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ADHD Parents Together
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Adderall rebound

My 5 year old recently started adderall 2.5 mg and took it once in the am and once at around 4 hours later, then we increased it to 5mg each dose, we noticed he seemed extremely angry in the evening starting between 4-6pm on both milligrams, the doctor recommended he get a 2.5 mg dose as soon as he got home from school which we started today and there was no change. Is that normal? Am I not waiting long enough to see positive results? When you look into his eyes during those trying times it's not him in there. I was worried about medication all along because I don't want to loose my son.

Is there hope at the end of this?

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Tracey1782- Thanks for asking the group about this, I am sure someone has experience with this.

I know this might sound weird, but I am not sure it is the medication, or maybe his way of not having any more medication in his system and not knowing how to deal with it.

I remember when our son was very young, my friends and I called that time of day the witching hour. I think sometimes I don't realize the demand our kids are under all day then it's their down time and medication is not in their system and kaboom...

I would first off recommend you work with a child psychiatrist if you are not already ( this is one thing I would change if I had a time machine to go back) adjustments to medication are a life long journey and the quicker things get adjusted the better. I would think they might suggest changing medications (but I am not doctor).

Hope these thoughts help in some way. Take care!

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Thank you for your insight, we definitely are working with the doctor.

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Hi - sorry to hear about this. I know the medication trial phase can be a very trying time. Though please keep in mind that, in my experience, once you find the right one, it can really be a big win for your child and your family. And stimulants leave the system so quickly, that if you ultimately decide they aren’t working, the side effects will usually be gone by the next day if you stop taking it.

How long has your son been taking Adderall? Sometimes the side effects lessen after continued use for a week or two.

4-6p anger does sound like a rebound / crash after the Adderall wears off. I believe this may be more prominent with short acting medications. If the after school dose isn’t taking some of the edge off of that, I’d consult your prescribing physician. They may want you to stick it out a few more days, or not.

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Thank you. He has been in it for a little over 2 weeks and we tried the afterschool dose 1 day and it was the exact same thing just later in the day. He is much more aggressive when he is coming off the meds then he was prior to taking it.

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I’d definitely consult your prescribing physician, as a dosage or prescription change may help. Though it is not an uncommon side effect, it still isn’t something you necessarily have to accept & live with. Hope you are able to help your son!

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Thank you

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The come down from these type of medications cause that type of behavior my daughter that is now 13 was diagnosed at 5 with ADHD and has been prescribed all sorts of different ADHD meds because of the bad side effects each would give her until she came up to me not long ago begging to not have to take these meds anymore. It was heartbreaking for me and I never made her take it again. Everyone reacts differently to every medication her experience with adderall she had hallucinations and extreme anxiety. The small period of time she was on it was the scariest thing I've ever dealt with as being a mother.

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Thank you for your response and I'm sorry to hear about your daughter, that would definitely break my heart. I hope what she is taking now helps.

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We still have not found the right med after 7 yrs. So I really feel you. Is your daughter on meds now? What do you do for school?

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hi Tracey, I know it's tough. My son is grown up now, but when he was around 14 he was on a med called Dextrostat. His after-school hours were dreadful, he was so angry, irritable, belligerent. It was definitely the rebound from the drug but looking back on it, I'm sure his whole mental state factored in to the equation, as he was not happy at school.

He eventually was moved to different drugs and ended up with Adderall which he doesn't seem to have a problem with.

As someone else said, everyone is different with how their body reacts to drugs, and I think the child's age factors in as well. Hang in there, you will find the right balance eventually.

Hugs to you and God bless.

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Thank you!

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We had a similar experience with our son at age 8. Adderall was the first medication we tried and in the first two weeks we saw similar angry/aggressive behaviors after school when the meds were wearing off. His pediatrician switched him to Ritalin after those two weeks, and while there was still some of the same behavior it was definitely minimized, and the have made a HUGE impact on progress his school.

I was recently diagnosed as an adult and started on adderall as well, but also stopped taking it. I found my jaw clenched and I was really more stressed out coming down off of it than was worth the benefit.

Every kid is different, maybe adderall isn’t right for him. Good luck!

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Thank you for your insight, I think they are going to switch to Ritalin due to insurance company, I'm hoping that will work.

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We found with our insurance that the short acting meds (both adderall and Ritalin) were covered under “tier 1” and had a fraction of the co-pay than the slow release medications. It worked out okay for us, thankfully, but we’d be a lot poorer if it hadn’t!

