Do people usually build up a tolerance to ADD meds?

My husband is diagnosed with ADD and depression. He's been taking the same anti-depressant for years successfully. Then we realized he has ADD too, and found him a doctor to prescribe ADD meds.

Strattera made him so depressed he was suicidal and refused to go to work. Withdrawal was even worse. He did well on Vyvanse for a while, then symptoms came back. Ritalin and Adderall made him jerk and shake to the point he had several falls. He's been on Concerta now for nearly a year and it made him shake but somewhat less. He takes another drug to help with the shaking. But I'm seeing things that suggest to me that Concerta is also losing effectiveness and he finally admitted they are noticing the same things at work. Thiis is complicated by the fact that he discontinured counseling at the university AD/HD clinic he was going to (he said the young student he was seeing didn't have any more ideas for him) and therefore has no access to the doctor who was prescribing his meds.

My question is: Is it typical for an ADD med to "wear off" after a while, so that you have to keep changing them? What else is there for him? People at work (he works in mental health, so they all know a lot of "shrinks") have been suggesting different doctors for him to go to. There are no neuropsychiatrists within 100 miles of here. How do you pick someone to go to? And how can they prescribe for him when he builds up tolerance to all the medications, or has other devastating side effects?

 

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that's challenging

Thankfully, the Concerta my husband is taking has been working along with Wellbutrin, I believe. I heard that it is not known to build a tolerance but, people can be different. My husband has recently added ginkgo biloba to his daily regimen and seems to think his energy level and alertness has increased. The doctor actually said he had heard good things about it and lowered his Concerta dose. It might be good to consider an alternative and use caution trying it out. (Get good quality products, start with lower dosages and let the doctor know what you're doing) I usually do my own research and I know some chiropractors are knowledgeable about nutritional alternatives. Though it sounds like you could use something more reliable. Have you heard of the Amen Clinics? http://www.amenclinics.com/ I don't have any first hand experience but the kind of testing they do is fascinating. 

I don't just plow through on my own but continually pray that I'm led in the right direction. We found a doctor after making many phone calls. Thankfully, a few of the doctors did talk with me regarding their treatment of adult ADD and I made an appointment with the guy I liked best. Thankfully, my guy liked him too.

Hopefully, some of this info helps, I wish you all the best!

Yes, I've heard of the Amen Clinics

We live in the south (I know Melissa doesn't like us to give to much personal information), so that's not possible. It seems that all the best places to go (Hallowell Center, Amen Clinics, etc.) are out of reach for us geographically. A book by Dr. Amen called ADD and Romance was the first ADD book that we read. It gave me hope that we could have a fairly normal marriage and life if he could be properly medicated, but that hasn't seemed to be the case.

I'm leaving the whole medication thing up to him

He works about 30 miles from where we live, in a whole other city. His collegues live there and they are the ones giving him recommendations of doctors to see.

He would have to go to see this doctor alone and I've decided just to let him figure ir out. Very scary....I am a student and only work part-time. What if he doesn't get any meds and he loses his job? Or just decides not to go to work? If he loses this job it would just destroy him.

When I left the idea of getting a house in the city where he woks up to him, he didn't do it, and we still live here.

Opinions, please. I am letting our whole future ride on him doing something himself but I don't see that i have any choice.

It's all you can do

When I called doctors to figure out who to make an appointment with I was told that I can't make him do anything, he has to make that decision on his own for treatment to be more effective. It just seems crazy to allow someone to influence my life to such an extent and I can't really do anything about it. He does recognize when I'm at the end of my rope and makes a bit more of an effort then, that's when I'll press him with "if you don't follow through, I'll be forced to" kind of statement. I hope he recognizes how important his situation is.

Please don't allow yourself to think of the worst case scenario and do hope for the best!

Others are noticing the problem too

My husband's boss called him into her office today and told him some of the clients have been complaining about bad driving on his part. She gave him a week to get an appointment with a doctor to work on his meds. So I'm not crazy, others have noticed that he seems to have built up a tolerance to his meds.

He did ask me to call, but they wouldn't let me make the appointment because of HIPPA regulations. So he did call and make an appointment.

Interesting that he wouldn't do it when his wife asked but he would for his boss.

catic15's picture

Boss yes, wife no?

I think many times people with ADD/ADHD use work as their "organizing method" - I know my husband did. He could hold things together at work, because it gave his life structure that he just couldn't get from home (or me).  So it doesn't surprise me that when his boss made an issue of it he made the call. . . it may have been more frightening to him, or it may have seemed more real somehow. 

Costs

My husband took me with him to the doctor today. Not a permanent solution, but a GP who's willing to prescribe ADD meds. I went with him at his request because he can't remember anything.

The co-pay on the doctor's visit was $25, then $130 for the meds. They did increase his dosage of Concerta, we aren't sure if that will cause more side effects or not. Meanwhile I have no gas in my 1992 car and my oil light is coming on. There is no money for these things. I can pick up my paycheck on Friday but don't have enough gas to get to the bank to cash it. (Job doesn't offer direct deposit) I may blow up my engine on the way to the bank to cash my check because we don't have $2 left for a quart of oil.

I lit into him. Why can't they just learn to remembe things like I do? Why do they need expensive pills to make them aritificially happy? I can't manage my chronic physical medical conditions because we can't afford both. So I do without.

Why is it in a choice between me and the ADD I always lose out?

Bi-Polar and ADHD Confused?

My husband saw a new psychiatrist yesterday. He talked to him for about an hour and says he might be bi-polar and not have ADHD. Huh? Three different doctors have diagnosed ADHD.

If he were bi-polar, wouldn't he be happy sometimes? Wouldn't he be able to function sometimes?

