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Alternate ADHD meds—is it time to switch?


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Posted (edited)

My 21 yo was diagnosed ADHD (inattentive-impulsive) at 18. They didn’t start taking medication regularly until  a year or two later. They found the IR adderall super helpful. It reduced anxiety and allowed them to get things done in more normal amounts of time.  They take 10mg 1-2x a day, depending on the demands of the day. It doesn’t seem to be sufficient anymore. Dc has bad task avoidance and failed two college classes due to apparently just not doing any assignments all quarter and not telling me until finals week (they have been a Dean’s list student up to this point). They can take their adderall and then go to sleep. It just doesn’t seem to do much anymore. I’m wondering if trying something else would be better than increasing the adderall.  They are on lexapro for anxiety as well, so it needs to be compatible. 

Edited by KSera
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Our only experience with Adderall was extremely limited -- I think DS only used it for a day before we knew it wasn't working for him and switched to something else. But he has tried quite a few different ADHD meds over the years and has changed when things quit working as well. Currently he uses Concerta, and he also does use Lexapro, as well, so they can be used together.

For your situation, It looks like that's still a fairly low dosage of Adderall, so it would be possible for them to go up, as one option. It does sound like what they are taking now  is not working well enough, if they can go to sleep while on it. Since the Adderall used to work better, trying a higher dose might be a good first step, but I think it's also fine to ask the doctor to try something different instead.

Hopefully they will have enough time this summer before classes start again, to get an optimal med regime in place. As a side note, we found last fall that increasing DS's Lexapro dose by 5 mg made a huge difference with some issues he was having at the time, so changing that dosage could be something to discuss, as well.

If it were my decision, I might ask the doctor to increase the Adderall dosage by quite a bit and try that for a couple of weeks. I bet you could tell a difference in just a week. And then switch to a different kind of med after that, if the increase doesn't have the impact that is needed. Our doctor's first response is usually to increase dosage before switching the med, but if you feel strongly that you think they should try something new, you can advocate for that.

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Posted (edited)
30 minutes ago, Storygirl said:

As a side note, we found last fall that increasing DS's Lexapro dose by 5 mg made a huge difference with some issues he was having at the time, so changing that dosage could be something to discuss, as well.

Thanks. Your whole post is very helpful. This is an interesting thought I hadn’t considered. I feel like it’s a bigger deal going up in lexapro than adderall, but given all the sleeping and the decrease in mood and function the last couple months, maybe that would be good to consider. It’s all their choice at this point, but they still look to me for help in these kinds of things and they have a history of being fairly medication averse, so increasing dosage is likely to make them nervous (they were apparently going on and off their medication all quarter “to know they could” 🤦‍♀️, so that absolutely wouldn’t have been helping their functioning. It’s still not been a month back fully on the lexapro, so we’ll let that kick in fully first.)

Edited by KSera
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The first step is to increase dosage. That’s normally how it’s done. Is the 10 mg the amount prescribed initially, or has that been an increase already?

My son is in the process of getting up to speed on an ADHD med. We’ve done this in the past, then tried taking him off, and now he’s back on…and we’ve gone round and round with about 4 different meds.  The normal way they do this is to start you off at the lowest dose, and then up it bit by bit every 2 weeks until the person can feel the effects. 

I don’t think a doctor would advise you to switch meds before changing doses, unless there are adverse side effects from this one.

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1 hour ago, Storygirl said:

If it were my decision, I might ask the doctor to increase the Adderall dosage by quite a bit and try that for a couple of weeks. I bet you could tell a difference in just a week. And then switch to a different kind of med after that, if the increase doesn't have the impact that is needed. Our doctor's first response is usually to increase dosage before switching the med, but if you feel strongly that you think they should try something new, you can advocate for that.

I agree.

We found that for meds adjustments with the adult in the household, using a psychiatric nurse practitioner helped a lot. From there, the family doctor picked up on the scripts and made the monthly refills happen.

1 hour ago, KSera said:

It’s all their choice at this point, but they still look to me for help in these kinds of things and they have a history of being fairly medication averse, so increasing dosage is likely to make them nervous (they were apparently going on and off their medication all quarter “to know they could” 🤦‍♀️, so that absolutely wouldn’t have been helping their functioning. It’s still not been a month back fully on the lexapro, so we’ll let that kick in fully first.)

