I've recently been diagnosed with ADHD and have started ritalin (10 mg - instant release).
The first 2-3 days worked amazingly however I've come to learn that I do not like the sharp onset with similar comedown. Whilst on the medication I feel great and can focus on what needs to be done however I get a strong sense of anxiety as the medication wears off. I'm meant to be taking the medication 3 times a day spread out by four hours however if i feel the medication wear off in under 4 hours I contemplate taking another to alleviate the anxious feeling.
I suppose this becomes a lot more tricky when evaluating my past. My past used to include taking recreational substances such as cocaine and I can't help but draw similarities with the ritalin wearing off to when that recreational substance wears off. I believe that the medication wearing off doesn't actually feel 'that' bad, but it's triggering past memories of when I actually did feel that bad after a weekend out.
I'm only on day 8 of the medication right now and this is bothering me a lot. At the start I could see just how great this medication could benefit me but currently the negative feeling i'm experiencing is serving to be a strong deterrent and if it continues im considering stopping it all together!
Is it normal to feel more anxious during the adjustment period? Do people get redose anxiety? Do people feel 'down' or panic when they notice the effects wear off? IS THIS NORMAL?
Funny enough however I feel like after the first 2 days that this dose is actually not strong enough. its not yielding the same level of focus I had at the start. First 2 days I would get a little hot and sweaty with dry mouth. But now my blood pressure is the same, heart rate the same, no dry mouth.
Its something im worried about and I would love to hear if anyone has experienced something similar.
My strategy currently is to ensure I stick to a strict dosing regimen and more importantly; I believe switching to a controlled release formula will give me a much more gentle come up and comedown where it wont trigger the sharp and rigid highs and lows of prior recreational drug use thus, eliminating the current distress I feel as the medication sharply falls off.
Let me know your thoughts
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PapaSmurf17
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First of all, welcome to the community PapaSmurf17 !
Based on what you've described, plus your prior substance use, you very well might do better on an extended release formulation like Concerta.
I was on Adderall XR before, and my experience with it was that it did have a relatively gradual onset and letdown. I did experience feeling irritable when I came down from it, as if I hadn't had any coffee all day kind of irritable.
I ended up switching to a non-stimulant, but only after I experienced side effects (elevated heart rate) when put on a higher dosage. - In my case, the non-stimulant works better with less side effects, but more people are treated better on stimulants.
Extended release like stem_dad says is a good idea. Some people who have addiction background can get addicted to stimulants in general, so it’s awesome of you to make the connection but be extra cautious. You may want to try the non-stimulant route instead if the craving to take the med gets too high.
You can also check out the gene sight test. That may help you with knowing which meds have adverse side effects with your specific genetics.
I agree with the others on Concerta. It is smoother up and down. Ritalin for me was like a light switch on then off. There are many other variations on methylphenidate based drugs. You can look them up if interested in what other options might work. But Concerta is the go to for extended release has a generic available.
Make sure you are getting enough quality sleep each night. Otherwise you are tired the next day, need more meds to get over it. Which means more stimulation at night, and less sleep etc. That cycle screwed me up and got me to the max dose on several medications. Till it happened on Adderall and had nothing stronger to switch to. And lots of negative side effects for me for years.
Often starting doses of ADHD meds are too high. Which makes us think that we need a slight euphoric feeling and lightening focus to be working right. But that means doses that are more likely to cause higher tolerance. Aim for a dose that allows you to function well, but don't worry about lightening focus.
