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blke22 12-26-15 09:42 PM

Adderall - first thread post since registration - anxious/nervous, dousy of a thread
Hi All (that may read),

So, as to not hijack to many other threads of others as I bring in to much content indirectly related to those threads of others, I figure it is time to start my own (first) thread. No doubt this may be long, as I am already hitting the extreme for the day of running low on effective medication level. So an advance thank you to those that can read this all and respond.

First things first, recently diagnosed. Just mid way through second month of a changing Adderall XR dosage. Could categorize this this post into concerns about Adderall, but also about diagnosis, continued care, addiction concerns, and a host of other "tag" or "key words" that could have resulted in this being in many sub forums. Maybe will copy this into a "introduction" post/sub-forum eventually, but right now (given the best I can focus), this seems the best place for this topic to start.

With that said.. Where I sit today. Not big on sharing exact age, but will say I am in my early 30s. Since a child, not diagnosed with ADHD or anything really. Kindergarten was a few months of rough time before being put into "special education" only to be put back in normal class before the end of year as continued time result in my parents and others in the school being noted I was just easily bored and not paying attention. Small rural school, not sure anyone at the time in the class ever left for part of the day for any medication for something like ADHD. Lots of rough years to come as I was even evaluated and placed into a "gifted and talented" program before leaving elementary schools. School was always a fun cases of getting unusual grades fro lack of doing homework or taking notes but passing quizzes/tests without issue. College, well, I eventually found something interesting and went to college and did quite well.

Time marches on, years of ups and downs with depression like issues I held in and hid from family and friends and co-workers. A massive demand fro soda/caffeine all my life (since those days of being in grade school). Even when limited to dialup internet access, having access to it and so much in the way of help from others (parents did what they could, even if not wealthy by any means to keep me active as well). So I had great support, and some bad support in caffeine. Been off caffeine before for half year or more without issue, but not realizing it was only happening when I was otherwise receiving enough novelty/stimulation out of life (including work). Out of a job in my career/education area for a while didn't help for a few years, but was able to make do with outside of formal work activity keeping me going. Activity that actually steered me back to a related job/career-path again if not helping develop skills for it.

So, not for the not so distant past with a bit more detail. About 4 years ago getting back into that career path. 2 years ago reaching a point of not being content with it (not so much pay, but challenge...... and really, more so stimulation). I get another job with the same employer, but it only last about 9 months before I want to hop again. I hop again, same employer, but then starting to feel it all break down on me.. As I think about how I have started to feel less and less about the job or any job, concerned one will never be the one for me and feeling hopeless. Not only that, noticing things I have done over the past decades no longer filling the gap others tell me I can't expect my "job"/"career" to completely fill no longer fill. Not even the idea of a permanent significant other or having children really seems like something I could chance taking a risk on filling. Especially if I risk it and like so many other things I am eager to jump to the next thing after finding that other or having children. Caffeine and fury of learning (formally or via reading, watching educational material on tv, seeking out new information and challenges via the internet in things I can purchase to experiment with and continue my education by doing so.. None of them seem enough.

So 7 months ago, it becomes all to obvious I am destroying my career and more so my current job. I enjoy it at times, but when not interesting I am always defeating myself. Same goes with relationships with others as friends and family. They not providing even the filler they used to provide, and me feeling horrible for not wanting to be by them, just like my job, even at times when they could use my presence in their lives).

So, I go see a primary care provider (after finding one, as I am one of those guys who has been OK most of his life and as such doesn't even care to visit a doctor until he is sick or feeling broken). First thing, "anxiety" and "depression". Plus I note family history of thyroid issues (so I am tested). First day, offered some basic SSRI to try dealing with "depression" (which I note to me is reaction, or secondary symptom to a longer ongoing issue from the get go). And within a week on thyroid medication (only slight variation in levels and it goes in and out of acceptable levels in weeks/months to come).

