Skipping the story book, I work rapidly changing shift-work and couldn't sleep, stay awake, or function when i was supposed to. I saw a specialist that diagnosed me with "shift-work disorder." The solution cocktail includes Ambien to go to sleep, and Modafinil/Provigil to stay awake. I only use them during the times when I'm on the odd-ball shifts (not days), and they work great. I've had no issues.
I have also recently gotten prescribed Adderall after voicing my (and former teachers) life-long concerns of possible ADHD. Low dosages did nothing, and I can "kind-of, maybe?" tell some improvements with a higher IR dose. I don't want to ask for more at risk of looking like a drug seeker, and I don't want the jitters to increase, but I'm also not really sure what I'm supposed to "feel."
Until I've recently went back onto one of those odd-ball shifts and took modafinil again. I can absolutely without a doubt tell that I'm on it. I am focused and am constantly completing something. This is what I imagined Adderall was supposed to be. The con is that it has this effect that I don't notice I'm hyper-focused until many hours later when it wears down a bit, and it's noticed in retrospect. It's weird enough that I take it as rarely as possible (I'd rather feel this then constantly falling asleep while at work, which is extremely dangerous at my job)
If it's working correctly you should not "feel" anything physical, but you'll be able to concentrate and focus (within reason) on the things that previously took significant effort. It certainly isn't a 100% thing -- focusing on some things is hard with/without medication, just as it's hard for people who are not on the ADD spectrum to focus 100% of their time.
Regarding your comment about "jitters", I'll offer you a short anecdote of my own.
I was on a higher dosage schedule of Adderall XR (60 mg/day) for a couple of years before I started to experience jitters and moderate insomnia set in. After talking to my psychiatrist we decided to give Vyvanse a try (70 mg/day). A few days after taking it my jitters went away and my body's circadian rhythm started to return to normal.
Vyvanse may not be for everyone's system, but if Adderall or Adderall XR don't agree with you, it's worth talking to your doctor about it.
Happy to discuss further offline if it would be helpful, you can get in touch with me through any of the links in my profile.
It's worth noting that different psychotropic drugs work differently for different people.
For example: when I was diagnosed with ADHD a few years ago, I trialled three drugs. I definitely noticed ritalin. I certainly noticed dexedrine (and hated the experience). Strattera did nothing for me.
Other people have other experiences. YMMV.
Also, my doctor told me my diet will greatly affect how the adderall works in my body. And that really rang true to me. I usually eat pretty lean, so 10mg, or even 5mg is enough for an effective dose for me.
I tried to get provigil from the same doctor and he couldn't even believe I would ask for it, said it was too expensive to prescribe to someone like me.
Not all drugs work the same way for treating ADHD. If simply increasing the dosage isn't working, they may try (and you may suggest) switching to try out Ritalin or some of the other options.
I find it rather presumptive that you simply tell this person not to do something, period. They have more information about their own life and the trade-offs involved. As a straw man, maybe they earn enough from occasional shifts to pay for treatment of an otherwise deadly medical condition, or don't have other economic opportunities.
In addition, many jobs simply need to be done in shifts, and someone's gotta do it. Servers need monitoring, hospitals need staffing, power plants need running.
I'm not going to go grab links for you, but yes, shift work is terribly detrimental to your health. Google "shift work health risks".
> In addition, many jobs simply need to be done in shifts, and someone's gotta do it. Servers need monitoring, hospitals need staffing, power plants need running.
Indeed. They can pay extra for the requirement, while we ensure we have regulations to keep people who have to do it as healthy as possible.
Take a few minutes and google it, this has been studied for 100 years or more.
And yes besides melatonin I follow the recommendations for improved sleep.
I tried adderall for concentration at a standard therapeutic dose, but the jitters and palpitations.
These days, I just use mirtazapine (depression) and flonase (sleep apnea) and occasional caffeine, and all is sweetness and light.
EDIT: If anyone can add peer-reviewed, reasonably-safe, well-studied neuroenhancement lifestyle choices (food, supplements, pharma, etc.) that aren't just spam/gimmicks, that would be interesting.
At my 200mg dose, I've seen no changes in vital signs (BP, heart rate), affect, or cognition.
I guess people around me might say I'm smarter on it, but only because the comparison would be to me asleep at my desk. It hasn't allowed me to reconcile gravity and quantum mechanics, at least at the 200mg dose.
Told my doc that I was taking it instead of Provigil (the brand name for modafinil) and they're all for it, as long as I get my liver enzymes checked on a regular basis.
Technically, I was prescribed Provigil to deal with very bad sleep apnea, but it's also to take care of my mild ADHD. Sleep apnea / shift work disorder are the only "on label" ways that insurance will pay for it.
