Blog about personal experience with ADHD by Robert Dawson

My first significant break from Concerta

Tomorrow will mark my first significant break from Concerta. I need a refill but my doctor, who I might change due to the inconvenience of traveling to her office, is out until Thursday. So I have to call that morning to ask when I can pick it up. Hopefully, that can be Thursday afternoon. Worst case is Friday afternoon, I suppose.

Tomorrow, I expect to feel tired. And I worry that I will feel especially moody. In one sense, the best case is that I don't feel any different. But, then, that would mean that the medication isn't working. So, I have to at least feel less focused. Or maybe I'll crave dopamine and want to skydive.

The one thing I can control, though, is sleep, and I'm sleeping early tonight to feel my natural best tomorrow and be somewhat productive.

New research on methylphenidate

I ran across a great website for finding and participating in clinical trials. It's Here is a recent one involving methylphenidate:

A Placebo-Controlled, Double-Blind, Parallel-Group, Dose-Titration Study to Evaluate the Efficacy and Safety of CONCERTA in Adults with Attention Deficit Hyperactivity Disorder at Doses of 36 mg, 54 mg, 72 mg, 90 mg, or 108 mg per day

What I learned

  • This study was sponsored by Johnson & Johnson, makers of Concerta.
  • Concerta was found effective at 36-108mg. Can't tell which dose worked best. But I guess that depends on the severity of ADD/ADHD and genes.
  • Most common side effects:
    • decreased appetite (25.5%)
    • headache (25.5%)
    • dry mouth (20.0%)
    • anxiety (16.4%)
    • nausea (12.7%)
    • blood pressure increased (10%)
    • insomnia (9.1%)
    • initial insomnia (7.3%)
    • heart rate increased (7.3%)
    • bruxism (6.4%)
    • irritability (6.4%)
    • muscle tightness (6.4%).
  • "The mean change in weight from baseline to the Final Visit (LOCF) was -2.2 kg in the All CONCERTA group and +0.2 kg in the placebo group." That's -4.85 lbs for the metrically-challenged. I can't tell from the study how long this weight loss took.
And, because I like visuals, here is one quickly showing the side effects:

Quick update

I've decided to stay at 36mg because I felt more nausea on 54mg. This is unfortunate because I felt more productive on 54mg. Although, that could be coincidence. And the difference wasn't drastic.

But even on 36mg, I feel nausea sometimes. I feel slightly nauseous now. I need to figure out what contributes to it or why it happens at all. Google hasn't helped me so far, but I'll look again.

Overall, though, this week at work I was very productive, so I'm glad Concerta seems to be working.

Oh, and I didn't drink as much caffeine this week, which is good for my heart! And no noticeable withdrawal.

Finally, I should note that I slept a fair amount this week, more on average than last week and more consistent.

Trying 54mg of Concerta

This morning, I tried 54mg of Concerta, 18+36mg. I felt slightly nauseous on the way to work and breathing seems slightly labored. And when you hear "breathing" in the context of a side effect of medication, you immediately think "not worth it." But it was not enough to make me feel that bad. It was just enough to annoy me. So, unless today is incredibly productive, I'm going back to 36mg tomorrow. Eating helped some, and I actually ate a little before I took Concerta, but, so far at least, it's not worth it.

And I slept 7.5 hours last night, so I should feel okay. Or, at least, I shouldn't feel nauseous this afternoon, if my theory holds.

I noticed this morning that I haven't been playing my usual iPhone games as much lately. I noticed because I received my second notification that a game would be forfeited if I didn't play. That's never happened. More focus? I guess so, although it could just an adjustment phase.

How Concerta works genetically

If you're interested in genetics and you take medication, you have to check out PharmGKB. I looked up the pharmacogenetics (new word for me, too) of methylphenidate (i.e., Ritalin, Concerta) and found that it is thought to be associated with several genes and to target several others.

