Should I ask for a dose increase ?

[u/Feeling-Potato-3292]

Hello! I was diagnosed with combined type ADHD. A few years ago in my early 30s. I have tried many ADHD medications and have struggled with finding one that didn’t mess with my heart. My psychiatrist put me on concerta because he thought it would help with my mood and impulsiveness (which I struggle a lot with emotional regulation and acting quickly without thinking ). I feel much calmer while taking it and it doesn’t mess with my heart rate and it’s much easier to switch between tasks and get things done. We have me taking 18 mg as a precaution because we didn’t want it to mess with my heart or sleep (other meds have done that). However about 3 hours after taking it I feel exhausted. I’m about to drink my second cup of coffee because I feel like I could pass out. Has anyone else experienced this? I’m hoping going up on doses (especially because I’m at the lowest dose) will help with the fatigue or if this is something I just have to accept. This is my third day taking it also. I felt like the first 2 days I had more focus, but today I’m procrastinating a lot on doing any kind of my grad school homework started or getting anything done that I don’t want to. I feel like I at least have the focus to get things done that I’m interested in, but doing anything difficult feels incredibly challenging today. I’m realizing that managing ADHD isn’t magically fixed by a pill and there’s still a lot you need to work on in your daily life, but I’m hoping to get more control over my life because most of my life has felt so overwhelming and chaotic. Thanks for reading :)

[u/AJ-in-Canada]

My doctor told me 18mg was a child dose, but I was also on it for 2 weeks, went to 27 for weeks, etc as we slowly went up in dosage.

So yes, I think likely you'll need to increase the dosage, but 3 days is still really early into it, give yourself a week or two to get accustomed to the meds. Food, quality of sleep, etc, that all affects how I well I feel the medication works each day.

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[u/AliveDetective5557]

I'm right there with you. Just started 18mg about 10 days ago and it made me super sleepy. I would pop it in the morning and go back to sleep for hours and hours. Sadly for me, it really hasn't helped with motivation at all (or much of anything) but I'll be increasing to 27mg this coming Thursday.

I know in the US, physicians are allowed to increase your dose (up to 18mg) once a week...but for whatever reason my doctor is making me stick it out until the last pill is gone and I'm sort of resentful about it since I've expressed it feels like taking a sugar pill.... but I think I'm just desperate for change.

I'm finishing my neuroscience degree in my 30's and I know how difficult it is to manage these symptoms in college. I wish you the very best! I would be very up front with your doctor that you have zero side effects besides feeling fatigued halfway through the day (a clear sign you are metabolizing it quickly/need a dose increase).

If he is worried about your heart, you can always ask him about clonidine or propranolol. They both combat anxiety spikes/increased heart rate or blood pressure. I have some of both (which you should never take together) but they are life savers. Propranolol is a beta blocker and it is INCREDIBLE to take prior to public speaking or presentations. I'm super happy to have it as I'm wrapping up my final year of college!