This is the composite knowledge of almost a decade of my experiences on, off, and around being prescribed this powerful tool. Like any, it must be used with respect. You're putting part of your body into overdrive and must respect that -- and, in so doing, yourself. The synergistic effects will be cumulative and permanent in a positive way.
1. You'll be fine. Really. Remember that.
2. Sleep. No kidding. Just because you feel like you can stay up doesn't mean your body is in any way more receptive to it than before you took the medication. It's tricky that way. Which leads to
3. Eat. You need balanced, consistent nutrition including all vitamins, branched chain amino acids, and low glycemic index carbohydrates balanced with a good macronutrient balance with good freshly-cooked protein and the gamut of healthy fats. If you have genetic issues metabolizing, e.g. MTHFR/MTRR mutations & folic acid (23andme cleared that up for me), take care of them ASAP.
4. Exercise. If you don't use it, you'll lose it. Remember, stimulants induce catabolism (metabolizing proteins -- as in your muscles -- and fats -- including in your brain) in cases of caloric deficit, and potent stimulants won't stop as per usual. This will also dramatically re-balance everything in your physical and neurochemical profile, provided you get enough nutrients and sleep. Seriously, dopamine, serotonin, endorphins (endogenous opiod-like painkillers & happy fun time chemicals), et.c. go up -- permanently -- and cortisol goes down.
5. Meditation. It actually works.
6. Yoga/nature/sex/travelling/friends -- whatever centers you and brings you back to that happy place. Part of the composite issue is that by worrying about a stimulant's side-effects obsessively while on stimulants (or even not) you are wiring your cells to fire together in the Hebbian fashion to continue a negative feedback loop of psychological, and thus physiological, stress and unhappiness. This, again, increases your cortisol levels.
That brings me to cortisol management. Initially, cortisol is part of the effect of the chemical working as intended, as it is elevated in response to exercise, stress, and as a metabolic by-product of dopamine and norepinephrine -- which are significantly and continuously elevated on stimulants -- degrading along their metabolic pathway into adrenaline, which includes multiple steps that increase cortisol. This is part of what stimulants do. In the short-term, this can increase monoamine concentrations (as well as increase the level of hormones like testosterone). However, chronically elevated cortisol is highly correlated with significant stress, and essentially begins a regulatory feedback control mechanism using hormones to regulate neurotransmitters. A little bit of cortisol is excellent for getting you up and going from sleep in the morning, but it needs to decrease at troughs in your circadian rhythm or you will have problems. Some of these include: suppression of endogenous testosterone and growth hormone, reduction of slow-wave (deep, muscle-repairing, hormone- & neurotransmitter-rebalancing) as well as NREM (dreaming, memory consolidation, various neural hedge-trimming) sleep, and a slow increase in calcium channel (and others that I cannot accurately recall at the moment, but I suspect potassium channel and possibly sodium channel) firing rate along with your aforementioned magnesium-mediated signalling increase. Over time, as those become imbalanced, you can also potentially experience a glutamate/GABA imbalance similar to the withdrawal from GABAergics like alcohol & benzodiazepenes.
All of this can make your body feel somewhere between an induced anxiety disorder and, well, chronic fatigue syndrome. Luckily, the withdrawal from amphetamines makes you feel tired because it's repairing overworked mitochondria and slowly up-regulating downregulated dopamine receptors as well as possibly similar effects upon endorphins. The adrenaline-like effects from excess norepi/epi would continue unabated, and the undiscriminating alpha 1,2 & beta 1,2 adrenergic stimulation eventually gets tiresome to even the most indefatigable smooth muscle, hence jaw clenching and chest pains from, mostly, really tight muscles and constricted blood vessels.
