When to increase concerta dose
Titration and Signs of High or Low Doses – Frida
How is your initial dose of ADHD medication determined?
Doctors will use a combination of prescribing guidelines and personal experience to decide which dose of ADHD medications to start you on. Individual factors are also considered when choosing your initial dose, such as:
What is medication titration?
Titrating medication means changing the dose slowly over time to see how your body reacts to the drugs. In most cases, your doctor will start you with a low dose and increase your dosage every couple of weeks until you reach your “target dose.” A target dose means that you’re getting the most therapeutic effects with the fewest side effects. Medications can also be titrated down.
Factors affecting medication titration
The way your body responds to the most common ADHD medications (stimulants) has more to do with factors like metabolism, medication history, and severity of symptoms than it does with your height or weight.
To find your target dose, titrating can be done with any ADHD medication, including non-stimulants. Since ADHD medications are taken long-term, the goal is always to reduce the number of side effects and take the lowest dose possible for therapeutic benefits.
What is monitored during the titration process
During the titration process, your doctor will start you on an initial lower dose and check in every week to talk about side effects and benefits in order to guide the next dosing decision.
During this process, you and your doctors will discuss whether the dosage is:
Not giving enough therapeutic benefits: Your symptoms don’t feel sufficiently reduced
Too many side effects: The side effects are severe or outweigh any benefits
Over-responding: The symptoms control is overboard, and you no longer feel like yourself
When a medication isn’t getting the desired results after two to six weeks of titrating, your doctor may choose to switch medications and go through the process again.
Signs your ADHD medication is too high
Depending on your medication, the most common sign that your medication is too high is when you begin to experience significant, severe, or debilitating side effects that don’t subside after a week. When assessing the severity of your side effects, ask yourself questions like “do the benefits of this medication outweigh the side effects?” and “on a scale of 1 to 10, how bad are these side effects?” (1 being “no problem” and 10 being “these are absolutely awful and debilitating”). In general, side effects should be mild.
Common signs stimulant medication is dosed too high
Common stimulants include Vyvanse, Adderall, Ritalin, and Concerta. Visit the following guide for a list of all ADHD stimulants.
Significantly increased anxiety or depression
Feeling “too wired”, especially into the evening
Severe Insomnia
New tics
Extreme irritability or agitation
Hallucinations
No appetite and significant weight loss
No longer feel like yourself, “sparkle” is gone
Common signs non-stimulant medication is dosed too high
Common non-stimulants include Strattera and Qelbree.
Visit the following guide for a list of all ADHD non-stimulants.
Extreme fatigue (zombie-like)
Severe gastrointestinal upset
Significant constipation
Rapid pulse
Always talk to your doctor about your side effects before discontinuing your medication. Sometimes your side effects may feel extreme, but they are temporary and within the normal range. You can also call your pharmacy to discuss the normal range of side effects if your doctor is unavailable.
Signs your ADHD medication is too low
Medication that is dosed too low is generally ineffective at controlling your symptoms. If you’ve never been on medication before, you might feel uncertain about what “symptom control” actually feels like. In addition to working with your doctor, you can take ADHD self-assessments to help you determine how much your symptoms are improving.
Common signs stimulant medication is dosed too low
Difficulty paying attention or focusing
Only getting symptom relief for a brief period (talk to your doctor about symptom relief expectations or check out medication durations here)
Having difficulties with impulse control
Getting easily distracted
Feeling hyperactive or “on the go”
Common signs non-stimulant medication is dosed too low
Difficulty paying attention and avoiding distractions
Feeling hyperactive or “on the go”
No significant symptom relief after two weeks on medication
Symptoms of ADHD that aren’t affected by medication
Even with an effective medication at an ideal dose, you may still have some symptoms of ADHD.
The symptoms of ADHD that aren’t really influenced by medication include:
Am I taking the right ADHD medication?
Sometimes even the most popular ADHD medications don’t work well for a particular person. A medication being determined “not ideal” occurs after you and your doctor have worked to find a target dose, and you are still either feeling symptoms of ADHD or experiencing too many side effects.
In these cases, it may be something about the formulation that doesn’t jive well with you. There are now over 30 ADHD medications available, so don’t worry if the first one isn’t ideal– you have plenty of options. It’s also perfectly normal to stop or change medications over time for a variety of reasons. The most important thing is to find what works best for you and your health.
How to get a prescription for ADHD medication
To get a prescription of ADHD medication, you will first need to be seen by a healthcare provider who can assess and diagnose your ADHD.
