Is my Adderall treating my ADHD?
January 20, 2015 11:03 AM   Subscribe

My Adderall prescription works great for me. But increasingly, it feels like its functional effect on me is less about attention and focus, and more about depressive/anxious tendencies I have. Is this a problem? Does anyone have experience around this?

For a while I've been on a stable prescription of 20mg generic amphetamine salts twice a day. Honestly, it's increased my quality of life like crazy, with minimal but existing side effects. I can finish and start the things I want to do! I can engage in boring tasks that I've identified as important or necessary! I can function like a normal person!

However, when I really dig in and think about *how* my meds help me, it occurs to me that they are really doing what I imagine an anti-depressant or anti-anxiety drug does. Functionally speaking, the chief thing it does for me is quells my negative self-talk / obsessive spirals of worry and lets me get excited about things and feel like tasks are worth doing and that I'm an okay person. (I'm not talking euphoria here-- I'm talking about the basic ability to energetically engage with the world.)

I generally don't take my medicine on the weekends, and I do have trouble paying attention or completing tasks in this state, but it feels like the underlying problem is that I feel insecure, depressed, unworthy, fatigued, etc.

This kind of concerns me. On the one hand, there is absolutely no question in my mind that to whatever greater or lesser extent "ADHD" is actually a discrete phenomenon, I have it. I have a classic ADHD personality, and reading books like Driven/Delivered From Distraction have left me emotional with how on-point they feel like they're describing me and my struggles.

On the other hand, I've never been diagnosed with depression, anxiety, or anything like that and I don't really know where I would begin. I struggled with a lot of OCD-like behavior as a kid, but I have never been diagnosed with it and it sort of faded to a manageable (but not fully disappeared) extent by the time I became an adult. I was once diagnosed with hypomania by the first psychiatrist I ever saw, which concerned her enough to not want to prescribe me a stimulant (though as mentioned, ultimately Adderall has been working really well for me). I have a strong suspicion that I actually have cyclothymia (especially because there is a lot of bipolar in my family).

I am beginning to see a new psychiatrist in a few days (for irrelevant insurance reasons), and I'm wondering if I should mention all this to her? What I am terrified of is being prescribed something new to try, in lieu of my current prescription, and having it not work. Thanks to my meds, for the first time in my life I am finding real success in my career and elsewhere in my life, and I know from first-hand experience that without a stable prescription that works for me, this would all come crashing to the ground horrifically fast. I hate that that's the case, but it really is. I tried not taking my afternoon dose at work once, and I literally didn't get a single thing done.

I know there's a lot of "be fully honest with your doctor" advice that goes around, but so far I've had almost solely bad interactions with psychiatrists. They've ranged from wacked-out elderly psychonauts who seemed all too willing to prescribe me whatever I wanted without much in the way of advice, to a Temperance-esque psychiatric nurse who seemed about ready to call the police because I had my meds on me without the pharmacy bottle, to a doctor who robotically took down my intimate psychiatric history like a court stenographer and left me feeling really emotionally used up. Broadly, I feel like the psychiatrists I have dealt with have had lower than average emotional intelligence, which just feels so shitty in conjunction with the sort of stuff you're supposed to share with them.


--Does anyone have experience with feeling like their ADD meds are improving their life in a different way than they're "supposed" to? Or with relevant stories of having comorbid ADHD and depression/anxiety/etc.?

--How should I discuss this with my new psychiatrist in a way that deals with the full gamut of my issues, while not leaving me skydiving without a parachute?

Thanks all.
posted by anonymous to Health & Fitness (13 answers total) 14 users marked this as a favorite
What you're describing sounds like you're treating your ADD. The distractions (the things that deficit your attention) are the negative self-talk and the obsessions, so if those are no longer distractions, you can focus. I think you may be trying to pinpoint things a little bit too specifically. You wanted medication to allow you to stay on-task, and you've found one.
posted by xingcat at 11:31 AM on January 20, 2015 [2 favorites]

My Adderal prescription absolutely affects my mood. Once I started it, I was able to step down my depression meds because with the Adderall, I have focus and motivation, which are a big component of my depression. Now when I do the "how am I feeling and why," one of the factors I take into account is whether it's time to take an Adderall.
posted by freshwater at 11:35 AM on January 20, 2015 [1 favorite]

Well, let's see. First off, let me say that I take Adderall for my ADHD, which did have an amazing unanticipated effect on my (diagnosed) dysthymia. I did end up switching to Ritalin for a while (boring, irrelevant reasons) which did not work that well for me in terms of concentration or mood, so I switched back.

