Greetings All,

Allow me to begin by providing a little background, I have suffered from dysthymia (kind of a chronic but low-grade depression, you can still function, keep a job, etc) most of my adult life (I'm now 35) interspersed with periodic moderate-major depressive episodes (lasting from several months to several years when it hits) during the past 14 years. Back in the mid 1990s when my depression first began, I went to see a physician about for help and he began prescribing me numerous SSRI drugs one right after the other as soon as the previous one failed to help me. Well, I eventually became greatly disillusioned with pharmacotherapy when nothing helped, and determined to never go down that road again using psychiatric drugs to treat my mood issues after that pharmaceutical debacle (oh what sheer joy it was to withdraw from effexor, NOT!)

Now fast forward to the present - recently (3 months ago) I began to experience mild-moderate depressed YET AGAIN. Presently I'm a graduate student working towards a master's degree in a rigorous academic health care program and I'm nearly finished with my first year (I'm running on fumes at this point). I've literally gotten eaten alive this year by the furious demands of the curriculum, and my stress/anxiety level have been SKY HIGH. My grades dropped lower than is acceptable by my university last term, and so I was placed on academic probation and offered only 1 TERM to get my GPA up (to at least a 3.0 solid B average) or I will be dismissed from the program - well, I worked very hard to even get to this point so I cannot allow academic failure to be an option - talk about pressure & stress!!!! I've studied various depression treatement for many years (undergone treatments like cognitive therapy, naturopathic remedies, etc.) all with minimal-moderate success but never long lasting.

Alright I'm getting wordy so let me get to the reason for this post - scientifically it is well known that there exists a strong relationship between extreme stress and the onset of a depressive episode (perhaps what triggered my latest bout), so I went to see a psychiatrist 6 weeks ago to see if the new frontier of anti-depression drugs i've been reseraching might succeed where the SSRIs failed me, because a lot has changed since the mid-90s when the SSRI's were as good as it got back then.

The psychiatrist I'm seeing diagnosed me with ADD after our first 90 minute session, and said I most likely needed a stimulant and that that may solve much of my mood problems, needless to say I was completely shocked by his analysis (btw, he's involved in cutting edge depression research at a world eminent hospital in Boston where I live, so I have to at least strongly consider the merit of his diagnosis).

The AHDH thing had NEVER even gotten into my radar as playing a role in my depression, so I've never looked into it. Well I was desperate so I agreed to give stimulants a shot and see what happened. I started off with Ritalin for a few weeks but it made me tense (but did act as a mild anti-depressant & gave me focus). So our next meeting he prescribed me Adderall to for a trial run, and so I've been on it the last 7 days. It was astounding the soothing euphoria it provided the first 2 days, but that quickly subsided and now I get just extra concentration and energy (good thing it went away or I may never have wanted to stop this drug!). My side-effects have been a fast heart rate which has gone over 100 bpm at times, and also I've felt my heart contracting with greater force (these effects result from the extra norepinephrine at nerve synapses which adderall causes to be released). It's improved the last couple days, and man it's certainly no fun feeling fluttering/pounding sensations in your chest as I'm sure many of you reading have also experienced!

So, FINALLY to the reason for posting (sorry I can be verbose at times), I am receiving some MUCH NEEDED motivation from Adderall, it's not a perfect drug, meaning it's not magically solving my study habit/time management difficulties, but it is helping me organize myself better (which was virtually non-existent before) and is also helping me to prioritize academic tasks and actually begin to work on them along with an improved ability to concentrate for longer spans of time.

The problem though is that I'm TERRIFIED of getting physically addicted (we'll leave psychological addiction out of this, one issue at a time!) to Adderall, because this is an inevitable consequence of taking a pharmaceutical stimulant daily for extended periods of time - I believe it probably takes somewhere between 3-4 weeks of daily use until this physical dependency occurs (that may not be an exact timetable, but I'm pretty sure it's approximately correct) and whenever you do cross that threshold, you must then resign yourself to the inevitability of going through some potentially very uncomfortable withdrawal effects for a while.

