The topic here is prescription Adderall. Specifically: Adderall is too often prescribed badly. Adderall effects on personality can include irritability, anger, lowered empathy, and self-awareness.
Moreover, reckless prescribing patterns have intensified public and political backlash against the diagnosis itself.
Let’s get this out of the way:
- Prescription Adderall works very well for some people.
- For others, Adderall create more problems than it solves.
- Do they always know this? No.
- When Adderall does cause problems, it can negatively affect personality and objectivity to the point where the person will not listen to others’ concerns.
- Prescribers’ love affair with Adderall for adults with ADHD is based on misinformation. That is, many believe that Adderall is “best” for adults. That is patently false.
ADHD Medications: Self-Educate & Self-Advocate
How can you or your loved avoid being yet another victim of Madderall? Self-educate and prepare to self-advocate. No one cares more about your or your loved one’s life than you do. Being passive is extremely risky. Even with extremely confident prescribers. Perhaps especially with those.
The truly tragic part is this: Poorly prescribed Adderall can create negative personality changes in people who seek only to treat their ADHD:
- Anxiety
Short temper - Sleep deprivation
- Even what looks like (and might be) mania
Trouble is, they might not see this objectively. Unfortunately, their prescribers typically don’t ask—or connect the dots. This triggers a cascade of negative outcomes.
You might say, “So what? Just try another medication.” I often hear this from physicians who consider themselves ADHD-informed. Trouble is, they do not have their ear to the ground as I do. Moreover, for reasons I’ll explain, Adderall’s effects often mean no other stimulant will be tried.
A Necessarily Long Post — with Scanning Aids
This is a long post. By necessity. I created hyperlinked subheads to ease your scanning. At the end, I’ll offer a preview of what competent prescribing for ADHD looks like. So you can help guide it.
You will find other articles on this topic ….now. Mine was first, in 2013, and the only until very recently. One reason for this: Adderall has become a lucrative keyword in increasing web traffic. Not for me but definitely for commercial “health” and ADHD sites.
FYI — No Adderall-Abuse Tips Here!
Maybe you found this article while seeking to illegally procure or “hack” Adderall. Sorry to disappoint! If that is your goal, please read this first. It might save your life.
If you leave in disappointment after 5 seconds, my blog’s “bounce” rate increases. That’s a big Google-search penalty, kicking this post lower in search results. After a slew of paid and promoted superficial articles top the search list.
I leave it here anyway. Why? Chances are good that you actually have ADHD and are attempting to “self-medicate” it. That never ends well. I hope you will re-consider.
In This Post about Adderall, or Madderall:
Here are the overall topics in this post:
- The New York Times has a long history of anti-psychiatry reporting. This was my initial catalyst in writing this post, in 2013.
- Many prescribers (including psychiatrists) incompetently treat ADHD. This has devastating consequences.
- Why, to avoid these adverse outcomes, we might consider prescription Adderall not as a first try but rather a last-stop in stimulant medications.
- The importance of consumer self-education and self-advocacy.
- An excerpt from my first book’s chapters on medication.
The Major Sections — Hyperlinked
Click on any topic to go right to it.
- What your prescriber doesn’t know might hurt you.
- How reckless prescribing of Adderall has damaged ADHD’s legitimacy
- Why has this malpractice continued unchecked?
- Conflicts of interest abound
- ADHD treatment is complex in that it affects individuals, not clones
- Google search terms that bring readers to this post
- The New York Times anti-ADHD campaign — that pushed me to write the original post, in 2013
- Adderall works best—for some
- Core problem: Reckless Adderall prescribing and little monitoring
- Contributing problems: A larger view
- Excerpt from YouMeADHD on working with your prescriber
1. What Your Prescriber Doesn’t Know Might Hurt You:
- Poorly prescribed Adderall can ruin lives and relationships due to its negative effects on personality, among other factors..
- This sometimes true for Dexedrine, too. Those of you in Australia, where the the national healthcare system (Medicare) has long considered it the stimulant of choice, be aware.
- Individuals experiencing poor results from Adderall often don’t realize it. They believe it’s the price of long-illusive focus. Their loved ones might, too—while they walk on eggshells, frightened. (Read the comments.)
- Next stop: These adults with ADHD might develop a cannabis, alcohol, or benzodiazepine habit to “come down” from the Adderall.
- Or: They love the intense focus too much to let go— no matter if that focus dangerously reduces self-awareness. (In other words, they assume that everyone else has the problem, not them.)
- Poorly prescribed Adderall can create or exacerbate anxiety, irritability, grandiosity, tunnel vision, and even rage.
-
That’s why 25 years ago I started calling it Madderall.
(Note: I’m seeing the term Madderall now appropriated to describe combining marijuana and Adderall. That’s not my definition.)
2. Reckless Adderall Prescribing Fuels ADHD Backlash
The truly tragic part? There are so many less risky options to try first. Prescribers should be making things better, not worse. From my perspective, this is is a long-running public health crisis. It has contributed to a backlash against the diagnosis itself. Again and again.
Recent case in point: Alarming stories about “tele-health” clinics over-prescribing Adderall became inseparable from “ADHD is over-diagnosed.” For example:
Wall Street Journal Startups Make It Easier to Get ADHD Drugs: That Made Some Workers Anxious
Axios: Telehealth startup to Stop Prescribing Adderall for New ADHD Patients.
No doubt these venture-capital startups were cutting corners. Yet, it’s also true that COVID pushed ADHD to the fore for untold numbers of people who had been only marginally coping before. They needed care and found it wherever possible. Now news outlets and grandstanding pharmacies (I.e. CVS) conspire to make it harder to get the diagnosis and treatment—and create more backlash.
That’s a prime example of how the mis-prescribing of Adderall creates anti-ADHD stigma.
3. Why Has This Malpractice Gone Unchecked?
Why do doctors favor Adderall for their patients with ADHD? Especially given that they fail to provide guidance or use rating scales or seek third-party reports?
Here’s one shocking reason: Many prescribers misread a meta-analysis based on old, scant (and one might say one-pharma-skewed) data. A meta-analysis is not established standard of care. It is only as good as the research it analyzes.
Three other reasons:
- Adderall’s manufacturer was notoriously aggressive in its marketing and fraudulent in its claims—with lasting effects
This company was fined $56.5M in 2014 for its false claims about Adderall and a few other drugs. Read more at the U.S. Department of Justice website: Shire Pharmaceuticals LLC to Pay $56.5 Million to Resolve False Claims Act Allegations Relating to Drug Marketing and Promotion Practices
2. This manufacturer has long wielded, in my observation, undue influence over most ADHD websites and personalities you see online and elsewhere.
Unfortunately, this includes psychiatrists, psychologists, coaches, and non-profits, including board members and conference speakers and organizers. Most people would be shocked at how this one pharma covertly pushes its agenda through so many tentacles.
Please know, I’ve been openly “pro-medication” for decades. Medication properly chosen and prescribed, that is. This pharma’s marketing is something else entirely—and has resulted in ADHD backlash again and again.
3, Too many prescribers remain clueless, cavalier, and disconnected from consequences. I don’t say this to discourage seeking treatment! Instead, I want you to be a savvy healthcare consumer.
Yes, prescribers often have little time with a patient. That does not excuse this scandalous mess with Adderall and prescribing in general for ADHD.
Why haven’t other ADHD experts calling this out? You’d have to ask them.
4. Conflict of Interest: Pharma Industry Support
Back in 1999, I was an award-winning journalist before falling into ADHD world. As such, I naturally avoid conflict of interest. Good journalists know that even accepting a free lunch is a slippery slope.
My “pro-medication” stance was rare then —and therefore risky. The “ADHD Gift” campaign dominated. Accepting Pharma industry support would sabotage my credibility. That’s why I didn’t and never have. (It’s certainly not because I could afford to work without compensation.) This puts me squarely at odds with certain organizations, personalities, and outlets.
To be clear: Researchers receiving pharmaceutical funding falls into a different category. Research validity rests on the researchers’ reputations and methods — and replication. Researchers must disclose such funding. By contrast, most proclaiming ADHD expertise online or in books are not researchers nor do many of them have proper credentials.
This might shock you; Many “ADHD influencers” fail to disclose this pharma support. That includes licensed psychologists and physicians with platforms built by that pharma. This indirect support includes public relations efforts on their behalf and being placed (forever) in prominent positions at ADHD non-profits, at “tele-conferences,” and more. The upshot: Blinkered amateurism is presented as expertise.
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5. ADHD Treatment Is Complex:
- Treating ADHD is not simple. It is a complex syndrome that affects individuals, not clones.
- Genetic differences among individuals affect drug response.
- Late-diagnosis ADHD is typically complicated by longtime sleep disorders, adverse life events, and substance use; it takes time and skill to disentangle these contributors.
- Prescribing requires expertise and method. Start low, titrate slow. Rating scales. Third-party feedback. And much more.
- To further complicate matters: Adderall is also a popular drug of abuse. Yet, even the story of “Adderall Abuse” is complicated.
6. Which Adderall Search Term Brought You Here?
Mostly, readers find this post legitimately, using terms such as these (to name only a few):
- Adderall makes my spouse angry
- Can Adderall make you irritable?
- Why is Adderall making my ADHD worse?
- Depression and anxiety from Adderall?
- Anger outbursts and Adderall
- Does Adderall change your personality?
- Adderall is spiking my blood pressure?
- Why is Adderall dilating my pupils and making me look crazed?
- Irritable after Adderall
- Can Adderall cause bipolar?
- My husband started Adderall and is an angry jerk now
- Can Adderall cause aggression and sexual behaviors in the elderly?
- Why is Adderall just making me tired now, after working for 2 months?
- Adderall changed my personality
7. More Traffic-Boosting ClickBait From The New York Times?
7. More Traffic-Boosting ClickBait From The New York Times?Back in 2013, a back-channel tip came in one day. I steeled myself for the next anti-ADHD screed from the paper: “Drowned in a Sea of Prescriptions.”
As a young journalism student, I respected The New York Times as an exemplar of journalism. Sadly, that’s long in the past, at least in the context of reporting on psychiatry.
Make no mistake: The paper still has respectable editors, reporters, and sections. Yet, the front-page editor for several years seemingly demonstrated festering personal antipathy toward “biological” psychiatry. That is, the idea that our genes can adversely affect brain function—and that medication often helps.
Yet, no doubt something else was going on: the NYT website’s analytics. Any piece stigmatizing ADHD draws hordes of readers—and ad dollars. For years, the ADHD community protested in comments. Then they just mostly gave up.
Sure enough, after leaving the paper, former Executive Editor Jill Abramson called it “publishing by the analytics.” Google analytics, that is, that show traffic, how long a reader has read a page, where the reader went after, reader demographics, and lots more. It is now pervasive online, with virtually every news outlet and amplified in social media. That goes double for ADHD topics.
Over the years, I’ve called out the paper’s negative targeting of ADHD:
- Talking Back to The New York Times’ ADHD Myth-Mongering.
- The New York Times’ Unnatural Opinions on ADHD
- The Truth Behind “10,000 Toddlers Medicated for ADHD” – Parts 1 and 2.
This Time: More Adderall Grief—And Tiny Relief
Yet, when I read the 2013 story by reporter Alan Schwarz (“Drowned in a Sea of Prescriptions”), my reaction was both grief and relief.
Grief, that yet another person fell victim to prescription Adderall—and died by suicide.
Relief, that finally The New York Times’ grandstanding front page finally got something right about ADHD. Well, at least in tiny part. That is, the manner in which many prescribers treat ADHD largely resembles a giant game of “Pin the Rx on the ADDer.”
All else in the story is distortion.
It wouldn’t be former sports reporter Alan Schwarz’s last seeming bid to land a Pulitzer Prize. He didn’t—and no longer works at the paper. Nor is he still a reporter. But during his reign, he and his editors inflicted immense and still reverberating damage.
Example: Schwarz went on to resurface in a Netflix “documentary” from Maria Shriver and her daughter, Christina Schwarzenegger.
It’s called Take Your Pills — a real one-two punch castigating Adderall and ADHD, as if they are inseparable. Because, in too many prescribers’ minds, they are. That is exactly my point. (See Netflix’s Take Your Pills: Anti-Science—and Mean)
8. Prescription Adderall Works Well Sometimes
Again: For some people, prescription Adderall works well. It is the best choice for them.
Yet, prescription Adderall does have the highest side-effect profile among stimulants. If you’re just starting treatment, why start with the most risky choice? Why not try Adderall only after other stimulants (e.g. Ritalin, Focalin, Concerta, Vyvanse, etc.) have not proven effective.
