The Tragic Truth Of Prescription Adderall, or “Madderall”

Prescription Adderall

The topic here is prescription Adderall. Specifically, Adderall is too often prescribed badly. That means it can create negative personality changes in people who seek only to treat their ADHD. 

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. Subheads along the way should aid scanning.

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 Adderall Phenomenon.

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.

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) considers 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 benzodiazepene habit to “come down”.
  • Or: They love the intense focus too much to let go. Yet, it’s a focus that can reduce self-awareness. (In other words, they assume that everyone else has the problem, not them.)

The truly tragic part? There are so many less risky options to try first. Prescribers should be making things better, not worse. This is nothing less than a public health crisis.

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 are misreading a meta-analysis based on scant data. I will write about that in a future post. This doesn’t let them off the hook.

I find the main reason is three-fold:

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

This company was fined $54M a few years ago for its exaggerated claims about Adderall. Far too many prescribers still take those pharma-rep-supplied claims as fact.

2. This manufacturer wields undue influence over most ADHD “influencers” you see online. Unfortunately, this also means some psychologists and  non-profits, including board members and conference speakers.  Most people would be shocked at how this one pharma covertly pushes its agenda through so many tentacles. I’ll write about this when I retire.

3, Too many prescrbers are clueless, cavalier, and disconnected from consequences.

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

Professional Conflict of Interest as Contributor

I was an award-winning journalist before I fell into ADHD world in 1999. As such, it was natural to avoid conflict of interest. The way I saw it, pharma support risked tainting my “pro-medication” stance (rare at that time).

That means I’ve rejected any 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.  Now, I want no part of it.

To be clear: When researchers receive pharmaceutical funding, that is another matter. Research validity rests on the researchers’ reputations and methods. And they must disclose  such funding. Many of those proclaiming ADHD expertise online are not researchers. 

Moreover, many don’t disclose this support. That includes some who are licensed psychologists. I can find no disclosure of direct financial payments. The evidence is more clear when it comes to indirect support. This includes public relations efforts on their behalf and having 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.

Don’t Look Here for Adderall-Abuse Tips 

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. That’s especially true 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 also creating a backlash against ADHD
  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. Offering 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 or the publisher issues orders based on the website’s analytics. Any piece stigmatizing ADHD tends to draw lots of readers—and therefore ad dollars.

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 written several posts:

  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 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. Again, this is a legitimate medication that, even though helpful for many people, can create severe reactions 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 sensation and twisted assumptions. It wouldn’t be the last apparent effort by former sports reporter Alan Schwarz’s  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. (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. 

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

—Prescribing physicians should have a method for tracking progress

They should be using a checklist of symptoms that helps them monitor how well the medication is working—and what side effects it might be creating.

—Physicians 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 method

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

Has 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 actually penalizes this page because it’s not “reviewed” by an MD. 

3. Caveat: 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 problems 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 Psychiatrist Association. It was his way of summarizing why he failed to find ADHD treatment interesting and therefore not worth his study.

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, based on advice from the top experts I respect most. Yet still, that seems the status quo.

—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.)

D. People with ADHD impatient for results—want to “feel” it than objectively measure it

Some people with ADHD love Adderall because it feels like booster rockets attached to their behind. The hard truth is, however, 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. 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. And you might be so strung out you don’t even know it.

Often, patients (or their parents or partners) will 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 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. Did Richard Fee, the poor young man featured in the piece, truly not have ADHD, as his parents claim? I’ve seen no evidence of that. This was the weakest point of the story.

Reporter Alan Schwarz has made it clear that he has no 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 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. 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. (Their partners 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. And he was 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: I do not want to scare you away from seeking treatment that can vastly elevate your life. Just the opposite! You deserve that.

But I do emphasize: 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 the professional knows better. 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 the Medications category of posts

 

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

COPYRIGHT 1201 ALARM PRESS, 2008-2021

—I welcome your comments.
Gina Pera

 

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

  1. Hi Gina,

    I just started reading this article but I saw this line:
    ” Those of you in Australia, where the NHS considers it the stimulant of choice, be aware.”

    The NHS is the healthcare service for the UK, rather than Australia. As far as I know from personal experience and other ADHD people here, Adderall isn’t commonly prescribed here. Generic versions of Concerta and more recently Elvanse are the medications of choice. Though the NHS Scotland (where I live and who I work from) are separate to NHS for the rUK and both are split into tons of healthboards and trusts all with different formulary, so there may be individual areas prescribing it.

    1. Thanks for the correction, Cameron.

      Yes, I know that the UK healthcare system is called the NHS.

      With Australia, I was using the term generically….the national healthcare system.

      Australia’s system is called Medicare, which is confusing to American readers.

      But I will clarify.

      tx
      g

    2. Ah Apologies in that case Gina. I’m so used to thinking of NHS as a specific healthcare system I didn’t realise it’s also an acronym.

  2. Thank you, Gina!

    I almost started to cry when reading your article and the other people’s experiences from the comments.
    Everything was so spot on…I mean the severe anxiety, the tunnel vision, angry outburst. Even the cannabis to just relax and get sleep. AND THE GOOGLE SEARCHES!

    I’m 28 years old, and I’m currently taking Adderall. I have been taking it on and off for the last 9 years. I absolutely HATE how it makes me feel. I believe I started off at 5 mg and it continually increased over the years. I have not tried any other type of medication. Like you had mention, I kind of always just thought that I had the deal with the negative effects to get the positive ones. I have an appointment coming up with my doctor, so I’m definitely going to talk to him about making some changes. But I would love to know if you have any recommendations.

    Thank you so much! I’m so happy I came across your article. And I can’t wait to read your book!

    Julie

    1. HI Julie — good for you, for questioning!!

      Read the three medication chapters in my book. Photo copy them. Bring a copy to your prescriber. Or get a new prescribe. (But honestly, it seems that 80% are this ignorant.)

      The general idea is to try one (or more) choice in each class (methylphenidate and amphetamine).

      To note treatment goals (what are the improvements you’re seeking) and keep a log….does this dose/rx make things better or worse.

      good luck!
      g

  3. Ohhh man. Thank you Gina for this. I apologize…. what I wrote to comment is soooo long… I read the NYT article… I was shaking feeling disturbed. still feeling so emotional reading this.

    I am a social worker, I’m in my mid 20s and I’m prescribed Adderall IR 15mg 2x daily. Okay a little (lot) of background.. I also have sleep apnea even though I’m in decent shape (my father has it, severely) and I am non-compliant with my CPAP (claustrophobic & take it off in my sleep, also just hate wearing it in general).

    I’m now seeing a sleep expert for second opinion as I have sleep attacks and am dx hypersomnia. She thinks I have narcolepsy possibly so I’m doing a sleep study soon… this condition sucks. Very difficult I have a couple of jobs and my own company small time so got a lot going on and I need to get up 4:45am every day to get to my full time job (which I actually love). I hate the excessive sleeping.

    Also have hypothyroidism since 14 (mom has it), PCOS (supposedly…endo APN disagrees with gyno?), “deteriorating” discs (2) and mild scoliosis so I struggle with chronic pain. I know I probably sound like a hypochondriac but I really do have a lot of medical issues and real pain. I went through a lot of trauma in my childhood but still managed to succeed well in high school and undergrad, even grad school, only I really white knuckled my mental health.

    I have episodes of depression (especially in winter.. so half the year here), got therapy since early teens on and off. Was on Lexapro which stopped working, I think I became a bit manic and actually I ended up getting rx that again by a careless psychiatrist. He also would ask me what I wanted to be prescribed later when I developed VERY severe anxiety which led to SI. Thankfully my therapist at the time saved my life and intervened, since then life got a lot better without that type of obsessive anxiety. Only with the sleep issue worsening, I had periods of derealization basically because of completely untreated sleep apnea (and possibly narcolepsy) I was seeing a new psychiatrist (nurse one) who was like putting me on all these different meds for depression. Even Vrylar at some point which is an anti-psychotic was experimented with! That one made me not be able to control my limbs (side effects) normally and she took me off it.

    Honestly I don’t even remember what she had me on back then at first but I remember it was Vyvanse. Prompted by a brief assessment when i said I was having difficulty with work, my mood, my depression… I don’t think I was as focused on Attention issues then tbh because I was going through a dark time, being at that job during the height of COVID… so…

    Back in college my boyfriend had loads of ADHD meds because he had been diagnosed with it (he believed mistakenly… but was dependent on these drugs 20+ years) and I would take Vyvanse or Adderall every once in a while (he limited that out of these very concerns for addiction) and it helped me SO much.

    A lot of what i was complaining about to the psych nurse was sleep, sadness, stress and fatigue. So when the psych learned I was having these issues staying awake while driving, staying awake at work (different job back then that was awful too), couldn’t manage tasks because of excessive sleepiness… she put me on Vyvanse. It worked great but then after a bit it only lasted a few hours. And it felt much more mild than Adderall. Only I wasn’t able to stay awake after a bit again. Which I told my psych. She took off the Vyvanse, put me on Adderall 15mg XR which also worked great, it did give me anxiety though. It felt worth staying awake for work.

    By then I had the CPAP and was struggling through the “adjustment period” (this is 1 year ago now and I don’t believe there is any adjustment period for me) but ya know I was dx with ADHD. As a therapist myself I kinda wasn’t sure of the dx being done by a simple checklist. I clinically disagree with the simplicity of that and having read quite a bit about ADHD now since dx i stand by that too. The 15mg XR didn’t work after a bit either and then it was 20mg XR. (Okay as I wrote this I just remembered she switched me from some amount of Vyvanse to 20mg XR initially! That seems like a lot!!!

    Then I had awful anxiety and she took me down to the 15, as I wrote). That helped and then I lost the job I had (funding was given to another organization) so I didn’t take the Adderall. Honestly I never really wanted to take it if I didn’t need it because it would make me too heightened at times if I didn’t have a lot to do (like a normal weekend day without work) and my psych has said that’s fine to not take it on weekends. Later I start my current job which I love, as I said – only I need to be up early. And I have difficulty sleeping (a night owl forever + anxiety + chronic pain tends to worsen at night) so I am not one to achieve those 8 hours I know i really need.

