QUESTION:
Dear Dr. Heller,
I have been diagnosed with severe BPD and ADD , and I have been operated on countless times for a chronic pain problem that I must just live with. The Ritalin has permitted me to somehow ignore the pain and to focus on one thought at a time rather than being so scared and confused by having a myriad of half-thoughts that just keep circling in my brain like hamster loops without ever reaching any resolution - so loud and competing for equal attention from my brain that I can't "hear myself think". I am scared, as I heard that it can cause convulsions. Is eight Ritalin daily at 10mg each safe?
Please email me with your reply. I don't quite know who else to ask right now. Thanks for working for BPD people, and not dismissing us. Thanks for making our diagnoses one we can take control over - not a sentence to being "done to"!
Sincerely, and with great, genuine admiration!
ANSWER:
Most adults need high doses (Mass General, J Clin Psychopharmacol, Aug 1995 - "The
literature appears to support the use of robust doses of both stimulants and
antidepressants for ADHD in adults."). The 60mg "maximum" is for children -
and this is also suspect ((J Am Acad Child Adolesc Psychiatry April 1997: "...the
findings fail to support the practice of titrating methylphenidate on the basis of body
weight in children with ADHD.").
I don't consider 80mg daily to be a dangerous dose, although of course there are some
people who will have adverse reactions from a high dose. Tremors, high blood pressure,
worsening of glaucoma and palpitations may be a sign that the individual is on too high a
dose.
Both the BPD and ADHD need to be treated, not just one.
