Should I keep taking Adderall?

October 19, 2009 5:00 PM

I was recently diagnosed with adult ADHD (inattentive type) and put on Adderall. I have very, very mixed feelings about this -- hopeful, because it seems to really be helping me in multiple areas of my life, but also anxious that it is a crutch that I can't use forever. Does anyone have any insight or anecdotes to help me either (1) feel better about being on Adderall, or (2) come up with an alternative plan to manage my issues?

I am a 30 year old woman and I've struggled for most of my life with depression, severe anxiety/stress, and obesity. I've also, for as long as I can remember, suffered from the extreme inability to get my shit together, which often leads to the depression & anxiety that then lead to the emotional eating (pretty much eating for a fix) that I do.

I have always been smart enough to get by and do fairly well despite half-assing everything due to disorganization, inability to concentrate, and inability to get my shit together. For example, in 5th grade, my teacher wanted to put me in remedial math because I never did (or could find) my homework, despite my having been in the 98th percentile in the math portion of that year's standardized test. In high school, I never did my homework or studied, ever. I was in all honors and AP classes, and somehow managed to get a 4 on the AP Lit exam without having read a single one of the assigned books that year. I got into a good college and nearly flunked out both my freshman and sophomore years because I didn't study or attend class, but made it up junior and senior year by overloading classes to make up what I failed and switching majors to one that would better allow me to use common sense and BS to coast.

Now I have a good job and am a part-time grad student, but I struggle to keep my head above water. I know it isn't because I'm not smart enough or competent ... if I have a month to work on a project, I will struggle to do the research and planning at the beginning to do a good job. I will flounder for 2-3 weeks, and then panic for the fourth week, pulling together whatever I can to cobble together a passable result. Usually what I consider passable is plenty good to my employer or instructor, but the thing is that I can do so much better than what I am giving, and with so much less stress.

Not to mention that my home life is a mess. I am constantly forgetting to pay bills, losing important papers, leaving my house a mess (and not knowing where to start), starting exercise programs and then abandoning them because I am too overwhelmed with the rest of my life, budget, and work....

I've tried all kinds of methods for getting myself back on track. I am great at both implementing and making up my own systems for being organized -- schedules and charts and checklists. Oh God, I live for that stuff! But as soon as I create something and MAYBE follow it for a little while, I get distracted or overwhelmed and drop the ball and am back where I started.

And I'm miserable! I have so much to be grateful for, and yet I spend all my time being fat (100 lbs overweight), depressed, stressed, and overwhelmed. Antidepressants (celexa & trazodone) have helped, but only to an extent.

After talking with my psychiatric NP, she screened me for ADHD and found that both the results of the test and a family history (my dad & brother are ADHD) and my descriptions of my school life and adult life point to inattentive-type ADHD. She prescribed me ritalin, which I took for 3 weeks and simply felt sleepy on, and now Adderall, which truly seems to be making a difference. Suddenly I can concentrate and do alll the things I previously would think "ugh I need to do that", and then forget about or put off indefinitely.

AND. Suddenly I am losing weight.

I have been able to stick to my workout program and have felt no emotional triggers to eat over the past few weeks. I actually have almost no appetite at all during the day, which is a first, since snacks have always been the best interruption to getting anything done.

Which is great, right?

But I'm worried. I have a lot of weight to lose, and I have lost before and regained. I have read stories of people abusing Adderall to lose weight (which is NOT my purpose) and then regaining it once they go off almost immediately. I just do not want to lose weight "artificially" only to regain it when/if I go off Adderall. And I don't see myself being on Adderall forever. In a few years when I am done with school, I'd like to have a baby, and I certainly can't take it while pregnant or breastfeeding.

I am really just hoping that I can use Adderall as a tool to get me back on the right track in life. I never, ever learned to be organized, to keep my house neat, to keep my budget in check, to eat right, to do my work consistently instead of at the last minute. If I can focus now and get myself into a routine, and get my life in order, and keep it in order for awhile ... am I going to lose all that if I don't keep taking Adderall?

So, does it sound like I am doing the right thing by taking it? Am I going to have to pay later on for using this tool to get my life together now? Is there anything else I should be doing or plan to do to make the most out of this?

I'm sorry this was so long...I am just so stressed and anxious.

posted by dumbledore69 to health & fitness (23 answers total)

IANAD, but I work with a lot of teens who take Adderall and almost always, there's weight loss initially, but it levels off.