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Definitely there’s a rebound in the evening when Adderall is wearing off. My daughter has been taking extended release Adderall for 6 years and this felt like a reason to try a different drug, because she was so unpleasant in the evening. But it worked better during the day than everything else we tried. We found that the evening unpleasantness went away after a week or two. Subsequently, we have noticed it again every time we up her dose, but it always subsides after a week or two. I would give it a few weeks IF it is helping him during the day. That we (and the teacher) could tell in the first day or two. The other two medications we tried either had worse side effects or didn’t help with focus. With Adderall, she does so great once that one nasty side effect wears off. She voluntarily takes it because it makes her feel so much better and more productive. Good luck.

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Thank you, he was on it for about 2 weeks he is just worse now then he was when he wasn't on medication.

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Worse for that period in the evening? Rebound is definitely worse than no medication. In our experience, that went away. But it may be that this isn't the med for him. We like the XR better than the short acting. And evening rebound was worse when she took an afternoon booster dose. Concerta and vyvanse were not good at all for our daughter--both had side effects we couldn't live with AND they didn't work to help her focus during the day. It took a couple of months to get the right med sorted out--I remember crying in the guidance counselor's office. But XR Adderall has worked for years and we've been very happy with it (once we got through that adjustment period). She's totally herself, and she doesn't feel much different, it just works. She describes it at "I have a little pep talk in my mind to stay on task." And if she forgets to take it on a school day, she will say "oh THAT's why I couldn't pay attention" and such when she gets home. It's so hard in the moment to get it sorted out, but don't give up! 5 would be hard, because he's probably not very able to understand and tell you what's happening. She's almost 13 now, and has been taking it since she was 7/2nd grade. We've had to up her dose every year or two as she grows and each time we notice the evening problem (but now she's old enough to know what to expect and to be more aware of it and choose to do things to mediate it). I would go with whether it's helping him during the day at school or not. If not, it's probably not the med for him. 2 weeks should be long enough to tell a big difference (2 days should, really). If it's helping him during the day, then maybe give it just a little longer to see if the evening side effect wears off. If it persists, I would talk to his doctor about trying something different.

Sorry about this stressful period. It's easy to say "stick with it, you'll find the right thing" when that period is kind of a distant memory for me. You are doing the right things to try to help your boy have more success and feel better about himself. Even though this med process is hard for US, having untreated ADHD is really hard for them as they grow.

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Dear Tracey

One of the most wonderful things about this group is the compassion and knowledge we share with eachother. I have learned so much from this wonderful group. The silver lining of what can be a painful parenting challenge. I am not a doctor but I am fortunate enough to have access to one if the preeminent neurologists in this field. We had exactly the same experience with our son who is 9yrs old and 4 months ago started Adderall. Here is what I learned:

This come down is quite normal and fairly well understood.

This is not the child’s fault or a conscious emotional reaction - it is about brain chemistry

The rebound can sometimes be worse then the problem the parent is trying to help with

It can usually be fixed simply by simply switching to XR - extended release version of the same med - which is a newer medication developed to address this issue. Through some pretty extraordinary science, the molecules release slowly and ramp up, slowly peaking towards midday and then slowly decrease, usually preventing this extreme comedown

For our son, this simple switch worked immediately. Here’s the good news - these drugs need to be taken every day because they leave your system within 24 hrs. They are not like other meds (eg for depression) that can take weeks to have an effect. So a simply switch has an immediate effect

We too struggled with the decision to Medicate. It has been one of the best decisions I have ever made in life. What helped change my mind to start with, was what one dr said - “not helping your child with medication, is almost like not giving a diabetic insulin”. This is about brain chemistry. It’s about deficits in brain hormones and problems with neuroreceptors.

Another piece of good news - thank goodness with live in an era of modern science. You can now have your dr order a genetic test designed specially to look at this issue - Genomind does one, there are other companies but that is the one my Dr preferred because she explained they are slight more cautious about adding slight newer info - for example scientists have now discovered that there are 4 types of dopamine (one of the main identified hormones associated with ADHD and how messages get sent in the brain. They are zeroing in on the fact that ADHD may specially be a deficit in dopamine #4

But they are not sure yet so this company is holding off on adding that element for the moment. In our case we discovered from the genetic results that our son was getting about 80% of the dopamine of a neurotypical person. As she described, apart from message sending issues, if he were doing the thing he most loved in the world, he would get about 80% of the joy.

A Dr has to order the test. Our insurance paid for it. It was a simple saliva swab from the mouth. We learned quite a few other useful things too - like the fact our son hyper-metabolizes stimulants. Best to take a small dose - it goes a long way.

