Ah... now I know why I get impatient with all his pauses. He's an outstanding writer... as a presenter, not so much 😴💤 I usually don't like sped-up speech, but I'll try it, thx

I watch all videos on 1.25.

@ onlyusernameleft2 I usually don't because it's distracting to me. I have sensory issues which are really peaking at the moment.

More like 2x

even 2x 😂

[let me recommend you to where I got my pharma stuff Oxy's, Addy, Concerta, Xanax and more very refined and reliable also guides newbies]

on Telegram also Instagrams as

*@PHARMSTAIN,* that's the handle

Listening to this at 1.75 speed makes it more bearable.

Thanks. Feel free to share with others if you found it useful.

I have several friends who are child psychiatrists who report that for many individuals with ADHD, the very medications that seem to cause lots of side effects and resistance to children and adolescents seem to be much more acceptable to the bodies and minds of those individuals when they are adults. It is not clear if this is primarily physiological or psychological or some developmental forces at play.

​@@DrJohnKruseHello Sir I am a medical student with ADHD.I have a theory why this happens...Since methylphenidate is a reuptake inhibitor of norepinephrine and dopamine it lowers serotonin levels in the brain.This lowered serotonin causes crashes,anger,depression,muscle aches etc long term,so I believe adding an ssri to concerta may solve the problem.It did solve mine ,I take escitalopram because of it being the most selective to serotonin and supposedly with less side effects.Of course the ssri can cause apathy and make motivation worse ,so you need to carefully find a balance between the two drugs.For years I had symptoms of high anxiety and panic attacks from concerta suffering needlessly and all that is behind me. The other thing is a stimulant like legal methamphetamine-Desoxyn which raises serotonin along with dopamine or norepinephrine could be used by itself if the patient doesn't want to take two drugs.I haven't tried it because the drug is illegal here.There is of course stigma and neurodegeneration concerns with this method as well

In the long run, if enough unhappy people speak up, the system might change.

Generic definitely does not work. And there are shortages for, generics as well.

@@gizzelleboccia1806 a number of people do not obtain the full benefits form the generics. And the shortages are likely to last months longer.

@@gizzelleboccia1806the problem is they put lactose on concerta, it’s not even an option for me, and in France only methylphenidate is available so…

I hope that as long as you are alive you have questions! They're good things to have.

Thanks for the update. In our global economy lots of our supply chains area intertwined.

I'm glad that you found a combination of things that work for you.

The advantage of three IR doses a day would be that you could optimize a daily schedule for yourself, and that you could also change this daily schedule for a particularly demanding or easy day. The disadvantage, particularly for those with ADHD, is having to remember three times as many doses during the day, with the potential for forgetting or delaying each one, even if alarms have been set. I have a few adults who like the IR flexibility, and probably more who would rather find one pill that works for them. I also have a fair number of people who take an IR in conjunction with the extended release, either to get a more rapid onset of action in the morning, or to augment at another time of day.

Without knowing your health history and family history it's not appropriate for me to give specific advice, but it would be quite unusual for Concerta at this dose to provoke a brand new cardiac problem. But hearts are clearly very important, so I would discuss it with your prescriber, and consider having a more thorough cardiac evaluation if more alarming details come up.

Unfortunately, I don't have a generic answer. I've worked with some individuals who thrived on any formulation of Concerta, and didn't notice any differences. And others have been sensitive to the differences. If cost is not an issue, then you are at least getting consistency if you stick with the brand name.

It's possible that Concerta won't work for you - it doesn't help everyone with ADHD. But it could also be that the dose is too low. Stimulants usually produce results within hours, so if someone doesn't have benefits or troubling side effects, most doctors would increase the dose after a few days. (Many people have lots of day to day variation in their unmedicated ADHD symptom severity.)

