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

[HCStymie in reply to GreenGrass24]

I would just like to re-emphasize how important the non-medication based therapies are and hope it sinks in for people that it hasn't yet. Too many therapists just medicate and send people on their way. OT and other non medication therapies are half the solution. When people are only medicated, they only have half the solution.

I have 4 college degrees and most grades were As. While managing comorbid ADHD/SCT and narcolepsy. But wasn't diagnosed till the last semester of my last degree. While I was a full-time IT consultant. So, it was all non-medication strategies and tools up till then. It was a huge effort every single day. But with the right tools to manage it, it was a success.

[GreenGrass24 in reply to HCStymie]

I couldn’t agree more. Non-medication strategies are so powerful, especially when they’re tailored to the individual. Occupational therapy was a game-changer for me — learning practical tools for managing routines, improving focus, and handling overwhelm made such a big difference.

[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 in reply to penn_adhd]

You can have the therapist put instructions on the prescription to only fill with brands that work for your kid. For example, I take Adderall IR and my prescription always says "Teva or Sandoz generics only" when sent to the pharmacy.

Teva generic is the exact same as the name brand Adderall.

I am not as familiar with what other ADHD meds generic brands are best, and which drugs it does and does not make a difference for. I do know that amphetamine based meds (Adderall IR/XR, vyvanse, Dexedrine, zenzedi, evekeo, probably desoxyn too, etc. ) tend to be more sensitive to the excipients (inactive ingredients) than probably most other psychoactive medications. For those, research what people think are the more effective generics.

Adderall IR, from experience and what I have read from others (which can vary a lot person to person). In general Teva and Sandoz work for most people. Mallinckrodt has mixed reviews and often considered mediocre (what I experienced with it too). Before the summer of 2022, Lannett was a well liked generic. They had to change their formula which wan't good after that. But, their old formula is actually the Elite brand now (who was the original manufacturer and Lannett was just the marketing side prior.)

I was able to confirm recently that a generic brand Wilshire is an "authorized generic" of something but forget for sure which one LOL. I think it was Vyvanse but not positive. Meaning they are licensed to make the brand name formulary and sell it as a generic. Maybe someone can chime in and say if Wilshire is one of the good generics for Vyvanse or if I am thinking of something else?

[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?

[HCStymie in reply to Brothercare]

Strattera itself takes a few weeks to build up in the system before it may add full benefit that way.

To protect the NMDA/glutamate pathways so they can heal and regain function takes months. I don't remember how long it took to start noticing benefits or how long before I had to reduce my Adderall dose. I just know that in under a year, all 3 times, my therapeutic dose was cut in half. I never stayed on Strattera to find out what the full benefit for me could have been. I was on 60mg Adderall IR but my therapeutic dose was a bit over 80mg. Less than a year later I was only taking 40. The 3rd time I stayed on strattera for longer and at 15 months was about to reduce my 40mg but just stopped Strattera. Wish I knew what was going on back then so I would have stuck with it. Don't recall for sure my Strattera dose the first 2 times, but the last time it was definitely 60mg. But pretty sure a lower dose likely would have worked too.

Make sure they are also getting enough quality sleep. That is the time the brain does the most maintenance and needed to have energy the next day. Make sure they are eating enough protein as protein is where we get the amino acid that makes dopamine, norepinephrine, serotonin, glutamate, etc. Plus balanced nutrition in general is needed to get all the components for all the physical structure of various cells and everything we need for proper function. We are just electrochemical factories after all.

I'd recommend working with a nutritionist to find foods your brother likes that can help promote your goals. For example, just one egg can provide nearly 1/5th the RDA in choline. As well as being a "complete" protein source. i.e. having all the essential amino acids in it. Plus I think it has some B vitamins and other stuff.

A quick internet search and grabbing the first link shows how easy it is to find nutritional info that can be beneficial. health.harvard.edu/healthbe...

It is not well established if supplementing may help rebuild/repair in this situation if not deficient in something. But mentioning just a few things the body needs for repair and new cell generation include choline which is used in some parts of cell structure, Also used to make acetylcholine, a neurotransmitter involved in things like memory and long term potentiation. DHA Omega 3 fatty acid is the most abundant fatty acid in the brain. Various phospholipids are used for different structures in the brain (usually paired with DHA side chains, EPA and other Omega 3s have a role in the brain too.) The Omega 3 alpha-linolenic acid is the only Omega 3 that is considered an essential Omega 3 int the U.S. and has an RDA for it. Our bodies can make EPA and DHA from it, but our bodies are poor at conversion so EPA and DHA are conditionally essential when needed which may be true for brain repair/maintenance. But, Europe has decided it is important enough to have an RDA for EPA + DHA (250mg ). The western diet usually has far to much Omega 6 in it so usually don't need to worry about supplementing that. Especially when it tends to be proinflammatory and competes with Omega 3 for resources for metabolism and absorption.

