best stimulant alternative for adderall tolerance

[curiouscandela]

What's the next best ADD med after Adderall or for someone who responds really well to high doses of Adderall but has a developed a tolerance? Going off stimulants is not an option. I don't function without them. Would like something that will work as well or almost as well with a different chemical structure so I can lower my tolerance to Adderall and go back on it in awhile.

 

I've heard good things about Foucalin and Vyvanse. I tried Vyvanse a long time ago and didn't really respond to it. Can't recall my dose. I had a decent reaction to Metadate a few years ago.

 

Prefer something available in an instant release formula and generic, but am open to extended release and will pay whatever as long as it works.

 

What's worked best for you? Thoughts, ideas, suggestions?

[jt07]

There really are only the amphetamine-based stimulants and the methylphenidate-based stimulants. If you've developed a tolerance to amphetamine, then that leaves only methylphenidate, but I see that you've tried Ritalin and Concerta. How did Ritalin work for you? Would you be willing to try it again?

 

Edit: I guess that there are also Provigil and Nuvigil, but they are not technically listed as stimulants.

Edited December 3, 2013 by jt07

[mcjimjam]

I take Concerta, a long acting formulation of methylphenidate. It works well for me. I haven't had any tolerance and I've been taking it for a couple of years. I'm not sure if there is cross-tolerance between methylphenidate and amphetamine based drugs. IIRC there is a cross-tolerance with different forms of amphetamine. You would probably be better off, tolerance-wise, switching to methylphenidate or dexmethylphenidate, if they work for you, 

[Guest]

There are always the non stimulant options such as Strattera and Guanfacine (Intuniv), while they're not stimulants they are still highly effective in most people (probably moreso than modafinil/provigil which are not approved for it, and failed in their trials for it).

 

Gotta try them to find out though, nothing works for everyone, people are different.

[IndieVisible]

This topic is over killed on a ADHD forum I visit. What most people do is try different brands of amphetimines, there is stronger then adderall. Ritalin is considered the weakest. As for non-stimulant alternatives like Strattera, they get dissed as much as buspar gets dissed for anxiety on anxiety forums. They simply do not work for a lot of people tho there are some who claim they work for them. Anther alternative is Wellbutrin, again usually a waste of time. The best thing to do is be perfectly honest with your doc, there are other stims to try.Often it's just the correct dose. Some times going back to what you use to use will work again too. Good Luck!

Edited December 3, 2013 by IndieVisible

[curiouscandela]

There really are only the amphetamine-based stimulants and the methylphenidate-based stimulants. If you've developed a tolerance to amphetamine, then that leaves only methylphenidate, but I see that you've tried Ritalin and Concerta. How did Ritalin work for you? Would you be willing to try it again?

 

Edit: I guess that there are also Provigil and Nuvigil, but they are not technically listed as stimulants.

Thanks for the input. Ritalin worked fairly well.It was a few years ago. I only took it briefly. It's hard to gauge how effective it truly was though because I was in the mdst of a one and half year insomnia bout ( that started out of nowhere not from a med change and med changes didn't effect it). Couldn't stand taking sleeping pills because they knocked me out for more than a day, so I'd be  awake for a few days then fall alseep a little while. Not opitmal for concentration or productivity. To top that off I was severely anorexic with lots of health problems and vitamin deficiencies, so my concentration suffered even more, And I had persistant auditory hallucinations. Even when I took Adderall back then it didn't work as well. I tried Provigil to help with side effects( sedation) of Clozaril but they had me on a low dose, It had a minimal effect and didn;t notice much improvement to my concentration. Went  off Adderall when started doing ECT 3 times a week and stayed off. By then the hallucinations had stopped, my weight was in the normal range again, and after a few months of ECt, depression remitted. SO after a 9 month break from Adderall, I went back on it in June and it was like magic. I'd never felt it;s full effect before. Seriously changed my life. I started a company and became highly productive for the first time in a long time. So I'm thinking that even though I developed a tolerance in a relatively short time, ritalin or something else might work well since all my other conditions are gone.  Thanks for the input

[curiouscandela]

There are always the non stimulant options such as Strattera and Guanfacine (Intuniv), while they're not stimulants they are still highly effective in most people (probably moreso than modafinil/provigil which are not approved for it, and failed in their trials for it).