    I’ll get like 5 hours of sleep which Can feel kinda good enough with CPAP – but, I noticed even with using it a decent amount at times I still can’t resist my eyes closing during the day so I need to sleep for a few mins, during which I slip into REM instantly (I set nap alarms for like 3-5 mins sometimes…). That’s why I’m thinking maybe something else really is wrong with my sleep. I also sleep a lot on the weekends to try to catch up… so I did end up taking the rest of the Adderall XR only it took a couple of months because I think I didn’t finish a script and filled one… part of a HUGE problem is that (at least with my insurance) you need to pick it up when it’s filled at the pharmacy within a certain number of days.

    I know because when I didn’t (since I didn’t finish my bottle in a month) the insurance won’t cover the script the way it’s written past a certain number of days. I don’t know how long but it was a pain to get it resolved when I ended up needing the med (ya definitely notice life without it… especially with major sleep issues) so now I always pick up the scripts and I really haven’t abused it. I take it the way it’s prescribed and I’ve never been prescribed a crazy high amount nor do I want to. I actually do just want to stay awake and focused and experience my life without feeling I can’t focus because of how tired I am.

    I do think I have ADHD to an extent but maybe without the sleep stuff I could be on a more mild Med? Omg I’ll try to wrap this part up.. the 20mg didn’t work and it was also making me smoke more (cigs and vaping unfortunately… and medical marijuana… once per day usually) and the anxiety was kinda dulled by my fatigue.

    I got super busy too and I really depended on the energy from Adderall to get by. But the anxiety persisted and I did tell my psychiatrist, because when the XR didn’t work as well, she had me do 15mg IR with 10mg IR as needed. I felt anxious from this and also too exhausted + busy to function without it. My focus got bad and she added Wellbutrin 150mg XR, only she took away the XR Adderall (the smoking addition was becoming brutal… non stop vaping at times) she said Wellbutrin would help me quit smoking. And lost weight. And “some people just need the IR instead” my irritability worsened 3 weeks in to taking the Well. + Adderall 15mg IR 2x daily.

    I mean like wanting to rage type anger, not violent but severe irritability. It sucks to be around people like this and I’m super aware of it. I’m a deeply sensitive person and I actually really love people and love being a therapist. But i noticed I don’t want to be around people. Even after taking some of my time off. Even after having time to “introvert.” It isn’t like me. Also started being paranoid and having more panic attacks. The worst? Crying!!! At everything, oh my god. And my long term boyfriend who I live with said so too… he can’t predict my reactions. I made a psych appointment last week. So my psych just changed my meds to Adderall 20mg XR, Wellbutrin IR 100mg 2x daily, buspar (not sure dose, I took this before). She said “some people can’t tolerate the IR well” honestly I thought the problem was the Wellbutrin. I felt amazing the first few weeks initially on IR and Wellbutrin then it shifted from energy and productivity to irritability. But she changed both these meds anyway.

    As a side note I do believe I have an attention issue I could kinda just coast with my whole life. I didn’t pay attention in college and always fell asleep in class even since high school, but it was lots of little sleep attack type moments I could bounce back from. I graduated with honors I mean I did well in grad school the same but that was mostly writing papers – which I always thrived at. Sitting in class for longer lectures than ever, I was glued to my laptop googling stuff or reading on the Internet (this was no meds me) and I just knew how to coast pretty well to get by, but I wasn’t learning so much, not really. I had my attention divided by part time internship, a full time job in a restaurant, full time grad school, and a decent home/social/relationship life.

    I regret a lot of time I didn’t pay attention more in class but I also feel it can be hard for me to and I am surprised I genuinely identify with many of the criteria on the checklists…. so I guess sure. It’s a diagnosis. But it’s a diagnosis getting these strong meds thrown at it because I can’t stay awake more than I can’t pay attention. That’s the truth, I think. And that doesn’t make my problems or what I have any less valid but reading your article made me reconsider how much I’ve praised Adderall for how it gets me going in life – maybe I really was raging because of that and not Wellbutrin.

    I don’t know. I’m scared of life without these meds because I think I do depend on them. I really do take them as I am supposed to and my dosages are not high.. that’s what I thought before about the dosage amount, anyway. I’m straight up with side effects I even mentioned gastro stuff and panic attacks at my last appointment. I had panic attacks and anxiety before any of these meds too though. It feels good to not be depressed when I take the meds for a bit but they do wear off and I can even still fall asleep when I take them sometimes !! Also totally crushed my appetite – went to donate blood and got denied because of my iron. I was shocked because I felt I was eating ok enough the last couple days before my appt. I think this Med is causing me problems and now I’m more anxious to get my sleep study (in October) to get to the bottom of this. I told the psychiatrist this info.. she pushes me to keep trying with the CPAP. People don’t understand how hard that is when you have anxiety about it on your face all night. I really do try. I’m just really lost and now I do think I’m more afraid of this drug I’m just not quite sure what to do about it.

    As a side note, I did quit vaping completely which I’m really proud of. I still smoke a cigarette daily which I’m really trying to stop. I usually do it when I can’t stay awake. And i just want to stop. So I hope being back on XR doesn’t make me have terrible cravings. I’m working on making myself eat. I think malnutrition is playing into these feelings too. I feel too young to be struggling this much. I feel like adderall was kinda rx because I have depression that wasn’t responding to SSRIs well. But she didn’t go to Wellbutrin then or anything else even.

    I’ve only ever been on a series of SSRI, 1 anti psychotic briefly (prob pharma sponsored BS) and then amphetamines. But if i do have narcolepsy, this is the treatment… only in other forms. Idk what any of this means. I wish I had a Dr good enough to figure it out. I’m not spiraling completely out of control but I am struggling, mostly quietly because I don’t want others to see. I isolate for COVID reasons and fear rn but also because I don’t wanna be around others. I haven’t started my new meds yet. So I guess we’ll see. Thank you for writing this I will need to explore the website more and im sorry for the long message – rambly especially after meds are long gone.

    1. Hi Casper,

      I really hate that what sounds like your ADHD has been so cavalierly treated.

      A diagnostic evaluation depends on more than a checklist. The DSM-5 criteria includes 18 symptoms, but it also includes signs of impairment in at least two areas of life.

      Taking a full history is important, too.

      But, sometimes, ADHD is so clearcut — if one also offers anything from childhood and developmental years — an experienced clinician often knows how to recognize it.

      Look at how “depression” and “anxiety” is typically diagnosed ….by what it looks like. That means that ADHD is overwhelming misdiagnosed as depression and anxiety. As, it seems, you were, and given the wrong medication for ADHD — medication that can even intensify ADHD symptoms.

      It does seem that you’ve been using Adderall as a performance drug – not that this was your intention. But it seems you are using it as many do — to propel yourself through your day, no matter if it’s too busy or too disorganized a day.

      Treating ADHD means you can better develop systems to organize your time and priorities — and your sleep.

      Sleep disorders are associated with ADHD. And what you describe is not uncommon. I doubt the wisdom of calling it narcolepsy when you cannot stay awake after getting only 5 hours of sleep, consistently. And especially during “boring” activities. That can be ADHD. Full Stop.

      You’ve never tried a methylphenidate stimulant? (Concerta, Ritalin, etc.) You should have been given a trial. Trouble is, now that you’ve gotten accustomed to Adderall being your personal booster rocket. And this is why I would like to personally kick the a** of every clueless doc who does this to vulnerable people. There seem to be millions of them, unfortunately. Hacks.

      To be frank, if an MD prescribed for me Adderall and Wellbutrin, I’d say “thanks but no thanks” and head to plan B. Adding Buspar to a bad combination of medications is not a strategy. It’s a Hail Mary Pass.

      I encourage you to read my first book’s chapters on medication. Start from the beginning, but this time double-down on organizing your priorities and time, more realistically.

      https://www.amazon.com/dp/0981548709/ref=cm_sw_em_r_mt_dp_NJNDC54WGKM1247NYVHP

      Take care of yourself! Maybe ask your bf if you two can sit down together and hatch a new plan for treating your ADHD and taking better control of your sleep.

      g

  4. Thank you for this article. I’m so glad I found it. My husband was prescribed Adderall 3 years ago at the age of 47. He loves how it makes him feel. It has destroyed a good marriage in these 3 years. He has turned into a total narcissist, porn addict, lost 2 jobs in 3 years, no longer works and is a completely different person than the man I was married to for 17 years before this. We are now getting divorced. Myself and his family have tried everything to get him to stop. He refuses and thinks we are all crazy. I wish more people would realize the problems this drug can cause. Thank you.

    1. Dear Jennifer,

      I am so sorry. It’s a horrible thing, what’s happening.

      I should not be the only one to have called this out for 20 years.

      The fact that the manufacturer of Adderall misrepresented this potential — aided and abetted by psychiatrists and psychologists in its employ — just makes me sick.

      That this company still “owns” much of what it written and said on the Internet? Deplorable.

      It’s me against some very powerful forces.

      take care
      g

    2. Jennifer, please encourage him to read this blog, get help!

      I had no idea destruction was happening, I was on the drug 9 years.

      It is the hell Gina describes and the most insidious effect is you have no idea anything is wrong.

      In November 2019 I landed in an outpatient program, life falling apart, family in ruin, unable to get a job, believed I was very depressed. Walked into the hospital, they told me I did not have adhd and asked if I understood what Adderall was doing and within 4 days they forcefully and safely removed me from the drug.

      It was as if I just came back to life. I had anger issues, experienced mania, paranoia, delusional thoughts, physical pains in my stomach, didn’t sleep, was drinking to get to sleep, always sweating, had tremors and would incessantly grab my clothes.

      It all ended once the drug was removed from my life. That moment not only saved my life it brought the truth. I then was encouraged much like an alcoholic to go through 12 step recovery.

      In researching the drug, I came across this site and Gina is 100% accurate in the effects Adderall has in destroying lives if you don’t need the drug.

      Please have your husband read this….until December 2019 no one could tell me I was wrong, my wife had no idea it was the drug, no one did. The high each morning followed by the nightly crash was killing me after years of taking 30 mg xr every single day.