@@DrJohnKrusethank you so much for the answer, I have an appointment with my doctor in 2 weeks will discuss it as well. Because in my case I didn't get any bad side effects, (pharmacist literally scarred me with "be prepared you might sweat, heart palpitations, dizziness, anxiety..." I was postponing starting this medication for a week, and when started was again surprised- no side effects , no focus improvements like I took a vitamin or something, was trying to do my assignment and again distractions , re-reading everything, then social media ... something else ... and it's been a hours ... nothing is done, but time spent ... like always..... hopefully my doctor will find some solution for me... at the same time even before starting medication, I could sit and paint for hours and will not even notice the time... if start at 7 pm, I can paint till morning ... but school, appointments, exam dates - it's not sticking to my brain., I constantly loosing things, forgetting names... may be it's not ADHD but dementia or something. My whole life I was hearing "you have so much potential, just try better"... if only people knew how much "trying better" I did... successfully graduated from college and was literally crying when got that diploma because so many sleepless nights were spent to memorize stuff... and not to fall behind... I didn't had diagnosis yet, and not continued university studies and I feel so stupid for not being able to listen , for zoning out.. not being able to do things like everyone else . Sorry for the long message.

I'm sorry to hear that shortages are still having terrible negative effects on people. I hope that you're able to resume soon.

Without a thorough examination I can't make specific recommendations. My approach is usually to try to optimize someone's current medication, which often means trying higher or lower doses to see if they are more effective or cause fewer side effects. Vyvanse capsules can be opened to get a lower dose.

As far as I can tell, Rubifen isn't available in the US, and I haven't been able to determine what methylphenidate product it might be most similar to. I'm glad that it's providing at least some help.

Best wishes you find something that works for you.

update?

It's possible it was a dosage (too much) issue, and not just that it is a different substance - Vyvanse is dextroamphetamine while Concerta is methylphenidate.

I don't have a good explanation for your response. That's certainly a longer withdrawal than the majority of people experience after stopping methylphenidate products. Also, it wasn't quite clear from your comment what symptoms of schizophrenia you experienced, and whether that seemed to be a response to the Concerta or also part of the withdrawal. The older antipsychotics were all dopamine blocking agents, so it would be unusual for withdrawal from Ritalin to mimic schizophrenia.

@@DrJohnKruse thanks for the answer. I did experience pretty troubling reactions towards everyday things. For example music would sound oddly sharp and violent, a chair would grab my attention keeping me in a loop of confusion and horror, peoples expressions and intent seem evil and twisted. Occasionally heard voices and saw disturbing hallucinations. Simply everything was constantly out to hurt me, well thats what my brain felt which i made fun of. Not trying to be mean towards concerta, i actually plan on taking it on a lower dosage. The side affects I had were what I described but turned down a notch. Withdrawal amplified them, alot. Another thing i think anxiety wouldve been a better description than schizophrenia, or not im seriously unsure.

@@vexamili it sounds wise to proceed very cautiously.

It sounds like a scenario I see often. I would start with an evaluation by someone who knows about ADHD, and that through careful evaluation of when symptoms arose, and what makes things better or worse, should give some clarity regarding ADHD/anxiety/depression, which may lead to more effective treatment.

The bigger issue than the acidity (which may have minor effects on absorption rates) is that the energy drinks will contain caffeine and often other stimulants, so it makes it more likely that with Concerta you will feel too jacked up, irritable, agitated, and jittery, will have more trouble sleeping, and may have increased blood pressure and heart rate. If the doses are too big, there could be more serious side effects.

Most slow release drugs the mechanism for gradual delivery is a coating on the outside, or the matrix the drug is mixed into, that dissolves slowly after in enters the gastrointestinal system. Some of the fancier variations on this have layers that are affected strongly by the acidity of their environment. The Alza osmotic delivery system consists of the drug in a tiny permeable sack, and a quantity of a specific salt, both encased in a rigid but permeable shell. By the power of osmosis, the salt draws in water from the body at a very steady rate, and the influx of water compresses the drug sack, because the outer rigid shell doesn't change size. The compression of the drug sack pumps the drug out at a very steady rate. Apparently the tricky step is getting the size of the pores right. Wellbutrin XL is one of the other medications using this osmotic technology, and for more than a decade after they came out with a 150 mg and a 300 mg osmotic pill, they were unable to engineer a 450 mg pill, even after contracting it out to other companies. Importantly, these osmotic drugs should NOT be cut in half. Cutting the outer shell destroys the slow release mechanism, and the drug is not evenly distributed across the two halves of the pill.

