Abnormally Long Adderall Rebound?

[JamieJJL]

Has anyone else whose taken Adderall XR ever experienced seriously long rebound symptoms when it wears off? I started taking it again within the last couple months along with guanfacine on my psych's recommendation, but since then I saw a noticeable increase in irritability. I mentioned it to my doctor and he said it likely wasn't the guanfacine since that's not associated with irritability side effects, and that in the past I hadn't been overly irritable on Adderall, so he wasn't sure it was medication related. However, I've been paying more attention to when exactly my meds feel like they're wearing off, and I've noticed that a) they wear off way faster than they should (I'm talking taking a 30mg XR pill at 9:30am and potentially being fully worn off by 4pm), and that around then was when I noticed the most irritability. It was especially noticeable when I'd play fighting games (I know, those already make folks angry, but while they used to frustrate me at times before, I now find I go from having a great time to seeing red and slamming my desk so hard my hand hurts for hours in a matter of a minute which definitely didn't happen before), but I'd also get set off by really little things and have reactions that were far more explosive than the scale of the instigating issue deserved. Around the same time of day, I'd also start feeling very foggy and fatigued, and find myself totally unable to focus (which is really not a great feeling to have at 4pm as a grad student). It would get better for a little while when I took my 5mg booster, but after another hour and a half to two hours, it's back to unfocused, foggy, and full of rage.

I was reading up on some of these effects online since I couldn't get in to see my psych, but it sounded a lot like how folks were describing medication rebound - the rapid spike in symptoms that some people can see as their stimulants wear off. The problem is that everything I read talks about rebound lasting about an hour, while once these symptoms set in for me after my meds wear off, they remain pretty much constant for the rest of the day. The only way I can get around it is by going against my doctor's instructions and taking multiple of the 5mg boosters to try and stave it off as long as possible, but that's not really smart or sustainable. I'm wondering if anyone else has seen similar issues? I'm not sure whether it means I need a larger booster dose, to swap from XR to multiple IR doses a day, or change meds altogether. I'm just hoping it's not a med change because I have run the absolute gamut of ADHD medications over the course of like 20 years and Adderall is really the only one I've found to consistently work without (until now) significant side effects.

[Mamamichl]

I’m curious if you’re on the right booster or even med. My partner takes vyvanse and his booster is dextroamphetamine. He takes booster at lunch time and the way the booster, it wears off slower over time than the vyvanse. On his last adhd med, he would have outbursts like this, then took a genesight test that said that his last med had moderate side effects. I think the outbursts were the side effects for him.

This is why I took the gene sight test BEFORE starting meds. It took longer, and I’ve lost jobs over it, but today was my first dextroamphetamine and I feel confident I won’t have side effects because of it. I’m going to be seeing my psychiatrist in a week. You may also need another psychiatrist or doc that is willing to look into other options or even give you a gene sight test or a test on how fast the meds are processed in your system. Some people due process them faster than others, and I’ve heard of kids taking 3 doses in a day. However, I wouldn’t take more Han you are told to because then it may look like you’re addicted or hoarding the pills, which is a big no no (although I know some people who forget to take boosters or don't take some meds on off days then take them when they need them).

My partner still has some outburst after it wears off, but it’s rare and usually related to his pstd and the adhd meds help him not to think of his traumas. Having aggressive side effects is definitely scary, especially when you live with someone who doesn’t understand. Do you have any physical outlets when you feel this way? My partner has a post in the back yard that he beats with a stick to help him get the anger out until he’s exhausted.

Hope this helps!

[JamieJJL in reply to Mamamichl]

I've heard of those sorts of genetic tests but mostly in the context of antidepressants and such, I might have to ask my psych about it (though my med management is through my grad school's counseling center so while my psych is great and would probably agree, I don't know if that factor would play into the ability to actually do it). The reason I'm on Adderall right now is because I took it for a very long time through my adolescence, and through my undergrad (which was the last time I saw this psych), and it worked really well without experiencing these outbursts I'm having now. I stopped taking it because I was having issues with stimulants and antidepressants (it's also why I stopped taking Vyvanse, since that was the first one I tried after stopping adderall), but I'm not on antidepressants anymore so we figured that if it worked before, it should work now.

I'm trying to find a more consistent potential physical outlet, but right now it just consists of grabbing something off my desk heavy enough to feel aggressive but light enough not to damage anything and just hucking it across the room as hard as I can. Either that or slamming my hand/fist into my desk but that one isn't really sustainable (I've had bursts where I slam my hand so hard it still hurts as much as an hour or two later). Usually one-and-done is enough since the outbursts are very intense but very short, the big problem with them is how easily they come on as my meds wear off combined with how long that period of volatility lasts.

[Mamamichl in reply to JamieJJL]

Have you thought about getting a standing punching bag… one that fills the bottom with sand or water and doesn’t hang from a wall? Sometimes we get pent up energy and if we don’t have physical outlets, it comes out at the wrong times. Another idea is to have 3+ times a day that you do meditations. I do some at lunch, breakfast and before bed at least. Some good apps for this are calm and loóna. Some places have subscriptions for them and make it free for us. Other ideas for calm games that help the adhd brain are finch (like a tamogatchi) where you are given daily goals, and modern sam, which is like a mix between task/planner and a D&D game. It’s pretty cool, actually.

The genesight test does all mental health meds; antidepressants, anxiety meds, adhd (both stimulant and non stimulant) as well as psychotic meds. I learned a lot about the meds I’m already taking and why I was not liking them as well as better alternatives for my personal chemistry.

You are also in a different part of your life with different stresses and expectations of society. It could be you’re doing a different dose, or even having a different brand or filler in the med than you used to have. It’s surprising what little things can affect us.