Ideally, patients should receive a trial of both the amphetamine and methylphenidate classes. I explain in my first book, excerpted below. Why? Because it is impossible to predict beforehand how you will respond to either class of stimulant. It comes down to genetics. That means not just a few “ADHD genes”. It means potentially hundreds of genes, combining and contributing to this syndrome we call ADHD in myriad ways.
Oblivious to all these factors, many physicians routinely start new patients with Adderall—and at too high a dose. Among the people who join my groups or write to me, I’d guess it’s a whopping 90% who were started on Adderall. That is shocking.
9. Core Problem: Poor Monitoring of Prescription Adderall
In the early days of my advocacy, the early 2000s, I heard shocking story after story repeated in my Adult ADHD monthly discussion group in Palo Alto:
- Lackadaisical prescribing
- Poor monitoring (including no third-party feedback)
- Definitely over-prescribing of Adderall.
Similar accounts echoed through my local group and my online group for the partners of adults with ADHD (ADHD partner).
What was happening? ADHD treatment was supposed to make things better, not worse!
I’d done my homework in learning the evidence-based treatments for ADHD, including with prescribing. But I wasn’t seeing it in reality. As my husband the life scientist said, “It typically takes at least 20 years for the evidence of work works filters down to the clinical level.” (Twenty years later, I’m seeing worse, not better.)
Where Are Prescribers Failing Patients with ADHD?
To understand the essential problem, we must start with poor prescribing protocols for ADHD overall.
—Prescribers should track response
That is, they should be using a checklist of symptoms that helps them establish a baseline and then monitor medication response—and note any side effects. Only a tiny minority do.
—Prescribers should gather reports from family or close friends
ADHD is commonly associated with poor self-observation. Typically, this improves with medication. The wrong medication, however, risks further clouding self-observation — and worse.
—Too many prescribers don’t bother with either
Instead, they rely on a casual, “So, how’s it working for you?” If the patient complains of side effects, the physician often stops the Adderall and moves to Strattera, without trying any other stimulant. That’s bad medicine. It’s even worse when prescribers go farther afidle, with third, fourth, and fifth-line ADHD treatments such as Wellbutrin, Effexor, or guanfacine. (Don’t get what’s wrong with this? Read how it should go with the excerpt below of my first book.)
Poor Prescribing Created ADHD Backlash?
To summarize: The prescribing of any stimulant is often done badly. But the problems around Adderall appear an order of magnitude more serious.
The fact that I publicly predicted and warned about this years ago — verbally collaring this pharma’s reps at conferences, asking “why aren’t you warning prescribers?” — brings me no pleasure in being proved right.
But I am just one person, without an “authoritative” MD after my name. (Google now actually penalizes this page because it’s not “reviewed” by an MD. Meanwhile, the plethora of “health” sites scrape the bottom of the barrel for unknown MDs, some who’ve lost their license in several states, who will slap their “reviewed by” on the article.)
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10. Contributing Problems: A Larger View
Again, the issues around prescription Adderall remain only one piece of a problematic puzzle:
— Physicians who see ADHD as a “simple condition”
“You just throw a stimulant at it!” one psychiatrist told me at a meeting of the American Psychiatric Association. Obviously, he failed to find ADHD treatment interesting and therefore not worth his study.
(I saw him later at a presentation on Borderline Personality Disorder. Hundreds of psychiatrists. Hundreds were sitting on the edge of their seats, spellbound to dramatic stories. But not one presentation on adult ADHD, which has historically been misperceived as BPD.)
In fact, ADHD is a highly complex condition, especially when it is diagnosed later in life. Other conditions can complicate medication response. These include sleep and substance-use disorders. It also includes psychiatric conditions that are more highly associated with untreated ADHD in adults. (That is, living for years with untreated ADHD can increase incidence of depression, anxiety, and bipolar disorder.)
— Physicians who believe in a “starting” or “average” dose
“There is no starting or average dose!” I’ve emphasized that in my lectures for years. That’s based on advice from the preeminent experts I respect most. Yet still, that seems the status quo. The trouble with this?
— Some people are slow metabolizers: an “average” dose might be too high for them.
In response to the side effects, they might give up on that medication entirely. Yet, if might be that a lower dose would work just fine.
— Some people are rapid metabolizers: an “average” dose might be far too little for them.
They “burn through it” too fast. They need a higher dose in order to get an average effect.
My scientist-husband and I wrote a 7-part series explaining metabolizing issues and more: Genetic Testing for ADHD Medications.
— Insurance reimburses poorly for psychiatric treatment
Yes, insurance companies share the blame. They do not reimburse psychiatric treatment at a rate commensurate with the kind of expertise and time required. But physicians are responsible, too, for understanding basic protocols. Tools exist to help implement these measures with patients, without having to reinvent the wheel.
Are you thinking that single-payer health insurance is the solution, think again! The very worst countries when it comes to ADHD medication options are the single-payer healthcare countries. That includes the United Kingdom and Australia. France is far worse.
Many UK residents wait years even for an ADHD evaluation—only made worse by COVID.
In Australia, at least until very recently, adults cannot be diagnosed if they were not already diagnosed in childhood. Very handy, as pediatric ADHD was largely ignored except in the most extreme cases. Only recently was Vyvanse approved for us within the healthcare system, with the mainstay being dexedrine. Last I heard, Concerta was available for $100-150/month.)
— ADHD impatience —want to “feel” it than objectively measure it
Let’s be frank: Some people with ADHD love Adderall because it feels like a booster rocket attached to their back. And who can blame them? After years of struggling to turn intentions into reality, it’s happening!
The hard truth is, however, is this: You can’t depend on a “visceral feeling” to tell you when the medication is working. In fact, sometimes you won’t realize that the medication is working—or causing problems. But the people around you will!
Moreover, relying on that visceral feeling almost guarantees a bad end. Maybe not today. Maybe not tomorrow. But soon. What if you’re so strung out you don’t even realize it?
Over-relying on a “booster rocket” to propel you through your day means you’re using Adderall as a performance drug, not ADHD treatment. Even if it’s prescribed. Medication should help create more balance and self-regulation in learning new skills and habits.
Tragically, some patients (or their parents or partners) sometimes believe my cautions only after the fact. After all, I’m not a doctor. In other words, they write to me after the typical crash. That comes about two months into Adderall usage, in my observation.
That’s when they are completely depleted:
- Typically from exhaustion (why go to sleep when for the first time in your life you have “superhuman” focus?)
- But also perhaps due to Adderall’s unique mechanism of action, their very supply of neurotransmitters might be depleted.
I hate hearing, “Gina, you were right.”
— Parents’ and Loved Ones’ “Denial” of ADHD
Now we turn back to the NYT story for a moment. The story that finally prompted me to write this post in 2013, after years of warning about Adderall in my groups and public talks.
Did Richard Fee, the young man featured in the piece, truly not have ADHD, as his parents claim? Was he simply abusing Adderall as a “performance drug.” Perhaps, but the report shows no evidence of that.
Reporter Alan Schwarz repeatedly showed little understanding of ADHD’s complexity. He gave lip service to ADHD as a legitimate condition—and then proceeded to rip it apart. Schwarz started as a sports reporter. Using his apparent penchant for statistics, he reported on sports concussions. His editors apparently found that qualified him as a neuroscientist — and sic’d him on ADHD.
As a former newspaper editor, I have seen the pattern: “Hot Dog” reporters who will do anything to land on the front page. (Now, online, it’s the featured story, highlighted on the website and promoted through social media.)
In reporting about Fee’s suicide, Schwarz rejected that ADHD sometimes had a way of “sneaking up” on people later in life. That’s when their innate intelligence and ability to get by in school without good study habits no longer are enough.
In other words, it might seem that these people are “abusing” stimulants when really they are seeking help. It might also be that they are suffering from poorly titrated and monitored prescription Adderall. Not to mention the sleep problems it often brings.
Could it be that Fee’s parents’ own denial systems came into play here? Perhaps Richard felt that at least these doctors believed him?
Richard Fee, the subject of The New York Times article—Prescribers Failing to Seek Third-Party Feedback
Please understand: Richard Fee’s parents have my deepest sympathies. It seems they truly tried to warn the physicians of what was happening to their son.
This story is not new to me. The partners of adults with ADHD try desperately to get through to the Adderall-prescribing physicians. They try explain that their partners are turning into rage-aholics. (The ADHD adults themselves seldom report increased anger and ability to their prescribers. They don’t want to lose access to their life’s long-missing focus.)
Yes, there are privacy laws. But that does not mean the prescriber cannot request such feedback—nor cannot accept it.
Did Fee have a condition such as bipolar disorder (either instead of ADHD or co-existing to it)? That is, did he have a particular vulnerability to Adderall abuse or addiction? Or, was that particular vulnerability ADHD? Perhaps he was mis-using Adderall to minimize sleep so he could study more and achieve. Thus, he compounded ADHD with sleep deprivation and amphetamine addiction? Next stop, psychosis.
We’ll never know. But I suspect that there were red flags throughout his childhood and young adulthood. The same will be true of many others.
Rest in peace, Richard.
— Excerpt: You, Me, ADHD’s Chapter on Medication
Now I’ll share with you now with an excerpt from my first book: Is It You, Me, or Adult ADHD?
Being passive risks, believing you can trust the average prescriber, risks a lot. No one cares more about your or your loved one’s life than you do.
Identifying ADHD symptoms and medically addressing them is not, for the most part, rocket science. It’s not even brain science. It’s step-by-step logic and observation. I teach this in Course 2 of my online training, on medication and sleep: Solving Your Adult ADHD Puzzle: Physical Strategies
Chapter 21: RX Treatment Results That Last
It took Alex two grueling years to convince his wife to seek an evaluation and then treatment for her diagnosis of ADHD.
“Now, who knows how long it will take me to convince her to ditch this psychiatrist, who refuses for no logical reason to prescribe stimulants and find one who actually understands ADHD,” he complains. “My wife is skeptical that I or this support group could know something her psychiatrist doesn’t. But trust me, it’s alarming how little this guy knows.”
Looking back, Alex wishes they’d been far more careful in selecting a physician.
In Jeanette’s case, the irony is that she never found her husband’s ADHD a problem—until after he started medical treatment for it.
“I used to go to bed at night thinking I’m the luckiest wife in the world,” she recalls. “Yes, Mike is lousy at paperwork and he doesn’t remember to take out the garbage (or what day it’s collected!). But he is fun, very goodhearted, and rarely gets angry, and loves being with me and the children.”
Then It All Changed
All that changed soon after Mike learned that he might have ADHD and decided to do something about it. He had recognized in himself the traits he didn’t like in his father. That included poor follow-through on promises. He wanted to do a better job with his own family. “His attitude was, ‘If treatment can help me to be a better person, why not?” Jeanette recalls.
Unfortunately, Mike’s personality changed completely after starting medication.
“I went from this perfect marriage to hating my life and being ready to leave him. The worst part was that he didn’t realize that things were getting worse, especially the anger, until we were in major trouble. As far as he was concerned, his focus was better so that was great. But in reality, his focus was unrelenting.”
Jeanette found the support group’s feedback critical to realizing what was happening. He was probably either on the wrong type of stimulant medication or at too high a dosage. She also learned how to find a more qualified physician and, more importantly, convince Frank that he was turning into a father far worse than his own.
Such stories are way too common for the support group’s comfort.
How Do We Navigate This?
We want to trust our physicians. Yet, many physicians, including psychiatrists, are poorly trained to treat Adult ADHD. Some know that and respect their limitations. Some don’t.
It’s important that you know this going in. Smart ADHD healthcare consumers can avoid common pitfalls and come out a success story.
“My message to those embarking on this journey,” Jeanette says, “is don’t be afraid of medication; it can bring great changes. Just be aware.”
Please know that, prescribing for ADHD is a straightforward issue. In fact, ADHD Partner Survey respondents report that when their partner started taking medication, symptoms improved significantly within:
- Hours (15 percent)
- Days (39 percent)
- Weeks (19 percent)
As Jeanette learned, however, the initial “promise” of medications to smooth out the ADHD roller coaster can soon peter out if one isn’t…paying attention.
How These Chapters Can Help
The book’s three chapters on medication will support you and/or your partner in creating your own success story by helping you to:
- Avoid common pitfalls that lead to low treatment adherence.
- Understand that goal setting forms the foundation of successful medication treatment.
- Remember that each person has a unique biochemistry — no cookie cutters!
- Recognize that finding the best medication regiment requires a methodical process.
- Know that ADHD commonly coexists with other conditions, which must be considered in any treatment plan.
