Stimulant Medication Doses | ADHD | Episode 70
ฝัง
- เผยแพร่เมื่อ 22 ส.ค. 2024
- Rather than worrying whether a dose of stimulant medication is "too high" or "too low", focus on whether it is helping, and whether there are side effects.
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🎯 Key Takeaways for quick navigation:
00:11 💊 *Understanding FDA Recommendations on Stimulant Medication Dosages*
- FDA recommendations for medication dosages are guidelines, not strict limits.
- The FDA goes through phases of testing for safety and efficacy when approving medications.
- Insurance companies often limit dosages for cost reasons, not necessarily safety.
10:41 💡 *Finding the Right Stimulant Medication Dosage*
- Start with the lowest dose and gradually increase to find the optimal dose.
- Monitor for both improvements in symptoms and side effects.
- It's essential to focus on what the medication is doing for you rather than fixating on milligram amounts.
20:17 📈 *Factors Affecting Individual Responses to Medication*
- Absorption, metabolism, and brain chemistry can vary between individuals.
- Don't assume that a higher or lower dose is needed solely based on the severity of ADHD.
- Trust but verify: Assess if the medication's effects match the dosage and consider individual responses.
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Thank you for this information. I wish more providers had your philosophy on helping patients and less fear based/stigma driving their decisions when treating.
Me too.
Thanks for video, you are realy good speaker
Your videos are so incredibly informative! Can’t thank you enough for providing this information for the general public.
In your practice, have you ever seen paradoxical effects of stimulants at too low doses? Sleepiness, lack of motivation? Thank you for your insight.
Yes. I've particularly seen lack of motivation in people who counted on their anxiety to drive them to take care of tasks. And some people with ADHD sleep better with a low dose of stimulant at bedtime.
@@DrJohnKruse
Is there anything in the literature documenting this response with low doses? Or describing the mechanism behind this response? Thank you!
@@user-xe3mt9qd1v I don't have specific references at my fingertips, particularly since most research on meds is drug company driven and they only want to publish doses in the range approved by the FDA. But this is a very general biologic principle, that individuals in a population will vary regarding any bodily function you look at (absorption, enzymatic metabolism of drugs, access through the blood brain barrier, receptor densities within the brain). Most often these variables show close to Bell curve distributions, which means that although 95% of people will fall within two standard deviations of the mean, 2.5% will be way below the average and 2.5% way above it.
Excellent information about half life explained. Thanks for your videos
@@johnslot7397 You're welcome. Feel free to share them with anyone you think may appreciate them.
Thank you so much for your videos! Especially doing the take home first for those of us with ADHD. 😁
Hi Jen, how are you getting along with it all? On methylphenidate stimulants myself btw 👍😉
Thank you ! I enjoyed this video
How well they slept! Amen! If I've had a bad night, or had an alcoholic drink the night before, my Vyvanse seems to be much less effective.
I see that all of the time.
@@DrJohnKruse I suppose it at least keeps me away from booze; having the Vyvanse work well is as a result a bit like a reward for keeping healthy. I'll take that!
At 55 I was recently diagnosed. I am on vyvanse which works well however I crash and my Dr has suggested a shoot acting Dexamphetamine to help with the crash. I am worried about addiction. Is this a common practice and what are your thoughts
It is fairly common approach. Sometimes increasing the Vyvanse dose extends the half life and dampens any abrupt drop off. The risk is that most short acting agents also leave the brain more quickly, and are more likely to promote crashing - but they can certainly extend the hours of benefit, and if the crash is delayed until bedtime you may sleep through it. I have also had patients who felt Mydayis lasted a few hours longer than Vyvanse, so was better for them.
50 MG of Vyvanse is my ideal dose and med.
I'm currently taking 54mg of Concerta due to availability and feel it works for me except that it makes me feel slowed almost like anxiety medication. I wonder if the 54mg of Concerta is too high. It doesn't makes me feel anxious or energetic, just slowed down in a mindful way.
It sounds like it might be helpful to experiment with the dose.
@@DrJohnKruse thanks Dr Kruse, I'm not feeling the heaviness anymore. But there are other side effects that seem unique vs Vyvanse . It's a generic version of Concerta called Mefedinil. I should have gone for Neucon rather. I had a bad experience with this last year as well on a lower dose.
@@DrJohnKruse I discovered the Vyvanse may increase serotonin whereas the methylphenidate doesn't. There is a shared enzyme between the 5 htp and norepinephrine that may lead to a depletion of serotonin when dopamine is increased. I will talk to my Dr as I've learned more about OCD and think I may have it.
@@ImStephhhh that sounds really encouraging so far. I hope the benefits continue throughout the month and beyond.
Do you know why Lisdexamphetamine worked great on day 1 for 1.5 - 2.0 hours, then the effects wore off. By day 8 - 10 my dopamine level felt rock bottom and I was very depressed and had to stop the medication?
Well amphetamines force dopamine out of the neuron. If there’s no dopamine left to force out because your body isn’t making enough, then it might lead to depression. You could try supplementing L-Tyrosine and P5P for dopamine synthesis.
Either that or you may just need a higher dose.
It’s possible the med is just not the right med for you. Lisdexamfetamine has to be converted into Dextroamphetamine in the bloodstream. Some people convert LDX into DAMP too fast and find vyvanse gives them too much stimulation and burns too quickly. I’ve had this problem with Vyvanse. 30 mg only lasted me 3-4 hours and would drop me hard.
Is 20 mg of Adderall 3 times a day a lot for an adult with ADHD if there’s no side effects? Is long term safe?
I can't offer specific medical advice, but if you are obtaining benefits and have none of the common or uncommon side effects at this dose, many other individuals find sustained benefit at similar doses, for years.
