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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by antennastoheaven on June 29, 2013, at 16:57:56
Short version: I am diagnosed with ADD (inattentive). After a two-month break I started taking Adderall XR 20 mg every morning two days ago, and haven't felt good since. I feel moderately strong side effects during the seven hours or so the drug is effective, and then crash right on time and feel miserable for the next eight hours. I've experienced these crash symptoms before, but always attributed them to work-related stress or anxiety or simply not getting enough sleep. I'm thinking Dexedrine or Vyvanse may be a better choice since they wouldn't have the increased norepinephrine effects of levoamphetamine and Vyvanse has a better extended release mechanism. Or maybe I should just take this dose for a few more days so that I build up tolerance, or even get 10 mg XR and take that for as long as it works. I'm also taking Wellbutrin.
Thoughts?
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Long version:
After a two-month break from Adderall, I started taking it again two days ago (20 mg XR). I am also taking Wellbutrin XL 150 mg. Until I re-started Adderall, I had been feeling really good for the past week, with a decent mood almost all the time and enough motivation to go outside and exercise every day and keep things clean around my apartment. I am diagnosed with ADD (no hyperactivity), but generally don't have a problem until I start to do cognitively demanding work. I am currently on short term disability and in an intensive outpatient program, so now is the time to find something that's effective again before I return to work.Before the break, I had been using Adderall occasionally (about 2-5 days per week) since 2012, starting with a 10mg XR dose and moving up to 20 mg XR. I stopped Adderall (as well as Wellbutrin) because I wanted to try Emsam, an MAOI, which I took for approximately three weeks before giving up due to extreme fatigue. A week later I re-started Wellbutrin, and two weeks later, I re-started Adderall, which was two days ago. I wanted to start at 10 mg XR, but the pdoc said that dose was rather low and she wrote the prescription for 20 mg XR. I typically took Adderall only a few days a week; generally trying to avoid taking it two days in a row, although I occasionally took multiple doses in a day in order to stay up all night.
When I take Adderall, I also take 200 mg chelated magnesium and 10mg lithium orotate before bedtime to attempt to reduce tolerance.So far the side effects have been rather strong. Once the drug kicks in, I have been getting dehydrated, resulting in annoying dry mouth symptoms that affect speech and facial expressions. I drink a lot of water and end up using the restroom often. Most of the time I do feel some cognitive benefit and am functional, if not a little more awkward socially. My resting pulse has been 80-110 bpm during the time of the drug's primary effects. I've been experiencing minor symptoms of depersonalization and being "high", although I haven't felt euphoric except on the first day. I also have less of an appetite, which hasn't been a problem since I am still able to eat. At times I've been getting headaches, mostly on the right side of my head.
Because I'm so thirsty and drinking so much water, I am not spending any time outside when the dose is in effect. Going 45 minutes without using the restroom is tough unless I don't drink any water, and then I risk dehydration. This would only be worse in the summer sun and heat, and would be really bad if I were out driving (which is what I wanted to do this weekend.)
The bigger problem is how I feel after the primary effects of the drug have worn off. Every day so far, I have crashed about 7-8 hours in. Mental stimulation, extreme thirst and depersonalization symptoms mostly go away. I get an *elevated* heart rate and some strange feelings of anxiety (not like my usual anxious feelings). Specifically, I have an urge to be at home and don't feel like moving around. My appetite actually gets worse and it becomes a lot harder to force myself to eat solid food. (I have been consuming a lot of 350 cal nutrition shakes as a result.) I get lots of headaches, approaching the same level of discomfort as a migraine but not the same feeling. These symptoms so far have lasted well into the evening, and don't dissipate until about eight hours after the dose should have worn off (16 hours after taking the drug). Despite these symptoms, I still feel relatively clear headed and am able to write and read / research things online. Because levoamphetamine has a slightly longer half life than dextroamphetamine, it wouldn't be surprising to me if the norepinephrine effects lasted longer than the cognitive effects from the dopamine ... but the increased heart rate and vaguely anxious feelings last for hours and hours.
