Concerta and its side effects

[Sian Fernandez]

Hi there,

My 5 yr old son has just started CONCERTA and is on 18mg per day.
On the first day he took it he had what i would call quite bad side effects........
1)mouth moving constantly
2)eyebrows up and down
3)fingers in mouth and chewing on fingers.
4)crying all day
since then i have noticed a reduction in side effects but i would like to know
1)He already presented with fingers in mouth and chewing nails and skin, and also eyebrow raising, this has become worse on concerta, why would a child do this in any case and why would it become worse on CONCERTA?
2)His School has noticed an improvement in focusing abilities and handwriting but his behaviour has become uncontrollable at school (screaming and making noises and acting aggressive), who are now sending him home and also blaming the medication. Is this likely?
Can i add he is also on Sodium Valproate(epilim) for seizures which are under control as he hasn't had 1 in over 2 years.
Thanks

[Kevin Kennedy, Ph.D.]

Amphetamines such as Concerta are employed in the treatment of ADHD. Such medications can lower the threshhold for seizures, so they need to be used with caution in patients who display (or have a family history of) seizure disorder. It sound like your son already was displaying some tics (involuntary muscle movements), and such behaviors can be a side effect of stimulant medications such as Concerta. In some children, the stimulants have an activating impact and they can alter a child's mood. All in all, I'd discuss your observations with his health care providers and see if continuation on the stimulant medication is sensible.

[Sian Fernandez]

Can i just add my son has been diagnosed with Atypical Autism, Conduct Disorder and ADHD traits.

[Kevin Kennedy, Ph.D.]

It sounds like he might benefit more from (a) a change in dose of his mood stabilizer or (b) addition of antidepressant medication or small dose of an atypical anti-psychotic medication, but definitely discuss all this with the person who prescribes his medication.

[Sian Fernandez]

My son is not on a mood stabliser, unless you are refering to the Concerta. Nor is he on any other sort of meds for his other issues. Can i ask what would the standard procedure be for a child like my son in the states? We are in the UK and some of the approaches here are different to the states.
Also may i add that his dr and nis neuroligist did note that if he had ANY seizures on the Concerta he would have to come off it. Also why do children present with "tics", is this common with Autistic spectrum disorders?

[Kevin Kennedy, Ph.D.]

Valproate is a mood stabilizer (though that is not the reason he is being prescribed the medication). Anti-seizure drugs are often employed as mood stabilizers in children (rather than prescribe Lithium). There can be a number of reasons for tics, and sometimes they are not worrisome symptoms. But they are not regarded generally as a tolerable side effect if they are brought on by stimulant medications. In the U.S. and, I believe, in the U.K. as well, children with multiple psychiatric diagnoses, particularly those with biological basis (such as ADHD and conditions, like Autistic D/O, along the Pervasive Developmental Disorder spectrum) are often treated with more than a single medication, but this really depends on the symptoms and how much the symptoms impair the child's functioning. I always remind parents: We treat the symptoms, not the diagnosis. Your son's diagnosis of seizure disorder complicates the picture only in the sense that stimulants and certain antidepressants (e.g., Wellbutrin) have to be used with caution.

[Sian Fernandez]

Thankyou for your posts i will be seeing my sons DR on monday and i will be putting my concerns over to him.

[Sian Fernandez]

hi sorry to bother you again but there's 1 more thing i need to know.......
With regards to the fingers constantly in his mouth and chewing on his nails(which originally worsened on the Concerta but is now much the same as it was before).... Is that connected to something he used to do in the past which was to put the neckline of anything he was wearing in his mouth.Ie. his jumper or Jacket and he would just chew or suck at it. Also he would put sleeves into his mouth. What would provoke this type of behaviour and is it all connected with his other issues?

[Kevin Kennedy, Ph.D.]

