Your withdrawal symptoms should be discussed with your physician. A slight decrease in dosage that results in intolerable symptoms can indicate that perhaps the benefits of the medication do outweigh the potential risks. Personally, I would continue with the prescribed dosage until the matter was discussed at length with my physician. After this, an informed decision could be made.

Obviously, if you can function normally with a lower dosage or no medication that would be the ideal. However, if the medication has a therapeutic effect, it may be necessary to your well-being. It is also possible that there are alternative prescription drugs that could be effective and yet have reduced risks associated with long-term usage. It would be advisable to consider all your options before making any changes that cause you undue distress. I wish you well.

First off, a decrease in dosage from 20mg/day to 15/day sounds suspiciously *disconnected* from most of the issues you cite, perhaps excepting the concentration issue, a deficit in which is a positive indicator for one of the 3 main criteria measured in most ADD evals, and this cognitive function being one for which methylphenidate (Ritalin) is directly therapeutic (when appropriate and/or not contra-indicated by certain factors such as other medications and MAYBE a history of substance abuse).

So, yeah, if you had found that 20mg was a "bulls eye" so to speak, you may find that 15 "doesn't quite work as well. I'm assuming that since you didn't indicate multiple doses per day, that this is a sustained release formulation? If that is the case, you cannot break the pill or capsule and take your estimate of 75% of it (15, of course, being 75% of 20).

More likely, but I'm only hazarding a guess as you did not specifically indicate this, that you had been taking 5mg four times daily? And have now switched to 3 times?

Depending on your timing - a lot of things could be going on. A 4 hour dosing interval is not uncommon for this particular med, to which this author can personally attest based on a long and continuing history of said dosing schedule for the same med (different dose).

If you're spacing your doses out to, say, every 5 or six hours instead of every 4, your "rebound" effect could be profound - it almost feels like you could literally fall asleep standing up or a pronounced *comparative* return of your primary symptoms (lack of concentration, restlessness, poor impulse control).

The sleeplessness might - MIGHT - mean that you could be taking your last dose too late in the day, although I don't see that you would make that move as, mathematically, if you were switching from 5 mg every 4 hours - starting, for argument's sake, at 6am, then the dosing schedule would be 6am, 10am, 2pm, 6pm. If you did 3 doses 6 hours apart, it would look like so: 6am, 12noon, 6pm - this last dose occuring at the same time in each case.

But I think the above analysis is hogwash compared to the following - you mentioned both anxiety and depression issues. These are much more correlative of sleep issues, and it is no great leap of logic to think that your anxiety might increase if you felt that you might be compromising your effectiveness and symptom control by cutting back on a med that was working for you.

I would definitely hope that you were in consultatio with your doctor BEFORE making any changes in dosing or timing. If not, get on that - be honest with your doc(s). This means bringing your primary physician into the discussion and treatment plan if this isn't already so, as well as sucking it up and being honest with the psychiatrist, pharmachologist, or nurse practitioner (RN plus, in your case, at least further Master's level study and certification in psychiatry or another appropriate mental health specialty), that you've "self-regulated" your treatment, and if that could have the effects you have described.

The depression issues add just one more complicated layer to what seems like a very confusing and difficult to manage medical profile.

One comment about the sleep issues - and about "self-observation" in general - they may or may not have anything to do with your adjusted dosing. Unless, again, you are experiencing anxiety over how this might impact your life, or depression over what is in fact a decreased therapeutic effect, it could be unrelated.

Correlation does NOT prove causation! That is, just because two events or phenomena are occuring simultaneously, it doesn't mean that their is a causal or etiological link between them.

Your best best next move is to see your doctor ASAP, bring all of these concerns up, and since this was the basis of your change, if there are any longitudinal studies/findings that indicate a negative effect on long term health from long term use of a CNS stimulant such as methylphenidate.

There is no way you can get satisfactory information, OR health results, without including your doctor.

One last thing - I would get a second opinion about the medication effects. I'm assuming that either your therapist is qualified to prescribe (that is, she is an MD or a Nurse Practitioner), or that she is only ADVISING you to get off/self-titrate off of your meds - which would be nothing short of malpractice in my estimation.

My own experience (15 plus years on the med in discussion), and tons of lay research both primary (work in SpEd) and "bookish", is that any allegation of long term harm to your health, especially on a relatively moderate dose as yours, is tenuous at best, and more than likely, biased "anti-med" rhetoric.

TALK to your DOC!