Reply To: Might need a higher dose of Adderall, but prescriber is very cautious

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Hey I am in a kind of unique position of having struggled with this issue from both sides. I’m a psychiatrist, and I also have ADHD that I’ve dealt with since 3rd grade and take Adderall. I have dealt with the super strict way prescribers treat it, and felt like I’m doing something wrong for asking for dose adjustments, or noticed providers being really cautious about it. My primary care doc prescribes it to me, and when I asked to try Vyvanse for a while (didn’t work well), he gave me a big talk about how much trouble I could get in for abusing, even though I’ve never abused.

At the same time, I feel like prescribing stimulants is literally the hardest part of my job. They’re a totally legit treatment for a very real condition, and I’ve seen them really help people, but I’ve also gotten burned as a prescriber. I prescribed Adderall for one patient who was very courteous and nice with no substance use history and had the testing done and everything, and then after 6 months he admitted that he had been taking the whole month’s supply in a week and then suffering the rest of the time without it, going through huge ups and downs until he felt suicidal. Just had another person swear up and down they were taking it totally as prescribed, and needed max dose (60mg), then found out he was in the ED with stimulant induced psychosis having taken triple his dose for a week at a time, and started buying it online when I wouldn’t increase it more.

The few bad apples really ruin it for the rest of us. As a prescriber, all I have to go on is what people tell me, and once you are burned a few times, which happens to everyone, it can be really uncomfortable in certain situations.

I honestly don’t have an easy solution, but one thing I would recommend is talk openly with your prescriber about it. If a patient came to me and told me that they had these concerns, that they just didn’t know how to approach it, and felt they needed a higher dose, but just didn’t know how to ask due to the stigma and delicate nature of these meds, I’d be very open to listening to that.

Other things I can think of that help:
– Don’t ask for rapid increases. I get really uncomfortable when people ask for an increase, then don’t even wait until the next appointment to ask for an additional increase. Discuss up front how long you should wait to see if it is working.
– Show that you are doing more than just meds. Describe what behavioral approaches you are taking to address your ADHD, try to see an ADHD coach (if possible), or some other kind of therapist that can help. Like just about every primary psychiatric condition, meds alone are never as good as both approaches, and stimulants don’t treat ever part of ADHD.
– Get the testing, and keep a copy of your results. If you weren’t tested, getting tested can really put your provider at ease. ADHD can be hard to diagnose for a provider that doesn’t specialize in it, even a psychiatrist. Plus if primary symptoms are low energy and lack of motivation, providers are very aware that many other conditions, mental and physical, can have those symptoms. We want to feel sure that we are treating a legitimate condition with an appropriate treatment.