Stimulant Dosages and the Honeymoon Period | ADHD | Episode 35
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- Опубліковано 9 лип 2024
- Some people never recapture all of the initial benefits of their treatment with stimulants (the honeymoon period). Rather than fixating on dosages, focus on what is working for you.
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I very much enjoyed the first 13 seconds.
This is the perfect opportunity for a "that's what she said" joke.
Started 30mg Vyvanse and moved up to 40mg after a month. Been here ever since.
In my experience, I think it's important to differentiate the symptom relief from that inevitable "euphoria" from the amphetamine. You shouldn't really be looking to "feel" the medicine, or chasing that euphoria. Even though you may not feel it, it's still working.
I'd recommend to anyone to judge the medicines efficacy on how it addresses your symptoms. Not how you feel.
That's reasonable advice, but for many people it is hard to separate the two. If you feel better, you're likely to judge that everything is better.
I don't care about feeling high. In the beginning of taking Concerta, I could think so much more clearly and actually make long term plans, which usually feels next to impossible due to my brain fog. I was also much less overwhelmed by tasks I needed to do.
2 months in, and I feel like I get only 20% of the benefits. I know I could function much better but can't get there, which is haunting.
Why is feeling good-Euphoria being deemed bad!? Euphoria literally means to feel normal, to feel good. Why would that ever be bad? or an undesired symptom of medication!? I don’t understand why anyone would think that feeling good is bad..if taking drugs helps someone to function & feel good, seems thats EXACTLY the ideal desired! Thats why Pharmacology exists…to help people with living life & having some happiness prior to a brutal pain-filled death..
Regardless of whether ADD/ADHD people need assistance focussing if part of the medication provides a feeling of mild happiness..what in gods name is bad or wrong with that!? Life is HARD enough as it is! Anhedonia is a very real illness. Some people cant form natural Endorphins…so they need pharmacological help.
Not everyone is born into ideal home environment. The “Nuclear family” atomized decades ago. Drugs are often the one thing keeping people from offing themselves or offing others…
@BushyHairedStranger Because that euphoric feeling is temporary. Your body adjusts, you get used to the medicine, so that "up" feeling fades over time.
You could choose to go up in dose, but then you're just chasing a high and not trying to eleveate symptoms. And even then you'll soon reach the maximum dose that a doctor would feel comfortable prescribing. Then what?
You want a temporary high then sure, go down the block and get whatever off the street drug you want. But that's not sustainable.
@@jrod7929 In place of useless increases in dosage why not prescribe the appropriate medication for the appropriate reason? Example; Vyvanse or Nuvigil for patients who want a medication that provides focus without euphoria. If a patient just wants to feel good-euphoria then prescribe them Desoxyn which provides plenty of Euphoria and it does this at very low doses like 1-2mg up to 5mg. No patient should EVER be told to “go down the block and get whatever off the street drug you want”…saying that speaks volumes & not in any good way.
The War on Drugs could end if the DEA was defunded & the privacy between Doctors & Patients were restored.
another spot-on topic, dr.! i am so grateful for having any honeymoon period; it was truly an emancipation, but short lived. i found i had to taper down (from only 10mgs of adderall) because i became irritated. now, i have NASH liver issues, and from hearing you (i think) perhaps my blood levels(for want) were the culprit...i wonder, as i really miss the stimulant plus antidepressant combo. just putting this out there in case anyone else can relate!
Thanks for the feedback. I hope that your health recovers.
Thank you Dr John - really enjoyed this video, it's so hard to find any good information on tolerance. Really enjoyed hearing the data from your practice regarding stability of dose over time. You mentioned a time period of a year or more. However, I'm curious as to your experience with long term use, say 10 or even 20 years or more? A lot of people of forums talk about the medication stopping working after 4 or so years. I would love to hear your thoughts on this. Again, very much appreciated this!! James
I’ve been taking 20mg bid from 10mg (10mg only worked for the first hour of taking it for 6 days and couldn’t focus on my programming intern assignments still so my psychiatrist bumped me to 20mg bid) for the last 5 days. The euphoric feeling was prominent the first few days. Today and yesterday didn’t feel like that. However, the first few days, one was enough. Started to get the crash about 4 and half hours later. Started taking the second dose. The first day I took it, it sort of felt euphoric, but the second day, it didn’t, but I still felt focused.
With that said, the second dose feels way more effective and I feel more focus than the first dose. My psychiatrist said I can play around with my dosage, but I haven’t yet because I’m afraid of tolerance or going up too fast.
I have little to no negative side effects on my amphetamines outside a slight dried mouth.
I see him soon, but I was thinking maybe I should have a higher dose in the morning but my second dose should be lower so I can maintain my baseline. Of course even with my psychiatrists support in playing with the dosage to see what works, I don’t feel comfortable until I lay out my experiences and get their opinion. I’ve been seeing him weekly for the last 2 weeks, tomorrow will be my 3rd week since diagnosed and medicated (27 yo)
I keep trying to read up on how a consistently medicated person after years feel because I’m not sure if it feels more passive down the line or they’re still able to tell the difference when it hits. What are your thoughts? Do I gauge the dose as the right dose if I’m no longer feeling the euphoric feeling, but maintain the awareness of the focus with little to no side effect? Today was the first day I really put it to the test when after work (came home early) , when I wanted to do nothing, I took my second dose after feeling the crash and eventually got this focus and was able to do what I needed/wanted to do but didn’t have the focus and or tore down the wall of avoidance procrastination i have
As the video explains, many people get a more robust effect from stimulants in the first few weeks than they ever get again. Part of getting more benefit from the second dose probably reflects that at least some of the first dose is still in your body, so you are getting essentially a larger dose. There could also be some circadian rhythm effects, because alertness and other aspects of brain function fluctuate in moderately reliable ways across the day. If side effects are minimal, and there is room for more benefit, most experts would encourage going up on the dose, rather than undertreating.
