My Forum Comments
Put some thought into what relaxes you, like observing yourself in all situations. You may find relaxation in unexpected places and certainly not in what is typically expected to be relaxing. I am never relaxed on vacation and I can not even relax enough to enjoy a massage. I find myself most relaxed when moving, especially walking in the woods where I can observe nature around me. I also find relaxation in creation, I started woodworking. Once again I am moving and I only make small things so I have a chance of finishing them. It may take some time, it took years for me, but try to be aware of when you do feel relaxed and take note of what you are doing to make that happen. It’s a lifelong experiment and may change over time.
February 5, 2020 at 7:28 am in reply to: Strategies to cope with the organisation of an undergrad dissertation #141020
You actually have given yourself the best advice in your observation of recent success. You have good grades in the modules that were shorter. I struggled, undiagnosed, in graduate school but making the dissertation achievable was accomplished by both external pressure (typical ADHD last minute stuff) and breaking it down into smaller pieces. Break down your dissertation into small, manageable modules and build a timeline for each. Find a way to enforce that timeline with a friend or personal penalty that will motivate you. With over 20 years working in research, I rely heavily on project managers and people close to me to break down big projects into small, measurable accomplishments with short timelines I can adhere to. You’ll be surprised at how much you can do when you chunk it down.
In general, Adderall is not affected by food but there are some interactions that could affect the absorption of the drug. IN your specific case, Vitamin C and acidic foods (like fruit) can lower the absorption of Adderall (or amount that actually enters your body). As a general rule, take your Adderall at least 30 min after eating something acidic or a vitamin C supplement and don’t take the vitamin C or acidic food for at least 2 hours after taking the Adderall. If you take XR, I wouldn’t worry too much about the type of food intake later in the day.
Consistency is the key. If you have a routine, stick to it and you can take a properly adjusted dose accordingly. Work with the immediate release product twice a day for a while while you figure out how your dose is affected by what you eat and if what small changes (+/- 2.5 to 5 mg) can be done based on what you eat.
Overall, as long as you dont take huge amounts of Vitamin C, you shouldnt have to dose adjust based on your food choices. It is probably best to take your vitamin C at night or with dinner since you probably dont take Adderall in the evening.
I just wrote this excerpt in another thread but it applies here as well –
Your doctor is the expert in the treatment BUT YOU ARE THE WORLDS FOREMOST EXPERT IN YOUR OWN BODY (don’t forget that). If you feel your doctor does not listen or is not giving you the treatment you deserve, find another doctor. Most doctors don’t like to be challenged on their judgement so choose your words and approach carefully. You may already have a good doctor and you just need to find the right way to have a discussion. I was not ashamed to “interview” doctors. I found many doctors and psychiatrists in big HMOs or healthcare conglomerates have such limited time to devote to you. I ended up with a psychiatrist who does not take insurance. She prefers to spend the appropriate amount of time with a patient to get things right and does not want to have to deal with the volume pressure of a large practice. So, I pay out of pocket and get some reimbursement from my health insurance. I don’t mind paying extra. I consider my health and well being more important than driving a nicer car.
You should not go at this alone. Spend the time to find a good psychiatrist and therapist for finding the right drug to help and support to help you through this.
Also – I worry that your doctor had you push through the trazadone and didn’t take you off of it for one of the BP medications as you asked. I won’t challenge his judgement since I do not know your situation. Your doctor is the expert in the treatment BUT YOU ARE THE WORLDS FOREMOST EXPERT IN YOUR OWN BODY (don’t forget that). If you feel your doctor does not listen or is not giving you the treatment you deserve, find another doctor. Most doctors don’t like to be challenged on their judgement so choose your words and approach carefully. You may already have a good doctor and you just need to find the right way to have a discussion. I was not ashamed to “interview” doctors. I found many doctors and psychiatrists in big HMOs or healthcare conglomerates have such limited time to devote to you. I ended up with a psychiatrist who does not take insurance. She prefers to spend the appropriate amount of time with a patient to get things right and does not want to have to deal with the volume pressure of a large practice. So, I pay out of pocket and get some reimbursement from my health insurance. I don’t mind paying extra. I consider my health and well being more important than driving a nicer car.
Glad you won’t go back to benadryl. I wish people would stop using it as a sleep aid! Yes it makes you drowsy and helps you sleep but it does not allow you to get proper sleep. Bendryl disrupts the brain waves that occur while sleeping, these are the brain waves that your brain needs to recover from the day. That’s why people generally wake up from a benadryl induced sleep in a fog or still tired.