Genes associated with methylphenidate

  • ADRA2A - regulates "neurotransmitter release from sympathetic nerves and from adrenergic neurons in the central nervous system"
  • CES1 - "responsible for the hydrolysis or transesterification of various xenobiotics, such as cocaine and heroin, and endogenous substrates with ester, thioester, or amide bonds"
  • COMT - "catalyzes the transfer of a methyl group from S-adenosylmethionine to catecholamines, including the neurotransmitters dopamine, epinephrine, and norepinephrine"
  • DRD4 - "encodes the D4 subtype of the dopamine receptor"
  • SLC6A3 - "encodes a dopamine transporter which is a member of the sodium- and chloride-dependent neurotransmitter transporter family"
  • SNAP25 - "presynaptic plasma membrane protein involved in the regulation of neurotransmitter release"

Genes targeted by methylphenidate

  • SLC6A2 - "responsible for reuptake of norepinephrine into presynaptic nerve terminals and is a regulator of norepinephrine homeostasis"
  • SLC6A3 - "encodes a dopamine transporter which is a member of the sodium- and chloride-dependent neurotransmitter transporter family"
  • SLC6A4 - "encodes an integral membrane protein that transports the neurotransmitter serotonin from synaptic spaces into presynaptic neurons"
As an aside, I'm starting to think that lack of sleep contributes most to afternoon nausea.

Extreme focus with sufficient sleep

Last night, with the help of a sleep aid, I managed to stay unconscious for almost 10 hours. Guess how I felt today. Extremely focused. I felt so focused that I worried I might never stop paying attention.

This reconfirmed the value of sleep while taking Concerta. It makes so much difference. Sleep deprivation basically negates the benefit. Plus, I feel incredibly, inexplicably tired. Side note to self: Find out why Concerta does that.

Today, I read a small library's worth of ADD/ADHD information. And I found an excellent website that gives an excellent overview of symptoms. Check out I also bought the author's book entitled Adult ADD Factbook - The Truth About Adult Attention Deficit Disorder. I've only read a few pages, but I've already found a part discussing DAT1, the dopamine transport gene, and its possible relationship to ADHD/ADD. Highly recommended.

I also drew today in preparation for a still-life painting. The idea is to include enough detail and take enough notes to rely only on those things and memory while painting. I mention this because I felt very focused as well while drawing for accuracy. Its become harder as I've gotten older to focus on visual details when drawing or painting. I tend to want to draw expressively and improvise. That said, generally speaking, art has always been the one area where I hyperfocus and forget to eat.


I slept 5 hours last night. I stayed up to update my iPhone operating system to iOS 5. I love it! But I didn't sleep enough. And I feel horrible, worse than I would have expected given this relatively small amount of sleep deprivation. It feels like I've been awake for days. My body aches for sleep. This is a pattern.

Anyway, this morning, I went to my doctor for my first checkup. It helped that I prepared my observed changes and concerns. She listened, wrote almost everything I said down, and prescribed a one-month supply of 36mg, the dose I'm taking now in two capsules. And she told me that I could try 54mg if I'd like to see the effect. I'm basically experimenting on myself with professional supervision. But that's how it goes short of an MRI or other such direct brain-based observation. So, since I have only 6 18mg capsules left and already have my new prescription, I'll try 54mg one day this weekend.

She says that 36mg and 54mg are the most common doses and that I might see improvement with another increase. My two worries, I told her, are that I will have less appetite, which is now easily manageable, and that I will focus more, which, while being the point of taking the medication, can be a real problem if I focus on the wrong things. Wrong = want. Right = should.

And I asked about discontinuing Concerta on weekends. She said that some people do that, but that I might feel moody and tired. So, I'm not sure about that. My goal is to do more with less and, over time, to do more with nothing, on my own.

Concerta: changes and concerns (updated)

I recently listed changes I've noticed on Concerta and a set of concerns. Here is an update with a new effect and a new concern, both about the same annoyance I've noticed recently, which is nausea.

Effects of Concerta

  • Much better focus
  • Slight loss of appetite
  • Verbosity
  • More sensitivity to sound
  • Less moody
  • Nausea

Concerns about Concerta

  • Are there any potential long-term problems associated with using Concerta?
  • Will I develop a tolerance to Concerta?
  • What might be causing nausea?
  • Can I not take Concerta on weekends?

