New To Stimulants? Some Things You Should Know.
May 24, 2014 13:32:16 GMT -5
deenihle007, taintworthit, and 1 more like this
Post by Amtram on May 24, 2014 13:32:16 GMT -5
There are some pieces of information that are not covered by your package insert, or that your doctor won't cover, and even some you won't find out until you take the medication. I'd like to tell you some of the things I've discovered over the years so you can know how these medications work and how they work for you. I'll include as much as I can, but if I forget anything, feel free to post your own experience.
How Do I Know It's Working?
This depends entirely on why you began taking the medication in the first place. Which symptom gives you the most trouble? Do you have so much brain chatter that you're always distracted? Then the medication should make your brain quieter. Do you forget what you were supposed to do and instead act on impulse, leaving things started but not finished, or trivial things done and important things undone? You should notice that you're able to prioritize and finish things that you started. Do you daydream and then beat yourself up because you didn't do anything? You should feel more a part of the real world. Do you bounce off the walls, talk too much, interrupt conversations, make people nervous with your fidgeting? You should find yourself calmer and more patient.
Your doctor will probably start you on a very low dose - not enough to make these problems go away completely, but enough that you should notice a little bit of a difference. Even though stimulants act almost immediately, you will probably need to take them every day for a couple of weeks before their effect "evens out."
I Have to Wait?!?
Yes! You'll go through a few phases along the way as your brain chemistry adjusts to the medications. If this is your very first time, you may have a day or two of euphoria. Fortunately or unfortunately, this will not last. Your best bet is to take your first dose a few days before you start a week of work or school, because you won't be terribly useful and people will think you're high if this happens to you. As time goes on, your mood will be less extreme, and, if the medication is right, it'll remain fairly stable while the medication is in your system.
Another thing that is much less fun than the euphoria is the crash when the meds wear off. This is important to know about whether it's you taking the stimulant or your child, because you need to be prepared for it and know why it's happening. While the medication is working, those symptoms you're taking it for aren't a problem, and you feel really good not because the medication is altering your mood, but because you have this calmness, this focus, this ability to finish what you start, this clarity of thought, and bit by bit, your brain goes back to "normal." All the symptoms that were alleviated by the medication return without you being consciously aware, and everything goes back to being difficult and frustrating. What you will notice is that it makes you short-tempered.
I've likened this to those stories in which a guy who's been blind all his life gets a miracle operation that restores his sight, but then it begins to fail until he's blind again. He's angry because he now knows what it's like to see, and he misses it. Before, he was OK with being blind because he didn't know anything different. When your meds wear off, you'll be subconsciously feeling the same way.
You may also think that the medications aren't working - but that crash is an indication that they're doing something.
After the 10-14 days it usually takes for you to adjust, this crash should become less noticeable. If it doesn't, then you may need to change or augment your dose. If you've had negative side effects like digestive changes or insomnia, that's about when those should start to improve, also.
How Do I Know If It's Not Working?
Every stimulant is different, so if one doesn't seem to be doing the job, you do have other options. Look up at the top paragraph again - remember that these medications are meant to relieve specific symptoms, not magically transform your life. They don't perform miracles - mostly what they do is give you the ability to actively work on fixing the behaviors that have made your life difficult.
So first, if you see no change in the specific symptoms you were hoping to address, then talk to your doctor about a change - sometimes this may mean a different medication, but sometimes it might mean only a dosage change. Keep notes, and discuss all your concerns with the doctor.
There are some things that are stronger indicators that you might be on the wrong medication, or might need to augment with a different one (sometimes an antidepressant will balance out agitation, for example.)
1. You feel sleepy or lethargic. Very often this means that you need to switch the class of medication. Methylphenidate to amphetamine, depending on which type does this to you.
2. You get panic attacks. This could be fixed by changing medications or adding another medication. Tell your doctor immediately - you'll probably have to stop taking this until your next appointment.
3. You experience obsessive or compulsive thoughts. You may be able to focus, but not on what you choose to focus on, and you won't be able to divert your attention away from the thing that's attracting it. You may do just fine on a different formulation of the same stimulant class.
4. You feel angry, violent, or suicidal. Stop taking the medication immediately and call your doctor. This doesn't happen too often, but if it does, it stops as soon as the medication leaves your system. The change in treatment is highly individualized, so my only advice is in that first sentence.
The rest of the contraindications are pretty much covered in the package inserts, but I've never found these to be expressed clearly enough. The really dangerous ones are covered, and of course, if you experience any of those, get to the emergency room.
