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SmallTownDreamr,

May I add to my trusted friend, "Thurnor's," reply.

Thunor's reply:

The reason your doctors and pharmacist are unspecific regarding the tolerance issue is that there is no established rules in this regard. Just as dosage and specific pharmacology vary wildly from person to person, so too does the likelyhood, rate and level of tolerance to amphetamines and other stimulant meds.

My experience: I've developed a tolerance to how Adderall makes me feel. It no longer makes me feel good or bad. On the other hand, Adderall continues to control my ADHD symptoms better than ever.

Thunor: While most people tend to become tolerant to these meds, some experience no tolerance at all, while some actually become sensitized, and need to lower their dose over time. I suspect that someday, we'll actually understand the science of tolerance, but at present, we don't even understand the precise mechanism of action of amphetamine, so it's impossible to make predictions.

Thunor: Because it's impossible to tell ahead of time the likelyhood of tolerance, it's impossible to set down any hard and fast rules regarding 'holidays.' My shrink advises against them entirely, but I've seen many people swear by them.

My experience:

A) I have on numerous occasion taken "accidental" holidays. I run out to work without my meds, function just fine, and discover I hadn't taken my meds back home when my wife yells at me, "you didn't take your meds."

B) On other occasions, I run off without my meds, do a high speed 180, screech into the driveway, yell, "woman, where's my freaking speed?" She yells back, "right where it always is."

What's the diff between A) & B)? Brain load. We can talk about "load" later.

Thunor: As to improving efficacy, it's known that taking amphetamines with acidic food or drink reduces the effect.

Me: Maybe, maybe not.

Thunor: I suspect, though can't claim to truly know, that non-acidic foods that produce a net acidic response by the body (most meats and grains) will likewise reduce efficacy.

Me: Above parsed" "Maybe, maybe not.

Thurnor: Beyond that, clean living has been shown in many studies to reduce the severity of ADHD symptoms, specifically, eating a proper diet, low in refined sugars, saturated fats and chemical additives, getting sufficient sleep, drinking alcohol in strict moderation and getting enough exercise (sounds like fun, I know).

Me: Absolutely, positively, beyond all doubt - reasonable and otherwise, FACT.

ADHD sufferers also tend to do better in structured environments, so following an established routine as closely as possible will help.

Me: I do much better as long as I am the architect of my structured environment. "Established routine" is a relative thing. Each day my business pops the unexpected in my face. I thrive on it.
Recently (June 1) I hired a "nuts & bolts" manager. Corporate types title him "General Manager." I swear "Bill" (real name) is as freaking ADHD as me. I can't work with the guy. So I don't. "Bill, take care of this 'stuff,' bye." At day's end, "stuff" is done - perfectly.

The diff between Bill and Bob (me). Bill comes into my office while I'm on the blower with a customer trying to intimadate me. The cus claimed I billed for services never rendered. I told cus, "Bill will inspect the work first thing in the AM. If legit, we'll fix it. Otherwise, I putting a contractors lean on your property." Bill sees I'm unaffected, asks me, "how do you do it?" I replied, "it's fun." Phone rings. It's cus. "Check is in the mail." Blah, blah, blah, happy ending - this day, this time. More often than not, no happy ending. Still fun.

Bill, needs to be told, "what to do" NOT "how to do it." I'm the same. Bill has trouble dealing with people on a emotional level. I get it off on it. Both of us are as ADHD as can be.

Thunor: Any other drugs or strategies will be anecdotally based. You will find in many places people claiming scientific evidence for one remedy or another, but those people are generally trying to sell you something, and their 'science' is questionable at best.

Me: Their 'science' is BS at best.

Thunor: "As far as additives that make sense to me, apart from those that would fall under the 'clean living' heading (vitamins, omega-3s), you may consider supplementing L-Tyrosine, as it is a precursor to L-Dopa, which is a precursor to dopamine, which is a precursor to norepinephrine. Taking more L-Tyrosine will not necessarily result in production of more dopamine and norepinephrine, as there are several rate-limiting processes at play, but I suspect being deficient in L-Tyrosine may well lead to lowered levels of those all important neurotransmitters."

