Increased fatigue? | ADHD Information

My short question for anyone on amphetamine-based medication:

Has anyone noticed an increase in depression and/or a feeling of chronic fatigue that they attributed to the amphetamine itself? If so, was it related to dosage, type of amphetamine, or was it ruled that amphetamines in general can bad news for people with intermittent depression? I've heard of mood swings on stimulants but never of effects complete opposite of the drug's intentions.

The long story is...
I began taking dexedrine about six weeks ago for ADHD. For awhile, I couldn't really tell a huge difference in my concentration levels one way or another, but since Adderall had been so beneficial for that in the past (actually, my main concern was the "hyperfocus" made me feel like a zombie), I just figured I didn't have the right dosage. After all, the difference between the two should be pretty minimal (racemic mixture vs only one isomer...).
Anyway, about two weeks ago I started noticing a lot of the symptoms I'd associate with the off-and-on depression I've had all my life. Kind of a "dull" mental feeling (but not hysterical sadness), excessive sleep, and fatigue. I have insomnia at night and can't wake up in the morning to save my life. I have found it increasily difficult to get out of bed, and if I do make it to classes, I feel so exhausted I am at best not paying attention in class and, at worst, sitting around on campus or heading home early so I can go lie down. I can't really tell if I'm suddenly depressed again and should go back on an antidepressant and everything will be peachy (I responded very well in the past but again, like the adderall, didn't like a lot of the effects), or if maybe these problems are caused by the dexedrine itself.

I looked high and low on the internet already for any evidence of amphetamines excaserbating depression and fatigue, but all I could find was a bounty of evidence for the usefulness of amphetamine therapy for...depression and fatigue. If the cause is the dextroamphetamine, then what I'm experiencing would be due to a slight amphetamine overdose, which would make me dependent on it in order to feel normal again and I would only feel crappy if I haven't taken any or enough of it. But the problem is that I don't feel significantly better after taking my doses. And I don't know how related it is to my insomnia - the other day I took a nap when the dose should have been peaking, but couldn't sleep 8 hours later when it was time for bed. I guess maybe my dose is too high - but then I would think I'd feel jittery, not tired, unmotivated, and depressed.

My doc told me to go ahead and "experiment" with different dosages, so I have leeway on how much to take. However, if it is depression, then the dexedrine should only be suppressing a lot of these symptoms (not causing them), and I don't know how bad they would be without taking it or decreasing my dosage. And I really don't want to go back on antidepressants... =(Hey sleepy, I am experiencing similar symptoms.  I started taking Adderall for the first time at age 17 for a period of 7 months.  This was at a dosage of 20mg instant release once a day which was way more than enough to get me through the whole day.  From the beginning of the 2nd month, I started experiencing the crash more intense everyday, when I consulted with my doctor to try the XR version.  Long story short, it only induced major anxiety, and I was so slowed down by it to the point where I couldn't even write faster if I attempted to.  After 5 days, I went back on instant release, and tried administering an afternoon dosage of 10mg just to counter the side effects, which only left me feeling 10x worse in the evening and unable to eat.  For the rest of the 4 months, I just stuck with the 20mg 1x a day, and pulled through.  I stopped taking the medicine after the 7 month period had passed, because it was now summer.  I have been experiencing major fatigue just before I stopped it, and even seeked mental professional help who prescribed several anti-depressants with little success.  They all ended up making me even more tired, and being emotionally numb from head to toe isn't my idea of living, because I might as well be dead then.  I have went to two different physicians for blood work, and none of them were able to find anything.  I had a sleep study done because I thought I might have a sleeping disorder, and I was diagnosed with mild sleep apnea - although I was very surprised because im very slender.  Anyhow, I sleep with a CPAP device now, but I still suffer from chronic fatigue, so I decided to see a neurologist.  He ordered an MRI and some blood work, so I'll have to wait and see what he says.  I'm 19 years old, and whenever my body experiences any kind of stimulation, it automatically reverts to fatigue.  Even a cup of coffee will make me sleepy, and I have tried taking adderall a few times, but it only makes me sleepy and paranoid after it wears off.  In conclusion, I think your short question might be a very difficult one to get an answer to, or in my case to diagnose because I've done a tremendous amount of research, with few answers.  I do question stimulants' long term effects, because I do feel it somehow contributed to what I'm going through right now.  I also have major difficulty concentrating and remembering information, whereas before the medication I didn't.  I also noticed a permanent "dull" emotional feeling a few months before stopping the meds.  Most doctors are quick to diagnose it as depression, but I can honestly say, after throroughly thinking about it, I'm not sad, nor do I have any reason to be, I have too much going for me in my life right now anyway. Johnnyboi39029.4904976852Oh yea, I forgot to mention that my creativity has returned, and I can actually smile again.As an adult with ADHD and depression issues, I find Adderall to be very
helpful. I started taking Adderall XR a few of years ago. It helped my
depression way better than any antidepressants ever did, and my ability
to focus on my business and home were much improved. But I was also
really chatty and hyper, sometimes I felt like I couldn't go out for a run
because I was afraid of having a heart attack, and I did have some trouble
sleeping. So I stopped taking it for about 9 months.

Recently I made the switch to the short acting Adderall which I take 10
mg. 2 or 3 times a day, trying not to take the last dose too late in the
afternoon. By taking it this way, I don't get too hyper, I don't crash in the
afternoon, and the effects don't hang around all day. If I want to go for a
run in the morning, I can take my first dose later after and not be afraid I
won't be able to get to sleep because I didn't take it first thing, or I can go
for a run in the afternoon, take my second dose afterward, and not need
the 3rd.

