Can too high dose make ADHD worse?

[wonderist]

I have inattentive type, and my major problem is procrastination. I get stuck in hyperfocus and can't switch tasks to boring/necessary tasks like work.

I started Dexedrine a few months ago. At first there was a small effect (at 5mg) but that seemed to fade after a week. Then my psychiatrist upped the dose to 15mg. It seemed to have no effect on procrastination, though I was able to quit caffeine, which was nice.

Now I'm up to 30mg, noticing more side effects like loss of appetite and insomnia, but STILL no help with procrastination! Instead, now it seems like I spend all day doing MORE of nothing. I mean, I get lots of things done, but none of them are useful/important things. Anything but work, it seems.

On 30mg, I'm starting to think that it's even HARDER to get out of hyperfocus and switch tasks. I'm basically wasting my life away.

Am I on too high a dose? Or maybe too low, and it just hasn't gotten to a therapeutic level yet? Or maybe Dex is the wrong choice for me? My psychiatrist says he doesn't go higher than 30mg of Dex because he says higher doses aren't backed by science. He's a good psychiatrist, specializing in ADHD, so I'm not going to argue with him. But I wonder, even if I went to a higher dose, what if it just made procrastination even worse, and with additional side-effects?

Should I switch to something else? Maybe Adderall or Ritalin? I've been on meds for about 3 months and no help. It's killing me. Any suggestions would be appreciated.

[jayblaze2]

Coincidentally I also just switch from a lower dose of dex to a higher dose.

Originally i was taking:

5mg ir @ 6am
15mg spansule @ 10am
5mg ir @ 3pm
5mg ir @ 7pm (if needed)

Now i am taking:

15mg spansule @ 6am
15mg spansule @ 12pm

This is the second day of 30mg spansule and i too have the side effects of insomnia. This will pass after a couple days. My body is just adjusting.

I am going to give a good 2 weeks before i say its not for me.

[kippras]

I agree with jayblaze2 -- to a point.

How long have you been on this higher dose? If it's only been a couple of days, you might give it a while longer before you decide that it's not right for you.

Personally, I would rein in a bit on the dose. Bring it down -- I think a too high of a dose and you can get lost in hyperfocus-land forever. Or at least, that's what I do.

BUT don't forget -- you've got to fight your procrastination as well. The medicine is only there to help, not to do. So, you might want to look at prioritizing and organizational tips for people with ADHD to help you learn not to procrastinate.

I would definitely talk things over with your doctor -- tell him how you feel. As you said he specializes in ADHD, he may have a better idea as to what's the best choice for you to make.

[empty]

Originally Posted by wonderist

I started Dexedrine a few months ago. At first there was a small effect (at 5mg) but that seemed to fade after a week. Then my psychiatrist upped the dose to 15mg. It seemed to have no effect on procrastination, though I was able to quit caffeine, which was nice.

First, are you taking the Barr generic 5mg or 10mg tablets, or brand name GlaxoSmithKline Dexedrine Spansules? There's a huge difference in efficacy and duration of action between the generic (which is usually weak and inconsistent) and the brand (which actually works correctly).

Originally Posted by wonderist

Now I'm up to 30mg, noticing more side effects like loss of appetite and insomnia, but STILL no help with procrastination! Instead, now it seems like I spend all day doing MORE of nothing. I mean, I get lots of things done, but none of them are useful/important things. Anything but work, it seems.

On 30mg, I'm starting to think that it's even HARDER to get out of hyperfocus and switch tasks. I'm basically wasting my life away.

Am I on too high a dose? Or maybe too low, and it just hasn't gotten to a therapeutic level yet? Or maybe Dex is the wrong choice for me?

When during the day are you noticing these problems?

Since dextroamphetamine only lasts ~4 hours (or usually ~6 for GSK brand Dexedrine Spansules), hopefully your doctor has you taking 3 or 4 doses a day, once every four hours (assuming you want and need coverage for the entire 16-hour day, which I've always thought was a good idea).