You will then work with your provider to begin a treatment plan which may include medications for ADHD.
If you want to talk to a professional about which ADHD meds are best for you, Frida can help. Take our ADHD self-assessment today and learn more about how the experts at Frida can guide you through a diagnosis and get you a treatment plan with medications delivered right to your door.
11 Steps for Prescribing It Effectively
The most recent Practice Parameters update on attention deficit disorder (ADHD or ADD) from the American Academy of Child and Adolescent Psychiatry (AACAP) recommends medication as a primary therapy for ADHD because it shows detectable, lasting benefit over multi-modal treatment. In other words, ADHD medication works. Yet, 93% of psychiatry residencies don’t mention ADHD in four years of training, and a full 50% of pediatric residencies don’t mention ADHD, despite its prevalence in the U.S. So how is a physician supposed to understand and adjust treatment plans without a rich background in ADHD? That’s where the following guidelines come in.
1: Share the Facts About Medication and Its Alternatives
Medication is the primary treatment of choice for ADHD. It is not the treatment of last resort when a person has tried literally everything else they can think of. Or at least it shouldn’t be — except for someone who has very recent or unstable substance abuse problems, or a medical condition including uncontrolled seizures, untreated cardiovascular disease, or an unmanaged mood disorder. However, once these conditions are under control, medication is the treatment of choice.
This is not to say that alternative therapies and behavior management techniques can’t help, or that coaching isn’t valuable. Those strategies offer non-specific benefits. Anyone – with our without ADHD – would do better in a structured, predictable environment than they would in a random, chaotic one. Yet the AACAP reviewed 82 studies that treated ADHD without medication, and none were able to demonstrate a detectable, lasting benefit on the core symptoms of ADHD: inattention, impulsivity, and hyper-arousal.
2: Test One Methylphenidate and One Amphetamine
All of the 29 first-line FDA-approved formulations are just different ways of delivering only two molecules: methylphenidate and amphetamine. There is no evidence to indicate that one molecule is intrinsically better than the other. So how do physicians know which medication to prescribe? How can they be sure to match each patient with the best treatment possible?
One of the things that best informs the decision is a statistical calculation called effect size. It allows physicians to compare clinical experience and research done at different times, in different places. Effect size combines this information into a ratio that indicates how well this particular treatment works compared to all the others we might have tried.
[Free Download: Choosing the Right Professional to Treat ADHD]
Most medications have an effect size between 0.4 (barely but consistently detectable results) and 1.0 (quite robust effectiveness).
The effect size of stimulant medications in research is pretty close to 1.95, and in research, again, the dose is usually not fine-tuned to the individual. In dose-optimization studies when the stimulants are fine-tuned, they come in at 1.7 or above. In other words, what patients can expect from stimulant medications is nothing short of, “Wow, life changing and better than any other treatment in all of medicine.”
The side effect profiles are the same. Nothing can predict who will respond better to which medication, but most people have a preference for one. Which molecule works best does not appear to run in families (e.g., if a child or sibling does well on methylphenidate, it doesn’t mean a relative is any more likely to respond to methylphenidate.) Patients just have to try both options and see which is more effective.
In my practice, I give a trial of both medications to make sure we have the best possible result. At the end, I have patients rate which medication they feel is best on a scale of one to ten.
One is a nasty experience with no benefits and lots of side effects. Ten is the best result the patient can imagine. Anything six or below is a treatment failure, and physicians should keep looking for a better medication. Seven is acceptable, but the goal is between eight and ten.
It doesn’t make sense to have multiple trials of different kinds of methylphenidate or amphetamine. One trial of the best medication of each kind is enough to determine which will work best for the patient.
3: Choose the Smoothest Formulation
Extended-release formulations are preferred, if available and covered by insurance, because people with ADHD generally have a poor sense of time. 85% of adults and 95% of late adolescents with ADHD don’t own a watch. It’s much more convenient and easier for them to remember to take one pill that releases medication throughout the day than it is to take three pills throughout the day.
Additionally, extended-release medications allow for privacy and confidentiality for kids who might otherwise have to take a second dose at school.
In addition, patients report a more consistent, stable benefit: Extended-release formulations smooth out the rebound, the sudden drop off in medication levels that can make people weepy or irritable when taking an immediate-release formulation.
When stimulants medications are abused, 95% of the time it’s the immediate-release format; just one more reason to use extended-release.
