Same med (Concerta), same dose (54mg). Things have been going pretty well. Sleep is reliable with melatonin. Recently it seems that taking it a little earlier in the evening helps; say, 9pm instead of 10pm when I'm going to go to sleep around 10:30-11pm.
Concentration/focus is a little more difficult to assess (as always). I think I am building better habits every day, which helps. There is no doubt that my overall ability to focus, concentrate, and/or sustain effort has improved greatly. A consistent level of strong focus is still elusive, though; I still have days when I have a lot of trouble getting settled down to work.
On the other hand, I am always aware of the dangers of expecting meds to remove any and all difficulties. Normal people struggle with their work sometimes. Normal people have days when they just don't feel like they're able to get much done. If the population of sites like Reddit is anything to go by, a great many normal people have days when they spend large chunks of their time browsing addictive websites (here I am assuming that these popluations may be accurately characterized as "normal"). Meds simply cannot make everything perfect, at least not for long. The dosages required to do so imply other risks and side-effects that will simply shift the problem elsewhere. We all know where this goes: a chain of meds, each of which was started to alleviate the side-effects of the one before.
Normalizing persistent, pervasive use of medications just won't lead to happiness. So I reject that route. I want just enough meds to let me make some consistent forward progress on my work habits. I think I'm getting that now. I have to figure out how to evaluate where my weaknesses are and craft routines to build strength in those areas.
One thing I noticed a couple of weeks ago was that I'd gotten back in the habit of drinking a fair amount of caffeine. When I was on the Dexedrine variants, this was never necessary since they always made me feel very awake. Methyphenidate doesn't have the same effect. I think it improves my focus more, but it does not wake me up. After a few late nights I started drinking coffee & tea to help me get through the following days, like anyone would, and I didn't really get myself pulled back to minimal consumption.
This is something that I now think I have to be very careful of on methylphenidate. It seems like the relative effects of sleep loss on my concentration are greater now than they were before medication. Before meds I guess I was always kind of half-asleep, so being a little more tired didn't really matter that much. Now it matters much more. I should consider getting good sleep to be a fundamental part of my ADHD treatment, and I should expect that if I am not getting good sleep that I will have more trouble focussing during the day.
I am also wondering whether physiological caffeine dependency can change how the methylphenidate effects my concentration. Habitual caffeine use modifies the balance in the dopamine pathways in the brain in a way that counteracts the stimulant effects of caffeine. Methylphenidate modifies some of the same pathways. It is entirely possible that caffeine dependency reduces the effectiveness of my medication.
So, it's good sleep and much less caffeine for me. I've tried it that way for the past week and I think it's working well.
Sunday, April 10, 2011
Sunday, February 27, 2011
Focus questionable, sleep occasionally disrupted
Sleep has been pretty reliable for a while. Last couple of nights my sleep haven't been great, but there could be other reasons for that. I have to get back to practicing really good sleep habits to make sure I'm not having to cope with an irregular sleep schedule and the side-effects of meds.
I think the degree of focus during the day has gone down a bit. I will have to consider whether I want to up the dose soon or not.
I think the degree of focus during the day has gone down a bit. I will have to consider whether I want to up the dose soon or not.
Sunday, February 13, 2011
Still 56mg Concerta, sleep almost normal
About a week ago I finally noticed that my melatonin tablets were "sublingual", meaning I was supposed to be putting them under my tongue this whole time. Once I started doing that at bedtime as directed, sleep improved considerably. I'd say it is close to normal at this point.
Focus during the day continues to be good. I think the peak level of focus has decreased somewhat, but at the same time the feelings of tension/irritability/anxiety have gone away. I'll have to keep track of the focus and decide whether I need to up the dose.
Other than the insomnia, there have been no noticeable side effects. No mood problems in the evenings, no stomach issues (I have read they are common with Concerta).
In general, I'd say Concerta is working well for me. I have an actual physical appointment with my doctor in about a month, we'll see how things go until then.
Focus during the day continues to be good. I think the peak level of focus has decreased somewhat, but at the same time the feelings of tension/irritability/anxiety have gone away. I'll have to keep track of the focus and decide whether I need to up the dose.
Other than the insomnia, there have been no noticeable side effects. No mood problems in the evenings, no stomach issues (I have read they are common with Concerta).
In general, I'd say Concerta is working well for me. I have an actual physical appointment with my doctor in about a month, we'll see how things go until then.
Tuesday, January 25, 2011
Sleep improving, maybe?
The Good: 54mg Concerta is working for me during the day, for sure. It will be a week tomorrow that I started on that dose, and the positive effects are still with me. I'm much more focussed, and I don't feel jittery.
The Bad: sleep is still disrupted. I think it is getting to be less so, though. The last couple of nights I seem to have woken up less often during the night, and I've gotten back to sleep faster. I haven't been feeling too overheated, either, which is also a good sign.
The Meh: Irritability and tension. Not sure this is really a side effect, though. When I went to 40mg Vyvanse I experienced something similar, though I remember it being much more acute. As I mused at the time, it could just be that I am unused to remaining focussed on my problems. Being unable to distract oneself from them, after many years of doing so, is bound to be a stressful experience.
The Bad: sleep is still disrupted. I think it is getting to be less so, though. The last couple of nights I seem to have woken up less often during the night, and I've gotten back to sleep faster. I haven't been feeling too overheated, either, which is also a good sign.
The Meh: Irritability and tension. Not sure this is really a side effect, though. When I went to 40mg Vyvanse I experienced something similar, though I remember it being much more acute. As I mused at the time, it could just be that I am unused to remaining focussed on my problems. Being unable to distract oneself from them, after many years of doing so, is bound to be a stressful experience.
Sunday, January 23, 2011
54mg Concerta, disrupted sleep
Wednesday and Thursday were very productive, very focused. Friday a little less so. I am somewhat concerned that the positive effects are going to diminish over time after the dose increase, as they did in the past with Vyvanse, but the negative effects are going to accumulate.
