Will Adderall kill me, and can I take it on occasion?
April 26, 2007 9:13 PM   Subscribe

Two questions about ADD medication, especially Adderall: 1) How dangerous is it (for me)? 2) Can it be taken "as needed"?

Since I was young child I've had problems concentrating; I started school early but was held back a year for failing to pay attention, and then switched back and forth between "gifted" and "troubled" programs, etc. I'm still constantly forgetting and losing stuff and often unable to focus on tasks until after the last minute. I've nevertheless managed to cope, more or less, and should soon manage to complete a doctoral degree at a major university (they've been remarkably kind, letting me finish my degree in almost twice the time it usually takes--I'm now 35).

I'm tempted to ask about medication for ADD. This summer I have to finish and defend my dissertation, and while I'm quite close to completion, I'm nevertheless afraid that I might fail to do this, which I'm not sure I could bear.

Getting to my first question, then: the reason I've never really pursued the possibility of using ADD medication is that I think I may on occasions have benign heart palpitations. When I started to notice these, perhaps a decade ago, an EKG reveled a partial right bundle branch blockage which, they say, is supposed to be a pretty insignificant and common condition.

Here's the thing however: I don't even know that I *have* had palpitations. If I do on occasion have these, they never involve more that a few skipped beats, and have never produced faintness or other symptoms (I've never had a holter test). Additionally, these events seem to have become less frequent than in the past (or perhaps I don't notice them so much any more). All the same, the possibility of "sudden cardiac death" as a result of using stimulants has been a powerful deterrent to my asking about using Ritalin, Adderall, Strattera, etc.

Now however (as more and more of my students attest to the effectiveness of Adderall) I'm wondering whether an excessive paranoia about sudden cardiac death or etc. has kept me from trying medication that could make a major difference in my life, and I wonder: how dangerous *is* ADD medication (especially Adderall) for someone in my state? How much worse is it, for example, than caffeine, which I drink all the time? Mightn't I try it, in a controlled setting at first, and discontinue use if anything worrying occurs?

Also, I wonder whether it's possible to get a prescription that allows one to take ADD medication "as needed"? I hate the idea of long-term use of stimulants, which I suspect can't be good for one's cardiac system. I've (almost) managed to cope for a long time without medication, and on days when I'm just running errands or etc., I can manage fine. I'd like to take a medicine that doesn't give me the heart-damage of long term use of stimulants, or flatten my creativity, or my usual spacey digressiveness, except when it's necessary to do so. I think that people with real ADD can *sorta* get by without medication---I'm pretty sure that many can, and that I'm one of those people. Therefore, if it's not inadvisable, I'd like to try taking a low dose of Adderall on occasions when I need to fix my concentration on something and it just won't happen.

So, how likely is stimulant-type ADD medicine to kill me, and is it possible to legally take these medicines only "as needed"? Any advice or comments would be greatly appreciated.
posted by anonymous to Health & Fitness (18 answers total) 3 users marked this as a favorite
You need to ask a doctor about its risk to your heart. Nobody here can answer that question. Adderall is amphetamine. Yes, it can be much more dangerous than caffeine.

You can certainly take it as needed - your doctor would give you a "thirty-day" prescription and you'd take it whenever you needed it (it's not like, say, SSRIs, which require daily use to be effective). Once you've gotten a prescription once, it should be fairly easy to get it refilled whenever you need to, as long as you bring your old prescription with you. Of course, it'll be easiest if you stick with the same doc.

But again: you need to talk to a doctor. It can work really well (it has for me), and can be pretty safe if used as prescribed, but it's Schedule II for a reason.
posted by granted at 9:43 PM on April 26, 2007

"whenever you need to"

As long as there are at least thirty days between refills, I mean.
posted by granted at 9:45 PM on April 26, 2007

First of all, congrats on realizing that you may need help. It's amazing to me how many of my friends and family truly suffer from ADD, yet don't want to get any medical advice or take medication for fear of the stigma that follows it.

I am fully convinced that I would not be attending law school right now had I not talked to my doctor and gotten tested for ADD. My brother was diagnosed when we were in our early teens, and after reading many books my parents had gotten to explain what they needed to do to help him, I was fairly convinced that I, too, had it. I didn't want to take the drugs or admit that I had a problem - I was (and still am) bright, friendly, and outgoing. I was also EXTREMELY bored in classes and had trouble keeping up with my daily life. I had no idea that things could be better.

