Need help finding an alternative to Adderall IR

[harsh]

I've been prescribed Adderall IR for about a year and a half now, increasing dosage from 40mg/day to my current 60mg/day. As expected, my tolerance continuously increases to the point that 60mg barely does enough to keep my attention on typing a single e-mail at work anymore.

Of course, few doctors (at least none I've met) will cross the line of prescribing more than that 60mg/day limit. Unfortunately this has forced me to self-medicate on particularly work-intensive days. On these days, I take another 20mg every time my attention and focus slip off into ADHD land.

In my personal life, my girlfriend has always disagreed with the usage of Adderall and other drugs to treat what she thought was just my own form of laziness and carelessness. (In fact, this seems to be the mindset of a lot of non-ADD/ADHD people out there, as I've experienced the discrimination associated with my condition.)

Within the last couple of months, though, my girlfriend now thinks I actually need MORE medication rather than less. On the days I don't take my meds, she says she can barely handle me - I tend to be extremely flighty, forgetful, childish. She's a 5th grade teacher, so she says she spends half her day dealing with the ADHD 12-year-olds only to come home and deal with yet another.

I am going to a specialist today for the first time (usually just seen general doctors before) and I am hoping for a better long-term treatment. I just can't handle living like this forever, and I know I'm breaking the law by taking more than my prescribed dosage on those tougher days. Doubling or even tripling my dosage would probably cure my problem (I know - I've tried it), but few doctors will support that, plus it only does more to raise my tolerance.

Some other things I've tried in the past to help:

• Strattera (terrible)
• Ritalin/Concerta (far less effective than amphetamine)
• Dexedrine (I had a low dosage, but it still seemed to have little effect on me)
• Adderall XR (same as my current - just lasts maybe 1 hour longer)
• Vyvanse (pretty decent results, but would build in my system over several days and cause strong anxiety issues)

One other option that I believe is in the early stages of development is biofeedback training. Any insight on this type of treatment would be greatly appreciated.

Thank you all in advance.

 

[ATLL765]

The only thing you can do is take a break from it and lower your tolerance that way. In my experience ADHD meds are EXTREMELY over prescribed.

It seems as if doctors give these away faster than they do stickers to a little kid after a shot. Between that and parents that think that a 6-7 year old having attention problems MUST mean the child has ADHD and not just write it off to normal child behavior or even a problem with that parenting has created a giant amount of people who use ADHD meds that do not have ADHD. This has given off the idea that maybe ADHD either doesn't exist or that it's effects are greatly exaggerated. That may be why your gf didn't want you taking them at first. I tend to think that most people who take these meds don't have ADHD, but it's easier for most people who's issue is with motivation to take a drug that will force you to focus than to actually find a way to motivate yourself to focus and complete tasks.

You might also want to take a step back and think if you're mistaking the Adderall's effectiveness with the good feelings it gives you when you take it. I know if I take a 20mg IR, it'll have me pretty well focused enough for at least 4-6 hours and I don't feel like it's completely worn off for another couple hours after that. Admittedly though I have a fairly low tolerance for amphetamines and you've been on it for a year and a half, so I don't know how much that has affected your tolerance, but I would think a 20mg should have you set for at least 2-3 hours even with a fairly high tolerance.

To get back to my advice for you, there really isn't much else to do besides go on hiatus from taking Adderall. Do your best to tough it out without it for a couple weeks and then start taking it again and it hopefully will have lowered your tolerance enough to make lower doses more effective. I have never met someone over the age of 15 with ADHD that couldn't at least function well enough to get by for short periods of time without their medication. If you really can't go without it, there really isn't much else you can do.

 

[LonE1]

Do yourself a favor and TAKE A BREAK trust me I hear you on tolerance: I take about 40-60 a day when I need too, but Ill take breaks for about 3-4 days and for me, my tolernace will go down to the point where only 35 is enough to help me.

Also I HATE XR's, but maybe you need them to help you last longer??

