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Large doses of Adderall long term and anhedonia/depression


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(Of course, I'm speaking to my doctor about this next week, just wondered if anyone had personal experience.)

I have Major Depressive Disorder, ADD, GAD, and on top of this I have Chronic Fatigue Syndrome.

When I was diagnosed with CFS my GP put me on 60mgs of Adderall, and it was a godsend. I felt normal, I could work, I could stand long enough to wash dishes, I could cook again, I wasn't perpetually exhausted.

Eventually I grew a tolerance to it so we went up to 90, and again my experience was great. Oddly, I felt like the Adderall did even more for my depression than my antidepressants did.

But again, I grew a tolerance, but we were both hesitant to increase the dosage so my doc suggested on weekends I take med holidays from the Adderall to see if it lessened my tolerance. 

It didn't work, and eventually I wound up having to quit my job because they wouldn't make ADA accomodations for me and a bunch of other junk.

Anyway, I started a freelance career from home and everything seemed fine, until I pushed myself WAY too hard working a few months and decided I needed to take a break.

I became depressed more than I've ever been in September, and I took a holiday from Adderall the entire month. By the time October came around, I'd just slept for the whole month and was so depressed I saw a doctor who forced me into an inpatient program. When I was discharged, it was the day before Halloween and I still thought it was summer. I was shocked I lost 2 months of my life.

I'm seeing a new psychiatrist and I like her, and also seeing an endocronologist to make sure all my hormones are ok. I get results to all my endo's tests the week after next at my next appointment.

But I accidentally made a very stupid mistake the other day - and all day I felt so normal, so much less depressed.

I'd set my alarm and when it went off that morning, I took my Adderall (which I keep next to bed). I dosed off for a little while, and for some reason a second alarm went off (I don't know why I'd set that), and just by force of habit I took another dose. I realized what was happening before I swallowed the 3rd pill, so instead of 90 mgs I took 160mgs. 

I didn't have super human energy or anything, but I wasn't jittery either. No super human motivation to clean or do tasks or anything, but my depression just felt lighter.

But what was most markable to me, was that I almost felt like I cared about things again, like I almost felt like I could enjoy something. I never, ever have this feeling anymore, and I haven't for months. I feel joy in nothing, I rarely leave my apartment because I can't figure out anything I'd enjoy doing. It's been this way for over a year now. I'm a designer and I used to love work, I used to have a social life, I used to have hobbies and passions, but I just "exist" now.

My fear is that Adderal somehow permanently took this away from me and I need it in order to feel that. I decided to take the holiday from it in September, but I didn't start taking it again till mid-November, and I started feeling slightly stable again. I felt like I *might* be getting my life back. 

But what worries me is that that was a LONG med holiday, and I take short ones but they don't work. Adderal at my dose (which I know is high, because of the CFS), gets me out of bed, but it wasn't until my slip up the other day that I felt human.

I'm scared I've done permanent damage to my brain and I'll never be normal again. I just want my life and ability to feel emotions back. That other day was like a miracle for me.

Has anyone else had this experience? FTR I don't drink coffee (I like it, just too depressed to bother making it), but would coffee or other stimulants help me with this?

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yellowlovesgray -

 

Your experience doesn't sound so different from mine.  I was taking high-dose Effexor XR for ages and it never quite pulled my MDD/Dysthymia (double depression) over the top until my pdoc added some Adderall to the mix.  I was prescribed 60mg, but found that I couldn't take 60 because it was grinding my teeth to powder - I had to level out at 40mg.  I've had good results from taking regular Adderall "vacations", although my own reason was to ensure that I didn't develop a dependence.  I definitely identify with what you're saying when you talk about taking that large dose and then you say, "I didn't have super human energy or anything."  When I tell people I take Adderall, they often say, "Oh my god, you must be high all the time."  I just laugh bitterly and tell them I wouldn't know "high" if I was at the top of the Empire State Building.

 

If Adderall has lost its ability to help you, you might speak with your pdoc about trying one of the central nervous system stimulants that is a close relative to Adderall.

 

Another thought - Adderall is believed to have its effect on depression at least in part because it is a dopamine release agent.  Our understanding of the role of neurotransmitters is incomplete, but most antidepressants are thought to have some effect in either keeping the limited neurotransmitters your brain produces where they're needed longer, or helping your brain release more of them.  Dopamine is one of the big three (along with serotonin and norepinephrine) neurotransmitters most addressed by antidepressant medication, but dopamine is less often targeted than the other two, with serotonin being the most frequently treated.  In my case I believe I have a severe problem with my dopamine system, and the reason that my current med mix helps me is that Effexor at a high (450mg) dose acts as a dopamine reuptake inhibitor, and Adderall helps me produce more dopamine than I ordinarily would.  You don't specify your antidepressant, but you might ask your pdoc if it targets dopamine.