Over months, on and off of various anti depressant and other mood stabilizers.. No notable impact, and racking bills up from starting to see psychologists and psychiatrists that all keep going with depression and even thinking it is short term like seasonal. One in particular, got to a nice heavy dose of Sertraline/Zoloft with no results and finally jumping to a different psychiatrist that mentions some interesting genetic testing that can suggest (not guarantee) if there are medications I may uniquely be less or more responsive to in good or bad ways. Got the results (dug into them myself as I am not one to just take a med without questioning it), apparently sertraline is likely to be less if not nearly uneffective at all in me. Same psychiatrist though wants to keep focus on depression/anxiety vs concerns about lack of focus without massive interest/stimulation and my anxiety being about lack of sleep and concern about inability to hold my job as lack of sleep and lack of interest in a well enough paying job is not enough to keep me from ******* people off at work (or being unproductive at times to say the least).

Countless other meds in there, I finally reach out to a well known psychologist and note he is the last I plan to see if we can not actively talk about depression being secondary concern that just is what manifests the most when I see medical providers. I noted what was going on, and even not to sound like my own expert, the concerns about something like ADHD as even co-workers diagnosed since childhood have opened up with me and mentioned I am like a worst day version of them when they were not receiving care or taking medication. Family members even suspecting it when hearing about seeing past doctors (in some cases, btw, me reaching a point of visiting a ER/hospital one night by choice when a family member was concerned). Not listed as some specialist in ADHD or any given area, the guy listens. No psychiatrists in the care provider organization to provide meds even, so I figure there is no reason for him to push down depression meds or anything else. I end up going through more evaluations, similar to one I did months back that a psychiatrist said I should not even entertain getting the results of from a psychologist in another care provider organization as he thought it was just depression/anxiety from his inattentive 15 minute or less sessions with me (I should have never listened to that guy). So, evals and says results of various little tests that I even note I have a hard time believing could be all that accurate, especially in adults... Well, he says the results line up with certain possible. No extreme towards one diagnosis or not result. But with hours of time with him over days he would suggest at least seeing a psychiatrist again and talking about the lack of focus and other symptoms being a concern along with if not before the depression. And refers me to someone I actually was trying to get an appointment with already but first appointment was 1.5-2 months out.

I got to see her a bit early (after also seeing a psychologist in her office/provider-chain earlier with a family member along *thanks mom for helping deal with another visit to another doctor as I try to convey information to them as I continue to fall apart*). Second visit in, we talk about medications which on first medication I noted I want to stop all the SSRIs/etc doing nothing positive and her agreeing so we can open up possible medications that would not interact well with existing medications. She mentions stimulants. Lots of names, notable differences between them. Possible starting doses and such. Knowing the stigma of stimulants all to well, and my own concerns which she mentions as I am an older male there is always concern but more so as you age of stimulants impact on cardiac system. I note I know this, and even my past concerns about caffeine being a helper I really don't care to be using to the level I do. I also mention that I note she did not mention Strattera. She mentions OK luck with other patients, but given my desire to have rapid progress notes it is not the medication you will see response as quick. I asked her if there was any other reason she would not go that direction first, as I would be willing to try first given reading on the net about those that end up trying it after stimulants only to see an effect but not enough alone and either going back to stimulants or a combination as they get used to effectiveness of stimulants. I would rather try first and risk it not working and having to work with my employer to consume what was left of vac/pto or take a leave of absence as unpaid vs start with something with stigma and risks to my my health like a stimulant vs risks known by this Strattera instead. Not to mention, I specially note to her I get the concerns of doctors, and I don't even like the idea of something like a stimulant as I hear stories of addition and abuse. Caffeine has been something unneeded but yet I have been depending on for too long. Not going to trade one thing fro another that even worse I have to see her once X # of days or months to get a prescription for in person. "I want/prefer to try this without stimulants". Even the "Wellbutrin" route I had tried to ask one or two prior doctors about as a possible way to address this as depression and possibly see benefit for a yet undiagnosed ADHD. So we start with Strattera and offer from her to call before next appointment should anything arise fro concerns/questions. We stat low, and get up recommend level at a about 2 or 3 weeks. Nothing, but I know it is supposed to take up to many more weeks after reaching therapeutic dosage to become effective. First month goes by, I see her and note nothing really noticeable by me/family/co-workers.. Slight negative, like an SSRI in past, stomach aches.. Oddly though, just pain like knots in stomach at night while trying to sleep. But I note it is not all that bad and isn't impact already diminished sleep too much.. But it gets worse, and I do see her eventually to ask to get off the stuff sooner as it is not a matter of when I take it or when I eat any more. Not every day to the extreme, but it is destroying few hours of sleep and doing nothing positive.

