29y/o F - I have been taking adderall XR for a little over a year. It seemed to be working, but we did up my morning dosage to give me a bit of a boost. In May 2024, my OB prescribed me Wellbutrin, but it made me an anxious mess and my Psychiatrist told me to stop immediately. After tracking my symptoms (depression vs anxiety), Dr came to the conclusion that I had anxiety that was causing the depression symptoms. I have been on Lexapro for about 3 months, and I have noticed a mild improvement.
Unfortunately, I am more lethargic than ever at home. No matter what time I wake up, I sit with my coffee for at least an hour until I realize I have to race against the clock to get ready for work. When I get home, I am lucky if I complete one task. I meal prep on Sundays, so I don't have to worry about cooking, but folding laundry? Unloading the dishwasher? Walking to the mailbox? Forget about it!
I have started breaking the adderall in half to do 4 small doses throughout the day instead of the previous 2 doses per day. It gives me a tiny bit of boost to where I may be able to actually put my dirty dishes away or fold a blanket, but not much more. I haven't been to the gym in over 2 months.
I have read some benefits of combining lexapro and wellbutrin. Does anyone here have experience with mixing another prescription with the lexapro?
Honestly, any tips on how to motivate me to complete my to do list would be great!!! I miss running, but cannot seem to force myself to do anything!
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I would revisit this with your doc. Before I was diagnosed with ADHD, I had taken Wellbutrin for depression. When they upped the dose, I got super anxious and it took a while to realize it was the med. I also was on zoloft at one point and I felt like a zombie. I could sit and stare into space for an hour, had no motivation or ambition. Okay, I wasn't exactly depressed, but I still couldn't function. It was not the med for me! It isn't uncommon to need a cocktail to adequately address multiple diagnoses.
Back in the early 1980s, Paul Wender wrote about a patient who developed a slow tolerance to both dextroamphetamine and methylphenidate. Wender changed the stimulant every 6 months, so that as the patient became tolerant to one, he experienced a robust effect from the other. You might discuss this possibility with your psychiatrist.
After trying different drugs, nortriptyline worked for me.
It sounds like you're taking immediate release Adderall which comes in tablets that can be broken in half. Adderall XR comes in capsules. If so, ask your psychiatrist about writing 3 doses, or even 4 per day. Using XR should make this unnecessary.
I became tolerant when give too little stimulant. Some psychiatrists limit the dose to 40mg/day while others use a 60mg/day limit approved for narcolepsy. (The 40mg limit comes from the 1970s when ADD was a childhood disorder not recognized in adults.)
I find eating something with protein gives me a lift in energy and motivation.
Go to the gym. Get your blood pumping around your body, or if you can't get to the gym, do some at home. Adderall is a strong medication that will exceed the senses and wear you out quick. The Adderall will technically do to your heart what the gym does, but the rest of your body will suffer. It'll be stimulated but for no reason. Probably why you have no energy. So, going for a run, sprint, or a good session at the gym, will get your blood flowing, heart rate up, metabolism up, and the resting adderall that sits in your blood overworking your system will begin to be used and there you go. You'll be back in no time. You will have to force yourself, but, your blood and brain is full of stimulant and you're not stimulated
Hi- I’m sorry that your meds aren’t optimized for you yet by the sounds of it- I can only chime in about the adderall XR. I found that the XR made me feel very sleepy and not like the immediate release. I would start to feel it working in the first 2h, but when the second part would kick in, became so tired I could fall asleep standing up practically. Maybe it’s just the way my body metabolizes it, but I prefer the self-dosing to titrate over the day so my body doesn’t get too much too fast. Are you taking any ADHD supplements to complement your meds?
there is an app called dubbii from the adhd_love couple on you tube. This is about body doubling. Another idea is the app modern Sam. If you’re a gamer, this turns tasks into energy for a d&d type game. I also use lots of alarms with labels to keep me on task.
Was sleepiness and motivation an issue before the Lexapro? Or at least not nearly as bad? After 3 months, I'd say time to talk to doctor about another medication as that one may make you too sleepy and lethargic to function.
Sounds like you are not communicating issues with the medications enough with your therapist. Do they have a doctor portal to message between visits? etc.