If you do eventually go the amphetamine route (Adderall, Vyvanse, dexedrine, zenzeti, or others) I'd recommend Vyvanse. It has a much lower peak blood concentration than the others, and is a much longer duration. Providing longer therapeutic effect with less chance to build tolerance or have negative side effects. Adderall is a mix of 3/4 dextro-amphetamine salts and 1/4 levo amphetamine salt mix. The dextro portion is what tends to give the cognitive therapeutic effect. levo has a higher affinity for your cardiovascular system. ie. blood pressure, heart rate, and breathing rate, Which of course circulates more oxygen and can be a bit stimulating in itself. Dexedrine (ER) and Zenzedi (IR) are 100% dextro. Most people find it stronger than Adderall, but does have a sharper on and off effect because of it. Evekeo is 50/50 mix of IR levo and dextro. Only 15% of people find that more therapeutic over other amphetamine mixtures. Vyvanse is a prodrug of dextro. ie. it gets absorbed then your body turns it into dextro. But, a much lower blood peak concentration than the other options. There are other more fancy amphetamine options but not worth getting into at this point.
Strattera is a non stimulant option that worked well for me. But many people have a different view. It is one that takes a few weeks to build up in your system but is 24 hour therapeutic. For me it also had positive sexual side effects. But some found them negative and others not effect at all. Adderall, very negative sexual side effects. But, many are stable on it on low or medium dose for a very long time. So don't worry to much about my negative experience unless you have issues with dosage escalation. To help avoid nausea, take with food, and avoid taking it with milk or dairy products. For me, with milk gives me mild nausea on and off all day. when my stomach starts to get empty. With dairy, usually not much of an issue.
guanfacine (extended release version) non stimulant, goes well with stimulants if you have stimulant insomnia or insomnia in general. Many take it at night, it helps them sleep, then has therapeutic effect already before taking other meds in the morning. And may be able to reduce other meds while on it.
Clonidine - another non-stimulant, this one similar in action to guanfacine. Never tried it myself, but many like it better. Others say it has more side effects.
Qelbree, competitor for Strattera. Haven't tried it myself. Mixed reviews on it. Many like it better than Strattera, others not as much. Supposed to build up faster.
Desoxyn - 100% dextro-methamphetamine, many people find it smoother and less side effects than amphetamine meds. And stronger at lower doses. Obvious stigma of being methamphetamine, but don't mix it up in you head with the street drug.
Modafinil/armodafinil - prescribed off label sometimes for ADHD. technically a wakefulness drug. Stimulating but not as much for the cardio system as others. Good if you have daytime sleepiness issues. If you have daytime sleepiness with your ADHD, combining with another ADHD specific stimulant can often be more therapeutic than either alone with lower doses and less side effects. But prescribing more than 1 stimulant scares the heck out of most therapists.
There are some supplements that can be helpful.
vitamin B- complex, moderate dose. Used in body for energy and many brain functions. Also neuroprotective.
fish oil high in DHA and EPA, known to have mild cognitive effect for some people, plus very heart and brain healthy. I take 4 grams a day. And for me, makes my Adderall work noticeably better.
Can also look into N-Acetyl-Cysteine, Acetyl-L-Carnitine, Alpha GPC. Neuroprotective and can be mildly stimulating. Look like chemicals or drugs by the names but first 2 are just amino acids your body uses every day and 3rd is a choline booster. You have an RDA of choline like vitamins or minerals.
Take a moderate dose multi-vitamin to make up for anything you might miss each day. Your brain uses many vitamins and minerals daily.
See the daily RDA and ratio for calcium and magnesium. Need the right balance for your brain to work right.
Get at least 50 grams of protein a day. Protein I used to thing is just for muscle. But, many of the amino acids that build up into proteins are also used in the body to make things like dopamine, norepinephrine, serotonin, glutathione etc.
l-theanine - can help reduce stimulant jitters for ADHD meds or caffeine. Has other benefits too.
Don't get hung up on dopamine. Everyone talks about dopamine. Many researchers believe ADHD-I is more of a norepinephrine deficit and ADHD-H is a dopamine deficit. Other research shows that closing the HCN channels alleviates symptoms for many people. Much of the effect from amphetamine is on the AMPA/NMDA/Glutamatergic pathways. Mater of fact, amphetamine is named after the AMPA receptors.
