What about when Adderall doesn't work?

September 29, 2008 11:44 AM

I saw the doctor to discuss ADD and getting a diagnosis. He started me on Adderall XR, 10mg, slowly increasing the dose. By 40mg, I was jittery as can be, having serious anxiety apparently caused by the medicine, but still as ADD as ever. I have a follow-up appointment with the doctor tomorrow, and want to know what to ask for.

(First, in case anyone's alarmed... Yes, I backed off the dose at 40mg, and am back to 30mg, which for some reason is significantly less troublesome.)

I'd been tested for ADD in high school, but the doctor seemed to rely primarily on tests, which concluded I didn't have ADD. I was pretty sure it was wrong, but lived with it until a few months ago, when I went to see my doctor. (I'd finished reading Driven to Distraction, which could pretty easily be my life story.) He decided to start me on Adderall XR to see if it cured me, agreeing with my reasoning that being unable to focus on anything, ever, was a better test for ADD than a computerized test from a decade ago.

But... I'm not feeling better. I still can't focus. All the descriptions of people with ADD starting Adderall have pretty much been, "It just worked, just like that" and, "It was the difference between night and day." But not for me, which has me quite discouraged.

I'm getting all the side effects of Adderall. It certainly keeps me from being drowsy. It's suppressed my appetite, though not to dangerous levels. I'm bursting with (amphetamine-induced...) energy... I just can't focus it.

I should mention, since I can't follow up (being an anon) that I'm also taking 10mg Lexapro for anxiety, both social anxiety and generalized anxiety. The Adderall leaves me feeling more outgoing, but also leaves me feeling very anxious. And feeling very anxious about nothing plus feeling very jittery/hyper is pretty miserable... (My doctor and I discussed the risks of Lexapro+Adderall ("serotonin syndrome"), but the risks were minor and he's monitoring me for that, so don't think we overlooked a dangerous drug interaction.) This isn't my main complaint with the Adderall, I just wanted to mention it in case it was relevant to any answers.

ADD is really very handicapping in my life, especially right now when there's not a lot of outside structure. I've been working on things like setting up a structured environment, but that's no panacea. I'm not a big fan of drugs, but I think I need medication for this.

I have an appointment tomorrow with the doctor, and he is quite competent. But I don't want to go in empty-handed, either: I really like to go in already knowing my options and having some recommendations for treatment. Is it common for Adderall to not work on people with ADD? All my research really only turned up people who had Adderall work miracles, and a couple people who had bad experiences; I didn't see any stories of people in my case. Any advice at all, really? [e-mail] will reach me if need be. :)

posted by anonymous to health & fitness (9 comments total)

I wouldn't "ask" for any other drug - neither the internet nor you are qualified to decide what treatment regimen is appropriate for you except in cases where you feel that it is doing you more harm than good and are within your rights to decline treatment. I would explain your problem to your doctor and ask for his recommendations, whether for a different drug or a referral to a specialist. Your options are to get more information from this doctor until you are satisifed with an approach and/or seek a second opinion.
posted by Inspector.Gadget at 11:51 AM on September 29, 2008 [1 favorite has favorites]

I don't know if this is your problem. But I have increasingly heard people complain that Adderall "wasn't working," because they had the assumption that it was a magic pill that was going to make them get off the Internet and like doing homework or going to the gym or something.

It isn't going to do any of those things. It still requires you to exercise the willpower to get up from the television, or the computer, or whatever is distracting you, and sit down in front of your work and apply yourself.
posted by schroedinger at 11:56 AM on September 29, 2008 [1 favorite has favorites]

I'm not clear on how long you've been on Adderall and what other behavior modifications you've made, so I'm just going to answer your most direct question about advice.

Some people are really lucky on their first trial and some people take a little longer to find a medication that works. My son and husband both found the right meds on the first go-around but a friend went through months and months of different trials with her daughter before they found the right one. Just be really specific about what you didn't like and if there were any positives at all, be sure to tell your doctor that, too. Seconding not asking for a different drug. Every person is different and what worked wonders for others might not work at all for you (see: Adderall and you). What you could do, just to feel armed with information, is research a bit on the major players in ADD medications. Some of those include Ritalin, Ritalin XR, Vyvynase, and Stratera. There are stimulants, non-stimulants, atypical antidepressants, tricyclic antidepressants and antihypertensives approved for use with ADD. Adderall is a stimulant; perhaps stimulants aren't for you. Again, this is something to discuss in depth with your doctor (and is this doctor a specialist or a general practioner?).

A good resource for the different medications can be found here, at the CHADD website. Good luck.
posted by cooker girl at 12:04 PM on September 29, 2008

I don't think you should necessarily just go in and ask for another drug, but anecdotally I've had great results with Ritalin LR. It's the newest reformulation of Ritalin and constitutes a gigantic step forward for the drug, in my opinion - I was on the old Ritalin all through high school, and it was hell.

