Non-prescription ADD drugs with non-anectodal evidence
April 3, 2012 3:28 AM   Subscribe

37 y.o. with ADHD here, diagnosed a few years ago. Ritalin works a bit, but gives me headaches. Dexadrine doesn't seem to do a whole lot except make sleep impossible (hence the 6am post). My psychiatrist says that if I don't tolerate those, I won't tolerate the others, either. Are there any non-prescription supplements or medications that might help and have some kind of hard evidence to support their efficacy?

I've seen caffeine mentioned, but more than two cups of coffee a day makes me super-anxious and jittery and doesn't help me focus. Exercise and diet are on the list, but I'm looking here specifically for natural or over-the-counter remedies that I can buy at the health food store, the pharmacy, online, etc.

I'm also on Effexor for anxiety/depression, by the way.

And, yup, I know you're not my doctor.

posted by The Dutchman to Health & Fitness (20 answers total) 8 users marked this as a favorite
Not non-prescription, but it seems weird that your pdoc hasn't tried you on Strattera or Wellbutrin already. Most of the nonprescription stuff with any real weight behind it is just going to be other stimulants, but if you don't tolerate stimulants well, you probably won't get good results off of nicotine or ephedra, either.
posted by gracedissolved at 4:06 AM on April 3, 2012 [4 favorites]

You don't know how well you'll tolerate the other meds until you try them :-\ I'd systematically try everything and titrate the doses until you find one you like. I don't really see why, if you asked to do this, your shrink would refuse you.
posted by tel3path at 4:17 AM on April 3, 2012 [1 favorite]

Have you tried a lower dosage of your ADD medication? For a while, I was on 40 mg of Vyvanse, which made it very difficult for me to sleep, so I had the dosage titrated down to 20 mg. Now I sleep much better. Also, it really helps if I drink a lot of water throughout the day. When I'm on my medication, I can definitely feel the difference on days when I don't drink as much water compared to days when I do.
posted by nikkorizz at 5:09 AM on April 3, 2012 [1 favorite]

What is the timing and dose of the dexadrine? Either you are taking a LOT, and/or at the wrong times, or your body is a super non-metabolizer of amphetamine. In which case, just lowering the dose ought to work.

The only non prescription thing that ever worked for me was taking a 24-hour Sudafed and getting cranked on green tea. Couldn't do that every day.
posted by gjc at 5:52 AM on April 3, 2012 [1 favorite]

Also, investigate the XR formulations, which don't hit as hard -- and you don't crash as hard.
posted by eriko at 5:54 AM on April 3, 2012 [1 favorite]

Yeah, it's definitely odd that your doctor hasn't tried you on the non-stimulant medications available. You might want to see someone else who specializes in ADHD in adults.

on preview - the extended release versions of stuff are fucking awesome lifesavers. If I could legally marry my daytrana patch I would do so without a second thought.
posted by elizardbits at 5:56 AM on April 3, 2012 [2 favorites]

Omega-3 is supposed to help with various ADD issues, though I took it for over year and didn't notice anything other than I'd bleed more when I got a cut. I never noticed any difference with any prescription ADD meds either though, so take that for what it's worth.
posted by bondcliff at 6:16 AM on April 3, 2012 [2 favorites]

I don't think your doctor knows what s/he's talking about. I haven't tried Ritalin, but had less-than-ideal experiences with Dexedrine and Adderall, but am very happy with Vyvanse, despite its chemical similarities to those too. (The standard 30 mg dose of Vyvanse was too high for me, though -- have to get 20 mg formulated by the pharmacy or I'm a jittery stress ball by the end of the day). Not saying that Vyvanse will work for you -- every body is different. But it's foolish to dismiss an entire class of drugs based on two experiences.
posted by croutonsupafreak at 7:20 AM on April 3, 2012

Another vote for looking in to Strattera. I hated every second of my one month Ritalin trial and Wellbutrin/Strattera combo has worked well for me. I do sleep more lightly on Strattera, but it is sound and healthy sleep. Are you naturally a light sleeper?
posted by maryr at 7:23 AM on April 3, 2012

I take vyvanse and like it. It feels a lot smoother than adderal did for me. And less crash at the end, I don't think I even notice a crash.