Me: Absolute FACT.
SmallTownDreamr,

May I add to my trusted friend, "Thurnor's," reply.

Thunor's reply:

[I][COLOR="Blue"][B]The reason your doctors and pharmacist are unspecific regarding the tolerance issue is that there is no established rules in this regard. Just as dosage and specific pharmacology vary wildly from person to person, so too does the likelyhood, rate and level of tolerance to amphetamines and other stimulant meds.[/B][/COLOR][/I]

My experience: I've developed a tolerance to how Adderall makes me feel. It no longer makes me feel good or bad. On the other hand, Adderall continues to control my ADHD symptoms better than ever.

[B][I][COLOR="Blue"]Thunor: While most people tend to become tolerant to these meds, some experience no tolerance at all, while some actually become sensitized, and need to lower their dose over time. I suspect that someday, we'll actually understand the science of tolerance, but at present, we don't even understand the precise mechanism of action of amphetamine, so it's impossible to make predictions.

Thunor: Because it's impossible to tell ahead of time the likelyhood of tolerance, it's impossible to set down any hard and fast rules regarding 'holidays.' My shrink advises against them entirely, but I've seen many people swear by them. [/COLOR][/I][/B]

My experience:

A) I have on numerous occasion taken "accidental" holidays. I run out to work without my meds, function just fine, and discover I hadn't taken my meds back home when my wife yells at me, "you didn't take your meds."

B) On other occasions, I run off without my meds, do a high speed 180, screech into the driveway, yell, "woman, where's my freaking speed?" She yells back, "right where it always is."

What's the diff between A) & B)? Brain load. We can talk about "load" later.

[B][I][COLOR="Blue"]Thunor: As to improving efficacy, it's known that taking amphetamines with acidic food or drink reduces the effect. [/COLOR][/I][/B]

Me: Maybe, maybe not.

[B][I][COLOR="Blue"]Thunor: I suspect, though can't claim to truly know, that non-acidic foods that produce a net acidic response by the body (most meats and grains) will likewise reduce efficacy. [/COLOR][/I][/B]

Me: Above parsed" "Maybe, maybe not.

[B][I][COLOR="Blue"]Thurnor: Beyond that, clean living has been shown in many studies to reduce the severity of ADHD symptoms, specifically, eating a proper diet, low in refined sugars, saturated fats and chemical additives, getting sufficient sleep, drinking alcohol in strict moderation and getting enough exercise (sounds like fun, I know). [/COLOR][/I][/B]

Me: Absolutely, positively, beyond all doubt - reasonable and otherwise, FACT.

[B][I][COLOR="Blue"]ADHD sufferers also tend to do better in structured environments, so following an established routine as closely as possible will help.[/COLOR][/I][/B]

Me: I do much better as long as I am the architect of my structured environment. "Established routine" is a relative thing. Each day my business pops the unexpected in my face. I thrive on it.
Recently (June 1) I hired a "nuts & bolts" manager. Corporate types title him "General Manager." I swear "Bill" (real name) is as freaking ADHD as me. I can't work with the guy. So I don't. "Bill, take care of this 'stuff,' bye." At day's end, "stuff" is done - perfectly.

The diff between Bill and Bob (me). Bill comes into my office while I'm on the blower with a customer trying to intimadate me. The cus claimed I billed for services never rendered. I told cus, "Bill will inspect the work first thing in the AM. If legit, we'll fix it. Otherwise, I putting a contractors lean on your property." Bill sees I'm unaffected, asks me, "how do you do it?" I replied, "it's fun." Phone rings. It's cus. "Check is in the mail." Blah, blah, blah, happy ending - this day, this time. More often than not, no happy ending. Still fun.

Bill, needs to be told, "what to do" NOT "how to do it." I'm the same. Bill has trouble dealing with people on a emotional level. I get it off on it. Both of us are as ADHD as can be.

[B][I][COLOR="Blue"]Thunor: Any other drugs or strategies will be anecdotally based. You will find in many places people claiming scientific evidence for one remedy or another, but those people are generally trying to sell you something, and their 'science' is questionable at best. [/COLOR][/I][/B]

Me: Their 'science' is BS at best.

