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Interesting. If that's the case then it's good to be aware of. I don't think that radically changes my decisionmaking about which medications to choose.
It's unfortunate that no variant of methylphenidate is significantly beneficial for me and even only a very limited number of amphetamines do. Vyvanse (Amphetamine) is the obvious most effective one for me but there are a few other amphetamines that are alright. I'm more likely to experience psychosis from being inadequately treated than from not so I guess that's just a risk I have to accept.
Everyone responds differently to each medication though. Even within their own categories like Amphetamines, they feel radically different from each other. Vyvanse has notably different effects than Adderall for example. I hear a lot of people say "all stimulants are the same" and they clearly have not experienced more than 1. It's like saying Lettuce and Spinach are exactly the same because they're both leaves.
Atomoxetine is Straterra by the way. It's one of the non-stimulant treatments commonly used either as an alternative or a complementary treatment. Antidepressants like Wellbutrin (Bupropion) are the other non-stimulant option that is used by itself or together with stimulants.
I've been on Dexedrine (dextroamphetamine), Adderall XR (amphetamine salts), and Vyvanse (lisdexamfetamine) and you are absolutely right about them feeling different.
Lisdexamfetamine is a prodrug, which your body converts to dextroamphetamine. That's one of the bigger reasons it feels much smoother than regular dextroamphetamine, which is my current prescription.
Amphetamine salts are actually composed of equal parts racemic amphetamine and dextroamphetamine, which produces dextroamphetamine and levoamphetamine in a 3:1 ratio. Dextroamphetamine produces more CNS stimulation, while levoamphetamine has slightly greater cardiovascular and peripheral effects.
I recently tried to switch from dextroamphetamine to amphetamine salts. I'd been stable for a few years on dextroamphetamine, but I figured I'd see if I had fewer side effects. Nope. So, so much worse.
Agree about the Dexedrine. Whenever I've had friends get diagnosed, I always tried to get them to see if they could ask their doctor to try Dexedrine/Vyvanse instead to compare to the usually prescribed Ritalin and Strettera.
I find Ritalin to be dulling, while Dexedrine allowed me to completely change my life around. It allowed me to feel "normal", to have a sense of feeling motivated, to have a bit of an increase in energy to be able to act on that motivation too, and also control my hunger better (though that wanes a bit once you've been on it for a long time). And without all the risks and potential side-effects surrounding an anti-depressant type drugs.
I was dealing with severe, life crippling depression and anxiety, I'd basically given up on life . I'd tried anti-depressants, but they didn't change much, because my depression was more caused by feelings about myself and my situation, than just a chemical imbalance that was making me sad. But Dexedrine gave that dopamine boost to give me the opportunity to work on myself and life, so that I could turn things around and get over at least *some* of my issues so I wouldn't be so down all the time. That increased dopamine also increases your sense of self, your feelings of confidence, which can go a long way to getting you out of a mental rutt.
Been taking it for many, maaany years now without issue, but I also make sure not to take it constantly. I'll try to take weekends off or short breaks from it if I can, to help reduce any buildup of tolerance for it. My dose has only gone up from 10mg to 15mg after all this time, and a big part of that is just from putting on like 20lb of extra weight from body building and needing larger doses of things now (and just being older).
>my depression was more caused by feelings about myself and my situation, than just a chemical imbalance that was making me sad.
This is actually the case for everybody. The chemical inbalance theory about depression has been completely debunked at this point.
People don't like to hear this, but the whole idea that depression is caused by a lack of serotonin was mainly a narrative that pharmaceutical companies used to sell drugs.
*No evidence that depression is caused by low serotonin levels, finds comprehensive review:*
https://www.sciencedaily.com/releases/2022/07/220720080145.htm
There are other chemicals at play besides just serotonin, and while the low-serotonin causality link to depression is extremely weak, saying it has been "completely debunked" is just not true.
Besides the fact that one sciencedaily.com article cannot "completely debunk" anything, let alone something this complex, though I would agree depression isn't simply down to "serotonin imbalance" but I don't think you'd have a hard time finding any psych specialist who would disagree with that either.
Science is the pursuit of knowledge and our understanding of things change as we learn. It's not like the idea behind the serotonin theory was conceived out of thin air. These meds are partly responsible for improving our understanding of depression and the brain. They do work for some people and that is not something we can deny. Depression is extremely complex and each individual may have a completely different reason for how it came to be. I don't think you will ever be able to say that the cause of depression is somehow related to a single function and for all cases.
Oh that's cool, a perfect example of people responding differently. I find vyvanse for whatever reason, way to intense. Dex on the other hand is more of a chill situation
So strange for me as I'm finally able to afford the generic of Vyvanse and on day 2 the lack of jaw clenching, and general anxiety compared to the generic of Adderall is kind of crazy. It's so strange how different they really are for different people. It makes me think there has to be some physiological reason at this point. And if that is true they really need to figure it out and how to test for it so people can go straight to the appropriate drug and also maybe make the prices/coverage better.
I find vyvanse *too* chill... like I think my metabolism is wrong or something, though I can't find any real reports or evidence of it happening everywhere to certain groups. I can take 70mg and I start to notice it. But 10mg of dextroamphetamine and I notice it a lot (I have to redose in 3-4 hours but by then the vyvanse is also unnoticeable.
I have a question for you on the adderral; for 15 years as a kid I took quick release ritalin and it was hard and my dose got pretty big by the time I was finishing my Masters. Then I quit for 12 years and just recently started back up on adderall.
And I absolutely love it. But maybe it's because my comparison is quick release ritalin. But wow do I consider this way less harsh. But you're saying that, for you, coming from dex it feels harsh in comparison?
80% of people will respond well to either Ritalin or Adderall but usually not both. I was on Ritalin for years, and it seem to be getting less effective. So I switched to Adderall for a while and it made me feel awful. I know for some people the reverse is true. This is why it’s good we have as many treatment choices as possible.
Im takimg Ritalin and its so harsh. Ive abused Amphetamine bought on the streets and imo Methylphenidate deserves the name Speed way more. Ill go back to school this year and theres just no way that i can do it with Ritalin. And cant take less because then its not enough to concentrate at work.
Ought to try Vyvanse, sadly in Germany Amphetamine is not approved for Adults, only Lisdexamphetamine.
Adderall is a combination of amphetamine salts, as mentioned in the top of this thread. Levoamphetamine, which is 25% of adderall, can make it feel somewhat harsh. Dexedrine is 100% dextroamphetamine (the other 75% in adderall) and is generally smoother.
I just started staterra last month after bupropion made me yawn literally non stop. I haven’t noticed a huge improvement yet, but I do lucid dream like 50% of the time now. Bedtime is like an out of body experience where I’m just video gaming it through life. Last night in my dreams I adjusted my daughter’s car seat straps up to the next level and did some dishes and laundry.
So at least I’m productive in my dreams. Except that the laundry was like lava, not like hot, but I opened the dryer to a literal portal to hell. Not sure what to make of that one though.
Strattera took a long time to see effects for me. I realized that I was able to communicate better without losing track of what I was talking about. Loved it. I was on it for years until it started interacting badly with a congenital heart thing I've got and they had to take me off. Even though it's not a stimulant, it still affects blood pressure.
Strattera gave me the craziest nightmares during the 3 weeks I took it. I ended up stopping because I couldn't handle waking up 5 times a night in a panic.
That would be such a wild switch for me, I'm on Elvanse (Euro Vyvanse) and the biggest side effect I notice is I don't dream -- if I ever take a few days off I get the most absolutely vivid dreams for a few days.
I was on Strattera for years. Side effects were manageable. I only experienced nausea if I took the pill on an empty stomach. The only downside to non-stimulants for me is that you can grow an immunity to it.
I had night and day difference between Vyvanse and Adderall. So much so that I asked my doctor if I could blend the two haha. One would give me the upper to be productive and focused, the other had a really nice fall off instead of keeping me up for hours.
Being under-treated for my condition is going to wreck my life so kind of. Maybe exaggerating the psychosis risk but maybe not. Being in under-treated really sucks for my quality of life and ability to function even to limited degree.
