Some questions about adderall.
October 11, 2013 7:57 PM   Subscribe

I recently started on adderall for ADD-type issues, and I've got some questions about the effects it's having. I intend to bring them up with my psychiatrist when I see him next, but that won't be for a few weeks and I think it would still be valuable to get some outside perspective, especially from people with first-hand experience. A lot of this has to do with sexuality. Questions and details within. A bit long-winded.

OK, so after a long period of trying to find a way to get a prescription for adderall to deal with some serious attention/motivation issues that I've had for as long as I can remember, I finally made it through all the various hoops and hurdles and got my prescription a couple of weeks ago. My starting dose is 10mg of immediate-release generic dextroamphetamine/amphetamine, taken up to twice daily either separately or together, as desired.

Overall I am really liking the effects. I am getting a lot more work done, I feel less fuzzy-headed and distractible, and I really enjoy the feeling of being able to focus on a task and see it through. It really helps my confidence and self-esteem to finally feel like somebody who's capable of getting things done. I'll be seeing my psychiatrist in a few weeks to talk about how I'm getting on with the drug and whether I need my dosage adjusted. In the meantime, a few questions as I am feeling my way with this new medication.

Question 1: What to do, if anything, about the psychological side-effects? This drug is obviously potent. I mean, when the drug is at its peak (this immediate release stuff stays usefully effective for about four hours for me, and noticeable for perhaps six hours) I do feel a little "high". It's not a bad feeling at all -- I get a little hyperfocused perhaps, but I'm able to break out of it when necessary and interact like a normal human being. Perhaps I am a little bit more chipper and upbeat than normal, but given that I'm usually a bit laconic and depressed (I also take escitalopram aka Lexapro, 20mg a day, for depression/anxiety and yes my psychiatrist is aware) I think it sort of evens out.

I definitely don't feel manic, just a little more at peace with the world and in touch with my fellow humans. But I do feel it. My question is: is this something that I am likely to continue to feel, or will my brain sort of adjust to it eventually and it'll pass? If I were to increase my dosage, would this effect likely get stronger, perhaps to the point where it became a problem?

Question 2: My dosage is another thing I have questions about. I am currently planning to ask my psychiatrist for an increase from this starting dose at my next visit, but I am unsure what I should ask for. Obviously whatever I get will be subject to whatever he's willing to give me, but I'd like to go in with a good starting offer, so to speak. My main problem with my dosage as-is is that the 10mg pills don't have much effect if I take just one. Therefore I end up taking both at the same time most days (usually right when I get to work) which does get me where I want but then doesn't last me through the day. Ideally I would like to be "under the effects" all day long, at the level that 20mg gives me or perhaps a little stronger, with some time to ramp down before bed so as to avoid insomnia.

I'm thinking of asking to stay on the same version of the drug but at 20mg per pill instead of 10mg, so that I can have two effective doses per day. As I said, each 20mg dose seems to last me about 4-6 hours. Does this sound like a good plan to you, or do you think there is an alternative that I might consider with my doctor? Perhaps I should get on the extended-release version of the drug? Not really sure. Would love some perspective on the matter.

Question 3: Dextroamphetamine, the primary active ingredient in adderall, is a potentially-addictive stimulant. I am not terribly concerned about being addicted to it as I'll be able to work with a doctor to stop it if I need to, but I am concerned about building up a tolerance. I know that with many stimulants the body becomes acclimated after a time, such that larger and larger dosages are needed to achieve the same effect (often with negative long-term consequences). Is this sort of thing a big risk with adderall? If so, what can I do to minimize that risk? I don't want the drug to become ineffective, and I don't want to use more of it than is healthy for me.

Now, a couple questions about sex. These are more complicated, as if the stuff above wasn't complex enough. Basically, I haven't had an erection in the two weeks since I started this drug. My sex drive has been low -- I haven't felt like masturbating, watching porn, etc, which is something that I normally do on a reasonably regular basis. This wouldn't be especially concerning except that I have on my hands a potentially budding relationship with a very lovely woman, and I am concerned that if things reach a point where we start having sex I won't be able to perform. I know from experience that anxiety about performance can become sort of a self-fulfilling prophecy, and I'm already having some anxiety about this even though it's a totally hypothetical situation at this point. Also, and this is a bit odd, my (flaccid) penis actually seems smaller. Like, the way it would if I'd just been in some really cold water.

I've read that this is pretty normal and that it isn't permanent and doesn't affect the erect size, but that the lack of blood flow in the area can contribute to difficulty in achieving an erection. This seems entirely possible, given that I don't even seem that motivated to get an erection in the first place. I guess my questions here revolve around whether this is likely to pass in time as my body's chemistry adjusts, whether it's likely to be severe enough to cause performance problems (especially if I increase my dosage), and whether there's anything in particular that I can or should be doing about it.

