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Forum Name: Psychiatric Topics

Question: Adult ADHD


 carlotaD - Tue Apr 28, 2009 12:07 pm

Hi,

My husband is being treated for ADHD and I was just recently diagnosed with ADD and I can't find very many straight-forward answers anywhere, book or internet, about adult ADD/ADHD. I am extremely concerned about my husband's use of Adderall and caffeine. Some quick facts about him:
My husband is 34, 5'11, 190lbs and was diagnosed with ADHD as a child. Depression, anxiety, and bi-polar disorder run on his entire mother's side(his mom and 3 aunts are all being treated!). Drug and alcohol abuse seem to run on his father's side(we don't have extensive information on them)

Ok, so here are my questions:

1) Does caffeine have the 'opposite effect'(i.e, makes you tired) that it does on non-add people? My husband drinks energy drinks(redbull, mach, etc) up to 3 cans of it a day. And then coffee. Then complains about his sleeping!! Yet I will do fine with a cup or two in the morning...if I drink more than that, especially if I have taken my adderall(I am on 10mg BID) I get jittery.

2) What is considered an average dose, versus a high dose of Adderall(not XR)? My husband has been on 60mg for 3 months and I feel like it has done nothing to improve his symptoms. He was on it years before, but didn't have medical insurance and took to buying it off the street until we met and I asked him to stop. Some resources I have read say that 60mg is extremely high, some say that dosage can go up to 180mg. I am concerned that he is abusing it. In non-ADHD people, it appears to cause euphoria. So is it possible that if it is making him feel good, he is tricking himself into believing it's working? He has absolutely refused to try going a day or two without it to see what changes, try any other medications, or consider a different diagnoses. He got the prescription within a 15 minute evaluation done by a first visit with a psychiatrist. He confessed that sometimes he takes 4 pills a day instead of 3. He says he just feels like he 'needs' it. He also has high blood pressure and high cholesterol. The other day he had a violent temper tantrum because our insurance wouldn't pay for his prescription a week early. I'm very concerned. As his wife am I allowed to call his psychiatrist and talk to them? He won't listen to me.
 Debbie Miller, RN - Fri May 22, 2009 12:00 am

User avatar Hello,
This can be very difficult as a caring loved one to see someone struggling and possibly abusing substances. It is believed that caffeine can act a bit like other drugs used to treat ADD (after all it is a stimulant) so it is possible he is self-medicating.

Usually 60 mg of Adderall is the upper end of the dosage range for adults. Effective dosing is highly variable. It is also very possible to misdiagnose ADD because symptoms can be so similar to other conditions but often people believe a diagnosis of ADD is more acceptable than other possibilities so they refuse to consider either alternatives or comorbidities (additional problems along with the ADD).

You will not be able to force your husband on this but perhaps reading something on adult ADD and other disorders could be helpful. Adult ADD: The Complete Handbook by David B. Sudderth M.D., Joseph Kandel M.D. and online support like this may help: http://www.livingwithadd.com/index.shtml

C.H.A.D.D. is an organization dedicated to children and adults with ADD/ADHD and they may be able to refer you to a local support group. http://www.chadd.org/

Good luck. This is a challenging problem but it also comes with gifts and talents.

Best wishes.

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