Adderall and intense thoughts of suicide question.

[Pridan]

Dear Dr. J and company,

I am in my mid-thirties and I was diagnosed 2 years ago with adult ADHD. I was diagnosed when I went to a very good therapist for the treatment of anxiety and depression and she asked me if anyone had ever suggested that I have ADD. Of course this was the case, so she sent me to a neuropsychologist for testing and he determined that my testing and history pointed in the direction of ADHD with an anxiety disorder.

My therapist made the decision to treat my ADHD first because she did not feel my anxiety was the primary issue and that it may have been related to my untreated ADHD. I went to a GP (which I think was a mistake in hindsight), and she prescribed me 20 mg of Adderall XR.

As soon as the medication hit my system, it was as if there was a dissolving in my forehead and the static disappeared. That day I was able to focus on tasks, sit at the dinner table without feeling agitated, and even read to my kids (something I’ve never been able to do!). I found after a week, that the medication started to wear off, and that I also started to experience irritability. The doctor prescribed me a second pill of 20 mg to take at around 2:00. After a few more weeks, I was taking 40mg of Adderall XR in the morning and 20mg at 2:00. After the first few weeks taking Adderall, I noticed that I getting emotional and prone to sudden sadness, and in one instance I started bawling (something I don’t do). When this wave of emotion hit me, I had thoughts of suicide. To be clear, these were intense feelings. I wasn’t contemplating the idea in the abstract, I was thinking about doing it and it scared me. I was not planning it out and I was able to realize that these feelings were not normal, but they were almost overpoweringly intense. I’ve never felt that way before.

I scheduled a meeting with my therapist who noticed that this was not normal, especially considering that I had NEVER had thoughts of suicide in the past, and she told me to lover my dose and stop taking the medication if it happened again and call her immediately. I had taken the medication that very morning, and that afternoon the feelings returned with an intensity I had never experienced. I had to call my wife at work and tell her to get to me as fast as she could, and she spent the rest of the day sitting with me as I had some of the most intensely awful feelings of my life. The feelings subsided six hours later over the course of an hour as the medication wore off, and it was literally like flicking a switch. I couldn’t figure out how I could have felt so horribly hopeless just an hour before. It had been as if my body was a burning building and I wanted to jump out of it.

I quit taking Adderall XR (obviously), started meeting with a pharmacologist, and I started addressing my anxiety with Alprazolam. I finally got up the courage to try other ADHD medications, and I have tried Methylphenidate, Strattera, Vyvanse, and now I’m taking Focalin XR.

Even after my experience, I see the benefit of taking medication because while Adderall was working and even on some of the other medications, I have been able to put to rest past experiences that had been on a loop in my brain for the past 30 years. No medication, however, ever gave me the clarity that Adderall did when it was working initially. I am left wondering if I raised my dosage too fast, or if I didn’t know what I was feeling when I thought the drug was working. Were my feelings an unnatural euphoria and was my focus while doing my work over focused?

My question is this: Should I ever try Adderall again, or avoid it altogether? All the medications I have taken have showed some improvements for me, but with Adderall (initially) it was as if the mental restlessness went away. Could the problem be that Adderall and my biochemistry are a bad mix and it should always be avoided by me? I’ve discussed all of this with my doctor, and she said not to rule out Adderall, but to only try it if I feel comfortable. Any thoughts would be helpful.

P.S. I love this site, the film, and the work you are all doing. It is a source of strength, comfort, and important information delivered in a way I can process it and share it with my family.

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[Anonymous]

Hi Pridan,

Many of the psychostimulants can have sudden withdrawal though the long-acting ones, like Adderall XR shouldn’t but that is not always the case. The withdrawal symptoms can be even worse than your pre-morbid state (what you were like before you started the meds) and it is this swinging that leads to the sudden feelings of dread. The best strategy is to add a bit of regular dextro-amphetamine just before the withdrawal and time it so that the active ingredient actually tapers off.

Should you try Adderall XR again? Up to you and your doc but be careful about taking big doses and second doses too far into the afternoon. And remember, no medication is a solution but there to make the lifestyle changes happen.