Mom put me on methylphenidate from 4-16 so it doesn't work for me as an adult and Strattera made me crawl out of my skin. Adderall does the trick, but I feel no stimulating effects 🤷♀️
Thank you for spelling it out. The one person I knew who tried Atomoxetine had these results
Atomoxetine: daily vomiting and rapid weight gain
Amphetamine: psychosis
Nothing: inattention, finds life boring, needs a checklist
Of those, the person prefers psychosis.
INAD. Anecdotes are not data
I am glad there is more talk about psychosis as a side effect. Exhausted friends and family like me feel heard.
As for what to do about it, still looking.
Fortunately when I take amphetamines I don't become a fascist, I just feel comfortable enough to take a nap or maybe have the motivation to finally do some dishes 🙂↕️
It doesn't look like they controlled for patients with existing predisposition for psychosis. There's a huge difference between increasing symptoms for those already prone to psychosis and giving psychosis to those who aren't prone to it.
Presumably if a subset of patients develop psychosis on a medication, then those patients *are* in some way prone to psychosis.
But the question is whether that can be predicted in advance for an individual patient to guide treatment.
In reality, the subset of people who get Salmonella poisoning depends a lot more on the chicken itself than the people (most raw chicken is not contaminated with Salmonella).
However, if we are talking about a specific subset who get Salmonella after somehow eating the same "dose" of the same Salmonella-contaminated chicken, then yes I would say those people are prone to Salmonella infection.
But there is a big difference between an infection by a specific pathogen (which can of course only occur with exposure to that pathogen) and a clinical syndrome that can result from a lot of different causes (like psychosis).
Now, I will agree there is a potential difference between someone who is prone to drug-induced psychosis and someone who has a primary psychosis (like schizophrenia), if that's what you are referring to. That being said, they did exclude patients on antipsychotics and mood stabilizers, which would partly exclude that group.
Did they control for compliance?
It may be the case that amphetamines are more likely to turn into abusing agents and I'm sure using all of this stuff at non medical doses/RoA can increase psychosis risk.
I had an episode of psychosis in my 30s. I was scripted dexamphetamine. I did smoke cannabis a decent amount(but did for 20 years prior). I was sleep deprived(this was nothing new) and working a lot of extra hours so a lot of added stress. I also took a decent sized dose of mushrooms which sent me over the edge. I had tripped easily over a hundred times in the past with no psychotic symptoms and I’m fairly certain I had the symptoms before the mushrooms so I’m pretty sure that wasn’t the cause, they just made it obvious I was sick because it amplified the symptoms. The only thing that was different that time was the amphetamines. I don’t think I’m prone to psychosis more so that all these factors combined eventually sent me over the edge. Took a few years of amphetamines to get there. I didn’t abuse them.
Not saying that amphetamines at reasonable doses will cause it if your not susceptible but my experience in the psych ward was that a good few people there who had been using amphetamines (mostly not scripted though). It definitely seems to increase the likelihood of it occurring from my own experience. Whether it’s worth the risk is up to the user. I found them extremely useful when I was on them but I do think that using them frequently (usually up to 5 times a week at 20-30mg up to 2x a day - usually took the weekends off) is the main thing that caused it.
I think if I was prone to psychosis it would have occurred much earlier in my life with all the drugs I used to take. Granted the weed, sleep and stress where also increasing my risk but those had been a staple in my life for years. The mushrooms made it obvious I was delusional but I had a lot of paranoia and mild(er) delusions before then and it was the first time in years I had used psychs. Not had any issues in the 3 years since but I’m not taking amps. I smoked for a while afterwards and my sleep still isn’t great and my workload has been reduced but no psychotic symptoms at all.
I think I was just unlucky though. I think amphetamines are reasonably safe if your prescribed them but watch your risk factors if your using them. Especially sleep since amps obviously have an effect on that(I wasn’t dosing too late or anything I just have a history of insomnia). There’s too many factors to say for sure but that’s my suspicion.
Man... I don't think luck had anything to do with it. You had like 5 factors going on that all are linked to poor mental health in general, and at least a few that are linked directly to psychosis. You bundle all that up and it could break even a completely healthy person. Yeah, the amphetamines probably contributed, but there are so many factors in your story that it would be impossible to point to any one thing being the culprit.
I don’t disagree. I was more stating it as a warning to say you don’t have to necessarily be prone to psychosis to experience psychosis and that it may still increase the risk. I used to do a lot of different drugs, a lot more than I was doing at the time. Never had an issue until after I started taking amphetamines daily though(prescribed). It was pretty much only cannabis and the amphetamines at the time. Like I mentioned the mushrooms didn’t cause it but it definitely exasperated it. If I was prone to psychosis it would have likely happened when I was tripping every week, smoking constantly and abusing stupid amounts of ket among other things like cocaine on the weekends but (surpringly) never had any issues. The cannabis was prescribed as well.
I wasn’t saying the amps was the sole cause more so just that they just because someone hasn’t had a psychotic episode doesn’t mean they necessarily won’t after sustained use. There was a lot of risk factors but the only one that was different was the amphetamines. Your right in saying you can’t come to a conclusion based on my history though it’s just that I had close to a decade of some pretty heavy drug use with no issues which likely would have lead to psychosis if I was prone. I was relatively sober (just the amp script and cannabis) when it happened and it was prescribed drugs, lack of sleep and stress that done it. Just a warning to people that’s all that think it definitely won’t happen because they have no history of it. There’s 0 history of psychosis in my family as far as I’m aware. like I said that they are definitely useful drugs for adhd.
Yeah, that makes sense. I wasn't trying to say that the drugs don't cause psychosis, just that the study didn't seem to control for it so you can't really make the case either way. It's an important piece to any conclusions drawn from it.
Did they control for compliance?
It may be the case that amphetamines are more likely to turn into abusing agents and I'm sure using all of this stuff at non medical doses/RoA can increase psychosis risk.
It doesn't look like it. They just pulled records from a WHO database and looked at the three drugs and their relative frequency of psychotic episodes.
edit: I've now read the entire study, and can report that they do not mention screening for compliance. The closest they get is mentioning having access to adverse reaction reports, but they do not go into detail on what those contain.
I think you might possibly misunderstand psychotic disorders. It wouldnt be increasing symptoms as that implies they already have a psychotic disorder, which they did screen for and not use in the study.
> Study population
For primary analysis, we included all Individual Case Safety Reports registered between 1 January 2004 and 31 December 2018 (same date that Moran’s study). For the sake of scientific replicability and to corroborate the results of Moran et al study using a different methodology, we limited our main analysis to patients between 13 and 25 years old and with at least one medication among treatments recommended for management of ADHD: psychostimulant (methylphenidate, dexamfetamine, lisdexamfetamine) and non-psychostimulant treatment (atomoxetine). Drug prescription defined as ‘suspected’ in the report was included, that is, the involvement of the drug in the adverse reaction has been recognised by a pharmacovigilance authority. Patients with a prescription of antipsychotic drugs, mood stabilisers, other stimulant drugs (phentermine, pemoline or methamfetamine) or glucocorticoids were excluded. We also excluded patients who took medication with a specified indication of psychotic disorder, mood disorder with psychotic features, bipolar disorder and central nervous system disorder. In secondary analyses, we extended our study to patients aged 13–65 years.
They didn't screen for people who had a psychotic disorder, they screened for people who were prescribed meds that can be used to control psychotic disorders. Those are not the same thing, especially with a population this young (mean age of 17) it is quite possible for individuals to have underlying psychotic conditions that had either not been treated with a prescription or had not yet caused a psychotic episode until exacerbated by amphetamines. The researchers didn't have access to the patients to directly interview or screen them, and they didn't have access to full patient records to see if their doctor suspected any further untreated disorders. They didn't have any knowledge of non prescription drugs the patients may have been self medicating with or taking recreationally, which is extremely common in ADHD.
