The Tragic Truth Of Prescription Adderall, or “Madderall”

 

The topic here is prescription Adderall. Specifically: Adderall is too often prescribed badly.

Poorly prescribed Adderall can create negative personality changes in people who seek only to treat their ADHD.  Trouble is, they might not see this objectively. Unfortunately, their prescribers often don’t ask—or connect the dots.

The topic is not how to illegally obtain and abuse Adderall.  Still, if that is your goal, please read this first. It might save your life.

This is a long post. By necessity. I hope the subheads aid scanning. At the end, I’ll offer a preview of what competent prescribing for ADHD looks like.

You will find other articles on this topic ….now. Mine was first, in 2013, and the only until very recently.  The reasons for that might be as disturbing as the Madderall Phenomenon itself.

Let’s get this out of the way:

  • Prescription Adderall works very well for some people with ADHD.
  • For others, Adderall  can create more problems than it solve.
  • Poorly prescribed Adderall can  create or exacerbate anxiety, irritability, grandiosity, tunnel vision, and even rage.

That’s why 20 years ago I started calling it Madderall.

(Note: I’m seeing the term Madderall has been appropriated to describe combining marijuana and Adderall. That’s not the topic here.)

Here’s what you likely won’t hear from your prescriber:

  • Poorly prescribed Adderall can ruin lives and ruin relationships. 
  • The same is sometimes true for Dexedrine, too. Those of you in Australia, where the the national healthcare system (Medicare) has long considered it the stimulant of choice, be aware.
  • Individuals experiencing poor results from Adderall often don’t realize it.  They believe it’s the price of long-illusive focus. Their loved ones might, too—while they walk on eggshells, frightened.
  • Next stop: These adults with ADHD might develop a cannabis or alcohol or benzodiazepine habit to “come down”.
  • Or: They love the intense focus too much to let go— no matter if that focus dangerously reduces self-awareness. (In other words, they assume that everyone else has the problem, not them.)
  • Adderall is unique among the stimulants in that it has an extra mechanism of action.

The truly tragic part? There are so many less risky options to try first. Prescribers should be making things better, not worse. From my perspective, this is is a long-running  public health crisis.  It has contributed to a backlash against the diagnosis itself.

Why Has This Been Allowed?

Why do doctors too often insist on prescribing Adderall to newly diagnosed patients?  Especially with so little guidance? 

Some prescribers misread a meta-analysis based on old, scant data. I will write about that in a future post. This doesn’t let them off the hook, of course.

Three other reasons:  

  1. Its manufacturer is notoriously aggressive in its marketing and fraudulent in its claims.

This company was fined $56.5M in 2014 for its false claims about Adderall and a few other drugs.  Read more at the U.S. Department of Justice website:  Shire Pharmaceuticals LLC to Pay $56.5 Million to Resolve False Claims Act Allegations Relating to Drug Marketing and Promotion Practices

Stunningly, far too many prescribers still hew to pharma-rep-supplied claims.

2. This manufacturer has long wielded undue influence over most ADHD websites and personalities you see online. Unfortunately, this includes some psychologists and  non-profits, including board members and conference speakers.  Most people would be shocked at how this one pharma covertly pushes its warped agenda through so many tentacles. I’ll write about this when I retire.

3, Too many prescribers remain clueless, cavalier, and disconnected from consequences.  I don’t say this to discourage seeking treatment!  Instead, I want you to be a savvy healthcare consumer.

Yes, prescribers often have little time with a patient. That does not excuse this scandalous mess that is happening with Adderall.

Why haven’t other ADHD experts calling this out?  Excellent question.  

Conflict of Interest

I was an award-winning journalist before falling into ADHD world, in 1999. As such, I naturally avoid conflict of interest. Good journalists know that even accepting a free lunch is a slippery slope.  My “pro-medication” stance was exceedingly rare at that time, when the “ADHD Gift” campaign was going full throttle.  Taking Pharma support risked muddying my stance.

I’ve rejected all Pharma support—covert and overt.  This fact puts me squarely at odds with certain organizations and outlets. People might ask, “Gina, why aren’t you speaking at this or that conference?” I used to, until I understood what was happening and until this one pharma rose to such stunning dominance.  Now, I want no part of it.

To be clear: Researchers receiving pharmaceutical funding is a distinctly different matter. Research validity rests on the researchers’ reputations and methods. And they must disclose  such funding. By contrast, most of those proclaiming ADHD expertise online are not researchers. A

Moreover, most “ADHD influencers” don’t even disclose this  pharma support. That includes licensed psychologists and physicians. I’ve searched unsuccessfully for disclosure of direct or financial payments. The evidence is more clear when it comes to indirect support. This includes public relations efforts on their behalf and being placed (forever) in prominent positions at ADHD non-profits. 

Other Complications:

  • Treating ADHD is not simple. It is a complex syndrome that affects individuals, not clones.
  • Genetic differences among individuals affect drug response.
  • Prescribing requires expertise and method. Start low, titrate slow. Rating scales. Third-party feedback. And much more.
  • To further complicate matters: Adderall is also a popular drug of abuse. Yet, even the story of “Adderall Abuse” is complicated.

No Adderall-Abuse Tips in This Post 

Maybe you found this article while seeking to illegally procure or “hack” Adderall. Sorry to disappoint!

Moreover, when you leave in disappointment after 5 seconds, my blog’s “bounce” rate increases. That’s a big Google-search penalty. That means my post will be less likely to turn up in search results. Especially when  a slew of paid and promoted articles top the search list.