I've experienced slight nausea in the afternoons. It may be associated with caffeine intake, since I usually drink coffee in the afternoon, but I have also felt nauseous before drinking coffee. Or, maybe it takes a while to feel nauseous after drinking caffeine.

What's odd, though, is that I typically drink a pre-workout mixture that has caffeine and I don't recall feeling nauseous during or after workouts. I guess it's possible that working out prevents nausea. Hmm. Hopefully, I'll find out tomorrow morning when I see my doctor again.

Productive day

Today, I woke up at 10:30am, so I took Concerta late. It hasn't caused a problem, though, if my current sleepiness is any indication.

Today was productive. I wanted to paint but, before diving in, I wanted to explore the changing role of painting throughout history. Amazingly, I did. In fairness, I started it yesterday. But finishing it is an accomplishment. And I managed to write two more blog posts today, not counting this one, one of which is nearly as long as the first.

So, today, I figured out painting's changing role throughout history and figured out my next painting based on a realization about painting's current validity as a creative medium. Not bad! I didn't paint, but at least I know that what I will paint tomorrow is grounded in a confident decision about what to paint.

Concerta and alcohol

Today was the first time I've had more than a glass of wine while on Concerta. And that was at night. This was during the day, while Concerta was still working.

Caveat: I can't speak for everyone. The experience must differ somewhat across individuals given their makeup and a variety of other possible contributing and commingling factors. But this is how I felt.

I felt amazing!!! No, I very much did not. Today, while searching for information about the combination of Concerta and alcohol, I ran across several forum posts praising it for its ability to do two things, counteract the downside of alcohol, effects like drowsiness and dizziness, and create euphoria. As an aside, I also learned that methylphenidate (aka Ritalin and Concerta), and ethanol (aka alcohol) combine to produce a similar psychostimulant to methylphenidate called ethylphenidate. I worried about that, but it doesn't seem a big deal, especially given how little I drank.

So, what did I feel? Not much of anything. I briefly felt drowsy and noticed a slight delay in reaction time. But that's about it. After a glass of sangria, maybe 1/4 of a glass of beer, and most of a shot of whiskey (sipped over the course of a couple of hours, mostly because I will never enjoy the taste of alcohol), still no buzz.

But I wasn't disappointed. Based on what little I had read about the combination before today, I expected not to feel that "out of it" sensation of intoxication. I expected to feel lucid. But I didn't expect to feel not the slightest bit intoxicated. That's a first. I can see why people might easily drink too much if they're not paying attention.

And, for this reason, anyone taking Ritalin or Concerta who isn't familiar with how much he or she can safely drink, like teenagers going to their first parties, should really watch it or, preferably, not drink at all. I'm not saying that to be parent-y. I'm saying it for the same reason that you wouldn't punch a brick wall if you couldn't feel pain. You're still hurting yourself.

For me, though, it was just a waste of money. I didn't even feel less inhibited. Lucid and less inhibited would be a cool combo. But nope.

Here is a good summary of the effects of this combination. From what I've read, and this makes the most sense, if you do know your limits and you are going to drink, do it at night, after your medication has worn off. You won't sleep well, but at least you'll know your limit. Otherwise, get ready for a horrendous hangover.

Concerta: changes and concerns

Here is a summary of the changes I have noticed from using Concerta, followed by a set of concerns that I have about using it, all of which I will mention to my doctor.

Effects of Concerta

  • Much better focus
  • Slight loss of appetite
  • Verbosity
  • More sensitivity to sound

Concerns about Concerta

  • Are there any potential long-term problems associated with using Concerta?
  • Will I develop a tolerance to Concerta?
Since I have, you know, the Internet, I decided to search for answers to my concerns above. Regarding long-term problems or side effects, all I can find is a problem with growth in kids. Other than that, it seems that no one has studied the effects of taking Concerta for more than 7 weeks, which is odd given how long Ritalin has been around. Concerta was approved for adults in 2008. Thanks, Johnson & Johnson!

Blah Friday

I slept 6.5 hours last night, but I feel exhausted. I'm not sure why.