Now that I am taking Adderall, my life is completely different. I do homework, I pay attention in class. I don't interrupt people, and I don't hyper-focus and miss what's going on in the world nearly as much as I once did.

Now, enough about what it did for me - to answer your question, yes - you can take it as needed. I often do not take the medication on the weekends, when I don't need to particularly concentrate. My doctor approves this - while I doesn't want me doing it for long stretches, he is of the opinion that it helps me keep from building a tolerance to it on a rapid pace - while almost everyone will need to up the dosage occationally, I've gone almost a year and a half on the same dosage, and don't feel like the effects have lessened over that time.

I will say, though, that if you are truly suffering from ADD, chances are you won't want to stop taking it for longer than a day or so. The difference it makes in your life is so drastic, its amazing. While you have no idea right now what will improve once you take the medication, once you take it and stop, it will be like someone took a highlighter pen and marked all the places in your life that are difficult without the drugs. I found it more frustrating after taking the drugs to cope through behavior changes than before taking them.

The biggest part that gives me pause is your potential heart condition; the medication did raise my blood pressure by about 4 points on both sides, so instead of my textbook 120/80, I now clock in about 125/84 on most visits. I also smoke, so that may add to it as well, depending on when I've had my last cigarette. Regardless, you should definitely talk to your doctor about this and get a serious opinion. I think you're on the right track though, and may be making the best decision of your life.

Oh, and your doctor could prescribe a non-stimulant medication if you do find that you have a heart condition that keeps you from taking Adderall. I know of one, Straterra - I took it at the beginning, but I had some nasty side effects, and it's still under patent so it's a bit expensive compared to generic Adderall.

Good luck, and congratulations again.

On Preview - I can tell you that the prescriptions for Adderall can be a pain in the ass; it's a schedule 2 narcotic, which means you have to pick up a prescription every month, in person - there's no refills allowed, and you'll have to sign for the drug each time you pick it up from the pharmacist.
posted by plaidrabbit at 9:45 PM on April 26, 2007 [1 favorite]

Oh. One other thing - you're going to feel a bit...tweeked, as they say, when you take it the first time. This is normal. You'll may be slightly freaked out, as it is a very powerful stimulant. I was, but it literally subsided in a day. If you do get clearance from a doctor, don't let the first day kick you off the horse.

I'll shut up now. :)
posted by plaidrabbit at 9:51 PM on April 26, 2007

I'm not a doctor. I don't play one on T.V. I have ADD; I've taken Adderall in the past to good effect; I am not currently taking Adderall because of concern about heart stuff.

The answer to your second question is that you can absolutely take ADDerall as needed.

I think there are really two parts to your first question:

1. Do you have a heart problem?
2. Is Adderall dangerous for people who have heart problems?

I have no idea what the answer to question 1 is. You really need to discuss that with your doctor.

Adderall is dangerous for people with heart problems. At least, the Federal government has dictated that it has to be packaged with a warning that it increases the risk of sudden death in people with heart conditions. So if you have a heart condition, I wouldn't take it. Sudden death is worse than not finishing your dissertation, and the "sudden" bit suggests that you wouldn't necessarily have problems before you keeled over.

I think you're getting ahead of yourself a little bit: you don't even have an ADD diagnosis yet, right? But if you do get a diagnosis, I would talk to your doctor about Strattera.
posted by craichead at 10:06 PM on April 26, 2007

I will add some anecdotal commentary.

I'm thirty and just started taking Adderall last year, coincident with a return to school after several years out in the working world. I have to say that, on balance, it's been like a revelation; like anonymous I always have have had difficulty with focus and concentration on specific tasks, as well as with executive functions of an organizational sort. The drug helps with that to a tremendous degree; it's like night and day.

I realize, in retrospect, how often in my former academic career I relied on my brain to extricate me from impossible jams created by my lack of organization, rigor and focus. This time around it's all different, and the medication has had a lot to do with the alteration in my approach to things.

Like anonymous, I was and remain very concerned about the potential side effects, particularly the cardiovascular ones. Despite assurances from medical professionals that it's probably not a big deal, I do not take the drug until after cardiovascular exercise; it's an unbreakable rule for me. I never run while I'm on it, in particular. I do take it only as I feel I need it, rather than all the time; I try to err on the side of taking less rather than more, and only in the afternoons when I require uninterrupted focus in order to get things done. I don't take it on weekend days when I'm not working (though those are rare, admittedly).

As the above poster said, even a very low dose will make you feel loopy the first week or two you have a prescription. The wierd feeling is not too serious and will go away after a little time passes, but is something to be aware of. As to habituation, I have been on the same minimal dosage for a year and have not had to up it at all.

What else? As somebody else said, the fact that Adderall is a scheduled substance is a real pain in the ass. No refills, prescriptions must be obtained on paper and hand-carried to the pharmacy every month. I feel like I get a suspicious squinty-eyed once over from the pharmacist whenever I drop off a prescription, too, but maybe I'm overanalyzing. On balance, I think it's worth the hassle.
posted by killdevil at 10:40 PM on April 26, 2007

You can take it "as needed".

But, comma.

Amphetamine is one of those drugs where normal use involves increased tolerance. It's nothing like as addictive as something like heroin, but as your body gets used to it, the body compensates by "pulling the other direction". That means that if you take it routinely and then skip a day, you're going to be groggy as hell. (Caffeine does that; amphetamine does it even more.)

You should also know that it affects sexual function. Withdrawal symptoms include seriously decreased libido.

(Of course, a lot of this is dose-dependent.)
posted by Steven C. Den Beste at 10:48 PM on April 26, 2007

Sorry to derail, but can you adderall takers weigh in on how much you are taking. I can't tell if I am not taking enough or if it just isn't working for me. I take 2 20mg pills a day and I have zero results. I hope the problem is that I just haven't hit the sweet spot with the dose and not that it just won't work for me.

To anon: if you do decide to take it, be prepared to focus on what you eat. I'll go days without eating because I simply forget and I don't feel hungry.
posted by necessitas at 11:15 PM on April 26, 2007

I asked my doctor about this, with regard to my drug (Focalin). He said that he didn't recommend doing the "as needed" thing, because every time you go off and then back on, you increase your risk of having side effects.

Not sure if this transfers to Adderall, however.
posted by palmcorder_yajna at 12:44 AM on April 27, 2007

Since everyone else is giving anecdotal evidence of their experience with adderall, I will chime in with mine.

I started taking it my second year in university - I had the typical ADHD problems, couldn't concentrate, couldn't get my work done, bad grades, etc. My grades didn't get any better, but I did lose 25 pounds and develop insomnia. I started smoking a pack or more a day, when before I occasionally bummed a smoke at a party, maybe once a month or less. I craved cigarettes with an intensity that bordered on absolute mania. I started biting my fingernails. I had an insane amount of restless energy, but I couldn't make myself put that energy towards schoolwork. I mean, I could have typed up a storm if I had anything to type, but I didn't because I still couldn't get any research or reading done. I couldn't even read for pleasure, which is strange for me, because reading has always been my number-one favorite thing to do. I could, however, suddenly organize and alphabetize like a demon, which worked out pretty well for my job. It was the holiday season and I was working at a big-box bookstore. I actually got a raise right before Christmas because of my new-found re-shelving skills and my willingness to come in on short notice to cover anyone's shift. My manager joked that he was going to hand out adderall to everyone who worked at the store. There was a policy in place that prevented overtime for hourly employees, but our manager got around that by having us write down our overtime during the holiday season so that when things calmed down in mid-to-late January, we could add hours each week up to 40 until we got paid for every hour we worked (not legal at all, of course, but it's better than not getting paid at all). I ended up with three week's worth of "paid vacation", which came in handy, because I woke up on New Year's Day with a fever of 103 degrees, and I ended up in the hospital for a week with the flu because I was so dehydrated and exhausted from working so much and not eating and not sleeping.

I stopped taking the adderall. My psychiatrist thought I might just need to "adjust my dose", but I was done with it. I also realized that I simply wasn't ready for college. I hated it, I felt that the work I was doing was pointless and boring and I wasn't learning anything. I took a few years off, waited tables, grew up a little, and when I went back, I enjoyed it and I had no problems getting my work done. And last summer, after seven years, I finally stopped smoking.

