Is my ADHD medication working?
April 12, 2021 10:13 AM   Subscribe

I recently started taking 5mg Adderall for ADHD but I can't tell if it's working? I would ask the nurse practitioner who prescribed it but I didn't get the sense that she has ADHD so I would not expect her to actually understand what I was talking about in terms of how I feel inside my head.

The way that this seems to feel in my head is that some people are riding a lovely, friendly horse in their head and other people are riding a zebra. If there's a watering hole up ahead or some delicious grass then me and my zebra are going there together, but if it's something my zebra doesn't want then it takes some force on my part to convince the zebra that that's what we should do, and I am not always as successful in that as I would like. I have thought about taking medication for a long time but finally it was hearing that a cousin of mine is also taking medication finally got me off my butt to see one of those online prescribers.

Comparing how I feel now with the medication to how I felt before, it seems to make the symptoms more intense? One of the most noticeable and easy to describe symptoms I'm experiencing is that for the last couple of weeks, I have my personal computer next to me at my work desk. While I'm working on my own work outside of meetings I do OK because my work interests me, but during meetings my brain is greedy for stimulation and I feel uncomfortable & almost in psychic pain without having twitter, metafilter & fb going on the side. This interferes with my work when sometimes I zone out so far that I didn't hear something important that was said.

I thought that the medication would help with this and make it easier to focus, but it seems to make my brain more frantic in its urges and even harder to get under control. I'm cycling between websites during meetings in a way that would look truly problematic to an outside observer.

I think this is even more important in the context of ADHD because what I have read makes it sound like in some ways the medication is a test of whether you have it or not and if the medicine doesn't work then you might not have it. Is it that the medication is new and me and my zebra have to get accustomed to a new normal? Or is it that maybe this medication isn't right for me and we should try something else? What do you think?

Re: what I wrote above the fold about my prescriber not being ADHD, in the time that I've been trying to ask health professionals for help with what's going on in my head, it's my experience that if they don't know from lived experience what I'm talking about, they classify it in their head as the same as someone describing their sprained wrist (just put a splint on it, you're fine), and that mindset never results in something helpful for me. If anyone has recommendations for someone who can actually help me, I am all ears.
posted by bleep to Health & Fitness (22 answers total) 9 users marked this as a favorite
Currently going through this exact same journey. I'm on generic Adderall XR on a 10mg low dose, started last week.

Things people didn't tell me that I'm learning so far:

Drink water with XR variants.
It doesn't really help you focus much better, but it absolutely does keep you in your chair a bit better, and task switches a bit less.
Just because you're on meds, doesn't mean you don't still have to do your "preparation routine" to get work done. Still use the bathroom, get a water, etc, before you sit down to get work done.
How you FEEL is a little different than the results. Are you actually getting more work done? Are you catching up on the lists.
You can't usually feel the drugs kick in, but you should be able to feel something when they kick off. Tired, cranky. Specifically for me, I am always cold, but I don't notice it when my meds are going, and I start shivering again when they wear off.
It doesn't give you motivation to listen to/do something you truly don't want to do. My performance in meetings that I shouldn't be in anyway, has also not improved at all. And I'm glad by that. If all of a sudden I was interested in things that I didn't care about, and focused on the most boring things, next thing I'll be listening to the BBC and watching basketball games.

Regardless, I think I'm going to try a higher dose. They usually start you low, and slowly increase to find what works best (read: until the side effects are bad enough where you complain).
posted by bbqturtle at 10:24 AM on April 12, 2021 [2 favorites]

Response by poster: I can definitely feel it working though! It feels like an electric current in my head. I wouldn't expect it to give me motivation, especially because I am highly motivated to pay attention already, I just can't, and this seems to make it harder to impossible. OK just wanted to clarify those things. Not going to threadsit. Even though I really want to!
posted by bleep at 10:28 AM on April 12, 2021

I think this is even more important in the context of ADHD because what I have read makes it sound like in some ways the medication is a test of whether you have it or not and if the medicine doesn't work then you might not have it. Is it that the medication is new and me and my zebra have to get accustomed to a new normal? Or is it that maybe this medication isn't right for me and we should try something else? What do you think?

I don't agree with this - I think everyone can benefit from taking stimulants, and it's the bad government that only lets us that go through special hoops to get there.

