Ritalin Question Please HELP!

[sarah1231]

I was diagnosed with ADD at age 12 and have been taking ritalin ever since.  I use to take 15 mgs and not often to do hw. I rarely took it in the summer or on weekends, if ever. When I started college I would never take it on the weekends, and my habit was much like it was in high school Now I am in my junior year of college and for the first time am very worried about my Ritalin use I have gotten into a habit of taking Ritalin everyday.  I take 60 mgs at once, and then 20 more as an hour or so goes by  I tried to go down I felt like it wasnt working and was depressed.  I am addicted? As low a dose does not work anymore, so I just increase it by myself. Can I can get back to a lower dose, and not feeling like I need to take it every day?   I wouldn"t be able to concentrate with out it. I need to know if I can break this habit but still use it, I"m very confused and don"t know what to do. My anxiety is much worse when I take it, but I still feel as if I need to. I feel very depressed when I try to take a lower dose, and have not gone a day without taking Ritalin in months. I am perscribed the medication but take more than recomended, I just need advice . Is this addiction?

[Jeffrey T Junig, MD PhD]

There are a number of different definitions of 'addiction'; the DSM for Psychiatry doesn't even have criteria for 'addiction', instead describing 'abuse' and 'dependence'.  That said, I think you would qualify as being 'addicted' by most definitions;  usually there is a component of 'tolerance', which you describe, and 'psychological dependence', which you also describe.

You have a few options;  there is of course the idea of 'rehab', and that should be considered if less intensive approaches fail.  The least complicated approach would be to taper down and probably off the medication.  Chances are not that you have developed the 'relationship' with the drug, you can no longer use it without it being a big distraction for you-- either because of efforts to get your mind off of it, or guilt and worry over your level of use.  It is like a romance with a bad boyfriend, and once you have done the 'love' thing, it is not generally possible to be good friends.

You may want to consider taking a week off to just be miserable; hole up with a good friend, get a bunch of old movies, and stay in bed for a week.  The withdrawal is not near as painful as from opiates, but you will be quite depressed for week or two-- that is why it should not be done alone.