Why am I immune to speed?
December 21, 2011 2:11 PM   Subscribe

Ritalin having no effect whatsoever, why?

I was diagnosed with adhd a couple of years ago in my early thirties. I tried Concerta at the time, and gave up when I had reached an intake of 90mg per morning with no effect.

I have recently tried Ritalin, with the instruction to ramp up 10mg at a time, up to 30mg, and max 60mg per day.
I had no effect at 10, 20 or 30mg. So I tried 50, and then 70, and then gave up. I have reported this to my doctor who will be talking to me in the new year, and have been told not to bother with the pills till then. By no effect I mean no weight change, no speededness, no improved concentration or executive function, no change in blood pressure, nada. What in the what is wrong with me?

FTR, I get drunk at what I consider a normal rate, but have never had a hangover. I have smoked hash (often) and taken acid (once) in my teens and didn't react enough to be able to say for sure if I was high or not.

Do I have a super-liver, or some crazy processing system for drugs?
posted by anonymous to Health & Fitness (13 answers total)
How much do you weigh?
posted by Sys Rq at 2:23 PM on December 21, 2011

no improved concentration or executive function

Ask yourself: How do you know this to be true?

In theory, a drug like this isn't really supposed to make you "feel" anything. It's not like aspirin, where you take it and a little while later the headache is gone and you go, "Whew! All better now!"

You may not be getting any effect, true. Or you may be getting great effects and are just not noticing them, because how do you really objectively measure "executive function" without the help of an outside perspective?

Moreover ... you've been on this for what? Five days (10, 20, 30, 50, 70)? Maybe you need more time to evaluate?
posted by Cool Papa Bell at 2:32 PM on December 21, 2011

I had a similar issue with Ritalin, no effect at all at doses under 30 mg. Once I kicked up over that dose I started experiencing the effects.

Everyone's body processes drugs differently, so I don't think it's too unusual that you don't get anything out of Ritalin at that dosage. The truth is that rarely drugs do exactly what they are intended to do. It will take a while to figure out what drugs will work for you.

If you aren't already working with a psychiatrist on this then I think you should make it a priority to make an appointment with one. They are better suited for figuring out this sort of problem than your GP would be.
posted by grizzly at 2:33 PM on December 21, 2011

Response by poster: Ask yourself: How do you know this to be true?

This is anecdotal and the poster could be different, but everyone I know who's tried Ritalin, ADHD or not, has absolutely felt a "speedy" effect from taking it.

OP, hopefully you can speak with your psychiatrist about this and perhaps try something different?
posted by Anonymous at 2:44 PM on December 21, 2011

I don't have any experience with Ritalin, but I do with other ADHD drugs.

The other posters are right: the perfect dose is the one where you don't feel speedy, but have enough symptom control to be able to better function. If you feel speedy (IMHO) you have taken too much. I have done that, and the tradeoff is no good: super-human concentration and energy while the dose is ramping up, and then mood swings and a total lack of control of symptoms during the "come down". (Because one of the drugs' effects is to amplify how much dopamine and noradrenelin is being spurted out by the brain cells, if you go too far, they will get exhausted and shut down.)

(Also, I don't think Ritalin is very speedy to begin with; I believe it works mostly on dopamine.)

For example: for work, I have to fill out forms. Same thing, over and over, many times a day. One of my symptoms was that no matter how hard I tried, I would get distracted and fail to complete the forms. During a moment of insight, I realized that I had adjusted my workflow to where I was "doing" the forms three times in order to get them done good enough. Upon taking the drug, I can still get distracted if I allow myself to do so, but if I try, I can concentrate and complete them.

Another example: my relaxing time usually involves turning every light in the house on, turning on the TV and then surfing/reading while all of that is going on. The ADHD "allowed" me to do all of that, because I could get distracted by many things and just hit rewind on the TV or reread what I was reading. When I started taking the medication, I found that I could not do this any more. My ability to focus was "stickier" and I had to choose what to be focused on.

It's very possible you do have a super liver, there are lots of polymorphisms in how different people metabolize drugs. But lots of other things are probable too. Adult-diagnosed ADHD is insidious, because we have lifetimes of coping mechanisms built up that were almost good enough, but that may not work at all once medicated. We often leverage our distractibility by giving ourselves other useful tasks to do while "procrastinating", or by ramping ouselves into a frenzy to get the stimulation we need to complete a task. We needed the adrenelin of "OMG this thing is due NOW NOW NOW" in order to be able to focus. Half the treatment of adult ADHD is reengineering our lives and thought processes to undo some of the unhelpful coping mechanisms, and the other half is sometimes medication. If someone is truly suffering from ADHD, neither will work without the other.
posted by gjc at 2:58 PM on December 21, 2011 [3 favorites]

Doubling up on the speediness thing: one of the theories of ADHD is that it is like depression, in that there is a chemical imbalance. ADHD brains don't put out enough of the right chemicals in the right proportions, at the right times, and this is what causes the inattentiveness/distraction/hyperactivity. The same way not enough serotonin makes one depressed.