I leave this post here anyway. Why? You won’t find what you’re looking for, but you might find something better.  Please consider this: Chances are good that you actually have ADHD  and are attempting to “self-medicate” it. That never ends well.

Which Search Term Brought You Here?

Mostly, readers find this post legitimately, using terms such as these (to name only a few):

  • Adderall makes my spouse angry
  • Can Adderall make you irritable?
  • Why is Adderall making my ADHD worse?
  • Depression and anxiety from Adderall?
  • Anger outbursts and Adderall 
  • Does Adderall change your personality?
  • Adderall is spiking my blood pressure?
  • Why is Adderall dilating my pupils and making me look crazed?
  • Irritable after Adderall
  • Can Adderall cause bipolar?
  • My husband started Adderall and is an angry jerk now
  • Can Adderall cause aggression and sexual behaviors in the elderly?
  • Why is Adderall making me tired now, after working for 2 months?

This Post Covers Five Points:

  1. The New York Times has a long history of anti-psychiatry reporting. This was my initial catalyst in writing this post, in 2013.
  2. Many prescribers are incompetently treating ADHD. This is having devastating consequences.  It’s creating a backlash against ADHD, and it causes many people to just give up. Unfortunately, these seem to be the people who write the “I tried ADHD treatment but it went badly, not I am into mindfulness meditation.”  (Another hot topic and also, weirdly, promoted covertly by pharma.)
  3. Why we might best consider prescription Adderall not as a first try but rather a last-stop in stimulant medications
  4. The importance of ADHD self-education and self-advocacy
  5. An excerpt from my first book’s chapters on medication

Adderall abuse1.  More ClickBait From The New York Times?

A back-channel tip came in yesterday. I steeled myself for the next anti-ADHD screed from the paper.  

Many reporters seem to view ADHD as rife for an expose. We who know better see transparently traffic-boosting clickbait. As a young journalist many years ago, I was taught to respect The New York Times as an exemplar of journalism. Sadly, that is no longer true.

Make no mistake: The paper still has respectable editor, reporters, and sections. Yet, the front-page editor for several years demonstrated festering personal antipathy toward neuroscience. That and/or  the publisher issued orders based on the website’s analytics. Any piece stigmatizing ADHD tends to draw lots of readers—and therefore ad dollars. For years, the ADHD community protested in comments. Then they just mostly gave up.

Bottom line: It’s an SEO (Search-Engine-Optimization) bonanza! After leaving the paper, former Executive Editor Jill Abramson called it “publishing by the analytics.”  It is now pervasive online, with virtually every news outlet, amplified in social media. That goes double for ADHD topics.

Over the years, I’ve called out the paper’s negative targeting of ADHD:

  1. Talking Back to The New York Times’ ADHD Myth-Mongering.
  2. The New York Times’ Unnatural Opinions on ADHD
  3. The Truth Behind “10,000 Toddlers Medicated for ADHD” – Parts 1 and 2.

This Time: More Grief—But Also Tiny Relief

Yet, when I read the 2013 story by reporter Alan Schwarz (“Drowned in a Sea of Prescriptions”), my reaction was both grief and relief.

Grief , that yet another person fell victim to prescription Adderall—and died by suicide. Again, this is a legitimate medication that, even though helpful for many people, can create severe reaction (including addiction) in many others.

Relief, that finally The New York Times’ grandstanding front page finally got something right about ADHD. Well, at least in tiny part.

The tiny part is this: The manner in which many prescribers treat ADHD  largely resembles a giant game of “Pin the Rx on the ADDer.” 

All else in the story, unfortunately, is distortion.. It wouldn’t be former sports reporter Alan Schwarz’s last transparent effort  to win a Pulitzer Prize. He didn’t, however, and he’s no longer at the paper. Nor is he still a reporter. But he still inflicted immense, perhaps lasting, damage. 

Moreover, he went on to write a horribly sensational book on ADHD. Then, Schwarz featured in a Netflix “documentary” from Maria Shriver and her daughter, Christina Schwarzenegger.  It’s called Take Your Pills. It’s a one-two punch castigating Adderall and ADHD, as if they are inseparable. Because, in too many prescribers’ minds, they are.(See Netflix’s Take Your Pills: Anti-Science—and Mean)

adderall anger

2. Core Problem: Poor Monitoring of Prescription Adderall

In the early days of my advocacy, the early 2000s, I heard story after story repeated in my Adult ADHD monthly discussion group in Palo Alto. I heard similar in my online group for the partners of adults with ADHD (ADHD partner). That is, they reported reckless prescribing patterns, particularly around Adderall. 

What’s Not Happening, Specifically?

To understand the essential problem, we have to start with poor prescribing protocols for ADHD overall.

—Prescribers should track response

That is, they should be using a checklist of symptoms that helps them monitor medication response—and what side effects it might be creating.

—Prescribers should gather reports from family or close friends

Sometimes folks with ADHD lack accurate self-observation. Typically, this improves with medication. The wrong medication, however,  risks further clouding self-observation — and worse.

—Too many physicians don’t bother with either

Instead, they rely on a casual, “So, how is that working for you?”

Poor Prescribing Created ADHD Backlash?

To summarize: The prescribing of any stimulant is often done badly. But the problems with Adderall often appear an order of magnitude more serious.

I credit these poor prescribing patterns for much of recent years’ blowback against ADHD. The fact that I publicly predicted and warned about this years ago — verbally collaring this pharma’s reps at conferences, asking “why aren’t you warning prescribers?” — brings me no pleasure in being right. 

