It's my party and I'll cry if I want to.
February 19, 2014 2:01 PM   Subscribe

Please help me survive the last 5 weeks of this quarter. I'm on generic (Watson/Actavis) Concerta (36 mg) for ADHD, and generic (Taro) Lamictal (100 mg) for depression/anxiety. I'm also a part time student at a local community college, taking PreCalculus II (Trigonometry) and Cultural Anthropology - both College Transfer courses. And night courses that start at 6pm, that last for 2.5 hours each. I was also taking Statistics. Since last September or so, the Concerta has been giving me crying fits, particularly when it wears off. I was also working full time, and taking an inline Computer Science course. This is when I go from 'normal, functioning person' to 'uncontrollable crying as soon as I hit something frustrating, like my code not compiling. And by 'uncontrollable crying', it lasts for an hour or more, and I basically cry until I get fatigued. And afterwards, my head is blank like a vacuum. It doesn't make for a good work or study environment! I was only on 18 MG of Concerta, so my doctor doubled that to 36 mg, thinking it would help. Oh, holy cats it didn't.

I started a new Quarter, I started Full Time, and the crying spells just got worse. I reduced my Statistics to an Audit class, thinking that would help reduce the stress load - it didn't. And I started crying all the time, multiple times a week. So, when I saw him last Friday, he upped the Lamictal to 100 mg a day. Which worked really well - until I had my Trig class last night, and the news that I didn't do as expected on my Midterm caused me to lock myself in a bathroom stall for an hour, crying. A classmate had to go find me. It's not even rational; it's a biochemical process that takes over. It's like a circuit breaker trips; I go from AOK to The Crying Girl in a minute. And when it starts, it doesn't stop.

So, how do I cope and finish off the Quarter with a minimum of angst? Despite the Midterm, I'm somehow maintaining a 4.0 in Trig, and I'm at a 3.0 or above for Cultural Anthropology. So academically, I'm doing well. And all I need gradewise in Trig to move on to Calculus is a 2.5.

What I'm doing to help this: I've been in contact with the college's Disabilities Office, my doctor sent a note, and I now have a quiet place with double time and Kleenex to take my exams - and I used this for my Midterm. I've told my profs what's going on, so they know. I'm trying to eat nutritious lunches that I bring in my Mr. Bento, and exercise, and I also started to take the Concerta so that it won't wear off in the middle of class. And I've eliminated all caffeine. I'm also not working, so I don't have that stress. Nor is Financial Aid affected, as I'm paying for this with a severance from a previous job.

I don't feel comfortable reducing the Concerta, because it works like a charm when I'm not a hot mess. And I can't boost the Lamictal up so soon, as there's a risk of acquiring a deadly rash. (Don't GIS 'stevens-johnson syndrome'. Just....don't.)

Anything else I can do? I've already decided that I'm not returning to school next Quarter, until all of this is completely settled - and the dept. people in my possible major, Computer Science, agree. But I need to finish this Quarter, especially the Trig class - because I want to be able to take Calculus when I am well enough to return. And when I'm not crying, I can study just fine. Halp?
posted by spinifex23 to Education (15 answers total)
If you haven't been put on any of the other ADHD drugs and you're getting this sort of common yet counter productive and quality of life altering side effect then you should fire your doctor.

Assuming you have gone to them with this previously and they didn't immediately switch you to something else, that is.
posted by hobo gitano de queretaro at 2:13 PM on February 19, 2014

Dumb question: can you time your meds later? I've found that if I know I need to be productive later in the day, I'll take my ADHD meds later in the day so that they're at full effectiveness then. In your case, maybe giving yourself a few unproductive hours in the morning is worth being at peak efficiency during your classes.
posted by Oktober at 2:28 PM on February 19, 2014

I actually forgot to put this in the question - I have gone through a battery of them: Adderall gave me mood swings, Vyvanse made me depressed, Strattera made me depressed, and Intuniv made me *really* depressed. Dexedrine Spansules worked like a charm - until they ramped up my heartburn like whoa, and I already have GERD.

