(trying to describe this right; details may vary!)
So methylphenidate (ritalin, concerta, etc) raises dopamine and norepinephrine. VERY common is “crashing” from ritalin (depression, irritability, others) after it wears off, as one or both of these chemicals go into withdrawal 'cause it was so high. My question is, is this crash caused 100% by the level of these chemicals, and hence can you get over that crash completely just by taking more ritalin?
So e.g. if my dop/nor levels on ritalin are +20 (I’m making this up), and after effect levels go down to -10, will taking more ritalin just boost it back up to +20 and COMPLETELY eliminate any and all withdrawl symptoms? Or is it like a hangover that you can’t cure just by taking more alcohol?
Do you think a great night’s sleep might help, as that might boost dopamine higher so if you come down from ritalin it might not be so bad?
yes I’ve read lots of articles, this point still eludes me. that’s when i turn to you guys
Someone correct me but is it accurate to say that stimulants have 2 main categories of effects, releasing agent or reuptake inhibitor (with subcategories within those 2 categories)?
We might expect that, to the extent a stimulant is a releasing agent, taking more would do little to curb a crash unless only a small dose was taken (thus leaving plenty of reserves). To the extent it’s a reuptake inhibitor, taking more would help curb a crash. If a stimulant is both, then it would be effective to the same ratio as it’s a reuptake inhibitor vs a releasing agent.
A reuptake inhibitor wearing off shouldn’t have you feeling that badly. A releasing agent wearing off could mess you up rather more badly.
Ritalin is only a reuptake inhibitor so it might be effective over a few hours or days. However, we might also expect that the habit of taking it would lead to a reduction in sensitivity to dopamine/norepinephrine after a few weeks, potentially really messing up someone with such a habit.
I sometimes get headaches when coming down from Adderall. When I did a bit of research on that I found that a lot of people mentioned making sure they had been eating and drinking enough before they got to that point. These stimulants tend to suppress your appetite as well as have the desired side effect of helping you focus while perhaps also helping you forget to do other things, like eat.
I’ve learned that I need to take a second does about 2 hours before I really think I’ll need it. So I tend to take my morning dose around 7ish and my afternoon dose around 11am. Before I was doing that, my afternoon dose was around 1pm. Usually sometime around noon I’d get a headache, but a second dose and some Tylenol would clear things up.
If this is real, I’d either ask your doctor about getting a second dose (which shouldn’t be an issue, 2x/day is pretty common) or even just try taking a second dose before you crash and see what happens.
TL;DR, try eating better and see if that makes a difference. Talk to your doctor. Crash or not, you generally don’t want to be coming down midday (exceptions, of course).
Also, if your crashing later in the day and/or you take two doses, I’d imagine sleeping more would only help in that it would limit the time you feel crummy. But at the same time, you can cause other issue if you start messing with your sleep cycle.
I recently had a terrible time after I skipped 3 or 4 days, went into terrible crash, and then started up without titration. Felt better eventually, but stayed up all night for another few days, which did make me feel shitty, but thank God not that kind of shitty.
Well, if he’s not sleeping well in the first place, he could be feeling crummy because he’s not sleeping well, and the Ritalin, as well as the fact that he’s just gotten up, could be masking it, but as the day wears on, having slept badly catches up with him, and he’s mistaking it for the effects of coming off of Ritalin.
I am the world’s greatest insomniac, and when I have a week when I’m sleeping five hours a night, I usually wake up feeling fine in the morning-- I wake up at like 4am, and I want to get out of bed. And I know from experience that when I feel like that, staying in bed and trying to sleep is useless-- better to get up and get things done now, because I’m going to feel rotten later. Sure enough, around 2pm, I start to feel bad. Just sort of run down at first, but sometimes by 4pm, I have nausea, and by 5 I have a headache. How seriously bad I feel depends on how many days I’ve been sleeping badly. I’m lucky I have a job that goes only to 3pm. By 5 or 6, I’m done. I can’t go to sleep yet, but the most I can do is sit on the couch and watch TV. I go to bed around 8pm, but I don’t fall asleep for an hour. Then I wake up at midnight, and am up for an hour, and I fall back asleep, and wake up again at four.
I take medication, so these stretches hardly ever happen to me anymore, and they last maybe three days when they do, but they used to happen every three or four months, and could last a week. Toward the end, I would start sleeping six hours a night, but the net deficit was increasing, and I was still feeling so lousy by the end of the day, it was hard to describe. Sometimes I’d cry myself to sleep.
Ritalin can interfere with sleep, which is why I’ve gone on about it. I have known several people on AD(H)D medications who needed something to help them sleep. Sometimes it was 5mg of melatonin OTC, and sometimes it was an Rx, like Klonopin, or even a tricyclic antidepressant. What you need is something you have to discuss with your doctor, but if you ave any reason to believe that you either aren’t getting enough sleep, or aren’t getting quality sleep, you really need to speak to your doctor.
Crashes aren’t normal if you are taking the medication as directed. Something is going wrong. Whether it is with your sleep, or that you possibly need a second dose, or another medication that will enhance the way that Ritalin works, this is really a conversation you need to have with your doctor. Please do.
