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Question

24 Apr

Urgent need of 2nd opinion from another doctor
Hello Doctor! How are you? I have been with the state hospital GP who specialises or has a focused area in psychiatry and the mentally ill but being with her for nearly four years is not really helping at all when it comes to adjusting, titrating my Ritalin dose, which is only 40 mg per day. 2 x 10 mg Ritalin IR in the morning and 2x 10 mg Ritalin IR at 14:00 I have been on Ritalin most of my life and I know that this dose now is way to low for me. I am not drug seeking per see, but the quantities do not last through the day and the depression and anxiety of it wearing off and the inconsistent ignorance of the need for at least 6 to 8 per day which I used to be on (90mg is the limit per day in SA). Also, she kept increasing Effexor to max dose of 300mg XR. The state does not have the Ritalin LA, and besides, they almost wore off just as quickly. I mean, as a Ritalin patient you know when you need to take another tablet. I have never had this problem before. In Natal, they upped to 6 per day without hesitation. Look, I know the law and rumours about Ritalin and adults but that is also not fair to say to adult patients. I know my body and its limits. Why can't she listen to me? There is no other doctor there for a second opinion and if I go private it costs on average R4000 per hours online. Thank you. Please reply. I also have slight autism and aspergers.
Answer
Expert
CyberDoc

08 May

Hi there
I am not familiar with the maximum dose of Ritalin, but 40mg does seem very high. I think the main reason that the doctor does not want to increase the Ritalin is the fact that she is worried about the long-term side effects. I am not sure why they prescribed a higher dosage without hesitation in Natal. Have you tried to discuss this with your doctor? As doctors, we are bound to do what is best for the patient, and such high doses of Ritalin is not without a lot of long-term side effects. To me, it seems as if she wants to increase the Effexor so that you don't need as much of the Ritalin. If this is really frustrating for you, then you will have to go for a second opinion. Good luck!
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