Ritalin- how to know if it is working?

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Permalink Reply by Susan on February 10, 2010 at 2:50pm

I take a long acting type and I take Adderall. I was started on 20 mg which "is a normal adult dose"(it can vary,but that is what my doctor did). I felt the inner calm and the ability to focus on things I would normally not focus on. Around the house I can go from thing to thing like a wild woman sometimes (still can - on meds too sometimes) I could feel it probably because it wasn't gradual. It didn't wear off until later in the day and I felt extremely tired and wiped out. After 2 days the wearing off part wasn't bad. I also felt just mental clarity. I could think about one thing at a time. I think that you will need more than what you are taking based on what you say. Long acting is going to have you avoid the up and down feeling. Your doctor may want to find out what dose you need and then switch to that - rather than you having a long acting in your body and have to go to work.

I am sure your medicine is gone by night time. We can hyperfocus on what we like or interests us and I was right there with you last night doing the same thing. Hence, Michael Phelps - he was interested in swimming. Look what we can do!!!! That part is still a work in progress. The medicine is not going to totally fix that. It helps you be able to focus and then behavior mod "I have to play games with myself to do certain things that I don't want to do." Sometimes I'm good at it, sometimes I'm not. We have problems with consistency so even if I do well for awhile, it is easy to slip. Other "normal' people will say the same for them, but it isn't the same.

You will not feel "high". Even though it is technically, speed what it is doing is stimulating those areas of your brain that are understimulated and thus causing your symptoms. Your environment may influence you and your diet. Don't take the medicine with a lot of fatty food and try to eat protein with your breakfast.

Hope this helps. Susan

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Permalink Reply by Jo Ellen on February 10, 2010 at 3:45pm

Hi, Jen:

I take the generic form of Ritalin SR (methylin ER 20 mg tablets) I am supposed to take two 20 mg in the morning and another 20 mg between 1 & 2 PM. I can take the two in the mornings around 8 AM, and go back to bed and sleep until 11 AM to Noon. I don't know how I can sleep while on this stuff in the AM because I take it on an empty stomach with a glass of water. You'd think it would go work within 30 minutes. I feel the pick-up if I am forced to stay up and eat something. I don't know what the half-life is, in fact I don't even know what 'half-life' means. Also, from my understanding, you need to be taking it for at least a couple of weeks before you make seem to notice the difference and your body adjust to it. Your doctor did reschedule another appointment with you, so you can report how it is working? Usually, within 2 weeks to a month in the beginning. If you have any serious reaction then you need to call your doctor right away. Give it a little time. Best of luck. Jo Ellen

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Permalink Reply by Karen L on February 10, 2010 at 7:08pm

Jo Ellen - From my understanding, you should notice effects immediately. Unless if you're taking Strattera, which does indeed take several weeks. But I'm not a doctor so I can't say for sure. And from my understanding, half life is the time it takes for the medication to completely leave your body. Usually 4-8 hours. But I might be wrong there too. The reason a person has to take medication every day is because each morning, the symptoms have returned (rebound) and there is no more half-life left. Maybe someone with more medical knowledge can help clear this up better? I hope I didn't add any confusion. LOL

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Permalink Reply by Susan on February 10, 2010 at 8:17pm

With stimulants you should feel the effect right away - Ritalin, Concerta, Adderall, Vyvanse, Metadate. . . .Strattera takes 3 or 4 weeks before you know. It is not a stimulant. There is a new med for kids now - Intuniv - which is actually long acting Clonidine. Clonidine is really a BP med that is used in kids some for ADHD. Not sure if Clonidine is ever used in adults for ADHD. It is interesting that the Intuniv was approved for kids first. Usually meds in kids are used after they see how they do in adults.

Since there was a discussion about half-life. I found a good explanation. Interestingly enough there is a portion about the ADHD meds - stimulants. The section on Half-Life and Steady State. Then read the nonsteady state. It has the part about the ADHD meds. Hope it is helpful.

Side Effects and Therapeutic Effects
Thomas A. M. Kramer


Posted: 01/29/2003; Medscape General Medicine. 2003;5(1) © 2003 Medscape

Introduction
There are two broad sets of issues that we deal with in psychopharmacology: pharmacokinetics and pharmacodynamics. Pharmacokinetics could be defined as what the body does to drugs, and encompasses all of the issues of drug interactions and drug clearance metabolism. Pharmacodynamics could be defined as what the drug does to the body. One could argue that it is the most important group of issues, because it encompasses the actual therapeutic effect of the drug.

Drugs have effects on the body. That is why we give them to patients. Our goal is to have the effect of the drug be therapeutic. Generally speaking, drugs have two kinds of effects: therapeutic effects and side effects. The ideal drug for any therapeutic indication would have only therapeutic effects and no side effects. We all know that in the real world, there are no such perfect drugs, but the best and most commonly used medications have a very high "therapeutic to side effect ratio."

It is, to a certain extent, a value judgment, however, whether a particular effect of the drug is a side effect or a therapeutic effect. Similar to the rallying cry of the software engineer -- "it's not a bug, it's a feature" -- sometimes things that start out being referred to as side effects end up being a primary therapeutic effect. This happens when drugs that were developed for one particular indication end up getting used for something quite different. One of the best examples of this is minoxidil, which was launched in 1979 as a treatment for hypertension. It was noted that many of the patients taking minoxidil who were bald started to grow hair back. Nine years later, minoxidil cream was marketed as treatment for hair loss, and that has become the primary use of this drug. Sildenafil is an enormously successful treatment for erectile dysfunction but was originally developed as an antiangina drug. On clinical trials, it was not particularly successful for that indication, but many of the subjects in the study reported dramatically improved erections.