I have a lot more flexibility with taking it this way, and I get the benefits
when I need them, and not for hours afterward! So far it seems to be
working well.
I sure hope someone reads this because I am having major problems sleeping at night. I'm on 20 mgs of adderall and 300 of the Wellbutrin until today. I decided I should try to only take 150 (I was told this also gives you a little energy) and see what happens. I get the jitters on adderall, I call it being tired, but wired. I could just drop, but feel like I have to move.
I had issues w/sleeping a couple of yrs ago, did 2 sleep studies and went onto a CEPAP machine, which I hate. Went to Eye, ears and nose specialist last yr and had my surgery to have my tonsils removed and nose cleared out, hopefully so I could get more air and not need the CEPAP. Did another study after surgery, still on it. Only fixed a bit of the problem. I went thru hell when I couldn't sleep for over a yr...thought I was going crazy. I take 1 ambien every night and use my cepap and usually feel pretty rested, sometimes not great. Lately I can't go to sleep or stay asleep. The other night I woke up at 2:30 am and couldn't get back to sleep. This is starting to wreck my life again and I can't live like this. I have a dr appt on thurs w/my psychiatrist (sp?) , but I hate talking to him because I always feel like he's rushing me. They only give you 10 mins or so as it is.
My work is suffering and because I can't stay focused. I feel like I'm on so much med's that I don't know how I feel anymore. I'm also on Prozac and Colozapam (sp?) for anxiety, which were working pretty well, I actually felt human. Then with talking, the next thing I know I'm on adderall and then being in NH the weather started to change and he thought it might be SAD because I've been depressed. I hadn't seen any family in 7 wks because all I would do on the weekends is sleep. I felt like a zombie too, like you all talk about.
So anyways, sleepytimerules, sorry for jumping in like this, but its getting really bad and I could use some advise.
Thanks everyone!
Stbear

I noticed this same thing when I started ritalin. It was a very low dose (5 mg twice daily) but the fatigue set in within 2-3 days. I never felt depressed but had pretty much of the dull mental capacity that you are describing. Anyway I stopped taking it after  about 4 or 5 days because it was really starting to mess with me. I even crashed  my bike in a busy intersection during rush hour - an intersection that I had ridden through a million times but still slammed head-on into a curb and flipped over the handlebars. NO serious damage done. 

Never had insomnia. If anything it made me sleep too much.  I do wonder, though, if I  had stayed on it longer the side effects would have subsided.

How long had you been depressed in the past and when did you go off the anti-depressants? It sounds like the depression is coming back and may not really be associated with the meds. You should go back to the doc.Johnnyboi: Have you looked into the possibility of having celiac disease?  It is very underdiagnosed, but one of its symptoms is feeling tired all the time. valnan, I took your advice and now I'm on regular Adderall 10 mgs a day and Ambien XR, to help with the sleep issue.

Thanks for your help!!
stbear

My doctor is a strong believer that excessive sleepiness is the CAUSE and not the effect of depression.  So, you may not be depressed because of the medicine but because of your need for sleep.  It is my opinion that many doctors or people in general underestimate the importance of sleep. My doctor also believes that if you experience some "extra" sleepiness it may not be because of a new drug or lifestyle change, but because your body is crashing from time where you worked hard and didn't get much sleep.  (Maybe last week?  Two weeks ago?)  He also said that he has noticed one person that reported that Adderall simply made him/her sleepy and that was about it--in which case the drug wasn't a good fit.

finn dodd39031.9075462963I've been thinking about it for awhile and I think it's mostly due to the sleep issue, as well. I've always had insomnia with or without medication from anxiety/stress, which may (or may not) be exascerbated by the dexedrine. It just sucks because the dex doesn't seem to help much with focus when i'm not well rested, but that's when I need it most since I'm in college. I think I'm going to talk to my doctor about sleeping aids, as I've just discovered from some internet research that prescription sleeping pills actually give you good sleep, as opposed to Benadryl, and aren't very addictive.

Thanks for the response, finn, and to everyone else.

Johnny - let me know what your neurologist says, I'm curious. What was most surprising to me when I first started wondering about this was that I found one of the off-label uses for amphetamines is for terminally ill patients who are still "well enough" to live at home, just so they have the energy to live some kind of life until their illness takes over (mostly HIV and some cancer patients). How can my fatigue possibly be worse or on par with theirs? Also, I probably "should" go back on antidepressants, as they worked very well for me in the past. I just hate that feeling of numbness - not being able to feel super happy or super sad just made me feel like a robot. So I just know I have to be careful when using dexedrine as a bit of a crutch for underlying depression, although it is (from my research) a very effective treatment. I think if I can solve the sleep issue a lot of things will clear up on their own. I'm using Straterra (off the label) for depression.  I like it because I definitely feel like "myself."  I believe it's used in other countries for depression but not so much the US.

Good luck getting a good night's sleep.  My doctor has explained to me that the state of mind that you go into sleep is also very important--for example, if you are making to do lists and worrying while falling asleep, this will put a damper on your quality of sleep (because your brain has not relaxed).  He suggests meditating before going to bed (telling yourself that today has been a good day, that you are "done" for the day, and that tomorrow will be a good day as well).  He also suggests making sure that your nasal passages are completely clear at night, because if you have any trouble breathing it can also lessen your sleep quality.  Additionally, he says that one's internal clock is very real and the hours before midnight actually provide the most restful sleep (kind of blows my mind but I believe it now too)... think about when your parents "made" you go to bed at a certain time, like 8:00 pm every night and how much energy you had at that point of your life (when you were a kid).  So YES, I bet your other problems will sort themselves out once you start sleeping better. =)
finn dodd39032.6258333333