Adderall is the best medication for me, but maybe try vyvanse?? I hear it works great for one of my friends.

I wouldn't recommend dexadrine (even though many people on this site will tell you different) because your already taking 75% d-amph in your adderall, and the I-amph for me helps with attention, even though dexadrine feels a bit smoother and doesn't have as bad a comedown.

 

[NotQuiteAnonymous]

Maybe a CYP2D6 inbibitor (like a SSRI) would be helpful with prolonging Adderall's effects?

Taking breaks from the med for even just a couple days and catching up on sleep can help reduce tolerance to Adderall.

 

[harsh]

I appreciate your reply and I'll try to stay objective in my response. I hope you find my comments constructive and not critical - I appreciate these types of discussions.

The only thing you can do is take a break from it and lower your tolerance that way. In my experience ADHD meds are EXTREMELY over prescribed.

What is your basis for this statement? What do you consider "over prescribed?" Is there a baseline for the perfect amount of ADHD meds a person should take?

It seems as if doctors give these away faster than they do stickers to a little kid after a shot. Between that and parents that think that a 6-7 year old having attention problems MUST mean the child has ADHD and not just write it off to normal child behavior or even a problem with that parenting has created a giant amount of people who use ADHD meds that do not have ADHD. This has given off the idea that maybe ADHD either doesn't exist or that it's effects are greatly exaggerated. That may be why your gf didn't want you taking them at first. I tend to think that most people who take these meds don't have ADHD, but it's easier for most people who's issue is with motivation to take a drug that will force you to focus than to actually find a way to motivate yourself to focus and complete tasks.

You have a lot of different thoughts crammed into this paragraph. But overall, I'm curious why you think people should force themselves to find motivation in something of which they would naturally have no interest? By taking ADHD meds, isn't a person also finding motivation in something that does not interest them naturally? Where do you differentiate?

You might also want to take a step back and think if you're mistaking the Adderall's effectiveness with the good feelings it gives you when you take it.

Though it did provide a certain euphoria when I first began habitually taking the medication, the attention and focus are the real components that remain once the euphoria wears off. I effectively used Adderall to get a BS in Mechanical Engineering, just as people effectively use cars to drive to work instead of walking. Sure I probably could've gotten there on my own, but why not improve my personal efficiency a little along the way?

I know if I take a 20mg IR, it'll have me pretty well focused enough for at least 4-6 hours and I don't feel like it's completely worn off for another couple hours after that. Admittedly though I have a fairly low tolerance for amphetamines and you've been on it for a year and a half, so I don't know how much that has affected your tolerance, but I would think a 20mg should have you set for at least 2-3 hours even with a fairly high tolerance.

Actually I've been on the IR for a year and a half. I've been on amphetamines for about 5 years (Adderall XR, Vyvanse, Dexedrine). No doubt tolerance suffers over time. I also weigh about 200 lbs and lead a pretty active lifestyle so my metabolism tends to be higher than average.

That being said, I can take 20mg and go to sleep in an hour without any noticeable change in my focus. If I take 40mg at once, then it hits, but only for about 1-2 hours.

Some people are different and require different treatments - that's how my doctor put it.

To get back to my advice for you, there really isn't much else to do besides go on hiatus from taking Adderall. Do your best to tough it out without it for a couple weeks and then start taking it again and it hopefully will have lowered your tolerance enough to make lower doses more effective. I have never met someone over the age of 15 with ADHD that couldn't at least function well enough to get by for short periods of time without their medication. If you really can't go without it, there really isn't much else you can do.

I have taken my drug holidays over the past few years, and my work has suffered as a consequence, whether that is due to the drug or my personal initiative. If it helps a person, then why not have it prescribed? Sure, people can abuse it, but that's their choice. People can abuse a lot of things that could also be used for good. I just chose to use the Adderall to better myself, get a degree, get a job, and help society.