If you are familiar with this guidelines, you can better recognize competent care when you encounter it. And when you don’t encounter it? You can either keep moving or, if your choices are few, diplomatically help it along.
For More Information
—Other posts related to ADHD medications:
Visit ADHD Roller Coaster’s Medications category of posts
—My first book: Is It You, Me, or Adult A.D.D.?
—My NEW Course on ADHD Medications and Sleep: Solving Your Adult ADHD Puzzle — Physical Strategies
—I welcome your comments.
Gina Pera
The first version of this post appeared in 2013.
Dear Gina,
I posted back in August of last year and would like to add a follow up to my story that could be useful to you and other readers.
I have since had a psychiatric work up and discovered that I have bipolar disorder in addition to my ADHD. I learned that it is actually common for one to be co-morbid with the other, but difficult to identify.
For one thing, my bipolar is not the traditional long swing from extreme depression to extreme mania that is often associated with bipolar 1. Atypical bipolar is what is often seen in individuals who have another disorder as well such as ADHD or OCD.
In some people, stimulant medication can trigger a manic episode which was what was happening in my case. It never occurred to me that I was bipolar because I didn’t know that mania or hypomania could come in the form of anger or irritability or even as a mixed episode in which symptoms of depression and mania are happening at the same time.
With my doctors’ help, I’ve found a dose of Adderall that works for me and I am going through the process of finding medications to control my bipolar. If anyone with ADHD experiences these kinds of mood changes, especially with stimulants medication, it may be worth it to explore bipolar as a possibility. Getting my symptoms under control is having an even bigger effect on my life than controlling my ADHD symptoms. Hope this helps the conversation.
Hi Natalie,
I hope you find something that works for you.
I will provide a caution — to you and other readers.
MANY prescribers mistake the side effects from Adderall as bipolar disorder. When it is NOT.
This has been a common problem FOR YEARS.
If you have never tried another stimulant, it’s only medical common sense to try something other than Adderall — especially before you consider adding a mood stabilizer.
Perhaps your prescriber is correct. But many are absolutely not in coming to this conclusion.
As always, I recommend self-education and self-advocacy.
cheers
g
You wrote a blog to lambast adderall users, as if they’re drug seekers, nevermind that a doctor somewhere prescribed it, and then went on and on angrily about how google buries your blogs and this isn’t a blog to get high. If you’re a “real” doctor, your degree must’ve come from a Cracker Jack box. I can see why others called you a shill.
Oops. Lauren, maybe you should actually read the post.
This time a little slower, without guns blazing, eager to chew me out.
No one takes to heart more the quality of treatment for people with ADHD.
It’s too bad you don’t seem to care about other people with ADHD — to the point of being willing to learn something you don’t know. Hey, it’s a free country.
But this is my blog, and I don’t tolerate bullying.
G
P.S. You seem unclear on the meaning of “pharma shill”. Pharma shills don’t write consumer articles that challenge bad prescribing patterns based on one pharma’s aggressive marketing. Pharma shills jump on anyone who dares to criticize any pharma’s bad behavior, no matter the cost to actual humans. And guess one, one slimy pharma controls much of what we see online—and too many other places as well.
Spoken like a raging amphetamine addict, who probably couldn’t get their fix during the end-of-the-year shortage. I’m an adderall user, and back in December I was as pissed off at everything in the world as you. Certainly not all adderall users are drug seekers, but honestly, a bunch of us are. I fit the ADHD profile, and I also exhibit addictive tendencies and drug seeking behavior. I’ve just normalized those things over a long arc. It’s not difficult at all to be prescribed adderall, ADHD or not, and obtaining a prescription does not validate honesty on the part of the patient or diligence on the part of the prescriber. This blog in no way lambasts adderall users. I’m here because I’ve finally had success in prolonged cessation from cannabis use, and I am making a plan to get adderall off the plate as well. This article promotes being an informed and self-advocating consumer, and underscores the issues of patients self-reporting back to their prescribers. I certainly wasn’t going to tell my doctor about my other habits, or the times I’d take much more than recommended or crush it up and snort it- there’s plenty of times where I’ve also just taken it as recommended. I just wanted it to keep coming without my behavior ever really being examined- and as long as I say it’s working, they keep writing prescriptions. Sounds great from my drug seeking perspective, but I’d be in complete denial if I said adderall has only been helpful to me. It’s exactly as this blog describes- a powerful stimulant which when prescribed properly can be a boon for certain people. It’s also quite popular for off-label use, highly addictive, and can have a host of negative side effects. I too have been a raging asshole while using it, which is a big part of why I want to stop. Good luck.
Thank you, T. I appreciate your validation.
Many people with ADHD, many of them very new to the diagnosis, tend to see this in black-white terms. Simplistic social-media memes make this worse.
Good luck to you, too.
Gina
Thank you for getting this information out there. I have been living the Adderall roller coaster with my husband for 8 years and thought I was the problem. Initially he seemed perfectly fine to me, maybe a bit boisterous, but claimed he couldn’t focus internally. He went on Adderall and within 6 months became a different person. His only focus was himself and he actually seemed to now exhibit ADD symptoms. He couldn’t complete any tasks without getting distracted and starting another, couldn’t sit and watch a movie or television, and when his meds wore off he’d fall asleep whatever time of day. Also yelled a lot and wouldn’t discuss anything with me. He finally went off the meds in Jan 2021 for 8 months because he was tired of the Dr. requiring random drug screens our insurance wouldn’t pay for. It was like he was back to his old self. He claims he was having trouble focusing again, for work only apparently, and went to a new Dr to get back on the meds over my objection. She required him to be rediagnosed and I went with him to the psychiatrists office, explained how he was previously when taking Adderall and how great things had been since he’s been off, but he prescribed it to him anyway. Am now living with someone who never follows through on anything he says he’s going to do, never listens, forgets everything, etc. etc. At least I’m alone in this.
Dear Ronni,
Imagine smoke coming out of my ears.
Seriously, the number of idiotic prescribers I hear about …. it’s just unfathomable. They need to lose their medical licenses.
The ignorance. The arrogance. Despite your stated concerns.
We have one pharma to thank for this “poisoning of the well” — and it’s the same pharma that “owns” many of the ADHD outlets and personalities we see online. Consumer beware.
I hope you will continue to try to get through to your husband. I encourage you to check out my new course on Physical Strategies — sleep and medication. I address this issue specifically, and authoritatively.
take care,
Gina
https://ginapera.adhdsuccesstraining.com/course-2-physical-strategies
I’m trying to come to terms with what I’m going through and I don’t think my doctor is any help. I feel a bit lost on who to turn to for good advice.
1) I’m an adult in my 40s who went to my primary care physician for an ADHD assessment after my psychologist suggested perhaps I had been living with ADHD my whole life. Through a quick conversation he quickly diagnosed me with ADHD inattentive type and prescribed 20mg XR Adderall. I told him that I’m also 3 years sober from alcohol and marijuana and had previously had issues with stimulants when I was in my younger 20s. He said, given my sobriety, I shouldn’t have an issue with Adderall.
I took 20mg for a week and it was overwhelming. I lowed it down to 10mg XR daily and it was a spot I was happy with.
So I was having trouble with my career. I feel lost being two and a half years of unemployment. I wanted something more fulfilling out of my career. The Adderall helped me sort of dive into things with a confidence I’d never had. I typically feel really lethargic and hopeless about bettering myself for career purposes or even personal satisfaction, even before the pandemic and unemployment. I always just felt, my life is over, it’s too late to start something new. But anyway, I’m not sure if it was the Adderall but I seemed to get into a positive upswing. I’m learning some coding languages by myself which is something I’ve never done before. I’m pretty active with it daily, and am keeping myself focused with it which is a far cry from the place where I was, just moping and hopeless that my life is permanently stuck and there’s no way up.
I’m at about the two month mark with taking 10mg XR. I’ve tried to not take Adderall on the weekends. The first day off usually feels fine, almost like the self I’d like to be. I’m more in touch with my emotions and feel my sensitivity that I’m used to. I was even able to still concentrate pretty well while studying. The second day, I was so tired. I didn’t leave the house and I slept like 11 hours that night. The third day the brain fog that I felt was normal before taking Adderall but returned with a vengeance. It’s the feeling of “What’s the point?” or “I’m back to being a ghost wondering around again, lost.”
So I took the Adderall again yesterday. I worked and retained focus again. However, I’ve been susceptible to getting moody and angry toward the end of the day. My emotions are guiding me more than I’d like. I got a little confrontation about a trivial thing with my wife. I’m seeing the downsides to the Adderall use and am concerned that my addicted brain has been reactivated. I haven’t abused it per-say, I’m even taking less than I was prescribed. I don’t even like taking the 10mg quick release tabs and haven’t used them.
I have mixed feelings, did this bout with Adderall pretty much reverse the hard work I put in to getting sober for 3 years? I’m nearing the end of my XR prescription and I don’t know what to do. If I get another refill, I feel like the longer on Adderall, further along the road I’ll be making it that much harder to stop. However, I have no clue what my alternatives are. I’ve tried SSRIs for anxiety/depression. I’ve tried an anti-anxiety drug that just made me completely lethargic.
I’ve had two doctor visits thus far. The last time when I told him I was taking half of what he prescribed, he said he thought I’d need more down the line. That to me is just insane. I’m literally telling him, I don’t want to take more but he’s saying that’s what I will need. So now I’m reluctant to even contact him about my issues but don’t have another doctor to turn to.
Hi Brandt,
I’m glad you found my blog post on Adderall.
I’ll be blunt. Your MD is a cowboy.
He should have listened to your concerns about your history with substance abuse.
He should NOT have started you at 20 mg.
It is a national scandal that one ADHD pharma has wreaked this havoc on untold numbers by “training” nitwit MDs like that. Deplorable.
Right now, can you lower the dosage?
The two-month mark is when I typically start hearing the “uh-oh” stories with Adderall.
The amphetamines are…amphetamines. Even if you have ADHD, you can still get addicted. Despite the amateurs online blaring the opposite.
There are many more options. SSRIs are for anxiety and depression, not ADHD. They can even intensify ADHD symptoms.
These bad-prescribing stories really anger me. Folks have the potential to finally seize upon their capabilities – and these clueless MDs drop them on their heads.
My book was the first (and still the best) to detail how to approach medication for ADHD.
Recently, I created a course….because we just can’t leave it to the “medical community.” I go through all the options, provide worksheets to help make selections and monitor effects. If MDs took my course, they would have a clue — and then some. When consumers take it, they know how to self-advocate.
https://ginapera.adhdsuccesstraining.com/course-2-physical-strategies
You deserve better!! See if you can get your wife involved. It goes best with teamwork.
Cheers
Gina
THIS is what I’m taking about ! My heart ACHES for this family and all the others ! Bc Drs prescribe ppl accept bc they think Drs are Gods . Vera imperial Wilson a script whore has no regard for ppls lives sheand all the others like her need to be shut down the problem is careless uncaring money motivated Drs. And the retail stores that sell other highly abused OTC drugs like Sudafed WAKE UP ppl
Thank you for sharing this information. My husband was prescribed Adderall about a year and a half ago or so. He has become someone I don’t even recognize anymore. He packed up and walked out about a week ago after eleven years. No conversation, no nothing, except for me to please keep him on the insurance. That got me thinking about his Adderall prescription. He travels for work constantly so I didn’t even see him enough to realize all the negative changes. I was too busy trying to be a good partner and support his work efforts. I am devastated trying to wrap my head around how this all happened. How he could just walkout without any emotion or feelings for me or our relationship/marriage after eleven years. I thought everything was going fine all things considered, but had no idea of how much he had changed for the worse. He’s like a total stranger now. He hasn’t been taking care of any of his obligations, he’s racked up huge amounts on his credit cards, all he focuses on is his job, nothing or nobody else seems to matter. Thanks again for this information. It helps explain so much that I had no idea was even possible.
Hi Dion,
I’m so glad you found my post. I’ve been a voice in the wilderness for many years about this. My calling attention to this problem has created some personal and professional blowback.
I don’t care. Because this is important. It is beyond-the-pale important.
And it’s absolutely SHOCKING and REPREHENSIBLE that so many prescribers remain clueless.
I hope you can use this information to start turning things around.
If you’re interested in how to help guide medication treatment (and maximize sleep, another key issue), you might be interested in my course. If more prescribers took it, I can only imagine how improved the status for so many adults with ADHD.
https://app.podia.com/products/course-2-physical-strategies
take care and good luck,
Gina
Hi
I got diagnosed yesterday. I was prescribed aderall 5mg 2x a day ( I am also taking the generic) I am more inattentive than hyperactive (maybe just internally) I took my first doses today. I think I have major tunnel vision right now. I been on my phone ALLL DAY. Should I be lowering my dose. I thought this acticle would give some clarity on weather if your’e feeling “madderal” lower the dose? My jaws feel tight too.
