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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by bigdaddy on September 18, 2004, at 23:29:19
I am a 38 yr old male, 6'9", 240lbs. I’m a generally happy, laid back, somewhat outgoing person. I am financially stable, have a good marriage, and enjoy my 3 daughters. There is some general stress in my life, but it’s manageable. I take Lexapro 10mg to treat mild depression. My depressive symptoms are usually irritability and decreased motivation. Nothing more serious than that, thankfully.
I've been taking Adderall at varying dosages for the past 4 months. I tried XR for awhile, but I seemed to get extremely irritable in the evenings, so I figured this was a side effect of the XR and changed to the regular Adderall (since the non-XR never caused those effects). The XR was good during the day but the evenings sucked and I was not my “normal” self. I was irritable to my wife and kids, etc.
I like the non-XR Adderall much better because I feel like I have more “control” with it in terms of duration of effects, etc. I have taken non-XR Adderall at 7.5, 10, 15, 20, and 30 mg dosages. I’ve experimented on my own by breaking the tablets in half or quarters to get the right dose. At the lower dosages, I don't get much effect. At 20mg I get a mild to moderate effect, and at 30mg, I get a very significant effect - increased ability to focus, energy, internal calmness, etc. I love it and can't believe what a difference it makes for me. I used to get quite a euphoric effect, which I couldn’t really articulate at the time because I was so new to the drug, but that has essentially worn off. I understand this is common – too bad! Actually, it was a bit weird being in SUCH a great mood.
I’ve never taken illicit drugs or drank alcohol. So it was my first experience with any drug no less an amphetamine.
Here's my question: I'm having a terrible time trying to figure out the right dosage for me. I usually take a morning dose at 7, then another at 11, then a last one at 3-4pm. When I take 30mg in the morning, it's fantastic, but wears off about 3.5 hours later. The next dosage of 30mg is good, but seems less “potent” than the morning dose. Then, if I take another dosage of 30mg in the afternoon, say around 3-4 pm, I not only get little effect, but it feels like the XR all over again - I feel irritable, anxious, and it produces very little, if any, positive effects like my earlier dosages. I also invariably get a feeling of low blood sugar, although I’ve never had a consistent problem with low blood sugar. There's a sense of "hunger" and whatever that feeling of low blood sugar is, but it's hard for me to describe.
Am I taking too much? My doctor says that because I'm such a big guy, 30mg 3/day would probably be okay. Do I take less mg. at my 2nd and 3rd times during the day? Is this some kind of rebound that I'm getting from too much? I’ve never personally known what a “come down” from a drug high is, but this is what I imagine it must be like, at least in a small degree.
Also, I hate to admit it, but my work involves sitting all day, I don't exercise, and I don't eat that well. My eating isn't horrible, but not that great. I wonder if I need to change my diet, eat more of something particular during the day, exercise, etc. I am not a big eater anyways, so it’s totally normal for me to eat breakfast, get busy with work, and not eat much again until dinner. Maybe a snack here and there.
Any advice is appreciated.
Posted by mattw84 on September 19, 2004, at 0:29:18
In reply to Adderall medication advice, posted by bigdaddy on September 18, 2004, at 23:29:19
30 mg per dose is quite a bit of adderall... But I won't go into that debate again...
In my personal experience, which not unlike yourself, I went through a few months of "trial and error" to find the correct dosing. I started with the XR and had a very similar experience as to what you described, so I switched to the short-acting (not to mention cheaper) version. Started at
15mg 3x daily; great in the morning and so on...Having tried numerous variations, my current dosing schedule is as follows:
** I set an alarm for 1 hour before I plan to wake up.
5:30 AM - 5mg
6:30 AM - Wake up
10:30AM - 10mg
2:00 PM - 5mg
6:00 PM - 5mgSo basically... start small (in my case start before your day actually starts) and then the bigger dose mid-day. Then a small dose to end the day and avoid the negative "rebound" effects.
