View Full Version : Meds finally started working for a few days... then stopped.. Why?


thisaddguy
07-08-17, 10:12 PM
Hi, new to all this so excuse the long post as there's a lot to cover :)

I've always had big goals and I know I'm more than capable of achieving them, the only block has been my ADD, procrastination, distractions, lethargy and I end up getting so annoyed at myself for letting myself down.

Mid 30's, finally diagnosed as inattentive type and put on Dexamphetamine 2 months ago, limited options for medication in my country (I think Vyvanse, Ritalin and Strattera are my only other options).

I started off on 10mg split in 2 doses for the first few days then up to 20-25mg split into 3 or 4 doses after a couple of weeks. Held this dose for as long as I could, sometimes going down to 20mg if I didn't need as much or sometimes going up to 25mg if I needed to. Preferred to increase only by 2.5mg increments to keep dose as low as possible. In the first couple of days I had the speedy feeling of taking too much and this made my ADD symptoms worse (more scattered thoughts, forgetful, couldn't focus) so I know what taking too much does to me, but as my body became used to it and I kept the dose low it started to work in some ways but not in others, I'll explain.

Lots of energy, higher (if that was possible) sex drive, great knowledge retention and was more calm and understanding in situations I normally would have let upset or anger me. Strangely I had opposing social effects, sometimes I would feel like going out, socialising, meeting people and dating women, then other times I would be content to be a hermit for days and just stay on the internet procrastinating or going into an ADD research binge or any other topic that I wanted answers for that day, ignored women, refused invitations from my friends to go out or catch up, I didn't feel depressed or negative, just couldn't be bothered or saw no extra enjoyment from making the effort to go out, it was weird as other times while on the Dex I'd be jumping at the chance. I seemed to be able to focus on things that interested me but I avoided work more than normal now which is the opposite of what I thought I'd feel like on the meds.

I'll mention the physical effects as someone might be able to recognise something here, maybe a hormone or nutritional imbalance/deficiency. Physically I was sleeping better, still eating like a horse and even more hungry sometimes, my stomach would actually grumble after taking my waking AM dose and I've never been a big breakfast person (I lift weights which helps appetite and I have a very healthy diet), increased heart rate, sometimes to very high levels but only briefly and during the first few weeks, blood pressure actually lowered, cold feet, sometimes feeling hotter and needing less clothing but other times feeling cold and needing more than usual, hayfever seemed to ramp up but that could have been due to my apartment block being freshly painted about the time I started the Dex and a normal allergic reaction, even though sex drive was constantly high erection quality was completely random, sometimes I couldn't keep it up, other times I couldn't keep it down.

Most of these physical and mental effects have settled down and become less varied/extreme and I'm getting a good feel of how much Dex to take and when to avoid these swings. I've also been taking Melatonin when I feel I need it and this could just be coincidence but it seems that when I've taken Melatonin the meds don't work as well the next day. Like I say, this could be coincidence as I'm told and have read that Melatonin actually helps most people get the best effects from the meds but then again I seem to be getting a lot of opposing effects.

However, no Positive effect on drive or motivation for work and I still procrastinated terribly, these were the main things I wanted to solve.

All of a sudden this last week I had a week of the drive and motivation I was looking for, I've had moments like this in my life before I was diagnosed but it wasn't consistent, it maybe lasted anywhere from a few weeks to a couple of months at the most. This time it was a week straight of just getting everything done without distraction and with great efficiency, just like what the Doctors told me it would do and what I've read from success stories on this site and others. I felt so good about myself at the end of the day for what I achieved and how great my life would become if I kept this up, and I was so confident that this was a permanent change. I imagine this is what successful people that don't have ADD feel like on a daily basis, the ability to focus on the future goal and outcome and just do what's needed to get there.

Then all of a sudden the next day it stopped, the effect was only lasting for 30 minutes after my dose kicked in and I even fell asleep during the day for the first time since I've been on the meds, this wasn't a calming effect, this was back to my old completely exhausted feeling where I needed to have a nap every afternoon just to function. I tried dropping the dose to 15mg but that was useless, felt nothing at all. I even took a day off and even though I felt like sleeping in a little longer I didn't have any extreme lethargy (except for the usual afternoon nap I needed pre medication days) or depression that I've heard people can have when they go off the medication, I just went back to my old self, maybe a little bit more forgetful and scattered but nothing major.