 

[ATLL765]

I appreciate your reply and I'll try to stay objective in my response. I hope you find my comments constructive and not critical - I appreciate these types of discussions.

-I also appreciate discussion with someone who has a differing opinion and I'm sorry if I seemed to get personal in any of my comments.

What is your basis for this statement? What do you consider "over prescribed?" Is there a baseline for the perfect amount of ADHD meds a person should take?

-I guess a better term would have been over and misdiagnosed, but I also do believe doctors can be too quick to put people, especially in the 12-18 year old category on too high of a dose. Especially since when I was in high school, many kids sold what they didn't need or use to other kids, which would lead me to believe they had more than what they needed to help with their ADHD. I went to high school in a fairly affluent area, so it wasn't kids selling it to make money to get by with either, they wanted the cash for spending on other drugs or whatever they might have wanted, but definitely not cash they needed by any means.

In fact, my gf is Rxed 50mg a day in the form of 20mg x2/day and 10mg x1/day. Honestly, she could easily just take one 30mg ER/day at 7-8am and that would take her through her school day without a problem, but her mother and her as well have pressured the doctor to script this.

Although there definitely is no "perfect" dose, it can get to the point where a dose gets so high, the negative side effects can outweigh the positive ones. I know many people here have referenced that studies have shown that even at therapeutic doses, amphetamines are neurotoxic, so that may add to your Dr being concerned about putting you on a dose higher than 60mg/day. I certainly wouldn't want to take that high a dose if I knew it was neurotoxic. I'm not 100% on where the line is drawn as to how harmful it is and at what dose, but many here have mentioned studies that have shown this, so I figured I'd bring it up.

You have a lot of different thoughts crammed into this paragraph. But overall, I'm curious why you think people should force themselves to find motivation in something of which they would naturally have no interest? By taking ADHD meds, isn't a person also finding motivation in something that does not interest them naturally? Where do you differentiate?

-I certainly don't believe that someone would be able to find interest in something while using Adderall that they did not before, just that they would motivate themselves to do what they need to even if it's not what they "want" to do.

To use my gf as an example again, I know for a fact that she has no problem focusing on something she enjoys or wants to do, watching long movies, or watching an entire season of a TV show, playing her PSP, whatever. She does however have an issue wanting to do homework or wanting to get to school. She seems to use the Adderall to motivate her to do these things even though without it, she'd just blow these things off.

I'm not saying she's typical of someone with ADHD, in fact, I don't think she has ADHD, but I'm using her to show how Adderall is prescribed not for ADHD itself, but for people who maybe use it as an excuse to use Adderall to motivate themselves to do things they don't enjoy.

Personally I would never want to need to take a drug in order to motivate myself to be productive in my life or to motivate me to take care of my responsibilities, but she seems to think that it's the best way since it's the easiest way. Her mother is no help seeing as she'd rather drug her and have her be more manageable than actually parent her into being a better person. Having to take this drug to be productive is in my opinion a serious crutch that will only exacerbate underlying issues by not dealing with them and allowing them to get worse over time since one day, her tolerance may get so high that Adderall is useless to her for this purpose.

Again, this is just to show how Adderall is used by what I believe to be many for motivational purposes rather than an actually inability to focus or be attentive, such as one would be if suffering from ADHD.

Though it did provide a certain euphoria when I first began habitually taking the medication, the attention and focus are the real components that remain once the euphoria wears off. I effectively used Adderall to get a BS in Mechanical Engineering, just as people effectively use cars to drive to work instead of walking. Sure I probably could've gotten there on my own, but why not improve my personal efficiency a little along the way?

-If you had done it without the Adderall, although it may have been a bit harder than it was with it, you would not be in the position you are today if you gone without it. I'm not saying you should have gone without it or that you don't have a genuine need for this med, but if you believe you could have done just as well without it, albeit with more difficulty, you would not have the tolerance you have today.

