I'm a 28 year-old male with 3 independent
diagnoses of ADHD that I received only in
the last year. I have been trying out
various dosages of Concerta for the last
month. I was given a prescription for 18
mg and was told to experiment with the
dosage a little. I only did that on the
weekends as I was unsure how well I'd do
at work while on the med.
I generally found the experience very
positive and just like I expected (I had
done a tremendous amount of research into
ADHD medication and its effects, which was
one of the reasons I was encouraged to
experiment, having that much knowledge and
knowing what to expect). I had severe
social and personal problems due to the
symptoms of ADHD, but managed to develop
my own coping strategies (I had managed to
come up by myself with almost everything I
later learned the literature suggests).
However after I got my degree I realized
that without an external structure pushing
me to discipline myself, I just would not,
and just sailed by going by the "least
effort" rule. Also, my ADHD is not mild,
so I have to use all my time and energy on
managing and preventing the associated
trouble. With a plethora of additional
personal problems, I've been seeing a
counselor who is an expert on ADHD, among
other things, and she agreed that testing
out the medication would be good for me.
I've generally found that the 18 mgs is
too little for me, the 36 mg is a little
too much but generally right for me, and
54 does more of what the 36 mgs did for me
but with added severe anxiety and
zombiefication. I was going to report this
to my ADHD doc this Friday (June 6th) and
ask for a 36 mg prescription. However, as
I decided to test-drive the 36 and 54 mgs
dosages again this weekend, I experienced
new strong side effects, which greatly
worried me. Before, I did experience some
side effects, which were very small and
manageable - mostly a dry mouth,
sensitivity to heat and cold, and slightly
blurred vision when the meds wore off, and
I also "crashed" a couple of times (low
mood, anxiety, feeling spaced out) but it
was not that bad since I knew it would go
away and it did, after 2 or 3 hours. Once
I felt pretty anxious all day on the 36
but it might have been due to the weather
(atmospheric pressure changes).
Last
weekend I took 36 mgs Friday, 36 Saturday,
and 54 mgs Sunday, and the effects I felt
were high anxiety and, most disturbingly,
a sort of muscle tension in my left
pectoral muscle, neck and my left arm. I
also had a tingly feeling at the base of
my throat like I was going to cough but
just wouldn't. This feeling started Friday
morning with the anxiety, which was due to
the fact that I was going to go to work on
Concerta for the first time, and also, due
to the fact that I measured my blood
pressure with a wrist monitor and got a
reading of 139/89 with a 90 pulse, which I
found scary since before, even on the 54
mgs my blood pressure was around 120 / 78
with a pulse of 85 (I was told to measure
blood pressure regularly while on the
Concerta). I have since realized that the
wrist monitor is not reliable at all,
since it can give 4 consecutive readings
varying by 30 points in the same body /
hand position, with readings done in 5
second intervals. Still, the anxiety this
initially caused was carried through the
day and over the weekend, and the
tightness in my left pectoral muscle,
neck, jaw and left arm came back every day
I took the Concerta that weekend.
Initially I thought this was chest
pressure, but I tracked the location of
the pressure to my muscles, with slight
pain at the top of my chest. The left side
of my neck was rock-hard to touch. I also
experienced some shortness of breath (like
I had to make more of an effort to expand
my chest while taking a breath).
Has anyone experienced anything like that?
What are your thoughts on the symptoms? I
must point out that I did have a very
similar experience once in the past (3
years ago), including the tightness in my
arm, pectoral muscle and neck, and the
slightly shallow breathing, in what was
probably a panic attack. I went to the ER,
they examined me, took my blood pressure,
x-rayed my chest, and gave me a diazepam,
an electrolyte drip and sent me home after
3 hours telling me to relax Also, for the week
before the weekend when I felt these
effects, I had been taking a new med for
my varicose veins, i.e. Diosmin, which
"prolongs the vasoconstrictor effect of
noradrenaline on the vein wall, increasing
venous tone, and therefore reducing venous
capacitance, distensibility, and stasis"
(Wikipedia
entry), so maybe its vasoconstrictor
action intensified Concerta's effects on
noradrenaline. I had an EKG and full
bloodwork done before I saw my doc for the
first time and there was nothing wrong
with anything there. Also, I had some
ticks as a child, one of which included
tilting my head to the left and bringing
my shoulder up to support my cheek (the
only way I can describe that), which is
directly reflective of which muscles
became tense in my last weekend's
experiences.