So, yeah, it's a dangerous drug. Some people say it helps them, and that's fine, but you need to know what you're getting into.
posted by Wroksie at 12:51 AM on April 27, 2007

Just to add - you are obviously far more mature and thoughtful than I was when I was taking adderall, and your circumstances are different, and I absolutely don't think that you're going to end up in the hospital. I just wanted to illustrate how dangerous it can be. I did cocaine a few times in my misspent youth, and the adderall felt really, really similar. I would say identical, but without the burning nose and the numb face. If you decide to take it on an as-needed basis, just be really, really careful because if you have even the slightest tinge of an addictive personality, you might find yourself needing it more and more often. You might consider keeping a journal of some kind where you write down when and why you take a dose so you can keep track of your usage patterns.
posted by Wroksie at 1:08 AM on April 27, 2007

Response by poster: I have taken Adderall intermittently since I started college. You can absolutely take it as-needed--that is the capacity in which I take it right now, as the side-effects of taking every day were too much for me. I was as focused and productive and organized as everyone in this thread says, but after three months of regular use f I ever didn't take it the come-down was just awful, I was worse off than I was without it. I wouldn't want to get out of bed or do anything. So if you do take it, I would shy away from every day, every morning usage if at all possible. Think of Adderall as a transitory drug, one that will allow you the focus to develop the helpful behaviors you need to manage your life without the Adderall.

As for heart issues, talk to your doctor, but I did experience some weirdness despite being otherwise healthy. If I was eating poorly and not sleeping enough (pulling lots of all-nighters), I'd get sweats and shakes, and would sometimes feel my heart speed up. Pretty scary stuff.
posted by Anonymous at 2:40 AM on April 27, 2007

It's pretty unlikely that you got to the point of being just about ready to defend with a serious ADD problem. Which is not to say that you don't have trouble concentrating, etc, but the successful grad school indicates that you don't have that much trouble. People will object to this, but those people are not taking the notion of ADD very seriously, just like folks who talk about PTSD the day after a car crash are not taking PTSD very seriously. Either there is a fairly discreet, diagnosable condition which you don't meet the criteria for, or you're talking about a lifestyle choice.

See a doctor about your heart concerns.
posted by OmieWise at 5:35 AM on April 27, 2007

Amphetamines have been around for a long time. There are many people who have taken them continuously for a large part of their lives. Adderall may cause long term health issues in some way that hasn't been noticed but the indications so far are that it does not.

As for your cardiac health issues you need to see a doctor. There is nothing more to it than that.

Some people do take amphetamines only on select days. For some it is weekdays only, or workdays only, or when they have a heavy load. It is definitely done, but regular use is far more common.

One medication you may want to ask your doctor about is provigil/modafinil. As far as I know it does not impact the heart.

Another reason why it is worth seeing a doctor is that the symptoms associated by ADD can be caused by other conditions. Most people don't want to hear about this. They want to start taking medication and turn into Mr. Productive. Still, respect that possibility. Sleep apnea, or thyroid can have serious health consequences.
posted by BigSky at 7:06 AM on April 27, 2007

Here is what they told us in pharmacy school about adderall and heart conditions with kids, since many parents are concerned. The relative risk of an adverse cardiac event is actually higher for high school athletes than it is for kids taking adderall. In other words, it is not a high risk. It's a well-known risk because it's so serious, but it is a very remote risk. Very remote.

You will of course talk to your doc but it sounds extremely unlikely to me that you have a heart condition. Palpitations are quite normal, most of us have them. Caffeine will give you palpitations very, very commonly. You are a grad student - I am going to go way out on a limb here and guess you have a lot of caffeine in your life.

Strattera isn't an amphetamine, it's more similar to Paxil or Prozac. The downside of that is that it can't be taken on an as-needed basis, but if you are really uncomfortable with the idea of an amphetamine it may be an option.

Necessitas - recommended adult dose of Adderall is 20 mg/day, so it sounds like you are taking enough. It may be time to talk to your doc and see if s/he wants to adjust your meds if it is not working.
posted by selfmedicating at 7:19 AM on April 27, 2007

When I was at my peak dose of Adderall, I was taking 40mg XR in the morning and allowed to take up to 40 mg quick release in the afternoon.
I disagree with OmieWise. Smart people make it extremely far with ADD. Sometimes you just get to a point where you are fed up with dealing with the consequences of your attention issues, and would rather seak help than constantly make up for it with extra time and extra thought. I don't have enough time to sit around and let my brain wander like it wants to, so I take medications to stop it from dancing across the desk.
posted by nursegracer at 7:39 AM on April 27, 2007 [6 favorites]

I second asking about Provigil. Search AskMe - there've been a bunch of threads about it.

I get more and better work done in one day using provigil than I do in four days not using it.
posted by dmd at 8:23 AM on April 27, 2007

I take Adderall on an as-needed basis, exactly as you describe, and it works fine. I dunno about the heart issue though.
posted by number9dream at 4:26 PM on April 27, 2007

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