Trying 54mg of Concerta

This morning, I tried 54mg of Concerta, 18+36mg. I felt slightly nauseous on the way to work and breathing seems slightly labored. And when you hear "breathing" in the context of a side effect of medication, you immediately think "not worth it." But it was not enough to make me feel that bad. It was just enough to annoy me. So, unless today is incredibly productive, I'm going back to 36mg tomorrow. Eating helped some, and I actually ate a little before I took Concerta, but, so far at least, it's not worth it.

And I slept 7.5 hours last night, so I should feel okay. Or, at least, I shouldn't feel nauseous this afternoon, if my theory holds.

I noticed this morning that I haven't been playing my usual iPhone games as much lately. I noticed because I received my second notification that a game would be forfeited if I didn't play. That's never happened. More focus? I guess so, although it could just an adjustment phase.

How Concerta works genetically

If you're interested in genetics and you take medication, you have to check out PharmGKB. I looked up the pharmacogenetics (new word for me, too) of methylphenidate (i.e., Ritalin, Concerta) and found that it is thought to be associated with several genes and to target several others.

Genes associated with methylphenidate

• ADRA2A - regulates "neurotransmitter release from sympathetic nerves and from adrenergic neurons in the central nervous system"
• CES1 - "responsible for the hydrolysis or transesterification of various xenobiotics, such as cocaine and heroin, and endogenous substrates with ester, thioester, or amide bonds"
• COMT - "catalyzes the transfer of a methyl group from S-adenosylmethionine to catecholamines, including the neurotransmitters dopamine, epinephrine, and norepinephrine"
• DRD4 - "encodes the D4 subtype of the dopamine receptor"
• SLC6A3 - "encodes a dopamine transporter which is a member of the sodium- and chloride-dependent neurotransmitter transporter family"
• SNAP25 - "presynaptic plasma membrane protein involved in the regulation of neurotransmitter release"

Genes targeted by methylphenidate

• SLC6A2 - "responsible for reuptake of norepinephrine into presynaptic nerve terminals and is a regulator of norepinephrine homeostasis"
• SLC6A3 - "encodes a dopamine transporter which is a member of the sodium- and chloride-dependent neurotransmitter transporter family"
• SLC6A4 - "encodes an integral membrane protein that transports the neurotransmitter serotonin from synaptic spaces into presynaptic neurons"

As an aside, I'm starting to think that lack of sleep contributes most to afternoon nausea.

Extreme focus with sufficient sleep

Last night, with the help of a sleep aid, I managed to stay unconscious for almost 10 hours. Guess how I felt today. Extremely focused. I felt so focused that I worried I might never stop paying attention.

This reconfirmed the value of sleep while taking Concerta. It makes so much difference. Sleep deprivation basically negates the benefit. Plus, I feel incredibly, inexplicably tired. Side note to self: Find out why Concerta does that.

Today, I read a small library's worth of ADD/ADHD information. And I found an excellent website that gives an excellent overview of symptoms. Check out adultaddfacts.com. I also bought the author's book entitled Adult ADD Factbook - The Truth About Adult Attention Deficit Disorder. I've only read a few pages, but I've already found a part discussing DAT1, the dopamine transport gene, and its possible relationship to ADHD/ADD. Highly recommended.

I also drew today in preparation for a still-life painting. The idea is to include enough detail and take enough notes to rely only on those things and memory while painting. I mention this because I felt very focused as well while drawing for accuracy. Its become harder as I've gotten older to focus on visual details when drawing or painting. I tend to want to draw expressively and improvise. That said, generally speaking, art has always been the one area where I hyperfocus and forget to eat.

My ancestry

I recently joined and submitted DNA to the personal genome service, 23andme. I'll post more about what I've found later. Much of it shows no direct relevance to ADD/ADHD, but some of the findings are significant.

For now, I would like to note that I have become very interested in my DNA. I know my DNA! That's crazy. Most people don't. It's understandably scary. But I haven't honestly learned that much about myself from their results. The most important finding for me has been that I process caffeine slowly, which means that having 2-3 cups a day increases my risk of heart disease. That's immediately useful information.

One part of 23andme is ancestry. So, just for fun, I want to share this. They conclude that I am most genetically similar to Northern Europeans:

Using Google Docs, I also made a chart of it from an admixture proportions tool at gedmatch.com:

And here is a more detailed look from 23andme. I'm the green marker.

36mg

I slept 5 hours last night. I stayed up to update my iPhone operating system to iOS 5. I love it! But I didn't sleep enough. And I feel horrible, worse than I would have expected given this relatively small amount of sleep deprivation. It feels like I've been awake for days. My body aches for sleep. This is a pattern.

Anyway, this morning, I went to my doctor for my first checkup. It helped that I prepared my observed changes and concerns. She listened, wrote almost everything I said down, and prescribed a one-month supply of 36mg, the dose I'm taking now in two capsules. And she told me that I could try 54mg if I'd like to see the effect. I'm basically experimenting on myself with professional supervision. But that's how it goes short of an MRI or other such direct brain-based observation. So, since I have only 6 18mg capsules left and already have my new prescription, I'll try 54mg one day this weekend.

She says that 36mg and 54mg are the most common doses and that I might see improvement with another increase. My two worries, I told her, are that I will have less appetite, which is now easily manageable, and that I will focus more, which, while being the point of taking the medication, can be a real problem if I focus on the wrong things. Wrong = want. Right = should.

And I asked about discontinuing Concerta on weekends. She said that some people do that, but that I might feel moody and tired. So, I'm not sure about that. My goal is to do more with less and, over time, to do more with nothing, on my own.