Appropriate Dosage of Ritalin

[Holden43]

Hi,
I have a question regarding the medication Ritalin (Methylphenidate) used in the treatment of ADHD. You may have answered similar questions previously but I don’t really have the time to go searching this forum. The drug I’m referring to is specifically Ritalin not Ritalin SR (sustained release). Ritalin is made in 5, 10 or 20 mg tablets. This question involve the dosage Ritalin is prescribed. I’ve read that the average dosage for adults is 30 mg/day. I’m a 25 year old male. I weigh 220 lbs. and am 5’11”. The only other medication I’m on is 100 mg of Zoloft/day for the treatment of depression.  I have no prior medical issues. What would be the appropriate dosage range for me if I were to take this medication? I’ve read that it may have negative effects on the heart. I’m considering talking with my PCP about this but am trying to find out on my own first. Would 60 mg/day be too much? Is it ever prescribed that high? Does it depend on the extent of ADHD a psychiatrist expects? Regardless of the extent of ADHD, what would be considered a high dose for anyone?

Thank you,
Doug

[Rebecca Resnik, PsyD]

Hello Doug,
    Since I am a psychologist and not a prescriber, I can give you information about stimulants and ADHD in general, but the only one who should be talking specific dosage with you is someone who has reviewed your medical history and given you a physical. I see you wrote that you are taking zoloft at a pretty standard dose, but as I am sure you have discovered the SSRIs are a very different experience from stimulants.

I don't see anything in your post about your having had a full evaluation with some formal data collected in the process, so lets start there--with the question of diagnosis. I'm of the opinion (based on the literature about how health care providers make errors) that diagnosing a person with a neurological disorder like ADHD should be done with both a thorough diagnostic interview and some objective data collection. The symptoms of ADHD can occur for many reasons, and ADHD in adults is highly likely to co-occur with anxiety and depression. This is thought to be because people with ADHD are at higher risk for underachievement in school and work, have more car accidents,demonstrate impulsive behavior, use illicit substances, and may even have higher rates of marital/relationship problems. Before you try any treatment, its important to get a thorough evaluation from a very thoughtful practitioner.

If your PCP is like mine and many I work with, he/she is great, but working a very tight schedule to make ends meet. I'm guessing your are doing your homework to make the most of the short appointment you are likely to get, or because you are not sure your PCP will know about all of your options. Either way, thats not a great scenario, and though I don't know you I am guessing you deserve to have someone spend time thinking this through with you. ADHD shouldn't be diagnosed on the basis of a 10 minute conversation, so if your PCP does not have time to do a full diagnostic interview, ask for a referral to a psychologist or psychiatrist. As it sounds like you are most interested in 'cutting to the chase' and trying medication, you may wish to ask for a referral to a psychiatrist or psychopharmacologist.

The literature on adults with ADHD is that they seem to benefit less from stimulants (and stimulant alternatives such as atomoxetine-- brand name Strattera, or Guanfacine--brand name Tenex) than children do. Nobody seems to know why this is yet. A psychiatrist would be your best choice for talking about your medication options based on your symptom presentation and overall health. Stimulants like Ritalin rarely have a dramatic life changing impact right from the first dose. Typically, people have to try a few of them before they find the right fit. Research indicates that if you give 4 people with ADHD a stimulant, at least one of those folks will not get any benefit at all from that particular drug. Expect to try more than one, and expect to try different dosages or time release formulas. Finding the right medication and dosage is a process that requires tweaking. Your final medication and dosage will depend on what drug actually helps you without generating intolerable side effects.

And finally, the literature indicates strongly that though stimulants and other psychotropic medications can make symptoms more manageable, they do not typically fix the problems that your symptoms may have created in your life. It can be very frustrating living with ADHD, and all of the 'fall out' can build up over time. Research suggests that adults with ADHD get the most benefit from a multi-modal treatment approach that includes medication (when appropriate), but also cognitive behavioral therapy and ADHD coaching. You may be rolling your eyes right now, or thinking something along the lines of 'yeah right, as if I have the time and the money for that', but in terms of the playing the odds for the best quality of life, going with stimulants alone may not help as much as working with a well trained professional  who has expertise in treating adults with ADHD. Your psychologist/coach can teach you ways of coping with your symptoms and help you overcome obstacles that are getting in your way.

Hopefully your PCP or psychiatrist will have some referrals for you--names of people they trust (or if you get lucky you can find a psychiatrist who can do therapy as well, though those folks are less likely to take insurance). Ask for a psychologist or an ADHD coach with a special interest in working with adults with ADHD. If you're not sure, try looking at Psychology Today's 'Find a Therapist' website or your state Psychological Association's website. Its not that hard to find in-network therapists if you live in a fairly populated area, so you can always start with the providers on your insurance companies list if you need more of the bill covered. You can also start searching online for providers in your zip code--try searching on Adult+ADHD or ADHD+Coach (or Coaching). Your local chapter of CHADD.org (children and Adults with ADHD) should have a referral list or run free support groups in your area.

Best wishes to you Doug, though I'm sorry what we do here at medhelp can't include recommending specific dosages to someone we have not met. If this information was not what you were looking for, feel free to contact the staff at Medhelp and ask them not to charge you for this question.

Rebecca
Disclaimer: This post was written for informational purposes only. It is never intended to replace face to face medical, psychiatric or psychological care. This post was not intended to create a patient-clinician relationship, nor to give or rule-out a diagnosis.

[Karen_and_Jim]

There has been some success using mega doses of vitamins.  Problem here is that store bought vitamins do not digest well.  They often crystalize in the gut and don't pass into the blood stream.  Then there is the blood/brain barrier.  Only sugars can pass here.  Most vitamins can't enter the brain since they aren't a sugar.  I know only of one company which bonds their vitamins with sugar.  They have had some luck taming ADHD.  ***@****

[Holden43]

I appreciate the detailed response. I learned much more about ADHD in general. I just wasn’t sure if there would be some pharmacological reaction between antidepressants and ADHD medication that would make it impossible to be put both. I may talk to my PCP about these issues and dosage at my next physical. I understand there are limitations for what you can discuss on this forum, such as appropriate dosage. I learned a lot.
Thank you,
Doug