He has to go back next week. I'm grateful this doctor is taking so much time with him (his experience has been more "take these pills and I'll see you in 3 months), but not happy to shell out two specialist co-pays in a week. Can bi-polar people act like they have ADHD (forgteful, not contributing to the household, etc.) all the time?

co-morbidity

ADHD and Bipolar often go hand in hand Sueann.  Its possible your hubby has both.  

I feel for you dear.

Bi Polar and ADHD

I think we all have to be careful about throwing around "names"  for disorders.

 

Bi Polar is a cover all word for something aint right about this human.

 

I would follow the 2 out of three dentists reccommend rule. 

How do I know this stuff?  I am a diagnosed bi polar on meds and my boyfriend is ADHD and un medicated.

our life is very interesting as you might imagine.  I think you might need to feel that someone has finally diagnosed the problem so the problem can be fixed once and for all.  Why waste time on trying something that might be a wrong diagnosis?  Right?  You need the problem fixed.

My guy and me have both becomed resigned to the fact that there is no silver bullet that's gonna "fix" either one of us.  This is by no means complacency, it's self acceptance then extending that acceptance to the other person as well.

My bf and I just recognize that there is no cure for what ails us on a long term basis, it's just the way life is for us and we admit that just because we aren't normal, that doesn't make either of us bad people, we just try our best to manage our abnormalities.

It's like having any other medical condition, diabetes, MS, or any other condition that has to be managed on a daily basis.  Do these things every day and you still have a bad day and feel shitty once in a while.

Would you be frustrated at a diabetic if when having a cold or flu that makes their blood sugar high while ill, they are more than lethargic and want to sleep all day? 

I think once you accept that this is the way life is for you guys, there will be a grieving for what is not going to happen, that you 2 will not live like other people.  Normal is subjective, look at other relationships around you, even ones that are considered good,  they are struggling with the challenges that are present in their relationships as well.

I hope this helps you some, it works for us and we are happy and sooo in love with each other.

Nettie's picture

Very Anecdotal Example

I have ADHD, and I bounce around the emotional spectrum a lot more than the men in my family would like. If I'm sad, I cry or express it dramatically, but the sadness goes away relatively quickly. I'm mercurial, yes, but not bi-polar. My friend with BPD stays low for weeks and then has extreme highs for a week or more.

arwen's picture

is ADHD+SAD a possibility?

My husband takes Concerta (for many years now) and Wellbutrin and has had not problem with building up any tolerance.  However, he takes the Wellbutrin (antidepressant) only 8 month of the year, to deal with his Seasonal Affective Disorder (SAD) -- I don't know if that makes any difference in the tolerance question.  Other people that I've known who have taken Concerta have not built up a tolerance either.  But I have read elsewhere that it is possible.

I don't know much of anything about bipolar -- certainly not enough to address questions about it.  I hesitate to suggest this -- it may sound like the proverbial "when all you have is a hammer, everything looks like a nail" situation -- but is it possible that what you are observing isn't your husband's Concerta wearing off, but a seasonal affect, along the lines of what my husband has?  The reason I bring this up is because we thought my husband's father was bipolar until we determined that it was really ADHD+SAD.

Most people don't realize that people who have SAD aren't at their worst when the days are shortest in late December.  SAD is driven in part by the amount of vitamin D stored in the body, which in turn impacts serotonin levels in the brain.  The body continues to store vitamin D during the early fall, even though the days are shortening, so the body's vitamin D reserve doesn't begin to deplete until late fall or early winter.    Therefore, the lowest vitamin D levels (and therefore lowest brain serotonin levels) occur in some SAD sufferers in late January but in others as late as  mid-March.  In the early spring, even though they start absorbing vitamin D again from the sun, it's usually not enough for their daily needs, so there is still a shortfall for several additional weeks.

Is it possible that the "wear-off" you appear to be observing is actually a late-falling low serotonin level due to SAD?  Have you ever noticed a seasonal pattern in your husband's behaviors in past years?  Is he more amenable in the summer (note: I don't mean happier -- I mean more engaged and less helpless)?  Is he more lethargic and difficult to communicate with in late winter/early spring?  Please note that if you live fairly far north, or if your spouse is of northern European or Russian descent, the chances of having SAD are twice what they would be elsewhere.

If you have any reason to think that there could be a seasonal component, please please mention this to your husband's new psychiatrist.

Also, regarding your husband's muscle tremors -- my husband had some problems initially with this on Concerta.  He started taking a magnesium mineral supplement and this helped stop the tremors.  (Magnesium can also be helpful sometimes to ADHD intrinsically, because it is an important component in building serotonin in the body and brain -- we found it does also help my husband's ADD a little.)  You might want to ask the doctor about whether magnesium might help.

Good luck with this!  I hope this doctor finally nails down what are the roots of your husband's problems!!!

 

"It matters not what someone is born, but what they grow to be."  Albus Dumbledore

Arwen, I always enjoy your comments

I think we might have become friends if we lived close to one another. We are similar ages and have grown kids. (Kids are from my first marriage, but I'm convinced my younger daughter has ADD, and her son is diagnosed with it.) I think our personalities are rather similar as well. I am highly intelligent and do not suffer fools gladly. You have described yourself as fundamentally impatient and angry, as I would myself also.

But I do not think SAD is a possibility here. He has had the worse problems in the last 2 weeks with feeling what he calls "gloomy." It's probably been about a month since he had clients complain about his driving and he had the duty of driving clients (to doctor's appointments and so forth) removed from him. His job, which involves a LOT of driving, probably woiuld prevent SAD, since he has lots of exposure to sunlight even in winter. We live fairly far south so I never hear of people here having SAD.

Thanks for your thoughtful responses to both this post and the one about "rules."