Aside from medication, what is most effective for me has been just those basic bedrocks of wellness: nutrition, exercise, and sleep.

I don't follow a strick diet, but go for high protein and try to get my vegetables. It's pretty hard to go wrong that way. I almost always go for whole grain rather than white for stuff like bread or pasta. I know some people who do better when they really limit grains, but my system handles them fine. And I'm not absolutely strict about whole wheat, because sometimes what you really need is a croissant. And if the majority of my diet is solid, I don't worry about small indulgences. I think there is some solid science about fish oil, but I don't have time to look it up at work. I'll try to remember when I get home. I tried to take it, but always ended up forgetting. It's on my "yeah, I should do that" list of things that aren't top priorities.

The diet does help a bit on its own (though more for my other health problems), but as far as my ADHD it's most important because it facilitates...

Exercise. Exercise exercise. It might be just as effective as meds for me, and if not, it's still pretty effective. There are more complicated physiological reasons it's so effective, but if nothing else it just works to burn of some of that static or fog in my brain. Even just walking or being up from a chair more helps me. But most effective is a good, vigorous workout (aerobic or strength for me) for at least 20 minutes a day. It's almost like magic, how well it works. If I'm working with weights, it's inside with music and no other distractions, because it's important to be focused on what your body is doing for safety. For aerobics I like swimming, exercise bike, and stationary rower. I also like to just stroll around outside, but I just consider that general activity, rather than exercise.

I love the swimming because I get to be outside in the sun, and swimming is like the most fun thing ever. Wearing myself out in the pool or one of the local springs or swim holes makes me feel better mentally and physically than just about anything else. If you could find something that works for you this way, you'd be set for life.

I like the stationary bike because it gets my heart rate ticking along while being simple and easy while not requiring my total attention. On it's own it would be dreadfully boring, but it's great because I can pair it with one of my more sedentary hobbies like reading, watching, or video games. I love it for reading or studying, because the physical exertion occupies my random ADHD distractibility which helps me really focus and pay attention to what I'm reading. I understand and retain sooooo much better. It makes such a difference that now I always like to read while moving, pacing around my living room. It feels a bit silly, but works for me. It's perfect for gaming, because that way I get to do something I really have fun with while getting energy and stimulation out of my body. Normally gaming is enjoyable, but is more just passively recieving more stimulation, so being active with it really really helps me.

I love love the rower because, like with weights, I have to be fully present and aware of what my body is doing. It's a full body, rhythmic movement that really facilitates slipping into that "flow" state of mind. It's almost always nearly meditative for me, and sometimes I use it as an actual form of body meditation (similar to a walking meditation). It clears away all of the fuzz and lets me just be. It's amazing.

And that reminds me of another method that's very effective for managing ADHD, backed by scientific study, and that's meditation. I was always very resistent to meditation, but that's because I totally misinterpreted what it was. I thought it was sort of abstract and elusive, and how could just sitting doing nothing not drive someone insane? But then I realized that I'd been doing a form of mindfulness meditation for YEARS as a pain management technique for chronic migraines.

At the core, meditation is attention and awareness practice. It's not some etherial attempt to reach a higher state of being, it's just brain practice. And there are a whole bushel of different kinds of meditation practice, including active versions like walking meditation or yoga.

And sitting meditation is obviously less physically active than my trademarked "rowing meditation" but I've learned that it's not just sitting doing nothing. It's a very engaged, active process. And it's very simple in its basic form. You're sitting down to practice noticing where your attention is, and then practicing placing that attention and focus where you want it. Its goal isn't to sit with your focus on one thing for an extended period of time (that's superhuman) but to notice when your mind has been distracted and wandered, and then to bring your attention back where you want it. It's not about whether you lose focus and get distracted, or how often or for how long, but about noticing you're distracted and refocusing. Even people who have been meditating for decades still get distracted all the time.