 

Gotta try them to find out though, nothing works for everyone, people are different.

Thanks for the suggestions. I started on an SSRI at 17 before I was diagnosed with ADD but it really helped my academic performance. At some ponnt in my twenties, we added wellabutrin which helped even more. At 29, I was diagnosed with ADD and I took Strattera( and wellabutrin and and SSRI) for 4 years. It helped a little. Hard to tell since I became anorexic( had an eating disorder since 16 , never recovered from it but had gained some weight at age 28) on Strattera and   developed auditory hallucinations 2 years after being on it. I don't think the strattera has anything to do with the psychosis.Then I switched to the stimulants and they worked better but not amazing since I was severely anorexic, had persistant auditory hallucinations, and went through a year and half bout of insomnia that just came out of the blue. Couldn't stand sleeping pills becase they knocked me out for more than a day. All of those issues interfered with the meds effectiveness. I tried several different ones and went off them a for awhile. During this time  I got  help for my anorexia and my treatment resistant the auditory hallucinations. With my weight back to normal and psychosis under control I decided to do an intense treatment of ECT and stayed off adderall , Nine months later, in June, I gave Adderall another shot and it was amazing. I 'd never responded to it so well and I was on a lower dose. I had no idea the meds could work so well. Now that my eating disorder, depression, and psychosis are under control I feel like any ADD med will be effective as long as I don't have a tolerance. I 'd prefer to try another stimulant since my experience is they work better for me, but if several of them don't work out, I'm open to Strattera. It will probably work better now without the other issues. Thanks for mentioning it.

[jt07]

Let us know how things go for you at the pdoc. I'm interested in what the doctor suggests.

[IndieVisible]

I'm in a pickle right now as I have BP w/psychosis, GAD, and ADHD. I would like to get on adderall but the docs, pdoc and gdoc are not sure. I am currently on strict watch and review for being on Zoloft along with Wellbutrin. I been hanging on a ADHD forum too just to get as much info as possible. I'm not sure what all the concern is. I found other bipolar folks on adderall too. Oh well, please keep us posted on your progress and good luck!

[curiouscandela]

Let us know how things go for you at the pdoc. I'm interested in what the doctor suggests.

 Ughh... it was awful at the pdoc today. She was typing on the computer while I was pouring my heart out to her. I'm seriously distressed about my lack of productivity. It's been going on a month and she wasn't even listening to me. Normally she's great and spends a lot of time with me. I think she was in a bad mood. I overheard her having to deal with a massively disgruntled patient prior to our session.

Anyway, when I finished my pleading and had fully explained the situation. She said, well there's really nothing she could do because I'd already been on lots of the other ADD meds. She's really against making any changes to my medication because I've been doing so well. Then she said, don't underestimate the fact that you've had MRSA( that's the health issue I had and was on Cipro for, but I've been off antibiotics for almost 2 weeks now). And I had MRSA a month before it was diagnosed; the adderall was still working that month ( not as well as this summer and earlier in the fall, but it didn't stop working completely until early Nov, at the same time I found out I had MRSA)

So I had to remind her about all of that and restate that I was on the other ADD meds years ago when I was psychotic,depressed severely anorexic, and went through a year and half bout of insomnia. They never worked that well, including Adderall until I.got proper treatment for those issues and took a 9 month break from ADD meds. When I tried Adderall in June it was a wonder drug. It had never worked that well. It was life changing. Once I explained this for the second time, she seemed a bit more open

She asked if I had tried Vyvanse. I said I had briefly but hadn't responded that well to it, but with all those other factors at play back then it was hard to tell, that it might work now. I said I'd tried Metadate and Ritalin and they had been okay. Then I said I'd heard really good things about Focalin. She perked up when I mentioned Focalin. I asked her if I would be better with Vyvanse or something in the Ritalin family since I had developed a tolerance to Adderall. She said they were all similar and that it didn't really matter.

