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Comment by ulisesrmzroche | Hacker News Reader

I stopped on 56mg for two months and did not have any withdrawal symptoms. You may want to talk to your doctor about this, withdrawal like the one you experienced is not very common, I think.

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When I used to be on an Adderall IR prescription, I didn't have any withdrawals but the effects declined very noticeably after a few days use, and the side effects worsened. I started taking it only a few days a week at most instead and was much happier. If I didn't have work that needed the extra focus on a particular day, there was no need for taking it that day. I've never understood the people who use it daily, including weekends, unless it's for something else like narcolepsy of course.

I don't get the "happier" part, it's very subjective. I take it daily, as the doctor prescribed, and it has made my life noticeably better.

If you use the medication only once in a while, do you have ADHD or do you only think that you do?

My doctor prescribed it for daily use too, but I asked him about it and was told it's fine to take it whenever I feel the side effects are worth the relief from ADHD. Where did you get the idea that it's necessary to take it every day or not at all? Adderall is not a drug that requires that. You should ask your doctor more about it.

That's how it's commonly prescribed, but I'm sure it varies depending on the person.

I have stopped taking the medication in the past and I did not have any withdrawal symptoms or felt happier or anything of the sort. I've always used caffeine though.

I guess what I'm saying is that someone who thinks they may have ADHD shouldn't discount methylphedinates because some people have withdrawal symptoms, which mostly happen only when someone is abusing the medication, or is nervous about it in the first place.

I'd be interested to hear why the GP thought tapering would be worse. It's almost universally the better option.

I think it's probably a lack of familiarity with this sort of thing. Sort of like how folks are thinking 56mgs is insane, and 25mgs are almost cocaine and speed.

High dosages are up in the 150+, more like people who binge on 3 pills, or crush and snort them. That would create withdrawal symptoms and be neurotoxic. Therapeutic dosages (like the ones the doctor will prescribe you) are supposed to be just that.

The reason I went cold turkey was that I was already seriously tolerant to my prior dose, and the doctor had recommended several months of tapering to reduce my tolerance. (I had been on that dose for about 5 years.) I couldn't afford to spend that amount of time eliminating my tolerance, because I'd be operating at such a reduced capacity (from withdrawal) that I'd risk my job.

So, instead, I took a week off coinciding with a long weekend, and just went off it completely. It sucked really bad, but I had some stuff in place to make sure I wouldn't be in as much danger as I could be. (I removed all potential weapons/poisons from the house, stocked up on "comfort food" so I wouldn't be tempted to get in a car, etc.)

I wouldn't recommend it for everyone, especially due to the suicide risk, but in my case (for various reasons) that risk was pretty much 0. (I'm aware that self-diagnosing suicide risk is really unreliable, but I have a few personal situations that make suicide impossible to seriously contemplate, so I'm pretty safe in that regard.)

That's a high dosage, to the level where I expect it is neurotoxic. I think you might be more of the exception than the rule... some withdrawal is to be expected, though not necessarily as strong as OP.

I really don't think my psychiatrist would prescribe me anything that is neurotoxic.

High dose stimulants in rats are neurotoxic. http://www.dr-bob.org/babble/neuro/20091104/msgs/931964.html Your mileage may vary, but I think prescribing patients >50mg amphetamine is often irresponsible. Ask your psychiatrist at what dosage he thinks amphetamine is neurotoxic. 90mg maybe? Doctors agree that a certain dose is neurotoxic but disagree on what that dosage is. 60mg is the official maximum safe dose, but it's not like you should put all of your trust in the FDA. Given clear stimulant burn-out I have noticed in multiple taking >50mg of amphetamine daily, I have no doubt that dosages like that cause negative neurological effects and that caution is merited in amphetamine dosing.

Methylphenidate and amphetamine is not the same thing, and I have not experienced anything like what you've said.

I really don't think burn-out is as common as people say, high-doses are more like in the 100+mgs, and that's not in anything that is considered therapeutic and extended release.

Stimulants aren't neurotoxic, specific substances at specific levels are. Methylphenidate's majority of benefit comes from its reuptake inhibition of both dopamine and norepinephrine. While it is also a dopamine releasing agent, it does so at dramatically lower levels than the amphetamine family. The difference turns out to be significant - while they both promote more dopamine activity in the brain, it turns out that preventing the disposal of brain chemicals is generally much safer than promoting their release. As far as I know there aren't real concerns about MPH neurotoxicity.

Sorry, yes, I'm suggesting that amphetamine is much more dagnerous than methylphendidate.

56mg means Concerta, which is an all-day extended release formulation - not the same as injecting 56 mg into your mainline, or taking an immediate release tablet.

Concerta wouldn't come in a 56mg tablet if it was expected to be neurotoxic.

Good point. As he was responding to someone discussing amphetamine, I thought he meant amphetamine. I have known someone prescribed 3x20mg short acting amphetamine daily who after stopping is now quite aware of the long term negative effects.

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