I don’t either. If I took a super high dose I’d feel out of my mind and riddled with anxiety. I know people who abuse them, like 100-120mgs of adderall a day until they are out, and they claim to say it’s amazing. One said it’s the best thing ever. I could never.
@@grapelights all wired differently. Some like uppers some like downers. Yes some amphetamines in high dose can even be more euphoric than heroin for some.
Thanks for covering the topic Dr. Kruse! I was diagnosed with Methamphetamine use disorder and ADHD later in life and have since been taking 300 XL of Bupropion and 40 mg X2 a day for a total of 80 mg of Vyvanse daily. This has been tremendously helpful in curtailing my use of methamphetamine without affecting any of the positive effects such as the ability to focus and remain productive throughout the day. They have not had negative side effects such as causing psychosis and insomnia though by the end of the day I am tired (feeling a slight crash) and ready to sleep. Therefore, I'm in support of the use of Bupropion and Vyvanse in treatment (harm reduction/replacement) for people who use methamphetamines.
I can really relate to what you are saying here. I have the same issue. Sometimes i had the same issue with red wine. It would...loosen the noose so to speak. It helped. But at a high cost. I have Wellbutrin in my drawer...but i haven't used it in ages. Maybe I should reconsider it. I told my doc about my rampant vyvanse abuse and I lost the rights to it as a result. I wonder now if that was a mistake or a lifesaving intervention.
I'm curious if you have any information on modafinil and ADHD. In terms of effectiveness, side effects, contrast vs concerta. Also any reason why concerta or other stimulants change body oder?
Hey! Dr.Kruse does have a video on the subject of Modafinil, it's called: ''Modafinil: The Non-Stimulant Stimulant'' He also a medium article on the subject, but it requires a paid membership for full article access, called: ''Should We Use More Modafinil, the Non-Stimulant Stimulant?'' Have a good one!
I'm not aware of (but there may be) research on the odor question. I've seen speculation about how these drugs can change hormonal status, hydration, and even the microbiome of the gut and skin, all of which could change body odor.
Dr Russell Barkley does the same topic of Psychosis and high amphetamine usage, regarding the same study.....but they are working backwards in the study....these are people who are severely Damaged individuals and consequently they were on the most medication........
I am apparently on a high dose (i noticed when first going to get my meds at my regular pharmacy, her reaction).. late diagnosed ADD adult at 45yo... i take 30mg Ritalin in the morning and 20mg again in the afternoon... life is so much less chaotic!!
Been a while since I did the math, but you have to compare the entire salts. For dexamphetamine sulfate vs. lisdexamfetamine dimesylate, it's more like 40% by weight. Also, as you discuss, absorption differs, and.lisdex less affected by pH. Ultimately, I think you're very clearly right. It would be charitable to even call the guidelines seat-of-the-pants. Edit: at 36 minutes you do give the number, from the paper, as 40% dextro. With Adderall, I guess 30% is about right since it's plausible levoamph is not clinically relevant.
You're cooking with the analogies. I think ADHD people are like the turbocharged gasoline 4-cylinder, needing to get way high up in the RPM range to do real work, but when they do, can kill it. Normals are like the inline-6 turbodiesel, and have enough torque to just lug through the sticking points.
May I ask what’s the risks for going back and forth between 5 mg and 7.5 mg of Dextroamphetamine on a daily basis? For example, taking 5 mg one day and 7.5 mg the next day, then 5 mg again. My doing drug titration and I’m not sure what I’m doing. Some days I feel I would be ok on 5 mg and some days I feel I’m struggling more and 7.5 mg would works better. Is this an acceptable use of the medication? If not, what would you recommend? I don’t take my medication daily, only on weekdays (when I do remember) to work.
I can't make individual recommendations, but I would say this situation could be described as someone who alternates between days of 0, 5 mg and 7.5 mg dextroamphetamine. If varying between 0 and 5 is okay, why would the variation between 5 and 7.5 mg be problematic. Adjusting dosage to meet symptoms at that time sounds like a generally appropriate medical principle.
I’m on up to 6 a day 5mg .. and was told to take days off .. I’m an ex heroin addict .. But it’s helped me stop vaping and craving cannabis .. But I can’t seem to take those days off because I’m afraid of crashing and losing motivation ..EVEN though they lose the motivational effect within two -3 days .. I’m also on Mirtazipine at night .. I need to follow advice of my psychiatrist .. and I’ve come to the realisation after a year that I have TO DO this right !I am getting really tired and losing energy .. I have innaetentive ADHD
Yes, it sounds like there is a lot to discuss with your psychiatrist. Including the possibility that a long acting version may place you at less risk of relapse/addiction than frequent immediate release doses.