What often works is this: don't think of the medication as a life-long thing. For now, it can help with focus (and perhaps other things), and that's great.

As you feel your focus increasing, this is the best time to do some CBT and get help with ways to keep yourself focused, and then you can slowly wean off the medication. See how it goes. Most of my students who have had serious ADD/ADHD do this and after about a year, they've learned enough self-help techniques to go off the meds for good.
posted by dzaz at 5:15 PM on October 19, 2009

I am in the exact same situation you are. The description of you life and your feelings towards being on medication could be me. I'm male, 29, and was just diagnosed a couple months ago.

Here's something that helped me:

Would you feel bad for wearing glasses if you were near-sighted? Your medication is the same way. For some reason or another our brains just don't function "right" and your medication will correct that just as glasses will correct vision.

If that doesn't help you could always consider the lesser of two evils: feel horrible for not having your shit together or feel guilty for using a "crutch". I'll take a crutch and having my shit together any day of the week.

Also, pick up Driven to Distraction. I'm only halfway through it, but it makes you seem less alone when you read story after story of people just like us.

It could be worse...I got prescribed Strattera and it's not working, but I can't get anything different until December when my insurance kicks in at my new job.
posted by damionbroadaway at 5:22 PM on October 19, 2009 [1 favorite]

Would you feel bad if you had to take insulin for life? Do you think diabetics who need it are weak or bad? Why should Adderall be any different? We have this bizarre idea that it's normal and acceptable to get physical illnesses or to need medical care for conditions like diabetes-- but that if you need lasting medical help for mental issues you are somehow defective.

Let go of the stigma! Embrace the fact that you have found something that works for you. If you find that it no longer works (which can sometimes happen but not always), deal with that. But if its working for you with minimal side effects, why would you need to stop? You wouldn't say "OK, insulin works for my diabetes-- now I'll quit taking it." Why would you think differently about something that helps for a mental condition?
posted by Maias at 5:26 PM on October 19, 2009 [6 favorites]

To help yourself develop the habits you'll need after you stop meds, I can't recommend flylady enough. Her system seems really dorky and hokey but it is amazing. Just do it and you will develop habits that will help you your whole life.
posted by selfmedicating at 5:28 PM on October 19, 2009

I just want to clarify that the main reason why I say I will not take it forever is because I plan to get pregnant in a few years. You cannot take Adderall while pregnant or breast-feeding.

If I need it while I am neither of those things (like right now), I have no problems with taking it. But part of the reason I am so eager to get my life in order, to finish grad school, and to lose weight, is to be more stable and healthy for when I do have a kid.

I guess I just want some reassurance that I can develop positive changes and routines (like a better diet, workout routine, cleaning routine, work habits, etc), that if I do go off Adderall ... everything won't just go to shit again, ya know?

I know part of it is definitely that part of my brain that still thinks deep down that nothing counts unless I do it unaided (and also, btw, that nothing I do is ever nearly good enough), but I see real possibilities to put into action all the things I've been trying to do for years and years and years ... and I just am scared that it's going to disappear one day if I do have to stop taking the drug.
posted by dumbledore69 at 5:36 PM on October 19, 2009

Also, selfmedicating, thanks for recommending FlyLady! I actually like her quite a bit and already try to follow her system.
posted by dumbledore69 at 5:37 PM on October 19, 2009

As far as Adderall and pregnancy/breastfeeding. The weird thing about drugs and babies is that no one wants to participate in clinical trials, so most drugs are not recommended for pregnant or lactating people. HOWEVER, if you actually talk to OBs and lactation consultants, people do in fact take all sorts of drugs while pregnant and breastfeeding with careful observation.

Me? I dropped the Adderall when I was pregnant. Upon breastfeeding, I was really concerned about needing to take Adderall at pivotal points in my grad school career. So one day, after extensive consultation with my OB, my GP, and a lactation consulting, I took an Adderall with the plan to "pump and dump" my milk.

However, the addition of Adderall into my system after 11 or 12 months off of it was pretty intense and although that was easily my most productive day in about 20 months (pregnancy + baby), I decided that pumping and dumping was not an option for me, so I didn't take the Adderall again.

When I was pregnant I assumed that at some point around year 1 I'd wean the babe. It turns out that I love breastfeeding more than I love Adderall. (My work is probably suffering.)