On the first day, these side effects were so bad that I took something to calm down after the crash. Yesterday I took l-tryosine about eight hours after taking the dose, in the hopes that it would help make things better. I didn't feel as anxious, but the rest of the symptoms were all there. Today I took Adderall later, since it's the weekend and I slept in - I'm not sure how I'll react when the drug wears off, yet. I haven't been doing much after the crash happens because I feel unmotivated to move around. I haven't been exercising because I don't want to do anything strenuous when my resting heart rate is so high (the last two nights, it was at 90-120 until about 10 pm). My apartment is getting cluttered again since I no longer feel like putting things away.
When I took Adderall in the past, I never experienced these kinds of effects at a 10 mg XR dose. But this dose eventually became less effective and I moved up to 20 mg XR. I'm not sure if this is because I had built up tolerance, or because I was on other psych drugs at the time that may have reduced the effect of Adderall (SSRI and/or antipsychotic). However, at 20 mg XR, I have definitely felt the crash before. The problem is that I never made the connection that I was crashing so hard from Adderall. I figured that the extended release mechanism would provide a gradual comedown. SInce I'd often take Adderall on days where I hadn't slept well the night before, I figured I was just becoming tired and anxious because of that. And when I felt anxious after the crash, I attributed it to work stress, especially since I took Adderall mostly on work days. In retrospect, these effects were clearly just an amphetamine comedown.
Despite the bad experience on the first day, I've continued to take Adderall every morning in the hopes that I'll get used to the side effects and build up a little tolerance. I asked for advice from the pdoc but didn't get an answer on Friday (yesterday)... hoping to get an answer from her on Monday. I want to try Vyvanse since it looks like its extended release mechanism should result in a more gradual comedown; and since it lasts longer, if I do crash, it'll be later in the day and unlikely I'll still be at work. Dexedrine is another option; like Vyvanse, it won't have the same level of norepinephrine stimulation as Adderall since it doesn't metabolize into levoamphetamine. The combined NRI effects of Wellbutrin and norepinephrine stimulation from levoamphetamine may be too much for me. IIRC Wellbutrin is more of a NRI than a DRI, and considering that the desired cognitive effects of amphetamine are dopaminergic, having only dextroamphetamine would probably be better.
Thoughts?
Posted by Phil on June 29, 2013, at 18:14:52
In reply to Daily crash and dysphoria after starting Adderall, posted by antennastoheaven on June 29, 2013, at 16:57:56
I like posts from people on stims. Look like an encyclopedia. :)
Sounds like you need two adderall a day. What are your side effects?
Vyvanse is the best stim I've ever taken. If it agrees with you you'll love it.
Posted by antennastoheaven on June 29, 2013, at 18:57:11
In reply to Re: Daily crash and dysphoria after starting Adderall » antennastoheaven, posted by Phil on June 29, 2013, at 18:14:52
side effects while the dose is active (first 7 hours): thirst/dry mouth and related speech/facial expression changes, increased heart rate, slight depersonalization/derealization, decreased appetite (but able to eat anyway), minor headaches
after effects (next 8 hours): drastic crash, anxiety-like feelings, continued elevated heart rate, low physical motivation (while still motivated to read and write), even lesser appetite (very difficult to eat), painful headaches (not migraines but similar level of discomfort)Right now the dose should still be active (5 hours since taking Adderall XR) and I feel like I've already crashed. I've been obsessing over my mental health all day and now have an Incredibly low mood.
Posted by Phillipa on June 29, 2013, at 23:09:33
In reply to Re: Daily crash and dysphoria after starting Adderall » Phil, posted by antennastoheaven on June 29, 2013, at 18:57:11
Vyvanase is supposed to be good and longer acting. Phillipa
Posted by Phil on June 30, 2013, at 13:05:46
In reply to Re: Daily crash and dysphoria after starting Adderall » Phil, posted by antennastoheaven on June 29, 2013, at 18:57:11
Sorry that your going through that and for my post. I'm lucky with most meds including stims.