I have been through many medications to help me sleep. I do not tolerate them well. I mentioned seroquel because it was so effective for me. Also, it needs to be a very low dose to induce sleep without agitation. If you had a bad experience with it, I wouldnt go back to it. You could also try Remeron (mirtazipine). I caution you on that one since it stays in your system for so long. It helped me sleep but I was in a daze for over a week after taking it for just 2 days. I don’t blame you for not wanting to take benzos either. They make me feel funky.
For me, the two things that help me sleep are 1} limit screen time in the evening and 2} therapy. I started with CBT but I am now in ERP (exposure response prevention). It took me about 5 years to find a really good therapist that works for me (I think 4 of them and spent about a year with each trying to make it work). Also, keep a notebook and pen at your bedside. When my head is busy at night, it helps to write it all down. Part of my anxiety keeping me awake is worrying about stuff I will forget. Writing it down relieves that anxiety and helps me put it down and park those thoughts for later.
I have never tried Vyvanse. I take Adderall XR 2 x 20 mg (40 mg) which fairly equivalent to your 80mg dose of Vyvanse. I had problems with the roller coaster of Adderall XR too. I handle this in a couple ways. You really need to know your body, how the medication affects you, and how other circumstances change how you feel while on medication to do #2 and #3 below.
1. I take the Adderall XR in a split dose. I start with the first 20 mg after I wake up. I eat breakfast and then take the second 20 mg after breakfast and about 45-60 min after the first 20 mg. This allows the first dose to hit your system and the second dose is delayed a little by time and by the addition of food. Food does not change the overall effectiveness of the drug but it does slow down how quickly it is absorbed. This delay on the second dose keeps the drug concentration from getting too high too quickly at any point in the day.
2. I titrate my dose when I am not “feeling right”. I keep a bottle of immediate release Adderall 20 mg tablet (the kind you take 2x a day). If am off, sometimes I take the immediate release in the morning and nothing in the afternoon. Sometimes I’ll take the dose in the morning and half dose or 3/4 dose in the afternoon. Sometimes I’ll take one 20 mg XR and half immediate release tab in the morning and take half tablet in afternoon if needed. This dose titration is tricky but you really need to know your body and how it responds. Because of the delay of drug availability in your body from the Vyvanse, you cannot titrate you Vyvanse dose as easily. I developed this system with the help of my psychiatrist but I am also a pharmaceutical research scientist and one of my specialties is to determine the dose of a drug for the prescribing information.
3. Mydayis is Adderall. Think if it as Adderall XR with an extra kick at the end (like taking 3 doses in a day). Honestly, I don’t want that 3rd kick in the day, I would have more difficulty sleeping at night. I start my work day at 6 am and the Adderall XR is generally wearing off around 3 pm. If I need another kick for a long day, I just take one or a half of an immediate release Adderall 20 mg tablet. Once again the advantage of having XR and non-XR in your cabinet.
4. strategically space your coffee (or caffeinated drinks) throughout the day if you need it. Don’t pile it on top of the stimulants when they peak.
5. If you can help it at all, do not take your stimulants every day. Give your body a break. Generally I only take my stimulants on work days or on days at home when I really need to focus. If you live in a state that only allows a 30 day supply, skipping days will allow you to get a little ahead in your cabinet so that after a few months you will be able to skip a prescription for the XR and have the doc write a 30 day supply for the immediate release tablets. My cycle allows me to get the immediate release once or twice a year and XR on the rest of the months. Then you don’t run into any insurance issues either.
6. Really limit your sugar intake throughout the day and eliminate corn syrup from your diet. It helps with the ups and downs and you will feel better overall.
I hope this is helpful and be patient. It really takes a long time to figure out the best doses and right drug for you. Don’t go about this alone. Make sure your team works well for you (Psychiatrist and Psychologist). Those relationships are so important for support and can really help.
Best of luck.
Discuss in depth with your doctor.
Your dose of Vyvanse in not out of the question and everyone needs to find the right dose. You may also want to look into Mydayis if you need a longer lasting effect. It is fairly new and is more or less an extended Adderall XR.
If you have trouble sleeping, upping the stimulant dose or taking it too late in the day is more likely to make things worse than better for sleeping. But, everyone does respond a little differently.
