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Re: Why do ADD stimulants stop working?

Posted by cumulative on October 15, 2007, at 9:51:05

In reply to Why do ADD stimulants stop working?, posted by Ashley B on October 15, 2007, at 8:47:11

As was discussed in a thread above, I wish I could bottle up that euphoric feeling and summon it when I like as well.

But that effect, related to dopamine activity in the nucleus accumbens, develops tolerance incredibly quickly. It's not something you can chase for long before getting problems.

Now, as for the therapeutic effect, which is what is now fading for you, 1.5 years in ... well, this takes a lot longer to happen, because the dopaminergic effects in other brain ranges (which comprises most of the "therapeutic" effect) takes much longer to develop tolerance, and can even display <i>reverse tolerance</i> or <i>sensitization</i>, ie you need less of the same drug to produce the similar effect. So for this reason many people take their medications for years.

Where the point is that the medications lose their effectiveness seems to vary incredibly, on god knows how many factors in play. There's a woman on addforums.com posting right now whose dexedrine just pooped out for her after 15 years.

But if you've hit that point where not just the initial euphoria of the early days, but the therapeutic range of effects (*improved focus, concentration, executive function, and yes, the pleasant non-euphoric mood boost) then it's time to look at options.

What Dr. Hallowell of Delivered From Distraction notes is that the cross-tolerance between methylphenidate and amphetamine is not high, so when they hit that brick wall, it's time to the next interval with a different mechanism of treatment. A few people switch them every month -- I wouldn't advise that for a number of reasons, but if it works for them then that's great.

Lars from addforums.com also switches from a methylphenidate to an amphetamine about every year or two. I think he's in his thirties, re-doing college, Dean's List, considering medical school.

>1. Why do they stop working? Do they deplete the adrenal glands, or the supply of dopamine?

Probably a bit of these and more. Probably powerfully downregulated activity of Tyrosine hydroxylase and dopamine receptor functions. Glutamate toxicity ---> tolerance? Psychological tolerance? It's such a nebulous concept, and so much goes on.

2. supplements

Magnesium gets drained from your body by psychostimulants anyway -- and this should certainly ease anything that might be going on with glutamate toxicity via Ca++ overflow. I take 400mg Magnesium citrate 4x daily -- this might be too much for some people.

Search some articles on zinc supplementation increasing the effectiveness of ADD meds.

Also, there's this glorious little piece of our Chairman's:

http://www.dr-bob.org/babble/20060304/msgs/616992.html

Good luck Ashley!


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poster:cumulative thread:789346
URL: http://www.dr-bob.org/babble/20071009/msgs/789355.html