Fish oil high in EPA and especially DHA is something I definitely recommend. But, can find food sources listed on the internet. Like I mentioned before, it actually makes my Adderall work better on top of being neuroprotective and other things. If I forgot to take it, it was like a 25% reduction in my Adderall dose. Can't say they would respond the same way. but this is one supplement doctors actually do endorse often.

Anti-oxidants are important as ADHD medications can increase oxidants and be a source of oxidative stress on cells and pro-inflammatory among other things. Phytonutrients do a bunch in the body but are not considered essential since there isn't just 1 that has a specific function that another can't do. But, getting various phytonutrients will aid in proper function. Phytonutrient is a fancy word for "other stuff" besides vitamins, minerals, fatty acids, and the usual list of nutrients. Each type of fruit and vegetable, even their sub types, often have a different list of phytonutrients in it. So eat a variety of vegetables and fruits. And phytonutrients are not limited to plants.

Animal based products can have their own phytonutrient profile. Milk has things like phenols, carotenoids, terpenoids, and antioxidants. More so if it comes from cows that graze and don't just get fed animal feed. Milk from cows is one of the best foods you can eat, despite all the propaganda plant based competitors have put out there. Not that plant based milk can't be healthy and have a lot of benefit. But the vast majority are not a good substitute and it takes a lot of research to find one that actually is.

[Brothercare]

Yeah it's just a nightmare dealing with this. He's an adult trying to complete goals and is very impatient when these medications just stop working. He's been incorporating the fish oil and NAC but i'm just wondering how to make these meds much more effective for him. It's been years of switching constantly and have no idea what else to do.

[HCStymie in reply to Brothercare]

First thing. They are an adult. You are not their parent. And at their age, they should be responsible for themselves. If they are going to be stubborn, that is on them. You can lead a camel to water, but you can't make them drink.

Therapist should be helping them cope and manage themselves better. Unless they are not seeing a therapist. Or a sub par one.

The first thing I should have done was ask what brand are the meds he takes and did the brand get switched. Some brands are total crap. For example I was on 40 mg Corepharma brand for a long time and got switched to Aurobindo Adderall IR. Even up to 140mg of Aurobindo was not therapeutic. Amphetamines are particularly sensitive to the inactive ingredients (excipients). Cheap excipients result in amphetamine not crossing the blood brain barrier. And why it is not therapeutic. That is a whole other conversation.

If you are saying his meds all of a sudden stopped working, and not that he kept building tolerance, that may be the issue. Can identify the generic brands from the link below. From there, can find out if they are generally a good or bad brand. Hint, most are bad.

drugs.com/imprints.php

I know Adderall IR. Most people respond to Teva or Sandoz. Seems like Mallinckrodt is mediocre. Lannett was liked by most till they changed their formulary the summer of 2022. Their previous good formulary should be the Elite brand currently.

Vyvanse, I don't know which are good and bad. I think Wilshire might be an authorized generic, meaning licensed to produce the brand name formula and market it as their generic. But I might be mixing that up with Zenzedi. I did confirm it with one drug, but forgot which one. Will have to search online to find out what are good and bad brands for generic Vyvanse.

I always tell my doctor to put "Teva or Sandoz generic only" on my prescription for Adderall IR. If they can't get it, I go somewhere else.

With NAC, he needs B-vitamins or it may impair the function or cause him to build up homocysteine. ALCAR is often paired with NAC. Since I tried them together, I can't say which or both together gave me the benefit. Either way, ALCAR is also neuroprotective. And also sustains energy production in the brain.

Many people also benefit from Alpha GPC, or CDP choline for those who find alpha GPC too strong (but not both at the same time). Huperzine A can also have potential for mild boost to stimulation. But need to be careful when taking with Alpha GPC or CDP Choline. If you end up with too much acetylcholine I think it can make you sleepy.

Have to look on the back label of the fish oil. If it is not high in EPA and DHA, especially needs to have a decent amount of DHA, otherwise it needs to be changed. Here is a link to one that balances content and affordability. This is the Walmart store brand. Note, they have variations that look the same, but different levels of EPA and DHA, some don't tell you specifically how much. Those can be avoided. If getting theirs from online, stock up in the cold season. Freezing it doesn't harm it. Cause transport and sitting outside in the warmer months, or warmer areas in general, can cause it to oxidize and go bad or rancid. The one below has 1290 mg EPA and 620 DHA per 2 softgels. For comparison, my prescription Lovaza has 930 EPA and 750 DHA for 2 soft gels. I'm prescribed 4 a day.

walmart.com/ip/Spring-Valle...

Caffeine may be a temporary stop gap while waiting for Strattera to lower tolerance. But that depends on how they respond to it. If not already using it, can get the pill form and split it to manage using the least amount that is beneficial. I started using it in 2023 out of desperation. Now, it is part of my daily routine. And my body had adjusted to it. Just not good to pair it directly with sugar when you take it. For some reason that promotes caffeine addiction much more than caffeine alone. When I was a teen, I got addicted to caffeine from soda and I was only drinking maybe 2 cans a day. (70mg total). Now I start with 200 and may add more later in the day without issues.