 

Bear in mind that theories about the role and action of neurotransmitters are just that at this time - theories.  But it's at least one direction to look.

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yellowlovesgray -

 

Your experience doesn't sound so different from mine.  I was taking high-dose Effexor XR for ages and it never quite pulled my MDD/Dysthymia (double depression) over the top until my pdoc added some Adderall to the mix.  I was prescribed 60mg, but found that I couldn't take 60 because it was grinding my teeth to powder - I had to level out at 40mg.  I've had good results from taking regular Adderall "vacations", although my own reason was to ensure that I didn't develop a dependence.  I definitely identify with what you're saying when you talk about taking that large dose and then you say, "I didn't have super human energy or anything."  When I tell people I take Adderall, they often say, "Oh my god, you must be high all the time."  I just laugh bitterly and tell them I wouldn't know "high" if I was at the top of the Empire State Building.

 

If Adderall has lost its ability to help you, you might speak with your pdoc about trying one of the central nervous system stimulants that is a close relative to Adderall.

 

Another thought - Adderall is believed to have its effect on depression at least in part because it is a dopamine release agent.  Our understanding of the role of neurotransmitters is incomplete, but most antidepressants are thought to have some effect in either keeping the limited neurotransmitters your brain produces where they're needed longer, or helping your brain release more of them.  Dopamine is one of the big three (along with serotonin and norepinephrine) neurotransmitters most addressed by antidepressant medication, but dopamine is less often targeted than the other two, with serotonin being the most frequently treated.  In my case I believe I have a severe problem with my dopamine system, and the reason that my current med mix helps me is that Effexor at a high (450mg) dose acts as a dopamine reuptake inhibitor, and Adderall helps me produce more dopamine than I ordinarily would.  You don't specify your antidepressant, but you might ask your pdoc if it targets dopamine.

 

 

 

Bear in mind that theories about the role and action of neurotransmitters are just that at this time - theories.  But it's at least one direction to look.

Interesting! Thanks so much for your input. :^) I take Cymbalta, which is an SNRI, is Effexor one too? Effexor is like the one antidepressant I have not tried. 

A few years ago Wellbutrin+Ritalin was like a MIRACLE for me but eventually Wellbutrin makes me constantly agitated and irritated all the time, I couldn't take the angry feelings. :(

Long ago a pdoc did tell me once that I seemed to have problems with medications that affected my dopamine levels. I seem to have a thin line between "balanced" and "agitated/angry."

The FDA has only approved amphetamine doses at up to 60 mgs a day total.  Higher than that is potentially addictive, dangerous, and untested. 

 

Most of what you describe sound like symptoms of depression and not the result of any meds though.

Really? 60? Is that just for ADD or for anything? I take it partially for Chronic Fatigue Syndrome. My pdoc's even talked about keeping me where I am with IR and adding an ER dose because it wears off for me very quickly.

Edited by yellowlovesgray
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yellowlovesgray -

 

Effexor is an MRI, a Multiple Reuptake Inhibitor.  Its effect on selected neurotransmitters appears to be related to dosage; at lower levels it has a greater effect on serotonin, at mid-levels on norepinephrine, and at high dosages it begins affecting dopamine.  It's not surprising that Wellbutrin would have had a positive effect, as Wellbutrin's principal action is on dopamine.  Like you, Wellbutrin doesn't play well with my system - I get wiggy if I try to take it.

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The FDA has only approved amphetamine doses at up to 60 mgs a day total.  Higher than that is potentially addictive, dangerous, and untested. 

 

Most of what you describe sound like symptoms of depression and not the result of any meds though.

 

True - we just can't seem to get this depression under control. :(

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yellowlovesgray -

 

Effexor is an MRI, a Multiple Reuptake Inhibitor.  Its effect on selected neurotransmitters appears to be related to dosage; at lower levels it has a greater effect on serotonin, at mid-levels on norepinephrine, and at high dosages it begins affecting dopamine.  It's not surprising that Wellbutrin would have had a positive effect, as Wellbutrin's principal action is on dopamine.  Like you, Wellbutrin doesn't play well with my system - I get wiggy if I try to take it.

 

I'm taking Cymbalta right now - would Effexor have a greater effect on dopamine?

I wish that Wellbutrin didn't make me SO irritable. I'm usually good on it for a while then one day I  just wake up an angry BEAR. But, this depression just isn't going anywhere. :( I almost feel like I could tolerate the irritibility short-term if it could just get me over this "hump" with the depression.