Or maybe I need to get the non generic and see how that works.
Hi Natalie,
It’s good that you’re self-aware. Many people get caught up in the “tunnel vision” without knowing what is happening.
Most adults do not have physical hyperactivity. By adulthood, the physical hyperactivity has morphed into more of an internal restlessness.
So, it’s most likely that you have combined.
A tight jaw and tunnel vision with your phone are not great signs.
Yes, maybe a good idea to try non-generic.
But in my opinion — and in the opinion of veteran preeminent experts — it makes more sense to try a MPH choice first. That’s the protocol described in my book, linked to in the article.
g
Another issue that I personally have had to deal with is: I had a pretty dialed in medication profile and dose, things were pretty positive and working for me. I was taking a generic. The pharmacy simply swapped the manufacturer one month. There are many articles about generics possibly not having the same effects. Well, let me tell you first hand…Within a month my fingernails had disappeared. I chewed them off…Heart raced, anxiety. Maybe for some conditions and medications generic swaps are ok, but for psychotropic substances it flat out should never be done..I’m currently going through the prescription coverage fight now to get a non generic, so the composition of my meds never changes again..At this time I’m breaking the current pills I have in 1/2 while hoping for stability.
Dear Author,
I am struggling in my marriage and believe Adderall is to blame for many issues, but not all.
When my husband does not take his Adderall, he is and can be a sweetheart. Once he takes his “speed” as he nicknames it, he often gets irritable, loud, aggressive, suspicious, and even manic.
We have only been married less than a year, and due to synergism, when we have tried to go out on a day that he may have take Adderall, he often ends up drinking copious amounts and then making very bad a destructive decisions that result in infidelity.
This morning, he has been up almost all night. We had an argument last night because he thought I was being distant and was being quite short and snappy with me. I become defensive trying to convince him otherwise and being met by what I perceive as coldness. If he lashes out, I then get upset that I am being treated poorly and ask if he has taken his Adderall which he often claims he has not, when he actually has.
Sadly, for me, I feel I am often the target/ focus of his intense negative energy, while others often get treated very well and lovingly. In his intense focus, he will frequently decide to monitor me and make claims that I am cheating or not at work, when I am at work. Trying to convince him is futile.
He will see an erroneous GPS plot on our phone or device and fixate. There is also fixation on my timelines; if I am perceived to have missed a “deadline” to come home or change plans like going to get my car washed, I get very negative responses and incessant phone calls, if I set a boundary when I am being baselessly accused of being “distant,” “suspicious,” “acting abnormal,” and “questionable.”
I feel like this drug puts me under an unwanted and unfair microscope and I am constantly squirming like an ant being burned by the magnified sunlight.
I try to not get defensive, but this drug seems to have exacerbated his negative traits, and put our marriage and relationship into a tumultuous state. He isn’t honest with his psychiatrist about his behavior and often pegs me as being the aggressor/ disruptive one in the relationship.
I am definitely not perfect, but I know I am pretty even just this rollercoaster ride has thrown me for a massive loop and brought out the worst in me. I crave the good days and ones where he is relatively sober and not on Adderall and then using alcohol or drugs to come down.
Hi Madame,
Unfortunately, I’ve seen this pattern too many times.
In addition to the anger and irritability, Adderall for some people with ADHD can create “tunnel vision.” That’s what your describing him having you “under a microscope” sounds like.
What are you doing to do? You’re only one year into a marriage. Things typically don’t get better from this type of situation.
You can let the psychiatrist know what’s happening (privacy laws do not preclude that, just the MD not responding). But any MD reckless enough to prescribe Adderall without using rating scales or getting third-party reports (such as from spouse) will probably refuse to consider your perspective. It’s risky.
g
My doctor had me on a very high dose of Adderall for 6 plus years. 180mg daily. I had a genetic test done she said I was ultra rapid metabolizer.
My tolerance became so high that I needed 4 30mg adderall just to began my day. I believe my dose never should have been above 90 mg. I felt it was sufficient at that time and when it got raised ya at first I felt like I was super mom. Now I’m 40. I had difficulty filling the script every month. Pharmacists questioned the dose. I decided after my mom died suddenly that I didn’t want to do this forever. My doctor was old. I knew my dose was unlikely to be prescribed by anyone else and I needed to ween off. My doctor didn’t agree so I changed doctors.
Anyways it’s been 6 months without adderall and I feel no motivation still. I gained 20 pounds within 3 weeks of quitting adderall which put me at a 28 bmi. I feel no joy. Taking a shower is dreadful. I stair at the wall and typing this is the most productive thing I’ll do this week. I don’t know If I’ve made the right choice.
No article gives me hope. I’ve depleted my dopamine my receptors etc.. everything says if u took it as prescribed u should recover within a few months. I took it as prescribed and honestly the last year I usually never took the full dose. I can’t find anything regarding research on anyone who has overcome longterm high dose use. I can’t fins anyone who has been prescribed 180 mg daily. Also I forgot to add that I asked to be switched to vyvanse.
Instead of switching me to vyvanse she just added vyvanse. So I was prescribed 180 mg of Adderall and 60mg of vyvanse daily. I wish I could have a brain scan to see if anything is happening if there is any point to keep staring at this wall or if I should just start taking a lower dose again just to feel something and contribute to my family.
Dear Sleepy,
Outrageous. I’m so sorry this happened to you.
Thanks for writing this comment. Because ADHD specialists routinely think I am exaggerating. “All medications have side effects,” some say, patronizingly. Yes, they often “gaslight” me.
I don’t care for my sake. I know what I know. But I do care for the public’s sake.
1.
You say you were taking 180mg daily — and, toward the end, took a “topper” of Vyvanse.
I’m really glad you didn’t have a stroke or some permanently crippling side effect.
2.
You have gone from taking that much Adderall over six years to taking nothing for the past six months.
Of course you will feel no motivation, joy, etc.. You’ve gained weight, etc.
There will be a period of active recovery — optimizing diet, sleep, overall health, etc.
3.
I assume that you legitimately needed the Rx in the first place. In other words, you had significant ADHD symptoms, and Adderall helped to some degree.
There is no reason to think that, over those six years, your ADHD symptoms went away. They are probably still there.
4.
At this point, you cannot know what is a long-term effect of high-dose Amphetamine and what is untreated ADHD?
I encourage you try again — this time learning more about proper prescribing for ADHD so you can better self-advocate.
I cover ADHD-related sleep and medication issues in Course 2 of my online training:
https://ginapera.adhdsuccesstraining.com/course-2-physical-strategies
5.
If you were never tried on a methylphenidate-class stimulant (e.g. Ritalin, Concerta, etc.), it might be worth a try.
Genetically speaking, some people with ADHD respond better to one than the other.
Perhaps Adderall simply was a poor choice for you — resulting in such high dosages. But anything’s possible.
I hope this helps. Good luck!
Gina
Gina,
I just wanted to thank you again. I posted a comment on 12/19/21 about my husband’s unwillingness to see how negatively adderall was affecting him. It completely transformed him into someone none of our family and friends recognized anymore. He was always a goofy, kind-hearted person and adderall made him into a walking ego. He was at best insufferable and at worst scary to be around for two agonizing years.
Things finally changed when I told him I honestly just didn’t like the person he had become and didn’t want to share my life with him anymore. He just… completely unraveled.
He said he’s noticed things for a while and he’s been lying to himself as much as me. He hasn’t taken adderall since and the craziest part is it was just like flipping a switch. He went right back to the same funny, lovable person he always was… I kept waiting for the shoe to drop. For him to crash or… idk, something. But it’s been weeks and he’s just… happy. He’s back to being a parent and husband and son again.
He brings up a lot how sorry he is for what he put us all through and that he’s grateful I finally just told him I was done because it saved him from ruining his life and losing everyone he cares about.
But I think it’s important to stress that I didn’t make anything about adderall when I told him I was done with our marriage.
When I would bring it up in the past (“can we just see if things improve with our relationship by not taking it for a short period?” Etc) he would get irate. Once he grabbed his rx bottle in a rage and pointedly threw it in the trash but I got it out and put it back on his desk. Because I knew if he only stopped taking it, “for me,” then he might not come to the realization on his own that it was affecting him so terribly (and resent me for it, only making things worse).
I just wanted to share that part because it could help someone in the same situation and because he brought it up, specifically. He said it was one of the moments that forced him to realize he was being irrational (even though he wasn’t ready to admit it, yet).
I had quit taking adderall a couple months before he did (in an attempt to encourage him to try, also) so now neither of us are taking anything. It’s a little frustrating because I think it probably is the right adhd med for me, but I’m happier without it in the house of it means I have my best friend back.
Dear Jane,
Thank you SO MUCH for taking the time to share your story with ADHD Roller Coaster readers. It’s critically important to have these first-person stories.
And, to see how skillfully you negotiated this. That is, by not “making it about the Adderall.” By making a clear and definitive statement about what YOU were going to do — leave the marriage. That seems to have given him the “mental space” to realize that your previous concerns were no joke. Nothing that would pass.
It’s VERY easy to get distracted by fighting about these things. “It’s the Adderall” and “No, it’s not.” Thereby completing ignoring the core issue.
I hope that once things settle, you will again find a medication that works for you (maybe Adderall, or maybe Vyvanse, if you haven’t tried it). And something that works well for your husband.
Do you know about my new course? It’s on medication and sleep. This is THE course I wish I could have given to everyone who has written desperate e-mails to me over the years, every support-group member.
I have HAD IT with MDs bungling ADHD medication — not even aware that they are wrecking lives.
I’d love for MDs to take this course (there are others, by MDs, but honestly, I don’t find them detailed enough or “real world” enough). But meanwhile, consumers will know more than 80% of prescribers and sleep specialists by taking this course.
It launched yesterday and the sale continues through midnight Labor Day (in U.S., September 5):
https://ginapera.adhdsuccesstraining.com/course-2-physical-strategies?coupon=LABORDAY75
Thanks again and good luck!
Gina
Dear Jane/Gina,
Jane – I take comfort in your story. I am living a nightmare with my husband who was casually prescribed Adderrall for “concentration” several months ago. To say that he is a changed person is a total understatement. He was so caring, thoughtful, helpful, kind – a wonderful human all-around. We have been married for almost 12 years and have three young children and a beautiful life. Despite that, he is decimating our marriage and family with his apathy, hostility, contempt, and misery. He has distorted our past – making it this narrative of how I have never supported him, loved him or been happy. None of which is true. All the while, he is laser focused on work and fully immersed in other bad habits – including desires for other women. I am at a loss and simply devastated here. Despite visiting our doctor a couple of weeks ago to request no more prescriptions, he just got another one filled, and I am crushed because I know this saga will continue. (Meanwhile, my doctor had reassured me that he would not give him another one without recommending testing. He called me to say “sorry, his request feel through the cracks.”.)
My had feels forced to end our marriage because the living situation is is untenable. The constant criticism and avoidance is too much to bear. I have asked him to stop taking the drug but he laughs that off and only points to my flaws and defects. It is truly sad that this drug can transform someone like this – and, sabotage the most sacred relationships around you.
Sara
Sara,
Not another one….how awful for you.
And yet, still, when I try to alert ADHD professionals in positions of influence, they pretty much “gaslight” me.
Some of them, anyway. The smart ones know that I speak the truth.
My public posts about this in LinkedIn recently drew a condescending comment from a pediatrician who specializes in ADHD — “just ask for another medication.”
So clueless. Of course she didn’t know who I am or my work. Just thought she’d do some MD’splaining.
They don’t get it. They don’t get how once a person gets hooked like this (not necessarily the addiction kind of hooked but hooked to that feeling of super focus).
If you feel you have a marriage to save, you might want to try a little harder.
We all swim uphill with this one.
Absolutely failure among leading clinicians and those who formulate guidelines to warn about Adderall.
Absolute failure of his prescriber failing to include you in the discussions and offer feedback.
Absolute failure of the online hustlers and snake-oil charlatans that no doubt are feeding the distortions….”see, you could have felt this great all alone. Your ‘neurotypical’ wife was holding you back.”
It’s just horrible.
take care
g
Dear Gina,
Thank you for this and other posts that have provided info on my ADHD that I can’t find anywhere else.
For several years, I was on Vyvanse and Zoloft. Things were not perfect, but better than they are now. I had to stop taking the Zoloft because of stomach bleeding. After that the Vyvanse began making me very angry, even at a lower dose.
