Quick history - diagnosed in August, started adderall xr 10 mg once a day. It was only lasting about 4-5 hours, so the Dr. added another 10 mg to take around 1 or 2. That worked for awhile, but kind of lost effectiveness after a couple of months.

Last month the Dr. changed me to Vyvanse hoping to get longer/more coverage, but at the same dosage level as the adderall (50 mg), which worked great for a few days, but stopped working around 2, then I would get in quite a wicked mood (hating the world) for an hour or 2 between 2-4.

A week ago, he increased the dose to 70 mg, and again, it worked great for about 5 days, then the moodiness came back, and it's even earlier this time, which is weird - it starts around 12 or 1 now, and I get sleepy, very aggravated, then kind of sad for several hours. The focus I have for about 4 hours is fabulous though.

So - I couldn't take it anymore and called him today and I am going back in tomorrow. I don't know what to do - the Adderall XR was fine, just not strong enough, and I feel like the only reason he switched me is because he didn't want to increase the dose (which he eventually did on the Vyvanse). He is super cautious, which is good, but it's a little excessive..he won't work with adolescents with ADHD/ADD and he won't go above 40 mg Adderall. I have tried to explain to him that I am a fast metabolizer of this stuff but I feel like he doesn't trust me for some reason. I don't know why - I have a full time job and am in Grad school full time, I'm obviously not abusing this stuff.

Sorry for the long post, I just don't know what to do. Does anyone have any suggestions for how to talk to him, or what I should change to? I think he may try to switch me to the ritalin type meds, but I have heard that those are worse with the irritability. The other thing is that all this medicine is expensive, and I don't know if my insurance is going to cover me switching again in a month. :confused:

Most posts I read around here suggest you find another doc if your current one won't go above "recommended" doses. There's no reason to keep seeing a doctor who's unwilling to treat you as an indiviual.

I can't say what's going on w/ the Vyvanse. I have read a lot of posts about the fatigue and irritability between 2-4 pm. This has also been my experience. I recently went up to 100mg to see if I could push the fatigue and rebound out a little later, but it hasn't helped. I took another 25mg this afternoon around 3 and things have been much better. Whether or not I sleep tonight is another story. :eek:

If he won't go up on the Vyvanse, maybe you can ask about switching back to Adderall. There's still room before you hit his arbitrary dose cut off and you've barely scratched the surface w/ the 2 10mg XR doses. See what he says/does tomorrow, but keep the idea of finding another doc in the back of your mind.

Thanks for the advice. I have been doing some research and I think part of the problem may be that a) I am a fast metabolizer of medicine (not just this one), and b) I have digestion issues (IBS, gallbladder removed last year), and this medicine is based on the body's ability to digest and metabolize it, and it's just not doing that effectively.

I was thinking the same thing - I think I will ask to be switched back, because at least I didn't have any side effects with the Adderall. Do you think the IR would be better if the time released medicines don't seem to actually work? Or should I stick with the XR?

The IR will give you more flexibility and control, but you'll have to remember to take multiple doses throughout the day. I don't know how IBS etc. would effect metabolism of the IR vs. the XR. Maybe just resume the titration process w/ the XR and add an IR booster in the afternoon if needed? You didn't really get to titrate up before switching to the Vyvanse.

You know that consuming foods that contain citric acid can affect Adderall's effectiveness, right?

Just an update - thank you for your replies! My doc switched me to the IR and it is working MUCH better. No mood swings!!!