I get a lot of email from women who are searching for just the right solution/treatment for their ADHD — "Penelope" agreed to let me share her message with all of you:

Hi Linda!  I stumbled across your blog after searching google for Adderall
vacations.  I tried to read as much as I could…but I'm in a fog right now and
reading isn't really working.  Long story short, I've been on Adderall for about
4 months, 10mg/am and 5mg/pm.  It worked wonders at first, but has been a
downwards spiral the last few weeks to the point that I was curled up in a ball
last night sobbing.  Saw my doctor yesterday, wants me off Adderall, and start
Zoloft.  I'm not excited about that….another medication is not necessarily
what I want to do.  So I made an appointment for acupuncture.  Just curious if
you have heard anything about that procedure…for ADD or for depression. I'm
not setting my hopes/expectations high…but I would be delighted if it helped. 

Here is my response:

I am so sorry to hear about the Adderall
experience! I actually liked my Adderall
but it felt like I was getting more and more
hyper (a natural state for me but not
needed in excess!).

If Adderall worked well for you at first, your ADHD
may respond better to a drug that hits dopamine
receptors/transmitters pretty hard — that's Wellbutrin
and Adderall. Ritalin and Strattera (a reformulation
of an old tricyclic antidepressant that is approved
for treatment of ADHD adults) aim more toward
the neurotransmitter norephinephrine.

All you can do it try them…honestly, it's a pain in
the butt to figure it out for your special body
and brain. It's not ADHD friendly at all. Think
about it: keeping track of how you feel when you
take a pill, which is hard enough to remember
in the first place? Agony. But worth it to
feel better and be more productive and
on track.

Do you trust your doctor? So few docs really
know how to treat ADHD, it's scary. And they
all SAY they know all about it, because it was
on the test in psychiatry school! Not. This is
a highly specialized area that is evolving
every day. There is no specialization in
ADHD offered, but there should be. You will
find great ADHD docs in the weirdest places.
Some family docs and psychiatrists are great,
most suck at ADHD treatment.There are
even some great nurse practitioners out there
who specialize in ADHD. How to find them?
Talk to other people with ADHD — support
groups are a good start. Find out who is
good and not so good in your area. I maintain
a list of excellent providers for the members
of our local Meetup support group. And we
carefully warn against those who aren't
effective (and perhaps dangerous).

Don't give up. Taking medication isn't a
bad thing. I am leery of anything chemical
these days … even food that is contaminated
by those darned chemicals. But it's the
best we have right now. And meds do work.

Alternative..consider CogMed working memory
training or another brain training. Acupuncture
hasn't been really effective for ADHD to my
knowledge, nor has chiropractic medicine.

Exercise is the most effective treatment for
ADHD and depression, too. Serious, aerobic
exercise … daily or at least 4-5 times a week.
My best friend Marty has had depression
issues for years and when she misses
a few days of exercise her husband notices
the difference in her state of mind. She does too.

If you are already exercising regularly (frankly,
I'd be surprised if you were … it's not an ADHD
friendly thing to do either) then
look at diet. There is no research support
for altering your food intake, but clinical results
and anecdotal evidence suggests that
most ADHD adults do best on a
low carb diet (also ironic since ADHD and
depression cause carb craving). Eggs and
bacon or turkey sausage for breakfast;
salad and broiled chicken for lunch,
broiled meat (or vegetarian equivalent)
with lightly steamed veggies for dinner…
that's the recommendation. Wish I could
stick with that one! My carb cravings are
out of control at the moment ; – (

Please let me know what happens. It's
important to follow up ….know that I care!

Hugs
LInda

Should you stop taking your Adderall or Vyvanse or Dexadrine now that you've heard Dr. Tracy Ware's presentation about the potential dangers of amphetamines? Maybe yes. Maybe no.

I just got off the phone with a woman (let's call her "Maggie") who recently started taking Vyvanse with great success. No side effects and improved attention, etc. After she listened to Tracy's presentation, she was unnerved by the possibility of brain damage with amphetamines so she switched medications (to a second tier ADHD drug). Maggie's been in a downward spiral ever since. Missed appointments, foggy brain, battered self esteem. Nothing we aspire to, right?

