Huh? Wha? Adult ADD Meds

June 11, 2006 11:42 PM

Need some anecdotes/advice about meds for adult ADD.

I have taken Ritalin and Concerta in the past. Hated Ritalin due to the 'drop off' effect. It was like switching off a light once it was out of my system. Concerta made me tired in the mornings and didn't help me focus all that much. I no longer see the MD who prescribed me those meds 'cause, well, he died.

I take Lexapro (antidepressant) and Topamax (for migraines).

I have another MD now. I just started with Strattera a week ago. I'll give it a month but so far I'm not sure I like it. I'm tired a good part of the time. I eat less, but that's OK. It's calmed me down a bit and I'm less impulsive, but I'm also too tired to do anything constructive.

The next step would likely be Adderall. I know everyone is different, but if you take or have taken Adderall as an adult, what's been your experience? Has another ADD med besides the ones mentioned helped?

posted by miltoncat to health (21 comments total)

I am reluctant to mention it, but Ask Slashdot had a discussion on this very topic.
posted by Mr. Six at 11:59 PM on June 11, 2006

Just remember how painful it is to keep up with prescriptions of controlled meds. (no refills, remember? Controlled meds. Need a new scrip every time.) Strattera, though I've never tried it, would probably not require that you get a new scrip from a quack every 30 days.

And, boy, do those psychiatrists quack LOUDLY when they get the slightest impression that you just want to use them to get the meds, and nothing else. Yes, I want my medication for a condition that was diagnosed 18 years ago. No, I don't want to talk to you about my life; you'll just think of golf anyway.

(To be fair, they carry liability in cases where abusers hoodwinked them to get the drugs just to then go sell them in a park. But they're just a little self-important, too. And I get insulted when they take my copays for having done nothing.)

Also learn to love coffee if you ever lose your health benefits. A can of Maxwell House is $4, while a bottle of Adderall is upwards of $160 at a drugstore. Not counting the cost of a consultation from the psychiatrist that was needed to get the scrip.
posted by brianvan at 12:36 AM on June 12, 2006 [1 favorite]

The controlled thing is annoying, but with so much more focus and just plain Getting Things Done, you'll remember to put "get Adderall scrip" on your calendar with both an alarm and an automatic monthly repeat.
posted by mimi at 3:59 AM on June 12, 2006

I took ritalin as a teen and hated it. Got through college unmedicated before finally heading back to the psychologist. She prescribed adderall, and it has been GREAT! None of the side effects that I hated about the ritalin. My psychologist usually writes me two prescriptions...one for the all-day time-release capsules and one for the 4-hour tablets (I found that taking one of the capsules after about 10 in the morning keeps me up ALL night).

Nothing but good things to say about the stuff from me...
posted by richmondparker at 4:00 AM on June 12, 2006

Also learn to love coffee if you ever lose your health benefits. A can of Maxwell House is $4
Agreed! (But drink better coffee.) One of the most productive / happy / fun times in my life was when I was working for a coffee company, and drinking a concoction that was 4 shots of espresso + 1 shot of chocolate syrup floating in a pint of coffee. Adderall XR is a little kinder on my stomach and you don't crash. If you feel too jazzy / wild-eyed in the late afternoon, you can always scale it back.
posted by mimi at 4:05 AM on June 12, 2006

This is slightly off-topic, but just might prove useful: when I started taking Lexapro, my migraines went away. I asked my doctor about it, and he said that it made sense: serotonin levels affect your likelihood of getting migraines, and that while antidepressants aren't prescribed for migraines, that is a known side effect. So, you might be able to save some money by dropping that prescription. On the other hand, if you ever do get a migraine again, you'll be cursing my name forever....
posted by kimota at 5:10 AM on June 12, 2006

I've been on Strattera for about 2 weeks and haven't noticed a difference in my concentration/focus. My MD said it should take 6 weeks to reach effective potency in my system. I HAVE noticed, however, a sharp drop in libido. If it persists I am going off of this medicine.