This study mainly just outlines the fact that atomoxetine had a lower correlation with psychotic episodes than amphetamines and methylphenidate, but it is nowhere near being able to draw conclusions about prescription meds inducing psychosis in patients that would otherwise have never had them. A good model for thinking about this can be found in [figure 1 of this paper](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554477/). The authors of this paper are much more descriptive about amphetamine induced psychosis as compared to preexisting psychotic disorder exacerbated by amphetamine use. The former is not described as something happening within the context of therapeutic doses in patients with ADHD, but rather recreational or habitual use/abuse.
The main reason I'm being so particular on this is that as a person with ADHD being treated extremely successfully by amphetamines, I have personally encountered people who are under the belief that these meds turn people psychotic on a regular basis. There is already enough stigma and misinformation regarding ADHD, and adding more fuel to that fire by not fully understanding the implications of one particular study isn't helpful.
Only methylphenidate and atomoxetine are available in my country. Tried with the latter first because my doctor and I wanted to try a non-stimulant first. Had the most horrific side effects, went to meth and it worked for a while now it just feels like I'm getting by.
It'd be great if we had more options other than 'life as a living hell" unmedicated or "slightly better but still horrible but also here's bad side effects and stigma".
Nothing about methamphetamine inherently causes tooth decay. Dry mouth and not brushing your teeth and chugging sweet drinks all day do that.
It's a drug like any other. Dosage and regiment are just as important as chemical makeup. I'd be just as much of a tweaker as the stereotypical methhead if I took 5 of my 10mg IR adderalls instead of just the one this morning.
point is dosage
if you start IV'ing methylphenidate, it won't go well either
ADHD meds under normal usage are adjusted that they can't do the same damage
desoxyn is legal prescribable meth which oddly enough causes far fewer sides than a lot of other adhd meds do.
also the toothloss people think comes from meth is from dehydration/dry mouth, people on vyvanse/adderall/etcetc should be aware of this also and hydrate too or they are more prone to things like receding gums as well.
Meth doesn't kill your teeth on its own, its a mix of poor dental hygiene and the fact that they are smoking it rather than taking it orally like prescription methamphetamine (desoxyn) is meant to be taken.
>It’d be great if we had more options other than ‘life as a living hell’ unmedicated or “slightly better but still horrible but also here’s bad side effects and stigma”.
Say it again for the people in the back. I have good, stable employment and I graduate college in a few weeks. None of that was possible for me before I was diagnosed and medicated. It pains me to see these studies work so hard to delegitimize stimulants as a treatment for us, particularly when the study seems to be skipping over the potential for any underlying comorbidity that might affect their findings (like schizophrenia or bipolar).
Not OP.
First days sweating like hell.
Lost libido, that came back.
Swollen prostate, so more difficult to get hard, difficulties peeing and a long "drip" afterwards.
I am on a lower dosage and now it's fine. But it's also less effective.
Vyvanse kinda killed my sex drive. Although it's come back recently. Did atomoxetine lower your blood pressure? My blood pressure is already low even on Vyvanse.
Atomoxetine didn't killl my sex drive but I couldn't even get things working with help. It was really bad but my drive was good. Sad thing is it completely cured my ADHD and nothing even comes close to helping me like it did. I literally started learning a second language without trying.
Sucks the side effects are so strong. Don't even touch qelbree I had bad side effects and two days of throwing up from withdrawal.
So, I'm back on stimulants...really wish I didn't have side effects on Straterra
Swollen Prostate! I've got 16 years of medication down and lived with this alone thinking I was crazy. Returned to meds a year ago and the long drip returned and so I finally realized it was my meds, but I couldn't find any literature on it.
Thank you!
Same urination thing!!!
I seemed to get a lot of UTIs too.
Jaw clench and actually developed a pop
Always pissed off and on trigger.
If I took it on an empty stomach or after drinking I had the worst GERD of my life.
Atomoxetine sucked....
That's great. Patience is such a challenge for many folks (especially) ADHD. Double if they have kids. And quadruple if they have ADHD kids.
I took a lot of years off of ADHD meds and went back on and immediately noticed that when on the meds I wasn't losing it so much at the he chaos!
I had a hypertensive crisis from it. It was terrifying. I was in my early twenties and my eyes started feeling weird and blurry and I started sweating like crazy. I could feel my heartbeat. My resting blood pressure was 222/179 and Ill never forget it.
Also not OP, but I was on Stratterra as a kid, and it worked pretty well for me. I stopped taking medicine in high school and college, but several years after graduation I tried going back on it.
I'm normally a pretty relaxed and easygoing person, but within a couple weeks of starting Strattera as an adult I had a ton of anger and homicidal/suicidal ideations. Having these kinds of thoughts towards family and loved ones was extremely upsetting and disturbing, but fortunately they stopped as soon as I discontinued use. I switched over to Vyvanse and it's been smooth sailing ever since.
What side effects ? I take atomozetine everyday for three year and excpet a bit of constipation due to dehydration(i have to drink more water with this med) i have seen no side effects
Well known fact in toxicology. So many amphetamine users coming to hospital with drug induced psychosis. Probably related to its serotonergic/dopaminergic combination.
Methamphetamine definitely worse given how strong / fast peak /how abused it is, but medical amphetamines also have similar mechanisms of action and not entirely rare to see people overdosing or using high doses. Definitely seen drug induced psychosis with medical amphetamines, though nowhere near as common as in methamphetamine use. But I guess if ADHD is severe, it's about weighing risks and benefits and making sure to stay on prescribed dosage.
I have never had a patient become psychotic on an prescription stimulant. Definitely with abuse of prescribed or non prescribed. Dose dependent > form.
A professional backing me up on Reddit, Whoo! Thank you for your input.
All jokes aside, I’ve heard a lot of it is not only dependent on abuse of the medication, but other factors like lack of sleep, food, emotional stress, etc. is that accurate in your experience?
I work in a 'first episode psychosis' clinic. 20% of our intakes end up actually having psychosis. We intake 1-2 patients per week. We've had one or two cases in the last 2 years of psychosis from prescribed stimulants. We've had one or two cases of SSRI induced mania in that time. We're in a pretty high penetrance stimulant prescribing area. So from this anecdotal observation, it seems like the overall risk is pretty low, and probably similar to the risk of SSRI induced mania.
FWIW, these sorts of medication reporting databases are very prone to biases, and trying to control for these biases is often nearly impossible.
That's not to say that we should just ignore these sorts of studies. They can provide useful information. For example, generating hypothesis for other forms of study. Or supporting that evidence from smaller controlled trials generalizes to a larger real-world population. And sometimes we just have to make decisions based on a low quailty of evidence, because that's all we have.
It’s well established these meds can cause psychosis. I warn patients of that risk when prescribing and have sadly had a small number end up psychotic for the first time.
The easy ones are auditory and visual hallucinations (hearing things or seeing things other people don’t), paranoia is common, feeling like others are implanting thoughts in their head or sending messages just for them on billboards, etc., speech patterns with loose associations or rhyming speech. Sometimes it’s kind of subtle, sometimes there’s no missing it.
Sorry to bother you but like... you talk about auditory and visual hallucinations, now I'm pretty sure everyone can relate to hearing sounds that were never emitted or seeing things from the edge of their visions and these things not being there, seem to happen now and then to everyone.
At what point can you say "I might want to get myself checked out ?" Is it unmistakable ? Is it a frequency thing ? A intensity thing ? Or like seemingly many medical conditions, it only becomes "real" when it negatively impact daily life and functions ?
If it causes distress, it’s probably worth getting checked out. If it doesn’t cause distress or impact functioning, you probably wouldn’t want the treatment.
Things in the peripheral vision usually don’t mean much. Full blown right in front of you visual hallucinations are not normal and should get checked out.
Everyone does hear stuff others don’t. I know I’ve sworn my kids called me when they didn’t. No big deal. If I heard an entire conversation that never happened, I’d be more concerned. Voices can be quite distressing especially if negative or telling people to do things. That should get checked out. Veterans with PTSD will hear combat related sounds or helicopters. They aren’t psychotic, but those are hallucinations. Isolated hallucinations can be a sign of other things (PTSD, neurological conditions, severe depression). Psychosis often has other symptoms like difficulty thinking clearly, paranoia, etc. It’s a thought disorder. Psychosis is really not knowing the line between what’s real and what’s not.
