View Full Version : Is my dosage too low?


SilenceDogood
08-29-17, 11:50 AM
Hello,

Though diagnosed 16 years ago with adhd I only started treating it with medication 2-3 months ago and am unsure of what to expect. After searching and reading a few people's experiences of what their medication does for them I'm starting to wonder whether I'm actually benefiting from the medication or if my dosage is too low. Other than Wellbutrin, which I take at 200mg a day, I've never been on any sort of stimulant medication and assume that I shouldn't have any tolerance. Also 5'11" 190lbs if that has any bearing on dosage requirements.

For the first month my psych prescribed me 15mg adderall xr to be taken only on the days I have to work. I felt absolutely no effect from my first dose. It didn't quiet or organize the beehive of a thought process I have, my motivation didn't increase, my energy level was exactly the same as it always was, and I definitely couldn't discern any improvement on my level of focus. I tried the medicine 6 or 7 more times but still no effect.

At my one month check up I told this to my psych and she said it was a low dose and would increase it to 25mg XR. She gave me two scripts since I wouldn't be seeing her for two months this time but told me if the 25mg was too much for me and made me anxious, jittery, or gave me insomnia to not fill the second script, call, and she could prescribe 20mg instead.

The 25mg was a little more effective... I think. If it does have an effect it's subtle and I can't say 100% that it's not a placebo effect from my expectations that it should work. It definitely wasn't too powerful and didn't give me the least bit feeling of being anxious, jittery, or keeping me up at night. What I may have noticed did surprise me however. About an hour after I took it I actually felt a little tired and my mind felt a little more calm as if my thoughts weren't running as fast and we're flowing in a more coherent fashion. I also noticed when I tried to read a book instead of having to read each line 5 times before I actually retained and comprehended it, I could get through a whole page before my mind started drifting off into random impulses of thoughts.

What I definitely didn't experience was any form of increased energy, increased motivation, any elation or improved mood which I hear people describe as happening when they first start taking the medicine, and I've never experienced a "crash" from my medicine of being tired and irritable after it wears off.

Since then I typically take my medicine 4 days a week, on an empty stomach with tums as I've heard this increases the absorption amount. I feel that it's semi helping with my adhd symptoms but not to the amount I had hoped or expected.

I guess my question comes down to being do you think that I still need a higher dose, as I would have thought 25mg a day would have been a lot for someone with no tolerance, or do you think that the medicine is doing what it's suppose to and my expectations are just too high for focus and motivation?

Any feedback is greatly appreciated!

sarahsweets
08-30-17, 07:29 AM
Hello,

Though diagnosed 16 years ago with adhd I only started treating it with medication 2-3 months ago and am unsure of what to expect. After searching and reading a few people's experiences of what their medication does for them I'm starting to wonder whether I'm actually benefiting from the medication or if my dosage is too low. Other than Wellbutrin, which I take at 200mg a day, I've never been on any sort of stimulant medication and assume that I shouldn't have any tolerance. Also 5'11" 190lbs if that has any bearing on dosage requirements.

For the first month my psych prescribed me 15mg adderall xr to be taken only on the days I have to work. This makes me wonder about your doctors' competency. ADHD is a 24/7 thing and taking it everyday at least when you start out is the best way to see if it works.

The 25mg was a little more effective... I think. If it does have an effect it's subtle and I can't say 100% that it's not a placebo effect from my expectations that it should work. It definitely wasn't too powerful and didn't give me the least bit feeling of being anxious, jittery, or keeping me up at night. What I may have noticed did surprise me however. About an hour after I took it I actually felt a little tired and my mind felt a little more calm as if my thoughts weren't running as fast and we're flowing in a more coherent fashion. I also noticed when I tried to read a book instead of having to read each line 5 times before I actually retained and comprehended it, I could get through a whole page before my mind started drifting off into random impulses of thoughts.

Consistency is key when you first start these meds. Taking it only 4 days a week isnt consistent.

What I definitely didn't experience was any form of increased energy, increased motivation, any elation or improved mood which I hear people describe as happening when they first start taking the medicine, and I've never experienced a "crash" from my medicine of being tired and irritable after it wears off.

Those are side effects and not everyone experiences them the way you describe,and its important to adjust your expectations.

Since then I typically take my medicine 4 days a week, on an empty stomach with tums as I've heard this increases the absorption amount.
This is potentiating and borders on med misuse since it is not part of the medication guidelines and associated with pro-drug abuse sites. Increasing absorption doesnt make it work any better all it does is potentiate any high you can get from it.

[quote] I feel that it's semi helping with my adhd symptoms but not to the amount I had hoped or expected.

ToneTone
08-30-17, 01:45 PM
Like Sarah, I don't think taking the med 4x a week is a great idea, especially at the start of treatment. The only way for you to get a real sense of things is to take the thing 7 days a week. You need all that data to be able to make a confident report.

Elation is not part of the deal. That's often a side effect of someone starting treatment and taking a dosage that is too high. Skip that. You want functioning, not elation.

