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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by JuniperF on May 30, 2002, at 16:49:06
I have been taking Adderall 30mg three times a day for 4 months. I have noticed that since I started taking this medication I have more mood swings. I notice these especially if I haven't eaten or if I have consumed alcohol. Mainly I get angry or very irritable. Sometimes I will cry. I am also on Paxil. Before I started Adderall I didn't have these mood swings or angry outbursts with alcohol or without. I have been on Paxil over a year. I was rarely grumpy and now I am grumpy much more often. Now, the good part of Adderall. I lost 20 pounds, but I don't want to be an unhappy thin person. I can concentrate way better and am able to read more. I do a much better job at work. I am much more focused. I will be going back to school and it is immensely helpful for that. I was going to just drop this med altogether, but then I read some stuff about concerta being better with controlling anger, etc. However, it is still amphetamine based so I am doubtful. Thanks!
Posted by Ritch on May 30, 2002, at 23:38:22
In reply to Concerta vs Adderall and mood swings, posted by JuniperF on May 30, 2002, at 16:49:06
> I have been taking Adderall 30mg three times a day for 4 months. I have noticed that since I started taking this medication I have more mood swings. I notice these especially if I haven't eaten or if I have consumed alcohol. Mainly I get angry or very irritable. Sometimes I will cry. I am also on Paxil. Before I started Adderall I didn't have these mood swings or angry outbursts with alcohol or without. I have been on Paxil over a year. I was rarely grumpy and now I am grumpy much more often. Now, the good part of Adderall. I lost 20 pounds, but I don't want to be an unhappy thin person. I can concentrate way better and am able to read more. I do a much better job at work. I am much more focused. I will be going back to school and it is immensely helpful for that. I was going to just drop this med altogether, but then I read some stuff about concerta being better with controlling anger, etc. However, it is still amphetamine based so I am doubtful. Thanks!
That is a very high dose (90mg/day of Adderall). I believe the maximum recommended by the manufacturer is 60mg/day for narcolepsy. I would suggest tapering the Adderall carefully and slowly (over weeks) to see if the irritabilty improves(perhaps a target of 30mg/day). You may be getting dopamine "depletion". Also, high levels of the stimulant may be exhausting your adrenal glands and playing havoc with your blood sugar levels, hormones, etc. I wouldn't mess with a different stimulant until you see how a dosage taper on the Adderall fares, IMO.Mitch
Posted by JuniperF on May 31, 2002, at 10:12:45
In reply to Re: Concerta vs Adderall and mood swings » JuniperF, posted by Ritch on May 30, 2002, at 23:38:22
Thank you for responding Mitch. I made a typo. I am taking 10mg three times a day.
Posted by katekite on May 31, 2002, at 12:33:45
In reply to Concerta vs Adderall and mood swings, posted by JuniperF on May 30, 2002, at 16:49:06
When do the mood swings and tendency to cry happen in relation to when you take a dose of medication?
Many people experience a rebound about an hour after the med wears off that can last anywhere from one to 8 hrs where their mood is worse than before they were ever medicated. So if it's at those times its most likely rebound. There are ways to manage that.
Or if you find its worst during the medication peak (2-4 hrs) you might benefit from trying the other stimulants because each individual person has one that fits better than the others. Concerta tends to be more calming than adderall but that's not true for all.
How are you sleeping?
kate
Posted by JuniperF on May 31, 2002, at 12:37:13
In reply to Re: Concerta vs Adderall and mood swings, posted by katekite on May 31, 2002, at 12:33:45
> When do the mood swings and tendency to cry happen in relation to when you take a dose of medication?
>
> Many people experience a rebound about an hour after the med wears off that can last anywhere from one to 8 hrs where their mood is worse than before they were ever medicated. So if it's at those times its most likely rebound. There are ways to manage that.
>
> Or if you find its worst during the medication peak (2-4 hrs) you might benefit from trying the other stimulants because each individual person has one that fits better than the others. Concerta tends to be more calming than adderall but that's not true for all.
>
> How are you sleeping?
>
> kateI am sleeping ok. The moodiness usually happens in the rebound time and/or 1 hour after I take the medication.