So, off the meds, and see her in a week. Will try stimulant option of her suggest, and welcoming it as I have been going to work yet (while trying to avoid family for the most part) to have work be my testing ground and work is getting more difficult (me working from home at least some days with employers OK, but then not testing the medications effects in an environment where I am visible). But I noted to her I want exacts of plan to get off even a starting dosage before I take a prescription from her as prior medications where enough alone let alone my concerns about this type of medication. Even as she describes one to try to fit a work day (Adderall XR) and mentioning possibly still prescribing a anti-depressant.. I note I really don't want two things in me at once unless we know for sure one is targeting the intended symptoms alone and other targeting other symtoms as I am used to not having any other medications in me (thyroid medication still being taken, but otherwise never any long term medication needed) and I prefer to keep them to a minimum. If she really thinks it will target different symptoms we can attribute to one or other of two medications only if there are results, I will chance it. If really for anti depressant, is there a way we could try Wellbutrin given it's history of secondary affects/off-label-usage for this instead of a stimulant plus other anti depressant. She noted she would prefer not to go with that yet, so we agree to start with a single dose of Adderall XR for 2 weeks with a prescription for the following 2 weeks with higher dose and see her after the 4.

So, paper in hand, down to the pharmacist. Not enough in stock, I am OK with that as I am nervous about starting this on a work day. I got to pick them up days later, and of all things they have both 2 weeks fills ready and wear ready to hand them over as prescription indicates, but then get all weird about doing so out of their own concern and talk about holding it. I am fine with that, but note to them they are making me nervous as I hear of (been told by doctor even) all the tight concerns on this type of med. But we work that out, I get original script back for the second dose and they hold the second 2 weeks until I come back in and pickup and sign off for them.

First week is quiet, first 2 days, somewhat of finger tingling (suddle, but noted by doc as side effect and not be concerned unless extreme). Detailed notes every day of first 4 weeks taken, these first two weeks don't seem like much. Pickup the next 2 weeks, first two-three days at second dose, fingers tingling in first few hours and a slight odd sensation in head for a bit those first two days of increased dosage. Not a headache, but maybe similar to a day with too much caffeine too quick.. Anyway, about a week in, a few things seem easier. If timed right, I am a bit more OK with work one the "slow" days. Bit easier to hold in emotions relating to work or lack of visits with family lately (tearing up, I should note, is uncontrollable at work at times and when seeing docs as I think of family I am essentially avoiding). But biggie, 8/10/12 hours? If I time taking it and even days where I figured finger tingling was start of some effect on me and rush to work, this stuff is not working for 8 hours. While I can't gauge the start, I and co-workers views of me can tell when it is going from possibly effective to wearing off. Days going OK at work I could last a bit longer, but if the AM started off bad before work or at work, well.. I was lucky if I could rush out of work and get home before water works or extreme emotions and then bring myself back into focus on work while working from home. But, I keep experimenting with timing of the single dose per day and eventually see the doctor.

We agree to go a month with level of dosage we were at at the end of the last month. 15mg XR, plus, as I noted to her that there seemed to be a noticeable early end to optimistic level of effect I could see in myself way shorter than the 8 hours+. The end was often far worse then if I just avoided work and exposure to people as it often resulted in other emotions I did not care to be showing at work. We will try 15 for the normal time and a second 5mg XR after.

With that said, appointment to be one month from that day. Which is now a few days off.

