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.

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.