I tried Adderall, same problem, though not quite as bad. Concerta was all but useless and the end of the day crash was terrible. My doctor just shrugged her shoulders and basically said I am out of options.
Is that really all I can do as far as stimulants? I know there are more drugs under different names, but my impression is that there are only 3 main stimulant drugs. I haven’t tried non-stimulents yet, but I am wary because Strattera made my daughter deeply depressed. It’s been about 6 months and I’m not really functioning, especially as mom to my kids. Are there any other options for me?
Dear Natalie,
How frustrating, to say the least. I’m frustrated just reading of your ordeal. In fact, I would like to give that “doctor” a piece of my tiny mind! 🙂
Seriously, you’re “out of options”. No. Just NO.
If only more prescribers read my first book’s chapters on medication…..they would know so much more than they do!
As it is, there is typically no method. Just throwing a stimulant at someone. Like a game of Pin the Tail on the Donkey.
You deserve better and so do your children.
re: Concerta. Are you sure it was brand? Here is my ongoing coverage of the Concerta generic debacle:
https://adhdrollercoaster.org/adhd-medications/authorized-generic-concerta-update/
Also, there are other factors that most prescribers don’t even know to ask about, such as how much sleep are you getting, what about any hormonal factors (peri-menopause or menopause…..or even estrogen dips each month…can affect ADHD symptoms.
So can caffeine, nicotine, diet, etc..
If your daughter didn’t do well on Strattera, maybe you won’t, either. But your genetics are not the same. So who knows. Strattera doesn’t work as well as the stimulants for most people. Maybe 25% of people with ADHD, by some estimates.
Stay tuned on my blog. I’m about to release Course 2, on Physical Strategies. This is an in-depth but highly digestible course on medication and sleep. It’s been an exhausting task but somebody needed to do something. 🙂
Hang in there. In all likelihood, there are workable options for you. It just will take some informed sleuthing.
take care,
Gina
When I need to take a break from work and wonder what else I should know about my new ADD diagnosis at 43 as an American living in Germany I come to your page. I was lucky to convince my Psychiatrist to consider my ADD (ADHS in Germany) as a potential catalyst for my depression. Citalopram got me out of my funk and leveled enough to continue with the 43 years of learned masking and coping skills, but boy did it make my symptoms of ADD more profound! So, here we are today and I’m taking 10mg of Attentin work days with a weekend break. My psychiatrist had set me up with a collegue of his who specialized in ADHD but that guy spent 5 mins reviewing my file and then prescribed me mediknet saying the Attentin was only for “kinder”. The sad thing is the mediknet made me very very depressed and I stopped it immediately when I had suicidal thoughts.
I’m back on the Attentin which is “ok”. I crash about 3 pm every day. Some caffine will get me alert enough to drive home after work but at 6pm I want to sleep!!!! The weekends are worse, I just want to sleep! Then Monday and Tuesday I’m in a fog, often very talkative at work, Wednesday through Friday I’m ok if I have a nap after work. As I said my Psychiatrist isn’t an expert on ADHD. He treats one other patient with it and he too was disappointed with the the collogue he sent me to. Would it be wise to ask for for another drug option?
Hi Joe,
I’ll make this quick as my COVID booster vaccine has hit me like a ton of bricks.
Absolutely, you should be able to try whatever stimulant is available to you. Keep track. A log. There is no stimulant just for kinder.
Do you have my first book? It details the basic procedure.
You deserve to get what works best for you.
Good luck,
G
So happy to have found your site. Your insight is right on! My beloved baby brother just took his life. He had been on Adderall for quite some time. I would love to share his story soon so others can gain insight. Thank you for your work here. It helps more than I can say….
Dear Jennifer,
Words cannot express….. my condolences to you and your family.
best,
Gina
My wife started taking Adderall over three years ago, and showed manic symptoms immediately. They continue to this day. She became paranoid and delusional, even thought I was going to poison her or kill her in her sleep. After 30+ years of total trust and never having a problem we weren’t able to work through with honesty, empathy, love, trust, and a mutual dedication to truth, responsibility, and accountability.
We have now separated. I had to move out for my own safety after she called the police on me for NO REASON other than I asked her to leave me alone and that apparently made her terrified, though no rational person would have reacted that way.
She has blown up her relationships with me, our daughter, and half a dozen friends she has been close with for decades, yet cannot, or will not, recognize that SHE is the problem, not everyone else. She has a story for each broken relationship, and none of them assign any responsibility to herself. It’s absolutely nuts, she and I have been anti-denial as a core foundational principle in our relationship forever.
I’ve written her prescribing physicians multiple times and they do nothing. My wife refuses to stop taking the drug for even a couple of weeks, as I have begged and pleaded for her to do so she can clear her mind and determine the truth for herself.
I don’t know what else I can do. Is there *any* way to get through to her or her physicians? Is there any way to trigger the APA or someone else to do an external review of the prescriber and this prescription?
Or do I just have to give up on the love of my life and a 30+ year relationship? It’s so heartbreaking.
Dear Chris,
I’m so sorry to learn of this nightmare.
I know of a similar story, where the psychologist (a well-known name online) dealt with a similar problem by telling the wife, his client: Your husband doesn’t understand ADHD treatment.
Well, neither did her parents, her siblings, and multiple friends.
The thing is, all the wife knew was that she was finally getting FOCUS — and she did not want to give it up.
And that is the problem with trying Adderall first.
I don’t know what to tell you. If you’ve written to the prescribing physicians and detailed, in brief bulleted points, the behavior that is endangering her and estranging her from loved ones…. I’m not sure what else you could do.
If it were me, I’d be writing letters of complaint to the state licensing board. Note dates and times where your wife did these things, such as called the police. Be as clinical and specific as you can.
Maybe ask her friends and other relatives to sign a joint letter.
I imagine much will depend on your state laws. Maybe this site will be helpful: https://www.psychsearch.net/complaints/
But beyond that, Chris, if everything was so great for 30+ years, why did she seek an ADHD diagnosis and treatment? Because all those things you describe are often hard to muster when poorly managed ADHD is present.
g
I don’t know where to begin with my post, so here goes…
My husband has had untreated ADHD since he was around 12 or so. He was diagnosed but the doctor didn’t really consider his “slight” ADHD a big enough deal to treat (my husband is 52 now). I’m doubting any medication will truly keep his symptoms at bay. It’s even more difficult because he has MDD, anxiety and panic. All of these exploded around the time of the pandemic, and it took forever for him to get treatment.
He was recently started on Adderall short acting last month, but then doc switched him to supposedly long acting Vyvanse for his symptoms and it seems to work. But it’s not as long acting as we thought. It is only effective from around early morning when he takes it until 2PM. After 2PM he gets horrible crashes where his symptoms are sometimes even more severe. He has had these afternoon episodes even before he started the med.
Symptoms are very scary, and some therapists didn’t even want to treat him because they were unfamiliar with this kind of behavior: slurred speech, loss of motor skills, and sometimes he falls – I obviously can’t pick him up so I’ve had to call an ambulance a few times. He gets very mean and verbally abusive and slams things, bangs walls and doors and shouts, sometimes what he says doesn’t even make sense. These episodes occurred decades ago very rarely.
It was a few years ago where the occurrences got closer together and now, he has them almost daily – and ALWAYS in the afternoon when he is exhausted. I don’t know if this is severe and crippling anxiety and panic all mixed in with ADHD rage? No doctor or therapist seems to know. Just this week he started to add Adderall (5MG) short acting in the afternoons since the Vyvanse (30MG) isn’t working for long.
He is also on lowest dose of Lexapro (10mg), and that seems to have helped with the little things that would upset him. But what about the ADHD meds? Can they make his rage worse? Just tonight he had another episode, and then he fell when he was trying to get out of bed to use the bathroom. He is incoherent and it’s terrifying. He didn’t take his Adderall dose until after 3PM (he usually takes it at 2PM). Perhaps this episode was caused by him not taking it early enough to prevent symptoms?
Anyway, does anyone have any insight into ADHD meds and depression meds together? Are antidepressants such Wellbutrin better for someone with this rage? I just don’t know what to do anymore – it’s getting harder and harder to live like this.
We are both unfamiliar with ADHD and are now just getting a crash course in this.
Hi Deborah,
I can only imagine how scary these situations are for the both of you.
MDs who prescribe Adderall and other amphetamines so easily — and always first — should be called before a disciplinary board. They are wreaking havoc and are too arrogant to have a clue.
Your question is much larger and broader than “ADHD meds and depression meds together”?
Caution: I don’t recommend getting random opinions online. It doesn’t seem you have enough margin of error.
As a recognized expert on Adult ADHD, I work hard to steer folks straight.
For starters, I highly recommend that you read my first book. It will help educate and validate you — and help you self-advocate with reckless MDs.
https://amzn.to/3HEDLtW
I just cannot imagine….the behavior you describe and Adderall being ADDED. smh.
What you describe could be a rebound — a crash — where symptoms return stronger than at baseline. But there could be many other explanations.
If he does well on Vyvanse, maybe talk to the prescriber about a second dose. Most people taking Vyvanse don’t get the 16 hours they advertise. For some, it’s more like 6-8.
But I also encourage you to think about the kind of sleep he’s been getting, also diet, and also consumption of other substances — including caffeine, nicotine, and cannabis.
All of this can increase medication side effects.
But the Lexapro itself could be making things worse. It’s extremely important to distinguish between a legitimate Depression disorder and the “depression” that can hang around people with poorly managed ADHD. These require different treatments.
Even if the Lexapro seems to help with the anger, etc., but it could also be making things worse, such as when he fell. Maybe even in having trouble regulating angry reactions.
My online training will give you the “crash course” you need in Adult ADHD, including relationships. I implore you not to self-educate with most of the stuff we see online. That mostly keeps people going in circles.
https://adhdsuccesstraining.com/solving-your-adult-adhd-puzzle-for-couples-and-individuals/
That is the foundational course.
I’m soon launching Course 2, on medication and sleep.
take care,
Gina Pera
It’s been awhile since anyone has commented, but I just wanted to comment on the MARKED difference I felt between taking Adderall XR and Adderall IR(?). I was initially prescribed the “typical” introductory dose upon re-diagnosis at age 32(ish; I had originally been diagnosed with ADHD at 18, thought probably should have been tested around 11… another story).
Anyways, my productivity and focus is perfectly timed with my 15mg about 20 minutes before heading into work, or getting ready to start my day… however, my partner and I just came to the realization that I need to take another half dose around 2pm to complete the “rest of my day” at home…
However, this was self-tested, which can be risky, BUT also necessary (in my opinion) for each individual to find out whether or not their doctors actually know them better than they do themselves … (does that make sense?)
Hi there,
The previous comment was 6/2/22 — just a few days ago. Perhaps you are looking at the older comments first.
As to your question, yes, absolutely it makes sense. This is why I have always focused on educating consumers (Adults with ADHD and couples) about medication.
The hard truth is, we just cannot rely on the average prescriber to have a clue.
If you’ve only tried Adderall — XR or IR — that is a huge indication that your prescriber is clueless.
I’m not encouraging being your own psychopharmacologist, and it’s probably a good idea to let your doctor know what you’re doing.
But it’s not as if you’re abusing the medication that you were prescribed. You’re just trying to extend it throughout the day and evening (time of relationship interaction!)
If you’ve tried no other stimulant, it’s important to know that the recommended protocol is to try at least one medication in each class of stimulant.
I hope this helps.
Gina
My doctor first put me through three different medications. First it was Strattera, which only made me depressed. Then, Vyvanse, which I favored out of the three, only because it made me feel more normal. But because my insurance wouldn’t cover it, they switched me to Adderall, which was okay at first. After about three months I started to become something evil, lashing out on my loved ones without realizing. One minute I was on cloud nine, the next I was irritable or depressed. All of the motivation I had was gone, and I began to question my purpose/existence. Almost as if my brain would go numb and I’d feel like I wasn’t in control of my body or thoughts. When I miss a day or two, I crash, and sleep for sometimes 14+ hours. Without the medication I do not feel normal, I feel zombified. But the issue is, I prefer who I was before the medication, because that person had hobbies, and friends. My doctor then prescribed me Wellbutrin as well, in combination with the Adderall. I’ve been taking both for about two months now and it helped in the beginning, but I despise myself without it, and feel off about having to take a pill to survive now. Adderall has ruined so many of my cherished relationships, caused me to flunk out of college, and most importantly made me lost my mind. I’m only nineteen and I feel like my life is ruined.
Brooke — I’m so sorry that an RX that was working for you….was no longer accessible.
Sometimes it’s a matter of getting a pre-authorization, as to why Vyvanse worked best for you.
