Hi, Downandout. I know exactly where you're coming from. In fact, I've been feeling that way the past two or three days myself. Fortunately, these days I know I will come out of it. But I've experienced being stuck there - it's like being dead, only you're still breathing.

You definitely have insight into your condition. Yes, you would think the Adderall would give you a jump start. For lack of a better term, I would define Adderall as a "dopamine-enhancer." Anything legal that boots up the dopamine in the brain is worth considering. Other dopamine enhancers would include Provigil (used for fatigue), Wellbutrin, other ADD meds, and various Parkinson's meds.

Various recreational drugs such as meth and cocaine flood the brain with dopamine. The legal drugs reduce the flood to a trickle. The theory is you get the clinical benefit without experiencing the high and becoming dependent.

Serotonin gets all the attention, but the reason we often feel tired and don't care is because key dopamine systems in the brain are down. Information isn't getting back and forth from the frontal lobes to the limbic system.

Pleasure and reward, anticipation of both, mental clarity, energy, motivation, the ability to feel - dopamine mediates all of this and much more.

In addition to your Adderall, the Pristiq with it's dual serotonin-norepinephrine action in theory such be giving the Adderall an assist. Norepinephrine plays a role in alertness and is synthezised from dopamine.

You may want to enquire about another dopamine-enhancer. Or you may need to be patient. Often, the brain needs time to boot up.

The brain, of course, is way too complex to yield easy answers. For instance, we may be barking up the wrong neurotransmitter. Glutamate is the "excitatory" neurotransmitter that literally shakes your neurons awake. But we don't have glutamate meds yet, or at least not ones for treating psychiatric disorders.

Just to complicate things further - all the neurotransmitter systems are interconnected. So it's conceivable that a dopamine-enhancer could indirectly boot up the glutamate, but this is wild speculation and not a viable treatment strategy.

In the meantime, you have a family who needs you and your brain is literally on strike. I wish I had an easy answer, but I'm afraid the best I can do is urge you to trust in the healing process. Don't feel guilty that you're brain isn't cooperating with you right now. We get bedridden with the flu and no end of physical ills. The brain is a physical organ - it needs time to mend. YOU need time to mend.

Please try to explain that to your family. Often, I've been surprised at how family members understand. Yes, they want to see you get better right away. But they also understand that healing can be a slow process. Have faith. Hope this helps.