Now that's not what I've heard or read.I think she wasn't in the mood for a long session and didn't feel like going into details. Vyvanse, Adderall, and Ritalin are all different chemically and I wanted to know which would be the best to take to lower my Adderall tolerance so I can eventually go back on the Adderall. She acted like it didn't make much difference. So I asked what her other patients have had luck with. She replied shortly that it varied.Then she said just go with something in the ritalin family since it worked fairly well before. I asked about focalin again and she said did I want extended release or immediate release. I said I thought Focalin came in both. She said she only prescribes Focalin once a day. So I said I'd prefer to take something I have more control over and can take multiple doses of a day. So she said we'd go with Ritalin. She prescribed 20mg 3 times a day. I asked if that was equivalent to the amount of adderall I had been taking since I'd heard ritalin was weaker, and she dodged the question by saying she wasn't starting me on the lowest dose.

 

I asked her if she could just write a prescription for a week or two so I could try it to see if it worked and she said no. Said she had to write a month's worth for insurance to cover it and that she couldn't write another one until next month, so I would just have to tough it out if it didn't work. I was so pissed. She doesn't give a shit that my work life is in ruins. She's changed my dose of adderall before a month is up, so I know she can do it and I know insurance will cover it. She's treating me like I'm drug seeking. I'm just trying to find a medication that works. I'm really not happy with her.

 

I also asked if I could switch my ativan to klonapin and she said no right away. I told her that the only reason I'm ativan is because I had to switch to it last year when i started ECT 3 times a week. I normally take klonapin and prefer it. It seems to work better for me. Now that I only do ECT once a month, my ECt shrink told me it was ok to switch back to klonapin. That's a minor change. I dont know why she's so against it. She said she's think about it and we could discuss it next month.

 

Here's the kicker: I started the ritalin today and it's not doing much of anything. I've felt tired most of the day. And I've felt extremely irritated. Adderall never did that. I know it's just the first day but things don't look promising. I'll give a week but I'm not going to take something that causes me to be  this irritated and doesn't work well. I'll call her if things don't improve. She can have the ritalin prescription if she writes me a script for something else. I don't care if insurance doesn't pay for it. I'll pay out of pocket. My work and well being are too important for this b.s. She'll have a fit probably since she already doesn't want to help me, but if I'm having side effects from it- the kind that it tells you to call your doctor about, she has to do something. I was so upset with her today I wanted to switch doctors.

 

So what do you guys think? So you think I'm being unreasonable? Do you think my doctor is being harsh or just a typical doctor? I've never had a doctor take something I'm seriously upset about so lightly before. not happy. Maybe she was just having a bad day. I think I'm extra annoyed because of the ritalin. I'm usually pretty low key.

Anyone else have bad reaction to ritalin?

[curiouscandela]

I'm in a pickle right now as I have BP w/psychosis, GAD, and ADHD. I would like to get on adderall but the docs, pdoc and gdoc are not sure. I am currently on strict watch and review for being on Zoloft along with Wellbutrin. I been hanging on a ADHD forum too just to get as much info as possible. I'm not sure what all the concern is. I found other bipolar folks on adderall too. Oh well, please keep us posted on your progress and good luck!

I didn't have any problems getting on a stimulant when i was psychotic. the doctors just told me to watch and see if it made the hallucinations and paranoia worse. They were already bad to begin with but the stimulants didn't seem to intensify them. My anorexia seemed to exacerbate my psychcosis more than anything. I didn't notice that much benefit from the stimulants when I had auditory hallucinations though. It was impossible to focus. Hope you figure something out. Maybe they'll let you try a low dose.

[curiouscandela]

Since I've started the ritalin today, not only have I been extremely iritable and agitated, but I've had mood swings, heart palpitations, and have been sobbing for hours. I feel like ripping my hair out. I haven't felt this bad in years. Can't believe how intense my reaction has been. Maybe I had this reaction to ritalin when I took it a few years ago but I was so used to feeling terrible all the time, I never noticed. Anyway after almost switching doctors and insurance, but getting some wise advice froma trusted health advisor, I decided to call my pharmacist and check the seriousness of my side effects. he encouraged me to call my doctor which I did. He also suggested that I might want to stick with extended release adderall and he said insurance should cover it. Was able to speak to my doctor. She was very kind and understanding. Told me not to take anymore ritalin and to take some ativan and drink lots of water. Reassured me that everything will be okay. We just know now that I can't take Ritalin type meds. She said I could try something else. I said I don't want to risk another bad episode and would prefer to stick with extended release adderall, She agreed that was a good idea. She told me to call in the morning when she was at the office so she could review her notes and she'd prescribe something else. I told her I'd bring her the remaining ritalin which seemed to please her. She was very sympathetic and told me to call her back tonight if I neede her. Very different than her reaction this morning. Now I see her wisdom in not wanting to make in any changes to my meds. I knew i liked her for a reason. Just hope the extended release adderall works. But I guess being non productive is 100 times better than feeling like a sad, evil witch who wants to destroy everything and that life is over. just a small taste of how I used to feel everyday. I prefer to do without these blasts from the past. will keep you posted...hopefully no more drama

