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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by jealibeanz on November 24, 2006, at 15:26:16
I just started Concerta for ADHD and fatigue. I took 18 mg for 3 days, and took 36 mg today. It is extremely mild! I can barely even tell that I took it. Luckily, I'm not having side effects, so I'm not considering discontinuing the medication, just asking my doctor about increasing.
I know that maximum FDA approved dosage is 72 mg. Even though I've only taken Concerta for 4 days, I can't imagine that 72 mg would be stimulating enough. I need more! Does anyone have experience with taking more than 72 mg?
BTW, I'd previously been taking 400mg Provigil, which is higher than the approved dosage. Although it's not considered a stimulant, it does have stimulating properties. This could be an indication as to why I'm barely responding to 36 mg Concerta. Apparently my body can handle more stimulation than most.
Posted by lymom3 on November 24, 2006, at 15:45:49
In reply to High Concerta doses?!, posted by jealibeanz on November 24, 2006, at 15:26:16
I used to take 108mg. I never felt like it did much for me. I have taken Ritalin LA and that makes me crash and burn about 1-2 pm. Concerta didn't do that but I didn't feel like it helped much at all. Adderall was good for me and Focalin XR was good at the focus part and it does great for my 18 year old son, but for me it made me too sad and depressed until the dose wore off. I think I've been past the recommended dosage of every stimulant at some point....
Posted by jealibeanz on November 24, 2006, at 16:36:45
In reply to Re: High Concerta doses?!, posted by lymom3 on November 24, 2006, at 15:45:49
Adderall was depressing for me. Concerta seems to induce a "pleasant" feeling.
Posted by Phillipa on November 24, 2006, at 20:52:59
In reply to Re: High Concerta doses?!, posted by jealibeanz on November 24, 2006, at 16:36:45
Glad you found a med that helped but since you're only half way to the max why not just increase slowly? Love Phillipa
Posted by jealibeanz on November 24, 2006, at 21:51:09
In reply to Re: High Concerta doses?! » jealibeanz, posted by Phillipa on November 24, 2006, at 20:52:59
Haha... I bet I could shoot right up to 72 mg right now without any adverse effects, and mayyybe I'd feel like it's enough! I have a very very rigorous lifestyle right now... very tiring and requires huge amounts of concentration and focus. If this weren't the case, I probably wouldn't require so much stimulation, nor would I be concerned with achieving my optimal level and care to fine-tune my meds.
My doc just gave my the 18 mg capsules basically as a test drive. It technically is a months prescription of 30 pills, but he told me to double it, and that I'd run out within a couple of weeks. So I need to call him within the next week or two anyway. The end of this week would be best since I need to have the time to get the script before I actually run out.
I'll definitely indicate in my message that I'm feel well physically (no nausea, headache, etc), but that the dosage seems weak and barely noticeable. He doesn't mind when I imply or tell him flat out what I think should be done.
Posted by lymom3 on November 25, 2006, at 6:33:31
In reply to Re: High Concerta doses?!, posted by jealibeanz on November 24, 2006, at 21:51:09
Isn't it nice to have a relationship like that with your doctor? The first time I saw my new pdoc he looked at the meds I've taken, talked to me about stupid side effects that I've had and told me to be honest about how I'm feeling; if the meds are good but not quite enough; side effects etc. He said that he'll always believe me (something I've kind of had problems with because of the side effects that I get) and he'll keep trying til we get it right and he has ideas about what to try next.
I guess the point of that rambling is that a good doc can make all the difference :)
Posted by jealibeanz on November 25, 2006, at 6:59:47
In reply to Re: High Concerta doses?!, posted by lymom3 on November 25, 2006, at 6:33:31
I agree. I would not be pursuing further treatment if I had even a slightly less understanding doctor. It makes all the difference in the world, especially when discussing such personal topics. This isn't like being treated for an ear infection. Mental health is so much different, and many aren't very good providers in my opinion.
I actually think that my doctor is good about it because he's a family physician, and certainly no expert in any field. This means he's got no ego. He just wants to help people and is very willing to listen to me. He's not all into psycho-analyzing me. We talk about medications and side effects. If it's working, we stick with it. If it's not, a change is made.
Posted by jealibeanz on November 25, 2006, at 15:37:34
In reply to Re: High Concerta doses?!, posted by lymom3 on November 25, 2006, at 6:33:31
Would it be inappropriate for me to call my doc on Monday and tell him it's not doing much? It's only been a few days of taking the Concerta, but it's not like an AD, which takes a while to kick-in. You know right away as to whether or not you have much of a stimulating effect. I don't want to constantly bother him with concerns and making new appointments in between my scheduled ones, but this is a real issue of mine, even though it's not life or death.
He does know that I'm having some big problems with school, and he was very concerned for me, so it is apparent that something I need to be worried about immediately, since I only have a few weeks left of the semester. I can't crash and burn now. I need a jump-start, not maintaining my previous condition.
I've even been taking my Provigil when I wake up, which I'm not supposed to do. I only have a few more left though and although I have refills, I think my issurance would turn it down without authorization from my doctor.