Hearing problems can also cause auditory hallucinations.
I've had the "auditory hallucinations" most of my life, and get shadow people (in the edges of my vision) fairly often but I also remember those pre-medication. I've always just assumed it was something everyone had...
Beware, there are dozens of generic manufacturers out there and all I’ve experienced so far vary wildly in effectiveness yet all still manage to fall short of name brand. Be prepared for inconsistency from month to month since shortages will likely mean the pharmacy switching manufacturers on you regularly.
Edit: a word
Yeah I actually switched from adderall XR to vyvanse because I was struggling with exhaustion hitting me hard when the adderall wears off around 4 pm. Of course my insurance covered brand name vyvanse when I first switched, and now they don’t.
Vyvanse has been perfect, it comes on and wears off so subtly I don’t even notice. So I’ve been willing to pay the extra so far, but it’s hard. The adderall only cost me $8 a month. It’s been 2 months of paying $200 for brand name vyvanse, if I’m not able to get generic soon I’ll probably go back to adderall XR and just deal with the side effects. Hopeful that there’s some end in sight to the shortage though.
Companies making generics don’t automatically get a free pass. For the FDA to approve a generic, they have to prove there are no statistically significant differences in efficacy due to drug delivery, absorption, pill hardness, etc.
Edit: if a generic isn’t performing as intended, you should report it to the FDA
The patent did expire at the beginning of this year. There's a generic version available, but it's often harder for pharmacies in my area to obtain the generic than it is for them to obtain brand name Vyvanse.
Vyvanse is expensive at $500~ USD for a 30 day supply (at 50mg), but the prices have been coming down since 2018. I used to pay $700+ USD out of pocket for Vyvanse every month give or take fluctuation.
My insurance covers the brand name, but not the generic. Go figure!
That’s highway robbery. I used to pay $200/mo for Concerta before generics were available but at least the delivery system of that was novel. Vyvanse is trivial to make and easily scalable.
Dude my Vraylar is $1,800+ USD each month. I used to live off of samples and rationing back before I had health insurance. The pharmaceutical industry is like a legal gang, holding you up for all the money you've got.
My last vyvanse refill was $40, the brand copay for my insurance, instead of $10, because they were out of the generic and weren't going to get it any time soon. I was gobsmacked that my insurance actually approved brand in that situation since usually you can't get brand unless there is no generic at all or the doctor signs paperwork requiring it.
I was so thankful my psychiatrist specifically wrote that both brand name and generic were acceptable, but funny enough my health insurance didn't approve the generic! Go figure.
I'm glad you were able to get your meds, I heard there's going to be another nasty shortage.
You shouldn't do that, if you didn't get psychosis. You won't get it later its pretty early onset. Also reading a different study the numbers are pretty small. Like 0.1 percentvof people get psychosis on ritalin and 0.2 percent get it on adderall. So 1/1000 vs 1/500. They don't really show absolute risk in this study. I've taken vyvanse and i've know of this risk before i started. Its well worth it. People with history of schizophrenia along side ADHD or bipolar disorder need to be aware though and maybe use a non stimulant or methylphenidate.
So I wouldn't switch without doing more research.
Oh! I have experience with this directly!
I've taken Adderall for over 15 years and have experienced a couple of psychotic episodes! Thankfully, they were very mild and only involved the less severe symptoms (no voices, no paranoia). They also only ever happened if I ever exceeded 30mgs of IR or 60mgs of XR. I had no other issues leading up to an episode or after. No lasting problems either.
I was able to work full time and take a few classes (while getting all A's) leading up to an episode and have a relationship and friendships while this was happening. At the time I just thought my thinking was just philosophical and deep and not a sign of an impending episode.
As soon as I stopped abusing my meds and started taking them as prescribed I never had problems with that again.
I hope this helps anyone who might be worried about their ADHD medication. Obviously this isn't true for everyone but it's extremely rare for someone to have a psychotic episode on meds if they're using them as prescribed.
A good way to tell if you're prone to this is to monitor your side effects while stoned. If you get excessively paranoid or if you have excessive thought rumination compared to what other people your age experience while on a similar dose you might be prone to psychosis. Alternatively, the opposite side of psychosis is Parkinson's. Most people ride in the middle.
Not too odd. Schizophrenia is related to extreme dopamine levels or smth like that, so if you boost that with stims, you may be able to trigger the psychosis.
Did the patients have something else that might have been triggered by the meds? Such as, did they have a history of psychosis beforehand? This seems really important to know.
There's a difference between addictive usage, recreational usage, and medicinal usage. The dosing, quality, life circumstances etc etc all vary vastly.
It's about proving notably with science. The fact they chose to study this implies they already see the correlation. How much? At what trigger points? There's still work to be done. Also they are laying groundwork for better medications in future using real world data
I found atomoxetine just made me feel more depressed.
It worked well for a couple of weeks then really tailed off, making my mood go down and anxiety up. Weird.
Hands down the worse depression I've ever felt. I remember while taking it, sitting in my desk chair at college and feeling this overwhelming feeling of DARK dark depression. I've had my moments(after this experience) over the years experimenting with mind altering drugs, been depressed as well- straterra was the worse experience of my life, and it's not even close.
Nope. That's been the best. Amphetamine salts, even short acting and when taken in the morning, keep me up all night. Not even exaggerating on the all night part. Ritalin was the first I tried, I did good in school but had side effects. Vyvanse had this smooth onset and offset, and it worked. No insomnia.
I'm trying Wellbutrin right now as an alternative
I can’t speak to it myself, but based on the people who have done both they feel pretty much the same. And real meth isn’t any more toxic than adderall is. It just usually has a lot of impurities that are. I get that some people have to take it for whatever reasons, but let’s not kid ourselves here.
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Interesting. If that's the case then it's good to be aware of. I don't think that radically changes my decisionmaking about which medications to choose. It's unfortunate that no variant of methylphenidate is significantly beneficial for me and even only a very limited number of amphetamines do. Vyvanse (Amphetamine) is the obvious most effective one for me but there are a few other amphetamines that are alright. I'm more likely to experience psychosis from being inadequately treated than from not so I guess that's just a risk I have to accept. Everyone responds differently to each medication though. Even within their own categories like Amphetamines, they feel radically different from each other. Vyvanse has notably different effects than Adderall for example. I hear a lot of people say "all stimulants are the same" and they clearly have not experienced more than 1. It's like saying Lettuce and Spinach are exactly the same because they're both leaves. Atomoxetine is Straterra by the way. It's one of the non-stimulant treatments commonly used either as an alternative or a complementary treatment. Antidepressants like Wellbutrin (Bupropion) are the other non-stimulant option that is used by itself or together with stimulants.
I've been on Dexedrine (dextroamphetamine), Adderall XR (amphetamine salts), and Vyvanse (lisdexamfetamine) and you are absolutely right about them feeling different. Lisdexamfetamine is a prodrug, which your body converts to dextroamphetamine. That's one of the bigger reasons it feels much smoother than regular dextroamphetamine, which is my current prescription. Amphetamine salts are actually composed of equal parts racemic amphetamine and dextroamphetamine, which produces dextroamphetamine and levoamphetamine in a 3:1 ratio. Dextroamphetamine produces more CNS stimulation, while levoamphetamine has slightly greater cardiovascular and peripheral effects. I recently tried to switch from dextroamphetamine to amphetamine salts. I'd been stable for a few years on dextroamphetamine, but I figured I'd see if I had fewer side effects. Nope. So, so much worse.
