Concerta increase dosage issues

Patricia - posted on 11/11/2013 ( 8 moms have responded )

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We just increased the dosage of my ADHD son's Concerta from 18mg to 27mg. We have seen an increase in irritability, emotional instability and hyperactivity as the medication wears off. Additionally, he won't eat; not even bowls of ice-cream! Has anyone else experienced these symptoms with an increased dosage?

And, does anyone have an suggestions on high calorie foods to feed him? He will not drink ensure or muscle milk.

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Patricia - posted on 11/15/2013

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Kelly, your post was very helpful. Thank you. We have taken him off the 27mg dosage. His irritability, emotional instability and hyperactivity have all abated. We put him on a 4 hour dose of Ritalin. It is working SOOOOOO much better. He is eating now. We see the psychiatrist in 1 month, at which time we will discuss a better plan than Concerta.

[deleted account]

I used Concerta to control my ADHD for about two years.
As you know, it is a time release, 12-hour dose. This causes some problems.

It does suppress the appetite, and I ended up weighing 88 lbs (as a 5ft 2in adult) before my doctor refused to continue giving me the prescription. High calorie foods won't work because he can't eat them. If you do manage to get him to eat them, and keep them down, he will feel sick and lethargic all day. Instead, opt for a big breakfast, high in protein for stamina.

Like you son, I was very irritable and emotional at the end of the day when I came off the medicine. It was like the ADHD had just been suppressed all day and was building up inside me, but the medicine was keeping it from being released. When the medicine wore off, it was like it all flooded forth at once. There is nothing you can do about that, it's just part of the medication and what it does to the mind and body.


I don't know if you are up for recommendations, but I've recently switched to Ritalin. I do have to take it more often, but I can eat comfortably between doses, so I have more energy and do not have to worry so much about my weight loss issues. Also, because it tends to wear off a little more gradually than the Concerta, and after a shorter amount of time, I am less irritable and emotional coming off of it.
Ritalin also allows you to have a little more fine control over the dosage. I was on 54mg Concerta. With the Ritalin, I can take 20mg in the morning, for a strong dose, then 10mg for the afternoon. I can also take an evening dose of 10mg if I am working late, but if I am going home, I skip it. Your son might benefit from a more customizable dosing regimen, as it has helped me tremendously.

Remember, ALL ADHD medications will cause emotional turmoil and irritability when wearing off--that is just part of having ADHD--but I notice that it is significantly less sever with the ritalin than the concerta. Medication doesn't make ADHD go away, it doesn't even really alleviate the symptoms, it just helps us cope with the symptoms a little more easily. I always recommend behavior modification regimen along with medication. It does take a lot of dedication and commitment, but that is where you will really see results.

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[deleted account]

Please let me know if I can answer any more questions. This is a topic near and dear to my heart, so to speak. I want children with ADHD to be happy because so many people become just so frustrated with them that the kids feel broken and worthless. They are really strong kids, I want them to be recognized for the efforts they put in, even if they don't get the glowing results children without ADHD get.

[deleted account]

Okay. Electronics. Video games and TV are pretty addictive to everyone, but for people with ADHD, it is a whole different ball game.

For starters, we can't stop. If a TV is on, my brain will be immediately sucked into it, and I may or may not remember what I saw. I can look at a TV for what feels to me like 10 minutes, and in reality, I've wasted 6 hours staring at a screen with pictures in it. I do have a TV, but it is in a cabinet in our office where I don't see it throughout the day, and unless someone is actually watching it or playing a game on it, it is turned off and the doors are closed.
Video games are similar. If I start playing a video game (and I don't even enjoy them) I WILL play for several hours straight. I avoid them completely, but that would be difficult for a 7 year old boy because video games are such a large part of their culture. Allow him to play, but limit the time to an hour or less per session (and limit sessions to 2 or 3 days per week....see below)

Secondly, TV and video games screw with our brains. After watching TV or playing a video game for as little as 1 hour, I am more stressed out, more hyper, and more emotionally unsettled. The longer I watch TV, the more stressed, hyper, and emotional I get afterwards. Don't get me wrong, I enjoy the occasional sitcom or movie, but the reason we like these activities is because they guide our brains for us--we don't have to work so hard trying to keep ourselves thinking about the things we should be thinking about, but our brain isn't running hog wild either. It's nice, relaxing, even comforting. But the longer we let technology guide our brains, the more difficult it becomes for us to start guiding ourselves again when we are finished with the technology. Don't ban the TV, computer, or video games, but do limit them.....A LOT.

Lastly, make sure he has time to "Go Wild". This might mean running around the yard screaming his head off for 20 minutes, or it might mean quietly sitting in a corner drawing a picture or just staring into space. The point is to give him some time where he doesn't need to be working so hard on controlling his brain. It really is exhausting. Letting him have a few minutes to "rest" (even if "rest" means running wild) will do wonders for him. He will feel recharged and more in control afterwards.

