YANMD Complicated Feelings about Adderall

January 31, 2018 8:56 PM

My question history is a perhaps-all-too-public narrative of the struggles I've faced, professionally and personally, as someone with a physical disability, a stutter, and a history of depression. Two months ago, I was prescribed Adderall after having wasted 15 years of my life and being at my wits' end. It isn't perfect, but it's given me my life back. More than that, it's changed what I saw as being both the story and trajectory of my life. But I'm scared.

I'm just going to allow my thoughts to spill into a puddle here:
- I can write again(!!!!)
- I'm reaching out to friends- even old ones- and responding to dating profile messages. People have complimented the new me with exuberance.
- I'm interested in things. Like, really excited about them. I'm thinking about academics here, but really, it seems I can deep-dive into anything.
- I can be engaged in conversation again without having to push aside a brain fog with dissolved particulates of anxiety and self-doubt and forethought
- I can do work oh my god. I think I've written more professional emails, sent out more resumes and done more to fix up my LinkedIn in the past two weeks than in the preceding 10 years. Things get done when I tell myself they're going to, or are dutifully prioritized.
- I'm not a raw, scattered mess!

I actually have a temp position- my first ever paid job!

That's the good stuff. There is SO much good stuff.
That being said, this is an amphetamine. That scares me. I've sort of become dependent on Klonopin for anxiety relief ( but am okay with that because I have circumstantial reasons to be anxious and am on a low dose, never going over. If I need to be on it for life, so be it. Though, I'm doing my best to begin mindfulness training and therapy and have seen notable improvements even when not on it).
But I can't be " okay" with that same scenario here. For a few reasons:
- I have high blood pressure because I'm overweight. I'm young, and take medication to control it, but that medication can have unpleasant side effects and often doesn't provide adequate control. ( 100mg Losartan, 10mg amlodipine). I do NOT want to take anything else for blood pressure.
- At a time when I'm considering weight loss surgery, because I'm 268 lbs, I can't afford what the crash does to me. I want to eat- nay, shovel- everything in sight, when coming down.
- Some days, I can become very irritable when coming down. I've tried to notice it and control myself, but it's unpleasant.
- There have been a few days where, when coming down, the worst, darkest, most severe depressive thoughts have perniciously taken up residence in my head. I can become intensely suicidal, if that makes sense. This seems to have lessened in severity over the past few days, and I know to expect it now and how to triage.


My PCP/GP is prescribing 20mg XR and 10mg IR generic. I have only used both on the same day twice so far ( hours apart) but doing so seems to be what I need to have a fully productive day.

I was on anti-depressants (an SSRI). I don't want to take it anymore. SSRIs absolutely help some people but there is a ton of research showing they are not the definitive treatment for depression. If I'm honest, I always knew I had a dopamine problem. Wellbutrin made me anxious and gave me killer muscle spasms.

All that being said, my question, I guess, is what does my life need to look like now? I don't want to get addicted, die ( or wish I would), or gain more weight. But the changes this little pill has wrought have prompted so many tears of joy. What do I do?

posted by anonymous to Health & Fitness (18 answers total)

Lots of people have been on stimulants for a long time. It's totally reasonable to be worried about them, but it sounds like—aside from that last bullet point, which I have no experience with and have to beg out of evaluating—you're tolerating them pretty well right now. (I have taken them, on and off but mostly on, for six years.)

I had to take a few of the stimulants before I landed on Ritalin, which (for me) was the right combination of focus and... pleasantness, I guess. When I talk to other people on stimulants for ADHD I always hear about Vyvanse and Focalin as being particularly "gentle," though your mileage may vary re: folk-knowledge about very similar prescription drugs.
posted by Polycarp at 9:23 PM on January 31, 2018

Stimulants+high blood pressure history= increased stroke risk due to weakening of blood vessels. My husband had to go off the stimulants he was on for ADHD treatment because they were weakening his blood vessels and leading to trimenial neuralga (sp? Too lazy to look up the proper spelling right now). It has been hard for him to no longer have the medication but as soon as a few weeks after he came off of them the problems went away with his blood vessels. So proceed with caution.
posted by TestamentToGrace at 9:30 PM on January 31, 2018

Can confirm that in my experience (switching from adderall xr to equivalent vyvanse dosage), I found vyvanse to completely eliminate the drastic crash at the end of the day and the headaches I used to get around 7pm while on adderall. If the 20mg xr works for you but the come-down is very severe, I recommend talking to your Dr about switching meds and seeing how you feel with a different formulation.

