The topic here is prescription Adderall. Specifically: Adderall is too often prescribed badly. Adderall effects on personality can include irritability, anger, lowered empathy, and self-awareness.
Moreover, reckless prescribing patterns have intensified public and political backlash against the diagnosis itself.
Let’s get this out of the way:
- Prescription Adderall works very well for some people.
- For others, Adderall create more problems than it solves.
- Do they always know this? No.
- When Adderall does cause problems, it can negatively affect personality and objectivity to the point where the person will not listen to others’ concerns.
- Prescribers’ love affair with Adderall for adults with ADHD is based on misinformation. That is, many believe that Adderall is “best” for adults. That is patently false.
ADHD Medications: Self-Educate & Self-Advocate
How can you or your loved avoid being yet another victim of Madderall? Self-educate and prepare to self-advocate. No one cares more about your or your loved one’s life than you do. Being passive is extremely risky. Even with extremely confident prescribers. Perhaps especially with those.
The truly tragic part is this: Poorly prescribed Adderall can create negative personality changes in people who seek only to treat their ADHD:
- Sleep deprivation
- Even what looks like (and might be) mania
Trouble is, they might not see this objectively. Unfortunately, their prescribers typically don’t ask—or connect the dots. This triggers a cascade of negative outcomes.
You might say, “So what? Just try another medication.” I often hear this from physicians who consider themselves ADHD-informed. Trouble is, they do not have their ear to the ground as I do. Moreover, for reasons I’ll explain, Adderall’s effects often mean no other stimulant will be tried.
A Necessarily Long Post — with Scanning Aids
This is a long post. By necessity. I created hyperlinked subheads to ease your scanning. At the end, I’ll offer a preview of what competent prescribing for ADHD looks like. So you can help guide it.
You will find other articles on this topic ….now. Mine was first, in 2013, and the only until very recently. One reason for this: Adderall has become a lucrative keyword in increasing web traffic. Not for me but definitely for commercial “health” and ADHD sites.
FYI — No Adderall-Abuse Tips Here!
Maybe you found this article while seeking to illegally procure or “hack” Adderall. Sorry to disappoint! If that is your goal, please read this first. It might save your life.
If you leave in disappointment after 5 seconds, my blog’s “bounce” rate increases. That’s a big Google-search penalty, kicking this post lower in search results. After a slew of paid and promoted superficial articles top the search list.
I leave it here anyway. Why? Chances are good that you actually have ADHD and are attempting to “self-medicate” it. That never ends well. I hope you will re-consider.
In This Post about Adderall, or Madderall:
Here are the overall topics in this post:
- Many prescribers (including psychiatrists) incompetently treat ADHD. This has devastating consequences.
- Why, to avoid these adverse outcomes, we might consider prescription Adderall not as a first try but rather a last-stop in stimulant medications.
- The New York Times has a long history of anti-psychiatry reporting. This was my initial catalyst in writing this post, in 2013.
- The importance of consumer self-education and self-advocacy.
- An excerpt from my first book’s chapters on medication.
The Major Sections — Hyperlinked
Click on any topic to go right to it.
- What your prescriber doesn’t know might hurt you.
- How reckless prescribing of Adderall has damaged ADHD’s legitimacy
- Why has this malpractice continued unchecked?
- Conflicts of interest abound
- ADHD treatment is complex in that it affects individuals, not clones
- Google search terms that bring readers to this post
- The New York Times anti-ADHD campaign — that pushed me to write the original post, in 2013
- Adderall works best—for some
- Core problem: Reckless Adderall prescribing and little monitoring
- Contributing problems: A larger view
- Excerpt from YouMeADHD on working with your prescriber
1. What Your Prescriber Doesn’t Know Might Hurt You:
- Poorly prescribed Adderall can ruin lives and relationships due to its negative effects on personality, among other factors..
- This 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. (Read the comments.)
- Next stop: These adults with ADHD might develop a cannabis, alcohol, or benzodiazepine habit to “come down” from the Adderall.
- 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.)
- Poorly prescribed Adderall can create or exacerbate anxiety, irritability, grandiosity, tunnel vision, and even rage.
That’s why 25 years ago I started calling it Madderall.
(Note: I’m seeing the term Madderall now appropriated to describe combining marijuana and Adderall. That’s not my definition.)
