Ritalin questions about my son

[Cathleen]

I was wondering if anyone out there has had the opposite reaction to Ritalin.  In August of this year I finally decided to put my 8 year old son on medication.  He is only taking 10mg of Ritalin once a day in the morning but my husband and I have noticed when he takes it at home he is actually worse but school has said he's fine until it wears off and said he should probably take it twice a day instead.  I am just confused because how can he be fine at school but at home if he is on it he seems to be ten times worse.  Has anyone heard of this or experienced this? His doctors are even puzzled by this and I am not sure what to do.

[Cathleen]

Thank you all for the feedback.  I am just relieved to know that my son isn't the only one who experienced these symptoms.  Thanks again.

[Lyn Zoe]

Dear Cathleen

I an 29 was diagnosed  not more than 6 months with ADD. I have been on Ritalin not more than 5 months now. My results are totally confusing my doctor but he insists i must continue. By Jan 2012 i will be put on concerta which my doc believes is better than Ritalin. ( I live in Holland health insurance can only be changed once a year-Dec so i must find an insurer willing to pay for concerta) My experience is reading gets horribly worse with Ritalin plus focusing gets almost non existence with Ritalin. But the reason i continue to take it is my libido is been greatly improved. (like from a 1 to a 10) My conclusion is Ritalin only magnifies only ones interests. If your Child gets worse at home its probably because he wants to play/ mess around at home, while he probably knows that school means work so when at school gets serious. Remember Ritalin works by focusing ones brain on activity he is 'aiming' at despite  my strange experience with books 

Ps. More strange pluses Head aches gone, can sleep with ritalin, i feel more awake while awake

[Margaret]

Firstly, that is a really tiny dose of medication for the day. Ritalin is quick-acting, but not long-acting, and wears off in about 4 hours. Some people do experience a nasty let down effect as the meds wear off - a good hour or more of totally hyper, almost out of control type behaviour, and often lots of emotional swings. Once the meds are gone, if the hour or so hasn't started huge fights and getting into trouble, most will settle back into their non-medicated selves.

Why is your son on ritalin instead of one of the longer acting meds? Ritalin really should be at least 2 times a day, usually 3 times.

If you think the teacher is seeing a placebo effect, then don't give the med some morning, or even a couple of mornings, before school (don;t tell them), and see what happens. If the school starts mentioning problems, then you will have to accept that it is real.

Do you give the meds on the weekends? If so, what do you see for the first 4 hours then? After that just doesn't count - it is the med wear off.

Also, is it possible that he is doing well in part because of the structure at school, and there may be less structure at home?

Just wondering.

Good luck.

[Dana Arcuri]

What works great for one individual may not work great for another.  When I tried Ritalin as an adult, I experienced horrifying results & had to immediately discontinue.  In 2009, I tried Adderall and was pleasantly surprised at how well it helped me focus & stay on task.  I took this medication for two years, but recently I had to discontinue it, due to a few medications negatively interacting with one another.  Up until the medication interaction, Adderall was wonderful.  Once the interaction occurred, all hell broke loose & the medicine actually began doing the complete opposite.....imagine that!?

[Jeanine Coffman]

I too have heard that certain stimulants can have a nasty letdown reaction.  My son is adderall xr and we have had very few if any side effects. However i can tell you that around 5 oclock when the medicine is out of his system he is more "moodier" than usual.  I say more moodier b/c my ADHD child has always been a tad bit moody.  A friend who is a nurse told me that some people say that drinking a caffeine beverage during this time will help b/c it is a stimulant. I have yet to try it but it would make sense.  We take 15 mgs of adderall once a day.  I was diagnosed formally this year (at 40) and my doctor put me on vyvanse i am on 40 mgs and i have had NO side effects except an occasional headache when i first started.  I do not have a let down period.  This has made me wonder if vyvanse would be a better option fo rmy son, yet u hate to change things when they work.  There really are sooo many drugs out there, if one is not working have your doctor provide you better options.  My son see's a child psychiatrist, not a gp b/c i wanted someone who specialized in childhood disorders.  Good luck in your search!

[Cathleen]

It's funny that you say this Jeanine.  I got a second opinion last Saturday from a doctor who specializes in ADHD and he changed my sons meds to vyvanse 40 mg too and it seems better for him so far. He also mentioned he has had headaches too but I assume it's just part of a side effect for now.  I am crossing my fingers.  The only thing I don't like about the vyvanse is that it is VERY expensive but if it works and helps him it's worth it :)

[Jeanine Coffman]

if you go to the website for vyvanse they will allow you to sign up for the membership program in which you get 1/2 off your copays for a year. I am not sure if this will work for you but it allows me to pay 17.50 a month for my meds.  I hope it works!!!  Our kids are the most important thing in the world and the decision to medicate them is one we do not take lightly. It is a struggle to always know if we are doing what is best for them. I understand your journey!

[Sabrina A]

Thank you for mentioning this. I'm checking their site now. Due to MedCo forcing my company to use mail order, I'm looking at a potential $1200 prescription bill by mid-February... and I don't have an FSA so if it ain't in the medical acct, it comes OOP - which I don't have.

[Madelyn Griffith-Haynie, SCAC]

You are probably experiencing what is known as REBOUND.  Dr. Paul Elliot (one of the early ADD experts who was unbelievable generous with his time and information on early support groups like this one) distinguishes it more clearly with his term "filtered rebound."  

Below is from Elliott's content on the topic - part of the materials of my Brain-based ADD Coach Training Curriculum (not currently offered, btw, but still covered by copyright protection).  Paul's medication of choice is not R. - so I have edited out the references to the stim he does prefer to keep from confusing anyone.

About 15-20% of patients will not need a second dose of [medication] at the end of the xx-hour period. [meds duration period] They simply notice that the benefit of the medication fades away, with a gradual return of the ADD symptoms.

The remaining 85% of patients, however, will notice a rather abrupt drop-off in the effect of medication, with a rapid return of the ADD symptoms.  In fact, patients often experience a rebound of the ADD symptoms, which are actually amplified above the pre-medication level.  I refer to this as "filtered rebound."

By this, I mean that even though the medication's effectiveness has subsided, there is still a small amount of the medication remaining in the blood stream which can modify the symptoms of ADD as they return.

Therefore, the symptoms in this rebound period may be somewhat different from the symptoms in the pre-medication state, and are frequently amplified over the pre-medication state. 

This "filtered rebound" lasts anywhere from 2-8 hours, but is more likely to be toward the 8-hour end of this range.

Because of the rebound effect, adults and children may have difficulty going to sleep.  There are several ways this can be managed, but it frequently does not indicate too much medication, as is often assumed.  What it actually represents is too little medication at the wrong time.

Hope this helps.

xx,

mgh (Madelyn Griffith-Haynie, SCAC, MCC - blogging at ADDerWorld and ADDandSoMuchMore - dot com!)

[Jeanine Coffman]

Madelyn, this is great information, I think it's probably contrary to what most people assume, which is that their dose is to low.  I am currently struggling w/ trying to figure out if I need to increase my 9 year olds meds as he is not "hyper" in school and his behavior reports are great, but his grades have taken a sudden drop for the worst and he is a gifted student.