Also, I've already decided that if I can't establish a good balance between the therapeutic effects of adderall and its damping effects on my sexuality, I'm going to ask to be put on a different drug -- presumably Vyvanse. If I did end up going this route, do you think it likely that it would help with the sex drive thing?

Thanks a lot for taking the time to read all this, I realize that I kind of went on for a while there. As I said at the beginning this is all stuff that I plan to discuss with my psychiatrist when I meet him next, but I would like to go into that conversation as informed as possible. I would especially appreciate any insight that is based on either reliable research (which I would love to read) or personal experience, or a combination of the two. Thanks for being a group of people who I feel I can trust enough to talk about such an intimate topic, and who I know I can count on for solid advice.
posted by Scientist to Health & Fitness (14 answers total) 8 users marked this as a favorite

Please give it 2-3 months before you start making drastic changes. There's a slightly manic feeling to your question that I recall from the early days of my husband's treatment, when you really just need to lean back and let it shake out.

If you are still having serious dealbreaker side effects at six months. bring them up with your doctor.
posted by Lyn Never at 8:27 PM on October 11, 2013 [4 favorites]

My main problem with my dosage as-is is that the 10mg pills don't have much effect if I take just one. Therefore I end up taking both at the same time most days (usually right when I get to work) which does get me where I want but then doesn't last me through the day.

Don't do that. You get a bigger effect, but you also get bigger crash. That is how addiction happens.

If you need a bigger dose, ask your doctor first. And get the XR version.
posted by Sys Rq at 8:29 PM on October 11, 2013 [1 favorite]

Response by poster: Not to threadsit, but I did want to say that my psychiatrist (actually two psychiatrists -- a resident working with an experienced psych, who were sitting together when they had this conversation with me) told me that I could take both pills together if I felt the need for a stronger effect. They explained that this option was part of the reason why they prescribed me the immediate-release version rather than the extended-release that I had been expecting to be given. I assume that if this was not OK then they would not have told me to do this. However, I will take this under advisement and if I get my dosage adjusted will make sure to ask whether or not it's still OK to take a double dose. In any case, I would like to get on a medication regime where double-dosing was not necessary.

OK, I'll go away now unless anyone has specific questions for me. I just wanted to clarify that I am double-dosing with the full approval of both of my psychiatrists.
posted by Scientist at 8:34 PM on October 11, 2013

My response is mainly to Questions 1 & 3.

You will get a bigger effect with a bigger dose, though you'll find at some point "upbeat" will transition to "mania". If I forgot and took too much I felt like I had drunk way too much coffee. it was extremely unpleasant. If I were you, I would take the very minimum you need to get the effect you desire, as more may not be better.

Re: tolerance: I developed a tolerance to Adderall. I know some people use it for years and years and it keeps working as it always did, but that was not the case for me. I kept having to up the dosage, and to make matters worse if I didn't take it I would be laconic and depressed all day. When I decided to go off it, it precipitated one of the worst depressive episodes of my life which lasted approximately a half-year. Perhaps your Lexapro could help offset this effect, but I found the stimulant made my depression worse when I wasn't on it.
posted by Anonymous at 8:44 PM on October 11, 2013

If you used to watch porn and masturbate as a form of procrastination and the Adderall is now keeping you from getting distracted with procrastination activities that could explain the apparent decrease in your sex drive.

In my experience, Adderall just made me want to keep doing whatever I was doing when it kicked in. So if I was studying or working, I couldn't be distracted by sexual stimuli or thoughts. But if I was masturbating when it kicked in then I'd pretty much keep doing that for 4 hours.
posted by Jacqueline at 8:58 PM on October 11, 2013 [10 favorites]

IANAD, this is based on my experience (taking it for medication resistant depression in combination with Wellbutrin, not for ADD/ADHD) and discussions I've had with others who take it for ADD/ADHD:

Question 1: I think the feeling you are describing will probably level out in 4-6 weeks, which is different than developing a tolerance. I did have an initial jittery or slightly more "up" feeling which faded in a few weeks once my body adjusted (this was years ago, so I can't be more precise). Years later, I still get the same benefits I always did but nothing akin to that one too many cups of coffee feeling, even when I've resumed my medication after long lapses in between prescriptions (related to moving and finding new doctors) or there was a (slight) increase in dose. Keep in mind that most of the time you should feel "normal," a little more energy, a little more focused, but never high or artificially up. You will be the best gauge of that, but also enlist some people close to you who you trust to let you know if you seem to be exhibiting symptoms of being high or manic such as atypical fast talking, aggression, grandiose ideas, prolonged insomnia, etc.