So, here I am finally posting in this forum. Wanting insight, if not even some words like :

Jules: [All while Honey Bunny is screaming] Tell that b***h to be cool! Say 'b***h be cool'!
Pumpkin: Be cool honey!
Jules: Say b***h be cool! Tell that f****n' b***h to chill!
Pumpkin: Be cool Honey Bunny!
Jules: Chill that f***n' b***h out!
Pumpkin: Shut up, Honey!

So, I get to see psychiatrist next week. 15mg dose is right about 5-6 hours tops yet, but catching it most days and the 5mg helps a bit. Make it through 8-10 hour days of work. But not always, and timing the start of the day is a pain as I honestly can't tell if it is effective in 30 minutes or 45/60/75/90 now as there is nothing noticeable like the finger tingling ever. And I fear going to work before I can count on it being there cause being there is being there. Let alone if the day starts of even slightly bad before leaving for work or when being there for first hour.. I say that, as beyond being able to bring myself to deal with others pace (often feels too slow for me) and boredom (especially if tasks combined with slow pace to allow others to keep up with me or my desire to get something done quickly and on to something "newer") I am still faced with random concerns about is it working at all or I am just getting luck with enough "novelty" in the day being enough to fill in the possible lack of effective dose and my own concerns about wil the day end on a bad note again.

As is, it almost always comes. A let down on me, unless I can fill in the gaps at the end of day and each morning before I take the first and later second dose to give me a few hours of not so much effort to hold in emotions and have to be questioning myself as I go off on tangent topics at work. Emotional control, it helps in the first round most days with the 15mg in me. The 5mg helps enough some days, but not always. Much like the 15mg, I spiral down the wrong random thoughts leading to unwanted emotions that I can sometimes conceal at work long enough and bring myself into "oooooo, interesting" topic. And now, a bit of anxiety as I have to contemplate the coming appointment with the doc.

Topics that role through, and generally I can think intently/focused on without the related thoughts causing too much trouble, as I wait for the day:

1. Askign for increased dosage on the 15mg, as it is not adequate at times ti seems.
2. The second dose isn't, and more to the point, Would gladly not increase any given dose if I can help the duration.
3. End of day, maybe what some call a come down, it doesn't always happen. But when it does, it is like a fall from a new better level that seems to make it more of a fall then on the bad days I collapsed before taking this medication. I really am not sure I want to go on with this medication fearing that it helps for a short part of the day but then ends up on many days only being the glimse of sun behind a much bigger storm. I actually fear it, given my past history of extreme "depression" as identified by docs before. Will this make me fine for a few each day but then in the long run make me worse to the point of one day hitting an extreme I dare not mention.
4. Stigma, all of above. Meidcation refils, and getting them. Not to mention, will I become tolerant and need to ask for more. Worse, financial directly, insurance, or even doctor one day for non financial of seeing her or paying for prescription, will I find some sense of "OK", let alone happy/joy/relief, only to have this taken away from me completely. And then, what happens in the first dew days of the possible extreme I hit?
5. 1-4, prescription free life for the most part. Nothing long term, antibiotics/etc being extent before this and thyroid medication. Nothing illicit ever, caffeine being the worst. Hell, not even alcohol as the stuff is revulting and I already had enough relatives have issues with that substance and/or nicotine via smoking. But, as I read all these topics about dependence, addiction, abuse.. And some even in thsi forum debating definition of each of those words.. I ask myself, what is the line? Will this become caffeine of the past for me? Is dependence simply acknowledging I need it to be OK like my eye glasses (analogy so often referenced by others)?
6. I am being honest with everyone, myself, family, doctors.. But will I be perceived as not even as I am? Do I actually hold back and say nothing vs asking about increasing dose level or quanity per day just to make sure I don't sound "seeking" as so many posts here and elsewhere I have run into?

I am terrified to keep taking this, or keep taking it this level, or to ask for more help. First thing showing any signs of help even as I ask people at my job for their input as I don't trust myself knowing for sure (from lack of ability to see it, or maybe now not wanting to see it in myself). All this, while knowing the various articles/posts/threads out there about how something I only liked to acknowledge the strangths of could at this moment be being my vary worst weekness/enemy. By that, I mean hoping between topics and sometimes being able to focus on the right things and see things others can't because I think so much (to point of it becoming overthinking).. And as the second side of that, me overthinking or ruminating on things to the point of paranoia (medication/doctor/appointment/etc, but even my employer saying I doing fine for productivyt and even then commenting I am doing better in past weeks but me thinking as they just saying that and will let me dig my own hole and then let me go one day).