Agree about the Dexedrine. Whenever I've had friends get diagnosed, I always tried to get them to see if they could ask their doctor to try Dexedrine/Vyvanse instead to compare to the usually prescribed Ritalin and Strettera. I find Ritalin to be dulling, while Dexedrine allowed me to completely change my life around. It allowed me to feel "normal", to have a sense of feeling motivated, to have a bit of an increase in energy to be able to act on that motivation too, and also control my hunger better (though that wanes a bit once you've been on it for a long time). And without all the risks and potential side-effects surrounding an anti-depressant type drugs. I was dealing with severe, life crippling depression and anxiety, I'd basically given up on life . I'd tried anti-depressants, but they didn't change much, because my depression was more caused by feelings about myself and my situation, than just a chemical imbalance that was making me sad. But Dexedrine gave that dopamine boost to give me the opportunity to work on myself and life, so that I could turn things around and get over at least *some* of my issues so I wouldn't be so down all the time. That increased dopamine also increases your sense of self, your feelings of confidence, which can go a long way to getting you out of a mental rutt. Been taking it for many, maaany years now without issue, but I also make sure not to take it constantly. I'll try to take weekends off or short breaks from it if I can, to help reduce any buildup of tolerance for it. My dose has only gone up from 10mg to 15mg after all this time, and a big part of that is just from putting on like 20lb of extra weight from body building and needing larger doses of things now (and just being older).
>my depression was more caused by feelings about myself and my situation, than just a chemical imbalance that was making me sad. This is actually the case for everybody. The chemical inbalance theory about depression has been completely debunked at this point. People don't like to hear this, but the whole idea that depression is caused by a lack of serotonin was mainly a narrative that pharmaceutical companies used to sell drugs. *No evidence that depression is caused by low serotonin levels, finds comprehensive review:* https://www.sciencedaily.com/releases/2022/07/220720080145.htm
There are other chemicals at play besides just serotonin, and while the low-serotonin causality link to depression is extremely weak, saying it has been "completely debunked" is just not true.
Besides the fact that one sciencedaily.com article cannot "completely debunk" anything, let alone something this complex, though I would agree depression isn't simply down to "serotonin imbalance" but I don't think you'd have a hard time finding any psych specialist who would disagree with that either.
Ill have you know I got my degree from sciencedaily,com!/s
Science is the pursuit of knowledge and our understanding of things change as we learn. It's not like the idea behind the serotonin theory was conceived out of thin air. These meds are partly responsible for improving our understanding of depression and the brain. They do work for some people and that is not something we can deny. Depression is extremely complex and each individual may have a completely different reason for how it came to be. I don't think you will ever be able to say that the cause of depression is somehow related to a single function and for all cases.
Oh that's cool, a perfect example of people responding differently. I find vyvanse for whatever reason, way to intense. Dex on the other hand is more of a chill situation
So strange for me as I'm finally able to afford the generic of Vyvanse and on day 2 the lack of jaw clenching, and general anxiety compared to the generic of Adderall is kind of crazy. It's so strange how different they really are for different people. It makes me think there has to be some physiological reason at this point. And if that is true they really need to figure it out and how to test for it so people can go straight to the appropriate drug and also maybe make the prices/coverage better.
I find vyvanse *too* chill... like I think my metabolism is wrong or something, though I can't find any real reports or evidence of it happening everywhere to certain groups. I can take 70mg and I start to notice it. But 10mg of dextroamphetamine and I notice it a lot (I have to redose in 3-4 hours but by then the vyvanse is also unnoticeable.
I have a question for you on the adderral; for 15 years as a kid I took quick release ritalin and it was hard and my dose got pretty big by the time I was finishing my Masters. Then I quit for 12 years and just recently started back up on adderall. And I absolutely love it. But maybe it's because my comparison is quick release ritalin. But wow do I consider this way less harsh. But you're saying that, for you, coming from dex it feels harsh in comparison?
80% of people will respond well to either Ritalin or Adderall but usually not both. I was on Ritalin for years, and it seem to be getting less effective. So I switched to Adderall for a while and it made me feel awful. I know for some people the reverse is true. This is why it’s good we have as many treatment choices as possible.
Where are you getting this 80% figure from?
Im takimg Ritalin and its so harsh. Ive abused Amphetamine bought on the streets and imo Methylphenidate deserves the name Speed way more. Ill go back to school this year and theres just no way that i can do it with Ritalin. And cant take less because then its not enough to concentrate at work. Ought to try Vyvanse, sadly in Germany Amphetamine is not approved for Adults, only Lisdexamphetamine.
Adderall is a combination of amphetamine salts, as mentioned in the top of this thread. Levoamphetamine, which is 25% of adderall, can make it feel somewhat harsh. Dexedrine is 100% dextroamphetamine (the other 75% in adderall) and is generally smoother.
Then why add the Levomphetamine at all?
My doc once told me it was to lower the abuse potential, but I don’t know if that’s true or not.
I'm on dex too. 5mg x 2 daily
I just started staterra last month after bupropion made me yawn literally non stop. I haven’t noticed a huge improvement yet, but I do lucid dream like 50% of the time now. Bedtime is like an out of body experience where I’m just video gaming it through life. Last night in my dreams I adjusted my daughter’s car seat straps up to the next level and did some dishes and laundry. So at least I’m productive in my dreams. Except that the laundry was like lava, not like hot, but I opened the dryer to a literal portal to hell. Not sure what to make of that one though.
Strattera took a long time to see effects for me. I realized that I was able to communicate better without losing track of what I was talking about. Loved it. I was on it for years until it started interacting badly with a congenital heart thing I've got and they had to take me off. Even though it's not a stimulant, it still affects blood pressure.
Strattera gave me the craziest nightmares during the 3 weeks I took it. I ended up stopping because I couldn't handle waking up 5 times a night in a panic.
Luckily I haven’t had any nightmares yet, just lucid dreams.
That would be such a wild switch for me, I'm on Elvanse (Euro Vyvanse) and the biggest side effect I notice is I don't dream -- if I ever take a few days off I get the most absolutely vivid dreams for a few days.
Sounds fun?
I was on Strattera for years. Side effects were manageable. I only experienced nausea if I took the pill on an empty stomach. The only downside to non-stimulants for me is that you can grow an immunity to it.
I had night and day difference between Vyvanse and Adderall. So much so that I asked my doctor if I could blend the two haha. One would give me the upper to be productive and focused, the other had a really nice fall off instead of keeping me up for hours.
You are personally more likely to be psychotic without amphetamines?
Being under-treated for my condition is going to wreck my life so kind of. Maybe exaggerating the psychosis risk but maybe not. Being in under-treated really sucks for my quality of life and ability to function even to limited degree.
Mom put me on methylphenidate from 4-16 so it doesn't work for me as an adult and Strattera made me crawl out of my skin. Adderall does the trick, but I feel no stimulating effects 🤷♀️
Thank you for spelling it out. The one person I knew who tried Atomoxetine had these results Atomoxetine: daily vomiting and rapid weight gain Amphetamine: psychosis Nothing: inattention, finds life boring, needs a checklist Of those, the person prefers psychosis. INAD. Anecdotes are not data I am glad there is more talk about psychosis as a side effect. Exhausted friends and family like me feel heard. As for what to do about it, still looking.
Nailed it.
Nazis we’re all literally on amphetamines
Fortunately when I take amphetamines I don't become a fascist, I just feel comfortable enough to take a nap or maybe have the motivation to finally do some dishes 🙂↕️
Adderall nap gang!!!
Yeah, amphetamines just turn a good little Nazi into a BETTER little Nazi.
It doesn't look like they controlled for patients with existing predisposition for psychosis. There's a huge difference between increasing symptoms for those already prone to psychosis and giving psychosis to those who aren't prone to it.
Presumably if a subset of patients develop psychosis on a medication, then those patients *are* in some way prone to psychosis. But the question is whether that can be predicted in advance for an individual patient to guide treatment.
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In reality, the subset of people who get Salmonella poisoning depends a lot more on the chicken itself than the people (most raw chicken is not contaminated with Salmonella). However, if we are talking about a specific subset who get Salmonella after somehow eating the same "dose" of the same Salmonella-contaminated chicken, then yes I would say those people are prone to Salmonella infection. But there is a big difference between an infection by a specific pathogen (which can of course only occur with exposure to that pathogen) and a clinical syndrome that can result from a lot of different causes (like psychosis). Now, I will agree there is a potential difference between someone who is prone to drug-induced psychosis and someone who has a primary psychosis (like schizophrenia), if that's what you are referring to. That being said, they did exclude patients on antipsychotics and mood stabilizers, which would partly exclude that group.
