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ADHD Medication Dosage: Precision Counts

ADHD Medication Rules

ADHD Medications Require Precise Thinking

These 5 Stimulant Rules Prevent ADHD Medication Disasters:
Many thousands of individuals are treated everyday for ADHD disorders using stimulant meds that don’t last 24 hr, but only last for a portion of the day. So why aren’t we paying attention to those important details for every single person treated for ADHD, every medication dose adjustment, every med check – even if we don’t plan to adjust the meds?

This, my friends, is a national problem of enormous proportions, as the medication adjustment simply is not sufficiently discussed or addressed. It’s amazing to me that so many of these problems exist into 2011! 90% of the questions raised here at CorePsych Blog in all 2555 comments have to do with how-to-use-the-ADHD-meds-correctly. And, of those comments and questions, the predominate questions address dosage. My two most popular posts [in the thousands of views] are Intuniv Dosage Details and Vyvanse Dosage Strategies – I report that with considerable certainty as I just now checked my stats!

ADHD Med Tutorial – Video
My YouTube Video on ADHD Medication Dosage numbers over 4300 views, and when you check it out you will see even more explicit details on this remarkably overlooked subject.

Why the problem? No one has set specific dosage strategy guidelines – simple as that.

Rules: The Stimulant 5
1. Know The DOE: Start by knowing the specific expected Duration Of Effectiveness [DOE] for every stimulant medication. These are listed in detail in my book ADHD Medication Rules – Bottom line: Amphetamines [AMP] short acting = 5/6 hr DOE, AMP XR = 10 hr DOE, Methylphenidate [MPH] short acting = 4 hr DOE, MPH extended = 8 hr DOE.  If the med DOE is longer than these numbers the patient is likely out the top of the Therapeutic Window.

2. Use The DOE: Dial the medication in by using only the DOE and expected increase in DOE according to each dosage increase. Vyvanse increase by 10mg = 2 hr longer DOE, Adderall XR increase by 5mg = increase of about 2 hr, MPH is more unpredictable, but an increase on Ritalin LA by 10 mg = about 2 more hr DOE. If “toxic,” out the top of the Window, then lower the dose carefully and check back. Usually the overdose level clears in ~ 3 days.

3. DOE Over Time: Adjust stimulant meds over time based upon the DOE. Each med check, every med check requires a review of the DOE as metabolic variables change, people grow, diets change – and each of these may require change over time. The standard of care in the US for med checks with stimulant meds is quarterly, about every 3 mos. Some pediatricians check biannually or even annually. My own take in this diminished frequency of med checks in practice: inadequate supervision for controlled substances. My take on monthly med checks for stimulants: not indicated, churning the system.

4. DOE Problems: Problems with the DOE arise from multiple causes, from genetic to metabolic, to drug interactions. These problems are simply too numerous to review in this brief posting, but must be addressed as they are often associated with comorbid metabolic variables, not the meds or the ADHD diagnosis itself – sleep, diet, nutrition, breakfast, etc, all covered in detail in ADHD Medication Rules.

5. DOE Reveals Comorbid Diagnosis: Problems with treatment arise from undiagnosed, misdiagnosed comorbid conditions associated with ADHD. For a significant list documented here at CorePsych Blog of the 171 [at last count] comorbid conditions that look like ADHD, may be associated with ADHD, but often don’t improve as they are not purely prefrontal cortex, executive function related – from the underlying neurophysiology.

I hope this helps explain these important matters to those you counsel, to yourself or your family. Without precision the stimulant problems abound! Please pass this along to your colleagues and do leave a comment below re your take on these DOE stimulant measures.
cp

 

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218 Comments
  1. Details on the Roving therapeutic window found on Search at CorePsych Blog – and in my book on ADHD meds.

  2. @capitalist4life I’ve already tried Cymbalta. It would work for a month and then suddenly stops. I even increase the dose. In which case, it’ll work for another month and then follow up short.

  3. Well, what test would I do exactly to test how many neurotransmitters I have? And recently, I’ve been taking 60mg (30mg in morning, 30mg in afternoon) of DXM/day. It actually has helped with my lethargy and grumpy moods, making me mroe social and outgoing. I do not intend to trip off of it; I just remember reading from a few sources that it can have antidepressant qualities. And it’s working.

    However, I have not discussed this plan with my psych due to the thought that he may not like the idea.

  4. Strongly recommend *firmly against* this recommendation – encouraged by some colleagues who don’t get the unpredictability of partial or complete blockage of 2D6. You’re right about the blockage, incorrect from my perspective about the value of trying to use potentially dangerous interactions to alter blood levels in this manner.

  5. Try Cymbalta. It will raise your Vyvanse blood levels by partially inhibiting CYP2D6.

  6. Abilify does slightly affect those two neurotransmitters, but there are so many additional variables. If you don’t have sufficient neurotransmitters in the first place no med will work effectively, in fact supplements also fail. Best bet if problems continue: get a measurement of IgG and Neurotransmitters, even perhaps a tissue mineral analysis to visualize the biomedical corruptions.

