ADHD meds not as effective tips on how to make them work better

[Brothercare]

My brother is suffering trying to read as his Vyvance 50mg just stops to perform well to aid him in the concentration. It's been years of this same cycle for him ( constant med changes) and all he wants to do is succeed in school and can't get his reading done. Anyone know what else he can take with the stimulants that can help them work best? Need help!

[Onthemove1971]

We have had great success with Guanfacine for mood and focus with Wellbutrin for symptoms of hyperactivity. We also never realized the anxiety he had and Wellbutrin has helped with that a lot.

I am not sure how old your brother is, but therapy and an educational plan really help a lot.

There are also many studies that strongly encourage exercise/sports help a lot.

Another option is taking a "booster" dose to keep the stimulant steady in his body before the am dose wears off.

Best of luck with helping him find what works.

[Brothercare in reply to Onthemove1971]

Thank you. He was on guafacine that didn't seem to do anything. And he's on wellbutrin currently as well. Any idea of which boosters to try next? In the past he's had dextro to accompany these meds but they seem to just stop being as effective. It's hard for him to make time to exercise when he's so focused on trying to get schoolwork done, which has been a lifelong struggle.

[Onthemove1971 in reply to Brothercare]

It sounds like you guys are working with a Child Psycharist? They really specialized in medication management. As far as the "booster" it is usually the same stimulant but an added additional dose, ours was 1 dose lower..so if he was on 10mg and the next lower dose was 5mg he would take that a little before the dose wore off.

We were told when the type of medication is correct, it's the right type of medication and the timing is right 60% of the symptoms will go away.

If you are not seeing a difference with the Guanfacine, you can ask for an additional dose in the afternoon. Not increase the medication, but add more.

As far as to much school work that can be addressed in a 504 educational plan.

If medication designed to help for ADHD is not making as much of an impact, you could discuss if there are not additional diagnosis, like learning disabilities and Autism ( I am not saying he has these). People with ADHD often have "comorbid" things like eating struggles, learning struggles, etc.

To me the label of what he had was not as important as getting him the tools to deal with the symptoms. The tools that help us were exercise, counseling, medication and an educational plan. Have you considered tutoring to help with school work. Having an outside person go over the material and pratice really helped our son a lot.

Hope you find the tools that help your brother. It sounds like you are an incredible support for your brother.

[Brothercare in reply to Onthemove1971]

My brother is an adult 44 yr old, and yes I have mentioned to him to get a school coach to help organize the work (he doesnt think that does anything). Yes my brother is also on the Spectrum as well, for years we are struggling to get the right dose that "fits" him. Your idea of taking a lower dose in combination with his Vyvance might need to occur. Although we have done that in the past (dextro, Adderal) it wouldn't be as effective after a few days and it caused my brother to want to take extra just to get the college work done. It pains me to see this happen over and over for him because he is really smart and wants to finish his degree.

[GreenGrass24]

Honestly, working with an occupational therapist helped me a lot. My OT taught me a lot of practical strategies like breaking tasks into smaller steps (there’s a website called goblin tools that she told me about), using timers, and setting up a better workspace. It made a huge difference in getting things done, even when meds weren’t enough. It's also covered by my insurance, which is a huuuuge plus. Hopefully this helps! And hope your brother find one that works for him soon

[penn_adhd]

Is he on the name brand only or generic? A lot of folks are seeing decreased effectiveness to not helping at all with the generic. My kid was seesawing with his helping or not until I learned about that from the r/adhd threads about it. Some months he got name brand and some months he got genric and for a while we had some of both bottles as he takes breaks on weekends and school holidays and he'd just grab a bottle so he was on both for a while and it was like "Why is it not working today??"

[Brothercare in reply to penn_adhd]

No he is always on the name brand

[HCStymie]

I'd recommend adding low dose Strattera or Memantine. [Obviously would need to be discussed with actual doctors first]

1.) Technically Strattera is a non stimulant so therapist is more likely to prescribe it with Vyvanse.

