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husband stopped taking concerta and im lost

My husband was prescribed concerta and it seemed to help him focus and calm down. The last month he has been getting really bad side effects. High blood pressure mood swings, trouble sleeping, not being able to turn off just being on the go nonstop. I told him to talk to his Dr and the Dr just gave him meds to treat the side effects which made me mad. We were fighting and he took his pills and flushed them. I worried that my husband will go back to being the selfish neglectful person he was before meds. I don’t want him to have all the side effects but I don’t want the ass hole back. With 2 kids I need the support. What do I do or say.

Replies

What meds did he give him for the side effects?

Posted by BC on May 04, 2014 at 7:46am

And how long has he been taking Concerta?  And what were the dosages?

Posted by BC on May 04, 2014 at 7:47am

And by the way, if those things had happened to me (things go from ok on Concerta but then something happens and that med starts causing problems, but rather than change the dose of the Concerta or try a different ADHD med the doctor just gave more meds) that would make me mad too.

And it might have also not seemed like the “ideal” solution to your husband either….

Frustrating for all parties involved.  But please, we just need a lot more info to try to help out.

Posted by BC on May 04, 2014 at 7:54am

He was on 36 mg concerta with a 5 mg booster of Ritalin in the afternoon. The side effects he started getting where. High blood pressure 158/104. He’s only 26 and in very good shape. He was getting very aggressive mean and was not having any enjoyment out of anything. He was always on could never just relax. He was having issues with sleep and eating. The Dr gave him a mood stabilizer.  I’m not sure what one. But when he took it it knocked him out within 20 min of taking it and the Dr was going to Put him on blood pressure meds if he had a nother high reading. He’s only been on concerta for 3 months.

Posted by tocool29 on May 04, 2014 at 5:40pm

It sounds like the dose of Concerta was either too high for him OR Concerta (and perhaps all the methylphenidate class of drugs) was not the right drug for him. 

Concerta comes in doses of 18mg, 27mg, 36mg, and 54 mg.  Was he originally started on the 18mg dose then slowly titrated upwards to the 36mg dose OR just started at 36mg + afternoon booster?

Posted by BC on May 04, 2014 at 6:39pm

He started at 18 mg for 2 weeks then went to 27mg for 2 weeks then 36 with the afternoon booster.

Posted by tocool29 on May 04, 2014 at 6:46pm

So…
Month 1 - 18mg then 27mg
Month 2 - 27mg + afternoon booster 5mg Ritalin
Month 3 - bad side effects begin to appear…high BP, mood swings, trouble sleeping, “on”

During that Month 2, the addition of the afternoon booster could have been what started the sleeping problems and/or the increase to 27mg Concerta combined with the booster started causing the sleep problems.  Inadequate sleep makes anybody cranky & “moody” & also can elevate blood pressure.

If he were my patient (I’m a physician assistant) I would have seen the increased dose plus afternoon booster as the suspected culprit that was causing these new problems and backed the dosages down, asked about the timing of the afternoon booster (to see if taking everything—Concerta plus booster—earlier would have had less disruption on sleep).  See if backing down on meds would eliminate NEW ONSET problems instead of adding more meds to try to counter-act side-effects of those meds.

Starting a mood stabilizer was just stupid IMO without first investigating the most likely cause of his NEW ONSET “mood issues”—inadequate sleep. 

Personally, I think you need a new doctor—one who isn’t so liberal with adding more pills to fix side-effects.  And I honestly believe your husband’s reaction to this medical mismanagement of flushing them all down the toilet was understandable (and “normal”).

Posted by BC on May 04, 2014 at 7:04pm

I know his Dr probably has a very high work load and my husband just got put on the back burner. I know he doesn’t want to go back on concerta. Wants to try something else but I know his Dr is pro Ritalin. And there isn’t many other options for drs where we live

Posted by tocool29 on May 04, 2014 at 7:45pm

Oh and he told me that His high bp started the end of month 1

Posted by tocool29 on May 04, 2014 at 7:49pm

More editorializing…

Doctors who “treat” ADHD like this are doing us all a huge disservice.  Often times patients come away from an experience like this proclaiming they “tried drugs” but had a “bad reaction”—and having your life turned upside-down & the daily suffering involved can leave a really bad taste in your mouth, so to speak.  Bad enough to not want to try something like THAT again. 

The drugs didn’t fail him; gross medical mismanagement did.  And if he’s like the typical patient who endures something like this, not only will he proclaim taking drugs for ADHD to have been a total failure & a huge waste of time, he’ll proclaim that very same thing to any/all people he talks to about it from here on out.  So he becomes a walking advertisement to stay away from taking meds for ADHD.

