"Adderall Crash"

[romanticscience]

I have become suspicious nowadays of some of my patients' experiences, especially the ones with risks for somatization--dissociation who are very suggestible. Especially after reading the following:

Yeung, A., Ng, E., & Abi-Jaoude, E. (2022). TikTok and attention-deficit/hyperactivity disorder: a cross-sectional study of social media content quality. The Canadian Journal of Psychiatry, 67(12), 899-906.

Now, people have been telling me about their late afternoon "crash." I see ads on social media for remedies for this. I get amphetamine withdrawl and the potential masking of sleep deprivation with stimulants. But what about people who consistently take long-acting stimulants for 5+ half-lives?

Curious about others' experiences and remedies. Thanks!

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[annoyedpsychiatrist]

People also commonly confuse the intended result of stimulants and judge how well its working based on how their mood/energy levels, rather than their concentration/focus, as that part becomes more subjective and they sometimes miss that. Plus like you said, a lot of these often have sleep issues.

Tik tok has made ADHD more unpleasant to treat. Everyone has decided that subjectively reduced attention=ADHD. Or it just normalized stimulants to the point that people feel more comfortable seeking out performance enhancers.

 

[allantois]

ADHD adds on Tik Tok are cringe and also probably why we are in a stimulant shortage. I've now seen a few patients from those platforms misdiagnosed as ADHD (some depression, some bipolar and very obviously so). The FNPs they hire are woefully incompetent. The only saving grace is that pharmacists are starting to refuse to fill controlled meds from those platforms.

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"1 minute online assessment" and "30 minute appointment" Stahl is on advisory board..

 

[clausewitz2]

"1 minute online assessment" and "30 minute appointment" Stahl is on advisory board..

Has that man ever met an honorarium he didn't like?

 

[SmallBird]

I only prescribe once daily long acting stimulants. I realize that may seem concrete, but by making it a rule it avoids validating the notion that the point of medication is to feel exactly the way we want for just as long as we want. Of course now they can just go somewhere else anyway.

 

[Merovinge]

I only prescribe once daily long acting stimulants. I realize that may seem concrete, but by making it a rule it avoids validating the notion that the point of medication is to feel exactly the way we want for just as long as we want. Of course now they can just go somewhere else anyway.

Even though I all about individualization of treatment planning, I think this approach makes far more sense than the insanity of Adderall IR 30mg TID that is running rampant in more recent times. I think 90% of cases are best practice managed by ER/Vyvanse/Concerta formulations and if you need a low dose of PRN IR that can be reasonable.

I will say now that I do more SUD specialized treatment, I have had 95% of psychostimulant abuse cases be on Adderall IR. I think the people pumping this into the system either A) Don't know (FNP at age 23 out of training etc., don't believe that psychostimulant use disorders are a problem) or B) Don't care and just want more money or less headache.

 

[Candidate2017]

Who doesn't get sleepy during afternoon siesta time? Tell your patients that if Adderall is causing them to crash, then clearly they shouldn't take Adderall. Sit back and enjoy the lolz.

Even though I all about individualization of treatment planning, I think this approach makes far more sense than the insanity of Adderall IR 30mg TID that is running rampant in more recent times.

It's not insane at all. It makes perfect sense to me why someone would take Addy IR 30 mg TID. But yeah, whoever prescribing it might be insane. Or maybe just $$$$.

 

[Liquid8]

I will usually discuss the expectations regarding mood and function from the outset – i.e. increased mood may occur, but this goes away after a while and "not feeling it" won’t be a reason to increase the dose.

With crashes, it depends on the timing. If it is reported between dosages, then either increasing the dose or reducing time between doses can be considered. But it has to be within reason. If I hear that the medication runs out after a very short period (eg. 2 hours or less), then I’ll recommend a long acting or alternative option instead. Have found that most patients are quite reasonable and will accept that it’s more suitable and convenient to take one LA over Dex or Ritalin 2 hourly. The ones who are just after a short acting hit tend to be a lot more reluctant.

If the crash happens at the end of the day, then it’s useful to highlight what’s been achieved before that as it’s normal to feel tired at the end of a long day.