My GP was the only one who would actually talk to me about ADHD, and he put me on Ritalin and titrated my dose up to the point where I was at 20mg bid. When I was at 20mg, this was the only dose that had any noticable effect. The others might have well been placebos. I told him that I could notice a difference at 20mg, but it was minimal, and I could definitely notice when it was wearing off (which was ALWAYS limited to less than 2 hours, not the 4-6 claimed).

So he put me on CONCERTA 27mg with bid dosing. Nothing. I increased my dose to 54mg (2 27s) in the mornings. Something, but no changes in organization, initiative, or stuff like that. But I liked it, it was smooth. But it only lasted for about 6 hours, out of a pill designed for 12-hour release. I also had a lot of headaches -- common with methylphenidate.

So last Friday (2/11), he put me on ADDERALL XR 20mg bid. I don't have any heart problems, so Health Canada can rest in peace, but I'm noticing some general weirdness on the ADDERALL. It has definitely made me a calmer person over the past 3 days, but also has blurred my eyesight (a sign of increased BP, which I don't have), and generally hasn't had any significant advantage over the CONCERTA, besides that I don't have headaches. My legs are constantly shaking as well, which has always been a somewhat subconscious habit of mine, but only happened when I was sitting still or otherwise just happened sporadically. But with the ADDERALL, my left leg has been bouncing up and down since Friday, and while I can stop it if I notice it and want to, I often just keep on shaking until I start walking. Could this be a part of the ADDERALL? I'm not otherwise jittery or feel "pepped up." If anything I feel slightly sedated, less need to speak, etc.

But with the ADDERALL, supposedly a 2 fold greater potency than methylphenidate, I am drifting in and out of lectures, finding reasons to procrastinate, et. cetera. At this moment, since I got back from class at 12pm, I've been sitting at the computer for 2 hours, putting off going across the street and moving my car to the garage. I didn't even feel like walking up the street to get something to eat, or check my mail.

My doctor told me that it was fine to take two of the 20mg ADDERALL XRs once a day, like I did with the CONCERTA, but I'm hesitant to do this because I need the other capsule for the afternoon, otherwise I'm not going to be able to focus in my evening classes.

Is anyone familiar with Dexedrine? It's my understanding that what Shire essentially did with ADDERALL was take 4 different amphetamine derivatives, knowing that all of them would metabolize almost immediately into dextroamphetamine, which is the same thing in the 60+ year old drug Dexedrine and DextroStat, and repackage it as a superior treatment for the sole purpose of increasing revenue. In addition, only releasing XR when it was apparent that the immediate-release ADDERALL was going to lose patent protection very soon.

I asked my MD about Dexedrine when he wanted to put me on ADDERALL, but said that he wasn't familiar enough with it to prescribe it. He also said that ADDERALL targets 4 types of neurotransmitters, while dextroamphetamine targets 3, and methylphenidate only 2. It's my understanding that the only neurotransmitters affected by any ADHD-stimulant drug are dopamine and norepinephrine. Can anyone clarify? I asked him which ones, but he appeared agitated and said he couldn't remember

So enough of my ramblings, point blank -- should I up the dose to 40mg qam? I know it took some changes in the CONCERTA dosing schedule in order to get any benefit, could the same be true for this "wonder drug" that is ADDERALL?

Thanks,

Benjamin K. Earle
Charleston, SC

OK, so almost a week into Adderall therapy I have a mental collapse last night and into this morning. Just severe depression, hating my life, doubting the future, and blaming myself for all of my misfortunes -- and crying all along the way.

I've read where on occasion, the comedown off of adderall late in the evening can trigger this, but usually only if you're hypersensitive to amphetamines.

I don't understand the pharmacological differences between amphetamine and methylphenidate, which I was on since november to great effect, minus the headaches and the decreasing usefulness.

please help me -- i've stopped taking the adderall and luckily I still have a few concertas left over. What else is out there? Is this sensitivity and bad reaction because of d-amphetamine, l-amphetamine, both, or neither?

I'm also on effexor xr, 225mg for depression - are the interactions between that and adderall severe enough to cause that 12 hour period of hopelessness?

There are two different classes of stimulants used for ADHD - those that are amphetamine based and those that use methylphenidate (cocaine works the same way as methylphenidate). The two classes of stimulants work in slightly different ways, but both increase the availability of the neurotransmitter dopamine. Amphetamines also increase the availability of adrenaline/noradrenaline (a.k.a. epinephrine/norepinephrine). Adderall is amphetamine based and consists of 4 amphetamine salts which are thought to smooth out the effects of the drug as compared to drugs that have just the one salt, like Dexedrine. The overall effect is very similar for the amphetamine products - the differences are subtle. I have never been able to find any info on the difference in the pharmachology of these salts - the mechanism of action of amphetamines is known (as much as you can really know what is happening at the molecular level inside a working neuron!) - but destinctions aren't made between the different salts, etc. Your body does metabolize the different salts at different rates and there is some thought that the levo- molecule (there are left and right handed molecules - so called levo- and dex-) behaves slightly differently than the dex-, which all contribute to making Adderall smoother - apparently - I haven't tried it myself, and as a Canadian, I guess I never will!
I guess because of the differences in the way the drugs work, people often prefer one type over the other. Sometimes one type will work for them and the other won't. Some find the noradrenaline effect of amphetamine to be too much - it can trigger anxiety, and it's effect on heart rate and blood pressure is more profound than methylphenidate - but for others, it's just what they need. In my case, I had tried Ritalin and found it to be quite effective, it just didn't last very long for me, so I asked to try Dexedrine, which is know to last longer. The first time I tried the dexedrine, I knew which I prefered! It's noradrenaline effect had the most wonderful effect on my procrastination - the feeling is much like that of a looming deadline, I guess, because historically that's what I've needed to get my tail off the couch!
I also found that, for me, the "come down" phase for dexedrine was almost non-existant as compaired to Ritalin. For others this is the other way around - go figure!?!
Ritalin is about 1/2 as powerful as Dexedrine on a mg for mg basis, so 10mg ritalin is roughly the same as 5mg of dexedrine, although in some people this ration is more like 1.5 to 1, acording to literature I've read. Adderall is slightly weaker than dexedrine - again on a mg for mg basis - since the dextroamphetamine component is stronger than the other salts. The difference is around 30%, I think, so depending on the person, Adderall may not be that much stronger than Ritalin/Concerta, and definately not 2 to 1.
Ultimately the choice between the two types will come down to which works best for you, and the choice of what pill/brand/type to take will come down to convenience. Myself, I prefer to take regular release tablets, as this gives me the best control - I can take when I need it, take a morning or afternoon off if I want to, take a little bit more if I feel I'll need it 'cus I'm tired or have an extra boreing meeting or my day is going to be longer than normal, etc.