Questions in the Mental Health Forum have been answered by Roger L. Gould, M.D., affiliated with U.C.L.A. and by doctors from Henry Ford Health System.

Question Title: Tolerance to Ritalin ?

Forum: The Mental Health Forum
Topic: Attention Deficit Disorder (ADD)

Posted by Webmaster on June 24, 1999 at 12:44:38

I am 22 year old male and about a month and a half ago, I was diagnosed with ADHD and prescribed Ritalin. For the first four days I was taking one 10mg Ritalin tablet per day. I felt very able to concentrate on tasks and not daydreaming, and to sit down. Also doing things such as reading etc.., gave me a strong satisfaction (reward) for the first time in my life. I also felt having a very good mood when taking Ritalin. Tben after the fourth day I took a 10mg Ritalin tablet but twice daily this time. From the follwowing day Ritalin did not have any effect anymore. I tried higher and lower doses but in vain. Then I stopped it for a week and restarted taking it on Wednesday of last week when I took two tablets together (20mg dose). It still had no or little effect. Then two days later, on Friday of last week, I took two tablets again and I started feeling euphoric. Then after Friday it again stopped having any effect even after taking larger doses such as 4 tablets (40 mg dose) together. Now I ' ll stop it for a week again so hopefully this tolerance reverses.I would like to know why is Ritalin having an inconsistent effect on me. I thought it could be due to depletion of dopamine since I don't think postsynaptic receptors downregulate that fast. I read that under such conditions tyrosine hydroxylase is usually not saturated and maybe taking a tyrosine supplement might help ? Also the improvement in mood etc..., could this mean that I am very sensitive to Ritalin ?

I haven't talked to my psychiatrist yet, because I am afraid he might withdraw Ritalin which is the only thing which has ever gave me such a tremendous improvement. I am a medical student so you can use techical words etc...

Thanks


Posted by HFHS MD-JM on June 25, 1999 at 19:04:36

Webmaster,

The first thing I recommend is that you consult your psychiatrist to
discuss these issues further. It is important to follow your Ritalin prescription as directed. Keep in mind that Ritalin has a duration of 3-4 hours
and requires repeated dosing to have a sustained effect.
Ritalin does act on the neurotransmitter dopamine. Sometimes Ritalin has tobe titrated to effect (the usual dose is 0.5 mg-1mg/kg/day). There are other medications that can be helpful in ADHD such as dexedrine, Cylert, Adderall and Wellbutrin. I once again encourage you to discuss these issues further with your psychiatrist. Remember this information is intended for educational purposes only.

Sincerely,

HFHS MD-JM

Keywords: ADHD, Ritalin




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