So then, if someone is reading this post and has already gone down this road of becoming physically dependent on Adderall, and then at some point decided to get off of Adderall, then will you please be a good samaritan and share your experience in some detail? I know that depression and lethargy are some of the possible symptoms, but how long do the withdrawal symptoms last generally speaking? How exactly did you go about getting off of Adderall? Did you carefully taper down over time, and if so did that method lessen the severity/intensity of your withdrawal symtoms? And honestly, how miserable of an experience is it getting off of Adderall when one decides too, is it within the range of tolerability? Is there something a person can take to help get them through the withdrawal period, e.g., briefly using an opiate or benzodiazapine (or some other pharmaceutical) to help offset the worst of the withdrawal period?

I'm finding that I only respond to higher doses of Adderall, and this is maybe the case with with any stimulant because I required higher doses of Ritalin as well. I've titrated up to 50mg (instant release) twice daily with my psychiatrist's approval, and at this dosage schedule I'm functioning ok, but it still takes a good deal of effort to do the things my classmates do (study for long stretches and retain everything) seemingly with minimal effort. If taking a drug like Adderall to enable me to function "somewhat" like other people do normally, then it may be a necessary and acceptable trade off to stay on it for a couple years or so until I have sufficient time to research a more long-term solution that will not potentially harm my cardiovascular system by wear and tear arising from a constantly elevated pulse pressure (this results in all you major organs aging faster over the long-term).

Ok I'm done droning on, if you've read this far I thank you for doing so and it's my hope that a kind soul (or 2 or 3 . . .) will share some insight into the above concerns I shared, because at some point VERY SOON (I've been on it daily 7 days) I'm going to have to decide to stop Adderall or continue with daily use past the point where my body/brain becomes dependent, and just have to accept the fact that somewhere down the line I'm going to have to go through the experience of withdrawing from Adderall. Taking days off was tried and is not really an option because I revert to a slugs pace with everything and will surely be dismissed from my school due to sub-standard grades if this pattern continues.

Anyways, again thank you for reading and a HUGE thank you in advance to anyone who will take the time to share their Adderall story!!

Robert

The problem though is that I'm TERRIFIED of getting physically addicted (we'll leave psychological addiction out of this, one issue at a time!) to Adderall, because this is an inevitable consequence of taking a pharmaceutical stimulant daily for extended periods of time - I believe it probably takes somewhere between 3-4 weeks of daily use until this physical dependency occurs (that may not be an exact timetable, but I'm pretty sure it's approximately correct) and whenever you do cross that threshold, you must then resign yourself to the inevitability of going through some potentially very uncomfortable withdrawal effects for a while.


Poppycock - there is no law saying one MUST become physically dependent on Adderall or any other stimulant medication. The "feeling" of being on Adderall goes way when your body adjust to the medication however just because ones body adjust doesn't mean horrible with draws are sure to follow.


I have been on Adderall sense 1997 before that I took Ritalin - I have yet to notice "withdraws" - My ADD comes back with a vengeance {some call this rebound} but I am no more ADD it is just the ADD returning because my medication wears off - frankly I rarely notice myself but every one else does - I have been told a huge clue is that trail of disaster that begins to follow me where ever I go.

I take Adderall regular release and the medication wears off every night while I sleep and I have never been awaken by with draw symptoms. This isn't saying some people have never gone through with draw I am just saying at prescribed doses taken as directed by one's doctor withdraw or physical dependence isn't inevitable - it is in my opinion with draw is an exception rather that the rule - in my experience it hasn't happened even after a decade of use.

Stimulants are sometimes used off label as adjuncts in treatment resistant mood disorders. So is thyroid medication.

I'd really recommend adding Hard Exercise and possibly a morning SAD light.

Some people are also finding improvement with TMS (transcranial magnetic stim).

Since you are in a stressful program, and it sounds like, a stressful field of work, I'd really recommend the Exercise component.

Hi Robert:

I cannot answer to becoming dependent, because I do not find myself in that situation. I have been on Adderall for a couple of months now, and once I got the dosage down right, I have been fine. In the beginning, I had many of the cardiac sensations you describe, but they went away after a stopping of the meds and a re-titration onto them.