Treating the side effects of Adderall with Wellbutrin…..[banging head against wall]…..
Also, you were never given a trial of the other class of stimulants — methylphenidate? (e.g. Concerta, Ritalin, etc.)
You should have been. That’s basic protocol.
But now you’ve tried the Adderall they pushed on you, and you feel it’s wrecking your life.
You deserve better. I encourage you to self-advocate for what you need.
This is your life. And you have a right to live it fully.
take care,
g
I understand completely how you feel. I was also previously prescribed vyvanse, and it worked well. I felt “normal”. Then insurance stopped covering it, so I take adderall. I hate feeling dependent on it. I believe I read that a generic for vyvanse may be available next year. I hope so
Hi Michele,
Have you tried appealing?
I’m not optimistic about a Vyvanse generic. When a new White House administration moved in, its new FDA chief pushed through all kinds of generics. Including those with novel delivery systems.
That created a HUGE mess for people who take Concerta. Authorized Generic Concerta Medication Update
FDA scientists had wanted more proof of “bioequivalence” but the Trump-appointed FDA chief disregarded concerns.
Now that the cows are out of the barn, I can’t imagine we’ll ever be able to fix this. But who knows.
Vyvanse also has a novel “pro-drug” delivery system. It might be easier to replicate than Concerta’s laser-drilled osmotic pump (OROS). But that remains to be seen.
Also, as their drugs near patent expiration, the pharmaceutical companies tend to find ways to make deals — and extend the brand.
If you do best on Vyvanse, it might be the smooth, extended delivery system. Or it might be the fact that is DEXEDRINE — unlike Adderall’s mixed amphetamine salts.
If the latter, you might do better on dexedrine than Adderall.
good luck
Gina
I was prescribed Adderall three years ago and it ruined me. I was paranoid, delusional, euphoric… I lost my husband, family, friends and so much more. I can’t believe where I am now.
Dear Carrie,
I feel for you, Carrie. That sounds like a long-running nightmare. I wish you all the best in your recovery.
Gina
I’m a 37 year old female who was diagnosed last year with ADHD and almost immediately, my entire life made sense. Every pro-treatment article I have read, I have identified with. I was that child with all the “potential” that I never lived up to.
Time paralysis. I’d never seen a task to completion in my life. Being physically and mentally unable to make myself or anyone else proud led me into a downward depression spiral at 15 which led to a bipolar diagnosis that followed me around for 2 decades. I’d tried every medication in the book and nothing worked.
The twist? My alcohol addiction. It took the right therapist actually listening to me to hear the facts: When on a bender, or in general really, my alcoholism mimicked mania. Everything in between was left me to feel my own feelings sober, and I never liked how I felt unless I was drowning it all in booze. Any time I wasn’t drinking, I was depressed. And as my addiction progressed, I was depressed even when I was drinking.
I strongly believe I turned to alcohol in the first place because of the issues caused by my ADHD. Now obviously because of my addiction history, no doctor wanted to touch a diagnosis. That was, until, a doctor finally heard me. My psychiatrist started me on Vyvanse after I’d had a year sober, which only made my heart rate spike and caused me to lose 20 lbs in a few months. This was worrisome because I had ED history that I had under control and I knew I was looking at the weight loss as a “positive” and that I’d be better off trying something else. So we tried adderall. I’m on 20 mg XR and a 10 mg IR booster in the afternoon. We started on 10 and 5 and we didn’t raise my dose until 6 months after the initial dose and adjustment.
I feel fairly confident that my doctor is doing right by me. I feel like she asks the right questions. This article makes me wonder though if I’m acting any differently than I was before in a negative way. I sometimes feel irritable but it’s not consistently. Adderall hasn’t been the life-altering drug I thought it would be. I had almost hoped for an epiphany, but I cannot deny how much it helps.
After years in AA/NA, I knew not to grow too fond of that initial euphoria. I didn’t want abuse to even be an option (even though I trusted myself) so I have my brother manage my medication, and my psych is aware of this.
I often feel so stigmatized. I’m ashamed of the fact that I’m on this medication because of my past. It’s frowned upon in a lot of AA circles, and moreso in NA. It feels like my dark secret.
I’m looking forward to reading your other articles and your book. It’s rare to find writing on this topic to be both pro-treatment AND deeply pro-awareness, especially of the less talked about side effects. I’m glad you touched on that Netflix documentary. While I haven’t watched it, I had bookmarked it. The way you describe it sounds like how I imagine my peers feel about ADHD medication. That it’s just evil. My life is remarkably different now, not just because of my sobriety but because of my ADHD treatment. I had tried to get sober in the past and it never stuck. Now that my issues are being properly addressed, I don’t feel the need to drink anymore. I felt compelled to share my story with you and thank you for writing this article.
Hi Christina,
I understand. You articulate these issues in all their complexity very clearly.
MANY people with unrecognized ADHD turn to “something” to feel better, to stop the noise in their heads — alcohol, meth, sex, shopping, eating, trolling, etc.
ADHD already means lower-than-average inhibition. Add alcohol and that low inhibition goes even lower. Hence, maybe, that mania-like appearance.
Unfortunately, your doctor maybe isn’t fully aware of the issues. Kudos to that doctor for sincerely wanting to help you. Many won’t touch a patient with “addiction history” — especially with stimulants.
But she should still know that you don’t prescribe as the first options amphetamines to a person with addiction history.
This is partly because the majority of prescribers remain clueless about ADHD. As I wrote here in the context of Adderall.
So you’ve been prescribed two amphetamines — Vyvanse and Adderall — and never a methylphenidate (e.g. Ritalin, Concerta, etc.)
It’s true that some people with ADHD will lose weight once they start any stimulant treatment — because they are better able to regulate food consumption and to avoid “self-medicating” with food. But the amphetamines in particular can cause weight loss beyond that, sometimes out of spiking anxiety.
I am glad that you have validated a point I often make about AA — and that is, beware of the meetings where there is an anti-medication mindset. It’s not every meeting. But it’s some. And to deny that is to deny reality.
I wrote about AA here, and there are many comments on the topic of ADHD and AA and alcoholism.
https://adhdrollercoaster.org/adhd-news-and-research/alcoholics-anonymous-and-adhd/
You might be interested also in this article on ADHD and meth — especially the comments:
https://adhdrollercoaster.org/essays/i-was-addicted-to-meth-when-i-was-diagnosed-with-adhd/
Finally, people of my generation well remember when “almost everybody” smoked cigarettes. They were ubiquitous. Imagine how much ADHD that obscured. Imagine how much ADHD was revealed when folks stopped smoking! 🙂
https://adhdrollercoaster.org/myth-busting/adhd-nicotine-historical-ads/
You sound very clear to me, and very smart. I’m sorry that you are not getting the kind of support you might need from those around you. Maybe look for ADHD support, specifically, or an ADHD group that is a little more sophisticated, medically, than others. Perhaps one near a university or teaching hospital.
Obviously, you have nothing to be ashamed of. You were trying to get through life the best way you could manage, absent ADHD diagnosis and treatment.
Unlike some of those people criticizing you, you have stepped into the 21st Century and are appreciating the ridiculous complexity and vulnerability of the human brain.
Kudos! And wish you all the best.
g
Hello! I’m a 24 year old woman with ADHD and autism, and I take adderall. Was wondering if there’s some other combination of symptoms that tend to work really well with adderall?
At a high enough dose, it does wonders for me. Before I took it, or when the dosage was too low, I was exhausted all the time, extremely emotional, negative, irritable. Struggled to get out of bed, struggled to do basic chores, would sometimes get overwhelmed and just stop moving and stare forward. I’d get so upset I’d start hitting myself. I’ve also always moved and talked slower than everyone else.
On adderall? I simultaneously have more energy and more focus. I’m like a zombie when I’m NOT on my meds, or when the dosage is too low. Went from wandering around my workplace feeling agitated and unfocused to getting stuff done. I moved faster! It also had the wonderful effect of giving me the ability to read again. I felt good for the first time in my life.
I understand not wanting to rely completely on how people feel, but I literally went from being exhausted and miserable to being relatively content. Even if it does change my personality, my dopamine-deprived personality is not very good company for myself or anyone else. I’m nicer because I can remember social cues and don’t have to fight through misery to act on a desire to be nice. I clean up after myself at home. My suicidal ideation just about vanishes when the adderall works properly.
I wonder if it had something to do with having primarily inattentive features. Everything in my brain is already so slow, except for looping nonsense anxiety thoughts – which reduce considerably on the adderall. My anxiety gets better on it. My natural energy levels are very low.
The only clear negative side-effect I’ve had is dehydration and the resulting constipation. Which is what is so strange. I see so many report such extreme negative side effects, or even just moderate negative effects that have to be balanced out in other ways. Yet for me it has been wholly positive. Adderall also works incredibly well for other members of my family.
It’s difficult to tell if my sleep is impacted because I’ve always had issues with sleep – an autistic tendency that’s incredibly difficult to break. I might even sleep better or more consistently taking adderall because it’s easier to break looping behaviors on it – though I always try to follow the instructions not to take it too long after 5 pm (work sometimes means I have a nontraditional sleep schedule).
Basically, if it ever turned out that adderall had too many side-effects to use, or stopped working, it might be a tragedy for me. I’m not chasing focus. It gives me emotional regulation and a baseline level of energy that helps me make healthier lifestyle choices. Ironically, it tends to interrupt hyperfocus when it’s working at optimal levels.
Today I started an increased dose and looking back at the rambling depressive text I’ve written and impulsively sent to people or put on the internet as recently as yesterday is scary. And I want to emphasize that I did things like that before I ever took adderall, as well. That’s how quickly it changes my behavior for the better.
Apologies if this is too long. I’m not trying to argue, but was more wondering what it is about my brain that seems to work so well with this medication.
Hi Victoria,
Just to be clear…..I did open with this:
—Prescription Adderall works very well for some people with ADHD.
—For others, Adderall can create more problems than it solve.
—Poorly prescribed Adderall can create or exacerbate anxiety, irritability, grandiosity, tunnel vision, and even rage.
Absolutely. It no surprise that you felt improvements in the various challenges you mention when you started Adderall. This might be true with any other stimulant, depending on your neurochemistry.
But what I’m not seeing in your post is mention of any other stimulant you have tried. In other words, prescribers should give a trial of both classes of stimulants. If you’ve had only Adderall, you’ve had only one class (amphetamine) and Adderall works differently than the other amphetamine, Dexedrine.
Another thing: You mention that your issues with sleep are an “autistic tendency.” Sleep disorders are enormously common with ADHD, too.
I am not disputing your ASD diagnosis. But I will point out that many mental-health professionals diagnose ASD when what they’re actually seeing is ADHD. They just don’t know how to differentiate ADHD-driven “social anxiety” or “not reading social cutes” with that associated with ASD.
Yet, the two often travel together (moreso when ASD is the primary condition than in the opposite direction). Even then, the expert consensus is to maximize ADHD treatment first and then see what’s left that might be ASD.
If Adderall is working well for you, great. If you’ve never tried anything else, especially in the Amphetamine class, it might be worth trying Vyvanse. Just to see. Maybe you’ll experience less dehydration and constipation.
I hope this helps.
Gina
Thank you for this article!
I was on 5mg of generic adderall for a year and a half after being diagnosed at 32. I decided it wasn’t working very well after seeing my best friend also get diagnosed and start treatment with adderall and the positive changes it made for her that I wasn’t experiencing.
I spoke with my psychiatrist who recommended we try switching to 15mg extended release. A short time later, I was feeling worse. I had a noticeable cognitive decline. Words simply weren’t coming to me when trying to have conversations, I felt like a zombie.
So, she switched my dose to 10mg XR twice daily. For the first couple of weeks I usually forgot to take the afternoon dose, and I was feeling EXHAUSTED all the time. I emailed her and her response was to do a sleep test and look for apnea? Out of the blue.
Well, it’s been a week after that and I set reminder alarms and haven’t missed a dose. Now, I’m angry. I’m a complete b*tch to my partner. I work in special education and my years long reputation for being the warm, nice and patient one is out the door. I’m impatient and snappy with everyone.
I’m glad I’m realizing this in such a short amount of time, but I’m concerned my doctor won’t accept this and make a change. I would gladly go back to the 5mg dose if it meant ditching this. My insurance is notoriously terrible with mental health care, and I don’t have much of an option to switch doctors. This has inspired me to do everything I can to self advocate for trying a different medication altogether.
Hi Natalia,
How DARE that doctor. I mean, seriously. How DARE SHE?
Following even the most basic established protocol, you should have been given a trial of each class of stimulants (methylphenidate and amphetamine).
