ADHD meds

[Alm751]

I have adult-onset ADHD and was on Adderall 60 MG for 15+ years. I also take Duloxetine 90 mg and Wellbutrin 150 mg. Post-COVID, I was still doing Zoom calls with my psychiatrist in Chicago, and she thought she noticed some lip-licking. I went to see her in person, and she took me off of Adderall and started me on Strattera, which didn't work as well as Adderall.

We then moved to TX, and I found a GREAT PA who said I should not bother taking Strattera if it was not working that well. Her position was eliminated and since I was stable, her supervising psychiatrist recommended that my PCP handle my meds.

My focus has gotten worse in the last few months.

Has anyone been taken off of Adderall due to possible TD and then restarted on Adderall without negative effects?

My struggles with focus and time management are impacting my professional and personal lives. TIA.

[Mamamichl]

I would talk to your doctor about this. If it did well for you, tell your doc you did better on that than you are now. I would notice how much you may have tics now and after you start, just in case.

[Alm751 in reply to Mamamichl]

I asked her to restart at a lower dose and she wouldn't. I lived in Chicago at the time and now live in TX. It's not only hard to find an MD to manage my meds, if I find one I might wait months to get an appointment. Thanks for your response.

[Mamamichl in reply to Alm751]

Yeah. I had a psychiatrist but kept getting big bills and fees, so I asked my pcp to manage it. She Refilled a few of my mental health prescriptions last month but one I requested yesterday was denied. I have 4 days left and an appt with her on Monday.

Last time my meds were off I went to a psychiatric facility. I’m so scared. It’s frustrating because I feel I’m being bullied into going back with the psychiatrist when I’m on Medicaid but the psych place didn’t take straight/open card so they thought they could charge me. With Medicaid they aren’t supposed to. I did have work insurance but lost my job because my meds were off, which was because work insurance wouldn’t cover a med I had been taking for 10 years.

I guess what I’m trying to say is I get how frustrating it is to have to advocate and that some docs just don’t seem to fit.

[STEM_Dad]

Did your psychiatrist in Chicago notice the behavior on more than one occasion?

Lip-licking can be due to various reasons. The most obvious ones that come to mind are dry lips, hunger, and (in the case of my kids when they were younger) wearing flavored chapstick.

But I recall having classmates back in school who licked their lips regularly, and seemed to have other behaviors that I would now characterize as being like OCD behaviors. (When I was a kid, I thought that they were just interesting quirks. I didn't think anything bad about my classmates' behaviors.)

I know that tardive dyskinesia is a concerning possible side effect of ADHD medication, but that it is also rare. However, I remember reading somewhere that people who experience it once from a given medication are likely (but not guaranteed) to experience it again in response to the same medication.

So, my question to you before you consider taking Adderall again is: Can you think of any other reason why you might have been experiencing the lip-licking behavior?

Or do you think the psychiatrist was correct in their assertion that it was the Adderall causing it?

~~~~~

I was only on Adderall for a few months, and not above 20mg. At that dosage, I experienced tachycardia (elevated heart rate), so my doctor dropped my dosage back down again.

Switching to Strattera (and later Wellbutrin) has worked better for me than Adderall did...but I recognize that I tend to react differently to ADHD meds than the majority of people when ADHD do. (Even a low adult dosage of Strattera worked very well for me.)

[Alm751 in reply to STEM_Dad]

Thank you for your thoughtful response. She noticed it during winter in Chicago and I think I did have a tendency to lick my lips when it was cold. This was 3-4 years ago. I told her that lip licking stopped and would she be willing to start me at a lower dose of Adderall and she would not. I think there are 1-2 new non stimulant ADHD meds. The problem in TX is finding a dr and getting an appointment!!! Maybe an increased dose of Strattera would work. I just know that I'm struggling more than usual. Thank you again.

[STEM_Dad in reply to Alm751]

I know that Qelbree is a new non-stimulant ADHD medication, approved by the FDA a few years ago.

Like Strattera, it is a selective norepinephrine reuptake inhibitor (SNRI). Qelbree has been reported to have less chance of side effects, and is more effective for more people than Strattera. It is especially recommended over Strattera for children.

• The only downside is that it is so new that it is only available as the name brand formulation. There is no generic available.

Aside from that, there's Wellbutrin (prescribed off-label to treat ADHD), which you have already mentioned taking. Also, there are guanfacine or clonidine, both the same class of blood pressure medication and have both been found to help treat ADHD (particularly mood-related traits).

• About 3 years ago, I found a lot of mentions of Wellbutrin and guanfacine being prescribed together to treat ADHD.

[Alm751 in reply to STEM_Dad]

Thx. My goal right now is finding a dr!