Always appreciate fans…..spread the word

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[Pridan]

Thank you for your response!

I am taking a different medication right now and doing okay, and I am so appreciative of your detailed response. i think you’ve hit the nail on the head in describing the “feelings of dread.” As I’m sure you have heard thousands of times from adults with ADD/ADHD, it is very difficult to understand what is the medication, the dosage, or the withdrawal. I know it must be difficult to be a doctor and offer your thoughts without having someone as a patient, but it means the world to be able to have a place where I can get information to inform my conversations with my doctor. Thank you.

I’m telling everyone about the site and thank you all for your wonderful work!

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[Anonymous]

Wow… This post REALLY helped me understand what’s been going on with me lately. I also noticed sudden sadness, although not strong enough to make me consider suicide. It was however strong enough to bring me to the edge of crying… at work… yeah, not very professional for a 39 y.o man. I do am an anxious person by nature, but I am far from being depressive; quite the opposite in fact because I always like to laugh and have fun… usually.

I’m actually on Vyvanse 60mg. I noticed that the sadness is bigger if I eat some stimulant food in the morning (coffee, chocolate, etc.). I therefore think it might be that my dosage is too high. I had some Concerta left (45 mg) from my previous prescription so I quit Vyvanse for a few days, taking nothing to kinda “clean-off my body” (OMG… I just forgot how disorganized I am without this stuff). Then I spent a few days on Concerta. No sadness, but way less focus. Pretty hard to balance-off huh?

I will see my psychiatrist next week. @Dr.J. , what are the other medication options that might make sadness less important? Is Atomoxetin acting the same way?

Thanks and kudos for this amazing site!

Improman

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[MarieAngell]

Hey, @improman, everybody’s different. That said, I had a very similar reaction Vyvanse. I stopped and doc switched me to Focalin XR (I take 5 mg), which has worked very well for me.  He also prescribed a non-extended release Focalin (only 2.5 mg for me because more hypes me up too much–I guess I’m sensitive) as needed for an afternoon boost.

As a sidenote, I found that my Focalin XR works better if I take it with food.

There are a lot of different formulations of ADHD meds. It’s a pain to have to experiment, but the right pill makes a big difference.

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[shutterbug55]

@improman

I too was diagnosed late in life with ADHD and Anxiety Disorder. My counselor and I both agreed the anxiety disorder was due to untreated ADHD. I have spent a life time looking over my shoulder, convinced the world is watching and waiting for me to make another one of my numerous and embarrassing screw-ups. It’s enough to give anyone an anxiety disorder.

Thoughts of suicide? Yea. I’ve been in that dark place many times.

I think Adderall was tailor made for my brain, and if they ever pull it off the market, I will have to somehow get a 20 year supply.  I take 5mg twice a day. It is enough to give me the relief from the symptoms I need and quiet the monkey chatter in my head so I can think on the things I need to. It does all of this without side effects.

While on meds, I have not gone to that dark place. My life is no bowl of cherries, but I can deal with the things thrown my way and deal with ADD.

I have posted on this before, and I will try to be brief.

Write notes on the symptoms you most want reduce. Order them by importance. Talk to your doctor about them.

When taking meds, start at the lowest dose possible, to achieve results. Ask your doc about varying the dosage and timing. Learn what works and what doesn’t.

Results will vary. It took me 6 months of experimentation to find the right dose, the right timing and the right drug.

Write down the results. Are you married? Get your spouse on the note writing too. Mine noticed an almost immediate change, when took my first dose of meds. While I did not.

Use the time with your doc to ask questions, and deliver your results. If they are at all good, they will help. If they are a pill-pusher, get a new doc.

 

Hope this helps.

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[shutterbug55]

A couple more things:

My wife had a list of symptoms SHE wanted reduced. A lot of the issues we suffer at the hands of ADD is not so much what is going on internally, but how we affect those around us. I have been fired, laid off, and pushed out of almost every job I have ever had. Last year on meds, I was nominated for employee of the year! You could have knocked me over with feather.

There is no quick fix, but if you work the people around you: the ones who most want to help, the time yous spend dialing in your meds will be greatly reduced.

Hang in there.

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