@@DrJohnKrusewhat are the longer release medications Is vyvanse considered o her acting We are in a very tough position with my son he’s 24 diagnosed at 19 with adhd inattentive though at that same time he was heavily using high thc cannabis and a year and a half later into a cannabis induced psychosis bc he tested positive for amphetamine bc of Vyvansse so had amphetamine induced psychosis too We don’t know what part vyvanse played in the psychotic break they believe there is a chance he had emerging bipolar not adhd and that’s why he looked adhd and also why he medicated with cannabis Pro Jeb we face is bc he has a bipolar 1 with psychotic features diagnosis no Dr feels it’s sage for him to ever be on a Ashdod stim again that it will quickly trigger psychosis again But at same time he’s craving and downing energy drinks pre workout coffee I feel if he was on a low dose stimulant it was curb those cravings for highs through energy drinks which are terrible and also has relapsed to thc today I feel abilify plus low dose vyvanse or Ritalin pike work better he is on 300 Wellbutrin not making a dent
Can I ask how a gastric bypass effect intakes of stimulants? 36 mg concerta, and I feel nothing at all. My md is afraid to give a higher dosage. And I think it's a total waste of time and money.
@@ladyoftheflowers9781 actually, the literature is quite consistent that amphetamine (Adderall) is more effective than methylphenidate (Ritalin) in both children and adults. But children tend to have more problematic side effects from Adderall, so the cost/benefit analysis has been to recommend Ritalin as the first choice stimulant for children, and amphetamine products in adults.
Can you expand on why you "detest" the language the FDA is using in regard to higher doses of ADHD stimulants? Words like "licensed" and "unlicensed" strike me as having incredibly neutral connotations to me.
License has the strong implication of legal. You need a license to operate a car, and you're breaking the law if you drive without one. This wording implies that doctors are breaking a law by prescribing outside of the recommended range.
I found 20mg and 60mg of vyvanse helpful and all the other doses annoying and disruptive. Obviously 60 worked better than 20, but it's interesting that 30, 40, 50 and 70 were terrible in different ways. I am giving atomoxitine great and am side effect free, apart from a bit of nausea
Big false assumption with the "start low, then go high" approach. What makes you think you could find a provider to give you another appointment after only three days? Also, people need to "know it works" - especially adults. You can also titrate down, and many adults with ADHD do just that.
I may not have been clear enough in what I was saying. It was start low, and then go (fast) not high. As opposed to start low and go slow for most medications. Step up rapidly every few days if you're getting inadequate benefits. Most people will pretty quickly see that it works. A prescriber and patient can have an informed discussion regarding titrating the dose upwards every three days, depending on benefits and side effects, and can meet back in two weeks to report back where they are regarding dose at that point. If the patient is unfamiliar with stimulants I would never start with a big dose, and plan on backing down, because the risk of causing panic attacks or other averse effects that would make them avoid medications in the future is too high.
I was on one low dose for 3 days to have time to adjust to the side effects. The first time I took vyvanse I felt calm for the first time in my life and managed to clean up without getting stressed or overwhelmed, then I didn't sleep for 35 hours and wasn't tired. Turns out I metabolise it very slowly and even if I take it at 6am I'm still feeling the effects at 12pm. The point is you start low because if you can't tolerate a little you won't tolerate a lt, and starting low gives you a chance to adjust, it stopped causing insomnia after a while I didn't need a seperate appointment. I was given a prescription of 7 days of low dose (to be tried for a minimum of 3 days) and 1 month of medium dose at the pharmacy
@@DrJohnKruse Ok, I understand what you are saying I think - give the patient enough meds so they can titrate upwards. Even getting a psychiatric appointment within two weeks though would be difficult for many, impossible for some.
I was dosed too high for a bit and it was horrible. Honestly I don’t know why anyone would want to abuse adhd meds
I don’t either. If I took a super high dose I’d feel out of my mind and riddled with anxiety. I know people who abuse them, like 100-120mgs of adderall a day until they are out, and they claim to say it’s amazing. One said it’s the best thing ever. I could never.
@@grapelights all wired differently. Some like uppers some like downers. Yes some amphetamines in high dose can even be more euphoric than heroin for some.
@@Rocketman0407 I know. These specific people are addicted.
@@grapelights They might be, but there are lots of people who abuse medications who aren't addicted.
@@DrJohnKruse true. These specific people are though. They lost their families over it. I’m not talking about recreational drug use.
The asmr I get while learning more about my adhd is so nice. I found your channel from David Pakman, and I am hooked.
That's so funny, because next week I'll be talking about ASMR and ADHD.
this guy rocks!!!
Thank you.. from the bottom of my heart and my brain!!!!❤Great Podcast and information!!!