I am also interested in trying Adderall, as I have a roommate who takes it occasionally before tests and seems to be 50x more productive while on it (the only time he will actually clean the apartment). How addictive is it? Are there any nasty withdraw or come down effects?
posted by mhuckaba at 5:48 AM on June 12, 2006

My experience has been that Wellbutrin is the best. I've had no side effects at all with it, even when we ramped up to 400mg/day.

Straterra is pure evil and should be pulled from the market. When it first came out, they claimed no sexual side effects: lie. When I started experiencing them I did a search and found out I wasn't alone (I will let you find out what they are on your own, it isn't info that's hard to find). The manufacturer at the time claimed there weren't any serious side effects, and frankly still does. They are finally listing that there are sexual side effects, but the fact that it's been linked to a few deaths doesn't really come up. Their claim is "most people weren't bothered enough to stop". That claim isn't backed up by even the mildest of research.
posted by Spoonman at 5:54 AM on June 12, 2006

I actually tried Welbutrin for a month I believe. It didn't help me at all and I became extremely irritable and aggitated. I'm normally a very laid back person but I just started being nasty and snapping at everyone.

Thank you for validating my concerns with the Strattera. I'm giving it another week and if symptoms persist I'm flushing it.
posted by mhuckaba at 6:09 AM on June 12, 2006

i have taken adderall for approx 7 years now as an adult, after having taken ritalin, dexedrine, desipramine, and god only know what else. when i was in college i was prescribed 60 mg a day (20mg 3x). As i've gotten older and the demands on my focus have lessened, i find myself taking less and less -- now i take 20 mg in the am and usually that is enough for me all day; sometimes i take another 5-10 mg in the afternoon if i know i'll need it for the evening as well. as i've gotten older, the "drop" has gotten a lot worse as well -- the "cracked out" feeling of being overstimulated and over-focused but not being able to channel it to anything. I have found that taking some caffeine (green tea or coffee) about 5 hours after I've taken the pill really helps. i have never been addicted to adderall, though i have friends (both legitimately prescribed and not prescribed) who have been addicted to it.
I don't know about strattera, though some people swear by it, i've thought about switching but the havoc that changing medications has wrought in my life before makes me awfully dubious. feel free to email me if you have particular questions about adderall at allaboutaddiesATgmailDOTcome
posted by Soulbee at 6:14 AM on June 12, 2006

i've had fairly good success with Adderall. sometimes i feel that it doesn't help as much as i'd like with my focus, but when i look at it over time it's clear that i'm getting more done.

with regard to getting prescriptions filled, i'm able to have my doc write three at a time, noting the fill date on the second two. for example, if he wrote them today, the second one would say "fill 7/12/06" and the third would say "fill 8/12/06." this might just be an Ohio thing, but my gosh it helps!
posted by lisaj32 at 8:07 AM on June 12, 2006

I've been on Strattera for 3 years and really like it. It took a few months to find the proper dosage, but once it was settled, it worked great. It has changed my life.

My doc was one of the original trial doctors and knew the drug in-and-out, which was helpful in determining dosage.
posted by k8t at 9:03 AM on June 12, 2006

Oh, and just remembered:

- When I started taking Strattera, it hurt my stomach. I learned to take it with dinner. It also made me tired, so I started taking it later at night.

Strattera stays in your system longer, so it doesn't matter if you take it every 24 hour or not... a 22 hour difference or a 27 hour difference won't affect you.
posted by k8t at 9:06 AM on June 12, 2006

Strattera gave me super-vivid dreams all night long (seemingly), leaving me feeling wholly unrested in the morning. After about 4 nights of this, I quit before the sleeplessness drove me really crazy.

Methylin ER (extended-release methylphenidate, the active ingrediant in Ritalin and Concerta) worked well for me, but it only took a few months for me to acquire enough tolerance to my dosage for it to do no good -- I quit rather than get on a cycle of needing ever-increasing doses.
posted by Zed_Lopez at 10:22 AM on June 12, 2006

I've been taking Dexedrine for years and it has worked well for me. The MD prescribes 15mg 2x per day but I usually only take one in the morning. The fact that it's avaliable as a generic also means it is cheap.
posted by Carbolic at 12:02 PM on June 12, 2006

I've been on strattera for a few years. I like it. Sure it's got side effects and it might dissolve my liver, but hey, I can focus.