So why didn't she immediately stop the new meds and go back to Vyvanse? I suspect she called me for a reality check on whether I believed amphetamines really killed off brain cells. And I do. I told Maggie that many medications have potentially serious consequences: high blood pressure medication can cause sexual problems for men. The FDA reported today that taking a malaria drug could cause severe kidney damage and heart failure. There are unintended consequences to almost every choice we make.

But also I told her that returning to Vyvanse sounded like a good idea. I'm not a medical doctor so my opinion is worth about what you pay for it – $0. But it makes eminent sense to me to stick with something that works versus flailing around trying to save your brain cells. And yes, I DO understand that salvaging brain cells is an important goal, but the jury is still out on whether those cells will regenerate or not. There is a LOT we don't know yet about the brain and how it repairs itself.

Even more important, there is a quality of life issue here.  We ADD women have been through a lot of stuff (OK, sh**t) in our lives. Finding a medication that actually works to bolster our time management, organization, sense of well being, is a godsend.

We shouldn't stop exercising because we might pull a hamstring or sprain an ankle. And we shouldn't stop taking our amphetamine medication because someone told us there is potential for cell death. For heavens sake do NOT stop taking medication without telling your doctor! Those consequences could be even more dire than continuing the meds!

Anyway, Dr. Ware doesn't shun amphetamines; she prescribes them for her patients who need them. That includes those of us who don't see much improvement with Ritalin-family meds (like Tracy's own husband!).

The fact that I stopped taking my Adderall was more about looking at the factors that were causing me to feel out of control and a bit crazed. Sure there is a lot going on in my life. There is ALWAYS a lot going on in my life. And changing one thing at a time, to see the effects, is the way I can narrow down the cause of the problem, and then find my way back to a solution.

I don't know about you, but I want to feel alive every day. I want to feel good about myself and productive. I want to feel proud of myself and I'd like the people I love to be proud of me, too. It's not too much to ask of an ADD life. I know. I've lived it. And I'm going back there.

That means I will probably go back to Adderall. Not sure yet. Working on it. But if I do return to amphetamine medication, it will be MY truth about stimulants. Not Tracy's. Not Maggie's (Vyvanse is awful for me, BTW). Not Susan's or Ellen's or Mary's. Mine.

You need to find YOUR truth about stimulant medication. Yes. No. Maybe. Sometimes. Alternatives. Rotating. It's all part of the mix. If there is one thing I have learned about ADHD it's that it is literally a different experience for everyone. Personalized treatment..that's where we're headed, according to another psychiatrist who visited our Meetup group last night.

Work with your doctor, monitor your symptoms, get reaction from your loved ones. Find your OWN truth and then, make peace with it. None of us are gonna get out of this alive. Something, somewhere, sometime when we least expect it and probably don't want it, will cause our bodies to shut down and we'll bid farewell to the mortal coil.

So how do you want to live your life in the meantime? At my retreats I always read a poem by Mary Oliver that ends with this line: "Tell me, what is you plan to do with your one wild and precious life?"

You alone have the answer. For all of it.

OK, it's been three weeks since my last Adderall and I am reporting on the effects (or lack of them).

For the first few days, I found myself on autopilot, reaching for the pill case that contained my little blue "energy pills." But I steeled myself against taking them and let the ride wind down. I thought after a week, I'd evaluate my energy and focus, then decide whether to resume my meds…or not.

Well, Tracy Ware, the psychiatrist who spoke at the Meetup group two days after I stopped taking Adderall, scared the beejeezus out of me – her warnings about neurotoxicity seemed to be based in science. And I don't want fewer Dopamine receptor sites – I want MORE. Now the jury is still out on the overall effects of amphetamines, but why tempt fate?

Tracy told me privately that the Adderall would stay in my system for at least a month. A MONTH? She said that the second week would likely be worse than the first week. Hmmm .. this sounded a lot like detox, right? I didn't think of myself as an addict. Not ever. This was prescription medication. And I took only a tiny amount (max 2-3 pills a day of short acting 10 mg brand name Adderall).

But sure enough, the second week, I was draggy and had a hard time staying alert. Mostly, I was sleepy.

