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ADD-ADHD Treatment – 7 Tips on Finding the Elusive Top of the Therapeutic Window
Psychiatric medications are like any other medication: they should always be on adjusted correctly to function properly. The size and weight of the patient no longer matter. Today, medication adjustments are all about this little-known Mental Biomarker: the therapeutic window We used to think that weight and body size were the two most important variables for understanding proper dosing. Today those somatic parameters are old news. What really matters in 2008: metabolic ratehow medicines are burned and whether they are burned correctly.
It seems complicated at first, but in the end it is very simple and the benefits are clearly measurable. We are now taking the understanding of drugs from using only somatic surface appearance as predictors, to the molecular and cellular level: metabolism, metabolic rate, is the key predictor to unlock that challenging door and to properly adjust stimulant drugs to address the challenges of ADD/ADHD. If the medications are properly adjusted, the patient lives within that therapeutic window—they don’t go over the top or hit the bottom. They float just inside that important window as follows: Simply put: the top is too much, the bottom is too small.
Overview: After recognizing these fundamental lessons, the patient becomes an essential partner in the complicated process of medication dose adjustment. Without this essential information, medication adjustment becomes a roll of the dice, reactions often occur because “How do you feel?” it is nothing more than a small, often macro, imprecise measure of the subtle micro processes of each person’s metabolic activity: their burn rate. And the good news in this regard: the therapeutic window is actually not difficult to find or measure, it just takes a little more time. The therapeutic window represents the body’s ability to metabolize the drug effectively. Seven simple tips for recognizing the upper part of the therapeutic window apply here:
- The Reasonable Goal – No Side Effects: If the medicine is fair in dosage and duration you will feel like you are simply floating through that effective window opening – no problem and no, or very few, “side effects”.
- Recognize too much: If the medicine is too much, too high in the dosage, it will have signs of toxicity, and you will hit the top of the window – hit your head on the top of that window.
- Toxicity Timing: All day problems – Toxicity can appear as absolute: buzzing all day and can’t think, just outside the top of the window, feeling stoned or so full of thoughts that you can’t do anything.
- Timing of toxicity: On and off issues -Toxicity can appear as cyclical, mercurial — off and on — with hyper focus and later disability to focus This is the side effect most often missed at the top, and most important clinically, because it fosters regular and predictable negative medical consequences. Most of the time with amphetamine products such as Adderall IR, Adderall XR, Vyvanse, and Dexedrine, a person at the top of the window will have periods of hyperfocus that appear later in the morning, then fluctuations later in the day in the midday time frame. It seems that the drugs almost work, and it is often confused with the bottom of the window: it is not enough. Adjusting upward without recognizing this essential problem at the top of the window can become catastrophic, because it is very likely to become toxic and completely out of control. A simple mistake: interpreting only the part of the cycle on the unfocused side as insufficient medication, which is why you need to step back and review the whole day.
- “Drugged” is too much: You just feel like you’re toxic, it’s too much. You shouldn’t feel high or high.
- More symptoms at the top: Confusion, disorientation, cognitive stress, anxiety, increase, while self-expression decreases.
- Different stimulants, different tops: Incorrectly adjusted stimulants: You may feel moody and depressed throughout the day, and relieved at night as they have a shorter half-life with an expected duration of less than 12-14 hours. If you feel better when they’re out of your system, this is a great clue. [Big drops in the PM are also associated with comorbid depression – more later.] With amphetamine stimulants too high you can feel a buzz, an uncomfortable intensity, too attentive, with angry and often sad mood swings. co methylphenidate [‘Ritalin-like’] products you may feel more “stoned and out of it” if medications are adjusted beyond the top of the window.
If you feel these types of symptoms during the first few days after starting a new medication, there is usually no problem. If symptoms persist, urgency is required and an adjustment is most likely required; consult your doctor and feel free to pass this article on to your medical professional and friends.
This is the first article in a series dealing with the dosing of ADD/ADHD stimulant medications. I’ll be back with tips on the “bottom of the window,” “duration of effectiveness,” and other important practical tips about the therapeutic window for medication management. We strongly support your medical team and hope this helps with your progress.
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