chris A.
Posted by Krazy Kat on June 3, 2002, at 11:11:36
In reply to Re: Concerta Update - Mitch and Anyone » Krazy Kat, posted by Chris A. on June 2, 2002, at 20:50:37
it's unfortunate that americans seemed to develop a fear of stimulants, just as we seem to have an odd aversion to using marijuana as a prescribed medication. the media, of course, had a great deal to do with the "Ritalin Scare" - blowing its addictive qualities and overuse out of proportion.
I'm very happy to hear that it has helped your daughter. Esp. at her age, I can't imagine why it shouldn't be tried, though I'm sure some would still disagree.
Just the fact that she was frustrated about not being able to concentrate shows there was a problem with her "circuits", not a lack of interest.
Good news. It's helping me as well, though I'm having a few side effects and this dosing thing... good suggestion re: the regular Ritalin. I had two 5 mg left over and actually thought to try that yesterday evening - it worked. That might be the solution...
- kk
Posted by Krazy Kat on June 5, 2002, at 10:24:08
In reply to Re: Concerta Update - Mitch and Anyone » Ritch, posted by Krazy Kat on June 2, 2002, at 16:43:34
ah, tis a fascinating subject, tisn't it? perhaps i will keep this thread going for years... ;)
i am taking 36 mg of Concerta for the first time today. Took 18 mg for about a week. I'm having some struggle with a mild depression, and pdoc wants to see if the Concerta can handle this. I'm a little skeptical, but then I do not want to add Welbutrin (his other thought) because it made me so irritable and just plain mean the last ime i tried it.
Concerta downsides - nausea, nausea, nausea. Headaches in the afternoon. Jumpiness. Desire to bawl (but I think this is the depression now).
Concerta benefits thus far - am awake more and can focus somewhat better.
Am still taking Depakote 1000 mg at night and 1000 mg in the morning.
Posted by Chris A. on June 5, 2002, at 11:52:56
In reply to more on concerta, posted by Krazy Kat on June 5, 2002, at 10:24:08
It doesn't work for everyone and not everyone takes it for the same reason. My pDoc is against me taking stims because of all of the evidence out there that they can easily destabilize someone with bipolar. At one time a few years back he did try me on dexadrine for a few days - a disaster, from what little I remember.
Hope you find the right combo.
Blessings,
Chris A.
Posted by Krazy Kat on June 5, 2002, at 12:58:38
In reply to Re: more on concerta » Krazy Kat, posted by Chris A. on June 5, 2002, at 11:52:56
I should have said, "I'm skeptical, but also hopeful." I tend to sound negative about a situation, even when I'm not. Bad trait.
I don't think it's causing instability, but we'll see. In fact, I thought that stims were considered "safer" in that dept. for Bipolars than SSRI's. Ah, it's all so confusing... :)
I know I can't take an SSRI, so hopefully, this, or a different stim, will do it.
Take care.
- kk.
Posted by Ritch on June 5, 2002, at 13:18:09
In reply to more on concerta, posted by Krazy Kat on June 5, 2002, at 10:24:08
> ah, tis a fascinating subject, tisn't it? perhaps i will keep this thread going for years... ;)
>
> i am taking 36 mg of Concerta for the first time today. Took 18 mg for about a week. I'm having some struggle with a mild depression, and pdoc wants to see if the Concerta can handle this. I'm a little skeptical, but then I do not want to add Welbutrin (his other thought) because it made me so irritable and just plain mean the last ime i tried it.
>
> Concerta downsides - nausea, nausea, nausea. Headaches in the afternoon. Jumpiness. Desire to bawl (but I think this is the depression now).
>
> Concerta benefits thus far - am awake more and can focus somewhat better.
>
> Am still taking Depakote 1000 mg at night and 1000 mg in the morning.
KK,Have you noticed that it lasts long enough throughout the day at the higher dose? I am a little surprised your pdoc didn't notch you up to the 27mg dose first, though. I hope it works out OK. I know what you mean about SSRI's. For me they are *instant* hypomania (*all* of them!). Effexor was even worse. Remeron made me agitated and confused/hostile. Serzone settled me down, but I was very confused (like trazodone). Wellbutrin makes me very panicky and grouchy. Dexedrine has been the weirdest experience (for a stimulant). That stuff actually makes me feel sleepy, my eyes get this relaxed-tired look to them. The thing about stimulants that I have noticed (*all* of them), is they tend to cause mood SAMENESS all day for me (that is if the blood levels are reasonable constant). Now, the SAMENESS might not be that super of a feeling. They tend to make me too nervous and jittery, but it is the SAME feeling all daylong, day after day. When I was on the dex for a month-my mood chart just shows nothing but goose-eggs (0) for mood. If I could just tolerate the anxiety..
