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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Noa on February 8, 2001, at 14:13:44
Adderall: What doses do people take?
I take 10 mg. twice a day.
Here is why I am asking:
I am considering lowering my Effexor Dose slightly. As a next possible step, I was thinking that if I needed it, I might want to raise my adderall dose a bit. But I would like to know what dose people are on and how it affects them, what differences they noticed at different doses of Adderall. Thanks.
Posted by Sulpicia on February 8, 2001, at 17:09:01
In reply to Adderall Dosage, posted by Noa on February 8, 2001, at 14:13:44
> Adderall: What doses do people take?
>
> I take 10 mg. twice a day.
>
> Here is why I am asking:
> I am considering lowering my Effexor Dose slightly. As a next possible step, I was thinking that if I needed it, I might want to raise my adderall dose a bit. But I would like to know what dose people are on and how it affects them, what differences they noticed at different doses of Adderall. Thanks.I take 40 mgs, 10 mgs 4 x or 20, 10, 10.
Basically I moved up from 15mgs [5mg x3] until my problem with reading concentration stopped. Each time I moved up I experienced appetite suppression and a slightly increased heart rate. I don't know about Effexor but paxil slightly potentiated the adderall so when I began taking 20mgs in the AM along with the paxil [30mgs] I got a bit jittery, too hyperfocused, and at one point when I was really stressed and not eating well either, I experienced an exacerbation of ADD/HD symptoms.
Since I'm stopping paxil and simultaneously introducing tofranil, I realize that I may have to increase the adderall -- tofranil dampens its effects. 60mgs would be the upper limit but I would hope to be able to simply add an extra 5mgs in the AM when the tofranil levels are still high in my system.
If Effexor is like paxil in sort of increasing the effect of the adderall, you could: add 5mgs in the AM if this is when you take the Effexor; or add 5mgs around 4-6PM.
You probably know this, but the pills are a bitch to split with your fingers and absorb moisture like anything. You can get a pill cutter from your pharmacist. I'm sure you're under the care of a doctor but have your blood pressure checked if you raise your dose and always remember sleepyness=too much.
May I ask why you want to lower the Effexor dosage?
Good luck!
Liz
Posted by Noa on February 9, 2001, at 13:19:07
In reply to Re: Adderall Dosage » Noa, posted by Sulpicia on February 8, 2001, at 17:09:01
Thanks, Sulpicia.
I want to lower the effexor because I thinkit is overactivating for me. This has always been an issue. Last year, I lowered the effexor from 375 to 300, and then raised my serzone from 225 to 300.
Then, a couple of months ago, I started to feel jittery again, so my pdoc suggested raising the serzone to 350. That helped, especially with the sleep (it was getting hard to fall asleep again with all that jittery-fidgetiness).
Now, I feel some of the jitteriness coming back--always needing to jiggle my leg, etc. It isn't affecting my sleep as much as before, and I attribute that to the fact that I am getting a lot of exercise these days. But I am bothered by the inability to sit still without shaking my legs, etc. I wonder if this effect from the effexor is happening now because of the exercise--could it change how it affects me? Maybe the exercise increases serotonin, and there is too much serotonin acting on my 5HT2 receptors? I don't know.
I wanted to see if lowering it by 37.5 would help.
Also, at the moment, I am starting to feel like the adderall isn't as effective in the afternoon as I need it to be--I get really brain dead around 4 pm. Of course, that has to be partially a function of being up at 5:30 am, I guess.
If I do end up lowering the effexor, I feel like I might need something in its place--either an increase in serzone, or an increase in adderall (for this reason and for the reason mentioned above--afternoon crash).
Any ideas welcome.
I don't know, this isn't as well thought out as it could be. I just have never liked it when the effexor is feeling overactivating. It comes and goes.
Posted by Noa on February 9, 2001, at 13:20:19
In reply to Re: Adderall Dosage » Noa, posted by Sulpicia on February 8, 2001, at 17:09:01
I was reading archives, and came across a suggestion to stop adderall for a while and restart, in order to get back some effectiveness. Does this really work? How long of a "vacation" do you need from the med to make it work better upon resumption?
Posted by bissie66 on February 9, 2001, at 14:30:27
In reply to Re: Adderall Dosage--another question, posted by Noa on February 9, 2001, at 13:20:19
> I was reading archives, and came across a suggestion to stop adderall for a while and restart, in order to get back some effectiveness. Does this really work? How long of a "vacation" do you need from the med to make it work better upon resumption?
Noa, may I ask, why do you take Adderall? I've got it in my mind to ask my dr. about taking it. I've heard it helps with sexual dysfunction and also works on depression. I take Neurontin, and I've read that docs sometimes prescribe the 2 together. I'd love to find some combo that made it possible for me to stop taking SSRI's.
BTW, my doc raised my Levoxyl dose to 1 mg. and I don't know if it's coincidental, but I have been feeling more energetic.
Bissie
Posted by Noa on February 9, 2001, at 15:15:18
In reply to Re: Adderall Dosage--another question » Noa, posted by bissie66 on February 9, 2001, at 14:30:27
I take the adderall as an adjunct to my ADs. My doc also hypothesized at one point that I might have ADD. I don't think so. I think my depression/anxiety have caused similar problems to ADD--internal distractibility, difficulty focusing, etc.