I would also recommend taking the weekend off if you can, or at the least reducing your dosage significantly on weekends. That will help with the tolerance it sounds like you have developed.
Try something like:
15mg Before you get up
15mg Mid-Morning
30mg Mid-day
10mg EveningThat still is a total of 80mg a day which is pretty darn high. Good luck!
Matt
Posted by bigdaddy on September 19, 2004, at 0:46:48
In reply to Re: Adderall medication advice, posted by mattw84 on September 19, 2004, at 0:29:18
Cool, thanks for a thoughtful answer. Should I expect much in those afternoon doses? When I tried the 10mg's and 15mg's before, they didn't do much for me, but that was when I was taking them first thing in the morning, and then only the same dosages throughout the day. I hadn't thought about varying dosages at different points during the day...
Also, why do you take 5mg before you get up. Does it help you get up?
Finally, how do I tell I've built up tolerance? Is that why a later afternoon dose of 30mg is less effective, etc.?
Thanks
Posted by mattw84 on September 19, 2004, at 11:32:16
In reply to Re: Adderall medication advice, posted by bigdaddy on September 19, 2004, at 0:46:48
I think that increasing the dose as the day goes on makes the later doses more effective. I take the dose before waking because it makes me of a morning person, and not stuck in a fog trying to get my brain going... add'ers are notoriously not morning people!
I would guess you have a tolerance built up. Namely because 30mg 3x a day is quite a bit. It's when the dose loses it's overall efficacy... most docs will just keep increasing your dose whenever that happens. I suggest the weekend breaks to avoid the tolerance and make your regular dose more effective.
Posted by katalina on September 19, 2004, at 17:26:32
In reply to Adderall medication advice, posted by bigdaddy on September 18, 2004, at 23:29:19
Hi there,
I've been taking Adderall for about 3 years now and have obviously experienced a tolerance by now.
Firstly, from what I have researched and my own neurologist's opinion as well, is that body weight/size is not indicative of a "proper" dose. I am 5'4" and weigh under 100 lbs. and have 90 mgs. of Adderall XR per day at certain points during the past year. I usually take 30 XR in the a.m., like Matt said an hour or so before knowing I have to get up. This makes an enormous difference in my ability to rise and "shine". I am not a morning person and have two daughters 4 & 5 to get ready for preschool, which can be daunting on anyone, no matter how cheerful they are. I then take 20 IR (regular) Adderall at around noon and am good for the day.
I take 1.5 mgs. klonopin at night for sleep, which is losing it's effectiveness (I know it's not meant for sleep long term, but take it anyway to mellow out for those couple hours before bed).
I took 1 month off from Adderall at one point (cold turkey, no withdrawal, just back to my original unmotivated, bored with everything self) which allowed me to restart with taking the 90 mg. dose. I think the bottom line is that too many people continue to chase the dragon; to re-create that initial "zing" they got from the first few times they took Adderall. It doesn't come back, isn't prescribed to make ADD'ers act like speed freaks and talk a mile a minute about every little thing and clean your car with a q-tip. It's just meant to help non-functioning, disorganized people, function normally and create some order out of the chaos that everyone has in their life from time to time. Adderall still works for me, it just doesn't make me feel like it did in the beginning, which is why it's a Schedule II drug. JMHO.
Anyway, I would second Matt's advice on the dosing. The earlier doses are always more effective it seems. When I first started adding a second dose, I would almost forget some days because I would still be "high" from everything I accomplished in the morning and that would be enough to carry me through. It's easy to get greedy, I have done it many times, and like the saying goes "what comes up, must go down."
Good Luck - Katalina
Posted by utopizen on September 19, 2004, at 19:50:43
In reply to Re: Adderall medication advice, posted by katalina on September 19, 2004, at 17:26:32
I'm still convinced it's some level of depression that is at the root of the problem as to why I can't take it in the A.M. anymore to "wake myself up" doing that little 30 minutes before wake up trick I use to do.