I tried upping the dose to 30mg after a few days of this which helped keep me awake and made me feel like I did the previous month and a half on the medication but I didn't get that same feeling of motivation and drive I had last week, I went back to procrastinating or happy to stay at home on the internet or playing video games. I can even sit back on 25mg with the same effect now as 30mg was feeling like too much towards the end of the day.

What happened and how do I get back to that sweet spot of feeling motivated and focused again? I know what I want to achieve and know how to get there but its so frustrating taking these meds and dealing with the side effects if they don't fix those parts of my ADD which are most important to me. I'm told by my Docs and keep reading that the week of drive I had is what these meds are supposed to do consistently so surely there's a way to get there again since they did work, even if it was only for a week? I was told the meds were supposed to be effective straight away or does my mind need more time to adjust to this new change in chemistry?

Pilgrim
07-08-17, 10:27 PM
It took me awhile to adjust to the medication , so don't expect miracles. Keeping life as simple as possible, forget lofty dreams, in so far as striving to the fullest. Diet and exercise help heaps.
Sleep consistency and routine are key.IMO

aeon
07-09-17, 12:27 AM
If you are taking dextroamphetamine expecting it to help with issues of motivation and procrastination, you either need to change your expectations or change to a different medication.

I've never experienced dextroamphetamine to be the slightest bit motivating. On dex, I can be a slug...albeit clear-headed and focused...but a slug nonetheless.


Cheers,
Ian

thisaddguy
07-09-17, 04:49 AM
Thanks for the replies.

Pilgrim: I understand what you mean, I wouldn't say I'm expecting miracles but when I have a week of it actually working as I was told it was going to and how so many others have described it working for them then that must be a sign that it can work like that for me again too? Are you saying it is possible but I might need more time to adjust like you did? How long did it take you, out of curiosity?

aeon (Ian): I guess I expected more as the Psychologist and Psychiatrist I saw both told me it would change the way I think and work in the exact same way it did in that week where I felt very focused and motivated and was able to get so much work done. I mean motivation was always there at some level at least but it was more the focus that allowed me to work without getting distracted. If it worked that week and in other moments in the past why can't it be a more consistent thing like so many others have experienced? I genuinely want to know if there's a reason it did work that way and if its able to be recreated because that's exactly what I asked the Psychs to help me with and that's exactly how they sold me on the idea of going on the medication in the first place. I might try Ritalin next and see if there's any difference.

Thanks.

Exuberantfrost
07-09-17, 11:17 AM
In my experience, dextroamphetamine is by far the greatest medication in terms for sharpening the memory and remembering complex thing's fast, but when it comes to treating "tendency to get caught up in procrastination" or "feeling more motivated" it's extremely underwhelming. I am really fond of the drug since it has significant effect on my ability to understand chemistry but I would never take it, without taking it in conjunction with another ADHD-medication (for instance Intuniv or Strattera) because alone it really isn't much of a help.

Pilgrim
07-09-17, 05:46 PM
Some other posts explain well dosage and frequency. Know what you need to aim at and what works for you. I would keep a consistent schedule.

thisaddguy
07-10-17, 03:15 AM
In my experience, dextroamphetamine is by far the greatest medication in terms for sharpening the memory and remembering complex thing's fast, but when it comes to treating "tendency to get caught up in procrastination" or "feeling more motivated" it's extremely underwhelming. I am really fond of the drug since it has significant effect on my ability to understand chemistry but I would never take it, without taking it in conjunction with another ADHD-medication (for instance Intuniv or Strattera) because alone it really isn't much of a help.

I've emailed my Doc (he's hard to make and appointment with as he's booked out for long periods of time plus he's expensive so email communication is the best I have at the moment) about possibly adding in Strattera or Ritalin rather than increasing Dex dose so I'm waiting to hear back. Every time I've asked him about a problem I've had on the Dex though he seems very keen to switch me to Vyvanse, a little too keen actually which I find strange since its 10 times more expensive than the equivalent Dex dosage and from what I've heard its one of the least effective for most people.

Some other posts explain well dosage and frequency. Know what you need to aim at and what works for you. I would keep a consistent schedule.

My dosing schedule has never changed, the most I've ever changed dose was by 2.5mg (half a tablet) and only after a few days of that particular dose being too little or after 1 day if that particular dose was too high. The only inconsistency has been diet but we're talking moving a meal an hour one way or the other where I eat 5-6 meals a day and small fluctuations in macro nutrients as I don't eat the exact same thing every day but try to keep my macros consistent. My Doc seems to think its Tachyphylaxis, from what I understand its a very rapid change to tolerance or desensitisation instead of a gradual onset.

