Is it this ADD med? Or all ADD meds?
July 9, 2018 8:24 AM   Subscribe

I started taking an ADD med that has helped but also has a troubling side effect. I'd like to hear if this is normal for these types of meds or if I need to switch.

So, the issue is that I'm now getting way into details and losing site of big picture things. For example, getting really hung up in filling out a bunch of grids - but not remembering/realizing that I don't actually need to fill out the grids. I'm really troubled and embarrassed by some of the particular mistakes and things I've forgotten. It's like I have a hole in my brain or blinders on. It also makes it hard to do work that requires a lot of thought, which is terrible. I mean, it is great to be able to actually get started and do stuff, and there's all kinds of little chores I've finally polished off after years, but this is not the type of concentration I was looking for. I'm looking for the type of concentration that lets you read a book for several hours at a time (which I had when I was younger, but lost as an adult). Is that possible with these kinds of meds?

The medication is Vyvanse, and I take 20mg a day. I also tried Strattera, but it made me gravely physically ill. I also tried Concerta, which initially worked well, but sometimes didn't work at all.

I'm also still consuming caffeine, but so far haven't noticed a direct correlation between how these meds affect me and how much I consume.
posted by unannihilated to Health & Fitness (13 answers total) 7 users marked this as a favorite
You may do better on a lower dose, though those are probably symptoms you can train yourself out of if you're otherwise happy with what you're taking now. It's not that you're forgetting, you're focusing on the wrong thing. That's a fairly normal problem, imo, even among those who don't have ADHD and don't take meds.
posted by wierdo at 8:32 AM on July 9, 2018

Oh, the alternative is to just deal for a few weeks. Your body will acclimate somewhat and the dose you're on now will do less to your cognition.
posted by wierdo at 8:33 AM on July 9, 2018 [1 favorite]

A few clarifying points: I've been on this dose for a month. Often these things don't come to my attention until someone points them out after the fact, which is part of the reason I'm so troubled by them. I just completely don't see them. I think the recommended starting dose for Vyvanse is actually 30mg, so I'm already on what's considered a low dose.
posted by unannihilated at 8:36 AM on July 9, 2018

I've been on ADHD meds for over a decade now and I think there's a misconception a lot of people who go on them (myself included!) have which is that you get the skills for concentration along with the ability. Being able to read a book for a bunch of hours at a time while having ADHD is something you need to learn (or re-learn) to do, just having the ability to focus on it alone isn't going to "work" as intended. For instance, I got a fidget cube which helps a lot with sitting and reading for extended periods of time. Depending on what is distracting you and how you may still need to account for it.

The thing about focus that you get via stimulants is that it's by default just a sort of 'loose' focus that ends up getting easily devoted to detailed busywork. It's the difference between cleaning your bathroom and scrubbing the grout millimeter-by-millimeter. The meds can help with either but you actually have to know how to do the former and take steps and make a plan, while the latter will come more naturally as there's not a lot of thinking involved. At the end of the day, though, focus is focus, you just have to put a bunch of force of will behind it to make it do what you want (rather than being severely limited or not having it at all without the meds.)

Also try cutting out caffeine entirely for an extended period of time. I know this sounds like a giant pain in the ass if you're a regular caffeine drinker but it helped me immeasurably and after a while I was able to re-introduce small amounts of caffeine without weird side-effects.
posted by griphus at 8:47 AM on July 9, 2018 [15 favorites]

I also get some of this on Adderall, so I think it's the stimulants in general, possibly. I hear you on the Strattera thing--would have been a miracle drug if I could have kept food down consistently. A couple things that I've noticed that help:

1. One of the ADD habits that needs to get broken is doing the thing without planning the thing first. Don't start doing work without an outline of the work you're going to be doing. The big picture doesn't necessarily come by realizing 25% of the way through that you're doing the wrong thing, it comes by identifying the right thing to do to start with whenever you can. There's a big temptation to just dive in, but usually it's not a great approach.

2. If it's an activity that's really vulnerable to rabbit holes, set some kind of alarms or notifications to remind you to come up for air periodically, and if possible get some kind of accountability buddy--even if it's not someone you work with--who you can talk things through with, again to try to get the feel for when you've gone after the rabbit. 20/10 or 20/5 intervals give a good period to get into stuff and then stop and ask: Okay, how is this going? Is this the right place to be focusing my time? What did I achieve in the last 20 minutes? Then you can redirect if you need to.
posted by Sequence at 9:26 AM on July 9, 2018 [7 favorites]

When I was taking Adderall I thought of the concentration power it gave me as a power tool. It let me do a bunch of things I couldn't have done without it. But I still needed to be skillful about pointing it in the right direction and turning it on at the right time.

