[jobu]

As the parent of a child with ADHD that is medicated, it seems completely plausible that it could cause depression. When my kid has had too high a dosage (or accidentally takes a double dose) she's like a zombie, completely flat affect, and very little motivation. It's like it drains her life away.

Part of the problem is that it's very difficult to get the right dosage for any given day because diet, metabolism, and hormones seem to have a big impact on how effective it is. We've found it's better to go with a lower-dose extended release, and then let her self-medicate with 5mg regular tablets as needed. This works great now because she's a fairly responsible teenager (when medicated), but it was really hard when she was younger.

[falcolas]

Extended release (XR) is very nice, since it avoids the dopamine peaks and valleys caused by individual doses. I will say, generic XR is usually pretty crappy, since it basically breaks the dose into two parts. Name brand XR is better because they construct the pill to where there is an actual extended release. Which sucks, because it's super expensive as a result.

What I do instead is two lower-dose XR pills per day. The four hits over about 8 hours seems to work pretty well for me.

[connicpu]

Extended release on the lower end of dosage + self-medicating with caffeine as a booster has been my go-to for about 15 years now. As an adult who's been taking it since middle school I can say that, while it's had its ups and downs, overall life is better with it than the times I've had to go without due to insurance disruptions or moving and having to find a new doctor who will prescribe it.

[mesh472]

This has been my experience almost exactly. Low dose XR + controlled caffeine usage. Been about 3 years for me now.

[krono]

I share this experience myself, in particular the dosage not providing a consistent effect day to day - every specialist I've spoken has told me this is weird and shouldn't be happening and yet it is so. Switching to staged release medication (Medikinet CR) has helped me too.

Unfortunately extended release Methylphenidate of any kind/brand is only partially covered by Dutch health insurance[1], and I'm certain the cost is prohibitive for people who might be less well off.

1: In essence, the government has determined that all Methylphenidate variants are equal, and so you can just take the cheapest instant release variant or else pay the difference out of your own pocket.

[nobodyandproud]

I take phentermine (another legal amphetamine; partial doses), and this doesn’t surprise me at all.

The bipolar-level manic highs and depression/lows are very real.

The feelings of suicide and hopelessness creep up; I have enough personal awareness and grit to ignore it but it feels awful.

To avoid that creep-up, the best thing I found is to have “break” days at least once or twice a week. That is, no pills.

I doubt your daughter or others with ADHD have that luxury though.

[mrtranscendence]

I’ll be honest, I’ve been on adderall (with occasional periods off the drug) for almost 20 years now, and I’ve never experienced anything remotely approaching mania or severe depression (as distinguished from rare bouts of sadness). And I’ve not always been the most careful taker of the medication, frequently alternating between taking too much or lowering my dose.

I’m not saying it’s not possible to have those side effects, I just haven’t experienced them.

[aidenn0]

Everyone is certainly different; I know people on Adderall (or Vyvanse, which is similar) that have great outcomes, but Adderall gives me manic episodes, raises my resting heart rate by 20bpm, prevents me from sleeping, and causes mild hallucinations. I took it exactly once. Vyvanse had the same side-effects, but much milder and it lasted longer. I ended up on Focalin, which works and the only side effect is mild interference with my sleep.

[jobu]

> The bipolar-level manic highs and depression/lows are very real.

I've had to be very careful about NOT using those terms when talking to doctors and psychiatrists. As a layperson that description seems to fit, but it causes huge red flags for medical professionals and they freak out, resulting unnecessary tests and evaluations for my kid.

The key term for the "manic" phase after the meds wear off is "Rebound Effect". Also when the dose is too high the generally accepted term is "zombie mode" or "zombie-like". Calling it an "overdose" will really cause people to freak the fuck out.

[andybak]

There's big differences between drugs in the same family. Personally speaking Methylphenidate is much less intense and easier to fit into my normal life than the Lisdexamfetamine (which are probably closer to phentermine)

[adastra22]

What is she taking?

[jobu]

It's changed a few times over the years because of insurance, but right now it's Focalin XR and 5mg Ritalin as needed up to 2 times a day.

[adastra22]

Thanks!

[swayvil]

If a double dose noticably zombifies then a single dose must zombify too, just unnoticably.

Surely any zombie is too much zombie.

[mrtranscendence]

That’s not true. For example, a lot of Benadryl will make you hallucinate, but that doesn’t mean a normal dose will make you hallucinate a small amount.

Getting horribly fall down drunk as a teenager caused me to shit my pants once. But I didn’t so much as fart when I got tipsy on vacation recently.

[swayvil]

I wouldn't bet on that. It's far from a sure thing and the price of losing is too great.

[danShumway]

I would absolutely be willing to bet that a small dose of Benadryl won't make someone hallucinate "a small amount".

Put it another way if makes you feel better -- a little bit of D3 via direct sunlight and D3 rich foods will improve your mood and health outcomes in a variety of ways. An excessive amount of D3 will give you kidney stones and harm your bones.

[swayvil]

Would you notice it if you became slowly, progressively, stupider over several years? Maybe, maybe not.

[danShumway]

This is mostly just scaremongering, but even if I had a noticeable drop in intelligence from taking medication over multiple years, gaining the ability to actually schedule appointments in a calendar, to do focused research on topics that I'm interested in, and to build productive habits like eating regularly, exercising daily, and daily practicing skills I wanted to improve at -- would more than offset the downside.

It's one thing to be worried about subtle effects from medication, but I already know what the long term health and brain effects are from constant insomnia and regularly forgetting to eat. Neither of those are good for brain function.

So yeah, seems like a pretty reasonable risk to take, particularly given the fact that I have a psychiatrist, therapist, and multiple friends and family monitoring me.

Let me flip the question back to you. Would you notice if D3 or iron or protein intake was subtly harming you over the course of multiple years? Is that something that terrifies you?