I've spent all morning reviewing lots of threads regarding Adderall XL. Nobody seems to have had the experience I'm having, so I'm starting this thread to see what other's think about my problem.

After years of being treated for depression, with no meds working (zoloft, celexa, lexapro, wellbutrin) I finally went to see a therapist. She thinks I might be ADD (inattentive type), and that was causing my depression. I immediately went the the library to get all the books I could on ADD, and its been so enlightening. I finally feel like there is hope for me!

I started on Adderall XL 10 mg one time per day last Wednesday (3/28). Day one was ok, felt a little funny, but had patience and clarity for the first time in as long as I can remember. The next 3 days were perfect! I felt like a new person, my focus and the ability to manage my day was so encouraging. I had an overwhelming sense of calmness and I felt genuinely happy-- my husband noticed a positive change as well. I'm a stay-at-home mom, with 3 and 4 years olds so life is pretty crazy. I finally felt like I could handle things.

On day 5, the day started out ok, but in the afternoon, my head felt fuzzy and I was tired, and irritable. Day 6 (yesterday), I was functioning ok in the morning, but by lunchtime I was done. I got my kids to take a nap, and I passed out in bed. I was positvely exhausted the rest of the day.

Today, I woke up, took my 10mg and started about my day. I feel absolutely horrible. None of the clarity and focus or calmness, even for a brief time. I'm even teary today. I've cried 3 times, and I NEVER cry.

I've got a call in to the Dr., but I haven't heard back from her yet.

Any ideas what might be going on? Wrong meds? Too low a dose? Not ADD?

Thanks,

Jenn

Here are 2 ideas:
1) Get sleep, a lot of sleep, and then see how the day goes. I mean 8+ hours.
If 1 fails, and only if 1 fails,
2) Get a higher dose

I don't think it's the dosage. It's the norepinephrine effect subsiding.

There are many possibilities for what could be going on.
One thing I noticed, is that Adderall intensifies my emotions. I'm usually a very emotionally stable person, but if I do have some stressful event occuring in my life, my emotions get out of control when I take Adderall. Sometimes when I'm stressed out, taking Adderall will make me brake down and cry or have panic attacks. I don't think it makes me sad or anxious, it simply intensifies pre-existing things. And I never cried or felt this way before when this kind of stuff happened before Adderall.
But I took Adderall for 6 months without any problems before discovering this feature of the drug.

Maybe you are experiencing a combination of anxiety intensification as well as tolerance development. Just an idea.

Keep your doctor informed! Also your therapist. I'm not sure what kind of therapist you have, but if they're an actual psychologist then they are most likely pretty good and knowledgable about what you are going through.

Thank you for the responses. I did finally speak to the nurse practitioner, who prescribed and "manages" my medications. She said to up my dose to 20mg. This, of course, means that I'll run out of the med. before the month is up. I'm not sure this is what I want to do.

Sargon: I'm so not knowledgeable about these meds (my bad, I know), but what do you mean by the norepinephrine effect subsiding? I did forget to mention that initially she had me start zoloft with the wellbutrin I was taking. I had no changes, so when she prescribed the adderall, she said to just stop taking the Zoloft. Would that be part of the problem?

optimum00: Sleep on the first couple of days was sketchy, lately I've been getting ok sleep. However, I've always had anxiety that shows up at night, so it can take time for me to go to sleep. I don't want to add another med, but you might be right about not getting enough sleep. I'm ready for bed right now though....

xmikef: Thanks for talking about your experience. After posting this thread, and talking with the NP, things got worse, I was crying even more. Its crazy! I don't like crying, and I can't figure out why I can't stop. My therapist is an LPC, and then I have a meds nurse. Maybe this isn't the right combo.

My husband is so upset right now. He doesn't understand why they can't up my dosage. Poor thing, the first days on adderall were so great, he doesn't know why we can't get back to that. Quite honestly, I wish I could too. I know that there's trial and error with the meds, but he doesn't get the whole "controlled substance" part of it that limits me (all of us).

I'm still deciding whether to take 20mg in the morning...... I'm thinking I'd be better off getting off the adderall alltogether.

Any other input is desired, and welcome. Thanks to you all!