Originally, we added a stim because I was tired all the time. I am less so now (no more sleep apnea, and thyroid is under control) but it seems the stims really do help me be alert and less depressed.
As for sexual dysfunction, I do have that from the effexor. I found ritalin to help with that, but not adderall. Do not know why.
But I like the adderall better than the ritalin anyway.
Glad to hear you are feeling better, and maybe it isn't a coincidence!
Posted by Sulpicia on February 11, 2001, at 17:05:18
In reply to Re: Adderall Dosage, posted by Noa on February 9, 2001, at 13:19:07
> Hi Noa -- as to the exercise, all I can say is from my personal experience with what paxil did to my muscles [from running 5 m 7x wk to nothing from muscle weakness] there is probably some connection -- what I don't know.
The one thing I forgot to mention about my dosage is that it took about 2 months to get right. My pdoc and I did a ton of talking about my daily routine, natural periods of alertness and my inevitable 1-2:30 PM period of semi-consciousness. I found it never worked well to fight against my body's lifelong patterns. I'm most productive in the AM [5:30? me too] so we boosted this dosage for maximal results -- a good prolonged productive period, then a smaller dose to keep my blood levels from plunging entirely -- I do mindless work in the afternoon. Then I take the last dose with dinner and can get another 4 to 5 hours of work done.
Good luck and I hope things work out for you.
Liz
Posted by dalukens on February 14, 2001, at 6:07:12
In reply to Re: Adderall Dosage--another question, posted by Noa on February 9, 2001, at 13:20:19
---Noa,
---This is exactly what I do; I have to, as Adderall loses effectivness for me after 3-5 days. I usually find that 24-48 hours without it is long enough, but that I'm not good for very much during that time. I don't really get back full effectiveness in that time, but that's about as long as I can stand being without.
---DaL> I was reading archives, and came across a suggestion to stop adderall for a while and restart, in order to get back some effectiveness. Does this really work? How long of a "vacation" do you need from the med to make it work better upon resumption?
Posted by Noa on February 14, 2001, at 11:37:05
In reply to Re: Adderall Dosage » Noa, posted by Sulpicia on February 11, 2001, at 17:05:18
After talking to my pdoc, he suggested I add a half of a 10 mg pill in the afternoon. So, now I take 10 mg at 5:30 am, 10 mg. at about 11 am, and then 5 mg at about 4. This is only the second day of this, but yesterday, I noticed my end of the day experience was much more bearable. I wasn't brain dead at the end of the day, and my mood didn't crash as it often does at around 5 pm.
BTW, I ran out of the adderall over the weekend, and by Monday I was a basket case!!! I felt edgy, irritable, agitated, unfocused. I got a new scrip on Monday evening and was back on it on Tuesday AM. I felt better as the day went on. Today, I feel fine so far. Anyone else have withdrawal reactions like this?
Thanks everyone.
Posted by SLS on February 20, 2001, at 10:56:09
In reply to Re: Adderall Dosage--Update, posted by Noa on February 14, 2001, at 11:37:05
> > I was reading archives, and came across a suggestion to stop Adderalll for a while and restart, in order to get back some effectiveness. Does this really work? How long of a "vacation" do you need from the med to make it work better upon resumption?> ---This is exactly what I do; I have to, as Adderalll loses effectivness for me after 3-5 days. I usually find that 24-48 hours without it is long enough, but that I'm not good for very much during that time. I don't really get back full effectiveness in that time, but that's about as long as I can stand being without.
Hi guys.This is a pretty frustrating and discouraging position to be in.
The following is just a bunch of stuff that crossed my mind. It may not have a single thing right with it. Any hypothetical scenario is something that I haven't taken the time to substantiate any further than using the stuff currently floating around between my ears:
All appropriate caveats...
Going on and off Adderall is not only a difficult roller-coaster to ride, but it might be counterproductive. Regular usage might foster dopamine depletion and change receptor sensitivities. Such could at best mask, and at worst prevent, an antidepressant response to other drugs. One example of Adderall-induced systemic changes is represented by the appearance of irritability and possibly a *worsened* depression immediately after the Adderall is withdrawn. Perhaps you "lower" the starting point from which an antidepressant must work. "Pulsing" true antidepressants on and off in the manner that you are currently using Adderall seems to promote treatment-resistance, and can also induce mania. But you gotta' do what you gotta' do. If I were in your shoes, I would probably join your club. All of this being said, I don't think you are taking much of a risk by continuing to pulse Adderall. However, it is something to think about based upon your current situation. It is my gut feeling that the system would be much happier establishing a homeostasis to create a stable milieu within which the antidepressants can work.
Noa, I think you may want to try high dosages of T4 if you haven't already. I don't remember if you ever tried T4 or if you have taken T3 exclusively.
