Adderall is a life changer for many people,
but it can be a double-edged sword for those with ADHD
who look forward to feeling like
they have a normally functioning brain while they're on it
but then dread the emotional crash and burn
that comes later when the drug wears off.
What makes that happen? That's what I'm talking about today.
(keyboard clacking) I'm Dr. Tracey Marks,
a psychiatrist, and I make mental health education videos.
Adderall is a prescription stimulant medication
that treats attention deficit hyperactivity disorder, ADHD,
in children and adults, and it also treats narcolepsy.
It's made up of a mixture of two drugs,
amphetamine and dextroamphetamine.
Adderall acts by increasing dopamine
and norepinephrine in parts of the brain
that control attention, focus, motivation,
and impulse control.
The emotional crash that some people experience
after taking Adderall is referred to as a comedown
by some people, and it's a withdrawal effect.
It's a response that your body and brain have
to declining levels of dopamine and norepinephrine.
Some people experience it intensely,
while others hardly notice, and even if you hardly notice,
you may notice that your focus level has decreased
and maybe you're more distractable and less productive,
but those changes aren't as dramatic or negative for you.
Some of the things that you can experience
with the more dramatic withdrawal effect
is depressed mood, hopelessness, irritability,
extreme fatigue like you can't move
or get off the couch or out of the bed.
You can have trouble sleeping,
even if you feel physically tired.
You can also feel very anxious and nauseous.
Some people, because of the anxiety or depressed mood,
want to isolate and not talk to people.
I've had patients say that they feel like they can't speak.
Now, literally, they can speak,
but it's like this weird social shutdown feeling
where you just have nothing to say.
If someone asks you questions,
you maybe answer them with one or two words.
How long this effect lasts depends on the person
and how often you take the medication.
For some people, they can feel better the next day,
maybe not back to their baseline, but better,
while others may need a day or two
to feel back to their usual self.
The low mood, asocial feeling
(clock ticking) may even take days or weeks
to resolve after you've stopped taking the medication.
What are some of the factors that affect
whether this happens to you?
It could be the dose.
This tends to happen with higher doses of the medication.
The recommended maximum dose of Adderall
is 60 milligrams for the whole day, but unfortunately,
most people develop a tolerance to Adderall
and any of the stimulants for that matter,
and then if you've been taking it for years,
it's not hard to max out.
Your doctor can switch you to a different medication
or some people will end up with really high doses
if their doctor continues to increase the medication.
Another factor is immediate release versus extended release.
Immediate release stimulants
tend to only last between three to four hours,
requiring you to take it twice a day
to get through a full eight-hour day.
The stimulant comedown is affected by the slope
of the activity curve.
Immediate release drugs reach their peak faster
and drop off faster, whereas extended release Adderall
is supposed to last between six to eight hours,
so its curve is not as steep,
giving you a smooth on and a smooth off.
So for example, let's say you take Adderall,
60 milligrams a day.
If you take the immediate release,
you'll take 30 milligrams in the morning,
and then three to four hours later,
you may start to feel it wear off,
so then you take another 30 milligrams midday
to get through the rest of the afternoon.
If you take extended release,
you would take 60 milligrams all at once in the morning,
but because of the slow release mechanism,
your body only sees 30 milligrams over the course of the day
until it finally wears off around six to eight hours later.
Now, some people can still feel a crash
when the extended release wears off,
but the effect tends to be less dramatic.
A third factor that I'll mention is lifestyle.
Your sleep habits, level of physical activity,
and fluid intake can also negatively impact
the way you feel when Adderall wears off.
Now, I'm focusing on Adderall,
which is an amphetamine stimulant,
but what about the methylphenidate stimulants like Ritalin?
Withdrawal can happen with any of the stimulants
but tends to be more intense with the amphetamines.
The reason is because of the difference between
how amphetamines and methylphenidate work
to increase the brain chemicals.
Adderall increases dopamine and norepinephrine
by pumping more of these neurotransmitters
into the nerve synapse,
which is the space in between the nerves,
whereas methylphenidate increases dopamine
and norepinephrine by preventing reuptake
of these transmitters.
What that means in practice is that you get
a lot more dopamine and norepinephrine pushed out
into the brain from Adderall than from Ritalin.
(bell chiming)
Does this make Adderall a better drug?
Yes and no, depending on the person.
Adderall may be considered more potent and effective
at giving you more of the chemicals
that help you focus and function,
but it may not be the best choice
for someone who has other medical conditions
that can be aggravated by these high levels
of dopamine and norepinephrine.
