Adderall questions
June 6, 2013 7:10 AM   Subscribe

I have some questions about Adderall and tolerance.

I am legally prescribed Adderall for ADD. I have been taking it for a year and a half and it's been a lifesaver for me. I was prescribed 40 mg (instant release) from the start (I first started on ER but didn't like them because they gave me headaches. ER dexadrine made me extremely irritable and depressed. I think IR works better) and my doc said I could play around with the dosage to see how it worked. I started at 20 and did that for 9-12 months or so and then upped it to 30 (20mg at 7am and 10 at around noon - I don't like to take it any later because I won't sleep). I feel like 30mg is not really working as well anymore but I'm kind of scared to go up to 40 because I think that's high and I worry about constantly having to increase my dosage indefinitely.

I've talked to my doc and she says that sometimes people need to take a break from the meds - she said about two weeks or so. I am fine with trying this but I'm wondering if anyone here has done this and can tell me their experiences? Mainly:

1. After a two week break, will my tolerance reset itself? Meaning, will it be the same as when I first started? And if a drug tolerance resets, does it take the same amount of time to build up again or does it build up more quickly?

2. This sounds bad, but one of the great side effects of Adderall has been that it helps me to eat normally. I have always been a really compulsive eater (think Oprah and her story about not even being hungry but so obsessed with wanting to eat she ate hotdog buns drenched with maple syrup) and Adderall helps me eat normal meals only when I'm hungry. I am terrified of taking a break and eating everything in sight. I know this will happen because when I've taken weekend breaks it is what I do (I have never had an eating disorder such as anorexia or bulimia, I initially lost about 10 pounds on Adderall but my weight has stayed steady since. I am slightly overweight).

So my question is - how to best prepare take a med break? How do I ensure that I function as normally as possible at work and how do I prepare myself to not eat compulsively? The focus and clearmindedness that I would need to do this is what adderall gives me.

Also, if anyone has any tips or advice on Adderall and tolerance generally, I would love to hear it. I am female in my 30s. I was prescribed ritalin and dexadrine (both IR) for ADD as a teenager and in college. Thanks.
posted by anonymous to Health & Fitness (9 answers total) 4 users marked this as a favorite
1. Two weeks will absolutely reset your tolerance. One week would suffice, actually. You could compensate with increased caffeine in the meantime. Expect irritability and mood swings.

2. Plan your meals. Snack on things like shredded carrots if that's what you do.
posted by oceanjesse at 7:17 AM on June 6, 2013

Do you take this daily, seven days a week? I find that I really start to feel burned out if I'm doing that, and the drug starts to lose its power.

I take a day off every week, at least. I try to take two days off every week. In other words, I try to not to take the drug over the weekends, while I'm off work. If I'm working the weekend, or I need to "have my head together," I try to pick a workday when I can be less focused but it won't be obvious. Fridays are good for this.

My doctor recommended this, and also recommended taking longer "drug holidays" when possible, like not taking it for many days over a longer vacation or break. I have not been as successful at picking off many days in a row when I can just let myself be nonproductive and unfocused. The most I've managed is 4-5 days off in a row.

I am on XR, and have been for about 18 months. I have not had to up my dose at any point, and I think that has a lot to do with my frequent days off from the drug. When I've had multiple weeks in a row with only one day off, I start to feel sucked dry and a weird kind of exhausted. Two days a week is optimum, but then I'm saving all my focus and productivity for the office. So I try to be smart and strategize.

When I do take the drug for the first time after even just 2 days off, I can really feel the drug much more clearly than I can at the end of a workweek. It's pronounced! So that's cool, too.
posted by aabbbiee at 7:29 AM on June 6, 2013 [1 favorite]

After a two week break, will my tolerance reset itself? Meaning, will it be the same as when I first started? And if a drug tolerance resets, does it take the same amount of time to build up again or does it build up more quickly?

It should, but it depends. I used to take ritalin and then adderall, and I found that after many years, my tolerance would come back quickly. I eventually had to quit taking the stuff altogether because at the dose I needed the side effects became a real pain. Your mileage may vary.
posted by dortmunder at 7:34 AM on June 6, 2013 [2 favorites]

I usually take the weekends off from Adderall and that helps reset me.
posted by Lucinda at 7:54 AM on June 6, 2013 [5 favorites]

I had exactly the same experience as dortmunder. For me, I had to quit taking meds after 13 years because they no longer worked as well, even after med holidays, and I started having issues with irregular heart rhythms.
posted by rabbitrabbit at 8:00 AM on June 6, 2013

Can your pills be split into 5 or 2.5mg increments? If so, you have a lot more room to play around with dosage before hitting a typical max dose.

With two doses/day you could also do variable dosing by day. For example weekends do one dose. Weekdays take afternoon dose prn.