I can hear your concerns, and I want to encourage you to think of this in a different light. Rather than thinking of this as taking a substance which has a potential for becoming addictive, and projecting into your future a horrible withdrawl, think of the fact that you are taking something which balances the chemistry within your synapses, and allows you to function within your environment in the manner you must.

You mention that you have taken anti-depressants before, and that you are studying in the health care field. Think, for a moment, about what you would say if someone told you that anti-depressants are addictive, and that anyone who cannot "cheer up", or cannot even function without them, is addicted to them. What would you say? I bet it would be like what meadd823 said above: "Poppycock". (I also work in the Boston area, and am in the mental health field. Every day I hear people saying that the folks I work with are "addicted" to their anti-depressants, or anti-anxiety meds, or even to their anti-psychotics. As though a schizophrenic could stop hallucinating if they really tried hard enough. I'm sorry, but this makes me fume. :mad:)

I do understand that there is a difference between stimulants and anti-depressants. My point is, the fact that something has a potential for being addictive does not mean that a person will become addicted. With some substances, there is no room for error, but in others, there is a reason for them and a need that is not psychological or physical in an addictive sense, but a need for them in order to balance things. I encourage you to read this post, especially the area marked "Primer on medications": http://www.addforums.com/forums/showthread.php?t=9767 (http://www.addforums.com/forums/showthread.php?t=9767)

I am going to bring two things to your attention that may seem harsh. Forgive me in advance, because I say them out of concern for you, and because I can hear the stress you are under and understand it, at least in part.

First of all, are you worried about the addiction, or are you still struggling with the diagnosis? I wonder if the fact you were thrown by the doctor's statement is affecting your feelings about taking the medications. ADD/ADHD is something that people struggle with daily, just like depression or anxiety or any number of other conditions. There is no shame in it, there is no shame in not having been diagnosed before. You are not dumb, you are not brain damaged or retarded because you have it. You have it, and you treat it.

Secondly, in reading all that you have read about the possible negative and/or dangerous effects of being on a stimulant for an extended period of time, do you think you may have taken in only the negative, and be over-thinking the whole thing? I think that there is a "healthy fear" of the stimulants, meaning you are aware of the potential for abuse and you stay mindful of that. However, fearing them completely and projecting a horrible outcome is self-defeating.

There is one other point I would like to make to you. Comparing yourself to others will not help you at this stage. You have been coping as best you can for years, with some very, VERY difficult circumstances. You are now in a position where you see all of the potential, and may also be seeing all the ways in which you feel you must catch up. I am 39, and although I have had ADD all my life, I was only just diagnosed recently. I am realizing now that I have a lot of old habits that must be un-learned, and new ones to learn. You have an opportunity here to learn how to cope with this new way of thinking and viewing things. A therapist or a coach could really help you tremendously at this point in time.

Like any medication for any condition, going off of Adderall can be difficult. As many others can attest, you can live your life taking the meds daily. Not everyone chooses to take meds for their ADD, and I have read many stories from people on the boards here who do just that and are happy. It's not always easy from what they say, but it isn't ever easy for anyone, is it? Many people on here have been on stimulants for years. They will tell you about what has happened to them, and what has helped them cope.

There are other things you can do to stay healthy while on the meds: exercise, mind your diet, let your PCP know about the meds and get an EKG if you are concerned. If your psychopharmacologist did a complete medical and family history, he/she is aware of any potential coronary issues which might cause concern now or later on. However, quite frankly, many people have the same issues which you fear, and have never taken an Adderall or Ritalin in their lives.

Robert, please know we are here to support you, and I hope you return to ask more questions and let us know how you are doing. I'm sorry if this is long, I have the rambling bug too at times!

The problem though is that I'm TERRIFIED of getting physically addicted (we'll leave psychological addiction out of this, one issue at a time!) to Adderall, because this is an inevitable consequence of taking a pharmaceutical stimulant daily for extended periods of time - I believe it probably takes somewhere between 3-4 weeks of daily use until this physical dependency occurs (that may not be an exact timetable, but I'm pretty sure it's approximately correct) and whenever you do cross that threshold, you must then resign yourself to the inevitability of going through some potentially very uncomfortable withdrawal effects for a while.

