Has anyone heard of Ritalin causing extreme fatigue?

[homeschoolally]

We just made an appt with the neurologist, so I expect he can explain this, but I'm impatient! I googled it but didn't find much. I'm curious if anyone here understood why this occurs to some people.

Our family doc prescribed 5 mg short acting ritalin for DS. During the 4 hrs it is supposed to be 'active' he is extremely tired--to the point that he has a hard time keeping his eyes open. When it wears off, during the late afternoon and evening, he is wide open, hyper and irritable. This is a child who suffers from tiredness and lethargy on a daily basis--he has never been 'hyper' a day in his life--just extremely inattentive and spacey. We've tried it multiple times and it has happened this way consistently.

It reminds me that when he was small, benadryl would make him wild, instead of sleepy.

Does anyone know the chemical explanation for this? We're giving up on the Ritalin, but I'm very interested in what would be going on in his brain if a stimulant makes him very sleepy.

Thanks!

[Ottakee]

I have not heard of that effect but I think I would stop the med for now.

 

You said that he is tired/lethargic daily. Have you had a sleep study done? How about had him seen ENT? (tonsils and adenoids can interfer with sleep) Has his thyroid been checked?

 

It really sounds like something else other than ADD is going on. Our ENT said that he has "cured" many ADD/ADHD cases by removing tonsils and adenoids. Come to find out, the kids weren't really ADD/ADHD but rather very sleep deprived from having sleep apnea from overly large tonsils and adenoids.

 

The neurologist might also want to test for seizures by doing a simple EEG.

[milovany]

I'm very interested in what would be going on in his brain if a stimulant makes him very sleepy.

Thanks!

 

DISCLAIMER: I'm not a doctor nor do I play one on the Internet.

My only "qualification" is sitting in on a college level special education class since the end of September. :001_huh:

 

I think I recall hearing that Ritalin, while by chemical composition is a stimulant for most people, for those with ADHD/ADD it has the *opposite* effect. So it calms ADHD/ADD people down rather than stimulates them. That would seem to make sense, but again, I'm just typing something I *think* I heard in this class.

Edited November 11, 2009 by milovaný

[homeschoolally]

You said that he is tired/lethargic daily. Have you had a sleep study done? How about had him seen ENT? (tonsils and adenoids can interfer with sleep) Has his thyroid been checked?

 

We have done tons of bloodwork-including a thyroid check--everything comes back fine. I'd love to do a sleep study, although having done it myself I can't picture him actually doing it! Do they allow moms to stay in the room? =) I agree it is a good idea--

 

It really sounds like something else other than ADD is going on. Our ENT said that he has "cured" many ADD/ADHD cases by removing tonsils and adenoids. Come to find out, the kids weren't really ADD/ADHD but rather very sleep deprived from having sleep apnea from overly large tonsils and adenoids.

 

Will be sure to ask about this--

 

The neurologist might also want to test for seizures by doing a simple EEG.

We haven't done that since he was a toddler and wouldn't sit still long enough to get a decent reading--will ask the neuro about trying again.

Thanks for the ideas--will follow up on them!!!

Edited November 11, 2009 by homeschoolally
tried to fix quotes

[Mrs Mungo]

Like the others, I am no medical professional. However, I cannot take certain medications because I have a fast heart rate. Certain meds speed up your heart rate. If my heart beats too fast it makes me lethargic because my body is trying to slow down my heart. This might be something to ask about because I know Ritalin is a stimulant.

[kalanamak]

Our family doc prescribed 5 mg short acting ritalin for DS.

 

Why?

[LunaLee]

Way back in the day (about 15 years ago) when my brother was on Ritilan, he would come home and sleep from the time he walked in the door from school until it was time to go to school the next day. I think he managed to eat before he fell out. So my mom took him back to the dr and they gave him another med to take in the afternoon, which of course kept him up all night. Eventually he just stopped taking meds all together. Now keep in mind this was some time ago, so I'm sure they were just trying to work out his dosage, but in answer to your question yes I have heard of this happening.

[Heather in WI]

I don't know the medical reason, but it made my little brother very tired and groggy when he was on it 20 years ago. He stopped taking it after awhile because he hated how it made him feel.

[asta]

I'm not a doctor. My job IRL is to translate the gobbledygook of medical journals into something lay people can read. I have a flipping economics degree.

 

That said...

 

Yes, amphetamines, of which Ritalin is one kind, have an opposite effect on someone with ADHD. Instead of speeding the person up, as they would a "normal" brain, they slow them down and allow them to focus.

 

That said, when amphetamines make a person excessively tired, usually one of two things is going on: either the person does not actually have ADHD, or it is the wrong type of medicine. When someone has run through a drug from the #1-3 class, tried #4, and perhaps #5 of the meds I detail below, and had issues with them, it is pretty obvious that the problem is NOT ADHD. I've never heard of the tonsils thing, and I've been doing this for 8 years, but hey, the brain is a big place, and sleep is a HUGE component in everything we do.

 

As much as I hate to say it, early focusing problems are often the first signs of a mood disorder. And people along the bipolar spectrum (diagnosed or not, no matter what age - eg: whether or not it has fully "emerged") often have significant idiosyncratic reactions to medications such as benedryl, certain cold and cough preparations, prednisone, opiates, etc.

 

On to the drugs:

 

1. Ritalin is the most commonly known ADHD med. It is very short acting, and many people prefer it because they can adjust it easily (only use it for mornings, or only for afternoons or not on weekends, etc.). 2. Concerta is its longer acting version, but they are both methylphenidate.

 

3. A related drug which works slightly differently is Focalin. It has a similar chemical basis (dexmethylphenidate vs methylphenidate) but some people find it to be "smoother" as it is most commonly dispensed in an extended release version.

 

4. A completely different formulation is Adderall, which is a cocktail of amphetamine salts. It is very basic, has a very low side effect profile, and is used in both children and adults.

 

5. Finally, there is the not-an-amphetamine but approved for ADHD drug, Strattera, which, if titrated very slowly from a very low dose can be an excellent treatment for ADHD.

 

HTH

 

 

a

[Ottakee]

When we did the sleep study for my daughter I was able to be in the room with her the entire night. She got a reg. bed, I got a nice "comfy" cot :glare: so I didn't sleep much at all. It was helpful though for us.

[homeschoolally]

Thanks so much for all the thoughtful replies. They were very helpful!!!!!!!!!

[homeschoolally]

For a severe case of ADD.

[kalanamak]

For a severe case of ADD.

 

 

I recall a girl in high school who had this, and was such a motor mouth, we'd all chip in and buy her coffee so she'd take a nap.

 

Personally, if I had a kid who needed help, I'd go to someone who specializes that and not the FP. I know this can be expensive and challenging. :grouphug: