View Full Version : How to avoid dose escalation?


SiliconValley
09-20-09, 12:27 PM
Two years ago, as an adult, I was finally diagnosed with ADHD (It had previously been misdiagnosed as a mood disorder), and since then I have been on stimulant meds - first dexedrine, and now Adderall XR (20mg) for about a year.

The meds have certainly transformed my life - I went from being a lost college dropout to making 6 figures as an engineer - all self taught. I'm also now only normally messy, as opposed to before, when my living environment likely would have been condemned by the department of health.

But the problem is this: these medications feel too good, I have quite an addictive personality, and not once in these two years have I been able to make a 30 day prescription last more than 20. And the issue is definitely not that I need a higher dose - the 20mg I am prescribed definitely does the job in terms of therapeutic effect.

Now, I haven't ever seriously "gotten into trouble" with the stuff... each month, I run out, and have a useless and unfocused 1 - 2 weeks (I'm sure the sudden withdrawal makes these times worse than I would be otherwise without medication.) I don't think I'm actually addicted, because I don't attempt to find another source of stimulants when I run out - I just wait for the next prescription.

I'm wondering if any of you guys have dealt with this issue and can recommend some strategies for using stimulants responsibly. I have tried Strattera in the past and had a very bad reaction, so switching to that is not an option. But I am curious about Vyvanse - is it actually less addictive than Adderall XR? Or is that just a marketing claim?

Thanks for any help... I am well aware that what I've been doing is not particularly good for brain or heart, and I don't feel comfortable talking to my Dr about it because I'm worried he'll refuse to continue treating me.

:)

SV

chartreuse
09-20-09, 02:21 PM
I think more information might be helpful.

Are you taking more at one time than you're prescribed, or are you taking another dose later in the day? What is your dosing schedule supposed to be? Is it 20 mg once a day? I've heard a lot of people say that the XR just doesn't last as long as it's supposed to (I'm on IR myself). Was your doctor's intent that you only have coverage for part of the day, or are you like me and actually needing it pretty much every waking minute?

At the very least, before you talk to your doctor, you should try to figure out why you're doing what you're doing. It may not be as straightforward as you liking the feeling it gives you "too much." On the other hand, it might. It's just hard to know without knowing how much you're taking and when.

Cdh1129
09-22-09, 03:39 PM
Well, I know that regardless, Adderall is an Amphetamine.. and amphetamine is a drug that blocks reuptake and increase release of dopamine, serotonin and ephinephrine. There is ALWAYS risk of addiction.

However, addiction follows a continuous cycle of:
-preoccupation/anticipation: (you get the first big high, and then you start to chase it. When you don't have the drug, you're anxiously looking for it and you're anticipating using it.)
-binge/intoxication (As your body adjusts to the drug, you need to take more and more each time to get that same high, which takes you back to the first step)
-Withdrawal/Negative effects (Then you get to a point where when you are not on the drugs, you feel awful. And at this stage you need the drug to function without serious withdrawal.)

But this is referring more to people who are abusing drugs like adderall. This would be like if you went on an adderall binge/rampage and stopped taking care of yourself, stopped dealing with you responsibilities, started having a negative impact on those around you because of your addiction, etc.

But then again, the reason why Adderall is *safe* and legally prescribed is because it is carefully controlled by your doctor and by you.

If you find that you are taking more adderall because you can't even feel it after a certain time or it's not lasting so long.. then you might need a dose increase.

When talking to your doctor, specify whether you think the adderall is or isn't enough for you in terms of:
-intensity (so when you take your dose, do you focus better? does it do what it's supposed to do?)
-duration (does it wear off too early in the day when you still have more stuff to do?)

Just because you feel the need to take it more doesn't always mean you are addicted, although you should always keep the potential for addiction in mind so that you can keep yourself in check.

Roserazzle
09-22-09, 07:46 PM
20mg xr might not be enough for you.
You should talk to your doc about how the med is not covering you the whole day
I take 20mgxr in the am and 5mgxr afterlunch (for a smooth landing)
I am a lightweight too (113) and pretty sensitive to meds

SiliconValley
09-22-09, 11:05 PM
That is a good point about the stuff not covering the whole day. I only take my prescribed dose in the morning... but by noon, I end up taking another half, chewed, to provide instant release... that way I am on the same level all day.

I have tried 2 at once but it is too strong... lots of side effects.

The not lasting thing has been a problem especially since I moved to the US, where I am given the Barr "Mixed Amphetamines" instead of Adderall XR - seems like they did a very poor job with the time release. But even the brand name has this problem.

