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

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    • #137876

      Hey guys,
      Been taking Adderall XR for about 2 months. I’m on 15mg and while it helps, I feel like it’s not enough for it to keep me as focused, productive, etc as I’d like. My prescriber is really cautious and she doesn’t suggest upping my dose when I mention her that it’s not working as well as I’d like. I plan on bringing it up more directly, but I don’t want to seem pushy or “drug seeking.” Not sure if part of her cautiousness is my naturally high heart rate(which gets worse during my appointments due to anxiety) perhaps due to my lack of exercise or the fact that I’ve been losing weight (bad eating habits, working on it). I get no side effects from Adderall. No anxiety, no insomnia, I can eat just fine.

      I really feel like my treatment needs to be tweaked either by increasing dosage or by trying the IR version to fine tune it better! How would you guys approach this situation?

    • #137952

      try concerta 54
      and if you need ad a 10 ritalin to it

    • #138088

      I am having a similar problem with my doctor. I am taking amphetamine salts ,15 mgs/ 2 times a day.
      I don’t have any side effects from it,. On the plus side it helps calm my anger issues and am seeing it helping my awareness just a little.
      I am not sure how much or to what extent that drugs can help ADD, and I don’t think my doctor knows either. So it is frustrating to want to help “ NOW” and the doctor wants to take it slow. I am going to start taking more days off to see if my body is just getting used to the drug and maybe the present dose might work better?! I don’t Know, worth a try and probably better for my body at the same time as
      Amphetamines are addictive.

      • #138758

        Being successfull is addictive, not the medication.
        im addicted to my successes

    • #138117

      I wish I could offer you answers, as I struggle with the same issue.

      Everyone continues to caution that the medications are addictive, but I can’t see getting addicted to any of this. I feel bipolar on bad days, and on good days, I just feel normal.

    • #138189

      I have been going to the same neurologist for my ADHD for several years now and I still get like this. Whenever we have appointments, she asks how I’m doing with my meds. I always say they are fine butI wish it lasted all day. I always fear that she’s judging me or thinking I’m just after more medication. I don’t just need the medicine to work while I’m working, but also for home as I have a toddler. And I really feel like being focused and attentive at home is more important than anything, since my toddler’s safety and well-being are at stake. I’ve explained this, but she’s reluctant to prescribe 2 Adderall XR dosages.

      It’s hard because there are people who abuse this medication. Which makes it more difficult for those of us that really need it to get it or even feel comfortable asking without fear of judgment.

    • #138192

      I find it works best to acknowledge that they are careful and considered in prescribing medicine and thank them for taking good care of your health. Then I say the meds have been a bit helpful and you wonder if it would be possible to try a slightly higher dose because you notice x or y (giving examples where you think a higher dose might help). Don’t bring up drug seeking because it will sound like you are. If she refuses to try a higher dose, ask what she might suggest to help with the problems you are still having. If she wont increase or offer other solutions you might need to look for another provider.

    • #138195

      I would ask your doctor as a matter of fact. If the doctor doesn’t want to help any further, try to find another doctor who is more understanding of your condition.

    • #138216

      I took the adderall xr for a few years and did fine, but once I became a mom of two two years apart, I needed a higher dose because I had more than just my own brain to distract me and stress me out. Everyday life was too overwhelming. I switched to the instant release tablets. I know I get a solid 4 hours of productivity and no anger outbursts after each dose. I now take 20mg twice a day and that is working well. I have traditionally low blood pressure, so that’s not been an issue for me. One thing I have noticed though, is that heart palpitations are usually caused by another medication in conjunction with the adderall – any other stimulants such as sudafed or anything with steroids. I don’t take these when I’m taking the adderall. A good provider who understands ADHD will not judge you for needing more help managing your symptoms. If your provider still pushes back you might need to find a new one. Don’t give up though! Once you find your optimum dose, life will be much more manageable. Good luck!

    • #138274

      UGH I’m having the same issue with my psychiatrist. My therapist seems much more willing to listen to my concerns and doesn’t feel threatened or second guessed if I discuss what I’ve learned by doing my own novice research on the side. The second I bring up things I’ve read elsewhere to my psych she immediately halts me to tell me that every person is different so I shouldn’t be attempting to look into this on my own at all. I should just show up, answer her questions, and accept whatever she decides to put me on without any question or input. Obviously she cares if a particular prescription was negatively affecting me, but she has no desire to get into the business of helping me tweak my meds to get the most out of them. Thankfully she granted my request to only issue me 14 day scripts so that I can see her sooner to adjust, but it’s just such a frustrating process. Add to that my suspicion that she’s not super-well-read into the particulars of ADHD meds, in my case Adderall, as she simultaneously claimed that XR caps “last for 24 hours” when I’m all but certain they wear off after 12 hours max or earlier and that she considers a switch from (1) 10mg IR to a 15mg XR an increase. Literally, I suppose, but a decrease in the amount that’s active in my system within a given window. Sigh, I’ll see how this goes but switching docs is going to be a real PITA since this practice is only 10 minutes from work and I can go there on a lunch break and not be penalized. Best of luck!