If you want to over-research this topic, I found these two articles INCREDIBLY INTERESTING:
posted by bbqturtle at 10:28 AM on April 12, 2021 [8 favorites]

I thought that the medication would help with this and make it easier to focus, but it seems to make my brain more frantic in its urges and even harder to get under control. I'm cycling between websites during meetings in a way that would look truly problematic to an outside observer.

Oh I so know what you’re talking about. And this is an extremely important point: ADHD medication makes you better able to focus on whatever it is you’re doing. But you still have to choose the thing you’re doing and have a plan for how it’s gonna go.

If I take my meds and don’t have a plan for what I’m gonna do that day, I can wind up playing video games for 12 hours, or, on one memorable occasion my first week taking them, staying up until 4 in the morning scrubbing the kitchen floor tile by tile while also watching an entire TV show season.

But the other thing meds do is make it POSSIBLE for me to follow through on my plans. I used to make lists and then ignore them; now I can actually focus up and do that stuff. But I have to decide to first.
posted by showbiz_liz at 10:29 AM on April 12, 2021 [8 favorites]

Best answer: I tried both Adderall and Ritalin when I was first diagnosed. Adderall definitely made me more focused, but it was in an intense way that didn't feel comfortable, and in that way I do think it actually exacerbated some symptoms of ADHD (like hyperfocus). Ritalin is completely different - I don't necessarily even notice it, but I'm just more easily able to choose where to put my focus.

Like others say, you still need the motivation, and you need to choose where to put your attention, but if you are feeling like it's torture to not do a million things at once, that to me is a red flag that this might not be the right medication for you. There are several different kinds of meds for ADHD, and they all work differently, so I would definitely talk to your prescriber and ask about trying something else.
posted by lunasol at 10:40 AM on April 12, 2021 [8 favorites]

Oh and:

I think this is even more important in the context of ADHD because what I have read makes it sound like in some ways the medication is a test of whether you have it or not and if the medicine doesn't work then you might not have it.

I think this might be the case if you tried a bunch of different types of meds and none of them worked, but I don't think you should reach this conclusion from just one med.

(I say "might" because I think that's a very broad brush and while it may be true in the aggregate, I doubt it's true enough to be used as a diagnostic criteria unless there's something else going on that you can identify would cause the ADHD symptoms, like chronic depression, a thyroid disorder, etc.)
posted by lunasol at 10:45 AM on April 12, 2021 [1 favorite]

I recently started taking ADHD medication, and while it doesn’t always work as well as I’d like, I noticed an improvement right away and I don’t have the troublesome side effects you’re describing.

If you aren’t feeling good on the medication, don’t keep taking it. But just because the one medication doesn’t work for you doesn’t mean you don’t have ADHD — some medications just work better or worse for different people. In my non-medically-trained opinion, it’s worth trying a different medication — maybe an extended-release one like Adderall XR or Vyvanse, or even Strattera which is a non-stimulant ADHD medication.
posted by mekily at 10:46 AM on April 12, 2021 [1 favorite]

Response by poster: it's torture to not do a million things at once
Yes, thank you for these words, these are the words I was looking for
posted by bleep at 10:49 AM on April 12, 2021 [2 favorites]

I think that anyone who conscientiously treats ADHD knows that most people have to try many meds/doses to get to the sweet spot. Take some comfort in knowing you have overcome a HUGE hurdle. You have a diagnosis and have started treatment. YAY! That's a really big deal!

I very acutely remember how precarious my treatment felt during the first while. I was worried (still do sometimes!) about looking like a drug seeker/addict or that my psych would change his mind about the diagnosis. Be confident in your diagnosis and also in your right to excellent health care.

FWIW, for me, the symptoms that stimulants improved were more to do with managing my emotional impulsivity, not motivation & procrastination.
posted by i_mean_come_on_now at 10:52 AM on April 12, 2021 [1 favorite]

I was put on Adderall XR, and I do tend to find adderall tends to make hyperfocus worse and also just sort of make me feel weird and agitated.

Vyvanse was the medication that really worked for me. I could always feel that I was on a stimulant with Adderall, but with Vyvanse, I'm not aware of it, except that I'm actually able to follow through on my organizational systems, I'm able to sit through lectures more easily, I can control where my focus goes.

It's not a magic bullet. I still have to do the work of organizing and planning my time. Also, COVID has made all of this harder. Even with Vyvanse, it's a struggle to stay focused through some of these zoom meetings, especially ones where I'm mostly listening. It's hard not to pull out my phone or pull up mefi. I also have to work harder to make sure I plan my days.