@@dr.johnkruse6708 Oh sorry, when I was explaining the euphoric part, I meant it in a way that I'm aware of it that it exists, it's something I get past and looking for what works the best with minimal negative side effects.
I think I will try 25mg and see how that feels. If still no negative side effects, try 30mg. I won't experiment past 30 since I think 60mg is the the max daily for prescribed amphetamine medication. With that said, do you think my second does should be cut in half? for a 30-15-0 or even 3 times a day if needed in a 30-15-15? sometimes i still want to get things done but by the time i get home, the crash from the second dose is coming and its hard to not want to just do minimal things. So this could let me ride it out without a huge peak and still recover from the crash while maintaining focus if i need it for after work things like chores or at home work.
Great video !
I'm glad that you found something useful.
Informative and nuanced. I appreciate this information, as it fills some holes in what I've wanted to learn for a while. I still see doctors and psychiatrists in person and on UA-cam that hold differing opinions on the "tolerance" effect (ie, whether or not to take drug holidays), but I haven't been able to see from any other source the specific idea of tolerance as it is linked to euphoria vs cognitive benefits of various stimulants. I would REALLY like to see all of these doctors in the same room (along with a bunch of researchers and the existing data that they have), and I would like to lock the door until we can release a heavily nuanced statement that relays the exact state-of-the-art information about how this issue should be viewed both from a research level and from an anecdotal level.
I guess you could say that what I am trying to do with these videos is provide my distillation of the good work out there, while acknowledging what isn't known, along with what my own biases are. But even if we could come up with a nuanced set of general statements, we would still need to translate what that means for each individual.
great episode on the topic. a bit confusing the bit on the receptors, it seems like a particular dose should result in less signaling after the receptors down regulate after exposure to higher dopamine than is 'usual'. but you seem to say that the same dose could result in similar signaling because the downstream receptors upgrade?
I hope I wasn't being too confusing. Some of the comparisons were between the unmedicated state and the medicated state, and the expectation is that more dopamine is released in the medicated state. If receptors down regulate, as commonly seems to occur, and as you suggest, then the net effect could be more, less or equal to the pre-medicated state, depending on the extent of downregulation.
Dosing and medication-finding out of the big 6 are a big part of the most pressing issues in adhd treatment.
Its so insanely easy to leave people without treatment or shitty treatment.
I wonder how bad it can get before regulatory body’s acknowledge there is a problem. At least switzerland basel. But since the information is also lacking big time im pretty sure it is like that almost everywhere. Seems most people dont think it has to be fine tuned like glasses 👓 are. I mean the brain is way less important than if you can see farther or closer without truble.🙄
Most of the medical system in America doesn't provide doctors with sufficient time to listen to patients and to tell them everything they need to know. Although I did some research in Basel thirty years ago (and loved living there), I didn't get to see the clinical side of care there, and don't know how much it might have changed over the years.
I’ve been on vyvanse fir 2 months, I’m now on 50mg after starting on 40mg, I’ve been on 50 mg fir 2 weeks and it’s already starting to wear off at 2:30-3pm, I usually leave fir work around 6:30am and get home between 5-6-7pm.
I was on dex for 2 months before that and it just seems that I get used to whatever dose I’m prescribed and when it wears off it causes so many problems, what’s worse is getting my psychiatrist to increase my dose is like pulling teeth.
My own experience is that most people can find a stable dose for their ADHD after an initial few weeks or months of adjustment, and that they continue to obtain benefits in the long run from that dose. Many doctors are wary of increasing the dose of a stimulant medication, so I am glad that you are being persistent in working with your psychiatrist. Some of the early afternoon wearing off may be more related to siesta time/circadian rhythm effects (I have video about that) than that the Vyvanse has worn off, since it should still be releasing considerably amounts of medication for at least twelve hours.
I also had that issue, it got fixed by taking half the dose in the morning and the other half early afternoon
Is medication usually taken every day during the titration period? If it were not, would it have any effect on the long-term down-regulation of the receptors?
Usually the recommendation is for every day. More consistent usage is usually associated with the potential for greater down regulation.
What is considered a BIG dose? and is there a blood plasma peak & trough test to support or disprove need for big doses?
I encourage people to not focus on the milligrams but to pay attention to the physiologic and mental effects. A big dose/too much is what makes you feel agitated, restless, increases blood pressure to high or causes other signs of body tension. Some people get genetic testing to demonstrate that they are rapid metabolizers to convince insurance companies that higher than normal doses are reasonable for them. Assays of stimulant levels in the blood can be ordered, but usually these are just taken a few hours after dosing to confirm or refute whether blood levels are within an expected range.
@@dr.johnkruse6708 I assume you
mean a peak & trough blood plasma assay?