I tried adderall a few years ago, and it was great for ADHD / productivity / made me much more outgoing (according to my girlfriend at the time), but I'm one of the few people that has the side effect of massive uncontrollable sweating. I could be sitting in a 75F degree office and just dripping. Had to stop taking it after two weeks. The changes in prescription laws (must have a new prescription every time, no refills, and then supply issues for a while) are almost too much trouble to be worth it, anyway.
In the US?
50mg daily every now and then works best for me.
It's no magic bullet; I still need to self discipline to pick the right things to work on. FWIW, I pretty heavily rely on todo lists for this.
If I don't have a clear task, I will procrastinate even harder.
In short, it works. I have been taking 200mg doses. I don't notice any focusing effect. I just don't get sleepy, at all, during the day. Only other effect, for me, is caffeine sensitivity -- as other posters have noted, modafinil will not make you feel wired, but add half a cup of coffee and there you go, if that's your thing.
It is great for feeling a little more awake when you're really sleep-deprived, but the tunnel-vision effect on high doses isn't always useful.
Exercise , healthy eating, and mindfulness will yield more benefits than any smart drug.
I've also dabbled in a bunch of the *phetamine ADHD drugs. They were more effective, but the effects taper off after a couple of months as your brain adjusts to work around the imbalance that the drugs create. They also had nasty side effects like raising my blood pressure and making my heart feel like it was racing when I was sitting in a chair doing nothing.
My experience with oxiracetam was just money down the drain. No effect I could notice whatsoever except maybe a little more sleepiness, which was definitely not the effect I was looking for.
I've been much more satisfied with my approach the last couple of years which is as you say:
Exercise - cardio on an exercise bike every day, strength training 4 or 5 days a week, yoga a couple of times a week.
Healthy Eating - low carb works for me. Carbs are my worst enemy in terms of staying clear-headed. Most of my meals are Keto Chow shakes supplemented with salads, fresh vegetables, and lean meats.
Mindfulness - I try to meditate every day, typically while I'm on my exercise bike or whenever I find quiet moments shortly after waking up or before going to sleep at night.
These three things have proven to be much cheaper than the drugs and way more effective. The downside is that they aren't as easy as popping pills.
And just for the record - I work out every day, take cold showers, medidate, my diet is impeccable (macro nutrient balanced) and all that combined still doesn't give me the same level as nootropics do.
From there you should be able to find other resources; but they're the best.
Reports vary. A friend of mine took some (of mine) and claimed to experience extreme jitters and paranoia, whereas I can only describe moda as giving me an extremely mild calming effect. Calm and hungry.
It took me a week of taking it before I could say definitively whether it was having an effect at all, so I eventually decided the drug as a recreational experiment wasn't worth the money.
If you are looking for cognitive enhancement and focus improvements nothing will help more than yoga and meditation.
50mg is ideal IMO.
20mg of instant release Adderall daily (or worse, twice daily) is not a trivial amount to be taking. The long-term effects of the increased heart-rate and sudden spikes you will get from Adderall are not yet well studied or well understood in the medical community.
Stress, arterial stress, vasoconstriction, increased heart rate, and high blood pressure are all just a few of the things that happen when you take amphetamine salts. It's not just the jitters.
While these side-effects are okay from time to time, the body is not used to being treated this way on a daily basis, for years and years.
If you are in a place in your life where you don't think you need to be taking it, consider not taking it. Take a break on weekends, or a week at a time.
1: This is part of why many of you get "short" or "agitated" on these drugs... drink more water to at least help.
Whenever I hear that someone takes Adderall IR, I ask them if they've tried XR or Vyvanse since the latter are superior in most ways. Mainly, IRs produce tolerance too fast and the curve is too steep.
I don't think Modafinil has an XR solution. Though, Modafinil feels like a sugar pill compared to a low dose of amphetamine.
Exactly. From the linked article: Modafinil "indirectly upregulates cerebral serotonin" ...a concern for those focusing on quality of life rather than quantity of output.
"To give you some perspective: the type of behavior displayed by upper classes of society; the elegance, the subtlety, the higher levels of intelligence and conscience, most likely reflect low serotonin levels (or rather, a lower ratio of serotonin to other neurotransmitters). Now take the opposite, high serotonin, say in combination with a poor immune system, low metabolic rate, chronic inflammation, and what will you have? Well, a serf/thrall."
Further discussion here:
I've thought about putting one together by interviewing people about their non-amphetamine-based get-shit-done regimen (timings, dosages, ± side effects, results). It'll be like an Internet bad-broscience guide, but with a slant towards combining wider anecdotal evidence with results and performance benefits/drawbacks across everybody.
email me if you're interested. If there's enough seed interest, I'll make it happen.
Have you seen which website you're on? More-More-More for Me-Me-Me is pretty much the MO around here.