[Use This Checklist to Assess ADHD Doctors and Clinicians]
4: Tailor the Dose to the Individual
No test can predict what dose will give a patient the optimal level of benefits with no side effects. Every patient’s dose is determined by trial and error.
Genetic testing to measure alleles that metabolize a medication cannot predict the dose a person will need. Many pediatricians are trained to give a certain number of milligrams per kilogram of a patient’s body mass, but there is no evidence that dose is affected by size, age, gender, scale scores, or severity of impairment.
Here is what does determine dose:
- How it’s absorbed by the GI tract (this changes constantly for kids under 16, so meds should be adjusted once a year in August just prior to the beginning of school).
- How efficiently that molecule crosses the blood-brain barrier (from the blood into the brain).
- The rate at which medications are metabolized or eliminated in urine.
- Vitamin C and citric acid block absorption of medication – so they shouldn’t be taken with juice or soft drinks.
Think about ADHD medications as you would eyeglasses. I wear glasses because I can’t focus my vision, in the way that someone with ADHD can’t focus their attention span and impulse control. You and I cannot exchange glasses. We each need our prescription, the one that’s right for us. The notion of a high-dose prescription glasses versus a low-dose is pretty nonsensical. What we want is the right dose for us, and when we have the right prescription for us as unique individuals, then we see 20/20, virtually without side effects.
5: Learn to Recognize the Wrong Dose
There is a tremendous variability of optimal dose. The dosage range approved by the FDA covers only about half of all people. About 6-8% of children, adolescents, and adults optimize at doses lower than the lowest dosage sizes made. As many as 40% of people optimize at doses higher than those studied and approved by the FDA.
Physicians have to stop looking at dosing from a high vs. low dose perspective, and focus on fine-tuning dose to the unique individual. By putting Vyvanse in water, for example, or using liquid formulations such as Quillivant XR, you can adjust the dose to lower than the lowest dose made if someone responds well to a small amount.
Where Dosing Goes Wrong: Patients expect that they should feel stimulated or different in some way.
The Rule: The right molecule at the right dose should return a person to normative levels of functioning, not to some artificial amped-up state, and without side effects.
If a person feels different, the dose is too high or too low. When the dose is off, hyperactive people tend to slow down to a crawl that’s known as zombie syndrome. Other people get stimulated with the wrong dose, and this is called the Starbucks syndrome. If a patient is experiencing personality changes or feels revved up or slowed down, the dose is typically too high and needs to be decreased. Traditionally, physicians were trained to give the highest dose that a person could tolerate. Now research shows that this “highest dose” is too high; the optimum is typically is at least two dosage strengths weaker than this threshold.
6: Work with the Patient to Fine-Tune
Fine-tune the medication according to target symptom response. Doctors should educate their patients about how the medication can alleviate impairments of ADHD. Remember, these patients have always been ADHD. The way they are is their normal. They have no idea what is possible with medications, so it’s important to tell them what to look for, what will change, what won’t change, and what they get out of taking it.
Physicians can sit down with patients and say, “Let’s make a list of the things about ADHD that you want to get rid of, that you don’t like.” There are lots ADHD characteristics that people do like — the cleverness, the problem-solving, the creativity, the wacky, zany sense of humor — and the nice thing is, all of those things stay when medication gets rid of the things that a person doesn’t like. Then ask, “What is it about ADHD that bothers you the most?” The impairments that respond to medication are procrastination, distraction, finding it hard to stick with boring tasks, impatience, impulsivity, and restlessness. Symptoms that are not as affected by medication include disorganization, argumentativeness, and oppositional behavior.
Stimulant medications, with the exception of Concerta, are effective within one hour – including all of the benefits and all of the side effects. There are no late-appearing side effects. Stimulants are fast-acting, so adults can change the dose every day if the doctor and patient wish.
Children and some adolescents who cannot communicate the effects of medication need a week between dosage adjustments. In these cases, if you have to choose one person to give feedback, pick the child’s teacher. She knows what typical second-grade behavior looks like, and can help evaluate a child who is too young to report on how the medication works.
7: Find the Lowest Possible Dose
Emphasize that you will fine-tune to the lowest dose possible. Physicians can say, “Look at your target symptoms. Each time, when we raise the dose, you should see a clear, dramatic improvement in all your target symptoms, and no side effects other than a mild, transient loss of appetite.” So long as you see things getting better and better, without side effects, physicians can keep raising the dose.
At some point though, physicians will raise the dose and the patient will say, “There weren’t any further improvements. Every other time we raised the dose I could clearly see improvement.