She also added, the test is not a quick and easy fix. You still need guidance and often trial and error is invoked in finding the right mix. But it’s another tool in the Drs tool box

I don’t know if you saw in the news - but last week they had a fairly major breakthrough for ADHD - they identified the specific genes associated with it - a step forward we hope to perhaps one day finding a cure.

Here is a very short talk by Dr R. Berkeley at a CHAD forum lecturing to Physicians about how the meds work and how sometimes smaller doses of combinations can help. We combined Addderal with Guafacine and that helped with the extreme meltdowns that sometimes happened.

You may also enjoy his 3hr lecture to parents, avail on YouTube.

I’m going to end by saying, I am not a physician, I am explaining what my doctor described. Others my differ in result or opinion. It’s worked for us, may not for another child. I share in the spirit that I hope that this helps provide some useful information on this often difficult Journey we are now on. I knew to ask doctors and find many of these pieces of information from other parents sharing their experiences on this site. I have also done a fair amount of reading. Given that ADHD is one of the earliest disorders identified (by a Scottish man in the 1700s) I feel fortunate to live in an era where we are learning so much more.

I wish you and your daughter the very best on your journey.

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Thank you for the information, I appreciate the support of this community. I do know that when he is on the adderall he is more focused it's just the behavior when he is coming off them are so extreme.

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I’m gonna second what Suzette said. An extended release medication seems to have helped our son from the evening meltdowns and many of the side effects we were fearing as well.

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Hi there, if your son is experiencing irritability around the time the medication is wearing off, this is known as the stimulant medication crash, which means that his Dopamine and Norepinephrine neurotransmitters that the medication is helping the brain with, are temporarily depleted before going back up to their normal levels. This is common problem that I see brought up with clients I work with and with many families here. What I recommend is for you to consider having your son try the supplement N-Acetyl Tyrosine. The reason I recommend this supplement is because it works with Dopamine and Norepinephrine just like stimulant medication does, and if it is taken 30min to an hour before the medication is suppose to wear off, it eliminates the stimulant medication crash and irritability because it helps the brain boost those two neurotransmitters. There are gummy/kid versions of both these supplements I am recommending.

Another possibility could be that your son might need a slight Serotonin boost. The reason I mention this is because Dopamine and Serotonin are known as the brains "feel good" neurotransmitters. As I mentioned above, one of the neurotransmitters stimulant medication increases is Dopamine, and if Dopamine keeps getting increased WITHOUT Serotonin, then Serotonin levels start to lower (the same thing happens vice versa). Serotonin deals heavily with mood, sleep, and anxiety just to name a few. What I would recommend if this was the issue, would be to consider trying the supplement L-Theanine. L-Theanine is the calming agent found in green Tea, and the reason it is calming is because it helps the brain with Serotonin. I myself need a Serotonin boost and take L-Tryptophan for it, and also take N-Acetyl Tyrosine as well, along with a whole list of supplements that cover the other areas of difficulty ADHD brings.

From my research on ADHD these last 4+ years, I have frequently seen these neurotransmitters as the cause of lots of the issues that come with ADHD. People with ADHD have low levels of these neurotransmitters, and if anyone were to create a supplement plan, it should aim to help these neurotransmitters....

Dopamine : A neurotransmitter in the brain that affects your levels of concentration, motivation, pleasure senses, and sense of pain.

Norepinephrine : A neurotransmitter and stress hormone that deals with attentiveness, emotions, impulse control, planning ahead, sleep, and interpreting actions of others.

Serotonin : A neurotransmitter that deals with mood regulation, sleep, nervousness, empathy, appetite, digestion, and sexual urges.

Acetylcholine : A neurotransmitter that deals with muscle contraction, pain responses, mood regulation, REM sleep, and coordination.

I have some helpful links to supplements for ADHD, a book I published on Inattentive ADHD, and some other helpful stuff in my bio section on this website, in case you're ever interested. Hope all goes well.

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Thank you, would you mind giving me your website?

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You might request a trial of a methylphenidate. My 6 year old nephew started out on Adderall and he became aggressive and angry. The methylphenidate worked for him both at school with focus and self-regulation and at home he behaved as he normally would off medication.

What works for one person doesn’t always work for another, but it’s relatively easy to switch from one stimulant to another since they work immediately.

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Thank you, I will discuss that with the doctor.

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Hi there, my son has been on 5 different medications that significantly changed his personality. His last was Straterra. He gets a morning dose and a bedtime dose. He gets easily agitated and is angry until the meds wear off. Then he is more like himself.

There are other medications available that you can try if you do not like the effects of the one your son is on now. Ask to try a different medication.

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Thank you for your response, I will talk to them about changing it

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