Mitch
Posted by Krazy Kat on June 5, 2002, at 13:58:24
In reply to Re: more on concerta » Krazy Kat, posted by Ritch on June 5, 2002, at 13:18:09
Heh Mitch. How are you?
Re: the 27 mg. - my pdoc and I discussed this. I had been up to 25 mg. before on Ritalin and hadn't noticed a big difference between 20 and 25, so he felt that 36 would be an o.k. jump. I'm o.k. with it because I would have had to wait for yet another script if we went to 27 first.
First day, so I'll let you all know about the possible extension of benefits into the evening tomorrow. He didn't feel it would affect that and mentioned the same thing Chris did as a solution - taking 5 mg at, say, about 4:00. He said no later than that, though.
My sleep patterns are still wacky, so I imagine he wants me to try it at this level for a little while before adding any at the end of the day. Of course, I am getting impatient and want it all fixed now!!! :)
I have not tried Effexor.
Re: "Serzone settled me down, but I was very confused (like trazodone). Wellbutrin makes me very panicky and grouchy."
Boy, both of those affect me the same way. I find it fascinating that we have quite a few similarities because of our sex and age difference.
Re: "mood SAMENESS"
That would be a goal, IF, that anxiety/jitteriness can be controlled. So again, it seems as if we react similarly here.
Perhaps a small amount of something else can control that? It couldn't be sedating for me. How many meds does it take? Ug. ;0
Also, after I am on 36 mg of Concerta for a few days, I will try your suggestion of taking the Depakote at even more spaced out intervals - maybe 500 mg in the morning, 500 in early afternoon, 1000 at night.
And my mood chart/journal is a big goal...
- kk
Posted by Ritch on June 5, 2002, at 23:41:36
In reply to Re: more on concerta » Ritch, posted by Krazy Kat on June 5, 2002, at 13:58:24
> Heh Mitch. How are you?
Well.. springtime hypomania is definitely over. I can tell because I am not buying any new music. I am listening to old vinyl instead. The imipramine is helping (good for generalized anxiety), but seems to have too much antihistaminic fog compared to nortiptyline. I still need to wait another full week to see though. Desipramine had zero effect until about 10 days into it and then things started "sharpening up". What starts to happen with the NE meds (for ADD symptoms), is a shift in perception of details. I start noticing things I hadn't noticed before, and I start marking times/dates on calendars and PLANNING things. The present moment seems to be a wider, more forgiving "space" to use my short-term memory and it doesn't feel like such a huge EFFORT to process ordinary tasks. Moderate seasonal depression will be kicking-in by the end of the month and be in full bloom by mid July.
>
> Re: the 27 mg. - my pdoc and I discussed this. I had been up to 25 mg. before on Ritalin and hadn't noticed a big difference between 20 and 25, so he felt that 36 would be an o.k. jump. I'm o.k. with it because I would have had to wait for yet another script if we went to 27 first.
That seems fairly logical-he probably didn't want to wait and go through another bump in dosage.>
> First day, so I'll let you all know about the possible extension of benefits into the evening tomorrow. He didn't feel it would affect that and mentioned the same thing Chris did as a solution - taking 5 mg at, say, about 4:00. He said no later than that, though.Chris's suggestion makes a lot of sense-you use the same med, but just "fill-in" the last few hours of the day.
>
> My sleep patterns are still wacky, so I imagine he wants me to try it at this level for a little while before adding any at the end of the day. Of course, I am getting impatient and want it all fixed now!!! :)Have your sleep "patterns" always been "wacky"? Or is this a phenomenon of stimulant use? Can you explain the "wackiness"? I noticed during major depression that Adderall stabilized and made my sleep *more* consistent*. However, with dexedrine I noticed an overall reduced sleeptime (but no interruptions), Focalin did the same thing. But those two trials were during my hypomanic time of year. The Adderall was tried during a major depressive episode-I slept 7 hrs a day instead of the typical 10hrs. at that time of year.