For example, sleep wasn't too bad on Wednesday and Thursday nights. I woke up, but I was able to get back to sleep relatively easily. I didn't feel hot, and I didn't toss and turn. The last couple of nights have been worse. The waking up hot is a particularly bad sign, because it tells me that my body is not shutting itself down for the night. Besides making me mentally tired, this also means that physically, I am not getting that time to repair and rejuvenate.
The worst thing about the sleep problems is that they interfere with my assessment of whether or not the medication is helping. It could be helping quite a bit, but if I am exhausted all the time I might not notice. In fact, I might feel worse.
I know my doctor is going to suggest some sort of sleep remedy. I am already taking melatonin. I do not want to take anything that might be habit-forming, or might have side-effects of its own. I am very concerned about jumping on a medication merry-go-round that leaves me without the ability to determine what is normal and reasonable any more.
I completely understand how the doctors feel about this. I am an engineer by training, a software developer by profession. I solve problems using the tools at my disposal. When I have a system in front of me that is not working, and I can't nail down exactly why, I may introduce speculative fixes and see what happens. If I am told I can't try certain kinds of fixes, I respond that that may prevent me from solving the problem.
I guess I'm OK with that. I'll talk about options with my doctor, but there are some roads I'm just not willing to start down. Multiple potentially (or even certainly) addictive, side-effect-laden medicines is one of those roads.
In any case, I'm going to give the Concerta some time to settle down before I decide it's too much. I have read some information that suggested it might take a couple of weeks for the long-term side-effects to really become clear.
For example, sleep wasn't too bad on Wednesday and Thursday nights. I woke up, but I was able to get back to sleep relatively easily. I didn't feel hot, and I didn't toss and turn. The last couple of nights have been worse. The waking up hot is a particularly bad sign, because it tells me that my body is not shutting itself down for the night. Besides making me mentally tired, this also means that physically, I am not getting that time to repair and rejuvenate.
The worst thing about the sleep problems is that they interfere with my assessment of whether or not the medication is helping. It could be helping quite a bit, but if I am exhausted all the time I might not notice. In fact, I might feel worse.
I know my doctor is going to suggest some sort of sleep remedy. I am already taking melatonin. I do not want to take anything that might be habit-forming, or might have side-effects of its own. I am very concerned about jumping on a medication merry-go-round that leaves me without the ability to determine what is normal and reasonable any more.
I completely understand how the doctors feel about this. I am an engineer by training, a software developer by profession. I solve problems using the tools at my disposal. When I have a system in front of me that is not working, and I can't nail down exactly why, I may introduce speculative fixes and see what happens. If I am told I can't try certain kinds of fixes, I respond that that may prevent me from solving the problem.
I guess I'm OK with that. I'll talk about options with my doctor, but there are some roads I'm just not willing to start down. Multiple potentially (or even certainly) addictive, side-effect-laden medicines is one of those roads.
In any case, I'm going to give the Concerta some time to settle down before I decide it's too much. I have read some information that suggested it might take a couple of weeks for the long-term side-effects to really become clear.
Thursday, January 20, 2011
54mg Concerta
Started 54mg yesterday, and I felt pretty focused all day. I also felt a little tense, but I'm starting to think that there may be a necessary relationship between the two. Either the tenseness is indicative of a state that is required for focus, or the tenseness results from being consistently connected with my work rather than distracting myself as soon as any frustration starts.
Feeling good so far today. I know it will take a while to settle down after the dose change, so I'm giving it time. Sleep was a little disrupted last night. I think I woke up once in the early hours, and then I woke up again around 5:30am. Got back to sleep each time, though, without too much trouble. The dose change can always disrupt sleep.
Feeling good so far today. I know it will take a while to settle down after the dose change, so I'm giving it time. Sleep was a little disrupted last night. I think I woke up once in the early hours, and then I woke up again around 5:30am. Got back to sleep each time, though, without too much trouble. The dose change can always disrupt sleep.
Monday, January 17, 2011
Good Start to Monday
Hey, I just resisted at least 2 major temptations at the start of my day. That's hopeful!
Sunday, January 16, 2011
36mg Concerta
Last Monday, I called my doctor and we discussed the med-free insomnia. He was a little perplexed. We agreed that I shouldn't start anything else until the problem resolved itself. He suggested I take 3mg of melatonin around 8pm, and I was to call him if it hadn't gotten better by the end of the week.
I don't know whether it was the melatonin or not, but on Monday night it improved considerably, and on Tuesday night I slept like the proverbial log. It must have taken less than 5 minutes to fall asleep, and I remember nothing else before waking up in the morning. So, good news.
It turns out that neither the kind of insomnia I was experiencing nor the improvement after a week should be that much of a surprise. I looked up some research on amphetamine withdrawal, and very light, disrupted sleep is a nearly universal withdrawal symptom. One of the papers also found that most of their subjects recovered from the worst acute withdrawal symptoms after about one week.
Of course, the real question is: why would those symptoms start when I was still taking my meds? I see two possibilities:
There are many outstanding questions here. One of the most central for me is: Why am I so sensitive to amphetamines to experience withdrawal on such a low dose? My effective daily dose was only ~20mg Dexedrine. The subjects studied in the papers were taking 5-10 times that much. It is unlikely that I'll every really know the answer.
The question now is: Will I experience fewer problems on methylphenidate? The experiment we're running to find out is the only one possible: Try methylphenidate and see what happens. On Wednesday, sleep problems resolved, I started 18mg Concerta. Didn't really notice any effects, positive or negative. Maybe a little more awake without any need for caffeine, but that's it. No insomnia.
Today I went up to 36mg as instructed by my doctor when he gave me the prescription. Still not noticing much of anything, but I am feeling nicely awake and alert. So, that's good.