But I am just one person—without an “authoritative” MD after my name. (Google now actually penalizes this page because it’s not “reviewed” by an MD. Meanwhile, the plethora of “health” sites scrapes the bottom of the barrel for MDs who will slap their “reviewed by” on the article.)

3. Prescription Adderall Works Great Sometimes

Make no mistake: For some people, prescription Adderall works well and with few side effects. It is the best choice for them.

Yet, prescription Adderall has a higher side-effect profile.  What does that mean, in practical terms? It means that if you’re just starting treatment, you might want to begin with a less risky choice.  In other words, try Adderall only after other stimulants (Ritalin, Focalin, Concerta, Vyvanse, etc.) have not proven effective.

Ideally, a trial should be given of both the amphetamine and methylphenidate classes, as I explain in my book. There is no way to predict beforehand how you will respond to either class of stimulant. It comes down to genetics. 

Despite all that, many physicians routinely start new patients with Adderall—and at too high a dose. 

Adderall

Contributing Problems: A Larger View

The issues around prescription Adderall remain only one piece of a problematic puzzle:

A. Physicians who see ADHD as a “simple condition”

“You just throw a stimulant at it!” one psychiatrist told me at a meeting of the American Psychiatric Association.  Obviously, he failed to find ADHD treatment interesting and therefore not worth his study.  (I saw him later at a presentation on Borderline Personality Disorder. Hundreds of psychiatrists, on the edge of their seats, listening to dramatic stories.  But not one presentation on adult ADHD, which has historically been misperceived as BPD.)

In fact, ADHD is a highly complex condition, especially when it is diagnosed later in life. For example, other conditions can complicate medication response. These include sleep and substance-use disorders.

B. Physicians who believe in a “starting” or “average” dose

“There is no starting or average dose!” I’ve emphasized that in my lectures for years. That’s based on advice from the preeminent experts I respect most. Yet still, that seems the status quo.  The trouble with this?  

—Some people are slow metabolizers: an “average” dose might be too high for them.

In response to the side effects, they might give up on that medication entirely. Yet, if might be that a lower dose would work just fine. 

—Some people are rapid metabolizers: an “average” dose might be far too little for them. 

They “burn through it” too fast. They need a higher dose in order to get an average effect.

My scientist-husband and I wrote a 7-part series explaining metabolizing issues and more:  Genetic Testing for ADHD Medications.

C. Insurance companies reimbursing poorly for psychiatric treatment

Yes, insurance companies share the blame. They do not reimburse psychiatric treatment at a rate commensurate with the kind of expertise and time required. But physicians are responsible, too.  

(If you think that single-payer is the solution, think again. The very worst countries when it comes to ADHD  medication options are the single-payer healthcare countries. That includes the United Kingdom and Australia. UK residents are waiting years even for an ADHD evaluation. In Australia, adults cannot get Concerta unless they had a diagnosis in childhood. Very handy, as pediatric ADHD was largely ignored except in the most extreme cases.)

D. ADHD impatience for results—want to “feel” it than objectively measure it

Let’s be frank: Some people with ADHD love Adderall because it feels like booster rockets attached to their behind.

The hard truth is, however,  is this: You can’t depend on a “visceral feeling” to tell you when the medication is working. In fact, sometimes you won’t realize that the medication is working—or causing problems. But the people around you will!

Moreover, relying on that visceral feeling almost guarantees a bad end. Maybe not today. Maybe not tomorrow. But soon. What if you’re so strung out you don’t even realize it?

Often, patients (or their parents or partners) consider my cautions only after the fact. Meaning, after the typical crash that happens. For many people, in my observation, that’s about two months into Adderall usage.

That’s when they are completely depleted:

  1. Typically from exhaustion (why go to sleep when for the first time in your life you have “superhuman” focus?)
  2. But also perhaps due to Adderall’s unique mechanism of action, their very supply of neurotransmitters might be depleted.

E. Parents’ and Loved Ones’ “Denial” of ADHD

Now we turn back to the NYT story for a moment.

Did Richard Fee, the young man featured in the piece, truly not have ADHD, as his parents claim? Was he simply abusing Adderall as a “performance drug.” I’ve seen no evidence of that. It seemed the weakest point of the story.

Reporter Alan Schwarz repeatedly made it clear that he lacks understanding of ADHD’s complexity. He gives lip service to ADHD as a legitimate condition—and then proceeds to rip it apart.

As a former newspaper editor, I have seen the pattern: “Hot Dog” reporters who will do anything to land on the front page, above the fold. They might have had success on one topic (in his case, starting as a sports reporter, concussions from sports) and fancy themselves a rockstar on all brain-related topics. 

Schwarz failed to comprehend that ADHD sometimes had a way of “sneaking up” on people later in life. That’s when their innate intelligence and ability to get by in school without good study habits are no longer enough to let them keep up with their goals.

In other words, it might seem that these people are “abusing” stimulants when really they are seeking help. It might also be that they are suffering from poorly titrated and monitored prescription Adderall.

Could it be that Fee’s parents’ own denial systems came into play here?  Perhaps Richard felt that at least these doctors believed him. 

Richard Fee Adderall
Richard Fee, the subject of The New York Times article

F. Prescribers Who Fail to Ask for Third-Party Feedback

 Please understand: Richard Fee’s parents have my deepest sympathies. It seems they truly tried to warn the physicians of what was happening to their son. 

This story is not new to me.  The partners of adults with ADHD try desperately to get through to the Adderall-prescribing physicians. They try explain that their partners are turning into rageaholics. (The ADHD adults themselves seldom report increased anger and ability to their prescribers. They don’t want to lose access to their life’s long-missing focus.)

