Which ADHD med won't cause anxiety?
April 19, 2011 6:33 PM   Subscribe

What's a focus-enhancing ADHD medication that won't cause anxiety or make me feel "out of it" the way caffeine does?

I've always had trouble with concentration and sustained task focus, and after years of fruitlessly working with my therapist to address the problem through better work habits, I'm finally ready to stop pretending and admit I may have (perhaps subclinical) ADHD—and that I may, as my therapist suggests, benefit from trying Adderall, Ritalin, Provigil, or similar.

I have observed that caffeine works wonders for my concentration and productivity. It gives me the laser focus I always wanted, and I bang out tasks one after the other until they're done.

But caffeine also makes me irritable. Worse, it makes me feel out of it. I feel out of sync socially. I have trouble engaging people. I don't feel funny and relaxed among people the way I normally do. I feel like I'm moving too fast to get or tell jokes. This effect lingers weeks after I stop drinking coffee. Whether it's due to chemical action or placebo effect, I don't know, but weeks after I stop the caffeine, I continue to feel "off," and friends continue to tell me I seem "out of it." Eventually this wears off and I regain my sense of social rhythm.

Provigil helped me focus the month my doctor prescribed it for daytime sleepiness, but it also made me anxious—including painful social anxiety—and gave me insomnia.

The daytime sleepiness is now gone, but the inability to focus—and the lack of productivity—remain.

My therapist referred me to a psychiatrist. When the psychiatrist asks me which ADHD medication I'd like to try, what should I say? Which ADHD med will help my focus and concentration without making me anxious or throwing off my social rhythms?
posted by incandescentman to Health & Fitness (20 answers total) 9 users marked this as a favorite
Oh man. This is a trial and error process. You might hit the perfect medication and perfect dose for you on the first try.

But you probably won't.

The thing with stimulant side effects is they're pretty personal, and so is your level of tolerance for those side effects.

That said, my generic adderall doesn't make me anxious.
posted by bilabial at 6:45 PM on April 19, 2011

Tell the psychiatrist exactly what you wrote here. A good doc should be listening to you and offering you options, not asking what you'd like to try right off the bat. (How could you possibly know?)

This kind of thing is exactly what psychiatrists do, so you're on the right track.
posted by corey flood at 6:49 PM on April 19, 2011

I avoided Adderall and other stimulants like the plague when I was first diagnosed. They scared the crap out of me, especially since I'd had problems with anxiety in the past. We tried Strattera at first but it didn't do a darn thing. A year later I was so frustrated with my lack of concentration and decided to go for it. Generic Adderall does not make me anxious or twitchy, in fact, it feels like it calms my brain down so I can stop and process everything that's going on. The ONLY time I get twitchy on it is if I'm stupid and have many cups of non-decaf coffee right after I take it.

But tell your doctor about your concerns. They can try Strattera first.
posted by elsietheeel at 7:30 PM on April 19, 2011

Response by poster: To clarify: I took Provigil for a month and it made me socially anxious and sleepless so I stopped taking it. I've since resolved the sleep issues that were causing the daytime sleepiness. But I still need to address the issues of concentration and focus.
posted by incandescentman at 7:33 PM on April 19, 2011

IANY(A)D, etc.

My friend swears by Focalin for this purpose. I've never tried that medication, but I can personally recommend Aplenzin, as it does for me exactly what you describe caffeine doing for you, without any side effects that I've experienced whatsoever (I'd even say it decreases irritability for me).

Above all, as a previous poster states, it's a personal trial and error process. Good luck.
posted by nzero at 7:51 PM on April 19, 2011

I have a prescription for Focalin. I've also had a prescription for Ritalin in the past. As others have mentioned, it's not just the medication that matters, it's the dose. Finding that dose takes time--took me 6 months at least this most recent time. I can't recommend Focalin or 30 mg because it works for me, because that has no bearing on how well it will work for you. It's an ongoing process and if you're interested in medication, you have to realize that you may experience side effects and you have to take an active role in making sure your dose and prescription are adjusted to minimize them.
posted by TrialByMedia at 7:57 PM on April 19, 2011