How can you not fill a new script? It's for a new dose, I've never heard of this type of problem. You are expected to run out unless 10mg is enough for you. You will take a med for ADD, but not sleep problems? I'm pretty sure that your situation is related to the poor sleep you are having. You should get a benzo (xanax/ativan/klonopin) for the anxiety that is messing up your sleep. I think that combo of Adderall with a benzo is what would work best.

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How can you not fill a new script? It's for a new dose, I've never heard of this type of problem. You are expected to run out unless 10mg is enough for you. You will take a med for ADD, but not sleep problems? I'm pretty sure that your situation is related to the poor sleep you are having. You should get a benzo (xanax/ativan/klonopin) for the anxiety that is messing up your sleep. I think that combo of Adderall with a benzo is what would work best.I truly appreciate your advice! However, I'm sensitive right now, so please be kind!

First, the nurse who manages my meds specifically said with my first adderall xl rx that it had to last a month. This was reiterated during our phone conversation today. I too don't understand why she can't write a new rx for a higher dose, but apparently them's the rules. If anyone else knows differently, let me know. Also, I'm in Colorado, so I don't know if it varies by state.

Secondly, I have xanax. I only take it when I'm having anxiety/panic, which is not regularly. I suppose with starting out with a new med (adderall) I didn't want to add anything to the fire. I'm not being hypocritical, just trying to sort out what works and what doesn't. So far, it seems like the adderall is throwing everything off.

Thanks again for your comments, it gives me alternatives to investigate.

And finally, to everyone, I failed to mention that on 3/7 (or crap, 3/14, I forget), the med. nurse started me back up on Zoloft in addition to the Wellbutrin I was currently taking. After our visit on 3/28, when I told her there was no change in my situation, we started adderall xl and she said to shop the Zoloft. I stopped it cold turkey. I realize this is probably valuable info I didn't originally include. Could this also be an issue?

Thanks to everyone in the addforums for all the valuable information you provide.

Jenn

SSRIs dull and often screw with the efficetiveness of amphetamines. 10mg of XL is quite a small dose and i would probably blame the zoloft rebound.

When you quit SSRIs your brain has to learn to balance its self out naturally again and could lead to all sorts of weird effects.

First, the nurse who manages my meds specifically said with my first adderall xl rx that it had to last a month. This was reiterated during our phone conversation today. I too don't understand why she can't write a new rx for a higher dose, but apparently them's the rules. If anyone else knows differently, let me know. Also, I'm in Colorado, so I don't know if it varies by state.You can't get refills on sched 2's but they can write all the new prescriptions for you that they want. If she tells you to take 2x the dose but won't write a new Rx, perhaps you should get a different doctor.

And sleep problems have been shown in numerous studies to cause ADD-like effects. Try to give yourself an hour in the evening to wind down in dim light, doing a relaxing activity (not TV, computer, exercise, etc... instead try listening to music, meditating, taking a bath, reading a book). Try to go to sleep and wake up at consistent times. The human brain tracks circadian cycles by light, and the CLOCK gene specifically tracks dawn and dusk via mPer1 and mPer2 expression, respectively. Impairing the ability to track dusk conditions leads to diminishment of mPer2 expression, which downregulates tyrosine hydroxylase production during the day-- lowering levels of dopamine, norepinephrine, etc in your brain.

And for the "dawn", try setting a lamp on a timer by your bed to turn on before your alarm clock. I think you'll be surprised-- the natural cues for light are very powerful. I don't even use my alarm clock anymore.

Also, if you have anxiety that manifests in the evening and at night, this may be a sign of an inverted circadian cycle, where the cortisol peak is shifted 4-6 hours later than the natural noon to middayish peak. Naturally, what will happen with proper light cues is your body releases a ton of cortisol, norepinephrine, dopamine etc when you wake and through midday or so, which dimishes in the evening as melatonin and adenosine build up to prepare you for sleep. If you invert that, you have the excitatory hormones present at evening and in your sleep, and the relaxing/sedative hormones present during the day.

It's so very easy to stay up late thanks to artificial lighting and all of our electronic toys, but it can take a toll upon our body and mind.

So, I think from your description of sleep issues you could benefit from trying a few things, and possibly seeing a sleep specialist as needed.

(caffeine is also quite horrible on sleep architecture. even if you only have it the morning. I can cite studies on this if needed.)

