Adult ADD

Not everyone has a good response to treatment for ADD. Those who do are often very happy with the results. A few have agreed to share their experience with those who are considering treatment.  The following are some notes these patients have written to me.  I wish I was responsible for the remarkable changes some of them describe, but the major factors that account for their improvement, as you will read, are the acceptance of the patients who have ADD that they have it, the effects of the stimulant medications and the determination of the patients to improve their lives by using various techniques, some of which are described in this “Living Well with ADD” section of this site.

It is important to remember that ADD treatment does not turn people into super-people.  There is the old joke:  Patient:  Doctor, when you take off the bandages, will I be able to play the piano.  Doctor: (confidently) Yes, you will!!   Patient: That’s great. I never could play before.          But it can help many people get much closer to being their best selves. So keep your expectations modest and you are much less likely to be disappointed.

I am starting this section with reports of patients who have done very well. In time I will encourage a few who have not done so well to tell their stories too.

Self-Reports

Woman in her forties talks about ADHD and her treatment:
I was alternately worried, surprised, and somewhat relieved to learn that I have the disorder.  I started to read about adult ADD when my brother told me he was diagnosed with it.  Although it was occasionally irritating to me that I rarely finished one thought before beginning ten more, I figured it was a feature of quick thinking. I always chalked up my personal “failings” (losing things, forgetting meetings) to being overburdened.  The more I read, the more I realized that my “failings”, and my repeated inability to focus, meant there might be something wrong with me, and worry set in.  My surprise stemmed from the fact that I an accomplished woman.  How could I have ADD, and not have had trouble completing my education?  I actually did have trouble in school at one crucial point, and it changed the course of my career although I tend not to dwell on it.  I was relieved to learn that my issues, which kept recurring despite my best efforts, are not character flaws, but are actually symptoms of a disorder that can be treated.  I don’t have to be a typical absent-minded professor for the rest of my life if I don’t want to be.

And I don’t want to be.  So, at age 45 I have started to take stimulant medication to treat my ADD.  I was reluctant to start medication because I was worried it might be habit-forming.  You helped me to understand that in addition to incorporating coaching tools from your web site, I could make substantial progress in reducing my symptoms with medication.  You were absolutely right.  I am one of those patients who felt clearer minded in a single dose.  When I occasionally forget to take my pill I have no withdrawal and no feeling of dependence, only a low-energy day.

I don’t know whether your colleagues or prospective patients understand the profound impact that ADD medication can have on the quality of life of adult patients. I recently completed a major work related project to the best of my ability, on time – ahead of schedule actually.  I realized with that submission that I’ve never shown my best work.  Ever.  My chronic inability to focus made me unable to bring to light the excellence I am capable of.  Now I am able to reveal the beauty of the work I can accomplish with my complete attention, and it brings me great joy.

Consultant reports being much more focused and efficient on amphetamine (Vyvanse):
I’ve been taking the medication for only a few weeks, but I’ve seen some real changes.  I used to have trouble paying attention when I was talking to client, but now I seem to have a phenomenal listening ability. I actually feel relaxed when talking to others because I don’t have to concentrate on what the person is saying to understand and remember it.

I’m also much more efficient, much more disciplined staying on task. Before I started treatment, I had a task list, but I didn’t methodically tick things off.  Now I catch myself when I stray off task.

My energy level is very consistent throughout the day. I no longer need to get high on coffee then struggle as it wears off. Actually I’ve had no coffee since I started the medicine.

Initially my heart raced a bit at times, it felt like a big cup of coffee.  That’s worn off now. At first I wasn’t getting a deep sleep. But now, when I get into bed, I hardly think about my problems or the events of the day or the next day, I lie there a bit and fall asleep. I have had a little loss of appetite.

College student concentrating better with amphetamine (Vyvanse)
I just wanted to let you know that with medication, things have been going great.  I feel much more alert and am able to concentrate on schoolwork in a productive, organized way.  I have been taking three pills a day and am working my way up to taking the time release ones starting this week.  While I initially noticed that my heart rate seemed to increase a bit, that seem to have decreased as I have become more used to the medication.  I also have been using the iPhone calendar and alert system to remind me of when to leave for classes, and it has been great!  Thanks for that tip!

Note from Dr. Schwartz: Each time you make an appointment, enter it into your smart phone calender.  Don’t plan to enter it later.  Always do it at the time you make the appointment.

Then ALWAYS enter alerts into the phone that will ding at the times of the alerts to remind you.  The iPhone allows you to set two alerts for each appointment.  I set one for a day before the appointment and another for whenever I need to get going to get to the appointment on time. For example, I set the second one 5 minutes before I have to leave to deal with the appointment hand if it involves no preparation or travel. I set the second one for an hour beforehand if it will take me 45 minutes to get to the appointment.  Always prepare to leave at least ten minutes early.

Stimulant addiction helped by Intuniv (guanfacin)
Just letting you know Intuniv was a huge relief to find. As you know I had been abusing stimulants and addiction to other drugs. With Intuniv I have been free of narcotics for 18 months now. I recently went up to 4 mg which has made me a bit irritable, but that is settling down after continued use. I would be “self-medicating” still if it were not for this medicine.

Sleep problem helped by Intuniv (guanfacin)
I suffer from the usual ADHD symptoms, but my most severe problem is with impulsiveness, though Stattera has helped a good bit.  This impulsiveness has caused me a lot of trouble throughout my life.  In particular, I spew out everything I have knowledge of.  Many are impressed by my knowledge, but most consider me a know-it-all.  Stimulants (all have been tried) helped with some problems, but not the impulsiveness.

Dr. Schwartz’s response:
Intuniv is a long acting version of a much less expensive generic, guanfacine.  It needs to be taken more often than Intuniv but works the same way. You might want to check with your doctor about it.