I took Adderall very briefly. Holy smokes. It gave me cyborg focus, almost scary. I felt like I'd melt my computer screen with my death-ray eyes. And it also made my brain feel like it would explode. And it also made me a powderkeg. I had this elevated level of tension and stress and agitation that was just waiting for you to walk into my office and say something and I was ready to leap across the desk and sink my fangs into your neck RAAAAHHHH! So yeah I stopped taking that. Good Lord, that's some drugs right there. Remember, it's four kinds of amphetamine squashed into one pill. If caffeine affects you that dramatically, you might want to start with a micro micro micro dose of Adderall. I see others above saying YMMV, so I'll defer to that, but just be sure to describe your caffeine sensitivity to the doctor. You might shoot straight off to the moon.
posted by Askr at 8:07 PM on April 19, 2011

Different medications do different things for different people.
Most likely, you'd first be put on Strattera or something non-amphetamine based.
Then you'd probably be put on a low dose adderall or ritalin .
Depending on how you react to those medications would move you into longer lasting or stronger doses.

Everyone is different, low doses of adderall make me crash after about 4 hours, and ritalin doesn't feel as "clean" as far as focus goes as I get antsy.

The best is dextroamphetamine or dexedrine, but generally one has to jump through hoops before they are given that, as it is very clean and can last quite a while.

Go see a doctor and start the process. They can lead you down the road of medication as it is trial and error.
posted by handbanana at 8:17 PM on April 19, 2011

I was diagnosed with ADHD in December, however both of my parents and 3 of my siblings have it also (supposedly ADHD is partly genetic haha). Point is, I or my family members have tried nearly every ADHD drug out there.

I am on Strattera which works in a totally different way than most of the other drugs. For me, when it started I had some pretty bad side effects at first such as sexual problems and problems with not feeling hungry. The sexual issues went away after a few weeks and the hunger problems were solved by switching to taking it at night (which is a definite advantage for Strattera, I believe it's one of the few ADHD meds that doesn't usually cause sleep problems, and therefore can be taken at night).

Something to keep in mind is that the drug takes at least a month of use to really see the effects, at least for most people. However, now that it's working I love it. Almost no side-effects these days and it helps me concentrate quite a bit. I suspect my psychiatrist will up my current dosage from 100 mg to 120 mg so I can get where I'd really like to be. Something else different, and a definite advantage of Strattera is it can help with anxiety. I'm naturally very introverted, but it has helped me overcome some of my minor social anxieties.

I personally have experienced Vyvance as well. For me it was awful. Not worth the terrible insomnia it gave me. It works with both of my parents though and is there ADHD med of choice.

Hope this helps!
posted by BenS at 10:16 PM on April 19, 2011

sounds like a lot of the symptoms i was having...turns out a lot of it was low-grade depression...bouts of lying around alternated with bouts of getting up and out and trying to do stuff (and being generally ineffective and distracted) and lots of social awkwardness...thought it was ADD or ADHD, went and saw someone, they asked me a bunch of questions about my habits, and told me i sounded depressed...and you know what, i had to agree. keep in mind that the 'mania' part of manic depression can feel a lot like ADHD. (also, physical inactivity, be it lying in bed or sitting in a cubicle, can MAKE you depressed) talk to a pro, and listen to them.
what worked for me? wellbutrin (and the generic, bupropion, is cheap!)...although, at first, when they put me on the 250mg, i felt a bit whacked out, but still, better, so i asked about a lower dose (i am not a large person) and they put me on the 100mg...and i feel muuuch better...focused, funny, not paranoid or irritable, and better sleep habits.
buuut...IANAD. my advice, though:
1) listen to the questions...even if they don't seem related to ADHD (doctors have this whole '20 questions' checklist...it's called 'diagnosis', they study it for years, they know what they're doing)
2) answer everything honestly.
3) listen to the words that are coming out of your mouth...they might surprise you.
oh, and exercise is good for both ADHD and depression...maybe try a bit more of that...even if it's just walking...
posted by sexyrobot at 10:39 PM on April 19, 2011

First of all, you need to get a diagnosis. Then, if you do in fact have ADD, you're going to just have to try 'n' see. People are unique, and drugs are tricky.

The best is dextroamphetamine or dexedrine, but generally one has to jump through hoops before they are given that, as it is very clean and can last quite a while.

