Methylphenidat (Ritalin, Concerta ...)
Posted: Wed Dec 07, 2016 7:08 pm
Normally I would just post in "My pharma diary" here on the board: viewtopic.php?f=4&t=8731 but this topic developed a significance in a way that I decided to start a new topic for it.
It is about battling RLS associated insomnia. I can be 100% free of somatic symptoms but I still just can't sleep. In the past I had various solutions for this problem. Adding Carbamazepin and later Melatonin helped quite a while for me but then I had to stop Melatonin because it was worsening my RLS and Carbamazepin alone couldn't do the job alone.
More by accident I found out that Methylphenidat can help. This drug is well known under the brand names Ritalin and Concerta. It is used to ADD/ADHD and patients who suffer from narcolepsy.
I've been diagnosed with ADD when I was 14 so I kind of always had access to stimulants. In "My pharma diary" I'm describing how Amphetamines (Adderall, ...) was helping me to reduce side effects of Seroquel and use it as a sleeping pill for RLS related insomnia. Unfortunately this only worked for about 12 months before Seroquel was worsening my RLS in a way that couldn't be controlled any more. The this hole very experimental treatment was kind of extreme but after 3 years of extreme insomnia it was the first solution that helped for a while.
Anyway, stimulants are potent dopaminergic drugs and so it is no surprise that they can improve RLS symptoms. I had a lot of experience with Methylphenidat, much more then with Amphetamines but I never figured out that it could help with RLS related insomnia until last summer, when I had to stop Melatonin.
I was under a lot of pressure then and by accident I discovered that when I take Methylphenidat during the day at a high enough dose I will be able to sleep at night. I had some hopes that I now will be able to reduce or even stop the Carbamazepine but that didn't work out. It was more important then ever that I take Carbamazepine and Methylphenidat each day at the right time so that my system get's used to day/night rhythm. It turned out to be problematic when I started taking Methylphenidat only at lunchtime or later. But sometimes I just forgot to take it in the morning and I was able to resolve the insomnia at night by taking a very low dose of 2.5 mg Methylphenidat. But this was not a reliable solution.
But (3rd time, hahaha) taking it at the morning, at lunchtime and a lower dose in the afternoon was reliable. This is my new solution to insomnia since summer 2016 and in many ways I think it is much more natural then taking sedative drugs at night. I always had this problem of getting up in the morning. I still have it but when I get up now I am more focused, less chaotic and it just fits perfectly in this massive dopamine lack I seem to have in the morning. At least that is the way I experience it.
Well and there is my ADD. I asked in ADD/ADHD boards and people there told me that they would have severe sleeping problems without taking Methylphenidat during the day. So maybe my insomnia is more related to ADD then to RLS and this might apply to other patients who suffer from RLS associated insomnia. Patients with ADD/ADHD are more likely to suffer from RLS then average persons and patients with RLS are more likely to suffer from ADD/ADHD then the average person. But of course the brain is more complex. A big part of the ADD problem is related to dopaminergic pathways so no wonder that both groups suffer from similar symptoms even RLS & ADD are two completely different disorders they seem to have overlapping areas.
So my conclusion is that it may be worth trying ADD/ADHD insomnia treatment strategies when you have RLS and suffer from insomnia, even when you don't have any visible ADD/ADHD symptoms.
I never experienced any augmentation from using stimulants but I've to say that amfetamines don't work for me anymore. Using them together with Seroquel in my situation was kind of risky. I always knew that and now amfetamines just shake my dopaminergic system and cause more RLS symptoms when they start to wear off.
It would be worth exploring how RLS patients are affected by stimulants. Like can they help to reduce symptoms, prolong augmentation, reduce the need for opioids and augment their effects etc.
I am just a 3rd year medical student (med school is minimum 6 1/2 years in Germany!) so it will take some more years until I can start my own research projects.
It is about battling RLS associated insomnia. I can be 100% free of somatic symptoms but I still just can't sleep. In the past I had various solutions for this problem. Adding Carbamazepin and later Melatonin helped quite a while for me but then I had to stop Melatonin because it was worsening my RLS and Carbamazepin alone couldn't do the job alone.
More by accident I found out that Methylphenidat can help. This drug is well known under the brand names Ritalin and Concerta. It is used to ADD/ADHD and patients who suffer from narcolepsy.
I've been diagnosed with ADD when I was 14 so I kind of always had access to stimulants. In "My pharma diary" I'm describing how Amphetamines (Adderall, ...) was helping me to reduce side effects of Seroquel and use it as a sleeping pill for RLS related insomnia. Unfortunately this only worked for about 12 months before Seroquel was worsening my RLS in a way that couldn't be controlled any more. The this hole very experimental treatment was kind of extreme but after 3 years of extreme insomnia it was the first solution that helped for a while.
Anyway, stimulants are potent dopaminergic drugs and so it is no surprise that they can improve RLS symptoms. I had a lot of experience with Methylphenidat, much more then with Amphetamines but I never figured out that it could help with RLS related insomnia until last summer, when I had to stop Melatonin.
I was under a lot of pressure then and by accident I discovered that when I take Methylphenidat during the day at a high enough dose I will be able to sleep at night. I had some hopes that I now will be able to reduce or even stop the Carbamazepine but that didn't work out. It was more important then ever that I take Carbamazepine and Methylphenidat each day at the right time so that my system get's used to day/night rhythm. It turned out to be problematic when I started taking Methylphenidat only at lunchtime or later. But sometimes I just forgot to take it in the morning and I was able to resolve the insomnia at night by taking a very low dose of 2.5 mg Methylphenidat. But this was not a reliable solution.
But (3rd time, hahaha) taking it at the morning, at lunchtime and a lower dose in the afternoon was reliable. This is my new solution to insomnia since summer 2016 and in many ways I think it is much more natural then taking sedative drugs at night. I always had this problem of getting up in the morning. I still have it but when I get up now I am more focused, less chaotic and it just fits perfectly in this massive dopamine lack I seem to have in the morning. At least that is the way I experience it.
Well and there is my ADD. I asked in ADD/ADHD boards and people there told me that they would have severe sleeping problems without taking Methylphenidat during the day. So maybe my insomnia is more related to ADD then to RLS and this might apply to other patients who suffer from RLS associated insomnia. Patients with ADD/ADHD are more likely to suffer from RLS then average persons and patients with RLS are more likely to suffer from ADD/ADHD then the average person. But of course the brain is more complex. A big part of the ADD problem is related to dopaminergic pathways so no wonder that both groups suffer from similar symptoms even RLS & ADD are two completely different disorders they seem to have overlapping areas.
So my conclusion is that it may be worth trying ADD/ADHD insomnia treatment strategies when you have RLS and suffer from insomnia, even when you don't have any visible ADD/ADHD symptoms.
I never experienced any augmentation from using stimulants but I've to say that amfetamines don't work for me anymore. Using them together with Seroquel in my situation was kind of risky. I always knew that and now amfetamines just shake my dopaminergic system and cause more RLS symptoms when they start to wear off.
It would be worth exploring how RLS patients are affected by stimulants. Like can they help to reduce symptoms, prolong augmentation, reduce the need for opioids and augment their effects etc.
I am just a 3rd year medical student (med school is minimum 6 1/2 years in Germany!) so it will take some more years until I can start my own research projects.