And that's why it's so effective for ADHD, because it's all about attention. It's not like you and I have too much or too little attention, it's that we have a diminished ability to place that attention where it's appropriate for the given moment. Whether you're unable to focus or hyperfocused, your attention isn't operating in a useful way. And meditation (or "attention practice" if the term has too much baggage) is how we practice controlling our attention rather than letting it control us.

So those are my recommendations. Eat good brain fuel. Exercise and sleep (I didn't talk about it because I'm already going on longer than I intended, but it's huge) and some sort of attention practice.

You're of course in the best position to figure out what would be best for you, but I'd recommend starting with something along the lines of my "rowing meditation" to kill two birds with one stone. But maybe you want to read or play games on an exercise bike or elliptical, and rather practice midfulness and attention while you eat, or walk, or do yard work.

And ask your doc about wellbutrin and strattera. I took wellbutrin for awhile for unrelated reasons, but it helped some. Not to the degree of adderal or vyvanse, but some help is better than none, and maybe you'll respond well.

Good luck!
posted by f_panda at 7:26 AM on April 3, 2012 [5 favorites]

I've been trying omega-3s as well - but not supplements. I've been eating a can of sardines every day for the past few months. I'm sure that sounds extreme but I've experienced a noticeable difference. Other diet changes haven't had much of an effect on me, but sardines are high in omega-3, B12 and vitamin D, all of which I think I was probably deficient in before anyway.
posted by fromageball at 7:34 AM on April 3, 2012

To potentially explain what your doctor means: He probably means that you won't tolerate the others because there are two main classes of stimulant drugs. Ritalin, or methylphenidate, and amphetamine drugs, your adderall and dexadrine.

Within the amphetamines, there are two different stereoisomers, d and l amphetamine. Different drugs have different ratios of d to l, and this can affect people differently. So another amphetamine drug may work for you, or it may not.

Straterra is different again from these two types of drugs, although it takes longer to kick in as it works over time, more like an antidepressant.

*not a doctor, just someone who researched this for myself
posted by sarae at 8:00 AM on April 3, 2012 [1 favorite]

Response by poster: sarae: Is there a similar thing going on with the drugs on the methylphenidate side that makes it worth trying variations, or are those more similar? Of the two, the Ritalin worked better for me.
posted by The Dutchman at 8:32 AM on April 3, 2012

For me, at least, the difference between Ritalin, Ritalin LA, and Daytrana is vast and imponderable. Regular Ritalin is ghastly because it wears off so fast and so harshly; Ritalin LA (long-acting? long & awesome?) is much better, but FULL of lactose; and Daytrana (ritalin in a patch) is a glorious concoction created by direct intervention from the gods and delivered atop a majestic ponycorn accompanied by a heavenly chorus.
posted by elizardbits at 8:47 AM on April 3, 2012

...Full of lactose being a problem if you're lactose-intolerant?
posted by maryr at 8:52 AM on April 3, 2012

(yeah. day-long controlled release of lactose = sad butt)
posted by elizardbits at 9:03 AM on April 3, 2012 [2 favorites]

I think the only difference in the methylphenidate drugs is the release time. I take biphentin, which is a slow release form. The release ratios differ between drugs (concerta, ritalin la, daytrana) so one might release 50% shortly after taking the pill and the remaining 50% throughout the day, where another one might release 40% then 60% gradually.
posted by sarae at 12:05 PM on April 3, 2012

Is there any particular reason why exercise is off the table? It releases the same chemicals in the brain that anti-depressants and add meds do - manily dopamine. I've read many, many articles over the years about it, you can search for it on Google.
posted by eq21 at 8:25 PM on April 17, 2012 [1 favorite]

posted by eq21 at 8:25 PM on April 17, 2012

Sorry, I misread your question. I though you said "off the list :) has a forum where people discuss notropics. I'd look there.
posted by eq21 at 8:28 PM on April 17, 2012

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