Why is Adderall affecting me inconsistently on a day to day basis?
January 22, 2014 12:10 PM   Subscribe

I was diagnosed with inattentive-type ADD and prescribed Adderall a little over two months ago. It has been a mostly positive experience, and is definitely working well with my symptoms. However, in the past couple weeks I've been having trouble with the same dosage of Adderall working in different ways and to different degrees. I'm wondering if there is anything in my daily routine that I'm overlooking that could be causing this.

I'm currently taking 200mg Wellbutrin and 10mg Adderall a day, both in instant release generic form. My doctor has given me the option to take an additional 5mg of Adderall later in the day if I feel myself crashing too soon, but I've only done this once or twice. I take the Wellbutrin for mild depression and anxiety, and it works wonderfully with zero side effects.

I'm getting frustrated with the varying effects, both positive and negative, of the Adderall I'm taking. Sometimes it seems like it takes 3 or 4 hours for my focus to improve, sometimes its within 30 minutes. About once or twice a week I feel slightly focused but then get extremely drowsy and need to take a nap within 2 hours of taking the dose. Today I got a pretty intense tension headache and had some anxiety, which I haven't felt since starting the Wellbutrin. My mood has been swinging a bit on some days. I'd say about 75% of the time I don't have some distracting negative side effect going on, but the amount of time it takes to kick in still varies by quite a bit.

Overall, I am very happy with how Adderall is affecting my life in general. For the few weeks, it was very consistently good with no side effects. Even the bad days are much better than pre-Adderall days. I almost never feel "speedy" - the anxiety I get is of the dizzy spaced-out kind, no heart pounding. So, I've been trying to figure out if there's anything I can do to stabilize the effect - its proving difficult to find a good dosage.

My current routine is as follows:

I wake up at the same time everyday and general sleep about eight and a half hours. I take my Wellbutrin and Adderall immediately upon waking with a big glass of water and a handful of almonds. I eat breakfast about an hour later - mostly protein and vegetables. I eat consistently throughout the day and drink a ton of water. I exercise a couple times a week and am in general very healthy.

Factors I've considered:

- Stomach acidity. I've read that Adderall absorption is reduced in acidic environments and it is probably best to take on an empty stomach, that's why I try to leave some time before breakfast. I'm not sure if this is helping?

- Caffeine intake. I like to drink one cup of coffee a day in the morning. I prefer to drink the coffee immediately upon waking and before my breakfast. I tried doing this for a couple weeks with Adderall and it exacerbated mid-afternoon crashes, so now I'm drinking less coffee and I drink it with breakfast.

I have an appointment with my doctor in the next month to check on the dosage, but I'd really like to be able to have my day be a bit more predictable than it is right now until then!

Is the inconsistency just a part of adjusting to Adderall? Am I being impatient?

How do you take your instant release Adderall?

Are there any supplements I should consider that might help with the drowsy/inconsistent energy side effects? Different ADD medications to bring up with my doctor?

Is this something that might be an issue of brand-name versus generic?

posted by supernaturelle to Health & Fitness (16 answers total) 6 users marked this as a favorite
Different ADD medications to bring up with my doctor?

There's quite a number of them (I can probably rattle off a half-dozen off the top of my head) and they're not all created equal, but your doctor should be the one to pick an alternative based on the effects you're experiencing on the current one.

If Adderall isn't working consistently for you -- and there are many people for whom Adderall (or any other specific ADHD med) has bizarre and counterintuitive effects -- try a different one. The nice thing is that you don't have to taper off or wait for your blood levels to build up. X not working? You can try Y the next day (or however soon as your doctor says.) If you're not happy with it now, see if you can move up that appointment.

Also, is there a reason you're on instant release? Extended release is better in almost every way I can think of. Definitely something to bring up w/ your doctor.
posted by griphus at 12:18 PM on January 22, 2014

When I was on Adderall, I got the most consistent results when I took it with food and never drank caffeine.
posted by Jacqueline at 12:18 PM on January 22, 2014 [5 favorites]

Oh, yeah, definitely try to stop drinking anything with caffeine. Stimulants don't tend to play well together.
posted by griphus at 12:20 PM on January 22, 2014 [2 favorites]

what are you eating/drinking when you take it?

Go discuss this with your doctor/pharmacist. Especially your pharmacist. And mention what you're eating/drinking when you take it.
posted by discopolo at 12:20 PM on January 22, 2014

I'm on Concerta. A few months ago I stopped feeling the increased focus and felt more sad and numb. I talked to my doc and she gave me a higher dosage. Even that didn't seem to help much.

Then the sun came out and my focus and mood improved. I went back to the lower dosage.

It seems that other things that affect my mood (sleep, exposure to sunlight, grief) can impact how the stimulant affects me.
posted by bunderful at 12:23 PM on January 22, 2014

I find that my meds worked better when I didn't take the Wellbutrin in the morning along with the Adderall. For me, it had a counter effect of cutting that alertness, making me have to take a higher dose of Adderall to get the desired result of, well, basically, functioning.

When I took the Wellbutrin later (usually at lunch, and not recommended any later than about four in the afternoon, because it can also make you feel a bit anxious and squirrelly close to bedtime), it really helped. Maybe try not taking them together first thing in the morning?
posted by misha at 12:34 PM on January 22, 2014

Is this something that might be an issue of brand-name versus generic?

Generic drugs are allowed to have their dosage levels vary somewhat, if you have been switching between brand-name and generic it's possible the dosages are slightly different.

Also, for some drugs the different formulations generics have can affect absorption. I don't know if adderall is one of the drugs this is an issue for.
posted by yohko at 12:35 PM on January 22, 2014

It's the coffee. Take a week off.
posted by oceanjesse at 12:48 PM on January 22, 2014

Random thought before I get into it: I've heard that orange juice causes Adderall to be metabolized faster than normal. Do you drink OJ with breakfast on your bad-side-effect days? Maybe that's it.

