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Author Topic: Suddenly unable to tolerate Concerta  (Read 313 times)

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Offline DaveDog2010

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Suddenly unable to tolerate Concerta
« on: November 22, 2013, 04:19:33 PM »
Hello everyone, my problem is I'm confused on what went wrong with my medications. Since November 2011, I have been taking 10mg of Lexapro for G.A.D anxiety and 18mg of Concerta for ADD daily. From that time up until 2 weeks ago, this combination of meds has worked beautifully. But then, I started noticing after taking them together in the mornings, I would experience anxiety. I would describe the feeling as feeling tense, nervousness, coupled with slight paranoia, e.g, the slightest bump/noise on the train to class would freak me out. Plus I would be hyper aware, throughout the day. All this was accompanied by a feeling of fear in the pit of my stomach. So I withstood this for two days before I when to my Psychiatrist. He immediately said stop taking the Concerta while continuing to take the lexapro. Ever since then I've felt fine, however; Concerta worked beautifully for treating my ADD. I'm in school right now and having my ADD under control is critical. My question is what do you believed caused this sudden change to happen? Why was the combination working so well at one point but not anymore? Will I ever been able to go back on Concerta without having the G.A.D symptoms? Is there hope for me?
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Offline insights

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Re: Suddenly unable to tolerate Concerta
« Reply #1 on: November 22, 2013, 06:16:10 PM »
Why was the combination working so well at one point but not anymore?

I don't know, but Concerta (methylphenidate) is a stimulant and these can make anxiety worse so it may be that either the Concerta is triggering more anxiety than before for some reason, or the Lexapro has become less effective at masking the Concerta anxiety, perhaps because your GAD is spiking. Or maybe there is some other factor yet to be determined. 

It is possible that upping the Lexapro dose will restore the previous status quo. IMHO, it's worth a shot. You could also try taking Concerta in the morning and the Lexapro at night. Before doing either run it past your psychiatrist as there may be reasons why you shouldn't that I'm unaware of.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline DaveDog2010

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Re: Suddenly unable to tolerate Concerta
« Reply #2 on: November 22, 2013, 06:45:46 PM »
Hmm I was thinking the same thing, specifically upping my dose of Lexapro. However when I visited my psychiatrist he immediately said stop taking the Concerta. Ever since then I'm just on Lexapro. A side note is that my psychiatrist doesn't spend a lot of time speaking with me. Whenever I'm in his office, I always have this rushed feeling. He doesn't listen all that much. I'm frustrated; I tried non stimulants like Strattera and that didn't work either. I just want my focus back. That's all.
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Offline insights

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Re: Suddenly unable to tolerate Concerta
« Reply #3 on: November 22, 2013, 09:57:33 PM »
A side note is that my psychiatrist doesn't spend a lot of time speaking with me. Whenever I'm in his office, I always have this rushed feeling. He doesn't listen all that much. I'm frustrated;

Then, IMHO, he is a waste of space. Are there other psychiatrists you can go to? Do so if you can. Meanwhile your family physician should be able to advise you.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline DaveDog2010

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Re: Suddenly unable to tolerate Concerta
« Reply #4 on: November 22, 2013, 10:44:21 PM »
Then, IMHO, he is a waste of space. Are there other psychiatrists you can go to? Do so if you can. Meanwhile your family physician should be able to advise you.

Ian

Honestly, ever since going to see him I've always felt like he doesn't take enough time with me as patient. When I'm in his office he only spends about 5 minutes talking to me and then he's already walking me out the door. He's way overbooked and sometimes he double books appointments (making two appointments at the same time). Honestly, the average wait time in his office is an hour.  Is this normal when you goto see a psychiatrist? It's frustrating because I'm not able to describe my whole problem. I just feel like telling him to hold on for a second. How should I go about handling this situation? How do I find a good psychiatrist?

Dave
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Offline insights

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Re: Suddenly unable to tolerate Concerta
« Reply #5 on: November 22, 2013, 11:14:21 PM »
How should I go about handling this situation?

You could try telling him that you need more time to discuss your situation and get advice on how to best deal with it. However, I suspect you won't get it. Another tactic is to not get up until you're completely satisfied. Write down any questions you have and take the list with you so that you don't forget anything and remain seated until you've ticked each item off.

Quote
How do I find a good psychiatrist?