If you need a PM for your child to read about why skipping meds is a bad idea, I have a vivid description of how meds played a non-trivial part in our deciding to fire one of kids' therapists because she was going off her meds as a trial before getting pregnant. I am not sure when she was on vs. off her meds while she worked for us, but it wasn't pretty--she volunteered the information about the meds herself at some point, but I didn't probe about how long she'd been not taking them to know entirely how it lined up with all the balls she dropped that we had to pick up. We're talking about an adult professional with multiple degrees and credentials to work with kids who had ASD and ADHD. Talk about a face-plant emoji! It was a painful year of trying to work with her, though she did identify a specific problem that no one else had so far (and then proceeded to blast my kid about his ADHD when her accommodations were not effective enough to solve or accommodate the problem, which was not due to ADHD!!!). We have since gotten effective intervention for that problem, and it's very clear that her diagnostic skills were good even if she blamed him when her therapeutic skills failed to make a difference. Anyway, when all else fails, blame someone else's ADHD, right? Anyway, there is so much more I could say. ADHD + adulthood + no meds does not equal good things, IME. My other examples of unmedicated ADHD are not necessarily diagnosed.

I do have one good example of someone who does well as an adult with meds, if you need that as well. 

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Another note about the Lexapro... I'm sure this can vary a lot, but when DS first started on it, we weren't sure whether it was having an effect. We were seeing the psychiatric nurse practictioner pretty frequently at the beginning, monthly maybe. She would ask if we wanted to try something different/stronger, and we would say that we wanted to wait and give the Lexapro more time, because we were hesitant to jump up to a more intense kind of med with more potential side effects. Our NP was great and would explain the way all of the meds would work (she would draw diagrams) and would give us options and let us choose.

Anyway, I wasn't sure for a couple of months whether the Lexapro was working, and then suddenly we could definitely tell that it was, and it is super helpful for DS. He feels that for himself, which is a big deal, because he can't really tell for himself when his ADHD meds are working.

So it possibly could take a few months for the Lexapro to be giving its full effect. I'm no expert, but that's been our experience.

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2 hours ago, Garga said:

The first step is to increase dosage. That’s normally how it’s done. Is the 10 mg the amount prescribed initially, or has that been an increase already?

 

Starting dose was 5mg for the first month. It’s been probably 18 months since they first started it. 

1 hour ago, kbutton said:

I agree.

We found that for meds adjustments with the adult in the household, using a psychiatric nurse practitioner helped a lot. From there, the family doctor picked up on the scripts and made the monthly refills happen.

If you need a PM for your child to read about why skipping meds is a bad idea, I have a vivid description of how meds played a non-trivial part in our deciding to fire one of kids' therapists because she was going off her meds as a trial before getting pregnant. I am not sure when she was on vs. off her meds while she worked for us, but it wasn't pretty--she volunteered the information about the meds herself at some point, but I didn't probe about how long she'd been not taking them to know entirely how it lined up with all the balls she dropped that we had to pick up. We're talking about an adult professional with multiple degrees and credentials to work with kids who had ASD and ADHD. Talk about a face-plant emoji! It was a painful year of trying to work with her, though she did identify a specific problem that no one else had so far (and then proceeded to blast my kid about his ADHD when her accommodations were not effective enough to solve or accommodate the problem, which was not due to ADHD!!!). We have since gotten effective intervention for that problem, and it's very clear that her diagnostic skills were good even if she blamed him when her therapeutic skills failed to make a difference. Anyway, when all else fails, blame someone else's ADHD, right? Anyway, there is so much more I could say. ADHD + adulthood + no meds does not equal good things, IME. My other examples of unmedicated ADHD are not necessarily diagnosed.

I do have one good example of someone who does well as an adult with meds, if you need that as well. 

We do use a psychiatric NP, and we like her and have good rapport. She takes time with the kids. My dc was not just taking the adderall sporadically, but doing the same with the lexapro and also her thyroid meds 🤦‍♀️. It actually makes me feel better realizing it’s been not yet a month since they resumed lexapro after being sporadic and then taking a couple weeks off. They might not be back to fully medicated baseline yet  

 

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Posted (edited)
20 minutes ago, KSera said:

Starting dose was 5mg for the first month. It’s been probably 18 months since they first started it. 

