ADHD meds - stop or continue?

September 18, 2016 6:21 PM

I've been on and off ADHD meds since I was first diagnosed about 5 years ago. Most recently I tried Adderall XR; previously I've tried Concerta, Vyvanse, and Straterra (one at a time). Straterra is awful - made me drowsy during the day and kept me from sleeping at night. The other drugs all help me focus, but they also make me feel frazzled and exhausted if I take them continuously - so I have to take a drug holiday on the weekend.

When I've been taking meds, the first day or two off it I am good for nearly nothing - stupid, exhausted, completely unfocused. I usually don't leave the house and try to avoid any responsibilities. When I do have responsibilities there's a good chance I will screw them up. Like showing up 30 minutes late to a meeting and not even realizing I am late - my executive function is even worse than normal.

For this reason, because taking meds feels like prioritizing work to the point that the rest of my life suffers, I'm considering going off them completely and trying exercise and meditation instead.

However, I'm wondering if there's something I could do that would help me feel less frazzled when I take the meds continuously. If the frazzled-ness suggests another issue.

I'm also wondering if the adderall/etc causes me to use up my dopamine more quickly, which is why I feel depleted when I take it continuously. And if so, if there's some way I could encourage dopamine production (as opposed to dopamine release).

Has anyone else had this experience? Were you able to resolve it? What did you do?

posted by bunderful to Health & Fitness (19 answers total)

Response by poster: (I know I'll be advised to talk to my doctor. I've mentioned this to both my primary care doc who prescribed the meds and my therapist who suggested them. They both seem a little confused by my experience and don't have much to say about it. I can look for a psychiatrist but in my area it could take several months to get an appointment).
posted by bunderful at 6:33 PM on September 18, 2016

Do you get regular exercise, eat a balanced diet that includes a lot of protein and vegetables, take a B-complex supplement, and drink a ton of water? If not, try working towards that. It can help.

I know that sounds flippant, but it's made a huge difference. A lot of those meds make it hard to keep on a balanced diet, and hard to force yourself to remember to get nutritious food into your body on regular intervals during the day when you're on them.
posted by erst at 6:50 PM on September 18, 2016 [2 favorites]

I'm on Dexedrine (which is essentially the same as Adderall, I think) and the frazzled-ness is what happens to me when my dose is just slightly too high for several days in a row. (And for me the definition of just slightly too high can be just 5mg.) My non-medical gut feeling is that it's because the half-life is about 48 hours even though the noticeable effect tends to be about 4-6, so several days of just-slightly-too-much builds up.

So maybe lower your dosage, or instead of a full drug holiday, try taking half or three-quarters of your dose? But I would also highly recommend exercise and meditation in addition to medication, I feel so much better when I do that.
posted by Xany at 6:57 PM on September 18, 2016 [3 favorites]

Try a lower dose, keep the weekend vacations up, for sure. Consider taking agmatine (anecdotally I find it reduces brain fog, potentiates amphetamine quite a bit, reduces a lot of negative side effects such as cold extremities). Also take b-vitamins. I'm not a doctor, but I've been taking Adderall for a very long time, and this is what has worked for me (the agmatine is a recent addition).
posted by so fucking future at 7:00 PM on September 18, 2016 [4 favorites]

It seems like the ADHD medications that you've tried have all been the "all day" long lasting kinds. Perhaps a short lasting medication would work out better for you, so you can have control over the timing of the medication.

Definitely bring it up with your PCP since it seems like you're having issues with the extended release medications.
posted by QueenHawkeye at 7:04 PM on September 18, 2016

Your results from the stimulants don't seem typical. The drug holiday results do. Might you have some anxiety that worsens from the stimulants?

As for making dopamine - methylfolate and methylcobalamin?
posted by Emmy Noether at 7:05 PM on September 18, 2016

Response by poster: I do have anxiety and depression, both of which are currently unmedicated. They are annoying but I can live with them.

I should have been more clear in my question - it's when I take meds with no holiday for 2 weeks that I experience the frazzled feelings. On my current dose, I feel okay on the meds when I take them during the week and break on the weekend.
posted by bunderful at 7:08 PM on September 18, 2016

In your shoes, my first step would be to see a psychiatrist, preferably one who specializes in adults with ADHD, but if that's not possible, still definitely try to get in to see one. I know family physicians often prescibe psych meds for people, but especially when first line treatments aren't working or aren't working as they normally should, it's definitely worth seeing a doctor who specializes in psych meds, in addition to the therapist that you already see.

More generally, have you tried taking a one day drug holiday versus a two day drug holiday? It's also definitely worth playing around with the dosages a bit.

