issues with prescriber

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    • #82844
      lakinapook
      Participant

      I am 46 and have been on adderall generic since I was 28. After my psychiatrist retired a few years ago I had a hard time finding a new doctor. It seemed that most docs that accepted my insurance were not doing medication management for adults with add. Finally I found an aprn that would work with me,but she has always been uncomfortable with my dose of 30 mg of adderall twice a day. I have explained to her that this dose is one I have been on for at least 10 years, that the psychiatrists I dealt with before don’t seem to feel like it is too much and so on. Well today I saw her and again she brings it up, tells me that the psychiatrists she works with would never prescribe me this dose, and that she is giving me a prescription but that she wants me to try only taking half a dose in the afternoon. She said she wants to see if we can get the dose down. I have never heard of such a thing, and I know that the optimal dose for me is 30mg 2 times a day. I also know that I can go off it for over a year, because I did while I was pregnant and breastfeeding, and that within a few months I am back to needing 30 mg twice a day.

      I am confused, because no psychiatrist has ever suggested that I need to lower my dose, and she hasn’t presented any actual reasons WHY she thinks my dose is too high. Does anyone have any idea what is going on here? I hate to have to find another doctor, but I am feeling like there is some mistrust here, and I can’t figure out why.

    • #82860
      Penny Williams
      Keymaster

      It is a lot of Adderall, but some people need a high dose to see the benefits (Maybe your metabolism is super high?). With so much Adderall being sold illegally, practitioners are really cracking down on prescriptions out of fear. It could be that she’s worried you’re taking half and selling half. It could be that she just doesn’t like the idea of an individual taking so much stimulant.

      Unfortunately, you need to come to a place of mutual trust somehow, or find a new clinician for medication management.

      Adderall XR

      Penny
      ADDitude Community Moderator, Parenting ADHD Trainer & Author, Mom to teen w/ ADHD, LDs, and autism

    • #83308
      sandman2
      Participant

      First, it won’t hurt you to try it. You will know within a few days if it is working the way you want it to. And you can document what you can or can not do under the new plan.
      Second, there are a lot of new meds out there that function even better then the adderall. For example one Vyvanse pill will last longer then the doses you now are taking and its a much smoother medication.
      ADHD medication has always been a trial and error thing because everybody is different. You can’t just say, “oh, this is what everybody takes” That is a good excuse to run from that doctor as fast as you can. However, it does not hurt and may actually help to try new doses.
      If they want you to try lowering the dose ….get from them a checksheet that you can use to tell if it is working or not. If they can’t tell you what to expect – that would not be a good sign. I can provide links that you can use to tell if you are being underdosed if you are interested.
      Do keep in touch, this information will help others.

      • #83314
        lakinapook
        Participant

        Ok, first off I never said that this is what everyone takes, just that this is what I have been taking for a long time and that it has been working.
        Second, I would really like whatever you have related to documenting effects to see if it is working, because a systematic approach is probably best and I quite frankly have no idea how to do that so a tool to help would be great. Thank you.
        Third, I agree there may be something that works better, I have been thinking about that, but change is scary and I don’t think I trust this APRN who doesn’t seem to understand adderall very well to have her start tinkering, so I would definitely have to find a doctor that I trusted. Now isn’t a great time to blow my life up , you know?
        I think that mainly my question here is that it seems like there isn’t any valid reason for her to be concerned about my dose except that for reasons I don’t understand, she doesn’t trust me. Given that prior to her, an APRN, I had been under the care of a psychiatrist who had absolutely no issues with my dose, in fact how I got to that dose is because over time I developed a tolerance to the previous dose, and the dose has creeped up over time, as is common with adderall.

        So, does anyone know of a reason outside of lack of trust, why she would have a problem with my dose? Because if it is lack of trust then I can not continue to see her, I already feel like I have to defend and justify myself which is stressfull and I can’t have a stressfull relationship with a care provider, there are too many other things in my life that cause stress.