2. Reckless Adderall Prescribing Fuels ADHD Backlash
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. Again and again.
Recent case in point: Alarming stories about “tele-health” clinics over-prescribing Adderall became inseparable from “ADHD is over-diagnosed.” For example:
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Wall Street Journal Startups Make It Easier to Get ADHD Drugs: That Made Some Workers Anxious
No doubt these venture-capital startups were cutting corners. Yet, it’s also true that COVID pushed ADHD to the fore for untold numbers of people who had been only marginally coping before. They needed care and found it wherever possible. Now news outlets and grandstanding pharmacies (I.e. CVS) conspire to make it harder to get the diagnosis and treatment—and create more backlash.
That’s a prime example of how the mis-prescribing of Adderall creates anti-ADHD stigma.
3. Why Has This Malpractice Gone Unchecked?
Why do doctors favor Adderall for their patients with ADHD? Especially given that they fail to provide guidance or use rating scales or seek third-party reports?
Here’s one shocking reason: Many prescribers misread a meta-analysis based on old, scant (and one might say one-pharma-skewed) data. A meta-analysis is not established standard of care. It is only as good as the research it analyzes.
Three other reasons:
- Adderall’s manufacturer was notoriously aggressive in its marketing and fraudulent in its claims—with lasting effects
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
2. This manufacturer has long wielded, in my observation, undue influence over most ADHD websites and personalities you see online and elsewhere.
Unfortunately, this includes psychiatrists, psychologists, coaches, and non-profits, including board members and conference speakers and organizers.
Please know, I’ve been openly “pro-medication” for decades. Medication properly chosen and prescribed, that is. This pharma’s marketing is something else entirely—and has resulted in ADHD backlash again and again, not to mention huge profits.
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 with Adderall and prescribing in general for ADHD.
Why haven’t other ADHD experts calling this out? You’d have to ask them.
4. Conflict of Interest: Pharma Industry Support
Back in 1999, I was an award-winning journalist before falling into ADHD world. 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 rare then —and therefore risky. The “ADHD Gift” campaign dominated. Accepting Pharma industry support would sabotage my credibility. That’s why I didn’t and never have. (It’s certainly not because I could afford to work without compensation.) This puts me squarely at odds with certain organizations, personalities, and outlets.
To be clear: Researchers receiving pharmaceutical funding fall into a different category. Research validity rests on the researchers’ reputations and methods — and replication. Researchers must disclose such funding. By contrast, most proclaiming ADHD expertise online, in books, or at many conferences these days are not researchers. Nor do many of them have proper credentials.
This might shock you; Many “ADHD influencers” fail to disclose this pharma support. That includes licensed psychologists and physicians with platforms built by that pharma. This indirect support includes public relations efforts on their behalf and being placed (forever) in prominent positions at ADHD non-profits, at “tele-conferences,” and more. The upshot: Blinkered amateurism is presented as expertise.
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5. ADHD Treatment Is Complex:
- Treating ADHD is not simple. It is a complex syndrome that affects individuals, not clones.
- Genetic differences among individuals affect drug response.
- Late-diagnosis ADHD is typically complicated by longtime sleep disorders, adverse life events, and substance use; it takes time and skill to disentangle these contributors.
- 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.
6. Which Adderall 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 just making me tired now, after working for 2 months?
- Adderall changed my personality
7. More Traffic-Boosting ClickBait From The New York Times?
Back in 2013, a back-channel tip came in one day. I steeled myself for the next anti-ADHD screed from the paper: “Drowned in a Sea of Prescriptions.” As a young journalism student, I respected The New York Times as an exemplar of journalism. Sadly, that’s long in the past, at least in the context of reporting on psychiatry.
Make no mistake: The paper still has respectable editors, reporters, and sections. Yet, the front-page editor for several years demonstrated seeming personal antipathy toward “biological” psychiatry. That is, the idea that our genes can adversely affect brain function—and that medication often helps.
Yet, no doubt something else was going on: the NYT website’s analytics. Any piece stigmatizing ADHD draws hordes of readers—and ad dollars. For years, the ADHD community protested in comments. Then they just mostly gave up.
