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Board Index > ADD / ADHD | 0-9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

I remember my first post here, I also remember apologizing for it, because reading it was like running a marathon! ;) Several things came to mind while reading your post, I'll address them as I remember them, which means they'll be in no particular order.

[LIST]55mg of Adderall is not double the recommended dose. For treatment of ADHD in adults, 40mg per day is considered the upper end, though 60mg is recommended for narcolepsy. I have seen people here report being prescribed 100mg or more of Adderall per day, so honestly, 55mg isn't really all that much. I am currently on 40mg of Adderall, plus 450mg of Wellbutrin daily (which [I]is[/I] a monstrous dose), and I haven't had the police knocking on the door yet. ;) My 40mg Adderall is all extended release (instant release isn't legal in Canada), and is prescribed to be taken all at once in the morning, though I often break it into two doses to extend the period of efficacy (my point being that 35mg at a time isn't an unreasonable dose).

[*]It's possible that your sleep disorder is a major cause of all your problems (that's not to say the [I]only[/I] cause). I would see if you can get a referral to a sleep clinic to address the sleep disorder. You may well find that once you're consistently getting proper sleep (which the majority of us ADHDers don't) that your mental health issues diminish significantly.

[INDENT]If you can't get a referral, or if financial considerations make it impossible, make sure you're getting plenty of exercise, do your best to focus on natural foods, and try to maintain a consistent schedule seven days a week. These things may help you control your sleep disorder, and thus alleviate your symptoms.[/INDENT]

[*]Many of the side effects you mention, the jitters, the anger, the short temper, tend to be associated more strongly with Adderall than with many of the other ADHD stimulant medications. I would recommend talking to your doctor about giving either a dextroamphetamine only (such as Vyvanse or Dexedrine), or a methylphenidate (Concerta, Focalin, Daytrana, Ritalin) option a try. If you're concerned that he'll view you as a drug seeker, keep the conversation on Vyvanse or Concerta, as both of these meds are considered to have a lower abuse risk than Adderall; if your doctor is indeed an ADHD expert, he likely knows that subtle changes in medication can yield major results. Unfortunately, neither of those are available in generic versions yet, so Ritalin might be your best bet if cost is an issue.

[INDENT]This option may or may not work for you, as Adderall's weakness (increased incidence of side effects) seems also to be its strength, as many people find it works the best of all the ADHD medications.[/INDENT]

[*]Tolerance is very likely to occur, though it doesn't happen to everyone. I tend to be rather obsessive about the possibility of tolerance myself, and often convince myself that I've developed tolerance every time I have a bad day. Unfortunately, it's one of those things we can't predict, and can't control, so all we can do is take the meds and deal with issues as they arise. Obsessing over tolerance can cause so much anxiety on its own that it makes the meds less effective, a sad irony, to be sure. Do your best to let your fears of tolerance go, they're going to do more harm than good.

[*]I tend to recommend against days off. Although common wisdom seems to contradict me in this case, I have found that I need several days of Adderall to get the full effect, and a day off leaves me with less overall effect for days afterward. My shrink agrees with me on this, keep the meds consistent to keep the effects consistent.

[*]Give Wellbutrin a try. I can honestly say, that after several years of unsuccessfully seeking the right treatment, that Wellbutrin changed my life. Wellbutrin is what I call an antidepressant style treatment for ADHD because along with other similar meds, it's a reuptake inhibitor, which means it increases the available levels of neurotransmitters in the brain by slowing the process by which they're broken down and reabsorbed in the body. In this way, it's similar to SSRIs, but rather than working on seratonin, it works on dopamine and norepinephrine instead. By this action, it can work in concert with your stimulant medication to further increase the available levels of the required neurotransmitters in your brain (it can also work as a standalone option, though probably with less effect than the combination).

[*]The ironic effect of ADHD is that our outward [I][B]hyper[/B][/I]activity is caused by [I][B]hypo[/B][/I]activity in the brain. It's thought that this is the reason that stimulants work to calm us down. Because the messaging system in the brain is short on raw materials (specific neurotransmitters), many messages sent from the higher brain don't reach the lower brain (which is the part that has actual control over our actions), leaving the lower brain to make decisions on its own. The effect is that our lower brain, which is similar to that of lower animals, acts as it sees fit, which is why we tend to lack impulse control, and react poorly under stress.

[INDENT]Because the brain's messaging system is short on couriers, many messages are lost. Your higher brain might be screaming "We need sleep!" but the message isn't getting through. Once the proper supply of neurotransmitters is restored, the message gets through, and we're able to calm down. Sadly, not sleeping exacerbates the issue, and the supply of messengers is further reduced, leading to further declines in delivered messages.[/INDENT]

[*]Would your doctor consider trying to intervene on your behalf with the relevant health authorities? Despite the fact that Adderall is a controlled substance, it's still a valid prescription for a valid illness. Your doctor, especially if he's a respected member of the medical community, may have more success cutting through the red tape than you do on your own. He may also assist with finding a new doctor if you move, and may help your case with a new doctor by providing a letter, or relevant documentation. Although he may be unwilling to get involved, you won't know if you don't ask.

As I final word, I will urge you to be patient. Finding the right medication or combination of medications at the proper dosages can be a long and frustrating process. You may find meds that work at first, but lose efficacy quickly, you may find meds that do nothing for you. You may, like me, find that it takes 2 years of trying to find the right option, but trust me, it's well worth the effort. 35 years of hell ended for me a matter of months ago, but my level of function and self control are at levels I've never experienced before. I finally can see a tiny dot of light at the end of my dark tunnel, my challenge now is to stay on the tracks and not derail before I reach it. It's a profound and wonderful feeling that I hope you can experience soon, but even if it takes time, stick with it, you won't regret it in the end.

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