Yes, there are privacy laws. But that does not mean the prescriber cannot request such feedback—nor cannot accept it.

Did Fee have a condition such as bipolar disorder (either instead of ADHD or co-existing to it)? That is, did he have a particular vulnerability to Adderall abuse or addiction? Or, was that particular vulnerability ADHD? Perhaps he was mis-using Adderall to minimize sleep so he could study more and achieve. Thus, he compounded AHDD with sleep deprivation and amphetamine addiction?

We’ll never know. But I suspect that there were red flags throughout his childhood and young adulthood. And the same will be true of many others.

Rest in peace, Richard.

ADHD couple therapy training gina pera

5. Excerpt: My Book’s Chapter on Medication

Now I’ll share with you now the introduction to my first book’s chapter on medication. 

Please know:  The last thing I want to do is scare you away from seeking treatment that can vastly elevate your life. Just the opposite! You deserve that.

Rather, I am emphasizing: We consumers must be educated, we must self-advocate.

To lack vigilance is to risk a lot. Please don’t let you or your loved one be another casualty. Don’t be passive, thinking that any licensed professional knows better than you or I do. No one cares more about your or your loved one’s life than you do.

Identifying ADHD symptoms and medically addressing them is not, for the most part, rocket science. It’s not even brain science. It’s step-by-step logic and observation.  I will be teaching this in Course 2 of my online training, on medication and sleep. Subscribe to this blog to be notified when it’s online. 

Chapter 21: RX Treatment Results That Last

Adderall

It took Alex two grueling years to convince his wife to seek an evaluation and then treatment for her diagnosis of ADHD.

“Now, who knows how long it will take me to convince her to ditch this psychiatrist, who refuses for no logical reason to prescribe stimulants and find one who actually understands ADHD,” he complains. “My wife is skeptical that I or this support group could know something her psychiatrist doesn’t. But trust me, it’s alarming how little this guy knows.”

Looking back, Alex wishes they’d been far more careful in selecting a physician.

In Jeanette’s case, the irony is that she never found her husband’s ADHD a problem—until after he started medical treatment for it.

“I used to go to bed at night thinking I’m the luckiest wife in the world,” she recalls. “Yes, Mike is lousy at paperwork and he doesn’t remember to take out the garbage (or what day it’s collected!). But he is fun, very goodhearted, and rarely gets angry, and loves being with me and the children.” 

Then It All Changed

All that changed soon after Mike learned that he might have ADHD and decided to do something about it. He had recognized in himself the traits he didn’t like in his father. That included poor follow-through on promises. He wanted to do a better job with his own family. “His attitude was, ‘If treatment can help me to be a better person, why not?” Jeanette recalls.

Unfortunately, Mike’s personality changed completely after starting medication. 

“I went from this perfect marriage to hating my life and being ready to leave him. The worst part was that he didn’t realize that things were getting worse, especially the anger, until we were in major trouble. As far as he was concerned, his focus was better so that was great. But in reality, his focus was unrelenting.”

Jeanette found the support group’s feedback critical to realizing what was happening. He was probably either on the wrong type of stimulant medication or at too high a dosage. She also learned how to find a more qualified physician and, more importantly, convince Frank that he was turning into a father far worse than his own.

Such stories are way too common for the support group’s comfort.

How Do We Navigate This?

Sure, we want to place our faith in our physicians. Yet, one troubling fact remains. Many physicians, including psychiatrists, are poorly trained to treat Adult ADHD. Some know that and respect their limitations. Some don’t.

It’s important that yo know this going in.   Smart ADHD healthcare consumers can  avoid common pitfalls and come out a success story.

“My message to those embarking on this journey,” Jeanette says, “is don’t be afraid of medication; it can bring great changes. Just be aware.”

Please know that, prescribing for ADHD is a straightforward issue. In fact, ADHD Partner Survey respondents report that when their partner started taking medication, symptoms improved significantly within:

  • Hours (15 percent)
  • Days (39 percent)
  • Weeks (19 percent)

As Jeanette learned, however, the initial “promise” of medications to smooth out the ADHD roller coaster can soon peter out. Support-group members have agonized over this phenomenon for years.

How These Chapters Can Help

The book’s three chapters on medication will support you and/or your partner in creating your own success story by helping you to:

  • Avoid common pitfalls that lead to low treatment adherence.
  • Understand that goal setting forms the foundation of successful medication treatment.
  • Remember that each person has a unique biochemistry — no cookie cutters!
  • Recognize that finding the best medication regiment requires a methodical process.
  • Know that ADHD commonly coexists with other conditions, which must be considered in any treatment plan.

If you are familiar with this guidelines, you can better recognize competent care when you encounter it. And when you don’t encounter it?  You can either keep moving or, if your choices are few, diplomatically help it along.

For more posts related to ADHD medications:

Visit ADHD Roller Coasters Medications category of posts

For more information on my first book: Is It You, Me, or Adult A.D.D.? 

 

The firs version of this post peaked 2013.

—I welcome your comments.
Gina Pera

 

229 thoughts on “The Tragic Truth Of Prescription Adderall, or “Madderall””

  1. I was prescribed Adderall three years ago and it ruined me. I was paranoid, delusional, euphoric… I lost my husband, family, friends and so much more. I can’t believe where I am now.

    1. Dear Carrie,

      I feel for you, Carrie. That sounds like a long-running nightmare. I wish you all the best in your recovery.

      Gina

  2. Hello! I’m a 24 year old woman with ADHD and autism, and I take adderall. Was wondering if there’s some other combination of symptoms that tend to work really well with adderall?