>
> I have not tried Effexor.I wouldn't be excited about trying it-if I were you. The only thing I really liked about it was-if I was experiencing a very major depressive dip, I could take just 12.5mg and snap out of it in a matter of hours and that would last for a few days! But, it was just too destabilizing overall, and made me itch.
>
> Re: "Serzone settled me down, but I was very confused (like trazodone). Wellbutrin makes me very panicky and grouchy."
>
> Boy, both of those affect me the same way. I find it fascinating that we have quite a few similarities because of our sex and age difference.I liked Serzone because it didn't send me pacing all around like SSRI's did. In fact, I felt physically rested and calm sitting still. I just had trouble focusing mentally and I also have trouble with my eyes crossing and difficulty keeping them both aimed straight (exotropia). Interestingly, meds that help with *mental* focus also keep my eyes straightened out. Serzone also made me itch, too!
>
> Re: "mood SAMENESS"
>
> That would be a goal, IF, that anxiety/jitteriness can be controlled. So again, it seems as if we react similarly here.
>
> Perhaps a small amount of something else can control that? It couldn't be sedating for me. How many meds does it take? Ug. ;0That's what I am hoping the imipramine will do for me. I know it has been effective for ADD symptoms, and panic/generalized anxiety.
>
> Also, after I am on 36 mg of Concerta for a few days, I will try your suggestion of taking the Depakote at even more spaced out intervals - maybe 500 mg in the morning, 500 in early afternoon, 1000 at night.
>
> And my mood chart/journal is a big goal...
>
> - kk
I saw some guidelines for Depakote dosing (can't remember the source) that mentioned that you should avoid single doses greater than 500mg. In your case you would need to take 500mg tabs 4x daily. Are you taking the Depakote ER 500mg instead of the regular Depakote CR 500mg? You just *might* be able to take get by with 1500mg Depakote a day instead if you were taking 500mg ER 3x daily-possibly. You can ask your pdoc if you aren't already taking the ER version.Mitch
Posted by Schuyler on June 6, 2002, at 11:23:22
In reply to Re: Concerta Update - Mitch and Anyone » Ritch, posted by Krazy Kat on June 2, 2002, at 16:43:34
I did not like Metadate CD, which I think is just like Concerta, because it began to wear off after 9 or 10 hours (like the package insert said it would). I'm going to try Methylphenidate SR (slow release) instead: one dose when I wake up, another about 2 in the afternoon, so I'm covered for 16 hours or so.
Schuyler
> thanks! what do you think about Concerta wearing off after about 10 hours? I know its half-life is 12 hours, but I will need something that lasts a good 12-14 hours to handle "real life" eventually. :) If I up the dose to 27 mg., does that extend the half-life as well?
Posted by Krazy Kat on June 6, 2002, at 11:53:13
In reply to Re: Concerta Update - Mitch and Anyone, posted by Schuyler on June 6, 2002, at 11:23:22
Posted by Krazy Kat on June 6, 2002, at 12:14:48
In reply to Re: more on concerta » Krazy Kat, posted by Ritch on June 5, 2002, at 23:41:36
>> Well.. springtime hypomania is definitely over. I can tell because I am not buying any new music. I am listening to old vinyl instead.
Is this good or bad?
>> I start noticing things I hadn't noticed before, and I start marking times/dates on calendars and PLANNING things.
Yes, that's the first thing my husband said he noticed when I started Ritalin - I was "scheduling" again. I used to be responsible for scheduling in publishing, so the loss of that skill has been an evident one.
>> it doesn't feel like such a huge EFFORT to process ordinary tasks.
That's a little better for me, as well.
>> Moderate seasonal depression will be kicking-in by the end of the month and be in full bloom by mid July.
Do your meds help with this, or is this something you have come to work through on your own?
> Have your sleep "patterns" always been "wacky"?Yes. I imaigine all of "ours" have been. :)
>> Can you explain the "wackiness"?
Even though I get really tired after about 10 hours on Ritalin, I usually can't sleep. But, regardless and prior to the Ritalin, for about a month I've been falling asleep between 1:00 and 2:00 am and sleeping until about 10:00. Alarms do not wake me up. Or I turn them off.
Now this is less in hours than it was before, but the time frame drives my husband crazy. And he hates having ti wake me up. I feel "guilty", as if I should be sleeping 10:00 pm - 7:00 am. Maybe it's more of a relationship issue...