I'm definitely soliciting a second opinion, preferably one that specializes in Adult ADHD, when this quarter is over. BTW, I live in the Seattle area, and have health insurance through Cigna.
posted by spinifex23 at 2:29 PM on February 19, 2014

If the Concerta is giving you crying fits, you need to talk to your (hopefully new) doctor about taking something else. Has your doctor tried Straterra? It's not a stimulant, so it might not cause the same side effect. Even if a medicine helps with a problem, you shouldn't have to suffer through a debilitating side effect. Adding an atypical antipsychotic like risperdal or abilify might help with your mood and anxiety.

As for the doctor part, I highly recommend seeing a psychiatrist over a GP if you're not already. They are familiar with a much wider array of drugs and dosages. Most GPs only have a few drugs that they are comfortable prescribing.

I'm bipolar and have ADD. I've taken many psychotropic medicines over the years but I am not a doctor.
posted by double block and bleed at 2:29 PM on February 19, 2014

I can't advise you on your medication, but I finished my own CS degree a few years ago, and I know where you're coming from re: anxiety over grades (though an order of magnitude less than what you have, it sounds).

Maybe it would help if you had a study partner? Perhaps you could reach out to one of your classmates, preferably one who is patient and understanding? I know that college study halls and office hours with profs and TAs can be a bit of a nightmare. If you felt comfortable with it, you could ask a closer friend (not necessarily a classmate) to help you study--it sounds like you may just be in need of focus/emotional support rather than help with formulas and such. If you like, you could MeMail me; as I mentioned I've been through all this, and I have a small amount of experience tutoring (though doing that sort of thing over the internet is tough, and if you can find someone IRL you'd probably have an easier time of it).

Here's a practical suggestion that may help a tiny bit: when you get a midterm or a homework assignment returned to you, don't look at the grade. Just put it in your backpack/Bag of Holding/equivalent carrying device and leave it there until you get home. That way you'll be in a safer environment when you receive bad news (though hopefully it will be good news instead). YMMV, but it might be worth trying.

I will say that from your grades it sounds like you will almost certainly do better than you fear you might. I was always motivated by the fear of failing, though I actually ended up doing very well (whether this was because of that fear or not, I have no way of knowing!) You may be obsessing over it too much (though it could just be me projecting my own obsessiveness onto your description of yourself). Take a break now and then, if you aren't already doing that.

Best of luck.
posted by Androgenes at 2:46 PM on February 19, 2014 [1 favorite]

Er, by "all this" I mean college, not similar health issues.
posted by Androgenes at 2:49 PM on February 19, 2014

This is heavily heavily exacerbated by dehydration and not eating enough, which are common side effects of ADD meds. Are you eating/drinking well? Not only well, but are you drinking 1.5-2 times as much as before? Because you need to be. And seriously, it helps with the crying, or it can at least. If that's what your body needs.
posted by jjmoney at 3:14 PM on February 19, 2014 [2 favorites]

Your crying jags make me think of what I used to do when very ill. Someone suggested to me that it was due to a nutrient deficiency.

I cannot at the moment seem to put my fingers on a nice handy listing of which drugs cause which deficiencies, but I know this is a real thing. (linky) My need for b vitamins went way, way down after I finally got off Advil, something I took essentially daily for about six years. It is known to deplete one of the b vitamins.

So I would look there as a means to get safe, short term relief while trying to solve this issue. If you can determine which nutrients are typically depleted by the specific drugs you are currently taking, supplementing for that is fairly safe and may do wonders to relieve some of the side effects.

Sorry this is so hard.
posted by Michele in California at 4:40 PM on February 19, 2014 [2 favorites]

I had a terrible reaction to Strattera, which is a different class of drug, but still....full on panic attacks, tachycardia, dissociated thinking, etc. Doubling up on a drug you've had an adverse reaction to is an odd choice, to me. (As opposed to trying a different family, or even a diffferent drug/formulation in the same family. Like Ritalin, which is very close to Concerta.)

I took Dex spansules for years. There are ways to combat the indigestion that it can cause over the day.

Maybe talk to a different doc? I know this is a terrible time for that.
posted by snuffleupagus at 7:21 PM on February 19, 2014

Have you ruled out the possibility that the Lamictal might be responsible for the emotional side effects you're experiencing? I was RX'd Lamictal many years ago by a doctor who didn't "believe" in adult ADHD & I can remember crying uncontrollably for days at a time (no other psych drug has done this to me, and I've been on PLENTY). Moreover, IANAD but I don't think Lamictal is generally prescribed as a first-line treatment for unipolar depression or anxiety; I was given it in conjunction with my long-standing antidepressant (Remeron) for suspected bipolar disorder.

