Return to 8 ADHD Medication Fallacies That Persist: Optimal Adderall Dosage, Risks and Interactions, Side Effects & More
8 ADHD Medication Fallacies That Persist: Optimal Adderall Dosage, Risks and Interactions, Side Effects & More
Optimal dosage is pegged to weight. Afternoon stimulants disrupt sleep. Adderall causes high blood pressure. And other falsehoods about ADHD medication that may put your treatment plan at risk.
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6 Comments: 8 ADHD Medication Fallacies That Persist: Optimal Adderall Dosage, Risks and Interactions, Side Effects & More
I agree with a lot that was stated in this article. You also need to research for yourself because most GPs really don’t have the time to keep up to date on ADHD; many will gladly accept any research you have to share.
We started out with our kids being diagnosed and treated by a pediatrician who only saw them monthly for med checks, so it was a very slow process to find the right meds and as they aged we had to change type and dosages. We were so grateful for the nurse practitioners that he had as they knew more than he did about ADHD meds and their side effects and even drug interactions (who knew that taking Ritalin and steroids could lead to paranoia; happened to my adult ADHD person when he hurt his back).
The main problem in our household is that two of the three ADHD persons need a dose that is higher than what the government allows to be prescribed by a GP. The adult has seen a psychiatrist for this and it has been an absolute nightmare with the insurance company as they do not want to pay for the dose needed despite it being generic. They have even questioned the credentials of the psychiatrist who has been in practice for 40 years and the needed dose even though he has been on it for 32 years. The adolescent found a workaround in drinking caffeine in the am with their XR so that they don’t have to wait for the hour it takes for the XR to start working. Once again, the insurance company doesn’t want to pay for it despite it being a generic and is max dose allowed for a GP to prescribe. It is so frustrating that in the USA we have a dose limit on drugs that are prescribed by effectiveness and not weight and age.
I finally found a great Dr. a 7 years ago. We had weekly appointments and we increased my dose gradually. Not on a scheduled “two week” or “monthly” basis. I finally found my right dose. He let me decide when the dose felt ok. I’m on a fairly high dose of Adderral but it works for me. I ended up moving out-of-state to Florida and finding a Dr. here was a nightmare. it is wasn’t “this is what the recommended dose is for your height and weight” it was “hmm, why don’t we try something else”. one Dr. prescribed a very low dose of Vyvanse and I was a mess. The Dr. I found now only does medication management… it sucks and I always feel like I have to say “Everything is GREAT” so he doesn’t change my dose.
Florida is extremely strict with controlled medications, I get it, some people abuse them. Doctors are afraid to prescribe anything outside of the recommended dose. What happened to doing what is best for your patients? After being diagnosed and on the right dose of Adderral, I was able to slowly get off of anxiety meds and a mood stabilizer. I consider that a win.
An excellent article.
My only quibble is that it might have been prefaced with a sympathetic nod to the bulk of specialists doing their level best to help people, albeit imperfectly. That said, too many clinicians succumb to a swag of cognitive biases and assorted other very human flaws that can make for some pretty crappy judgement. Most are too damn busy and don’t have the time to keep up to date with the latest research. Sadly, some don’t care enough to make the time, or deal with the things that skew their judgement, or just don’t have a knack for the fuzzy, human side of medicine. Nobody’s perfect.
A little while ago, I worked for a national college of physicians on a programme to promote what’s sometimes called ‘right care’, i.e. avoiding the over-use of medical advice, treatment, and procedures for which there is little good evidence of cost-effective benefit and/or a real risk of harm, and the under-use of the best, evidence-based medicine. (There’s now a stack of research on this and what drives clinicians to make bad or ‘low-value’ calls, e.g. https://www.thelancet.com/series/right-care, https://evolve.edu.au/evolve-research, etc.) Together, these clinical behaviours mount up to big costs worldwide—costs to our personal health, wellbeing and bank balance, not to mention an enormous and unnecessary toll on the public purse. Here in Australia, an estimated 20–30% of patients receive care that is unnecessary, ineffective or potentially harmful. And, according to Boston Consulting Group, government and the private sector spend around A$30 billion each year on low-value care. Even in the US, which boasts the world’s best medical care (highly debatable!), doctors are still making basic medical mistakes. For instance, up to 90% of antibiotic prescriptions are for mostly viral upper respiratory tract infections. (Happy to supply references if people are keen to dig deeper.)