2. Doses vary and everyone is different, but you should start slow and wait before increasing. 1 month is really too soon to tell. I think I started with 10mg 2-3x a day, only taking the third when I had a longer day ahead and was feeling that dip. As time went on, my dips were less noticeable. If you can transition to the extended release formula, I recommend it. It's more convenient and a more consistent effect. I ran into issues taking extended release, and have unfortunately had to stick with immediate release (which is a bit of a hassle).

3. Developing a tolerance can be an issue (again everyone is different as to when and how that will manifest), which is why you should stick with the lowest dose possible for as long as possible. Discuss your concerns with your doctor and s/he can also be on the lookout for tolerance issues. The only thing that precipitated an increase in dose once I found the right one for me was a significant weight gain and even then, we're only talking an extra 10 mg.

Lastly side effects: Adderrall has never adversely affected my sex drive but being female, I can't speak to the erection issue. While these aren't sex related, in case it's helpful, the most significant side effects for me are: 1. Dry mouth/excessive thirst. This gets a little better (or maybe I just became more used to it), but for several months in the beginning, I was constantly parched and even now, I am always drinking water/liquids. 2. Lack of appetite/disinterest in food. Again, this was more severe in the beginning when I actually had to force myself to eat and it was incredibly unpleasant. My appetite has mostly returned to normal, but I would say that I don't enjoy food and drink nearly as much as I used to pre-Adderall. Not necessarily a terrible thing, but when the things that trigger hunger and satiation are shut off or dulled, it can be hard to gauge when you are full, as well as when and what you really need (or want) to eat. 3. Inability to urinate. This is not a common side effect, so in all likelihood this won't be an issue for you, but it can happen, so I figured I'd mention it. If I have too much of it in my system at one time, I cannot pee. Like I need to go, my bladder is full, and I literally cannot make myself pee without considerable effort and even then, sometimes I would just have to just give up and wait awhile longer. It's similar to being constipated but with urine and it's awful. This is why I can't take the extended release and also why I don't worry too much about becoming addicted because I physically can't hack having too much in my system at one time. Again, this is a weirdo side effect and will probably not happen to you.

Finding the right dose takes time and while there are common protocols, everyone is different. Be patient, listen to your doctor, and go slow. If this is the right medication for you, it will take some time not only for your body to adjust but also for you to mentally recalibrate as you feel better. Side effects can happen but they will hopefully lessen over time or perhaps go away completely. If they don't, then you need to reassess whether the benefit out weighs the cost and investigate alternatives. Good luck!
posted by katemcd at 10:42 PM on October 11, 2013 [3 favorites]

Answering as ADHD diagnosed, but currently off medications~~

To question 1: if it is the right medication for you, it will calm down and you get used to it. Your brain is not used to the fuzzy noise-feeling being muted, and it's exciting and new! But give it another month or three after stabilizing on a dosage. Make sure you eat, stick to your recommended dosage, and perhaps back off on coffee. I found coffee brought on mild mania if I had too much of it on weekdays. If you notice things like mood swings tell your doctor.

Question 2: 10mg was what I started on, and I am a 5'1 small woman. It was perfect for me right off the bat, but that's not the case for a lot of people, sounds like you included. If your doctors okayed you to take both doses, that's fine. They probably anticipated it. They will likely give you a 20mg script next time. If it is not lasting long enough throughout the day, talk to them. There is the option of more doses a day or extended release.

Question 3: Your doctor will keep an eye on your dosage history, and it is possible to develop a tolerance. My best suggestion will be to use something other than completing boring work as a gauge. The "hooray I can get everything done!" feeling will normalize, and with that comes back the "ugh, work" feeling. Watch your other symptoms. I know my dosage is wearing off when I can no longer follow trivial conversations all the way through.

I can't help with penis questions, but for me all biological needs get kind of tamped down in their signaling. I forgot to eat a lot, and sex wasn't important unless my partner made it important. Once the need gets flagged though things were as normal.

Don't be afraid to try other medications if this one doesn't match all your needs. They all work in different ways and there will be a difference between XR and multiple daily doses, as well. And talk to your doctor! The more feedback you give them the better they know what needs tweaking.
posted by teslacoilswoah at 11:00 PM on October 11, 2013

Not numbered with your questions...

1. Get the 20mg XR--I am concerned about your dosage and the feeling of being high, TBH. I know the doc said it would be okay, and I'm sure it will, but it's not ideal at all. Immediate release (IR) is not so great for most people, the high and then the crash are disturbing, unsettling, unpleasant...and yes, more likely IMO to encourage irresponsible self-dosing.