      Please, please, please encourage him to talk with an outpatient program, they will help him and perhaps your marriage. I’ll pray for you, your husband and your family.

    3. Hi Al,

      Thanks for underscoring the importance of using Adderall only with these cautions in mind.

      Yes, it can definitely destroy lives “if you don’t need the drug.” But it can also wreak havoc for people with ADHD who would benefit from a correctly prescribed and monitored stimulant.

      best
      g

    1. Hi Nah,

      Perhaps you are unfamiliar with the role that fundamental science plays here.

      Adderall’s chemical structure stands out among all the stimulants.

      If prescribers knew this, they might be more cautious, in trying “simpler” stimulants first.

      The “science” that prescribers base their love of Adderall on comes from….wait….not science.

      It comes from a company well known for aggressive marketing. A company that was fined $54M for fraudulent claims about Adderall and another drug several years ago.

      Prescribers who prescribe based on what a pharma rep tells them are acting recklessly.

      Prescribers who think they can learn all they know about Adderall from a double-blind, controlled study betray themselves as mere proceduralists, not scientists.

      There are no such head-to-head studies.

      That’s why we go by fundamental science and the preponderance of anecdotes. Notice that none of the other stimulants shares this phenomenon.

      Cheers,
      g

  5. I am so deeply grateful for this article, I may or may not be sobbing with relief 🙂 It’s as if all of us googling-to-death “what is wrong with me?!” generated a current that helped strike this into our search results. And it’s illuminating in so many ways…it’s the hug (and light) we needed.

    Exacerbated anxiety, irritability, anger, and grandiosity? Check. And in my case, I add the triggering of: disordered eating (childhood maternal neglect); post traumatic stress (grotesque childhood paternal abuse, maladapted sibling dynamic); obsessive compulsiveness (Madderall “focus” for me = fixating, which – if you have subpar executive functioning as it is – obliterates all the previously-healthy areas of your life); paranoia (a product of my fixating + anxiety in my opinion, as I’ve dealt with far worse things in life before now but can’t seem to access my emotional intelligence); and lastly/gravely, the utterly crushing depression (which I know is evident, but when the VA diagnosed me with Major Depressive Disorder, somehow I was offended by it). That’s because I’ve worked really hard (since I was a kid!), to avoid the common maladaptive behaviors that many women with similar upbringings can develop. I was lucky to be fascinated with psychology/neuroscience/ observing human behavior from a young age – something I consider my own saving grace. So it’s bothered me to my core that my critical thinking gets completely hijacked now, after making it all this way.

    When you said step 2 is often developing a cannabis habit to come down, I felt some of this shame leave me and a little part of my sanity return. And it’s not sheer use of it that I’m ashamed of, it’s relying on it when I know (deep deep down) that the real me doesn’t need it AT. ALL., so it’s another reminder of how I’ve lost some self-control, that innate inner strength I once had, my autonomy. Speaking of guilt, beware of grandiosity, folks…it is SO embarrassing in hindsight and there’s often no repair. Of course anger and rage are in that same boat; the difference is when you humbly return after an arrogant outburst your peers and loved ones will likely still tolerate you, whereas being full of rage ensures you’ll be left out at sea. Meaningful relationships and well-deserved opportunities get replaced with these reflections of yourself, made up of poor decisions and behavior.

    Imagine feeling all of that inside and trying to nail a job interview. Deep insecurity follows, amplified by an inability to secure gainful employment. And you can multiply that if you’re the type to ruminate about how your new behavior messes fit the very social stereotypes fueling the obstacles that you had a hard time conquering when you were 100%! Something like..being a woman in the workforce, where your chemically-induced psychosis (“drama”) will make others more uncomfortable than concerned. A special kind of trauma. Anger isn’t even allowed but if it happens and you’re also a minority, the best outcome is losing your job and the worst outcome is always when people react with fear rather than concern. Having experienced each of these personally I can tell you it doesn’t make things like negotiating salary any easier, if you haven’t already burned that bridge unknowingly.

    Until this article, I wasn’t able to articulate the magical ease I seemed to have just winging it-but-passing K-12 grade school, much to my teachers and coaches’ frustration, bewilderment, and sometimes suspicion. I’d tell myself that when it’s a subject I’m interested in, I’ll be able to dial in and really see what I’m capable of! Enter early-30’s me: already a non-traditional student, returning to finish my bachelors after serving in the military. To my dismay, I wasn’t interested or sharp – not even sharp enough to wing it. Add another reflection of guilt. I was now a veteran and below-average adult student. I still had my younger sister and mom as my “dependents” as they were living with me and under my care (continuing from active duty). Working part-time, schooling full-time, while raising sis and caring for mom during her final days (end-stage cancer). To be sure I didn’t lose my mind (which happened anyway), I sought out therapy and found the VA. I’m grateful to have the resources I do as a veteran, but I regret not being vigilant or careful enough about the medicated treatments… since it was a tough time for me then, I try not to be so hard on myself about that part. Just know that even if you’re used to trusting your instinct with your life, outside of logic or reality sometimes but usually successfully, that part of you typically isn’t around when you’re in a sustained crisis mode. Your fight-or-flight response (or other haywiredness) has been standing around taking over all your capacities for way too long with nothing it could identify to fight or flee from. You’re going to WANT to just fall into the arms of some emergency treatment plan, even one created by an overwhelmed medical team that doesn’t know much about you. However I’d say that’s probably best for you at that point, I know it was for me.

    So my point and my advice is that #1) **YOU MUST BE SURE YOU UNDERSTAND THESE THINGS NOW/FIRST, before you ever accept any trial-and-error regiment.** Do whatever you need to do to alert yourself and have it set up before you ever try anything. And know that the first time you google your new behavioral/physical changes and symptoms, that it has already started and there’s still time to take a step all the way back.

    #2) And lastly, G E T T H E R A P Y… f#! stigmas. The stigma is just like high school peer pressure. You continue down a path that you know is not you, or not good for you, because of the judgment of others who have nothing to do with you/r wellbeing at the end of the day.
    I have to mention that my very first VA doctor, Dr. Jessica Nord, will ALWAYS hold a special place in my heart. She actually ended up dumping me (lol-but-not-really) after almost a year, it was the end of her..residency? and she was scheduled to cycle out and a new doctor in. (That was the story and I’ll stick to it 😉 But I don’t blame her if she dumped me, because I was having the crisis of crises during that time. Even so, she did a *phenomenal* job helping me. I learned SO much from her in a small amount of time. Every tool she taught me I grasped onto for dear life, and to this day they’ve never failed me. In one of the most crucial moments of my life she guided me in a decision that – in hindsight – was so simple! It’s because of her guidance that I was able to spend my mom’s final few months of life with her, which is an experience I’ll always cherish. It is moments like those and writings like this that end up being your resource. Thank you, Gina.

    1. Dear Sarah,

      I wish I could give you an actual hug.

      I find your story both validating of what I’ve been warning about for 20 years—and infuriating that prescribers are still abusing their patients in this way.

      Seriously. Suddenly their patients have a clue as to the obstacles ADHD has been creating in their lives. They seek “professional” treatment. And they get this flagrant malpractice.

      Grr.

      Your strength and intelligence and very deliberate approach to dealing with your life saved you here. (That and my blog post. haha) I hope those qualities continue to carry you upward and onward.

      Thank you for detailing your experience so that it might help others.

      g

  6. Hello Gina,
    I came across this blog/ article while I was researching if anyone else gets less agitated on Adderral. I am 48 and have been taking some form of SSRIs for more then 20 years. I am currently on Wellbutrin 200mg BID and can’t really take anymore. I have recently been prescribed Adderral because I think maybe I’ve been misdiagnosed all these years. My daughter and nieces have all been diagnosed with ADHD. I have never been hyperactive and in school I had no problems with focusing until now. One of my major symptoms is irritability and anger, Adderral allows me to think before I react and I’m consequently much nicer to be around. Unfortunately I have severe stomach pains and get shaky and nervous when I first take it. That eventually subsides except for the nausea and epigastric pain. My question is if I don’t have ADD why do I feel calmer but only AFTER the initial nervousness and shakyness. I hate feeling unwell but all day but like how my anger subsided. BTW I’ve just started taking it.
    Thanks
    I. K.

    1. Hi Irma,

      In general, people with ADHD feel “calmer” on a stimulant because the stimulant helps to “organize their brain.” With more organization and focus, there tends to be less cognitive anxiety (common with ADHD).

      Maybe you don’t have ADHD. But ADHD is a dimensional issue. You don’t need to qualify for the official diagnosis to still struggle with some related aspects.

      A few points: You’ve been taking SSRIs for 20 years. That might have had an effect on your brain, pushing more into the ADHD end of things.

      Also, you are 48. That’s nearing menopause age for many women. With the reduction in hormones, especially Estrogen, there can be a reduction in brain functioning.

      The physician should give you a trial of other non-amphetamine stimulants. They might work better for you, without the nausea and epigastric pain.

      (You’re probably taking a generic, which has its own variability.)

      What’s barely tolerable now might be absolutely intolerable in time — and might create some permanent effects.

      I hope this helps.
      g

  7. Hey, I’m 16 and in high school at the moment.

    I sometimes feel like I don’t have ADHD. Perhaps I’m in denial. I am on a low dose of Adderall XR (5mg), Intuniv (2mg)…both for the morning. And in the afternoon Adderall IR (2.5mg) which I typically take for work.

    I do feel the medication really working but I read in another blog post of yours about the overdose effect of feeling like a dull robot. That is something I feel, its harder to have social interactions with people and sometimes my focus goes into the wrong things. Like, I’m in class right now writing this. I’ve found I’ve also been losing interest in hobbies and certain friendships. I haven’t been inspired to do much but work at my job.

    I miss my personality and the fun I’ve had with my hobbies.

    Maybe I don’t have ADHD and that’s why these medications aren’t working correctly for me?

    But thats not right. I definitely do have it. I was diagnosed when I waa little and I notice without my medication my body feels weaker and I forget things easily, am more impulsive and less calm, I get annoyed easily, irritable, etc. My meds get rid of all this but what if my meds are causing these things due to withdrawel instead?