Today was the worst so far, my usual doses gave me the usual physical symptoms of slightly increased heart rate, slightly more forceful contractions, cold feeling but also some more extreme ones of feeling cold almost to the point of wanting to shiver, a few more muscle twitches than normal and an opposite reaction of feeling stoned like I took a sleeping pill.

However, not only were the mental effects non existent but I actually felt the opposite, my ADD had returned and was worse, zero focus or motivation for anything at all, very forgetful, I even felt stoned and tired when my medication took effect and I even felt depressed, I just wanted to stay in bed and go back to sleep. Its been a long time since I've been depressed and that was after a very rough break up so I know what depression feels like. The strange thing is that there was no reason for me to be so depressed, literally the only frustration I have right now in my life is the meds not working all of a sudden which I know I can fix, I just need to find the answer, whether that's here or by trial and error with diet, lifestyle or drug changes, I just want to know the best place to start.

I'll be taking a break completely tomorrow and I'm getting a blood test tomorrow to rule out any nutritional deficiencies or hormonal changes. I'm thinking since I'm still getting some of the physical symptoms but not the mental benefits it must be a receptor desensitisation rather than a lack of dopamine, but of course, I'm not a Doctor so I could be horribly wrong...

Any other insight or information anyone could contribute would be greatly appreciated. Thanks.

sarahsweets
07-10-17, 05:14 AM
I think you first need to stay consistent with your doses. I think you also need to change your expectations. For some of us, success with medication is being able to get up, eat and remember an apt. For others its to go to work on time and for others its being able to study or pay attention to our kids. You have to decide what basic thing will mean success to you. If you measure it by trying to get a bunch of stuff done every week then you will be disappointed when that doesnt happen. Have a few bottom lines. Things that you feel you must do everyday to know your meds are working, The rest will be gravy. I know that feeling of having a really productive day and then having three so-so days and 1 awful day. I found that it was consistency and dosing schedule that was something I had to work out. Adhd meds do not turn us into super humans, it helps us function and there are going to be WTF days mixed in. This us not to say that you shouldnt have any standards or goals or hopes, just that you need to forgive yourself more.
RE: the sleeping. I dont take dex anymore but sometimes I needed a nap to and I dont know why. I stopped wondering why and just napped and felt better.

Lunacie
07-10-17, 10:26 AM
Like Sarah wrote, stay consistent with the doses for awhile.

Keep track of your sleep, lack of sleep can make the meds useless.

Make sure you're eating and staying hydrated. Not drinking enough plain old
water seems to be one of the most common reasons the meds don't work well.
Dehydration causes brain fog.

Don't take the meds with orange/citrus juice or coffee. Citrus juice interrupts
the absorption of the meds, especially with instant release pills or the first
half of extended release capsules.

Caffeine can be a big problem with some who take stimulants. Caffeine is a
stimulant too, so too much or too many kinds of stimulants can cause some of
the problems you're mentioning: twitches or contractions, heart palpitations
and insomnia. And then lack of sleep makes the adhd brain fog worse.

Exuberantfrost
07-10-17, 02:32 PM
I've emailed my Doc (he's hard to make and appointment with as he's booked out for long periods of time plus he's expensive so email communication is the best I have at the moment) about possibly adding in Strattera or Ritalin rather than increasing Dex dose so I'm waiting to hear back. Every time I've asked him about a problem I've had on the Dex though he seems very keen to switch me to Vyvanse, a little too keen actually which I find strange since its 10 times more expensive than the equivalent Dex dosage and from what I've heard its one of the least effective for most people.
.

Vyvanse is, in my experience, a favorits among many psychiatrist because it lasts longer than dextroamphetamine. Some people are fond of it, but I get extremely tense and nervous when I take, and it doesn't work as smooth or as effective on me, as dextroamphetamine does. I do prefer to any methylphenidate drug out there, though. If you do get prescribed Strattera please be aware that you blood pressure may rise and if does, there are medication that can help with that. It can be terribly uncomfortable if the heart beat begins to race 24/7.

thisaddguy
07-13-17, 06:56 AM
I think you first need to stay consistent with your doses. I think you also need to change your expectations. For some of us, success with medication is being able to get up, eat and remember an apt. For others its to go to work on time and for others its being able to study or pay attention to our kids. You have to decide what basic thing will mean success to you. If you measure it by trying to get a bunch of stuff done every week then you will be disappointed when that doesnt happen. Have a few bottom lines. Things that you feel you must do everyday to know your meds are working, The rest will be gravy. I know that feeling of having a really productive day and then having three so-so days and 1 awful day. I found that it was consistency and dosing schedule that was something I had to work out. Adhd meds do not turn us into super humans, it helps us function and there are going to be WTF days mixed in. This us not to say that you shouldnt have any standards or goals or hopes, just that you need to forgive yourself more.
RE: the sleeping. I dont take dex anymore but sometimes I needed a nap to and I dont know why. I stopped wondering why and just napped and felt better.