    At a high enough dose, it does wonders for me. Before I took it, or when the dosage was too low, I was exhausted all the time, extremely emotional, negative, irritable. Struggled to get out of bed, struggled to do basic chores, would sometimes get overwhelmed and just stop moving and stare forward. I’d get so upset I’d start hitting myself. I’ve also always moved and talked slower than everyone else.

    On adderall? I simultaneously have more energy and more focus. I’m like a zombie when I’m NOT on my meds, or when the dosage is too low. Went from wandering around my workplace feeling agitated and unfocused to getting stuff done. I moved faster! It also had the wonderful effect of giving me the ability to read again. I felt good for the first time in my life.

    I understand not wanting to rely completely on how people feel, but I literally went from being exhausted and miserable to being relatively content. Even if it does change my personality, my dopamine-deprived personality is not very good company for myself or anyone else. I’m nicer because I can remember social cues and don’t have to fight through misery to act on a desire to be nice. I clean up after myself at home. My suicidal ideation just about vanishes when the adderall works properly.

    I wonder if it had something to do with having primarily inattentive features. Everything in my brain is already so slow, except for looping nonsense anxiety thoughts – which reduce considerably on the adderall. My anxiety gets better on it. My natural energy levels are very low.

    The only clear negative side-effect I’ve had is dehydration and the resulting constipation. Which is what is so strange. I see so many report such extreme negative side effects, or even just moderate negative effects that have to be balanced out in other ways. Yet for me it has been wholly positive. Adderall also works incredibly well for other members of my family.

    It’s difficult to tell if my sleep is impacted because I’ve always had issues with sleep – an autistic tendency that’s incredibly difficult to break. I might even sleep better or more consistently taking adderall because it’s easier to break looping behaviors on it – though I always try to follow the instructions not to take it too long after 5 pm (work sometimes means I have a nontraditional sleep schedule).

    Basically, if it ever turned out that adderall had too many side-effects to use, or stopped working, it might be a tragedy for me. I’m not chasing focus. It gives me emotional regulation and a baseline level of energy that helps me make healthier lifestyle choices. Ironically, it tends to interrupt hyperfocus when it’s working at optimal levels.

    Today I started an increased dose and looking back at the rambling depressive text I’ve written and impulsively sent to people or put on the internet as recently as yesterday is scary. And I want to emphasize that I did things like that before I ever took adderall, as well. That’s how quickly it changes my behavior for the better.

    Apologies if this is too long. I’m not trying to argue, but was more wondering what it is about my brain that seems to work so well with this medication.

    1. Hi Victoria,

      Just to be clear…..I did open with this:

      —Prescription Adderall works very well for some people with ADHD.
      —For others, Adderall  can create more problems than it solve.
      —Poorly prescribed Adderall can  create or exacerbate anxiety, irritability, grandiosity, tunnel vision, and even rage.

      Absolutely. It no surprise that you felt improvements in the various challenges you mention when you started Adderall. This might be true with any other stimulant, depending on your neurochemistry.

      But what I’m not seeing in your post is mention of any other stimulant you have tried. In other words, prescribers should give a trial of both classes of stimulants. If you’ve had only Adderall, you’ve had only one class (amphetamine) and Adderall works differently than the other amphetamine, Dexedrine.

      Another thing: You mention that your issues with sleep are an “autistic tendency.” Sleep disorders are enormously common with ADHD, too.

      I am not disputing your ASD diagnosis. But I will point out that many mental-health professionals diagnose ASD when what they’re actually seeing is ADHD. They just don’t know how to differentiate ADHD-driven “social anxiety” or “not reading social cutes” with that associated with ASD.

      Yet, the two often travel together (moreso when ASD is the primary condition than in the opposite direction). Even then, the expert consensus is to maximize ADHD treatment first and then see what’s left that might be ASD.

      If Adderall is working well for you, great. If you’ve never tried anything else, especially in the Amphetamine class, it might be worth trying Vyvanse. Just to see. Maybe you’ll experience less dehydration and constipation.

      I hope this helps.
      Gina

  3. Thank you for this article!

    I was on 5mg of generic adderall for a year and a half after being diagnosed at 32. I decided it wasn’t working very well after seeing my best friend also get diagnosed and start treatment with adderall and the positive changes it made for her that I wasn’t experiencing.

    I spoke with my psychiatrist who recommended we try switching to 15mg extended release. A short time later, I was feeling worse. I had a noticeable cognitive decline. Words simply weren’t coming to me when trying to have conversations, I felt like a zombie.

    So, she switched my dose to 10mg XR twice daily. For the first couple of weeks I usually forgot to take the afternoon dose, and I was feeling EXHAUSTED all the time. I emailed her and her response was to do a sleep test and look for apnea? Out of the blue.

    Well, it’s been a week after that and I set reminder alarms and haven’t missed a dose. Now, I’m angry. I’m a complete b*tch to my partner. I work in special education and my years long reputation for being the warm, nice and patient one is out the door. I’m impatient and snappy with everyone.

    I’m glad I’m realizing this in such a short amount of time, but I’m concerned my doctor won’t accept this and make a change. I would gladly go back to the 5mg dose if it meant ditching this. My insurance is notoriously terrible with mental health care, and I don’t have much of an option to switch doctors. This has inspired me to do everything I can to self advocate for trying a different medication altogether.

    1. Hi Natalia,

      How DARE that doctor. I mean, seriously. How DARE SHE?

      Following even the most basic established protocol, you should have been given a trial of each class of stimulants (methylphenidate and amphetamine).