  7. Synergy with Abilify, and specific receptors, often covers both, but a last choice with good diagnosis of comorbid biomedical details.

  8. Really? That’s interesting cause I’m now on Abilify and it’s suppose to affect those two.

  9. Gotcha, but stay tight with that rejection sensitivity thing… it’s often a mix between dopamine and serotonin that create that vulnerability… more vids coming soon on those issues.

  10. 1. No, I am bipolar, but it’s actually Bipolar I. I used to have a strong euphoric high during mania and was insanely intelligent too.
    2. I think Lamotrigine is weighing me down. I was prescribed it a year ago and it never changed me (pos/neg). I feel like it jsut makes me tired.
    MORE IMPORTANTLY, I have very high rejection sensitivity. I had terrible friends in the past and now anyone who ignores me I get depressed/aggravated/low ego…
    3. Already tried SSRI’s, worked for a month then stopped.

  11. 1. I have bipolar. I used to get weekly rotations of mania-depression and the depression was SEVERE. The mania was awesome, I was euphoric and I miss it.

    2. I’m thinkin it is depression, specifically atypical depression.

    3. I’ve already tried antiD’s, multiple kinds too. They only work for a month then stop working.

    4. You are right on metabolism. I can only go to the bathroom with the help of a stool softener. Otherwise I poop like once a week.

    I appreciate and love your response Doc. Tyvm

  12. Several issues may contribute to this tiredness.
    1. You may not be bipolar and the Lamictal could bring you down.
    2. You have a depression that remains unexplored and possibly untreated.
    3. Talk to your doc about low dose antidepressant if it makes sense.
    If any meds don’t work as expected I’ve formed the habit of chasing down other metabolic issues that might create medical problems.
    cp

  13. Hey I’m 18 years old. For my junior year I would take my vyvanse everyday for 2 months on 70 mg. I would feel like I wouldn’t even be medicated. I was more tired throughout the day than I was before I took my medication. So I stopped taking it everyday and take it every other day now. I notice the effects actually but I get sort of depressed during the comedown. Any advice? Also, I am Bipolar II on Lamictal, Lamotrigine, and Clonazepam.

  14. Download the Predictable Solutions report here: corepsych blog, that might help your doc get the process, and this link might also enlarge the conversation?
    cp

  15. & i can’t afford adderall xr or vyvanse since my insurance doesn’t cover any adhd med…
    DEXEDRINE IR costs me about .35cents for a 5mg tablet

    it’s difficult to ask him for a dose raise since i am young and don’t want to look like a drug seeker…. it’s what it feels like when asking for a dose raise… and awkward… i am not quite sure how to even begin the conversation

  16. i think i need to buy this book because:
    *i am up from 4am-2pm and evry other day is 8am-8pm*
    A. he said my ‘Dexedrine ir’ ’10MG at once’ said it should be taken 8-12hr
    B.I’m 19 years old & exercise 2hrs & drink lots of water.
    C. he said 20mg a day.. after a year of finally getting a upped dosage(FINALLY!)
    D.I’m a college student & I’m their basically until 6-8pm
    E.so dexedrine ir lasts me approx 3-4hrs & sometimes 2hrs.
    F. my doctor is just a regular DOCTOR & i can’t afford a psychiatrist

  17. Conjecture over the first few days must always focus on the individuality of each persons metabolic signature. Consider discounting those first days as valid. Your specific metabolic signature will likely, as many do, make a reasonable adjustment in those first 4-6 days, and a settling will occur that begins to permit a more accurate assessment of that DOE. Duration of Effectiveness [DOE] is reviewed in more detail as the science for dosage either in *New Rules* or at my blog *CorePsych Blog.*

  18. I was recently prescribed Vyvanse 20mg. The first day I took it, the effects lasted all day, the side effects were not pleasant, and I didnt see much of a difference in the way I concentrated. The second day I took it, it worked amazingly for the first 3 hours, I finished many projects in that short period of time and I didnt have the same unpleasant side effects that I had the first day, but the problem is that after the initial 3 hours, the effects were over. Any idea why this happened?

  19. [..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…

    • If you have a prob with long acting meds always check the breakfast drill: make sure you have a good protein rich breakfast before any psych meds, period. All this is spelled out in Rules as well.
      cp

  20. You got that right: Commoditization is out, custom work is definitely in.

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

  22. [..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.

  23. 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.

  24. (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.

  25. [..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.

  26. 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.

  27. [..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.

  28. [..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.

  29. [..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.

  30. 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.

  31. [..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)

  32. [..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)

  33. 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)

  34. 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!

  35. [..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!

  36. [..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!

  37. [..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.

  38. [..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.

  39. 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.

  40. [..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. ?

  41. [..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. ?