Am I Developing a Tolerance? Some people actually do, and they eventually need to make changes in their dose or change medications entirely. However, sometimes it only seems like you've developed a tolerance, because you don't continue to improve - you reach a certain level and that's all the symptom relief you're going to get. Want to know if the medication's stopped working? Discontinue it for a couple of days. If your symptoms are considerably worse, then you may just have gotten so used to your medication that you take it for granted. There's an upper limit beyond which a doctor will not prescribe, and you don't want to keep increasing your dose hoping to reach ADHD Nirvana and then get cut off. Take as little as you can, and work on modifying your life to make it easier to navigate.
Do I Need a "Holiday?" - IMHO, not unless you want to. Most of the scary stories about what stimulants can do to you over the long term are hyperbole. Your ADHD symptoms don't go away, so when you don't take your meds, you have the symptoms. Ergo, if you take your meds every day that you have symptoms, that would mean that you take your meds every day. A "Medication Holiday" is an option, not a necessity. Sometimes you might want to just sleep in or laze around or whatever, and that might be a good reason to take a day off. The only caveat I'd add is that some people experience that euphoria again after a couple of days off. It might not be as intense as it was in the beginning, but it could still be noticeable by others.
Food Interactions - the biggest one is ascorbic acid. This isn't a dangerous interaction, but one that makes the medication less effective. Different stimulants are absorbed differently, but they're all neutralized to some degree by this particular acid. If you want your medication to work, avoid citrus fruits and juices, and stay away from soda that has ascorbic acid. If you take vitamin C or a supplement with vitamin C, take it at dinner.
Some people have trouble with caffeine and stimulants. Some people don't. If your coffee or tea makes you more jittery than normal, cut back or switch to decaf.
Insomnia - If you have trouble with insomnia past your first full month of taking your medication, you do have options. You can split your dose and take a lower afternoon dose if you're taking an instant release formula. You can take certain sleep medications if you really need to. You can have a glass of orange juice a couple of hours before bed and see if that helps. Some fortunate people will find that they actually sleep better, but if you don't, let your doctor know.
Medications Are Different - Besides one type being based on methylphenidate and the other on amphetamine salts, there are different balances of ingredients, different release formulas, and different inactive ingredients that affect how stimulants will work for you. If you discover that one brand works better for you than another after you've found the right type of medication, try to stick to that brand. Not only are name brand formulas different from generics, but generics can be different from each other. Check what's in the bottle before you leave the pharmacy, and call around if your regular pharmacy can't get you the brand that works for you.
Splitting Pills - Don't. Not if you're taking an extended release or controlled release formula. If you're taking instant release and it has a clearly marked line for splitting, then that's OK, but if it's a capsule or a pill without a marking, the answer is NONONONO! There are a few different ways that extended release pills make sure that you get two separate doses in a single pill, and if you bypass those, you'll either get double the dose all at once, or you'll get two doses of distinctly different strengths. This will not be fun for you, I guarantee. If you're not happy with your dose, discuss it with your doctor - don't take it into your own hands.
These Medications Come With Legal Restrictions - As well-intentioned as these restrictions may have been regarding preventing abuse, they make it very difficult for those of us who rely on these meds. If you change medications or dose in the middle of the month, your doctor will possibly have to send a written authorization to your insurance company before you can fill your prescription. You will need to see your doctor in person every single month and get a new scrip every single month. No refills, no phone appointments. Find a doctor you like, be honest and compliant with instructions, stay with him/her for long enough, and you may be able to make different arrangements that suit you both, but don't count on it.
The Manufacturer May Have a Discount Program - Check the website. Even if you have insurance, there may be programs that reduce your out of pocket expense. If there's a time limit on the discount, check the site again when you're getting close to the expiration, because you can often apply for the same program again or enroll in whatever program replaces it. If you're taking a generic, it's less likely that the manufacturer will have a discount, but if it's an expensive generic, it's worth checking.
Find a Therapist or ADHD Coach - The saying is "Pills plus Skills." If you're an adult (even a young adult) you've developed behaviors based upon your symptoms. Some may be effective coping skills, but a whole bunch of them are probably maladaptive. You might not be able to tell the difference. A professional counselor can help you see the difference and teach you better ways of navigating through life. Learning these while you're medicated also helps you function better when you're not, because the medications help you focus on learning. Find someone who knows about ADHD so your goals are realistic and attainable. Don't look for someone who tells you you're doing just fine - you don't need someone to stroke your ego, you need someone who's going to challenge you.