I so strongly believe that this is a serious enough case of medical mismanagement that can/will have a negative impact on not only your husband but others who would typically hear about this kind of thing (and add it to their reasons for doing nothing about ADHD) that I would seriously consider reporting this to the appropriate Medical Board that oversees his/her medical license.  Prescribing a mood stabilizer was irresponsible (and leads me to believe he/she is a psychiatrist, not a general practitioner—so he/she of all people should be more knowledgable about psychopharmacology and the effects of sleep on “mood”).  In other words, a psychiatrist should know better than to prescribe a mood stabilizer before exploring the possibility/probability that medically induced sleep problems were responsible for all these bad side-effects.  Most general practitioners know better than to step out of their field of expertise and prescribe mood stabilizers without first exploring the effects of drugs on sleep and the effects of inadequate sleep on “mood.”  When/if that was a bust, then they might refer the patient to a psychiatrist for a mood stabilizer, but usually they don’t prescribe mood stabilizers since they are not psychiatrists.

So, the problem with going to general practitioners for ADHD is that they usually aren’t knowledgable enough about ADHD (and other psychiatric issues) to do a good job with the medical management.  The problem with going to a psychiatrist is that they often don’t know enough about ADHD to do a good job at medical management either.  Very few “experts” in managing ADHD would have failed to properly manage this one, whether they be in general medicine or psychiatry.  This is why going to an “expert” in ADHD is so incredibly important (and why weeding out those who are not experts via reports filed with medical boards is the “right” thing to do).  In a case such as this, filing a report will not likely result in taking away anybody’s license to practice medicine but it can/will result in them being reprimanded for their actions and forced to undergo further Continuing Medical Education about the condition they didn’t know enough about to treat properly.

[written prior to seeing your last two posts which I’ll address next].

Posted by BC on May 04, 2014 at 7:51pm

What makes you believe this doctor is “pro Ritalin”?

Posted by BC on May 04, 2014 at 7:53pm

Revising the timeline:(and editing my earlier typo)

•Month 1 - 18mg x2 weeks, then 27mg x2 weeks (at this point blood pressure is noted as being increased from baseline). 
•Month 2 - 36mg + afternoon booster 5mg Ritalin (Despite the fact that blood pressure readings were elevated from baseline, it was decided to go ahead and increase the dosage of Concerta plus add booster)***
•Month 3 - more bad side effects begin to appear…mood swings, trouble sleeping, always “on”

The revision of the timeline (***) now adds even more evidence that this doctor is not very good at medically managing ADHD.  Who would think that increasing the dose and adding the amount of time that a stimulant is circulating in his body would do anything other than raise his blood pressure a little bit more and for a longer period of time each day?  Was there some hope that the blood pressure elevations would just magically disappear or “fix” themselves through lifestyle changes such as diet & exercise?

Since he is only 26 years old, physically fit, and healthy, the fact that Concerta at a dose of 27mg caused a noticeable increase in blood pressure and a dose of 36mg & booster shot it up to 158/104 makes me wonder if there are underlying medical reasons for the high blood pressure (such as thyroid problems, pheochromocytoma, to only mention a couple) which should be explored.  Has the doctor gotten any lab work that includes thyroid function?

Posted by BC on May 04, 2014 at 8:35pm

If you are limited in terms of other options for doctors (and so have to deal with this doctor or nobody else) then the best way I can think of to proceed would be to go back and specifically discuss these concerns.  If he’s Pro-Ritalin to the point where he only prescribes Ritalin and its derivatives, then going back down to the lowest dose possible plus an afternoon booster would be a reasonable “compromise”—and monitoring BP regularly. 

If the doctor is only pro-Ritalin to the extent that it is always his first line of stimulant to prescribe then there should be some room for more negotiation.

Posted by BC on May 04, 2014 at 9:04pm

His Dr is a physiatrist. We do have a Dr appointment with a gp tomorrow and hoping that they can give us more options but the information I have read there are only 2 physiatrist in the city. I also am concerned that if he doesnt get on meds and everything I have read about couples I am never going to get the marriage I want. That I am always going to have to settle with him and his ADHD. I’m scared and worried. After 10 years I know who my husband is and his ways but after having our second child 8 months ago and having a very busy 2 year old who I am already concerned about having ADHD I DONT KNOW if I can handle my husband being so disconnected and I want meds to help him but if they don’t or if he won’t I’m scared I’m going to lose myself.

Posted by tocool29 on May 04, 2014 at 10:40pm

Try not focusing on the future and all the bad what-if’s.  Easier said than done, I know.  Focus on what you have which is a husband who is being agreeable about getting some help (& who is even willing to try again after such a fiasco).  Above all, try to be patient with the slowness of the progress. 

