Posted by Caslon540 on February 16, 2005, at 2:20:37
I'm wondering what the maximum adult dose is considered to be for Adderall (not what the official literature says, but how much doctors actually prescribe in real life to people with my problem). I'm currently on 30 mg Adderall XR, 20 mg regular Adderall, 300 mg Effexor XR, and 80 mg Geodon. I also take anywhere from 200-600 mg of caffeine in pill form (equivalent to 2-6 cups of coffee) and 400 mg of magnesium taurate. (I read on another board that magnesium helps keep amphetamine tolerance down.)
I'm on stimulants due to severe fatigue and hypersomnia from depression. (Before I started them, I was sleeping 20 hours a day, at least half of the week.) I started on Ritalin first, but my tolerance escalated rapidly, and after 4-5 months I switched to Adderall, which I've been on for about 9.5 months now (thanks to the magnesium, I guess).
OK, here's where the problem gets really long: I think I was able to function significantly better on Ritalin than I do now on Adderall, but a confounding factor when comparing the two is that I started taking Geodon at the same time as Ritalin, and have stayed on the same dose of Geodon ever since. Right around the time I switched from Ritalin to Adderall, I developed galactorrhea, and have had it since then. I've been examined, had blood tested, and was told it is probably caused by the Geodon. I think I've read that antipsychotics can take a few months to be fully effective (please correct me if I'm wrong), so I'm thinking that maybe one of the reasons Adderall hasn't worked as well for me as Ritalin is that the Geodon started causing side effects around the time I started taking Adderall.
Progressively over the past 5 months, I've been having problems staying alert throughout much of the day, regardless of whether I have 8 hours or even 12 hours of good sleep the night before. I'm most alert after I take my morning Adderall XR 30 mg dose, which has always seemed to last only about 4 hours. I take 40 mg of Geodon and 300 mg of Effexor XR later in the morning or at lunchtime. Curiously, it is shortly after I do this that I become very fatigued, followed by an inability to generate motivation to do anything, even tasks that are unchallenging yet enjoyable. I take 10 mg of regular Adderall at 2 PM, and then another 10 mg at 6 PM. I've noticed no effect from either of these doses for the past month. I usually feel a little sharper late in the evening, when the early dose of Geodon is probably wearing off. I take my second 40 mg Geodon dose at whatever time I go to bed for the night.
Why could this mental/physical drop-off be happening every single day? I don't think my Adderall tolerance is going up, because the XR has had pretty much the same effect every morning for months. When I wake up, I seem to have a clean slate regarding whatever it is that had pulled the plug the day before. I'm inclined to think the Geodon is interfering with the Adderall, as Adderall is a dopamine agonist and Geodon is an antagonist, but I'm not clear on the details, so I could easily be mistaken.
If it helps to know, I started the Effexor so long before anything else I'm on now that I can't even remember what year it was.
Do you think lowering the Geodon dosage would ameliorate this problem? Or should I ask/beg my psychiatrist to increase the Adderall? I'm kind of scared that if I ask for a higher Adderall dosage, he'll take me off of stimulants completely, because he just raised it about 4 months ago.
I assume people with ADHD are prescribed stimulants for years. Is a year and 3 months a ridiculously long time to be prescribed stimulants for a problem the complete OPPOSITE of hyperactivity?
I apologize that this is so wordy.