Past months have been so much more ofa hell and expense to me in relatinshops with job/family/friends and $$$ and time. Seeing no positive effects and now something is in front mof me, at least showing visible improvement to others around me. And my own thought process is tossing this up in the air as feers of stigma, addiction, negative results with doc if I am seen as seeking medications, or even the very fear of none of that being an issue but having medication to cover enough of a day that I feel OK for weeks/months but then forget one day or can no longer afford medication and I fall so far after having come so far. Is this all worth it?

Further, well beyond when medication would be ineffective for duration today, all the possible repletion and lack of clarity in this post as I type it.

Some-one/people please read all the way. Tell me to stay "cool", just continue being honest with everone involved and that I don't need to be concerned.

Greyhound1 12-27-15 12:59 AM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr
Welcome to the forum!

I honestly tried to read your entire post but couldn't I make it through it all. From what I got, I would say it is tricky getting the right dosage of Adderall for effective coverage. Usually, they start low and titrate up until you find the right dosage. I think it's a perfectly normal conversation to have with your Dr. if your needs aren't being met.

I say your words below are the way to go.

Stay "cool", just continue being honest with everyone involved and you don't need to be concerned.
Best of luck with it and enjoy the forum!

blke22 12-27-15 01:13 AM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr
Yeah, for last several hours, and about another 5-6 to come, I sit without the help of the medication. Thus the fury of thoughts (forum posts get a good chunk of it but trying to keep going on other things until I can fall asleep and star the day anew tomorrow AM and make it till next week for the appointment. Reading others here even having self doubt as to their diagnosis from long ago. Just have to make it to dosage and quantity to make it through the 8-10 hour normal work day.

DJ Bill 12-27-15 09:33 AM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr
"Some-one/people please read all the way. Tell me to stay "cool", just continue being honest with everyone involved and that I don't need to be concerned."


Hang in there....It does sound like you are finally on the right track after the years of treating the side effects of the ADHD. Your post to me looks like you are correct about "Further, well beyond when medication would be ineffective for duration today, all the possible repletion and lack of clarity in this post as I type it." as you have done a lot of the same stuff I do with typing....reversed letters and skipped ones, as well as being a little wordy. Spell check is my friend, and you wouldn't want to read my posts before corrections and editing.

If you can it may be worth doing a lot of brutal editing so you can get more folks to read about your MAIN concerns. Turn it into the "reader's digest " version if you will. I had a hard time remembering what you were saying by the time I reached the end, and it was a lot of work trying to comprehend all that. Most of us here can't handle the "wall of words" approach.

And, don't worry about the stigma. If medication helps, living life more productively should be reward enough...what other people think or say about me is really not my concern nor should it be my motivation. Don't go out of your way to tell folks about it either, especially those who are not affected by it.

Some places have self help groups for ADHD adults.. You might want to look into that but remember not to base your treatment on what works for others. Our bodies react differently to medications. Coping skills are what you can get from a group, as well as a safe place to talk about your concerns.

Best wishes for success on your path. Hang in there and it will be worth it.

What do you do for work that takes 8-10 hours? And what is the story behind your handle? (Motorbike or bicycle?)

DJ Bill 12-27-15 10:09 AM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr
Wait, I just noticed your handle is b(L) ke, not b(I) ke....OOpsie!

Little Missy 12-27-15 10:20 AM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr

Originally Posted by DJ Bill (Post 1777733)
Wait, I just noticed your handle is b(L) ke, not b(I) ke....OOpsie!

:lol: yeah, we are all pretty much in the same boat.

Greyhound1 12-27-15 10:58 AM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr
Same here. I thought it was Bike. :lol:

stef 12-27-15 01:09 PM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr
so did I :doh:
hey welcome to the forums and yes, stay honest and be good to yourself!

blke22 12-27-15 06:52 PM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr
Thank you all.