This time, this dose and the previous dose seem exactly the same to me.” At that point, the previous dose is the very lowest dose that gives the patient 100% of what that medication has to offer. If the person is over the age of 16, that dose should work for the rest of their life. Tolerance is very rare to the benefits of these medications; tolerance develops very quickly to their side effects.
8: Don’t Increase Dose to Boost Duration
Don’t increase the dose just to increase the duration of the medication. Accept whatever duration of action is at that person’s optimal stimulant dose. Increases past that will often push a person beyond her “sweet spot” dose to the point where she starts to have side effects. The increase in how long it lasts is very marginal.
Remember that even though extended-release is marketed as once-a-day or 24-hours, the longest duration is 10-11 hours of effectiveness, with the exception of Daytrana. Most times, insurance will only cover one extended-release dose per day, so to have evening coverage many people use an immediate-release format for the second dose.
9: Put It in Writing
Write everything down for your patient. There is too much information to remember accurately and most people aren’t really listening. Even people without ADHD have trouble remembering all the information needed to maintain a treatment plan. Remember that the parent accompanying a child could have ADHD, too.
Good medication outcomes require written, simplified instructions that the patient can follow step-by-step. I have developed forms for clinicians for such a purpose on a CD-ROM. If you would like a copy, contact me at [email protected] and I will mail a copy to physicians for free.
10: Cover the Patient’s Entire Day, Consistently
After the age of 14, many people need 16 hours of coverage per day. This requires multiple doses of medication throughout the day. Patients should use medication at all times and in all situations where there is impairment from ADHD, including bedtime. It’s more than just for school. Medication helps us to be social, get along with family, do homework at night, and drive a car safely.
Most clinicians don’t offer a follow-up dose because they are worried it’s going to keep patients awake, but we know that a nighttime dose can help people with ADHD slow down, and calms the chatter in their minds. After you’ve found the right dose, ask the patients to take a no-risk trial nap in the afternoon on their optimal stimulant dose to prove that evening doses will not keep them awake. 95% of people can nap on medication. When that happens, you know your patient can take a second dose to cover all the time they need.
There is no basis for a medication vacation. For children and teens, I recommend that they take the medication very consistently. Since medication is completely effective in one hour, adults don’t have to take medication all day every day. They can use it for a specific task, if that’s what they want.
However, it is worth noting that people who have ADHD and don’t take medication have a higher risk of developing a substance abuse problem, being in an injury-producing accident severe enough to go to the hospital, having an unplanned child, or being involved in the juvenile justice system.
On medication, the risks are the same as they are for the general population.
11: Explore Second- and Third-Line Medications
Fifteen percent of people do not respond to or tolerate the two standard molecules of methylphenidate and amphetamine. The second-line medications are Clonidine and Guanfacine. They work for about one in three people. They have a very robust effect size of about 1.3.
The only other FDA-approved medication for ADHD that has an effect size greater than 1.0 is methamphetamine. The mere mention of the drug makes many doctors, pharmacists, and patients uncomfortable, but it’s probably the most effective medication for the treatment of ADHD.
The dosages of methamphetamine that are used to treat ADHD are extremely low. The average dose used to treat a person with ADHD is approximately 1/200 of the dose people abuse. Nonetheless, finding physicians who feel comfortable with the use of methamphetamine is somewhat rare.
The third-line agent is Strattera (atomoxetine).
It has an effect size of 0.7 in elementary school-aged children. In high school students and above, and especially in adults, we see a barely detectable effect size of 0.44. Even the barely detectable benefit is found in only about half of people. So that’s why the American Academy of Child and Adolescent Psychiatry put it in a third-line, or alternative category.
There are other medications in the alternative, or off-label, group that include Bupropion (Wellbutrin), and modafinil (Provigil). These are not FDA-approved. They are not studied for ADHD, but there is some literature on their efficacy if everything else has failed.
I’ve never had a patient say, “Gee, I’m glad I waited a couple of extra years before trying medication.” It’s always the exact opposite. It’s, “What would my life have been like if I had known how well these medications worked earlier?” There’s a real period of grief about what might have been.
These medications don’t produce an artificial state.
They offer a return to normal functioning, often with no side effects other than maybe a mild loss of appetite that goes away for most people. With these steps, physicians can help more patients have that moment.