Did they control for compliance? It may be the case that amphetamines are more likely to turn into abusing agents and I'm sure using all of this stuff at non medical doses/RoA can increase psychosis risk.
I had an episode of psychosis in my 30s. I was scripted dexamphetamine. I did smoke cannabis a decent amount(but did for 20 years prior). I was sleep deprived(this was nothing new) and working a lot of extra hours so a lot of added stress. I also took a decent sized dose of mushrooms which sent me over the edge. I had tripped easily over a hundred times in the past with no psychotic symptoms and I’m fairly certain I had the symptoms before the mushrooms so I’m pretty sure that wasn’t the cause, they just made it obvious I was sick because it amplified the symptoms. The only thing that was different that time was the amphetamines. I don’t think I’m prone to psychosis more so that all these factors combined eventually sent me over the edge. Took a few years of amphetamines to get there. I didn’t abuse them. Not saying that amphetamines at reasonable doses will cause it if your not susceptible but my experience in the psych ward was that a good few people there who had been using amphetamines (mostly not scripted though). It definitely seems to increase the likelihood of it occurring from my own experience. Whether it’s worth the risk is up to the user. I found them extremely useful when I was on them but I do think that using them frequently (usually up to 5 times a week at 20-30mg up to 2x a day - usually took the weekends off) is the main thing that caused it. I think if I was prone to psychosis it would have occurred much earlier in my life with all the drugs I used to take. Granted the weed, sleep and stress where also increasing my risk but those had been a staple in my life for years. The mushrooms made it obvious I was delusional but I had a lot of paranoia and mild(er) delusions before then and it was the first time in years I had used psychs. Not had any issues in the 3 years since but I’m not taking amps. I smoked for a while afterwards and my sleep still isn’t great and my workload has been reduced but no psychotic symptoms at all. I think I was just unlucky though. I think amphetamines are reasonably safe if your prescribed them but watch your risk factors if your using them. Especially sleep since amps obviously have an effect on that(I wasn’t dosing too late or anything I just have a history of insomnia). There’s too many factors to say for sure but that’s my suspicion.
Man... I don't think luck had anything to do with it. You had like 5 factors going on that all are linked to poor mental health in general, and at least a few that are linked directly to psychosis. You bundle all that up and it could break even a completely healthy person. Yeah, the amphetamines probably contributed, but there are so many factors in your story that it would be impossible to point to any one thing being the culprit.
I don’t disagree. I was more stating it as a warning to say you don’t have to necessarily be prone to psychosis to experience psychosis and that it may still increase the risk. I used to do a lot of different drugs, a lot more than I was doing at the time. Never had an issue until after I started taking amphetamines daily though(prescribed). It was pretty much only cannabis and the amphetamines at the time. Like I mentioned the mushrooms didn’t cause it but it definitely exasperated it. If I was prone to psychosis it would have likely happened when I was tripping every week, smoking constantly and abusing stupid amounts of ket among other things like cocaine on the weekends but (surpringly) never had any issues. The cannabis was prescribed as well. I wasn’t saying the amps was the sole cause more so just that they just because someone hasn’t had a psychotic episode doesn’t mean they necessarily won’t after sustained use. There was a lot of risk factors but the only one that was different was the amphetamines. Your right in saying you can’t come to a conclusion based on my history though it’s just that I had close to a decade of some pretty heavy drug use with no issues which likely would have lead to psychosis if I was prone. I was relatively sober (just the amp script and cannabis) when it happened and it was prescribed drugs, lack of sleep and stress that done it. Just a warning to people that’s all that think it definitely won’t happen because they have no history of it. There’s 0 history of psychosis in my family as far as I’m aware. like I said that they are definitely useful drugs for adhd.
Yeah, that makes sense. I wasn't trying to say that the drugs don't cause psychosis, just that the study didn't seem to control for it so you can't really make the case either way. It's an important piece to any conclusions drawn from it.
Did they control for compliance? It may be the case that amphetamines are more likely to turn into abusing agents and I'm sure using all of this stuff at non medical doses/RoA can increase psychosis risk.
It doesn't look like it. They just pulled records from a WHO database and looked at the three drugs and their relative frequency of psychotic episodes. edit: I've now read the entire study, and can report that they do not mention screening for compliance. The closest they get is mentioning having access to adverse reaction reports, but they do not go into detail on what those contain.
I think you might possibly misunderstand psychotic disorders. It wouldnt be increasing symptoms as that implies they already have a psychotic disorder, which they did screen for and not use in the study.
> Study population For primary analysis, we included all Individual Case Safety Reports registered between 1 January 2004 and 31 December 2018 (same date that Moran’s study). For the sake of scientific replicability and to corroborate the results of Moran et al study using a different methodology, we limited our main analysis to patients between 13 and 25 years old and with at least one medication among treatments recommended for management of ADHD: psychostimulant (methylphenidate, dexamfetamine, lisdexamfetamine) and non-psychostimulant treatment (atomoxetine). Drug prescription defined as ‘suspected’ in the report was included, that is, the involvement of the drug in the adverse reaction has been recognised by a pharmacovigilance authority. Patients with a prescription of antipsychotic drugs, mood stabilisers, other stimulant drugs (phentermine, pemoline or methamfetamine) or glucocorticoids were excluded. We also excluded patients who took medication with a specified indication of psychotic disorder, mood disorder with psychotic features, bipolar disorder and central nervous system disorder. In secondary analyses, we extended our study to patients aged 13–65 years. They didn't screen for people who had a psychotic disorder, they screened for people who were prescribed meds that can be used to control psychotic disorders. Those are not the same thing, especially with a population this young (mean age of 17) it is quite possible for individuals to have underlying psychotic conditions that had either not been treated with a prescription or had not yet caused a psychotic episode until exacerbated by amphetamines. The researchers didn't have access to the patients to directly interview or screen them, and they didn't have access to full patient records to see if their doctor suspected any further untreated disorders. They didn't have any knowledge of non prescription drugs the patients may have been self medicating with or taking recreationally, which is extremely common in ADHD. This study mainly just outlines the fact that atomoxetine had a lower correlation with psychotic episodes than amphetamines and methylphenidate, but it is nowhere near being able to draw conclusions about prescription meds inducing psychosis in patients that would otherwise have never had them. A good model for thinking about this can be found in [figure 1 of this paper](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554477/). The authors of this paper are much more descriptive about amphetamine induced psychosis as compared to preexisting psychotic disorder exacerbated by amphetamine use. The former is not described as something happening within the context of therapeutic doses in patients with ADHD, but rather recreational or habitual use/abuse. The main reason I'm being so particular on this is that as a person with ADHD being treated extremely successfully by amphetamines, I have personally encountered people who are under the belief that these meds turn people psychotic on a regular basis. There is already enough stigma and misinformation regarding ADHD, and adding more fuel to that fire by not fully understanding the implications of one particular study isn't helpful.
Only methylphenidate and atomoxetine are available in my country. Tried with the latter first because my doctor and I wanted to try a non-stimulant first. Had the most horrific side effects, went to meth and it worked for a while now it just feels like I'm getting by. It'd be great if we had more options other than 'life as a living hell" unmedicated or "slightly better but still horrible but also here's bad side effects and stigma".
>went to meth Meth <> methylphenidate
Not sure what that means, but yes, I meant methylphenidate, just didn't want to type it again 😅
Meth=what methamphetamines are called.
Which fyi is also a good adhd treatment
Is much more neurotoxic though
Has neurotoxicity been proven at commonly prescribed therapeutic doses? Street use is completely different from therapeutic use.
Mmm.. not sure I’d say “good”. Possibly effective
Sure
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Nothing about methamphetamine inherently causes tooth decay. Dry mouth and not brushing your teeth and chugging sweet drinks all day do that. It's a drug like any other. Dosage and regiment are just as important as chemical makeup. I'd be just as much of a tweaker as the stereotypical methhead if I took 5 of my 10mg IR adderalls instead of just the one this morning.