I lost my insurance and had to get off of Vyvance, that hurt!
So I'm on Adderall IR and am making it work.
40 mg first thing in a.m. And 20 mg around two or three.
Good luck.
Posted by antennastoheaven on June 30, 2013, at 18:07:55
In reply to Daily crash and dysphoria after starting Adderall, posted by antennastoheaven on June 29, 2013, at 16:57:56
Today is the fourth day of trying Adderall. Still thirsty, but with less severe dry mouth, but heart rate is still high and I have a weird sense of anxiety. Resting pulse ~110. I'm hyper-alert right now, and even though going outside would probably calm me down, I don't want to risk dehydration.
I think I'm going to stop taking it and ask for something dextroamphetamine-only (Vyvanse preferred). It seems taking something containing levoamphetamine along with bupropion and its NRI effects should probably be avoided whenever possible.
Posted by Trevpr on July 2, 2013, at 1:40:51
In reply to Re: Daily crash and dysphoria after starting Adderall, posted by antennastoheaven on June 30, 2013, at 18:07:55
I've always wondered how it is that ANYONE can take stimulants long term... It seems that building up a tolerance only takes like a month or two TOPS and the effects of stimulants usually are short-lived, then you feel miserable for the rest of the day, anxiously awaiting the next dose.
They also have tons of side effects like rapid heartrate and anxiety/panic attacks in those who are prone. Again, it isn't so much the side effects that are the big problem, it's just that they do not seem to be sustainable.
They also downregulate "feel good" receptors and invoke dependence. To me, they are an all-around bad idea. I had to compulsively keep upping my dose of Ritalin because I kept getting a tolerance to my stimulant prescriptions (I'm not talking about "chasing a high," I'm talking about chasing any sort of positive effect at all.). I accidentally overdosed and they had to empty my stomach and all that. Not very fun (think extreme panic attack + heart rate at like 200bpm). I became tolerant to Adderall very quickly as well.
Well, luckily I survived that - and my caffeine overdose (had a similar sort of effect - panic attack feeling + sky high heart rate + high bp, etcetera).
I think people usually ask for stimulants just for fun. It's like getting a freebie for party drugs, lol. That's my opinion at least.
Posted by antennastoheaven on July 2, 2013, at 2:33:37
In reply to Re: Daily crash and dysphoria after starting Adderall, posted by Trevpr on July 2, 2013, at 1:40:51
> I've always wondered how it is that ANYONE can take stimulants long term... It seems that building up a tolerance only takes like a month or two TOPS and the effects of stimulants usually are short-lived, then you feel miserable for the rest of the day, anxiously awaiting the next dose.
Amphetamine tolerance can be reduced with NMDA receptor antagonists such as magnesium (the easy one to get and safe to use), DXM, or memantine. Not taking it every day seems to work.
> They also have tons of side effects like rapid heartrate and anxiety/panic attacks in those who are prone. Again, it isn't so much the side effects that are the big problem, it's just that they do not seem to be sustainable.
At least in the case of Adderall, this is in part due to levoamphetamine's norepinephrine effects. I haven't taken Dexedrine or Vyvanse personally, but I believe they are less anxiogenic since they only have dextroamphetamine.
> They also downregulate "feel good" receptors and invoke dependence. To me, they are an all-around bad idea. I had to compulsively keep upping my dose of Ritalin because I kept getting a tolerance to my stimulant prescriptions (I'm not talking about "chasing a high," I'm talking about chasing any sort of positive effect at all.). I accidentally overdosed and they had to empty my stomach and all that. Not very fun (think extreme panic attack + heart rate at like 200bpm). I became tolerant to Adderall very quickly as well.
Glad you survived.
10 mg Adderall XR seemed to be effective for me for about a year taking it only occasionally. Now that I think about it, it was only when I started taking other psychiatric medications besides Adderall and Wellbutrin that it subjectively stopped working and I needed to increase the dose - probably because the other medications were sedating or cognition-reducing, and not because I was actually more tolerant.