  42. 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. ?

  43. [..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!

  44. [..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!

  45. 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!

  46. 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.

  47. [..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.

  48. 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

  49. [..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!

  50. [..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!

  51. 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!

  52. 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 -.-“

  53. [..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 -.-“

  54. [..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 -.-“

  55. [..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!

  56. [..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!

  57. 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!

  58. [..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.

  59. 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.

  60. 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

    • Jackie
      This is such a great question! Good for you checking out her genetics – you’re a science mom! Here’s the deal in a nutshell, sorry to be so brief, really should do a blog post about this…

      Genetic testing is great but only tells you a portion of the tale. If that was the only contributory problem the answer would be transparent: Crank the dose to reach the correct DOE – been there done that thousands of times.

      But the informed consumer should also be aware that other factors can gum up the neurotransmitter pathways: genetic changes in COMT, the enzyme that turns over catecholamines like dopamine [eg] into their degraded breakdown products, can be defective [= too much dopamine no matter what you do] – or MTHFR genetic polymorphism is also a big deal, as without it more problems can occur with too few NT no matter how many precursors you take, and then taking a look at cytokines and IgG as those guys can also rain on your neurotransmitter parade.

      With refractory response: It’s often more than one variable to pull together an effective solution.

      This is a short answer, but gives you a hint at the complexity of those who don’t turn around as they should. First step for me, one of the highest percentage of returns: correcting immunity issues by measuring IgG.

      Also consider comorbid [as noted carefully in “Rules”] depression. She may not be clinically depressed but in my next book I will be breaking out yet another form of depression beyond Clint Eastwood… I call it political depression – with a clinical negative bounce based upon DA downreg of the 5HT.

      This is a starter, thanks again for a super question, love it!
      cp
      [My first answer on this came out too early in the AM… and misstated the COMT contribution! – Now corrected.]

  61. [..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

  62. [..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

  63. [..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

  64. 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

  65. [..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

  66. [..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

  67. [..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

  68. [..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.

  69. 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.

  70. [..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.

  71. [..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.

  72. [..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.

  73. [..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.

  74. 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.

  75. [..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.

  76. [..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.

  77. [..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.

  78. [..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.

  79. [..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.

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

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

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

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

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

  85. I meant less then 108 mg of Concerta is not notable.

  86. [..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 ??

  87. [..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 ??

  88. 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 ??

  89. [..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 ??

  90. [..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 ??

  91. [..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!

  92. [..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!

  93. [..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!

  94. [..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!

  95. [..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!

  96. 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!

  97. [..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!

  98. [..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.

  99. [..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.

  100. [..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.

  101. [..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.

  102. [..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.

  103. [..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.

  104. 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.

  105. 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.

  106. [..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.

  107. [..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.

  108. [..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.

  109. [..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.

  110. [..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.

  111. [..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.

  112. [..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

  113. [..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

  114. [..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

  115. [..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

  116. [..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

  117. 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

  118. [..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

  119. [..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

  120. [..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

  121. 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

  122. [..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

  123. [..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

  124. how long will vyvanse 40mg last

    • Darrius,
      Vyvanse dosage, as is all stimulant dosage, metabolism and genetics related, not based upon size, weight, sex or age, period. There are some studies that encourage a more weight related response with Intuniv [described in detail elsewhere on CorePsych Blog], but with the stimulants, not so.

      Having said that, Vyvanse, when correctly adjusted, should work for ~ 12 hr in adults, sometime up to 14 hr without side effects, without coming out the top of the Therapeutic Window. Adjustments up or down from 40 mg, in attempt to find that Therapeutic Window, will move most often by 2hr/10mg – meaning 10 mg more = 2 hr longer duration of effectiveness DOE.
      cp

  125. 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.

    • JK,
      Best bet is to simply ask [over the phone – no visit needed] if they are experienced with Adult ADHD treatment. Your doc, tho a nice person, is clearly not even aware of the standard of care and is sticking to the paucity of legalese on the package insert. Those guidelines work for those folks in the broad range of “average ADHD metabolizers” but often not for the edges. Just as your doc is worried about going too high we see many who simply go overboard because they don’t follow medical guidelines based on patient reports. – Don’t know anyone up there – take a look in the phone book, call around – I can assure you there are available docs with more experience.
      cp

  126.  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.

    • 3T,
      Often with Vyvanse it’s more difficult to see the effective range and adjust dosage. It takes awhile to see what and how it’s doing. Once that perception happens, then that particular stimulant remains more fixed in dosage, less necessary to adjust than any of the others IMHO ;-)
      cp

      •  I don’t understand.  I know how my mind and my body is different when it’s effective and when it’s not.  I have clarity, I start and finish things much better, I don’t get frustrated anywhere near as easily, and physically I’m not as tense and jittery.  At this point, taking the vyvanse has no noticeable effect.  None of these things are happening.  But on the adderall, those things were always happening.  On the vyvanse, all those things were for like a day for about 10-11 hours maybe, then the clarity disappeared, then the time got shorter and shorter until it was like I hadn’t taken it at all.  This happened at 70 mg and then again at 80.  The process took longer at 80 (about 4-5 days) than at 70 (pretty much instantaneous after 3 days of good effect), but it still happened.  And now, I’m stuck. because it’s not working.  

