<p>My son just called and said the Concerta which he counts on to help his focus has lost some of it’s effects. He said he normally takes them in 6 days cycles with a one day break, which supposedly resets the body. He said he had been taking them for 2 weeks straight to prepare for finals. He said he feels the decline is about 80%. I just spoke to a pharmacist friend and she said she’s never heard of such an effect. She said many children take Concerta with regularly with no breaks. My son is not classic ADD or ADHD. He has ADD like symptoms (his parapsychologist words). I think the Concerta helps with his severe working memory deficits in addition to helping him focus. </p>
<p>She also said at 54 mg, my son is already taking the highest concentration of the drug, and any additional dosage will not help. </p>
<p>I am at a loss to give my poor kid any suggestions except to say he will do fine and we are proud of him for trying his best. :(</p>
<p>I have not heard of tolerance buildup for Concerta, however, there are many meds that just stop working for no apparent reason. My friend’s husband hit a real crisis a few years ago when the wellbutrin stopped working for him, and non of the other anti depressants had the same effect for him. This happens a lot with anti depressants is what I was told, and is a problem.</p>
<p>You are in a very controversial arena. Time-release formulations of methylphenidate like Concerta were specifically developed to counteract acute tolerance. This is a class of drugs well-known for the development of tolerance, but it is generally believed that Concerta would counteract this problem. There have been many reports, all anecdotal, that for some patients, the effect of the drug may begin to wear off later in the day. (I am somewhat surprised your pharmacist friend has never heard of this, though she may not have much experience with the drug.)</p>
<p>Psychoactive drugs are tricky things, and if your son says it is wearing off, it is very, very likely that it is wearing off (he’s been taking it and, if he listens to his mind/body, he is an expert - not about the drug, but about what it is doing to him.)</p>
<p>During a break, I’d have him visit a psychiatrist (NOT a psychologist, but one with medical training) who has some expertise in these things.</p>
<p>I truly feel that any kids at college on those type of drugs should be seeing a counselor at school as well as having a psychiatrist overseeing the meds he is using. Someone should be monitoring these drugs as they are frequently abused in college. Kids sell them to other kids, take them recreationally, take them in increments that are not safe. One thing a regular visit with a counselor will do is to have some oversight on those meds and keep them in check. </p>
<p>I am on meds myself, and see a psychiatrist regularly. He always asks about the meds and is tracking them. Yes, I could lie and abuse the usage, but not as flagrently as I could if I was not being monitored. I know that a friend’s daughter was selling her Adderall in college which ended up with some dire results for her in terms of not taking her meds as scheduled not to mention the risk of being charged with being a drug dealer which she was when she started giving and selling her pills.</p>
<p>First off all: thank you to every one for their valuable suggestions and opinions. </p>
<p>I see I made a typo in the op in my haste (my son is waiting to hear back from me) : parapsychologist = neuropsychologist. </p>
<p>My son is under the care of a doctor, though I am not certain the doctor is a psychiatrist. </p>
<p>I am not worried about my son misusing the drug, he is quite opposed to taking them, and tried to do without them at the beginning of the semester. He said he couldn’t complete his tests, even with extended time though he knew his material. So he takes them when he needs the focus and concentration the drug provides. The side effects are that he looses his appetite completely so he has to remember to eat, and his contacts falls off. </p>
<p>It is unfortunate that right now, right before finals week, that the medication he is counting on lost it’s effect. His first exam is tomorrow so there is no time to react or adjust the medication for him. </p>
<p>This is his first semester back at college after a 2 year hiatus and he had been working so hard to succeed this time, my heart breaks for him.</p>
<p>munchkin, Hang in there. He may do better than you fear. Also, his hard work up until this point will help him. Encourage him to do what he can in terms of diet, rest and so on. </p>
<p>You need to find out what kind of doctor he is seeing. He needs to be seen by a psychiatrist who specializes in these issues. </p>
<p>SSRIs and probably other anti depressants seem to work for a while and then the side affects outweigh positive effects.</p>
<p>For the stimulants- I would wonder if his adrenals are depleted.
Not saying that he should go off them- but I would see about giving him nutritional support for adrenals and the liver.
[Adrenal</a> Fatigue / Adrenal Exhaustion](<a href=“http://thyroid.about.com/cs/endocrinology/a/adrenalfatigue_2.htm]Adrenal”>Adrenal Fatigue: Symptoms, Treatment, Causes, and More)
*As much as you may want them, stimulants are the equivalent of giving too much gas and “flooding the engine” in a car. It puts further stress on the adrenals to work harder and produce more energy, and ends up further depleting the adrenal glands. Things to avoid include: caffeine, ephedra, guarana, kola nut, and prescription stimulants…
The way Mindy described it was that taking excessive stimulants when your endocrine or adrenal systems are depleted is like “like kicking a dead horse.”
