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Old 03-08-2010, 05:51 PM   #1
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Adderall dose and body weight

I'm 45, male, 270lbs and 5'8" (i.e. obese) and just been diagnosed with ADD-Inattentive. Makes total sense given my history, but I've always been very suspicious of the whole ADD "thing" so never wanted to check it out until now. Anyway, my doctor has started me on Adderall (the instant release kind), and I'm in the very early stages - I think he called it "titrating". I started five days ago as follows:

Day 1: 10mg morning
Day 2: 10mg morning
Day 3: 10mg morning
Day 4: 10mg morning, and then 10mg early afternoon
Day 5 (today): 10mg morning, and then 10mg early afternoon

Tomorrow I move the morning dose up to 20mg and in a week he says I can try pushing up the afternoon dose if I want to as well.

So far I guess I feel I'm taking tic-tacs. It's very hard to say, and I may have experienced a *very* marginal level of ... what shall I call it, "directedness", but I can't be sure. I have a particular cognitive "test" I'm preparing -- namely, entering my overfull email inbox and seeing if I can avoid the usual feeling of being overwhelmed to the point of being unable to start on any of them. So far, I can't say the 10mg has helped there.

What can I expect tomorrow when I move to 20mg? Is the effect linear with dose? In which case I suspect I may be disappointed. And how much is efficacy affected by bodyweight. Remember - although I'm heavy, I'm fat. I presume that means from a dose point of view I may only need to be treated like a normal (180lb-ish) person for my height.

I guess I'll know the answer to my own question tomorrow. And I go back to the doc in a month to report in on how it's going. But I'd appreciate any thoughts/comments.

best.

 
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Old 03-08-2010, 07:11 PM   #2
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Re: Adderall dose and body weight

As a male that is much larger than yourself (both upwards and sideways), I've always felt that physical size does indeed play a part in proper dosing. I've received some support from medical professionals for my hypothesis, though it's always lukewarm.

There are a large number of factors to consider when determining proper dosing of Adderall, and size may well be one of them. However, there are a number of other factors that play into your response to Adderall, some can be predicted, others cannot. Ultimately, the only way to determine how you'll respond to a particular dose of Adderall is to try it. Your doctor is doing the right thing by starting you low and working up over time, you'd be surprised how many doctors don't. Adderall can be quite the shock to the system if not worked up to; the effect that I call the amphetamine roller coaster is very strongly present with Adderall, and if not used properly, you may end up feeling downright bi-polar.

Patience tends to be a virtue that we, as ADHDers are very short on, but it's the best policy in this case. Take your time and keep stepping up, see how each dose works for you. It may be that Adderall isn't the right medication for you, but you won't know until you've tried the higher doses.

Best of luck!

 
Old 03-09-2010, 08:43 PM   #3
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Re: Adderall dose and body weight

chronological,

Adderall has a wide response range. Other 45 yo males, same height/weight, might not sleep for 48 hours on 1 10mg Adderall. Most will feel some effect, and a few, like you, will feel nothing.

Titration is the process doctors use to determine the fewest milligrams of Adderall required to produce good ADHD symptom control in any given patient. Chemists alternately call "titration," "volumetric analysis." A heavier body has a larger blood "volume." Mgs/blood volume must be lower, thus weight must be one of the factors that influence response.

Evidently other variables compositely play a larger role.

Metabolism plays a role. Taking Adderall with an acidic drink such as orange juice reduces its potency. More Adderall is execrated than absorbed into the blood.

ADHD subtype plays a role. Higher doses are usually required to control the primarily inattentive subtype than the combined subtype.

All of us have a complex web of brain and body function relationships at work within us. It makes me stupid thinking about it. Change this neurotransmitter and 20 other neuros are affected that affect n number of other controls that ...

"Let's give the guy some dope and see what happens" is the only way through the maze.

Work with your doctor. The process should lead to paydirt - control of your ADD symptoms.

Bob

PS Thunor, good show in Vancouver.

 
Old 03-09-2010, 10:58 PM   #4
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Re: Adderall dose and body weight

Quote:
Originally Posted by addprogrammer View Post
Adderall has a wide response range. Other 45 yo males, same height/weight, might not sleep for 48 hours on 1 10mg Adderall. Most will feel some effect, and a few, like you, will feel nothing.
...
Work with your doctor. The process should lead to paydirt - control of your ADD symptoms.
Thanks for that. Today was my first day on the full 40mg (20 in the morning, 20 in the afternoon). Other than perhaps some reduction in appetite and an increase in blood pressure, overall effect was still nothing. Pretty disappointing to be honest. I'll keep at it for a while more, but I'm not inclined to put up with popping pills for no benefit for long.

<edited>

thanks again.

 
Old 03-10-2010, 04:27 AM   #5
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Re: Adderall dose and body weight

Quote:
Originally Posted by chronological View Post
I'll keep at it for a while more, but I'm not inclined to put up with popping pills for no benefit for long.
If less than a year is your def of "while more," good. Otherwise ...