@@DrJohnKruseThank you
Vincent Schiavelli's son became a doctor! Well I'll be! 😁
200 mg's sweet Jesus
Lmao, taking I'll sleep when I'm dead to the next level.
Thanks Doc makes sense, my Neurologist talked me down to 54mg Concerta even though 20mg Ritalin was allowing me to reach the 4hrs duration of effectiveness because she was worried the conversion of 20mg Ritalin to concerta 72mg was too high a dose. Will see how it goes, but I suspect the 72mg (2 x 36mg) will give me better results in terms of sustaining focus and regulating emotions. How accurate are conversion guidelines from Ritalin to concerta 18:5?
Usually the conversion guidelines try to approximate the same daily mg amount of methylphenidate. So 5 mg immediate release ritalin three times a day (15 mg) may be close to a single 18 mg Concerta.
Are you available in California to see patients?
I actually moved to Hawaii a little over a year ago, and am not taking on any new patients.
@@DrJohnKruse ok thank you.
I wonder what an equivalence to 40mg of Duromine would be. In Australia, this is an extended release formula.
I haven't been able to find a conversion factor for Duromine (phentermine) to Adderall (amphetamine) except for multiple comments that it is not as potent.
@@DrJohnKruse Interesting. Currently taking Duromine intially for weight loss but then found I went from writing one line answers to full paragraphs and became organised etc. This indicated to me ADHD. Currently medicated with 40mg Duromine, but today will be having an assessment with a psychiatrist after being referred to do so by my team of doctors. Hopefully all is well with the assessment and a diagnosis comes of it. Then will let you know my findings regarding medication strength and efficacy throughout the next week provided a second opinion is not required.
@@user-jk8kn3ij8o there is some research establishing that phentermine can reduce ADHD symptoms and I have worked with individuals who have shown improvement on it. In the US, it less rigidly controlled than amphetamines or methylphenidate.
Is there any reason to take two 20 mg Adderall XR spaced out instead of 40 mg's at once? I work 12 PM to 9 PM, Would taking the first 20 mg at 11 AM so it's working by 12 PM and then another dose at 2 PM provide a more even effect throughout the day similar to Vyvanse which my insurance doesn't cover?
I've worked with many patients who split up doses of Adderall XR (or long acting forms of Ritalin) so that they can effectively cover a longer period of the day. It doesn't work for everyone, but for many this helps, and it makes pharmacokinetic sense.
Thanks!!! @@DrJohnKruse
I just started taking medication again for adhd after about 10 years. It’s only been 2 days since I started, i am taking Adderall extended release 20mg. On my first day there was an uncomfortable adrenaline feeling, increased heart rate, fidgeting, like my brain was trying to work at hyper speed but not being able to actually think about anything, shaky, floaty and my body felt overwhelmed. Affect happened 2 hours after taking the meds and then went away for an hour and then came back again stronger the next time and at that point I couldn’t focus at all. On day 2 I halved the meds and still felt the uncomfortable adrenaline and shaky feeling but it was a little better. The adrenaline feeling lasts after 9hours of taking my medication when the benefits are no longer there. Is this something normal and my body needs more time or does that indicate the meds are too strong? Should I try methylphenidate?
I also woke up multiple times the first night.
The general answer is that these symptoms are moderately common starting out, and very often go away, but you seem to have a particularly strong response, so backing down even further on dose might make sense. If things are getting worse day to day, that it is a clear sign this is too much for you for now.
Can you be my doctor?
Unfortunately, I stopped taking any new patients two years ago. In part, I'm choosing to try to help a lot of people with a little information (in these videos) rather than a very few people with a lot of information (and support).
Have you given patients vyvanse + ritalin and if so, what are the typical dose ranges of this combination? Is vyvanse 50mg + 40mg ritalin reasonable? Would you give 70mg of vyvanse + 50mg of ritalin (spread over the day, like 10mg of ritalin with 70mg of vyvanse in the morning and 10mg at noon and 30mg of ritalin late afternoon?)
I don't focus on the mg, I focus on the patient. It's reasonable if it helps without causing side effect problems. I have worked with people who did well in the ranges you indicate, and I've also worked with people who were overstimulated from less than 1/4 of those amounts.
@@DrJohnKruseOk. Thanks for your input. Good to know! Because I found that nothing I've tried so far compares to ritalin (I haven't tried modafinil), in the sense that it makes me awake and attentive and much less impulsive and improves memory. Vyvanse doesn't so much. On the other hand vyvanse works more on the executive and cognitive side in working memory, where ritalin is not as good (maybe at higher doses though).
@@DrJohnKruseThanks for your input. I found that Ritalin is sort of like nothing else (haven't tried modafinil though). It makes you awake and attentive and much less impulsive and improves (recall) memory whereas vyvanse is better in improving executive function and cognition as in working memory, but somehow much more pronounced in combination with ritalin.
After a couple months, Concerta 27mg feels a bit too much for me in terms of side effects, and I sorta get that robotic feeling. I was thinking of taking two 18mg Concertas a day, since sleeping on the meds does not seem like an issue (so far). I say this because my evenings on 18mg are mediocre, and I seem to toss in my sleep like the old days and not get much restful sleep, compared to when I was on 27mg. Is it unheard of to take two Concerta in the same day? I’d hate to have to go back on robot mode
I've worked with lots of people who took Concerta twice a day, but the most common pattern was to take one dose on wakening, and the second late in the morning, to maximized the duration of effect.
Insurance companies often discourage it, but I have worked with many people who took one Concerta on awakening and the other a few hours later, and that provided optimal coverage during the day for them. Many individuals do have trouble falling asleep if the second pill is too late in the day.