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ADHD meds and appetite

I had great success last year with IF. I finally made it to One-Derland for the first time in about 13 years. This past spring I finally got medicated for severe ADHD though and it has absolutely wrecked my appetite. I used to be able to wake up and wait until at least noon if not 2 or 3pm for my first meal. On the meds, I began to wake up STARVING. Also my pandemic fatigue ramped up hard by summer and I started to get super lax about takeout. I need these meds. They are the only thing that helps me be consistent at my job. They have been an absolute game changer for my focus and mood stability and executive function at life in general. But my appetite and cravings are bonkers. I have had about 30 lbs creep back on in the last 8 months. This is terrifying to me. It affects my blood pressure too. Help! Any advice for real, physiological hunger and complete shift in brain chemistry?!!

Answer

I suspect that your dose is too high. Other psychiatric medications, like some SSRIs, can help with weight loss but if the dosage is too high, they contribute to weight gain. I also wonder whether the BP increase is from the weight gain alone or from the ADHD medication.

This could also be a rebound effect. You should talk to your prescribing doctor about potential options. (For example, I take a higher dose extended released pill in the morning and a smaller dose ER at lunch time when I break fast so that my treatment is smoothed out better and I don’t get rebound energy at night.)

Again, talk to your prescribing doctor.

Answer

That’s… funky. Definitely talk to your doctor, perhaps after talking with a pharmacist. They usually know all the side effects, alternative options, etc., and you might be able to talk with your doc and propose something the pharm recommended. I have a cupboard full of Adderall I stopped taking because of severe dry mouth (it kept getting delivered b/c I kept forgetting to cancel it), but when I was on it it killed my appetite almost completely. Most stimulants will do that, so definitely talk to someone.

Answer

Sounds like you are using concerta. Perhaps ask the psych to have you try out elvanse/vyvanse? I take 70mg elvanse every morning even when fasting and have no issues. I didn’t do any fasting while on concerta so can’t give any anecdotal comparison though. I do know that concerta and elvanse have very different mechanism of action for the delivery of the drug.

Answer

I have found that with ADHD meds, fasting initially is made a lot easier but with any major stress thrown in there, eating becomes like a nervous habit and a comfort blanket. Vyvanse has been prescribed off label to help with binge eating but we still have to be mindful of anxiety management techniques and recognizing when we’re turning to food for comfort.