What concerns me about your psychiatrist is that maybe he isn't working the way he does out of greed but necessity because there aren't enough psychiatrists in your area. If so there may be no point in switching. So you need to thoroughly check out his competition first. Phone all their offices and flat out ask how long the psychiatrist spends with patients and what the delay is in getting an appointment. Remember, you are, directly or indirectly, paying these guys, so you're the one with the power and entitled to ask whatever questions you wish. The answers you get can tell you much about how the practice is run. The ones you don't get may tell you even more.

Pharmacists are good sourced of information about the local medical professionals. People talk to them about anything and everything, including what they think of their physicians. They also know their prescribing habits too. So don't hesitate to quiz yours.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline DaveDog2010

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Re: Suddenly unable to tolerate Concerta
« Reply #6 on: November 23, 2013, 10:25:06 AM »
Honestly, I live near NYC, there are tons of psych doctors here. I believe greed might be a factor. Also thanks for the info about seeing a my pharmacist for quality doctor referrals. I will keep that in mind.

Dave
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Offline DaveDog2010

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Re: Suddenly unable to tolerate Concerta
« Reply #7 on: November 26, 2013, 10:21:20 PM »
Any other ideas or suggestions people?
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Offline Andrew90

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Re: Suddenly unable to tolerate Concerta
« Reply #8 on: November 27, 2013, 01:04:05 AM »
I can sort of relate to your story. I have ADD as well and was taking Adderall for a few years and had done marvelous on it, laser-sharp focus, but a few months back my anxiety just exploded and I suddenly found myself unable to tolerate any stimulants because of the anxiousness/panic that I felt would ensue. What I can say is of priority is to treat the anxiety first. Once the anxiety is treated, then a gradual re-introduction of a psychostimulant like Concerta may be warranted for your ADD.

In my case, I am currently on Guanfacine, which is a blood pressure med which also happens to be prescribed for ADD and anxiety. It's also well known to be an excellent adjunct to stimulant medications, to counter their unpleasant side effects. For example, before taking this med, my resting HR was around 90 but would go close to or over 100 at times due to my near-constant anxious state of mind. Having gotten to the right dosage, my resting HR is now around 60. So, I am much more comfortable with taking a stimulant now that my fight-or-flight system is more in control. I am also taking Klonopin twice daily, but benzo's tend to raise my heart rate. Alas, the Guanfacine solved multiple issues in my case, so that I am now on the benzo and can take Adderall again without worrying about tachycardia so much.

If you are unwilling or not given the opportunity to try a benzo to treat your anxiety, then it might be worth mentioning a medication like Guanfacine or Clonidine (in addition to your SSRI) because they tackle both anxiety and ADD, albeit mildly. They are not first-line medications for either condition, but still may be helpful in your case.
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Offline DaveDog2010

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Re: Suddenly unable to tolerate Concerta
« Reply #9 on: December 12, 2013, 01:28:04 AM »
I can sort of relate to your story. I have ADD as well and was taking Adderall for a few years and had done marvelous on it, laser-sharp focus, but a few months back my anxiety just exploded and I suddenly found myself unable to tolerate any stimulants because of the anxiousness/panic that I felt would ensue.
Wow, this is exactly what happened to me! Why do you think this happens? Its so annoying because its like you have everything figured out and your just sailing along and then bam! You take a few steps backwards. Do you know if it ever resolves?

What kind of anxiety do you experience? Mines is like panic attacks and slight paranoia.
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Offline Andrew90

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Re: Suddenly unable to tolerate Concerta
« Reply #10 on: December 12, 2013, 06:24:42 PM »
Yeah, it really just came out of nowhere. It's strange when I look back to the days before my anxiety hit the scene, how I wasn't ever really anxious those days. The brain is a very malleable organ, in that it changes and grows over time. New experiences contribute to how your brain gets impacted. Certainly, experiencing panic attacks is a drastic alteration of everyday perception and living (when you never had them before) but that's not to say that it totally controls how you will experience things going forward.

My panic attacks at first were really focused on my heart, because I felt very tense and whenever my anxiety ramped up I would get more ectopic heartbeats, or "skipped" beats. This would create a vicious cycle of reinforcement, so that it would just build and build, until the panic attack occurred and I would be petrified about how I feel. Now that I'm more aware and educated about panic attacks, they don't bother me so much. I also don't get them nearly as often as I used to back in September/October. Medication and therapy has really helped me significantly.
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