I just took another 18 mg pill right now, which brings me up to 54 mg. I neeeed to study tonight since I have a lot of catching up to do. I feel bad about experimenting and being a patient with constant needs, but I'm trying to get things right for myself. Thankfully, even when I do make mistakes or experiment, he doesn't get upset. He actually uses that as a guide to make a new plan.
Posted by lymom3 on November 25, 2006, at 16:17:42
In reply to Re: High Concerta doses...I'm not sure what to do!, posted by jealibeanz on November 25, 2006, at 15:37:34
I don't see why you can't talk to him about it. With the issues that he knows you have, I don't think he'll be surprised or upset that you need a higher dose. It seems that he trusts you and you have a good relationship with him. If he's partially responsible for convincing you to stay in school, then he should be open to medicating you properly to be able to do just that.
I am finding that I really like the alertness with Provigil but it doesn't help the focus. Not sure what to do about that either. I've been through all the stimulants that I can think of.
Posted by jealibeanz on November 25, 2006, at 18:09:29
In reply to Re: High Concerta doses...I'm not sure what to do!, posted by lymom3 on November 25, 2006, at 16:17:42
Yeah, he is aware of the fact that I need a high dose of a stimulant. I wasn't. He always tells me there's no way I can get through school without coffee.
The other day I told him I liked Provigil, although it was losing its effectiveness, because it was subtle. His response, at he just looked at me bewildered and laughed... "You don't need subtle!" Me... "Hmm, yeah I guess you're right."
Posted by Caedmon on November 25, 2006, at 22:24:40
In reply to Re: High Concerta doses...I'm not sure what to do! » lymom3, posted by jealibeanz on November 25, 2006, at 18:09:29
Jealibeanz best of luck with Concerta. I very much sympathize with your challenges, hope this works for you.
- Chris
Posted by jealibeanz on November 25, 2006, at 22:38:59
In reply to Re: High Concerta doses...I'm not sure what to do! » jealibeanz, posted by Caedmon on November 25, 2006, at 22:24:40
Thank you. I know I will be able to get things worked out as long as I am persistent and honest with my doc. He's very willing to help. I'd actually be letting him down I'm sure, if I were to run into further difficulties with school and outside, because he knows he can help.
I probably should call, I just don't know if I want to on Monday, or wait longer so I don't appear too demanding and high-maintainence.
Chris-
I hope you're getting the same quality of care that you've had for a while. It seemed like you had a wonderful pdoc. Good luck in school... and if you have the option to lower that courseload, by all means, do it! You'll be better educated and happier because of it.
Posted by lymom3 on November 26, 2006, at 6:47:26
In reply to Re: High Concerta doses...I'm not sure what to do!, posted by jealibeanz on November 25, 2006, at 22:38:59
Wanting to feel good is not demanding or high maintenance. Lord knows that I know the feeling. At least you have one doctor to get meds from and he knows you and likes you. It may be hard to get through tomorrow as it was a long weekend. You could use that to wait until Tuesday :)
Posted by jealibeanz on November 26, 2006, at 6:58:06
In reply to Re: High Concerta doses...I'm not sure what to do! » jealibeanz, posted by lymom3 on November 26, 2006, at 6:47:26
Yeah, it's always hard for me to call in between classes! It certainly gives me an excuse, although Tuesday may me more difficult for me. Waiting til then seems like I've given it a chance, and seen my performance at school (if only a day). Calling first thing Monday morning, which is the only time I could call, seems like I've been waiting since Thanksgiving to report my new symptoms.
Posted by lymom3 on November 26, 2006, at 7:04:37
In reply to Re: High Concerta doses...I'm not sure what to do!, posted by jealibeanz on November 26, 2006, at 6:58:06
I am needing to call about swelling in my legs. I sporadically have had issues with this like one day a month maybe. It is every day now. I have put on some weight due to the med changes; not enough to cause that I wouldn't think but the med changes themselves can cause it. I know that Emsam did and that was one consideration in stopping it.
What I don't know is who to call! My neurologist who I see for migraines? He is the one that prescribes the med I take for migraines but it is a beta blocker so it doubles for blood pressure. My internal medicine doc who prescribes me nothing but has my records? My psychiatrist who prescribes all my psychiatric meds but has none of my medical history?
So that's going to be my day tomorrow...It will be impossible to get through to anyone and I am already anticipating being tossed around like a hot potato...
Posted by lymom3 on November 26, 2006, at 7:06:46
In reply to Re: High Concerta doses...I'm not sure what to do! » jealibeanz, posted by lymom3 on November 26, 2006, at 7:04:37
I guess part two of that is that I like how the meds are working. My insomnia is getting better. The Provigil helps keep me alert. I am going to need to address the fact that my focus isn't helped by Provigil but at this point I feel awake enough to get things done so even though I still spin in circles because I can't or don't remember to finish one thing, they all get done before I run out of steam.
