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?
--
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?
poster:antennastoheaven
thread:1046078
URL: http://www.dr-bob.org/babble/20130617/msgs/1046078.html