Hey, cheers for the response. Happy to hear you can draw some parralels considering similarities with recreational drug use. Good news however! I switched to vyvanse slow release and its almost completely removed that comedown feeling which is simply great. Currently taking 30 mg, may have to try 40 but for now 30 seems to be a nice sweet spot/minimum effective dose. So far so good! Now its just a matter of optimising the dose and I think i'll be in a really good position. Hopefully people experiencing the same things we did can read this and find some tips that may help them.
Vyvanse might be a tough switch for you. 70mg Vyvanse converts to only about 32mg amphetamine. You currently take 30mg. Granted about 1/4 of that is levo while all vyvanse is dextro. But the long slow release of Vyvanse means it will not get near the peak blood concentration levels you get from your current dosing strategies. And likely be in the sleepy zone for you. I'd recommend trying it since it has less potential to build tolerance and damage/side effects. But be aware it may be sub par. And if so, you may or may not be able to undo the Adderall downregulation enough for it to be useful while still taking it. Or you may be lucky and it works from the start.
I don't know the context your therapist is talking about with IR vs XR in helping people who get tired on lower doses. XR is literally designed to mimic taking the same dose of IR about 4 hours apart. Since the drug is already in you, the 50% that is delayed release, a little will metabolize and get released sooner and later than 4 hours as compared to actually taking 2 IR 4 hours apart. So a slightly smoother BAC curve. But very close to the same.
I'd be a bit concerned if lower doses of Adderall made me sleepy and I needed a higher dose to not make me sleepy. The brain has a lot of checks and balances and feedback loops etc. So not possible to be sure exactly what is going on. But too much dopamine (DA)/norepinephrine (NE) can make you sleepy. Lower doses may cause too much to be released in certain parts of the brain, making you sleepy. And, it might be that at 20mg it causes a high enough release of glutamate to enhance signaling in the DA/NE and other pathways causing excitation. Problem is, if true, you may be overstimulating the NMDA receptor causing downregulation and oxidative stress, and excess glutamate can damage cells and trigger the apoptotic cell death cycle in some cells. Amphetamine can be excitotoxic to the NMDA/glutamatergic pathways and many researchers believe it is the primary way we build tolerance. Some therapists prescribe memantine (an Alzheimer's drug) with Adderall to prevent and in some, even degrease tolerance. i.e. it can protect those pathways preventing damage and allowing them to heal and upregulate. Memantine allows normal function, but only blocks during over excitement and protects many other pathways the same way. Might be worth trying out. If it makes your Adderall less effective, then I would worry about excitotoxicity and long term effects. If it does nothing, then it may simply be protecting. But, others also find it improves their Adderall. Some with ADHD have been found to have too much dopamine in a certain part of the brain that glutamate effects (forget which) and that blocking glutamate release reduces dopamine in that area, attenuating the too much dopamine inhibitory effect while increasing levels in other parts of the brain that need DA and NE. Or it can be none of those things I mentioned for you. I guess in my unprofessional spend to much time on google and in chatrooms opinion, Adderall is not a good fit. If too little DA or NE which is most often cited with ADHD is the issue, then you would expect a therapeutic response increasing those. Making a person sleepy makes me think there is an additional underlying mechanism that is not known. And you have to take a lot more meds to get over that other factor. Which is similar to my issues that caused dosage escalation and intolerable long term side effects.
Or, it might just be the right drug and right dose for you long term. The brain is weird like that. But after my last 15 years plus on Adderall, I wish I knew then what I know now. I'd err on the side of causation and only go with Adderall if I tried other things first and they did not work considering the poor response at low dose right off the bat.
Might be helpful to drink things with electrolytes like potassium, sodium, and chloride and making sure to get the FDA ratio of calcium and magnesium daily. Amphetamine is a diuretic and can eliminate electrolytes. I don't know which in particular it affects but I am pretty sure one of them is potassium. And low potassium can cause the racing heart rate at night you mentioned. But be carful if ever taking potassium supplements. It can be bad if you take too much.
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