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Signs that the Adderall is working


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Tomorrow morning is day 1 for younger DD, Adderall 15 mg.

 

DH is VERY nervous about her taking this.

 

I'm iffy.

 

I've spent the past two weeks since her appointment with the fast food psychiatrist researching ADHD, medication, natural remedies, etc.

 

I'm still not sure medication is the right choice.  However, a little while ago she came out from her bedroom so frustrated because she *just.can't.focus* but she really wants to finish the book she's reading.  She had her earplugs in and everything, but her mind kept wandering.

 

OK, so all that to ask this:  How do I know that they're helping?  

 

One BIG fear of DH's is that she's been misdiagnosed and she'll become addicted to the medication.  He talks about it like Adderall turns you into a drug addict.  BIG huge thanks to the selfish a-hole's without ADHD misuse it (gotta pass that chem test, dontcha know).  Y'all are awesome.  Thanks-so-much for affecting the public perception of ADHD medications and making things more difficult for the kids who actually need them.

 

 

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Is Adderall the first stimulant she has tried? Who prescribed it?

 

I am *VERY* leery about Adderall, though I don't think it should be totally banned as it is in many countries. But I absolutely think it should be a "last resort" drug after safer stimulants (Ritalin & its variants, Stattera, etc.) have been tried and found not to work. Unlike the other stimulants, Adderall is pure meth. It is much more prone to addiction and abuse than the other stimulants for that reason.

 

I wouldn't give it to her unless you've already tried other stimulants.

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Signs it's working.

 

If it's working she will likely notice an increased ability to concentrate and get stuff done. If not, she may need a different dose or different stimulant.

 

For my crew it was like night/day. There was a honeymoon period where the ADHD meds seemed like a miracle and then it leveled out.

 

 

We use concerta not adderal. Both are stimulants.

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Is Adderall the first stimulant she has tried? Who prescribed it?

 

I am *VERY* leery about Adderall, though I don't think it should be totally banned as it is in many countries. But I absolutely think it should be a "last resort" drug after safer stimulants (Ritalin & its variants, Stattera, etc.) have been tried and found not to work. Unlike the other stimulants, Adderall is pure meth. It is much more prone to addiction and abuse than the other stimulants for that reason.

 

I wouldn't give it to her unless you've already tried other stimulants.

 

Adderall is not meth.  It is a mixture of amphetamine and dextroamphetamine.  Meth is methamphetamine.  

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For my crew it was like night/day. There was a honeymoon period where the ADHD meds seemed like a miracle and then it leveled out.

 

This.  At first a miracle and then then things gradually go back to where they were (sort of--take them off it and it *really* goes back).

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Is Adderall the first stimulant she has tried? Who prescribed it?

 

I am *VERY* leery about Adderall, though I don't think it should be totally banned as it is in many countries. But I absolutely think it should be a "last resort" drug after safer stimulants (Ritalin & its variants, Stattera, etc.) have been tried and found not to work. Unlike the other stimulants, Adderall is pure meth. It is much more prone to addiction and abuse than the other stimulants for that reason.

 

I wouldn't give it to her unless you've already tried other stimulants.

 

 

Um. Please delete this misinformation. Adderall is NOT METH. It is a stimulant medication just like Ritalin and Concerta. 

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Adderall is not meth.  It is a mixture of amphetamine and dextroamphetamine.  Meth is methamphetamine.  

 

Yes, but Ritalin and its variants (Concerta, Metadate, Methylin) are methylphenidate. Not an amphetamine at all and therefore safer.

 

Seriously, compare the side effects of Ritalin vs. Adderall: http://www.rxlist.com/adderall_vs_ritalin/drugs-condition.htm

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Yes, but Ritalin and its variants (Concerta, Metadate, Methylin) are methylphenidate. Not an amphetamine at all and therefore safer.

 

Seriously, compare the side effects of Ritalin vs. Adderall: http://www.rxlist.com/adderall_vs_ritalin/drugs-condition.htm

 

I think they're all...not so good.  But my objection was to the characterization that Adderall was the same thing as meth.  

 

It is not.  Methamphetamine (meth) has a methyl group that makes it more hydrophobic and, therefore, more easily absorbed by the brain.

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Yes, but Ritalin and its variants (Concerta, Metadate, Methylin) are methylphenidate. Not an amphetamine at all and therefore safer.

 

Seriously, compare the side effects of Ritalin vs. Adderall: http://www.rxlist.com/adderall_vs_ritalin/drugs-condition.htm

 

I'm looking at the link, but I'm having trouble seeing it. That RXList link has just a few side effects for adderall and tons for ritalin. It would seem to imply just the opposite.

 

The Dopamine Dilemma—Part II  The study I'm looking at here seems to be saying paradoxical decompensation (worse when you go off, tolerance resulting in higher dose needs, etc.) occurs with both meds. The amph class have their presynaptic DA release effect. Other than that, I can't find significant, significant differences. And once you go to the prodrug version (Vyvanse), you can't insufflate, which makes it dramatically safer from an abuse perspective.