Posted by Ritch on May 31, 2002, at 13:08:53
In reply to Re: Concerta vs Adderall and mood swings, posted by JuniperF on May 31, 2002, at 10:12:45
> Thank you for responding Mitch. I made a typo. I am taking 10mg three times a day.
Yes, that is a more typical dose. Concerta (methylphenidate), might work better for you than the amphetamines. I noticed that Adderall and dexedrine had more impact on my *mood* than methylphenidate. For instance, I could "crash" on dexedrine and feel a little depressed (I never got sad and weepy though), but I could crash on methylphenidate and just feel tired and confused. My pdoc has me on a small dose of imipramine instead of stimulants for the ADHD symptoms. I have got bipolar symptoms, too, and you might look into a possible comorbid bipolar diagnosis. Perhaps a mood stabilizer added to your stimulant at some point could be beneficial.Mitch
Posted by JuniperF on May 31, 2002, at 13:45:45
In reply to Re: Concerta vs Adderall and mood swings » JuniperF, posted by Ritch on May 31, 2002, at 13:08:53
The other thing I am wondering about with Adderall and ADHD stimulant meds is the long term effects. There is this website ritalindeath.com, I think it is, where a patient had an enlarged heart because of long term ritalin use. He died because of this. I never worried about this before. I know to avoid meds that affect blood pressure, like decongestants for example, but I get my blood pressure checked regularly anyway and it is fine. What are your thoughts on this?
Posted by katekite on May 31, 2002, at 14:15:01
In reply to Re: Concerta vs Adderall and mood swings, posted by JuniperF on May 31, 2002, at 13:45:45
So its a little confusing what you described as being more moody both during rebound and during the peak of the med. It sounds like the time during its action that is the best is when it is already well into your system and you are up and going. So that makes me think you are mainly having trouble with the transitions.
Tips for dealing with the mood swing at onset include taking it with food (slows the rate, but not the extent of absorbtion), or taking it before you ever get up and letting yourself fall back asleep so that it comes on while you are dozing. Anything to slow the sudden change from one state to the other.
When you take a next dose during the day make sure you take it before the old one completely wears off.
Tips for dealing with evening rebound include drinking some caffeine about a half hour before it will wear off, or taking regular dexedrine or a tiny dose of adderall (like 1/4 your normal dose) to come down slower. Plan ahead for an activity that isn't high stress during that time.If evening out the up and down of it doesn't work, you could try Concerta.
Some people find Adderall xr the best, it wears off even slower so some say there's less rebound (or it occurs when they are asleep).
As to heart effects, stimulants are among the safest of drugs, considering the number of kids medicated over the years its amazing how few nasty websites there are. The massive doses ingested by drug abusers, who remain alive, say something.
Effects tend to be very individual and people with heart problems often can't tolerate stimulants... so yes check your blood pressure while you are on it and make sure when you exercise your pulse doesn't go higher than normal and you don't get a headache or feel shaky or lightheaded... but if all seems normal then it most likely is.
Posted by JuniperF on May 31, 2002, at 16:26:19
In reply to Re: Concerta vs Adderall and mood swings, posted by katekite on May 31, 2002, at 14:15:01
Thanks, I was starting to think that too. I have noticed that if I eat when I am coming down, etc it does seem to help.
Posted by Ritch on May 31, 2002, at 23:25:30
In reply to Re: Concerta vs Adderall and mood swings, posted by JuniperF on May 31, 2002, at 13:45:45
> The other thing I am wondering about with Adderall and ADHD stimulant meds is the long term effects. There is this website ritalindeath.com, I think it is, where a patient had an enlarged heart because of long term ritalin use. He died because of this. I never worried about this before. I know to avoid meds that affect blood pressure, like decongestants for example, but I get my blood pressure checked regularly anyway and it is fine. What are your thoughts on this?
If you have a doctor who is checking your cardiac condition fairly regularly I wouldn't be that concerned (you might want to see a cardiologist every year or two and get an EKG, etc.). I think the heart condition most talked about related to long-term stimulant use is mitral valve prolapse. They pulled fenfluramine off the market (I think) due to this problem. So, it isn't limited to just methylphenidate. Also, you can minimize the risks of that problem by keeping the dosage as low as you can and still maintain reasonable efficacy.Mitch
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