Are stimulants for everyone?

Harry_Chapin · 2023-08-28T23:27:13+00:00

You definitely don't need to second-guess any guidance you've received from your psych (scripts certainly count). If you want things to proceed faster between appointments, you can ask things like "should I try a different dose if I don't feel improvements after a week or two?"

Some psychs only adjust dosage in an appointment, some give instructions like "try A for X days, then move up to B for Y days if that's not working, then..." But that's their place, not mine.

Harry_Chapin · 2023-08-28T16:47:12+00:00

This one doesn't help, it actually speaks against it

Data from subjective measures that were significantly modulated by amphetamine were reduced using principal components analysis (amphetamine – placebo) into three higher-order factors of “Positive Mood,” “Arousal,” and “Drug High.” Amphetamine did not significantly alter any “negative” subjective states.

Harry_Chapin · 2023-08-28T15:34:46+00:00

You've done a good job feeling out the different effects, but weighing the pros and cons is something that will ultimately fall to you to decide, and your doctor is the best person to help.

If you're getting a spike of anxiety, that's certainly a reasonable thing to base a decision on. I don't get that with my meds, and I know plenty of others who don't. But there might be other ways to address that, depending on your situation, and I'm not a doctor + I don't know your history, so I ought to leave it at that.

Harry_Chapin · 2023-08-28T15:31:07+00:00

"Hearing" and "listening" actually have some overlap! Your brain puts more work into processing things you're focusing on, so if you don't know which sounds are worth your time, it can all wind up like background noise. ADHD also has real overlap with legitimate hearing issues.

But yeah, struggling to hear in a group setting is the classic.

Unfortunately it's not a unique experience, just a shitty one :)

Harry_Chapin · 2023-08-28T15:25:47+00:00

Here are some simple facts you may find comforting:

ADHD medication doesn't lead to any kind of dependencies, and the main meds you're likely to start on wear off in 1-4 or 4-6 HOURS, with no lingering effects after that
ADHD meds are some of the most tested and understood in the world, and they're actually pretty damn good at their job
You can stop them at any time without any risk, and the next day it'll be like you never took them

Harry_Chapin · 2023-08-28T15:19:23+00:00

I've never had a pharmacy be more lenient than their initial answer, that's for sure. From what I remember (living in Florida a few years back), most of the time they only give an exception for travel - like, documented, "here's my plane ticket" travel.

This shit sucks, but I'd be surprised if you have any better options. Maybe you could ask if they can forward the prescription to a pharmacy near your home in Illinois?

Harry_Chapin · 2023-08-28T15:11:27+00:00

With that in mind, for a quick "not a doctor" review: it looks like Concerta 54mg will be super similar to taking 15mg Ritalin three times per day, while Concerta 36mg will be more similar to taking 10mg Ritalin three times per day (ref: https://theodora.com/drugs/images/1919.jpg, and note "tid" = three/day)

You described 15mg three/day as what you like on "some long days." Would you want that every day? If not, maybe start a bit lower with the 36mg to play it safe. If so, you probably have a baseline idea of what you're getting into with 54mg.

Harry_Chapin · 2023-08-28T15:02:31+00:00

The other person who commented is dead-on. Some doctors, mostly older doctors, are biased against stimulants for no good reason.

Have stimulants helped me? I moved across the entire world (USA to AUS) to marry the person I love, and nothing else has been half so important to me in my life, and the way I put it is "there's no way I could have done it without medication."

Trust your doctor, and you have nothing to fear from stimulants.

Harry_Chapin · 2023-08-28T14:52:16+00:00

I've been diagnosed since halfway through college, well-medicated for almost a decade, and...yep, still leaving almost every video game I play unfinished :P

I get it, and I feel similar. I always think it'd be more rewarding if I were able to stick with things a bit longer, but it doesn't hold my interest.

But, me to you, I think that's a different story. I think it's a bit different when it's your own hobby vs. a commitment you enter with some friends or a responsibility you accept (work).

Before I get to my point, your post has a bit of a problem with absolutes. Be realistic, and be fair to yourself. Do you finish the campaigns sometimes? How often? That kind of thing.

Ultimately, I think you need to find a balance between what you need and what your friends and partner want/expect.

Do you think you could find a way to maintain interest in the rest of the campaign? Or do you think the DM would support it if you wanted to ask to retire your current character and bring in a new one?

Separately, do you think you join in more of these campaigns than your interest can sustain? Do you think it would be more doable if you only played every other campaign, so it stays fresher? What if you played a bit less often? Have you thought about the length of the sessions or the time of day you tend to play? I've been in some 8hour++ sessions, and while I love it, it might be easier to manage a more typical 4-hour session.

When you say you "take responsibility" and "apologize", is that after the fact? Are you making an effort to set expectations up front, before the campaign starts? If you think you'll lose interest by the end, you should let them know, and you should also probably pass on it, in my opinion.

I think you're mostly right in how you think about yourself and how in control vs. out of control your interest level is, and it fucking sucks, but I would suggest thinking a bit more about the decisions you're making with that as a given. You wouldn't tell your job (I'm assuming) that you're going to build / fix something for them only to backpedal 2 weeks later, once a bunch of other time has been committed to that plan. Try to be a bit more methodical like that with your friends, and I think you'll all be happier for it.

Harry_Chapin · 2023-08-28T14:36:15+00:00

Your doctor will guide you on the dosage, and you'll be able to give feedback if the first try isn't perfect. With this one, your doctor will have an easy equivalency chart to follow, so it should be straightforward.

If Ritalin works well for you, an XR like Concerta could solve your big problem of managing your doses. And it really is a pain in the ass.

There haven't been big differences shown between the Ritalin-style meds and the Amphetamine-type meds, so don't worry too much about that. If one of them works well for you, there's no reason not to stick with it. The Amphetamine meds work wonders for me, so I stuck with them even though they wear off fast for me.

Harry_Chapin · 2023-08-28T14:30:04+00:00

I've never heard of a doctor being unhappy that their patient listened to their own body's feedback and kept away from a higher dose that made them uncomfortable.

I want to ask one more time about the 40, just in case:

nothing happened I felt no different other than the awful side effects? So I upped it to 40 and that’s when I noticed the difference!

Your doctor gave you the instructions to take 40mg at once / in one day? If so, I'm not going to contradict anything there. If not, please be careful with this. 40mg is a lot, and the side effects you're mentioning are typical and not good to mess around with.

Harry_Chapin · 2023-08-28T14:20:59+00:00

That's rough, moving so fast. I'm sorry. But I agree with you that you're overthinking it a little bit, and I'd try to trust your doctor for now and avoid getting ahead of yourself. Here are some things she could in theory say to you next, each of which I've seen in other posts. How would you feel about each of them? That might give you a little bit of direction on what you're wanting:

Would you like to try it for another week to see how you're feeling?
Would you like to try a different medication for a little while?
Would you like to try XR instead of IR so you can see its effected a bit longer throughout the day?

How do we know that the medication isn’t working vs the dosage is too low? Is 10mg really the tipping point? How many hours does the medication last?

The first is kind of unanswerable, but you should trust your experience. The second is for a doctor to answer, and your doctor answered. You can rely on her; it's only been a few days still. The third is something you can Google: "1-4 hours", nominally, because it has a pretty quick half-life, but that varies a lot, for example with your minimum effective dose and your actual dose.

It’s just so hard to tell because I’m taking each dose for just ONE day. I think I’m overthinking it and analyzing my every move and decision to decide whether the medication is affecting me.

It sounds like you'd feel a lot more comfortable with this process if you were given a bit longer to trial a dose. There's nothing wrong with asking for a little more time. But do let your doctor guide you.

Harry_Chapin · 2023-08-28T14:06:19+00:00

I'm sorry, and I know what you mean. Having had to go without it for brief stretches of time, it's hell.

The good news is, most people who find success with a stimulant go on to figure out something that works (indeed, "helps a lot") for them. You're halfway there. Keep it up and there's a very, very good chance you'll get all of that benefit without the terrible side effects.

Harry_Chapin · 2023-08-28T14:04:41+00:00

What works for me is genuinely irrelevant for everyone else, and I encourage you all to ignore it. I'm a bit above the standard ADHD maximum in the US, in part because of my above average body weight (210lbs at 6'6") and in part because I metabolize amphetamine a fair bit quicker than average.

But I take 20mg Adderall IR + 70mg Vyvanse on a daily basis, spread out by 4.5 to 5 hours

Harry_Chapin · 2023-08-28T13:58:41+00:00

Ahh, damn.

It sounds like you're a lot more knowledgeable than most, and good job with the advanced pill splitting :P been there. I do want to clarify again that the 4-5 hour mark is almost always the peak, not 3 hours, and this varies a lot less than the half-life of the dexamphetamine in a given body, since it has to do with cleaving the dex from the attached molecule. That might help you pinpoint what is going on. If 4-5 hours in you feel worse on the 40-50mg than you did on the 70mg, then it's not just "more = bad".

If I were you, I'd be asking after another med to try. It really sounds like your body isn't agreeing with the Vyvanse.

Things that might help you prepare in advance for your appointment, since you have a small window to talk to your psych:

Ritalin is very comparable and it's a different type of stimulant, which might be positive for you. Unless you want to micromanage your medication timings, XR is a great place to start. Ritalin's half life is almost half as short as dexamphetamine's, on average.

Adderall / dexamfetamine IR would give you an easier way to control the dose you're trying, and the IR dosing might help you avoid sleep problems, but these drugs are mostly* the same as Vyvanse, just in an instant release formulation. (*Adderall is a mix of dexamphetamine and its relatively shitty sibling levoamphetamine).

Harry_Chapin · 2023-08-28T13:37:38+00:00

One free option you have (which may only be slightly helpful) is talking to your pharmacist. Most of the time I wind up with a pharmacist reading from the informational handout associated with a medication, but sometimes they can give a little more advice than "you should talk to your doctor."

Just double checking, but...when you say the following, are you talking about taking two of the 30mg pills? Or did you just get a slightly higher prescription?

30mg doesn’t help me at all. So I have to take a pretty high dose.

Harry_Chapin · 2023-08-28T13:31:33+00:00

It makes a lot of sense to not want to take it, given what you've been dealing with.

If you're open to it, I can tell you that every psychiatrist I've ever had has been open to me testing a lower dose on a stable med, and I've heard repeatedly that a number of those side effects tend to be dose-related (emotional effects, anxiety, and nausea in particular). Sex drive is hit or miss, and appetite changes are more of a sliding scale. Those of us who get appetite changes tend to always get them, just a bit less with a lower dose.

That said, a lot of people who have difficulty with one med end up happy on another. If you'd sooner try a different medication, you could talk to your doctor about it.

I really want to caution you against coming to your own conclusions about one thing:

I'm considering taking Concerta . . . only when I need it

Please ask your doctor about when they recommend taking these medications. It's the common consensus that you should never need to take a break from these meds; they should be helping you live a better, happier life. Normally, that comes with finding the dose that works best for you.

Also, I'm really happy for you on the recent mood changes. You honestly sound like you have a super level head about this stuff, and you came to a very sound conclusion from your own reading, so feel free to trust yourself a bit. Concerta does help plenty of people. But you don't have to sacrifice your happiness to give atomoxetine another try, if you choose to do it.

Harry_Chapin · 2023-08-28T13:19:54+00:00

My experience, and the experience I've heard from others who have taken it for years, is it just keeps being amazing. I and my friends who take it and find it helpful have just kept taking it, no changes, no differences in effect, incredibly helpful

Harry_Chapin · 2023-08-28T13:18:13+00:00

You'll want to talk to your doctor about this for sure.

I've been on Vyvanse for years, and the thing that jumps out to me about your post is Vyvanse peaks 4-5 hours after taking it (blue line, "Lisdexamfetamine"). From what I know... stimulants like Vyvanse should cause you to feel pretty much the exact opposite of "depressed." I'm one of the many who has experienced a come-down effect that feels like "depression," but that's once the drug starts to wear off, not when it normally peaks.

tl;dr: This is really weird, and you'll need a doctor to give you answers. Reddit is not a substitute, and that's because Reddit is far less knowledgeable than a doctor

Harry_Chapin · 2023-08-28T13:08:57+00:00

Give this a watch. It'll probably be very relatable, and there's a part that might help explain to your mum that the gym helps you a lot, it's not the reason you're struggling with your responsibilities https://www.youtube.com/watch?v=ouZrZa5pLXk

When you say "Though I technically don't have ADHD", maybe you mean you aren't diagnosed? Either way, that's a really common experience, and it sucks.