    I’ve never met myself unmedicated. I’ve always been on medications when I was little till now. When I was little I was on Xanax, risperdone, and adderall xr. I’m not on xanax or risperdone anymore though.

    I was abused when I was little as well. Whats the chances of me having ADHD or just being misdiagnosed and having symptoms that look like it because of withdrawel since I used to take meds inconsistently? I take them consistently now but i feel uncomfortable.

    1. Dear Eric,

      You ask excellent questions. It’s regrettable that you seem to lack anything approaching professional guidance.

      I wish this were a rare exception. Unfortunately, it’s the rule. And I see it play out every darn day.

      You say you’ve tried these medications — are these the only ones?

      1. Xanax (awful for a child, in particular, and addictive, should be prescribed only for episodic use…a crisis, not ongoing anxiety or insomnia)

      2. Risperdone – I really don’t understand the popularity of this Rx with children. It’s an anti-psychotic. It seems to be used as a “blunt force instrument” to knock back anxiety. That’s not going to help if the anxiety comes from ADHD symptoms.

      3. Adderall XR

      You’ve never been given a different stimulant?

      There are two classes of stimulant: amphetamine (Adderall, Vyvanse, etc.) and methylphenidate (Concerta, Ritalin, Focalin, etc.)

      You should have been given a trial of each class — because one might be clearly better for you than the other. And even a couple of choices, as the delivery system also makes a difference even with the same molecules (e.g. methylphenidate).

      Did that happen? If not, it should happen. The Adderall might be causing you to have “tunnel vision”. So, yes, you might have better focus, but it is narrow and inflexible.

      I encourage you to speak to your prescriber ASAP. If you can’t find a better prescriber, you’ll have to guide this on your own, diplomatically.

      You could say you’ve learned that Adderall can have the effect you’ve been feeling (losing interest in hobbies, friendships, having less fun, etc.). This all sounds like “over-focus” to me, and if your prescriber has any clue at all, it should to him or her, too.

      Ask for a trial of a methylphenidate. There are a few choices. The short-acting Ritalin might be a first choice, because it’s….short-acting.

      If you can get a copy of my book, read the medication chapters. Read and understand that, and you’ll know more than the majority of prescribers. No kidding.

      Maybe your library has it, or you can swing the $10 for the Kindle version. If I could, I’d just hand a copy to you. 🙂

      https://amzn.to/3wHyWJN

      Please let me know how it goes. Check back in. This is important, and you deserve so much better. Someone as insightful as you.

      g

    2. Thank you so much for the reply!

      I’ve never been on any other class of stimulants unfortunately. I’ve read from a post of yours that Adderall should be considered last before any other stimulant. Would you say Adderall is the “”harshest”” out of all the stims?

      I will definitely snag your book ASAP because my provider is kind of useless. They tried prescribing me Abilify and called it an “antidepressant” a few months ago. Thankfully I dodged the bullet and trusted myself not to take it.

      I was curious if you’ve ever heard of a medication called “Desoxyn” it has good reviews and people claim they don’t feel like they took any medication while on it but they still gets the helpful effects of any other stim (not that I plan on getting this since I have many other options to try first before this)

    3. Good for you, Eric. Questioning Abilify. It is sometimes helpful for some people with ADHD at a LOW dose. But typically only after a traditional route is tried.

      People who want anything close to evidence-based medication treatment for ADHD typically must be extremely pro-active.

      Many get nervous when I warn about this. “You mean I can’t trust my doctor????”

      Well, “trust but verify.”

      It’s just too important. Your LIFE. And there are just too many pharmaceutical cowboys out there, disconnected from consequence.

      PLEASE be equally cautious with the online “forums”, Reddits, etc.

      Desoxyn is pharmaceutical methamphetamine. Yes, meth. You read that right. Not street meth. But still perhaps an Elephant Gun when you require only a pea-shooter.

      There is no way you should go from Adderall XR to Desoxyn. So, as you say, yes, you have many other options to try.

      If you haven’t tried a methylphenidate, start there. And maybe a few of them, if you can. So much depends on the delivery system. And if you are stuck with generic, that adds another set of variables.

      Note one of my other most popular posts, on the critical differences between Concerta and it’s generics.

      https://adhdrollercoaster.org/adhd-medications/authorized-generic-concerta-update-6-1-19/

      If you don’t live in CA or MA, you might be able to get a big discount on the brand.

      https://concerta.net/

      g

  8. I really appreciate having an article that isn’t either anti stimulants or stimulants only as a last resort that is tackling Adderall as potentially problematic. The anger thing really hit a note. I am a woman in my thirties, I have been taking Adderall (my first stimulant) with good results for three years now, it is so hard to get this medication, my current doctor and state are very suspicious of stimulants, I have been having good results, and stimulants are so necessary for me normally but working remotely makes them essential, so I am terrified of fucking this up by trying something else, so I want to approach this as best as possible and I appreciate any advice/perspective you or your readers with ADHD especially have to offer.

    Is it possible that I am having this anger side effect even though I am not doing anything obvious or different in my behaviors? Could the Adderall be causing things like incredible tension that lead to headaches, neck pain and stomach issues etc? Cause like the anger feels normal in response to things that should make me angry, and I don’t do anything, like I don’t snap at people or yell or anything else I can think of. But I am just very very tense all the time, despite how much work I do to destress and center myself.
    If the Adderall has mostly worked really well for me with no obvious side effects (other than dry mouth and this potential tension stuff) does that mean the other class of drugs wouldn’t work for me? Should I go straight to Vyvanse? Have people had good experiences with switching over?

    1. Hi Chris,

      You are asking important questions. Questions your prescriber should be asking but….well….I mostly gave up on that a decade ago. It’s just not going to happen in the majority of cases.

      Here’s the thing: Adderall is your first stimulant. You say you are getting “good results”, which is great. But you have nothing to compare it to, right?

      Yes, absolutely, Adderall could be causing all those issues you mention. All things being equal.

      I encourage you to read my medication chapters…if you got to the end of this post, you’ll see an excerpt.

      https://amzn.to/2OJs0eM

      (I’ll soon be launching online training that covers all treatment issues, of all types, so be sure to subscribe to my blog to be notified.)

      There is a basic, methodical approach….but apparently it’s a state secret for most prescribers.

      You can take steps to minimize the risk. For example, don’t wait until you run out of your daily Adderall medication to try something else.

      Instead, ask for another stimulant. Maybe a 5-day supply or even a 30.

      This depends on your insurance policy pharmacy benefit. But it’s typically understood that the patient will not hit gold with the first stimulant, at the first dose.

      Some experimentation must take place.

      You mention your current doctor is very suspicious of stimulants (yeah, that makes perfect sense…be suspicious but not CAREFUL…. [roll eyes]), so if you mention “It’s making me angry,” that might be the end of it.

      You could offer other legitimate reasons for trying alternatives….such as you understand that Vyvanse (also in the AMP category) might have a more consistent delivery, less up and down through the day.

      It might be worth trying the other class, methylphenidate. But if you think you generally respond well to Adderall (minus all the tension, which is not an insignificant side effect), Vyvanse might be the logical alternative.

      You just won’t know until you try.

      I hope this helps. good luck!
      g

    2. Thank you so much Gina! And I totally will check your book out. That is a great reason to give my prescriber and I didn’t consider the fact that we could just get 5 pills or something similar to try out. I also appreciate the reminder that it is normal to have to try different meds and that doesn’t automatically mean I am just looking for a high (which lets be honest is a literal cry for help and not a horrible thing if I was). And thank you so much for validating my tension as not a small thing.

      And yeah, most prescribers are not great…. He told me that I could keep taking Aleeve for pain I was having (related to the tension) with no issues. I specifically asked him ‘can’t this cause digestive issues at least? I am already experiencing that.’ And he said sure, but just take some miralax, it will be fine. It wasn’t fine, and luckily I am no longer taking Aleeve either and my stomach has mostly recovered. So, I will get another prescriber if I can ever find a good one out here. The good news is most of my medical providers are good, they just can’t prescribe anything.

    3. Good thing you have your wits about you, Chris!

      The very idea….taking Aleeve for pain that could well be a side effect from a poorly prescribed…as a long-term solution.

      Good grief!

      When people talk about health-care reform, I talk about physician reform! 🙂

      good luck!
      g

    4. Dr. Anne Reyes

      People with actual adhd respond to adderall by being calmed. The ones who become angry don’t have adhd, they have been misdiagnosed and probably have a type of bipolar or some other illness that imitates adhd. Calling the drug madderall creates worse untrue stigma just because the wrong people are on it.

    5. Thank you for your comment, Anne.

      But it is misguided information such as what you state here that gets people into real trouble.

      Whether you are a prescriber or another type of Dr. (a chiopractor, it seems), I encourage you to please try to learn something critically important.

      Gina

  9. I was diagnosed with adhd when I was 11 and got prescribed adderall basically immediately after. I hated it as a kid because I just felt boring, sad, and sick all the time. I stopped taking it soon after so from that point onward, I had terrible grades and always felt stupid in school. I’m nearly 19 now, graduated, and I started taking it again illegally to fuel a preexisting eating disorder about 2 months ago without anyone knowing. Right now, I’m regretting everything but the only thing holding me back is the lack of appetite. I had multiple preexisting mental disorders aside adhd as well before this, so the mixture of malnutrition, sleep deprivation, severe OCD, and other meds I take for a physical condition is not pleasant to put it lightly. The second I started self medicating I’ve had the worst bruxism (which got so bad at one point I couldn’t speak), irritability, and anxiety. Since I’m so hyper-focused on everything, it often leads to focusing on intrusive thoughts or hallucinations. Just the other day I felt like I was going through psychosis. Saw spiders everywhere I looked, felt like bugs were all over me, thought things were moving when they weren’t, felt like people were watching me/stalking me, and I felt like I was trapped. It got so bad I had to call a friend to come check if what I was seeing was real. Yesterday was my first day off adderall and I felt much more in the real world than I did. I took it today since I’ve unfortunately grown dependent but I know I need to stop. I’m planning on getting serious treatment for everything, and I know it’s not going to be easy. I will never understand how people can find this drug fun or useful. It’s devastating.

