What ADHD drugs would be good for me?
February 24, 2023 11:52 AM Subscribe
I got diagnosed with ADHD! What should I think about if I'm taking stimulants?
I have a very inconsistent schedule, that falls into three categories:
Chill home time: Between contracts, my life is fairly relaxed - I have home duties and kids, but I do ok with those. I would probably not take any stimulants during these times.
Boring hard preparation: Sometimes I'm writing, or in preparation to start a contract. This is very difficult, unrewarding, anxiety-triggering work with a lot of important decisions to make all alone, and no feedback or dopamine or novelty, lots of uncertainty and no structure, and I'm avoidant and miserable about it. If I can get into a flow state it can be ok, but starting and sticking in the tasks long enough to get into hyperfocus flow is almost impossible and causes me daily misery. Plus there are a lot of meetings in this phase, so I get terrible anxiety about missing meetings (very bad and happens a lot and needs to stop), so between meetings I can't really work because I'm worrying about missing meetings, which leads to me having horrible anxiety and overwhelm spirals, restlessness, moodiness, low self-esteem, ugh. Very classic ADHD executive function meltdowns. I definitely think stimulants would help with this part. For this phase of my life, I need about 8 hours a day of brain power, mostly sitting at a desk.
Fun intense high-stakes work: When I am on a contract, I need to be able to sustain intense focus bursts of about 20 minutes per hour, for about 12 hours a day. I'm not an Emergency Room doctor, but the job's rhythm is somewhat similar. It's hands-on, there's constant task switching, occasional bursts of very high intensity and pressure where all eyes are on me to make the right call, lots of novelty, some physical activity. I love the pressure, I get a lot of natural stimulation from having interesting problems to solve, there's positive social feedback that also helps make it fun, and I drink tons of caffeine (3-6 coffees a day). There are intermittent boring parts (record-keeping), which are hard for me, but the recurring high-intensity parts are exciting and keep me going.
My job is naturally interesting so I do ok with it, but I'm levelling up in my responsibility, which also means more boring parts (meetings and emails and planning) and more severe consequences if my focus lapses or I forget something. I'm nervous about taking stimulants for my actual work days, because if they make me crash before the end of a 12 hour work day I'm screwed. So I would want to really be accustomed to how the stimulants work before risking it at work. I'm not even sure I need stimulants for work days, the job is pretty stimulating.
Schedule-wise, now's a great time for me to experiment as I'm not on a contract. My doctor and I have a very collaborative relationship, so we're discussing different possible stimulants to try out.
I was thinking Vyvance because several friends in my field take it, but they're all heavy drinkers and cannabis users, and I'm not (apparently it's often chosen because it doesn't interact with other substances). Other names floated around include Adderall and Concerta. I feel a bit overwhelmed by all the choices, big surprise.
Health stuff: I'm a healthy woman in my mid 40s. I'm anemic and get periodic iron infusions. I'm average size, BMI about 24, with a good appetite, could stand to be more active and lose 20 lbs but that's not a huge concern. About 3 times a week, I drink a cocktail containing 1 oz. of alcohol. No other recreational drugs or medications. I drink 2-6 coffees a day depending on work needs. I'm usually awake from 7am to 1am and I feel fine on 6 hrs of sleep.
What should I consider in terms of medication and dosing?
Thank you for any insight.
I have a very inconsistent schedule, that falls into three categories:
Chill home time: Between contracts, my life is fairly relaxed - I have home duties and kids, but I do ok with those. I would probably not take any stimulants during these times.
Boring hard preparation: Sometimes I'm writing, or in preparation to start a contract. This is very difficult, unrewarding, anxiety-triggering work with a lot of important decisions to make all alone, and no feedback or dopamine or novelty, lots of uncertainty and no structure, and I'm avoidant and miserable about it. If I can get into a flow state it can be ok, but starting and sticking in the tasks long enough to get into hyperfocus flow is almost impossible and causes me daily misery. Plus there are a lot of meetings in this phase, so I get terrible anxiety about missing meetings (very bad and happens a lot and needs to stop), so between meetings I can't really work because I'm worrying about missing meetings, which leads to me having horrible anxiety and overwhelm spirals, restlessness, moodiness, low self-esteem, ugh. Very classic ADHD executive function meltdowns. I definitely think stimulants would help with this part. For this phase of my life, I need about 8 hours a day of brain power, mostly sitting at a desk.