We'll see how work goes tomorrow. I'll call my doctor to consult. I imagine if I have no negative side effects he will put me up to 54mg on Wednesday. I'm fine with moving that quickly now; I think I'm better at assessing positive work effects now that I have more experience with the ups and downs of the meds. It may depend on how I feel today and tomorrow, though. Maybe if I feel like I'm getting some good help on 36mg I'll wait a little longer.
I looked up rough equivalences between Concerta and Ritalin, and Ritalin and Dexedrine. Concerta is equivalent to approximaetly 2/3 of the same daily dose of Ritalin (not all of the medication is released from the Concerta delivery vehicle). Ritalin, in turn, is equivalent to about 1/2 of the same daily dose of Dexedrine. Put that all together, and Concerta is approximately equivalent to 1/3 of the same daily dose of Dexedrine. So 36mg Concerta ~= 12mg Dexedrine.
Now, a given mass of Vyvanse is equivalent to a little over 1/3 of the same daily dose of Dexedrine: 30mg Vyvanse ~= 12mg Dexedrine. So it turns out that today's Concerta dose is about the same as my previous usual Vyvanse dose. Not surprising, then, if it is mostly making me feel more awake.
In any case, it is useful that Concerta turns out to be only a little less potent than Vyvanse mass-for-mass. It will make it easier to compare results vs. my Vyvanse experience.
Going up to 54mg Concerta will be the real test. That will be nearly exactly the Vyvanse dose at which I started to feel more jittery than focused, and at which I started to have sleep problems.
I don't know whether it was the melatonin or not, but on Monday night it improved considerably, and on Tuesday night I slept like the proverbial log. It must have taken less than 5 minutes to fall asleep, and I remember nothing else before waking up in the morning. So, good news.
It turns out that neither the kind of insomnia I was experiencing nor the improvement after a week should be that much of a surprise. I looked up some research on amphetamine withdrawal, and very light, disrupted sleep is a nearly universal withdrawal symptom. One of the papers also found that most of their subjects recovered from the worst acute withdrawal symptoms after about one week.
Of course, the real question is: why would those symptoms start when I was still taking my meds? I see two possibilities:
- I was going through withdrawal at night after my daily dose wore off. This might make more sense for my experience on 50mg Vyvanse than it does for 30mg Vyvanse.
- When it started on the weekend it was withdrawal from the higher doses I was taking during the week when I supplemented during work hours with dexedrine.
There are many outstanding questions here. One of the most central for me is: Why am I so sensitive to amphetamines to experience withdrawal on such a low dose? My effective daily dose was only ~20mg Dexedrine. The subjects studied in the papers were taking 5-10 times that much. It is unlikely that I'll every really know the answer.
The question now is: Will I experience fewer problems on methylphenidate? The experiment we're running to find out is the only one possible: Try methylphenidate and see what happens. On Wednesday, sleep problems resolved, I started 18mg Concerta. Didn't really notice any effects, positive or negative. Maybe a little more awake without any need for caffeine, but that's it. No insomnia.
Today I went up to 36mg as instructed by my doctor when he gave me the prescription. Still not noticing much of anything, but I am feeling nicely awake and alert. So, that's good.
We'll see how work goes tomorrow. I'll call my doctor to consult. I imagine if I have no negative side effects he will put me up to 54mg on Wednesday. I'm fine with moving that quickly now; I think I'm better at assessing positive work effects now that I have more experience with the ups and downs of the meds. It may depend on how I feel today and tomorrow, though. Maybe if I feel like I'm getting some good help on 36mg I'll wait a little longer.
I looked up rough equivalences between Concerta and Ritalin, and Ritalin and Dexedrine. Concerta is equivalent to approximaetly 2/3 of the same daily dose of Ritalin (not all of the medication is released from the Concerta delivery vehicle). Ritalin, in turn, is equivalent to about 1/2 of the same daily dose of Dexedrine. Put that all together, and Concerta is approximately equivalent to 1/3 of the same daily dose of Dexedrine. So 36mg Concerta ~= 12mg Dexedrine.
Now, a given mass of Vyvanse is equivalent to a little over 1/3 of the same daily dose of Dexedrine: 30mg Vyvanse ~= 12mg Dexedrine. So it turns out that today's Concerta dose is about the same as my previous usual Vyvanse dose. Not surprising, then, if it is mostly making me feel more awake.
In any case, it is useful that Concerta turns out to be only a little less potent than Vyvanse mass-for-mass. It will make it easier to compare results vs. my Vyvanse experience.
Going up to 54mg Concerta will be the real test. That will be nearly exactly the Vyvanse dose at which I started to feel more jittery than focused, and at which I started to have sleep problems.
Sunday, January 9, 2011
"...maybe amphetamine is just not your drug."
Prophetic words. Last weekend, just after posting about feeling like the Dexedrine wasn't working out very well, I started to have sleep problems. Same problem I had on 50mg Vyvanse: not too difficult to get to sleep initially, but then I wake up around 1:30am and barely get back to sleep at all after that. Really, really light, fitful sleep.
This actually started on the Sunday, when I was only taking Vyvanse. Didn't think too much of it, though. Only one night, right? I start off on only 2.5 Dexedrine on Monday, though.
On Monday night, same thing. Hmmm...now I notice the trend. So on Tuesday I take just the Vyvanse. At this point I'm completely sure that the problem will go away. After all, I've never had a single issue on 30mg Vyvanse.
Same problem Tuesday night.
Now I'm worried. On Wednesday, I don't take anything, not even any caffeine. I expect to feel completely bagged, but I'm oddly OK. Call my doctor, tell him what's going on. We agree I should stop the amphetamine-based meds and try Concerta. "At least," I think, "I'll get a good night's sleep tonight."
Nope. Wednesday night is the same as the others.
On Thursday I again take nothing, though I have some tea to get me through the day since I'm now really tired. Can't tell if this is some amphetamine withdrawal or just the effects of not sleeping well for several nights in a row. Despite having picked up my new prescription, I decide to stay off all meds until I've had a good night's sleep. Concerta has a 12% reported occurrence of insomnia; how am I going to know if I'm affected if I have sleep issues before I take the first pill?