Sure enough, after leaving the paper, former Executive Editor Jill Abramson called it “publishing by the analytics.” Google analytics, that is, that show traffic, how long a reader has read a page, where the reader went after, reader demographics, and lots more. It is now pervasive online, with virtually every news outlet and amplified in social media. That goes double for ADHD topics.
Over the years, I’ve called out the paper’s negative targeting of ADHD:
- Talking Back to The New York Times’ ADHD Myth-Mongering.
- The New York Times’ Unnatural Opinions on ADHD
- The Truth Behind “10,000 Toddlers Medicated for ADHD” – Parts 1 and 2.
This Time: More Adderall Grief—And Tiny Relief
Grief, that yet another person fell victim to prescription Adderall—and died by suicide. Relief, that finally The New York Times’ grandstanding front page finally got something right about ADHD. Well, at least in tiny part. That is, 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 is distortion.
It wouldn’t be former sports reporter Alan Schwarz’s last apparent bid to land a Pulitzer Prize. He didn’t—and no longer works at the paper. Nor is he still a reporter. But during his reign, he and his editors inflicted immense and still reverberating damage. Even years after, Schwarz went on to resurface 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. That is exactly my point. (See Netflix’s Take Your Pills: Anti-Science—and Mean)
8. Again, Prescription Adderall Works Well Sometimes
Again: For some people, prescription Adderall works well. It is the best choice for them.
Yet, prescription Adderall does have the highest side-effect profile among stimulants. This is not a question. If you’re just starting treatment, why start with the riskiest choice? Why not try Adderall only after other stimulants (e.g. Ritalin, Focalin, Concerta, Vyvanse, etc.) have not proven effective?
Ideally, patients should receive a trial of both the amphetamine and methylphenidate classes. That’s according to preeminent experts, not my little opinion. But I explain in my first book, excerpted below. Why is this the case? Because it is impossible to predict how you will respond to either class of stimulant. It comes down to genetics. That means not just a few “ADHD genes”. It means potentially hundreds of genes, combining and contributing to this syndrome we call ADHD in myriad ways.
Oblivious to all these factors, many physicians routinely start new patients with Adderall—and at too high a dose. Among the people who join my groups or write to me, I’d guess it’s a whopping 90% who were started on Adderall. That is shocking.
9. Core Problem: Poor Monitoring of Prescription Adderall
In the early days of my advocacy, the early 2000s, I heard shocking story after story repeated in my Adult ADHD monthly discussion group in Palo Alto:
- Lackadaisical prescribing
- Poor monitoring (including no third-party feedback)
- Definitely over-prescribing of Adderall.
Similar accounts echoed through my local group and my online group for the partners of adults with ADHD (ADHD partner).
What was happening? ADHD treatment was supposed to make things better, not worse!
I’d done my homework in learning the evidence-based treatments for ADHD, including with prescribing. But I wasn’t seeing it in reality. As my husband the life scientist said, “It typically takes at least 20 years for the evidence of work works filters down to the clinical level.” (Twenty years later, I’m seeing worse, not better.)
Where Are Prescribers Failing Patients with ADHD?
To understand the essential problem, we must 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 establish a baseline and then monitor medication response—and note any side effects. Only a tiny minority do.
—Prescribers should gather reports from family or close friends
ADHD is commonly associated with poor self-observation. Typically, this improves with medication. The wrong medication, however, risks further clouding self-observation — and worse.
—Too many prescribers don’t bother with either
Instead, they rely on a casual, “So, how’s it working for you?” If the patient complains of side effects, the physician often stops the Adderall and moves to Strattera, without trying any other stimulant. That’s bad medicine. It’s even worse when prescribers go farther afidle, with third, fourth, and fifth-line ADHD treatments such as Wellbutrin, Effexor, or guanfacine. (Don’t get what’s wrong with this? Read how it should go with the excerpt below of my first book.)
Poor Prescribing Created ADHD Backlash?
To summarize: The prescribing of any stimulant is often done badly. But the problems around Adderall appear an order of magnitude more serious.
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 proved 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 scrape the bottom of the barrel for unknown MDs, some who’ve lost their license in several states, who will slap their “reviewed by” on the article.)