I also added CBT into my regime and it has helped TREMENDOUSLY.

But in my research I did find some blogs from individuals as well as some forums with OBs in it that discussed taking Adderall during pregnancy and lactation with much supervision.

tl;dr: Don't assume that you wouldn't be able to continue Adderall while pregnant/lactating and perhaps at that point you'll decide (like I did) that being off Adderall for a period of time is worth it for pregnancy/breastfeeding, especially with some CBT.
posted by k8t at 5:47 PM on October 19, 2009

If after a few years you have your life all together and going how you want it, you will be in a much better position to make a thoughtful and rational choice about whether you want to go off the medicine for a year or two to have a baby. I don't think you should worry about deciding that now. Your world may look very different then, and you should trust your future self to find the right path. Celebrate that you are coming out of the fog, and get on with all the things you've been having trouble doing. Let go of your past failures. Enjoy.
posted by fritley at 6:08 PM on October 19, 2009

Well, let's run with the metaphor of the crutch (well, not run, because there's a crutch involved, but...well anyway)

So, you have a knee injury, do you avoid using crutches? Or do you use them as long as you need them and, at the same time, get treatment and physical therapy so your knee will get stronger?

Your brain is the same way. Yeah, adderall is a tool, a crutch, but if you can't get along without it, you might as well use it. At the same time, build strength in your organization skills, your confidence in yourself, your career.

If you're worried about losing too much weight too fast, monitor your intake and make sure you're losing weight at a sustainable rate (slooooowly).
posted by kathrineg at 6:08 PM on October 19, 2009

This is (to me, anyway) a great, great thread that deals with a lot of the questions you have, addressing questions about medications, non-medication options, etc etc. Answers range from specific ways to help your focus, and specific (personal) stories about trying meds, and the difference they've made. FWIW, it is probably my favorite thread on the subject, though I'd also recommend doing some searches in AskMe for ADHD, depression, and others.
posted by inigo2 at 6:47 PM on October 19, 2009

Your story is very close to mine I was not diagnosed until my late 20's. I was able to deal with the ADHD in high school college was a struggle but I made it through. When I got into the real world I would miss meetings was completely disorganized and had a horrible time collecting my thought in a manner that would effectively allow me to express myself. In my first job out of college I was close to being fired for it. I ended up in a job that was a good fit for someone with ADHD as my responsibilities grew in that position some of the ADHD traits came back to bite me. I had good insurance so I had a neuropsych evaluation and was given the ADHD diagnosis. I actually had some trouble dealing with that I felt stigmatized, Felt like if I just worked harder All this ADHD nonsense would go away. I got over it after i found out how well the drugs worked. I was on a few drugs before finally getting Adderall Straterra-made me feel numb to the world , Ritilian- made no difference, then tried Adderall which made a night and day difference in my daily life. It works great I can skip it on days that I have no need to be productive without any withdrawal effects (other than feeling lazy and unproductive). I had some bad side effects the first few weeks...chest pains.. trouble sleeping... then those went away. I have been on the same dose for about 5 years now. I dropped about 30 pounds since I started taking it. I attribute the initial weight loss to decreased appetite because of Adderall but eventually the appetite came back. I attribute keeping the weight off (have gained about 5 pounds back) to the better impulse control I have when taking Adderall. I don't know when I would go off of it for good. I haven't had any form of counseling to deal with my ADHD and FWIW I was told by my PCP that typically Adults do not need therapy for ADHD they need drugs.
posted by jmsta at 7:42 PM on October 19, 2009 [2 favorites]

I just do not want to lose weight "artificially" only to regain it when/if I go off Adderall. (...)
If I can focus now and get myself into a routine, and get my life in order, and keep it in order for awhile ... am I going to lose all that if I don't keep taking Adderall?

Others have appropriately addressed other concerns of yours, so I'll speak to this. I don't want to be a debbie downer but it is definitely possible that you'll gain the weight back when you go off Adderall. Not certain, but possible. Amphetamines make you lose weight, and they do so by a couple different mechanisms. If you can learn better impulse control while taking the Adderall you may be able to retain that once you go off, but it'll be work. And, of course, amphetamines are appetite suppressants and CNS stimulators, both of which contribute to weight loss.

As to the focus, again, you may well be able to learn various routines and methods by which to help maintain your focus and attention that you can keep doing when you stop taking Adderall. But you aren't going to magically retain the same biochemically induced stuff that amphetamines give you when you stop taking them. It'll be a lot of work to keep doing what you're doing.