Fun intense high-stakes work: When I am on a contract, I need to be able to sustain intense focus bursts of about 20 minutes per hour, for about 12 hours a day. I'm not an Emergency Room doctor, but the job's rhythm is somewhat similar. It's hands-on, there's constant task switching, occasional bursts of very high intensity and pressure where all eyes are on me to make the right call, lots of novelty, some physical activity. I love the pressure, I get a lot of natural stimulation from having interesting problems to solve, there's positive social feedback that also helps make it fun, and I drink tons of caffeine (3-6 coffees a day). There are intermittent boring parts (record-keeping), which are hard for me, but the recurring high-intensity parts are exciting and keep me going.
My job is naturally interesting so I do ok with it, but I'm levelling up in my responsibility, which also means more boring parts (meetings and emails and planning) and more severe consequences if my focus lapses or I forget something. I'm nervous about taking stimulants for my actual work days, because if they make me crash before the end of a 12 hour work day I'm screwed. So I would want to really be accustomed to how the stimulants work before risking it at work. I'm not even sure I need stimulants for work days, the job is pretty stimulating.
Schedule-wise, now's a great time for me to experiment as I'm not on a contract. My doctor and I have a very collaborative relationship, so we're discussing different possible stimulants to try out.
I was thinking Vyvance because several friends in my field take it, but they're all heavy drinkers and cannabis users, and I'm not (apparently it's often chosen because it doesn't interact with other substances). Other names floated around include Adderall and Concerta. I feel a bit overwhelmed by all the choices, big surprise.
Health stuff: I'm a healthy woman in my mid 40s. I'm anemic and get periodic iron infusions. I'm average size, BMI about 24, with a good appetite, could stand to be more active and lose 20 lbs but that's not a huge concern. About 3 times a week, I drink a cocktail containing 1 oz. of alcohol. No other recreational drugs or medications. I drink 2-6 coffees a day depending on work needs. I'm usually awake from 7am to 1am and I feel fine on 6 hrs of sleep.
What should I consider in terms of medication and dosing?
Thank you for any insight.
I mean most medical professional will try you on the XR (extended release) or LA (long acting) versions of all available formulations before putting you on straight Ritalin. And a lot of people who take prescription stimulants don't do so every day; my husband, who is on straight Ritalin, only takes it 4 days a week. People who have actual ADHD tend not to abuse their meds because the meds don't act as
There are over 30 brand names with varying formulations, but they are all formulations of one of six drugs. Methylphenidate and amphetamine are the most commonly dispensed in the US, so maybe talk to your doctor about the different brand formulations of one of those that you could start with. You can drink tea and coffee in limited amounts. You mostly cannot drink, as you note.
And contrary to popular belief, taking stimulants if you have ADHD leads to decreased levels of drug and alcohol dependency, not increased risk of abuse or dependency. There are like 7,000 studies on this.
posted by DarlingBri at 1:30 PM on February 24, 2023 [8 favorites]
There are over 30 brand names with varying formulations, but they are all formulations of one of six drugs. Methylphenidate and amphetamine are the most commonly dispensed in the US, so maybe talk to your doctor about the different brand formulations of one of those that you could start with. You can drink tea and coffee in limited amounts. You mostly cannot drink, as you note.
And contrary to popular belief, taking stimulants if you have ADHD leads to decreased levels of drug and alcohol dependency, not increased risk of abuse or dependency. There are like 7,000 studies on this.
posted by DarlingBri at 1:30 PM on February 24, 2023 [8 favorites]
I'm diagnosed and take dexamphetamine twice a day, on wakeup and at noon. I find that gives me 2-3 very good hours each time, but then can slow down.
