this post was submitted on 01 Oct 2023
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ADHD

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Those who have been on prescribed stimulants for many years (>5), how do you manage tolerance and crashing? (lemmy.world)
submitted 11 months ago by tonystark29@lemmy.world to c/adhd@lemmy.world
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I have been on ADHD meds for about 7.5 years now. I started with Vyvanse and my dose was at 70mg in the first year. I was having bad crashes at night, so I switched to Adderall 40mg with 10mg Dexidrine and stayed on it for a few years. Recently, I switched to Concerta 90mg because my tolerance was getting too high and it wasn't working anymore, hoping that by switching it will reset my tolerance. It didn't. In fact, my tolerance drops to being feeling depressed/unmotivated in about 3 days now. So that sucks.

Taking breaks is agony for me. I have the worst stimulat headaches, no motivation, and can't sleep. My doctor knows this but does nothing. He won't raise my dose.

How do you guys manage? Thanks.

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[–] transientpunk@sh.itjust.works 26 points 11 months ago (2 children)

I just try my best to function without meds on the daily, and save the meds for times when my focus is most needed. It's truly terrible. But, as much as stimulants help, they are really a bandaid, and will always end up in this cycle you're experiencing.

Short of behavioral therapy, and/or switching away from stimulants, there's not much more your doctor can do. Stimulants are hell on your heart, and increasing your dose would greatly increase the risk of heart issues, including sudden death.

Our society wasn't built with people like us in mind, and no amount of chemical therapy will change that.

[–] Hydrogen@lemdro.id 10 points 11 months ago (1 children)

Consider a lower dosage of a long-lasting stimulant instead. You won't feel a rush like instant release, but it'll manage symptoms much more sustainably in the longer term. Shouldn't be any issues for your heart this way (I'm monitored regularly and have never been healthier).

[–] transientpunk@sh.itjust.works 6 points 11 months ago

After being on stimulants for almost 30 years to treat my ADHD, I've tried every variation you can think of. I appreciate the suggestion though.

[–] Countess425@lemmy.world 4 points 11 months ago

This is what I do too. I can usually just get away with two-three days during the work week with meds, and the occasional Saturday or Sunday where I need to get a lot done. I don't really need to force myself to do more than that; seems on par with everybody else's productivity. If I use stimulants more than 3 days in a row my brain kinda turns to mush, so that already puts a cap on my usage.

[–] Hydrogen@lemdro.id 19 points 11 months ago* (last edited 11 months ago)

A lower dosage of Vyvanse split into two worked for me after my doctor sent me for a psychiatrist consult. It eliminated the crashes. It's also important not to chase the euphoria that comes with a new dosage (it's a temporary side effect). It's okay not to feel 100%. Trying to keep the euphoria will end up with higher and higher dosages.

Consider asking your doctor for a psychiatrist consult.

[–] hperrin@lemmy.world 8 points 11 months ago

That’s already a very high dose.

[–] couragethebravedog@lemmy.world 6 points 11 months ago* (last edited 11 months ago)

Once I became an adult I only take the meds on the days I work. I've never had any trouble with headaches or anything when I come off. I've been on every ADHD med available throughout the years all at the highest dosage they can give me.

[–] BilboBargains@lemmy.world 5 points 11 months ago

I don't have much of a tolerance to any amphetamine based stimulants. 40mg of lisdexamfetamine at 6am works fine until I'm ready to sleep at 10pm. No break in this routine for two years. I mentioned tolerance effects to my psychiatrist and he considered them to be minimal with respect to the cognitive component.

I wonder what is going on in your case, perhaps you are metabolising the drug much faster than average? Is the stimulant effect noticeable within an hour of dosing and then it rapidly diminishes?

[–] nick@midwest.social 4 points 11 months ago

I take 30mg of vyvanse every week day (for work). I don’t suffer the crashes I did on adderall, which is nice. I do not take them on the weekend usually to avoid tolerance buildup.

I was on staterra previously and it didn’t do anything other than make my dick stop working. No good.

[–] webghost0101@sopuli.xyz 2 points 11 months ago (1 children)

Concerta is related to antidepressants which means they have the side effect of making some people more depressed. I wish i was joking.

[–] PutangInaMo@lemmy.world 8 points 11 months ago (1 children)

How is methylphenidate related to antidepressants?

[–] transientpunk@sh.itjust.works 6 points 11 months ago (2 children)

Maybe they're confused by methylphenidate acting as a dopamine reuptake inhibitor, and getting that mixed up with selective serotonin reuptake inhibitors?

Maybe they're mixing up methylphenidate with Wellbutrin, which are commonly prescribed together. Wellbutrin is also prescribed alone to treat ADHD, and it is an antidepressant.

[–] webghost0101@sopuli.xyz 1 points 11 months ago

I am definitely getting some things mixed up because Wikipedia-ing these i am starting to question that i may have tried more different kinds than i actually remember taking.

Its not helping that the brand names are different yet similar depending of country.

The last adhd meds i took made me less socially/emotionally repressed like previous meds had been doing. Which was a breath of fresh air… that made me question my life ip to then. Like i woke up in the future after being gone for years. I went into depression very quickly with constant suicidal ideation. That last part went away quickly the moment i promised myself to stop taking adhd meds for good.

It was later made clear to me by a professional that “may cause suicidal feelings” was a known side effect. And its function compared to antidepressant, which for a subset of people can work very counterproductive.

[–] PutangInaMo@lemmy.world 0 points 11 months ago (1 children)

Interesting, I've never heard of wellbutrin being used to treat adhd.

[–] vivavideri@lemmy.world 1 points 11 months ago (1 children)

It's got a little something in it, I can't remember the specifics, but being on both bupropion and a stimulant really help me.

[–] PutangInaMo@lemmy.world 0 points 11 months ago

I read a little into it yesterday, looks like it's one of those "off label" uses that have been known to be used for adhd.

[–] Appoxo@lemmy.dbzer0.com 2 points 11 months ago

I don't think I have built a tolerance against ritalin but I can feel crashes now that I am older.

[–] can@sh.itjust.works 2 points 11 months ago

I started high and decided to lower it. It worked better for me.

[–] Badass_panda@lemmy.world 1 points 11 months ago

I have been on Concerta for around 6 years. As I understand it, Concerta does not have a cross tolerance with Adderall or Vyvanse, but both do with Concerta... so if I need to switch from Concerta it should be an open option.

With that being said, I try and maintain a roughly stable dosage, I try and eat right and sleep right, and I don't take my medication on the weekend or on vacation.