I found that if I got enough sleep at night (or with naps during the day), I was OK. But if I stayed up too late, got up too early or shorted my required 8 hours of sleep in some other way, I was blah. Just blah.

Couldn't get things done. Couldn't get motivated. Couldn't get going.

But here's the strange thing: I have been living in a mess in my bonus room/guest room for two years now. I am not proud of it. I am terribly embarrassed by it. But it's true.

Last week (third week off Adderall), I got the darned room cleaned up. Granted, I had motivation (my kids were coming to spend the weekend with darling little Lilly). And I had help (Erica the super organizer came on Thursday morning and Janine the super housekeeper cleaned the rest of the house).

But I've had help before.
I've had motivation before.
But this is the first time I actually DID something about it.

Not only did we get the room cleaned, I bought a new bed, new curtains, new lamps and redecorated the room with a new duvet cover, pillows, mirrors and ceiling fan before they arrived! (Yes I had someone install the fan and hang the mirrors – is that cheating? Nope).

Point is that I am still tired/sleepy, but I seem to be getting things done anyway.
I am clearer about what I want and need done.
And I am pretty happy about it.

Is this an aberration?
Is it related to the absent Adderall?

Not a clue, have I.

But we're gonna find out.
In 10 days, I am going to go back on Adderall and monitor myself closely to see how I feel, what I accomplish and how my loved ones respond to the difference (if there is a difference).

In the meantime, I am taking more naps, trying to get to bed on time (what IS on time anyway?) and working in my garden for the first time in months.

Neurotoxicity?

Permanent brain damage?

Hmm. That's not what I wanted to hear about my Adderall prescription. But stimulant medication may be causing more problems than solving them, according to Dr. Tracy Ware, a board certified psychiatrist from Chapel Hill who was this month's guest speaker at the Adult ADHD Meetup group held at GardenSpirit.

Research shows that even long term use of methylphenidate  (Ritalin and its ilk) is safe but taking amphetamines is a quite different story. Dr. Ware showed convincing evidence that amphetamines like Adderall, Dexadrine and Vyvanse induce an artificial "hyperfocus" by increasing the availability of dopamine (neurotransmitter) in the brain.

It mimics the "flight or fight" response that evolved to protect us from woolly mammoths (of old) and muggers (of late). In other words, everything that is non-essential to survival either shuts down or shifts focus. Our peripheral vision narrows (to better focus on the danger), our heart rate increases (to better escape the enemy) and our focus pinpoints precisely the object in front of us.

There are obvious advantages to this hyperfocused state – we pay attention to every detail that might save our lives. But for ADHD, hyperfocus is an overresponse to force our wandering brains to PAY ATTENTION, DANG IT!

I'll share more of Dr. Ware's info in a later post but, I wanted to come clean first:  I stopped taking my Adderall. Not as a direct result of her presentation, but a few days before the Meetup gathering.

I was in a terrible place when I returned from Chicago, the ADHD Coaches Organization conference and a visit with my family in central Illinois. I don't know what happened but I felt so out of control with everything that I needed to stop and regroup.

For some reason, it made sense to me to stop taking medications that were "optional." I have taken Adderall on a regular basis for only 18 months, so that went first. My Wellbutrin, which has been my main ADHD medication for years, stayed on board.

It's been three weeks now and … oh, I think I'll make this another post. It will get waaaay too long to read …. join me in the next post: "Three Weeks without Adderall."

Watch CBS News Videos Online

Last night's broadcast of 60 Minutes (CBS) confirmed my worst nightmares: that ADHD meds will become so popular they will be treated as "brain candy" instead of as a medical necessity for people with brains like ours.

College students agreed that pill popping is rampant on campus, especially with  stimulants like Adderall and Ritalin. They take them to stay up late studying; they take them to finish papers; they take them to focus on tests.

Apparently the stimulants are prescribed for truck drivers who are on the road for hours; and even doctors who work double shifts. But hey, back in my college days, didn't we do the same thing? Except the drug of choice then was No-Doz, 200 mg of caffeine concentrated in little white pills.

I went online to see if NoDoz was still around. Yep, it's still sold and it's a lot cheaper than Adderall or Ritalin. College students said Ritalin was selling for $3-$5 per pill. A bottle of 60 NoDoz costs only $9 online. Free shipping, too..

