ADHD medications no longer work. (x-post from Psychiatric Medications)

I'll try to keep this as short as I can.
Since my diagnosis of ADHD Inattentive Type (no hyperactivity) about 3 years ago, I've tried several different medications (Vyvanse, Adderal IR, Adderal XR, and Ritilin). The only ones that are helpful to me are Vyvanse and Adderal IR. For the last year or so, my tolerance to these grew quickly as I found that I metabolized (or something) these drugs very quickly. Vyvanse was only helpful for 5 hours, then 3, etc. My dose has been 70 mg of Vyvanse in the morning and 20 mg of Adderal IR in the afternoon.

For the last few months, the general effectiveness of them has completely diminished. For the last week, I've taken my regular doses and I've felt literally nothing as far as relief goes. I'm foggy headed, scatter brained and lost, and exhausted. I've taken week long breaks from these medications in the last year when my work life allowed it to try to "reset" my tolerance, but I was utterly miserable and unable to function the entire time and the benefits were short lived. I'm afraid I've reached the point where these medicines no longer work and I'm back at square one.

Have you dealt with something like this? Do I have any more options as far as medications go? Any help is much appreciated.

Like I said before, I hope that the people in this forum can give you suggestions but your pdoc is the best bet for changes.

It sounds like it's time to try a medication other than the traditional stimulants. Your options are:

-Intuniv: A blood pressure medication that has been found to help in a small portion of patients with ADD. It stimulates alpha adrenergic receptors in the prefrontal cortex which is thought to help improve inattention.

-Wellbutrin: An antidepressant that inhibits neuronal uptake of norepinephrine and dopamine uptake. It is more energizing than most other antidepressants, so may be "stimulating" for ADD but the exact mechanism for its effect is uncertain (as with many other psychotropic meds!)

-Strattera: strictly indicated for ADD use (for now). Norepinephrine reuptake inhibitor.

best of luck to you! keep us up to date on what your doctor and you decide to do next.

I'm intrigued by Intuniv, but one of my concerns is that it seems to really work for people with hyperactivity because it "mellows" you out. One of the biggest problems I have with Inattentive ADD is that I have the opposite of hyperactivity, I find it hard to move and hard to get going as it is, plus all the other meds that I'm on weighing me down, and I can't afford to be that worn or weighed down since I'm already struggling to find employment that I'm able to handle. I'd be worried that it would just make me more fatigued.

As far as Wellbutrin goes, I was on it about 5 years ago for chronic depression and for anxiety after developing PTSD (before my ADHD diagnosis) and I had horrible effects from it. I was angry and irritable, I had more intrusive thoughts than normal, etc. I'm on an SNRI (Cymbalta) and I noticed a huge improvement after starting it about 8 months ago, but not enough to make me feel like I'd done enough to try since I'm still struggling.

Since Straterra is an NRI, could I take it with Cymbalta? For some reason taking an NRI and SNRI together makes me think I'm going to just fall over from happy chemical overdose (lol, trying to make a joke on a MI forum sucks, sorry). I'm not sure how they interact with each other. I'm also worried about Straterra since I've heard so many bad things, plus watched my fiance go through a real struggle with this medication. I'm worried that if I take this, it will exacerbate my anger/irritation/negative intrusive thoughts and I'll be in a worse place than when I started. I'm just worried about becoming a danger to myself or of losing control for a while (which has happened before when switching meds, I'm pretty stable right now but it can change quickly).

Thanks for your reply!