Hi Jenn,

So sorry you're going through a bad time. (Ugh! I've been there too.) I take Adderall XR and Zoloft myself and it works well. I DID want to share this experience with you, however, in that I have run out of Zoloft before (insurance problem and that stuff is expensive to pay out of pocket) and suprisingly I became EXTREMELY EMOTIONALLY UNSTABLE. I felt so miserable (emotionally, mentally AND PHYSICALLY - which seems strange to me) and it didn't occur to me that suddenly NOT TAKING the Zoloft would have such an impact. It seems that even though these meds can take a while to help, I guess if you stop taking them suddenly - sometimes that can have an IMMEDIATE negative effect for some people.

I would also guess that a higher doseage of the Adderall would be helpful (when it's all "kosher" etc.). But I believe that starting with Adderall would be BEST when you are already STABLE & SET with your other meds. Perhaps the altering of the antidepressant meds at the same time as the Adderal induction is just making everything confusing: what's causing what???? Ya know.

Just try to take it very, VERY easy on yourself. You're going through a difficult time getting the medications sorted out - as MANY of us do - and, UNFORTUNATELY, our system does a very poor job of managing this problem in a timely manner. (IMO!)

Sue

Frang, how long does it take for the body to readjust its circadian rhythm?

I'll 2nd Sloppitty-Sues comments about the antidepressants. They take weeks to build up to notice any benefits but sudden changes in dosing (like stop taking them) and you'll get some bad side effects. I went through that with Effexor XR. Even by missing a day's dose I would start getting withdrawals (dizziness, loopy headed, nausea, sweating). I switched to Prozac for the reason that it has a seriously long half life so missing doses doesn't trigger anything. Been on it ever since (about 3 years).


J

Thanks D.B., Frangible and Sue for your responses. I appreciate your advice and opinions.

Today is a much better day. Not as good as it was last week when I first started the adderall, but better than the last few days.

I was at Target today, and I spoke with the pharmacist there. She said the same thing you all said about the rx. If its a new dosage, there's no problem in getting it filled. I don't know what to do. It took forever to get an appointment with my current docs, and I don't want to have to start over with someone else. I'm thinking about calling to get clarification as to why they can't write me a new rx for the higher dose. Maybe its an office policy. I just don't want to make them angry and say, "no meds for you." Regardless, I'm going to try this higher dosage or a few days before I do anything just to make sure it seems to be appropriate.

Also, I started back up on zoloft. I don't imagine that the 50 mg. I took could make much of a difference in a day, so I want to give that time to work too.

Thanks again to all.

Frang, how long does it take for the body to readjust its circadian rhythm?If you use melatonin, most of the changes for sleep/wake time happen in a few days, but it truly takes something like three weeks to readjust all the hormonal rhythms, etc. There are also other entrainable rhythms that are connected, but can become dysynchronized.

For example, if you change your diet to only eat before sunup, and after sundown, you will invert your circadian cycle almost instantly (but not in a good way). Yet other eating patterns will entrain rhythms completely apart from lighting cues, and some happen in peripheral systems in the body and are only indirectly affected by the whole process.

After about two weeks of normalizing my sleep schedule and doing relaxation at a specific time (9pm), I noticed that I was starting to feel relaxed/warm/vasodilated even before actually relaxing! The entrainment of the circadian cycle can be a good thing too.

It's not easy to be consistent with sleeping/waking sometimes, but I think it's worth it.

I'm thinking about calling to get clarification as to why they can't write me a new rx for the higher dose. Maybe its an office policy. I just don't want to make them angry and say, "no meds for you." Regardless, I'm going to try this higher dosage or a few days before I do anything just to make sure it seems to be appropriate.My doc has done dosage increases over the phone, or medication changes even. I think it just depends on if they're willing to work with you or not. You should definately try to talk to her.

One thing you can do is take some tums prior to taking the Adderall, and avoid acidic things in your diet (soda, some fruit juice, etc)... that will increase your body's absorption of the Adderall you do have. Hmm, what else... I read one study showing St. John's Wort potentiates the effects of amphetamine (though the dose in humans was unclear, it was an in vitro study... nonetheless, you cannot use SJW with a SSRI or you risk serotonin syndrome), and cardiovascular exercise should release lots of epinephrine/norepinephrine/dopamine/phenylethylamine (the "endogenous amphetamine") as well.

btw, I think SSRIs can antagonize the effects of Adderall, as can high estrogen parts of your menstrual cycle.

