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.
[advertising, not endorsement]
[advertising, not endorsement]
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.)
[advertising, not endorsement]
[advertising, not endorsement]
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.
Hi, my bf of 3 years has been taking meth ( snorting) since I met him. He just shared that he thought he had adhd. He shared this because I was protesting against his proclamation to order some Adderall along with others like Ritalin etc. from a friend he met at a party because he needed “performance enhancing drugs” as he has a test today that he had to study for for the elevator union. (Tell me this already sounds crazy! )
So after all this, just happening, I come home and he’s acting cracked out and talking to himself, pacing, being mean but blaming me, very irritable, and just like not right. He also partakes in daily alcohol use as well as high use of weed daily.
His mom is batshit crazy. His dad was a cheating “asshole” according to his mom, for he seems real nice to me. My bf has cheated on me before with tranny escorts. He has been unable to communicate in a healthy way all the time. The point is, I should be scared out of my fricken mind right? I googled in hopes of just looking up side affects and found your wonderfully written article and I really appreciate your work and concern and knowledge in the matter. You’re an angel. But right now I’d like to get a second opinion about what it is that I’m going through and how best to approach it or just not make me feel like I’m so crazy ! Thank you for your time and I hope you have a great day!
Hi Kristina,
If by “what you’re going through,” you mean adult ADHD, check out my book. It put these issues on the map and is still a bestseller. That will be your quickest and most reliable route.
There’s paperback and Kindle. Also audio, but I’m not crazy about the narrator’s voice.
https://amzn.to/3qc9ein
Please know….ADHD runs on an enormous spectrum. It’s a variable syndrome, and the people who have it are individuals.
That said, lifelong untreated ADHD combined with meth use and illegal Adderall use, along with other details you mention (including mom )those might make things much tougher than average.
It’s really important to keep an eye on reality, keep in touch with your old friends. And think about what a future together would look like for you.
take care,
g
This is entirely my story. Ended up with a month at the Priory. What’s odd is it was an entirely compartmentalised addiction.
Does Ritalin cause the same issues?
Luckily I just about managed to keep my marriage together, but lost my business and nearly my mind. Within a month of leaving the Priory I was entirely back to my own self and able to have the occasional beer and even a benzo while flying (which I’d developed an addiction too alongside the adderall). I won’t touch adderall again though.
Hi Wilbur,
It’s truly criminal. I’m glad you’re recovering.
Gina
This article was extremely helpful. My fiancé was diagnosed with ADHD and at first his diagnosis and starting on Adderall was life changing for him. Now I’m questioning if it’s causing him to be more aggressive and depressed. Notable that he had his dosage increased overtime since January and it’s been steady since March.
He’s always been a bit more quick tempered than most but not in a way that directly would impact me (think road rage, or generals frustrations with people – overstimulation).
We are a few months into being on his medication and we are struggling in our relationship. In particular, I feel like he has new sets of rules in place that I have difficulty keeping up with. I’m trying desperately to do right by him but it never a seems enough. We’ve landed that I need to do a better job of listening but I feel like I’m trying to achieve the impossible. Our relationship was never like this.
Any advice on how to talk to him about my concerns that it could be his dosage without making it seem like I’m dismissing what he needs from me in our partnership? I don’t want him to take it as I’m trying to shift the blame to him, and put us into a vicious cycle. But I’m really worried.
Thank you.
Hi Mel,
Of course I can’t say anything definitive about your situation. But I can tell you, I’m seeing several familiar red flags in your account.
A major risk of trying Adderall first, as I wrote, is losing self-awareness while simultaneously gaining long-illusive focus. It’s typically hard to get through.
This idea that you aren’t listening…..could be indicative of manic-like behavior. If that’s the case, it likely has nothing to do with your listening.
My sense of you, based only on your account, is that you’d do well to trust your instincts.
The hard truth is, this medical recklessness happens every day, perhaps thousands of times. And the patients are vulnerable.
Shame on these MDs. Seriously.
Take care of yourself and maybe watch being a passenger if he’s driving the car. Continue to educate yourself on what you might be up against. And read the section on Denial in my book: Is It You, Me, or Adult ADHD?
Gina
Hi. Was diagnosed with Adult ADHD 2 years ago at age 66. Dr. immediately prescribed Adderall. It definitely helps, but anxious to see what other medications may work better.
Hi Frank,
I believe folks with ADHD owe it to themselves to follow the science and try at least two other options.
The fact that prescribers don’t do this borders on malpractice. Maybe doesn’t even border. ;-). But you read the piece. 🙂
I encourage you to check out my online program. Self-paced. Structured supports. Interesting, even sometimes entertaining, videos. Short. 🙂
The overall umbrella is PHYSICAL strategies to Solving Your Adult ADHD Puzzle.