This habit pattern is not unusual in children with conditions along the Autistic spectrum. It can commence as a tension-reduction behavior and then become cemented as a habit. If at any point he is prescribed an antidepressant from the SSRI class or an atypical antipsychotic med, you may well see a reduction in the behavior (though I wouldn't regard it as a focus of medication).

[dorrin8]

I am a 19 year old male and 163 pounds.  I take a 36mg once a day for ADHD.

Up until now I have not done any research regarding the medication going into me, but now that I have, I am rather disturbed.  Supposively the medication releases itself gradually over a 12 hour period.  I am lucky to feel the benefits for as long at 8, and usually no more than 7.  Also, I normally notice a huge drop when the medication leaves my system.  When it is gone I feel depressed, sluggish, and irrational.  I know I'm being unreasonable but I cannot reason my way out, or will myself through the depression that follows.

I do have a 5mg booster I am allowed to take if needed once a day, but it may or may not work.

Is this normal?

Does anyone out there know why the medication is not effecting me as it should and why the depression sets in?

Also, does anyone know of a website or book that I could use to research the dietary approach to combatting ADHD?

Thanks for your time.

[Kevin Kennedy, Ph.D.]

A sub-set of patients who take stimulant medications to treat ADHD experience a depressive rebound as the medication is in its waning stages (some even experience an overall depressive side effect). Sometimes switching to a different stimulant can make a big difference. For example, you might do well on Adderall (adderrall) XR instead of Concerta.

[t-ski]

My 10 year old started taking Ritalin at age 7. His Dr. changed
him to Concerta 18mg Q day. He developed eye twitching clearing
of the throat after starting concerta. We continued the concerta
because it helped him so much and his Dr. thought the tics were
harmless. The tic ceased after he was off med. for the summer and
summer and spring breaks. This past year the tics bothered my
son socially so he switched to adderal with same effects. Then
switched to Strettera this past spring and continued with the tics. He has been off all medication for 1 month and the tics
continue. Are they permanent? Is there treatment for this? I feel
great guilt for continuing these drugs knowing he had the tics.
We have tried clonidine while on concerta last year and did not help the tics. What should  I do now?

[Kevin Kennedy, Ph.D.]

It would be beneficial for your son to be examined by a neurologist re: pssible treatment for the tic disorder, even though he didn't benefit from the Clonidine. Sometimes when stimulant medications induce tics, the tics do not disappear even when the medication is discontinued. But also don't be surprised if the tics go away spontaneously. In other words, even though the tics have persisted, it may not be a permanent condition. It's impssible to predict.

[bp-son]

hello,
        i'm just writing this post to clear up some issues and questions i've seen on this board.... my son whos 6 was dxed with adhd and has taken ...concerta, adderal, methifedidate, ritilin , none of these helped my son because adhd was just an underlying disorder truth being my son was bipolor and it presents itself just like adhd... and what most of u are not told is adhd being the sole dx is said when they have no idea whats wrong with your kid...my son has a 4 page dx witch is now down to 1 early onset bipolar disorder nos....and its states that if u have depressive moods stimulants are not a good medication for u because it causes rapid cycling....just for your own reserch check out the 2 disorders and you'll see what i'm saying is rite on ...also with bipolar the bp has to be treated before any underlying disorders can be and i will never do stimulant treatment for my son agian ...also about the moter tics my niece had them after taking methifedidate and she was taken off and her tics have stoped and she dosen't stutter near as bad i'd just give it a bit more time for those of u with this problem ....

[agnechas]

My son is 16 and weighs 120 pounds.  When he was 7 he was diagnosed with mild ADD (attention only, not hyperactivity).  Last year he took 36 mg. of concerta each morning,  It worked great except his grades were not as good as they should have been and he says it really did not make him focus well enough.  He has big concerns about his medication preventing him from being outgoing and personable.  I've got a sample pack of Strattera, but we've not started it because I'm concerned over all I've read about it causing anger outbursts as well as the big concern...penal shrinking and urinary problems. My sons never takes meds on weekends or during summer; the only drawback is he is hard to motivate and has little initiative...otherwise he's fine.  If you had a teen son who had a mild case of not being able to focus, yet needed to make decent grades to get into college, what would you do if you were me?  I need some advice.  I do plan on talking again to his doctor, but would like to see what you have to say. Thanks!