2. Take medication vacations/breaks to keep from building up a tolerance, some people do weekends, I did when I forgot to take it (oops).

3. ADHD and masturbating to porn quite frequently go hand in hand because guess what: porn is OMG STIMULATING!!!! WOW LOOK AT THAT!!! Hence your (relative) lack of interest--you're no longer bored with other stuff. The XR will also help with some of the ups and downs you're having.

4. IMPORTANT: these drugs can cause/worsen anxiety. Especially the IR. Cut caffeine and you'll cut a lot of your anxiety.
posted by the young rope-rider at 6:06 AM on October 12, 2013

I take the short acting adderall and haven't really changed the dose despite being on it for years.

1 - I think the affects will calm down. You haven't been on it all that long. Eventually your brain will get used to it and you'll be less aware of that jittery feeling.

2 - Why are you asking for an increase particularly since you already have concerns about your side affects? You're still new to this. Give more then a couple weeks before deciding you need more. If after 6 months IMO you still feel the need, then go ahead.

3 - Adderall is addicting but for me it's life saver. The only way I can explain it is if you are using it for non- prescription uses, you're already well on your way to potential problems. That said you can develop a tolerance, but I take "breaks". I usually take it every day except Sundays. Some people take a week long break every couple of months. YMMV

4 - I think Jacqueline has it. Adderall usually keeps you focused and on target - not to say sex isn't that but if you were using masturbation as a a calming technique it may have trumped that.

You have a lot of questions, I would suggest either ADD Forums or CrazyMeds

One thing my dr. explained to me was that hopefully by taking this med you will be able to retrain your brain and pick up more positive behaviors so that you don't have to use Adderall for your whole life (if that's your goal).
posted by lasamana at 7:12 AM on October 12, 2013 [1 favorite]

Response by poster: Popping back in, as briefly as I can manage.

Why are you asking for an increase particularly since you already have concerns about your side affects?

I guess I sort of glossed over this in my original question but I want to ask for an increase because my current prescription doesn't provide me enough medication to cover me through the day. Since a 20mg dose puts me in the low end of where I'd like to be functionally, but only remains effective for 4-ish hours, and since I want at least 8-ish hours of coverage most days, I'm thinking that two 20mg doses (or the equivalent in XR formulation) would be a good way to go. The side-effects with 20mg in my system are mild and well worth the trade-off in therapeutic effect, and they wear off in 4-6 hours just like the primary effects, if not faster.

So especially if it is likely that the side-effects will fade in time (as seems may be the case) I think it would be worth trying for a dosage that will give me coverage for a full working day. My psychiatrist told me that the dose he was prescribing was on the low end of the therapeutic range, and that it might well not give me as strong an effect as I need but that it was important to start low in case my tolerance turned out to be poor or my sensitivity to be especially high. My experiences with the therapeutic effects thus far have seemed to be in line with this.

However I will take under advisement the possibility that the side-effects might be more severe than they seem from the "inside", and am enlisting a couple of IRL friends who know me well to help me watch out for behavioral changes. For what it's worth I hadn't had a dose in about 10 hours when I wrote this Ask, and as I write this reply it's been about 20. I have always been a verbose, long-winded person online -- especially when talking about personal issues. Whether on the drug or not, I am definitely nowhere near this effusive when talking face-to-face. I definitely wasn't feeling high when I wrote this question, but the comments in that area have put me on a higher alert for behavioral problems so thank you for that.

Some recent *ahem* experiments seem to show that at least when I'm not under the influence of the drug (at night when I'm going to bed, in the morning when I first wake up) my sex drive is in fact intact. As others suggested, it takes a slight effort of will to say to myself "OK sexytimes now" but once I make the shift it's all back to normal. Don't yet know if that is also the case during the 4-6 hour period when the adderall is affecting me more directly, but since it's not like I plan to be on the stuff 24/7 I think I can live with that either way. I can deal with not having a sex drive while I'm at work or doing chores, if anything that might be a feature rather than a bug. Thanks for the insight there, that's a real weight off my mind.

OK, going to go away again and just let the thread play out on its own. I probably will not respond again, so if you have something specific for me then maybe you should MeMail me.
posted by Scientist at 8:09 AM on October 12, 2013

Since a 20mg dose puts me in the low end of where I'd like to be functionally - I get this. My concern for myself has been that I tend to think if a little is good - a lot is better (and I think most ADHD people do the same). I really think you should give a it 6 months simply because you have to give your brain time to adjust as well as any new habits (both good and bad) to form.