Thursday night I take 6mg melatonin. Never had to take it before since my previous sleep problems have gone away as soon as I reduced the meds. Friday I try 3 mg, and last night I tried 6 again.
I think last night I finally saw some improvement. I still woke up around 1:30am, but I had to pee and unlike the previous nights I felt pretty sleepy. Don't remember having a ton of trouble getting back to sleep. I did wake up a couple more times, but my memories of the night are of brief periods of wakefulness. I'll take 6mg melatonin again tonight and we'll see how things go.
One very interesting part of this experience has been doing my job through it. I have definitely had more trouble with alertness (not shocking given the lack of sleep), but I haven't had a ton of trouble getting things done. I feel much more relaxed. I don't know why, but it seems like over the last month the amphetamines stopped making me feel motivated and energetic, and started just making me jittery.
Hopefully my sleep will settle down and I can try the Concerta. Will post when I do.
This actually started on the Sunday, when I was only taking Vyvanse. Didn't think too much of it, though. Only one night, right? I start off on only 2.5 Dexedrine on Monday, though.
On Monday night, same thing. Hmmm...now I notice the trend. So on Tuesday I take just the Vyvanse. At this point I'm completely sure that the problem will go away. After all, I've never had a single issue on 30mg Vyvanse.
Same problem Tuesday night.
Now I'm worried. On Wednesday, I don't take anything, not even any caffeine. I expect to feel completely bagged, but I'm oddly OK. Call my doctor, tell him what's going on. We agree I should stop the amphetamine-based meds and try Concerta. "At least," I think, "I'll get a good night's sleep tonight."
Nope. Wednesday night is the same as the others.
On Thursday I again take nothing, though I have some tea to get me through the day since I'm now really tired. Can't tell if this is some amphetamine withdrawal or just the effects of not sleeping well for several nights in a row. Despite having picked up my new prescription, I decide to stay off all meds until I've had a good night's sleep. Concerta has a 12% reported occurrence of insomnia; how am I going to know if I'm affected if I have sleep issues before I take the first pill?
Thursday night I take 6mg melatonin. Never had to take it before since my previous sleep problems have gone away as soon as I reduced the meds. Friday I try 3 mg, and last night I tried 6 again.
I think last night I finally saw some improvement. I still woke up around 1:30am, but I had to pee and unlike the previous nights I felt pretty sleepy. Don't remember having a ton of trouble getting back to sleep. I did wake up a couple more times, but my memories of the night are of brief periods of wakefulness. I'll take 6mg melatonin again tonight and we'll see how things go.
One very interesting part of this experience has been doing my job through it. I have definitely had more trouble with alertness (not shocking given the lack of sleep), but I haven't had a ton of trouble getting things done. I feel much more relaxed. I don't know why, but it seems like over the last month the amphetamines stopped making me feel motivated and energetic, and started just making me jittery.
Hopefully my sleep will settle down and I can try the Concerta. Will post when I do.
Friday, December 31, 2010
Holdays Are Hard
Yeah, they're tough. I get all used to not working, and then it is hard to get back into the grind. Gotta keep working on these good habits.
Still on 30mg Vyvanse + some amount of Dexedrine. 5mg hasn't worked out super well for me the last couple of days. That could just be because I spent more that 5 days on just the Vyvanse while taking a break from work. I guess we'll have to see.
Still on 30mg Vyvanse + some amount of Dexedrine. 5mg hasn't worked out super well for me the last couple of days. That could just be because I spent more that 5 days on just the Vyvanse while taking a break from work. I guess we'll have to see.
Tuesday, December 21, 2010
30mg Vyvanse + 5mg Dexedrine
7.5mg Dexedrine messes with my sleep. At least, it does if I take three 2.5mg doses around 9, 11:15, and 2:30. The result felt very similar to 50mg Vyvanse; I could get to sleep without too much difficulty, but I would wake up several times from 1am to 5am and never really feel like I got solidly back to sleep.
7.5mg Dexedrine is ~17.5mg Vyvanse, so from a total dosage point of view this is not so surprising. The Dexedrine is only supposed to last ~4 hours per dose, though, unlike the Vyvanse. The point of using them together was to have the Vyvanse provide a smooth base dose over the entire day, while using Dexedrine for a short-term boost just during work hours. Emphasis on short-term. There is absolutely no reason why the extra Dex should still be hanging around at 1am. Thanks, crazy metabolism.
Still, I didn't really feel like the extra Dex was giving me a big boost during the day. If anything, I felt a little jittery. Combine that with the sleep problems and it was time to drop back down a little.
What I am trying now is actually to do the first two doses in the 7.5mg schedule, and just leave off the third. If the amphetamines really are sticking around for longer than they should, then dosing early should be the way to go. I've tried this for a couple of days now, and it feels good.
As always, the highly variable nature of my work (particularly the fact that is is often quite challenging) makes it difficult to assess how much help the meds are giving me. One thing is very clear though: I do not need caffeine anymore.
I used to really need to use caffeine to stop getting drowsy at my desk, even when I had plenty of sleep. It wasn't a caffeine withdrawal problem just mistaken for drowsiness either; I have plenty of experience with caffeine and I always used it very, well, technically. I know how much to take, when to take it, and I know when I'm getting withdrawal symptoms. I didn't take that much (1 Starbucks "grande" brewed coffee sipped over the entire day), since the research shows that chronic high caffeine use will quickly cause significant tolerance and dependence. I even cut my dose back on weekends by enough to kill any built-up dependence while avoiding significant withdrawal symptoms. I was a caffeine boss.