I haven't eaten much and I'm not hungry, but my stomach seems to be telling me to eat, so I need to decide what to eat. I think I need carbs.

As for productivity today, I've been a little productive, but I need to pick up the pace this afternoon. Specifically, I need to make a list of next actions and self-imposed due dates. Otherwise, I have no direction and won't make much progress.

I wonder if Concerta is taking a toll on my body. How do human bodies typically react to the introduction of amphetamines? Although, this can probably simply be explained by basic lack of sleep. But, it feels like I'm tired, yet Concerta is keeping me going. Feels a bit strange. Could just be low energy.

Oh, and I see my ADD/ADHD doctor next Thursday, so I need to make a list beforehand of post-Concerta changes and concerns.

Verbosity on Concerta

Aside from loss of appetite, I've noticed another interesting side effect of taking Concerta, verbosity! If you want to be a writer, take amphetamines. Seriously, I could write a book.

I'm not so sure that I could sit and read for longer than usual, which, incidentally, would be about 20 minutes on a good non-Concerta day. But, man, can I quickly compose long sentences, nearly every word of which I contend to be at least amusingly informative! TMI? Not on Concerta!

But I'm not upping my dose, I promise. It lessens impulsivity, remember?

Concerta x 2 – Day 3

I slept very well last night, just not long enough at only 6 hours. The worst part of staying up late is not knowing why. I bet a lot of people with ADD/ADHD say this. What do I recall? Well, I know I read about Steve Jobs and pre-ordered his upcoming biography. And I'm pretty sure that I read some posts in Google+. But that can't take hours, can it? Unless time is more relative than we thought, yes, it can! I slept around 12:30am.

But I feel good now. Maybe the medicine is kicking in. Because I slept so well last night, Concerta wasn't likely to blame for poor sleep the night before. I'm not sure what to blame.

And yesterday went well. I had no stomach ache in the afternoon like I did on the first day of a double dose. And, as I said, I slept well, which was the other potential problem. As for focus yesterday, while I can't prove that yesterday was an improvement over the average, it felt like it was slightly more productive.

Oh, and, because I felt so tired and irritable this morning on my way to work (irritable because of rushing, not that it's rare), I took piracetam and Alpha GPC again. I want to test the interaction and I feel confident, despite my lack of degree and debt from that degree, that it's safe to try. If it wasn't, I would have felt horrible the first time as Concerta works immediately.

Concerta x 2 - Day 2

I didn't sleep well last night, although I slept about 7 hours, which is usually enough to feel fine. So, I'm guessing that the double dose is to blame. But, to be sure, I have to take another dose again to compare. So, I took 36mg again today. If I have another stomach ache this afternoon and I don't sleep well again tonight, then I'll revert to 18mg until I see my doctor.

I should note, however, that I felt alert as late as 11pm last night and, before bed, played what I hadn't finished earlier in the day of a MindSparke session, doing very well compared to how I've done recently. So, if I can sleep but I also stay alert, even after the medication has supposedly worn off, then I'm happy! That is, assuming that I'm not burning the candle of my life at both ends.

I should also note that I worked out last night for about 20 minutes, doing mostly weights. So, however unlikely given the short length of time, it is possible, that this contributed to poor sleep.

This morning, I took Concerta with food and I can't tell any difference so far. I feel good, although a little less vivacious than yesterday morning, a difference that I, again, attribute to poor sleep.

Concerta x 2 - Day 1

Today, I took two 18mg capsules of Concerta. Surprisingly, I feel calmer than yesterday. I got close to 8 hours of sleep last night, so I expected to feel wired or jittery. But, no. I feel calm. And focused. Good. But, it is a bit scary to take double the first dose and see a better result. But, if, at the end of the day, my day has been productive, then this is the dose for me. At least until I talk to my doctor.

Update at 4:12pm
At around 1:45pm this afternoon, my stomach started feeling a bit uneasy. I wanted to describe it as jittery before I started this update, but it's really a slight stomach ache. I'm guessing that Concerta is the culprit and that I didn't feel this way this morning because my body was fresh and energetic. When energy slumps, maybe the stomach can't deal with the drug as well? I'm clearly not sure, so I plan to try again tomorrow. I really enjoyed feeling calm and I have felt more focused than usual today, even more focused than any day since Friday when I started taking one 18mg capsule.

