| Psychiatric medications are just like any other | | | | 4. Toxicity Timing: On and Off Problems -Toxicity may |
| medications: they must always be adjusted correctly | | | | appear as cyclical, mercurial -- off and on -- with |
| to work correctly. The patient's size and weight no | | | | hyperfocus and subsequent inability to focus. This is |
| longer matters. Today, medication adjustments are all | | | | the most frequently missed side effect at the top, and |
| about this little known Mind Bio-marker: the Therapeutic | | | | the most important clinically, because it encourages |
| Window We used to think that weight and body size | | | | regular, predictable negative med consequences. Most |
| were the two most important variables to understand | | | | often with amphetamine products such as Adderall IR, |
| proper dosing. Today those somatic parameters are | | | | Adderall XR, Vyvanse, and Dexedrine a person at the |
| old news. What does matter a great deal in 2008: | | | | top of the window will have periods of hyperfocus |
| metabolic rate, how the meds are burned, and if they | | | | appearing later in the morning, then fluctuations later in |
| are burned correctly. | | | | the day in the noon range of time. It looks like the |
| It sounds complicated at first, but in the end, it's really | | | | meds are almost working, and is often confused with |
| easy, and the benefits are clearly measurable. We are | | | | the bottom of the window: not enough. Adjusting |
| now taking medication understanding from using only | | | | upward without recognizing this essential top of the |
| somatic surface appearance as predictors, to the | | | | window problem can become catastrophic -- because |
| molecular and cellular level: metabolism, metabolic rate, | | | | becoming toxic and completely out of control |
| is the key predictor to unlock that challenging door, and | | | | becomes highly likely. An easy mistake: interpreting |
| to correctly adjust stimulant meds to treat ADD/ADHD | | | | only the part of the cycle on the unfocused side as |
| challenges. If medications are correctly adjusted the | | | | insufficient meds, - that's why you have to step back |
| patient lives right inside that Therapeutic Window: They | | | | and review the entire day. |
| don't go out the top, nor do they bump on the bottom. | | | | 5. "Drugged" Is Too Much: Simply feels like you are |
| They float right inside that important window as | | | | toxic, it's just too much. You shouldn't feel stoned or |
| follows: Simply stated: The Top is too much, the | | | | drugged. |
| Bottom is too little. | | | | 6. More Symptoms at the Top: Confusion, |
| Overview: After recognizing these fundamental | | | | disorientation, cognitive stress, anxiety, are all increased, |
| Window Lessons the patient becomes an essential | | | | while self-expression diminishes. |
| partner in the complicated process of medication | | | | 7. Different Stimulant, Different Tops: Stimulants |
| dosage adjustment. Without this essential information, | | | | Adjusted Incorrectly: you can feel moody and |
| medication adjustment becomes a roll of the dice, | | | | depressed all day - and relieved in the evening as they |
| reactions occur frequently because "How do you | | | | have a shorter 1/2 life with an expected duration of |
| feel?" is but a small, often macro, inaccurate measure | | | | less than 12-14 hrs. If you feel better when they are |
| of subtle micro processes of each person's metabolic | | | | gone from your system, - this is a big hint. [Big drops in |
| activity -- their burn rate. And the good news in this | | | | the PM are also associated with comorbid depression |
| regard: The Therapeutic Window actually isn't hard to | | | | - more later.] With amphetamine stimulants too high |
| find or measure, it just takes a little more time.The | | | | you might feel buzzed, an uncomfortable intensity, too |
| Therapeutic Window represents the body's ability to | | | | overly attentive, with angry and often sad mood |
| metabolize the medication effectively. Seven easy | | | | swings. With the methylphenidate ['Ritalin-like'] products |
| Tips to Recognize the Top of the Therapeutic | | | | you may feel more "stoned and out of it" if meds are |
| Window apply here: | | | | adjusted beyond the top of the window. |
| | | | If you feel these kind of symptoms for the first couple |
| 1. The Reasonable Objective - No side effects: If the | | | | of days after starting a new med, usually no problem. |
| medication is just right in dosage and duration you will | | | | If symptoms continue, urgency is called for and an |
| feel that you are simply floating through that effective | | | | adjustment is very likely necessary, -- see your doctor, |
| Window opening -- no problem, and no, or very few, | | | | and feel free to pass along this article to your medical |
| "side effects." | | | | professional and to your friends. |
| 2. Recognize Too Much: If the medication is too much, | | | | This is the first article in a series dealing with dosing of |
| too high in dosage, you will have signs of toxicity, and | | | | ADD/ADHD stimulant medications. I will be back with |
| will hit the top of the window - bump your head on the | | | | tips on the "bottom of the window," "duration of |
| top of that window. | | | | effectiveness" and other important a practical |
| 3. Toxicity Timing: All Day Problems - Toxicity may | | | | Therapeutic Window tips for medication management. |
| appear as absolute: All day buzzing and can't think, just | | | | We strongly support your medical team and hope this |
| out the top of the window, feeling stoned, or so full of | | | | helps with your progress. |
| thoughts you can't get anything done. | | | | |