My fear is not that college students will get hooked on Adderall. My fear is that Adderall and its ilk will become so commonplace that their legitimacy as treatment for ADHD will be diminished, dismissed or even discarded.

The non-ADHD students interviewed by Katie Couric said they could focus better, they could read fine details even about uninteresting information. That's sure not what they do for the ADHD brain. I have clients who take their ADHD meds faithfully but still can't keep their attention on the chapter or the math problem or the To Do list. The pills help us pay attention; but sometimes we veer off into worlds of focus that have nothing to do with the original task.

So, let's be clear here. Just because everybody can take stimulants and gain some focus, it doesn't mean that ADHD isn't a valid diagnosis. We're out here. We still need our meds. And even if we forget to take a few each month, we shouldn't be sharing them (and especially not selling them) to all of the rest of you out there.

I guess it makes the drug companies happy. I guess students are happy and perhaps their professors.

I'm not so happy.

Recently, I heard a doctor tell a TV audience that stimulants like Ritalin and Adderall improve focus for ANYBODY, not just people with Attention Deficit Hyperactivity Disorder. His point was that a positive response to stimulant medication is not proof of an ADHD diagnosis.

Wait a minute. When I first tried stimulants they put me to sleep! It was the first thing that convinced me that I really had ADHD. I'd heard that people with ADHD have a "paradoxical response" to medication, so if I was sleepy after I took Dextrostat, I must have an ADD brain.

I later learned that I had misinterpreted that information. Stimulants don't really have an opposite effect on ADHD brains. Instead, they realign the dance of specific neurotransmitters so the neurotransmitters can hit their mark in the neuron network. I fell asleep when I took Dextrostat (100% dextroamphetamine) because it was the wrong medication for my particular brain chemistry. Adderall (a combination of four different amphetamine salts including dextroamphetamine) worked wonders for me – no midday naps, much more focus.

The TV doctor was reacting to news that some college students swallow stimulant tablets before exams to improve their competitive edge. No word on whether the stimulants actually boosted the students' test scores, but the doctor implied that the groundswell of adult ADHD diagnoses was based more on requests for stimulants than legitimate medical testing.

This kind of pseudo-medical nonsense makes me mad. It took me a long, long time to believe that my ADHD diagnosis was accurate. Now I realized I was deeply  influenced by the skepticism of the media, the public and even the medical community about the legitimacy of ADHD. There was the pharmaceutical conspiracy theory: Big Pharma had concocted ADHD to boost their profitability. Adult ADHD was trivialized: only children could suffer from this silly little disorder so if you "still" have ADHD you must be immature. There was stigma attached to having something "wrong" with your brain: ADHD people are to be shunned or at least marginalized. No wonder I wanted nothing to do with any of it.

But here I am, broadcasting my ADHD story to anyone who stumbles across this blog. Obviously, I've come to terms with my ADHD. I know it's legit, that I am not a hypochondriac and that I certainly would never choose to take powerful medication if it wasn't necessary.

It's my responsibility – and yours, if you or someone you love has been diagnosed with ADHD – to combat the misinformation that masquerades as truth.

Do some of today's college students take stimulants before exams? You bet. Just like some college students took No-Dose when I was in college in the 1970s. And just like mega doses of caffeine, stimulants send those little neurotransmitters into hyperdrive in "normal" brains, creating frenzy instead of focus

Does it mean that adult ADHD is over-diagnosed? Nope. In fact, it is dramatically under-diagnosed; estimates show that only 10% of adults with ADHD are actually diagnosed and treated. Mark my words: in the next few years, we will see dramatic increase in the number of adults who are newly diagnosed with ADHD.

There will be a tipping point, a place at which an ADHD diagnosis carries no emotional baggage. It will merely be a condition to be treated, much like Type 1 diabetes or kidney disease. And then we can get on with the rest of our amazing and extraordinary lives.

I am working with a new psychiatrist (nothing wrong with the old one; Dr. W specializes in mid-life women with ADHD). She is running me through a trial of three new meds, none of which were on the market 15 years ago when I first tried on ADD meds  – gosh has it been that long ago?