        • Time,
          It’s still hard to say from what you are reporting here… it is highly likely that you are simply on too much. Take a look at the Top of the Window post here and see if the late onset and confusion apply.
          cp

          •  Let me try again….
            What I mean is this —– 
            The first day or so, it was as you would expect.  
            On 70 — it lasted maybe 9 hours?  but I wasn’t sure then because it was my first med and didn’t know how I responded.  Either way, after 3 days, it did not help at all.
            On 80 — it lasted about 11 hours the first two days, then my mind was less clear the next day and it only lasted 8-9 hours, then over the course of the next several days the time got shorter and shorter until it was no longer helping at all.

            It was not a back and forth type thing you would expect with too much, which I have also experienced when I took about 100 mg unintentionally several weeks ago.

            I think it’s just not the right dose yet, but what I want to understand is why its worked for a little and then stopped.  Because I don’t want that to happen if we go up more!!
            Figuring out the adderall dose was much easier and it didn’t stop….for example, I could still take 20 mg and have it work for 3 hours.

            At this point, I’m no longer taking it at all.

          • Time,
            Now I understand – and this finding is so often seen with the background noise of metabolic disarray. My guess: you are grooving for a challenge with finding the sweet spot. Vyvanse is far more predictable in dosage, and, while it may take 2 weeks to stabilize, the longer it takes the more likely metabolic challenges are at work behind the scenes.

            Even your Adderall dose wasn’t working right: IR Adderall should last 5-6 hr when adjusted correctly [most of the time] – and only 3 hr was just too low a dose for your burning rate.

            My rec to your doc and you… stay the course, you aren’t there yet. Keep looking for the burn rate, the DOE, to last 10-12 hr. With adults we sometimes can take it successfully without incident to 14 hr.
            cp

  127. [..YouTube..] @thegreenhaze Join the remarkable club! Pervasive problem, too quick and too superficial diagnosis – suffering follows missed diagnosis.

  128. [..YouTube..] @thegreenhaze Join the remarkable club! Pervasive problem, too quick and too superficial diagnosis – suffering follows missed diagnosis.

  129. [..YouTube..] @thegreenhaze Join the remarkable club! Pervasive problem, too quick and too superficial diagnosis – suffering follows missed diagnosis.

  130. [..YouTube..] @thegreenhaze Join the remarkable club! Pervasive problem, too quick and too superficial diagnosis – suffering follows missed diagnosis.

  131. [..YouTube..] @thegreenhaze Join the remarkable club! Pervasive problem, too quick and too superficial diagnosis – suffering follows missed diagnosis.

  132. [..YouTube..] If we don’t start using the available science because we still believe the sun rotates around the earth… we remain awash in appearances.

  133. [..YouTube..] If we don’t start using the available science because we still believe the sun rotates around the earth… we remain awash in appearances.

  134. [..YouTube..] If we don’t start using the available science because we still believe the sun rotates around the earth… we remain awash in appearances.

  135. [..YouTube..] If we don’t start using the available science because we still believe the sun rotates around the earth… we remain awash in appearances.

  136. [..YouTube..] If we don’t start using the available science because we still believe the sun rotates around the earth… we remain awash in appearances.

  137. [..YouTube..] @thegreenhaze Another excellent example as reported in my book… so many throw bipolar around at the drop of a hat – simply because they can’t effectively label the target when emotions take over. cp

  138. [..YouTube..] @thegreenhaze Another excellent example as reported in my book… so many throw bipolar around at the drop of a hat – simply because they can’t effectively label the target when emotions take over. cp

  139. [..YouTube..] @thegreenhaze Another excellent example as reported in my book… so many throw bipolar around at the drop of a hat – simply because they can’t effectively label the target when emotions take over. cp

  140. [..YouTube..] @thegreenhaze Another excellent example as reported in my book… so many throw bipolar around at the drop of a hat – simply because they can’t effectively label the target when emotions take over. cp

  141. [..YouTube..] @thegreenhaze Another excellent example as reported in my book… so many throw bipolar around at the drop of a hat – simply because they can’t effectively label the target when emotions take over. cp

  142. [..YouTube..] @thegreenhaze glad the input addressed some other possibilities – see the Tutorial on all of the ADHD videos on CorePsych Blog, just type “tutorial” in the search box there. cp

  143. [..YouTube..] @thegreenhaze glad the input addressed some other possibilities – see the Tutorial on all of the ADHD videos on CorePsych Blog, just type “tutorial” in the search box there. cp