That means learning about:
—Various health conditions associated with ADHD (that those specialists might not know)
—ADHD issues with sleep (delayed sleep phrase, Restless Legs Syndrome, sleep apnea, and more) and how to address them
—How medications work and the differences among the many choices
—All supported by PDF downloads so you can personalize the knowledge and bring to your prescriber or other physician, so as to better collaborate.
You can learn more here: https://ginapera.adhdsuccesstraining.com/course-2-physical-strategies
take care,
g
This article reads as if G was on A
Aren’t you Little Mary Sunshine, Jonathan Cerpa
This is a public service. You don’t like it. You don’t have to read it.
Thank you very much for this article. I came here looking for answers to my partner’s severe personality changes. He has a long history of drinking excessively, but things took a darker turn about 8 months ago: His drinking has gotten much heavier to the point that 2-3 nights a week, he stays up drinking all night long, then pops an Adderall and goes to work, still drunk and on no sleep. (Fortunately for him, he’s self-employed.) He keeps going until he finally hits a wall and falls asleep or passes out. During these “all-nighters”, he frequently goes on angry tirades about people in his life, and most disturbingly, has even turned on me several times, which is totally out of character. He’s never been physically violent, just very verbally and mentally abusive.
I finally realized that the personality changes started right around the time he was prescribed Adderall. I landed here via a Google search as I was trying to find information, specifically, on the effects of Adderall mixed with heavy alcohol use. After reading the article, I’m even more alarmed. I thought about contacting his doctor – who I’m sure has no idea of the extent of my partner’s drinking – but since I’m “just his girlfriend”, I have no real standing, not to mention the risk that the doctor may or may not keep such a communication confidential. I have been at the point of deciding to end our nearly 2-year relationship over this, but if, indeed, it’s the Adderall that’s driving his erratic behavior, I want to try and help him if possible. I really don’t know what to do. But thank you for the information and allowing me to comment here.
Hi Julie,
Alcohol alone can really intensify ADHD symptoms.
Add Adderall and sleep deficits? Not to be alarmist, but the results could be dire indeed. Including psychotic breaks.
Unfortunately, most docs prescribing Adderall have no clue what might really be happening in their patient’s life. And many don’t ask.
I agree that you should be concerned about communicating this information to the doctor privately. If that doctor is the type who truly cannot fathom this scenario, he/she might depict you as the “interfering woman” or “controlling mother” or whatever old musty psychoanalytic tropes they have on hand.
If your boyfriend is drinking alcohol, operating on sleep deficits, and taking Adderall, such news could really inflame the situation. Please do be careful.
And when you say, “Just very verbally and mentally abusive,” please know: That is still abuse. That kind of behavior is unacceptable. From anyone.
You might want to check out my new course on Solving Your Adult ADHD: Physical Strategies. It’s all about maximizing medication and sleep. Because, unfortunately, we often cannot rely on the licensed professionals.
Even if you believe he would never be interested, that doesn’t matter. It’s important that you know what you are up against. And, in many cases, the ADHD Partner gets curious and dips in.
https://ginapera.adhdsuccesstraining.com/course-2-physical-strategies
take care of yourself!
Gina
Adderall works very well…for some. It works very well for me.
I stayed in touch with my psychiatrist of 15 years when my husband and I moved from NJ to NC. I easily – at 1st – found a Primary Care Physician willing to write my Zoloft prescriptions. I had been diagnosed with Major Recurrent Depression 15 years earlier.
Through testing, clinical observation and even a specialized brain scan it was determined I had ADD but, at the time I moved away, none of the possible treatments had proven to be effective. Taking Adderall and Adderall XR held promise but we were moving.
A co-worker at my new job was taking Adderall and she gave me the name of her psychiatrist who had recently started a private practice. That psychiatrist and I chatted for roughly 40 minutes. I gave her the contact info on my previous psychiatrist so that she could speak with him. She never bothered to do that. I could have been anyone and I left her office that day with the prescriptions I had requested. Hers was a new practice. She needed patients.
About 3 years later her practice had grown. No surprise there as private practice psychiatrists in the Charlotte, NC area are in short supply. When my pharmacy was bought out by another I followed along and almost immediately there were problems when the new pharmacy ‘lost’ my prescriptions and repeatedly called my psychiatrist over a long weekend.
Shortly thereafter I received a text from the Charlotte psychiatrist informing me that she was not able to devote so much time to a Schedule II med patient and she was dropping me. After months of uncomfortable withdrawal symptoms and failure to find another prescribing MD in NC I called my NJ psychiatrist and asked if he knew of any psychiatrists in the Charlotte area.