But for me, Vyvanse has made a big difference. I used to have all these organizational systems that I would start or try and all these schedules I would write, and then it all basically went out the window. With Vyvnase, I have a fighting chance to follow through on this stuff.

posted by litera scripta manet at 11:08 AM on April 12, 2021 [1 favorite]

I recently started on 10mg of Adderall XR, upping the dose to 20 after a couple of weeks. I definitely feel a little buzzy on it sometimes, and it hasn't been a substitute for actual motivation, but I feel like I can direct my attention better. As others have mentioned I still have to do my usual morning routine before sitting down to work but I'm getting up to do random stuff a lot less and find myself able to focus for a full workday instead of having a terrible mid afternoon slump.

Overall I'm more present in meetings but still find myself drifting if I'm not careful. I don't find myself reaching for words quite as much, actual conversations are easier to have now, even 1:1 where I would find myself drifting.

The biggest benefit for me has been the ability to achieve extended focus on an individual task when there are no other distractions, I feel like I'm getting some of the benefits of hyperfocus in a way that's on demand instead of just following the dopamine.

I'm curious about Vyvanse if it provides focus without the buzziness and might bring it up at my next appointment, but overall I think that Adderall has helped a lot, even if it hasn't been a magic bullet.
posted by mikesch at 12:33 PM on April 12, 2021 [1 favorite]

I've taken various stimulants and other ADHD meds on and off for years, and have finally settled on Vyvanse. Adderall turned me into a work machine for a few hours, but then would shut off, and that was jarring, and I kind of felt like a robot. The dosage for me on Vyvanse took a while to get right (too much = extra anxiety, too little did nothing notable.)

Meetings are still torture, and I have to close my personal laptop and maybe take some notes or just doodle to keep from being bored to death during the parts that are not about something I am working on. I still have to make myself do things I don't really want to do, but I can do them, and frequently complete them. It's not a cure, but it helps.

mikesch - I don't get buzzy from Vyvanse, but there is a sort of golden hour in the morning when it kicks in.
posted by wens at 1:47 PM on April 12, 2021 [3 favorites]

For me, the "experience" of an ADHD med working—not the physical reaction, which is pretty conventional—is simply that it's easier to get on a task and much easier to complete it. It definitely reduces the urge to have a million things going on at once (the proverbial 'TV on but not to watch it, just to have it on' feeling) and, while it's not magic, I'm objectively more productive.

If it's not working for you, your options are basically:
  • Ritalin/Methylphenidate. Different stimulant, same basic feeling, but some people do better on one or the other.
  • Time-release. There are a ton of these. Vyvanse is a popular and well-tolerated one on the Adderall side (actually not quite Adderall—it's just the part of Adderall that's supposed to have most of the mental effect, available in instant-release form as "dexedrine"), Concerta is a popular and well-tolerated one on the Ritalin side. Time-release drugs help a lot of people because, for obvious reasons, it is not always good to be in charge of implementing your own dosage patterns as a person who has trouble staying on task. If you find one that matches up with your body and metabolism it also helps dodge the crummy run-down feeling of a stimulant wearing off.
  • Non-stimulant. I've tried a few of these but frankly a lot of them seem like they would work much better for hyperactive people than inattentive people. Strattera is the one that's sometimes prescribed for inattentive people, and I've heard of some people having good results with it. (There are also some drugs uncommonly used off-label for ADHD, like Amantadine, but the keyword is uncommon.)

Dosage and medication choice definitely make a difference. 5 mg of Adderall is not very much, especially for inattentive-type ADHD—I'm on 15mg twice a day—and the physical/euphoric "speed" feeling tends to become more muted after a while on the drug (though I am definitely still in a better mood whenever I take a stimulant). What I would do in your position is continue to take it, see if the unpleasant "speedy" need to do even more stimulating stuff wears off, and then see how things feel on a higher dose once you're used to the physical effects of the drug.

The drugs are great, but one way of thinking about them is that they make it possible for you to do the normal be-more-productive interventions well-meaning people are always telling you to try. Once you feel dialed in, start implementing some of them and you'll find you really benefit from that added structure. Like, because of Adderall, I can put my keys away in the same place every time I get home from work instead of losing them every day, but I do still have to do it. Because of Adderall, I can focus on work instead of sitting on AskMe answering a question about Adderall, but—well, that's my cue.
posted by Polycarp at 2:08 PM on April 12, 2021 [1 favorite]

Best answer: I thought that the medication would help with this and make it easier to focus, but it seems to make my brain more frantic in its urges and even harder to get under control. I'm cycling between websites during meetings in a way that would look truly problematic to an outside observer.