  144. [..YouTube..] @thegreenhaze glad the input addressed some other possibilities – see the Tutorial on all of the ADHD videos on CorePsych Blog, just type “tutorial” in the search box there. cp

  145. [..YouTube..] @thegreenhaze glad the input addressed some other possibilities – see the Tutorial on all of the ADHD videos on CorePsych Blog, just type “tutorial” in the search box there. cp

  146. [..YouTube..] @thegreenhaze glad the input addressed some other possibilities – see the Tutorial on all of the ADHD videos on CorePsych Blog, just type “tutorial” in the search box there. cp

  147. [..YouTube..] the feeling of hopelessness involved with being diagnosed with bipolar disorder seemed to puzzle my therapist and pissed me off after telling them i was successfully administered ritalin xr 10, 5 in my twenties. since then your and one other doc on you tube have made me feel so much more optimistic about treatment again. biploar is a wastebasket term!

  148. [..YouTube..] the feeling of hopelessness involved with being diagnosed with bipolar disorder seemed to puzzle my therapist and pissed me off after telling them i was successfully administered ritalin xr 10, 5 in my twenties. since then your and one other doc on you tube have made me feel so much more optimistic about treatment again. biploar is a wastebasket term!

  149. [..YouTube..] the feeling of hopelessness involved with being diagnosed with bipolar disorder seemed to puzzle my therapist and pissed me off after telling them i was successfully administered ritalin xr 10, 5 in my twenties. since then your and one other doc on you tube have made me feel so much more optimistic about treatment again. biploar is a wastebasket term!

  150. [..YouTube..] the feeling of hopelessness involved with being diagnosed with bipolar disorder seemed to puzzle my therapist and pissed me off after telling them i was successfully administered ritalin xr 10, 5 in my twenties. since then your and one other doc on you tube have made me feel so much more optimistic about treatment again. biploar is a wastebasket term!

  151. [..YouTube..] the feeling of hopelessness involved with being diagnosed with bipolar disorder seemed to puzzle my therapist and pissed me off after telling them i was successfully administered ritalin xr 10, 5 in my twenties. since then your and one other doc on you tube have made me feel so much more optimistic about treatment again. biploar is a wastebasket term!

  152. [..YouTube..] recently my g.f. of 10 years was so disenchanted with my adhd* she had her family pack up all my stuff and drop it in my lap. this brought on some heavy anxiety. i sought out help and was put into inpatient (the anxiety concluded itself in suicidal thoughts and hopelessness at the time) and was again put on biploar meds which only addressed the anxiety and increased frustration with not being able to focus and function. iam going to forward your anxiety discussion to my therapists. thanks

  153. [..YouTube..] recently my g.f. of 10 years was so disenchanted with my adhd* she had her family pack up all my stuff and drop it in my lap. this brought on some heavy anxiety. i sought out help and was put into inpatient (the anxiety concluded itself in suicidal thoughts and hopelessness at the time) and was again put on biploar meds which only addressed the anxiety and increased frustration with not being able to focus and function. iam going to forward your anxiety discussion to my therapists. thanks

  154. [..YouTube..] recently my g.f. of 10 years was so disenchanted with my adhd* she had her family pack up all my stuff and drop it in my lap. this brought on some heavy anxiety. i sought out help and was put into inpatient (the anxiety concluded itself in suicidal thoughts and hopelessness at the time) and was again put on biploar meds which only addressed the anxiety and increased frustration with not being able to focus and function. iam going to forward your anxiety discussion to my therapists. thanks

  155. [..YouTube..] recently my g.f. of 10 years was so disenchanted with my adhd* she had her family pack up all my stuff and drop it in my lap. this brought on some heavy anxiety. i sought out help and was put into inpatient (the anxiety concluded itself in suicidal thoughts and hopelessness at the time) and was again put on biploar meds which only addressed the anxiety and increased frustration with not being able to focus and function. iam going to forward your anxiety discussion to my therapists. thanks

  156. [..YouTube..] @irishjohn831 Duration on Adderall immediate release, the tablet, is about 5-6 hr. Duration does often change as one becomes more adept at metabolizing the medication – called tachyphylaxis – but that dosage adjustment should emphatically stop. If it doesn’t consider metabolic challenges that result in the meds not working predictably. Much more on specific testing for those metabolic issues at Testing Options on CorePsych Blog.

  157. [..YouTube..] @irishjohn831 Duration on Adderall immediate release, the tablet, is about 5-6 hr. Duration does often change as one becomes more adept at metabolizing the medication – called tachyphylaxis – but that dosage adjustment should emphatically stop. If it doesn’t consider metabolic challenges that result in the meds not working predictably. Much more on specific testing for those metabolic issues at Testing Options on CorePsych Blog.

