Concerta 54 "It makes me so jittery, but I can concentrate better"

[BusynMember]

Any suggestions on what to do? Jumper came home and her eyes literally looked like they were glowing. I found out her dad had been forgetting to give her her ADHD medications so I quickly took over that duty and she took Concerta 54 mgs. for the first time in days. It was also her first 54 mg. dose. She was very jittery, even said she was talking to herself in school and didn't realize it until somebody pointed it out to her. She told me she had no idea why anyone would want to take this drug to get high...she doesn't like it at all. She also asked if it was because she just started it and if there was another medication for ADHD. She does want to do well, yet she doesn't want to feel this way. The doctor is calling me back, but I think I"m going to drop the ADHD medications and let the school deal with her learning problems without medications. Judging by what she said about how she did on the testing, I feel certain she is going to get another IEP (and hub and I will never ever ever agree to drop the IEP again...haha!) But we'll see. They may try that 504 stuff, which we don't like because it isn't a legal document and the school can mess with it.

 

[DammitJanet]

There are lots of ADHD medications. Maybe 54mgs is just too high a dose and she should start lower. Of course, there is the long standing ritalin which she could start at a very low dose and take twice a day. Adjusting to that would be easy to see where she needs to be.

I know you hate adderal but it can be a very good medication. There is the daytrana patch or vyvanese. I personally wouldnt give up on medications after one trial of one medication of one day. Not when medication can make a dramatic difference in a person with ADD and give them the tools to make life so much easier. In my mind its almost like denying someone a wheelchair when they have no legs and making them use crutches instead. They might be able to get around slowly but it would be so much easier with the chair.

 

[Marguerite]

Dosages vary and it doesn't seem connected to severity of symptoms. I would try a much lower dose. A friend of ours was actually cutting Concerta in half (not recommended) but did find this way that her son does better on a much lower dose.

The problem we have had with methylphenidate (ie Concerta and ritalin) is rebound. If you didn't see rebound problems (teariness or irritability as it wore off) then I would just ask the doctor for a much lower dose to begin with; maybe 18 mg. She could take two of those and still be on less than the 54 mg.

Other alternatives - our kids take dexamphetamine. We get it privately compounded into a long-acting tablet, 10 mg. difficult child 3 takes the biggest dose - 30 mg plus a short-acting 5 mg if needed. easy child 2/difficult child 2 takes half a long-acting tablet (5 mg total) and then only on some days.

It's good that she didn't like the feeling of taking more than she needed. Tell her to hold that thought, but see how she goes on a quarter the dose. Or a different medication. But medications clearly did help in her case.

Marg

 

[BusynMember]

Thanks, guys. She started out at 18 mgs. and went up. 18 mg. didn't help her concentrate nor did the next dose. Not sure about the 36 mgs. She doesn't like being jittery. And if she is jittery, even if she can concentrate better, hub and I aren't sure it's going to help her in life. One of her biggest gifts is her calmness and emotional intelligence, which goes on the rails when she takes this. I'll be talking to her doctors about options. I'm also going to ask Jumper how she wants to do this. She is level-headed and fourteen and we do take her opinion into consideration. She does not make impulsive or off-the-wall decisions. She makes them for reasons. I'm so disappointed though. I was hoping this would make school easier for her without affecting her negatively. I guess it's a 'wait and see" game now. I already talked to her doctor and he said to cut the dose by one. I literally could see how wild-eyed she was today...lol. And she hasn't taken any since 7am this morning...and she's still high!

 

[Marguerite]

I know I have said before that it is a blunt instrument - but how is she on caffeine? We run a caffeine-free household (although I do have "full leaded" coffee available). Our kids, if they react to stimulants, will also generally react to cola. If she also drank cola or had caffeine in other form while on the medications, it could have added to the 'wired' effect.

My sister sent me some coffee from her own plantation. I drank some and was wired for hours. Great coffee, though!

A woman I know self-medicates her own ADHD with cola and coffee.

Marg

 

[GoingNorth]

My late husband self medicated his ADHD during his military career by using strong coffee and tea. He even ate the chocolate covered coffee beans sold as candy in Europe. I tried 'em and they made me climb the walls.

Once he got out of the Army, he went on Ritalin and then on Dex, both of which worked well for him

 

[BusynMember]

Thanks to both of you. Unfortunately, Jumper drinks a lot of caffeinated drinks and they don't affect her either way.

 

[trinityroyal]

If Jumper is drinking a lot of caffeinated drinks then it may be the combination of stimulant and caffeine that is too much for her and making her jittery.
I wonder if something like Strattera might work. From what I understand it gives the focus but isn't a stimulant so it doesn't hop you up.