I hope that you can get back into treatment with someone that works well with you, because many of the symptoms of ADHD can be substantially improved with treatment.

I'm sorry to hear about it. Maybe you are the first to report it.

@@kontes9833 hangisi daha iyi ? Bana 'gerçek' concerta 54mg 1 günde tam geliyordu

How did you know it’s not the original? I’m on 27mg and I’m going through the same thing

How could u tell?

@@1gamz I memorized the effect and side effect, I have a big time attention deficit disorder so the difference is as big as being asleep and being woken up

It sounds important to discuss this with your doctor, there may be timing or other adjustments that can help.

In addition to the honeymoon period (and I have a video on that) most people have significant day to day variation in their ADHD symptoms, in part related to how well they slept the night before, but other factors, mostly unknown, are certainly in play. So it may take more than a day or two to sort out what works well for you.

@@DrJohnKruse Hello Doc! It's been a wild ride these couple of months was under a titration process (Now on 54mg+18mg taking the 18mg 3hrs after i take the 54mg) got on Concerta (Brand) and i will say it does have a smooth release profile and it's pretty consistent day to day in it's delivery of the medication. I had to change to generic again now to Actavis but under recent circumstances had to switch to STADA which is much like Xiromed so that has worked out pretty good when it comes to duration and symptom ease. Reason i had to change from Concerta (Brand) is i got stomach issues major IBS i am not sure if it's the medication itself or the actually capsule causing it. Cause i still have IBS issues with (Generic) but not as profound and harsh as when i was on Brand Concerta. Is it common to have IBS issues when on Methylphenidate? i have no know stomach ulcers i have tried taking Digestive enzymes / lactose intolerance pills ( i have no known lactose intolerance but then again i don't consume any dairy product due to skin breakout) I have a meeting soon again and we might discuss changing medication would Elvanse/Vyvanse (Lisdexamfetamine) be a fair candidate to consider as a replacement / trial?

For some people with ADHD a low dose of stimulant in the evening can help them fall asleep, but most of it is gone by morning, so it is usually not helping with next day focus.

I've been slowly trying to add references to the information for the older videos on this channel, but have not gone back that far yet. Gina Pera's ADHD blog is a wealth of information on Concerta brand name and generic differences. adhdrollercoaster.org/

Ativan withdrawal can certainly increase anxiety above baseline levels. I'm not aware of an association with psychosis. But as they say, "individual results may vary".

@@DrJohnKruse ok I think I felt that increase for some time after although I only took it for two weeks in hospital. Thanks again Dr Kruse

I took atomoxetine 18mg evening and 36mg Concerta morning and couldn't sleep for two weeks after the discharge. In hind sight I blamed my insomnia on the atomoxetine then was later diagnosed with stimulant induced mania by the same psychiatrist as I had a manic episode after abruptly stopping 54mg Concerta. In 2014 I was diagnosed with cyclothymia and adhd, the treating psychiatrist then increased it to bipolar 2 when I went off my meds. My sister had been treated for bipolar at that time. After going off them again and years without treatment I saw a new psychiatrist that diagnosed me with dysthymia and adhd. I did mostly talk therapy and took Ritalin here and there. So last year she subsequently determined that I do not have bipolar disorder that the stimulants triggered mania and gave me appropriate treatment. I abstained from stimulants the whole period and went off the mood stabilizer and antipsychotic in December as I needed to work night shift in January. A few weeks later I had psychotic symptoms again and got back on treatment before it progressed. I then saw a new psychiatrist that diagnosed me with bipolar 2. I then heard about Vyvanse and decided I wanted to try it and he agreed. I lowered my antipsychotic and mood stabilizer and increased the Vyvanse from 30 to 50. I haven't had any problems. My relationships are good, my work performance is good and I have nothing to complain about. I've posted about Concerta and I think maybe it's a bad generic that I have as the first time I tried the generic was last year and that became a horrible mess. The neucon worked well compared to the generic, just double the cost maybe that's the answer

