Playing Med-Roulette'

I know others of you have offered some advice about what meds worked for you, but I figure it's time to post my whole medication saga in the hopes that maybe there is a better way to find the right med/dosage for me without just picking at random and giving it a shot and then trying again over and over until somehow eventually stumbling on the solution.

I am 33 now. I was diagnosed at 18 during a semester off from college after nearly flunking out my first year. The psychiatrist who initially treated me put me on ritalin. Soon after, I went back to college (out of state) and then only saw a doctor at the campus med center once a month to get my refill. He drilled me with suspicious questions every month to be sure I wasn't just faking it and hooked on the meds, as if that could somehow suddenly change from one month to the next. I didn't like taking my ritalin and wasn't all that consistent about it. Knowing what I know now, I am sure it was either the wrong med or the wrong dosage. Eventually I stopped taking the ritalin. A few years later I went back on it for a while and, although I still wasn't sure I really liked being on it, I was told by others that it helped regulate my mood. Eventually, I went off it again.

Fast forward to now, over ten years later. I have since learned so much more about what ADD is, how it affects me, and how to better manage it. I also have different priorities and goals. I am now married with four kids. But, as time goes by and my kids are starting to get older, I have realized that I have never truly managed my ADD effectively, despite understanding it and dealing with it. But, I can't keep just dealing with it. I need to better manage myself, my home, and my family. And, it seems to me that I have an amazing set of tools I've acquired over the years, but can't seem to use them properly and being on medication is the missing piece of the puzzle. So, I went to my current doctor to get back on some meds.

 

My husband (who's also ADD) takes adderall, so I tried some of his for a few days before seeing my doc. (I know, I know. I don't need a lecture on why that's a no-no.) I told him about it and that I could tell there was something happening, and he put me on adderall, too. Started at 15mg 2x/day. Upped it to 22.5mg. Have also tried it at 30mg dose. I can tell some difference, most notably to my mood and patience. On adderall I am much more in control of my emotions and much more able to deal with the day to day challenges of having young kids. I am able to better focus mentally. However, I have never felt significant effect on my motivation and my ability to get started (much less finish what I start), which is one of the things I struggle with the most.

After a month of trying the adderall, I had a followup with my doc. I told him I can see and feel a difference, but not the clarity and "turning on the lights" or "fog clearing" I keep hearing about from others. He is now trying me on ritalin. I don't like it. It doesn't seem to help much with focus, not at all with motivation, and very little with moods. In fact, the opposite is often true. Quite often, ritalin makes me feel irrationally angry, almost raging. I can tell the anger and frustration is irrational, but it takes all my energy to keep it under control. I'm supposed to be trying this for a month and then go back for another followup. I don't think I can handle a month on ritalin, with basically no benefit and a side effect of extra anger and impatience.

 

My doctor, bless his heart, is great for all other health issues I've gone to him with. But, he just doesn't really know much about ADD or ADD meds. He just kind of shoots from the hip, and at this rate, it could be ages before we stumble across the right prescription for me. (Side note, although my doctor thinks 3 doses a day is too much, I find taking a third dose really helps because otherwise all the effects are gone my dinnertime, leaving me without the benefits of regulated mood and abilities during the time of day my family needs me to be at the top of my game the most.)

I know I ought to find a doctor who has more experience treating ADD, but I am at a loss as to how to find one of those. So, for now, I am trying to learn as much as I can about what course to try next, because this game of med-roulette isn't working for me. Any advice? Anyone experience similar effects from either of these, and if so, what eventually worked for you? Is there a better way to figure out the right combination of med and dosage, based on my most problematic symptoms and the effects of the two I have tried?

Pbartender's picture

You could try asking your

You could try asking your doctor if he knows someone with more specific experience...  Most doctors would be perfectly happy to refer you.

Also...  http://www.addreferral.com/ is a great website, most listings are ADHD specialized therapists, counselors, coaches and psychologists.

Also, also...  Most insurance providers allow you to search by specialty on their web-sites.

 

Pb.

Since it had been over a

Since it had been over a decade and I had no records detailing my previous medication treatment, my doctor had me spend an hour talking to the in-house mental health specialist to validate my diagnosis. I've always thought talking to counselors and therapists is rather fun. But this guy was anything but. He was one of those who says very little, sighs and grunts and lot, takes copious notes, and generally made me feel like he was looking down his nose at me and judging everything I said and did. It was such a horribly uncomfortable hour, at the end of which he told me that he would let my doctor know that, "as far as [he] can see AS OF NOW, there aren't any concrete, plainly evident reasons to bar [me] from trying a prescription for stimulant medication." He was like the mental health version of the doctor I saw for refills in college. When I saw my regular doctor a week later for my follow-up, I told him I ​really​ didn't want to ever have to talk to the other "doctor" again, as he was very condescending and refused to give any feedback or advice even when I asked specific questions.