Originally Posted by DJ Bill (Post 1777727)
And what is the story behind your handle? (Motorbike or bicycle?)


Originally Posted by Greyhound1 (Post 1777747)
Same here. I thought it was Bike. :lol:


Originally Posted by stef (Post 1777762)
so did I :doh:
hey welcome to the forums and yes, stay honest and be good to yourself!

Yeah, I am not big into "handles". The current one does not really represent a characteristic or characteristics of me so much as it is a username (nothing more really).

Generally a fairly private person when it comes to the Internet (not a social media person, etc... prefer more direct contact if I am going to have contact with people.... and realllllly don't put more about myself out there on the net to be picked up by someone compromising a company/sites systems one day). Longer post to come after this, you may see irony in my lack of interest in posting information on the Internet (or completely understand)

Perhaps will share the first name one day. ;)

blke22 12-27-15 06:55 PM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr
And yes, wrong time of day and I get really........ jumpy/anxious. :D At the moment, as I am typing this, that is not so much the case. However, I am well aware of how I can get some days as the last of the first larger dose and/or as the smaller second dose wears off (or if the second is not enough to help at the end of the day). "Jumpy/anxious" is the lighter side of the spectrum of what can happen to say the least. The extremes that have resulted in visits/checks on me by "others" or my own voluntary visit with a family member at my side to a ER are always there if I go down the right (more so "wrong") train of thought that just goes lower and lower. As is, with medication at least I can usually stop that during the day but it is normally only at the cost of it simply being delayed representation till later in the day. This is the reason I still mention the possible return to the trial/addition of an antidepressant. Even though I doubt the short or long term efficacy of one as I already know the conditions are there to become "depressed". Memories will always be there, and recollection of the memories are always possible but I feel this is a given possibility that I would rather deal with the ability to not focus on them or be able to break free of the focus on them just like when I need to break from focus on something exciting/interesting to complete something that needs to be done but is neither exciting/interesting nor a negative thought that would lead me towards a depressed state.

Having to decide between the good that comes during the day and the end of it each day often turning into something worse than the days without it is the hardest part about this. Getting to see the light but then finding out you are more afraid of the dark than ever before. The good in the day being the control of small emotional bursts (both good and bad) and the ability to be there in the moment even when it isn’t something that normally would be able to grab my attention completely and just be OK without the constant “yeah, woohoo, rush of new input/thought”. So far, medication has helped with this. Only sometimes still letting me side track onto unrelated topics that are not negative (well, for work side tracking is negative, but I am saying no negative emotional state) and sometimes enough of the old thoughts/memories build up and take over during the middle of the day at work. Until the first few really bad end of days came about after medication wore off each day, I was a lot more optimistic.


Originally Posted by DJ Bill (Post 1777727)
What do you do for work that takes 8-10 hours?

About 8-10 hours of work. I noted in another person’s thread in a response regarding my own history with employment. I am lucky (well, could be better I guess, but have a job and boss/employer being helpful) to be “ok” with my current job as far as retaining it and helping pay for medical help. Low end of “salary”, not “hourly”, job that I am expected to be available 5 days a week for a 9 hour contiguous duration (up to 1 hour of which could be a lunch break). Travel time not included of course to get to work and home. Days can last longer but are generally not “required” on the norm. As you might imagine, that is the “work” day. That doesn’t include AM time before getting to work. Nor time after for any sense of “personal life”. As for the job, since I hinted at it by asking in another thread if a poster happened to be in a given field, will simply say “Information Technology”. And yes, many characteristics I am trying to eliminate of the very condition I am trying to control (if not eliminate at times) are on the good days a useful “ability” in this field. This plus many other “compensating controls” have been used/created to get me this far. I have been on the edge for so long, been so close so many times, and many of coping mechanisms are becoming ineffective.

I have friends and family that are there for me. Many have been through some big medical issues, but always primarily physical. Also a co-worker or two that has been diagnosed since childhood or had children diagnosed since childhood. Both have been helpful.