Regardless, I could be clean of caffeine for well over a week, have gotten 8+ hours of sleep a night for several nights, and I'd still have trouble keeping my eyes open at more that just a couple of points during the day. I know now that this was likely an ADHD symptom. My brain was getting worn out from focusing and couldn't keep up the effort. I used caffeine as an over-the-espresso-bar-counter medication for it. I don't have to do that now, at all, so the meds are helping, and they are helping in a more consistent way. Heck, I've been grumpy and/or jittery many, many more times due to bad caffeine dose choices than I've experienced during all this messing around stimulant medication.
Maybe part of the reason I didn't notice as much of a huge change as I'd expected on the meds is I was doing a good job self-medicating with caffeine? I don't know.
What I am sure of, though, is that 30mg of Vyvanse alone is more than sufficient for my weekends. That's one thing I really like about using Vyvanse and Dexedrine tabs together. On the weekends I don't have to worry about carrying around the Dex and dosing at the right time. There are no worries about feeling grumpy or losing sleep. 30mg of Vyvanse is absolutely fabulous from that point of view. I've never felt even a twinge of extra grumpiness when using it, and most of the time I feel calmer, more relaxed, and more patient.
So hats off to Vyvanse for that, I guess, even if it does crazily stick around in my system for 12 hours longer than it is supposed to. Silly Vyvanse, I can't stay mad at you.
7.5mg Dexedrine is ~17.5mg Vyvanse, so from a total dosage point of view this is not so surprising. The Dexedrine is only supposed to last ~4 hours per dose, though, unlike the Vyvanse. The point of using them together was to have the Vyvanse provide a smooth base dose over the entire day, while using Dexedrine for a short-term boost just during work hours. Emphasis on short-term. There is absolutely no reason why the extra Dex should still be hanging around at 1am. Thanks, crazy metabolism.
Still, I didn't really feel like the extra Dex was giving me a big boost during the day. If anything, I felt a little jittery. Combine that with the sleep problems and it was time to drop back down a little.
What I am trying now is actually to do the first two doses in the 7.5mg schedule, and just leave off the third. If the amphetamines really are sticking around for longer than they should, then dosing early should be the way to go. I've tried this for a couple of days now, and it feels good.
As always, the highly variable nature of my work (particularly the fact that is is often quite challenging) makes it difficult to assess how much help the meds are giving me. One thing is very clear though: I do not need caffeine anymore.
I used to really need to use caffeine to stop getting drowsy at my desk, even when I had plenty of sleep. It wasn't a caffeine withdrawal problem just mistaken for drowsiness either; I have plenty of experience with caffeine and I always used it very, well, technically. I know how much to take, when to take it, and I know when I'm getting withdrawal symptoms. I didn't take that much (1 Starbucks "grande" brewed coffee sipped over the entire day), since the research shows that chronic high caffeine use will quickly cause significant tolerance and dependence. I even cut my dose back on weekends by enough to kill any built-up dependence while avoiding significant withdrawal symptoms. I was a caffeine boss.
Regardless, I could be clean of caffeine for well over a week, have gotten 8+ hours of sleep a night for several nights, and I'd still have trouble keeping my eyes open at more that just a couple of points during the day. I know now that this was likely an ADHD symptom. My brain was getting worn out from focusing and couldn't keep up the effort. I used caffeine as an over-the-espresso-bar-counter medication for it. I don't have to do that now, at all, so the meds are helping, and they are helping in a more consistent way. Heck, I've been grumpy and/or jittery many, many more times due to bad caffeine dose choices than I've experienced during all this messing around stimulant medication.
Maybe part of the reason I didn't notice as much of a huge change as I'd expected on the meds is I was doing a good job self-medicating with caffeine? I don't know.
What I am sure of, though, is that 30mg of Vyvanse alone is more than sufficient for my weekends. That's one thing I really like about using Vyvanse and Dexedrine tabs together. On the weekends I don't have to worry about carrying around the Dex and dosing at the right time. There are no worries about feeling grumpy or losing sleep. 30mg of Vyvanse is absolutely fabulous from that point of view. I've never felt even a twinge of extra grumpiness when using it, and most of the time I feel calmer, more relaxed, and more patient.
So hats off to Vyvanse for that, I guess, even if it does crazily stick around in my system for 12 hours longer than it is supposed to. Silly Vyvanse, I can't stay mad at you.
Monday, December 13, 2010
30mg Vyvanse + 7.5mg Dexedrine Sulphate
It's not going great, but it's not going badly. It's a little hard to tell because I've been very busy lately and had more and more strident stressors than usual. I've also been at one of those difficult points where I'm between tasks and have to do a bunch of assessment, organization, and record-keeping so I and the people I work with know what to do next.
One of the most difficult things about being at that sort of point, I now realize, is that I end up having to face up to what I have not accomplished or done well. I appear to have a very unfortunate self-image still stuck in my head that does not allow me to make certain kinds of mistakes and remain a competent and worthwhile person. It turns a straightforward, useful assessment process into a walk through the forest of why-I-suck. I hope that this insight into myself will help me do better at this kind of thing!
The Vyvanse alone isn't doing enough for me, but that is not really a surprise. The problem is taking the right amount of dex tabs at the right time so I get positive effects without a "down" later on. Still working on that.
I am concerned that I am developing a tolerance to the dexamphetamine in general, but there is no way to tell in the short term. I'll just have to track it. One of the ways I would be able to tell is decreased positive effects during the day and increased negative effects when coming off in the evening. The busyness and stress are making it hard to assess both.
One of the most difficult things about being at that sort of point, I now realize, is that I end up having to face up to what I have not accomplished or done well. I appear to have a very unfortunate self-image still stuck in my head that does not allow me to make certain kinds of mistakes and remain a competent and worthwhile person. It turns a straightforward, useful assessment process into a walk through the forest of why-I-suck. I hope that this insight into myself will help me do better at this kind of thing!
The Vyvanse alone isn't doing enough for me, but that is not really a surprise. The problem is taking the right amount of dex tabs at the right time so I get positive effects without a "down" later on. Still working on that.