If I were you I might try a 5mg AM step up combined with introducing variability in taking noon dose.
posted by crazycanuck at 8:16 AM on June 6, 2013

My experience is a little bit different: I'm a 37 year-old male and I don't think I ever got past 15mg (maybe 20?) and always extended release, but I took it for 9 months maybe two years ago then stopped. I started back up about 4 months ago at 10mg and I'm staying there for the foreseeable future. The problem I had was it worked so well for me the first time I really chased the dose under the heading "If Some Is Good, More Is Better", which, of course, is a line of thought Adderall seems to encourage.

I feel like 30mg is not really working as well anymore but I'm kind of scared to go up to 40

My perspective only, but that's the exact line of thinking that screwed things up the first time: as soon as I didn't notice something different I assumed it had stopped working. But it's not true, I had just gotten used to being focused and productive and didn't feel jittery anymore and instead of stepping back and realizing I was focused and productive I thought, "Shit, where are those jitters? I'm not sweating like Patrick Ewing in overtime any more. This drug has stopped working." 10mg was about my mid-point the first time, I started back up at that and it's been fine. There was a bit of Feeling Different for a week or so but then I settled in and have just tried to be pleased with where I am.

I do usually skip it on Sunday, but now that I'm at a lower dose I'm a bit torn. Having read the other comments in the thread though, I think I'll stick with it. We had friends up for Memorial Day Weekend and I forgot about taking it at all for four days. I don't recommend that, I felt like I could sleep for a week.
posted by yerfatma at 9:56 AM on June 6, 2013 [1 favorite]

I think I saw this description on AskMe, but I didn't favorite the comment, so if I'm paraphrasing someone, I'm sorry. But basically, before I started taking adderall, on a scale of one to ten in organization/focus/functionalness, my days were usually 3-4ish, with occasional 1s and 7s. When I started taking adderall, suddenly I consistently had 6 and 7 days, so at first it was like I was having the rare good days all the time. Eventually, a 7 day was normal, so it didn't feel as amazing as it first did, but the adderall was still working.

I also usually take at least a day off a week or don't take the second dose in the afternoon. You could try cutting down on the weekends as opposed to stopping altogether for a bit.
posted by raeka at 9:37 PM on June 6, 2013 [1 favorite]

I'm a 37 year old female, and I take between 45 and 60 mg of instant release Adderall per day. 15 mg every 4 hours. I've taken as much as 80 regularly and maybe 100 on very long days. My doctor is ok with this because she's watched me change in front of her as a dose wears off and I've forgotten to take the next one. At least once a week, when I am at home and don't need to leave, I skip it or just take my first dose. But my mother takes hers every day (for years now) and it keeps working just fine. Neither of us did nearly as well on Ritalin.

I'm on the high end of ADHD and have a weird drug metabolism and this is how much I need to take for it to be effective. I'm not tempeted to take more than I need to function because that is all Adderall does for me: makes it possible to function. But most people seem to need less than I do, and it is my understanding and experience that once you find the dosage that works for you it isn't necessary to keep raising it to get the same effect. My personal theory is that when a person takes a medication that corrects an imbalance it doesn't work the same way that it does when a neurotypical person takes the same med as a mind-altering drug that causes an imbalance and then requires more and more to get the same effect because the body is trying to correct itself. We do build up a kind of tolerance, but usually only to a certain point at which we find the right dosage.

Sometimes Adderall gets me focused and moving, sometimes it makes me sleepy. Sometimes I don't notice any difference until the dose runs out and I suddenly can't put two words together or look other people in the eye. Feeling like 30 isn't working anymore may mean that you actually need more, or that you've gotten used to it and aren't getting the side effects anymore. Are you having trouble concentraing or focusing when it runs out? Do you feel it run out? Or are you still functioning well but have gotten used to the side effects (appetite suppression, energy burst)? No matter how much you take, the side effects will eventually diminish and all you'll be left with is focus. On the other hand, if the appetite suppression has lasted this long, it might be treating whatever it is that makes you obsess about food. That is what it seems to do for my mother. So you're probably safe there.

As for a med break, a few days seems to lower my tolerance a bit as far as side effects go. But not how much I need to function properly. If it could cost you your job, a two week break could be a very bad idea. There isn't anything I know of that can help you keep focus without it, and you'll probably go through some kind of withdrawl that could be extremely unpleasant. It just isn't worth it. To me it would be as strange as a doctor telling someone to stop their blood pressure or thyroid meds for a while to make sure that they'll keep working.

On a side note, adding 1 mg of guanfacine (generic, not the expensive Intuniv profit grabbing stuff) has helped the Adderall work better for me. Somehow, it smooths the Adderall out and makes the times when I forget my next dose much less unpleasant (used to have horrible crashes, actually mentally painful). Something to think about. But it isn't enough to replace the Adderall for me, though apparantly it takes the edge off of the ADHD enough for some people.

One last thing, I've also noticed that the more stress I am under, the more thinking I need to do, the faster I burn through the Adderall. Sometimes I've just used it all up and need more. When the stress is over, I can go back down without any problem and it still works just fine. I think it is more about keeping a certain effective blood level than any specific dosage.

Sorry it was so long, but I thought it might help.
posted by monopas at 5:34 PM on June 7, 2013 [2 favorites]

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