While I understand the caution for the sake of myself and more so my doctors, I so wish we could move full steam ahead. This entire time I have been so wanting to reach a point of something that could just let me forget the memory of the things that have happened. I know that won't happen, but each day being another day I can experience more unwanted events leading to more unwanted memories that only serve to make it that much worse the day after that and the day after that and on and on and on.

blke22 01-02-16 04:49 AM

Re: Adderall - first thread post since registration - anxious/nervous, dousy of a thr
So, update (and yes, blke33 vs blke22 because of an issue with password reset email not making it to my email address, actually it doesn't work with any of my email addresses I tried).

Still anxious about progress. But got to see the doc as planned/schedule/appointment. Increased ER/XR dose for the AM/Day by one bump. Which is good, at the dose I was at during those times at work it was just beginning to be noticeable and I felt it was enough some days and not the the others.

However, the small second ER/XR dose I had been taking to try to deal with the first not lasting beyond 5-6 hours before I started feel very down (some days, for a couple hours, but not all) or start noticing myself being impatient with people at least... Although it seemed to help some days, I was hoping the doc would have tried increasing the dose of that ER/XR. Doc kinda did. Before any changes I noted I was concerned about how badly the couple hours (or evening/night) had been on some days (again, not all, not even many as long as I could get home and basically keep myself going on things I found interesting enough to keep the mind moving/distracted-almost). Best description I have seen from other here is a toss up between two words of "come down" or "rebound". What I can associate to days when this happens is when either the AM/day started out badly. As in, something happens early before taking first dose or getting to work and maybe it isn't quite up to right level in me yet due to timing. That, or the days I seem fine, but as I think back they are days of what should have been boredom by my definition any other day. Days that were not exciting, and I was OK (not irritated, or short with people, not other emotional break outs like tears as I think about family and my issue with being bored with them at times). But then, later in the day.. It's like I am aware of how boring the day felt anyway. Not trapped on thinking about it, but all of a sudden a feeling of something missing. Days with something a bit more in line with "interesting", or where I already have something lined up like that to do outside of work once I get home, I can still be OK. When not, though, the worst couple/few days over the last weeks are like a new level of OK being reached, and then having the worst days of past 7+ months come back in a rush. All the negative thoughts return and shoot further down then the bad days before. Or maybe not lower, but more like the rate is faster. This happens just like other times when this gets to me, one of the many thoughts I am jumping through normally that are not really bad/negative/sad (just OK or fine or even exciting/interesting) gets replaced with the first thought of the past actions or lack of action or failure to contain emotion(s). A few days, those have popped into my mind for a moment, and then I can go onto one of the others that are still there and OK and just let the first negative memory or thought fade into the background. But like before, when one takes focus and I just ruminate. It is the best word here I can think of , as it is one thought to another but all much more negative/dark either in frustration, agitation, anger or sadness, I spin into attacking myself for things. Of all things, not a big Star Wars fan but a bit into Science Fiction at times, one memory comes to mind that I oddly have just felt in the past at times similar to this:

Fear, uncertainty, doubt; the dark side of the force are they. - Yoda

Fear, uncertainty, doubt... Much like the last couple posts in this thread... I start to doubt this is going anywhere.. Medical care/treatment, and then pondering if the diagnosis is right/wrong, complete (maybe co-morbid depression vs as I have been seeing it depression as a result of feeling badly about my lack of interest in spending time with family or doing my job even though they care for me so much and I honestly get paid "enough" to live by my employer to a do a job that is interesting/stimulating at times but then I can't be "OK" with doing boring tasks even though from a knowledge/physical effort level the tasks are "easy". Why should I have an issue with that?)....