I think I know what it was now, my schedule didn't change but I moved 2.5mg of my 3pm dose to my midday dose as it felt the 5mg dose was wearing off too soon, I guess this small change was enough to cause an increased response, a little too much and cause the tachyphylaxis. Its a shame because that week was incredibly productive.

Like Sarah wrote, stay consistent with the doses for awhile.

Keep track of your sleep, lack of sleep can make the meds useless.

Make sure you're eating and staying hydrated. Not drinking enough plain old
water seems to be one of the most common reasons the meds don't work well.
Dehydration causes brain fog.

Don't take the meds with orange/citrus juice or coffee. Citrus juice interrupts
the absorption of the meds, especially with instant release pills or the first
half of extended release capsules.

Caffeine can be a big problem with some who take stimulants. Caffeine is a
stimulant too, so too much or too many kinds of stimulants can cause some of
the problems you're mentioning: twitches or contractions, heart palpitations
and insomnia. And then lack of sleep makes the adhd brain fog worse.

I was already following all of the above except the caffeine, although it was only 1 cup of coffee a day, then again if the moving of 10% of my total dose to a different time slot was enough to tip me over the edge then maybe a cup of coffee a day was too.

Vyvanse is, in my experience, a favorits among many psychiatrist because it lasts longer than dextroamphetamine. Some people are fond of it, but I get extremely tense and nervous when I take, and it doesn't work as smooth or as effective on me, as dextroamphetamine does. I do prefer to any methylphenidate drug out there, though. If you do get prescribed Strattera please be aware that you blood pressure may rise and if does, there are medication that can help with that. It can be terribly uncomfortable if the heart beat begins to race 24/7.

I'm going to see the Doc next week, he seems to think Strattera or Modafinil could be other options to augment or even replace the Dex for now, he didn't go into much detail so I'll find out more when I see him, I'm sure he'll try talk me into Vyvanse as usual lol.

I took a couple of days off and the Dex seemed to work a bit better today but still not as effective as they were (I don't mean the super productive tachyphylaxis inducing week) but at least my mood is back to normal, just the energy and focus lacking for now.

Cheers.

Pilgrim
07-16-17, 04:24 PM
What Sarah/ Lunicie is gold. IMO nothing works as well as Dex, horses for courses.

I still get as much done, with two thirds of the mental strain, by not measuring everything I do to the smallest detail.

Took me at least a couple of months to adjust.

sarahsweets
07-17-17, 09:15 AM
Vyvanse is, in my experience, a favorits among many psychiatrist because it lasts longer than dextroamphetamine.
Whether or not it lasts longer is up for debate. Its supposed to be abuse proof-or harder to abuse but imo all you have to do is take more of it and that qualifies as abuse. I personally have an issue with vyvanse that I freely admit to, but for me, it didnt last as long as it was purported to last. It also gave me headaches and anxiety. I also take issue with how heavily it is promoted in the US when there is no generic.

thisaddguy
07-19-17, 07:54 AM
So I took a few days off and the Dex started working again, although I had developed a bit of a tolerance and had to increase my dose to 27.5mg, its working well and not interfering with anything else like my appetite, sleep, mood ect. Although my previous ultra productive week of huge motivation and unwavering laser like focus was not natural and was a product of taking a little too much Dex, it helped me to remember what its like to have motivation and drive again and I can now call on that by remembering how it felt that week and get stuck back into work when I feel myself drifting off.

I want to have a couple of days a week at least off Dex so I got a script for modafinil and the Doc gave me some Nuvigil samples (that's all he had) so I can see how that works on my days off to keep me awake and functioning at least and to help keep Dex tolerance down.

Lunacie
07-19-17, 10:15 AM
How long have you been taking Dex? I doubt if you've developed tolerance if
it's only been a month or two.