So then, if someone is reading this post and has already gone down this road of becoming physically dependent on Adderall, [/quote] The first thing I would do if I were you is find out the huge difference between the word dependent and the word addicted. I am going to bed now, but there are many different threads and posts here about what I said.

Ughhh. Vyvanse has already worn off but I tried to read and re-read your post.

Anyways. I would not worry about physical addition. If you start chasing the euphoria of amphetamines that yes it will happen. When treating ADD with stimulants once you find the correct dosage you will obtain the benefits but no addiction. I've was on Adderall XR for about a year give or take and quit cold turkey for a few months. Zero withdrawals. Remember that with amphetamines and especially methylphenidate the half-lives are very short so every day your body has cleared them out.

The key to physical addiction is how rapidly the drug absorbs into the body and rapid release of dopamine. The faster the release, the quicker the high and greater likelyhood of developing addiction. So how can a person take a potentially addictive mediction, recieve the benefits and not worry about addiction? The answer is long acting medications.

Concerta and Vyvanse are probably the best examples in that offer a long, drawn out release profile and are pretty much abuse proof by design. The slower the release of medication (and dopamine) the less likable the drug is but you still get the clinical benefit.

Interesting to note that during clinical trials of Vyvanse prior to FDA approval there were studies done with methamphetamine addicts that either got controlled doses of d-amphetamine (Dexedrine) or Vyvanse. Not a single participant 'liked' the Vyvanse because of the slow release of the drug.

J

Having a 'Withdrawal syndrome' (as you describe) is not the same as 'addiction'.

The word addiction is often overused and misunderstood.

As one spry poster stated in another thread: the DSM doesn't even use the term 'addiction'.

--

NB If the withdrawal from Adderall is that dramatic, I'd recommend trying a much milder stimulant like Dexedrine... (it is a myth that it is more abusable or stronger or more euphoric than Adderall, etc.)

Bravo to all these posts! Right on the Mark!

I, too, have just recently started taking Adderall after living with ADD for 40 years. It has really done a 180 on my thinking.

I have found that it Compells me to do things correctly and pay attention to the details. Almost as if I take joy in seeing a Job Well Done whereas before it was shear agony. I hope you reach this point.
Insofaras the addiction situation goes, our brains do not process this chemical the same as "Normal" people. Meaning, it does not give us a "High" really. Since our brains are basically dopamine deficient, it give us what we are lacking enabling us to function "Normally." So, Adderall, for an ADD brain, is not a chemical enhancer but merely takes us to the status quo of focus and organizational skills. I agree totally with MEADD823, addiction to this is "PoppyCock."
I have not experienced any irregularities in my heart rhythm with this drug but if you have had any chest pains, or I think you said, "...heart pumping harder". This may actually be due to duodenal spasms as the (immediate release) drug is being absorbed. I have experience this but I would definitely tell my MD about that.

Robert,

Check out previous threads on this.

Frankly, if the med is working for you, I think you can focus on improving your lifestyle and health and habits so that it continues to work and so that you can live a life of joy, fun, great work, passion, good relationships.

Has a cardiologist warned you about the effects the medication is having on you? If so, that is one thing. If not, why go searching for a problem? I think you should try to enjoy this moment. This is a great thing for you, isn't it? It may or may not last, by the way. Some people have to have their meds adjusted over time.

I have no idea what you mean by "physical dependency." That phrase is packed with a lot of unwarranted assumptions and twists of logic. I mean I love to exercise; I love to run on the treadmill and to lift weights. When I don't do this for several days in a row, I can tell the difference. I don't sleep as well. I don't think as well. I'm not as happy. I'm more irritable and impatient with friends and coworkers. My body starts to sag and it feels more fat and flabby. Also my concentration worsens. My sense of an orderly day falls apart. So am I "physically dependent" on exercise? Who cares?!!!