Anyway, sometimes unpredictable timing of the ER/XR stuff in the morning, I am OK with. I note this to the doc as I have flexibility from my employer right now on start of each day in the AM and I don't want it to be there any faster then needed as the first 1-2 days after each increase of dose the first dose has been a bit undesirable for an hour or two. I really liked the simple tingling/numb fingers on those day as a mark of when medication might be kicking in, but nothing more.. But far worse then having to wait an extra hour or more to feel comfortable with going to work and starting this grand experiment of if the medication is helping/enough on my employer and co-workers, the end of the day when wearing off (I think as, it is 5-6 hours in) and hitting this much more rapid drop has me a bit fearful of myself. Doc was bit concerned as long after that comment, and talking medication etc, as I we were ready to end the appointment she asked about my concern for myself in a way some in this forum may be familiar with. I noted those thoughts are there every so often, as they are memories that don't seem to ever go away now that they have been there once. But I am fine still, part of the concern is long term future fro this if needed. As long as it is working and covering the hours of the day, great. But, even if right now it is a uncommon feeling/occurrence, what happens when/if I forget medication? (I have never done so in the past, but I could see it). Or, some other medical condition necessitates me no longer taking this medication or some stimulant at all (like heart condition)? Or I can't afford it at all do to something bad like loss of job and financial issues (not present now)? This even as I read threads on here from long ago about "Adderall" shortages in 2012.. Or even in last weeks people that run into timing issues with holidays and doctors schedules or a pharmacy or insurer problem? These questions (or scenarios in my mind) about inability to take the medication and concern about not doing so were not all mentioned to the doctor. At least not in this appointment. And they have been there since day one, and before, when the doc first wanted to prescribe the first medication to me since my first visit with her. It is why when the doc started by mentioning stimulants (no specific name), I stopped the conversation midway through and said why not non-stimulant like Straterra and ended up trying it first. Next round of thoughts later in the day as I realize I was able to keep those loops of "what if" scenarios in my head during the appointment, "If I talk with the doctor about those thoughts with that much concern, do I sound like I am addicted? When really I am quite aware of my own concerns about the medication or any medication becoming something I could become trapped on not because I am dependent on it to be "OK" in a good way, but dependent as in "addicted" so that other negatives come of me trying to stop taking it or having to stop taking it. Beyond my it's lack of positive effect in dealing with an issue there in me since before taking any medication for anything.

Anyway, she (doc) suggest an increase in dosage of second period of time (5-6 hours after first when first was appearing to loose effect as we had spoken about in prior appointment and thus the second dose being added then). At first, just increase the ER/XR form. Which I felt OK with, as it was a small bump in level at or less than the existing 15mg I was taking in the morning, and I thought I had a feeling for how timing of ER/XR was working. But then she suggested a change to IR form, single larger dose and trying it either whole or splitting and diving into two 4 hour doses. She mentioned, like others here have, that it may work better then ER/XR. This as I am thinking yes, but when I first was prescribed ER/XR the duration and having to repeated take this through the day was already a concern. But I then mentioned to her my concerns about my own reading online/etc about the other marketed/noted purpose of ER/XR and even things like Vyvance was the slower onset and offset of the medication to make it more gradual. And how I really did not like the few days in past month when it seemed like the timing of the offset of medication lined up with the rapid downward spiral of negativity was my focus and worse then days of the past when I hit extremes (even with caffeine being a big helper back then in soda or over the counter caffeine pills).

She said it is worth a try, and start with part of first dose if neded. First being 10mg only, so that would 5mg if I split it. Which I know some say is nothing to them, but I really am concerned more about onset/offset rate of medication than the total dosage. Anyone have comments about concerns of trying a instant release of Adderal (or generic of course) or of any other stimulant medication only after having tried just extended release versions that are designed for slower/more-gradual onset/offset? I know for me the IR tablets will be much cheaper, but to a certain extent I was already prepared to be paying a certain amount per month for medication beyond the ER/XR as the try at Straterra was far more expensive for 2 months given no generic available fro it.

I have a couple days of medication from this last month left to take (as month was not fully over yet when I got to see the doc) and am taking those before starting this new "increased ER/XR dose + change IR" prescription. Would love any thoughts/insights or (again) even just "don't worry so much, this will likely go fine and you are starting low/slow" or "I have been through the ER/XR change to some instant release, versus instant release change to ER/XR, and had same concerns but it went OK".

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