*</p>
<p>If his quality of nighttime sleep isnt good- that is the first thing to look at because it can affect the way you think and process, even if you don’t feel tired.</p>
<p>I just texted the suggestions to him. Seems he had been eating right but not taking supplements. He is visiting GNC on his way to school. He was planning to pick up some magnesium gluconate, he said supposedly supposedly stress and Concerta depletes magnesium levels. Before talking to us he tried to figure out the problem himself.</p>
<p>This year is pivotal for him and his future so he must be stressed. He was working hard and on track to aceing his courses. </p>
<p>I just told him to try to relax and he should do fine, and no matter what, we are happy with him that he is trying hard.</p>
<p>Is the Concerta wearing off earlier in the day? Or is it an overall feeling?
When my son first began ADD meds we used a neuropsychologist and the pediatrician. When my son made a stand against any meds the Dr had him see a psychiatrist. The psychiatrist was much more up to date on the different meds. They tried different drugs and more for a while he had prescriptions to two drugs. Long lasting adderall for the day and short acting ritalin for his night class.
If your insurance doesn’t cover much for a psychiatrist visit you might look into seeing a neurologist. My youngest see’s a neurolologist for her migraines. He also manages ADD meds. Our insurance pays little of my son’s Dr’s visit and pays almost all of my D’s. In our city it is hard to find a psychiatrist who is taking new patients and is a preferred provider. Much easier to find a neurologist. ( I apologize to any Dr’s if my spelling is off on their speciality. I am a terrible speller) Does CC have a spell check?</p>
<p>^I don’t know how exactly is it not working. He checked in with us through text messaging and in discussing his readiness for finals, mentioned ruefully that the Concerta is not working as well as it did. Upon further discussion he said the drug effect declined 75%. I know he uses the Concerta to help him focus so that he can concentrate longer in his studying. It must be the focus effect. In exams Concerta helps him complete the exam within his allotted time. He has exams today and tomorrow. </p>
<p>Like your son, he started ADD meds under the care of a neuropsy & pediatrician in Chicago. The whole family have since moved to another city and he is attending college at a different city from us. He is seeing a doctor regularly at his college, though I am pretty sure the doctor is not a psychiatrist. The doc has recently changed his meds but obviously he is not changing med during exams but is scheduled to switch to 15mg of dexedrine spansules (time release) after exams because it is covered under the drug plan, but Concerta ($18 a pill) is not. </p>
<p>After this is over the first priority is to find a psychiatrist who is familiar with ADD meds in his city. </p>
<p>We were thinking of having him take the Concerta in the morning and take a small 8 mg immediate release (he has 4 of them left over from different trials earlier in the year) right before the exam, but my pharmacist friend said 54 mg of Concerta is already at the max dosage. I don’t know if he can find his doc at such short notice, or have the time to do so. Trying out a different drug routine at exam time can be risky.</p>
<p>Look for a psychopharmacologist or a neuropsychopharmacologist to manage your son’s medication. This is a subspecialty of psychiatry, and these docs have additional credentials as experts in the ever changing field of use of psychtropics. Family docs are never the best at managing long term care of psychiatric medications, and while many psychiatrists are excellent diagnosticians, as are neuropsychologists, they are not always up on the nuanced changes in medication that psychopharms are.</p>
<p>I had the same problem with the medicine. I currently take 54 mg as well, and am about to get a new medicine once finals are over. I asked my docter why it seemed like the medicine isnt working any more and it is actually impossible to build up a tolerance to the medicine. the problem is that when someone grows and their body changes, a certain medicine may stop working for them as they get older. a new medicine called vivanse may be worthing checking out as it may be more suitable for your son now that his body is different and will react differently to different medicines</p>
<p>54 mg is the highest made tablet strength of Concerta. Some MDs will have the person take two strengths or add on regular methylphendiate in the afternoon.</p>
<p>That is what I was going to suggest - ask the doctor about a low dose of short acting something late in the day, when the concerta has worn off, to allow for early evening study focus.</p>
<p>I was traveling and didn’t see the new replies to this thread. I just asked my son, he is indeed taking 54 + 18 mg of Concerta right now. We took the advice given here and had him consult a psychiatrist who specialized in ADD medications. Cost us $800 under the universal health care system here in Canada even with additional private insurance because it was deemed not necessary. </p>
<p>I will ask him to talk to the doc about Vivanse. He seems not to have issues with his current medication right now. He has also, since that time, switched to an easier course of study and hopefully less stretched to his limits.</p>