My psych put me on dex over Ritalin because I also have anxiety and he thought dex was a better option.
I'd speculate that something on time release might work better for you, especially with the 12 hour days. Re caffeine, I haven't changed my doses and my psych/GP haven't said anything about it, but YMMV I guess.
posted by Pink Frost at 1:32 PM on February 24, 2023
My psych put me on dex over Ritalin because I also have anxiety and he thought dex was a better option.
I'd speculate that something on time release might work better for you, especially with the 12 hour days. Re caffeine, I haven't changed my doses and my psych/GP haven't said anything about it, but YMMV I guess.
posted by Pink Frost at 1:32 PM on February 24, 2023
Adding after seeing DarlingBri's post, I find Dex on weekends helped me overcome the general sense of dread and anxiety and inability to get started on life tasks, but if you're already doing fine then probably you could go without it.
posted by Pink Frost at 1:35 PM on February 24, 2023
posted by Pink Frost at 1:35 PM on February 24, 2023
I have no personal experience, but just want you to know that there is currently a shortage of Adderall in the US.
posted by soelo at 1:44 PM on February 24, 2023 [2 favorites]
posted by soelo at 1:44 PM on February 24, 2023 [2 favorites]
I actually wish I hadn't put a lot of thought and planning into when and how to take the medication (methylphenidate, lisdexamfetamine, atomoxetine, various doses, timings etc) as they didn't have an effect on me, apart from initial insomnia, so for me that planning was wasted. And I wish I'd had a clearer plan B.
You don't mention blood pressure - it sounds as if your doctor is fairly on the case, but just in case, if you have high blood pressure you are likely to need to address that first.
posted by paduasoy at 3:41 PM on February 24, 2023
You don't mention blood pressure - it sounds as if your doctor is fairly on the case, but just in case, if you have high blood pressure you are likely to need to address that first.
posted by paduasoy at 3:41 PM on February 24, 2023
I'm on atmoxetine. I like it because it gives me very steady-state energy and attention. My husband is on Adderall and gets pronounced peaks and crashes, which I definitely don't want. Srattera takes a while to build up but is then very effective.
posted by Miko at 3:57 PM on February 24, 2023 [2 favorites]
posted by Miko at 3:57 PM on February 24, 2023 [2 favorites]
It would be slightly off label, but I didn’t get my diagnosis till I was 36, and for my long 10/12/14 hour days, I used to take modafinil (Provigil). It’s more of an anti-fatigue drug than a stimulant, but it does interact with the dopamine system, and lasts for a solid 12 to 14 hours with no crash.
Vyvanse was tricky for me — it requires very consistent eating habits and gut health, because it’s metabolized into a stimulant in the stomach. However, it did last really well and have a smoother up and down.
posted by sixswitch at 4:26 PM on February 24, 2023 [1 favorite]
Vyvanse was tricky for me — it requires very consistent eating habits and gut health, because it’s metabolized into a stimulant in the stomach. However, it did last really well and have a smoother up and down.
posted by sixswitch at 4:26 PM on February 24, 2023 [1 favorite]
Nthing that you will want to be on an extended-release med. I don't have any sort of crash with Concerta (XR ritalin) but it does seem to start to wear off around 10-12 hours in. If I take it after noon I do have trouble sleeping, but not if I take it earlier. Honestly, I don't really have any noticeable psychoactive effect from it (certainly less so than 2-3 cups of coffee) - it just makes it easier for me to focus and get stuff done.
Don't let your doctor start you off on Adderall unless they have a good reason for it, because the shortage is real and not likely to end any time soon. Try some other ones first.
As for what days to take it, I would start with the days you know you are going to need it (boring hard preparation) and once you are comfortable with that, give it a try on the other days. I was surprised by how it helped me in my interpersonal relationships, for instance. And as I've gotten older, I find it's less and less sustainable for me to ride adrenaline to get things done, which is what a lot of us with ADHD are used to doing. Having a steady source of regulation from the meds has made a big difference.