It was a complete surprise to me to learn that stimulant medications have a distinct and negative interaction with foods that contain Vitamin C. Apparently the Vitamin C diminishes the effectiveness of the medication.*

Huh? I had NO idea this was true. I don’t know about you, but I want all the bang for my medication buck possible, so I’m gonna follow her suggestions (which she found on the package inserts of Adderall XR and Dexadrine Spansules – I need to get out my reading glasses to check that teeny tiny print more carefully).

Here’s the rule:

No foods with Vitamin C one hour before or after taking stimulants

Vitamin C big players on the food court include:

Oranges – juice or fruit
Grapefruit – juice or fruit
Strawberries
Papaya
Kiwi fruit
Mango
Cantaloupe
Lemons/lemonade
Limes/limeade

Potatoes (this is not a misprint)
Brussels sprouts
Broccoli
Kale
Cauliflower (who knew?)
Parsley
Mustard greens
Bell peppers
 

Other sneaky sources of Vitamin C

Coke/soft drinks/colas (!!!!)
Power bars
Fortified cereal
Power drinks
Granola bars
Pop Tarts
Any kind of jam or jelly made from fruits listed above

And of course…
Vitamins – multi-vitamins
Vitamin C tablets

 FYI
Dr. Wojdyska also nixes taking antibiotics in that two hour time span. And I found on the Adderall XR site that melatonin reacts with the medication, too. Insomniacs beware .. but only for that short time period.

(If you think taking an antacid like TUMS will allow you to eat citrus, you’re right, but note that *taking antacids INCREASES the effect of Adderall. Be careful out there….)

Thanks, Dr. W – you’re the best.

And now you know the rest of the label…

Hugs

Linda

Ever get "The Look" when you casually mention ADD or ADHD to a friend or colleague? It’s that poor-you-for-buying-into-the-hype cover-up smile that implies you are sadly mistaken about the validity of ADHD.

Read the rest of this entry »

I’ve always worried that generic drugs aren’t quite as good as the brand name version and now there’s mounting evidence to prove it.

Wellbutrin XL 300 (Budeprion XL) works just fine for depression and many ADHD symptoms. But when some patients are switched to the generic formulation, they reported frightening symptoms: fast onset of severe depression and serious suicidal thoughts.

In a recent article published by the People’s Pharmacy a woman reported no problems with the original Wellbutrin XL 300 but said that she had "the worst case of depression" she could remember when her pharmacy substituted the generic equivalent. It should be noted that the difference has not been reported in the 150 XL formulation at this point.

Apparently the generic version releases the medication at a different rate than the original, thus creating quite different response rates and effectiveness.

This news scares me – because a lot of ADDivas take Wellbutrin, including me – and there is the potential for serious repercussions. Suicide is not to be taken lightly, especially when antidepressants are supposed to ward off those thoughts and actions.

Equally important, however, is that many ADD women and men have already experienced differences in generic medications vs. brand name drugs that treat ADHD. I cannot take generic Adderall, for instance. Other people cannot take the brand name version. Ditto for any of the other drugs on the market today.

There are two ways to look at this issue, in my opinion.

1) We need to make SURE that we are receiving the exact drugs prescribed for us with NO substitutions by the pharmacy or insurance company (this may take some lobbying by you or your doctor).

2) If generics really do release their active ingredients at different rates than the original drug, it gives us even MORE options to play with to treat our ADHD symptoms.

After all, drug companies are making a fortune by adjusting the release time of ordinary drugs like old fashioned Ritalin, slapping their brand on the bottle and charging 10 times the price of generics. I know folks who can’t take the brand name drug but have good results with the generic. It works both ways. But the bottom line is the same: we all react differently to medication release schedules, to the type of drug prescribed, to the interval we take the drug, etc.

OK, now the disclaimer: this is NOT something to play with on your own. Obviously there can be serious consequences. Drugs are not a smorgasbord from which we can pick and choose. Work with your doctor to find the best combination for you.

But if you are switched to a generic and suddenly notice your symptoms change, call the pharmacy AND the doctor immediately. You deserve to take the meds that work best for you,
brand name OR generic.

Read the full report at Consumer Lab.