Talk to People Around You - Let people know you're taking medications/getting counseling. We can't see ourselves as well from the inside as others can from the outside. You need people who will let you know if they see changes in you, for better or for worse. Their input can help you and your doctor in making medical decisions.
I hope this has answered a lot of the questions you might have had, but if you have more, please ask!
How Do I Know It's Working?
This depends entirely on why you began taking the medication in the first place. Which symptom gives you the most trouble? Do you have so much brain chatter that you're always distracted? Then the medication should make your brain quieter. Do you forget what you were supposed to do and instead act on impulse, leaving things started but not finished, or trivial things done and important things undone? You should notice that you're able to prioritize and finish things that you started. Do you daydream and then beat yourself up because you didn't do anything? You should feel more a part of the real world. Do you bounce off the walls, talk too much, interrupt conversations, make people nervous with your fidgeting? You should find yourself calmer and more patient.
Your doctor will probably start you on a very low dose - not enough to make these problems go away completely, but enough that you should notice a little bit of a difference. Even though stimulants act almost immediately, you will probably need to take them every day for a couple of weeks before their effect "evens out."
I Have to Wait?!?
Yes! You'll go through a few phases along the way as your brain chemistry adjusts to the medications. If this is your very first time, you may have a day or two of euphoria. Fortunately or unfortunately, this will not last. Your best bet is to take your first dose a few days before you start a week of work or school, because you won't be terribly useful and people will think you're high if this happens to you. As time goes on, your mood will be less extreme, and, if the medication is right, it'll remain fairly stable while the medication is in your system.
Another thing that is much less fun than the euphoria is the crash when the meds wear off. This is important to know about whether it's you taking the stimulant or your child, because you need to be prepared for it and know why it's happening. While the medication is working, those symptoms you're taking it for aren't a problem, and you feel really good not because the medication is altering your mood, but because you have this calmness, this focus, this ability to finish what you start, this clarity of thought, and bit by bit, your brain goes back to "normal." All the symptoms that were alleviated by the medication return without you being consciously aware, and everything goes back to being difficult and frustrating. What you will notice is that it makes you short-tempered.
I've likened this to those stories in which a guy who's been blind all his life gets a miracle operation that restores his sight, but then it begins to fail until he's blind again. He's angry because he now knows what it's like to see, and he misses it. Before, he was OK with being blind because he didn't know anything different. When your meds wear off, you'll be subconsciously feeling the same way.
You may also think that the medications aren't working - but that crash is an indication that they're doing something.
After the 10-14 days it usually takes for you to adjust, this crash should become less noticeable. If it doesn't, then you may need to change or augment your dose. If you've had negative side effects like digestive changes or insomnia, that's about when those should start to improve, also.
How Do I Know If It's Not Working?
Every stimulant is different, so if one doesn't seem to be doing the job, you do have other options. Look up at the top paragraph again - remember that these medications are meant to relieve specific symptoms, not magically transform your life. They don't perform miracles - mostly what they do is give you the ability to actively work on fixing the behaviors that have made your life difficult.
So first, if you see no change in the specific symptoms you were hoping to address, then talk to your doctor about a change - sometimes this may mean a different medication, but sometimes it might mean only a dosage change. Keep notes, and discuss all your concerns with the doctor.
There are some things that are stronger indicators that you might be on the wrong medication, or might need to augment with a different one (sometimes an antidepressant will balance out agitation, for example.)
1. You feel sleepy or lethargic. Very often this means that you need to switch the class of medication. Methylphenidate to amphetamine, depending on which type does this to you.
2. You get panic attacks. This could be fixed by changing medications or adding another medication. Tell your doctor immediately - you'll probably have to stop taking this until your next appointment.
3. You experience obsessive or compulsive thoughts. You may be able to focus, but not on what you choose to focus on, and you won't be able to divert your attention away from the thing that's attracting it. You may do just fine on a different formulation of the same stimulant class.
4. You feel angry, violent, or suicidal. Stop taking the medication immediately and call your doctor. This doesn't happen too often, but if it does, it stops as soon as the medication leaves your system. The change in treatment is highly individualized, so my only advice is in that first sentence.
The rest of the contraindications are pretty much covered in the package inserts, but I've never found these to be expressed clearly enough. The really dangerous ones are covered, and of course, if you experience any of those, get to the emergency room.