Good luck and congrats on getting so much of your life back in the last few weeks!
posted by ttyn at 9:40 PM on January 31, 2018

There are other ADHD treatments out there, though many are also used or are closely related to antidepressants. That said, there are some alpha agonists that treat some of the emotional symptoms of ADHD that can often exacerbate the concentration issues. For some people even that is enough to give them to extra mental space to successfully live with the scatterbrained part. Might also get you off the Klonopin since anxiety is often a response to the heightened emotional states ADHD causes in many people. Since they also happen to work as BP meds you might even be able to keep taking the Adderall at least some days.

Only recently did I realize that many of my life long struggles aside from having zero attention span and an inability to shut down at the end of the day were also caused by the same disorder. So much ink has been spilled on the executive function part I didn't even realize there was far more to it.
posted by wierdo at 9:49 PM on January 31, 2018

Be aware that this is a very typical "honeymoon peroid" that is experienced in the first 3 months or so of any amphetamine. It will level out to the point where you have to take it just to function.
That being said, having adhd, I can empathize entirely with your experince, and also can only perform some very basic tasks while medicated. I would advise you try vyvanse instead, it does not have a harsh comedown to it, and only take as needed, when you take as prescribed, it leads to tolerance very quickly and this is where you can run into issues with feeling like you "need" more.
posted by OnefortheLast at 10:10 PM on January 31, 2018

There have been a few days where, when coming down, the worst, darkest, most severe depressive thoughts have perniciously taken up residence in my head. I can become intensely suicidal, if that makes sense. This seems to have lessened in severity over the past few days, and I know to expect it now and how to triage

I do think you should make this very clear to your doctor if you haven't already. There is always the possibility that you are covertly bipolar. You just also should not be experiencing suicidal ideation on any medication you're taking long-term, period. That is not something to triage, it is something to avoid if at all possible.

Good luck!
posted by praemunire at 10:46 PM on January 31, 2018

Different stimulants affect people in different ways. When I was diagnosed, also as an adult, I tried both Adderall and Ritalin. Adderall made me speedy in an unpleasant way (with concurrent crashes) where Ritalin never has. I now take Concerta, which is the extended release version of Ritalin, and I don't notice when it kicks in or tapers off.

So definitely talk to your doctor ASAP. There are other options.

Also, contra Oneforthelast, I haven't really noticed that I now need it to maintain a basic level of function. Again, if you do start to feel that way, tell your doctor because that is a sign of dependency, which you should NOT experience as a person with ADHD on ADHD meds. Now, I've definitely gotten used to the affect the Concerta has on me - it's my new normal, my new baseline. And I notice when I don't take it for a day or two. But I've been on the same dosage for 7 years and have not needed to increase.
posted by lunasol at 11:04 PM on January 31, 2018

If you have a diagnosis and weren’t able to be much more productive in years than in two weeks of medication, that does actually point in the direction of ADHD/ADD, quite strongly. It isn’t easy to fully accept such a diagnosis, not only for the implied disability but also for imposter syndrome reasons, like you don’t really deserve the medication and the help you’re getting from them. I’ve been there. For me, vyvanse has also been gentler, but depending on the dose still impacts my bp. I find I eat less food in total now on vyvanse, even if I eat quite a lot in the evening, compared to unmedicated, on Ritalin or Concerta. This is so individual, though. For you, I’m most concerned with the suicidal ideation, I’d try to address that immediately. Hang in there, you’re not alone.
posted by meijusa at 12:40 AM on February 1, 2018

Forgot to say that it’s really common for adults with ADHD to not be outwardly hyperactive, more inwardly restless. I didn’t know that and it kept me from suspecting that I had ADHD for decades. The hyperactive kid poster child for ADHD does not represent the adult version.
posted by meijusa at 12:44 AM on February 1, 2018

In addition to talking with your psychiatrist about different ADHD meds, consider that the IR has a much steeper effect and drop-off - crash. If the IR is leading to the steeper crashes and effects you mention, then another XR would be a possibility - though it lasts twice (ish) as long as the IR, ramp-up and back down are less severe to help with the irritability, hunger, and mood. Make sure to eat before you crash so you aren't starving - limiting the eating at the point of starving is much harder. Everyone is different but those doses sound low for your weight so there's that.
posted by RoadScholar at 4:46 AM on February 1, 2018

Make sure you're eating while you're medicated - this will help with the crash. Set a timer if you need to. If you can't make yourself eat a full meal go for string cheese, almonds, hard-boiled eggs, hummus packs - whatever works for you, but lean towards protein and fat and away from sugar and other simple carbs.

