ADHD Medication Dosage: Precision Counts

[..YouTube..] I am the opposite... I have bipolar disorder also and I have to have the little dips between short acting doses because I become almost manic when they wear off in the evening and on short acting the little dips are almost not noticeable. I take 20 mg of focalin 3 times a day and during those dips, i get hungry and talk a lot. Most people I know are the total opposite but it was always 4-5 hours of hell on long acting meds but everyone is different...

[..YouTube..] You got that right: Commoditization is out, custom work is definitely in.

[..YouTube..] Completely agree on these two comments, Prota. The most important problem with both diagnosis and treatment of ADHD is that folks look to label and oversimplify - missing the point about complexity and individual treatment. My mission: Not to put everyone on every med, just to use the meds accurately and well if we do use them at all.

[..YouTube..] (To follow along) I can manage my ADHD in the evening, it's the work day where I find my medication helps me the most. I don't take it on the weekend all the time either. I respect your opinion Dr but every patient is different.

[..YouTube..] I take Dexedrine for ADHD. 10mg in the morning and 10mg in the afternoon. I find the DOE to be about 4-5 hours. When I get up I take my first dose at 7, and my second dose at noon. It really improves my quality of life. You have a great point that ADHD is not only a day time disorder. But I find that sustained release drugs give me insomnia so I do not like them. And after doing my due diligence I am not willing to take an anti depressant.

[..YouTube..] The issue, imo, for any of this is data and evidence. Some NDs are completely wedded to data, some are not, some MDs love data, some fly by the seat of their pants. Even data can lead a person astray, but it beats absolute speculation.

[..YouTube..] @fetalbetal The issue, imo, for any of this is data and evidence. Some NDs are completely wedded to data, some are not, some MDs love data, some fly by the seat of their pants. Even data can lead a person astray, but it beats absolute speculation.

[..YouTube..] Thank you for the time and thoughts on these matters, I get conflicted viewpoints all the time. The best approach to anything complicated is to keep an open mind and weigh all of the evidence. I think my NP is much more reliable than I had previously thought, and my MD is, unfortunately, less educated or caring on any matter that isn't mainstream. I actually had to explain the difference between homeopathy & naturopathy. Hpathy= placebo, Npathy =89%bs (imo)

[..YouTube..] @DrCharlesParker Thank you for the time and thoughts on these matters, I get conflicted viewpoints all the time. The best approach to anything complicated is to keep an open mind and weigh all of the evidence. I think my NP is much more reliable than I had previously thought, and my MD is, unfortunately, less educated or caring on any matter that isn't mainstream. I actually had to explain the difference between homeopathy & naturopathy. Hpathy= placebo, Npathy =89%bs (imo)

[..YouTube..] I does sound, on cursory review that you might need more testing. Unpredictable outcomes with good meds from good docs always need more testing even if those good docs are me and my team!

[..YouTube..] @fetalbetal I does sound, on cursory review that you might need more testing. Unpredictable outcomes with good meds from good docs always need more testing even if those good docs are me and my team!

[..YouTube..] After hundreds of tests using hair analysis, not considered main stream but completely traditional, with insights documented from several JAMA refs, I can report with certainty that the NP is quite correct, a forward thinker, and evidence chaser, and mercury is but one of the most serious problems... here in VA Beach we are troubled with with high levels of bismuth associated with jet exhaust from Oceana and several high intensity carrier airports.

[..YouTube..] @fetalbetal After hundreds of tests using hair analysis, not considered main stream but completely traditional, with insights documented from several JAMA refs, I can report with certainty that the NP is quite correct, a forward thinker, and evidence chaser, and mercury is but one of the most serious problems... here in VA Beach we are troubled with with high levels of bismuth associated with jet exhaust from Oceana and several high intensity carrier airports.

[..YouTube..] I'll subscribe, and I'm not too worried about my use of meds, it's the majority of people I read, see, or hear about. My MD & psychiatrist both know I am dependent and overuse my Rx's. I'm honest with them, and often contradict myself when trying to explain. I suspect they think I'd resort to other drugs w/o the current ones. I'm concerned that I may have too much mercury in my organs. The MD says it's rare and the bloodwork results were not provided. The NP says it's common. ?

[..YouTube..] @DrCharlesParker I'll subscribe, and I'm not too worried about my use of meds, it's the majority of people I read, see, or hear about. My MD & psychiatrist both know I am dependent and overuse my Rx's. I'm honest with them, and often contradict myself when trying to explain. I suspect they think I'd resort to other drugs w/o the current ones. I'm concerned that I may have too much mercury in my organs. The MD says it's rare and the bloodwork results were not provided. The NP says it's common. ?

[..YouTube..] Your experience is not uncommon at all, and it only highlights the reason to subscribe here as will be turning out significant vids on the answers to those questions. To quickly summarize: please go to my blog link, and type the word metabolism into the SEARCH box there. Metabolism problems are measurable and correctable and fixing them will make the meds work predictably. Hang in there!