The great thing is I am not constantly afraid I will fall asleep during the day like I was on Topamax. I couldn't take the train home from NYC without having a panic attack the whole time that I would fall asleep and miss my stop. Ridiculous. Caffeine did nothing to help. And it took my pdoc months to accept that was a problem. That's when a Major depression hit, and I said "I won't take Topamax anymore and I'm going into the hospital if you can't fix this." ;)
It would be hard to convince me to try Effexor. I don't want to belittle its use, since I've seen posters here who benefited from it, but I just Know it would be a horror story for me.
>> I liked Serzone because it didn't send me pacing all around like SSRI's did.I recall having one of those epiphanies on Serzone one morning, feeling more optimistic than I had in years while walking to work. But then, that could have been a reaction to my seeking help. It didn't really touch my depression at that time, though.
>> Interestingly, meds that help with *mental* focus also keep my eyes straightened out.
That is interesting - I wonder if there's a physical connection?
>> That's what I am hoping the imipramine will do for me. I know it has been effective for ADD symptoms, and panic/generalized anxiety.
Ah, O.K. So this will be a good trial! I'll be intereseted to hear.
I haven't seen the Depakote guidelines you mentioned, but now I'm very curious. It certainly can't hurt to break up the doses. My pdoc was comfortable with my 1000mg at night and then 1000mg in the morning. I was taking it all at night to counteract the initial heavy sedation.
I'm not on ER. He wasn't "into" that option - I asked about it last time. I don't recall why he was against it. Maybe because he didn't feel it worked as well? I don't know.
Yeah, with his permission, I'd like to drop back to 1500 mg, but my blood level is low compared to others. My liver enzymes were up last time, not horrifically, but noticably, so maybe I can use that as an "excuse". It's odd, because I've taken it off and on for a year without there ever being an increase. AND, prior to that, I was drinking quite heavily at times, and tests were fine. So, I don't know.
I write too much in my responses to you. Sorry. :)
- kk
Posted by Krazy Kat on June 6, 2002, at 12:21:28
In reply to thanks for the input! (nm) » Schuyler, posted by Krazy Kat on June 6, 2002, at 11:53:13
Boy, was I more chipper yesterday than I have been in a long time. I didn't accomplish much, but then I haven't had internet access for about a week, and I was able to use hubby's computer. So I wrote a lot of emails.
Focus must be a little better. My spelling and editing abilities are returning to normal.
I felt myself getting tired after about 10 hours again. Big thunderstorms so had to stay up with scared old dog until about 1:00 am, so am not sure if I would have dozed off without that distraction.
Today, at 36 mg again, still feeling more chipper. Nothing hypomanic, just more energy, more optimism. It takes about an hour to kick in. So, I guess it's lasting about 9 hours for me.
Slept late again, though - nothing could wake me. I keep the concerta by my bed, and the IDEA is for me to take it when the alarm goes off, but I don't. I need a solution to this.
All in all, decent two days thus far.
Also, jitteriness doesn't set in until later in the day. Must be a reaction to the med's downslide.
No caffeine yesterday.
- kk
P.S. Should I mention that I'm 31, female, about 145 pounds so that others can see what my make-up is?
Posted by Ritch on June 6, 2002, at 13:06:57
In reply to Re: more on concerta » Ritch, posted by Krazy Kat on June 6, 2002, at 12:14:48
> >> Well.. springtime hypomania is definitely over. I can tell because I am not buying any new music. I am listening to old vinyl instead.
>
> Is this good or bad?
It is bad, because it means that I am slowing down steadily. It is the blah few weeks before the depression will strike. Yuck, I am going to ramp up AD's, do whatever. I want to wade through this as quickly as possible!
> >> Moderate seasonal depression will be kicking-in by the end of the month and be in full bloom by mid July.
>
> Do your meds help with this, or is this something you have come to work through on your own?Meds are absolutely necessary. Eeek, without meds I would probably lose my job. So far, only Adderall completely wiped one out, but the anxiety (yuck). If it gets bad enough I may have to bug my pdoc about some anyhow (for a few weeks).
> > Have your sleep "patterns" always been "wacky"?
>
> Yes. I imaigine all of "ours" have been. :)
>
> >> Can you explain the "wackiness"?
>
> Even though I get really tired after about 10 hours on Ritalin, I usually can't sleep. But, regardless and prior to the Ritalin, for about a month I've been falling asleep between 1:00 and 2:00 am and sleeping until about 10:00. Alarms do not wake me up. Or I turn them off.