Update at 4:45pm
It can't be this simple, and I should write a separate post to focus on the matter, but it seems from reading articles like this that ADD/ADHD boils down to low dopamine. And dopamine is what medications like Concerta increase.

Concerta - Day 4

Yesterday was great. Sure, I wasted time on something unimportant, but I was completely focused on that task, which is a start. And, generally speaking, I felt a lot of energy and focus throughout the day.

Today feels okay. I have been productive so far. But I haven't planned my day, which I need to do to make sure I don't spend too long on any given task. As the psychiatrist who prescribed Concerta said, medication can't make decisions for me. That's my job.

But I can confirm that sleep helps a lot. I'm pretty sure that more sleep (slept 7 hours) would have given me even more energy and focus. Although, this is true regardless of Concerta's influence.

Concerta - Day 3

Sleep helps tremendously. Last night, I slept over 9 hours and, today, I felt very focused. In fact, I still do, I assume because I took Concerta later than usual, around 10am.

My brain seems to be on fire today. I had a few good ideas and made several interesting connections, which is unusual, although perhaps usual on 9 hours of sleep. The only downside I noticed is that I spent a long time working on something unimportant. I got so absorbed. And I was fascinated with myself for being so focused and able to solve problems.

So, the lesson is to focus on what's important. And, first, to set a daily agenda!

Tonight, I will try to sleep at least 7.5 hours so that I have enough energy tomorrow and can see if sleep helps as much as it seems. If tomorrow isn't productive, then Tuesday I will try another 18mg.

Concerta - Day 2

I definitely feel a slight buzz, for lack of a better word, this morning. Now, I have had coffee, but coffee doesn't feel like this, at least as far as I can remember. I feel a pleasant, slightly energetic feeling.

And I definitely feel focused. I'm not veering as much as I usually do or getting caught in diversions and, after, wondering where the time went. It feels good.

Then again, it's not even noon yet. I still have nearly a whole day ahead. As usual, I'll report back later if I feel any different or notice something else.

Oh, and I did not take piracetam this morning. But I did last night before bed. It seems to intensify dreams and, since Concerta has worn off by then, there isn't fear of negative interaction.

Also, holy crap, it's October!

Concerta - Day 1

This morning, I started Concerta, 18mg, at 7am. It takes around an hour to kick in. I found this fascinating explanation of how this complicated, extended-release pill works. You might need to read it a few times. Brilliant!

I haven't felt much of anything yet. I might be feeling more focused; I'm not sure. Of course, last night was one of the worst nights of sleep I've had in a while. Before bed, I drank more than 8oz of water mixed with casein protein to help rebuild muscle after last night's workout. Bad idea. I woke up three times to pee, from 2-4am. I tend not to sleep well, anyway, when I'm nervous about something, as I was last night about starting Concerta, so I don't expect to see much benefit from Concerta today.

Oh, I decided to take a low 1g dose of piracetam around 8:30am, as a precautionary measure. I've read that suddenly stopping piracetam can lead to headaches. And, as a rule, I think it's best to stop anything gradually but also as quickly as possible. Also, again, Medscape shows no adverse effects of combining piracetam with Concerta. Yes, I realize that I have not attended med school and that self-treatment can be harmful, but I have also taken a lot of time to educate myself about both substances and I am doing what I think and feel is best for my body and brain and emotional stability on a Friday with poor sleep.

I will continue to post any observations I have about the effects of Concerta today. My guess is that I won't feel much, but who knows? It might just work!

Update at 11:17am
So far, I've noticed:

  • More attention to background noise
  • Slightly less focus
  • More sensitivity to sound

My guess is that the first two are symptoms of poor sleep. I could use a nap. But I suspect that I might feel even more tired without Concerta. I feel somewhat more alert than I would expect to be.

Sensitivity to sound is unexpected, although this could also be an effect of poor sleep that I've never noticed before.