It's very important for me to find an
explanation for these effects so I can
talk about ways of combating / preventing
them with my doc. Although Concerta takes
away some of my sense of humor and makes
me a little too serious, its effects on
the sense of time, making and sticking to
plans and sensing my thoughts has been
incredible, and I can't emulate that with
any coping strategy. Without it, I don't
see how I will be able to make the crucial
changes in my lifestyle I need to make
(e.g. finding a better job), even though I
can't take it every day because I need the
disorganized impulsiveness for my current
(dead-end, low-paying) job (of 6 years).
The problem is that the only ADHD meds
available in my country are Concerta and
Strattera, and Strattera is
cost-prohibitive (at over $350/month). So
I really want to find a way to be able to
use Concerta at least on the weekends
until I can maybe move to another
country.
Oh and I forgot to mention that my doc has
an eight-week waiting list, and probably
more now during the summer, so I would
really like to come in with some options
to avoid having to wait for 3 months just
to bring her a new EKG or whatever.
|
antigone
Supporter
Joined: 27 Jan 2008 Posts: 918 Location: IL
Thanks: 45
Thanked:16
Posted: 06-02-08 22:33pm
I would consult with a cardiologist very
soon. You are exhibiting signs of cardiac
trouble. The concerta could be
exacerbating an existing condition. An EKG
has limited value. You should probably
have a stress EKG, a doppler study of the
corotid arteries and discuss your
medication with a cardiologist. I am a
nurse and worked in the ICU for years. We
did continuous monitoring of our patients
with frequent blood pressures, sometimes
every five minutes. They will vary. At
times they vary quite a bit. We would keep
an eye on them if they had gross
fluctuations. This may not be anything to
be alarmed about but is worth mentioning
to a cardiologist. Your heart rate
increased which is secondary to the
medication. Again, worth mentioning to a
cardiologist.
I hope you will consider seeing someone
for a very thorough exam. You sure don't
want to have a cardiac event due to
medication. I hope this helps.
About the varying blood pressure: I
mentioned this but it was only due to my
cheap, faulty (wrist) monitor. I "tested"
it in many different ways, e.g. I measured
my BP every 30 seconds (literally) for 5
minutes and EVERY result was different,
e.g. 111/78
-->135/85-->125/69-->115/78 etc.
Same with pulse varying by approx 5 beats
up and down. But neither my BP nor pulse
was never really very high, I usually have
a BP of 120/80 (from standardized tests)
and even in the varying readouts it never
went higher than 139/80. If I experienced
any chest pain or had a BP/pulse reading
which was clearly "high", I would have
instantly panicked and gone to the ER I'm seeing my ADHD
doc (a neurologist) in 3 days and I'm
going to mention this all to her, of
course, then probably go on to see a
cardiologist or at least do a stress EKG.
But like I said, I was also wondering
about drug interactions with a
phlebotropic drug, which is essentially a
vasoconstrictor, and things like panic
attacks and tics, etc. These symptoms
began only AFTER I measured my BP (with my
faulty monitor) and saw that it was 139/78
and got scared and anxious seeing it so
high.
|
antigone
Supporter
Joined: 27 Jan 2008 Posts: 918 Location: IL
Thanks: 45
Thanked:16
Posted: 06-03-08 08:16am
Your blood pressure and heart rate are
never static. They change constantly. Your
blood pressures were not very high. Some
doctors would just monitor the values and
may not treat it.
As for interactions with a phlebotropic
drug, I do not find anything that suggests
any interaction. To be sure of this call a
pharmacist. They can tell you for sure.
Phlebotropic drugs are a type of
constrictor in that they prolong the
venous constriction which will aid in
venous return. They do not cause increased
constriction as in greater venous wall
pressure. I would ask a pharmacist this
question though.
Concerta has been associated with panic
attacks and other signs of anxiety. It is
now recommended that everyone who is to
take concerta or other stimulant
medications have an EKG. With your
experience taking the med. and the
physical symptoms you experienced I would
think it prudent to investigate things
further.
Also, for the week
before the weekend when I felt these
effects, I had been taking a new med for
my varicose veins, i.e. Diosmin, which
"prolongs the vasoconstrictor effect of
noradrenaline on the vein wall, increasing
venous tone, and therefore reducing venous
capacitance, distensibility, and stasis"
(
