If Adderall is out of stock, prescribers may recommend that a patient start taking a different A.D.H.D. medication in the interim, such as Vyvanse; people may experience varying responses to new types of medication.
“What we’ve seen over the recent years is there’s been a ballooning of available stimulants in the marketplace, and they’re not all equivalent,” said Sandy Mitchell, a clinical pharmacy specialist at Virginia Commonwealth University Health.
As the shortage slogs on, it has become increasingly common for clinicians to prescribe, say, an extended-release version of Adderall to a patient who used to take a shorter-acting tablet, or for prescribers to switch medications for patients based on whatever drugs are available, Ms. Mitchell said. Those changes can affect the way a patient feels throughout the day.
Starting and stopping medication
The shortage has forced some patients to go weeks, or even months, without Adderall. As a general rule, the higher the dose of medication and the longer a patient is on Adderall, the more likely it is that the person will develop withdrawal symptoms after going off it, Dr. Dube said. Patients may also struggle to readjust to the drug once they do resume taking it. Those who jump back into taking a large dose of the medication without incrementally working toward it from smaller doses may feel jittery and restless; some may even have heart palpitations, he said.
Disruptions and other factors
“You can’t diagnose A.D.H.D. in a vacuum,” Dr. Levin said. People with A.D.H.D. can be particularly sensitive to disruptions in their day-to-day lives; symptoms can flare up or intensify when a person grapples with the stress of a new job or a move, for example, or when there are changes to a routine. That’s why many patients with A.D.H.D. have struggled during the pandemic, Dr. Stutzman said. As more people return to the office or spend more time in public spaces with fewer masking guidelines, their daily habits may change and symptoms may worsen as a result.
Sleep also plays a critical role in how effectively medications like Adderall might work, Dr. Levin said. The consequences that come with sleep deprivation, like a foggy memory or difficulty concentrating, can overlap with A.D.H.D. symptoms. People who struggle to get a good night’s sleep may feel as if their A.D.H.D. is worse, or that their medication isn’t working as well.
Around a third of patients with A.D.H.D. have another mental health condition, Dr. Stutzman said. Symptoms of both can overlap with each other — the jitteriness that can come with anxiety, for example, may look a lot like hyperactivity. Patients who think that their A.D.H.D. has become worse, or that their treatment is not sufficient, may also be grappling with multiple disorders at once.