Adderall is a hard drug to handle for some. What dose are you prescribed? If you are on a higher dose and built a tolerance, it can downregulate and even damage your neural pathways and endocrine system. Some people are more tolerant than others and it varies widely. If you build tolerance, then when you stop taking it, or take to little, you can be below your natural premedication baseline. Hard to tell what part of your issues is Adderall withdrawal and which part is Lexapro side effects.
Adderall XR is designed to be 50% immediate release and 50% about 4 hours later. taking it all day will downregulate you faster as you need it out of your system long enough between doses (typically overnight), you can't upregulate receptors that downregulated during the day and build tolerance faster. This link explains the effect of acute tolerance and why taking Adderall twice a day can be bad, never the less 4 times a day. It doesn't get into the mechanism but simply put, body shuts down receptors to counter the stimulant, so you need more in your blood in the afternoon just to maintain the mornings therapeutic affect. Then out of your system overnight to upregulate those receptors. If not upregulated, they can be permanently removed causing tolerance (causes tolerance in several other ways too. Which can leave you understimulated causing lethargy and sleepiness, etc. So, don't know if Adderall is a factor or not as no idea your dose, which even then can be very different per person.
Did you have depression or anxiety before Adderall or did that come after you started it? Adderall can increase stress related hormones like ACTH and Cortisol which may contribute to the issues, or be the cause. ACTH and Cortisol naturally are highest in the morning and decrease during the day. Often, Adderall can cause them to increase instead of decrease during the day and be highest at night. Labs often have blood tests for ACTH and cortisol with a 9am and 4pm range (assuming a normal schedule and take Adderall in the morning). Mine were double the 4pm range by 2:45 in the afternoon and likely increased more into the evening. No idea at all if it is a factor for you, just info your therapist may not be aware of. And if they deny Adderall has endocrine or stress hormone activity, tell him to read the prescriber documentation that comes with the drug. Said it there for over 20 years.
If you are on a high dose Adderall, or moderate dose, Strattera can help give a boost while protecting your NMDA/glutamate pathways that Adderall can downregulate and damage. One of the primary ways it causes tolerance. If on a low or maybe moderate dose, probably not an issue. But someone taking XR twice a day, usually not on low dose. Took 9 months giver or take to reduce my adderall dose by half with Strattera. (did that 3 times in 11 years, not a fluke and research explains Strattera's NMDA antagonism) Plus, Strattera has been shown to help some with depression. Which is why it is often prescribed first to someone with ADHD and a history of depression. It's a non-stimulant ADHD medication technically so may be willing to add it on. Worth a discussion with your doctor.
But really, if Lexapro is what is making you sleepy, you just need to get off it. Anxiety and depression are often caused by not being able to function. So it is helping and harming at the same time. Which is not a solution, just another problem. Drug therapy is a process and may take several iterations., and can change over time. But you need to be proactive with your doctor. Don't wait 3 months to tell them you can't function on a medication.
Can see if your insurance covers a clinical dietician. The gut brain axis can play a huge part in depression, anxiety, energy, etc. for some people. Plus, can probably be beneficial regardless.
Not going to get into all the explanation, but some supplements have helped me which you can look into more yourself if interested. Neuroprotective, energy enhancing, generally healthy.
Vitamin B- Complex - body uses it to make energy and a ton more functions. Used in making glutathione and prevents cysteine conversion to homocysteine. Converts homocysteine that does get made to glutathione.
fish oil high in EPA and especially DHA (when I forget this, it is like a 25% reduction in my adderall dose.)
n-acetyl-cysteine (NAC) (need b-complex if taking it) (rate limiting amino acid of glutathione, bodies primary antioxidant in every cell, and a ton more functions)
acetyl-l-carnitine ( transports long chain fatty acids like EPA and DHA into mitochondria and aids in conversion to energy. Also clears out accumulated peroxides, antioxidant)
Alpha-GPC (choline booster shown to boost in brain best, structural component of neurons and precursor of acetylcholine)
Eat 50+ grams of protein per day. Protein gets turned into everything from bone to neurotransmitters.
probiotic/prebiotic healthy gut absorbs nutrients and drugs better. Plus, gut is bodies chemical factory and makes a ton of things in our bodies. Health starts in the gut.
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