Also, I just want to mention that you might look in to Wellbutrin if you can't find a good balance with the classic stimulants. IANAD, but I do currently take Vyvanse, and I previously took Wellbutrin (before I was diagnosed with ADHD). It wasn't as helpful as the Vyvanse, but it definitely did make a notable difference in my executive functioning. Since you also mention suffering from depression, it might especially be worth looking into. With that being said, I'm a kind of "high strung" personality, but I don't really suffer from anxiety, and Wellbutrin made me super anxious, which is the number 1 reason I got off of it. That's the kind of thing that really varies from person to person though.

But really, I would make seeing a psychiatrist your top priority in dealing with this.
posted by litera scripta manet at 7:30 PM on September 18, 2016

The two week time frame might also be enough time for sleep deficit to affect you. Do you have any insomnia with the stimulants?

Some people also take guanfacine for ADD. Might be worth a try.
posted by Emmy Noether at 7:38 PM on September 18, 2016

You're taking them in the morning... With breakfast or no food? Before or after eating? What do you typically have for breakfast? My doctor has advised my to take mine (Ritalin) with protein. If I don't, I feel hyper-something. Maybe frazzled is the word. It's horrible if I don't have breakfast. I am focused more on how weird I feel instead of what I'm supposed to be doing.

I don't know if your medications are similar in that way, but blah blah blah doctor.
posted by meemzi at 9:09 PM on September 18, 2016 [1 favorite]

Talking to my doctor, the weekend "holidays" are normal and perfectly OK. If I am not going to work, I don't take the meds.
posted by rudd135 at 4:05 AM on September 19, 2016

Response by poster: Those of you who take holidays - do you also experience being really stupid and tired on them?
posted by bunderful at 4:58 AM on September 19, 2016

I take Adderall XR. I only take it on weekdays when I work, and yes, the days with the drug are very different than the days without it. On the drug, I am focused and I work hard and I'm productive. On the days without the drug, I'm back to my old self. I'm unfocused, foggy, impulsive, unmotivated, and easily frustrated. It's not great, but I can live with being that person on weekends most of the time as long as I get to be the medicated focused productive person during the week while I'm at work. I need that person more for the five days I'm at work than the two days I'm not.
posted by aabbbiee at 11:21 AM on September 19, 2016

I take Adderall. I take the full dose on workdays and a half dose on the weekends. That way I get some of the drug-holiday benefits without spending the entire weekend sleeping and snacking.
posted by 8dot3 at 11:27 AM on September 19, 2016

Nthing that your regular dose may be too high. When I lowered my dose, the workday functionality didn't suffer at all, and the unmedicated-state mental swings smoothed out.
posted by desuetude at 5:08 PM on September 19, 2016

I'm on generic Ritalin, the old-fashioned drug. I take it twice a day every day unless I forget the 2nd dose or remember too late. I've only ever gone off it since my diagnosis when I forgot to get it refilled in time and once when I moved to a different country and it took 6 months to get into the system for controlled meds there. If I forget to take my morning meds first thing I will notice that I'm kind of foggy mid morning and that's my reminder to take my pill. I'm not super productive on Ritalin but I'm super unproductive and unhappy off it so I'm glad I can take it every day. It doesn't seem to take a toll on me to be on it; it takes a toll not to be on it. The dose has been adjusted over the years; I am not a doc and yeah, wondering if your dose is somewhat too high. I see a meds shrink and the existence of such pros, in addition to therapists and GPs, is a wonderful thing. But I understand not everyone has access to them, which sucks. Good luck!
posted by Bella Donna at 5:13 PM on September 19, 2016

What's your dosage currently? I started at a 5 mg immediate release dose (2 x a day) and then went up to 10 mg immediate release dose (2 x a day). Weekend holidays were fine, I wasn't able to do the concentrated work I did during the work week, but I could handle chores, social engagements, etc. My doctor changed me to 18 mg extended release (1 x a day), and like meemzi, I need to eat a protein-rich breakfast otherwise I feel super weird. I still take the weekends off and feel fine (not dopey, not crazy tried, just regular distracted and inattentive). As far as I understand, I'm on the lower end of dosage, but this is what works for me!
posted by spamandkimchi at 6:43 PM on September 19, 2016

Response by poster: spamandkimchi, I'm on Adderall XR 15mg

I picked up a multivitamin which includes all the same B vitamins I saw in the B-complex options. I'll talk to my doc about adjusting my dose - that seems more practical than just quitting. Thanks for all the comments!
posted by bunderful at 7:13 PM on September 19, 2016

I take Adderall instant release, 20 mg 3 times a day. That's how it's prescribed, but I only take it in the morning and early afternoon. I usually don't take it on the weekends/vacation/holidays and don't find myself struggling too much. There's definitely a difference, but it's super manageable. Taking it in the early afternoon gets me through till about 7 pm, and I'm able to go to sleep (usually) fairly easily between 11 and 12 at night.

I tried the XR initially and had many of the same issues you seem to have, switching to the IR was great.
posted by hollygoheavy at 7:36 AM on September 20, 2016