Actually I've been on the IR for a year and a half. I've been on amphetamines for about 5 years (Adderall XR, Vyvanse, Dexedrine). No doubt tolerance suffers over time. I also weigh about 200 lbs and lead a pretty active lifestyle so my metabolism tends to be higher than average.

That being said, I can take 20mg and go to sleep in an hour without any noticeable change in my focus. If I take 40mg at once, then it hits, but only for about 1-2 hours.

Some people are different and require different treatments - that's how my doctor put it.

-That's a good way of putting it. I am not nearly as big a guy as you, so I can definitely see how you would need a far larger dose to achieve a similar effect to what I would with a lower dose.

I have taken my drug holidays over the past few years, and my work has suffered as a consequence, whether that is due to the drug or my personal initiative. If it helps a person, then why not have it prescribed? Sure, people can abuse it, but that's their choice. People can abuse a lot of things that could also be used for good. I just chose to use the Adderall to better myself, get a degree, get a job, and help society.

So I guess to sum up what I'm trying to say, Adderall and other ADHD meds are commonly Rxed to people who have no medical need for them and these people use it for motivational purposes rather than to correct an inability to focus and be attentive. Also that lowering you tolerance may be the best option because of the neurotoxicity of amphetamine in even low doses, so you may not really want to take higher doses and risk damaging your brain because of it.

This of course is all best discussed with your Dr because I have no training or real education in medicine, this is all just from personal research and experience with the drug myself and people I've seen on it.

One last bit here, you could ask your Dr about a drug called Desoxyn, which is literally Methamphetamine (not a joke) in pill form. This is rarely prescribed and usually done so as a last resort when all else has failed or tolerance has reached a point where other drugs have become ineffective.

Pheww, I feel like I wrote a novel here, but I hope the information is useful.

 

[Bupe]

If adderrall worked dexedrine will work better (adderrall is 75% dexedrine)

 

[edarrin]

^ I think it depends on the individual. Personally I find Adderall significantly more stimulating than dexadrine. I think the l-amphetamine has more peripheral effects and gives it a 'speedier' feel. At least IME. Dexidrine is mostly central and has little peripheral effects (increased HR, zitery(sp?) etc) .

I just don't find dexedrine that effective but my dose is pretty low. Today I took 12.5mg in the am and had to get some methylphenidate to insufflate during the afternoon. I know I'll probably get roasted for this but I find methylphidate insufflated better. I will try the dextro insufflated to see if it increases bioavailabilty. Not sure if it will help because 7.5hg of that was taken the 100% bioavailability method (nudge,nudge) and it just didn't work. Made me sleepier almost.

 

[Bupe]

^ I think it depends on the individual. Personally I find Adderall significantly more stimulating than dexadrine. I think the l-amphetamine has more peripheral effects and gives it a 'speedier' feel. At least IME. Dexidrine is mostly central and has little peripheral effects (increased HR, zitery(sp?) etc) .

I just don't find dexedrine that effective but my dose is pretty low. Today I took 12.5mg in the am and had to get some methylphenidate to insufflate during the afternoon. I know I'll probably get roasted for this but I find methylphidate insufflated better. I will try the dextro insufflated to see if it increases bioavailabilty. Not sure if it will help because 7.5hg of that was taken the 100% bioavailability method (nudge,nudge) and it just didn't work. Made me sleepier almost.

You are at a tiny dose I get 30mg. Yeah you notice adderall more because it gets you tweaked out feeling like shit. Dexedrine is the clean version.

 

[BIGsherm7272]

yes, the L-amphetamine in adderall is what is responsible for most of the nasty side effects. Dexedrine is far superior, imo.

To the OP: What about desoxyn? It is prescription methamphetamine, and many find it to be rather effective.

 

[wtblife]

Dexedrine should be a tiny bit stronger per mg, try a higher dose of it.

 

[harsh]

If adderrall worked dexedrine will work better (adderrall is 75% dexedrine)

Yes, I had read that Dexedrine is the more "pure" version of Adderall, and I asked my doctor to give me a week's worth to sample about a year ago. And that leads me to the next comment...