I'm not trying to be negative, only realistic. You should probably expect both keeping the weight off and maintaining the sort of focus you feel now to require quite a bit of effort once you're not taking Adderall. It's absolutely not impossible, or even really unlikely, but it doesn't just happen without effort.
posted by Justinian at 2:00 AM on October 20, 2009

Would you feel bad if you had to take insulin for life? Do you think diabetics who need it are weak or bad? Why should Adderall be any different? We have this bizarre idea that it's normal and acceptable to get physical illnesses or to need medical care for conditions like diabetes-- but that if you need lasting medical help for mental issues you are somehow defective.

This is facile. Yes, we are defective if we find these aspects of our character problematic. These medications effect things much more a part of our identities than blood sugar.

Previously.
posted by phrontist at 3:14 AM on October 20, 2009

I know exactly where you are coming from, because your story is very similar to mine. Diagnosed with inattentive ADD in grad school after fighting depression for years caused mainly by constantly trying to force myself to attend to things. I had managed to be fairly high performing in spite of it all, but it caused way too much stress and depression in the process.

Despite almost the exact same worries about it being a crutch, and wondering how it would be when/if I ever wanted to come off of it (pregnancy was a looming factor for me, too) I stayed with it for 4+ years in grad school. Because, frankly, it worked, and ultimately my life was so much better with it than without it that any other concerns receded into the background. This is not to say they disappeared -- they just receded, but that was enough. When you're drowning you take the rope people offer you and don't second guess it. And that's fine. It doesn't make you bad or weak, and it doesn't mean that you'll always need a rope: it just means you needed it at that point.

For me, once I got out of grad school I started a job with a lot more variety and where my particular brand of inattentiveness is as much an asset as a detriment. I have been off medication for about a year and a half now. I don't see that as a particular achievement, though, because this whole experience has shown me that it's all a function of circumstance, and needing or not needing medication is just a fact one way or another. I think there is some possibility that at some point I might need medication again, if my job ever changes or I get a different one, and that's fine, too: you do what you gotta do, and you're no better or worse a person for having to do it.
posted by forza at 4:26 AM on October 20, 2009 [1 favorite]

This is facile. Yes, we are defective if we find these aspects of our character problematic. These medications effect things much more a part of our identities than blood sugar.

Well, I suppose you could call diabetics defective, too, but there's really little point to it because it doesn't automagically make them not need insulin because they can finally admit that all they need is the strength of their will.

As for identity, I feel much more like myself since I started my medication. Sometimes living with ADD is like those dreams where you're trying to run, every part of you wants to run, but for some reason you can't move your legs.
posted by kathrineg at 4:41 AM on October 20, 2009 [3 favorites]

Also, consider taking adderall for only part of the day or only on days when you need to get stuff done. I usually take it only during the week unless I need to do something on the weekend. Even then I try to only take it in the morning so I have some time for my body to chill out and recover a bit. And, yes, eat.
posted by kathrineg at 4:43 AM on October 20, 2009

I was diagnosed ADHD in my early 30s, at the tail end of grad school, and was on Ritalin for a few years to quite good effect. In fact, I wish I had stayed on it longer, and/or had the courage to go back to a doc and get back on it during the times when my life was really overwhelming and I was *not* coping well. ADHD+depression is a challenge.

Many others have spoken to the issue of taking meds long term. I'd just like to add that for me, as I get older and as my life takes on a certain predictable day-after-day, year-after-year sameness, I think I *have* gotten better at managing my issues through non-medical means. Recognizing and acknowledging the problem is an important first step. Some routines I have gotten fairly good at with the right structures running in the background (work, for example), while others have been spottier (exercise). It never gets "easy," but at least I've become better at recognizing what doesn't work ("if I beat myself up enough about dropping my son off at rehearsal and forgetting to pick him up, then it won't happen again!") and what does ("if I put an alarm on my cell phone, I can cross this off the list of things I have to remember to remember").