I think it may be possible to reduce amphetamine induced downregulation and neurotoxicity with various supplements, but I don't understand the mechanisms (how amphetamines actually work seems very complicated). There are threads on Bluelight and Longecity that talk about it.
> Well, luckily I survived that - and my caffeine overdose (had a similar sort of effect - panic attack feeling + sky high heart rate + high bp, etcetera).
Caffeine OD seems unpleasant. Around five years ago I had a caffeinated breath spray. I once accidentally sprayed it up my nose and felt incredibly uncomfortable for about 15 seconds.> I think people usually ask for stimulants just for fun. It's like getting a freebie for party drugs, lol. That's my opinion at least.
There are better drugs to have fun with.But, Adderall + weed + alcohol was my favorite concert combination last year...
Posted by SLS on July 2, 2013, at 3:39:03
In reply to Re: Daily crash and dysphoria after starting Adderall, posted by Trevpr on July 2, 2013, at 1:40:51
The therapeutic effects that amphetamine and methylphenidate produce when treating ADHD usually persist.
When one is taking stimulants to feel energized or euphoric, the desired outcome usually will not last for very long.
- Scott
Posted by antennastoheaven on July 7, 2013, at 19:55:10
In reply to Daily crash and dysphoria after starting Adderall, posted by antennastoheaven on June 29, 2013, at 16:57:56
I've taken Vyvanse 30 mg for the last two days and have not noticed a major crash at the end of the day. It feels a lot smoother than Adderall XR. My resting heart rate has been closer to 80. It doesn't increase my thirst nearly as much. So far, it's working about as I would expect it to. Seems to last for around 9-10 hours, I think.
However, I've been feeling fatigued and excessively thirsty for the past few days (before starting Vyvanse) and I'm not sure why. It started after the four days I took Adderall. I don't find it surprising that I felt fatigued right after I stopped Adderall, but since it didn't go away I suspect something else might be wrong. I have been sleeping adequately. I am not diabetic (confirmed today with blood and urine tests) and standard labs came back normal with no indication of immune activity; waiting on TSH results. There is no other apparent cause of illness... the doctor I saw thinks the excessive thirst is just drug-induced dry mouth, but that doesn't explain the fatigue.
I did wake up on Saturday morning (not having taken Vyvanse or Adderall XR the day before) feeling very tired and a little dehydrated after sleeping 11 hours. It took a lot of motivation to get out of bed and move around.
Posted by jrbecker76 on July 8, 2013, at 14:50:18
In reply to Have Vyvanse now, maybe better?, posted by antennastoheaven on July 7, 2013, at 19:55:10
> I've taken Vyvanse 30 mg for the last two days and have not noticed a major crash at the end of the day. It feels a lot smoother than Adderall XR. My resting heart rate has been closer to 80. It doesn't increase my thirst nearly as much. So far, it's working about as I would expect it to. Seems to last for around 9-10 hours, I think.
>
> However, I've been feeling fatigued and excessively thirsty for the past few days (before starting Vyvanse) and I'm not sure why. It started after the four days I took Adderall. I don't find it surprising that I felt fatigued right after I stopped Adderall, but since it didn't go away I suspect something else might be wrong. I have been sleeping adequately. I am not diabetic (confirmed today with blood and urine tests) and standard labs came back normal with no indication of immune activity; waiting on TSH results. There is no other apparent cause of illness... the doctor I saw thinks the excessive thirst is just drug-induced dry mouth, but that doesn't explain the fatigue.
>
> I did wake up on Saturday morning (not having taken Vyvanse or Adderall XR the day before) feeling very tired and a little dehydrated after sleeping 11 hours. It took a lot of motivation to get out of bed and move around.
Despite battling borderline ADHD and attention/apathy issues from psych meds, I've had little success in adding a stimulant to my regimen for the same aforementioned reasons you discussed. I will say though that my experience with Vyvanse was definitely far less prone to causing dysphoria, irritability and come-down effects in comparison with Adderall. I also found generic Dexedrine to be smoother as well.
This is the end of the thread.
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