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Ritalin / Concerta / fish oils / supplements... What to do?

9 replies

OlennasWimple · 06/02/2019 23:07

DS is 13 and just been diagnosed with ADHD. It's been suggested that he start ritalin or Concerta while we figure out the best neuro therapy option for him, given that his school work is plummeting along with his confidence and his friendships.

We are seeing the doctor next week to discuss, but grateful for thoughts and experiences on the meds options and the supplement alternatives (or do you take Omega stuff on top of meds??). And what questions should we ask, other than dosage and side-effects?

TIA

OP posts:
Sirzy · 07/02/2019 07:29

www.mumsnet.com/Talk/special_needs/3135222-ADHD-medication-thread

You may find that thread helpful.

We do give fish oils alongside adhd meds. Whether they help I don’t know but they aren’t doing any harm!

Lara53 · 07/02/2019 08:55

Krill oil is s better supplement

cakesandtea · 07/02/2019 12:37

I have experience with meds for DC for 10 years and from my experience what I hear a lot on this board, they work. They work fast and make a day and night difference. They don't solve all problems, but go a long way and are an essential first port of call imo.
My experience is with Ritalin (Methylphenidate), Concerta (Methylphenidate slow release) and Strattera (Atomoxetine). Ritalin is short acting and creates a roller-coaster when it phases out after 2-4 hours and when in phases in after the next dose is taken in the afternoon. This creates problems of its own and require huge organisation and discipline, which is not the strength of people with ADHD. So you need Concerta really, which is continuous release throughout the day and lasts 10 - 12 hours. However we started on Ritalin before moving to Concerta, it is the recommended procedure, I understand. You start on 2.5 mg of Ritalin and go to 5 mg after a few days, then to 10, you stay on 10 then go to 15mg after a couple of weeks. It is body weight dependent. Going straight to 10 mg or to slow release can trigger stronger side effects and create more setbacks, it's important to start little by little. You should be seeing a difference after a couple of weeks and be on the optimal dose of Ritalin in 4-6 weeks. A good Psychiatrist would move to Concerta after 2 months.

There was a recent thread on side effects,
www.mumsnet.com/Talk/special_needs/3482078-Positive-stories-of-ADHD-treatment

I suppose you read the big thread on meds mentioned above.
Some DC discussed in there are autistic with complex needs in addition to ADHD, so you need to separate the issues. Mitigating ADHD symptoms makes ASD more apparent, more dominant, so parents react to that, thinking it is side effect of meds; it is not, it is autism showing itself anadulturated. I also note that those with problems are not on Concerta. Some of the medicines mentioned there, like Elvanse (similar to Adderall), are heavy amphetamines. They are short acting and not first line (not recommended to start with) and are not accepted by the NHS (you would depend on private prescriptions for years), so I wouldn't worry about those at this stage. I personally would not use those for my DC anyway.

Personally I think some parents overthink the medication, they project their own anxieties onto medicating, but obviously there are various experiences reflected in various threads. I remember one mum a few years ago. She started with panic and misgivings, strong prejudice about the idea of medication and once started, everything looked to her as confirmation of doom and gloom. There is not need to overthink and dramatise.
Perhaps you might ask the doctor how not to overshoot the suitable dose, how to judge whether the dose is enough without going higher, because I suppose this could cause some (mild) problems discussed by some in the big thread, mainly because they used the bazuka amphetamines or jumped straight to slow release or 10 mg dose. See here www.mumsnet.com/Talk/special_needs/1384372-Methylphenidate-Medikinet-Opinions.

The Omega stuff and supplements might be nice as supplements, but surely you don't consider them to be an alternative to meds? Because they are not and the effect is probably ...
I mean would you take vitamins instead of an antibiotic for pneumonia?

Not sure what a neurotherapy is. I suppose CBT and some coping skills or life skills training could be helpful. To learn techniques and good habits to cope with the condition if you can access this privately.

What is really essential is help at school, the SEN stuff, because meds will not solve all the problems and proper SEN support will be required according with the SEN process and procedures. Are you in touch with the Senco at school? Do you have an individual educational plan for DS?

OlennasWimple · 07/02/2019 18:08

Sirzy - thank you! I thought that there must be a thread already, but the MN search function is so terrible that I couldn't find it...

Cakes - thank you too! The info about starting on Ritalin and then considering progressing to Concerta is exactly the sort of stuff I need to know. We're in a slightly odd situation in that we aren't in the UK, and we are having to navigate an unfamiliar foreign healthcare system as well as everything else. So no SENCo etc etc. Talking to school will be the next thing on my To Do list once we decide how to proceed regarding medication.

Frankly, at the moment I'm too cross to have the necessary conversations, because the last year has seen DS being repeatedly told off at school for forgetting this not doing that, really struggling with long projects (our school loves long projects) and being threatened with being pulled out of the G&T extension programmes that he loves if he carries on forgetting things. Not once has anyone at school suggested that it would be worth exploring ADHD / other diagnoses. It's depressing sometimes to realise that people you hoped were professionals with years and years of experience dealing with a variety of kids have dropped the ball. (As have we as parents - I'm very sad for DS that he has got to 13 without us exploring this Sad )

Anyway, I digress...

I asked about omega and fish oils (thanks for the tip on krill oil, Lara) because a couple of branded supplements were mentioned by the psych who did the evaluation. I'm not a fan of homeopathy as an alternative solution, but I told DH (who is VERY opposed to medication) that I would explore them some more, and I have read various glowing testimonies online about them. I'm naturally sceptical, but well, anything is worth considering

OP posts:
Seline · 12/02/2019 07:48

I take Concerta and it's amazing. It helps so much I'm annoyed I didn't have it when I was younger.

I don't know if it's different for adults but I didn't have to take Ritalin first. Just the lowest dose Concerta.

cakesandtea · 12/02/2019 19:20

Dose depends on body weight, so for an adult the lowest dose of Concerta (18 mg) would be equivalent to lowest recommended dose of Ritalin. But I don't remember exactly the equivalence. Basically it confirms to start low for a small child..

Waveysnail · 14/02/2019 01:26

Ds1 has been moved onto Delmosart. It defiantly seems to have a smoother release for ds

LittleMy77 · 14/02/2019 01:52

Olennas we were recommended nordic naturals fish oils as the best brand with highest concentration of DHA etc in them. Also told to avoid buying them from amazon US as there were loads of clones - their website tells you the nearest stockist, and DH got them from a GNC (I think you're in the US iirc?)

Maldives2006 · 20/02/2019 13:12

My son takes medikinet XL (long acting) apparently it’s considered the gold standard for medication. My son is very happy on Medikinet his appetite is good and it enables him to take part in football and the activities he likes to do.

We used to do the fish oil tablets bit to be honest haven’t noticed any difference and it made his breath smell which for an 10/11 year old boy is not so good.

As for your husband tell him to grow up and make sure the next time he has a headache you tell him that you don’t believe in medication and he should just cope.

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