      Instead, she stuck with ONE amphetamine, the one with the highest side-effect profile! First, generic (a potential can of worms all its own). Next, higher dose and extended release.
      Finally, ratcheting down 5 mg.

      Still not seeing the error of her ways, she suggests a sleep study! That’s beyond the pale.

      NEVER TRYING ANOTHER AMPHETAMINE (E.G. VYVANSE) OR METHYLPHENIDATE (E.G. CONCERTA, RITALIN, ETC.).

      Sometimes, MDs would prefer being told what to do by patients. It’s easier. Maybe your physician is like many others who disregard all evidence and continue to believe “Adderall is Best.” Based on nothing but aggressive pharma marketing 20 years ago! It sticks around in the mythology.

      Maybe you could diplomatically ask for a trial of Ritalin. Now, this will come with issues all its own because you will mainly get generics. But you’re taking generics now, so…
      If you think you can get authorized-generic Concerta, you can try that.

      Read this post first: https://adhdrollercoaster.org/adhd-medications/authorized-generic-concerta-update/

      Mostly, I encourage you to get your hands on my first book. https://amzn.to/3P205Ro

      Among its many “firsts” is a detailed approach to optimizing medication. If more physicians read just those chapters, we’d see an incredible step up in the standard of care. But alas, too many just wing it. I’d like to report them all to state licensing boards—and “Yelp” them, too. Nobody is looking out for their patients!

      Here’s what I would do:

      1. Read the book. Get the paperback, not the Kindle, so you can take it to the MD, if need be.

      2. Write down on paper, in BRIEF bullet points, the changes that you have experienced on Adderall. Use two columns – positive and negative.

      Any MD with any working neurons at all, seeing nothing but a list of negatives — some quite alarming (losing words) — should clearly see…..this has to change.

      3. Mention a friend who might have tried Adderall, to similar response, and then tried Vyvanse or Concerta, to much better response.

      Do you have such a friend? If not, I do. You can borrow them. ;-). I’m not encouraging you to lie. But this is a bit like guerrilla warfare: You are stuck with a lazy MD, and you must get what you need. It’s not like you are a “drug seeker”. Those seeking to abuse stimulants always want Adderall. You do NOT want it.

      4. If none of that works, show her my book. The medication chapters, in particular.

      Point out the high-level endorsements, the fact that the protocol I share I developed with a preeminent ADHD expert.

      5. I would say forward the link to this article, but some lazy MDs don’t want to see what their patients are “reading on Dr. Google”.

      I’m sure you will figure it out. Just put your mind to it!

      Good luck
      Gina

  4. Cheryl McGettigan

    My son was prescribed Adderall ER in fifth grade. By 11th grade, age 17, he wanted out so we talked to his doctor who referred us to a psychiatrist. He weaned him off. Things were fine for about a year then slowly a monster emerged. He started having psychotic events, anger, depression, then when he thought it a joke that he said he was going to cut his wrist, then if that didn’t work use a rope or his belt I called 911. The psych ward diagnosis was bipolar disorder. So our lives have been hell since. His is now going to be 30 and lives in his own sad, angry world. And he lives with me. I refuse to put him on the street. He was not addicted to his meds and now refuses meds because well the Adderall was a lie and he knows this. Where do we go from here. His life is not his own and neither is mine.

    1. Hi Cheryl,

      I’m confused. Your son took Adderall ER from 5th grade to 11th grade. At which point he “wanted out.”

      But you don’t mention that he did poorly on the Adderall. Otherwise, why keep him on it for 6 years?

      It’s possible that he was unable to cope with his ADHD symptoms, after treating them for six years. Perhaps it’s also possible that he was abusing street drugs, cannabis, alcohol, going without sleep? That alone can create psychotic events.

      It makes no sense that he suddenly has bipolar disorder. After being on an amphetamine that could push bipolar to the extremes.

      From the sound of it, he’s been failed by the “care providers” he’s seen. He might have given up hope. Especially if he’s gotten the idea that the Rx he took for 6 years was a lie and he “really” has bipolar disorder.

      I encourage you to think again about the sequence of events, get more clear, and then set about pursuing more effective treatment.

      good luck,
      Gina

  5. Thank you for this article! I’ve been on generic adderall ( 20 mg XR daily) for about a year, after being diagnosed with ADHD at the age of 39. It seemed to be helping but I was having work related anxiety (ER Nurse) so my psychiatric provider started me on escitalopram and within two days I wanted to rip my skin off, was having palpitations and balance issues. Stopped that, started Sertraline which wasn’t helpful and they increased the dose when I told them my anxiety was getting worse, because ” the therapeutic dose is actually higher.”
    After 20 years working in the hospital environment I realized it was the Healthcare system itself and it was time for a career change. I still feel super anxious yet apathetic, spacey and just off, like my thoughts are fast and my physical movements are slow and I need to think about the steps to doing tasks. Weirdly grateful that I don’t have insurance so I can wean myself off of both. Definitely not a combo with synergistic benefits and I miss feeling like myself.

    1. Hi Ashley,

      Career considerations aside, the sorry truth is that you’ve received very poor medical care.

      Shockingly bad, really.