For financial reasons, pharmaceutical firms always go through the expensive task of applying for FDA approval for ADD medications for children before they do it for adults.  Once approved, medications can be prescribed for adults, so the firms often don’t bother to go through the expensive approval process again.

Adult doses of medications are usually a little higher than children’s doses, but that needs to be worked out through trial and error as individuals’ sensitivity to medication is quite variable.

Cheers from a Reader for the ADD Tool-Kit
Wow – I do all of these things in the Took Kit to keep myself on track…it had never occurred to me that I might have ADD or ADHD.  I am going to look into it further.  In the meantime, I have a recommendation:  Check out the Wunderlist app on the iPhone…I have never really found a good To Do list system that works very well….but so far I am really liking Wunderlist.

For emails, the best way for me has been to mark them as unread and then look at the unread emails….  Starring or flagging them is ok too….but I never seem to go back to flagged/starred emails like I do with the unread ones.

I have a Livescribe pen….it was a gift last year…I don’t use it much…but I think it is awesome and if I was still a student, I am sure I would use it all the time.  I use it once in a while in meetings when a client is talking through things they want me to do….so I can go back later and catch it all in detail.  I rely very heavily on my calendars – work and personal.

For more information about the ADD Tool Kit, click here.

College Freshman helped by amphetamine (Vyvanse)
After a bad first semester in college, I was diagnosed with A.D.D. Even though I was studying hard, I had trouble concentrating, often couldn’t remember what I had read, I was waiting till the last minute to get things done. The medication I’ve been taking for it over the past two months has made an enormous change in my life. For the first time, I’m really doing well in school. Not only has it helped with my ADD but I have had no major complaints with it. I have not experienced any crashes or drowsiness nor have I experienced any trouble sleeping. Some mild side effects that I have experienced are loss of appetite and dry mouth, but it hasn’t been anything that I was unable to fix. I have yet to see any downside to taking the medication.

Vyvanse vs Adderall
I am currently a student and was diagnosed at age 19 with ADD.  I was started at 20 mg Adderall IR (Immediate Release) and increased to 40 mg. Though I did experience insomnia over a month and a half, after one full month 40 mg, a dose I found effective, my sleep patterns returned to normal.  I did start and stop working fairly rapidly so I had about a half hour irritability for 2 hours after it wore off.

I have tried to switch to something that started working more smoothly than the IR. I tried Vyvanse 30 mg but it didn’t work at all.  My doctor raised the dose to 40 mg but then suggested I see a psychiatrist, who put me back at 30 mg again.  For about a week, I got some headaches and slept 2-4 hrs more a day.  After that those withdrawal effects subsided, now I’m just as spacey as I was before I started the medications and of course my anxiety when communicating with others is back- I can understand what everyone is telling me but I can’t get the words out of my mouth fast enough to keep up with conversations.

My doctors are still so reluctant to change anything and are barely moving me up on Vyvanse (or even back down again).  I’m not looking to feel anything from the medicine, I just want to be normal.

Dr. Schwartz’ response:
Vyvanse and Adderall contain the same medication, dextro-amphetamine. With Adderall or the other short acting dextro-amphetamine medications like  Dextrostat or mixed amphetamine salts, the medication is effective usually for four hours. Vyvanse delivers the medication to the body more slowly. A 60 mg dose lasts about ten to twelve hours by delivering the medication steadily to the body steadily over that period of time.  I find it works more smoothly than two doses of short acting dextro-amphetamine medications or even long acting Adderall which. even though it is one capsule, delivers the medication in two four-hour doses.

So if taking 20 mg short acting Adderall twice a day or two 20 mg XR long acting Adderall once a day works for 8 hours, the same patient most often needs 60 mg/Vyvanse to achieve the same effect over ten to twelve hours, but doesn’t change the per hour dose. In fact 60 mg Vyvanse would be about the same dose as taking 20 mg of Adderall three times a day.

On another topic, I can find no evidence in the literature that 60 mg of Adderall or Vyvanse is any more hazardous than 40 mg for people who have safely taken 40 mg.  However, your physician must be the one who makes the dosing decision with you, as he or she knows you best.

Amphetamine vs methylphenidate (Adderall vs Ritalin)
I have found that Ritalin has a more subdued effect. I am more persistent in focusing on one thing at a time when I take it.  I do one thing at a time then move to the next thing.  I feel less physical excitement and energy than from the Dexedrine but I can wind down at the end of the day.  It’s better for something like taking an exam the next day.

Dexedrine increased my focus and gives me the excitement to accomplish what’s next on my plate. I can do things with enthusiasm even late into the night.  It’s better than the Ritalin for doing a list of things, the Ritalin’s better for doing one really well.

What I like most about the medication in general is that I no longer have to think about keeping things straight.  Being more efficient and not having to think about my inefficiencies saves me an incredible amount of time.

Intuniv
I am a 51 year old female with ADHD diagnosed about 2 1/2 years ago. I have tried stimulants and did not like the side effects so now I am trying Intuniv. I started the 1 mg for a week approx two weeks ago. I took it in the morning by about 7:00 a.m. with food. I felt sleepy by about noon and took a nap about 4:00. I also had a little headache each day. I took 2 mg after 6 days of the 1 mg and by the end of the day, had a giant throbbing headache with light sensitivity. I discontinued the 2mg after just one day. The only med that really ever helped with my symptoms was Adderall but I didn’t like the speedy feeling and I was a bit short tempered with little patience for my 11 year old son. After one month of Adderall, I felt the negative effects out weighed the positives so I gave up on meds for about a year before  trying non stimulants. I thought I would share my experience with you.