Depression is funny like that-- I am majorly depressed now, but looking back over the last two years I realize now depression was slowly creeping up on me, giving me things like insomnia early on. i stuipdly convinced myself "no, I'm too happy to be depressed" until it got so severe I couldn't fool myself anymore.
Posted by man_oh_man1977 on September 19, 2004, at 22:22:50
In reply to Re: Adderall medication advice, posted by utopizen on September 19, 2004, at 19:50:43
Hi gang,
Very happy this post is going - I just started adderall two weeks ago and wow!, what a difference. Because I take Zyprexa I can conceivably sleep *all* the time. I am just learning how to regulate my dosages. This thread is very insightful. As for what you said, bigdaddy, "I wonder if I need to change my diet, eat more of something particular during the day, exercise, etc. " I know it's easier said than done, but part of you knows you should be doing this, so go for it! It will definenitely (sp?) elevate your mood. I suggest walking as it doesn't cost a thing, fresh air, you don't need a personal trainer, etc. And for mattw84 "add'ers are notoriously not morning people!", right on! Morning for me is around 1pm. (Thank goodness I work from home). Okay folks, thanks again for bringing this stuff up.
Peace,
Man-oh-man
Posted by bigdaddy on September 20, 2004, at 0:14:27
In reply to Re: Adderall medication advice, posted by katalina on September 19, 2004, at 17:26:32
Thanks for the advice and thoughts everyone. I'm fully resonating with what you said Katalina - I'm chasing that dragon. It was as if all the static on the radio dial became clear, I was energetic, and actually did stuff I always avoided. It still works well, but it's not that initial zing.
Btw - is anyone familiar with the side effects I spoke of in my first post - that "come down," empty, low blood sugar feeling. I'm just curious if this is typical, been experienced by others, or unique to me.
Posted by mattw84 on September 20, 2004, at 0:40:12
In reply to Re: Adderall medication advice, posted by bigdaddy on September 20, 2004, at 0:14:27
The "come-down" is commonly usually called the 'rebound' in the medical community. I am pretty sure it has nothing to do with blood sugar or the like. I think of it as like an engine running on 87 octane, adderall is the octane booster -- but the tank only lasts so long...hmm... Bad idea to try and make an analogy there, emmy's are on and I am far too distracted here to make sense... sorry! So yes, that is very common. I think everyone who uses stimulant medications has some degree of rebound. When I took Concerta (Ritalin) my rebound was far far worse than with the adderall.
I still think your dose it mighty high, like katalina mentioned, the dose is not related to weight. Also, IMO, such a high dose makes it much less likely that you will ever stop taking it. Personally I am trying to learn to be just as focused and motivated without the meds, at least that is my goal. Most ADHD meds are essentially speed, so I guess I just would like to not be dependent on it for the rest of my life. To each his own though... Meh...<shoulder shrugging> That probably makes no sense, but neither does me being distracted by the emmy's.
Matt
Posted by bigdaddy on September 20, 2004, at 0:55:52
In reply to Re: Adderall medication advice » bigdaddy, posted by mattw84 on September 20, 2004, at 0:40:12
I've wondered about what you've said - dose being too high. I'm certainly open to considering it. The lower dosages I've tried, including 7.5, 10, and 15 didn't do much. At least I think. I'm far more "in tune" to my body's reactions to the meds now that I've had a few months practice "listening."
Do you think I should take a week - several weeks break, and then start all over again with a more systematic way of finding a good dose? Mind you, I'm not really looking for the Zing, although I did like it. I'm looking for the perceptibly noticed increase in energy, motivation, clarity in thinking, etc. I'm really not interested in turning this into a thing where I'm looking to get stoned, and I can see how seductive that is, at least for awhile. What I really want, is just to find a dosage that makes a noticeable difference, but that I won't crash so hard either.
Btw, I tried a 15mg 1-hour before I got up this morning, then another 15mg at 11am, then a 45 at three. My day went so much better today no hills and valleys -- until later in the evening when the 45 wore off - crash time again. But the idea of doing it this way is potentially very helpful for me, so thanks again for the advice. Perhaps I need to take that last dose down just a bit!