Also: Have you tried Focalin for your ADHD? Its sort of like the "dexedrine" of ritalin/concerta chemically speaking, and may have fewer side effects for you- they even make IR (immediate release) tablets that you could likely take around dinner time without too much of a threat to your sleep schedule. You might even consider taking a low dose Ritalin IR "booster" at the tail end of your Concerta to help get you through your classes- I currently supplement a 60mg daily Vyvanse pill with a low dose of Adderall in the early evening & have found the booster to make a world of difference (I teach evening classes, so I share your scheduling concerns!).
posted by ritual system at 11:49 PM on February 19, 2014

This is kind of lame, but regarding vitamins: you're in Seattle, it's winter, and we're all vitamin D-deficient here. I bring this up largely because my psychiatrist once specifically had me tested for vitamin D levels, and gave me these absurdly enormous supplements when it turned out that I was even more than usually low. They tell me that D can have a significant effect on your mental well-being. You well may already know this, but I thought I would bring it up just in case.
posted by Because at 1:23 AM on February 20, 2014 [1 favorite]

Here's an update:

I'm pretty sure the Concerta is causing the anxiety and panic. Metadate would merely result in anxious sweating, but I had to get off of that because of Insurance. Concerta without the Lamictal? If Starbucks was out of half and half, I'd have a meltdown right in the store. Lamictal has blunted that, somewhat.

Vitamin D was one of the first things I got checked, as well as seeing a Gynocologist, in case this is hormonal. Hormones are AOK, and the Vitamin D is low, but still slightly in normal levels. So, I'm taking 10,000 IU daily with my doctor's blessing. I'm also trying to walk a bit every day. This is pretty easy to accomplish; I just walk to the college from the Transit Center instead of taking another bus.

I have also been taking my Concerta later in the day, after my Statistics class, so that it's fully in effect by the time the night classes hit. Past two days? It's been good!

The third thing I did was to register for classes for next Quarter anyways. But, they're all at the comm. College closer to my home (SCCC), and I'm only taking 10 credits. 5 are Computer Science (if I can get into the class!), and 5 credits are Anthropology, which I've really fallen in love with. The classes are also spaced closely together.

And the fourth? If this doesn't recede, talk to the doctor about Focalin, or something like Daytrana, which is a Ritalin patch. It'd be $60 a month on my insurance, but worth it to save my academic career. Or, return to the Strattera. It may not be as good ADHDwise, but I actually did good on a surprise Statistics pop quiz, despite me not taking my Concerta for the day, and not reading the textbook nor doing any homework for two weeks, because I'm an Audit Student in the class. But? I was able to do it all so calmly!
posted by spinifex23 at 12:08 AM on February 21, 2014

Fascinating update:

I talked with my doctor, and he thinks that one of the problems is that I'm on too much Concerta. So, we cut the dose back down to 18mg, with his blessing. My grade is also so good in Trig that, if I do poorly in the rest of the course, I'll get that 2.5 to get into Calculus. Obviously, I *want* to keep the 4.0, but it's good to know that I can't fail. Takes a load off.

And I'm skipping next Quarter, until things are totally and completely straightened out. Again, this is on the recommendation of my doctor, and a school counselor.

Thanks for the advice, all!
posted by spinifex23 at 11:18 AM on March 5, 2014

A small update - the exact same thing happened on Strattera last Friday, but magnified 1000 percent, to where I was a basket case that entire weekend. Which is weird! I took a different track, hightailed it to my excellent GP, who thinks that it may have actually been a type of seizure. I'm getting massive amounts of blood work done, including a full thyroid panel, and maybe a CT scan. I got onto WA State Medicaid, so I don't have to worry about COBRA payments anymore. So I'm ending that next month.

As a result, I've stopped the Strattera, and am only on the Lamictal until further notice. The good thing is that, on 100 MG of Lamictal? I am so calm and collected that I'm getting stuff done, without the need for ADHD meds right now. And I'm to see my current Psychiatrist once a month until this is solved, which I'm more than willing to do.
posted by spinifex23 at 11:31 AM on March 27, 2014 [1 favorite]

Glad things are working out. Hang in there.
posted by snuffleupagus at 11:06 PM on April 3, 2014

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