Quote:
Originally Posted by Thunor View Post
Patience tends to be a virtue that we, as ADHDers are very short on, but it's the best policy in this case. Take your time and keep stepping up, see how each dose works for you. It may be that Adderall isn't the right medication for you, but you won't know until you've tried the higher doses.
Don't blow it. The difference between life with and without ADD (under control) is about the same as life and death. Don't blow it.

Bob

 
Old 03-10-2010, 10:25 PM   #6
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Re: Adderall dose and body weight

it depends on the drug - some need to have their dosing based on lean or ideal body weight, others need to be dosed based on current weight

Also, people differ in their response to medications - my sister, who is tiny, takes 4 x 5mg Dexadrine twice a day for her ADHD

 
Old 03-11-2010, 05:46 AM   #7
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Re: Adderall dose and body weight

Quote:
Originally Posted by chronological
I'll keep at it for a while more, but I'm not inclined to put up with popping pills for no benefit for long

Quote:
Originally Posted by addprogrammer View Post
If less than a year is your def of "while more," good. Otherwise ...
Really? Are you suggesting that even though I've seen no results in seven days, with two of those being on the max dose, that it may still get to work eventually?

Until I just saw your email, I was planning to go back to the doc today to give him an update. Will he just kick me out the door and tell me to be patient?

Remember - so far, after 7 days with the latter two being 2x20mg of IR, I've seen absolutely zero effect.

Thanks for the advice.

 
Old 03-11-2010, 08:32 PM   #8
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Re: Adderall dose and body weight

I'm 58 years old. I was diagnosed at age 53. I have been and continue to be highly motivated in my efforts to control my ADHD symptoms. Like my boyhood hero, John Glenn, said not long ago, "There is more runway behind me than in front of me." It's fly now or never.

Within the past two years, I began seeing progress with less and less regressions. Today, I feel I got the bad boy, my ADHD, licked. Decades of low self-esteem, depression, anxiety, short lived successes quickly followed by blazing crashes ... gone. Low self-esteem has been replaced with a healthy sense of self-worth, heck, maybe even a little cocky or a lot cocky. Confidence feels so much better than unrelenting self-doubt. I could go on and on but it boils down to "I got the bad boy licked."

Aren't I something? Let's do the math: 58-53=5 years, actually closer to 6 years of getting my butt repeatedly kicked, often needlessly because I wanted instant victory. I'd stop therapy, get beat up worse, then resume.

Chronological, I'm on your side. Please read my replies in that light.

Quote:
Originally Posted by chronological View Post
Really? Are you suggesting that even though I've seen no results in seven days, with two of those being on the max dose, that it may still get to work eventually?
Yes, I am absolutely, positively saying just that.

Quote:
Originally Posted by chronological View Post
Until I just saw your email, I was planning to go back to the doc today to give him an update. Will he just kick me out the door and tell me to be patient?
After just 7 days, if your doctor does NOT tell you to be patient as he is kicking you out the door, you should fire the dumb bozo on the spot and go find a real doctor.

Quote:
Originally Posted by chronological View Post
Remember - so far, after 7 days with the latter two being 2x20mg of IR, I've seen absolutely zero effect.
Not true. You said you experienced decreased appetite and higher BP both of which are effects. They indicate that unaware to you the med might also be working on your ADD already.

You still feel overwhelmed by your email?

Medication enabled me to learn a technique that helps me solve problems that previously left me feeling overwhelmed.

Before looking at your mail, grab a piece of paper and a pen and write at the top ...

How can I effectively manage my email?

Then list possible solutions without worrying whether any will positively work. Write down all semi-reasonable steps you can take to get the job done. Don't worry about sequence at this point. "Turn off computer" can be listed first, for example. Sequencing comes after all your possibilities are listed.

You may want to do a little research to see how others manage the barrage.

You should have little trouble ferreting out from your lists the solution most likely to work for you. Next, test it. Tweak it. Edit the written sequenced list of steps each time to keep it current. Untweak what prove to be a bad tweak. Don't get OCD trying to find the perfect solution. Once you have a reasonably effective solution, continue to read each step each time you look at email until the sequence of steps becomes so habitual that it is automatic. Throw away your executable lists and live happily ever after - with email anyway.

We are prone to feel overwhelmed because we are overwhelmed. What else can be expected if it takes hours to do what take minutes for our not-ADHD peers who are work load stressed crazy themselves?

Medication makes learning new skills much easier. Doesn't teach, though.

Attempting to learn new skills such as email management is a better test of the medication's effectiveness. Just keep in mind that no one learns anything over night. You should find it easier. The impossible becomes possible if the med is working.

Over and out.

Bob

 
Old 03-12-2010, 11:00 AM   #9
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Re: Adderall dose and body weight

Hi Bob,

Quote:
Originally Posted by addprogrammer View Post
Chronological, I'm on your side. Please read my replies in that light.
Thanks, I really appreciate you taking the time to write such a detailed reply. I'm going to discontinue my use of this forum, but I wanted to thank you for your input. I'll be continuing my discussions/ponderings on ADD elsewhere on the internet.

thanks again and to everyone else who offered advice.

Last edited by mod-anon; 03-12-2010 at 11:24 PM. Reason: Please read the posting rules

 
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