    The comments are very validating though and I’m glad to see someone talk about the issues with prescribing amphetamines as if it’s the only solution after getting diagnosed.

    1. Dear Nate,

      What happened to you shouldn’t happen to anyone. I”m so sorry that some reckless prescriber would do that to an 11-year-old.

      Whatever dependency you feel you might have, it’s not your fault. But you know that.

      It might be that just a small change….switching to Vyvanse perhaps…gives you a bit of relief. Though I’d recommend “start low, increase slow”.

      And just 15 minutes more sleep each night…

      You’re only 19 and you have plenty of time to get yourself on track, physically and mentally. I don’t mean procrastinate, though. 🙂

      A big motivation in writing my first book, started in 2000 and published in 2008, was educating consumers so they would not be vulnerable to the reckless prescribers.

      Overall, the prescribers have learned nothing. Most of them are in complete denial of the points I make — and readers make — in this post/comments. It’s made me extremely leery of psychiatric prescribers. I don’t “trust” until I “verify.”

      take care of yourself,
      g

  10. My sister recently visited her daughter out of town. For no apparent reason my niece physically attacked my sister, then threw her out of her apartment. My niece is taking Adderall (we don’t know for how long), she will take little bites the tablets all day long. She is bouncing off the walls and hardly weights 100lbs. Can this medicine make her become so aggressive? I also heard she had attacked one of her sisters and threw her out. She is an adult (just turned 30) and lives more than half way across the US.

    1. Hi Kendall,

      Theoretically, that behavior absolutely could be from the Adderall.

      Actually, I cannot say. Your sister might have other issues — sleep deprivation, alcohol use, co-existing psychiatric conditions (bipolar, schizophrenia, the list goes on), etc.

      Curses on the prescriber — if she’s getting the Adderall legally — for absolutely failing to monitor and being so reckless with such a potentially dangerous drug.
      g

  11. Hi Gina. I’m in my early 30s and was recently diagnosed with ADHD. It’s been a wild ride of emotions throughout this journey of realizing what I’ve been dealing with since childhood isn’t normal and it has a name. I was tossed a script for Adderall and at first loved it but now 2 months in, I’m getting horrible mood swings when coming off in the evening. Seriously almost don’t recognize who I am when that happens. I’m hateful and short tempered. I can’t tell you what this article has meant to me. Thank you so much for shedding light on all of this. I feel seen and thankful that I have other options. You are truly appreciated!!

    1. Dear Elizabeth,

      I am so grateful for your note — and that you found this post.

      All weekend, I worked putting the finishing touches on the text for my online training course 2, on medication. More than you ever wanted to know! But all necessary!

      Stay tuned!

      I hope you can work with your prescriber on better options. good luck!
      g

  12. I had a ‘vague’ diagnosis of ADHD in college (a comment by a doctor at Planned Parenthood). To be very blunt, I do meet the criteria by both mine and my husband’s evaluation.

    I have gone through a very badly done thyroidectomy and getting proper treatment (T3 thyroid hormone, slightly above replacement levels), alcoholism, and about 3 different (via criteria) eating disorders. (Proud to contribute my genetics to the EDGG to help others in the future).

    I newly acquired true Binge Eating in absence of caloric restriction/overexercise. I did the self-help part, and I was still getting binges. My doctor wanted to help and Vyvanse wasn’t going to be a financial option.

    Ritalin left my whole body racked with pain after 2 doses. (Come to find out it can block (IIRC) serotonin receptors/what is used to make serotonin in your body.) I have a loose diagnosis of Fibro so this was OUT as an option for me.

    I had been doing better on Adderall. 20 in the am, 10 when it wears off (I seem to metabolize quickly, so I get 2 ‘good hours’ on 20mg, and wait for 4 hours since I have the first dose before taking my 10mg).

    My doctor thinks I need to raise my dose as I’ve had issues with very small ‘subjective’ binges (which is controversial in recovery from eating disorders, what is a ‘subjective’ binge) and my focus is waning. Understandable he thinks I need to go up.

    Here is the odd thing for me. I take supporting amino acids (L-Tyrosine, but I watch it b/c it can be a problem for me), Inositol (which was a HUGE brain changer when I first tried it), B vitamins, L-Carnitine, Chelated magnesium, Fish oil, small amt of DHEA (I’m going through menopause). I know the research as well as a interested layperson can.

    I am on an eating schedule. I am not undereating, I’m not overeating for my weight. I moderate my exercise but do get some as I can due to pain. I have a good marriage and a very supportive husband.

    The plus of adderall is my chronic pain is less (likely serotonin cycle related?), I can focus a bit more, and I’ve found a small amount of medium joy in life after about 2 years straight of feeling like I was in a semi-depressed fog.

    But, some days, when my digestion is ‘off’ I am just sad, like, dark ‘life isn’t worth it anymore’ sad.

    Sometimes it does leave when I take my second dose. Sometimes it doesn’t. Dopamine enhancing activity helps but there’s only so much coffee I can drink and I can’t take vigorous exercise.

    I lowered my dose recently to 15mg in the am, 10mg 4 hours after.

    It’s about the same.

    I give this ‘book’ of a post because, I don’t know what to do. I feel like I’ve DONE everything right. I’m in menopause. I don’t know how to troubleshoot menopause + adderall + binge eating and gah.

    Is there anything that jumps out at you as being a thing?

    Thank you in advance. I will keep reading.

    RDK

    1. Hi RDK,

      I appreciate the complexity of your question.

      Some thoughts:

      1. I know very little about thyroidectomy. But my friend who had one, due to cancer, seems to constantly be on a bit of a roller coaster– mood, cognition, weight, etc.. So, I imagine that is playing a large role here.

      2. Have you investigated the Vyvanse savings program? https://www.vyvanse.com/

      In the end, Vyvanse still might not work as well as Adderall for you. But it’s a smoother and more extended delivery.

      It might be that what your prescriber views as “not enough medication” is really “dips” in the availability — as one dose wears off and before the next kicks in.

      The only reason that Vyvanse was FDA-approved for binge-eating disorder was because Shire paid for the process. There is no evidence that it alone among the stimulants helps with regulating food consumption. In fact, ADHD has been associated with “treatment resistance” obesity — and, in some research on those who qualified for the ADHD diagnosis, stimulant medication helped.

      3. I would be careful with the amino acids. I know that this was all the rage for a while. But the research I’ve seen indicates this might have unintended consequences. Maybe best to eat foods that have the range of amino acids.

      4. Stimulant as serotonin-suppressor — yes, I’m the one who has been beating the drum on that. That and the opposite — antidepressant as dopamine suppressor.

      It’s complicated, and it’s not true for everyone. But it’s not limited to Ritalin. It’s all the stimulants.

      Have you considered taking an SSRI along with the stimulant? Starting with a low dose (lower than most MDs realize is enough to work).

      5. Coffee is not a good idea when taking stimulants — it can mitigate the effect or exacerbate it.

      6. Menopause itself can put a “whammy” on women with ADHD. Dr. Patricia Quinn says that many will benefit from Hormone Replacement Therapy. (Many women also report — even those without ADHD — that “aches and pains” resolve once they start HRT.)

      7. How is your sleep?

      I hope I’ve given you some possibilities to think about!

      take care,
      Gina

  13. Hi Gina,

    Reading this article and all the comments has made me feel so validated.

    My husband was diagnosed with ADD and then place on Adderall about four years ago. At that time I had no idea that I should have been a part of that process so I wasn’t.

    His physician prescribed it and he would go back every 3-6 months for check ups etc. I was never apart of the process. But I started to notice changes in his personality. He would get super irritable and frustrated easily. His fun loving nature seemed to disappear.

    Someone mentioned an unrelenting focus. His focus is now on our marriage and realizing how there were certain dynamics he didn’t like about how I behaved. He is unrelenting in that focus. It feels like I can never make amends the way he needs, he tells me he has a list of things I need to clean up and I never seem to do it right so the list grows.

    I believe because of his clearer thinking he has discovered things he hasn’t liked in our marriage which is okay but it has been absolutely unrelenting in his dogmatic focus.

    In the beginning he was having a lot of explosive reactions but seems to be managing that better now. He tells me that I am reactive but after so much focus on my shortcomings all the time I an starting to feel crazed and reactive as well. He refuses to let me go to his doctor with him to tell the doc what I see.

    He refuses to go to counseling. His intensity has increased dramatically. I miss my fun and light husband. He seems to be able to lighten it up with others. I see him mostly at the end of the day when he is coming down off the meds. (during the week) He is taking the pills every day now as well. He wasn’t’ at first but one time he ran out for 3 days and he told me he felt the worst he had ever felt in his life, even having suicided thoughts.

    I think he is scared to go off them now because he is worried he won’t be able to function at work.. I do not believe he abuses (takes more then he should) them but I def. see personality changes. He also is starting to have insomnia at times, and drinks in the evening to come down I believe. I am at the end of myself and don’t know what to do. I know they feel like a miracle drug to him as they help him so much with his work to focus. Do you have any advice for me? I have your book. Are their other resources out there about this topic or online support groups?

    1. Dear Sharon,

      Of course you had no idea that you should have been part of the process. You will hear this from VERY FEW professionals. That’s why I have made it an issue.

      You can send a letter or e-mail to the doctor, expressing your concerns. The doctor doesn’t have to respond to you. But HIPPAA does not prevent that.

      If it were my husband, I’d tell that doctor I will hold him responsible for any car accident, job loss, or, heaven forfend, loss of life thanks to his gross negligence.

      Your husband is behaving abusively toward you but probably lacks the insight to know what he is doing.

      Your husband has other options. There are many choices of stimulants that are not as problematic as Adderall.

      Moreover, you don’t know how he is truly performing at work. He might lack insight to see the problems he is having there, too. Do you know anyone at his workplace you could ask, in confidence, about his behavior?

      I wish there were other resources on this topic for you. I’m afraid I’m it.

      This is a very delicate situation. If he hears from his prescriber that you are “saying bad things about his Adderall,” he might become enraged at you for meddling.

      This is medical malfeasance, plain and horrifying.