ADHD and depression have a sick, twisted relationship and I can't say for sure the effect one has on the other. When I look back on my life, I had my first experiences with depression around the time my life reached a level of enough complexity that my undiagnosed ADHD was starting to interfere. I mean, not being able to get anything done and not knowing why and just thinking you are this inexplicably worthless person OMG WHY CAN'T YOU JUST PUT AWAY YOUR LAUNDRY is damn depressing! And if you got diagnosed as an adult (I wasn't diagnosed until I was in my 30s) there's a lot of time for baggage to build up, regardless of the exact workings of your brain chemistry.

So maybe what I am trying to say is yea for Adderall! I'm glad it is working for you. Don't worry so much about why it is working or how it is working and just enjoy the fact that it is? If you would like to say something to your doctor, I think it would make perfect sense for you to say how much better you feel now that you can get stuff done and how surprised you were that your mood improved when you started taking meds without asking about whether you now need some sort of formal anxiety or depression diagnosis. No doctor worth their salt is going to say to a patient, wow, those meds are working too well! Let's take you off them and see what happens! On the other hand, I understand your concerns. My first psychiatrist was not the most pleasant person and I interacted with her as little as possible during our appointments. Then she died (!) and the doctor that took her place in the practice is really wonderful. So if this psychiatrists sucks, try to find another. I promise good ones exist!
posted by fairfax at 11:40 AM on January 20, 2015 [2 favorites]

Seconding xingcat. Another thing worth considering is the difference between having anxiety and depression separately from your ADHD and having anxiety and depression due to your ADHD. Anxiety and feelings of low self worth are a natural side effect of struggling to do things like a "normal" person. It doesn't take a lot of dropped tasks, struggle to complete simple things, procrastination, time management problems, etc. that, on the surface are things you're capable of doing and yet struggle to do to make a person start questioning their self-worth and feel anxiety. When that adds up over the years, those feelings of anxiety can take over your life and seem like the main symptoms instead of your ADHD.

(Personally, it was my feelings of anxiety that led to my diagnosis; I'm a very upbeat, naturally happy person, yet I got so anxious about using the phone that when my husband had to start holding my hand just so I could make a phone call I knew something was fundamentally wrong - and it took a few years of treatment to ease those feelings away.) You didn't say how long it's been since you've been diagnosed, but it does take a little time, particularly if you've been diagnosed later in life. Personally it took a few years to a) first recognize and b) work through all the ways that having ADHD affected/s my life, and I was constantly being surprised. If your medication is working on your feelings of self-worth without the need for anything else, that's a pretty good argument that is one of those areas for you.

You mentioned weekends - untreated, ADHD can also consume a tremendous amount of mental resources and energy - off my meds, I always need a nap around 3 in the afternoon, and I'm exhausted in the evenings - so that can explain your feelings of fatigue on the weekends. Also, all week long you've been able to act "normal" and then you come crashing down into the other reality. When you weren't on medication, this was the normal state, so you were habituated to it and it wasn't so easy to draw a parallel. It can be hard and stressful to switch back and forth, so you might ask your doctor for a 5 mg pill (for example) for weekends or whether or not it'd be worth not taking that break (some docs do it to help you not get used to the medication and then need higher dosages, so that's something to consider).

As for your new doctor, do you have the ability to pick one that specializes in ADHD for adults? Read reviews if you can. A good doctor will recognize that medication is just one pillar of ADHD management and work with you on all of them, and that may help you separate out whether or not you're inclined toward anxiety/depression or if it's a side effect of your ADHD.

Good luck! I'm glad your Adderall is working for you.
posted by barchan at 11:49 AM on January 20, 2015 [4 favorites]

Depression and anxiety can absolutely be components of ADD and ADHD. So are helplessness, anger, frustration, exhaustion, omg. SO MANY THINGS.

