A! D! H! D! and screwing around with medication
January 4, 2014 10:04 AM   Subscribe

I am trying to experiment (with my pdoc of course) with ADHD medication. Adderall works well for me, but not well enough. I am trying Concerta right now and I don't really like it. What can I do?

Is anyone aware of a way to augment Adderall? I can only take 15mg because anything above that makes me feel off. The 15mg makes me feel so much more focused/calmer. However, it only takes me from severe ADHD to moderate ADHD, and I would like to get rid of as many symptoms as possible.

Just wondering because I have stuff to do, and so far this trial of Concerta is worse than without any medication. Luckily it has been Christmas break so I haven't had much important stuff to do, but I am going to start work again soon. Therefore I am looking for combinations that may have worked for other people so that I can get back to business without messing my life up.

I have an anxiety disorder I am taking an SSRI for, which is probably why more adderall=bad (because it increases anxiety).

I feel scatterbrained right now and I can't keep my attention enough to really try to figure this out by myself, so any help is seriously appreciated.

You are not my doctor, nothing I find here is medical advice, but I would like to call my pdoc with more substantial information for her to help me with. Obviously she is the expert and everything, but the hive mind usually is pretty smart and I need to be my own best advocate.
posted by tweedle to Health & Fitness (8 answers total) 3 users marked this as a favorite
Is this the 15mg XR or the 15mg regular tablet? I have found that the extended release versions of all adderall doses are far, far superior to the regular ones.
posted by elizardbits at 10:54 AM on January 4, 2014 [1 favorite]

Seconding elizardbits: the roller-coaster effect of instant release adderall (or any instant release stimulant, really) is unpleasant as hell, and extended release is a lot gentler.

There are a couple of non-stimulant meds that get prescribed for ADHD. The ones I'm familiar with are wellbutrin and strattera. Both of them can make anxiety worse, though, so it's not clear that they'll be better than adderall — but they might be worth a try. You know the drill: Ask Your Doctor If They're Right For You.

It's possible that the best solution for you will be to get back on a low dose of adderall and then start looking at non-medical ways of improving your symptoms further. I am a big fan of psych meds, but they don't always get the whole job done on their own. The usual hippie-ass recommendations — counseling, meditation, exercise — would really be worth trying here. (And if you found them unhelpful or impossible to keep up with before you started adderall, give them another try now that you've started. For a lot of ADHD sufferers, the real value of stimulant meds is "They give me just enough focus that now I can keep track of my therapy appointments and sit still to meditate without wanting to claw my eyeballs out.")
posted by Now there are two. There are two _______. at 11:09 AM on January 4, 2014 [2 favorites]

According to my psychiatrist, the established maximum effective dose for Adderall (IR anyway, dunno about XR) is 40mg/day. At 15mg/day, you're taking less than my starting "tolerance" dose. If you're having unpleasant side effects at just 15mg/day, Adderall may not be for you. Your doctor will probably have some suggestions for you, but here are a couple options that she might bring up.

One, you might switch to Vyvanse. Part of the reason why it was designed was to provide a better delivery system for dextroamphetamine (the same primary active ingredient as Adderall) that would cause fewer side effects. So if Adderall works but you can't take enough to give you the level of therapeutic effect you need, Vyvanse might do the trick.

Two, you could try switching from Adderall + SSRI to Wellbutrin. It's listed for depression/anxiety but commonly prescribed off-label for ADHD as well. It has a very high (relatively speaking) success rate with depression and anxiety, dunno about with ADHD; I don't think it's been formally tested for that. And it has a lower rate of side effects than SSRIs, so it might work well for you.

Those are the main options that my own psych has mentioned to me should Adderall turn out not to be the right medication for me. Your doctor will have her own opinions, but I think you'd be safe in at least bringing up those two options as possibilities next time you see her.
posted by Scientist at 11:17 AM on January 4, 2014

I take up to 60 mg of Adderall per day. 15 mg every 3.5 to 4 hours, because that is how long it lasts for me. 20 at once is too much, but 10 isn't enough. I'd still take 60 if I took the extended release, but my drug plan doesn't cover XR. I also take Wellbutrin, but a smaller than usual dose because it makes me sleepy at a full 300 mg. Also, a tiny tiny dose of Xanax at night. And a drug called guanfacine, which is cheap and generic and kind of helps with the ADHD. They've got an expensive time release version for ADHD, but I'm not going to pay for that for a drug that was once a day anyway!

It has taken years of tweaking to find the right meds and doses. I've learned that for me treating the ADHD has helped with anxiety far more than anything else, SSRIs don't help me at all and make everything worse, and I metabolize most drugs either more quickly or far more slowly than most people so I can't always expect typical results.
posted by monopas at 11:48 AM on January 4, 2014 [1 favorite]

I second Vyvanse. It works well for me and is much gentler than being jumpstarted by Adderall first thing in the morning.
posted by thatone at 11:50 AM on January 4, 2014 [1 favorite]

Enjoy the boost and augment with non-med strategies has been my approach.
posted by theora55 at 12:40 PM on January 4, 2014 [1 favorite]

For what it's worth, if you do try Wellbutrin, you might have some increased anxiety for a while. That was a side effect I had for the first few weeks and it was pretty bad. But it went away after a while. In my experience it didn't help the ADHD very much, but friends of mine have had better results in that arena. So it could be worth trying.
posted by litlnemo at 6:08 PM on January 4, 2014

I also have an anxiety disorder, and I take my Adderall with an Inderal tablet, which makes it feel much better and I'm much less inclined to get panic attacks while taking it. Whatever you're taking, you may want to look into that route to see if that offsets some of the unpleasant side effects.
posted by Sequence at 10:54 PM on January 4, 2014

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