I'm sorry that you had a bad experience. I'm not aware of any controversy about Concerta and depression / suicidal behavior. If that were the reason, you would think that they would have removed brand name Concerta and the branded generic version, but they didn't touch the brand name Concerta. To me that strongly suggests that it was purely a business decision, and they are making more money by just selling the brand name, even if they lost out on the volume of patients treated. People with ADHD are far more likely than those in the general population to have depression and anxiety issues, even without any medications in the picture. Many people find methylphenidate to actually alleviate depressive symptoms.

Hard to follow conceptually, or hard to follow because of the quality of the sound or distractions in the video?

It would concern me. Sufficient and regular sleep is important for mood and ADHD. Insomnia is a known possible side effect with Concerta or any stimulant.

[let me recommend you to where I got my pharma stuff Oxy's, Addy, Concerta, Xanax and more very refined and reliable also guides newbies]

on Telegram also Instagrams as

*@PHARMSTAIN,* that's the handle

I actually start with the point, in the take home message. I've found over time that many people appreciate understanding things, rather than just memorizing isolated facts. But I'm aware that I speak slowly and methodically and that won't appeal to everyone. As others have pointed out, listening at a faster speed may make for a better experience for you.

@@DrJohnKruse Thank you for your reply. May I suggest more visual stimulation for our ADHD watchers, drawings, pictures, etc. I maybe wrong but we like facts and creative ways to carry through your take home message. Do you have a video on how concerta/ritalin affects the GABA/Glutame system? I am currently weening off Alzam with my unformed GP precribed me as a chronics medication instead of the maximum of 1 month to avoid dependence, to address an withdrawl from an addiction I had. Now 3 years down the line I realized how devestating benzos are taken over such a long period. Trying my best with diet and lifestyle changes to get that balance back. I managed to go from 6MG to currently 1mg pd, with the guidance of an experienced medical proffesional, taking off .5mg every 2 weeks which seems like a harsh taper but so far the withdrawl effects are worth the elimination of this toxic drug. Thank you.

Many people with ADHD notice a lot of day to day variation in their symptoms. How well they slept the night before can be an important contributing factor, but not the only one. Concerta should be pretty consistent in terms of your blood levels each day that you take the same dose, so the bigger variable is where your brain is at each day. I hope that you and your doctor can find a plan that works for you.

​@@DrJohnKrusethis is a helpful comment for those of us adjusting ourselves and our doses. It takes some getting used to shifting from ritalin-style to concerta-style medication, I'm five days into the latter, having a so-so experience with it, but my doctor also says it simply works differently and there will be a reaction and some adjusting. It seems logical to observe other factors in daily rythm as part of it.

how long you took it and what was the dosage? Thank you

@ernestalab6592 4 years stopped for pregnancy. Back on for 2 years. Spent another year trying to come off but relapsed 3 times. Its been a whole journey full of depression and fatigue

My talk on this channel on Vyvanse has been one of my most popular. kzfaq.info/get/bejne/jNhlZ5iVqavXZJc.html In summary, many of my patients have felt that it worked better for them than any other stimulant. But everyone's brain is different.

Thanks for sharing your individual response. It doesn't seem to match that of many others. Feel free to adjust the speed if it works better for you.

Anything is possible, but more commonly (and still pretty uncommon at that) drugs that promote norepinephrine can result in priapism - or erections that last longer/harder than usual or desired.