I've been 'taking' adderall for about 2 years now. I usually take it for a day or so and then stop (sometimes for months). I feel that I primarily need it for school (college), though I do love the concentration I have when I use it on days I go to work. It just seems that I can manage all of the mundane reoccurring things at work much easier than new notes in class, etc.

Beginning last Wednesday, I decided to start taking it as prescribed - daily. The first few days, I had the familiar euphoric feelings, talkativeness, hyper concentration, etc. These eventually subsided and I begin feeling somewhat 'normal' but found my ability to maintain concentration on tasks increased. I guess it was doing it's job.

The last two days, however, I've felt incredibly depressed. I do have an excessive amount of stress in my life right now - I work (3) 12 hour days Monday, Wednesday, Friday, go to school full time on Tuesday and Thursdays, and run a screen printing business out of my house during what I call my 'free' time. I've seen the effects of this stress throughout the last few years. I began having anxiety (something I never had throughout high school) and even had a few panic attacks. I contributed a lot of this to the stress in my life. Rarely, though, did I ever feel as depressed as I have felt the last two days. It's this reason that I contribute it to the adderall.

I haven't found many who have felt the same other than the original poster, so I'm trying to find some similarities between our situations. I definitely do not sleep enough, but this is an ongoing situation. I'm not a 'morning person,' so maybe my cycle is inverted as mentioned above. I've decided to stick it out until next week and see if it fixes itself.

I'm prescribed 20 mg twice daily but usually only take the one dose in the morning. I took the second dose for the first time yesterday and it seemed to somewhat alleviate the depression. It's a crazy feeling - I don't feel worried, etc., I just have an urge to cry about nothing at all. I don't feel like doing anything, really. My concentration isn't poor, however. My head does feel slightly fuzzy, but as this message can prove, I'm still somewhat talkative.

Couple of things I'm going to change in the next few days to see if it alleviates it:

1) Going to eat more. I've loved the initial weight loss, but I'm probably only consuming about 1000 calories a day. (i'm a 22 year old male, btw) I just simply do not feel hungry nor want to eat. I ate half of a Lean Cuisine frozen meal for lunch today. Normally, I can consume a double quarter pounder with cheese and some fries with no problem.

2) No more soda. I've pretty much stopped this, but I'm going to cut it out completely.

3) Exercise. I haven't done regular exercise in years.

4) Sleep. I think I'm going to set a strict 9:45 pm bed time for myself.

These are all things I think anyone should implement into their lives that I have failed to do so. I almost wonder if the adderall is simply amplifying the crappy feelings I should be experiencing because of my crappy lifestyle.

Wow, my daughter takes the 20 mgs once daily, but the only thing I've noticed as far as depression is that she seems to be really "down" when she misses a dose for more than one day. Right now we are every other day, her doctor thinks her metabolism has changed and thats why the every day dose doesnt work (she has been technically on it for two years as well) maybe the "down" feeling comes from the missed dose, otherwise the only other option is doing as your doing and trying to pin point exactly what might be causing it. She is effected sleep wise as well when she takes the dose daily now, say Monday she is rock bottom on it (and everyone including school and daycare want to know if she is ok) on Tuesday if she takes it again, she is wired by the time I pick her up and then cant sleep that night. Thats the hardest part with these meds, finding the right dose and the right "way" to maintain the dose.
I hope you start feeling better and hopefully things will work out soon. Maybe take some "me" time too, just because.

Mr. Bonzo - I'm the OP. Sorry to hear about your recent troubles. However, it sounds like you're tackling it objectively and working towards improvement.

I wanted to share with you that my original dosage was increased to 20mg (XR) once per day. That seemed to help with the depression issue. Additionally, I started taking Zoloft again (I had abruptly stopped), and I'm discontinuing that on a gradual basis vs. cold turkey. I haven't had any more episodes like the one I originally posted about. That said, I'm still not feeling as well as I did when I initially started the adderall. I think its dying on me in the afternoon now. I'm new to the med. so I'm sure this is just a process in trying to find the appropriate dose. So in a nutshell (If you can consider my blather concise!), I haven't had the depression issue that I did 2 weeks ago.

Might I mention, that you said this started 2 days ago. Even though you may not think it has any affect on you, the nightmare incident in VA seems to coincide with your depression. Just a thought....

Best wishes to you!