[..YouTube..] @fetalbetal Your experience is not uncommon at all, and it only highlights the reason to subscribe here as will be turning out significant vids on the answers to those questions. To quickly summarize: please go to my blog link, and type the word metabolism into the SEARCH box there. Metabolism problems are measurable and correctable and fixing them will make the meds work predictably. Hang in there!

[..YouTube..] My issue with adderall/vyvanse: Tolerance. I don't understand how these medications are supposed to be used daily, they are effective and beneficial at first, then, paranoia, depression, abuse. I believe if these meds are used in a different ( as needed/desired) way, less people would become dependent/suicidal, etc. My clonazepam says 'as needed' and I know I don't need it at all, however, I desire to use it because it lessens anxiety, with or w/o stimulants in my system.

I got you covered with another complete answer over at the posting on Immunity Details. On this question it's more clear that you haven't dialed in the stimulant consistently enough. Take it for at least 4 days, and if it falls off you need to work with your doc to increase the DOE as you are coasting on the bottom of the window. If, on the other hand, you are experiencing the narrow therapeutic window effect, then we're back, as I pointed out on the other reply, to the metabolic question. cp

[..YouTube..] Hey Jay, get that dose right, watch the DOE and jail becomes a bad memory. No reason not to dial it in correctly, and if the window moves you can fix the dose by unearthing the underlying metabolic challenge. If it moves: measure it!

[..YouTube..] @JayParkeroni Hey Jay, get that dose right, watch the DOE and jail becomes a bad memory. No reason not to dial it in correctly, and if the window moves you can fix the dose by unearthing the underlying metabolic challenge. If it moves: measure it!

[..YouTube..] Thanks dawg, you a life saver. By the way, you found me on twitter lol I was in jail for the last two days haha, so yeah thanks again! Concerta helps me with impulse control as well, part of the reason I'm gonna need it, considering I end up i jail without it -.-"

[..YouTube..] @DrCharlesParker Thanks dawg, you a life saver. By the way, you found me on twitter lol I was in jail for the last two days haha, so yeah thanks again! Concerta helps me with impulse control as well, part of the reason I'm gonna need it, considering I end up i jail without it -.-"

[..YouTube..] If you experience constant needs for changing dosage, whatever psych med you are on, but most importantly the stimulants, you quite likely are suffering with a metabolic challenge in the background - too subtle to be considered a problem. I call this the "Roving Therapeutic Window" and you can learn more about that phenomenon over at CorePsych Blog - search that term there. Best!

[..YouTube..] @JayParkeroni If you experience constant needs for changing dosage, whatever psych med you are on, but most importantly the stimulants, you quite likely are suffering with a metabolic challenge in the background - too subtle to be considered a problem. I call this the "Roving Therapeutic Window" and you can learn more about that phenomenon over at CorePsych Blog - search that term there. Best!

[..YouTube..] I'm on concerta for ADHD, and I'm concerned that I keep getting used to the dosage to a point that I feel as though I need to keep moving up in dosages...I'm afraid this will continue and that I will eventually be hitting beyond normal dosages by the time I am, 20.

Dr Parker, I've been loving your recent writings and radio appearances, and could really use your thoughts on my 18-year old daughter's situation. She's currently on a tiny (5mg) dose of adderall xr, actually generic. All other ADD meds, including Vyvanse and Intuniv seem to depress and/or irritate her, and so far this has been the best med for her. On this low dose she experiences mild improvement in focus for 4-5 hours, then experiences about an hour of strong irritability and restlessness, then is happy again but unfocused for the rest of the day and eve.  A potential kicker is, we had her tested - and she is actually a 2d6 ultra-rapid metabolizer. So my questions are: - have you seen ultra-rapid metabolizers a) experience more of this kind of rebound? 2) burn through adderall xr this quickly? - given her ultra-rapid status, do you think a) raising the dose will improve the DOE?  b) in a typical 5mg=2hr ratio? b) or conversely should she try adding a second pm dose instead? - have you seen generic mixed amphetamine salts create more rebound than brand? For the coming month our doc has Rx'd brand and written the scrip bid so that while my daughter's home from college on break, she can try slowly raising the am dose and/or adding a 5mg second dose. What do you think? Thanks so much! Jackie

[..YouTube..] Right, it sounds like you are already having some problems with duration, often a key sign that either the dose is too much, coming out the top of the window, or that you have some metabolic background noise causing the IR Adderall to burn unpredictably long. That unpredictability could be corrected by assessing and understanding possible challenges that at firs appear sub clinical. - cp

[..YouTube..] @kalikiter1 Right, it sounds like you are already having some problems with duration, often a key sign that either the dose is too much, coming out the top of the window, or that you have some metabolic background noise causing the IR Adderall to burn unpredictably long. That unpredictability could be corrected by assessing and understanding possible challenges that at firs appear sub clinical. - cp

[..YouTube..] Wait so is the take home message here, that if you are on IR adderall, switch to XR? I am currently taking 20mg IR's and have a love hate relationship. The drug has changed my life dramatically, but often times I have a hard time determining appropriate times to take them and will often suffer for it (no sleep til early morning if taken to late). Im curious about asking my doc for xr, but not sure.. My biggest issue is sleep deprivation and somehow I don't see a XR pill fixing that.

