Adderall not working like it use to

[tom81101]

Recently diagnosed from the VA for ADHD which I knew I've had for a long time. I started with adderall a few months ago. Started with 10mg 2x a day, then went to 15mg 2x, then 20mg 2x and now I'm at 30mg 2x a day and I feel like I've built up such a tolerance to it so fast that it isn't working like it use to. Anyone have any suggestions. When I first started with adderall it was amazing and I felt so great, able to finally concentrate and complete tasks, helped a lot with my anxiety. It was like night and day when it was working. I'm at the max dosage that the VA will prescribe which is 60mg. Are there other medications that I can take to help work with the adderall cause I can seriously take 90mgs and it still feels like I only took the 30mgs which honestly feels like nothing. I should also add that I take zoloft and propranolol for my depression/anxiety, trazodone at night to help sleep and I take a multivitamin, fish oil, zinc, magnesium, CoQ10, milk thistle, curcumin, ALA, choline/inositol and saw palmetto

[tom81101]

I should also add that I take zoloft and propranolol for my depression/anxiety, trazodone at night to help sleep and I take a multivitamin, fish oil, zinc, magnesium, CoQ10, milk thistle, curcumin, ALA and choline/inositol

[quietlylost]

I'd talk with your providers at the VA to see about options. There are longer acting stimulants that may be more effective than the Adderall. Are you on the XR or the immediate release right now? Per Dr. Dodson, people typically don't develop tolerance to stimulants. It could be that there are other things going on related to stress, depression, or anxiety that may be making the medicine seem less effective. Also, we sometimes put too much responsibility on the medication to help us. Usually after the initial burst we get when starting on the medication things level out and we're still left with some ADHD symptoms that we have to manage.

That being said, there are not only other medication options but some medications that can be used to help augment what you're on. I'm not sure how willing your providers at the VA are to explore those options, but it's worth a conversation. They may be hesitant, though, if you've been taking higher doses than prescribed (i.e. 90 mg).

I'm on Vvyanse and find that for me it is very effective. I noticed a huge benefit when I first started, but the changes aren't so noticeable now that my body has adjusted and my overall functioning has improved. I don't get a huge sense of clarity when I take the medication, but I do still get the benefits. I can definitely tell when it wears off or if I don't take a dose, but when I'm on it I still struggle with symptoms that I have to manage in other ways.

Good luck, and thank you for your service!

[tom81101 in reply to quietlylost]

Thank you for your support..I wouldn't tell them that I've taken 90mgs just cause they'll automatically assume I'm abusing it, I just wanted to see if I got the same effects like in the beginning and I didnt. Might see an outside doctor to maybe try something else out. Thanks for your help.

[SleepyMomof3]

I had a similar experience using Ritalin. I hit a point where my results were amazing but then it tapered off and even with an increase I never got back to that sweet spot where it was working great. I did lower my Zoloft dosage a little too, but with minimal improvement. I did a lot of reading and found it was pretty common and it was suggested to use it only as needed. So I skip it most weekends or when I have a down day where I don't have to accomplish a lot. I'm not sure if Adderall works the same way if it's okay to skip, but it has helped me with my Ritalin being more effective on days that I take it. It never feels as impressive of a change as it did in the beginning, but I am able to do more and focus longer.

I'd talk to your doctor about trying that before changing meds as a tolerance does seem to be a common issue with these types of drugs.

[rtistics in reply to SleepyMomof3]

I can second this. I was on Concerta XR for about a year. It worked at first but it started to be less and less effective. My Dr switched my to regular, immediate release Ritalin, 20mg 3 times a day. This has been super helpful. I can use it more accurately. I don't always need it in one big block of time. I am a programmer and on a flex schedule. So I may work 6 hrs in the morning and come back to it after dinner for 3+ hours. So I may take 2 early and 1 around dinner time.

As mentioned by SleepyMomof3...

If you try and take some days off or not take all 3 in a day (when applicable); I find that helps to maintain effectiveness.

[tom81101 in reply to SleepyMomof3]

I'm sure it works the same way. I just really loved how great it worked in the beginning, I was hoping to be like that every day. Maybe I need to try something else for a little and then go back. Thanks for your help

[ScanMyBrain]

You can change to dextroamphetamine ER.

Adderal is 1/2 amphetamine 1/2 dextroamphetamine

My forensic psych told me amphetamine does nothing for adhd.

I been on dex for 19years. It doesn’t work like it did in Beginning, but it does work.

I take 60mg. in the morning, when I remember, sometimes I wonder during the day if I took them. Coffee has always been a bigger stimulant to me than my medicine, you probably know what I mean by now if your not feeling the effect of your medication. Change to dextroamphetamine ER can be modified with 10 mg. Instant release.

By the way, the sleepy meds your taking for depression and anxiety, will take away some of the affect of your morning brain med.

If you can cut down on some of your anxiety depression meds, it will benefit your thinking meds. Believe me when I say that their is no medicine that will give you a brain like a doctor.