So, when someone with this imbalance takes the drugs, the drugs act to restore balance and the ADHD brain doesn't feel speedy, it just feels normal. If the baseline is slow, then kicking it up a notch gets you normal. If the baseline is normal, kicking it up a notch gets you speedy.
posted by gjc at 3:04 PM on December 21, 2011

To echo everyone else, many drugs affect individuals differently. Ritalin has never really done much for me either, but never ventured into the mgs you've mentioned. It may not be a good fit.
For example, I've had tramadol injections with no ill effect, but scripted as a pill, I end up unbelievably sick, with a terrible migraine. Things sometimes just work differently in terms of serum levels, metabolism and a variety of others.

Get something esle scripted.
posted by handbanana at 4:47 PM on December 21, 2011

Ritalin and Concerta are both different preparations of the same drug, methylphenidate, so you may just not be much of a responder. The good news is that there's still the entire amphetamine class to explore. (With the help of a psych, I mean.)
posted by en forme de poire at 5:04 PM on December 21, 2011 [1 favorite]

I've only been on Ritalin for about a month (for narcolepsy/ADHD/depression), but what I notice and like is that it's not about what I feel, but what I don't feel. For example, I don't feel sleepy, I don't feel distracted, I don't feel unable to make a decision or unable to move on to the next thing on my to do list. I still need to drum up my own willpower to take action, but the Ritalin doesn't let my focus and alertness fly out the window after 5 minutes.

To reiterate, you shouldn't feel speedy. Ritalin is really not the same as recreational speed; it won't propel you into action if you have no real desire to act in the first place. The only thing you should be feeling that you say you're not is improved concentration, but have you tried a controlled experiment? For example, how long can you read a newspaper on vs. not on Ritalin? Is there truly no difference?
posted by infinityjinx at 8:35 PM on December 21, 2011 [1 favorite]

OP here, vacillating between "nothing to be ashamed of" and "that's private".

Thanks for the answers so far, thought I should clear some things up.

gjc: My reference to speedy was due to that being the described likely reaction to taking too high a dose. In other words, not something I was looking for but rather that even at 70mg I didn't feel anything that would suggest I had taken too much. A lot of your post rings true, especially about how a much too tight deadline creates enough stimulus to get shit done. I am looking for the sticky effect, whereby my brain doesn't just slide on past stuff I want to do. Alternatively that the various things I do, in the end, always manage to do won't take the toll it takes now.

Cool Papa Bell and infinityjinx: I had various tasks I needed to, no wait, wanted to achieve on the days I took the medication. The differentiation is that had I needed it done it would have gotten done (the entire night before). I didn't begin the tasks any sooner than is usual, nor stick with them any longer than is usual, and that I started them at all I attribute partially to being fully aware I had just eaten a handful of uppers, so if I didn't at least fill the dishwasher it was going to be quite a waste. I also completed some "brain trainer" games on my lumosity account and didn't see any score fluctuations on attention. I think I may have missused the phrase "executive function" as shorthand for getting shit done, in which case sorry for the confusion!

Sys Req: I'm about 5'6" and about 200lbs. The nurse I spoke to said most of the people she meets are on 10 or 20 mg. I will be discussing this further with my pdoc as mentioned, but I am curious about specifically the lack of reaction from my body to what is a not insignificant amount of medication.
posted by Iteki at 10:39 AM on December 22, 2011

You may find this blog post interesting: How to take Ritalin correctly
posted by infinityjinx at 11:04 AM on December 22, 2011 [1 favorite]

I think you have too-specific expectations. The first thing you mention is weight loss, and wanting the sticky effect. Those are really specific and maybe you're not recognizing the more subtle or global effects it's having on you.
posted by whalebreath at 9:54 PM on December 22, 2011

I'm not being non-scientific/anti-science here. Ritalin is largely a made-up illness to sell drugs - look into the distribution of this 'illness' over the States or in any other country, discover the world wide picture and see how it links with economic gain. A few people exhibit the constellation of symptoms sufficiently to need medication, most don't need it. Check out what the psychiatric profession are calling illnesses these days and you will find - I guarantee - that most of them are normal human behaviours. Everyone gets depressed at times, everyone feels shy at times, everyone has adhd symptoms at times. Live with it. Why take an addictive drug with a lot of side effects when your own body can take care of itself given time and attention.
posted by nickji at 5:36 AM on December 26, 2011

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