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Taking Methylphenidate the right way with minimizing tolerance/dependency?

methylphenidate

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#1 floweryriddle

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Posted 25 March 2018 - 12:43 AM


My doctor recently put me on Concerta (extended release Methylphenidate) for ADHD. As this is my first stimulant, I'm a little nervous about tolerance and dependency build up to it and would like to play this as smart as possible from the beginning. This drug (and friends) are probably going to be part of my life now and upping dosages until I'm old just isn't sustainable. 

 

My question is, what can I do to minimize tolerance build up, reduce harm, and how fast does tolerance to this drug usually build? 

 

I read about break days (like on weekends) and how some people swear by it, and then some people say they are useless and a consistent intake is best. 

I also read about memantine and how it can help with slowing down tolerance build-up. 

 

Other Concerta/Methylphenidate users here? How are you dealing with this? 

 

 

Related: http://www.longecity...-and-memantine/


Edited by dvstr, 25 March 2018 - 01:13 AM.


#2 floweryriddle

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Posted 29 March 2018 - 06:19 AM

Pushing this up again. No one an idea? 



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#3 Keizo

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Posted 29 March 2018 - 11:34 PM

In my experience the most obvious negative and positive effects fade very quickly after day 1, e.g. anxiety, happiness, tunnel-focusing, bodily tension.

I have used methylphenidate for somewhere around a year now, maybe 80% of days in varying doses, I can't say tolerance has been problematic. I don't think it's too useful to judge the usefulness of this drug by how obvious the effects of the drug are here-and-now. 

What I can say however is that regular tablets (instant release) work better in preserving the sense of "wow this drug really works, day after day". E.g. if I take 36mg concerta every day, after some time I will barely notice the onset of effects or the end of effects. Whereas when I have taken only ~20 mg Ritalin (IR) per day split up in 2-5 doses it is much more obvious that there is a beginning of effects after 30-60 minutes of intake, and this lasts for at least several weeks (I think infinitely, I haven't taken Ritalin only for more than a few weeks). 

 

When taken for extended periods I have noted I do not feel a significant difference between 18mg or 72 mg (Concerta), using just "how I feel here and now" as metric. But there is probably some functional difference that is not immediately obvious but perhaps measurable by results ,productivity, etc.

 

Currently I'm prescribed 36 mg concerta and ~15 mg ritalin. I will probably move to 18mg concerta and a higher amount Ritalin if doctor will allow it. I personally like the more obvious effects regular Ritalin brings, even at e.g. 5 mg if taken infrequently, and I don't find the dips problematic in any way. I think for me Ritalin would probably allow me to use a lower daily dose. I'm considering removing concerta entirely because I find it quite annoying that I can barely feel if the drug does anything after a few weeks (even though I am quite sure it still does a lot).


Edited by Keizo, 29 March 2018 - 11:49 PM.


#4 floweryriddle

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Posted 30 March 2018 - 02:44 AM

In my experience the most obvious negative and positive effects fade very quickly after day 1, e.g. anxiety, happiness, tunnel-focusing, bodily tension.

I have used methylphenidate for somewhere around a year now, maybe 80% of days in varying doses, I can't say tolerance has been problematic. I don't think it's too useful to judge the usefulness of this drug by how obvious the effects of the drug are here-and-now. 

What I can say however is that regular tablets (instant release) work better in preserving the sense of "wow this drug really works, day after day". E.g. if I take 36mg concerta every day, after some time I will barely notice the onset of effects or the end of effects. Whereas when I have taken only ~20 mg Ritalin (IR) per day split up in 2-5 doses it is much more obvious that there is a beginning of effects after 30-60 minutes of intake, and this lasts for at least several weeks (I think infinitely, I haven't taken Ritalin only for more than a few weeks). 

 

When taken for extended periods I have noted I do not feel a significant difference between 18mg or 72 mg (Concerta), using just "how I feel here and now" as metric. But there is probably some functional difference that is not immediately obvious but perhaps measurable by results ,productivity, etc.

 

Currently I'm prescribed 36 mg concerta and ~15 mg ritalin. I will probably move to 18mg concerta and a higher amount Ritalin if doctor will allow it. I personally like the more obvious effects regular Ritalin brings, even at e.g. 5 mg if taken infrequently, and I don't find the dips problematic in any way. I think for me Ritalin would probably allow me to use a lower daily dose. I'm considering removing concerta entirely because I find it quite annoying that I can barely feel if the drug does anything after a few weeks (even though I am quite sure it still does a lot).

 

Thanks for chiming in!