One of the reasons I continue with the short acting form of Adderall is I am a poor sleeper so I have to make sure that I "crash" well before my bedtime. I tend to sleep less then 6 hours a night and wake up early between 5:30 and 6:30 most mornings. It may be better for you to have the XR instead. However if you find that in the sexual department you do better when it's worn off, you may to play around with the times you are taking the meds instead.

Feel free to memail me.
posted by lasamana at 9:12 AM on October 12, 2013

Talk to your psychiatrist about all these issues and let him/her come up with a plan to address them. Going in there after a couple weeks of use and essentially asking to double your dose may raise some flags for them.
posted by teamnap at 2:00 PM on October 12, 2013

I've taken Adderall for years. And I get about 3 to 4 hours out of a dose of the regular on a normal day. 10 isn't enough, but 20 makes me jittery so I take 15 mg (1/2 of a 30 mg). I take up to 60 mg per day, have taken 80 on a few occasions. My doc is ok with this and it actually helps with my anxiety because I am better able to function. I've been known to take a dose to help me sleep.

Dosing is incredibly individual. Tell your docs the truth about your reaction and see if they think it would be ok to take more when needed. XR is nicer if you have to take a sizable dose, and it is also nice to not have to remember your booster doses. I take regular because my drug plan doesn't cover XR, and I like to be able to control my doses more closely.

About addiction: Even with the rather large amount I take, I don't have withdrawl if I don't take it. I'm just back to fogland and get nothing done. And I'm from a family with a lot of addicts, so I have tended to be a bit cautious.

Vyvanse is basically just fancy expensive Adderall. It is a precursor drug that forms amphetamines in your body. The other choice that isn't an actual amphetamine is methylphenidate (Ritalin). Shorter halflife, less energy. The first kind of "extended" release only lasts 4 hours. Concerta is the only type of methylphenidate that lasts all day. Adderall seems to have better antidepressant qualities. My doc has said that she finds Ritalin loses effectiveness over time for people more than Adderall does. It was true for me.

To be clear, this is just my experience. Just sharing, maybe you'll find it helpful or reassuring.
posted by monopas at 7:54 PM on October 12, 2013

I've been taking Dexedrine for about four years now, but I still remember the adjustment period, and it sounds like mine was a lot like yours.

1) If I'm understanding your description of it correctly, that feeling of peace and connectivity isn't a direct side-effect of the drug. Untreated ADD, for me, is like walking around in a fog, with all the disorientation that implies. I'd guess what you're experiencing is that fog having finally cleared. You're feeling at peace because you're not living with the permanent anxiety of being lost and disoriented; you're feeling more in touch with your fellow humans because you can focus on them long enough to make a connection.

It's pretty awesome, right? The novelty will probably wear off after a while, but I'd expect these feelings to remain as long as you're effectively treating your ADD.

2) I found immediate-release Dexedrine to be slightly more effective, but at the cost of crashing harder, and sooner. The extended-release spansules strike a much better balance: these days I take 30 mg (2×15) first thing in the morning, and all other things being equal, I'm alert and on task all day, with minimal jitteriness and without any insomnia come bedtime.

Based on your experience so far and your stated goals, I'd recommend discussing an extended-release alternative with your doctor. (Depending on your routine and the length of your commute, you might also want to experiment with taking your morning dose at home so you're ready to work by the time you get to the office.)

3) All I have for this one are my own experiences with Dexedrine, which is (as I understand it) quite similiar to Adderall, but not identical. I only take it on work days, and haven't noticed myself building up a tolerance. Quite the opposite: I tend to take a half dose (15 mg) my first day back after a long weekend or a vacation, because hot damn, it hits me hard after a little time off.

As for your sex drive: I noticed a similar dip in my own when I started taking Dexedrine, and I've heard anecdata from various sources that this is a fairly common side effect. Like the jitteriness, headaches, and inexplicable flashes of anger, it stopped being an issue after a while, but I don't recall it ever leading to performance problems. I was less interested in initiating sex, alone or with a partner, but once things got underway, everything worked fine, and after a few months everything was back to normal.

That said, if the Adderall starts consistently cockblocking you, I'd definitely talk to your doctor about trying a different drug.

Congratulations on getting diagnosed and treated, by the way. It took me until my mid-20s, and it was in every way a life-changer. I can (obviously) go on about this stuff for ages, so feel free to MeMail me if you want to talk more.
posted by Zozo at 2:11 PM on October 15, 2013

« Older Help me remember an old board game about a haunted...   |   My church, my taxes and me Newer »
This thread is closed to new comments.