I had a hard time on the same dosage of XR and asked to bump it down to 15. It's less of a dramatic help but I'm less anxious and the side effects are more manageable.
posted by bunderful at 5:10 AM on February 1, 2018

It's hard for me to gauge how long you've been on this new medication, but it doesn't sound like it's been that long. Maybe just hold off on trying to plan everything forever right now; try this for, say, six months - set a reminder on your calendar, and re-evaluate then. Caveat: but don't eff around with those suicidal thoughts. If that happens again, I would absolutely call your doctor.

But for the other stuff in the meantime:
For weight/blood pressure -- I lost some (not a ton, but noticeable) weight once I started taking Adderall, and not just because it suppressed my appetite; it helped me organize my workday in such a way that for the first time in like forever, I was finishing my daily task lists in such a way that time freed up for me to do something like actually go to the gym or take a walk. I don't seem to experience the desire to eat everything in sight when it wears off, but I also maybe don't worry about it because when the Adderall is in my system and I'm focused, I don't do the kind of wandering-snacking-distracted-comfort-eating I did before, so I feel like my calorie intake is mostly about the same these days (even, perhaps, a little less) despite what eating I may do in the evenings.

You said some days you're irritable; I'm irritable some days, too -- everyone is irritable on some days. Adderall isn't a panacea. Nothing is. It's okay to be crabby sometimes. Just make sure you're not expecting Adderall to fix everything. But for what it's worth, I actually like the IR better than the ER. I may be an outlier here, but I like having a little more control over the interaction between my system and the Adderall so that I can take it as I seem to need it. I also take a very low dose: 15mg/day. I take one 5mg does around 8am, another around 3-4 hours after that, and only sometimes do I take the third dose: if my workday is going to have to go long. For me, it's very much a tool I use for one specific thing: to focus on work stuff/overall life organization. I think that closing out my work day at 5pm and taking that walk or going to the gym, flush with the feeling of "I did all the stuff" helps me smooth out any crash that I'm experiencing, too.

Finally, I was ashamed to discover (in my late 30s!) that it turns out I'd been struggling for a long, long time with something that had a relatively easy Rx fix. I didn't look like I was struggling to people on the outside; but the Adderall made everything so so much easier than it had ever been; I had to do a little grieving for my past self. There's a lot of "stimulant-addict" panic around Adderall, fueled in part by its reputation as an intellectual performance enhancer. I just try to remember that we're talking really low doses here. I did some casual research: Adderall abusers take high, really high, quantities of the stuff, and addictive behaviors showed up for them elsewhere, too, with other substances and habits.

I talked about this a lot with my shrink; they reassured me that it really was safe to use - especially if you have no history of addiction and if you continue to work with your care providers and see it as one tool (and not the only one) you use to manage the ADHD. I've been taking Adderall now for almost a year, I've never increased my dose, and it's not unusual for me to skip taking it on the weekends. I don't even notice, except of course that I don't get a lot done on those weekends. For me, too, I don't feel "speedy" when I take it. I feel more alert or energetic, sure, but it's actually a calm sort of feeling: like I am relieved as well as excited when the brain fog lifts. Good luck to you.
posted by pinkacademic at 6:51 AM on February 1, 2018

I've taken Adderall for ADHD as an adult, and found that it affects me remarkably strongly, in many of the same ways it affects you. My doctor prescribed me two 10mg XR tablets a day, plus 5mg IR tabs to smooth the come-down, and for a few weeks I tried taking it as prescribed--but it made me miserable, hateful, and untenably irritable both when I was coming off of it and cumulatively after a few days. Talking to my doctor and a couple different prescribing nurse practitioners wasn't much help, so I ended up adjusting my dosage down on my own, which seems to work better with the way I metabolize stimulants. I found one 10mg XR tablet per day worked well for me--but that I could actually open the capsules and take as little as 1/3rd of the contents once or twice a day and still attain most of the focus and clarity of my prescribed dosage, without the feeling of manic brilliance and intense, all-consuming evening crash. I'd often supplement that with half of a 5mg IR tab, especially when I wanted to avoid the long-lasting effects of the XR, which kept me up at night. I also found that I needed to take a full two-day break after taking Adderall three days in a row, otherwise I'd have really intense periods of irrational depression and irritability that I can only attribute to dopamine depletion. As far as I know, this is an abnormally low dosage and my rigid set of self-imposed usage "guidelines" may seem a little nuts to anyone whose body/brain chemistry handles stimulants more easily, but for me it seemed so necessary to take Adderall at all that I suspect the specific drug is just the wrong stimulant for me. I'm just now coming back to it after a nine-month break, which I took partly because I was so freaked out by the sense that I needed and craved Adderall to function, the texture of which was so obviously compulsive in addition to the genuinely valuable effects of the drug. I'll likely finish off this prescription, which was meant to last me three months and has lasted five (not counting my nine-month break), then talk to my doctor about Vyvanse or something like it. I should probably just do that now, in fact, but I already know what works for me w/r/t Adderall, and don't want to deal with the mood swings and misery of trying out a new drug again, yet.
posted by tapir-whorf at 7:33 AM on February 1, 2018