We do use a psychiatric NP, and we like her and have good rapport. She takes time with the kids. My dc was not just taking the adderall sporadically, but doing the same with the lexapro and also her thyroid meds 🤦‍♀️. It actually makes me feel better realizing it’s been not yet a month since they resumed lexapro after being sporadic and then taking a couple weeks off. They might not be back to fully medicated baseline yet  

 

It can take 6 weeks for Lexapro to get up to its full effects, taking it consistently without stopping and starting.

Edited by Garga
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Also, my son is 18 and on ADHD meds and I don’t care how much he fusses at me, but I set an alarm and I check with him Every Single Morning to be sure he’s taken his meds.

It’s the nature of having ADHD that you forget to do things like take meds.

I have him send me a screen shot of his empty day-of-the-week pill case. 

He forgets to take them about every 5 or 6 days. Someone who is 18 years old and has ADHD has the executive function of a 12 year old. If you wouldn’t expect a neurotypical 12 yo to remember to take some serious meds every day (and I wouldn’t), then you can’t expect an ADHD 18 yo to remember to take them. 

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1 minute ago, Garga said:

18 years old and has ADHD has the executive function of a 12 year old. If you wouldn’t expect a neurotypical 12 yo to remember to take some serious meds every day (and I wouldn’t), then you can’t expect an ADHD 18 yo to remember to take them. 

I agree, but circumstances dictate that I be as hands off as is prudent (which is now clear is less hands off than I had been this past 6 months). 21 is a different stage than 18, and dc wouldn’t even be living at home right now if not for Covid. They will be on campus in the Fall. This was an issue not of forgetting, but of dc being worried about getting addicted to the medications and wanting to keep going off them to show themself they weren’t addicted. Possibly a bit of an OCD related issue. 
 

My 18 yo is an entirely different issue and I hold and administer all of that dc’s meds. 

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1 hour ago, KSera said:

This was an issue not of forgetting, but of dc being worried about getting addicted to the medications and wanting to keep going off them to show themself they weren’t addicted. Possibly a bit of an OCD related issue. 

I hope you can get through with a more helpful POV. Hugs.

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Just now, kbutton said:

I hope you can get through with a more helpful POV. Hugs.

Thanks. They seem on a good track right now. I think it was all exacerbated by a bad therapist who thought dc needed to put more distance between themself and us and be more independent (without therapist having any clue why we were still needed to the degree we are). Failing classes was a wake up call and dc has fired that therapist and is doing much better than they were under her care. Why do so many therapists think they know better than the parents who have known the kid their whole life?

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Posted (edited)
4 hours ago, KSera said:

I agree, but circumstances dictate that I be as hands off as is prudent (which is now clear is less hands off than I had been this past 6 months). 21 is a different stage than 18, and dc wouldn’t even be living at home right now if not for Covid. They will be on campus in the Fall. This was an issue not of forgetting, but of dc being worried about getting addicted to the medications and wanting to keep going off them to show themself they weren’t addicted. Possibly a bit of an OCD related issue. 
 

My 18 yo is an entirely different issue and I hold and administer all of that dc’s meds. 

OoooOOoo! I thought you were talking about the 18 yo and that they wanted help with medical stuff. I’m realizing I got you mixed up with another poster that was saying her 18yo *did* want help with medical issues. Since the context was all wrong, I probably came across as sounding self-righteous! Yikes! I’m sorry! 

 

Edited by Garga
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13 minutes ago, Garga said:

OoooOOoo! I thought you were talking about the 18 yo and that they wanted help with medical stuff. I’m realizing I got you mixed up with another poster that was saying her 18yo *did* want help with medical issues. Since the context was all wrong, I probably came across as sound self-righteous! Yikes! I’m sorry! 

 

No, no, you came off fine. I probably came off a little brusque in my reply, and didn't intend it that way either. I just sound that way when I type 😂. We're all good 😊.

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12 hours ago, KSera said:

Thanks. They seem on a good track right now. I think it was all exacerbated by a bad therapist who thought dc needed to put more distance between themself and us and be more independent (without therapist having any clue why we were still needed to the degree we are). Failing classes was a wake up call and dc has fired that therapist and is doing much better than they were under her care. Why do so many therapists think they know better than the parents who have known the kid their whole life?

Yup they do this. 
 

If the anxiety is still not under control with firing the person who destabilized them then that’s the place to start. Med noncompliance due to anxiety means get the anxiety tamped. Maybe try a medication app?

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