I should add that we weaned me off Geodon a few weeks ago because it was having effects on my physical health, but for years Geodon was all that even touched the depression besides the Wellbutrin/Ritalin combo. I just could no longer take the side effects of Geodon, so this process feels like it's taking FOREVER and like I'm never going to get better. :(

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  • 3 months later...

Hi yellowlovesgray,

 

I registered just to reply to your post. What happened to you back in February is what happened to me about 7 years ago. I wish I could say things have gotten drastically better since then but I'm afraid I can't. I experience very little pleasure, excitement, and motivation from day to day. It's a serious drag. Have things gotten any better for you?

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  • 5 months later...

Hi yellowlovesgray,

 

I registered just to reply to your post. What happened to you back in February is what happened to me about 7 years ago. I wish I could say things have gotten drastically better since then but I'm afraid I can't. I experience very little pleasure, excitement, and motivation from day to day. It's a serious drag. Have things gotten any better for you?

I just saw this -- I really appreciate you responding.

Have things gotten better? You know, not really.

I've made positive changes in my life and they helped marginally for a while, but nothing spectacular.

I stopped working from home and got a really cool full-time job at a company that actually promotes the state of happiness (it's weird, it's a magazine and a movement). My work is fun, my coworkers are nice and my boss is awesome, but I still can't get out of bed with any sort of enthusiasm about anything in the morning. I never feel good. I never feel joy or happiness. Or even just normalcy. Being in a "normal" routine and surrounded by positive people does help a little, but not nearly enough.

Some days the depression is outweighed by the anxiety, lately the depression and lack of motivation has been winning because we changed my cocktail yet again to something I'd tried before that helped a little -- I'm now back on Lamictal and taking Effexor. I can physically get out of bed easier now without the Geodon, and I'm not as sleepy, but it kills absolutely any and all motivation, thought and creativity in me. And I forget things like who people ARE. I was in a meeting earlier and someone was talking about an "Emily" and I was like "Which Emily? Does she work here onsite?" And I'd forgotten a woman I know fairly well that sits 60 feet away from me is named Emily. Everyone was looking at me like I was insane. 

Today I had to skip my meds because I work in the creative side and I HAD to finish an illustration today. It worked - all I took today was my Adderal - but I know over time without a mood stabilizer I'm going to become even more depressed than usual. So I have to balance my ability to do my job with my ability to feel like not dying. It's a mess. 

I've been fighting this for years now -- so much time, money, energy...and nothing's working. I wish I had more positive things to say for other people struggling, but yeah. I'm not sure how much more hope I can pretend to feel. I'm pretty numb to it all now. I've been fighting pretty hard since about 2006.

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I'm not sure what the question is, but the picture is clear: your'e depressed.  You said so yourself! You have all of the characteristic or hallmark features: lack of motivation, lack of energy, anhedonia.

 

In my experience Adderall helps with depression as an adjunct or off label.  Certainly many people don't respond to SSRI's and this indicates issues with their Dopamine systems.  I am one of those people.

 

In the past I used Adderall for ADD.  The highest dose I was on was 80 mg.  Eventually I went into a Psychsos, which I think was unrelated, and my PDOC at the time was reluctant to ever prescribe me a stimulant again.   He didn't have the balls to pull the trigger.  In any case, Adderall worked wonders for my depression: I had the energy and motivation to perform hobbies and complete tasks, something that eluded me.  However, there were diminishing marginal returns and I developed a tolerance like yourself.

 

Since I took Adderall life has not been the same.  Without it life seems joyless and pointless and I am anhedonic, flat, disengaged, ambivalent, numb and disinterested.   After receiving Adderall treatment/therapy I craved it.  I craved the way it made me feel on a day-to-day basis and the way it made me think and act.

 

Today I am on Vyvanse and the relationship is much the same. I can't imagine my life without it.  I would either be a black hole or would be completely absent and catatonic.  It gives me quality of life and allows me to do the necessary things to help myself, like exercise, read, and write.

 

Still, my depression isn't cured.  Rather, instead of being a 3/10 I am probably a 5.5/10.  I've told my PDOC this.

 

I don't think there's anything wrong with Adderall to treat depression as long as it's used as per directions and responsibly.  Some people don't respond to anything else.

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IMO - Coffee is inferior and inadequate.  Is a treatment it has a very short halflife and you can't just keep drinking more.  The side effects, racing heart and palpatations, are too palatable. 

 

I don't think you did any permanent damage to your brain.  That is, I don't think you permanently did any re-hardwiring.  My PDOC doesn't even think my Pscyhosis did that.   The brain is a remarkable organ and can regenerate itself and restore it's equilibrium.  For me, the difference is psychological: I know what life feels like on and off of Adderall and I like life on Adderall better.   Perhaps I was high most of the time.

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