[spemat32]

I have been on immediate release Dexedrine since I was 5 or so and I have always gotten that quiet, calm, never want to eat when it works (which is why I take the tablets) and my dose was higher as a kid (115 mg) but I take either 20 mg 4 times a day or 20 mg 3 times a day when I need to depending on the generic.  I have to take higher doses when I start getting manic but I have childhood onset bipolar disorder and to me the severe ADHD is worse because it never stops.  I tried everything and can tolerate Focalin if there were another shortage but I had rough luck with Ritalin, Adderall and the Desoxyn was effective but the pharmacy drama was insane, they sent out the prescription and then a week later we had to pick it up and then we were lectured about dropping it off early and we weren't treated like patients, nonetheless.  Ironically, coffee has more kick to it than Desoxyn.  Dexedrine was really pretty much the same.

[curiouscandela]

I have been on immediate release Dexedrine since I was 5 or so and I have always gotten that quiet, calm, never want to eat when it works (which is why I take the tablets) and my dose was higher as a kid (115 mg) but I take either 20 mg 4 times a day or 20 mg 3 times a day when I need to depending on the generic.  I have to take higher doses when I start getting manic but I have childhood onset bipolar disorder and to me the severe ADHD is worse because it never stops.  I tried everything and can tolerate Focalin if there were another shortage but I had rough luck with Ritalin, Adderall and the Desoxyn was effective but the pharmacy drama was insane, they sent out the prescription and then a week later we had to pick it up and then we were lectured about dropping it off early and we weren't treated like patients, nonetheless.  Ironically, coffee has more kick to it than Desoxyn.  Dexedrine was really pretty much the same.

Does the Dexedrine still work for you after all this time? I was on it years ago before I was diagnosed with ADD for severe depression but I recall that it helped my concentration. Sorry you've had to try so many different meds. Does anything help the ADHD completely? I'd switch to a pharmacy that treats you better. I love mine. I'm there all the time, so they know me well.

[curiouscandela]

Okay, I'm back with an update and I have good news!

 

I met with my doctor again in early Dec, after speaking with her on the phone the night of the Ritalin upset. And boy am I glad we met in person again. She was fantastic. It turns out, she doesn't like to change people's meds around the holidays. That was her big concern.

 

We reviewed all my meds and decided i should go off my Metformin, since I had noticed I problems with my concentration and feeling more tired as soon as I started taking it, not to mention issues with low blood sugar. It takes about a month to get into your system and that is when my syptoms got worse, which happened to be at the same time I was dealing with MRSA and Cipro, so it made everything very confusing. I had aksed my pharamacist if metformin interfers with adderall and he said no, researched it, and even posted about it here way back in Oct.

 

My doctor said I could always go back on the Metformin if I wanted but we both agreed i should try going off it and see if my concentration improved. When we discussed meds, she said she hasn't had much luck with extended release adderall. I asked about brand name adderall, and she thought that was an excellent idea. So we went with brand name adderall at the same strenght. ( I'd done some research on the difference between generic and brand).

 

Then I mentioned vitamins, which I'd also researched- specific ones to combat adderall tolerance, help ADD, and for overall mental health. We came up with a short list.

 

So I started the vitamins and went off the Metformin in early Dec. The pharmacy  had to order the brand name Adderall, which took a week. I noticed an improvement just on the vitamins and being off the Metaformin. Then the brand name Adderall was really great- big difference. I'm taking 15-30 mg less Adderall than prescribed a day now. Have been off Metformin 3 weeks now, so it's almost out of my system. Very pleased with the solution. It was definitely worth looking at my other meds ( even if they didn't technically interfere- they still might  have an effect ), considering supplements ( with medical advice), and exploring brand name meds- to bad I didn't do all of that before switiching ADD meds in the first place. Now I know