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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by jazzaholic on July 6, 2002, at 18:11:03
Hi,
I have been treated many years for depression and ended up doing pretty well with Prozac 20 mg and 10 mg of Klonopin. So well I quit smoking and drinking! When I recently started to feel some depression again, I described a lack of concentration, weariness, and also asked about something my daughter had responded well to - Adderall.
He gave it to me for a month, 20 mg and when I went back I told him how I was focused at work again, getting things done, feeling confident and how it seemed to offer a renewed outlook with vigor and determination. He therfore prescribed 5 months worth and I see him again later this month.
The problem was the good effect did not last. I began taking the Adderall a bit later in the day as I was starting to feel like i was falling asleep again after lunch and driving home.
Bottom line is, i think the dose is not working anymore. I tried 2 one day and the benefits returned.
Since I was prescribed a certain amount, I knew that wouldn't work however. I then experimented with medicines similar. Namely Didrex and Phentermine which were available online. This helped allot, but there was no question the Adderall felt healthy and right while these misxtures could make me nervous. I also knew self medicating was bad for me.Well, I want to work with my doctor. When i see him, i am afraid of mentioning the experiments as he may give me nothing. What I want is advice as to how to get the benefits of Adderall without it becoming less effective. I think a greater dose might help, but if that just happens again, then what?
In other words I had a glimpse of productivity and being able to focus again, and now I don't know what to tell him. I was going to just say it helped for awhile and the benfits became less.
Any thoughts on getting the right help from your doctor without being branded as an addict and left with nothing? Why did the Adderall have to start failing? Would an increase dose help? IS there a group of medicines you rotate through.
By the Way, he diagnosed ADD when giving it to me in the first place. he cautioned about addictiveness.
Any insight is most welcom.
Posted by fachad on July 6, 2002, at 21:00:16
In reply to Please Advise on Adderall Loosing Effectiveness??, posted by jazzaholic on July 6, 2002, at 18:11:03
jazzaholic,
The first thing you should think about and really become clear on is what you mean by "effectiveness", and what things are not the same now that it has "lost effectiveness".
The euphoria, appetite suppressant, and stimulant effects of amphetamines wear off eventually for everyone that takes these meds on a regular basis.
Those effects are short-term achievable, but not long-term sustainable.
Increasing the dose only buys a little time and you will eventually hit the FDA prescribing limit, where no further dose increases are possible. Thus, increasing the dose as tolerance develops is a dead end strategy.
I don't know how well you would fare if you asked for a dose increase after this much time. Pdocs are usually willing to adjust the dose in the initial period, but they are usually reluctant to do so later in the game. You could try asking, your pdoc may be fine with it, but I'd tread lightly there.
Short of actually increasing the dose, there are a few things you can do to help maintain the benefits of your current Adderall dose.
First and most important IMHO, is to set realistic expectations about what this med will do for you long term. As I said earlier, the euphoria, appetite suppressant, and stimulant effects will wear off. If you increase the dose, those effects will come back; then they will wear off again. Thinking about that may make a dose increase seem like less of a good answer to you.
Second, you can take supplements to make sure your body does not become depleted of dopamine. Adderall causes release of dopamine from storage; with regular use you can deplete your stores.
Dopamine is synthesized from l-tyrosine. Vitamin C and several of the B Complex Vitamins are required for the synthesis. So a Vitamin C, B complex and l-tyrosine supplements would not be a bad idea.
Finally, you could try several variations on the "drug holiday" concept. Often people take Adderall on Monday thru Friday, skip it on the weekends, and then find that it is working again on Monday.
If you stopped completely for a week or two, you would probably get effects similar to when you first started taking it. So you could try a 2 week drug holiday every few months.
Another thing to try that works for me is to take a lower dosage for a period of time or just frequently take a lower dosage. Your 20 mg tablets are double-scored; break a tablet into quarters and then try taking only 3/4 or 15mg for a few days or a week. Then 20 mg will seem like an effective dose again.
Good luck. Be sure to let us know how it goes.
