ADHD medication making no difference!

[ADHDnewbie]

My 13 year old DD recently started on 18mg of Delmosart and apart from a bit of a decrease in appetite reports no differences at all.
Teachers say the same, absolutely no change.
Is this normal until the dose increases to 27mg next week or is it likely this medication doesn’t work for her?

She’s so upset as was hoping to be more focused in class and be able to absorb the information

Just to add, dd was diagnosed with inattentive adhd and is taking Elvanse.

YABU and expecting too much too soon! The point of titration is to start at the lowest dose to minimise any side effects and these can be severe in some people, it's known to increase BP/ HR. Then gradually increase dose till you find the sweet spot with maximum benefits on adhd symptoms for tolerable side effects, they should push above to work out if better or worse rather than arbitrarily stop at say 54mg because that suits most of their patients as it's so highly individual and to do so would leave some with sub-optimal results.

Here's the Additude Ultimate Guide To ADHD Medications which may help

Its probably a slower process for children and but when I titrated on methylphenidate XL we did the following plan
Wk1 1 x18mg
Wk2 2x 18mg =36mg
Wk3-4 3x 18mg = 54mg -
At Wk3 they'd decide what to order for next month's prescription depending on the results
you may stay on 54mg, drop to 36mg or increase up to 72mg The max adult dose is 108mg (it's not dosed on weight).

I would have to submit a monitoring form each week to track side effects, any changes to ADHD symptoms, mood, sleep, appetite and check BP/ HR/ BMI. This would be reviewed by Titration Nurse or Psychiatrist and they'd advise on side effects and treatment plan accordingly. If had severe side effects would notify immediately and you can just cease taking the meds while wait for them to contact and advise as unlikely to be same day.

Methylphenidate is available in a range of brand/generics for both XL (and IR) but while the active ingredient is the same other ingredients vary as does the dosing ratio's in 3phase tablet so it's possible that it won't feel identical and may have different side effects. I had to stop taking one brand due side effects but thankfully had started titration on another so knew it wasn't actually the active ingredient.

The 2 stimulant families (methylphenidate in XL /IR) & Amphetamines ( lisdexamfetamine (XL) and Dexamfetamine (IR) the US also has Adderall ). The stimulants have the best efficacy which is why they're the first line of treatment over the non-stims.
Likely all down to our genes, but some find one family may have little to no effect even at high doses so would then switch to the other family. The majority will notice some benefit with both types but one family may suit them better in terms of benefits Vs side effects. Then those that didn't suit stimulants or have conditions which make them unsuitable can try the non- stimulants (Atomoxetine & Guanfacine)

Hormone fluctuations often make ADHD symptoms worse and meds seem less effective before & during periods.

Some also metabolise medication faster so it doesn't last as long as it should and they may be prescribed a top up of short release to extend or try different medication type.

I had a feeling it would be private as there’s no way CAMHS/Nhs would send you away with such a lack of information.

It's definitely not a 'Private vs NHS' issue. The (NHS) Dr who is supposed to be supporting my dd, has been hopeless. She is constantly having to chase him. He only answers specific questions put to him, and doesn't offer explanations to her. Obviously, you don't know what to ask about when you don't know what you don't know.

Thank you for all the replies

The dr did explain the process but did say we should see a difference on the first day which is why it’s been confusing

The good thing is that there are no side effects so hopefully that will be the case on the 27mg too

She didn’t seem very interested in trying a non stimulant when I asked and said they are never as effective as stimulants

Usually you'd feel the medication start working around hour after taking for XL types, but it likely won't be very effective for ADHD symptoms at that dose.The 1st day or 2 can feel bit more intense till body gets used to it, but can sometimes feel more sleepy at that dose.
It's good there are no side effects as makes it much easier to continue, some you get do pass as adjust to it.

Agreed. Our NHS paediatrician is dreadful. Minimal information and desperately hard to get hold of for advice. Most people who I know who have gone private are getting much better support.

That dose isn't working for her. The joys of titration.

She is really looking forward to trying the higher dose on the weekend

What doses are your children / yourselves at if you don’t mind me asking?

My daughter (18) is on 50mg Medikinet xl. This has been her stable dose since she was 14.

Has anyone had very bad nausea on delmosart?
DD keeps being sent home from school since she started it complaining of feeling sick 😢

Op, it's possible that it might take a while to get the right medication at the right dose. Usually I'd think that especially with the first dose you would notice something if it had an effect on you. If she genuinely hasn't noticed anything she might need to increase her dose (and it's definitely worth increasing slowly as the side effects can be fairly unpleasant and usually kick in much quicker).

However having said that what exactly do you mean by the medication isn't making any difference or that there has been no change? What exactly did you expect to change and what hasn't changed?

Ideally, once she is used to the medication at that particular dose she shouldn't feel massively different but certain things (like shifting her focus when required or focussing on what is required) should be easier.

Also, it takes a while to learnt to be effective with the medication. They usually don't help with procrastination. On the contrary. She might need behavioural strategies to get her started working on a task but once she has started it should be easier to stay on task. (As an example)

Just no further ability to focus in class or on homework then before and this is the reason she wanted to try it