[B][I][COLOR="Blue"]Thunor: "As far as additives that make sense to me, apart from those that would fall under the 'clean living' heading (vitamins, omega-3s), you may consider supplementing L-Tyrosine, as it is a precursor to L-Dopa, which is a precursor to dopamine, which is a precursor to norepinephrine. Taking more L-Tyrosine will not necessarily result in production of more dopamine and norepinephrine, as there are several rate-limiting processes at play, but I suspect being deficient in L-Tyrosine may well lead to lowered levels of those all important neurotransmitters."[/COLOR][/I][/B]

Me: Absolute FACT.

Bob
Fascinating information...thank you all for your perspectives!

I've heard of others (especially parents with ADHD children) doing a "weekends-off" approach like yours, thisguy86. Unfortunately, I'm on a very high dose of dextroamphetamine and the chasm between being on and being off is staggering. I actually did end up doing a 3-day-long drug holiday soon after my original post here...and I basically slept most of those 3 days. I'm guessing that the amount of energy I get from the dextroamphetamine is so much that going off for a few days is like an old car at a sudden stop: You suddenly take your foot off the pedal and the engine stalls!

Bob/addprogrammer, thanks for confirming some of Thunor's specific recommendations and for the entertaining reality check with regard to my psychiatrist! Alas, I would get the best psychiatrist money could buy if I weren't on a budget and my psychiatrist wasn't covered by my insurance. Unfortunately, I had two terrible experiences with other psychiatrists prior to my current one (who, by the way, is as far from "babe"-hood as possible...I only love her in the most respectable sense :)) and after all the success I've had with her over several years (especially the past few with the dextroamphetamine), I'm extremely hesitant to change an otherwise satisfactory formula and risk another bad experience. But it's certainly an option, and one I may yet try.

Your apparent drug sensitization, marisuela, is intriguing and just more evidence of how seemingly unique everyone is with regard to tolerance. I *wish* I was able to quit cold turkey without any side effects! Alas, my entire life becomes a side effect when I go off the meds.

I feel obliged to self-disclose that I actually don't suffer from ADHD. (I didn't want to complicate my original post with tangential information that might lead off-topic.) Along with a maximum dose of the antidepressant bupropion, I'm taking just under the maximum dose of dextroamphetamine (half in the form of the extended-release pro-drug Vyvanse and the other half as plain dextroamphetamine/Dexedrine) for dysthymia (relatively mild but very chronic depression) as well as, to a lesser extent, obsessive-compulsive personality disorder. My psychiatrist decided to try it out after trying numerous SSRIs all to the same effect: I was less emotionally depressed, but I was still physically depressed and lethargic—I slept a lot and would frequently stay in bed from lack of energy. Since going on the dextroamphetamine, my life has done a 180, and I'm now in the best physical and mental health of my life (though still far from what I'm working toward). Unfortunately I seem to have developed a tolerance to the dextroamphetamine and am starting to slip back into dysthymia. I'm at the maximum dose and my psychiatrist refuses to increase above the maximum (my insurance wouldn't cover a super-maximum dose either), which is probably the right call on her part given the experimental nature of using this drug for dysthymic disorder and its potential for problems at too high a dose. I'm looking for ways to reverse my tolerance and boost myself back up to 100% so I can continue to improve my physical health and life situation to a point of eventually being able to get off drugs altogether. (I may [I]have [/I]to be on drugs the rest of my life, but my goal is to get to a state where I can at least try reducing or eliminating them. I'm about 70% there.)

I posted to this board because my savior happens to be an ADHD drug, and nobody on the "depression" boards has much experience with what I'm taking or experiencing. I also have a niece who [I]is[/I] ADHD and taking Adderall, and your ADHD-specific suggestions about clean living and such are ones I can relay to her as well. Interestingly, some of them still hold true for dysthymia albeit for different reasons. For example, Bob mentions how structure helps coping with ADHD. Structure also helps tremendously with dysthymia though in a very different way!

Again, thank you for your extremely helpful input. I've already started employing some of it (like the L-Tyrosine and avoidance of acidic foods) and I have started to notice a bit of improvement though not yet back to the 100% I was at. :cool:





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