Concerta;every day or some days for not to develop tolerance?

[PI-ADHD 29]

I went a new doc today. He prescribed me concerta 54 mg and fluvoxamine 100 mg. I told doctor that i've already developed tolerance to methylphenidate. He recommended me to take concerta every day even if doesn't work. I said doc that i wasn't taking concerta every day for not to develop tolerance at my previous use. He said me you're wrong, you should take it every day.
My previous doc had told me to take it only when i need, not every day.
To my knowledge if it's took every day it increases dopamine levels, so dopamine receptors decrease in the brain.
What's your idea? Should i take every day or only when i need?
(Unfortunately in Turkey methylphenidate is the only licensed stimulant med. So I have no other chance.)

[aeon]

Take it as prescribed.

Cheers,
Ian

[qanda]

I don't know about Concerta, but my daughters on Adderal XR and her child psychiatrist told her to only take it on days that will be challenging, and to take days off, even the entire summer off if she can (she's a student). I am not sure if concerta needs to build up or not though, which Adderal does not, which might mean a different approach.

[sarahsweets]

I think if its prescribed as daily then it should be taken that way.

[PI-ADHD 29]

According to a reddit page I saw, Russell Barkley has mentioned that the practice of taking drug vacations is obselete.
I'm uncertain. Why most of stimunlant users take a break (drug holiday) ? Is drug holiday required to prevent dependence or to prevent tolerance ?

[aeon]

Originally Posted by PI-ADHD 29

Is drug holiday required to prevent dependence or to prevent tolerance ?

Neither, and absolutely not.

Dependence is normal and to be expected.


Cheers,
Ian

[sarahsweets]

Originally Posted by PI-ADHD 29

According to that reddit page: (https://www.reddit.com/r/ADHD/commen...rug_vacations/) Russell Barkley has mentioned that the practice of taking drug vacations is obselete.
I'm uncertain. Why most of stimunlant users take a break (drug holiday) ? Is drug holiday required to prevent dependence or to prevent tolerance ?

Dependence is a given. No matter what medication you take you will become dependent on it and there is nothing wrong with that. Tolerance is also a real thing. I think its something that can develop over time or in some cases abruptly happen. IMO though taking med vacations does nothing to affect tolerance and whether you will experience it or not. For years I had no issues with tolerance and would even be a pain in the a** to people preaching how rare it was. Then it happened to me. It was slight and easily adjusted but taking med breaks did zero for it one way or another. I say that because inevitably I manage to not pick up my script exactly on time, or the pharmacy has to order the medicine so I end up going a day or two (sometimes longer) with no medicine. I also wonder if tolerance is dependent on what type of med you take. You tend to hear of it less with methylphenidate drugs than you do with amphetamines.

[qanda]

According to my daughters child psychiatrist, she said some docs do not believe holidays should be taken with Adderal, but others do and she does. She said the reason she believes so is in her experience her patients typically need higher and higher doses over the years. To slow this tolerance down, she finds taking days off has this benefit.

I certainly believe those on this site who have reported taking the same dose, with no decrease in benefits, for years.

But I have also ready plenty of reports on this site where the effectiveness has decreased and higher and higher doses are needed, sometimes reaching such a high dose that a switch in meds is needed as they can't go any higher.

So it seems people react differently & I see no good way to tell how you will react. So if it were me, I would take days off if it didn't negatively impact me too much. But if I needed it every day, then I would take it every day, and deal with tolerance when/if it comes.

[PI-ADHD 29]

In fact, I absolutely need stimulant every day. Because i'm an academician and i have to study every day. You can guess how hard for me w/o drug. But i had developed tolerance in 1-2 weeks even though not taking every day, in my previous usage. So i'm afraid of tolerance. Nonetheless, i'll take it every day who knows it may work.
Also i think methyph. and amph. are unlike about tolerance. It seems much less amph. users develop tolerance than methp. users. I read too much tolerance problems for mph. but rare for amph.

[Lunacie]

Originally Posted by PI-ADHD 29

In fact, I absolutely need stimulant every day. Because i'm an academician and i have to study every day. You can guess how hard for me w/o drug. But i had developed tolerance in 1-2 weeks even though not taking every day, in my previous usage. So i'm afraid of tolerance. Nonetheless, i'll take it every day who knows it may work.
Also i think methyph. and amph. are unlike about tolerance. It seems much less amph. users develop tolerance than methp. users. I read too much tolerance problems for mph. but rare for amph.

I don't know if you can or cannot develop tolerance in such a short time (just
1-2 weeks) or if you were just feeling your body adjust to the med so you
didn't notice it as much. There is often a brief "honeymoon" or euphoria time
before you adjust to the meds and I do wonder if that's what you actually felt.

[PI-ADHD 29]

I've taken 54 mg concerta for four days. It's effect decreased day by day. Even though I intended to go on to use. But i've found an article (https://www.ncbi.nlm.nih.gov/pmc/art...ne.0033693.pdf). In brief according to it methylphenidate caused a significant loss of dopamine neurons in mice in long term. I know mice and human are very similar generally but also may be different. But i'm in doubt and so took a break.
What do you think about this article?

[Lunacie]

Originally Posted by PI-ADHD 29

I've taken 54 mg concerta for four days. It's effect decreased day by day. Even though I intended to go on to use. But i've found an article (https://www.ncbi.nlm.nih.gov/pmc/art...ne.0033693.pdf). In brief according to it methylphenidate caused a significant loss of dopamine neurons in mice in long term. I know mice and human are very similar generally but also may be different. But i'm in doubt and so took a break.
What do you think about this article?

It would be interesting to hear from someone who lives with you or works with
you to see what kind of changes they have seen. It's possible the Concerta is
still working and you're not aware because you're just getting used to the way it feels.

As to whether long term use of stimulants cause a loss of dopamine neurons,
it's possible. There are probably other unknown changes. Some research shows
that when used in early childhood (elementary age) these meds can increase
growth in parts of the brain that have delayed development. As with anything,
we can only look at the benefits and the risks and make our own decisions.

[Little Missy]

This reads as a continual problem for a year with you. Perhaps actually take it as prescribed for a year and then give a self report.

[PI-ADHD 29]

Originally Posted by Lunacie

It would be interesting to hear from someone who lives with you or works with
you to see what kind of changes they have seen. It's possible the Concerta is
still working and you're not aware because you're just getting used to the way it feels.

As to whether long term use of stimulants cause a loss of dopamine neurons,
it's possible. There are probably other unknown changes. Some research shows
that when used in early childhood (elementary age) these meds can increase
growth in parts of the brain that have delayed development. As with anything,
we can only look at the benefits and the risks and make our own decisions.

Yes you're right, there are many brain scane images which demonstrates significant improvement in brain after treatment like that:Scan your Brain and Find its Secrets from IConnectDots blog