Instead, she stuck with ONE amphetamine, the one with the highest side-effect profile! First, generic (a potential can of worms all its own). Next, higher dose and extended release.
Finally, ratcheting down 5 mg.
Still not seeing the error of her ways, she suggests a sleep study! That’s beyond the pale.
NEVER TRYING ANOTHER AMPHETAMINE (E.G. VYVANSE) OR METHYLPHENIDATE (E.G. CONCERTA, RITALIN, ETC.).
Sometimes, MDs would prefer being told what to do by patients. It’s easier. Maybe your physician is like many others who disregard all evidence and continue to believe “Adderall is Best.” Based on nothing but aggressive pharma marketing 20 years ago! It sticks around in the mythology.
Maybe you could diplomatically ask for a trial of Ritalin. Now, this will come with issues all its own because you will mainly get generics. But you’re taking generics now, so…
If you think you can get authorized-generic Concerta, you can try that.
Read this post first: https://adhdrollercoaster.org/adhd-medications/authorized-generic-concerta-update/
Mostly, I encourage you to get your hands on my first book. https://amzn.to/3P205Ro
Among its many “firsts” is a detailed approach to optimizing medication. If more physicians read just those chapters, we’d see an incredible step up in the standard of care. But alas, too many just wing it. I’d like to report them all to state licensing boards—and “Yelp” them, too. Nobody is looking out for their patients!
Here’s what I would do:
1. Read the book. Get the paperback, not the Kindle, so you can take it to the MD, if need be.
2. Write down on paper, in BRIEF bullet points, the changes that you have experienced on Adderall. Use two columns – positive and negative.
Any MD with any working neurons at all, seeing nothing but a list of negatives — some quite alarming (losing words) — should clearly see…..this has to change.
3. Mention a friend who might have tried Adderall, to similar response, and then tried Vyvanse or Concerta, to much better response.
Do you have such a friend? If not, I do. You can borrow them. ;-). I’m not encouraging you to lie. But this is a bit like guerrilla warfare: You are stuck with a lazy MD, and you must get what you need. It’s not like you are a “drug seeker”. Those seeking to abuse stimulants always want Adderall. You do NOT want it.
4. If none of that works, show her my book. The medication chapters, in particular.
Point out the high-level endorsements, the fact that the protocol I share I developed with a preeminent ADHD expert.
5. I would say forward the link to this article, but some lazy MDs don’t want to see what their patients are “reading on Dr. Google”.
I’m sure you will figure it out. Just put your mind to it!
Good luck
Gina
My son was prescribed Adderall ER in fifth grade. By 11th grade, age 17, he wanted out so we talked to his doctor who referred us to a psychiatrist. He weaned him off. Things were fine for about a year then slowly a monster emerged. He started having psychotic events, anger, depression, then when he thought it a joke that he said he was going to cut his wrist, then if that didn’t work use a rope or his belt I called 911. The psych ward diagnosis was bipolar disorder. So our lives have been hell since. His is now going to be 30 and lives in his own sad, angry world. And he lives with me. I refuse to put him on the street. He was not addicted to his meds and now refuses meds because well the Adderall was a lie and he knows this. Where do we go from here. His life is not his own and neither is mine.
Hi Cheryl,
I’m confused. Your son took Adderall ER from 5th grade to 11th grade. At which point he “wanted out.”
But you don’t mention that he did poorly on the Adderall. Otherwise, why keep him on it for 6 years?
It’s possible that he was unable to cope with his ADHD symptoms, after treating them for six years. Perhaps it’s also possible that he was abusing street drugs, cannabis, alcohol, going without sleep? That alone can create psychotic events.
It makes no sense that he suddenly has bipolar disorder. After being on an amphetamine that could push bipolar to the extremes.
From the sound of it, he’s been failed by the “care providers” he’s seen. He might have given up hope. Especially if he’s gotten the idea that the Rx he took for 6 years was a lie and he “really” has bipolar disorder.
I encourage you to think again about the sequence of events, get more clear, and then set about pursuing more effective treatment.
good luck,
Gina
Thank you for this article! I’ve been on generic adderall ( 20 mg XR daily) for about a year, after being diagnosed with ADHD at the age of 39. It seemed to be helping but I was having work related anxiety (ER Nurse) so my psychiatric provider started me on escitalopram and within two days I wanted to rip my skin off, was having palpitations and balance issues. Stopped that, started Sertraline which wasn’t helpful and they increased the dose when I told them my anxiety was getting worse, because ” the therapeutic dose is actually higher.”
After 20 years working in the hospital environment I realized it was the Healthcare system itself and it was time for a career change. I still feel super anxious yet apathetic, spacey and just off, like my thoughts are fast and my physical movements are slow and I need to think about the steps to doing tasks. Weirdly grateful that I don’t have insurance so I can wean myself off of both. Definitely not a combo with synergistic benefits and I miss feeling like myself.
Hi Ashley,
Career considerations aside, the sorry truth is that you’ve received very poor medical care.
Shockingly bad, really.
Read to the end of the article to see how things should go. It sounds like it’s worth trying again, this time with education and self-advocating.
good luck,
g
Thank you so much for this article. My husband and I have been together for over 20 years, every single one of them very happily. We both have adhd so I have a pretty good understanding of it.
I take 10mg twice a day and while it calms me and decreases my pain levels from ai disease, I will gladly go back to no treatment if I could get my husband to stop taking his.
He has gone from a kind, thoughtful, goofy guy that loves being with our kids and I, to a self-absorbed, ego-maniacal, special interest-obsessed, sometimes downright mean person that none of us recognize anymore.
My problem is *he doesn’t see it AT ALL.* I don’t know how to make him see it.
I’m his mind, he has reached his full potential and nobody likes it because we’re so used to him being the, “weaker,” version of himself.
My marriage is on a path that I never in a million years would have seen coming. We truly were genuinely happy, we’ve been best friends above all for 25 years, and adderall is going to cause the end of it all. I don’t know this person… I’d say who sleeps in my bed but that’s when he actually sleeps.
How do I get him to realize what’s happening to him?
Dear Jane,
I just hate it when I’m right about this. So sorry you are dealing with the fall out of yet another reckless prescriber not having a clue about Adderall’s potential effect.
I would write to the prescriber, reporting what is happening. But that’s me.
You also might consider an alternate Rx, such as Vyvanse. If you like it, maybe you can convince him go try it.
take care,
g
Dear Jane,
I have experience with this. My marriage ended and I blame adderall. I have adhd but adderall warped my mind and body and I was aware but unable to stop. Twenty three years later I’m finally off this drug but no marriage and poor health. If you can see what’s happening, you are a step ahead of where I was. I was the addict and my husband didn’t know my behavior change was drug related when I lost my mind and then filed for divorce. I miss him every single day if my godforsaken life. I was so euphoric in the early years of that drug that couldn’t admit or see the problem.
I hope you find help. I would recommend alanon meetings or something similar. You may learn how to avoid enabling while still keeping your sanity. I wish my experience could help someone else. I’d love to think your husband might read this and have it resonate enough to stop the drug.. It’s so so hard to live with the aftermath of adderall addiction damage. Best of luck to you and your family.
Hi Pam,
I’m so sorry your prescriber failed you so badly. I wish this were a thing of the past. Unfortunately, no.
I wish you all the best.
g
I am in tears reading this. I feel like I live with dr hey jell and mr. Hyde.
Off the meds it’s amazing and we are happy
But on the meds it’s a living hellish nightmare.
I could go on but it’s like I live in a prison and am told how awful I am every day.
It’s a hellish landscape but at least I know I’m not alone.
Hi Rachav,
No, you’re not alone. And life can be better.
Adderall is not the only choice in stimulants. FAR FAR from it.
I encourage you to read my book to learn how medication treatment SHOULD go for ADHD — but hardly ever does.
https://amzn.to/3rCe3Ac
take care,
g
Thank you for this article. I discovered it while researching my side effects. I was prescribed Adderall and took it for over a year. I loved it- I was able to finish tasks at work and home with ease. I didn’t realize how negatively it impacted my personal relationships until I came off of it due to my marriage failing. I was filled with anger, rage and uncontrollable outbursts over small issues. While on Adderall I never thought I was the problem and I was accomplishing my tasks so it was working, right? After two weeks of being off of it I returned to my normal relaxed “chill” self with no feelings of anger or rage. My marriage improved 100% and things were fine again. I will take my ADHD symptoms over the anger/irritability and rage from the medication. The rage I felt is such an indescribable feeling and it was truly awful but due to the medication working for my ADHD I wasn’t able to see this. I am happy for articles like confirming this which is what lead me to my search. I was well aware of the common side effects like insomnia and decreased appetite but I never would of thought it would turn me into such an angry unrecognizable person. My heart was filled with hate. I wish I was able to find something without the risk of that ever happening again.
Hi Chelsea,
Thank you for sharing your story. Less-than-astute (and self-interested) voices in the field have “gaslighted” me for years about this.
It’s only when they discovered how popular this post is that they appropriated the “keyword” and use it to drive traffic to their sites.
Your story represents a key reason I’ve taken up this educational mission. That is, people who try Adderall and have a similar experience decide never to try medication again. That they’ll take ADHD symptoms over that hellish experience.
And that’s just criminal.
I encourage you to read my first book’s chapters on medication. You will learn what maybe 20% of prescribers know….and about 5% practice.
Is It You, Me, or Adult A.D.D.?
You deserve relief from ADHD symptoms—without paying a price.
Good luck!
Gina
Hi Gina,
Thanks for sharing this article. My wife sent it to me. This year (2021) I started taking psych meds for the first time in my life. I am on 20mg Citalopram for depression (working?) and I have been prescribed 30mg Amphetamine-D salt combo (Generic for Adderall.) The prescription is for 20mg in the AM and 10mg in the afternoon. I am a recovering addict and do not choose to self-prescribe with medications, so I have negotiated with the psychiatrist down to 10mg in the morning, and 0 in the afternoon. This seems to me to be working reasonably well; 20mg a day gave me a sense of “dark and desperate stress” after 5 days in a row. That has lifted with the lighter dose. I have a work-from-home job and I am also involved in a new business start-up with some friends. Also involved at church and in four 12-step programs. I understand I am very busy and need to keep everything organized, which is difficult with my untreated brain, and a little better with the medication.
The main concern is that my wife is noticing and commenting that she does not see my level of distraction improving (leaving the heater on in the basement; forgetting a commitment I made – that I did not add to the calendar; etc.)
I have a concern that she is possibly noticing things that have always been true but assigning value to them. (We are both adult children of alcoholism and/or abuse.) I am 54, and I do not want to destroy my brain or my memory with medication; I also do not want to lose my job because of underperformance.
I saw what you said about trying different classes of medications. I did try another medication, Strattera (atomoxetine hydrochloride), and it seemed to have no result for me other than horrible constipation. I spoke with a friend who swears by it, and he said he has had to take stool softeners since he was a teenager.
I have another friend with ADHD who takes Vyvanse (lisdexamfetamine dimesylate) and believes in it (actually encouraged me to try it.) I find that this particular medication has no generic form, so I am highly resistant to trying it because of some of the drug company issues you raised; specifically my own mistrust of them.
I have asked the psychiatrist (who seems to be a reasonable person) about Vyvanse and he does not think it is a good fit. Thinks it is too expensive and would not be great for me.
I will consider asking the psychiatrist about the methylphenidate class of medication (and possibly the dexmethylphenidate, although that also seems limited to one manufacturer.) Not sure why you separate out Adderall and do not discuss generic forms in your article…
Thanks for listening.
Hi John,
Thanks for visiting. You ask great questions.
Unfortunately, answering them properly will require more information than I can provide here.
I will hit the highlights and refer you to my first book
Both the book and the course could critically speed your learning curve and build a strong foundation for continued progress.
Here are some highlights:
1. ADHD is often misdiagnosed as depression. Because people with ADHD get “depressed” about their challenges. Also, ADHD can “look like” depression to the average clinician because it is associated with low motivation, initiation, etc..
The upshot being, Celexa (Citalopram) might not be helping you at all. It might be making ADHD symptoms worse.
You and your doctor should be clear about this.
2. Why would any physician prescribe Adderall to a patient with a history of substance-use challenges? It beggars belief. But it happens all the time. 🙁
Vyvanse is also an amphetamine but it has a slower release than Adderall. Moreover, it is dexedrine while Adderall has multiple amphetamine salts. There is a savings program you might check out. https://www.vyvanse.com/coupon
You should have been given a trial of a methylphenidate stimulant (e.g. Concerta, Ritalin, etc.)