Let's say that I am "physically dependent" on it. Let's stipulate that. Does it follow that I therefore should stop exercising? Let's see: at some point if, God willing, I live to 80, I won't be able to exercise like I do now. So do I worry about the effects of "withdrawal" from exercise in the future and use that worry to justify not exercising now? What if I injure my back in 10 years in a car accident and I can no longer exercise as I do now? I'll most likely really miss the exercise right? My mood is likely to suffer. Does it follow that therefore I should worry about that possibility now? Should I stop exercising now for fear of the pain of "withdrawal" later? (By the way, are YOU exercising? Exercise is one of the best things adhd people can do for themselves and consistent aerobics lowers the heart rate over time.)

Of course, for me the answer is of course not! That's getting way ahead of things. This is more my fear and anxiety and negative thinking talking than medical logic. But a lot of us with depression and adhd have negative thinking patterns (I certainly do) and we often worry about some future possible disaster while our rooms remain messy, our job tasks not done well, our relationships frayed and in tatters.

As for heart problems, I think you can chill out on this worry. First of all, your body is still adjusting to the medicines and your heart rate may slow down over time. Have you withdrawn from caffeine? From nicotine? Sometimes caffeine in addition to a stimulant causes a lot problems. As for an increased heart rate, that takes its toll in decades, if that, not in months or even a few years. You're getting way ahead of yourself. Let the docs monitor your blood pressure and rate over the next year or so.

On the other side of the ledger, what you're missing is that depression is horrible for the heart (and for the brain). So if you stop adderall because of fear of heart damage, then you need to weigh that against the heart damage caused by depression. Depression raises the incidence of congestive heart failure and heart attacks; it leads to poor recovery from heart attacks and from heart surgery. Apparently the release of the stress hormone cortisol is horrible for the heart.

Untreated depression and adhd decrease life expectancy, often dramatically. They result in an increase in car accidents, injuries, recklessness, avoidance of medical treatment, poor judgment in medical treatment, financial disaster, bankruptcy, broken relationships, isolation, job firings, drug addiction, alcohol addiction, food addiction. All of these addictions dramatically lower life expectancy.

You should also know that the latest thinking among brain researchers is that depression results in an increased risk (and earlier onset of) Alzheimer's and dementia. Again, the release of cortisol that occurs with depression is horrible for the brain. Given the high rates of comorbidity among adhd people, these are no idle concerns.

So, what you probably want to do is WEIGH the advantages vs. disadvantages of taking a stimulant. It's far more complicated than you think.

But right now, I think you are WAY overthinking things. If you're worried about your heart, then schedule a meeting with several first-rate cardiologists. Inform them of the benefits of the medication you're taking, why you're taking it. Let them brainstorm with you to devise a medical regimen that would minimize the likelihood of any heart damage. Notice that this is a concrete step.

In the meantime, I say you have a right to enjoy your life and make the most of it. You probably suffered a lot in your life (I know I have). Why not give yourself a chance to enjoy life a little bit? You deserve it!

Wow everyone,

I'm overwhelmed my your responses and sense of concern for a complete stranger! Thank you everyone for taking some of your free time to offer insights & suggestions to me.

Being new to the pharm stimulant world, I have much to learn at present. It seems my worry over addiction, or better worded as post-synaptic membrane adaptation (perhaps semantics problem here) i.e., down-regulation (reduction in receptors able to be stimulated by DA) of my dopamine receptors in my reward pathways where most dopaminergic receptors are located.

The withdrawal experience I speak of relates to the brain decreasing D1-5 receptors as a result of chronic excessive dopamine between pre & post synapses (i.e., lingering in extracellular space). Thus, one when ceases to ingest the stimulant after several weeks/months of daily use, it then takes sometimes weeks for the DA post-synaptic receptors to be restored to their original quantity in certain regions (apparently close the the center of the brain), this restoration process of rebuilding the DA receptors is experienced as the classical stimulant withdrawal syndrome (e.g., marked lethargy, anhedonia, listlessness, severe depression, etc, etc).

But hey, I'm no expert, just trying to learn all I can w/o going out and enrolling in a neuropharmacological PhD program to learn how to fix my twisted up brain biochemistry!! That would also be a very selfish motive, oh well, much (most) of what we do in life is to please the self or is self-serving in some way, whether we admit to it or not (just an opinion!!)

