SleepingUgly wrote:AHI15 wrote:No, there are tremendous differences. Everyone responds differently, but for me at present, only Ritalin can make me alert no matter how fatigued I am. Not that I would consider that as a viable daily solution. Ritalin also produces a miserable crash when it wears off, though its not so bad if I only stay on it for a short time. Like to survive a drive to a Dr. appt
You're "crashing" off Ritalin because you're taking an immediate release formulation. You wouldn't "crash" as badly if you were on an extended release, and you would perhaps not "crash" much at all if you were on the patch.
Well, I think I'm taking an IR preparation because 1. I need a higher peak concentration to even begin to get an alertness benefit than could be achieved by all but the highest XR or OROS doses; 2. I can have the flexibility of "turning it off" faster if I don't want to be on it all day, or taking it only in the afternoon if I want to have a pleasant lunch without the appetite suppressing effect that would occur (for me) if I was on it through the lunch period. I'm pretty sure I'd crash even on an XR prep. because if I take Ritalin for a longer time period, my dosing schedule basically approximates the release pattern of a high-dose XR preparation.
If you read on the ADD forums, a large proportion of people have Ritalin crashes no matter what preparation they take. Certainly for me, if I only take a 2-3 hour dose, then the crash is mild or maybe not a crash at all. If I stay on it for 4-6 hours, it is worse. Some people report being frazzled for the rest of the day after even a small dose of Ritalin wears off. For me I recover normal mood and my usual evening peak in alertness, once the 1.5 hrs or so of misery passes. Also, for me the crash is worse if I was more fatigued from the get go. So, I'm learning to just avoid any stimulant meds. on a "bad day." It's just not worth it because it a) won't help much and b) the crash will be worse.
SleepingUgly wrote:
It is possible that for you, and many others, the effects of amphetamines or methylphenidate are more robust than modafinil.
A lot of people's lives are improved by the addition of a wake-promoting agent. It can be temporary, but some people have to take them long-term.
Yes, modafinil worked well for me for alertness for about 2-3 months, then began to stop working. That is, the balance of benefit to adverse side effect slowly shifted from fairly positive to decidedly negative. Moda often kept me from sleeping until 1-3am. However, there were times when I fell asleep at the normal time and slept not too bad.
There was always strong anxiety and stomach turning, which subsided along with the alertness benefits.
In the end I was left with only mild anxiety, consistent insomnia, and still not being able to hold my eyes open. And that was even with only intermittent (2-3 per week) use.
Unfortunately, it is looking likely that I will be in that category of people who need to take a stim. med long term, for both ADHD and EDS management. It's looking like the only two remaining choices are amphetamine and methylphenidate. The former is causing a similar insomnia problem as modafinil, while only the latter works for me with no sleep disruptions.