    • #83355
      Figgety Phil
      Participant

      I can think of a few reasons she may want a trial at a lower dose.
      1) the long-term effects of stimulant use have never really been studied and adderall’s own medication guide suggests trials off the medication when used long term to make sure it is still needed and to assess the dose needed
      2) in general doses higher than 40mg total per day are rarely more effective (not saying that is the case for you)
      3) when someone needs that high of a dose of short-acting stimulant its always a good idea to try a long-acting form. If it works you get the added bonus of only needing to take it one time per day, and if not you can always go back to your current medications
      4) stimulants, like every other medication, have the potential for side effects. Given stimulants can affect the heart I would hope the APRN just has your best interests in mind

    • #83410
      sandman2
      Participant

      The best resource I have found for ADHD medications is the book, New ADHD Medication Rules: Brain Science & Common Sense. by Dr. Charles Parker. If you don’t want to get the book. you can read the essentials at this link….. http://www.corepsych.com/add-adhd-medication-find-the-sides-of-the-therapeutic-window/
      Or see his series of short Utube videos on adhd medication here….. http://www.corepsych.com/adhd-medication-tutorial/

      another good overall link is this one….. https://www.additudemag.com/stimulant-medications-for-adhd/?utm_source=eletter&utm_medium=email&utm_campaign=treatment_march_2018&utm_content=030818

      Hope this helps.

    • #83486
      lakinapook
      Participant

      Yeah, I would hope she has my best interests in mind as well, but I have to confess that I think she is probably more concerned about her own bottom line, which is fine, we all are to some extent. Mainly because, while you have articulated several possible reasons, she has simply not explained to me why she is concerned except to say that the psychiatrists that she works with would never prescribe this dose. In my experience if someone has a good reason they aren’t usually tight lipped about it. And I have no idea what her psychiatrist would actually do, but every psychiatrist I have worked with over the years has eventually suggested increasing the dose which is obviously how I got to this dose. The thing is, I already KNOW that I can’t realistically lower my dose, because I have taken breaks, the longest being a year and a half for pregnancy and breastfeeding, and while the therapeutic dose at first goes down, it doesn’t go down by that much, maybe to 20 mg twice a day, and the tolerance comes back much quicker than it initially took me to get to that level, and within a very short time I am back to needing the 30 mg 2x per day. That is mainly why I am getting frustrated, because the tolerance issue is well known and I am not aware of any mechanism by which one can permanently decrease the therapeutic dose of this medication, tolerance creeps up on you. Decreasing the tolerance just means that the slow creep back up is going to start again.

      Am I Developing a Tolerance to Adderall?

      She and I discussed the long acting and I don’t see the benefit of the long acting version. I had a friend who got into a very bad cycle with that where it really messed up her sleep cycles. If something delays you being able to take the pill first thing then you either suffer the effects for the rest of the day of not having it or you take it late and it interferes with your sleep. My son was on Quillivant and while the dose was supposed to last 12 hours he actually started coming down off it at 5 hours and became a miserable jerk, because the long acti g stuff isn’t a panacea, there is still much individual variation in how it works. I also don’t always NEED both full doses every day, depending on what is on the agenda, so I don’t usually end up refilling like clockwork. BUT, if I NEED to be productive, a dose of less than 30 mg doesn’t move the needle enough. Being able to not take the full dose if I don’t need it is one of the ways I keep the tolerance from creeping up from the current dose, although I don’t know how long I can hold that off either.

      I have explained to her all of the above several times, but she still cycles back to her feeling of my dose being to high. I just need to find a psychiatrist to work with I guess.

    • #83503
      ymsedivy
      Participant

      First, stop seeing the arpn. I had 2 that wanted to lower my son’s dosage because they thought it was too high. The other part of this was they had no idea he has been under care of a psychiatrist for 5 1/2 years now (yes, my ex husband doesn’t want him medicated). I stopped it right there and went to the Dr at the practice. She understands the cost/benefit of it and would not suggest that. Most physician offices do not know about the various levels along with the comorbid conditions of ADHD.
      Find a doctor who is willing to work with you. You know what works and I wouldn’t change mine either, I have been told the same thing about how much Ritalin I take. I’ve been through the rounds of testing and the other part is I cannot afford the copay of a non generic prescription.
      Best wishes to you.

    • #84753
      KatyH
      Participant

      I agree with finding a doctor who’s willing to work with you. That’s what I love about my doctor. She listens to my concerns and doesn’t treat me like I’m dumb. I’ll ask her questions about the medication, and she’ll answer them, and if she doesn’t know the answer, she’ll research it.

      I noticed that one person posted a link to Adderall XR, and I’d also suggest trying that. Along with ADD, I have a neurological condition, and at one point, my meds stopped being as effective, but I didn’t want to take more than what I was on. My doctor suggested the XR version, and it changed everything. I couldn’t take Adderall because, like many stimulants, the effect hits you all at once, and I got debilitating migraines. I switched to Vyvanse (which isn’t specifically XR, but the way it’s processed in the body means that it has a tapered release effect), and it works much better. If you have to take your Adderall twice a day, it could be that your body just processes that first 30mg really fast and so you need another. So definitely find a new doctor willing to work with you, but I’d also recommend giving the Adderall XR a try.

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