Ehhh... Not so much. Dexedrine is the granddaddy of all the rest, but there's a reason all the rest came around, namely that dexedrine is a quick-up/quick-down thing. That is, it takes effect quickly and very noticeably, and a few hours later, it just stops, and you crash into a puddle of fatigue. That's a pattern that makes it a) a fun night out, and b) highly addictive. Those are the reasons it's hard to get. The "very clean" to which you refer means it doesn't have the stuff in it that makes the ascent and descent nice and gradual. (Vyvanse is dextroamphetamine plus that stuff. I found it utterly useless, but YMMV.)

Strattera--not a stimulant, but a selective norepinephrin (adrenalin) reuptake inhibitor--just made me sleepy all the time, but the multiple orgasms (male) were pretty neat! (Come to think of it, those two side-effects may have been related...)

I found that amphetamines--I've tried them all--didn't make me jittery like a pot of coffee does, but I definitely felt sped up (more so, in a good, productive way). Certainly my heart was beating a lot faster, which is why I've been relegated back to caffeine jitters. D'oh.
posted by Sys Rq at 12:20 AM on April 20, 2011

Bupropion and exercise.
posted by krilli at 12:32 AM on April 20, 2011

My son used Focalin, as well. He was on it for about 2 years until he decided for himself he was able to come off of it. It really did help him out.
posted by rich at 6:22 AM on April 20, 2011

I'm on Strattera, which *can* cause sleep problems, because it caused them in me. I had to switch from taking it at bedtime, which caused me to wake up in the middle of the night and not be able to get back to sleep for hours, to the morning. Then I pushed it to 9A.M. after I got to work and ate, because taking it in the morning before eating made me nauseated and occasionally throw up.

I used to take a higher dose, but had more nausea problems so the doc backed me down a bit and added a small dose of buprorion (Wellbutrin), which helps it a bit. I don't have laser-like focus, and still have a problem with getting started on projects, but I can actually get those projects done once I get started, instead of losing interest a quarter of the way through.

Exercise is supposed to help a lot. Meditation is reported to help, also (practice in sustained focus? You don't say!).
posted by telophase at 8:23 AM on April 20, 2011

It depends on the individual (as so many people have said), but I know one person with ADHD and anxiety who's trying Intuniv and it seems to be working for him.
posted by The corpse in the library at 8:35 AM on April 20, 2011

Like everyone says, people react differently, but one person I know was prescribed Celexa along with the usual ADHD meds to counter the social anxiety, and then needed that cut back because with the lessened anxiety, he also lost much of his motivation to do the tasks he wanted to improve focus on.
posted by Obscure Reference at 10:17 AM on April 20, 2011

Adderall....you just described me....caffeine and everything...and i have been on Adderall, but it doesn't help with the insomnia...
posted by TeachTheDead at 12:32 PM on April 20, 2011

I take 5 MG of Dexedrine Spansule a day. I found that it increases my attention significantly, especially with long, boring tasks, and I don't get any anxiety or emotional lability issues with it. I also don't take it on the weekends to give my system a break, with my doctor's knowledge and consent. The only side effects I get from it are heartburn (which I'm watching by not drinking coffee), and increased spasticity - but unless you also have Spastic Paraparesis, I highly doubt that this'll be an issue for you.

I used to take Adderall. That also worked really well on the attention span. However, when I was on it, it made me happy, and when the drug wore off, it made me sad, angry, anxious, and really REALLY grumpy. Not a happy state to be in, and plus it was also really expensive for me on my insurance plan.

I also used to take Ritalin. Again, it worked like a charm, except I constantly felt short of breath. Um, no. I like breathing, thank you.

However, everyone's reactions to medications is different, and the only way to find out the one that works for you is to talk to your doctor about it, and then try them out.
posted by spinifex23 at 2:02 PM on April 20, 2011

Oh, and Dexedrine Spansule is the 'long form' of Dex. It lasts 8-10 hours for me, and I really don't notice a crash at the end of the time span.
posted by spinifex23 at 2:04 PM on April 20, 2011

I do not have ADHD but I do experience the same side effects with coffee that you ascribe generally to caffeine. The crazy thing is, I can drink a whole pot of tea, green or black, and it does not make me jittery, bitchy or anxious. Mate tea is especially potent and making me feel 'on point' but not edgy. I have no medical theories or evidence to support any of this but that's my experience. So I tend to stick to decaf if I'm drinking coffee and drink lots of tea when I need to focus or wake up.
posted by mr.ersatz at 3:24 AM on April 21, 2011 [1 favorite]

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