I assume you meant “psychiatrist”—not “physiatrist.”

Since your available options are limited, try to figure out which doctors know the most about ADHD—whether it is GP or psychiatry.

Posted by BC on May 04, 2014 at 10:50pm

OK thank you very much. smile

Posted by tocool29 on May 04, 2014 at 11:00pm

And while you’re patiently waiting, if you haven’t already read it, read the book “The ADHD Effect on Marriage,” by Melissa Orlov.

Posted by BC on May 04, 2014 at 11:12pm

My husband has ADD and is off of meds due to side effects.  He is on blood pressure medication, but that does nothing for his train of thought and negativity.  We have been married for 4 1/2 years with this being his third marriage and my second marriage.  This marriage is basically over due to his temper tantrums, for lack of a better way to phrase it.  I started therapy two weeks ago to aid in pulling myself back together.  The amount of emotional pain I carry is incredible because I can not consistently rely on him for anything.  This level of dysfunction is destructive and self-centered, and there is no amount of love (or medication) that is going to make a difference.  I am owning the realization that I don’t want to live this way and what is it going to take FOR ME to be happy, healthy and whole again.  If he doesn’t have a constant incoming flow of entertainment and excitement with no interruption of dealing with the every day occurrences of paying bills, home repairs, caring for pets/people/family, then all hell breaks loose and the target is me.  Whatever, dude.  I just don’t care anymore.  Life is far easier without you in it, and good luck with everything.  It really doesn’t matter what his GP, PA, psychiatrist does or doesn’t do for him, in my opinion.  This chemical imbalance is devastating and destructive to anyone in its path.  My advice is to realize that YOU ARE ALREADY ALONE in this relationship.  He can not be there for himself let alone you and the kids.  If you want to keep the marriage, then enjoy the good moments because he is providing them at considerable effort, and set strong boundaries on the days when the chemistry imbalance rules.  There will not get easier.  In fact as time goes by, I feel that the disappointment and frustration hurt worse as I become more unfulfilled personally and aware that I am unable to help him with each occurrence.  Not sure the psychologist I am seeing is the right fit as his approach is practical.  Right now I am looking for a safe place to process and heal mentally and emotionally.  Maybe the only thing to do is just call it quits, get divorced, and move on wiser and stronger.

Posted by kag63 on May 04, 2014 at 11:21pm

First of all I want to say I hope the new doctor offered more help with your situation and some renewed hope - as I have seen first hand with my now husband how the ups and downs go and can affect everything!  My husband is 27 and was diagnosed when about 7 but Concerta had always been what worked for him, amounts have been adjusted throughout the years but that is the medicine we always ended up back with.  The not being able to turn off is definitely a sign of being over medicated - as we went thru that at one time - he would just lay in bed wide awake until like 2am and then of course not want to get up since going to bed so late.  It was a miserable few months and we finally got it figured out - but it really is a trial and error with the medication - but mediation is SO necessary to have a happy functional life.  The Ritalin at night was definitely not needed as a booster as I’m not sure what type of concerta he was taking but if the time release then it works for about 12 hours and if he was already being over medicated the Ritalin made it even worse.  When I read he flushed them down the toliet I could so see that as that is exactly how my husband would lash out when aggravated, jump to the extreme, which leaves us to be the logical ones and figure out how to get life right.  I would also say that any good doctor always makes you do blood work.  My husband always got medication through his regular doctor until about 6 years about and finally went to a psychiatrist - and while she helped she was not the right one - she didn’t believe in enough medication, when he complained of not being able to wake up (and I mean late to work every day, like a zombie, couldn’t so anything) she told him to try COFFEE!!  He has to wake up to drink coffee - duh!  So it was frustrating that he grew but then she restricted his further growing… But then he found his current doctor who is awesome!  She doesn’t over or under medicate, listens, he gets blood work regularly, she watches his blood pressure, weight, everything to look at the BIG picture.  Please update us, as I know the answer is out there but it isn’t always easy to find but is worth it, just don’t be afraid to speak up if you feel medications are wrong - y’all live with it - the doctor doesn’t… Good luck and sending prayers your way - there is light at the end of this tunnel smile

Posted by FightForLove on May 09, 2014 at 12:51am

It’s time to get another doctor. Their’s other types of medicines he can take.

The doctor should have given him something else to try. My daughter has been on 3 different pills in the last 2 years (Concerta, Adderall and now Focalin).

Why didn’t your doctor prescribe one of these ADHD pills instead?
http://www.webmd.com/add-adhd/adhd-medication-chart

That’s just laziness, that’s why I said it’s time to find another doctor.

Posted by not2day on Jun 22, 2014 at 8:40pm

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