Now, on to the main answer...

Your dosage confuses me a little. I'm not a doctor of course, but 10mg of Adderall IR seems pretty low. Maybe it hits harder because of the Wellbutrin (which is a reuptake inhibitor for the same neurotransmitters that Adderall is an agonist for) but I'm on 150mg of Wellbutrin plus 50mg of Adderall IR and 20mg of Lexapro and the effects are pretty mild (that is to say, I feel "normal" when I'm on my meds, and "bad" if I go off them, but that's about it). I drink coffee, too. Of course, everybody reacts differently so it's hard to make a direct comparison.

Either way though, that 10mg of Adderall IR should be pretty much worn off by noon if you take it first thing when you get up. Usually people who take Adderall IR either take it on an as-needed basis whenever they feel they need an extra boost in focus, or else space it out over 2-3 doses a day (as I do) to keep things on an even keel. Maybe you should talk to your doctor about switching to XR? Or maybe, if you're having unpleasant side-effects from just 10mg of Adderall you should talk to your doc about switching to a different medication entirely. Usually after two months your side effects should have pretty much stabilized.

Whatever's happening, I think it's hard to pin down. Inconsistent effects are tricky to figure out. All I can say is that you should plan on talking to your doctor about this in much the same way you talked about it here – include information about your sleep, food, time of administration, caffeine intake, exercise, etc. as well as the symptoms that you are experiencing. Come in with a problem (inconsistent unpleasant side effects), as much information as you can provide that might shed light on the cause, and a desired solution (therapeutic effects as good as or better than your current regime provides, with less side effects). See what the doctor can give you as far as options, and go from there.
posted by Scientist at 12:58 PM on January 22, 2014 [1 favorite]

If you have grapefruit juice with breakfast, it interferes with a lot of medications.
posted by yohko at 2:11 PM on January 22, 2014

The IR only lasts like four hours. It would be really, really unusual for you to actually be responding to it at all and actually be fine all day on a dose you take only first thing in the morning. But you can break them up, and I find that vital: I take half my morning dose on waking, and half a few hours later. Then half my afternoon dose a bit after lunch, and half a bit before dinner, to give me a full day's worth of some impact.

It's not necessarily best to take it on an empty stomach. It's fastest to take it on an empty stomach. Fast != best. I actually have learned to be religious about my Prilosec because I want to be metabolizing it as slowly as possible. The harder it hits, the faster it fades. The faster it fades, the more likely I am to end up needing a nap, and when I nap I end up awake half the night, so I try to avoid that. (I don't take it with food because it sometimes makes me a little queasy if I do that.)

I very occasionally get a strange paradoxical sleepiness at around that same 2hr mark you mention. Breaking up the dose seems to have stopped that for the most part, or else it got easier over time, I'm still not sure which.

But I have not taken it with Wellbutrin and I do not know how the two might be interacting, either.
posted by Sequence at 3:04 PM on January 22, 2014

Unless there's some reason you're on instant release specifically, consider long-release... works much better for a lot of people, with a much more stable effect. And caffeine, well, you're just not doing yourself any favors whatsoever if you're ADD or ADHD and drinking it at all, let alone at the same time you're taking your medication.

Anecdote-info - be careful with the Wellbutrin. It doesn't seem to play nice with some people, and the two that I know personally that didn't react well to it were both ADHD adults, which the doctor later suggested was a thing that sometimes happens. (One in particular, my ex, went way beyond his usual ADHD impulsive behaviors during those weeks x1000, with everything from exhuberance to despondence, and including a suicidal episode.
posted by stormyteal at 5:07 PM on January 22, 2014

If you have recently refilled the prescription and it coincides with the changes you've been feeling, please check the manufacturer of your generic Wellbutrin. If it is Ranbaxy, ask your pharmacist to fill it with a different company's generic medication, as Ranbaxy Wellbutrin is terrible and unsafe.

I find that with Adderall, the XR works much better, even in the smaller doses. There is a noticeable difference to me between the brand name and the generic, unfortunately.
posted by elizardbits at 5:55 PM on January 22, 2014

Caveats: All bodies are not created equal, YMMV, and of course, I am a very frequent patient but not a doctor.

Answer: From my lifetime of experience with many medications and many medical conditions, having any given medication work 100% exactly the same every single day, even when most other factors are mostly the same, probably isn't going to happen.

Disclaimer: It is, of course, possible that for those of you who only take one or two daily medications, that kind of result is closer to being a realistic expectation than it is for those of us with multiple chronic illnesses, so refer to Caveats, above.
posted by The Underpants Monster at 6:53 PM on January 22, 2014

I've had the opposite experience with generic Adderall IR vs. XR - the immediate release works for me, while the extended release did almost nothing for me.

I too noticed the amount of time it takes to really kick in varying - sometimes almost immediately, sometimes it takes a couple hours. I've found that it takes longer to kick in right around the time I'm on my period.
posted by SisterHavana at 11:01 PM on January 22, 2014

elizardbits is correct about Wellbutrin/bupropion and Ranbaxy, but for the record...Teva was the manufacturer whose formulation of bupropion was pulled off the market.

While the same thing hasn't happened to Adderall's generics in an official sense, there is lots of discussion in ADHD forums about the differences patients experience across generic manufacturer varieties. In the XR world, Sandoz is often considered the ideal choice because Shire, the makers of name-brand Adderall, manufactures theirs. Not sure about the IR world.

At any rate...it's probably worth looking at all of last month's and this month's generic prescription labels to see if there were any changes.
posted by gnomeloaf at 6:59 AM on January 23, 2014 [1 favorite]

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