^ I think it depends on the individual. Personally I find Adderall significantly more stimulating than dexadrine. I think the l-amphetamine has more peripheral effects and gives it a 'speedier' feel. At least IME. Dexidrine is mostly central and has little peripheral effects (increased HR, zitery(sp?) etc) .

I agree with edarrin on this. Dexedrine had very little effect on me (this is after having taken Adderall for 3 years). The dosage I took was about 15mg spansules at the time - maybe too low to feel anything considering my elevated Adderall tolerance?

Either way, it didn't give me the get-up-and-go feeling that Adderall does, which is what I like. It's a dangerous line because that same L-amph that smacks you up can smack you down if you take too much. I feel I've been on Adderall long enough to know my limits so I never have an issue with withdrawal anymore, even if I take 200mg throughout a long work day (happens rarely, but has happened).

yes, the L-amphetamine in adderall is what is responsible for most of the nasty side effects. Dexedrine is far superior, imo.

To the OP: What about desoxyn? It is prescription methamphetamine, and many find it to be rather effective.

Yeah this reiterates what I am saying, and I agree with the L-amph being the culprit with side effects. But if you're safe and know you're limits then I think it actually helps.

As far as Desoxyn - yes I have done some research on it and have thought about asking my doc about it. I think I want to build a stronger relationship with my doc, and try out several other options before going that route. I just moved to a new area and changed docs, so I doubt he'd be willing to write a script for Desoxyn now if ever. Would love to try it over the Adderall, though. If it could take away mild anxiety issues and last longer than the Add then that would be great. Just things I've read though.

On a separate note... I did visit my doc yesterday and he was very adamant about me trying Provigil or Nuvigil. Gave me a week's supply of Nuvigil, and wrote me 3 refills for it. Only problem is my insurance may not cover it for ADHD, in which case it's something like $350 for a month!!

I took the Nuvigil (300mg) this morning and I can definitely feel the effects, but I can't say I like them. It's kind of like a mild form of Adderall, but with more anxiety (at least for me) and less motivation. I got to work this morning and kind of just stared at my Inbox while frantically tapping my foot.

I guess there's no cure-all for anything, but I don't think Nuvigil is hitting the nail right on. Back to the Add it is.

 

[BIGsherm7272]

Your doc is just trying to get you off adderall, probably because he thinks that you have built up quit a tolerance. With your usage of adderall, I'm sorry but provigil and nuvigil are not going to do much for you.

 

[harsh]

Your doc is just trying to get you off adderall, probably because he thinks that you have built up quit a tolerance. With your usage of adderall, I'm sorry but provigil and nuvigil are not going to do much for you.

Yes, I think you're definitely right about that. It has given me this crazy muscle twitch in my jaw and temple all day long, probably due to anxiety. The anxiety detriments far outweigh the concentration benefits with this line of pharmaceuticals.

 

[K'd-OUT-in-AZ]

Have you asked about Desoxyn? You think your doctor would prescribe it? Not all doctors will. I was on it for 1 1/2 years and one of the best things about it, other than the extremely limited side effects was the fact that I never gained a tolerance like I did with all the other meds. I found the right dose and it always worked for me. Doesn't hurt to ask.

 

[harsh]

Have you asked about Desoxyn? You think your doctor would prescribe it? Not all doctors will. I was on it for 1 1/2 years and one of the best things about it, other than the extremely limited side effects was the fact that I never gained a tolerance like I did with all the other meds. I found the right dose and it always worked for me. Doesn't hurt to ask.

Yeah a few other members have mentioned that on here and I'm definitely considering it now. I also read a lot of posts claiming that it's pretty rough to convince some docs to script it.

I think I might give this new doc a couple months to get comfortable then see if he'll work with me in that direction. Sounds great, though. Would love to find something without strong side effects or tolerance issues.