Whatever you end up taking, cut out coffee and other caffeine-containing drinks or treats entirely.
Moderate use of caffeine is fine for most people who take ADHD stimulant meds. I have found that I naturally decreased the amount of caffeine I drink over time as I've been on the meds, but every doctor I've talked to said a cup or two of coffee or tea is fine. Honestly, this commenter also seems pretty alarmist about addiction as well, so I'd take this with a grain of salt and trust your doctor. There is no causal link between therapeutic doses of ADHD meds and addiction (this is just one source but if you look into it, you will find a medical consensus).
posted by lunasol at 4:58 PM on February 24, 2023 [6 favorites]
Don't let your doctor start you off on Adderall unless they have a good reason for it, because the shortage is real and not likely to end any time soon. Try some other ones first.
As for what days to take it, I would start with the days you know you are going to need it (boring hard preparation) and once you are comfortable with that, give it a try on the other days. I was surprised by how it helped me in my interpersonal relationships, for instance. And as I've gotten older, I find it's less and less sustainable for me to ride adrenaline to get things done, which is what a lot of us with ADHD are used to doing. Having a steady source of regulation from the meds has made a big difference.
Whatever you end up taking, cut out coffee and other caffeine-containing drinks or treats entirely.
Moderate use of caffeine is fine for most people who take ADHD stimulant meds. I have found that I naturally decreased the amount of caffeine I drink over time as I've been on the meds, but every doctor I've talked to said a cup or two of coffee or tea is fine. Honestly, this commenter also seems pretty alarmist about addiction as well, so I'd take this with a grain of salt and trust your doctor. There is no causal link between therapeutic doses of ADHD meds and addiction (this is just one source but if you look into it, you will find a medical consensus).
posted by lunasol at 4:58 PM on February 24, 2023 [6 favorites]
Vyvanse has worked well for me. I -would- suggest that you initially cut out caffeine initially, if for no other reason than to be able to clearly see how the new med is working for you in isolation before adding caffeine back onto the stack. I tend to have two caffeinated sodas per day - they help kickstart me in the morning before the Vyvanse starts kicking in.
posted by isauteikisa at 5:20 PM on February 24, 2023 [1 favorite]
posted by isauteikisa at 5:20 PM on February 24, 2023 [1 favorite]
Having been on all the majors at various times (Vyvance, then Adderall, then Ritalin, now Ritalin plus Strattera), I offer you the extreeeeemely boring answer that..it depends. It depends on your personal health history, what your provider thinks makes sense, and (right now, more than ever) what is even available where you live.
Please talk to your prescriber, be as honest and open as you can about your own background and concerns, and prepare for some guess-and-check and frustration. What works for you may change over time, and that’s OK too! As you might have guessed, that was absolutely the case for me.
(There may be absolutely no good reason to give up life-giving coffee. If, like many of us, you’ve subconsciously been self-medicating with the stuff, I agree that your appetite for it is likely to decrease with meds. Ask your prescriber about that, too.)
One note about Strattera: it can cause intense nausea and surprising appetite loss. I find the former diminished with time, but the latter not so much. Please tell your provider if you have a history of disordered eating, or anything else that might make these side effects especially problematic for you.
posted by armeowda at 7:05 PM on February 24, 2023 [3 favorites]
Please talk to your prescriber, be as honest and open as you can about your own background and concerns, and prepare for some guess-and-check and frustration. What works for you may change over time, and that’s OK too! As you might have guessed, that was absolutely the case for me.
(There may be absolutely no good reason to give up life-giving coffee. If, like many of us, you’ve subconsciously been self-medicating with the stuff, I agree that your appetite for it is likely to decrease with meds. Ask your prescriber about that, too.)
One note about Strattera: it can cause intense nausea and surprising appetite loss. I find the former diminished with time, but the latter not so much. Please tell your provider if you have a history of disordered eating, or anything else that might make these side effects especially problematic for you.
posted by armeowda at 7:05 PM on February 24, 2023 [3 favorites]
I couldn't deal with the various side effects I was having on Strattera, which was the first one prescribed to me. Now I take Adderall 10 mg XR. My doc prescribed me enough to be able to take it twice a day, but said to start with one and see how it goes. I think one might be enough, most of the time, and considering the shortage mentioned above, I like the idea of not running out quickly.