>
> Now this is less in hours than it was before, but the time frame drives my husband crazy. And he hates having ti wake me up. I feel "guilty", as if I should be sleeping 10:00 pm - 7:00 am. Maybe it's more of a relationship issue...
> I haven't seen the Depakote guidelines you mentioned, but now I'm very curious. It certainly can't hurt to break up the doses. My pdoc was comfortable with my 1000mg at night and then 1000mg in the morning. I was taking it all at night to counteract the initial heavy sedation.
>
> I'm not on ER. He wasn't "into" that option - I asked about it last time. I don't recall why he was against it. Maybe because he didn't feel it worked as well? I don't know.
>
> Yeah, with his permission, I'd like to drop back to 1500 mg, but my blood level is low compared to others. My liver enzymes were up last time, not horrifically, but noticably, so maybe I can use that as an "excuse". It's odd, because I've taken it off and on for a year without there ever being an increase. AND, prior to that, I was drinking quite heavily at times, and tests were fine. So, I don't know.
>
Hmmm. That sounds like oversleeping due to the that big Depakote dose at bedtime to me! I can reliably change my sleep duration by adjusting my bedtime Depakote dose up or down. You also must realize that your Depakote blood level is the lowest of the day right before you take your dose at nite. It is going to take a few hours for that dose to peak, that's why you can't get to bed until later. Then it kicks in big time while you are sleeping and you are a zombie when you try to wake up. I really think you might try 500mg 4x daily, that sounds like a pain in the arse, but I wonder if you will get to sleep earlier, not sleep as heavily-because your lowest blood level would be shifted to wakeup time. Hey, then if you are still too tired during the day then drop the dose to 500mg 3x daily (evenly spaced). My guess is that your pdoc doesn't write for the ER because it is probably a lot more expensive for the same thing and he thinks it is just a gimmick that won't really help all that much-it may very well be :).
>
> The great thing is I am not constantly afraid I will fall asleep during the day like I was on Topamax. I couldn't take the train home from NYC without having a panic attack the whole time that I would fall asleep and miss my stop. Ridiculous. Caffeine did nothing to help. And it took my pdoc months to accept that was a problem. That's when a Major depression hit, and I said "I won't take Topamax anymore and I'm going into the hospital if you can't fix this." ;)Hey, I almost wrecked my car on Topamax (just 50mg/day), not to mention drawing complete blanks at work.
> >> Interestingly, meds that help with *mental* focus also keep my eyes straightened out.
>
> That is interesting - I wonder if there's a physical connection?
Oh, I am sure there is. I think it has to do with neurotransmitter not being available to coordinate my eyes properly. When there is enough available, I am more attentive as well. Or it is just my overall level of wakefulness. That is what my depressions are like-extended narcoleptic spells.
> I write too much in my responses to you. Sorry. :)
>
> - kkOh no, That's quite OK. All of these detaily things may answer somebody else's questions about something similar and save somebody else some time, too. :)
Mitch
Posted by Krazy Kat on June 9, 2002, at 12:03:04
In reply to Re: more on concerta » Krazy Kat, posted by Ritch on June 6, 2002, at 13:06:57
last two days have been very slow. i have been very tired and Concerta was no help. but then i slept badly. today i am better, though not at the point i was the first few days on it. i have a fear i react well to stims initially then they even out and don't help much. we'll see.
Posted by Ritch on June 9, 2002, at 14:20:35
In reply to a few bad days..., posted by Krazy Kat on June 9, 2002, at 12:03:04
> last two days have been very slow. i have been very tired and Concerta was no help. but then i slept badly. today i am better, though not at the point i was the first few days on it. i have a fear i react well to stims initially then they even out and don't help much. we'll see.
KK,There are a lot of posters here that have mentioned tolerance and poop-out with stimulants. I didn't have that trouble with Adderall. I started at 5mg/day and just stayed there. I felt mildy euphoric and had some insomnia the first few days, but that wore away rapidly and I just had focus-and that was it. It really wasn't mood elevating in any way. d-methylphenidate gave me zero mood elevation from the start-just an immediate focusing effect. Dexedrine was mildly mood-elevating, but didn't help me focus that well. They all make me a little too anxious. Do you think the stimulant is aggravating your cycling?
Mitch
Posted by Krazy Kat on June 12, 2002, at 9:15:02
In reply to Re: a few bad days... » Krazy Kat, posted by Ritch on June 9, 2002, at 14:20:35
re: worsening cycling - I don't know.