Coming close to a normal brain, is the best I can do. I maxed out on my meds. The only med that might improve me that I haven’t tried is methamphtamine. Doctor won’t prescribe due to the name. They make it in 10mg only. There are people that take it, good luck finding doctor to prescribe it.

[tom81101 in reply to ScanMyBrain]

Thanks I'll ask my doctor about that

[ScanMyBrain]

I agree with this statement:

I noticed a huge benefit when I first started, but the changes aren't so noticeable now that my body has adjusted and my overall functioning has improved. I don't get a huge sense of clarity when I take the medication, but I do still get the benefits. I can definitely tell when it wears off or if I don't take a dose, but when I'm on it I still struggle with symptoms that I have to manage in other ways.

[StoneJeweler]

That happened to me too, but later I also had to switch to a generic due to the high cost of name brands. I am very thankful for trazodone , it finally gave me a full nights sleep. Most of my life I rarely slept all night, and I haven't had to increase the dose since I started about 18 yrs ago. Anyway I assume you take generic forms of adderall XL, since you are going to the VA. The generics are suppose to be the same-a lie-and even it were true they all use different types of filler that play apart in how they all work. Try asking for a different generic, it may be better or not. I am in the process of getting the name brand again in a few days. I just want to know if it still works the same as it did before I started generics. But then I looked up the name brand, there were so many of them I am not sure if I believe if they are truly the exact same ingredients that the first one was. I think maybe because they can charge a whole lot more if labeled name brand, it is not just another generic. If there is little difference, I will have to try something else.

Along with vitamins and supplements I am trying SAME and Focus and Energy made by Brain MD, doctor Amens brand, I am also taking his Brain and Power boost. This has PhosphatidylSerine, AcetyCarnitine, N-Acetylcysteine. NAC, Gingko, Vinpocetine, and Huperzine A., plus Omega 3 Power. I used to take these but when my depression got worse I forgot [easy for me to due}.

I would add that I hope you are taking high quality supplements, what you are taking is a good mix. And ORGANIC. If your Zoloft and propranolol are working great. If not, maybe trying something different. Good luck and enjoy Thanksgiving.

There is always the option of going outside the VA for a second opinion, if nothing is working.

[Cattattoo1983]

Hey omg im exactly in the same boat! I take 6 of the 5mg dexamphetamine in the morning, upped it to 8 in the morning and by 2 pm i need 4 more! If i want to even just watch tv i take 3 more at 6pm. My script is staged so only every month i can pick up 200 tablets and im getting through them twice the rate im supposed to. Tried stopping taking them for 2 days to save the tablets and went into detox. Literally couldnt move i was crawling.. have you managed to take a day or two off them with any luck? Im an addict i think! Cant function without them whatsoever, do u get withdrawl symptoms too? I know what you mean exactly about the tolerance it crazy! Used to feel so switched on and energetic and focused. Lately my bipolar is worse when im manic i can do anything but when im crashing with depression the tablets do nothing. Definitely let me know how you go? Can your psych increase your dose? As im terrified of asking my psych, hes the coolest though; and hes legally not allowed to prescribe the max dose of 6 tablets a day. I have a very addictive personality and thought it was just me.. thanks so so much for reaching out,

Cat xxx

[SunniM]

Do you take the immediate release or extended? I Agree about generic not being the same as brand and that not all brands are equal. My insurance forces me to get generic unless the dr writes no substitution for brand. and sometimes it still doesn’t allow it. Depending on the manufacturer/brand of the generic it also may not work as well. This was true for me when I picked up the med and it was a different color but same dose. Dr and my Pharmacist insisted it was just as effective but admitted that they buy from manufacturers that they get the lower price. I was so upset at the time about it all I talked to my therapist about it and she said she had several other clients say the same thing. So, at least I could be assured I wasn’t imagining it. Too bad the dr couldn’t have validated me on that. Anyway, If this is the case for you that it’s a different manufacturer and you noticed the change after that, you can ask them to put a note on your profile so that you always get the one that works for you. I’m not sure if it will work at all pharmacies, but my local Walmart market pharmacy has been great. They know me now because I always ask to just check before I pay to make sure. That month was not a good month for me when I had the other brand. Literally felt like I was taking a sugar pill. I still ask every time I get it filled and they are like, “yeah, we know.” 😂 Maybe I’m a little obsessive about it! Haha!

[HCStymie]

How have things turned out in the last 3 years with your meds?