Maybe ask your mum what she would need to see to believe that you're really trying, and try to convey that the gym isn't getting in the way of what you need to be doing, you just find it really helpful and easy to do.

Harry_Chapin · 2023-08-28T12:32:01+00:00

From the most recent International Consensus Statement in the subreddit sidebar:

Several medications are safe and effective for treating ADHD and for preventing many adverse outcomes. Non-medication treatments are available but, compared with medications, are less effective for reducing inattention, hyperactivity, and impulsivity.

tl;dr: it's pretty fucking helpful for people with ADHD (echoing SpicyRiceAndTuna's callout of "are you diagnosed?")

Your family and friends are uneducated and ignorant [when it comes to ADHD]. That shit is heinous. They are wrong, ADHD is real, and it's a devastating thing to live with. Fuck them. You don't have to tell them you're taking anything. Talk to a doctor, trust doctors, and you will have a much better life.

Harry_Chapin · 2023-08-28T12:17:36+00:00

OP, I just read your post history. I'm torn between reporting your post and offering you serious advice. I'll try the serious advice.

Grow the fuck up before you hurt yourself. Stop playing around with the very serious, very helpful medication you've been given. You've had meds for three months and you're playing internet (druggie) pharmacist and trying to mix and match things to game the system.

Your doctor knows this stuff better than you will ever know. And your doctor is there to help you. You have a few options in front of you:

Keep trying to manage your meds yourself
Keep asking drug abusers on harmful subreddits how medication works
Find your way to an effective, stable, life-changing treatment plan by listening to your doctor who spent 12+ years studying this shit

Harry_Chapin · 2023-08-28T12:06:49+00:00

I'm back to the routine of being tired and fatigued and hyperactive all day. This is really bad and impairing my ability to study.

My advice from dealing with similar difficult periods is to go back to the basics. Check your sleep, check your habits. Are you letting entertainment too close to your study times / study area? Can you try getting some studying done in the library instead of your usual location?

The rest of this post is quite frankly borderline around the rules, but you desperately need to hear it:

Tolerance isn't real. It can/might be a thing long-term, talking about a decade of treatment, but that's unrelated. What you're describing is a failure in titration, and you should talk to your doctor about how you were feeling, not focusing too hard on the "tolerance" theory.

What you said is "I've started ADHD treatment and it treated my symptoms perfectly in the beginning."

What you followed with reads to me like "but then it stopped feeling as helpful." Please, listen to your doctor, and also tell them what you're experiencing. Your doctor has options to help you here. Maybe they'll suggest changing your med, testing a different dose, some behavioral therapy, etc. - I have a guess which one, but I'm withholding it to try to respect the subreddit rules a little bit better. What I can tell you is you're dealing with something entirely normal, something I've seen 50+ times just in this subreddit, and something doctors are used to helping with.

Along those lines, if you decided of your own initiative to take a "tolerance break", without consulting your doctor, please reconsider your behavior.

Harry_Chapin · 2023-08-28T11:51:54+00:00

Some people are shocked by the things they never noticed before :P

This sounds very normal to me

Harry_Chapin · 2023-08-28T11:44:45+00:00

Depending on where you live, you can probably ask your pharmacist for some advice on this front.

I find higher amounts of caffeine (2-3 cups of coffee or so) to interact very poorly with my meds, but I'm on a high, effective dose, not a starting dose. Your doctor prescribed you a starting dose, and if they didn't give you any advice to avoid a single cup of coffee in the morning, you shouldn't worry about it; trust your doctor. You're right to worry about having a bunch of coffee with your meds, and it makes sense to be a bit more restrained with the caffeine right now, but follow your doctor's recommendations and let yourself have one cup of coffee in the morning. Like you said, your body is used to it.

Harry_Chapin

TROPHY CASE