[drcassie8]

Hi--
It occurred to me this would be the place to hopefully get a useful answer and I will appreciate any help.

About 18 months ago, I was diagnosed with a couple of serious progressive rare autoimmune diseases. The primary one attacks the bile ducts, generally in middle-aged women of European descent ("me"..and no, I don't drink, smoke etc). Though they think they caught it in the early stages, one of the side issues is a terrible unrelenting level of fatigue--one doctor told me it's like now my liver is manufacturing it, and so I don't get much relief after a 'good night's sleep,' nap or whatever.

Meanwhile, I work about 50 plus hours a week and have been finding life getting pretty limited. A while back, my gastroenterologist suggested I try taking methylphenidate sa; but when I found out it was ritalin, I let it sit on the shelf for about 4 months because I was afraid to take it. (Actually, what the mail order company sent was methylin ER, 20 mg.)

Finally did because I really wanted to take an evening writing course--and the first 10 days or so were incredible. I felt like I'd been wrapped up in 15 layers of saran wrap but was now down to 2 between me and the world--still had a certain level of physical fatigue but could push thru it to do things and also had that extra level of sharpness that let me start generating ideas again and then sustain the effort of writing.

Very early on, when I mentioned a slight 'buzz' that kept up while sleeping (though it wasn't really that bad), my doctor had me try alternating 20 one day and 10 the next...which was like not taking it at all, so he let me go back on 20 a day. By the time we tried that experiment, though, I was already finding that I was starting to get run down more easily.

Maybe 2 weeks after I began, I found I was actually pretty tuckered out before lunchtime...I take it about 6:15 am (before other medications or food). Mentioned to nurse who said to keep tabs on that. Now another 2 weeks have passed and I wake up groggy and barely get thru the day; today in fact I had to use my lunch time to take a nap and then had to take sick leave early anyway...exhausted to the point of almost fainting.

BTW, while waiting for my mail order prescription to arrive, I took a short-term prescription to my local pharmacist, which substituted what doc had originally prescribed (methylphenidate sa); that made for about 2 of the worse days of my life (horrible constant headache, nausea and still tired!) so to this patient they do not seem to be totally equivalent.

I spoke with a pharmacist that I know who mentioned she had seen adults did better with Aderall XR(?) but I'm not sure if that would apply to people being treated for fatigue vs. adhd. When I e'd my doctor to to follow up about this, I asked about a possible change in dose or whether her suggestion might work. He was kind of vague ('ok to any of that') but said I'd have to get the prescription from my GP?? (Was he mad at me? I realize he's probably tired of this especially if it's not working.)

OR since I now have almost a full bottle of the mail order prescription (methylin er, the one that at least hasn't caused headaches) would it be safe to take the regular dose of 20 in the morning and then half a pill with lunch?? Or even alternate days when I would add that half pill??

On the one hand, I am worried about raising my tolerance level and/or getting addicted but on the other, it just seems ridiculous that I am taking a stimulant and barely able to sit up through the day--to be honest, I am kind of depressed about this. I will have to work at least 10 more years...and right now I can barely think ahead the whole day.

Anyway, if someone can help me figure this out I'd sure appreciate it. I guess my main 2 questions are, could it just be a matter of dosing (though usually I do well on low doses of everything) or a different formulation?? Am a little hesitant about trying a new variation again.

If you have any suggestions or even if you have just bothered to read this far--thank you. Cassie