- working out the best dose, that satisfies patient and family
Usually within the first two months we get to the point the medication is working quite well, and the patient is happy. But we need to know if others around them are just as happy, or is there more work to be done.
We have to determine whether this is the perfect dose, the dose that basically fixes your ADHD, but without over medicating and turning you into a crabby hyper focused robot lacking any personality (that’s what happens when you go too far).
There are three basic ways to determine if you are on the right dose of medication.
- use your own gut feeling, and that of the people closest to you to determine if the medication is basically solving your adhd problem. If you have a significant other, we need their buy in here.
- we give you a copy of the original assessment notes so you and your partner can review the symptoms you said were problematic (you were famous), and whether they are now either well controlled or are not an issue in your life.
- At some point, it is probably worth doing an experiment to see what would happen if you try a higher dose of medication. There are three possible outcomes of increasing the current dose (assuming you aren’t already on the maximum dose). You might get a bunch of side effects. End of story – you can’t take more. You might find a very modest improvement in symptoms – is it worth it? Or you might find that what you thought was good control didn’t hold a patch to the bigger dose.
Using these three methods we can determine if we are where we need to be.
At this point, having established the right dose and experiencing it, we can ask the question, does it last long enough. The reason for not asking this question till now is that as we increase dose, the duration gets a little longer, perhaps an hour or two at most.
Some patients can’t tell when the medication wears off and are still able to function well in the evening. Others can tell me that it definitely doesn’t last past 3 PM, even though they are on what was marketed as a 12 hour medication taken at 7 AM. Truth is there’s a lot of variation in how long these medications last, sometimes even within the same patient – some days are better than others.
I find that about half of my adult patients need a lunch time top up of long acting medication, either to avoid withdrawal side effects of fatigue, irritability, anxiety or irritability, or to make sure it’s still effective with they are home with partner and kids, or when dating.