  158. [..YouTube..] @irishjohn831 Duration on Adderall immediate release, the tablet, is about 5-6 hr. Duration does often change as one becomes more adept at metabolizing the medication – called tachyphylaxis – but that dosage adjustment should emphatically stop. If it doesn’t consider metabolic challenges that result in the meds not working predictably. Much more on specific testing for those metabolic issues at Testing Options on CorePsych Blog.

  159. [..YouTube..] @irishjohn831 Duration on Adderall immediate release, the tablet, is about 5-6 hr. Duration does often change as one becomes more adept at metabolizing the medication – called tachyphylaxis – but that dosage adjustment should emphatically stop. If it doesn’t consider metabolic challenges that result in the meds not working predictably. Much more on specific testing for those metabolic issues at Testing Options on CorePsych Blog.

  160. [..YouTube..] @irishjohn831 Duration on Adderall immediate release, the tablet, is about 5-6 hr. Duration does often change as one becomes more adept at metabolizing the medication – called tachyphylaxis – but that dosage adjustment should emphatically stop. If it doesn’t consider metabolic challenges that result in the meds not working predictably. Much more on specific testing for those metabolic issues at Testing Options on CorePsych Blog.

  161. [..YouTube..] I am taking adderall ir, 30Mg x 2 per day (take more like 40 for the most part) I have found that if I get at least 8 hours sleep, and understand that as the initial euphoric sense (meaning euphoria on understanding how to read & write, and finish tasks) and you become more used to the medication, you understand that it is not working less effectively, the initial honeymoon phase is gone and one should stop worrying that it is not working because of this. Also, consulting with your MD and stick

  162. [..YouTube..] I am taking adderall ir, 30Mg x 2 per day (take more like 40 for the most part) I have found that if I get at least 8 hours sleep, and understand that as the initial euphoric sense (meaning euphoria on understanding how to read & write, and finish tasks) and you become more used to the medication, you understand that it is not working less effectively, the initial honeymoon phase is gone and one should stop worrying that it is not working because of this. Also, consulting with your MD and stick

  163. [..YouTube..] I am taking adderall ir, 30Mg x 2 per day (take more like 40 for the most part) I have found that if I get at least 8 hours sleep, and understand that as the initial euphoric sense (meaning euphoria on understanding how to read & write, and finish tasks) and you become more used to the medication, you understand that it is not working less effectively, the initial honeymoon phase is gone and one should stop worrying that it is not working because of this. Also, consulting with your MD and stick

  164. [..YouTube..] I am taking adderall ir, 30Mg x 2 per day (take more like 40 for the most part) I have found that if I get at least 8 hours sleep, and understand that as the initial euphoric sense (meaning euphoria on understanding how to read & write, and finish tasks) and you become more used to the medication, you understand that it is not working less effectively, the initial honeymoon phase is gone and one should stop worrying that it is not working because of this. Also, consulting with your MD and stick

  165. [..YouTube..] I am taking adderall ir, 30Mg x 2 per day (take more like 40 for the most part) I have found that if I get at least 8 hours sleep, and understand that as the initial euphoric sense (meaning euphoria on understanding how to read & write, and finish tasks) and you become more used to the medication, you understand that it is not working less effectively, the initial honeymoon phase is gone and one should stop worrying that it is not working because of this. Also, consulting with your MD and stick

  166. [..YouTube..] @DrCharlesParker That makes sense. I’ve never really felt bipolar, and was diagnosed only a week ago so i’ll definitely discuss this with my psychiatrist. Thank you

  167. [..YouTube..] @DrCharlesParker That makes sense. I’ve never really felt bipolar, and was diagnosed only a week ago so i’ll definitely discuss this with my psychiatrist. Thank you

  168. [..YouTube..] @DrCharlesParker That makes sense. I’ve never really felt bipolar, and was diagnosed only a week ago so i’ll definitely discuss this with my psychiatrist. Thank you

  169. [..YouTube..] @DrCharlesParker That makes sense. I’ve never really felt bipolar, and was diagnosed only a week ago so i’ll definitely discuss this with my psychiatrist. Thank you

  170. [..YouTube..] @DrCharlesParker That makes sense. I’ve never really felt bipolar, and was diagnosed only a week ago so i’ll definitely discuss this with my psychiatrist. Thank you

  171. [..YouTube..] @RileyBorup Your observation is so completely true and so pervasively overlooked – Take a look at the Anxiety Video on ADHD as you are in there – and with insufficient info to address your bipolar I can only speculate that the provider had no knowledge of ADHD thereby making the bipolar diagnosis debatable – so many think multivariate thinking is synonymous with BPD Hope this helps, much more info over at CorePsych – Download the free Special Report on Precise Solutions whilst there. cp

  172. [..YouTube..] @RileyBorup Your observation is so completely true and so pervasively overlooked – Take a look at the Anxiety Video on ADHD as you are in there – and with insufficient info to address your bipolar I can only speculate that the provider had no knowledge of ADHD thereby making the bipolar diagnosis debatable – so many think multivariate thinking is synonymous with BPD Hope this helps, much more info over at CorePsych – Download the free Special Report on Precise Solutions whilst there. cp