I am concerned that I am developing a tolerance to the dexamphetamine in general, but there is no way to tell in the short term. I'll just have to track it. One of the ways I would be able to tell is decreased positive effects during the day and increased negative effects when coming off in the evening. The busyness and stress are making it hard to assess both.
Wednesday, December 8, 2010
30mg Vyvanse, again
Ugh. What a difference a few days makes. A few hours, actually, since things kind of fell apart on Sunday night, less than 12 hours after the last post.
I'd noticed a bit of irritability in the evenings on the Spansules during the week. I didn't take it too seriously, as short-term side effects are not unusual after changing doses or medications. I'd also noticed, with a little more alarm, some difficulty maintaining an erection around the same time. Again, I was willing to wait it out and see if there was really a long-term pattern.
Well, those things came together to make one big unacceptable problem on Sunday. Suffice it to say that my grumpy, anxious self made a nice wreck out of the end of the day. I had a horrible night, and I spent the morning lying in bed contemplating my own worthlessness until I couldn't delay getting up any longer.
Luckily, I did manage to get up and take my dose. An hour later, back in my right mind, I called my doctor and said I had to back off to 30mg of Vyvanse. That's the last problem-free dose I was on, and I have to get back to problem-free before I can seriously consider another experiment. I accept that this is a fundamentally experimental process, I really do. I just refuse to jump from problem to problem. I have to make sure I have a stable baseline of experience to compare with.
My doctor suggested that amphetamine may just not be my drug (his turn of phrase), and that we should consider trying methylphenidate (Ritalin) or atomoxetine (Strattera). I'm not ruling that out, but I don't think I should jump there from a crisis if I can avoid it.
In any case, it is clear that Spansules were definitely not my thing. Not only did I have negative side-effects, I didn't feel like I was getting the level of positive effects that I experienced on 30mg or 40mg of Vyvanse. This is surprising, since 20mg of Spansules is pharmacologically equivalent to 50mg of Vyvanse. I guess more amphetamine is not what I need.
So, back to 30mg Vyvanse for me. In addition to the 30mg of Vyvanse, though, I also have a bunch of 5mg dexamphetamine sulphate tablets. My deal with my doctor is that I'm going to try splitting those into 2.5mg halves and spreading 2 and then maybe 3 of them over my work day. My hope is that the smooth base of medication from the Vyvanse will prevent an evening "crash" without causing insomnia, and the tablets will let me play around with a bit of a higher dose during the day.
The best I've felt this whole time was when I was on 40mg of Vyvanse with a 5mg dexadrine tab at noon, but even on 40mg I remember feeling like I was sleeping a little too lightly and wasn't tired enough in the mornings. I think it is worth trying 30mg of Vyvanse as the base and seeing if I can't get back to the same level of positive effects by augmenting with the 5mg tabs.
I have to keep remembering that my goal is to get just enough help to be happy. I can't shoot for feeling awesomely focused all the time, or I'm likely to end up chasing that goal into riskier meds and doses than I'm really comfortable with. I'm getting a sense now, though, for how this process can take you in that direction. It is so tempting to just try a little more medication. Then when you get the negative symptoms, you get the offer to fix it with another medication, or a different medication. Going back to less seems like a step backwards, a concession, a defeat.
Well, I don't see it that way. Going back to a known good state is the only way to recover the stability necessary to make a good decision on your next steps. Maybe I'm just lucky that my unmedicated state was already not too shabby. If I was coming to meds with my life falling apart, I can see how it would be a much harder decision to back off in that direction again.
I'd noticed a bit of irritability in the evenings on the Spansules during the week. I didn't take it too seriously, as short-term side effects are not unusual after changing doses or medications. I'd also noticed, with a little more alarm, some difficulty maintaining an erection around the same time. Again, I was willing to wait it out and see if there was really a long-term pattern.
Well, those things came together to make one big unacceptable problem on Sunday. Suffice it to say that my grumpy, anxious self made a nice wreck out of the end of the day. I had a horrible night, and I spent the morning lying in bed contemplating my own worthlessness until I couldn't delay getting up any longer.
Luckily, I did manage to get up and take my dose. An hour later, back in my right mind, I called my doctor and said I had to back off to 30mg of Vyvanse. That's the last problem-free dose I was on, and I have to get back to problem-free before I can seriously consider another experiment. I accept that this is a fundamentally experimental process, I really do. I just refuse to jump from problem to problem. I have to make sure I have a stable baseline of experience to compare with.
My doctor suggested that amphetamine may just not be my drug (his turn of phrase), and that we should consider trying methylphenidate (Ritalin) or atomoxetine (Strattera). I'm not ruling that out, but I don't think I should jump there from a crisis if I can avoid it.
In any case, it is clear that Spansules were definitely not my thing. Not only did I have negative side-effects, I didn't feel like I was getting the level of positive effects that I experienced on 30mg or 40mg of Vyvanse. This is surprising, since 20mg of Spansules is pharmacologically equivalent to 50mg of Vyvanse. I guess more amphetamine is not what I need.
So, back to 30mg Vyvanse for me. In addition to the 30mg of Vyvanse, though, I also have a bunch of 5mg dexamphetamine sulphate tablets. My deal with my doctor is that I'm going to try splitting those into 2.5mg halves and spreading 2 and then maybe 3 of them over my work day. My hope is that the smooth base of medication from the Vyvanse will prevent an evening "crash" without causing insomnia, and the tablets will let me play around with a bit of a higher dose during the day.
The best I've felt this whole time was when I was on 40mg of Vyvanse with a 5mg dexadrine tab at noon, but even on 40mg I remember feeling like I was sleeping a little too lightly and wasn't tired enough in the mornings. I think it is worth trying 30mg of Vyvanse as the base and seeing if I can't get back to the same level of positive effects by augmenting with the 5mg tabs.