I am still new to Concerta but already know what you mean. The first days I felt a rock-solid focus, but the more I take it, the more that disappeared. I'm now on 27mg of Concerta until Monday with breaks now and then, and try to not use it more than 2 days in a row, but currently I barely feel anything except a slight coffee buzz. 

When I start concentrating however, this seems to get stronger and stronger to a point where I feel jittery (* theory to why that happens below). 

On some days I can't feel a thing, on some days I can feel it, but still loose focus easily, on some days it's great. It's a really mixed bag for me. (Although this could also just be perceived effects, and under the hood it actually helps a lot that I am not aware of.)

 

Sadly where I live (Japan), stimulants are still not common. The 3 only adhd meds that are available are strattera, concerta and guanfacine, concerta being the only stimulant (vyvanse is in phase 3 trials but that could still take a while).

I'll talk to my doctor about IR Ritalin but from my research it seems like that's not an option for me. 

 

Are you splitting out dosages with breaks in between or did you notice other issues with dependency where you feel you need it? 

 

 

(* I don't know much about biology and brains, but MPH is a dopamine reuptake inhibitor that blocks dopamine transporter and thus leaves more dopamine in the synaptic cleft. When doing something rewarding that would release dopamine anyway, wouldn't this mean that even more dopamine is in the synaptic cleft that can't won't get reuptaken? Thus the stronger perceived buzz and jitteriness?)


Edited by dvstr, 30 March 2018 - 03:39 AM.


#5 Keizo

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Posted 30 March 2018 - 11:21 AM

I usually only take the 36mg concerta in the morning, or only Ritalin IR split in 2-5 doses.

I do try to take a week completely without now and then. I would say after 3-4 weeks of taking concerta every day or almost every day I feel quite annoyed by the lack of any obvious effect (or not being able to recall if this state is significantly different from without the drug), so that's about usually when I try to take a short break. I do think 1 week completely without greatly brings back obvious effect afterwards. I think every day without helps bring back some perceived effects. If you find it hard to do but feel the urge to take a break then I can say it is a lot easier if you replace it with something else that does something for the period you want to give the stimulant a rest. That's often how I have done it, but I can't say I have found many substances that work very well for ADHD type problems. Only thing coming close or perhaps even better than prescription stimulants is Fasoracetam, but I don't feel entirely comfortable taking this for fear of unknown side-effects (as I understand this is still a new substance under investigation).

 

As far as substances that probably do something about tolerance: I have used Cerebrolysin now and then, not recently. I don't usually combine it with the methylphenidate, or if I do I use a very small dose methylphenidate because Cere seems to increase the effect if combined but also I'm quite sure increase the effect for a long time after using it (not as much as taking both at same time). I don't really use it for this reason, I use Cerebrolysin because of anti-depressant effect and general improvements in thinking. I recall someone else somewhere said when they took Cerebrolysin they also felt happy reducing their dose of methylphenidate a lot. It is a bit expensive however and has to be injected IM or IV (or IV infused with >10ml doses), also not something doctor will help you with most likely. My plan is basically to only use Cerebrolysin (maybe something like Selank, Semax, or beta-NGF http://www.longecity...f-spray/page-21 would work roughly the same way) for a few weeks here and there and then prescription stimulants in the time between. 

 

I may have experienced something similar to what you describe about concentrating increasing effects of drug, probably (I'm not doing much hard mental work in recent times). However some things that might help with stimulants if you ever happen to feel anxiety or too much (or little) stimulation is to 1. move your body . 2. listen to music.

3. talk to people.

I have barely used stimulants recreationally in my life but if I recall a lot of people do like to dance while under the influence of stimulants. I do recall several times when I took for the time too much Concerta and felt like it didn't do anything but make me tense, and the above 3 things at different times seemed to help a lot in making it feel better. 


Edited by Keizo, 30 March 2018 - 12:00 PM.


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#6 floweryriddle

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Posted 07 April 2018 - 03:39 AM

As expected, my doctor upped me to 36mg of Concerta. I talked with him a bit about what his plan is and he said given my weight, gender and age that he suspects my optimal dosage to be around 54mg and wants to titrate me up to that. 

 

The first day was a pure rush. I even felt euphoric. A few days later, even after taking 2 days break in between, I am back at often barely feeling anything at all similar to what you said. 

I upped my memantine intake from 10mg to 15mg to now 20mg and want to try to keep it on that level for a while to see if it helps. Side effects from the higher memantine dosage were pretty annoying at first but have since gone away. 

 

As expected, I wasn't able to get instant release Methylphenidate, but might want to try introducing a low dosage of strattera again if my doctor is okay with that. I had great results on strattera but had to switch to Concerta due to irregular heartbeat caused by it







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