Great video! Thank you very much for this insightful video. I’m currently doing dose titration and your information is very helpful.
Thanks for covering the topic Dr. Kruse! I was diagnosed with Methamphetamine use disorder and ADHD later in life and have since been taking 300 XL of Bupropion and 40 mg X2 a day for a total of 80 mg of Vyvanse daily. This has been tremendously helpful in curtailing my use of methamphetamine without affecting any of the positive effects such as the ability to focus and remain productive throughout the day. They have not had negative side effects such as causing psychosis and insomnia though by the end of the day I am tired (feeling a slight crash) and ready to sleep. Therefore, I'm in support of the use of Bupropion and Vyvanse in treatment (harm reduction/replacement) for people who use methamphetamines.
I can really relate to what you are saying here. I have the same issue. Sometimes i had the same issue with red wine. It would...loosen the noose so to speak. It helped. But at a high cost. I have Wellbutrin in my drawer...but i haven't used it in ages. Maybe I should reconsider it. I told my doc about my rampant vyvanse abuse and I lost the rights to it as a result. I wonder now if that was a mistake or a lifesaving intervention.
Fascinating analysis
great information
Thank you for addressing this
I'm curious if you have any information on modafinil and ADHD. In terms of effectiveness, side effects, contrast vs concerta. Also any reason why concerta or other stimulants change body oder?
Hey!
Dr.Kruse does have a video on the subject of Modafinil, it's called:
''Modafinil: The Non-Stimulant Stimulant''
He also a medium article on the subject, but it requires a paid membership for full article access, called:
''Should We Use More Modafinil, the Non-Stimulant Stimulant?''
Have a good one!
The link is here: th-cam.com/video/T01xvC1OeBw/w-d-xo.html
I'm not aware of (but there may be) research on the odor question. I've seen speculation about how these drugs can change hormonal status, hydration, and even the microbiome of the gut and skin, all of which could change body odor.
Dr Russell Barkley does the same topic of Psychosis and high amphetamine usage, regarding the same study.....but they are working backwards in the study....these are people who are severely Damaged individuals and consequently they were on the most medication........
I am apparently on a high dose (i noticed when first going to get my meds at my regular pharmacy, her reaction).. late diagnosed ADD adult at 45yo... i take 30mg Ritalin in the morning and 20mg again in the afternoon... life is so much less chaotic!!
I hope it continues to work for you, without side effects. The dose doesn't strike me as particularly high.
@@DrJohnKruse thanks for the feedback! I hope so too :)
Been a while since I did the math, but you have to compare the entire salts. For dexamphetamine sulfate vs. lisdexamfetamine dimesylate, it's more like 40% by weight. Also, as you discuss, absorption differs, and.lisdex less affected by pH.
Ultimately, I think you're very clearly right. It would be charitable to even call the guidelines seat-of-the-pants.
Edit: at 36 minutes you do give the number, from the paper, as 40% dextro. With Adderall, I guess 30% is about right since it's plausible levoamph is not clinically relevant.
You're cooking with the analogies. I think ADHD people are like the turbocharged gasoline 4-cylinder, needing to get way high up in the RPM range to do real work, but when they do, can kill it. Normals are like the inline-6 turbodiesel, and have enough torque to just lug through the sticking points.
@@kenhaze5230 I'm not agreeing with your analogy, but I love it all the same!
May I ask what’s the risks for going back and forth between 5 mg and 7.5 mg of Dextroamphetamine on a daily basis? For example, taking 5 mg one day and 7.5 mg the next day, then 5 mg again. My doing drug titration and I’m not sure what I’m doing. Some days I feel I would be ok on 5 mg and some days I feel I’m struggling more and 7.5 mg would works better.
Is this an acceptable use of the medication? If not, what would you recommend? I don’t take my medication daily, only on weekdays (when I do remember) to work.
I can't make individual recommendations, but I would say this situation could be described as someone who alternates between days of 0, 5 mg and 7.5 mg dextroamphetamine. If varying between 0 and 5 is okay, why would the variation between 5 and 7.5 mg be problematic. Adjusting dosage to meet symptoms at that time sounds like a generally appropriate medical principle.
I’m on up to 6 a day 5mg .. and was told to take days off .. I’m an ex heroin addict ..
But it’s helped me stop vaping and craving cannabis .. But I can’t seem to take those days off because I’m afraid of crashing and losing motivation ..EVEN though they lose the motivational effect within two -3 days ..
I’m also on Mirtazipine at night .. I need to follow advice of my psychiatrist .. and I’ve come to the realisation after a year that I have TO DO this right !I am getting really tired and losing energy ..
I have innaetentive ADHD
Yes, it sounds like there is a lot to discuss with your psychiatrist. Including the possibility that a long acting version may place you at less risk of relapse/addiction than frequent immediate release doses.