I have to keep remembering that my goal is to get just enough help to be happy. I can't shoot for feeling awesomely focused all the time, or I'm likely to end up chasing that goal into riskier meds and doses than I'm really comfortable with. I'm getting a sense now, though, for how this process can take you in that direction. It is so tempting to just try a little more medication. Then when you get the negative symptoms, you get the offer to fix it with another medication, or a different medication. Going back to less seems like a step backwards, a concession, a defeat.
Well, I don't see it that way. Going back to a known good state is the only way to recover the stability necessary to make a good decision on your next steps. Maybe I'm just lucky that my unmedicated state was already not too shabby. If I was coming to meds with my life falling apart, I can see how it would be a much harder decision to back off in that direction again.
Sunday, December 5, 2010
20mg Dexedrine Spansules...
Wow, the last couple of weeks have been a blur. 50mg Vyvanse worked fine without the 5mg Dexedrine, except for one thing: I couldn't sleep through the night. I could get to sleep well enough, but I would wake up several times during the night. Each time it would take a long time to get back to sleep.
Most telling of all, for me, was that I couldn't even manage to get a half-hour of sleep at the end of the night, around the time I usually get up. This is also the time I usually take my dose. I was too alert to sleep even 24 hours after taking the Vyvanse, even after barely sleeping that night. It was clear to me then that the Vyvanse must be sticking around in my system for way too long. In retrospect, this fit with my experience on Vyvanse from the very beginning. When I started on 30mg, exactly the same thing happened. I'd sleep for maybe 4 hours, and then pop out of bed effortlessly.
My doctor doesn't have any particular explanation for this. It is possible he thinks I'm just imagining the whole thing. I couldn't find much information on why it might be happening, other than some stuff about acidic diets speeding up the metabolism/elimination process, and basic or acid-neutralizing diets doing the opposite. My diet happens to not include many acidic items, so maybe that is it.
I got fed up with not sleeping on a Friday when I would not have an opportunity to talk to my doctor, so I just dropped down to a left-over 40mg Vyvanse for that day, and then went to 30mg for the weekend. No problems sleeping at all on the 30mg. Felt a little blurry around the edges dropping down to 30 that quickly, but nothing serious.
On Monday my doctor recommended trying Dexedrine Spansules as they are not supposed to last as long as Vyvanse. The mechanism for releasing the drug over time is also less complicated than Vyvanse, so it is less likely that something odd about my metabolism would cause it to last longer than usual. So far this has worked out well. I am not having difficulty sleeping, and I wake up in the morning feeling more like my usual non-medicated self; that is, I don't want to get out of bed.
I think I've been on the meds long enough to say that they are having a positive effect for sure. I think that the Spansules are not quite as potent as the Vyvanse was yet, so I may have to go up to 30mg. We'll see. My experience on Vyvanse indicates that I may have been receiving a higher, longer dose of medicine than most people would on the same intake, so it may take a larger-than-expected dose of Spansules to produce an equivalent positive effect.
Most telling of all, for me, was that I couldn't even manage to get a half-hour of sleep at the end of the night, around the time I usually get up. This is also the time I usually take my dose. I was too alert to sleep even 24 hours after taking the Vyvanse, even after barely sleeping that night. It was clear to me then that the Vyvanse must be sticking around in my system for way too long. In retrospect, this fit with my experience on Vyvanse from the very beginning. When I started on 30mg, exactly the same thing happened. I'd sleep for maybe 4 hours, and then pop out of bed effortlessly.
My doctor doesn't have any particular explanation for this. It is possible he thinks I'm just imagining the whole thing. I couldn't find much information on why it might be happening, other than some stuff about acidic diets speeding up the metabolism/elimination process, and basic or acid-neutralizing diets doing the opposite. My diet happens to not include many acidic items, so maybe that is it.
I got fed up with not sleeping on a Friday when I would not have an opportunity to talk to my doctor, so I just dropped down to a left-over 40mg Vyvanse for that day, and then went to 30mg for the weekend. No problems sleeping at all on the 30mg. Felt a little blurry around the edges dropping down to 30 that quickly, but nothing serious.
On Monday my doctor recommended trying Dexedrine Spansules as they are not supposed to last as long as Vyvanse. The mechanism for releasing the drug over time is also less complicated than Vyvanse, so it is less likely that something odd about my metabolism would cause it to last longer than usual. So far this has worked out well. I am not having difficulty sleeping, and I wake up in the morning feeling more like my usual non-medicated self; that is, I don't want to get out of bed.
I think I've been on the meds long enough to say that they are having a positive effect for sure. I think that the Spansules are not quite as potent as the Vyvanse was yet, so I may have to go up to 30mg. We'll see. My experience on Vyvanse indicates that I may have been receiving a higher, longer dose of medicine than most people would on the same intake, so it may take a larger-than-expected dose of Spansules to produce an equivalent positive effect.
Sunday, November 21, 2010
Whoops, forgot my Dexedrine...
I'm away from home today, and I forgot to bring my Dexedrine with me. Not a big deal, I was thinking of seeing how I do without it anyhow now that I'm taking 50mg of Vyvanse.
The last few days have been typical of dose changes. For the first 2 days in particular, I'm on a bit of a high in terms of productivity and mood. Things seem effortless. Yesterday, though, I noticed a bit of a low in the evening. I seemed more irritable than usual, but as always it could just have been an irritating day.
It will be interesting to see whether I get irritable this afternoon without the Dexedrine, and it will also be interesting to see how work and the evenings are next week now that the dose-change effects have worn off.
The last few days have been typical of dose changes. For the first 2 days in particular, I'm on a bit of a high in terms of productivity and mood. Things seem effortless. Yesterday, though, I noticed a bit of a low in the evening. I seemed more irritable than usual, but as always it could just have been an irritating day.
It will be interesting to see whether I get irritable this afternoon without the Dexedrine, and it will also be interesting to see how work and the evenings are next week now that the dose-change effects have worn off.