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10. Contributing Problems: A Larger View
Again, the issues around prescription Adderall remain only one piece of a problematic puzzle:
— 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. Hundreds were sitting on the edge of their seats, spellbound 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. Other conditions can complicate medication response. These include sleep and substance-use disorders. It also includes psychiatric conditions that are more highly associated with untreated ADHD in adults. (That is, living for years with untreated ADHD can increase incidence of depression, anxiety, and bipolar disorder.)
— 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.
— Insurance reimburses poorly for psychiatric treatment
Yes, insurance companies share the blame. They do not reimburse psychiatric treatment at a rate commensurate with the expertise and time required. But physicians are responsible, too, for understanding basic protocols. Tools exist to help implement these measures with patients. No need to reinvent the wheel.
Are you thinking that single-payer health insurance 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. France is far worse.
Many UK residents wait years even for an ADHD evaluation—only made worse by COVID.
In Australia, at least until very recently, adults cannot be diagnosed if they were not already diagnosed in childhood. Very handy, as pediatric ADHD was largely ignored except in the most extreme cases. Only recently was Vyvanse approved for us within the healthcare system, with the mainstay being dexedrine. Last I heard, Concerta was available for $100-150/month.)
— ADHD impatience —want to “feel” it than objectively measure it
Let’s be frank: Some people with ADHD love Adderall because it feels like a booster rocket attached to their back. And who can blame them? After years of struggling to turn intentions into reality, it’s happening!
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, you might not even 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?
Over-relying on a “booster rocket” to propel you through your day means using Adderall as a performance drug, not ADHD treatment. Even if it’s prescribed. Medication should help create more balance and self-regulation in learning new skills and habits.
Tragically, some patients (or their parents or partners) sometimes believe my cautions only after the fact. After all, I’m not a doctor. In other words, they write to me after the typical crash. That comes about two months into Adderall usage, in my observation. Sometimes longer.
That’s when they are completely depleted:
- Typically from exhaustion (why go to sleep when for the first time in your life you have “superhuman” focus?)
- But also perhaps due to Adderall’s unique mechanism of action, their very supply of neurotransmitters might be depleted.
I hate hearing, “Gina, you were right” when it means such personal tragedy.
— Parents’ and Loved Ones’ “Denial” of ADHD
Now we turn back to the NYT story for a moment. The story that finally prompted me to write this post in 2013, after years of warning about Adderall.
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.” Perhaps, but the report shows no evidence of that.
Predictably, reporter Alan Schwarz showed little understanding of ADHD’s complexity. He gave lip service to ADHD as a legitimate condition—and then proceeded to rip it apart. Schwarz started as a sports reporter. Using his apparent penchant for statistics, he reported on sports concussions. His editors apparently found that qualified him as a neuroscientist — and sic’d him on ADHD.
As a former newspaper editor, I have seen the pattern: “Hot Dog” reporters who will do anything to land on the front page. (Now, online, it’s the featured story, highlighted on the website and promoted through social media.)
In reporting about Fee’s suicide, Schwarz rejected 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 no longer are enough.
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. Not to mention the sleep problems it often brings.
Could it be that Fee’s parents’ own denial systems came into play here? Perhaps Richard felt that at least these doctors believed him?
—Prescribers Failing to Seek 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 rage-aholics. (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 ADHD with sleep deprivation and amphetamine addiction? Next stop, psychosis.
We’ll never know. But I suspect that there were red flags throughout his childhood and young adulthood. The same will be true of many others.
Rest in peace, Richard.
— Excerpt: You, Me, ADHD’s Chapter on Medication
Now I’ll share with you now with an excerpt from my first book: Is It You, Me, or Adult ADHD?
Being passive risks, believing you can trust the average prescriber, risks a lot. 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 teach this in Course 2 of my online training, on medication and sleep: Solving Your Adult ADHD Puzzle: Physical Strategies
Chapter 21: RX Treatment Results That Last
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?
We want to trust our physicians. Yet, 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 you 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 if one isn’t…paying attention.
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 Information
—Other posts related to ADHD medications:
Visit ADHD Roller Coaster’s Medications category of posts
—My first book: Is It You, Me, or Adult A.D.D.?
—My NEW Course on ADHD Medications and Sleep: Solving Your Adult ADHD Puzzle — Physical Strategies
—I welcome your comments.
The first version of this post appeared in 2013.