To this I'll add the fact that even women with no history of neurological issues can become complete scatter-brained idiots while pregnant/nursing. So, (a) you'll fit right in; and (b) hopefully you will have a partner who is attuned like never before to providing a support system and picking up the slack.
posted by drlith at 4:56 AM on October 20, 2009

There are a ton of behavioral strategies you can put into place to help manage some of your attentive behavior, especially when it comes to organization. Hopefully, while on your meds you can implement a system that really works for you, and maintain it once you're off. Sometimes a workable organization system just takes time to get into, and once you're in the momentum, you won't want to stop. I'd suggest seeing a psychologist for help implementing such strategies. Having somebody teaching these skills and helping problem-solve any difficulties you have, plus keeping you accountable is great!
posted by gilsonal at 4:59 AM on October 20, 2009

My experience and thus advice with adult-diagnosed ADHD Inattentive is that the Adderall is a tremendous benefit. It gives the ability to concentrate. However, anyone I've even encountered with said disease has a lifetime of crutches and compensation mechanisms that simply don't work any more once medical treatment is being used.

For example, in your case- the month long project done in less than a week. The pressure of the deadline acted as a natural stimulant and gave you the focus needed to complete the project. Once complete, your body needed to heal up from the stress, and you probably were even more inattentive and anxious/depressed than usual.

(As an aside, even while taking Vyvanse (a different kind of adderall basically, which I recommend), I had a 3 week period where realities of work were such that I was literally doing the work of two people. I did nothing but sleep and work. It was tolerable because I was able to focus enough, and because I knew it would end soon. But the stress was such that when I was done, it took literally months before I was feeling back to normal again.)

My point is, using stress as a stimulant to fix ADHD is not a long term, nor a happy solution.

The drugs are only part of the process. My doctor recognizes that I'm a go-it-alone kind of guy, and has basically given his blessing that I am working on the non-medical aspects myself, and I am. When darting from shiny object to shiny object and stressing through life is normal, the focus that Adderall allows you to have is a double edged sword. You have to re-make your life to acknowledge and take advantage of the focus. It sort of feels weird to only do one thing at a time, like you are somehow not living fully. This is false and ironic, because the truth is that being able to do things and complete them allows one to finally live a full life. Just a little differently than we are used to. Imagine the clarity and joy of being able to go to a party or go on a date, and not be constantly dragged down by those 1000 things that you had to leave half-done in order to go.

The trick is in time management- you now have the ability to stick to a plan, so you need to re-work your life so that you make plans. I still have breakdowns, but it works best for me if I sit down at the beginning of the day and just make a to-do list. I often find that I'm done quite early, and have plenty of free time. I predict that if you work at this, when the time comes that you have to stop taking the adderall, the habit of the planning will be ingrained enough that you will be able to make do. Even if temporarily.

Eating: I've lost a bit of weight on it, but not nearly as much as I'd like to. Mostly because of the way it seems to work. I don't know the deep down mechanisms, but for me it seems to just silence the hunger signal. I can easily go all day without eating, which isn't a great way to do anything. But for someone plagued by eating issues, the "silence" of not having the hunger signal is glorious. I've had to retrain myself, aided by this silence, to eat according to my body's needs, rather than being a slave to the constant hunger.
posted by gjc at 9:17 AM on October 20, 2009 [1 favorite]

You're feeling better and now you want to tackle every problem. Take is easy, prioritize, get things in order. There are lots of threads on ask.me and lots of good books about coping w/ ADHD. Use this as an opportunity to learn better organizational skills, make some progress. And recognize that perfection is unattainable and not the real goal.
posted by theora55 at 11:35 AM on October 20, 2009

Not to take over this thread but how does one get tested? Did you call up a psychiatrist and say, "I think that I need to be screened for ADD?"
posted by jasbet07 at 1:05 PM on October 20, 2009

Yes, you can do that. I already see a psychiatric NP due to my anxiety & depression, and she actually mentioned it as a possibility and brought up screening after a recent freakout over a work project, and my being very anxious to never do that sort of thing to myself again. To see a psychiatrist or psychiatric NP, you can either call your insurance company for a referral, or get a recommendation from a friend, or just use the phone book.

There are two kinds of screening -- one is a questionnaire, and one is a computer-based focus test. The first is more common but the latter is more accurate, I think.
posted by dumbledore69 at 2:10 PM on October 20, 2009

Just as an update, I have decided to continue with Adderall. I realized I am still feeling a bit discombobulated in terms of prioritizing and coming up with realistic strategies for managing all that I have to deal with, so I'm working through some books and also looking into a good therapist or coach to work with. Thanks everyone for the support & advice!
posted by dumbledore69 at 10:54 AM on October 29, 2009