  173. [..YouTube..] @RileyBorup Your observation is so completely true and so pervasively overlooked - Take a look at the Anxiety Video on ADHD as you are in there – and with insufficient info to address your bipolar I can only speculate that the provider had no knowledge of ADHD thereby making the bipolar diagnosis debatable – so many think multivariate thinking is synonymous with BPD Hope this helps, much more info over at CorePsych – Download the free Special Report on Precise Solutions whilst there. cp

  174. [..YouTube..] @RileyBorup Your observation is so completely true and so pervasively overlooked – Take a look at the Anxiety Video on ADHD as you are in there – and with insufficient info to address your bipolar I can only speculate that the provider had no knowledge of ADHD thereby making the bipolar diagnosis debatable – so many think multivariate thinking is synonymous with BPD Hope this helps, much more info over at CorePsych – Download the free Special Report on Precise Solutions whilst there. cp

  175. [..YouTube..] @RileyBorup Your observation is so completely true and so pervasively overlooked – Take a look at the Anxiety Video on ADHD as you are in there – and with insufficient info to address your bipolar I can only speculate that the provider had no knowledge of ADHD thereby making the bipolar diagnosis debatable – so many think multivariate thinking is synonymous with BPD Hope this helps, much more info over at CorePsych – Download the free Special Report on Precise Solutions whilst there. cp

  176. [..YouTube..] Thank you so much for these videos. I’ve always had ADHD but only have been diagnosed with 18mg concerta which i stopped taking in highschool a few years back since they were such a low doasge and weren’t very effective. I’ve been diagnosed with social anxiety and bipolar disorder and have been having the hardest time concentrating and remembering things. Could this all be related to ADHD? Please respond, thanks again

  177. [..YouTube..] Thank you so much for these videos. I’ve always had ADHD but only have been diagnosed with 18mg concerta which i stopped taking in highschool a few years back since they were such a low doasge and weren’t very effective. I’ve been diagnosed with social anxiety and bipolar disorder and have been having the hardest time concentrating and remembering things. Could this all be related to ADHD? Please respond, thanks again

  178. [..YouTube..] Thank you so much for these videos. I’ve always had ADHD but only have been diagnosed with 18mg concerta which i stopped taking in highschool a few years back since they were such a low doasge and weren’t very effective. I’ve been diagnosed with social anxiety and bipolar disorder and have been having the hardest time concentrating and remembering things. Could this all be related to ADHD? Please respond, thanks again

  179. [..YouTube..] Thank you so much for these videos. I’ve always had ADHD but only have been diagnosed with 18mg concerta which i stopped taking in highschool a few years back since they were such a low doasge and weren’t very effective. I’ve been diagnosed with social anxiety and bipolar disorder and have been having the hardest time concentrating and remembering things. Could this all be related to ADHD? Please respond, thanks again

  180. [..YouTube..] Thank you so much for these videos. I’ve always had ADHD but only have been diagnosed with 18mg concerta which i stopped taking in highschool a few years back since they were such a low doasge and weren’t very effective. I’ve been diagnosed with social anxiety and bipolar disorder and have been having the hardest time concentrating and remembering things. Could this all be related to ADHD? Please respond, thanks again

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  185. [..YouTube..] @Carnosaur432 Concerta is a significantly different drug than Vyvanse with a variety of different actions. Often those with Concerta problems do better on Vyvanse, but one cannot make rules about these issues as there are so many variables to consider. The bottom line, Vyvanse has a proven track record, but isn’t for everyone either. Go slow on dosage, and titrate up with your doc to a 10-12 hr DOE.

  186. [..YouTube..] @Carnosaur432 Concerta is a significantly different drug than Vyvanse with a variety of different actions. Often those with Concerta problems do better on Vyvanse, but one cannot make rules about these issues as there are so many variables to consider. The bottom line, Vyvanse has a proven track record, but isn’t for everyone either. Go slow on dosage, and titrate up with your doc to a 10-12 hr DOE.

  187. [..YouTube..] @Carnosaur432 Concerta is a significantly different drug than Vyvanse with a variety of different actions. Often those with Concerta problems do better on Vyvanse, but one cannot make rules about these issues as there are so many variables to consider. The bottom line, Vyvanse has a proven track record, but isn’t for everyone either. Go slow on dosage, and titrate up with your doc to a 10-12 hr DOE.

  188. [..YouTube..] @Carnosaur432 Concerta is a significantly different drug than Vyvanse with a variety of different actions. Often those with Concerta problems do better on Vyvanse, but one cannot make rules about these issues as there are so many variables to consider. The bottom line, Vyvanse has a proven track record, but isn’t for everyone either. Go slow on dosage, and titrate up with your doc to a 10-12 hr DOE.