Drawback is that there's no generic version.
posted by koeselitz at 12:16 PM on September 29, 2008

Consider getting another, more modern ADHD screening, from someone with experience administering such screenings. To me, a negative on an ADHD screening (and it sounds like you may have had negatives on more than one of these), coupled with a poor response to ADHD medication suggests that ADHD may not be the correct issue to be treating. I'm working on my Master's in school psy, and if a kid came in with that history I'd immediately start looking at other possibilities such as understimulation, etc.

The fact that your current doctor was willing to prescribe an ADHD med without doing an up-to-date ADHD screening suggests he may be disregarding the variety of mental, personal, neurological, or chemical factors that can affect one's ability to pay attention. Hoping that a pill will be a cure-all makes it sound that both you and your doctor are minimizing other factors that may be involved.

ADHD meds are not a cure-all, especially if you're using them to cure something that may not be ADHD.
posted by Benjy at 12:54 PM on September 29, 2008 [3 favorites has favorites]

Adderall is a stimulant. There are non-stimulant treatments to ADHD. Its also worth noting that someone with GAD could be misdiagnosed with ADHD. Regardless, work with your doctor on this. The right treatment usually takes a few tries.
posted by damn dirty ape at 1:17 PM on September 29, 2008

I'm not a doctor, but I have experience with these medications -

I'll second Benjy. Formal, scientific ADHD evaluations are invaluable. They're also hard to find. I took one that involved me sitting in a room for the better part of an hour, sitting in front of a computer running MS-DOS, pushing a button whenever I heard a beep, like a goddamn monkey. But the results can tell you if you really have ADHD, and to what degree.

damn dirty ape also has a good point. There are two main types of ADHD drugs: stimulants and non-stimulants. Adderall, Concerta, Focalin, and Ritalin are all stimulants and work in roughly the same way. They are different drugs, though, and behave way differently for different people, so part of the process is figuring out which one works best in your body. Hopefully your doctor is willing to use a scientific trial-and-error system to figure out which suits you best.

The only oddball is Strattera, a non-stimulant. Strattera was originally developed as an anti-depressant drug, but researchers discovered it has significant effects on ADHD, so that's how it's marketed. Because it's a non-stimulant derived from anti-depressant drugs, you may find it makes you less jittery and anxious. I would read up on Strattera and maybe chat with your doctor about it - I'm just some guy on the internet.

I'm not sure what kind of doctor you're seeing - family practice? Psychiatrist? Finding the perfect drug and dose is really an art, and you should find a doctor who's willing to pursue any reasonable medication. Many doctors are familiar with only one ADHD med, and aren't willing to deviate from what they know. You may want to find a really good psychiatrist in your area, maybe one specializing in adult ADHD. Teaching hospitals are good places to look, generally.

It is possible to handle ADHD without medication, so remember that's an option if drugs just make things worse. Usually the best outcome is seen with both drugs and some life changes. For example, maybe there's room for a better organizational structure in your life, or you could restructure your daily schedule to take advantage of your peak hours, or you could ask a roommate or coworker to play a role in an incentive system. But you're right, that isn't a panacea, if you want to minimize the burden of ADHD in your life, you should pursue both drugs and behavior modification.

I also just want to mention that I know how you're feeling! ADHD is tough to attack, and it sucks when lauded drugs just make things worse, and make the wheels in your head spin out of control. These drugs are not universal miracles for everybody. If 30mg of Adderall doesn't work, I'd keep looking.
posted by Sfving at 8:15 PM on September 29, 2008

Oh, and if you'd like to follow up, my email is in my profile. :)
posted by Sfving at 8:16 PM on September 29, 2008

Not sure anyone would read this now, but....

Are you really sure you have ADD? More to the point, why are you really sure you have ADD?

In medicine, there are multiple disorders that can cause subsets of the same symptoms.
The symptoms for ADD are very vaguely defined, so it goes doubly so there.

What if you instead, have anxiety disorders, compounded by bad habits etc?

Do you seem to be hyperactive? If so, are you actually hyperactive, or are you nervous?
Do you procrastinate terribly? If so, is that ADD, or anxiety about tasks?
Do you constantly lose track of what you *should* be doing? If so, is that ADD, or avoidant behaviour, because you're worried you'll do badly, you don't like the task, you *should* like the task but you've started late and are now worried you'll fail, you don't want to focus on it because then you'll see how far behind you are, etc, etc, etc? Basically, see above?

How much is compounded by habits?
If you had exercise, and structured routines, used a watch, used alarms, used a calendar, made notes, would that have a positive effect?

Do you realise that all those things in that last sentence are used by normal organised folk? That they don't just try to remember it?

See if you can go see a psychiatrist, explore and see if there's other options. I know that may suck, because ADHD seems like it could be a solution! Finally! And an easy one - just take a pill!
But, it still might not be true. And those might be reasons blinding you to alternatives.

Good luck.
posted by Elysum at 9:45 PM on October 2, 2008