As for coffee, I'm an espresso + varying amounts of steamed milk drinker, at most twice a day, and I haven't found caffeine to be a problem.
posted by emelenjr at 8:05 PM on February 24, 2023
As for coffee, I'm an espresso + varying amounts of steamed milk drinker, at most twice a day, and I haven't found caffeine to be a problem.
posted by emelenjr at 8:05 PM on February 24, 2023
Regarding nausea on Strattera: my psych warned me about this, and I had a little but absolutely not enough to make it worth stopping the drug. It was mild and temporary and the trade off really worth it. It does seem to demoed appetitive, which for me at midlife is fine, and the additional energy it gives my attention allows me to plan and make meals and make sure I’m still getting good nutrition.
Just weighing in because side effects are different for everyone and can be quite mild. I was worried about them but i haven’t had many problems at all and wouldn’t want to discourage anyone before they know how they’ll react 1 you can always change meds if something isn’t working: Stimulants also change appetite as well.
posted by Miko at 8:10 PM on February 24, 2023
Just weighing in because side effects are different for everyone and can be quite mild. I was worried about them but i haven’t had many problems at all and wouldn’t want to discourage anyone before they know how they’ll react 1 you can always change meds if something isn’t working: Stimulants also change appetite as well.
posted by Miko at 8:10 PM on February 24, 2023
Explanation on the coffee/caffeine:
A lot of people with adhd are self medicating with the stimulant caffeine - unsurprising.
Changing stimulants to adhd meds often means you don't need the coffee. And coffee has a number of downsides (eg decreases iron absorption, and despite many medical professionals freaking out about people taking adhd stimulants during pregnancy, there's less clear evidence of harms from that, than there are from 4 cups of coffee a day).
Problem is, that many, not all, but a huge number of people with adhd people get bad side effects if they *combine* adhd stimulants and coffee.
Racing heart, jitters, anxiety etc.
From adhd meetups it is well, a lot of people.
Therefore you want to massively decrease your caffeine consumption for a few days prior to starting meds, to give yourself the best chance possible to experience the adhd meds as they should function.
If you do it the other way, then if you have a bad reaction that means you can start to associate meds with anxiety, that can just become a psychologically self-fulfilling prophecy. So give yourself a chance to try the meds 'clean' first.
I have heard of a few people who weren't even told about the possible caffeine interactions and just thought the adhd meds were giving them intolerable side effects.
Once you're used to them, you can cautiously see if you can handle a cup or two of caffeine.
For trying meds, I guess just take as prescribed, start low & slow, go up, and see how you feel and how it effects you.
Even in my 'chill home times' I'm clearly adhd and not very functional, so I would start meds when there's nothing too pressing, but it would be obvious on me if it is helping.
And atomoxetine is great for those who it works for (consistent action rather than only when you take the stimulant!), but it's about half as likely to work, and yeah, didn't work for me.
posted by Elysum at 9:53 PM on February 24, 2023 [2 favorites]
A lot of people with adhd are self medicating with the stimulant caffeine - unsurprising.
Changing stimulants to adhd meds often means you don't need the coffee. And coffee has a number of downsides (eg decreases iron absorption, and despite many medical professionals freaking out about people taking adhd stimulants during pregnancy, there's less clear evidence of harms from that, than there are from 4 cups of coffee a day).
Problem is, that many, not all, but a huge number of people with adhd people get bad side effects if they *combine* adhd stimulants and coffee.
Racing heart, jitters, anxiety etc.
From adhd meetups it is well, a lot of people.
Therefore you want to massively decrease your caffeine consumption for a few days prior to starting meds, to give yourself the best chance possible to experience the adhd meds as they should function.