At my last appointment, I brought up the possibility of finding someone more specialized to work with, at least while we try to find the right prescription for me. My poor doctor told me he would normally just send me to the in-house guy I had seen before, but since I was so opposed to that, he wasn't sure where to send me but would maybe ask around and see. That was when I decided it would most likely fall to me to find the right doctor. I have been in contact today with one of the coordinators of the local CHADD chapter and she said she would track down a couple of referrals for me from other ADD adults in the area. Hopefully that pans out.

I have looked at listings for local therapists and doctors who list ADHD as one of their specialties. But, the ones I've found list ADHD right along with pretty much every other mental health issue and, in my experience, that doesn't mean a thing as far as real experience in the areas I need. I am going to look into that website you recommended, too. Thanks for the tips.

Holy crap, PB.  A million

Holy crap, PB.  A million times thank you for sharing that link. I looked up my area and was shocked to discover that there is a ADHD treatment center in the same hospital network as hubby's GP. WOW.

This couldn't have come at a better time either. Hubby started school last week and it's been very up and down. He missed two classes last week and I'm not sure if he missed today's two classes because he's been MIA since this morning. He won't sleep essentially. He stays up until at least 4am, sometimes 6am, and then expects to be able to get up at 10am to go to class. Plus he's really struggling to get a handle on all of the online resources they are supposed to use to turn in homework, get assignments, etc. He's been un-medicated for weeks and I'm starting to feel some resistance from him on that score. He's started making excuses for not taking it (he's on Vyvanse too)...makes him irritable, too expensive, it makes him feel like he's not himself, etc. He thinks the dosage needs to be decreased, but when I made him the appointment to go talk to his GP, he got mad and said he still had one month left on his current medication. But when I asked him about getting it filled, he said he lost the prescription form. [angry face]

I'm trying to let him go on the school thing...if he flunks out because he doesn't attend classes, then so be it. But I just can't do it. I know the ramifications if he fails. It will be an epic disaster for him emotionally. He's already hauling around enough baggage for ten people. He's definitely at the sink or swim phase right now. Hopefully I can get him to this treatment center; he's been open to switching doctors in the past, so we'll see what happens.

I've said those same things

I've said those same things in the past about how my meds made me feel. I've since learned it's because I wasn't on the right med. The things your husband says about his meds is similar to how ritalin has made/makes me feel. I used to say that, although I could see benefits to being on the meds, I felt like I lost some of myself in taking them. My current meds do NOT make me feel that. I feel exactly like myself, just more productive and capable and put together. When my pills are working, it's like I'm still everything that make me me, only better. It still takes plenty of work to manage my ADD, but my meds make me more able to do that work. So, I would definitely agree about him changing doctors and meds. My ADHD hubby is back in school, too, and it's hard. It takes both of us to keep him successful. He does the actual schoolwork and attending classes, and I maintain his schedule and any other student management, help stay on top of his assignments, and generally nag (as un-naggy as I possibly can). College plus Adhd (esp as an adult) is most definitely a group effort.
Pbartender's picture

I wanted to talk about

I wanted to talk about this...

"I told him I can see and feel a difference, but not the clarity and "turning on the lights" or "fog clearing" I keep hearing about from others."

...just a little bit.

I'm on Vyvanse right now, and I like it better than the Concerta I started with.  Concerta was just like drinking a whole pot of coffee at once for me.  Alert, attentive and energetic, but also jittery and mood swingy, with a crash at the end.

About half an hour or so after I take the Vyvanse, I can feel that change your talking about...  but only if I'm closely paying attention for it.  It's very subtle.

Do you know when you go to the eye doctor, and she's testing your vision?  She's got that contraption over your face and she's flipping the little lenses around, asking you, "Is this one better, or this one?"  One is perfectly clear, but the other is so slightly out of focus that you hardly even notice, except by comparison, and even then you have to think about it for a moment to be sure.  That's what it feels like.  And for me it's not a sudden pop between one and the other...  It slowly takes a couple seconds to slide from one into the other, and so isn't obvious at all.

Once it takes effect, I don't really feel any different.  It's not like having a few drinks and feeling tipsy.  But I can tell the difference when I do things...  I still notice distractions, but it's easier to ignore them and stay on task.  I don't get bored or disgruntled as easily during tasks that aren't "interesting", and if I do it's easier to stifle it and keep working.  My memory has a higher rate of success.  Paying attention, especially in social situations, is not as mentally exhausting.

