Tips for dealing with Ritalin Crash?
November 2, 2013 9:17 AM   Subscribe

Ritalin is having a good effect on me for ~3 hours. In a few weeks, I am going to take a 3.5-hour-long test. What can I do before/during the test to avoid crashing near the end of it?

22-year-old female, recently prescribed 10mg of instant-release Ritalin, and it's really helping me study and stay focused for about three hours, after which I get the common "crash": jittery feeling, restlessness, and all in all much less focus than without Ritalin. In four weeks I'll be taking a very important, 3.5 hr long exam, and I need to stay focused throughout all of it.
I have tried taking another 10mg after 3 hours, but found that it just worsened the symptoms. Should I drink something caffeinated? Eat something high in carbs/sugars? As a runner, I know there are certain foods that are give you prolonged energy, like dried fruits - would this work for a mental workout, as well?
posted by alona to Grab Bag (18 answers total) 3 users marked this as a favorite
Could you just take it 30 minutes into the exam?
posted by acidic at 9:21 AM on November 2, 2013 [1 favorite]

I don't take my time-release Ritalin until I've had a full meal that includes protein and fat, otherwise I get jittery. Definitely call your doctor about it now, since you will want to explore solutions to this problem well before you have to take a test. No doubt he or she has seen this issue before.
posted by corey flood at 9:28 AM on November 2, 2013 [2 favorites]

You have four weeks; explain the upcoming occasion to your doctor and ask if you can try out Concerta.

Concerta might take up to an hour to bring you into focus (maybe - I take mine an hour before I wake up, so I wouldn't know) and will hold you for nine to twelve hours afterwards. If you can find a dosage of Concerta that you like between now and your exam, you can take one 2 hours before the start of your exam and be right as rain. It comes in various dosages, I take the 36mg one but it comes in higher and lower dosages than that.
posted by tel3path at 9:30 AM on November 2, 2013

By Concerta, I sound like I'm prescribing to you over the Internet when I am in no way qualified to do so, and obviously wouldn't do so if I were. Cringe.

I'm just saying it sounds like a job for slow-release stimulants, and Concerta worked for me right off the bat. Obviously your specialist will know what to do. I'm just recounting my personal experience.
posted by tel3path at 9:32 AM on November 2, 2013

Could you cut it in half and take the first half before the test begins, and the other halfway through? Maybe experiment with this prior to the test and see if you get the same crash feelings you described when you took two.
I would also look into things like test taking tips students to maximize your performance while you're in your best zone. I did a small amount of ACT prep in high school and the principles (how to triage questions based on their difficulty, answering 5-10 questions on the test before bubbling in the scantron to save time, etc) are still very helpful for me in college in almost all courses.
posted by rubster at 9:36 AM on November 2, 2013 [1 favorite]

Talk to whoever is administering the test about possible medical accommodation, depending on what your doctor says.
posted by Dasein at 9:36 AM on November 2, 2013 [1 favorite]

Nthing trying Concerta. I had the same issues as you on the single-dose Ritalin (same dosage too) and have really liked Concerta. If the test were next week, I might not suggest it, but you have plenty of time to try it out and see how it works for you.
posted by lunasol at 9:37 AM on November 2, 2013

2nding asking your doctor about Concerta. Concerta is extended-release Ritalin. It's fairly new, so there's a good chance the doc's got some free samples (or coupons for same) lying around.
posted by Sys Rq at 9:38 AM on November 2, 2013 [1 favorite]

(P.S.: Is it likely that you'll actually be writing the exam for the full 3½ hours?)
posted by Sys Rq at 9:44 AM on November 2, 2013

As a middle ground between instant-release (which is considered to last for about 4 hours) and Concerta (12 hours), there is also an extended-release formulation (brand name Ritalin-SR) which is meant to last for about 8 hours.

It seems like this might do what you need, while keeping a lower overall dose than Concerta, if that is of interest to you.
posted by Juffo-Wup at 10:10 AM on November 2, 2013

Adding to the chorus of trying concerta. It's new, but it's been out long enough that its available in a generic.

Concerta and Ritalin are both methylphenidate, but Concerta is time-released.

I have experienced pretty awful crashing from non-time released stimulants--anxiety, crying, headaches, etc. I do not experience any crashing symptoms with concerta at all. YMMV of course.