This just jumped out as an ENORMOUS red flag for me - but I'm coming from a very particular perspective, which may not apply in your case. But I'll tell my story and let's see. (I'm going to change some of the details to protect this person.)

Earlier this year, a friend was trying out medicating their mild ADHD. They started on one medication in November, then when that didn't work all that well they switched to about 5 MG of Adderal - and then upped the dosage a bit, and then switched to Vyvanse.

After a couple weeks of them being on Vyvanse they seemed a, but there was some weird work stuff going on for them so I chalked it up to that. But over the course of a week they seemed more and more "off" - making all kinds of weird connections between movies and their own life, TV shows and books and their own life, etc. I even tried hanging out with them once and showing them cat videos on Youtube and they were still tying that back to The Realization They Had About How Their Family Communicates or whatever. And after a week of that the manic talk moved into paranoia and then a full on psychotic episode, and their roommate had to call 911 and they ended up in a psych ward for a couple days. (They're TOTALLy fine now - they were fine within a week - but they completely gave up medicating their ADHD and sought other ways to manage it, which have been working better.)

One VERY big difference between my friend and you is - we all realized that my friend was REALLY not being all that well monitored by the doctor who was prescribing them medication. They found a "get your ADHD meds from us" kind of web site, and the doctor working with them was clear across the other end of the state, and trying to diagnose my friend via Zoom and taking their word for it about how they were doing. From what you're describing, it sounds like you have a nurse who is keeping much closer watch on you - which is very good.

I would still discuss this kind of "frantic" feeling with your doctor, to see if that is something that could be a problem. This is something my friend says they felt, but....they didn't have the advantage of having their doctor be able to monitor that, and it caused problems. If you have a closer relationship with your doctor - and it sounds like you do - bring that up, and see if it's worth discussing.

Good luck.
posted by EmpressCallipygos at 2:27 PM on April 12, 2021 [5 favorites]

My son had a really strange reaction to Adderall and it turns out that he lacks the enzyme to process stimulant medication you might considering getting genetic testing to find out how you metabolize the various kinds of ADHD meds before trying another one.
posted by victoriab at 3:15 PM on April 12, 2021 [1 favorite]

Best answer: As someone with ADD, I just wanted to agree with lunasol and EmpressCallipygos that this is raising a few red flags for me. I mean, I agree with everyone else above that medication doesn't help you decide where to focus on, it still comes from you, etc, but the "torture not to do a million things at once" was for me a thing that went DOWN when I was appropriately medicated. For me, the meds just calm shit down in my head; it sounds to me like yours are making your head fill with even more turmoil.

This is not to say that this means you don't have ADHD or something else wouldn't work for you! Different meds do different things and operate in different ways. I found a big difference between Concerta and Ritalin, for instance (the only two I've tried). I would suggest you ask for a different medication or at least be very, very clear to your nurse that this is distressing, describing the feelings in detail so she's not inclined to dismiss it as just "getting used to things."
posted by forza at 3:29 PM on April 12, 2021 [3 favorites]

Response by poster: Yes ^ the feelings are just incredibly hard to describe to someone with no frame of reference.
posted by bleep at 3:38 PM on April 12, 2021 [1 favorite]

Best answer: For me, the meds just calm shit down in my head;

This is a really good and succint way of describing one of the major differences I notice with Vyvanse. I don't feel agitation on Vyvanse. Before Vyvanse, that kind of fidgety bored need to do all the things can't sit through this meeting feeling could be awful and feel unbearable at times. Even if I'm bored, it's easier to tolerate.

Do you have any friends or family who know about your mental health situation who you communicate with regularly? Even if they don't know all the details, just giving a few people a heads up that you're trying a new medication, and they should keep an eye out for if you seem off.

Years ago, I tried SSRIs. Long story short, they induced a manic episode (I'm not bipolar), and my close friend/roommate was the one who spotted it first.
posted by litera scripta manet at 3:59 PM on April 12, 2021 [5 favorites]

I can try to tell you what I feel like on a stimulant med without ADHD. I was prescribed Vyvanse for its secondary use (eating disorder) and as an experimental off-label treatment for antidepressant-resistant depression. I don’t have an ADHD diagnosis (though I can relate to a few of the symptoms, especially the ones that overlap with depression.)