So tell me, is there anything better? Concerta is not an option - any of the ritalin derivatives do absolutely nothing for my symptoms.

Thanks!

river09
09-27-09, 10:21 PM
I can totally relate with your problem. I say problem because, whether it is or isn't a problem for you, it sounds similiar to my situation, which, I think is a problem. I think we "addictive types" don't want to admit it, because deep down we know that we should probably stay clear of it, but at the same time, can't let go.
Maybe you do need a higher dose; You should ask your doc to just try it.
But if your an addictive personality it will be hard to control any dosage you have access to. You might just get to the point where you still run run out in 2 weeks, even if your at 50-60mg daily.

I wish you the best. Sometimes, I just want to give my meds to someone who will give me the perscribed dose a day, but I can't.
I know what I need to do, and what is most healthy, that is stop altogether. Yet, I'm scared because I graduate this year and want to go to graduate school.

But I don't want to hurt my body, or age quicker, or have to go to the hospital some day cause my heart can't take it.

Well, good luck. My goal is self discipline and better diet. Also I think, if possible, trying to wait as long as possible in the morning before taking your first dose. I find that once I take it, I think I need more. I'm trying to rise in the morning, eat a little (something with protein & fiber), maybe take a vitamin & an Emergen C for bones, heart or immune function), then a couple hours later take it. Maybe, maybe not, huh?
Take care.

river09
09-27-09, 10:29 PM
I also hear that a person needs to drink lots of water to make XR work.

Also, sorry if how I responded doesn't fit your situation. I hear "addictive personality" and hate to think of others going through the same thing I do.
Its like, why can't I control my life instead of letting circumstances control me.

river09
09-28-09, 02:26 AM
just ignore my advice; I think I am just way to negative...that helps no one I guess

kiosk
09-28-09, 11:40 AM
Tfirst dexedrine, and now Adderall XR (20mg)

you need speak to your doc about dose duration.....i myself am on 20x2 XR per day and one 20mg IR in afternoon....but some difficult days I take up to 100mg combined, this is after 1.5yrs on the med and I know for fact that beyond 100mg it gets worse and not better......but am also on an antidepressant (lexapro) which counters some of the neg side effects.....

i never run short our out of the monthly supply, if I go over one day, I cut back on another

dont read this as you need more, only your doc can determine this!

Roserazzle
09-28-09, 12:05 PM
very interesting responses.
SiliconValley, Do you take an antidepressant?
Sometimes that is all you need to get over the 'wanting' effects of the meds.
I take Paxil. I am not nuts about that pill, but I do not have an addictive personality.
I understand though, conpletely what you are talking about.
I hope you can explain this to your doc and get some ideas.
Best wishes

albino226
09-28-09, 11:08 PM
SiliconValley,

First, if the doctor is worth ANYTHING, you shouldn't be afraid of telling her/him what's going on. In fact, s/he may up your dose based on your symptoms. That being said, do you take med holidays on the weekends? May want to consider that to avoid addiction and to make the drug last longer for you.

By the way, neither Adderall nor Ritalin should EVER be chewed! This puts the drug into the bloodstream faster and at a higher concentration than the pills do, which can cause all kinds of problems, namely agitation, liver poisoning, and heart problems. As a student doctor, I ask you all, PLEASE don't do this!

dviper785
09-29-09, 06:16 PM
SiliconValley,

First, if the doctor is worth ANYTHING, you shouldn't be afraid of telling her/him what's going on. In fact, s/he may up your dose based on your symptoms. That being said, do you take med holidays on the weekends? May want to consider that to avoid addiction and to make the drug last longer for you.

By the way, neither Adderall nor Ritalin should EVER be chewed! This puts the drug into the bloodstream faster and at a higher concentration than the pills do, which can cause all kinds of problems, namely agitation, liver poisoning, and heart problems. As a student doctor, I ask you all, PLEASE don't do this!


Another blerb on this is when you crush XR it's not as simple as "releasing the goods" out of the little pellets - I'm not sure about the proportion of material but I know a large amount of the material you'll be consuming are actually the binding agents to make the Adderall extended release. And these binding agents are made to be digested at a normal digestion rate, which is why extended release and instant release are totally different medications. A seasoned stimulant abuser will actually look down on people who crush extended release capsules while browsing stimulant abuser forums with comments like "have fun with your pill binders," when people say they have crushed XR capsules for the extra high. I have never tried it and never plan to, but it doesn't sound pleasant at all from what I hear!