That being said, it sounds like each individual dose may be slightly too large for you, assuming you experience this undesirable hyperfocus within the first 3 or 4 hours after each dose.

Remember that ADHD medication essentially just puts gas in your car and pushes the accelerator, but you still need to steer towards your own goals. Otherwise, you'll waste your treatment by hyperfocusing on irrelevant things for hours on end, just like you described.

I've also experienced hyperfocus when I've taken slightly too much Dexedrine at a time. With an even larger dose than this, the hyperfocus usually transitions into stalled cognition (gaps in thinking) and eventually sedation (at which point I'd just take a nap). Note that this is an ADHD specific effect, so don't assume you'll respond like a neurotypical person would respond to an overdose of dextroamphetamine.

One thing I've noticed is that if I'm too hyperfocused (due to an excessive dose), but I force myself to switch tasks near the end of the 4-hour dose period, the hyperfocus rapidly disappears (i.e. once it's gone, it's gone forever), and I cannot regain any focus on the new subject of my attention, until my next dose at least.

Assuming you take 2 doses of 15mg four hours apart (i.e. 30mg a day, if your day is really only 8 hours long), you might want to try dropping back to 10mg per dose to see if that helps. You can also do smaller doses every 3 hours (still at 30mg/day), since I've found this helps eliminate hyperfocus too, plus you'll get ~10 hours of coverage on your existing script.

If you take 15mg tablets or 15mg Spansules, you'll probably have to ask your doctor for pre-made 10mg pills, since it's really difficult to accurately split a 15mg tablet (let alone a capsule) into exactly 2/3 (10mg).

Originally Posted by wonderist

My psychiatrist says he doesn't go higher than 30mg of Dex because he says higher doses aren't backed by science. He's a good psychiatrist, specializing in ADHD, so I'm not going to argue with him.

No offence, but your psychiatrist is an idiot.

First, the FDA itself recommends up to 40mg per day of Dexedrine for children, let alone adults. The FDA wouldn't certify this as safe and beneficial if the "science" didn't support it.

Second, your doctor's knowledge is clearly out of date. For adults, I don't believe any official dosage recommendation was ever released, but in typical clinical practice (by doctors who aren't trying to win the DEA's "most conservative prescriber of the century" award, apparently), most adults take between 10mg and 20mg per dose, which totals an average of 40mg to 80mg per day.

Personally, I take 80mg a day (20mg every 4 hours of the genuine GSK brand), and I've never had any doctor claim this wasn't "supported by science", although I obviously titrated up to that dose over two years.

Finally, if you're taking the Barr generic, each tablet typically contains at least 30% less dextroamphetamine sulfate compared to the GSK brand, so you're effectively getting even less medication than your doctor realizes. The Barr generic time released capsules are even worse - IMHO they flat out don't work at all, and are basically placebos for at least the delayed release portion.

It's very possible your doctor just trying to discourage you from increasing (a good idea, based on your original complaint of hyperfocus). However, you can and should challenge him if you still believe you need a higher dose (not necessarily right now, but at some point in the future, if and when your tolerance increases over time).

Originally Posted by wonderist

But I wonder, even if I went to a higher dose, what if it just made procrastination even worse, and with additional side-effects?

Originally Posted by wonderist

Should I switch to something else? Maybe Adderall or Ritalin? I've been on meds for about 3 months and no help. It's killing me. Any suggestions would be appreciated.

My suggestion? Find a doctor who actually understands modern ADHD dosing practices, and is able to determine if and why (for each individual patient!) a dose is too high or too low.

If you talked with your doctor about this hyperfocusing problem, and his only rationale for not increasing your dose was that "not supported by science" excuse (rather than the real reason w.r.t. hyperfocusing), it doesn't inspire much confidence in his ADHD knowledge and/or honesty with you.