Am I Developing a Tolerance? Some people actually do, and they eventually need to make changes in their dose or change medications entirely. However, sometimes it only seems like you've developed a tolerance, because you don't continue to improve - you reach a certain level and that's all the symptom relief you're going to get. Want to know if the medication's stopped working? Discontinue it for a couple of days. If your symptoms are considerably worse, then you may just have gotten so used to your medication that you take it for granted. There's an upper limit beyond which a doctor will not prescribe, and you don't want to keep increasing your dose hoping to reach ADHD Nirvana and then get cut off. Take as little as you can, and work on modifying your life to make it easier to navigate.
Do I Need a "Holiday?" - IMHO, not unless you want to. Most of the scary stories about what stimulants can do to you over the long term are hyperbole. Your ADHD symptoms don't go away, so when you don't take your meds, you have the symptoms. Ergo, if you take your meds every day that you have symptoms, that would mean that you take your meds every day. A "Medication Holiday" is an option, not a necessity. Sometimes you might want to just sleep in or laze around or whatever, and that might be a good reason to take a day off. The only caveat I'd add is that some people experience that euphoria again after a couple of days off. It might not be as intense as it was in the beginning, but it could still be noticeable by others.
Food Interactions - the biggest one is ascorbic acid. This isn't a dangerous interaction, but one that makes the medication less effective. Different stimulants are absorbed differently, but they're all neutralized to some degree by this particular acid. If you want your medication to work, avoid citrus fruits and juices, and stay away from soda that has ascorbic acid. If you take vitamin C or a supplement with vitamin C, take it at dinner.
Some people have trouble with caffeine and stimulants. Some people don't. If your coffee or tea makes you more jittery than normal, cut back or switch to decaf.
Insomnia - If you have trouble with insomnia past your first full month of taking your medication, you do have options. You can split your dose and take a lower afternoon dose if you're taking an instant release formula. You can take certain sleep medications if you really need to. You can have a glass of orange juice a couple of hours before bed and see if that helps. Some fortunate people will find that they actually sleep better, but if you don't, let your doctor know.
Medications Are Different - Besides one type being based on methylphenidate and the other on amphetamine salts, there are different balances of ingredients, different release formulas, and different inactive ingredients that affect how stimulants will work for you. If you discover that one brand works better for you than another after you've found the right type of medication, try to stick to that brand. Not only are name brand formulas different from generics, but generics can be different from each other. Check what's in the bottle before you leave the pharmacy, and call around if your regular pharmacy can't get you the brand that works for you.
Splitting Pills - Don't. Not if you're taking an extended release or controlled release formula. If you're taking instant release and it has a clearly marked line for splitting, then that's OK, but if it's a capsule or a pill without a marking, the answer is NONONONO! There are a few different ways that extended release pills make sure that you get two separate doses in a single pill, and if you bypass those, you'll either get double the dose all at once, or you'll get two doses of distinctly different strengths. This will not be fun for you, I guarantee. If you're not happy with your dose, discuss it with your doctor - don't take it into your own hands.
These Medications Come With Legal Restrictions - As well-intentioned as these restrictions may have been regarding preventing abuse, they make it very difficult for those of us who rely on these meds. If you change medications or dose in the middle of the month, your doctor will possibly have to send a written authorization to your insurance company before you can fill your prescription. You will need to see your doctor in person every single month and get a new scrip every single month. No refills, no phone appointments. Find a doctor you like, be honest and compliant with instructions, stay with him/her for long enough, and you may be able to make different arrangements that suit you both, but don't count on it.
The Manufacturer May Have a Discount Program - Check the website. Even if you have insurance, there may be programs that reduce your out of pocket expense. If there's a time limit on the discount, check the site again when you're getting close to the expiration, because you can often apply for the same program again or enroll in whatever program replaces it. If you're taking a generic, it's less likely that the manufacturer will have a discount, but if it's an expensive generic, it's worth checking.
Find a Therapist or ADHD Coach - The saying is "Pills plus Skills." If you're an adult (even a young adult) you've developed behaviors based upon your symptoms. Some may be effective coping skills, but a whole bunch of them are probably maladaptive. You might not be able to tell the difference. A professional counselor can help you see the difference and teach you better ways of navigating through life. Learning these while you're medicated also helps you function better when you're not, because the medications help you focus on learning. Find someone who knows about ADHD so your goals are realistic and attainable. Don't look for someone who tells you you're doing just fine - you don't need someone to stroke your ego, you need someone who's going to challenge you.
Talk to People Around You - Let people know you're taking medications/getting counseling. We can't see ourselves as well from the inside as others can from the outside. You need people who will let you know if they see changes in you, for better or for worse. Their input can help you and your doctor in making medical decisions.
I hope this has answered a lot of the questions you might have had, but if you have more, please ask!