      Perhaps you can find another, more responsible prescriber and suggest your husband get a second opinion — that maybe he can have the focus he needs for work without insomnia, etc.

      It might help you if you joined my online discussion group. Apply with an address that doesn’t show your name. That way, you can speak freely. I think you need support now.

      https://groups.io/g/ADHDPartnerWithGinaPera

      take care,
      Gina

    2. Sounds just like what happened to my 29 year old son. You feel helpless and angry and not sure where to turn, although you know eventually something got to happen because you can’t go on like this..it did in my sons case, he got very paranoid and delusional. We managed to get him into a mental health/substance abuse 30 day inpatient. It’s been two weeks and he sounds so much better being off Adderall. He finally faced his fear of not having it. It’s a terrible addicting drug and can’t understand why a doctor would prescribe it so easily Knowing the damage it can do.

    3. Hi Sharon,
      Sorry you have this difficulty at home.
      It is indeed hard.
      May I suggest, read all you can. My first books were written by Gina Pera.
      I even ordered one via Amazon and had it sent to my physicians office!
      She has two books.
      “Is is YOU, Me, or Add?”
      also
      “Couples Therapy for Adhd”
      You’ll be underlining nearly every sentence!
      Please, when you make that next appointment with a new Doctor, ask the front desk if patients, adult patients with Adhd, are treated by the doctor.
      If not, keep calling around.
      Kindest regards to you,
      Sincerely,
      Nancy
      ps If your partner ……….
      had a Cancer, Diabetes, or Kidney failure, both of you would be working together to beat it or get a handle on the newest information. What you hear, your partner may not.
      Take notes. Lots of them. Even when at home. Document what ya eat and mood changes. Date your notes.
      Be sure to take your notes with you to the doctors office.
      As they will give you only so much time, make it worth while.
      Good Luck.

    4. Thanks, Nancy, for that vote of support!

      I just “wrapped” the 45th video for the first course in my online training series.

      It is ALL about education and becoming pro-active mental-healthcare consumers.

      g

  14. I am 41. I started law school once and failed because there is no way I could collect my thoughts and communicate them in the allotted time.
    I gad not recalled a time every struggling in school. I may not have gave it my all, but school came with ease.

    Well that’s what I thought anyway. Five years later, 6500 worth of student loans to pay for three evaluations and testing.

    The third time was a charm. It was over a three day period I was given multiple tests and or games.

    Fast forward to now. I am in my last year of law school, I was able to get an accommodation for extra time and five months ago ( and many years later) I finally was given medication as management.

    There is no follow up, nothing. I first tried cymbalta because along with the adhd I have chronic pain from car accident.

    The cymbalta did not work and made me feel like I was having zaps to my brain

    I’m not on med two, Adderal. I have been on this med for about a month and I feel like I want to explode. I have no patience and I am snappy and irritated 90% of the time. I would venture to say this drug is not for me.

    My doctor scheduled an appointment for 3 weeks, but in the meantime doubled my dose to adderal Xr 30 mil. I am currently at 15mg.

    I am getting ready to start prepping for the bar. Although I do like my ability to stay on task with it, the side effects are excessive.

    How do I go about getting someone to help me. I have Kaiser and they suck, I don’t have money to spend on private care and I want to be on regulated medication by May to sit the bar in July. Please help!!!

    1. Dear Adrienne,

      I am outraged for you. HOW DARE THEY.

      Can you possibly delay taking the bar???

      That doctor sounds like a knucklehead — you’re describing bad side effects and he says to “double the dosage”.

      We joke about that in my local adult ADHD group. But its gallows humor. Our incredulity at the inanity. And it happens more often than most people realize.

      Adult with ADHD: I tried the new medication. The first day, all my hair fell out. The second, I sprouted a third leg. I called the doctor to report the symptoms. What do you think he said?

      The rest of us: DOUBLE THE DOSAGE.

      I tell you, it would be laughable if it weren’t so reckless. Kaiser-Permanente has a VERY bad reputation here in Silicon Valley, at almost all locations (except maybe SF). KP has also paid millions of dollars in fines for underserving patients with mental-health issues.

      If you’re stuck with KP, you will have to self-advocate.

      I don’t know where the MD love came from for Cymbalta, especially for ADHD. (I suspect a big marketing push.) It’s not even close to being recommended for ADHD. It’s outrageous.

      Moreover, many people with ADHD have an easier time managing the “pain signals” from chronic pain once they start stimulant medication.

      Why would he prescribe Adderall? Because every MD with a Rx pad seems to have gotten the idea that it’s the “best” for adults.

      Why? It’s a mystery. Well, at least that’s all I’ll say publicly.

      PLEASE. Take control of this.

      If you’ve never tried the other class of stimulant (methylphenidate), you might want to try Ritalin or Concerta. ASK the MD FOR IT.

      If you try Concerta, try to get brand (typically a problem with KP, though). There’s a savings program now but some KP members have told me it doesn’t matter; the docs won’t prescribe it: https:Concerta.net Avoid the generics: They are nothing like Concerta brand. Unless you can get the authorized generic, which is a bit complicated– and more than you need to deal with right now.

      I don’t know what the KP doc will prescribe. They can be very difficult and the pharmacy limiting.

      Alternatively, you could try a LOW DOSE of Vyvanse—some KP members have been prescribed that. Don’t let the MD talk you into an “average starting dose”. There is no “average” when it comes to ADHD.

      The motto is: Start low, increase slowly. If you get a low-dose pill, you can more conveniently just double it — rather than waiting for a new prescription, etc. etc.

      Some people might be outraged that I am suggesting that you manage your prescriber. Who am I? I am someone who has seen this human tragedy play out way too many times. It’s a public health crisis.

      Read my book’s chapters on medication. Use that as your guide. The advice comes from a preeminent ADHD expert, Margaret Weiss, MD, PhD.

      https://amzn.to/398b7Ao

      Best of luck to you. Don’t be cowed. You’re obviously smart. Read those chapters and self-advocate.

      take care,
      g

  15. I started Adderall XR about a month ago. I was diagnosed with ADHD at 37. It took a good 2-weeks of consistently taking the drug to finally get used to it. Those first two weeks I felt so calm all I wanted to do was listen to music and lay in bed. Starting the drug was a little rocky, with some mood swings. I must say,though, I had very bad mood swings before starting Adderall. With proper diet, yoga, meditation and a positive mindset, only then Adderall works. You can’t just pop a pill and expect it to work. You got to get to bed at a reasonable hour, stick to a morning routine, and eat healthy.

  16. They put me on adderall as a kid and it gave me focus but it also destroyed my social life, gave me crushing anxiety that I still deal with today, and turned me into a zombie. That drug may be good for some but I wish doctor’s and especially insurance companies would stop trying to force it on people. My insurance for instance wouldn’t even pay for anything else till I had tried adderall again. Finally found what would work for me in zenzedi (dextroamphetamine) but I’ll probably be on anti anxiety meds the rest of my life now after years of my childhood being forced to take large doses of adderall

    1. Dear Evan,

      I’m so sorry that you have the first-hand experience on this.

      I absolutely agree with you. I’ve worked for 20 years to get prescribers to shape up re: Adderall.

      Would you believe I’ve never found one to support this view? What I’ve heard instead is, “Well, Gina, you know Ritalin can have side effects, too.”

      It’s a good thing I’m not vulnerable to gaslighting, because I might have capitulated long ago.

      Unlike these physicians, I am privy to the stories. Far too many stories. Not rarities.

      I assume that you’ve tried the methylphenidate class? Sometimes the amphetamines create anxiety — or exacerbate underlying anxiety.

      So maybe it’s possible that it’s the AMP class that is creating the anxiety problems?

      At any rate, many adults with ADHD have a neurogenetic co-existing condition. That is, for example, anxiety that is related to problematic serotonin/norepinphrene transmission rather than anxiety as fallout from untreated ADHD.

      I suspect I know why the insurance company requires you to try Adderall first. Because a meta-analysis based on VERY paltry evidence determined that Adderall was the best option for adults.

      That’s another blog post in draft mode. Counting that horribly flawed meta-analysis.

      take care and good for you, for looking out for yourself,
      g

  17. This whole article really spoke to me. I’m 19 now, and I was first put on Adderall when I was 9 years old. I can’t even remember life without Adderall in it. I have wasted so much time going to different physiatrists, doctors, specialists; you name it I’ve seen them. I’ve always known that Adderall has been causing problems because it never really worked in the first place. I became so dependent on that drug that when I did not take it I would feel moody and anxious. For the first time in my life, I have a choice, and after reading this I am going to talk to my physiatrists about stopping it.

    1. Dear Blaire,

      Good for you. Being pro-active is the only way to go.

      So many kids with ADHD have been turned against treatment because the prescriber was not careful, did not educate the child on how they should (or should not) feel, did not ask for feedback from the child or parent. It’s just criminal, really, especially because it still happens.

      It might be that you still benefit from stimulant medication, but that Adderall is not the best choice. So, you should know your options. Trust me on this.

      I encourage you to read my book’s chapters on medication before talking about this with your psychiatrists. Chances are good that, after you do, you will know much more than they do. You can even provide them with a photocopy.

      https://amzn.to/3jdB1FS

      Good luck!

      Gina

  18. as drug addiction. Elvis, who in his last decade lived on alternating currents of uppers and downers, took pain medication and other approved substances. But like most prescription-drug casualties, he was convinced that he occupied a different sphere from all the scurrilous and sordid addicts hooked on cocaine or heroin. (He wasn t a junkie; he was taking his medicine.) Today, if you talk about the opioid crisis, or what it means to be a methamphetamine addict, you ll conjure up a desperate, grunged-out myth of heartland depravity that s light-years removed from the safe medicalized images of a dutiful shrink writing out a prescription for Adderall. Yet in the urgent and eye-opening documentary Take Your Pills , which premieres today on Netflix, the director Alison Klayman deconstructs those prejudices to show you how potentially misleading and dangerous they are. Her movie focuses on the class of psychotropic stimulants (Adderall, Ritalin, etc.) that are now prescribed, at epidemic levels, to treat ADHD and other attention disabilities.