Posted by Caedmon on November 26, 2006, at 9:52:40
In reply to Re: High Concerta doses...I'm not sure what to do!, posted by jealibeanz on November 25, 2006, at 22:38:59
> I hope you're getting the same quality of care that you've had for a while. It seemed like you had a wonderful pdoc. Good luck in school... and if you have the option to lower that courseload, by all means, do it! You'll be better educated and happier because of it.>
I haven't decided yet how I feel about the new pdoc but he's certainly not *bad*. I'm impressed at the thoroughness of the evaluation he gave me. He was the one to suggest a testosterone lab and, sure enough, the initial screening came back low. [Verifying that hormones are in the right place before getting too psychiatric - ah! what a good idea.] :-)
Meanwhile, Lamictal is being kind. Fewer headaches and body aches than last time I tried it. I feel optimistic that I will be able to give it a full trial.
- Chris
Posted by jealibeanz on November 26, 2006, at 15:51:39
In reply to Re: High Concerta doses...I'm not sure what to do! » lymom3, posted by lymom3 on November 26, 2006, at 7:06:46
Yup, that's how I feel about Provigil too. Not a bad drug at all in terms of keeping you awake. I never felt wired or too stimulated, just normal.
Posted by jealibeanz on November 26, 2006, at 18:03:50
In reply to Re: High Concerta doses...I'm not sure what to do! » jealibeanz, posted by Caedmon on November 26, 2006, at 9:52:40
Good that he caught that. Hormone levels aren't something young people usually think of, but getting them to proper levels can make a world of a difference in some.
Posted by jealibeanz on November 28, 2006, at 10:49:57
In reply to Re: High Concerta doses...I'm not sure what to do! » jealibeanz, posted by lymom3 on November 26, 2006, at 6:47:26
OK, now I'm rethinking calling now. I don't know why. I really should since I only have 2.5 weeks of school left and need to study hard!!! It probably would be an easy fix over the phone. I'd just most likely double what I'm taking now and he'll send me the new script if he decides that increasing would be a good idea. 36 mg is pretty low, especially for someone who's got 12 hours of classes a day and 13 finals! Concentration and energy is a must! Haha, I'm just trying to talk myself into this and need encouragement!:)
I want to call today, maybe I'll call tomorrow, haha or the next day...
Posted by lymom3 on November 28, 2006, at 17:03:38
In reply to Re: High Concerta doses...I'm not sure what to do!, posted by jealibeanz on November 28, 2006, at 10:49:57
You want me to call for you or what??? lol You know what you need. Just make sure you're not doing it for the wrong reasons. Having said that, you are on a low dose by and I'm sure that you DO need more. Pick up the phone...the absolute worst he can do is say no and I don't think that is very likely.
Posted by jealibeanz on November 28, 2006, at 20:52:13
In reply to Re: High Concerta doses...I'm not sure what to do! » jealibeanz, posted by lymom3 on November 28, 2006, at 17:03:38
Yeah, I'm calling tomorrow. Hopefully, he'll call me back to talk. That rarely happens because nurses do the message taking and call backs, but he's called me before when there was a problem.
I know I'm one a low dose right now. I'd hope that increasing would help. Yesterday, I took 54 mg, wasn't supposed to, but also was at school til 8 and slept little since I got back from Thanksgiving break vert late the night before. It definitely wasn't much of a response, despite the fact that I was tired.
Either I need a realllly high dose, or a different med! And it certainly is not a 12 hour drug for me.
Posted by lymom3 on November 28, 2006, at 21:00:48
In reply to Re: High Concerta doses...I'm not sure what to do!, posted by jealibeanz on November 28, 2006, at 20:52:13
Neither me nor my son have ever done well on Concerta. On my first appointment with my new pdoc he kind of snorted when he came to Concerta and Remeron...he obviously doesn't think much of either one of them. For sure it's worth trying a higher dose before you change again.
If you're looking for your next med, I would say to try Focalin XR. Still not a 12 hour med I don't think but a healthy am dose and another dose at noon, a small one, has been great for my 18 year old. Nothing had ever helped him before and his psychiatrist said that he's one of the worst cases of ADHD that he's seen in 30 years of practice.
I know that everyone is different but it is a refined form of Ritalin and it has made a difference. It's at least something different to try.
Posted by jealibeanz on November 28, 2006, at 21:08:55
In reply to Re: High Concerta doses...I'm not sure what to do! » jealibeanz, posted by lymom3 on November 28, 2006, at 21:00:48
Isn't Concerta also a refined form of Ritalin? I've never taken Ritalin, but from what I've heard, it's certainly stimulating. Concerta seems sooo mild.
Posted by lymom3 on November 28, 2006, at 21:29:24
In reply to Re: High Concerta doses...I'm not sure what to do!, posted by jealibeanz on November 28, 2006, at 21:08:55
Concerta is Ritalin; it's just the delivery that is different in that barrel shaped pill. The barrel part never does dissolve all the way. It was supposed to be the greatest thing when it first came out when my son was in grade school. His current psychiatrist doesn't even prescribe it in his practice anymore.
I'm sure there are plenty of doctors that do prescribe it and I'm sure there are plenty of people that take it that swear by it, I just have never met any....lol.
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