Posted by grandcentral on September 20, 2004, at 10:10:15
In reply to Re: Adderall medication advice, posted by man_oh_man1977 on September 19, 2004, at 22:22:50
Man-oh-man,
I just started adderall xr on Friday so I'm interested in your experience thus far. You wrote that you started two weeks ago and apparently it has made a difference. How much are you taking and what is your sachedule throughout the day? I was told to begin with one 5 mg capsule in the am and then up it to 10 mg. So far I have not noticed much.
> Hi gang,
>
> Very happy this post is going - I just started adderall two weeks ago and wow!, what a difference. Because I take Zyprexa I can conceivably sleep *all* the time. I am just learning how to regulate my dosages. This thread is very insightful. As for what you said, bigdaddy, "I wonder if I need to change my diet, eat more of something particular during the day, exercise, etc. " I know it's easier said than done, but part of you knows you should be doing this, so go for it! It will definenitely (sp?) elevate your mood. I suggest walking as it doesn't cost a thing, fresh air, you don't need a personal trainer, etc. And for mattw84 "add'ers are notoriously not morning people!", right on! Morning for me is around 1pm. (Thank goodness I work from home). Okay folks, thanks again for bringing this stuff up.
>
> Peace,
> Man-oh-man
Posted by mattw84 on September 20, 2004, at 12:30:11
In reply to Re: Adderall medication advice, posted by bigdaddy on September 20, 2004, at 0:55:52
Maybe try 15-15-30-15, last dose about when you would normally "crash." I find that the later I take my evening dose the easier it is for me to fall asleep, but for some a late dose might cause some insomnia. So try it sometime when you can risk not sleeping well, just to see if that works for you... worth a shot!
Matt
Posted by grandcentral on September 20, 2004, at 13:16:13
In reply to Re: Adderall medication advice, posted by mattw84 on September 20, 2004, at 12:30:11
Thanks, thats a big help. My doctor said we would have to start low and work high and then stop once I said it was too much or that I didn't know the difference after an increase. What did you notice when the dosage was too high and has it affected your appetite?
Also, how many hours in between your dosages?
Posted by grandcentral on September 20, 2004, at 13:22:42
In reply to Re: Adderall medication advice, posted by grandcentral on September 20, 2004, at 13:16:13
Actually, I realized that I am currently taking the xr and that it might be different than the timing and dosages of the other adderall type. Any preferences on the two?
Posted by mattw84 on September 20, 2004, at 14:43:40
In reply to Re: Adderall medication advice, posted by grandcentral on September 20, 2004, at 13:22:42
The XR is intended to be once daily, I think the max dose for it is 30mg. It is essentially like taking 2 doses of the immediate release throughout the day. At 10mg the XR releases 5mg immediately, and 5mg 4 to 5 hours later; in my experience you get about 9 or 10 hours of decent coverage with the XR. When you get to the right dose you should be more motivated, more able to focus on one task at hand, and any other symptoms that led you to the ADHD dx in the first place. You should not have much appetite suppression, if you do have this side effect you need to force yourself to eat because not doing so will make the adderall not only less effective, but can increase other negatives like headaches, nausea, jitters, etc... At the ideal dose you shouldn't 'notice' the drug taking effect, just that you feel like it's time to get some work done. You may feel a little 'rebound' as the drug wears off, that is normal though; if it is an unpleasant 'crash' when the drug wears off you may be taking to much or may just need to try another stim. I had a nasty crash with Ritalin, headaches, extreme fatigue, irritability, and just felt weird. So I switched to the adderall which I have found to be much much better! The XR works great depending on how long you need coverage, if the coverage doesn't seem long enough you should ask to switch to the regular release version. Some pdocs will have you take the XR twice daily, which I strongly advise against. Good luck! BTW, very few people respond to the 5 or 10mg XR's, at 15 or 20 you should begin to see some dramatic changes.
Matt
This is the end of the thread.
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