    1. You’re welcome, Brian! I’m glad you found it useful.

      Treating ADHD with medication is not typically that complicated — for prescribers who know what they are doing.

      Too many, however, see treating ADHD as simple. As one psychiatrist said to me (and I’ll never forget it):

      “Treating ADHD is easy. You just throw a stimulant at it.”

      take care,
      g

    2. I was misdiagnosed with ADHD at 38. And adderall ruined my life and relationships. I am still trying to repair the damage. It ruined my relationship with my family, my children, my friends, my coworkers. I destroyed my health. Adderall is a terrible drug especially for someone who doesn’t have ADHD. I’ve beem off of it for over a year. I took it for almost a year. My life has improved immensely. I am so grateful to be off of it and rebuilding my life.

    3. Dear Dan,

      I’m glad you have been on the road to recovery.

      It’s so difficult, to have heard these stories for years, and still to—after finally helping someone to get diagnosis—learn that the doc has prescribed Adderall.

      It’s insane, really. And I’d like to take away their prescribing pads.

      Thanks for validating the phenomenon,
      g

  19. Gina,
    I came across your article while researching adderall as I have just started taking it. I wasn’t diagnosed until now, at 22. I really resonated with the section in your article about ADHD sneaking up on people. I felt seen, heard. I was the smart kid in high school who didn’t have to pay attention to do well, so I didn’t, and no one noticed because my grades were good.

    But then I got to college. I struggled through college, I couldn’t sit through a lecture without messing around on my laptop, or my phone, or just doodling. I didn’t even get help until I actually graduated and realized I can’t even watch tv anymore because I couldn’t focus for a 30 minute episode.

    Anyway, I just appreciated knowing I’m not alone in this situation. Especially now, coping with my new diagnosis and thinking about what could have been if I’d gotten help before.

    1. Dear Madeline,

      Thank you for validating a storyline I’ve heard a few times—but that of course raises eyebrows among people who don’t understand ADHD. Including the grandstanding reporter at The New York Times.

      It’s a storyline that many mental-health professionals won’t understand, either.

      It might be that your distractibility, etc in college is “professionally” interpreted as something else entirely….after all, you did great in high school! It must be that you have Fear of Success or …something.

      It can be the same thing with marriage, with buying a house, with having a child, with getting a promotion. Even “good” things can be the straw that broke that camel’s back — that is, push the brain’s executive functions beyond their capacity the brain’s executive functions.

      Though it may be difficult, I support your reflecting on what might have even — not to be maudlin or stuck in the past (and not that you can really ever know how the past might have been different…it might have been not so good!). But rather to understand on a profound level how when ADHD goes recognized, it can rob people of their free will and the future they might have had.

      I hear from people of all ages, many decades older than you, only now discovering that ADHD explains so many mystifying (and sometimes crippling) challenges.

      Thanks for writing and good luck to you.

      G

  20. Hello I have been in a relationship with a man who has a severe adderall addiction. I won’t get into the horrendous details in this comment.
    But, your article came up, about adderall and you spoke of how your husband? Is this correct? How the medicine changed him? And then I clicked on your book link and felt like this may be a book I really might need to read. But I wanted to get reviews on it, Amazon didn’t offer a description of what the book was actually about…
    So I googled it…
    And I found a link that actually allows you to read the first 40 pages like a “sample read”
    And I have just read the introduction, I guess you could say, it sort of confused me and wasn’t really what I expected…
    I read the introduction and you state how you are “pro-medication? Is this correct?
    Because they introduction to me didnt seem congruent with what I read in your article online?
    I just want you to know that I am genuinely trying to understand is all. And please correct me if I am wrong.

    The introduction seemed more focused toward identifying adult ADHD, and how to deal with it, and manage it, which is great for people seeking out this very much needed information, which I absolutely commend you and others for sharing your stories, and for putting this information tool out there for people who I am sure have and will benefit very much from…
    Because what I think I was able to perceive about you? Is that you are very well knowledgeable and educated about the subject of ADHD.
    I did also get the feel that you want to help.

    AND me myself I apologize for any struggles and my heart sincerely goes out to you and any other person who is affected by anything having to do with mental issues, strife, conflict, addiction, grief, or any sorta struggles in life making life more of a struggle than others already is.

    I have a deep empathy because I myself am a single mother of 5 children ages 19- down to 6… who have been diagnosed with different mental illness ranging from high functioning aspergers/with a combination of prevalent comorbiding bi-polar, to Borderline personality disorder, in the middle I have a child also on the spectrum but has been dianoised with ADHD also raised two boys that my ex-husband had from his first marriage and they are ages 25 and 26 now, were 5 and 6 when I met him. The 25 year old was also dianoised with aspergers so I understand fully the struggles and my ex-husband and I myself are very educated about a wide variety of mental issues, unfortunately it seems we are more knowledgeable than “the experts” to the point of having to educate them…if that makes any sense?

    and I hate to say this, and I don’t want to come across as arrogant but it is true, and it has been a very difficult road I have to say for him? Over 20 years, for me? 20 years and it continues to be a struggle… But we constantly educate ourselves effectively co-parent best we can, during the times we don’t have horrible communication breakdowns….

    But like I was saying, I was expecting the introduction to be more anti-medication I guess??

    Giving information about the drug adderall and the cons of taking it and the effects it has on a person’s brain, personality ect that people may be unaware of.
    And how “adderall” was what changed your husband, causing martial break-down and the affects that did to you? And your marriage. Like, what I have perceived from this article.

    But, like I said that’s not what I gathered when i read the introduction and a sample page.

    Your book introduction actually contradicts this article? I believe because you say you are pro medication, and it more focus on how ADHD was the problem in yours and others situations? Not the medication

    Like the stories of the husband that had a spending problem, or the one who would get distracted when the children were left in his care?
    So, please. If you could help me understand my perception of incongruency? And correct me if what I have perceived is incorrect…I would appreciate it very much.
    Thank you

    1. Dear Faith,

      I appreciate your question. And I understand your confusion. I’ll take each question separately.

      1. My “pro-medication” stance

      When my first book came out, in 2008, Adult ADHD was little known. Much less well known: Adults taking stimulants for Adult ADHD. There was also a certain organization that calls itself a “church” (for tax purposes) that was waging quite a nasty campaign against ADHD and the medications used to treat it.

      As a book based on the science, my book confirmed the science of ADHD medication treatment: It works. That’s why I wanted to take a very clear statement on medication.

      My book also, though, detailed an approach to medication that few prescribers follow. Instead, many have been “throwing Adderall” at patients, with little regard for monitoring.

      That is what I warned about in this article (and warned about for years previously):

      https://adhdrollercoaster.org/adhd-news-and-research/the-tragic-truth-of-prescription-adderal-or-madderall/

      Adderall is unique among the stimulant class of medications. It has additional effects. That means it works the best for a minority of people. But it creates a higher side effect profile for many others.

      That’s why prescribers need to pay attention.

      But no, Adderall did not cause a marital breakdown for me and my husband. He tried Adderall early on, and that’s when I noticed that the “treatment was worse than the condition.” But the condition was still difficult enough.

      That motivated me to help others avoid the dangers of mindless prescribers.

      Done properly, medication for ADHD can make an enormously positive difference. This is an essay from a woman diagnosed later in life with ADHD, followed by her husband’s diagnosis. She writes about the before and after of medication treatment for them both.

      https://adhdrollercoaster.org/book-club/medication-help-adhd-relationships/

      2. You are more knowledgeable than “the experts.”

      You ask if that makes sense. Unfortunately, yes.

      Especially when it comes to the “specialists” who see only one piece of the puzzle and ignore the rest.

      For example, if you see a mental-health professional who knows about (or thinks he or she knows about) autistic-spectrum disorders (ASD), you might get that diagnosis for yourself or your child when the correct diagnosis is actually ADHD. Or at least ASD and ADHD.

      That’s because the professional doesn’t understand that ADHD is not always about “hyperactivity.” It can be about difficulty with social skills, making eye contacts, etc….all the things they think are ASD.

      Also: At least half of those diagnosed with ASD are thought to also have ADHD. So treating the ADHD might help them, too.

      And the same with “bipolar specialists” — they want to see ADHD symptoms as a type of bipolar.

      All this misdiagnosing and mistreating is a public-health crisis, in my opinion. That’s why I do this work.

      I hope that answers your questions. And best of luck to you in helping your children. You have a lot on your plate.

      g

    2. She says numerous times that it does work very well for some but not for all. She’s trying to educate people so they can make more informed decisions or know what kind of things to look out for. Why condemn a medication all around when it can be a good thing?

    3. Thanks, Courtney. 🙂

      As my husband is known to say to me: “Are you trying to convey nuance and gray area on the Internet again? You know that’s a recipe for trouble.” 🙂

      take care,
      g

  21. Hi Gina,
    I have a few questions. I have been prescribed vyvanse for my ADD and taking it for over 9 years now. My tolerance had built gradually and for the past 3 years I’ve been on 70mg. My doctor also prescribed myself 20 mg adderall to take on afternoons if I had excessive work that evening. I’ve had my “as needed” prescription of adderall for the past 4 years now. I am a 21 year old student in college. For the past few months I have noticed my extreme lack of motivation and excessive sluggishness—even with my vyvanse. And I can do absolutely NOTHING without it—even the smallest tasks I used to be able to do. I can confirm that I am reliant on it to even get out of bed. THE SMALLEST TASKS FEEL IMPOSSIBLE. I even struggle to take my pill in the morning because I don’t even have enough motivation to go get a glass of water to take it. I have also been experiencing chest pains from time to time and it has been really hard for my eyes to focus lately (specifically when I take my adderall). This realization has been extremely concerning to myself so I reached out to my mother. Here is the thing, I told my mother that I think I am dependent but she dismisses me. Considering I’ve been on meds since 6th grade, my mother knows how much they have helped me focus with my add. I think she doesn’t want to believe that this dependency is a problem because she has seen firsthand the good they have done. She thinks I’m exaggerating and since she can’t feel what I’m feeling she doesn’t understand. She only sees 9 years of positive results.