He offered to see me via telehealth and send the Adderall Rx s to my NC pharmacy. All went well until shortly after Walgreens, CVS and another pharmacy were heavily fined for an opiate issue. I was then informed that despite my telehealth meetings with my NJ psychiatrist and my now 20 year history of being his patient they would no longer fill my Adderall prescriptions.
The pharmacy staff person said something vague about ‘DEA’ and I have yet to find anything beyond proposed regulations. My PCP will write 1 month’s worth. That’s it. As far as I’m concerned my current pharmacy is observing their own policy…not a DEA policy. And once again my life is being disrupted by poorly covered reports on the effects of opiates* which have spilled over into reactions to Adderall.
I am tired. My husband is a 100% Disabled Vietnam Veteran thanks to Agent Orange exposure and he is about to begin dialysis. The game-like nature of finding an MD who will prescribe Adderall in a medical environment monopolized by 2 major corporations (Atrium and Novant)will leave me trying to help my husband while experiencing Adderall withdrawal and returning to the state of confusion and overstimulation which Adderall enables me to manage.
*I do not mean to be complacent or uncaring about the many deaths that have been caused by opiate overdoses. I too, have lost loved ones to this travesty. I don’t see extreme reactions to this as being helpful. To paraphrase something Colin Powell once said…take a good idea to a stupid extreme and you end up with what looks to have been a stupid idea.
Dear Alice,
You have my full sympathies. Truly. This is just cruelty, plain and simple.
There is a lot of tumult happening now around medications, especially ADHD medications. Caused by many factors — an upsurge in diagnosis due to COVID-related stresses, a boatload of junk Concerta generics pushed by Trump’s FDA Chief, and new amphetamine drugs whose manufacturers need to match with customers.
Also, I hear you on the opiate issues. The horrible irony, imho, is that many people who got addicted to the oxycondone likely had unrecognized ADHD.
Here’s the thing….sometimes when we keep hitting a brick wall, we need to go find a software wall to beat our head against. 🙂
That is, if you’ve tried nothing but Adderall XR, you don’t know if something else might work as well — if not even better.
The closest might be Mydayis — a longer-acting Adderall. Or maybe Vyvanse.
But it might even be that a methylphenidate stimulant will work well for you. That landscape is trickier now, given the Concerta mess. (Concerta has been the most popular stimulant in that class for many years.)
Barring getting access to any of those, you might get some relief from the “non-stimulant” ADHD medication Strattera/Atomoxetine. Your family MD might prescribe that.
It is thought to be helpful for maybe 30% of folks with ADHD. You might be one of them. But be sure to start at a low dose and go up slowly. Many prescribers don’t understand the importance.
Best of luck to you.
g
Excellent post!!
thank you! It was a lot to slog through! 🙂
g
Hi Gina,
Can you please tell me more about reaching out to my partner’s psych? We use the same facility for med management. My person was great and gave me a very useful drug for anxiety and trauma. But my partner has been getting ADHD meds from them for years now. Then prescribed Wellbutrin on top of that for sleep issues. The hypomanic episodes and intermittent hatred towards me, as well as the constant centering himself and refusing to do any of the day-to-day stuff that comes with parenting school-age kids has become unbearable. These telehealth appointments are like five minutes long and there is no way that is enough time to pick up on the mania. And I think he currently lacks the self awareness to report symptoms.
Will the NP at the psych office be required to tell him if I reach out? Or even if not required, would she be inclined to? I’m so worried about the backlash from my partner. Thanks in advance for your feedback.
I understand your situation and am sorry you are dealing with this.
Prescribers should be including the partners.
When it comes right down to it, your partner has to get over his ego and focus on his family, not to mention his own health and future. Wellbutrin is not a first line treatment for ADHD. Nor is it 2nd or 3rd.
IMHO, it’s favored by poorly qualified prescribers who believe it gives a twofer— stimulant and antidepressant. Plus it’s not a schedule II substance so less hassle.
It’s really best if your partner provides a hard copy letter, with e-document follow up, explaining that you should be included in medication discussions.
If your partner gets violent, I understand your hesitancy. But if not. If the blowback will be screaming and accusations, maybe get some earplugs and don’t react. If you present reasons objectively, maybe he will come around after his emotional defenses cool.
You can send a note to the prescriber, stating your concerns. They can read it without your partner’s permission. But they might also tell your partner. That can very much feel like you’ve gone behind his back….. cub trickier than explaining why you need some teamwork.
I think it’s best to be matter or fact and up front about it. Everything he does affects you and your children. He needs to understand this and work with you as a team. Seriously.
I explain this in detail in my course on sleep and medication: https://ginapera.adhdsuccesstraining.com/course-2-physical-strategies
Good luck,
G