Stimulant Medication Doses | ADHD | Episode 70

Rather than worrying whether a dose of stimulant medication is "too high" or "too low", focus on whether it is helping, and whether there are side effects.

[jonathanberry]

🎯 Key Takeaways for quick navigation:

00:11 💊 *Understanding FDA Recommendations on Stimulant Medication Dosages*
- FDA recommendations for medication dosages are guidelines, not strict limits.
- The FDA goes through phases of testing for safety and efficacy when approving medications.
- Insurance companies often limit dosages for cost reasons, not necessarily safety.
10:41 💡 *Finding the Right Stimulant Medication Dosage*
- Start with the lowest dose and gradually increase to find the optimal dose.
- Monitor for both improvements in symptoms and side effects.
- It's essential to focus on what the medication is doing for you rather than fixating on milligram amounts.
20:17 📈 *Factors Affecting Individual Responses to Medication*
- Absorption, metabolism, and brain chemistry can vary between individuals.
- Don't assume that a higher or lower dose is needed solely based on the severity of ADHD.
- Trust but verify: Assess if the medication's effects match the dosage and consider individual responses.

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[JR-mqwd]

Thank you for this information. I wish more providers had your philosophy on helping patients and less fear based/stigma driving their decisions when treating.

[MAGreNpotter]

Thanks for video, you are realy good speaker

[AlluraGrim]

Your videos are so incredibly informative! Can’t thank you enough for providing this information for the general public.

In your practice, have you ever seen paradoxical effects of stimulants at too low doses? Sleepiness, lack of motivation? Thank you for your insight.

[ADHD_guy_reacts]

Hi Doc I just started my adderall it is my first week I dont feel any improvement. DO i have to ask my MD to increase or wait to finish the prescribed 30 days?

[jen_counihan]

Thank you so much for your videos! Especially doing the take home first for those of us with ADHD. 😁

[Yahman]

At 55 I was recently diagnosed. I am on vyvanse which works well however I crash and my Dr has suggested a shoot acting Dexamphetamine to help with the crash. I am worried about addiction. Is this a common practice and what are your thoughts

[notrace]

50 MG of Vyvanse is my ideal dose and med.
I'm currently taking 54mg of Concerta due to availability and feel it works for me except that it makes me feel slowed almost like anxiety medication. I wonder if the 54mg of Concerta is too high. It doesn't makes me feel anxious or energetic, just slowed down in a mindful way.

[chriscrypto]

Do you know why Lisdexamphetamine worked great on day 1 for 1.5 - 2.0 hours, then the effects wore off. By day 8 - 10 my dopamine level felt rock bottom and I was very depressed and had to stop the medication?

[rhoadestraveled]

Dr do you have any experience with ADHD meds and gastric bypass patients? Ritalin didn't help at all and Addarall had some effectiveness the first week or two but now Im at 20 mg x2 per day and it simply feels like a strong cup of coffee. No effectiveness in executive function, only that I don't buffer on decision making. What are your thoughts?

[RVEREND]

Thanks Doc makes sense, my Neurologist talked me down to 54mg Concerta even though 20mg Ritalin was allowing me to reach the 4hrs duration of effectiveness because she was worried the conversion of 20mg Ritalin to concerta 72mg was too high a dose. Will see how it goes, but I suspect the 72mg (2 x 36mg) will give me better results in terms of sustaining focus and regulating emotions. How accurate are conversion guidelines from Ritalin to concerta 18:5?

[thefreshprince-tm]

I wonder what an equivalence to 40mg of Duromine would be. In Australia, this is an extended release formula.

[jen_counihan]

Are you available in California to see patients?

[nezukori]

I just started taking medication again for adhd after about 10 years. It’s only been 2 days since I started, i am taking Adderall extended release 20mg. On my first day there was an uncomfortable adrenaline feeling, increased heart rate, fidgeting, like my brain was trying to work at hyper speed but not being able to actually think about anything, shaky, floaty and my body felt overwhelmed. Affect happened 2 hours after taking the meds and then went away for an hour and then came back again stronger the next time and at that point I couldn’t focus at all. On day 2 I halved the meds and still felt the uncomfortable adrenaline and shaky feeling but it was a little better. The adrenaline feeling lasts after 9hours of taking my medication when the benefits are no longer there. Is this something normal and my body needs more time or does that indicate the meds are too strong? Should I try methylphenidate?

[andrewhall]

How well they slept! Amen! If I've had a bad night, or had an alcoholic drink the night before, my Vyvanse seems to be much less effective.

[jen_counihan]

Is 20 mg of Adderall 3 times a day a lot for an adult with ADHD if there’s no side effects? Is long term safe?

[clintparsons]

Is there any reason to take two 20 mg Adderall XR spaced out instead of 40 mg's at once? I work 12 PM to 9 PM, Would taking the first 20 mg at 11 AM so it's working by 12 PM and then another dose at 2 PM provide a more even effect throughout the day similar to Vyvanse which my insurance doesn't cover?

[digxx]

Have you given patients vyvanse + ritalin and if so, what are the typical dose ranges of this combination? Is vyvanse 50mg + 40mg ritalin reasonable? Would you give 70mg of vyvanse + 50mg of ritalin (spread over the day, like 10mg of ritalin with 70mg of vyvanse in the morning and 10mg at noon and 30mg of ritalin late afternoon?)

[LucasKirbyMusic]

Vincent Schiavelli's son became a doctor! Well I'll be! 😁