Driving, Ritalin, And Sympathetic Exhaustion?

[peregrine]

Folks here might remember that my biggest problem in terms of day-to-day life is spaciness, along with brain fog and some presyncope, and that the spaciness keeps me from driving. My new neurologist suggested that we try ritalin (methylphenidate, a stimulant used to treat ADHD, apparently also FDA-approved for POTS!), so I've started taking 5mg twice a day.

The upside is that my seated spaciness is pretty much gone when I'm in the ritalin "high" (a 2-hour period following taking it, followed by a 2-hour slump). I'm also a lot less tired during that period - I can sit up straight at my desk because I have energy! and much of the brainfog is gone - I can think coherently about my tasks for the day, I can read scientific papers (which is a lot of what I try to do many days), etc.

Since we were already taking the cat to the cardiologist for a pre-dental checkup (he has an overactive vagal response! this is kind of hilarious), we had some extra time with the Zipcar. I tried driving (with my partner in the passenger seat) - first around the parking lot, then around the block, and eventually on regular streets - all of this while the ritalin was at its peak efficacy.

It went great for the first ~30 minutes, but after that I started having more and more trouble talking, began spacing again (so we headed back to the parking lot, of course), and by the time we got out of the car I was exhausted and could barely walk or talk. My blood pressure (via wrist monitor) was fine this entire time - it actually seems normal when I am feeling spacey. These symptoms are very similar to my presyncope, only presyncope for me also includes the cold sweats and nausea, and I got neither (maybe because I was sitting down?). Yesterday when I got presyncope I also had a normal BP - is this due to systematic BP having ~nothing to do with cerebral blood flow in my case?

So... is this sympathetic or adrenal exhaustion? I recovered after resting (sitting upright) for about 30 minutes and eating something, and never noticed any BP or HR change - just the speech issues and fatigue. It looks like I can drive one-way trips - maybe spell someone else - but with this set of symptoms I can't make the return trip. I'm hypothesizing that it's something like this:

1 - Some stressor, either upright position or driving, leads to spaciness.

2 - Spaciness is worsened (caused?) by sympathetic overdrive.

3 - Spaciness worsens and proceeds to presyncope (or exhaustion/speech issues) due to adrenal exhaustion.

4 - I eventually collapse until I restore adrenal hormone levels?

Does this make sense? How would you distinguish adrenal exhaustion/sympathetic overdrive from other things? Am I totally off my rocker here? Would like to try clonidine, since the ritalin hasn't done anything for the standing spaciness. Hopefully I can convince my neurologist to give it a shot in a few weeks.

(thanks! sorry for the info dump, just lots of new data and I'm confused)

[Libby]

My brain doesn't want to think right now, so I won't be much help on the adrenal exhaustion theory. But I just thought I'd mention that I had limited success when I tried Ritalin - I ended up switching over to Adderall and it was like night and day. I remember asking my doc if this is how normal people feel, all the time. My POTS has gotten worse (and/or I've developed a wicked tolerance) so it's not as effective as it used to be, but for a while I was doing incredibly well.

If you are having adrenal exhaustion, not sure if adderall would give you much different results...but I definitely have had a similar crash with adderall (can't remember ritalin, it's been a few years). My mind just goes completely blank. I can't focus, can't find the words I want to use. The frequency of that dropped significantly after a month or so on the med. I also have a second dose to take in the afternoon that gets rid of it, if it's happening.

[peregrine]

Thanks for the info on Adderall! The crash doesn't appear to be due to the Ritalin - the exhaustion and speech issues while driving were while I was still on the "high" from the Ritalin.

How does one test for adrenal exhaustion? I don't know anything about it, though I know folks have talked about it here.

edit - ah, adrenal exhaustion is the alternative/holistic medicine concept, tested via salivary cortisol, etc. Hunh.

[Alaska]

I take Adderall now, but I can only tolerate the extended release and not the immediate release. I tried to save money and do the immediate release (as it's cheaper), but I think it activates too quickly and then leaves the my body too quickly... which causes more dizziness. The extended release adderall seems to be a more gentle up and then down.

[peregrine]

Hunh - yeah, I noticed that the immediate release was kind of a yoyo - hard to tell if the fatigue post-high is due to the post-stimulant slump or due to me returning to my normal level of energy. I might talk with the neurologist about Concerta (or some other extended-release form of Ritalin) if trying 10mg twice daily doesn't solve it.