Loading practices
Loading practices
Areas › Focus, starting, and ADHD › Medication and how it works
The hours when you most need to hold back are frequently the hours the medicine has stopped covering. Raising the morning dose to solve an early evening problem means more medicine all day for a gap at one end of it. Work out where the difficult stretch really falls, write down a few days of it, and take that to the prescriber instead of a general sense that this is not working.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
'He knows that some of you will be sick', and the instruction given is to do 'as much as is easy for you' (Quran 73:20). The demand is fitted to the person and their day, which is the same idea as fitting coverage to the hours.
المزمل
۞إِنَّ رَبَّكَ يَعۡلَمُ أَنَّكَ تَقُومُ أَدۡنَىٰ مِن ثُلُثَيِ ٱلَّيۡلِ وَنِصۡفَهُۥ وَثُلُثَهُۥ وَطَآئِفَةࣱ مِّنَ ٱلَّذِينَ مَعَكَۚ وَٱللَّهُ يُقَدِّرُ ٱلَّيۡلَ وَٱلنَّهَارَۚ عَلِمَ أَن لَّن تُحۡصُوهُ فَتَابَ عَلَيۡكُمۡۖ فَٱقۡرَءُواْ مَا تَيَسَّرَ مِنَ ٱلۡقُرۡءَانِۚ عَلِمَ أَن سَيَكُونُ مِنكُم مَّرۡضَىٰ وَءَاخَرُونَ يَضۡرِبُونَ فِي ٱلۡأَرۡضِ يَبۡتَغُونَ مِن فَضۡلِ ٱللَّهِ وَءَاخَرُونَ يُقَٰتِلُونَ فِي سَبِيلِ ٱللَّهِۖ فَٱقۡرَءُواْ مَا تَيَسَّرَ مِنۡهُۚ وَأَقِيمُواْ ٱلصَّلَوٰةَ وَءَاتُواْ ٱلزَّكَوٰةَ وَأَقۡرِضُواْ ٱللَّهَ قَرۡضًا حَسَنࣰ اۚ وَمَا تُقَدِّمُواْ لِأَنفُسِكُم مِّنۡ خَيۡرࣲ تَجِدُوهُ عِندَ ٱللَّهِ هُوَ خَيۡرࣰ ا وَأَعۡظَمَ أَجۡرࣰ اۚ وَٱسۡتَغۡفِرُواْ ٱللَّهَۖ إِنَّ ٱللَّهَ غَفُورࣱ رَّحِيمُۢ
[Prophet], your Lord is well aware that you sometimes spend nearly two-thirds of the night at prayer––sometimes half, sometimes a third––as do some of your followers. God determines the division of night and day. He knows that you will not be able to keep a measure of it and He has relented towards all of you, so recite as much of the Quran as is easy for you. He knows that some of you will be sick, some of you travelling through the land seeking God’s bounty, some of you fighting in God’s way: recite as much as is easy for you, keep up the prayer, pay the prescribed alms, and make God a good loan. Whatever good you store up for yourselves will be improved and increased for you. Ask God for His forgiveness, He is most forgiving, most merciful
Qur’an 73:20read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
A randomised crossover trial compared once-daily long-acting methylphenidate with three doses a day, in the laboratory and in natural settings, and found them comparable. So the shape of a day's coverage can be arranged in more than one way without losing benefit. It tested formulations rather than an afternoon top-up specifically, and it supports thinking in terms of coverage across the whole day.
William E. Pelham; Elizabeth M. Gnagy; Lisa Burrows-MacLean; Andy Williams; Gregory A. Fabiano; Sean M. Morrisey (2001). Once-a-Day Concerta Methylphenidate Versus Three-Times-Daily Methylphenidate in Laboratory and Natural Settings. PEDIATRICS doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Cover the hours where the demand actually sits rather than adding to the hours already covered.
Never add a dose on your own, since timing affects sleep and appetite as much as it affects the afternoon.
Once you can follow the sequence, release, landing, clearing away and breaking down, most new drugs turn out to be recombinations of those four. That is a fair claim to competence and a good place to stop.
Nobody asks whether you believe in insulin. The language of belief has attached itself to ADHD medication, which happens to be among the more heavily tested treatments in medicine, so the useful question is what the testing found.
When you pass on the long term brain findings to a family, call it a hypothesis out loud. The study that would settle it, years of random assignment to a real drug or a dummy one, could not ethically be run.