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:

1. 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.
2. 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.

A combination of these things is also possible. It may have been mostly #1 while on 50mg, and a combination of #1 and #2 while taking 30mg on the weekend. Of course, once I dropped the meds entirely it would have been just regular withdrawal.

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.

"...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.

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.

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.

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.