Just keep in mind you can stop whenever you like and you don't have to take it every day. If the side effects get too bad or you want to stop for a while or forever or you want to try a different med option or change the dose, you can do that any time you like. Just take it one day at a time. I highly recommend asking your doctor to try as many different meds as you can if none of them are perfect for you yet. Everyone responds differently.

People get weird about adderall because it has a bad reputation from people who misuse it, but there is nothing about the drug itself that makes it addictive - much less so than coffee for example. I take mine only a few times a week because the sleep side effects get too bad for me otherwise, and I never "crave" it or feel like I need it to function (well, at the level of my unmedicated adhd self, which is not always super functional, hence the meds, but that was true before meds too....). I wish I could take it every day but that's because it really helps my adhd, not because I miss the feeling of it or whatever. And I've never been tempted to up my dose after 5+ years of being on 20mg. The opposite, actually - I keep trying to get by with a lower/less frequent dose.

But please. Next time you have suicidal thoughts, please talk to a friend or a help line in the short term, and talk to your doctor to work out a long term solution. It may or may not be caused by the adderall, but it's not a normal side effect (sad and irritable yes, suicidal no) and it's not something you should accept. There might be some untreated depression being masked by the adderall, which can have a mood-boosting effect.
posted by randomnity at 7:37 AM on February 1, 2018

Seeing you mention you're getting this from your GP, and that you also have depression, I'd really strongly suggest switching to a psychiatrist.

I'm not saying you necessarily need antidepressants. It is possible to treat depression in other ways. What I am saying is that you have multiple mental health conditions that interact in complicated ways — one of which is potentially fatal* — and that puts you outside a GP's area of expertise. Even if you're only going to take medication for one of those conditions, you need a treatment plan that accounts for both of them. Finding a med that will help your ADHD without exacerbating your depression is a job for a specialist.

*I'm not trying to be an alarmist here, but suicidal ideation is SERIOUS SHIT and CAN KILL YOU, and telling yourself you can handle it on your own is not a great plan. (There are people who think "I can handle this" and are right; there are also people who think "I can handle this" and are wrong; it is hard to tell without an outside opinion which group you're in.) Please, please talk to a professional about it and be bluntly honest about how severe it is.
posted by nebulawindphone at 7:50 AM on February 1, 2018

Sorry, I missed that you do have untreated depression and don't want SSRIs. So the suicidal thoughts may continue even if you stop adderall. I don't know a lot about depression meds but I'm pretty sure there are non-SSRIs you can try, and psychotherapy techniques like CBT, and lifestyle changes can really help as well. Please talk to your doctor about your options for managing depression. You can always say no, they won't force you to take SSRIs, but may have some new ideas for you to try.
posted by randomnity at 7:55 AM on February 1, 2018

You mention that your GP prescribed the medication; given that you are taking Klonopin for anxiety and have other mental health concerns (depression), I highly recommend seeing a psychiatrist instead. A psychiatrist is better suited to be able to help you figure out the right medications or combination of medications. GPs are a great place to start, and there’s often no often no need for psychiatrist if someone has a simple medication need (e.g., my GP prescribes my SSRI) - but once you start getting into multiple psychiatric mediations, I think it’s worth seeing a specialist.
posted by insectosaurus at 10:40 AM on February 1, 2018

Yes, you should definitely see a psychiatrist. Being on a benzo and a stimulant at the same time is... something that MAY turn out to be the best thing for you, but something I'd be questioning and I think needs professional oversight. It also sounds to me like you haven't quite got the release schedule sorted out yet in a way that works for you. Don't panic, keep taking your meds, and make sure you use this productivity to improve your life in as many ways as possible. But get that referral.

(IANAD, just to be clear - just someone with a bunch of lived experience of psych meds)
posted by Acheman at 4:30 AM on February 2, 2018