    • #138283

      We have had to increase my grandson’s dosage several times. They always start low and then build. However, this past summer, we had a sleep study done on him. The doctor did not think he had Sleep Apnea because he was so thin…however, the test totally disproved that theory. He would stop breathing about 10 seconds 4 times per hour…so, he was trying to function through the day without a good nights sleep! Lack of sleep just increases ADHD behaviors. Since having the test done, he now sleeps with a CPAP and let me tell you all…What an improvement in behaviors…all day behaviors! We have also decreased the amount and dosages of his ADHD meds. Different Kid…Different Life… If he doesn’t use the CPAP at night, the next day isn’t too bad, until we get to about 5pm and it hits…and I think “This is how it used to be all the time” Blessed and Grateful for that CPAP and the changes in behaviors…all of them for the better…memory, attitude, work at school, social skills!!!

      • This reply was modified 2 years ago by pummillp.
    • #138326

      I’m on Concerta 18mg now. Started out on 10mg an Psychiatrist started raising fr there. Dx in Dec 2019 at 50.I was reluctant to start a stimulant. Tried Adderall. No way. Even extended. Body pain an very bad mood an increased anxiety. So Concerta started. It DOES NOT last no 12 hrs. 6-7 at best on me. Even on 18mg. Then went to 27mg for a mth but just called an said I wsnt yo go back to 18mg. So I explained ” the crash” to Dr. Its horrible. Freaking out. Crying. Depression. An its rt when Im needed. Homework supper etcc so 5mg fast acting Methylphenidate was started. I take around 6 hrs or 7 hrs fr Concerta ER dose. Then upped to 10mg fast acting. Some say a Dr should try the pt on fast acting of both kinds first to see which one does better. Ritalin(generic is methylphenidate) or adderall fast acting. Then which ever does best try the long acting of it. Sometimes people do better with 2 doses of fast acting but I was afraid of gettin use to fast one. Ive lost wt. 115lbs. 5’3. Was 122. In July. Also deal with Fibromyalgia an lower back pain. So Tramadol I take in between both doses but only 1 a day. Id like to stop stimulant because Tramadol helps with all my issues. Pain. Depression. Anxiety an ADD symptoms. I dont know why. Everyone is diff. But Im afraid also to go to my M.D. an say that an ask to b on Tram full time . Like 3 a day. Or 2 a day an thats it. Im also tapering off Clonazepam 0.5mg. Was on 2 pills a day. Which is 1mg. Its taken a yr to get down to 1 pill a day. Quarter of pill cut out for 6 mnths or shorter if no withdrawl symptoms until ur done. So hoping to be off by this time next yr. But Im worried whats gonna help my GAD? My mind racing constantly. Tram slows it. Tram increases serotonin levels an norepinephrine and dopamine. So my Psych cannot write for opiates. Only my M.D. an my old M.D. just retired in Dec! Rt now im prescribed 60 pills for 2 mnths. Havent seen new MD an its a woman. Im a woman. Not sure I like that. So Im afraid she will see the Clonazepam (im tapering with psych an its documented with old M.D.)& the 2 stimulants (3 scheduled 2 drugs)& say nope. But it helps with my pain. I do not want any higher opiate. No way. I just want to feel normal an be able to do stuff an live my life! So Im in same boat sorta but diff drug. I would say to Psych that you feel that this dosage may be to low an can u have a trial of next higher dose an no refills or qty of 2-3 wks to see how it does. Or chg drug. That ur symptoms are not under controll an ur having issues. Its either yes or no. An they can call in a new rx even if old one ur on isnt ready to fill as long as dosage chg or qty. How would u abuse such a low qty? An no refill or not asking for refill just a trial. If still issues find another Dr that treats ADD.

    • #138346

      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.

    • #138349

      Great advice by VVALL. The other thing to keep in mind is that everybody is different. There is no “one size fits all” when it comes to medication. Doctors should start off slow and then listen to their patients. 15 mgs is a mid sized dose. It should last for about 8 to 10 hours. One good indication of to low a dose is it not lasting long enough. The more information you can give you doc the better. Chart when you start to notice the med wearing off. If you can go in with concrete examples, there is a much better chance the doc will listen to you.

    • #138361

      I feel your pain. My doc started me on a *very* low dose of Adderall – 5 mg, and titrated me up to 10. I’ve been on 10 for awhile, and actually found it helpful, but these days feels nearly useless. The problem is, I’m dealing with some hypertension as well, so my doc doesn’t want to increase the dosage until that’sunder control – which it isn’t yet (I’m only 33!) I definitely have a bit of “white coat syndrome” going on – my BP always reads way high in his office, but even when I take it on my own, it’s a bit higher than it should be, and we haven’t figured out if it’s the meds or something else yet. So I’ve been stumbling along at 10 mg for months, wanting to increase. He said last appt. he may take me off it entirely, I assume will try me on something different. It’s hard when you know others who walked in right after getting their dx and their docs started them on 20 right off the bat. But I think my doc is trying to be responsible, especially with the potential side effects.

    • #138755

      I’m an older adult with ADD, and my doctor was reluctant to prescribe more Adderall than I was already taking because it can cause high blood pressure. I did some research and found that the main ingredient in Adderall is Dexedrine, and it only affects the central nervous system, so doesn’t raise blood pressure or cause heart palpitations. He was willing to prescribe that. Now I’m on 20 mg twice a day of Dexedrine and it’s much better than Adderall. It doesn’t have the “jagged” feeling when it wears off, and I don’t see any side effects. With Adderall I had anger issues and with Dexedrine I don’t. If you have research that you can cite while discussing it with your doctor, or bring that research with you, it can help them make that decision.

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