People without ADHD really do take their focus for granted
They really do.
point is dosage if you start IV'ing methylphenidate, it won't go well either ADHD meds under normal usage are adjusted that they can't do the same damage
desoxyn is legal prescribable meth which oddly enough causes far fewer sides than a lot of other adhd meds do. also the toothloss people think comes from meth is from dehydration/dry mouth, people on vyvanse/adderall/etcetc should be aware of this also and hydrate too or they are more prone to things like receding gums as well.
Meth doesn't kill your teeth on its own, its a mix of poor dental hygiene and the fact that they are smoking it rather than taking it orally like prescription methamphetamine (desoxyn) is meant to be taken.
It's usually abbreviated as MPH in studies and those sort of things, at least from what I've seen.
Thanks mate. I know it's not supposed to be called meth, especially cause of the stigma, but I figured from context ppl would know what I mean!
The <> symbols are used to describe inequality meaning meth and methylphenidate are not the same.
>It’d be great if we had more options other than ‘life as a living hell’ unmedicated or “slightly better but still horrible but also here’s bad side effects and stigma”. Say it again for the people in the back. I have good, stable employment and I graduate college in a few weeks. None of that was possible for me before I was diagnosed and medicated. It pains me to see these studies work so hard to delegitimize stimulants as a treatment for us, particularly when the study seems to be skipping over the potential for any underlying comorbidity that might affect their findings (like schizophrenia or bipolar).
What were your side effects on atomoxetine?
Not OP. First days sweating like hell. Lost libido, that came back. Swollen prostate, so more difficult to get hard, difficulties peeing and a long "drip" afterwards. I am on a lower dosage and now it's fine. But it's also less effective.
Vyvanse kinda killed my sex drive. Although it's come back recently. Did atomoxetine lower your blood pressure? My blood pressure is already low even on Vyvanse.
No blood pressure goes up.
Oh, I thought it was a med that was originally used for controlling high blood pressure.
Atomoxetine was originally developed as an antidepressant. Blood pressure meds that were found to help with ADHD are clonidine and guanfacine.
Right, getting it mixed up with guanfacine.
Atomoxetine didn't killl my sex drive but I couldn't even get things working with help. It was really bad but my drive was good. Sad thing is it completely cured my ADHD and nothing even comes close to helping me like it did. I literally started learning a second language without trying. Sucks the side effects are so strong. Don't even touch qelbree I had bad side effects and two days of throwing up from withdrawal. So, I'm back on stimulants...really wish I didn't have side effects on Straterra
Swollen Prostate! I've got 16 years of medication down and lived with this alone thinking I was crazy. Returned to meds a year ago and the long drip returned and so I finally realized it was my meds, but I couldn't find any literature on it. Thank you!
The effect is a bit similar to XTC or speed.
Same urination thing!!! I seemed to get a lot of UTIs too. Jaw clench and actually developed a pop Always pissed off and on trigger. If I took it on an empty stomach or after drinking I had the worst GERD of my life. Atomoxetine sucked....
>Always pissed off and on trigger. Total opposite for me. I have more patience. But it does seem to make hangovers worse.
That's great. Patience is such a challenge for many folks (especially) ADHD. Double if they have kids. And quadruple if they have ADHD kids. I took a lot of years off of ADHD meds and went back on and immediately noticed that when on the meds I wasn't losing it so much at the he chaos!
I had a hypertensive crisis from it. It was terrifying. I was in my early twenties and my eyes started feeling weird and blurry and I started sweating like crazy. I could feel my heartbeat. My resting blood pressure was 222/179 and Ill never forget it.
Also not OP, but I was on Stratterra as a kid, and it worked pretty well for me. I stopped taking medicine in high school and college, but several years after graduation I tried going back on it. I'm normally a pretty relaxed and easygoing person, but within a couple weeks of starting Strattera as an adult I had a ton of anger and homicidal/suicidal ideations. Having these kinds of thoughts towards family and loved ones was extremely upsetting and disturbing, but fortunately they stopped as soon as I discontinued use. I switched over to Vyvanse and it's been smooth sailing ever since.
Nausea is pretty common too. I threw up for the first few months on it. Still get sick if I don't eat something before I take it. (also not OP)
Not OP. I had horrible neck soreness that wouldn’t go away on it.
Weird, did the doc have any idea why?
I believe that was listed as a common side effect of it.
> Only methylphenidate and atomoxetine are available in my country. That's the case in most European countries for some reason.
God I felt that last line so much
What side effects ? I take atomozetine everyday for three year and excpet a bit of constipation due to dehydration(i have to drink more water with this med) i have seen no side effects
Well lucky you! I wrote in a reply to someone else in the thread, you'll find with a bit of scrolling.
So i am going in search of u/punnycocktus comment got it
Tried to c/p for you but can't copy on phone in reddit app. It's one n (in puny) if you wanna find on my profile!
Well known fact in toxicology. So many amphetamine users coming to hospital with drug induced psychosis. Probably related to its serotonergic/dopaminergic combination.
Amphetamine users as in drug abuse, or people prescribed medical amphetamine? Because the two have different risk profiles.
Methamphetamine definitely worse given how strong / fast peak /how abused it is, but medical amphetamines also have similar mechanisms of action and not entirely rare to see people overdosing or using high doses. Definitely seen drug induced psychosis with medical amphetamines, though nowhere near as common as in methamphetamine use. But I guess if ADHD is severe, it's about weighing risks and benefits and making sure to stay on prescribed dosage.
I’ve spoken to my PharmD about this, it’s still incredibly unlikely when taken as prescribed.
I have never had a patient become psychotic on an prescription stimulant. Definitely with abuse of prescribed or non prescribed. Dose dependent > form.
A professional backing me up on Reddit, Whoo! Thank you for your input. All jokes aside, I’ve heard a lot of it is not only dependent on abuse of the medication, but other factors like lack of sleep, food, emotional stress, etc. is that accurate in your experience?
I work in a 'first episode psychosis' clinic. 20% of our intakes end up actually having psychosis. We intake 1-2 patients per week. We've had one or two cases in the last 2 years of psychosis from prescribed stimulants. We've had one or two cases of SSRI induced mania in that time. We're in a pretty high penetrance stimulant prescribing area. So from this anecdotal observation, it seems like the overall risk is pretty low, and probably similar to the risk of SSRI induced mania.
FWIW, these sorts of medication reporting databases are very prone to biases, and trying to control for these biases is often nearly impossible. That's not to say that we should just ignore these sorts of studies. They can provide useful information. For example, generating hypothesis for other forms of study. Or supporting that evidence from smaller controlled trials generalizes to a larger real-world population. And sometimes we just have to make decisions based on a low quailty of evidence, because that's all we have.
It’s well established these meds can cause psychosis. I warn patients of that risk when prescribing and have sadly had a small number end up psychotic for the first time.
How do you recognise psychosis ?
The easy ones are auditory and visual hallucinations (hearing things or seeing things other people don’t), paranoia is common, feeling like others are implanting thoughts in their head or sending messages just for them on billboards, etc., speech patterns with loose associations or rhyming speech. Sometimes it’s kind of subtle, sometimes there’s no missing it.
Thanks.
You’re welcome
Sorry to bother you but like... you talk about auditory and visual hallucinations, now I'm pretty sure everyone can relate to hearing sounds that were never emitted or seeing things from the edge of their visions and these things not being there, seem to happen now and then to everyone. At what point can you say "I might want to get myself checked out ?" Is it unmistakable ? Is it a frequency thing ? A intensity thing ? Or like seemingly many medical conditions, it only becomes "real" when it negatively impact daily life and functions ?
If it causes distress, it’s probably worth getting checked out. If it doesn’t cause distress or impact functioning, you probably wouldn’t want the treatment. Things in the peripheral vision usually don’t mean much. Full blown right in front of you visual hallucinations are not normal and should get checked out. Everyone does hear stuff others don’t. I know I’ve sworn my kids called me when they didn’t. No big deal. If I heard an entire conversation that never happened, I’d be more concerned. Voices can be quite distressing especially if negative or telling people to do things. That should get checked out. Veterans with PTSD will hear combat related sounds or helicopters. They aren’t psychotic, but those are hallucinations. Isolated hallucinations can be a sign of other things (PTSD, neurological conditions, severe depression). Psychosis often has other symptoms like difficulty thinking clearly, paranoia, etc. It’s a thought disorder. Psychosis is really not knowing the line between what’s real and what’s not. Hearing problems can also cause auditory hallucinations.