 

To me the issue is what happens when they take a break and are experiencing the paradoxical decompensation (ie. are worse than they started). That, to my mind, would be a really vulnerable time. And the author of that study seems to be saying they just intentionally are sweeping stuff under the rug, not talking about the harder issues, not collecting data on them. So like to have data that says when the danger point is for abuse in kids taking ADHD meds, is there even data on that? Or to have tools to predict how long before the decompensation approves and they're back to their baseline set-point. I don't know if there's data on that. Those to me seem like the big issues, not whether it will work. For most kids (70%), the meds just work and it doesn't matter which one. 

 

That link also talks about drug holidays to decrease adaption and need for increased doses. But again, there doesn't seem to be enough data on it.

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So we finally started the Adderall today.  15 mg.  DD fell asleep a couple of hours after taking it.  She says it didn't really help.  On the bright side there were no negative side effects, so yay for that.   I don't know whether to keep having her try it or not.  Will it eventually start helping if she takes it long enough? Do I ask for him to increase the dosage?  

 

He gave us no instructions beyond "see you in 6 weeks, if she has a bad side effect call me, oh, and call in a month for a refill."   We're supposed to try it for 4 months and see if it helps.  What the... ???  He's our only psychiatrist option, so I have to make this work with him.  And, for what it's worth, I know I'm painting him as a total jerk.  He's not.  I'm just frustrated with the level of care. The more I educate myself, the more I realize that this isn't the way things are supposed to work.

 

 

 

 

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If I'm remembering correctly, 15 mg is a pretty low dose, assuming that your daughter is adult sized.  

 

Are you doing schoolwork right now?  If not, you may have trouble seeing any subtle effects that might come with a suboptimal dose.  

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She may need a dose adjustment. My son (short acting Ritalin) had no effect or very little effect until we got to the right dose. Then it was night and day--he said he felt calm inside, he stopped constantly moving and talking, he was able to sit down and do math on his own, less impulsive, etc. All that was from the first dose at the right dosing level. I would expect the same type of immediate response for the right dose of Adderall if a child was responsive. Kids react better or worse to certain meds sometimes. My son has tried and failed three different ADHD meds. I'm glad the Ritalin helps him.  

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I would give it a few days. Having math go better was a big indication for us that the meds were working for DS. Big change there. The meds do make a big difference in his behavior, but they do not make all of his ADHD-related issues disappear. If the change in your daughter is fairly subtle, it may take a few days to observe the differences. Put her in some situations that were challenging before, and see if things are a little better now (such as doing math, in our case).

 

DS had to try several different meds at various dosages before we hit the one that worked but didn't cause side effects. Our pediatrician worked very closely with us to tweak things. There were two meds that we instantly knew were wrong. One caused aggression (Adderall), and one made him sleepy (guanfacine) but didn't help otherwise. We discontinued those immediately, and the pediatrician called in a different prescription. Having a doctor who was willing to figure it out for us was key. In our case, it was our pediatrician. We did see a psychiatrist, but our pediatrician asked to oversee the meds himself, and we were glad we agreed, because we got very personalized attention from him during that med adjustment period.

 

After a few days, you could call the doctor's office to see if they might increase the dosage, as the first thing to try. If you don't like this doctor, would your pediatrician do the prescribing? They may be better to work with or more responsive.

 

One other thing. You mentioned that your daughter didn't notice a difference on the meds. Is she usually self-aware, or not? DS lacks self-awareness, and he cannot tell when his meds are working, even when it is obvious to the rest of us that they are in effect (or have worn off). So you may not be able to rely on your daughter's opinion alone; you will need to make observations yourself. I don't know if this is an issue at your house, but one of the things that is remarkably better for DS on meds is his ability to get along with others. He doesn't notice this himself, but those around him definitely do ;) .

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So we finally started the Adderall today.  15 mg.  DD fell asleep a couple of hours after taking it.  She says it didn't really help.  On the bright side there were no negative side effects, so yay for that.   I don't know whether to keep having her try it or not.  Will it eventually start helping if she takes it long enough? Do I ask for him to increase the dosage?  

 

He gave us no instructions beyond "see you in 6 weeks, if she has a bad side effect call me, oh, and call in a month for a refill."   We're supposed to try it for 4 months and see if it helps.  What the... ???  He's our only psychiatrist option, so I have to make this work with him.  And, for what it's worth, I know I'm painting him as a total jerk.  He's not.  I'm just frustrated with the level of care. The more I educate myself, the more I realize that this isn't the way things are supposed to work.

 

When my DS started Adderall, he (and we) noticed nothing at 5 & 10 mg.  He's 17 and a pretty big guy, FWIW.  When we switched to 20 mg, there was a definite difference.  Instead of lounging on the bed in the morning, he would actually go up and do his work without reminders.  He also worked more efficiently, although he didn't/doesn't like the way it makes him feel.  We have had a busy summer and have failed to follow up (I need to make an appointment ASAP), but after some good input on this thread,

 

http://forums.welltrainedmind.com/topic/649124-a-question-about-adderall/

 

I think we're going to have him try it for at least anther month when heavy school work starts again.  If he still feels uncomfortable after a month, we will try something else.