Some examples of these conditions are bipolar disorder,
schizophrenia and anxiety.
All of these conditions can be worsened by stimulants.
So I call methylphenidate a kindler gentler stimulant.
It's still effective and there are some people
who respond better to it, but what I've also seen
is that Adderall and other amphetamines have a tendency
to cause more overstimulation than Ritalin
or the other methylphenidate medications.
(suspenseful music) So if you're prone to anxiety
or prone to the physical effects of being stimulated,
like increased heart rate or increased blood pressure,
then methylphenidate may be a better choice
from a tolerability perspective.
What can you do to help this problem?
The first thing is to make sure
that you're taking the medication as directed.
I mentioned taking it twice a day for an eight-hour day,
but what if you work a 10-hour day
or what if you're a student who has morning classes
or morning work and then a 7:00 PM class?
In this case, you're going to want coverage for the entire day
and part of the way into the evening.
To make this happen, it's tempting to take
an extra third dose in the early evening
so that maybe you end up taking, like,
90 milligrams for the whole day.
This is easy to do without running out of your pills
if you usually skip pills on the weekends,
but 90 milligrams a day is a high daily dose.
Your body doesn't give you credit
for skipping a pill or two later in the week,
and when you come down off of that 90 milligrams,
you're more likely to have some of these negative effects.
You may say.
- [Narrator] Well, what am I supposed to do
if I have a 16-hour day?
- I say you have to adjust your expectations
about how efficient you should be for 16 hours.
(bell chiming) No one is supposed to be
at top form for 16 hours straight.
(uplifting music) Our brains aren't designed
to work intensely for that long.
Everyone has a comedown at the end of the day
in preparation for rest.
If you're defying that by doing high intensity mental tasks
in the evenings after you've also worked all day,
just know that you're not going to be very good at it,
and if you force high performance
by taking more medication to keep you sharp,
it may work in the short run,
but you're setting yourself up
to burn out (explosion booming)
because you're pushing your mind past its normal capacity.
So if you take classes that span an entire day
with gaps in the day or you work and then take classes,
pick a chunk of the day that you feel you can manage
without the medication.
Maybe you take it early for an 8:00 AM class
and then wait until later in the afternoon
to take the other dose.
Better yet, try to work within your limitations.
Appreciate that you've got eight good hours to work with.
Then shift the important mentally intensive activities
to the times that you're normally at your best.
If you're a morning person, start early and end early,
or if you're more of an evening person,
don't expect to get rolling until late morning or midday.
You're not going to be able to be razor sharp
and pumping out work for 12 or more uninterrupted hours.
No one can do that effectively and consistently
without some kind of performance enhancement.
The other thing to focus on
to help mitigate the stimulant comedown
is to optimize four things:
sleep, fluids, diet, and exercise.
These all sound very basic, but they matter.
I know that ADHD all by itself can cause sleep problems.
So in this case, if that's the problem,
if that happens to you, optimizing your sleep
may be asking your doctor for a sleep aid
to help you fall asleep at a time
that allows you to get seven to nine hours of sleep.
It also means not taking your medication too late
so that it doesn't interfere with falling asleep.
I usually recommend (keyboard clacking)
to my patients not to take their second dose
after two or three o'clock
for someone wanting to go to bed by 10 or 11.
If you get a sleep aid,
you still need to stop the Adderall early.
You don't want to take Adderall at 9:00 PM
to get in one more hour of work
then take a sleeping pill at 11:00 PM.
(silly music) The sleeping pill probably
wouldn't work anyway.
You also want to stay hydrated.
If you don't have medical problems
that affect your fluid balance,
like kidney or heart disease,
a typical recommendation is drinking half of
your body weight in pounds converted to ounces.
So if you weigh 150 pounds,
you would drink 75 ounces of water a day.
As for diet, you want to make sure you're eating
as much unprocessed food as possible.
Why?
Because when foods are heavily processed, like potato chips,
important nutrients from the original whole food are removed
and replaced with artificial ingredients and additives.
You want to fill your diet with vegetables,
grains, if you can tolerate them,
and healthy fats to maximize your intake
of omega-3 fatty acids and antioxidants.
Standard exercise recommendations are getting 150 minutes
of moderate intensity exercise a week
or 75 minutes of high intensity exercise.
Exercise has an antidepressant effect
that can help offset the stimulant crash.
If you want to know more about how exercise helps depression,
watch this video.
Thanks for watching today. See you next time.