[10 Things Your Doctor May Not Have Told You About ADHD Medications]
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there are other drugs, the doctor explains
Photo: shutterstock
"Ritalin" and its analogue "Concert" have become the most popular drugs for hyperactivity and attention deficit disorder (in Hebrew, this diagnosis is called "be'ayot keshev verikuz", in Russian - ADHD). However, they do not help about a quarter of patients, and sometimes side effects, especially in children, force them to stop taking it. Common side effects are headache, nervousness, loss of appetite, nervous tics, and weight loss.
But there are other remedies that a neurologist or psychiatrist can prescribe if Ritalin doesn't work.
Adderall is a popular stimulant treatment for attention deficit disorder in the US. In Israel, it is sold under the name Attent. Similar to Ritalin, this amphetamine increases the production of dopamine in the brain, which improves attention and concentration.
Fast-acting and extended-release versions are available: regular Adderall lasts 6 hours and Adderall XR lasts 12 hours.
Unlike Ritalin, this drug has fewer side effects, in particular due to the lower dosage. They appear less frequently and are less pronounced. The dosage is selected individually, in most cases - 40 mg, similar to Ritalin, but in the USA they are also used in higher doses.
Attent with a 6-hour effect is included in the national health basket and is prescribed for children with Ritalin ineffectiveness and concerts. The long-acting drug XR is not included in the health basket.
Includes, like Adderall, dexamphetamine, and has no special advantages over the named drug.
Contains amphetamine derivatives. It is activated after splitting in the blood, therefore it is not suitable for drug addicts.
Since the assimilation is gradual, its concentration in the blood does not increase abruptly. This helps to avoid side effects caused by a rapid increase in concentration. If the child cannot swallow the capsule, it can be opened and the contents dissolved in water.
Due to the slow onset of action, the effect of the drug is more subtle and side effects are less common.
This is an isomer of the active substance Ritalin, but with a different molecular structure. Changing the structure allows you to reduce the dose compared to Ritalin by 2 times. As a result, side effects are less pronounced.
The regular form of the drug lasts 4 hours, the XR form, like Ritalin LA with a slow release of the active principle - 12 hours.
Methylphenidate (the active ingredient in Ritalin) stickers. The substance is absorbed directly into the blood and is not decomposed by the liver, as when taking tablets. (Degradation products themselves cause side effects, and this process forces you to increase the dose.)
The label allows you to enter into the patient's body smaller doses. The skin accumulates the substance and slowly releases it into the blood, so the concentration in the blood rises slowly, which prevents side effects.
The sticker can be removed at any time, thereby adjusting the duration of action. This is important, for example, for meals, because Ritalin suppresses appetite.
Labeled for up to 12 hours, causes few side effects. The sticker is attached for 9 hours, after removal, the action lasts for 2-3 hours.
Sold under the Strattera brand. It belongs to norepinephrine reuptake inhibitors, that is, to a class of drugs other than Ritalin.
This class of drugs is also used as an antidepressant. They must be taken daily, but the effect, like that of antidepressants, appears only after 3 weeks.
Advantages of the drug: does not suppress appetite, can be taken at any time of the day, does not cause nervous tics, like Ritalin and Concerto, on the contrary, helps to get rid of the existing ones.
But there are also disadvantages: the drug is effective only in 60% of those who take it, you have to take it constantly, including weekends and holidays, and it affects behavior more than concentration.
Originally intended for the treatment of hypertension and sold in the US under the Tenex brand and other generic brands for this purpose. Based on it, the drug Intunice was created for the treatment of ADHD.
The direct effect on the syndrome is insignificant, but the drug eliminates tics, reduces impulsive behavior and improves sleep. Therefore, doctors often prescribe the drug in parallel with stimulants.
The selection of a drug is not easy, there are 11 dosages of methylphenidate alone, and other drugs have their own dosage options.
Selection of the type of medicine and dose takes a long time and is accompanied by communication between the doctor and the patient. A common mistake made by patients is to stop treatment if the first prescribed drug does not help. Sometimes the result is achieved by changing the dose, this also affects the side effects. The doctor should explain this to the patient and set him up for a long process of adjusting the drug to the body.
In Israel, treatment is usually started with Ritalin 10 mg. These tablets are easily cut, and patients can take a quarter. Then they move on to long-acting Ritalin LA or to a concert - depending on the required duration of the effect.
If the medicine does not help or causes severe side effects, the doctor selects another, also from the group of stimulants. Each drug has its own characteristics, and the patient may not give the desired reaction to the classic options - Ritalin or concerto.
In most cases, they then switch to Focalin, Vyvanse or Attent.