The Vyvanse has little or no effect on my moods one way or the other, but because my performance at home and work has improved, I'm naturally experiencing an upswing in confidence.  Because I'm don't have put as much effort into memory and attention, I also don't get as tired mentally and emotionally and consequently, I'm not as irritable as I used to be so it's a lot easier to regulate my emotions on my own.

 

Pb.

Pbartender's picture

I noticed this difference this weekend...

It was a rough weekend...  Our cat died Friday, and the kids and I had a rather low-key weekend.  Yesterday, for the first time since I started two months ago, I didn't take my meds for the day.  For the most part, I didn't feel any different, really, but...

I'd woken up early before everyone else, and decided to hop on the computer and play a game I hadn't played in a long time.  i decided to hold off the meds until a little later in the morning, because some friends were thinking about showing up for board games after dinner (they didn't, in the end, but that's beside the point).  Without realizing it, I played for almost 6 hours straight through, missed breakfast, almost missed lunch, missed my window for taking the meds, and only pulled myself away when I realized my wife was leaving for work for the evening.

Wow.

That's the whole reason I cut back on games even before I was diagnosed...  and I haven't lost track of time like that since I started medication and coaching.

That afternoon, I did get some more constructive things done, but I could really tell the difference both in the effort in took to get started and the effort it took get finished, and I was rather less tolerant of annoyances...  By the time I was, I mentally exhausted, and ended up vegging out in front the TV for the evening.

I could really notice the difference, by comparison....  Blecch.

 

Pb.

I meant to reply...

...but you know how ADD goes.

I really appreciated all your comments, advice, and insights. I can so relate to your story about forgetting your meds and just losing a whole day somehow. That happens to me far too often, although not as much anymore. It is still a constant struggle for me, even with the meds, but I am getting better. Part of it is retraining myself and the way I do things. Part of it is making sure I take all my meds and supplements, and on time. That's where it gets me often, is the time when it's time for another dose and I'm caught up in something as the previous dose is wearing off and I just lose track of time and priorities and suddenly far too much time has gone by and important things (like taking pills on time or feeding kids lunch) go forgotten until the chaos level has built to where it pushes it's way into my line of sight.

As an update on my game of finding the right med/dose: I am back on the adderall, this time at 30mg. I know there are other possibilities out there I haven't tried, but I am at a point where I don't have the luxury to be a mess while playing with meds. I need to go with whatever works well enough for now. And, for me, that seems to be adderall. But, what made all the difference for me was the discovery of adding the right supplements to my routine. My baby brother was recently diagnosed with ADHD and his psychiatrist seems to really know his stuff, and my brother was sharing with me all the things his doctor had put him on. I learned some new things, tried them out, and it was like finding the missing piece of the puzzle, the thing that clicked into place to make my adderall actually feel like it's working so much better.

Here's what I do now: Every morning I take a good multivitamin. I take my adderall, of course (short acting seems to work better for me, so I have to stay on top of things to get doses on time throughout the day). I also take vitamin B12 and D3, and sometimes omega-3 (although if the omega-3 makes any difference for me, it is so subtle that I can't tell, so sometimes I take it and sometimes I just don't feel up to such a giant pill full of fish oil). Then, I take the B12 two or three more times throughout the day, including with any additional dose of my meds. The B12 is what has made all the difference for me, which is the same as reported by both my husband and my brother. It helps so much that I have also started giving smaller doses of B12 to my kids with each dose of their ritalin, too, and then one more around dinnertime to round out the day. In all of my reading about ADHD, I had heard of the omegas and vitamin D, but I had never considered a multivitamin as being important (I was already taking one daily, but I switched from taking it before bed to now taking it first thing in the morning). But I had never heard or read anything about vitamin B12 anywhere in relation to ADHD. This has been such a life-changing revelation for me that it's a new soapbox of mine. I just want to tell everyone I know who may benefit from the information like I have. 

Oh, and I also often take a third half dose (15mg) of adderall in the afternoon or evening. Although, I have to be selective about this one, because my doctor doesn't see why it would be necessary and thinks that, since my dose is so high, I should really stay away from taking any more than the two prescribed doses. So, he won't adjust my prescription accordingly. No matter how I explain it, he doesn't seem to get that I can't afford to be down off the meds by dinnertime, when my family's demands on my time, attention, and patience are often at their highest. He just thinks it's unsafe to take "so much of such a potent drug, considering [my] already high dose". Plus, he is constantly bringing up concerns over my being able to sleep with taking a later dose, although I have told him that it doesn't seem to be an issue for me. Some doctors, no matter how good their intentions, just don't get how it works or why what I'm trying to explain is important, I guess.