How do we turn this around? First, we (doctors and patients) need to admit we have a shared problem. And it turns out one of the most effective ways to start dealing with it is to empower patients with solid, understandable, evidence-based advice. Something ADDitude magazine does in spades. Good job, folks!
But I digress…
I recently got my formal ADHD diagnosis. (Yay me! :-/ ) I had already done a lot of my homework, for which this site proved immensely useful (thanks again!). I’ve an excellent relationship with my GP, who, at my request, packed me off to a psychiatrist who knows a thing or two about adult ADHD. I found the her to be a lovely person, very professional, and with none of the god syndrome one too often sees in medical specialists. A warm, no-nonsense professional who, I’m happy to say, treated me like an adult and appeared to listen to my concerns and questions. So, 10/10 for bedside manner.
But… As lovely as my psychiatrist is, she is also human. And one or two things about our first appointment still irk me, and a couple of them are on this list. One that isn’t: she remarked that I could use the medications (Dexamphetamine and Clonidine) ‘as needed’. This is something that very much appeals to me; the last thing I want is to become overly dependent or outright addicted. I had tried Ritalin before and really didn’t like the side effects, including the kind of see-sawing of emotions and energy.
Well, silly me. Of course a stimulant medication like Dexedrine isn’t something one can take or not take like a headache tablet. I’m partly to blame, of course. I know enough to have pulled her up on this; I just didn’t have my wits about me. Nerves, I guess. It’s not every day one gets diagnosed with a neurodevelopmental disorder that explains an awful lot about why one’s life is so screwed up. Still, she could have been clearer about the meds and I’ll gently raise it next time. I do feel she’s someone I can work with and it’s hardly a hanging offence, but it is important. And it’s important that she knows I’m a partner in this, not just a patient.
So, perhaps a good follow-up article to this one (or add a link, if it already exists) might be some tips on how to talk to/work with your clinician(s). You know? How to deal with difficult shrinks, the sorts of questions to ask, when and how to query their judgement respectfully (but firmly), how to establish a good working relationship, how to deal with the trial-and-error drag of finding the right clinician… That sort of thing.
This article is spot on, at least for me.
I live in Canada (where you can’t see a psychatrist without a referral). My family doctor did refer me to a psychiatrist for diagnosis when I said I think I have add however, the psychiatrist left it up to the family doctor to prescribe and monitor medication.
This family doctor doesn’t log anything, just quickly askes how I’m feeling sometimes. Then when I said I think my 18mg concerta dose is not enough and want to try 27, his attitude was if 18 isn’t enough then we need to big or go home and put me up to 36 which seemed too much. After not finding a concerta dose that works, (finally tried 27mg). I might ask to try ritalin or adderall. I just hope he can prescribe those properly.
The bottom line is, Just because you may have a competent doctor in prescribing ADD meds, doesn’t mean everyone else does.
I don’t think I understand the sentiment of this article….to not trust the professionals who went to school for a decade to understand the condition as well as the medication for treatment? I think this is subjective, and based on just one person’s bad experience. Which is unfortunate, but I’ve been having a great experience so far with my physicians as we explore the best treatment for my attention deficit symptoms. With doctors and ADHD patients in my own family, I can surely say everyone is different and will respond differently to treatments. It’s really a trial/error type of process.
Some of this needs to be taken with a grain of salt. My doctor made some similar comments that I took as encouragement. It is so difficult to find a doctor to help with ADHD. It took me 3 months to find and get an appointment with a Psychologist. I am very grateful Strattera works for me. Not so much with my hyperactivity, but with my racing thoughts. With those under control life is much more enjoyable.