LONGECITY

I've lived with mild Tourette's all my life (I'm in my 20s).

I take guanfacine IR 3 times a day to manage that, but still have some mild tics that I control.

Unknown to me until this year, I also have ADD. I was diagnosed through a therapist, then psychiatrist. Looking back at my childhood and life, a lot of things made more sense.

I tried Adderall through a friend (before I saw the psychiatrist for a prescription) because I wanted to know if stimulants would make a difference.

I tried 10 mg 15 mg, and 20 mg Adderall XR. I took the 15 mg dosage for a period of a week, and a few times on and off, with no change in response.

The 15 mg was my sweet spot, and was the first time in my life I felt like I could CONTROL when I wanted to focus and on what, and whether or not I wanted to be anxious, etc. I also noticed that it improved my tics.

After seeing my psychiatrist, I was prescribed 36 mg Concerta.

The first two days were great. I felt the same benefit that I did when I tried Adderall. Amazingly, my Tourette's disappeared entirely, which I had never experienced in my life. However, by day 3, I felt mild sedation and dulling on the same dose. Day 4 got substantially worse.

My doctor had mentioned to me, that after day 3 or 4, I might need to take another 36 mg Concerta dose later in the afternoon (roughly 4 hours after the initial dose). I tried this on Day 5. This was horrible. My body was physically very stimulated, but mentally the brain fog was still there, as was the discomfort. I went back to one dose after that.

Today is Day 7, and the sedation is still there. I find that I'm slower with reading, forget things very quickly, and feel dull and emotionally vacant. It really does feel like being a "zombie", the way I've read other people describe their experience.

I'm confused as to why I responded so well the first 2 days, and why my Tourette's are still non existent on this medication. I'm entirely sedated and unable to function properly, but my Tourette's are gone. However, the first two days, I was able to function optimally and was content and focused. Higher doses seem to make things a lot worse.

Does anyone have any idea what this means in regards to my neurochemistry? Does this mean that I need more norepinephrine stimulation rather than dopamine? Are my dopamine receptors overstimulated compared to norepinephrine receptors? I know that methylphenidate has a 1:1 impact ratio on DA:NE, while Adderall is 1:2 from what I've read. I've also read that methylphenidate has a stronger impact on dopamine in adults than it does on children (at least in a mouse study, which not translate and I could not find any other publications validating that).

Anyone have any experiences? Ideas? I don't think it is right for me to say that I don't respond to the methylphenidate family, because I saw a fantastic response the first two days.  I'm more interested in why this effect diminished and what's actually going on with my brain?

Sorry, not much to add, except that some people seem to react a lot better to Adderall than to Concerta, as it is in my case.

I'm not sure about the methylphenidate DA:NE ratio. It seems that while Ritalin is pure d-MPH which has roughly 1:1 ratio, Concerta actually might be dl-MPH which has 1 DA : 7 NE affinity ratio. This might also explain some differences in the research papers.

So yes, you might be right and it might be that you're actually feeling lack of NE stimulation. In any case, I'd recommend talking with your doc about replacing Concerta with Adderall. 

Sorry, not much to add, except that some people seem to react a lot better to Adderall than to Concerta, as it is in my case.

 

I'm not sure about the methylphenidate DA:NE ratio. It seems that while Ritalin is pure d-MPH which has roughly 1:1 ratio, Concerta actually might be dl-MPH which has 1 DA : 7 NE affinity ratio. This might also explain some differences in the research papers.

 

So yes, you might be right and it might be that you're actually feeling lack of NE stimulation. In any case, I'd recommend talking with your doc about replacing Concerta with Adderall. 

Ritalin is dl-mph

Focalin is d-mph

OP: The same thing happens to me and I can't take it for more than a few days, it's almost like my brain used up all the neurochemicals or something. I dropped my dose back and only took it occasionally....I haven't needed it in over a year now though. Take a break and try lower dose or go back to adderall.

 

Ritalin is dl-mph

Focalin is d-mph

 

OP: The same thing happens to me and I can't take it for more than a few days, it's almost like my brain used up all the neurochemicals or something. I dropped my dose back and only took it occasionally....I haven't needed it in over a year now though. Take a break and try lower dose or go back to adderall.

 

You are correct, seems I misread an article where they mentioned both Ritalin and Focalin. So Focalin 1:1, Ritalin and Concerta 1:7 ratios. 

My gues is that you need a nmda antagonist like memantine, in the past the third amp dose of the day made me depressed witch mem resolved, and the timeframe goes in line with receptor downregulation, but its just a gues wheter thats the culprit.