If you do it the other way, then if you have a bad reaction that means you can start to associate meds with anxiety, that can just become a psychologically self-fulfilling prophecy. So give yourself a chance to try the meds 'clean' first.
I have heard of a few people who weren't even told about the possible caffeine interactions and just thought the adhd meds were giving them intolerable side effects.
Once you're used to them, you can cautiously see if you can handle a cup or two of caffeine.
For trying meds, I guess just take as prescribed, start low & slow, go up, and see how you feel and how it effects you.
Even in my 'chill home times' I'm clearly adhd and not very functional, so I would start meds when there's nothing too pressing, but it would be obvious on me if it is helping.
And atomoxetine is great for those who it works for (consistent action rather than only when you take the stimulant!), but it's about half as likely to work, and yeah, didn't work for me.
posted by Elysum at 9:53 PM on February 24, 2023 [2 favorites]
Fyi - Vyvance and Adderall are both amphetamines, but unlike Adderall there is no generic version for Vyvance.
More anecdata: I've taken Adderall for 20+ years and I still drink coffee and alcohol (in moderation, as always). I wake up around 6 a.m., take a 30mg extended release about an hour later, and another 30 mg (regular tablet) late in the afternoon.
posted by she's not there at 10:30 PM on February 24, 2023
More anecdata: I've taken Adderall for 20+ years and I still drink coffee and alcohol (in moderation, as always). I wake up around 6 a.m., take a 30mg extended release about an hour later, and another 30 mg (regular tablet) late in the afternoon.
posted by she's not there at 10:30 PM on February 24, 2023
In my experience, it doesn’t really matter, you’ll only know once you’ve tried them out. And then once you get a good effect with one, you can tweak the dose, timing, and formulation.
posted by meijusa at 12:37 AM on February 25, 2023 [2 favorites]
posted by meijusa at 12:37 AM on February 25, 2023 [2 favorites]
I just started Vyvanse and noticed it is somewhat expensive, did a little digging, and wouldn't you know it: The patents expired yesterday! I decided I can afford it for awhile if a generic might happen soon.
posted by secretseasons at 8:51 AM on February 25, 2023 [2 favorites]
posted by secretseasons at 8:51 AM on February 25, 2023 [2 favorites]
I've been on Vyvanse for nearly 12 years. It has been a very positive influence. I could do with it being a lot cheaper, though.
A few things I noticed:
posted by scruss at 10:56 AM on February 25, 2023 [3 favorites]
A few things I noticed:
- You might feel very ‘speedy’ for the first couple of weeks: teeth grinding at night, general jaw clenching, whirlwinds of go-go-GO! energy. This will pass. (So, sadly, does the appetite suppressant effect, dammit.)
- Dry mouth can be a thing. Biotene toothpaste and mouthwash helped, but then the brand was bought by a huge company and they removed the active ingredient, so it's now no bloody good for anything.
- If you have any kind of arrhythmia, get specialist advice. Not that it's affected mine, but everyone's different.
- This might be just me, but Vyvanse + alcohol = a very bad scene indeed. I basically can't drink any more, but that might be Vyvanse + alcohol + arrhythmia.
- There's anecdotal evidence in the ADHD community that Vyvanse isn't great for your liver.
- Learn to recognize when the meds are wearing off every day, and don't start any new projects when they are. For me, that's about 9 pm, or “meds o'clock” in our household.
- If you have to come off Vyvanse for a short while as you're just becoming used to it, do it when you have downtime planned, if possible. I felt very stupid and small and sad when my doctor took me off it a month into starting, as I could no longer understand the project models I'd developed. The good news is, this passes with time, too. I recently had to come off Vyvanse for a week, and I was able to notice wheel-spinning, flailing and "best idea ever, right now!" feelings coming up.
posted by scruss at 10:56 AM on February 25, 2023 [3 favorites]
This thread is closed to new comments.
Whatever you end up taking, cut out coffee and other caffeine-containing drinks or treats entirely.
posted by infinitewindow at 12:40 PM on February 24, 2023 [2 favorites]