      Read to the end of the article to see how things should go. It sounds like it’s worth trying again, this time with education and self-advocating.

      good luck,
      g

  6. Thank you so much for this article. My husband and I have been together for over 20 years, every single one of them very happily. We both have adhd so I have a pretty good understanding of it.
    I take 10mg twice a day and while it calms me and decreases my pain levels from ai disease, I will gladly go back to no treatment if I could get my husband to stop taking his.
    He has gone from a kind, thoughtful, goofy guy that loves being with our kids and I, to a self-absorbed, ego-maniacal, special interest-obsessed, sometimes downright mean person that none of us recognize anymore.
    My problem is *he doesn’t see it AT ALL.* I don’t know how to make him see it.
    I’m his mind, he has reached his full potential and nobody likes it because we’re so used to him being the, “weaker,” version of himself.
    My marriage is on a path that I never in a million years would have seen coming. We truly were genuinely happy, we’ve been best friends above all for 25 years, and adderall is going to cause the end of it all. I don’t know this person… I’d say who sleeps in my bed but that’s when he actually sleeps.
    How do I get him to realize what’s happening to him?

    1. Dear Jane,

      I just hate it when I’m right about this. So sorry you are dealing with the fall out of yet another reckless prescriber not having a clue about Adderall’s potential effect.

      I would write to the prescriber, reporting what is happening. But that’s me.

      You also might consider an alternate Rx, such as Vyvanse. If you like it, maybe you can convince him go try it.

      take care,
      g

    2. Dear Jane,
      I have experience with this. My marriage ended and I blame adderall. I have adhd but adderall warped my mind and body and I was aware but unable to stop. Twenty three years later I’m finally off this drug but no marriage and poor health. If you can see what’s happening, you are a step ahead of where I was. I was the addict and my husband didn’t know my behavior change was drug related when I lost my mind and then filed for divorce. I miss him every single day if my godforsaken life. I was so euphoric in the early years of that drug that couldn’t admit or see the problem.

      I hope you find help. I would recommend alanon meetings or something similar. You may learn how to avoid enabling while still keeping your sanity. I wish my experience could help someone else. I’d love to think your husband might read this and have it resonate enough to stop the drug.. It’s so so hard to live with the aftermath of adderall addiction damage. Best of luck to you and your family.

  7. I am in tears reading this. I feel like I live with dr hey jell and mr. Hyde.

    Off the meds it’s amazing and we are happy

    But on the meds it’s a living hellish nightmare.

    I could go on but it’s like I live in a prison and am told how awful I am every day.

    It’s a hellish landscape but at least I know I’m not alone.

    1. Hi Rachav,

      No, you’re not alone. And life can be better.

      Adderall is not the only choice in stimulants. FAR FAR from it.

      I encourage you to read my book to learn how medication treatment SHOULD go for ADHD — but hardly ever does.

      https://amzn.to/3rCe3Ac

      take care,
      g

  8. Thank you for this article. I discovered it while researching my side effects. I was prescribed Adderall and took it for over a year. I loved it- I was able to finish tasks at work and home with ease. I didn’t realize how negatively it impacted my personal relationships until I came off of it due to my marriage failing. I was filled with anger, rage and uncontrollable outbursts over small issues. While on Adderall I never thought I was the problem and I was accomplishing my tasks so it was working, right? After two weeks of being off of it I returned to my normal relaxed “chill” self with no feelings of anger or rage. My marriage improved 100% and things were fine again. I will take my ADHD symptoms over the anger/irritability and rage from the medication. The rage I felt is such an indescribable feeling and it was truly awful but due to the medication working for my ADHD I wasn’t able to see this. I am happy for articles like confirming this which is what lead me to my search. I was well aware of the common side effects like insomnia and decreased appetite but I never would of thought it would turn me into such an angry unrecognizable person. My heart was filled with hate. I wish I was able to find something without the risk of that ever happening again.

    1. Hi Chelsea,

      Thank you for sharing your story. Less-than-astute (and self-interested) voices in the field have “gaslighted” me for years about this.

      It’s only when they discovered how popular this post is that they appropriated the “keyword” and use it to drive traffic to their sites.

      Your story represents a key reason I’ve taken up this educational mission. That is, people who try Adderall and have a similar experience decide never to try medication again. That they’ll take ADHD symptoms over that hellish experience.

      And that’s just criminal.

      I encourage you to read my first book’s chapters on medication. You will learn what maybe 20% of prescribers know….and about 5% practice.

      Is It You, Me, or Adult A.D.D.?

      You deserve relief from ADHD symptoms—without paying a price.

      Good luck!

      Gina

  9. Hi Gina,
    Thanks for sharing this article. My wife sent it to me. This year (2021) I started taking psych meds for the first time in my life. I am on 20mg Citalopram for depression (working?) and I have been prescribed 30mg Amphetamine-D salt combo (Generic for Adderall.) The prescription is for 20mg in the AM and 10mg in the afternoon. I am a recovering addict and do not choose to self-prescribe with medications, so I have negotiated with the psychiatrist down to 10mg in the morning, and 0 in the afternoon. This seems to me to be working reasonably well; 20mg a day gave me a sense of “dark and desperate stress” after 5 days in a row. That has lifted with the lighter dose. I have a work-from-home job and I am also involved in a new business start-up with some friends. Also involved at church and in four 12-step programs. I understand I am very busy and need to keep everything organized, which is difficult with my untreated brain, and a little better with the medication.
    The main concern is that my wife is noticing and commenting that she does not see my level of distraction improving (leaving the heater on in the basement; forgetting a commitment I made – that I did not add to the calendar; etc.)
    I have a concern that she is possibly noticing things that have always been true but assigning value to them. (We are both adult children of alcoholism and/or abuse.) I am 54, and I do not want to destroy my brain or my memory with medication; I also do not want to lose my job because of underperformance.
    I saw what you said about trying different classes of medications. I did try another medication, Strattera (atomoxetine hydrochloride), and it seemed to have no result for me other than horrible constipation. I spoke with a friend who swears by it, and he said he has had to take stool softeners since he was a teenager.
    I have another friend with ADHD who takes Vyvanse (lisdexamfetamine dimesylate) and believes in it (actually encouraged me to try it.) I find that this particular medication has no generic form, so I am highly resistant to trying it because of some of the drug company issues you raised; specifically my own mistrust of them.
    I have asked the psychiatrist (who seems to be a reasonable person) about Vyvanse and he does not think it is a good fit. Thinks it is too expensive and would not be great for me.
    I will consider asking the psychiatrist about the methylphenidate class of medication (and possibly the dexmethylphenidate, although that also seems limited to one manufacturer.) Not sure why you separate out Adderall and do not discuss generic forms in your article…
    Thanks for listening.