2) Vyvanse is d-amphetamine (active thing it converts to) which some researchers believe can be excitotoxic to the NMDA/ glutamatergic pathways, and the primary way it causes tolerance. Strattera, secondary characteristic (being studied by researchers, not just making this up), is an NMDA antagonist (blocker). Protecting the NMDA/glutamate pathways over time can potentially reduce tolerance to amphetamine by allowing the pathways to heal and regain function. Glutamate is our bodies primary modulating neurotransmitter. So, when glutamate is increased, it makes dopamine and norepinephrine and others work better. Amphetamine does more than just boost dopamine and norepinephrine and to a lesser extent serotonin. It is also an AMPA/NMDA agonist (triggers them) which releases glutamate as one of the functions. AMPA causes faster signalling, NMDA causes the effect to stay active. Kind of a reductionist view but if you want to know more, Google is your friend.

3) If the therapist is an "evidence based" doctor, instead you may be able to get memantine prescribed. It's an Alzheimer's drug. In particular, an NMDA antagonist. But, unlike Strattera, allows normal functioning and only protects during over excitement. And protects several other pathways in the same way.

I found out about this while researching how to reduce Adderall (also amphetamine) tolerance or make it work better. And found some people were prescribed memantine to prevent and/or reduce amphetamine tolerance by their therapists. Which lead me to learning about NMDA, etc.

And when I found out Strattera was an NMDA antagonist, I finally understood why it had reduced my own tolerance by over 50 %. 3 times over the course of about 11 years. Took under a year each time to reduce close to 50% tolerance. If I knew what I know now, I never would have stopped taking it with Adderall. Several therapists did not know why it worked, some were even skeptical.

**Point is, adding more meds means adding more tolerance, side effects, and problems. Not everyone is stable on a small dose. For the rest of us, we need better options. I wasted over 1/3 of my life trying to make amphetamine work while accumulating side effects, making life harder and, well, ruining it. But, no single non-amphetamine medication is strong enough to switch to as amphetamine based meds are the strongest for ADHD. So I was stuck. Dependent, needed it to work for a living.

Currently, my neuropsychiatrist allows me to take both Strattera and Memanine while I am trying to reduce tolerance so I can move to a non amphetamine based solution down the road. (I am a much more complicated case than just that, but won't get into all of it here).

Also recommend that they look at the nutrition RDA tables and be sure they are getting enough of each vitamin and minerals each day. Plus macronutrients like protein, the 2 essential fatty acids, etc.

Was going to end there. But will say, fish oil high in Omega 3 EPA and DHA helped my Adderall work better. Forgetting it was like a 25% reduction in dose. (EPA is known for being heart healthy, DHA more for being brain healthy). If you do some research, you can find there are some good over the counter brands. Avoid the ones that are not mostly EPA and DHA. I cheat and am prescribed Lovaza which is prescription fish oil high in EPA and DHA.

Also found that Acetyl-l-carnitine (ALCAR) and N-acetyl-cysteine (NAC) allowed my brain to keep functioning longer as I got more tired. (An extra 2 to 4 hours instead of having to take a nap) And are neuroprotective. But, should take moderate dose B-complex with NAC as it is needed to convert cysteine to glutathione (primary antioxidant found in every cell in the body) instead of homocysteine (too much is unhealthy) when not having enough of right B vitamins available. NAC via glutathione in theory may help attenuate oxidative stress caused by medications. ALCAR among other things, transport long chain fatty acids into mitochondria and helps convert them to energy. I can only guess that more fuel in my brain made the difference.

Obviously, not everyone reacts the same to everything. So, talk to doctors, if they, say it is OK to try, see if it helps.

[Brothercare in reply to HCStymie]

He only started taking the Straterra like two days ago with his Vyvance and Adderal and is struggling to do homework and everyday chores. Can you give more guidance on how long the Straterra can help?