DaL, are you bipolar? Perhaps you should take note of the many stories, especially the older ones, that you can follow the history of that's case profile closely matches your own. Perhaps you will find someone else's subsequent successful medication regimen equally effective for you and give you some alternative directions to head in. It might be interesting to give Mirapex, a dopamine drug, a trial to see what it does. It might be a better way to stimulate the same system that Adderall does. It works using a completely different mechanism, and might afford you a more persistent improvement. Even if it doesn't, pay particular attention to and record your response to it as it might lend clues as to what to try next. I am guessing that there is a lot of stuff you haven't tried yet. For every drug or drug combination you try, much can be gleaned as relevant information how you respond to them. Make three lists:
1. Drugs that are partially effective.
2. Drugs that are neutral.
3. Drugs that make your depression worse.You gotta' start somewhere, Sherlock Holmes.
? What has been your experience with tricyclic antidepressants?
Without knowing your history, the first aggressive approach that popped into my head based on your responsiveness to Adderall is to use an MAOI as the core treatment. If you have had absolutely no partial responses to any medication other than Adderall, AND you have been properly diagnosed as having an axis I affective disorder without comorbitity, these are aggressive alternatives, but doable:
The choice of which MAOI to try first is difficult. There is trend to prescribe Parnate for someone who is anergic (low energy) or has bipolar depression. If there are anxiety or OCD tendencies (GAD generalized anxiety disorder, social phobia, social anxiety, panic attacks), Nardil seems to be superior. Sometime you just have to flip a coin. Parnate is usually the milder of the two in terms of side effects, which might be important when adding drugs that exert the same type of side effects. For me, I like the way I feel on Nardil better, even though I fit the "Parnate profile". I am partially responsive to both.
Unless you have already tried both Parnate and Nardil and are able to make a comparison, it seems reasonable to determine which of the two, if either, gives you some partial relief. You could perform 4-week trials of each to compare them and choose which to use as the core of treatment of any algorithm. Who knows? Maybe one of them will work great by simply adding it to Adderall.
* I would try throwing in low dosages (300mg-600mg) of lithium at some point. You'll know within a week if it yields any improvement. If it is not producing any side effects, you might as well keep it until you find something that works, and try removing it later to see if it is necessary. People seem to have particular success adding lithium to Parnate.
----------------------------------------------------------------------General format:
MAOI + Wellbutrin + tricyclic + stimulant + DA agonist + neuroleptic + thyroid + opioid antagonist + lithium
* You must take the (Adderall, Ritalin) continuously - no holidays.
** Consider Lamictal if bipolar
Example:(Parnate, Nardil) + Wellbutrin + (desipramine, nortriptyline) + (Adderall, Ritalin) + Mirapex (Risperdal, Zyprexa, ziprasidone, amisulpride) + (T3, T4) + naltrexone
* ALL of these drugs can be taken at the same time. However, this stuff is meant to represent "cocktail" destinations rather initial trials. Drugs are to be added methodically around the MAOI core.
** You should probably exclude any drug to which you have experienced a negative reaction.
Algorithm Summary: Mix and match. Pray. Get well. Smile. Help me get well.:-)
If something like this works, you can later try to remove the (Adderall, Ritalin) slowly to see if you really need it.There is so much more. I discover more and more viable and optimistic treatments the longer I participate on Psycho-Babble. There is quite a bit of data and logic supporting the idea that you will find something that works *well* for you.
My one request of you is that you occasionally remind me of what I wrote in the preceding paragraph. :-)
This is just one direction that I thought might be worth considering. I would love to hear from AndrewB regarding this approach as he has a much wider knowledge base to work with than I do. I would like to know from him if he thinks selegiline (Eldepryl) or adrafinil would have a place here. He will also help find a place for Buspar and/or pindolol as augmenters. However, if ziprasidone (neuroleptic) becomes available, it might already have a stronger Buspar "built-in".
Sincerely,
Scott
Posted by Corny on October 2, 2003, at 12:00:34
In reply to Re: Adderall Dosage » Noa, posted by Sulpicia on February 11, 2001, at 17:05:18
I am still trying to find a dosage of adderall that will give me the needed concentration and escape from lethargy without the aggitation. I also take 10mg of Paxil a day and have tried Efexor and Stattera. I am new to this forum and noticed that the prior posts are a couple of years old.
Posted by Festus on October 3, 2003, at 23:55:04
In reply to Re: Adderall Dosage » Sulpicia, posted by Corny on October 2, 2003, at 12:00:34
Howdy,Corny,welcome to a very informative place for general medication advice.Are you ADD?Are you taking any other meds other than Effexor and Adderrall?This would be helpful info to help folks give you a better answer.I take Dexedrine for ADD and to off-set the "Droopies"from 2 other meds.I think it,s a bit smoother than Adderrall(for me,anyway).Adderrall is a potent mixture of several amphetamine salts that was originally used as a "Diet pill"in the 60,s.It was re-packaged a few years ago by Shire Co. and re-marketed as an ADD med.Festus
Posted by Corny on October 4, 2003, at 0:41:27
In reply to Re: Adderall Dosage, posted by Festus on October 3, 2003, at 23:55:04
Taking 12.5mg Paxil CR at night;10mg of Adderall in AM and 5mg in the early afternoon. Depression and ADD cocktail of sorts. No longer taking Effexor.
This is the end of the thread.
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