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Old 02-10-2008, 12:16 AM   #1
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Question 27 year old male with questions about newly prescribed medication. Please Help!

I am 27 years old. I have recently decided (November) to go back and finish my degree program in College. In preparation for this, I decided to seek out treatment for previously diagnosed ADHD in order to succeed in my classes this time around. When I had previously attended classes in college (2001-2003) I had been on various antidepressants at one time or another and tried stratterra my final semesters to get the help for a previously undiagnosed issue (adhd). Up until about 7 months ago, I had still been taking Effexor for a generalized anxiety disorder. The medication worked great for me and my moods. I lost a job, lost insurance, and in turn, lost my medication. I had been on the effexor about 2 years and I really didn't notice any withdrawl. It turns out that I felt fine months after the medication had run out and I felt "cured" of previous problems. When I reported this to my psychiatrist, he congratulated me on my medical "success" if you will. When I asked and inquired about the adhd medications, he told me that he would ONLY write me a script for stratterra. He felt that he had a moral obligation not to put any more adderall or "cocaine" in his words on the street. I mentioned to him that I had previously tried the medication and it had produced some very unwanted sexual side-effects. He told me that is all he could do for me. I tried the strattera. Once my dosage was reached (80mg) the side-effects came back much more severe than before. I had trouble urinating and there were also the ejaculation problems.

I couldn't take it anymore and sought out a new Dr. The new Dr. prescribed me the adderall which I originally inquired about. He put me on 2 20mg ir tabs with another possible 20mg ir dose to get me through the early pm lull depending on how I felt. I began the treatment right away as I had started my classes a couple weeks prior. I am not going to lie, at first I felt great and experienced the "high" that I was told about. I found that after about 4 days of the 60mg throughout the day, I was getting some undesirable side-effects. I started to feel edgy and almost hyper-focused as I could still not concentrate on any one thing unless it was the thing I chose to focus on. In my case it became sex. I have read that adderall has effects on libido, but generally a decreasing effect.

My sex-drive has gone through the roof and the only way I can control it is through self-release. This in and of itself is not a problem (or so I first thought). The problem with this is that I can literally spend 4 hours at a time on the internet looking at various images to aid in my efforts. I tune everything else out. It seems that even in classes now, I can easily focus on the lecture, notes, and professor, but as soon as a sexual thought comes into my mind, the focus on the class is gone. Any ideas?

In addition to this, I felt the increasing need to urinate (which I read is more of a common "less-common" side-effect than shire states due to the fact that it is a diuretic), slight swelling of the prostate (rather uncomfortable at times), and the teeth clenching (I do not realize I do this, so I imagine I do it in my sleep as my teeth seem to be a little loose in the mornings with slight pain). In attempt to reconcile this, I have played with my dose as far as trying to take 10 mg intervals 6 times through the day, but I still notice some of the effects (although much less severe). I attribute some of this as my body's own adaptation to the adderall so I want to give it some more time. The past few days I have tapered my dose down to a total of 30 maybe 40 mg a day spread out at 10mg intervals.

My question is how long does it take one's body to adapt to such a powerful drug such as this (not develop a dependency, that is different, but adapt)?

I have also noticed that on days I do not take the medication (also on the rebound when I do not take the medication to get me through the entire day), I feel "disconnected" from everything, I have incredible mood swings (over very irrational crap), some of my anxiety is back, and I overall feel like crap if I do not take the medication. Could this also be because my body has not adapted to the medication? Should I be taking this every day (I have been trying to take only on days of classes but it seems to wreck me emotionally and physically if I do not)?

The medication works, I have no doubt about that, so far strait A's, even in subjects that are ridiculously challenging for me (I have a 2 1/2 hour lecture every week on DNA and Genetic engineering) but I am doing well.

How can I maintain taking the medication while eliminating some of the hyper-focused traits previously mentioned?

Are some of the side-effects mentioned (increased sex-drive, the edginess, highs and lows, frequent urination, teeth clenching) my body adapting to the medication? If this is the case, how long can I expect this to go on (I have read one story where a child had the frequent urination and teeth clenching for several weeks and then it just stopped)?

Would it be possible to re-introduce the effexor to help with the mood-swings and anxiety (The effexor originally worked great for me for anxiety and mood-swings)and still take the adderall for the focus? I do not want to give up on the adderall as my grades have never been this good and I haven't been so concerned on the outcome.

I realize this is a very long post, but I really would appreciate any help. I have a couple more weeks before I go back to my doctor and want to go in with an action plan if you will.

Thanks in advance.

 
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Old 02-10-2008, 09:43 AM   #2
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Re: 27 year old male with questions about newly prescribed medication. Please Help!

Hi,

i can relate to the strettara sexual side effect. But it caused me to have no sexual desire. That was my first med for ADD. Then I started with Adderall. Now I'm on Ritalin. I take my meds every day. My advice for you is to take them everyday also. I've found that I'm sluggish without it. Also, I take zyprexa, lithium, prozac and klonopin at night. When I wake it feels sort of like a hangover. I hope you get things straight. I wish that I could help you more.

 
Old 02-10-2008, 11:49 AM   #3
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Re: 27 year old male with questions about newly prescribed medication. Please Help!

cme,

You are experiencing amphetamine intoxication.

The dose Doc2 prescribed is rediculously high - that is why you are high - and why Doc1 quit "dealing drugs."

Amphetamine intoxication is like being drunk in that your judgment is impaired and you don't know it. It is unlike booze in that motor control actually improves. That further obscures the impairment from you and others.

What to do?

I'd quit the Adderall, find yet another doctor, tell third doctor experiences had with Docs A & B and get the meds you need at the correct doses you need.

Bob

 
Old 02-10-2008, 04:52 PM   #4
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Re: 27 year old male with questions about newly prescribed medication. Please Help!

addprog,

Is the intoxication due to the fact that I have just started taking the medication? If so, will these issues subside? Also, will reducing my dose eliminate the intoxication but still produce the desired results (increased focus in school)>?

 
Old 02-10-2008, 05:38 PM   #5
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Re: 27 year old male with questions about newly prescribed medication. Please Help!

cme,

It will be harder to establish optimal dose since your system has been sensitised to some extent.

Normally adults are started at 20mg/day. For IR, 10mg AM / 10mg PM. Then the dose is increased gradually until the bulk of the ADHD symptoms are controlled. The maximum recommended dose for Adderall is 40mg per day. It rare, extreme cases, shrinks wil go higher.

Going from 60 to 20 will feel ineffective to say the least. Bear with it a few days to a week. You don't want to "feel" much different. You do want to be able to concentrate. Use ability-to-concentrate as touchstone of efficacy, not how you feel.

I feel bad for you. You had two doctors in a row screw you up. Look for another. There a few good ones in the mix - believe it or not.

Bob

 
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