[agnechas]

My son is 16 and weighs 120 pounds.  When he was 7 he was diagnosed with mild ADD (attention only, not hyperactivity).  Last year he took 36 mg. of concerta each morning,  It worked great except his grades were not as good as they should have been and he says it really did not make him focus well enough.  He has big concerns about his medication preventing him from being outgoing and personable.  I've got a sample pack of Strattera, but we've not started it because I'm concerned over all I've read about it causing anger outbursts as well as the big concern...penal shrinking and urinary problems. My sons never takes meds on weekends or during summer; the only drawback is he is hard to motivate and has little initiative...otherwise he's fine.  If you had a teen son who had a mild case of not being able to focus, yet needed to make decent grades to get into college, what would you do if you were me?  I need some advice.  I do plan on talking again to his doctor, but would like to see what you have to say. Thanks!

[Madeline65]

My Son is 7 and has been diagnosed with ADHD. He talks all of the time even to himself. Today we started him on 18mg of Concerta. He nearly had an anxiety attack getting to swallow the pill. I finally tricked him by sticking the pill in his french toast and he swalloed it. Now he has a strange tic with his fingers. He can't seem to stop moving them. His doctor was under the impression that he was already in school when she perscribed the medication for him.. He starts next week. She insisted that the medication was for only school hours so he could focus better. His father takes Strattera for the same problem, but takes it all of the time. Not just weekdays. Shouldn't he take the medication continusously or is age a factor to consider? Also, should I have him evaluated neurologically for the tic? Will this go away?

[Madeline65]

My Son is 7 and has been diagnosed with ADHD. He talks all of the time even to himself. Today we started him on 18mg of Concerta. He nearly had an anxiety attack getting to swallow the pill. I finally tricked him by sticking the pill in his french toast and he swalloed it. Now he has a strange tic with his fingers. He can't seem to stop moving them. His doctor was under the impression that he was already in school when she perscribed the medication for him.. He starts next week. She insisted that the medication was for only school hours so he could focus better. His father takes Strattera for the same problem, but takes it all of the time. Not just weekdays. Shouldn't he take the medication continusously or is age a factor to consider? Also, should I have him evaluated neurologically for the tic? Will this go away?

[Madeline65]

My Son is 7 and has been diagnosed with ADHD. He talks all of the time even to himself. Today we started him on 18mg of Concerta. He nearly had an anxiety attack getting to swallow the pill. I finally tricked him by sticking the pill in his french toast and he swalloed it. Now he has a strange tic with his fingers. He can't seem to stop moving them. His doctor was under the impression that he was already in school when she perscribed the medication for him.. He starts next week. She insisted that the medication was for only school hours so he could focus better. His father takes Strattera for the same problem, but takes it all of the time. Not just weekdays. Shouldn't he take the medication continusously or is age a factor to consider? Also, should I have him evaluated neurologically for the tic? Will this go away?

[Madeline65]

My Son is 7 and has been diagnosed with ADHD. He talks all of the time even to himself. Today we started him on 18mg of Concerta. He nearly had an anxiety attack getting to swallow the pill. I finally tricked him by sticking the pill in his french toast and he swalloed it. Now he has a strange tic with his fingers. He can't seem to stop moving them. His doctor was under the impression that he was already in school when she perscribed the medication for him.. He starts next week. She insisted that the medication was for only school hours so he could focus better. His father takes Strattera for the same problem, but takes it all of the time. Not just weekdays. Shouldn't he take the medication continusously or is age a factor to consider? Also, should I have him evaluated neurologically for the tic? Will this go away?