-fachad
Posted by jazzaholic on July 6, 2002, at 23:23:26
In reply to Adderall Loosing Effectiveness?? Some Ideas » jazzaholic, posted by fachad on July 6, 2002, at 21:00:16
Thanks very much. The effectiveness lost was the lost ability to concentrate on my work easily and the return of me wanting to fall asleep driving home. This has been for a few months and now it does little for a short time. I was afraid to ask for more thinking I needed to wait some more and see him at the next appointment. However, he has cancelled that now and pushed it up 2 weeks. I almost was in tears when i first got the stuff because i was thinking about my work so clearly, it was easy and I had time for other things. It was not euphoria - just confidence and enjoying the work. I returned to playing an instrument and started to feel i was alive again. I did my best work and had some good all around experiences. Now, it is gone by 11 Am and, if anything I am grumpy. I'd like to just ask for more at this point. The holiday thing doesn't sound good. I do allot of mental activities all the time including music and writing and its not just at work that I want to be able to function to my potential. I'll call him since he postponed and ask for an increase. I should have done that months ago. I didn't know about dose adjustment early on.
Posted by fachad on July 6, 2002, at 23:45:15
In reply to Re: Adderall Loosing Effectiveness?? Some Ideas, posted by jazzaholic on July 6, 2002, at 23:23:26
It's odd that he just gave you 5 months' worth of a new med without any follow up for dose adjustments.
My pdoc is not big on frequent appointments - usually 15 min every three months if you take controlled meds, 15 min every six months or once a year otherwise...
But I always get an appointment in 4 weeks if I get a new med, so he can find out if there are any problems, or if the dose needs to be adjusted. And if the dose is adjusted, poof, another appt in 4 weeks.
But once I say, "yes, this is the right dose"...bam, right back to quarterly appointments.
You could try asking for follow up appointments in the future whenever you get a new med or feel a dose may need to be adjusted / optimized.
-fachad
> Thanks very much. The effectiveness lost was the lost ability to concentrate on my work easily and the return of me wanting to fall asleep driving home. This has been for a few months and now it does little for a short time. I was afraid to ask for more thinking I needed to wait some more and see him at the next appointment. However, he has cancelled that now and pushed it up 2 weeks. I almost was in tears when i first got the stuff because i was thinking about my work so clearly, it was easy and I had time for other things. It was not euphoria - just confidence and enjoying the work. I returned to playing an instrument and started to feel i was alive again. I did my best work and had some good all around experiences. Now, it is gone by 11 Am and, if anything I am grumpy. I'd like to just ask for more at this point. The holiday thing doesn't sound good. I do allot of mental activities all the time including music and writing and its not just at work that I want to be able to function to my potential. I'll call him since he postponed and ask for an increase. I should have done that months ago. I didn't know about dose adjustment early on.
Posted by Xevious on July 7, 2002, at 0:34:21
In reply to Please Advise on Adderall Loosing Effectiveness??, posted by jazzaholic on July 6, 2002, at 18:11:03
You didn't say what form of Adderall you are taking... Are you taking the IR tabs or the XR capsules (the ones with the beads)? If you are taking the IR tablets, you really *have* to take them twice a day - one when you get up and the second about 4 hours later - because this drug only lasts 5-6 hours.If you're only taking one in the morning, this is why you feel so sleepy in the evening.
If you are taking two, and by 20mg you meant 10mg twice daily, or 20mg XR form, you may need to increase your dosage. In adults, taking 40-60mg/day is not uncommon.
My best dosage is between 40 and 50mg/day, with approx. 1/3 of the dose in the morning and 2/3 at noon, to overcome the same-day tolerance effect. When I started Adderall, I responded very well to only 20mg in equally divided doses - after about four weeks, my body needed more.
So try a greater dose, and be sure that you're dosing twice daily!
Good luck...
Posted by jazzaholic on July 7, 2002, at 11:57:05
In reply to Re: Please Advise on Adderall Loosing Effectiveness??, posted by Xevious on July 7, 2002, at 0:34:21
As for the type taking, it is XR capsules. Being new to what this was, I did actaully have a 4 week follow up.
I was thinking then that teh dose did not seem right, but did not mention it thinking he may have construed that as a bad sign. I was trying to go along and see if it worked out. I hope I have not ruined my chances at working with him to get a dose adjustment as I had never taken anything like this before. I'd like to try 40 or 60 a day spread out a bit and then maybe do the "holiday approach" as I may have accomplised what I needed to at work, I could actually just do some things that do not require a mental accuity at all times - like have fun!!For Prozac, I actually adjusted it down for about a year and he seemed to not mind my wanting to do that. Then, when I was not feeling well, I asked and he allowed it back up. I guess I thought that kind of long term give and take would be possible here. He is very open and knows I have, in general done very well under allot of stress.
Thanks to all, what a great group to find!
-Jazz
This is the end of the thread.
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