    1. Hi John,

      Thanks for visiting. You ask great questions.

      Unfortunately, answering them properly will require more information than I can provide here.

      I will hit the highlights and refer you to my first book

    2. and to my new course.

      Both the book and the course could critically speed your learning curve and build a strong foundation for continued progress.

      Here are some highlights:

      1. ADHD is often misdiagnosed as depression. Because people with ADHD get “depressed” about their challenges. Also, ADHD can “look like” depression to the average clinician because it is associated with low motivation, initiation, etc..

      The upshot being, Celexa (Citalopram) might not be helping you at all. It might be making ADHD symptoms worse.

      You and your doctor should be clear about this.

      2. Why would any physician prescribe Adderall to a patient with a history of substance-use challenges? It beggars belief. But it happens all the time. 🙁

      Vyvanse is also an amphetamine but it has a slower release than Adderall. Moreover, it is dexedrine while Adderall has multiple amphetamine salts. There is a savings program you might check out. https://www.vyvanse.com/coupon

      You should have been given a trial of a methylphenidate stimulant (e.g. Concerta, Ritalin, etc.)

      3. Strattera is thought to work for only about 30% of people with ADHD. For more, though, a low dose works well in combination with a stimulant.

      4. Combining Citalopram and Adderall carries some real risks.

      Maybe this page will come through. If not, just enter the two drug names and see.

      https://www.drugs.com/interactions-check.php?drug_list=679-0,190-1645

      excerpt:
      Talk to your doctor before using citalopram together with amphetamine.

      Citalopram may increase the effects of amphetamine, and side effects such as jitteriness, nervousness, anxiety, restlessness, and racing thoughts have been reported.

      Combining these medications can also increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.

      5. As far as your wife perhaps “noticing things that have always been true but assigning value to them.”

      I don’t understand your question here. Of course, both of you should be re-framing long-standing challenges through the ADHD lens. This is how you gauge how well the medication is working — or making things worse. Without, you are both guessing. Moreover, medication improves ADHD symptoms. You will also need to review your old interpretations of your challenges and means of coping.

      I emphasize this in my book.

      6. It makes no sense that your prescriber gives you Adderall but “doesn’t think Vyvanse is a good fit.” No sense at all.

      The fact that Adderall’s manufacturer also makes Vyvanse shouldn’t cloud anyone’s decision. Separate drugs.

      7. You ask: “Not sure why you separate out Adderall and do not discuss generic forms in your article”

      I don’t know what you mean, sorry. Adderall is the topic here. Including its generics. I’ve written MANY other posts warning about the potentially problematic differences between brand and generic.

      8. Increasing research shows that properly treating ADHD with medication actually can improve brain function and overall health. Those studies were done with methylphenidate, though, and not amphetamines. Especially Adderall.

      9. You and your wife should be working on cooperative strategies to support “getting things done” at home and elsewhere. You’ll find some in the last chapter of my book.

      I hope this helps.
      Gina

  10. It helps me.I would not get off the couch or hear my kids in the backseat because I would block them out.It lowers my bp.I feel like I get my 20 projects started done.I have a hard time with the stigmatism of taking Adderall.I take a very low dose.I dont abuse it.But unfortunately it makes my anxiety worse.

    1. HI Trinny,

      I’m glad Adderall seems to work for you. I noted in the first paragraph that Adderall works well for many people.

      The problem is the “denial” around its problems, especially from its manufacturer. Not by people “abusing” it. By people trying only to treat their ADHD.

      When a stimulant makes your anxiety worse, that is a problem. Your physician should try to address that. Unfortunately, many (especially those prescribing Adderall as a general rule) remain clueless.

      Possibilities:

      1. You also have an anxiety disorder that should be treated, along with ADHD.
      2. Adderall is causing the anxiety, due to its molecular function
      3. Generic Adderall
      4. Adderall is not the best stimulant for you. If you haven’t been given a trial of several others, you’ll never know.
      5. If you’re also smoking cigarettes or drinking coffee, that can exacerbate the reaction.

      good luck,
      g

  11. Adderall abuse has destroyed my wife
    She is a full blow addict and alcoholic now. I blame the Dr that gave her 90mg a day. She was depressed not adhd. Now our entire life is a mess. My 5 childeren and I have lost her completely. Someone needs to stop this from happening.

    1. Dear Brad,

      That is unforgivable. I’m so sorry that happened to your family.

      It might well be that she has ADHD, not depression. ADHD can look like depression.

      The problem is that reckless prescriber.

      The problem is also one Pharma that has way too many people and organizations in its slimy pocket.

      g

    2. Yes it has changed the total mindset of mine as well. I feel so deeply sorry for you just remember as I do the person on the medication is not the one underneath. The worst part is anyone of a age to fake the test can get it. Just answer yes to the correct questions then boom you now have a fix.

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