I find that strong tea and lots of it helps me with my ADHD symptoms. Stims however cause me to do handsprings. Literally -- when I was a teen they trialed me on ritalin, and I was doing tumbling runs up and down the hallway at school for hours until they wore off. Run, run...cartwheel, round-off, cartwheel, cartwheel, handspring...and dismount! Over and over.

 

[Marguerite]

After difficult child 3's experience, I would be wary of Strattera. But I do agree, it should be on the list for consideration.

Marg

 

[BusynMember]

Thanks again.
Right now Jumper is in basketball and the coach has told the team they can't have any soda drinks while they are on the team. She is taking that seriously and hasn't had any caffeine at all, so that wasn't it.
I have not heard really good things about Stratera and ADHD and since that is a drug that stays in your system, I don't think hub and I and I doubt Jumper would want to go there. We'll take it a day at a time, I guess.

 

[susiestar]

Wiz has taken ritalin, adderal, concerta, long acting adderal, and strattera. Concerta worked better than ritalin, largely because it worked longer. Oddly, we used a small dose of adderal in the afternoons for a few years because it helped with homework. He did very well on them for a long time, and had several dosage increases. He only felt jittery if he added caffeine to them in any significant amount. A sip or so from my coke wasn't a problem, but even a small coke of his own was. He has taken strattera for over 6 years, with only 1 dosage increase that was in the first year of taking it. It works amazingly well for him with NO side effects, at least not any that he ever mentioned. He had PLENTY of opportunities to mention side effects. My mother has said she would like to take it but because the way her digestive tract has been altered combines with her liver problems, it isn't processed safely by her system. My bro has a psychiatrist he has traded yard work, tree trimming and fire wood with in exchange for treatment and free samples of strattera and it is amazing how it helps him. He will not take stims because other issues. Strattera does stay in the system, but it also might help her. It might not, and there IS a risk of side effects, but Janet has a good point about the wheelchair.

She really NEEDS the help NOW. A short trial of strattera would tell you, and her, if it would help more than it would cause problems. It would clear out of her body in a short time, and if it would help her this might be worth trying. Yes, it can cause problems, but so can every other thing. Even AIR can be a problem, the trick to life is figuring out what is worth trying. Maybe strattera is something that would be worth trying for her? It is at least worth discussing with the doctor and Nichole, in my opinion.

I hope that the school gives her the help she needs, but if medications can also help it might open up an entire wonderful new world of opportunities for her.

 

[Marguerite]

Strattera doesn't stay in your system for very long, it would be washed out in a week. When we took difficult child 3 off it, it took about three days, max, for it to seemingly wash out totally. By next morning (ie first day of not taking it) we had our boy mostly back to normal. And remember, he does react oddly to a number of drugs, so do't let our experience totally put you off. Just go carefully and stop it if there are problems, don't keep her on it (like we did with difficult child 3) if the results are not what you hope for.

But there are other drugs to try, also short-acting.

Marg

 

[BusynMember]

Well, the thing is, Jumper's life is pretty good. She struggles in school, but not in any other way. If medications are going to cause feelings she doesn't like or behavioral problems, I would rather not go there. More importantly, Jumper is old enough to decide if she will or won't take medication. Now if she had a severe mental disorder or was struggling in all areas of life, hub and I would put our foot down. But she is a very level-headed young lady, quite mature in many ways, and she really doesn't like feeling drugged. I may ask doctor if he would try a faster acting in/out medication (good idea) like plain Ritalin. I don't know if she'll put up with the ups and downs though and I don't blame her. I was put on many medications that didn't feel right and I stopped taking them. It's too bad there isn't any medication that helps concentration and doesn't make ya hyper. Her friend was over last night, laughing about how goofy Jumper was acting at school. Jumper said she couldn't sit still, couldn't stop talking, and could barely stay in her desk. She DID finish her homework fast, but I guess in this case we will have to weigh the pros and cons.

They need to invent a magic pill that will fix everything with NO side effects

 

[Marguerite]

she really doesn't like feeling drugged

That is gold. For both of you.

A thought - easy child 2/difficult child 2 has only really needed medications when studying. She is prescribed medications for every day but especially as she got older, cut back her medications to nothing on days off. Not something I would normally recommend. At the recent appointment, the doctor asked her what happens if she doesn't take her medications. "I don't feel any different," she said. "But other people want to kill me."
At which point difficult child 3 proudly announced, "I can tell if I haven't had my medications. I am younger than she is, but far more self-aware." Far more smug, too.