[..YouTube..] Wait so is the take home message here, that if you are on IR adderall, switch to XR? I am currently taking 20mg IR's and have a love hate relationship. The drug has changed my life dramatically, but often times I have a hard time determining appropriate times to take them and will often suffer for it (no sleep til early morning if taken to late). Im curious about asking my doc for xr, but not sure.. My biggest issue is sleep deprivation and somehow I don't see a XR pill fixing that.

[..YouTube..] Without an exam, without talking to you in detail, I can speculate just a bit: you are either a fast burner, metabolizing the meds too quickly, but more likely do have an associated biomedical issue, likely from the work I have been doing secondary to immunity. Go to CorePsych Blog and type "immunity" or "IgG" into the SEARCH box there for more info.

[..YouTube..] I meant less then 108 mg of Concerta is not notable.

[..YouTube..] Correct me if I'm wrong-the highest dose of Concerta can be 2mg/kg ?? My main problem less then of 108 mg of Concerta if not notable what so ever !! Tolerance ??

[..YouTube..] Sorry to be so late getting back Irish... you are absolutely correct on the outdated way of looking at the Adderall effect. Too often folks get caught up with the more somatic *feeling* of the stimulant meds, rather than the objective of cognitive, thinking improvement. In addition, those with ADHD often seek to correct the executive function that has been compromised for years by running the dose too high as they take the correction process to the max, out the top!

[..YouTube..] @irishjohn831 Sorry to be so late getting back Irish... you are absolutely correct on the outdated way of looking at the Adderall effect. Too often folks get caught up with the more somatic *feeling* of the stimulant meds, rather than the objective of cognitive, thinking improvement. In addition, those with ADHD often seek to correct the executive function that has been compromised for years by running the dose too high as they take the correction process to the max, out the top!

[..YouTube..] Drug holidays are encouraged by those who either have a negative bias about stimulant meds based upon insufficiency of information - or those who recognize the abundance of counterproductive side effects and just don't know what to do about them, leaving the assumption that less is best.

[..YouTube..] @irishjohn831 Drug holidays are encouraged by those who either have a negative bias about stimulant meds based upon insufficiency of information - or those who recognize the abundance of counterproductive side effects and just don't know what to do about them, leaving the assumption that less is best.

[..YouTube..] Nope don't have ADHD, but have seen it in detail, the good, the bad and the very ugly for about 40 years - the ADHD investigations that changed my life and turned on the big picture: very simple SPECT functional brain imaging.

[..YouTube..] @irishjohn831 Nope don't have ADHD, but have seen it in detail, the good, the bad and the very ugly for about 40 years - the ADHD investigations that changed my life and turned on the big picture: very simple SPECT functional brain imaging.

[..YouTube..] Also, your thoughts on drug holidays. I see a lot of people suggest them, but I don't get it. Shouldn't they be weening down rather than halting the meds for 1-2 weeks ? My feeling is once an individual no longer feels the initial adderall reaction or rush if you will, they think it's not working. Seems to be more of an adaptation rather than a high. For me the only high with adderall was the ability to finally think in an organized and focused manner for the first time in 39 years. I'm Burgess

[..YouTube..] Still on the IR, doing well with my titration however I know this isn't the case for everyone. When you speak of the abuse factor, aren't we all prescribed a fixed # of pills per month ? Morning dose is a little higher, and I take about 1/3 of that dose 2- 3 more times. My idea is not to over shoot, and stay within threshold based on your calculations of time of effectiveness. Not trying to be disrespectful, nor do you have to answer but do you have ADHD and have you ever been prescribed these

how long will vyvanse 40mg last

Hello Dr Parker, My Name is Joe and I stumbled across your blog a week or so ago. I have found your post very informative. I have been battling depression for about 4 years. I have been trying to work with my Pdoc on adjusting my meds.  He will adjust them only until he nears the  recommended max dose(per the insert includedwith the meds). If that doesn't work he wants to move on to other meds. This is extremely frustrating. Currently my biggest symptom complaint is foginess and lack of focus. I am currently taking Adderall xr 30mg morning and noon. The DOE I am getting at this level is only about 4-5 hours. At this dose sometimes I have very little effect from the meds at all. I have no side effects from the meds. I was wondering if you might be able to suggest  a Doctor in the Albany NY area? If not what are the kind of question I should be asking a Doctor to make sure I am getting someone who shares your thinking on the therapeutic window? Thank you in advance for your time and Thank you for your Blog as well.

 so why does vyvanse work pretty well for a day or two and then become less effective, eventually to the point of not being effective at all?  This is the 2nd time that's happened.  This never happened with adderall ir at all, but I had wanted to switch back to vyvanse because it was more even, lasted longer, and I didn't have to remember to take another dose.  But apparently that was a mistake, because now it's not working at all.