I was diagnosed as having adult ADHD and was trialled on a few stimulants about 5-6 years ago. Ritalin caused a really strange reaction consisting of a deep depression, so I quickly gave up on it and asked to try dexamphetamine. This worked better and I was placed on a dose of 30 mg per day, which is a fairly high dose. I had been hoping that in addition to treating my ADHD the drug might reduce my anhedonia, which has been with me for many years. It may have done this initially, but once I was up to 30 mg/day for a while I started noticing that I had strong emotional blunting rather than a positive stimulant effect. I wasn't on any SSRIs or SNRIs, or any other serotonin drugs, or on benzos. I was switched to Vyvanse, 70 mg per day I think, again a high dose, and my anhedonia did not improve. In the end I decided to wean myself off stimulants because obviously they were creating an undesirable emotional state, even though they may have been helping my ADHD. I'm looking to give stimulants another try, maybe Ritalin this time, as it may have just been a coincidence that I had a depressive episode while trying it (I've had depression for many years). I tried the remaining Ritalin tablets later on, after I'd weaned off stimulants, and there was no depressive effect.
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BDD Moderators: Keif’ Richards
Stimulants Can too high a dose of ADHD drugs actually cause anhedonia in the long run?
- Thread starter Troppo
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Greenlighter
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I entirely misread this originally, but will keep the misread reply up anyways in case others are curious. But the answer is yes. For many people high dose stimulants cause anhedonia, likely related to the d2 receptor. You can try lower doses or alternatives. If you’re struggling with anhedonia that won’t respond to stimulants then aticaprant (especially), 9-me-bc, and roflumilast may be worth looking into. The dopamine system is highly complex and more isn’t always better, every has a unique neurobiology and responds to things differently, so no you aren’t broken for getting depression/anhedonia from stimulants, I sometimes get the same thing depending on the stimulant and the dose.
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Misread reply (thought you were asking if long term high doses of stimulants can cause anhedonia, keeping it in case others find value in it)
Yes absolutely, adhd meds intrinsically cause negative changes in the dopaminergic system. It’s innate to their mechanism of action. Amphetamines do this more so for a variety of reasons (particularly because they display signs of neurotoxicity to dopaminergic neurons), but Ritalin, which is generally safer in almost every regard, but less effective, also causes downregulation and dysregulation of dopaminergic signaling. The only adhd meds that would be unlikely to cause anhedonia with long term use are those that don’t act on dopamine at all, like norepinephrine reupatake inhibitors (strattera/atomoxetine) a2a agonists (Intuniv/guanfacine). Bupropion is a dopamanergic, but has some whacky pharmacology and isn’t super effective for adhd, but doesn’t seem to cause anhedonia frequently with long term use. Modafinil and its analogues are similar. In theory if you could find a dopaminergic that doesn’t cause an increase of DA in the nucleus acumbens it would be unlikely to cause anhedonia, and wouldn’t be reinforcing for that matter. I’m just not aware of any.
The good news is that it’s reversible! Your brain heals itself with time and substance-induced anhedonia has a much higher chance of going away than “natural” anhedonia. Certain supplements like cerebrolysin/cortexin, bromantane, and my favorite 9-me-bc can all speed up the process of returning to normal. Iirc there was a collection of Reddit anecdotes that showed even amongst the heaviest drug users, 9-me-bc tended to reduce anhedonic symptoms in as little as 7-14 days.
——————————————————————
Misread reply (thought you were asking if long term high doses of stimulants can cause anhedonia, keeping it in case others find value in it)
Yes absolutely, adhd meds intrinsically cause negative changes in the dopaminergic system. It’s innate to their mechanism of action. Amphetamines do this more so for a variety of reasons (particularly because they display signs of neurotoxicity to dopaminergic neurons), but Ritalin, which is generally safer in almost every regard, but less effective, also causes downregulation and dysregulation of dopaminergic signaling. The only adhd meds that would be unlikely to cause anhedonia with long term use are those that don’t act on dopamine at all, like norepinephrine reupatake inhibitors (strattera/atomoxetine) a2a agonists (Intuniv/guanfacine). Bupropion is a dopamanergic, but has some whacky pharmacology and isn’t super effective for adhd, but doesn’t seem to cause anhedonia frequently with long term use. Modafinil and its analogues are similar. In theory if you could find a dopaminergic that doesn’t cause an increase of DA in the nucleus acumbens it would be unlikely to cause anhedonia, and wouldn’t be reinforcing for that matter. I’m just not aware of any.
The good news is that it’s reversible! Your brain heals itself with time and substance-induced anhedonia has a much higher chance of going away than “natural” anhedonia. Certain supplements like cerebrolysin/cortexin, bromantane, and my favorite 9-me-bc can all speed up the process of returning to normal. Iirc there was a collection of Reddit anecdotes that showed even amongst the heaviest drug users, 9-me-bc tended to reduce anhedonic symptoms in as little as 7-14 days.