@@DrJohnKrusewhat are the longer release medications Is vyvanse considered o her acting
We are in a very tough position with my son he’s 24 diagnosed at 19 with adhd inattentive though at that same time he was heavily using high thc cannabis and a year and a half later into a cannabis induced psychosis bc he tested positive for amphetamine bc of Vyvansse so had amphetamine induced psychosis too
We don’t know what part vyvanse played in the psychotic break they believe there is a chance he had emerging bipolar not adhd and that’s why he looked adhd and also why he medicated with cannabis
Pro Jeb we face is bc he has a bipolar 1 with psychotic features diagnosis no Dr feels it’s sage for him to ever be on a Ashdod stim again that it will quickly trigger psychosis again
But at same time he’s craving and downing energy drinks pre workout coffee I feel if he was on a low dose stimulant it was curb those cravings for highs through energy drinks which are terrible and also has relapsed to thc today I feel abilify plus low dose vyvanse or Ritalin pike work better he is on 300 Wellbutrin not making a dent
Can u link the studies
I've just added links to several of the articles I discussed to the description of this video.
@@DrJohnKruse thanks 🙏
Can I ask how a gastric bypass effect intakes of stimulants? 36 mg concerta, and I feel nothing at all. My md is afraid to give a higher dosage. And I think it's a total waste of time and money.
Try Vyvanse. Methylphenidate tends to work a bit better in children in what I've read in the literature.
@@ladyoftheflowers9781 actually, the literature is quite consistent that amphetamine (Adderall) is more effective than methylphenidate (Ritalin) in both children and adults. But children tend to have more problematic side effects from Adderall, so the cost/benefit analysis has been to recommend Ritalin as the first choice stimulant for children, and amphetamine products in adults.
@@DrJohnKruse Good catch! Thanks for the clarification there!
Can you expand on why you "detest" the language the FDA is using in regard to higher doses of ADHD stimulants? Words like "licensed" and "unlicensed" strike me as having incredibly neutral connotations to me.
License has the strong implication of legal. You need a license to operate a car, and you're breaking the law if you drive without one. This wording implies that doctors are breaking a law by prescribing outside of the recommended range.
@@DrJohnKruse thank you.
I found 20mg and 60mg of vyvanse helpful and all the other doses annoying and disruptive.
Obviously 60 worked better than 20, but it's interesting that 30, 40, 50 and 70 were terrible in different ways.
I am giving atomoxitine great and am side effect free, apart from a bit of nausea
I'm glad that you found what worked for you.
Are you on amatoxtine plus vyvanse
Big false assumption with the "start low, then go high" approach. What makes you think you could find a provider to give you another appointment after only three days? Also, people need to "know it works" - especially adults. You can also titrate down, and many adults with ADHD do just that.
I may not have been clear enough in what I was saying. It was start low, and then go (fast) not high. As opposed to start low and go slow for most medications. Step up rapidly every few days if you're getting inadequate benefits. Most people will pretty quickly see that it works. A prescriber and patient can have an informed discussion regarding titrating the dose upwards every three days, depending on benefits and side effects, and can meet back in two weeks to report back where they are regarding dose at that point. If the patient is unfamiliar with stimulants I would never start with a big dose, and plan on backing down, because the risk of causing panic attacks or other averse effects that would make them avoid medications in the future is too high.
I was on one low dose for 3 days to have time to adjust to the side effects. The first time I took vyvanse I felt calm for the first time in my life and managed to clean up without getting stressed or overwhelmed, then I didn't sleep for 35 hours and wasn't tired. Turns out I metabolise it very slowly and even if I take it at 6am I'm still feeling the effects at 12pm. The point is you start low because if you can't tolerate a little you won't tolerate a lt, and starting low gives you a chance to adjust, it stopped causing insomnia after a while
I didn't need a seperate appointment. I was given a prescription of 7 days of low dose (to be tried for a minimum of 3 days) and 1 month of medium dose at the pharmacy
@@DrJohnKruse Ok, I understand what you are saying I think - give the patient enough meds so they can titrate upwards. Even getting a psychiatric appointment within two weeks though would be difficult for many, impossible for some.
@@therabbithat I appreciate you sharing your experiences that were pertinent to this topic.
Why did tachyfylaxia occur ?
Falco--Rock me Amadeus 😊
,,Primum not nocere,,
Who need insulin shock ?
First
I am on 15 mg of IR addarall. I'm supposed to take 2 a day but I end up having to take both at the same time for it to be effective.
I would encourage you to share with your prescriber how the medication works for you.
@@DrJohnKruseyea. I don't know why I haven't, I guess I'm weirdly scared they are going to think I'm abusing it or something.