3. Strattera is thought to work for only about 30% of people with ADHD. For more, though, a low dose works well in combination with a stimulant.
4. Combining Citalopram and Adderall carries some real risks.
Maybe this page will come through. If not, just enter the two drug names and see.
https://www.drugs.com/interactions-check.php?drug_list=679-0,190-1645
excerpt:
Talk to your doctor before using citalopram together with amphetamine.
Citalopram may increase the effects of amphetamine, and side effects such as jitteriness, nervousness, anxiety, restlessness, and racing thoughts have been reported.
Combining these medications can also increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.
5. As far as your wife perhaps “noticing things that have always been true but assigning value to them.”
I don’t understand your question here. Of course, both of you should be re-framing long-standing challenges through the ADHD lens. This is how you gauge how well the medication is working — or making things worse. Without, you are both guessing. Moreover, medication improves ADHD symptoms. You will also need to review your old interpretations of your challenges and means of coping.
I emphasize this in my book.
6. It makes no sense that your prescriber gives you Adderall but “doesn’t think Vyvanse is a good fit.” No sense at all.
The fact that Adderall’s manufacturer also makes Vyvanse shouldn’t cloud anyone’s decision. Separate drugs.
7. You ask: “Not sure why you separate out Adderall and do not discuss generic forms in your article”
I don’t know what you mean, sorry. Adderall is the topic here. Including its generics. I’ve written MANY other posts warning about the potentially problematic differences between brand and generic.
8. Increasing research shows that properly treating ADHD with medication actually can improve brain function and overall health. Those studies were done with methylphenidate, though, and not amphetamines. Especially Adderall.
9. You and your wife should be working on cooperative strategies to support “getting things done” at home and elsewhere. You’ll find some in the last chapter of my book.
I hope this helps.
Gina
It helps me.I would not get off the couch or hear my kids in the backseat because I would block them out.It lowers my bp.I feel like I get my 20 projects started done.I have a hard time with the stigmatism of taking Adderall.I take a very low dose.I dont abuse it.But unfortunately it makes my anxiety worse.
HI Trinny,
I’m glad Adderall seems to work for you. I noted in the first paragraph that Adderall works well for many people.
The problem is the “denial” around its problems, especially from its manufacturer. Not by people “abusing” it. By people trying only to treat their ADHD.
When a stimulant makes your anxiety worse, that is a problem. Your physician should try to address that. Unfortunately, many (especially those prescribing Adderall as a general rule) remain clueless.
Possibilities:
1. You also have an anxiety disorder that should be treated, along with ADHD.
2. Adderall is causing the anxiety, due to its molecular function
3. Generic Adderall
4. Adderall is not the best stimulant for you. If you haven’t been given a trial of several others, you’ll never know.
5. If you’re also smoking cigarettes or drinking coffee, that can exacerbate the reaction.
good luck,
g
Adderall abuse has destroyed my wife
She is a full blow addict and alcoholic now. I blame the Dr that gave her 90mg a day. She was depressed not adhd. Now our entire life is a mess. My 5 childeren and I have lost her completely. Someone needs to stop this from happening.
Dear Brad,
That is unforgivable. I’m so sorry that happened to your family.
It might well be that she has ADHD, not depression. ADHD can look like depression.
The problem is that reckless prescriber.
The problem is also one Pharma that has way too many people and organizations in its slimy pocket.
g
Yes it has changed the total mindset of mine as well. I feel so deeply sorry for you just remember as I do the person on the medication is not the one underneath. The worst part is anyone of a age to fake the test can get it. Just answer yes to the correct questions then boom you now have a fix.
Hi Gary,
These doctors need to be reported to state licensing boards.
I for one am sick of them getting away with this.
g
Thanks for this. I AM pretty confident that I have ADHD but every psychiatrist I saw in college would keep throwing SSRIs at me or Trintellix which, as you know, is an SSRI but also modulates receptors for some reason that no one can really seem to explain. Every single time I have taken an SSRI I’ve felt better for a bit and then gotten increasingly aggitated.
Eventually got diagnosed with ADHD and trialed metadate CD but had awful afternoon crashes. Adderall XL seems so far to be the best but at first I didn’t feel much now I think my dose is a bit too high. But, as is often the case, I’ve had emotional regulation issues my whole life. For some reason nurse practitioners / doctors keep throwing SSRIs at me so now I’m back on trintellix and adderall and that combo is NOT good. I feel increasingly agitated, much much more so than I did on adderall but instead of listening my nurse today told me to just switch it with Paxil. Which, in addition to being another SSRI, can SEVERLY boost concentrations of adderall through inhibiting the enzyme that breaks it down. I’m continuing to be more and more agitated and, yes was self medicating with pot that I’ve recently stopped using.
I really just wanted to try an alpha agonist but for some reason not a single nurse will prescribe. My issue is I can tell they don’t know what they’re talking about but when you try to ask informed questions they tend to act like its come insult to their credentials.
“You didn’t go to med school'”
“Yeah and yet I seem to know more about this than you I agree that’s pretty shocking”
I don’t know why it’s so hard to get Vynase but I really wanted to ask about it because it doesn’t have the D-isomer that is associated with some of the preipherial effects.
Fortunatley I made an appointment with an ADHD specific psychiatrist/ therapist for a month from now so hopefully I can just muddle through and finally be able to talk to somone who knows what they are talking about.
It does seem that the amphetamine class is the one I respond better to but I don’t understand why it HAS to be adderall and I especially don’t understand why they keep trying to add an SSRI when I have had bad reactions every time or, she even suggested a mood stabilizer. Why not an alpha agonist! I’ve heard very very good things about guanfacine. Ugh.
HI Will,
I appreciate your frustration.
The only reason it “has” to be Adderall is….ignorant prescribers brainwashed by one bad-actor (and I mean bad) Pharma. Years ago, but very aggressively. The one that distributes Adderall.
Aggressive marketing doesn’t go away on its own. There must be an active counter.
And yes, it’s nothing short of malpractice to keep throwing SSRIs at people with poorly managed ADHD.
Sometimes I get really tired of being the “watchdog” on all these points. 🙁
Maybe an alpha-agonist would be helpful. But they are much farther down the line, as far as proven efficacy, compared to the stimulants and Strattera.
In fact, few people were even talking about alpha-agonists for adults until one Pharma-dominated website made up a diagnosis and recommended alpha-agonists’ to treat it. Claiming “research” but not providing it. Guess who makes the Rx that’s recommended for this made-up diagnosis? You guessed it.
It’s horrible. Corruption at its worst. Gives evidence to the conspiracy theories about ADHD being a Big Pharma Invention.
There’s no reason you should not be able to try Vyvanse (ironically, made by the same company, and they made false claims about it, too, such as being “non-abusable” …. after denying for years that Adderall was highly abusable). Unless your insurance plan will provide only generics. There’s a Vyvanse savings card.
https://www.vyvanse.com/coupon
But how do you know you respond better to the amphetamine class? What have you tried in the MPH class? And was it brand or generic?
If you’re expecting to “feel” something from the medication, for the most part that’s the wrong approach. And it’s why people are so vulnerable to the Adderall bzz.
Good luck,
Gina
Thanks Gina, and I agree “feeling” it is the wrong approach. I don’t want to be amped up just calm and focused. I tried metadate CD first and it actually was more “noticable” than even adderall xr, I think because it wore off more sharply. Vynase or a lower dose of the adderall than I’m on now is probably the way to go. I just wish there was something out there that was especially good for the emotional regulation issues that I’ve had since I was a kid. I’ve always been a “hot head” and it’s really hard for me to step back and control my reactions. Adderall probably isn’t making it better but I know that it’s been a problem even before the adderall. Are there any drugs out there that are especially good for the more social/ emotional symptoms of ADHD rather than just the focus stuff? Being able to pay attention at work has been huge but I want to work on my relationships with other people and try to build some friendships but the reactivity is getting in the way. Thanks again
Hi Will,
That one MD, promoting a rogue idea with a rogue treatment, has confused so many people. It’s unforgivable.
The stimulants themselves can help mitigate “hot head” reactions— by giving people with ADHD better self-regulation overall. With mood, with temper, with focus, etc..
Metadate CD is an extremely old formulation. I don’t know anyone who takes that now. Maybe for some people, it might be useful. But it’s rarely used these days.
I encourage you to try a newer methylphenidate formulation, such as Concerta (brand or authorized generic).
A basic ADHD medication-treatment protocol, as detailed in my book (Is It You, Me, or Adult A.D.D.?) recommends trying at least two formulations in each class.
Some people will gain better control with their tempers/frustration via the amphetamine class. But some will experience increased irritability and anger via the amphetamine class.
You haven’t been given a fair trial, so I would not give up yet.
good luck,
g
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.
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
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.
It’s probably not an acronym! I was probably just tired. 🙂
Takes a lot of work to write these posts!
Thanks,
g
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
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
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.
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
I experienced INTENSE rage taking IR Adderall & Lexapro. I was on the max dose of Lexapro & didn’t realize the effect it was having until I switched from Lexapro to Zoloft. I also had a TON of sleep issues when I was on the Lexapro especially at the end. At least for me that switch from Lexapro to Zoloft with the same IR adderall at the same dose, that rage was SO much better within only a few weeks and basically gone within 3 months of being on Zoloft. And I started sleeping WAY better at night which helped me not feel so beyond exhausted during the day even taking the adderall. I thought it was more the ADHD meds being the issue and hadn’t seen anyone talk about Lexapro rage when taking it with Adderall, so wanted to come comment because I’ve since learned this seems to be something others have experienced but isn’t talked about enough. ALSO in my own experience & what little I’ve seen from others with the same experience, the rage doesn’t happen right away and initially the Lexapro and Adderall work great together & you feel ok, but after an extended period of time on Lexapro and increasing dosage, it seems to eventually stop working and this rage happens. I’ve actually seen people who do NOT take ANY ADHD medication also have the same experience with Lexapro rage after being on it for a while. I think having ADHD & stimulant medication probably intensifies whatever the issue is, but it seems to be a bigger issue for a lot of people in general who take it long term.
I wish they would look into the Lexapro rage more, but maybe you can try to talk to your psychiatrist about switching to a different SSRI anti depressant other than Lexapro and see if that could help with the rage, insomnia and exhaustion. I took Zoloft in the past and it didn’t work that well for me, but switching from Lexapro to Zoloft seemed to be a really good switch and it has worked really well this time. I’ve been on 100mg of Zoloft for over 2 years with no issues and been stable with feeling like all my meds are working correctly. I’m SO glad I switched. I haven’t experienced ANYTHING like that rage in my entire life, and haven’t experienced it since. Hope you can find something that works for you!
Hi Kay,
Thanks for sharing your story. I bet it will be helpful for other folks.
Those SSRIs…..quite a few of them, and they all work in similar ways…but with a few small differences.
Actually, there is a major drug interaction between Adderall and Zoloft, too, along with Adderall-Lexapro.
One risk is Seratonin Syndrome:
which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death.
So much depends on one’s particular genetics. Also, generics present a big variable.
From my perspective, I would want to be sure no other stimulant worked better than Adderall before settling upon it, with or without an SSRI.
I don’t know the details about Lexapro and rage. But I do know how many people with ADHD are misdiagnosed with anxiety and depression—and “treated” with SSRIs. These risk back-suppressing dopamine in parts of the brain, thereby intensifying ADHD symptoms (that are not first stabilized).
All in all, I find that too many prescribers “throw spaghetti at the wall.” And when a side effect pops up…..too many just add another medication to treat the side effect.
I’m glad you found something that works for you! That’s so big.
g
You are not alone check out all these I found upon researching
http://forum.quittingadderall.com/forums/topic/4305-my-story-living-with-my-adderall-addicted-wife/page/2/#comment-43511
Thanks
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.
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
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.
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
I love how there isn’t a single study cited anywhere in this, just anecdotes
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
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.
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
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.
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
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.
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
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)
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
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?
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
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.
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
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.
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
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.
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
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.
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
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!!
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
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
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
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?
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
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.
Dear Patrice,
I can only imagine that parental nightmare.
Best to you and your family,
Gina
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.
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
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!!!
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
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.
Hi Jon,
Thanks for your comment. That is a CRITICAL lesson. Thanks for sharing it.
Gina
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
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
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.
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
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.
Thanks for your comment, Molly.
Unfortunately, I found the “Take Your Pills” film highly abusive and exploitative.
I wrote about it here:
https://adhdrollercoaster.org/adhd-news-and-research/take-your-pills-pseudo-documentary-dont-take-the-bait/
Thank you, Gina, for the enlightening post. I never knew how complicated medicine could be before.
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
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.
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
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.
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
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
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
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?
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