It's better than wellbutrin which filled me with rage.
posted by Lord_Pall at 12:17 PM on June 12, 2006

Figured it might be okay to piggyback off this question, if miltoncat didn't mind. I was curious if they sell ADD drugs that can be taken when-needed (studying for exams, extremely busy day at work, a day when you just can't seem to focus on anything). Like how they prescribe people to take xanax only when they feel anxiety coming on. All the ones I'm familiar with require time to build up in your blood stream. Any anecdotes/advice about that?
posted by ZackTM at 1:25 PM on June 12, 2006

I took Adderall XR for about 6 months (quit when I got pregnant) and I couldn't believe the difference it made. I'd used all sorts of non-legal/ non-prescription drugs before to help me focus and Adderall gives me the same ability to get things done without the cracked-out overdrive. I noticed a slight grumpiness when it wore off initially but I adjusted to it and really had no problems.
It doesn't stay in your blood stream or 'build up' so I never had a problem with sleeplessness- in fact, my dreams became much more 'normal' and I woke up feeling better than I ever had before. Quitting wasn't a problem at all physically but I really miss being more focused and productive.
posted by Mamapotomus at 2:40 PM on June 12, 2006

1. there's a NY Post article today somewhat related to some of the points in the discussion, although not directly related to the question. But since we're all in the same small boat on a rocky lake, here's the link: http://www.nypost.com/seven/06122006/news/regionalnews/attention_deficit_adults_fail_to_get_help_regionalnews_carl_campanile.htm

2. Taking ADD drugs simply when needed? I find that Adderall is less effective that way in terms of the focus benefit (you lack control, sometimes it works too much and sometimes it works too little), but the trade-off is that you're dodging all the usual personality side-effects when you don't need to be on the meds. This was an issue for me because it significantly reduced my social capacity. The nature of the medication made me too withdrawn from others. I felt that being "who I am" carried far more importance than being an all-the-time study monster.

3. In my experience, most of my physicians and psychiatrists have balked at any long-term adult arrangements for Adderall scrips. I'll add that I was on a really bad health plan for my first (and only) permanent job, and I could never afford to keep making doctors appointments anyway on my anemic salary. When I quit that job and purchased an EPO individual plan from a good provider, that pretty much ended any contact I had with any doctors.

I'm just very surprised at how little people know about these drugs, and what bullshit they'll make you go through to get them. See above article: it's one thing when we forget to call the doc repeatedly, and it's another thing when we DO remember and the doc is the one who's not committed to finishing the job. Maybe the docs should take these pills too, eh?

In any case, good luck with dealing with the system and getting fair treatment from your health care insurance provider.
posted by brianvan at 3:41 PM on June 12, 2006

Im 27 and have never really taken prescription meds in my life. Growing up it was impossible for me to start homework projects and I have always had difficulty concentrating on things that I didnt find interesting. I still was able to get through school well enough mostly due to last minute rushes and all nighters after putting things off for weeks on end. This worked well enough for college, but I found that after I started working proffesionally that I just couldn't keep the same hours and put off work projects until the last minute.

I started talking to a few of my friends about it. One friend who I knew had ADD described his symptoms and they sounded pretty similar. He has a prescription for adderall and likes it a lot. Another friend who didnt have ADD or a prescription for adderall but still took it regularly told me it helped him concentrate and really "lock in" on things. I probably shouldnt be admitting this, but I actually tried adderall once or twice before going to see a doctor to see if it worked for me, I really liked the way it made me feel and helped me concentrate.

So, finally I did I google search for Adult ADD and the first site result has some information and local Physicians. I chose one closest to me and made an appointment. I went in and basically described my symptoms and how I felt. I didnt say that I had ADD, and I didnt ask for adderall, I was honest with everything and he had me take a test, I think the cutoff for the test was something like 23 points out of 30, and I got 22. He said that he wasnt going to quibble over a point if I felt that it was important enough for me to come in and seek help.

