I greatly appreciate you responses and thanks for the detailed post KDL. Sorry about not responding earlier but I've been somewhat busy.
KDL or others may appreciate a forum I primarily reside in : www.avantlabs.com/forum
It's really a goldmine on information especially in regards to neuroscience and pharmacology. I spend most my time in the neuroscience sub-forum.
Deltaforce38961.1569097222Ok so I was prescribed adderall XR (20mg), first dose today at 6 am (work beginning at 7am).I'll chime in a bit.
My experiences on adderall have been very similar. I've been on it for about four months now.
1. Many people find that caffeine makes the side effects of adderall much worse. Personally, I've always been able to have as much caffeine as I wanted without it making me jittery. In fact, the few times I took caffeine pills in college I passed out within an hour or two. On adderall, I am fine with a glass or two (in fact, I'll drink a soda about 30 minutes before I know that my adderall is going to wear off or before the second XR dose kicks in to prevent crashing and keep the transition to the next dose smooth), but I also tend to slip back into drinking soda like it's water as I used to. When I do this, I find that I get anxious and unhappy. So be aware that caffeine can actually be very useful, but you will find that it affects you more now than before.
2. Not necessarily. Stimulants actually work the same way on everyone fundamentally (despite rumors to the contrary). This is why non-ADHD people are such a big market for the drug on college campuses: it helps everyone focus and become more attentive. However, when it comes to hyperactivity...that's a different story. Most recreational non-ADHD users will report feeling revved up on moderate doses and simply more clear on lower doses. People who suffer from hyperactivity will often report drowsiness at lower doses and an internal sense of calm on moderate doses. Everyone gets more revved up on high doses, of course. But then again, people who suffer from hyperactivity may report anxiety and excess energy on low doses of stimulants. It's very difficult to determine what one reaction does or does not mean. Remember that stimulants affect a wide variety of things in your brain, not simply the regions commonly associated with ADHD.
3. The notion of building tolerance and medication breaks is common, but it's not actually very well supported through research. Studies haven't really found any evidence of tolerance to stimulants over long periods of time when they are taken as the doses prescribed for ADHD. Building a tolerance to stimulants is generally a side-effect of stimulant abuse. However, subjective experience comes into play here.
For one, many people associate the "rush" of the onset of stimulants with their effect. As your body and mind become more accustomed to the medication and its effects you are likely to feel fewer side-effects (and the "rush" is a side-effect), and you are less likely to notice the side-effect. My heart starts beating more rapidly when the stimulants take effect, for example, but after several months I hardly notice whereas when I first started it was VERY noticable and an indicator that the medication had set in.
People also may becoming adjusted to their new level of cognitive functioning to the point where they take it for granted. Remember that when you first start the medication, or every time you increase your dosage, you are, in part, measuring the effect by the comparison between your old cognitive abilities and your cognitive abilities on this new medication/dosage. The jump from no medication to medication in particular is substantial. As time goes on, you lose that reference point, and that "new" level of cognitive functioning may begin to feel old and stale even if it is objectively unchanged. Studies show that people continue to gain additional benefits with additional doses of medication. They don't quite tell you that on the Shire website, but every incremental dosage increase will come with an increase in your cognitive functioning.
The side-effects, however, will also increase, and they can actually end up mitigating or even overshadowing the cognitive boost from the dosage increase; which is another reason why people may falsely believe that their doses are wearing off. (For example, your brain may better be able to process new information with a big jump in dosage, but the side-effects may cause a cloudiness and headache that causes more harm to that process than the good of the dopamine increase) People who have severe ADHD and already have trouble regulating eating and sleeping may find that the increased dosages make them even less likely to eat and sleep properly, which may increase their ADHD symptoms beyond the benefits of the medication after several days or weeks, making them feel as though the medication has worn off. (I think we can all attest to how much more effective the stimulant medication is after a full night of sleep and a full stomach through the day than without these things)
All of these are possible reasons why people would interpret themselves as building tolerance when, in fact, they have not. Also remember that as part and parcel with the disorder, the ADHD individual's ability to self-monitor is generally quite impaired.
Finally, in terms of medication holidays (Which I briefly addressed above)...they are probably more likely to cause harm than good, but it all depends on the situation. Your body benefits from regularity with your medication. It's easier for the body and mind to adapt to side-effects, for example, and it creates more structure in your chemistry and behavior, which is always key to allowing the ADHD person to function properly. When your internal medication clock is way off, it just creates another series of distractions and introduces more randomness that makes it difficult for an ADHD person to properly care for themselves. Also, frequent breaks often mean a return of side-effects or a hindering of one's ability to adapt to those side-effects.
However, if your medication dosage IS making it more difficult for you to eat (as was the case for me at first since the dosages were high enough to eliminate my hunger but not high enough to give me the level of self-control I needed to plan meals and make myself remember to eat) or sleep, and you don't have the appropriate skill sets and external structures to compensate, then a medication break may indeed feel like a good thing. And in this instance, it would be. It is allowing your body and mind to catch up on the sleep and nutrition it needs to function properly, which also helps mitigate ADHD symptoms. But no, it will not prevent tolerance from building; largely because tolerance DOESN'T build period at prescribed doses.
Hope that helps.
I started Adderall XR about a week before you, and had similar experiences. I also lost my appetite (could work for so long that I didn't stop to eat, but could eat when I stopped to think about it), and just generally felt pretty optomistic and good. I've talked to my psychiatrist about 2 of these same issues in our last 2 appointments.