Really though, thanks again fo all your input, it's consoling to know other's are struggling with you and care enough to offer advice with the intention to help - your some really great people . . . Robert

A simple "thank you" will do.

The litany of proposed mechanisms for symptoms of withdrawl is unnecessary. I would concentrate less on the possible mechanics of the problem and focus on real-life solutions to your "proposed" problem.

HyperFly

dependent is where you need it. addiction is where you crave it. like people who crave cigarettes. you should not have any amphetamine in your system when you sleep. thats why you sleep. do not worry about being addicted if you just stick to your doctors recommended dose. and if you want to come off it you can.

adderall is like a one day affect pill. its out of your system by the next day. you could stop it the next day.(this may not be the case if you take it for years. i have not gotten to that point yet)

if you do get dependent, but it makes your quality of life better, so what

I am "dependent" on the antidepressants that I take....if I stop them tomorrow I will know it by the physical symptoms. I too stopped Effexor a few years ago...even tapering very slowly I still ended up taking a few days off work because I was so nauseated and couldn't walk straight. However, I don't crave antidepressants.
I just started Adderall XR about a week ago, 10mg OD. For a combination of probable ADD (my psychologist thinks I have it, but I have to be seen by another specialist), as well as short term memory problems and fatigue from the antidepressants (Cipralex 20mg OD and Wellbutrin XL 300mg OD).
Just like the other medications I am on, there is no doubt that I will become physically "dependent" on Adderall as well. After taking it for a long period of time it would obviously have to be tapered appropriately in the event of stopping it. Taking Adderall appropriately according to your physician's instructions will not lead to "addiction". Risk of addiction develops when people misuse or abuse this prescription medication...they can easily develop cravings to experience the euphoria of the drug, and may resort to taking it in forms that give a much faster "high" (i.e. snorting, smoking, or injecting it). Taking more than the recommended dose in order to feel the euphoric effect of the medication is likely the start of a path that could lead to addiction...
The short of it is....take it as prescribed and don't worry about it. If and when the time comes to stop it then taper it slowly with your doctor's help.

Cheers:)

The withdrawal experience I speak of relates to the brain decreasing D1-5 receptors as a result of chronic excessive dopamine between pre & post synapses (i.e., lingering in extracellular space). Thus, one when ceases to ingest the stimulant after several weeks/months of daily use, it then takes sometimes weeks for the DA post-synaptic receptors to be restored to their original quantity in certain regions (apparently close the the center of the brain), this restoration process of rebuilding the DA receptors is experienced as the classical stimulant withdrawal syndrome (e.g., marked lethargy, anhedonia, listlessness, severe depression, etc, etc).

Whew man there is such a thing as over thinking it - LAMO!

Honestly one can read all the literature on a medication and know more about the chemistry than the average pharmacist but you really will not know how a medication is going to effect you until you try it - If you are worried about your brain cell connections being affected by the chemical changes caused by the ADD medications then maybe you can ask you doctor about medication holidays. Some people feel they benefit from taking a break from the ADD medications periodically

Stimulants like Adderall do not necessarily have to be all or nothing experiences

Many moons ago I was in a group of folks who did martial arts performances I found my ADD medication made my performance to rigid while being un-medicated decreased my accuracy in timing - so I took half a dose and found this to be perfect.

Any time I performed or practiced I would only take half a dose -

Naturally we are all different therefore I would not recommend changing your medication routine in any way without consulting you doctor.

i think you should relax. things will fall into place. i think you are researching too much.. the more things you read about that could go wrong, the more you worry. let the doctor thing about the receptors and neurotransmiters, thats why he has that diploma on the wall.

Taking Adderall does not make it "inevitable" that you will become "addicted".

This is misinformation.

Tons of us actually 'forget' to take our meds. *LOL*

LoL, LoL!!http://www.addforums.com/forums/images/icons/icon10.gif

Sometimes I even forget that I forgot!

Then at some point during the day my wife will call and realize that there is a 2 minute delay in my response to her questions. I am then made to take it WHILE she is still on the phone. Does this sound familiar anyone??

HyperFly