The sort of thing you're describing is, yeah, what happens when you turn the tool on, set it down, and walk away.
posted by nebulawindphone at 9:37 AM on July 9, 2018 [3 favorites]

The medication is Vyvanse, and I take 20mg a day. I also tried Strattera, but it made me gravely physically ill.

I'm also still consuming caffeine, but so far haven't noticed a direct correlation between how these meds affect me and how much I consume.

Is me! Caffeine affects me in a different way than Vyvanse does. For example only caffeine would help me with morning sleepiness -- Vyvanse barely did anything.

I agree with the others that you probably just need a bit of practice and discipline. It's like learning to control a new superpower. You'll also likely build a bit of a tolerance to the jittier effects after awhile.

re: book reading, that's something I've also struggled with over the years. I've personally found that it's a habit I need to cultivate, drugs or no drugs.
posted by neckro23 at 10:37 AM on July 9, 2018

I'm looking for the type of concentration that lets you read a book for several hours at a time (which I had when I was younger, but lost as an adult).

Same. And I haven't found an ADHD med that makes this possible unless there is absolutely nothing else that I could be doing at the time. Like sitting on a bus without a phone.

I agree with the suggestion to cut out caffeine and then slowly reintroduce. But mostly this is just a thing you have to learn to control. It *does* come with effort and a bit of time, you just have to retrain your new detail-oriented brain.
posted by elsietheeel at 10:43 AM on July 9, 2018 [1 favorite]

What griphus said. ADHD medication is a tool; a computer, likewise, is a tool. Both tools require some knowledge, training, and practice to understand how to use for maximum benefit. I’ve been on Vyvanse 70mg for years. However, I did not start taking ADHD medication until after a couple years worth of ADHD-focused therapy that helped me build executive functioning skills. If your talk therapist doesn’t specialize in adult ADHD, find one who does. Check out books from the library on adult ADHD skill building. Learning how to create structure and schedules for yourself will also maximize the medication benefits.
posted by nightrecordings at 11:50 AM on July 9, 2018

When I was taking Vyvanse I found very quickly that I needed to be doing the thing I wanted to focus on when the medication kicked in in the morning. On days that I was already seated at my desk and working on important work tasks, I had great focus and got a ton of stuff done. On days where my pill kicked in while I was on the shuttle en route to work, dicking around on my phone, then I'd end up spending the majority of my day dicking around.

Basically, the drug allowed me to get deep into hyperfocus, but I lacked the skill to shift my attention to the thing that actually needed my attention. That was several years ago, and since then I've had the opportunity to build my skills -- I'm currently unmedicated, but much more skilled at shifting my attention away from busywork sort of activities. It sounds like you just need more time to learn some new skills in that regard.
posted by palomar at 11:51 AM on July 9, 2018 [2 favorites]

This was me when I started taking Vyvanse. Bumping my dose up to 40mg and cutting back significantly on caffeine (especially within a few hours of taking Vyvanse) made a world of difference.
posted by blerghamot at 3:46 PM on July 9, 2018

I felt that distinction strongly when I went on Adderall after being diagnosed at 42. So, I had many years of coping methods and habits built up to keep me on task already. The medication definitely helped tweak my concentration to make it a lot easier to retain focus and not get constantly distracted. It was not, however, good habits in pill form. I still had to exercise those, just as much as I did without the Adderall.

As for being able to focus on a granular task for many hours at a time, formulation or another may make that easier for you, but for me, that’s always been about needing a constant stream of input. I read a shit-ton because that was historically the best way to deliver a constant stream of input. For accomplishing tasks, I find the Pomodoro technique to be the most effective by far.
posted by Autumnheart at 3:49 PM on July 9, 2018

Another ADHD adult. I’ve been on all the big name Rx stimulants; calibrating and recalibration are more a journey than a destination.

I’ll echo the comments above about timing the task so it’s underway when the dose kicks in. ADHD is really a problem of our attention gushing out madly in all directions. Stimulants should streamline it, like a fire hose, but it’s still on us to consciously aim that hose where water is needed and helpful (rather than harmful or destructive).
posted by armeowda at 5:45 PM on July 9, 2018

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