<s>[INST] I am a 20 year old college student and I have had ADD for the past six years and have been changed medications about four times since. I started with 20mg of Concerta, then switched to 50mg of Vyvanse, then 60mg of Vyvanse, then I started to feel depressed and I wasn t having the same focused effect as when I first started with Concerta 20mg. So, now I m taking 52mg of Concerta and it kind of works but not as effective as 20mg of Concerta when I was first put on medication six years ago. Also, today I have a lot of work to do, and I took one pill of 52mg of Concerta at 9am, and took another at 1pm because I thought it would give me an extra focus boost, and all it has been doing is make me feel like I have a pain in my heart because it feels like its moving really fast. What do you recommend I should do? [/INST] HAI, if I were your treating physician. I would first advise you not self-medicate. 52 mg of concert twice daily is a fairly high dose and that is not recommended, there are not enough studies to show that more 72 mg of concert in divided doses per day is beneficial at all. The palpitation and chest discomfort that you are experiencing could very well be a side effect of the Chat Doctor.  If you are making these dose changes by yourself I will strongly advise you to see your psychiatrist at the earliest. </s>