My doctor told me the crashes were normal. When the Ritalin wore off in the evening I’d be down for an hour or two, then up again and unable to sleep. I tried more pills for sleeping and that just started a bad cycle of ups and downs and even less sleep. The time release version was supposed to be the fix but it didn’t seem to work on schedule for me and the Ritalin would start kicking in many hours later instead of gradually. IMO if you have sleep issues to start with then methylphenidate in any form can be problematic.
Oddly (or maybe not) when I was in college and taking ADD meds at probably above therapeutic dosages and not via therapeutic routes, I never really had any issues. But, then, I was taking them consistently through out the day, along with other things that would keep me wired. On top that, while I was never a drinker, the pot may very well have helped me sleep and rebooted me for the next day.
Yes, if he’s not sleeping or not sleeping well to begin with, that’s an issue in and of itself.
My comment about adjusting your sleep cycle comes from my neuro. I was talking to her about migraines and mentioned that sometimes when I’m having headaches lasting several days, I’ll do what I can to get more sleep. She said that doing that can backfire. She went on to explain that many people, when having bouts of headaches will go to bed earlier and/or take naps during the day, but this change in your sleep cycles can cause more stress and more headaches.
I can’t say I’ve ever known it to be true, but there it is.
Interestingly, for me anyway, on instant release meds, I’ve never had any issue. They work fine, they do what they should, they wear off and I can sleep with no issues. OTOH, both when I was in college and years later when I started them again, both my docs tried Adderall XR and Dexadrine (delayed release). In both cases, the delayed release meds did nothing for me, and if they did it was totally worn off within a few hours (that’s common for them). However, it would take me an extra hour or so to fall asleep.
But it just goes to show how everyone is different. In fact, whenever I see my doc and he asks me if the dosage is working, I usually tell him it is, but it’s odd, sometimes I take 1 in the morning, 1 later. Sometimes I forget about the second one. Sometimes I take 1.5 in the morning and the other half (or a full one) later. Sometimes I take 2 in the morning and sneak in a 3rd later on. He said that’s all pretty common.
I guess it makes sense. Most people have different levels of energy on different days. Coffee drinkers drink more or less depending on how they feel. It follows that someone that knows how their body works with these meds knows how much and when to take them. It does take some practice though.
I read somewhere, don’t recall where, a doc saying that if they’re kid seemed to wired or antsy to sleep, a half (quarter?) dose an hour or two before bed would help them sleep.
Also, if it’s taking too long to kick in, I know some people will set an alarm for an hour or so before they need to wake up, take their pill and go back to bed. It gives it a headstart and probably helps you wake up.
On this: I do take Klonopin (clonazapam) on occasion, as its prescribed for over-the-top anxiety, and yes it does bring you down and make you drowsy, but I’ve found that it does so when I took too much or could have gone without it–ie, it will work but it’s definitely “off-label,” and to me it isn’t worth the logy feeling I always get the next day. (Which is why I prefer normally Lorazapam, but that’s a different thread :).)
For similar “off-label” results, even before I had been prescribed the anti-anxiolytics–and of course not for clinical insomnia–a shrink once told me simply to take a Benadryl or two–the famous “drowsy” antihistamines all the others say they’re different from. In fact, the magic ingredient in all (?) the over-the-counter “sleep aids” is simply Benadryl.
It does work. Just don’t operate heavy machinery.
This seems bizarre to me, and I view it with horror–my cutoff time is noon, generally, and I just suck it up if I forget to take it or sleep late and miss that hour. (FWIW, my current shrink recommends I skip a day or two per week anyway–I take 54 mg Concerta.)
But everyone’s different, and your post reminded me that I either read or a shrink told me that a cup of coffee at some minimum time before bed–ie, before the caffeine effects that keep us up kick in–somehow works differently once you’re asleep, and can help.
That may work, a lot of stimulants can have that effect, initially charging you up, then becoming more of a depressant. I don’t want to speculate on how that works but MichaelEmouse was getting into the science up above.
This is a problem of not kicking in for hours, as if the stuff is sitting in my stomach and not getting absorbed at all for a long time, and then kicking in unexpectedly. I had similar problems with sleep medications, they wouldn’t seem very effective at night, but if I did sleep I’d wake up, seem to be fully alert, and then soon suddenly feel the medicine kicking in. And those weren’t time released. I don’t know what it is, I just know I’m better off in general without medications and just riding out the worst of the ADD and lack of sleep. The sleep issue gets pretty bad at times though, too much to go into now.
I tried Ritalin for a little while then Vyvanse (similar to Adderall). Having switched to Modafinil, I’ve encountered far fewer problems. It’s less abuse-prone too. I think Adrafinil is the milder, OTC version of Modafinil.
Sublingual administration doesn’t have that problem, unless the medication specifically requires some digestion-related mechanism. If you try that, you may want to try taking half what you usually take because your usual dose taken sublingually could be a little intense.
Huh - armodafinil is not OTC here in the US (brand name Nuvigil). I assume Adrafinil is a brand name for the same thing in Canada.