Concerta is definitely making me irritable/anxious/jumpy by early afternoon. It's a bad feeling.
No AD effect, but it is/was definitely helping with energy and focus.
I did not take it this morning, and I am exhausted. I wanted to leave it off for a couple of days and see what happened.
So I guess it will be adding something to counteract the side effects of the medicine I'm taking to counteract the side effects of the medicine I'm taking to keep me stable, OR try Welbutrin again, or Remeron...
- kk
Posted by Ritch on June 12, 2002, at 9:48:28
In reply to cycling and stims... concerta » Ritch, posted by Krazy Kat on June 12, 2002, at 9:15:02
> re: worsening cycling - I don't know.
>
> Concerta is definitely making me irritable/anxious/jumpy by early afternoon. It's a bad feeling.
>
> No AD effect, but it is/was definitely helping with energy and focus.
>
> I did not take it this morning, and I am exhausted. I wanted to leave it off for a couple of days and see what happened.
>
> So I guess it will be adding something to counteract the side effects of the medicine I'm taking to counteract the side effects of the medicine I'm taking to keep me stable, OR try Welbutrin again, or Remeron...
>
> - kk
Hi,So you are saying the *cycling* you are experiencing is a thru-the day phenomenon? If so, it may be the sixth-hour blood level peak of the Concerta combined with the undulating levels of Depakote. Have you talked to your pdoc about a possible flip to Adderall or Adderall XR? I found Focalin to be a lot more nerve wracking than the amp. products. The least nerve-wracking of those was dexedrine. It didn't seem to help focus much, but at least I wasn't fatigued (or restless). Perhaps 2 or 3 5mg Dexedrine spansules through the day would work for you? I would try a flip to that before you add-on anything else or switch back to an AD. I definitely had much *less* of the "several days up, several days down" type of cycling with dexedrine. You really need to chart, IMO. You don't have to fill out something really complex, etc. For many years, all I did was write a positive or negative number on a calendar. I would put a number in the bottom left of that day for how I felt when I got up, then a number in the bottom right for how I felt in the evening before I went to bed (and as a gauge for how the day went). Then all you have to do is glance at it and you can see the pattern (if it is wide enough).
Mitch
Posted by Krazy Kat on June 13, 2002, at 12:28:47
In reply to Re: cycling and stims... concerta » Krazy Kat, posted by Ritch on June 12, 2002, at 9:48:28
>
> So you are saying the *cycling* you are experiencing is a thru-the day phenomenon?Yes, Mitch, it's thru-the-day - sorry if that wasn't clear.
> If so, it may be the sixth-hour blood level peak of the Concerta combined with the undulating levels of Depakote.
You had mentioned that so I'm taking the Dep. in the afternoon now - I can't remember it more than twice a day.
All the others are good suggestions. Thanks for your continued support.
- kk
Posted by Ritch on June 13, 2002, at 22:12:07
In reply to Re: cycling and stims... concerta » Ritch, posted by Krazy Kat on June 13, 2002, at 12:28:47
> >
> > So you are saying the *cycling* you are experiencing is a thru-the day phenomenon?
>
> Yes, Mitch, it's thru-the-day - sorry if that wasn't clear.
>
> > If so, it may be the sixth-hour blood level peak of the Concerta combined with the undulating levels of Depakote.
>
> You had mentioned that so I'm taking the Dep. in the afternoon now - I can't remember it more than twice a day.
>
> All the others are good suggestions. Thanks for your continued support.
>
> - kk
No problema. It looks like you have to really *work* on getting your med levels smoothed out the best you can during the daytime, IMO. Also, intraday cycling can also be responsive to thyroid T3/T4 augmentation. Hmm.. You might talk about that to your pdoc.Mitch
Posted by Krazy Kat on June 17, 2002, at 19:20:14
In reply to Re: cycling and stims... concerta » Krazy Kat, posted by Ritch on June 13, 2002, at 22:12:07
thanks mitch - nice idea. i have taken it before and it might have helped. i'm not certain. that was when i was going manic so everything was out of wack.
i have been taking 1000 depakote and 18 mg of concerta upon rising - 8:00 - 9:00 am (on good days :)), and then same doses at about 2:00 pm. this is helping. I get tired some days at about 8:00 pm, And I have added a little "left over" Neurontin, not consistently but when I feel anxious at a certain point during the day. it seems to help the anxiety.
Where are you with your regime?
- kk
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