The first day I took 40 mg—a dose they prescribe to young children—I cleaned 1 room for 6 hours, had racing thoughts and euphoria, felt an urgent need to connect with everyone I knew, writing volumes and volumes of insane texts, then I threw up spectacularly. You know those anti-drug after-school special type dramatizations of teens on crank or whatever? That was me. (No one had warned me to take it easy on caffeine, lol. And I’m sensitive to caffeine to begin with.) In a word, I felt nuts. I had never heard of anyone with ADHD feeling so nuts on a child’s dose.

Once I figured out the caffeine and dosing, even now, months into treatment, I STILL get an hour or so of mild euphoria. I still feel the dopamine. I still get wild fixated on the task at hand, and it does not matter what that task is: my actual work, reading 4000 reviews of a conditioner I’m considering purchasing—I’m going to do that for hours at an intense level, and bombs could be going off around me and I wouldn’t notice. I can see how this would be useful for someone who needs to increase their focus, but for me the focus is FRANTIC, DRIVEN, teeth-grinding focus; not the calm, capable, controlled and centered focus those with ADHD might be seeking.

I also still feel it physically. I’m activated. I’m not physically bouncing off walls but my head and FACE and stomach all feel a little zingy. I don’t think most adults would feel cocaine-face if they needed this drug for ADHD.

The med is successful for me for its purposes, but it does NOT calm me in any way. Its effect on my focus is an unfortunate side effect I have to manage, NOT a benefit as it should be for you. I believe this is because I do not have ADHD.
posted by kapers at 4:12 PM on April 12, 2021 [2 favorites]

Also wanted to mention that from everything I’ve heard from my psych, ADHD presents differently in everyone, but especially men vs women. So it would not surprise me if a med was not effective for you, but I don’t think you must automatically rule out ADHD based on that.
posted by kapers at 4:28 PM on April 12, 2021 [1 favorite]

I have ADHD and did NOT have a good experience when I started on just Adderall (immediate release, taken multiple times a day). It made me very jittery quickly and feeling that cycle of kicking in/wearing off multiple times in a day was awful. I had a much better experience when I switched to Adderall XR, and now am doing even better than that having been on Vyvanse for over a year. Those make me feel "normal but able to do stuff". I'd definitely let your NP know and ask if an extended release formula is an option.
posted by augustimagination at 10:44 PM on April 12, 2021 [1 favorite]

Best answer: What you're describing is how I feel when my Adderall XR dosage ( for combo adhd/inattentive+fun) is outstripping the calming effects of my Lexapro (anti-anxiety escitalopram). It results in me being more paranoid/subconsciously antsing for stimulation, while also experiencing decisoon paralysis... the electric shock feeling in the head is from a dosage increase/too high of a jump at the start, in my experience.

When the dosage is right, there is no electric buzz, and it is easy to listen thoughtfully to other people talk (mind isn't racing ahead to fill info gaps/next questions or interrupting). Time goes by more slowly - and I can kust make decisions effortlessly (eg. Throw this our, place purse gere, eat xy for dinner without googling 4000 recipes, etc.)

I would not have guessed that I had an anxiety issue... mine stems from constantly feeling like I am screwing up/forgetting/unprepared (as a result of many years of unmanaged adhd)... you may find that you have a similar situation - an anti-anxiety med might help take the edge off.

For me, the proper ratio of lexapro:adderall XR ranges between 1:2, 1:2.5, and 1:3... (eg, 5mg lexapro:10mg adderall XR, 10mg lexapro:25mg adderall XR, 10mg lexapro:30ng adderall XR
The flux in ratio is related to whether or not I have hormonal birth control. When I am on birth control, a lower dosage at a 1:2 ratio does the job (5mg Lexapro:10mg Adderall)..
Off hormonal birth control, the higher dosage and a 1:2.5 or 1:3 ratio works.

Ymmv, of course, but I found it took some time to figure out the balance. Usually a electric shock in the head for a few days whenever I've done an increase, but it settles out in about a week :) I have experienced a bit of parasthesia (buggy/crawling sensation over my limbs) as well with Adderall XR which is slightly unnerving, but also goes away.

When I keep track of symptoms/my feelings/productivity/ease of decision making, etc., as well as dosage on a daily basis, it help me sort out what is happening/whether an adjustment may be needed... I usually know whether the ratio is working within a week or 2 of each change.
posted by NorthernAutumn at 10:57 AM on April 13, 2021 [1 favorite]

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