I use the stuff for daytime sleepiness (no matter how ‘well’ or long I sleep, I’m tired). It doesn’t make me feel rested but it lets me function. It’s got a longer period of action than plain Ritalin (or even plain modafinil / Provigil) which means I can get by on a single dose - but I cannot take that too late in the day or I’m up all night.
I liken the effect to buying something on credit. You have the benefits now, but at the end of the day you have to pay that bill.
I do have a small supply of Ritalin as well, that I can use when I have to do long drives. It lasts a couple of hours, then I am in dire need of sleep. On occasion, I’ve taken a second one a couple hours later, and it works as well as the first and mitigates the crash. I wouldn’t do it at 11 PM, mind you, but I’ve taken it at 8 PM and slept just fine at midnight. I would think that continuing to take it beyond that might keep me able to drive but then bring on all the other issues with lack of sleep.
Despite my post being responded to by others, the OP him/herself still has not cleared this up. The OP strikes me as odd for a few reasons, not the least of which being his reliance on sources like online articles and the opinions of random strangers on a messageboard for information he could easily obtain from a much more verified and trustworthy source, his doctor.
I’ve both had personal experience with stimulants (used non-therapeutically) and known a couple people very well who legitimately were prescribed them. In both cases, they can, even when allowing one to sleep, cause that sleep to be fitful and of a poor quality. Also, I like how you characterize tricyclic antidepressants as a step above klonopin as far as a sleep aid. Not the case at all. First of all, one is a controlled substance (klonopin sch. IV). Also, I am both an insomniac AND i am prescribed a tricyclic off-label for migraine. The med does absolutely zero to make me drowsy or help my insomnia whatsoever. This is in stark contrast to klonopin, which knocks me out. It’s not a long term option for me however due to dependence risk (for me personally, even the long acting benzos pose this risk). I will agree with you, based upon my personal non-therapeutic usage in contrast to those i knew who used it legitimately, that crashes weren’t really a thing IN LEGIT DOSAGES/USAGE. I definitely crashed but i was using it recreationally in supra-therapeutic doses. ETA: (edit upon preview) of those people that i knew closely, they did need sleep aides to function properly on stimulants. But they did function properly (at a relatively high level actually). This was an anecdote of mine based on two people tho, so take it with some salt.
This seems hard to believe. Hasnt the idea that those with ADHD (legit, diagnosed by medical professional) have a counterintuitive reaction to stimulants been debunked? Or am i misremembering? Meaning if you give it to a hyper adhd patient, it will calm them down, while it has the opposite (and logical) reaction in those without the disorder? I thought the positive effects of stimulants (for adhd) are now attributed to a more seemingly non-counterintuitive cause?
If you have criticisms of me, you could raise them productively, in a polite, constructive tone, or even send a PM. This childish whining doesn’t belong on any message board, you’re basically trolling. You may be trolling only one specific person, but that doesn’t make it any better.
I posted this thread 10 days ago, and I’ve been checking back frequently and mentally processing your helpful responses (I say all the time that I’m very thankful for people’s help/advice/info/etc on this board). Please point me to the response-rate that I’m required to adhere to on this board. You guys post a ton of info and I respect/appreciate that so much, so I try to take time to thoroughly read and mentally digest every post carefully. It’s not just reading the length of text on the board; it’s digesting the info carefully because it’s a not a kiddie-book. I usually read most of your responses multiple times so I can integrate them into my worldview.
When someone links to an article they think is useful, I try to spend time with that article. That effectively amounts to dozens–or if I follow links to other articles that those articles directly reference (e.g. Wikipedia internal links), hundreds–of pages of reading. With all that, there’s an element of TLDR and something has to be left unread. If you link to an article and I spend 10 min digesting it because it’s interesting and helps answer my inquiry, maybe I don’t have another 10 minutes right then to read more responses under the link or write responses at that time. I regularly go back to many previous threads I’ve started and continue to digest the answers and think about them.
Other readers may find your advice helpful, both current people passing through and people 10 years from now who might search for these topics. I occasionally steer away from very specific questions to me because I think it can make the thread a bit less useful to other general readers. It’s very nice for you to think of me personally, but it’s also nice to think of the general reader too. It can also be a balance of both. There are threads with tens of thousands of views. Maybe not every one of those people have time to go to their doctor and ask them the question that can easily read on this board. Or, they might not even realize they had the question until they stumble upon a thread.
I specifically started a thread on when to go to StraightDope vs other sources, and there were different opinions. naita said that “If you are dissatisfied with the first page of results on Google, go ahead and ask the SDMB”. Projammer said “I come here when I want opinions or some discussion/debate on the question”. And other opinions. I will genuinely factor in your opinion–that I shouldn’t post so many medical question–and consider it amongst the zany mosh-pit of other opinions.
Any one doctor will have one particular opinion. This board has many people with manywise and creative opinions and different personal experiences. That diversity can’t be obtained by one doctor’s opinion.
If you don’t like me, my threads, etc, why spend your personal time responding??
Sometimes I wonder why direct foul language on message boards is instantly deletable, while direct personal attacks are kosher.
Daft, cruel, and childish.
(I’m a “him” by the way.)