Try Intuniv or Clonidine. These are mild blood pressure medications that can have a calming effect at low doses.
Ativan can help get you to sleep but won’t keep you down long/ Seroquel at sub-therapuetic doses can also help make you sleep better. For me, 25 mg of Seroquel will put me down for 12 hours.
If you are like a lot of ADHDers (and me), you dont like to read. Grab a book with no pictures (like a cheap novel) and try to focus on reading it. That can put you down too.
No TV or screen time for at least an hour before bed. That will help signal your brain it is time to sleep.
Lastly, for some, going to the gym and working out later in the evening can quiet the mind and prepare you for bed.
I wanted to chime in on this thread because it is very important to all of us. I am not denying that CBD has a therapeutic benefit but I am not supporting it either. I want to shed some light on CBD in general:
1. There is very limited regulation on CBD products and they can vary widely by manufacturer and can also have high variability between lots of the same product from the same manufacturer. Most regulation is at the state level so consistency of products will be an issue.
2. There is a higher tolerance of THC impurity in states that have legalized marijuana. THC can be found at trace amounts (~0.3%) up to 5% and still be acceptable in some states. Don’t be surprised if you take CBD and test positive for marijuana in a drug test and have never smoked or ingested marijuana.
3. CBD is delivered in many ways – through skin, swallow, inhale. It is difficult to quantify how much you get from each method and switching can be difficult to compare
4. CBD may alter the effects of other drugs you take. Consult your doctor before starting CBD since certain drugs may have increased or decreased effectiveness when combined with CBD
5. There are no well controlled clinical trials that show a therapeutic effect of CBD (in anything). By well controlled trial, I mean the type of study that the FDA will accept to allow for treatment of an indication (like a pharmaceutical)
6. Careful what you read on the internet. Remember, Facebook and Google filter your search results to things they think you want to see. This filter can bias what you are reading and you really need to dig deep to substantiate any claims made by any product.
7. THC (as an impurity) can have detrimental effects on a developing brain (children), there are no long term data for CBD in children. Be careful!!!!
I just wanted to bring these thoughts forward for those looking for more information. It is not my intent to say CBD is bad (except for children, adolescents and young adults because of THC impurity) but to make sure you do a little homework before taking someone’s word that CBD is a cure all.
I admire your drive for not giving up.
Regardless of your past and current situation, think about what motivates you? Does your motivation align well with your skills? Focus your career search around what motivates you most, especially areas where your skills and expertise are in demand.
Also consult a professional resume writer, someone who can help you combine your past, your motivation and your skill set into one concise document and help prepare you (these services are not cheap but are tax deductible). Living with ADHD myself, I understand your struggle but was able to align my career and motivation early on (even though I was diagnosed in my 40s). When I was seeking some career changes, I went to an online company: distinctive document. They gave me a long questionnaire, and an 90 minute phone Q & A and my new resume attracted a lot of attention right out of the gate.
best of luck to you.
I reiterate the comment above about writing everything down. Keep a journal – when you take the meds, how you feel during the day, what you eat and when and the side effects you get through the day. A 2 week journal will be very beneficial for your doctor in sorting things out.
The racing heart can come and go. It can also be affected by other things during the day. Ultimately, the heart racing should decline over time with not other factors other than the medication.
Not all medicines work the same for each person. Ritalin, methylphenadate, Focalin and Concerta are all the same active ingredient but can also have different effects on you since they deliver the medication to your body a little differently. Adderall, Adderall XR, Mydayis, Vyvanse and amphetamine salts are also the same; but once again, may give you different dosing strategies and different effects. There are other non-stimulant options your doctor may be able to offer you as well.
Finding the right dose and medication is a long and tedious task, especially if you are growing and still developing. You should spend no less that 2 weeks trying a dose and medication out before moving up or down a dose or changing medication (unless bad side effects and you should stop right away). You and your doctor should invest the time into this and your efforts will be rewarded.
Congratulations for making through Medical School. You already have the tools to succeed, you just need to maintain control of them.