[deleted account]

Sure. These are things I use for myself. Keep in mind that, for now anyway, you WILL have to remind him to take a bath, pick up his toys, and change his clothes. I have a 9 year old without ADHD and I have to remind him to do those things too, the difference is that I can tell him to go do them, and he'll usually go do them....he may put up a bit of a fight, but that's a kid for you--they hate hygiene.

Anyway, I uses framed lists for almost everything. Believe it or not, I'm in my 30's and will still sometimes forget to put on my deodorant if I'm not reminded.
In my bathroom, I have a list of everything I need to do, in the order I need to do it in. When I go into my bathroom in the morning, my rule is that I don't leave until it's all complete. I printed the list on pretty paper and put it in a frame. I attached a dry erase marker and I mark off the tasks as I do them. Brush teeth, shower, comb hair, face cream, make up, etc.
It sounds stupid. I know that. But it works because there is something in ALL of us, ADD or not, that likes checking an item off. When I check the item off, I am immediately reminded of the next item on the list.
I have similar lists in every room for cleaning up, and one by the door that lists all the items I need before I leave.
I use the same method with my son. On his bedroom door is a list for cleaning his room, and by the hook where he hangs his bookbag is a list for everything that needs to be in his bag before leaving for school.
Print up the lists for him and hang them up. You will have to teach him to use them, and probably have to remind him to look at them for a few months, but eventually it will become habit for him. (It may take a few tries to get the lists perfect--I had to rearrange the items on mine a few times, and I originally left a few things off)

Handling the "NO!" is the toughest part.
As an adult, I know that my biggest issue when I am upset about something is that I can't organize my thoughts well enough to be heard. The same goes for your little one. Something that helps me is to organize my thoughts by writing them down (my husband and I actually argue via email). Obviously, this won't work for a 7 year old, BUT perhaps when he opposes something you've said, you can help him organize his thoughts. Sit down with him and say "Okay, you don't want to take a bath. Tell me why." and you write down his ideas, then counter them. Each time you counter one idea, give him the opportunity to speak up. You would be amazed by how much just "feeling heard" will improve his behavior and make him more cooperative.

Organizing my work.
If it is physical work, it is pretty easy. I set a timer for a short period of time, like 15 minutes.....sometimes 10 depending on how difficult the task is (difficult tasks get less time). For example, If I am cleaning a room, I don't leave that room until the 15 minutes is up, and I keep working the entire 15 minutes, even if I think I am finished after 5 minutes. This has forced me to look for details that I used to overlook, like the sock on the floor in the corner, or the dust on top of the dresser, etc.
Mental work. That is HARD. Honestly, I still have difficulty with it. I TRY to set the timer and stay focused on the task at hand until it dings, then "reward" myself by letting my brain wander wherever it wants to for 5 or 10 minutes in between tasks, but I'm not always able to accomplish that. Sometimes, I find myself staring at a document I should be editing and thinking about something entirely off topic.
Short intervals help. For example, with his homework, make sure he gets a short break between subjects, but he should NOT use that break for anything electronic (I'll get into that next). No computers, video games, TV, etc. He can draw, run around, stare off into space, whatever he wants as long as it doesn't involved electronics. Well, he can listen to music, but that's it.
Sit down with him to complete his homework. When he gets distracted, if he starts talking about something say "I'll make a note, and we'll talk about that next, but right now you need to _________" and make the note. Having that note is SUPER IMPORTANT to him because when you have ADHD you think "If I don't address this thought now, it will be gone forever!!" but putting it in a written note gives us the reassurance that our idea won't get "lost" in the clutter that is our brain."
If he doesn't start talking, but you know he is distracted, just say "Hey, we need to focus on _______ now. Do you want me to make a note so you can come back to this thought later?"

TO BE CONTINUED (Sorry, I need a break).

Patricia - posted on 11/18/2013

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we would love some behavioral methods that you use! Any around taking a bath? putting away toys? changing your cloths daily? dealing with hearing "no," organizing your work, etc. . .

I know these sound normal for a 7 year old, but a 7 year old with ADHD has the human experience quadrupled.

[deleted account]

That is great to hear! I think that the 12 hour release in the Concerta is just too long for little kids--it was too long for me and I am an adult!! It sounds convenient that you will only have to keep up with one pill a day, but the emotional side effects are so much more difficult to handle than one or two extra pills.

One other suggestion if you are open to it. Since you are getting the ritalin script from your physician, I would opt for a psychologist over a psychiatrist if possible. The reason being that a psychologist is more equipped to help you develop a behavioral plan and work with non-medicinal coping methods for the ADHD, whereas a psychiatrist is more equipped to treat it with different combinations of medications. I'm not saying medication is bad, but you already have a physician handling the medication, and ADHD on its own does not really warrant a psychiatrist to manage the medication. The psychologist will be able to offer input that you do not already have.

I can also give you some behavioral methods that I use if you wish to have some ideas on hand to use until your appointment.

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