If you're not happy with your psychiatrist, and I know finding a good one is a hell of a crapshoot, you can always switch it up to a therapist or psychologist instead, and get your adderall through a neurologist. IME it is hard for my adult friends with add/adhd to find a psychiatrist willing to prescribe adderall without making a huge fucking ordeal of it.
posted by poffin boffin at 11:49 AM on January 20, 2015 [1 favorite]

Adderall is a mixture of amphetamine salts and stimulant therapy for ADHD also has a marked affect on mood. This is a feature, not a bug. While speaking to my therapist yesterday about the anxiety and depression that I have been struggling with lately, she recommended that I take half of my regular dose on weekends to allow me to relax and not feel compelled to complete nonessential tasks, but still benefit from the mood elevation that Adderall provides.
posted by elsietheeel at 12:38 PM on January 20, 2015

I generally don't take my medicine on the weekends, and I do have trouble paying attention or completing tasks in this state, but it feels like the underlying problem is that I feel insecure, depressed, unworthy, fatigued, etc.

There is a big misconception that if someone has ADHD, that person is not effected by Adderall qua speed, and is instead sort of effected by it as if it were something other than amphetamine. This is a false idea. Adderall is amphetamines, which are speed in common parlance. The effect they have on ADHD is because they are speed. They have the same effect on people who are not diagnosed with ADHD, which is to say that responding to the drug by being focused does not "prove" that someone has ADHD.

What you are describing about your weekends looks to me very much like you are having minor withdrawal symptoms. One would expect this if one took speed twice a day for the rest of the week. You cannot possibly speak cogently about your "unmedicated" mood, focus, or fatigue levels until you are off speed for far longer than two days.

All that said, psychotropic meds basically treat empirically. If they work for you, they work for you. I wouldn't worry about it.

I'm not your doctor, of course, or any doctor, of course.
posted by OmieWise at 1:08 PM on January 20, 2015

BTW, I'm not trying to cast any doubt on your ADHD or on the disorder. I'm using language to highlight that if you look at things from a different perspective you would expect exactly the result you are getting when you stop taking your medication.
posted by OmieWise at 1:09 PM on January 20, 2015

I've been on 20mg of Adderall XR for about 10 years. I've never had to up my dose. I will occasionally skip a dose on the weekends and there is definitely slight but present withdrawal symptoms. When I skip a dose the ADHD symptoms come back which really isnt a problem if I don't have anything that I need to do. But... I always have an underlying sense of doom and feel that things are just wrong. Its not debilitating but its definitely there on days that I don't take the Adderall. Are you sure what you are experiencing when you skip a dose is not just withdrawl effects from the Adderall? I know I did not have these symptoms before I started taking it.
posted by jmsta at 1:13 PM on January 20, 2015 [1 favorite]

It is very clear that OmieWise is not a doctor, or at all educated about the effects or use of Adderall, so feel free to ignore that comment as it is almost entirely incorrect. Yes, you can speak of your unmedicated self when you're off Adderall for 2 days, especially the instant release form of it. I hate that we have to explain this every time we talk about Adderall on AskMe.

Yes, OP, this is how Adderall is working for you. I was also surprised at this when I first started on Adderall. I no longer had the negative self-talk or the emotional response to having to rev up my own motivation. I didn't have to plow through all of that anymore. I was just focused. I am a naturally anxious person, but it turns out a lot of my anxiety is caused by my ADHD, so treating the ADHD makes me less anxious overall! It's awesome. It's life-changing. Go you.
posted by aabbbiee at 3:45 PM on January 20, 2015 [6 favorites]

Depression and ADHD both are based on low dopamine and serotonin. The same drug will work for both.
posted by eq21 at 4:24 PM on January 20, 2015

The same drug will not work for both. ADHD is primarily related to dopamine and depression to serotonin. Adderall affects dopamine and norepinephrine, which elevate mood. However, an antidepressant that affects serotonin is not going to improve ADHD symptoms. Serotonin is a neurotransmitter that regulates mood, appetite, and sleep, and it does have some affect on memory and other cognitive functions. Dopamine has a greater affect on cognitive functions like concentration, as well as reward activity in the brain. Reward activity makes you feel good, but the dopamine boost doesn't last if your serotonin is depleted. Your brain needs both.