Efficacy Vs Effectiveness
A major part of the drug development process is to weed out those compounds whose side effects overwhelm their therapeutic effects. This gets to the fundamental issue of efficacy vs effectiveness. A drug's efficacy is a measure of the ability of the drug to treat whatever condition it is indicated for. It is not a statement about the drug's tolerability or ease of use. Effectiveness is a measure of how well the drug works and encompasses all 3 of these issues. A drug may have very good efficacy but is so unpleasant to take that its actual utility is extremely limited. This would be determined in clinical trials, and the development of such a compound would cease.

For those drugs that do make it to market, there usually is a qualitative difference between side effects and therapeutic effects. The side effects of most compounds, psychiatric or otherwise, are transient. A drug company is much more likely to market a compound if whatever side effects it has go away in a few weeks. All of us who prescribe medications spend a great deal of our time with our patients reassuring them that the difficulties they may be having with their medication are temporary. This then begs the question: why are some drug effects short-lived and others long-lasting with chronic administration of the compound?

Half-life and Steady State
One of the main reasons for this gets back to the issues of pharmacokinetics. To review some of the basics of pharmacology, medications vary in how long it takes to clear them from the body. Some are metabolized fairly quickly, while others can take a long time before they are eliminated. We quantify this with the use of the term "half-life." The half-life of a given medication is how long it takes for the body to get rid of half of the dose. When the patient is taking a medication on a regular basis, there is an ongoing process of drug absorption in the form of each dose of the drug and, concurrently, an ongoing process of drug removal with the drug's metabolism and clearance. Eventually, there comes a point when the amount of drug going in is the same as the amount of drug getting taken out. We call this "steady state." It takes somewhere between 5 and 6 half-lives for a medication to reach steady state. Thus, medications with short half-lives reach steady state relatively quickly, while those with long half-lives take a long time to reach steady state.

Many drug effects occur primarily when the blood level of the drug is either going up or going down. When the drug reaches steady state, these effects can be either attenuated or completely absent. For those of you who are familiar with calculus, one way to understand this is that these effects only take place if there is a first derivative other than zero. Unwanted side effects from a particular compound are great deal more acceptable if they only take place on the way to steady state (ie, they are transient). Another way to classify drug effects into 2 groups is to classify them into those effects that take place primarily while the blood level is changing and those effects that take place primarily when the blood level is stable at steady state. Ideally, for any drug, all of the unwanted effects would be in the former category and all of the therapeutic effects would be in the latter category. There are many examples of side effects of psychotropics that are considerably worse during increasing or decreasing blood levels of the medication. Extrapyramidal side effects from antipsychotic medications, gastrointestinal side effects from selective serotonergic reuptake inhibitors, and memory problems from benzodiazepines are some examples of this phenomenon.

Nonsteady State
There are some examples, however, of medications whose therapeutic effect takes place solely during a rise in their blood level and are considerably less effective at steady state. The euphoric effects of alcohol, probably the most widely used psychotropic compound, only occur when the blood level of alcohol is rising. Unfortunately, the same cannot be said about alcohol-induced impairment. These are some of the reasons alcohol can be addictive and dangerous. Perhaps the best example of this phenomenon in prescribed psychotropics is the use of methylphenidate in attention deficit/hyperactivity disorder (ADHD). While methylphenidate is very effective in the treatment of ADHD, for many years it was somewhat problematic because in order for it to work, the child needed to take multiple doses during the day, requiring visits to the school nurse or other similar arrangements. This is because the therapeutic effect of methylphenidate only takes place when the blood level is increasing. The initial attempts to make a long-acting preparation of methylphenidate were less than satisfactory to both patients and clinicians because they essentially put the child into steady state rather than simulating the process of giving the child multiple doses. The recent success and widespread use of long-acting methylphenidate preparations is because these preparations are made not to slowly release the drug but to release it in a series of boluses so that with a once-a-day administration they can create pharmacokinetics similar to what was achieved with 3-times-a-day dosing.

Premature Intervention
Clinicians can often inadvertently exacerbate problems with side effects by doing multiple dose adjustments. For a medication that is going to be taken for a relatively long period of time, it is important to determine what the side effect burden will be at steady state. Addressing and attempting to intervene with side effect problems before that occurs can cause the problem that the clinician is trying to solve.

[CLOSE WINDOW]
Authors and Disclosures

Thomas A. M. Kramer, MD; Associate Professor of Psychiatry, University of Chicago, Chicago, Illinois

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Permalink Reply by jen on February 10, 2010 at 9:49pm

Thanks, I talked to my mom about this and she is on 10 to 20 per day. I had the feeling though that the doctor thought I was trying to score pills or something... maybe that is why the low dose... ANYWAY.... I just totally lost my train of thought, lol...... sorry.

Wow, I have been sitting here for a good 3 minutes and cannot remember what else I was going to say.... well, anyway, I am going to try the 10 again tomorrow and then call the doctor if I am still feeling nothing. Now I need to go spend time with my husband because this is supposed to be our night we watch tv together and instead I am looking up add stuff......

Susan, good to know I had a partner in crime last night!!!

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Permalink Reply by Karen L on February 10, 2010 at 10:06pm

Susan - Thank you so much for the in-depth citation! It explains a lot.

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