Pharmaceutically, you can try to counteract this physiologically with adrenergic blockers: beta blockers like propranolol -- which also works off-label for anxiety, but is totally unselective -- or alpha 2 agonists like guanfacine (originally prescribed as an adjunctive medication for stimulants, but I believe was shown to be somehow unsafe) or clonidine (also used for sleep and easing withdrawals). There are other medications like this, but these are all heart medications, so beware -- consult with your medical profession, and have them consult with pharm/psych/neuro/cardio et.c. specialists as well to be extra sure. Adding anything can complicate the variables, and these can have paradoxical rebound that could exacerbate your situation. The other alternatives like benzodiazepenes and SSRI's have some significant health issues with addiction and withdrawal/post-acute withdrawal syndromes that may or may not ever recede, depending on whom you ask. I would advise not going down that road unless you have exhausted every other imaginable option for that reason. Don't turn a resolvable temporary psychologically-mediated issue into a longer-term physiological issue.
All of these things are mostly insignificant and unnoticeable until you run yourself down, and you do that by being stressed, not eating right, and not working out while not sleeping enough.
Also, check your dosage -- maybe the XR 30mg is too much for you. I know adults (both >6' & >=200lb) who have been taking Adderall since they were in elementary school who didn't like taking Adderall XR 30mg because it was, quote, "too much": http://pi.shireconte...lXR_USA_ENG.PDF -- see page 6 for ng/mL plasma concentrations across T(hr). Also note how important food consumption is in the text directly below that graph: the effective time increased from 5.2hrs fasted to 7.7hrs after a high-fat meal. I like steak, eggs, and potatos; but that may be overkill on your HDL/LDL lipid frag panel. To be fair, I also know a ~5'10" & ~160lb guy who was prescribed XR 30mg b.i.d (twice a day).
If you like the effectiveness of dosage but experience these peripheral side effects, consider large vitamin C doses a few hours before you wind down for the day so you can help excrete the amphetamines at a significantly faster rate -- there's a reason they tell you not to drink fruit juices when you take it, but that can help at the end of your day.
Stack to improve symptoms on or off medication:
Day:
- a simple multivitamin every day helped immeasurably. Don't forget! And try to take it in the evening as per the above vitamin C issue which I'll mention in a moment. (I'm using NOW Adam, which surprisingly has a solid quantity of high-bioavailability forms of vitamins & minerals -- very important)
- Fish oil (high DHA 400+ as per the inspirational MrHappy) seems to help, especially with
- Uridine, which MrHappy cued me to. It had subtle but noticeable effect over time -- simply more positives and less negatives from the medication. 100-200mg daily, or twice daily -- I'm new here, go with his recommendations.
- CDP-Choline taken sparingly -- every few days (a post I read after I stopped my daily regimen stated that it and its metabolites can last for days, no citation there), but when I take it regularly at ~100-250mg it doesn't seem to cause any drowsiness or headaches, but rather calmly energizes me. If I take it every day, i.e. to stave off potential head pressure sensations from Noopept, I'll have ~150mg 1x or 2x a day.
- ALCAR -- I don't like too much, maybe 200-400mg. I feel like it can overload me. Anytime I feel "overload" I expect negative repercussions as my body balances itself back out.
- Noopept (with piracetam, but only for the verbal fluency increase) -- I wasn't a huge fan of piracetam 400-800mg, even 2-3 times a day with or without CDP-choline, if simply because I didn't notice much effect besides a slight overfocus (although the verbal fluency increase was cool, but I don't usually have a problem with that). Then I added Noopept, which seems to work almost as well on its own. Well, it works, and may be too potent -- sometimes I feel like a zombie computing machine, particularly combined with low dose Adderall. Less is more: 5-10mg, maybe 2x (or even 3x? seems to begin to wear off between hour 3-5 similar to instant release Adderall). At the end of the day I seem to sleep a bit harder, especially if I only took it in the morning. I've even had some vivid, occasionally lucid dreams. I like to take it 3-5 days a week as I don't like my state of mind to be modified every single day of the week.
At the end of the day:
- Vitamin C -- particularly C, and in higher (I'm still playing with specifics) dosages in order to increase the rate of renal excretion of amphetamine & its metabolites. If taken earlier it will "dull" the effects, which is good if you haven't reached max plasma concentration yet and suspect overstimulation when you do arrive. If you are already overstimulated, you may have a minor sensation of sedation as you relax and reach equilibrium. May make medication ineffective, though.