The question you pose (how do I know the med is working as it should?) is a frequent question here.

One answer is simply to skip that big question ... and instead think of your job as reporting back to your provider exactly what you have reported here. That's one of the doctor's jobs: to add up the detailed, conflicting, uncertain, ambiguous info we give them. Literally, your report here would be an excellent report back to the provider!

Based on this report, for example, what I take is that you are having a mildly positive effect on reading concentration, but you're not feeling much of an overall positive effect. You seem unsatisfied and disappointed with the effects of the medication so far.

Generally, I would say, if you're not feeling really good about how you are functioning, keep going ... Assume that life that can be better and treatment can be better.

Finally, you can create a few questions ... like what do you WANT to be better in your life ... examples:


I want to perform better at work ... I'm missing deadlines currently and getting low reviews ... I make x kind of mistakes ...

I want to be able to remember more of what my spouse and I discuss. I completely forget key things I agreed to do ... and didn't follow up.

I want to not feel like I'm in crisis-emergency mode all the time.


Once you lay out these goals ... then you evaluate the med by how it helps you with these goals.


Tone

Jillybean
08-30-17, 03:35 PM
I agree with Sarah 100%, not everyone experiences the side effects of increased energy, elevated mood (i would think that is more like a "feeling high" effect), and increased motivation. I get none of those things from my adhd medication nor do I crash. I actually I feel more relaxed and calm on vyvanse. When I question if my medication is working I usually test it out. I get myself started on something I know I usually would not complete, like house work. After I get started I end up forgetting about my meds and next thing I know, I have completed the task. That's how I tell if my vyvanse is still working for me. My doc explained it to me like this when I asked about having more motivation. He said the medication is there to help you along not do things for you. Now keep in mind I'm not referring to motivation in a sense where you can't get out of bed, that would be a diff story. Anyhow, therapy has also me. I am able see more of what I can do to improve some of my adhd issues, like using list and what not. One more thing, I have found for me. Sometimes when I get myself fixated on something I have trouble recognizing that I am more focused by my medication and can get a little carried away. This has led me to some feelings of depression and hopelessness. Not that that is what is going on with you but something I personally have to look out for.

PoppnNSailinMan
08-30-17, 03:58 PM
It sounds to me as if the Adderall XR at 25 mg is starting to work for you based on what you've said about feeling more calm and your mind not running as fast. But you might not even realize all the ways that it is helping you. I've read that sometimes the person with ADHD doesn't notice all the ways that their medication has improved their symptoms and that it helps to get feedback from other people they know (a partner or a spouse or a close friend) who might have noticed these improvements. As others have said, what you've written in this post would be a good first report to your psychiatrist.

I just started Vyvanse three weeks ago after being off of any stimulants for 5 years and the first thing I noticed more than anything else was not a sense of euphoria but a sense of calm and quiet inside which is pretty amazing to me by itself. Everything has definitely slowed down inside. And like you, I've also noticed that I can read a book with less effort.

The other things I've noticed are more subtle. I can tell that I'm more attentive in my driving and pay better attention to the other cars around me.

When someone else is talking to me, I've noticed that I'm less likely at the first chance I get to divert the conversation onto some tangent or change the topic altogether to something else that is more interesting to me. Instead, I get these thoughts before I open my mouth which say, "Maybe I should wait for just a second to see if this person has something more they want to say before I speak," or "Maybe I should wait and talk about this other thought that just popped into my head a little later or maybe not say it at all." In the past, those thoughts usually came after I had already opened my mouth. I'm definitely feeling more restrained in these kinds of social situations when the Vyvanse is working. To paraphrase what someone else said online, the Vyvanse is providing me a "space between thought and action." And there are other subtle improvements, too.

I'm going to see my own doctor this Friday and report on what I've noticed so far and maybe my partner will come with me and report his own observations as well. He's probably noticed things that I didn't.

SilenceDogood
08-30-17, 08:37 PM
Thanks for the replies and great advice all around! As most of you suggested I think a good next step is just taking what I said to the doctor and getting some feedback. Also as you said Tone reevaluating what goals I hope to get out of my treatment would probably help me discern whether the medicine is being effective.

I also should clarify that the idea to only take my adhd medicine during work days was mine, run by and ok'ed by my psychiatrist.

As I agree with you Sarah adhd is something innate to an individual and doesn't disappear and reappear arbitrarily. I do believe however, it is something that does display a situational varying level of detriment. Thus resulting in periods of time where treatment would yield little benefit and may actually be counterproductive if it results in medication being less efficacious at a later pivotal time. As far as I'm aware, this is something most psychs are at least cognizant of and is common practice to do such things as not medicate children during summer vacation.

Though I must admit I may be prematurely worrying about something at such an early stage of treatment. The goal of limiting treatment to as little as possible is my attempt to avoid a perpetual cycle of dosage increases or medication holidays due to tolerance complications.