A bit late to the conversation, but might benefit someone else who reads this. Generics are assumed to be bioequivalent to the name brand based on tests that are based on blood concentrations between the generic and the control (usually name brand) within the same people. Has to be within a certain tolerance (I won't get into the details but when someone says it is based on +/-20% active ingredient in the medication compared to the control, they don't actually know what they are talking about). When they pass the test the generic can get the ok from the FDA. That being said, it ASSUMES bioequivalence and therapeutic equivalence, but never actually tests for it. To be affective amphetamine has to make it through the blood brain barrier and do it's think on your neurons. Excipients (inactive ingredients) are likely what make the difference between generics and the name brand. Excipients often have their own drug profiles and effects. Many of them for medications are chosen for their specific properties. Which may assist the medication and in some cases, possibly hinder it. So, I can say for certain that I got switched to a different generic brand a year ago, and I was taking 120 to 140 a day IR and it was not as effective as 50mg of the generic I had been on for a few years. Didn't pique as high and did not last as long. But did cause my stomach to feel off, slight headache, and increased heartrate. Even at the same dose as the other generic.

So, always ask the pharmacist what brand they have before you get it filled. And if they order itm double check before you purchase it, They don't always get the one they think they will from the distributor. If it's not a good brand, go somewhere else or you will have a very bad month. Can't say if you were affected by bad generics, if you are more sensitive to different generics, or just built up a tolerance.

Someone wrote Adderall is 1/2 amphetamine 1/2 dextroamphetamine". That is correct for the most part but not if you aren't familiar with the underlying context. "Amphetamine" in this context is a racemic compound meaning there are levoamphetamine and dextroamphetamine in it and the molecules are mirror images of each other. But they have different effects in the body. The levo tends to affect the peripheral system (heart rate, breathing) while the dextro is what treats your symptoms. So the half that is "amphetamine" is actually itself 1/2 dextro and 1/2 levo. The other 2 salts are dextro salts. So Adderall is essentially about 3/4 dextroamphetamine. Evekeo on the other hand is actually "Amphetamine" a true 50/50 split of levo and dextro. About 15% of people are more responsive to Evekeo than Adderall or Dexedrine. So, if you switch to Dextroamphetamine at the same dose as your adderall, most people would feel a stronger therapeutic effect.

That being said, you will never get back to that clearheaded feeling you had earlier on unless you quit Amphetamine based medications, allow your brain to go back to homeostasis (if there are no permanent effects) and start the process over again. But, there will be permanent effects and you would build up your tolerance much more quickly the second time around. Amphetamine is neurotoxic and changes your brain. At the point you are at, your brain is not able to efficiently manage your neurotransmitters and relies on Adderall to do it. It's dependence.

Someone else mentioned "Dr. Dodson, people typically don't develop tolerance to stimulants." Dr. Dodson is just repeating the same montra psychiatrist are taught but does not actually know what he is talking about. Yes, most people are stable on a low or moderate dose, but everyone to some degree builds a tolerance. It is not just my opinion, extended release amphetamine and methylphenidate based drugs are designed based on that actual fact. When something happens to your body, it tries to compensate for it since it wants to get back to what it thinks is normal. When you take your pills in the morning, you brain starts that compensation process and starts shutting down receptors (literally pulls them back into the neuron). So, by the afternoon you actually need a higher blood concentration of the medication in the afternoon to reach the same therapeutic effect. And why many people, even on low doses feel at least a little slump when it wears off. And why most people will have to adjust their medication at least once to titrate to what works long term. The break from the medication in the evening and overnight allows people with a steady dose to upregulated those receptors again and bring them back. So that the same dose will work the next morning for them and start the process over.

Of course someone like tom81101 and I are in a different boat. Our brains are note efficiently regulating the affected aspects of our brains and rely on the meds to do it. Which is working on a less than stellar base to begin with each day. If we stop taking the meds, we crash hard and do not function well since not just those receptors I mentioned have a much lower number on the neurons, but other mechanisms have been affected. Adderall is much worse than methylphenidate in this way. Methylphenidate blocks the reuptake (literally re-uptake) of the neurotransmitters back into the cells to be used again. So there is more outside the cell and less is needed for a cell to output into the synapse to meet the threshold of receptors stimulated to create a signal.

Quick basic neuroscience if anyone doesn't know yet. Your nerve cells, "Neurons" don't touch each other to communicate. They have a gap in between. When a cell is stimulated enough, it spits out the chemical, neurotransmitter, and when enough of the receptors on the other cell are stimulated, it potentiates a signal from that neuron to the next one. Then, it reabsorbs most of the neurotransmitters and holds it for the next time it is triggered.

Amphetamine gets absorbed into the neuron into the Dopamine and Norepinephrine storage tanks. Then kicks dopamine and norepinephrine out. It also blocks reabsorption back into the cell. Which results in more in the synapse and requiring less stimulation to reach the threshold to send the signal. But if not at the balanced does that can reset for the most part overnight. You get into dependency. Your brain starts to depend on the amphetamines to manage the neurotransmitters. receptors don't re-emerge from the cell and end up with lower density. Too much neurotransmitter in the extracellular space that doesn't get reabsorbed. Downregulation of the process that generates the neurotransmitters can occur leaving you depleted off the meds. Even worse some neurotransmitters end up in the cytoplasm and get oxidized creating oxidative stress. Start messing up the cell lining, mitochondria and other things. Too much extracelular transmitters also get oxidized and cause issues. Much more..