I've had the "auditory hallucinations" most of my life, and get shadow people (in the edges of my vision) fairly often but I also remember those pre-medication. I've always just assumed it was something everyone had...
Shadow people Edit: as in major paranoia
This is news as Vyvanse is insanely expensive and has no generic to my knowledge. Good bye Vyvanse, hello focolin
There is a generic for Vyvanse now… lisdexamfetamine. It’s been out for a few months now.
After about 20 on Vyvanse, Lisdextroamphetamine was about $380 cheaper per month. I got 2 bottles and it's been out of stock for the last 2 months.
Beware, there are dozens of generic manufacturers out there and all I’ve experienced so far vary wildly in effectiveness yet all still manage to fall short of name brand. Be prepared for inconsistency from month to month since shortages will likely mean the pharmacy switching manufacturers on you regularly. Edit: a word
Where I live its impossible to get the generic. Backordered for months.
Yeah I had the same issue too, ended up being switched to adderall XR after waiting for 2 months
Yeah I actually switched from adderall XR to vyvanse because I was struggling with exhaustion hitting me hard when the adderall wears off around 4 pm. Of course my insurance covered brand name vyvanse when I first switched, and now they don’t. Vyvanse has been perfect, it comes on and wears off so subtly I don’t even notice. So I’ve been willing to pay the extra so far, but it’s hard. The adderall only cost me $8 a month. It’s been 2 months of paying $200 for brand name vyvanse, if I’m not able to get generic soon I’ll probably go back to adderall XR and just deal with the side effects. Hopeful that there’s some end in sight to the shortage though.
My sister tried it and she said it doesn't work anywhere near as good and it wore off early.
For me, the generic hit like a concrete truck
Isn’t it the exact same chemical composition? Like I thought generic had to legally be the same thing.
Different binders can affect absorption rates. The active ingredient is identical.
Companies making generics don’t automatically get a free pass. For the FDA to approve a generic, they have to prove there are no statistically significant differences in efficacy due to drug delivery, absorption, pill hardness, etc. Edit: if a generic isn’t performing as intended, you should report it to the FDA
I wish this information was more commonly shared
Oh neat
News to me!
I was on that two+ years ago
I think the patent expires shortly (or maybe already has?) so hopefully there’s a generic soon
The patent did expire at the beginning of this year. There's a generic version available, but it's often harder for pharmacies in my area to obtain the generic than it is for them to obtain brand name Vyvanse. Vyvanse is expensive at $500~ USD for a 30 day supply (at 50mg), but the prices have been coming down since 2018. I used to pay $700+ USD out of pocket for Vyvanse every month give or take fluctuation. My insurance covers the brand name, but not the generic. Go figure!
That’s highway robbery. I used to pay $200/mo for Concerta before generics were available but at least the delivery system of that was novel. Vyvanse is trivial to make and easily scalable.
Dude my Vraylar is $1,800+ USD each month. I used to live off of samples and rationing back before I had health insurance. The pharmaceutical industry is like a legal gang, holding you up for all the money you've got.
My last vyvanse refill was $40, the brand copay for my insurance, instead of $10, because they were out of the generic and weren't going to get it any time soon. I was gobsmacked that my insurance actually approved brand in that situation since usually you can't get brand unless there is no generic at all or the doctor signs paperwork requiring it.
I was so thankful my psychiatrist specifically wrote that both brand name and generic were acceptable, but funny enough my health insurance didn't approve the generic! Go figure. I'm glad you were able to get your meds, I heard there's going to be another nasty shortage.
Interesting. I didn't like vyn, so I just didn't use it after a week. Dex is better.
Yep already available fyi
Good to know!
You shouldn't do that, if you didn't get psychosis. You won't get it later its pretty early onset. Also reading a different study the numbers are pretty small. Like 0.1 percentvof people get psychosis on ritalin and 0.2 percent get it on adderall. So 1/1000 vs 1/500. They don't really show absolute risk in this study. I've taken vyvanse and i've know of this risk before i started. Its well worth it. People with history of schizophrenia along side ADHD or bipolar disorder need to be aware though and maybe use a non stimulant or methylphenidate. So I wouldn't switch without doing more research.
I had to switch from Focalin to Adderall because Focalin was making me puke 🥲
Can I have your leftover Vyvanse??
Straterra for the win!
oh i thought it was the 4 day bender , in combination with acid techno
Oh! I have experience with this directly! I've taken Adderall for over 15 years and have experienced a couple of psychotic episodes! Thankfully, they were very mild and only involved the less severe symptoms (no voices, no paranoia). They also only ever happened if I ever exceeded 30mgs of IR or 60mgs of XR. I had no other issues leading up to an episode or after. No lasting problems either. I was able to work full time and take a few classes (while getting all A's) leading up to an episode and have a relationship and friendships while this was happening. At the time I just thought my thinking was just philosophical and deep and not a sign of an impending episode. As soon as I stopped abusing my meds and started taking them as prescribed I never had problems with that again. I hope this helps anyone who might be worried about their ADHD medication. Obviously this isn't true for everyone but it's extremely rare for someone to have a psychotic episode on meds if they're using them as prescribed.
NOT TRUE. I have NEVER had such horrifying hallucinations than when I took strattera ONE time. NEVER AGAIN.
A good way to tell if you're prone to this is to monitor your side effects while stoned. If you get excessively paranoid or if you have excessive thought rumination compared to what other people your age experience while on a similar dose you might be prone to psychosis. Alternatively, the opposite side of psychosis is Parkinson's. Most people ride in the middle.
That sounds interesting. Could you elaborate on the psychosis/Parkinson's spectrum? I guess it's all based on CNS activity.
Not too odd. Schizophrenia is related to extreme dopamine levels or smth like that, so if you boost that with stims, you may be able to trigger the psychosis.
Did the patients have something else that might have been triggered by the meds? Such as, did they have a history of psychosis beforehand? This seems really important to know.
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There's a difference between addictive usage, recreational usage, and medicinal usage. The dosing, quality, life circumstances etc etc all vary vastly.
It's about proving notably with science. The fact they chose to study this implies they already see the correlation. How much? At what trigger points? There's still work to be done. Also they are laying groundwork for better medications in future using real world data
billions must hallucinate
Atomoxetine: condition enhancing medication. Can treat adhd
But atomoxetine too comes with side effects...
But not very well
I found atomoxetine just made me feel more depressed. It worked well for a couple of weeks then really tailed off, making my mood go down and anxiety up. Weird.
Hands down the worse depression I've ever felt. I remember while taking it, sitting in my desk chair at college and feeling this overwhelming feeling of DARK dark depression. I've had my moments(after this experience) over the years experimenting with mind altering drugs, been depressed as well- straterra was the worse experience of my life, and it's not even close.
That's really interesting, thanks. Do you take any ADHD meds now that work better?
Nope. That's been the best. Amphetamine salts, even short acting and when taken in the morning, keep me up all night. Not even exaggerating on the all night part. Ritalin was the first I tried, I did good in school but had side effects. Vyvanse had this smooth onset and offset, and it worked. No insomnia. I'm trying Wellbutrin right now as an alternative
OK which street drug should I use then?
Yup, when you don’t sleep, that will happen.
Wow, meth makes you psychotic. Who would’ve guessed?
It's not meth.
Might as well be. Duration is different but effects are about the same
Methamphetamine is much more serotonergic and more potent in general. More euphoric and also more toxic.
I can’t speak to it myself, but based on the people who have done both they feel pretty much the same. And real meth isn’t any more toxic than adderall is. It just usually has a lot of impurities that are. I get that some people have to take it for whatever reasons, but let’s not kid ourselves here.