He started me on Straterra 2 weeks on 20mg, 2 weeks on 40mg, and then two weeks on 60mg, he said it takes 6 weeks to start really feeling the effects and that different dosages will affect people differently, for example, we might find that 20mg works better for me than 60mg. Anyway I took it for the full 6 weeks and for the first week I felt pretty good, but after the second week I was back to normal for the remainder of the 6 weeks, and also the "small chance of sexual side effects" SUCKED. It definitely affected my libido as mentioned above, but it also made sex pretty difficult, making it so I couldnt get the little guy to do anything. I talked to my brother who was also taking an SSRI which is what straterra is, and he said the same thing happened to him. So this may just be a thing in my family and YMMV.

Anyway, I told all this to the doctor and he put me on adderall and I havent looked back since. Its helped me concentrate a lot and the thing I like most about it over straterra (beyond the sex issues) is that I dont have to take it everyday. Adderall basically gives me a boost and it gives me focus, so Ill take one in the morning, and If I know im in for a long haul Ill take one after lunch. If I dont have much to do in the office, I wont take one, and I usually dont take it over the weekends.

Ive been on it for about 2 years now, and the only drawbacks, Ive seen so far are:
1. I dont take it after 3pm. If I do I have problems falling asleep at night.
2. Refills are a bitch. You have to go and get prescriptions every 30 days for it because its a Class B drug and heavily regulated. My Doctor prescribed me 20mg 2 times a day, but I usually only take one a day, and none on the weekends, so my 30 day precriptions will usually last me 2 months or more. However my Doctor has been pretty accomodating with the prescriptions also where he will leave them at the front desk or write a few months for me at a time. It depends on your Doctor, but usually they will work with you.

All in all Ive been pretty happy with life after adderall, if you feel like straterra isnt working for you, ride it out for the 6 weeks and go back in and tell them its not working.

good luck!
posted by skrike at 9:49 AM on June 13, 2006

This response is a little late - I haven't had computer access for the past week or so. I started taking Adderall about two months ago. The first two or three weeks were uneven - I increased my dose too quickly and it murdered my sleep schedule - so I started over, taking 20 mg most mornings, and 30 for an especially busy day.

So far, I love it. My biggest problem with with concentration is that I get trapped in my kaleidoscope head, constantly bombarded with fragments of thoughts and emotions that disappear before I can convert them into action. The Adderall doesn't cause me to be super focused by any means, but at least when I'm on it I can act, period, instead of just sitting around thinking about acting and feeling more and more stressed as I'm continually pelted with items from my crazy mental to-do list. For example, if I had a big pile of dishes in the sink before starting on the Adderall, my mental assessment of the situation would be something along the lines of "Aaarughhhdishes i need to do the dishes write paper call e-mail friend call dishes water soap dishes take shower let dishes soakarrrrgghhhhhh" and then I'd curl up in a ball in my bed and shut my eyes really tight. On the Adderall, I think, "I need to do the dishes" and then I either get up to do the dishes, or I do something else, but at least I do something.

The effect is subtle enough that I'm not like The Productive Wonder when I'm on it, and I'm definitely still myself, but when I haven't taken it it's very noticeable. I can't get a thing done. I've just finished college (wish I'd started taking it five years ago, and then maybe i wouldn't have taken an extra year to graduate) and am consequently off my parents' insurance, and I'm really scared about what will happen when I run out of pills! Since I'm only taking 20 mg, my doctor wrote me a prescription for thirty days worth of 40 mg a day to buy me an extra month, but that'll come really fast. The increase in productivity might be worth the out-of-pocket expense, though. Argh! America!

Side effects: as I said, the insomnia was TERRIBLE at first, but that's completely calmed down. I was pretty jittery when I initially increased my dose too fast, which really defeated the whole purpose of taking the pills at all, so you want to be careful about that. And they're not kidding about the appetite reduction - I've lost about ten pounds so far.

Addiction is always a concern, of course, but I think it's not terribly likely as long as you take the pills as prescribed. Best of luck to you!
posted by granted at 5:08 PM on June 17, 2006