    Here’s the other thing.
    I decided to research theses changes and the more I researched the more problematic things became. I think I was misdiagnosed with ADD and that in 6th grade I SHOULD have been diagnosed with Sensory Integration Disorders (which are commonly mistake for ADHD). I have never had the hyperactivity—my main symptoms were that I could not focus on homework and if there was even the smallest sound I would throw a tantrum. I also had trouble with reading comprehension (which the doctor attributed to my inability to focus).
    I am 99 percent certain I have SID after reading about it. I Don’t know what to do now. It’s been over 9 years of my life on these meds and I’m not even sure if they were the correct diagnosis to begin with—what if that is the reason I kept upping the doses—not tolerance but because they weren’t fixing all of my symptoms (specifically my reading comprehension skills—my meds only caused me to hyperfocus and dissect words and reread paragraphs 50 billion times until they made sense). Then I started reading about long term effects of taking these drugs if you don’t have ADHD as well as long term abuse. Chest pain, blurred vision, etc. I have literally experienced multiple of the effects over these years and I never even knew it. I’m terrified that I have done 9 years worth of irreversible damage on my body. I don’t want my mom to dismiss me again and I know she will and I’m worried that my doctor will stop my meds because they are already so cautious with prescribing them (for good reason). And I’m worried if I tell her these things and it turns out I’ve done irreversible damage on my body, how will I ever get out of bed again?? I cannot fathom how I will handle that especially with the numbness and lack of motivation I have recently been feeling.

    Sorry this is so long! I just needed to get this out.

    1. Hi JoAnn,

      I’m sorry you are struggling with these side effects—because from what you’ve written, it seems likely that’s what they are.

      But I completely understand why you are questioning your diagnosis of ADHD, in favor of one for SID. I’ll explain about that below.

      Overall, I encourage you to relax a bit about the side effects you are reporting, insofar as doing “permanent damage.” There is a lot of nonsense online about ADHD and stimulants.

      That doesn’t mean you should just live with it. No, you should definitely try to improve this situation — and recruit your mother’s help. None of what you report should be the price of “focus.”

      https://amzn.to/3a9WDQH

      Here are my thoughts:

      1. Battle for Territory

      SID is one of those conditions that tend to be secondary to ADHD — that is, ADHD neurobiology can result in those symptoms. That means ADHD treatment typically helps treat the “SID” as well.

      Keep in mind: SID is a term used in the field of occupational therapy, not psychiatry. It is not a psychiatric diagnosis. It is not even a medical diagnosis.

      And that’s part of the problem. It’s a “territory battle” between two specialties: medical psychiatry and occupational therapy.

      The trouble is, occupational therapists (as much as I respect them) are not neuropsychiatrists. That means too often the occupational therapists (OTs) see SID where a competent neuropsychiatric sees SID as resulting from ADHD neurobiology.

      In other words, OTs are essentially seeing one “side effect” of having ADHD — and viewing it as a standalone condition.

      Speech therapists often do the same thing with “auditory processing disorder” (APD). But there is no evidence that APD exists except as secondary to ADHD.

      It’s important to make these distinctions because in both cases stimulant medication has been shown to be the most effective.

      In the end, it might be that you have only SID (even though it’s not a recognized medical diagnosis). But I see enough other issues that point to having inferior treatment for ADHD, and that might be causing the side effects you report.

      I encourage you to start there and put SID on the back burner for a while.

      2. Stimulant addiction

      I understand your mother’s perspective — she is probably worried that you are close to rejecting the ADHD and stopping the only treatment that has been effective.

      But I also understand your perspective. You express alarm at feeling that you would be completely non-functional if it weren’t for the drug that is also potentially creating chest pains. You report also experiencing blurred vision.

      It might be that you have developed a tolerance. But it might also be that your dose is too high or other factors are at work.

      Some questions I would ask about factors that can increase stimulant side effects:

      Are you getting sufficient sleep>?
      Are you consuming caffeine?
      Are you eating a well-balanced diet, including sufficient proteins (not “HIGH PROTEIN DIET”, but enough protein ….because protein’s amino acids are the building blocks of neurotransmitters such as dopamine)
      Are you taking a supplement or other medication that might be interfering?
      Have you been evaluated for co-existing depression or anxiety (that is, standalone conditions that aren’t the result of being “depressed” or “anxious” from facing ADHD fallout)?

      3. The “booster” dose

      Personally, I am not a fan of the “booster” dose. That’s because I’ve seen it too often used when the entire process of “dialing in” a medication for an individual has been done in a haphazard manner.

      70 mg is a relatively high dosage of Vyvanse (if you aren’t a known fast metabolizer). Sometimes doctors increase the dosage when they should be adding another dose hours later. In other words, instead of increasing the dosage in order to make it last longer, they should be considering adding a second dosage later. Increasing the dosage above what works well for a patient means more side effects.

      In other words, maybe you would do best on one lower dosage of Vyvanse in the morning and another dose as that first is wearing off. The fact is, these long-acting medications don’t always last as long as promised. It depends on the individual’s metabolism — slow, normal, or fast.

      For another thing, Adderall is NOT the same as the medication in Vyvanse. Both are amphetamines but their mechanism of action is very different. By taking Adderall when Vyvanse wears off, you are essentially starting an entirely different process in your brain, one that might require adjustments each and every time.

      Moreover, it might be that you would do better on a methylphenidate option (e.g. Ritalin, Concerta, etc.) than on an amphetamine (e.g. Vyvanse, Adderall, etc.). If you’ve never tried a methylphenidate option, that might be worth looking into.

      I encourage you to print my comment for future reference and for sharing with your mother. And do read my book’s chapters on medication — and ask your mother to read, too:

      https://amzn.to/3fBADzl

      I hope this helps!

      g

  22. Hi Gina,

    Great write up! Definitely know your stuff. I see some comments about people stating their opposition – most of them with a strong emotional response rather than using logic and rational thought.

    I had been on vyvanse 60mg for over a year (30s, Male/active/health-conscious) and saw many of the undesired sx that you mentioned: increased irritability, random bouts of anger (often internalized into “unused adrenaline-dump” feeling), and lack of emotion – all during the second half of the day. I wouldnt say it was ruining any relationships but I realized something was not right.

    I assume it has something to do with dose and come-down type effects – but many of these symptoms became worse as time goes on even with routine breaks in medicating. I soon found though that I could not take more than a day w/o meds before I was sad, unmotivated, and stuck in bed all day.

    I am interested to hear your thoughts on how hormones might play in here. Obviously you have extensive knowledge so I am sure this has crossed your mind. But I recently had a blood test for total/free testosterone (and some other markers) and although I was considered “normal” – ~400 total T – I knew from speaking with other professionals that normal falls under a large window for males, ~250 – 1000. I saw an online MD and he prescribed me TRT with a follow up blood panel.

    Generally I dont advocate HRT or TRT for individuals still in their prime but after about two months I am around ~750 total T and my other markers look normal. I cant believe how amazing I feel: no anxiety, fear, anger, etc. during those two months starting TRT I weaned off vyvanse from 50mg to 40mg, to cold turkey. I slept extraordinarily well the first three nights off, then felt normal with no depressive sx and havent looked back. I feel focused, calm, and driven.

    Sorry for the long response. Just wanted to share and hear your thoughts. Thank you!

    1. Hi Cam,

      Thanks for the kind words.

      Over 20 years, I’ve sort of gotten used to the attacks. Mostly, I see how desperate the people making them feel. Even though it can still sting, I get it.

      You ask a question I’ve been asking for a long time. About testosterone.

      Shortly after I started this work, a urologist came out with a book on testosterone, mood, libido, etc.. He made a very convincing case.

      I’d heard from more than a few men with ADHD about having “low T.”

      The more I researched, the more I wondered if ADHD itself was creating the low T.

      For example, hormone functions are controlled by the brain. When the “signals” are erratic so too can testosterone (and other hormone) production.

      Also, I read about some evidence that testosterone can be affected by one’s perceived “status”. That is, roughly, a man whose ADHD means he has trouble at work, in relationships, etc. feels “low in the pecking order” — and that, on some primitive level, can affect testosterone.

      Plus, for men with ADHD who lack the motivation and initiation to exercise regularly or eat well, that can affect testosterone, too.

      So, I could see that pursuing ADHD treatment (including medication, improving diet/exercise/sleep, etc.) might raise T levels.

      My main concern with testosterone supplementation, from what I’ve read, is that there are risks. For a man in his 30s, the risks might be particularly worth heeding.

      Generally speaking, 400 is not low. Most of the men I know with ADHD who complain of low T hover in the 300 and below level.

      The thing is, maybe Vyvanse was not the right Rx for you. Or, maybe it was exacerbating brain-based vulnerabilities around serotonin (anxiety, irritability, depression, etc.).

      Most adults with ADHD will have at least 1 co-existing condition — and 50% will have two.

      It’s important that the prescriber address the full range of symptoms. Ask me how often this seems to happen. I’d guess about 20% of the time, if that.

      If you feel great, it’s hard to argue with success. But I might encourage you to get a second opinion. An “online MD” might have quite the mill going, with insufficient concern for patients.

      Thanks for writing.
      g

    2. Hi I struggle with amphetamine script addiction I so desperately want off this medication but can’t stop now I’m wondering if this could be because of my hormones could you tell me what TRT and HRT mean.Thank you so much.
      Gina you will never know how your helping people may God bless you..

    3. Hi KC,

      Thanks for letting me know. It helps to re-charge my batteries. 🙂

      I’ll give Cam a chance to respond. But HRT= “hormone replacement therapy” and TRT = “testosterone replacement therapy.”

      Which amphetamine are you taking? Adderal? Dex?

      If you’ve never tried the other class of stimulants (methylphenidate), you might talk to your doctor about that. The choices include Concerta, Ritalin, and many more.

      Or, if you do better with the amphetamine class, maybe try a smoother delivery such as Vyvanse.

      Sometimes the biggest problems are caused by the delivery system. Immediate release or even some extended-release options can be very “hill and valley” or “roller coaster”.

      The more sophisticated delivery systems, such as with Vyvanse and Concerta, offer a long, smoother, steadier release.

      take care,
      g

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