Also I assume that you have discussed the jitteriness you have been experiencing with your doctor right?
posted by inertia at 11:54 AM on November 2, 2013

Definitely discuss this with your doctor, who should be able to troubleshoot this easily for you. I take Adderall and cannot take the extended release formula, so the following might help you think of questions and/or suggestions to run by your doc. I was told by my doctor to take my next 10 mg dose about 30 minutes before my crash/dip happens, so for you that would be 2.5 hours after your first dose. Ask your doctor about doing something like that for this specific instance. I'm not sure how similar Ritalin is to Adderall, but you might be able to split the tablet for your second dose in in half and use a 5 mg to get through without a noticeable change. Whatever your doctor advises, I would ask about doing a test run a week or so before the exam so you can confirm that will work. I would hesitate to take the medication later or change medications so close to an important exam. This is working and while something might work better, it also might not, and that seems like a big risk to take while you are prepping and taking a test. Good luck!
posted by katemcd at 12:09 PM on November 2, 2013

Take half or a quarter just before the test. Get good sleep and eat a solid, well rounded meal.
posted by oceanjesse at 12:47 PM on November 2, 2013

Take it on a full stomach of slow-digesting food (protein and fat). Also try taking half doses more frequently.

Get all this experimenting (ideally while taking a practice exam under exam conditions) done ASAP and find a good eating/dosing schedule/routine for you so you can be on it in the weeks leading up to the exam. You don't want to change things up just for the exam.
posted by Jacqueline at 2:40 PM on November 2, 2013

I'm no doctor, but If the prescription you have now works great for you in every other way, try hacking your own extended release version for this one event.

Look in your own cabinet for any vitamin/energy capsule/supplement, or even a medicine you don't take anymore. Many of them (especially supplements) come in little clear capsules with the powdered whatnots inside. These capsules can be pulled apart fairly easily and you can trash or flush the original contents. Take your regular dose maybe using a pill splitter, insert a portion of your regular dose into the capsule. Or, if you think it will take more than one dose, take your regular dose and a portioned dose inside the capsule.

This should give you a normal release time of the regular dose and then a slightly extended release on the partial dose.

THey also make a pill spray that's supposed to be a "makes it easy to swallow" but I've found it seems to just coat the pill with a slick coating which - when dried also seems to delay how long even simple ibuprofen takes to work for me. Using some combination of these may give you an extended release of a single or single+partial dose to get you through the 3.5 hours without much effort.

You could even test it out in the next few weeks to see if you can do some other extended activity or test session to tweak the partial dose.

I'd also stick with whatever your usual routine is that works for your regular 3 hours focus (same eating/sleeping/exercise habits that is)
posted by emjay at 5:10 PM on November 2, 2013

Thanks all, I'm going to try some of your suggestions and will update on results, for feedback and for future searchers.

Sys Rq, I will be taking the exam for the full 3.5 hrs.
posted by alona at 12:53 AM on November 3, 2013

Also try taking half doses more frequently.

Very good advice. This works for me with Adderall. If you are like me, the therapeutic range on stimulants is very narrow. The higher you go, the further you fall. So the goal is to keep the curve of blood concentration flatter. For me, dosing along the lines of half-quarter-quarter gives me good efficacy without crashes.

If you look at the first graph on this page, it compares 40mg Ritalin LA (Long Acting, which I believe is longer acting than SR) versus taking two 20mg instant release 4 hours apart. You can see that the first 20 mg dose is wearing off at about 3 hours, which maps with your experience with crashes. You can also see that dosing higher has diminishing returns. Your blood levels spike and drop, leaving you with very little in useful effectiveness.

It also shows that taking two equal doses spaced apart causes the spikes in the curve to be even higher. Instead of preventing a crash, dosing this way causes two crashes. Using the shape of those curves, you can tailor a dosing regimen that gives you a nice smooth curve. The area under the curve remains the same, but the effectiveness of the drug is much more useful and much less spikey-crashey.

It looks like the Ritalin LA has sort of a three pronged approach. An initial spike of 20mg, and then a slow release starting at hour 3, culminating with another spike around hour 5. To replicate that, I would probably try taking 10mg an hour before the test, and then another 5mg about an hour into the test.

(Or, just get some 20 mg Ritalin LA from your doctor.)

Another thing to experiment with is reducing caffeine and carbohydrates. Try eating a bacon and eggs kind of breakfast.
posted by gjc at 4:55 AM on November 3, 2013

Update: Eating a balanced meal beforehand is definitely helping. Taking it in the morning induces less symptoms than later on in the day. Also, I'm finding that I'm getting used to Ritalin and the symptoms are less noticeable. Thanks!
posted by alona at 11:18 AM on November 19, 2013

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