But my point is - the amount easy child 2/difficult child 2 was originally prescribed, and she used to take, was about twice what she takes now. She didn't like how it made her feel and she chose to cut it back. She finally worked out the dose where she felt she could function at school, cut herself right back to the lowest possible level while still able to concentrate. And that is very low compared to the boys. But it is enough. And the side-effects, from her observation - she can't tell how she feels, whether she's taken medications or not. But before, on the originally prescribed dose, she could and didn't like it.

She was about 15 or 16 when she cut her dose back to its current level (on the days when she is medicated). She does take her medications when she is at work, too. But I think she has cut her dose a little further for work; doesn't need as much for work as for study.

As a result, she does tend to stockpile medications for which we are often grateful - we buy the extras off her and sell them to difficult child 1 when he has forgotten to organise his appointment with his new specialist; The new doctor orders difficult child 1's medications from the same pharmacy and they get delivered to us, the kids pick up their medications from us because it works out cheaper and more convenient. We get a bulk delivery, one fee covers all the kids. We pay for the medications and the kids reimburse us (including difficult child 3 - now he's on disability, he can pay for his own darn medications).

The ups and downs may settle a little, too. But it does sound to me like she is on about twice the dose she really needs to function. As I said, it's not a matter of severity of symptoms. difficult child 3's good friend is quite severely ADHD but his medication dose is microscopic. Funny how it works.

I hope you can find something for her, that she feels OK with. I agree, it is better to learn to cope without medications, than put up with unpleasant symptoms.

Marg

 

[DammitJanet]

Ritalin doesnt make you feel high. It works on different centers in the brain that regular speed. You would have to take a real boatload of the stuff to actually get it to cross the blood barrier to get to cause any sort of speed feeling and by then I would think you would really be sick. Also people with ADHD/ADD are lacking something or their brains react to these medications in a different way than people without these disorders. When my son was on ritalin you could literally see him calm down when the medicine took effect.

 

[BusynMember]

Ritalin did make ME feel high...lol. Ah, well. But I LOVE a combination of two ideas, which is why I ask you wise ladies for info.

1/I love the idea of only taking the medications, say, when she has to focus on a test. Under those conditions, Ritalin may be great for her. She has a tendency to get frustrated and distracted during tests. So that is one option. Jumper NEVER took medications on weekends or non-school days. Like I said she doesn't like the way she feels on it and, in spite of always whining "I'm fat", she doesn't like that she has no appetite when she takes it. Last night, she told me today, she couldn't fall asleep. So a little at time only when necessary might be a solution. And at a lower dose. She did not have problems at a low dose. I will talk to her Dr. on Monday. I appreciate all the helpful hints...it has formulated a possible plan. And it made me think outside the box. Jumper also will appreciate it. Thanks a lot.

 

[Marguerite]

I hope you can work something out between you, the doctor and Jumper. She especially needs to feel she can own the choice being made. I found the same thing when easy child 2/difficult child 2 was the same age; I didn't want her to cut her dose but she spoke to the doctor (in my presence) and complained that the medications made her feel 'flat' and boring. So he okayed a drop and we found she could still function academically, even though she became a lot more hyper on the lower dose. We gradually got used to the new easy child 2/difficult child 2 and she also got used to needing to apply her own dampers on her enthusiasm and "blondeness".

And I think that's an important point too - as they get older, they learn to apply their own controls and this overlays any medications. In those who are unmedicated, the need to learn your own controls is much stronger and if it is possible, they do learn to do it. I know difficult child 1 wouldn't have been able to make much adjustment without medications, he needed it too much. Ditto with difficult child 3. But in some more borderline cases, they do grow up without medications and learn to adapt anyway. So a low dose could be a valuable compromise - give her enough control, when she needs it, and at other times she has to learn to manage and find her own coping skills.

She's a smart girl and very self-aware; that is gold also.

Marg

 

[DammitJanet]

Ritalin or low dose focalin may be the answer here. They are quick in and quick out medications. I remember having these huge bottles of ritalin when both boys were on it before they came out with longer acting ritalin. They had to take them twice a day each...sometimes even 3 times a day if we had something important in the late afternoon. Like maybe 10 or 20 mgs in morning and at lunch then a 5 mg kicker at 4 to get thru the afternoon event.

Jamie didnt take his ritalin during summers or on weekends unless he had some big homework thing he needed to do. He will tell you that the medication taught him how to handle his attention issues. He would have never made it without it. I have a feeling he and his wife are going to have a fight about medicating their dtr one day. He believes in medication, she swore before she ever had a child that no child should be on medication...we shall see...lol.