Instead of listening to a bunch of armchair psychiatrists, you should probably talk to your doctor. You might benefit from an antidepressant in addition to your ADHD meds. But you also shouldn't feel guilty because Adderall elevates your mood. As I said before: it's a feature, not a bug. Embrace it.
posted by elsietheeel at 6:07 PM on January 20, 2015

I'm afraid I may have given the wrong impression in my comments yesterday. I'm not a psychiatrist, but I am a clinical social worker independently licensed to diagnose mental disorders (of which ADHD is one) in a couple of states. I teach psychopathology, diagnosis, and treatment in a Masters of Social Work program. I've worked personally with many patients who have ADHD, more than 50 but less than 100, and I've diagnosed a fair number of them myself. I have worked closely with 10s of psychiatrists, both in general and in consultation about shared patients with ADHD. In contrast to people who have been participants in their own treatment, and the often frustrating and then miraculous changes attendant on that, I have a fairly broad understanding of the current thinking about treating ADHD in a variety of ways, as well as a balanced approach to the critiques attendant on some of that treatment. While I'm not sure what aabbbiee thought was "almost entirely incorrect" about my comment, I am confident that the substance of it, which is that discontinuing amphetamine use will lead to withdrawal symptoms, is correct.

Now, there is no doubt that amphetamine withdrawal exists, and that it looks like what you describe occurring to you on the weekends. That is, amphetamine withdrawal, as defined in the DSM 5, and here I'm looking at page 569 of my hardback edition (APA, 2013) includes cessation of prolonged stimulant use, dysphoric mood developing anywhere from a few hours to several days after discontinuation, and then some combination of fatigue, vivid dreams, in-or hypersomnia, increased appetite, and agitation or psychomotor retardation. You only need two from that last list.

What I believe people here are objecting to in my comment is the notion that these medications, used as prescribed, can lead to this kind of withdrawal. There are a number of reasons why people might object to that notion. One reason is that people with ADHD are stigmatized, and people who use stimulants to treat it are stigmatized. Claiming that stimulant use for ADHD is a special case is an argument (even if incorrect) against this stigma. Another reason is that the prevailing discussion in our society about the effects of psychotropic medications is that the efficacy of the medication both identifies and confirms the diagnosis of an illness. In this narrative, the medication is "replacing" something necessary, in much the same way that insulin is replaced by injection for some people with DM, and so does not carry the normal side effects that might otherwise be attendant on using the medication. Unfortunately, both of these arguments are false. We know that people who take psychotropic medications experience discontinuation syndromes, even from relatively benign medications not known to be drugs of abuse (like amphetamines are) such as SSRIs. The SSRI example is important because the argument for SSRI use in depression is the same with respect to serotonin as the use of amphetamine is with respect to dopamine in re ADHD. It's well known that if you upregulate neurochemicals receptors tend to shut down. This is, in fact, what causes stimulant withdrawal, and there is no biological reason to assume that just because someone has ADHD this does not also happen during stimulant treatment.

Despite some claims in this thread, you can't take Adderall twice a day all week and expect to experience no changes to mood, motivation, behavior, or well-being when you stop taking it. The changes you experience on the weekend are not dispositive of what your underlying mood is like. This is not to say that you don't have an underlying mood disorder, or ADHD, it's only to say that in order to determine that empirically, you would have to wait until the likelihood of withdrawal symptoms was past. 48 hours is not long enough for that.

Depression and anxiety disorders do occur comorbidly with ADHD. As the DSM 5 says, "Anxiety disorders and major depressive disorder occur in a minority of individuals with ADHD but more often than in the general population." (APA, p. 65) Amphetamine certainly raises mood, and "excessive happiness" is one of the major reported side-effects in studies of the tolerance of amphetamine treatment in kids with ADHD. This is why, after all, many people use speed recreationally. As one of the giants of modern psychiatry used to say, "Everybody does better on a little amphetamine," by which he meant that it's almost a panacea when used consistently at low doses. As I said in my initial comment, if you have been prescribed the medication and are using it as directed, and it is working for you, I would not worry about it. You may have some low mood that is being addressed, and even if that low mood is not clinically diagnosable (and despite the sloppy lay use of the terms on Metafilter, "depression" is actually a few different things, all of which one needs to meet criteria for before diagnosis), the fact that it's better on the meds is not something to feel bad or concerned about.

As far as talking to your psychiatrist, I would just say that the Adderall is working really well for you, use concrete examples to illustrate that, and also say that you think it is improving your mood. If you are not describing hypermania, and you don't seem to be in your question, they will likely not change your prescription. If they say they want to do that, you can have a reasoned conversation with them about why you would rather not. Obviously, I don't know who your psychiatrist is, but in my experience good ones respond well to this kind of reasoning. As I said above, I've worked closely with many psychiatrists. You can MeMail me if you want to talk further about what exactly you might say.
posted by OmieWise at 7:38 AM on January 21, 2015 [4 favorites]

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