Sarah, good point about those being side effects and not necessarily desired results. I guess I incorrectly assumed that in the beginning looking towards obvious signs of side effects could indicate the medication working instead of focusing more on my actual ability to focus. However, I definitely wouldn't be so rash to instantly jump to the conclusion that someone wishing to take their medication in the most effective manner borders on drug abuse. In fact the guideline that I read (put out by the FDA) in the pharmacokinetics section they made a point to make note that in all the studies they reviewed subjects were administered medication after fasting (aka on an empty stomach) and made note that subjects with a lower pH exhibited a higher bioavailability with the medication.

Therefore I respectfully disagree with your statement that its approaching med misuse and feel having a higher bioavailability would help prevent doctors from unnecessarily over dosing patients due to absorption problems. I wouldn't be surprised if a company combined Adderall and sodium bicarbonate into a single pill if they had valid studies showing something like 25% better absorption if consumed at the same time. Such as what they did with Vimovo.

sarahsweets
08-31-17, 04:35 AM
I also should clarify that the idea to only take my adhd medicine during work days was mine, run by and ok'ed by my psychiatrist.

As I agree with you Sarah adhd is something innate to an individual and doesn't disappear and reappear arbitrarily. I do believe however, it is something that does display a situational varying level of detriment. Thus resulting in periods of time where treatment would yield little benefit and may actually be counterproductive if it results in medication being less efficacious at a later pivotal time. As far as I'm aware, this is something most psychs are at least cognizant of and is common practice to do such things as not medicate children during summer vacation.

The breaks that kids take over summer are more about allowing their appetite to come back and to encourage proper growth, not to avoid tolerance. Kids sometimes can experience a bit of stunted growth due to stimulants. IME with my kids, that didnt apply and my son needed his meds everyday for years. My daughter did not and had longer breaks, but none of it had to due with tolerance, it had to do with their development. I think that situation sort of transforms into "breaks are necessary to avoid tolerance" when in most cases its very hard to mitigate or treat a problem that hasnt developed yet.

Though I must admit I may be prematurely worrying about something at such an early stage of treatment. The goal of limiting treatment to as little as possible is my attempt to avoid a perpetual cycle of dosage increases or medication holidays due to tolerance complications.
again, the idea of breaks and kids has more to do with growth, not tolerance and IMO the only tolerance issues an adult might have, would happen after years, not months or days, of use, if at all.

Sarah, Good point about those being side effects and not necessarily desired results. I guess I incorrectly assumed that in the beginning looking towards obvious signs of side effects could indicate the medication working instead of focusing more on my actual ability to focus. However, I definitely wouldn't be so rash to instantly jump to the conclusion that someone wishing to take their medication in the most effective manner borders on drug abuse. In fact the guideline that I read (put out by the FDA) in the pharmacokinetics section they made a point to make note that in all the studies they reviewed subjects were administered medication after fasting (aka on an empty stomach) and made note that subjects with a lower pH exhibited a higher bioavailability with the medication.

I shouldnt have jumped to conclusions like that and I apologize. You would be surprised at how many "can I take tums to feel my meds better" questions we get. But still, increased absorption and bioavaliability is not the same as better efficacy.

CharlesH
08-31-17, 04:02 PM
According to the DSM, ADHD is supposed to affect you in more than one major life domain. In other words, it's not just when you study, or when you are trying to do work. Do you think that ADHD affects your everyday life? Safety while driving can be of particular concern. That being said, the stimulants don't need to build up over time in your system for them to work, so if you truly are negatively impacted by your ADHD only on certain days of the week, then I guess it might make sense to take it as needed. You're still well within the normal dose range, so IMO it'd be reasonable to ask for a dose increase. Can your provider authorize a dose change in between visits if you call his/her office and explain the situation? Maybe you could also ask your provider for some smaller IR doses to combine with the XR so that you can try out different daily doses.

SilenceDogood
09-04-17, 01:36 PM
again, the idea of breaks and kids has more to do with growth, not tolerance and IMO the only tolerance issues an adult might have, would happen after years, not months or days, of use, if at all.


That makes sense as I have heard of that concern too. Thank you again for the input. That's exactly why I came here, to clear up any ignorance I have on such matters from those more familiar with this topic than I.

Also CharlesH, yes I am the same person everyday and experience the same issues no matter the time, location, or activity. I'm primarily inattentive type adhd so if I'm not working and I find my self procrastinating on chores or unable to focus while I'm watching a movie or reading a book, or forgetting to finish putting groceries away, shut cupboards, etc. its more of a nuisance and wasted time than it is detrimental to my career or well being. Therefore at this time I chose to only take it while at work where errors of the same caliber can lead to more drastic consequences.

I'm not going to be pushing a dose increase yet till I have my follow up appointment in a few weeks and explaining everything I've said here and getting some feedback on which direction the psych thinks I should go. Adding IR in doses in with the XR might be an option to prolong the effectiveness of the medicine as shes mentioned possibly needing a booster dose before. Which is something I can see why, because honestly for the subtle effects that I believe I have noticed, I only notice them for maybe 7 hours max.