At the medical consultation of Dr. Gal Meiri, head of the children's psychiatric department of the Soroka hospital in Beersheba
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Pudding, this is Alice. "Alice", this is a pudding
The "Invasion" festival ended successfully. No one was killed, it was interesting, and by Monday evening, probably, the dirt will have already been removed.
Rock festivals themselves are terrible, regardless of whether they are held near Moscow, near Tver or on the Isle of Man. Violence. Promiscuous sexual relations. Terrible food. Drunkenness. Disgusting. Loud music. Begging. Regardless of the number of stages, audience and artists, these components are unchanged. And it is precisely for the sake of these seven deadly sins that thousands of schoolchildren and students go hundreds of kilometers to rock festivals.
The Emmaus invasion was attended by 52,000 people, counted by the number of tickets, accreditations and guest badges.
This means that at the same time there were no more than 40 thousand on the destroyed meadow on the banks of the Volga. A gigantic figure for any Moscow stadium, a kindergarten for the "Invasion", which in Ramenskoye saw 100, and even 150 thousand fans, say, "The King and the Jester".
There was very little violence at the Invasion. Of course, someone's head was broken, someone's jaw was broken, in addition, the games of "meat" and "tags with a pendel" became widespread, but in general the level was not high, even the policemen managed not to beat anyone.
The same thing happened with promiscuity, and this fact cannot but rejoice.
Thousands of young Beavis and Buttheads traveled to the Tver region in vain hope for the main pleasures of life.
But rock festivals do not increase the birth rate, although Yuri Shevchuk dreams of the opposite. Instead, the guests of the festival ate unpalatable kebabs, instant Chinese pasta and charcoal-fried sausages wrapped in bacon - the worst food mankind has yet come up with.
Drunkenness also flourished - beer flowed in buckets, young men flaunted a fashionable novelty - a cartridge belt that fits six cans.
Well, and disgusting, of course. The piggy this year has reached a tragic level. There was not a single urn for the entire festival. Empty beer cans, plates of terrible food, glasses, flyers, newspapers of information sponsors, programs, cigarette butts and the remains of terrible food covered the ground in a thick layer. The ground itself was not level - from time to time, the feet fell through ankle-deep into pits and ruts filled with debris. It looked wild in a tent city: rag houses standing in pits of smelly garbage. The last squeak of the festival fashion is to relieve yourself in the Cossack way, where you found it.
But the music was great.
Why are there so many remakes in your work - "Chayf" gave "Naiva", Cord sang the song "I was looking for you" about how one famous singer threw him and did not start a joint project, and "I'm free" - about the radio and about how his friend Mikha Kozyrev was thrown out of there.
He sang this song twice - and it's unlikely that it was intended, he probably just forgot. The cord was generally at least somewhere - he tired himself out even before the concert, so he sang the song VZPNB (“Birthday”) with such a tragic anguish ... And he also yelled a rather anatomical new song about love - “After all, you love me, and I love you too Come on, Oksana, take it from Serezha. Well, right…
That's right, by the way: if there was at least one truly wonderful moment in the whole "Invasion", at least one stage, one performance, at least one song - the festival has already been saved and everyone who was at it, too.
And here there were more than enough such moments. Dnepropetrovsk "... and my friend truck", the former "Me and my friend my truck", a trio with a soloist, bass player, the best in the former Soviet Union, and a drummer played a wonderful, energetic, long set. He, of course, is a little too much for the mind, hardcore with semi-senseless poetry, but the soloist Anton has a special key to turn on the audience and make them jump to the ceiling, and he himself, plump and plump, rushes around the stage like a madman, yells, squeals , spits and fights.
.. And bassist Rostislav Chaban plays chords and tapping for bass, guitar and keys on an unpretentious four-string bass, and his sound is both dense and transparent, gentle and furious. And after all, quite a lot of people gathered at the small stage, scoring on the "Mara" to listen to the Dnepropetrovsk originals.
Max Pokrovsky, somewhat overly tanned and fit, has achieved new successes in his allied specialty - choir conductor.
Every year "Haru mamburu" is sung more and more harmoniously and more clearly. This year it was sung offhand by five thousand people, or even more.
Folk-rock diva Inna Zhelannaya performed in the Odd Warrior project (“Shura Bi-2 invites friends”). And the whole song was boring and useless, and Inna sang in her usual little voice. And then bam, something clicked in her head, and she began to vote - already for this you could only come to the festival 165 kilometers from home, although this lasted for thirty seconds.
The whole punk festival was wonderful, almost the best that was in Emmaus.
