ADHD medications no longer work.

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.

Does your pdoc know that the meds aren't working very well for you. He/she would know best what to try next but some of the others here might have suggestions.

Yep, she knows about it. I see her once a month, and last time I saw her, about a week ago, we discussed some of my options but she didn't want to give me and definite answers until she had checked some things with my insurance. So, I'm just waiting on that next appointment and I figured I'd try to find some comfort here for a while, just to calm my anxiety about it I guess.

is it ADD. or is ADHD Inattentive Type a different diagnosis?

theres a med thats a long word with "Dexa" at the beginning. it reacts in the same way vyvanse does(but isnt extended release. and also doesnt have vyvanse in it).
have they tried you on two 30mgs of vyvanse in the morning? or 30 and a 40mg? or has it always been just one pill of vyvanse.
also you'll wanna make sure you're eating either right before, during or after you eat. the food will make it last longer in the day. i found that out after many years and a pharmacist said that without eating with it, the body takes it all in at once instead of the extended release method.

have you been able to take a few days to a week break off of these stimulants? it will restart the tolerance once its out of your system and the brain is functioning without the meds.

energy drinks (red bull) can boost mental functions. which is another stimulant.

theres stratterra too (but i wouldnt recommend that one to anyone(a few searches on it and that will likely find those who absolutely love it, and those who absolutely hates it.

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Technically, ADHD Inattentive Type IS the same thing as ADD, but ADD isn't used very often because of how they're classified by DSM 4 (I think, they're both officially called AD/HD). I'll look up the dexa. I can't take two Vyvanse caps during the day because my doctor is positive that my insurance won't cover two doses per day. But I'm already on the highest dose, 70 mg, in the morning so it wouldn't make much difference to just take a 40 and a 30 instead of the 70.

I definitely take it with food. It doesn't suppress my appetite like it used to so I'm just eating normally. I've taken breaks from the stimulants before, but while I wasn't taking them, I was completely non functional and miserable, and my tolerance was back up within 2-3 days of starting up again.

Energy drinks/coffee/caffeine don't touch me, unfortunately. The first time I knew I was dealing with a problem was a day when I woke up at 7, took the 70 mg of Vyvanse, drank a cup of coffee, went to work, drank a RedBull, felt no different so I took the Adderal, and then still had to go out to my car for a nap at about 11:30.

And I've only heard really bad things about Straterra and I watched my fiance go through a really rough struggle when he reacted badly to it. I'm scared to go that route because I just ... don't have time to wait weeks to see if it works, and I'm worried about the effects it will have if it's bad. I have a lot of agitation and anger (some pretty severe mood swings), and that's one of the symptoms that Straterra is known to exacerbate.

Thanks for your input! I'm just really hopeful that something that helps comes up soon.

Has your doctor recommended Magnesium supplements with your meds? I've read it can help reduce the neurotoxicity of stimulants.

Where I am, it's a neurologist that monitors ADHD patients. There's that slight cns risk, makes sense they'd set up their practice, like that.

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They do stop working after a while.

There's a point at which taking stimulants just causes harmful side effects. I think you are at that point, perhaps even past it. I believe it would be a good idea to begin tapering your dose of Vyvanse by ~10mg every two weeks. You can do this by dissolving it in water. Just take a ruler and mark off even segments in mm with permanent marker. As part of preparing to withdrawal from Vyvanse I asked a pharmacist for a uniformly cilendrical bottle for it and got it and one which has marks measuring in ml. Don't do it with the Adderall though; it will only work with vyvanse. I would suggest stopping the adderall altogether.

Recovering from dependance on a drug can be hard, but I honestly believe you may be closer to addiction, or perhaps it is better to describe it as an 'unhealthy psychological reliance'. Your reliance on amphetamines has brought you to a point where on them you are far from functional and off them you are non-functional due to symptoms of withdrawl. Gradually tapering off will make withdrawal less difficult but it will take several weeks after completly discontinuing them before the one can reasonably expect to have recovered from the prolonged stress caused by using so many stimulants.

I also have ADD and was on Addrrall XR (60mg) with Adderrall IR (20mg) and the same thing happened. I know you take Vyvance ER but I don't think Adderall is too different. After a year or so the Adderrall XR stopped working and actually seemed to work in the opposite- I was exhausted all the time and unmotivated. My pdoc stopped the XR and upped my immediate release dosage to about 60 mg a day. It's been great and I like the face that I can manipulate the dosage- I don't always take the full dose since it's split up over the day.

I've heard a lot of people with the inattentive type of ADHD have trouble with the XR versions of these meds, though I don't know why. If I go a day without, I don't have physical withdrawal, but do notice a lack of energy, focus, organization and motivation. But since these are basically symptoms of ADD, maybe they are just more noticeable when there's an alternative to compare it to. Maybe you can talk to your doctor about just taking the Adderrall IR and see how that works.

I think you're correct about a lot of these things- I wouldn't describe it as an addiction but I could easily say there's an issue with dependence. The only thing that confuses me about it is that I don't think I necessarily have withdrawal symptoms because the way I feel without it is the exact same as I felt before I started taking it. Moody, irritable, low functioning status. Do they count as side effects of withdrawal if I had them before I even started the medication?

I have been interested in slowly lowering my dose, I guess I'm just scared and hesitant to. I haven't taken any stimulants for the last two weeks in an attempt to "reset" my tolerance, and today has been my first day back on them, and I didn't take a full dose. Taking tolerance breaks in the past have been a little helpful, but my tolerance is usually back within 2-3 days. I'm on the right track with lowering it, though. I think I'll start lowering this way; I only took about half of a Vyvanse 70 today, about 4 hours ago, and I noticed my energy and concentration were immediately effected, much more than they would've been two weeks ago. If I can keep doing this, taking a half dose, or quarter, etc., and it seems to work pretty well, I should be able to sustain through this month without ending up on 70 mg/day. Of course, medication is always an adventure so there's no telling what will happen in the next few days/weeks.

Thanks for your input, sorry for writing a novel back to you!

It is probably dexmethylphenidate (trade-names include Focalin and Attenade).

It may be worth discussing with your psychiatrist.

here is another dexo
Dextroamphetamine (Dexedrine)

I am taking a break from stimulants, because I realized that when I was NOT on them I was SO tired, and more depressed. It was withdrawel. It took a few weeks to clear it out of my system.

I'm working through some non-stimulants which I am not very sure if they do anything at all.

I am also ADHD Inattentive Type.

I have been on both immediate release and extended release Adderall for over 7 years now. I have found my tolerance level has increased and I no longer get much benefit from taking the medication. ( BOO)