Wednesday, November 17, 2010
50 mg Vyvanse + 5 mg Dexedrine
I've spent a week on 40 mg Vyvanse with 5 mg Dexedrine at noon, and it has worked quite well. No more irritability or tension in the afternoons, and it didn't just shift to the evenings as I feared. Not sure why this is, but I bet it has something to do with how rapidly the medication wears off. Perhaps my body was getting rid of the Vyvanse very quickly, leading to a low, and the Dexedrine fills in this low so I get a smoother tapering off. I'll have to remember to ask my doc.
In any case, I've been finding that my ability to stay on track is better now in the afternoon than in the morning. Since this coincided with taking an extra dose of medication, it suggests that a higher dose of Vyvanse in the morning might be in order. I spoke to my doctor about this yesterday, and today I'm starting on 50mg Vyvanse.
In any case, I've been finding that my ability to stay on track is better now in the afternoon than in the morning. Since this coincided with taking an extra dose of medication, it suggests that a higher dose of Vyvanse in the morning might be in order. I spoke to my doctor about this yesterday, and today I'm starting on 50mg Vyvanse.
Wednesday, November 10, 2010
40mg Vyvanse + 5mg Dexadrine
The tension and irritability never really went away. It was still there on Monday. While I was speaking with my doctor on Tuesday, I realized that it always started in the early afternoon. He thinks that I'm a fast metabolizer, and the vyvanse is wearing off partway through the day.
So, today I took 5mg of straight Dexadrine a little after noon. Definitely helped the tension & jitters so far. I guess I'll see what happens this evening when it all wears off.
So, today I took 5mg of straight Dexadrine a little after noon. Definitely helped the tension & jitters so far. I guess I'll see what happens this evening when it all wears off.
Friday, November 5, 2010
40mg Vyvanse, Day 7
I think the stress/jitters are getting better gradually. I am very glad I decided to stay on each dose for 2 weeks. I'd have no idea what 40mg was really going to feel like if I was changing again today.
The big question now is: Is it really helping my symptoms? Again, I'm glad I'm not changing after only a week. I think it is helping. I'm finding it easier to stop distracting myself when I'm at a tough spot, which was always my big problem. I'm starting new jobs more easily, and sticking with them more easily. That's a big deal.
My hardest time is when I'm between big tasks. That's when I have to look around at what there is to do and pick the next thing. There are usually a few big things I could tackle, and a whole bunch of small things. I get paralyzed. The small things seem trivial and meaningless. The big things seem like too much of a commitment. Sitting down and doing an analysis of the options is way, way too formal, of course!
The frustration of trying to choose, combined with no clear deadline for doing so, leads me to distract myself. This leads to more frustration when I realize I've ended up getting nothing done.
I was in this situation yesterday, and I pulled through. I picked one thing and just did it, and I got it done. I started to distract myself, but every time I was able to snap out of it relatively quickly. Maybe the meds make it harder to fall into the numb, semi-trance state of self-distraction. They make that prefrontal cortex planning section of my brain keep saying, "Hey! Hey! Stop it! You have something to do!"
I remember thinking before I started the meds that the side-effect of irritability might not be so much due to the meds themselves. Maybe it's just that once you take the meds, you find yourself no longer able to ignore all the crap you've been putting off for so long. That would irritate anyone.
The big question now is: Is it really helping my symptoms? Again, I'm glad I'm not changing after only a week. I think it is helping. I'm finding it easier to stop distracting myself when I'm at a tough spot, which was always my big problem. I'm starting new jobs more easily, and sticking with them more easily. That's a big deal.
My hardest time is when I'm between big tasks. That's when I have to look around at what there is to do and pick the next thing. There are usually a few big things I could tackle, and a whole bunch of small things. I get paralyzed. The small things seem trivial and meaningless. The big things seem like too much of a commitment. Sitting down and doing an analysis of the options is way, way too formal, of course!
The frustration of trying to choose, combined with no clear deadline for doing so, leads me to distract myself. This leads to more frustration when I realize I've ended up getting nothing done.
I was in this situation yesterday, and I pulled through. I picked one thing and just did it, and I got it done. I started to distract myself, but every time I was able to snap out of it relatively quickly. Maybe the meds make it harder to fall into the numb, semi-trance state of self-distraction. They make that prefrontal cortex planning section of my brain keep saying, "Hey! Hey! Stop it! You have something to do!"
I remember thinking before I started the meds that the side-effect of irritability might not be so much due to the meds themselves. Maybe it's just that once you take the meds, you find yourself no longer able to ignore all the crap you've been putting off for so long. That would irritate anyone.
Tuesday, November 2, 2010
40mg Vyvanse, Day 5
Definitely less jittery today. I still find myself doing these big sighs, though, like I do when I'm really stressed out by something. I feel stressed out. Is it justified? Is it just that my life right now happens to be stressful?
Hard to tell. It feels justified, of course. When I step back and review what has actually happened in the last day or so, though, I'm not seeing the big stressful stuff. I think the meds are still making me feel on edge.
This is very different than the first 30mg. That made me feel calmer, if anything.
Today was better than yesterday. Tomorrow may be better still. We'll see.
Hard to tell. It feels justified, of course. When I step back and review what has actually happened in the last day or so, though, I'm not seeing the big stressful stuff. I think the meds are still making me feel on edge.
This is very different than the first 30mg. That made me feel calmer, if anything.
Today was better than yesterday. Tomorrow may be better still. We'll see.
Monday, November 1, 2010
40mg Vyvanse, Day 4, Evening
Productivity today was good. Mood, not so good. I've been jittery and kind of irritable since around noon. Low-grade headache. Not even a very typical headache, more like occasional aches shooting along different parts of my head. I haven't taken anything for it yet, because I don't want to mask any side effects.
Also kind of stiff, probably because my jitters/irritability have been causing me to clench.
Also kind of stiff, probably because my jitters/irritability have been causing me to clench.
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