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Concerta and morning irritability?
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<blockquote data-quote="buddy" data-source="post: 558172" data-attributes="member: 12886"><p>I'm not sure I have this straight and admit I haven't read all of the thread. Did you say that the concerta was started because of similar behaviors but once on the concerta he got more irritable in the earlier hours? </p><p></p><p>My son has taken ritalin and concerta for years. I have felt from the beginning it made him more crabby. But the benefits out weighed the negatives. Now in the last year as his aggression has increased at times again I (with permission ) reduced his dose at times to compare. He is much less oppositional and not as aggressive with about one third the dose less. Our psychiatrist was very clear (and his neurologist had even said this could happen as he gets older) that going down was always preferred if possible and that for children especially any individual can have responses like that. She is specifically trained in how bodies process drugs and did research at mayo Clinic. Nice for us because my son has an enzyme deficiency (two enzymes that are needed to metabolize some drugs are very low) and she worked on research for that. ( we.found her after his gen pediatrician found the problem ) So blood levels and therapeutic doses have to be very individualized for him. While learning about this I've read that there is such individuality in how we process medications that eventually dosing may be based on all of us having the enzyme tests to help guide medication selection and dosing. Anyway, I'm no expert but really get that each person is highly varied and thank God our doctor (mom to three with special needs ) never questions that it is likely medications....likes to test that theory first. </p><p></p><p>She and neuro have both told me to expect that as he gets older ...more importantly, as his frontal lobe develops more, he may need less and the stims for some can be more like they are for non adhd folks ......making them less helpful for what we sought treatment for. Not true for everyone .....but to watch for that. </p><p></p><p>****She also discussed how Concerta was developed to give a more even blood level compared to some other long acting forms of Ritalin. But, again it is individualized as well as not being a constant level. She describes it in general as 30-60-30....which I can't explain well but to say that if in your son's case the earlier hours are not yet at the level he needs maybe it is actually that he needs a small short acting dose till it fully kicks in. Just another idea compared to thinking the total dose is too high. I could be way off, its just a thought. </p><p></p><p>When we hit a point where we weren't sure of the most effective dose we went back to short acting to see what dose was best then converted that to the new concerta dose. Our doctor also said that.for some, other forms of long acting ritalin just work differently and are better for a given person. (We have considered patches because they work for us with the clonidine he is on) .</p><p></p><p>Anyway, bottom line yes for us it causes irritability but in your specific situation it could be interesting to see if it is dose related. </p><p>medication stuff hurts my brain sometimes, LOL.</p></blockquote><p></p>
[QUOTE="buddy, post: 558172, member: 12886"] I'm not sure I have this straight and admit I haven't read all of the thread. Did you say that the concerta was started because of similar behaviors but once on the concerta he got more irritable in the earlier hours? My son has taken ritalin and concerta for years. I have felt from the beginning it made him more crabby. But the benefits out weighed the negatives. Now in the last year as his aggression has increased at times again I (with permission ) reduced his dose at times to compare. He is much less oppositional and not as aggressive with about one third the dose less. Our psychiatrist was very clear (and his neurologist had even said this could happen as he gets older) that going down was always preferred if possible and that for children especially any individual can have responses like that. She is specifically trained in how bodies process drugs and did research at mayo Clinic. Nice for us because my son has an enzyme deficiency (two enzymes that are needed to metabolize some drugs are very low) and she worked on research for that. ( we.found her after his gen pediatrician found the problem ) So blood levels and therapeutic doses have to be very individualized for him. While learning about this I've read that there is such individuality in how we process medications that eventually dosing may be based on all of us having the enzyme tests to help guide medication selection and dosing. Anyway, I'm no expert but really get that each person is highly varied and thank God our doctor (mom to three with special needs ) never questions that it is likely medications....likes to test that theory first. She and neuro have both told me to expect that as he gets older ...more importantly, as his frontal lobe develops more, he may need less and the stims for some can be more like they are for non adhd folks ......making them less helpful for what we sought treatment for. Not true for everyone .....but to watch for that. ****She also discussed how Concerta was developed to give a more even blood level compared to some other long acting forms of Ritalin. But, again it is individualized as well as not being a constant level. She describes it in general as 30-60-30....which I can't explain well but to say that if in your son's case the earlier hours are not yet at the level he needs maybe it is actually that he needs a small short acting dose till it fully kicks in. Just another idea compared to thinking the total dose is too high. I could be way off, its just a thought. When we hit a point where we weren't sure of the most effective dose we went back to short acting to see what dose was best then converted that to the new concerta dose. Our doctor also said that.for some, other forms of long acting ritalin just work differently and are better for a given person. (We have considered patches because they work for us with the clonidine he is on) . Anyway, bottom line yes for us it causes irritability but in your specific situation it could be interesting to see if it is dose related. medication stuff hurts my brain sometimes, LOL. [/QUOTE]
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