The recommended method is to start low and increase slowly as you adjust to
having the meds on board. Chances are that you need a higher dose than you
started with, that doesn't indicate that you've developed a tolerance. Just that
you haven't found the correct dose for you yet.

sarahsweets
07-19-17, 01:55 PM
So I took a few days off and the Dex started working again, although I had developed a bit of a tolerance and had to increase my dose to 27.5mg, its working well and not interfering with anything else like my appetite, sleep, mood ect. Although my previous ultra productive week of huge motivation and unwavering laser like focus was not natural and was a product of taking a little too much Dex, it helped me to remember what its like to have motivation and drive again and I can now call on that by remembering how it felt that week and get stuck back into work when I feel myself drifting off.

I want to have a couple of days a week at least off Dex so I got a script for modafinil and the Doc gave me some Nuvigil samples (that's all he had) so I can see how that works on my days off to keep me awake and functioning at least and to help keep Dex tolerance down.
I dont understand... why take breaks? There is no solid evidence that taking breaks somehow lowers the potential for tolerance or keeps it at bay. Usually a person stops taking the amphetamine for a few days, resumes and gets that little euphoric kick they got when they first started taking it to begin with. it doesnt mean that you are holding off tolerance, it just means you might feel it more than if you took it daily. Tolerance is actually quite rare. Yes, it happens but not nearly as much as is claimed all over the internet.`

aeon
07-19-17, 02:23 PM
Tolerance is actually quite rare. Yes, it happens but not nearly as much as is claimed all over the internet.`

Especially with clinically-prescribed doses under 30mg.


Cheers,
Ian

thisaddguy
07-19-17, 06:18 PM
I guess what I mean as "tolerance" must be different, I'm new here so still learning lol. What I mean is that I want to avoid Tachyphylaxis again and I want the dose to remain as low as possible. If the meds worked at 20mg but now I need 27.5mg isn't that a form of tolerance? Just because they work now at 27.5mg and that's within what most would consider a therapeutic dose that's not a guarantee the amount needed won't creep up over time as it has been doing?

I understand in the US you can be prescribed quite large amounts of these medications but in Australia the maximum daily limit is 40mg, my worry is that I'll easily get to that limit and it become less and less effective and leave me with my old ADD self and no options.

I see so many cases on these and other forums where people have taken a couple of days a week off the meds and its helped with keeping their dose low, if there's any chance it'll help me I'm happy to try it at least.

But like I say, I'm new here and open to any suggestions or help, thanks again guys.

Little Missy
07-19-17, 06:22 PM
Just take it as prescribed every day and you should be just fine. :)

aeon
07-19-17, 06:43 PM
If the meds worked at 20mg but now I need 27.5mg isn't that a form of tolerance?

No, because until you can demonstrate those effects as repeated events over time, while at the same time maintaining good sleep, nutrition, physical activity, and social interaction, as well as not demonstrate any signs of depression, anxiety, and/or stress that exceeds your skills and resources to manage, there is no way to be sure, and even with all that, there isnít any means by which to take tissue samples from your dopaminergic pathways to look for neuronal changes.

The downregulation of receptors that is part of tolerance to a drug usually only occurs when the usage in question exceeds clinically-prescribed amounts and/or are abused in a chronic manner outside of clinically-prescribed regimens.

Iíve been taking dextroamphetamine sulfate at 60mg/day for years, both as CR spansules, and IR tablets. Have I had isolated days when my meds donít seem to work as well? Sure...but thatís always been a function of other behaviors/choices/situations in my life.

And I donít mean to say no one elseís experience should differ from mine. They have, and they will. At the same time, the decades of peer-reviewed data on both methylphenidate and amphetamine show that tolerance is almost exclusively associated with abuse of these medications, licit and otherwise, not adherence to a clinically-prescribed regimen in the treatment of those disorders for which these drugs have efficacy.


Cheers,
Ian

namazu
07-19-17, 09:26 PM
The downregulation of receptors that is part of tolerance to a drug usually only occurs when the usage in question exceeds clinically-prescribed amounts and/or are abused in a chronic manner outside of clinically-prescribed regimens.

[...]

And I donít mean to say no one elseís experience should differ from mine. They have, and they will. At the same time, the decades of peer-reviewed data on both methylphenidate and amphetamine show that tolerance is almost exclusively associated with abuse of these medications, licit and otherwise, not adherence to a clinically-prescribed regimen in the treatment of those disorders for which these drugs have efficacy.
These statements are not well-supported by the available scientific evidence.