- Magnesium Glycinate -- It does calm you down and acts as a mild muscle relaxant. I just happen to like glycinate, and maybe 150mg-300mg (for about 20-40mg elemental magnesium -- compare to 500mg Mg oxide that contains 12mg elemental magnesium) a few hours before bed. to be sure to check ozone's post (http://www.longecity...agnesium-types/) and order a high bioavailability kind. I like this one because mag cit is used as a laxative and this is the next best thing. Check into the threo- form, but I haven't tried it and have heard conflicting reports (and it's expensive.)
- L-Theanine -- it seems that most people love it and a few hate it, but in smaller doses (50mg) it helps to take the edge off any time of the day. Sometimes I'll have 100-200mg before bed to really drop me, but it seems that there is increased sedation from magnesium and/or any other somnolence-promoting agent like melatonin (which I unfortunately metabolize slowly and/or abnormally, thanks insomnia -- which you can thank for this post) or Ambien (which I, unfortunately, take more than I likely should and am attempting to slowly titrate off of and replace)-- something, possibly via the supposed enhancement of GABA effectiveness or serotonin acting at its inhibitory receptors -- if I have:
Special synergy note:
- Caffeine -- I rarely have coffee with any regularity anymore unless I'm in finals or taking a break from Adderall. If I do, the AM. but be aware that caffeine will exert a synergistic effect with amphetamines that may significantly wear you out. It definitely increases the rate that you will metabolize and/or simply excrete amphetamines causing the Tmax of the above curve to be shorter.
Experimental potentially-crazy or simply too-new-to-be-widespread "nootropics":
- Selank -- On its own, the first time I used it I felt noticeably calm, yet awake. Apparently acts to prevent enkephalins from degrading, which are the delta-opiod receptor endogenous opioid peptide similar to endorphins' action at mu-opioid receptors. It seems to -- if only via its generally calming qualities, but I suspect chemically -- reduce chronically elevated cortisol levels. Too much may make you not want to do anything. I found about 25-50mcg (vs. the 250-500mcg recommended to me) subcutaneously would take the overly-driven "hard" edge that early-morning Adderall can bring, particularly without enough sleep and/or with caffeine, without reducing the cognitive effects. I suspect a synergy between the secondary endorphin-activating effects of amphetamine at, if I recall correctly, sigma opioid receptors. I believe caffeine also has some sort of similar effect on endorphins.
- P21 -- A surprisingly useful tool recently added to my toolbox. Added an incredible ease of fluid thinking, if simply through accessible energy and capacity to manage attention and thus increased working memory. 125-250mcg provided ever-so-slight energy and noticeable awareness and lucidity for 3-6 hours on its own and with Adderall. 500-750mcg was fine without Adderall. More than that increased the effects but resulted in the slightest urge to take a nap after more of the positive effects above. At 1.5mg the effects seemed to result in diminishing returns in positive effects with a more pronounced sense of wanting to take a pleasant nap. Induced remarkably vivid memories of dreams the night before, and in particular involved becoming lucid, turning a neutral dream into positive, controlled one, and then waking myself up consciously feeling warm, calm energy. It seemed to be easier to store and retrieve complex information (bio, chem, calc). I've only tried it for 5 days and am taking a short break, as that is the protocol for Cerebrolysin, of which it is apparently a highly-active component peptide.
Next I intend to try Semax.
N.B.: I really reacted specifcally well to metabolically-active vitamin B complex (P5P for B6, methylcobalamin for B12) as well as pre-methylated folate due to the above MTHFR/MTRR issue that I recognized upon running my 23andme results at nutrahacker.com & geneticgenie.com (the former has actual recommendations along with the latter's list of methylation-related genes). Not to plug brands, but Thorne Research Methyl Guard surprised me and replaced all of my activated B and folate supplements in one for cheaper. A good high-bioavailability multivitamin with metabolically active B (e.g., P5P & methylcobalamin) lets you skip the Methyl Guard unless you want 5-methyltetrahydofolate to bypass methylation of folic acid for some reason. I really like this whole nutrigenetics angle and have been getting into it in the last few months with noticeable effects. Consider it if you want to do more research on yourself that has some (at least somewhat) scientifically-backed reasoning custom tailored to you.