If you are like me, you should write your notes and dont transcribe to a computer, do that later (it takes more time but you learn better) and will have a better memory of the interaction for when you see the patient again. A good therapist really helps, especially when you can’t use a stimulant to aid your executive functioning. Also, in practice, surround yourself with people that compliment your strengths and help cover some of your weaknesses. As you go into practice a good NP or RN will be an immense aid to you, especially if that person understands how you function. It’s not that they will do work for you but would be a good primer for getting you at the right starting point to access the information in your memory as you need it. One of the biggest problems with ADHD is where to start and what exactly you need to access from your working memory. A primer person can really assist in getting your focus in the right place. You may not work well in a major healthcare conglomerate since you will time limited constantly and the pressure to turn patients and paperwork over will be high. You will probably do best in a small private practice or specialty that allows you more time with a patient.
I am in the medical profession and have put myself in a research position. This allows me to think and ponder a little more without the pressure of a patient in front of me. I am also very shy and do not handle people well face to face. I progressed to this area naturally since I was not diagnosed until I was about 15 years into my career! You have a great head start to understanding yourself and can jump start your career in the right way.
You have a great gift in ADHD and can use it to benefit many patients since you will see things a little differently and may help them when they have not gotten answers in the past.
Congratulations for making it this far and here’s to a great career ahead!
What are you expecting to “kick in”? The effects of Vyvanse should hit you on the 1st or 2nd day taking it. Vyvanse is basically Adderall but chemically modified to control the way your body absorbs and utilizes it over time. Are you taking a comparable dose as you were Adderall? If you are taking 20 mg Vyvanse, you should have been taking 10 mg Adderall or 2x 5mg Adderall. If you are doing a mg to mg dose switch, you are unlikely to get the effects from Vyvanse, it needs to be about double or 1.5x the Adderall dose.
How did you take the Adderall that led to the side effects? You may also want to try Straterra or Focalin, everyone is a little bit different. Also there are other dosing schemes that you can use for Adderall that may also lessen the side effects.
For the impulsivity, you should supplement your medication with a good ADHD coach or CBT therapist. You probably need a little extra support to work through the impulsiveness even with medication.
August 16, 2019 at 9:38 am in reply to: Generic Adderall Aurobindo side effects, how to get a new prescription ASAP? #125371
If another generic form of Adderall XR worked for you ask your prescriber to specify that brand and mark no substitutions. As long as it is a generic equivalent, the insurance will cover it and your pharmacy will have to order it (usually will take 1-3 days). The no substitution box is not just for branded drugs. No explanation necessary to the pharmacist just make them comply to the no substitution mark on the prescription.
Brand to brand variation exists and most forms of Adderall will give a positive for amphetamines in a reliable drug screen.
I was diagnosed at age 40. Looking back, the signs were there but I was in denial about it. My child’s psychiatrist picked up on it and recommended I go see an adult psychiatrist. I hesitated treatment because I didnt want it to change me, I like who I was and what I have become. Treatment has only made things better and knowledge has really helped improve my life overall.
ADDitude Magazine and this website is a great resource. Dr Hallowell has good resources as well.
Embrace your gift (yest I call ADHD a gift or superpower). Now that you have a basis of understanding things that may be helpful or not to you, you can reflect back on yourself and identify where you need help (like starting projects or stability at work). Having some target areas of focus will help you identify the right resources for you. A good therapist that you can work well with can really help you sort things out in the short and long term.
Welcome to the club and best wishes!
August 16, 2019 at 9:17 am in reply to: Too much fun stuff, not caring about projects, cant wake up early #125369
A few things that help me –
When an impulse hits me (a.k.a. opportunity), I pause and ask myself to do a risk/reward or base value on the opportunity vs cost. This takes a lot of practice but I find myself controlling more of my time than before. It becomes harder late in the day when I am tired.
for your projects: this is really hard for many of us. You see them, you want to do them, you don’t get them done. For me, no matter how many lists or goals I set, they still don’t get there. For me, external help is needed. I call this help my primer. Anyone can be a primer (as long as they are not ADHD) and probably should be someone close (my primer is my wife). This person is the one who can help get you started. Basically someone to identify an opportunity to start a project and get you engaged in an appropriate starting point. With a little guidance on when and where to start, you will proceed in full force and that primer can disengage pretty quickly to move on to their own things. it is a very common problem that people with ADHD can see the project as a whole and without a good starting point, the project becomes to daunting to even start.
for getting up in the morning, I dont have any real useful advice. An interesting read that may help a little is “When: the Scientific Secrets to Perfect Timing” by Daniel Pink. If you are like my, you probably dont like to read books, so I recommend the audio version (less than 6 hours) and listen in the car.