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One other thing. You mentioned that your daughter didn't notice a difference on the meds. Is she usually self-aware, or not? DS lacks self-awareness, and he cannot tell when his meds are working, even when it is obvious to the rest of us that they are in effect (or have worn off). So you may not be able to rely on your daughter's opinion alone; you will need to make observations yourself. I don't know if this is an issue at your house, but one of the things that is remarkably better for DS on meds is his ability to get along with others. He doesn't notice this himself, but those around him definitely do ;) .

 

This is a good point.  My son is not very self aware, either.

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So, here's where my confusion lies.  If the Adderall wears off after 12 hours, why would taking it for a week versus a day give different results? 

 

We start up with lessons again on 8/14.  I can have her keep trying it for this week and see if it makes a difference on the 14th I guess.   Are there other ways to test attention?  During the summer she's mostly just kind of doing her own thing, so the ADHD symptoms aren't intrusive (mostly).

 

Regarding the excellent advice to have her pediatrician take over the prescribing... she doesn't have a specific pediatrician or doctor.  There is only one very large clinic in our town that accepts our state aid insurance.   Unless you want to wait a very long time, you can't request a specific person.  There are only a handful of actual MDs there, the rest are Nurse Practitioners.  I don't think she's ever hit the jackpot and seen a doctor there.  The NPs can prescribe, but it's a total crap shoot whether the one we get knows anything at all about ADHD.  So, DD is stuck with this psychiatrist.  

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When my DS started Adderall, he (and we) noticed nothing at 5 & 10 mg.  He's 17 and a pretty big guy, FWIW.  When we switched to 20 mg, there was a definite difference.  Instead of lounging on the bed in the morning, he would actually go up and do his work without reminders.  He also worked more efficiently, although he didn't/doesn't like the way it makes him feel.  We have had a busy summer and have failed to follow up (I need to make an appointment ASAP), but after some good input on this thread,

 

http://forums.welltrainedmind.com/topic/649124-a-question-about-adderall/

 

I think we're going to have him try it for at least anther month when heavy school work starts again.  If he still feels uncomfortable after a month, we will try something else.

 

 

You could also look into adding a med for the anxiety or doing some CBT. 

 

I get not wanting to go down the med, add a med, another med, etc. route, which is why in that thread I said you could consider a career path that doesn't even require meds. But if he wants to be on the meds to achieve his goals, you're probably going to need to meet the anxiety head-on and deal with it with some CBT, meds, strategies, etc. Have you ever looked into Social Thinking? That would be another area to look at as part of the mix. Not a replacement, but just a worthwhile thing to look into. 

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Shiny, are you in the US or somewhere else? That's rough if it's hard to get access and follow-up appts. Where we are, the ped would see you every month until the dose was right (or more often if needed) and every three months after that. Like physically in the office, see you. So that's rough if where you are you can't get enough access to get the dose right. It sounds like the dose is too low because, like the others are saying, when it gets pretty close to right it should be pretty WOW. 

 

In the meantime, while you're researching and working on getting the meds right, you could try mindfulness with her. 15 minutes of basic mindfulness (a body scan, anything) will literally bump your EF (executive function) 30%!! So even if the meds are too low a dose, that extra bump might get her there. You can also look into strategies from 360Thinking.

 

But yeah, the mindfulness is really good. You can do it in the shower with a pulsing jet head, just letting it pulse each body part and noticing how it feels and affirming it. It doesn't have to be complicated or weird. 

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So, here's where my confusion lies.  If the Adderall wears off after 12 hours, why would taking it for a week versus a day give different results? 

 

 

I don't have a scientific answer. But I found that giving it more time gave ME more time to notice the differences. And gave us a greater variety of environments and experiences over which to observe behavior.

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You could also look into adding a med for the anxiety or doing some CBT. 

 

I get not wanting to go down the med, add a med, another med, etc. route, which is why in that thread I said you could consider a career path that doesn't even require meds. But if he wants to be on the meds to achieve his goals, you're probably going to need to meet the anxiety head-on and deal with it with some CBT, meds, strategies, etc. Have you ever looked into Social Thinking? That would be another area to look at as part of the mix. Not a replacement, but just a worthwhile thing to look into.

He doesn't want to be on the meds. I don't think he has much anxiety -- it appears he has the opposite -- not really caring, KWIM? Unless that is just a front. Hard to tell with teenage boys.

 

I don't think he will go into a heavy pressure job. He loves Biology and nature, and some kind of field work or even lab work might suit him. If he could find some kind of job that is not heavy on the time pressure but needs someone who is very observant, he would be a great employee. He sees and notices things that the rest of us do not. But he's not fast, and that seems to be a problem with everything.

 

I will look into Social Thinking. I have not heard of it.

 

Thanks for your input.

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I don't have a scientific answer. But I found that giving it more time gave ME more time to notice the differences. And gave us a greater variety of environments and experiences over which to observe behavior.

Good point.

 

My son doesn't seem to realize the difference the meds make, but my DH and I surely do. We've only observed in a limit situation, though. I think you're right that it would be good to see how it affects him in different situations.

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