  189. [..YouTube..] @Carnosaur432 Concerta is a significantly different drug than Vyvanse with a variety of different actions. Often those with Concerta problems do better on Vyvanse, but one cannot make rules about these issues as there are so many variables to consider. The bottom line, Vyvanse has a proven track record, but isn’t for everyone either. Go slow on dosage, and titrate up with your doc to a 10-12 hr DOE.

  190. [..YouTube..] @chillidogdupree Most often insomnia results from the dose being too high, extending beyond the DOE as outlined in the video on Duration. Anxiety and Insomnia often indicate other side issues that effect the metabolic rate and outcome with Vyvanse. Every time I see problems like this I know we have to dig deeper into the underlying problems.

  191. [..YouTube..] @chillidogdupree Most often insomnia results from the dose being too high, extending beyond the DOE as outlined in the video on Duration. Anxiety and Insomnia often indicate other side issues that effect the metabolic rate and outcome with Vyvanse. Every time I see problems like this I know we have to dig deeper into the underlying problems.

  192. [..YouTube..] @chillidogdupree Most often insomnia results from the dose being too high, extending beyond the DOE as outlined in the video on Duration. Anxiety and Insomnia often indicate other side issues that effect the metabolic rate and outcome with Vyvanse. Every time I see problems like this I know we have to dig deeper into the underlying problems.

  193. [..YouTube..] @chillidogdupree Most often insomnia results from the dose being too high, extending beyond the DOE as outlined in the video on Duration. Anxiety and Insomnia often indicate other side issues that effect the metabolic rate and outcome with Vyvanse. Every time I see problems like this I know we have to dig deeper into the underlying problems.

  194. [..YouTube..] @chillidogdupree Most often insomnia results from the dose being too high, extending beyond the DOE as outlined in the video on Duration. Anxiety and Insomnia often indicate other side issues that effect the metabolic rate and outcome with Vyvanse. Every time I see problems like this I know we have to dig deeper into the underlying problems.

  195. [..YouTube..] @FATKATKY
    Sorry missed this note, thanks back at you!

  196. [..YouTube..] @FATKATKY
    Sorry missed this note, thanks back at you!

  197. [..YouTube..] @FATKATKY
    Sorry missed this note, thanks back at you!

  198. [..YouTube..] @FATKATKY
    Sorry missed this note, thanks back at you!

  199. [..YouTube..] @FATKATKY
    Sorry missed this note, thanks back at you!

  200. [..YouTube..] Thanks

  201. [..YouTube..] The problem with Vyvanse for me is the insomnia. Over time, the sleep deprivation corrodes whatever focus the stimulant provides, and I’m back to square one. Somnolents, too, detract from focus; if I have to take thorazine to sleep after taking Vyvanse, I’m a zombie the next day inspite of the Vyvanse in my system. So, will the Vyvanse-induced insomnia attenuate over time? Also, my anxiety with Vyvanse is severe.

  202. [..YouTube..] @KryoniKMessiah Totally agree on the idea that many are build differently – see my 2 new videos posted here on Medication Rules – watch for 12 hr DOE with Vyvanse and with a big drop watch for serotonin deficiency issues see on the ADHD Anxiety Video.

  203. [..YouTube..] Kryoni-
    Watch the video here on Anxiety And ADHD especially the last ~ 2 min on the relationship of serotonin to the dopamine. Spelled out in detail in my recent book – see the free white paper which addresses these issues at CorePsychBlog

  204. [..YouTube..] I’m on Vyvanse myself and it’s really about the only thing that works for me. I agree overall, but really, a lot of people are built differently so some stuff doesn’t work for people. I do notice a dropoff, but it’s usually after i’ve done all I need for the day.

    Downside is the irritability, and the lack of dopamine at the end of the day impairing thinking.

  205. [..YouTube..] @TheOmegaeyes oops: Misuse of the term placebo, – and quite agree, one shouldn’t simply go out and put anyone on these meds without more specific inquiry, and full knowledge of consequences.
    cp

  206. [..YouTube..] This man is a blathering placebo for people who actualy think these meds do anything, word to the wise don’t put your kids on any of that shit!

  207. [..YouTube..] Not appropriate to tell you what to do out here without evaluation, but I can tell you without reservation that Vyvanse has worked consistently better than Concerta for me in my office – and can be dialed in for a DOE of 12 hr with careful titration. So if you are looking forward to more academics I would go back and work it out with your doc as he/she seems to be on the right track from my perspective. cp

  208. [..YouTube..] Doctor, I have been prescribed to 54 MG concerta. I began the medication when I was 14 and now i’m 17 and I feel as if Concerta is beginning to interfere with my everyday life. What concerns me is these effects have just recently began. My doctor reccomended Vyvnase, I am not sure weather to trust this medication.

  209. [..YouTube..] jcm- always check with your doc before making changes, just not good to take advice over the internet for meds, bad habit. You doc can tell you if you are actually on too much, which very well might be the case.

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