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Ancient Mesopotamian Texts Show PTSD May Be as Old as Combat Itself“My past is an armour I cannot take off, no matter how many times you tell me the war is over.” - unknown.[1]Post-traumatic stress disorder, or PTSD—also known as soldier’s heart, shell shock, and battle fatigue—is the collection of symptoms that plague some survivors of traumatic events, including nightmares, flashbacks, depression, hyper-vigilance and severe anxiety, as well as uncontrollable thoughts about the event, lasting for months or even years interfering with day-to-day functioning.[2]PTSD wasn’t clinically recognized in the U.S. until 1980, following a surge in classifiable cases from soldiers returning home from the Vietnam War.[3] Before that, terms like “shell shock”[4] were used to describe post-combat psychological struggles, and many soldiers, either because of external pressures or their own feelings of shame, kept quiet about emotional injuries first sustained in war.Post-traumatic stress disorder (PTSD) can develop when one experiences, observes or gains awareness about an event involving actual or threatened death due to fire, natural disaster, mugging, robbery, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack, and other extreme or life-threatening events. The most common events leading to the development of PTSD include: combat exposure, childhood physical abuse, sexual violence or violation, physical assault, and being threatened with a weapon.[5] Doctors aren't sure why some people get PTSD, while others do not. As with most mental health problems, PTSD is probably caused by a complex mix of:Stressful experiences, including the amount and severity of trauma you've gone through in your lifeInherited mental health risks, such as a family history of anxiety and depressionInherited features of your personality — often called your temperamentThe way your brain regulates the chemicals and hormones your body releases in response to stress.[6]Most who go through traumatic events may have temporary difficulty adjusting and coping, but with time and good self-care, they generally improve.Post-Traumatic Stress Disorder in Assyrian soldiers | Archaeology News from Past HorizonsResearchers studying 500,000 cuneiform tablets from the time they were first written, about 3200 B.C. in Uruk until the 1st century AD., came across descriptions of symptoms that sound remarkably similar to post-traumatic stress disorder, or PTSD.[7]As such, this may be the earliest textual reference of PTSD in history. The findings were reported in the journal Early Science and Medicine by Walid Khalid Abdul-Hamid of Queen Mary University of London and Jamie Hacker Hughes of the Veterans and Families Institute at Anglia Ruskin University. The researchers said that the Assyrian soldiers “described hearing and seeing ghosts talking to them, who would be the ghosts of people they’d killed in battle – and that’s exactly the experience of modern-day soldiers who’ve been involved in close hand-to-hand combat.”[8]The potentially lethal nature of war made it attractive as it provided a chance to attain fame, regardless of eventual failure or success. The success of the Assyrian empire was due to an aggressive, murderously vindictive regime supported by a magnificent and successful war machine.[9] As with the German army of World War II, the Assyrian army was the most technologically and doctrinally advanced of its day and was a model for others for generations afterwards. The Assyrians were the first to make extensive use of iron weaponry [and] not only were iron weapons superior to bronze, but could be mass-produced, allowing the equipping of very large armies indeed.[10] Tiglath-Pileser III (745–727 BC) traversed the whims of nature by creating an entire standing army known as ‘kisir sharruti‘.[11] In other words, his army (or at least most of the manpower) was available to him throughout the year, with a strict recruitment policy being imposed from the native provinces.[12] This was supplemented by tributes in the form of manpower from the proximate vassals along with mercenaries, thus transforming the national Assyrian army into a diverse bunch.The triumph of king Ashurbanipal, from ancient Nineveh, Iraq (Library of Ashurbanipal: 2,600 Years of Mesopotamian History)Professional soldiers enlisted by the Assyrian Dynasty in Mesopotamia, present-day Iraq, between 1300BC and 609BC first went through a year-long bootcamp, which also involved civil works like building roads, bridges, and other infrastructure for the kingdom.[13] The ancient powerhouse would accept taxation in the form of men supplied for service from surrounding regions. These men would conduct 3-year cycles, the first being military service.[14] The Assyrian’s military was extremely active, so these recruits would see a lot of action in brutal hand-to-hand combat.The soldiers were then sent to war for a year and, if they made it back in one piece, they were allowed to return their families for one year before repeating the cycle again.But as the ancient texts analyzed by the researchers showed, although their bodies might have come back home intact, some of the soldiers’ minds were in shatters. Texts uncovered from the time mention that the King of Elam’s “mind changed”, meaning he became disturbed, pointing to the likelihood of him suffering from PTSD.[15] A scribe in the employ of the Assyrian King Sargon II gave in 714 BCE of the despair his opponent King Rusa of Urartu felt when he observed how his troops were routed and his sacred city destroyed and looted.[16] The unusual terminology in literary and medical writings in order to convey the Urartian king’s emotional breakdown are compatible with modern medical classifications of PTSD.While modern technology has produced very effective targeted weaponry:“Ancient soldiers facing the risk of injury and death must have been just as terrified of hardened and sharpened swords, showers of sling-stones or iron-hardened tips of arrows and fire arrows. The risk of death and the witnessing of the death of fellow soldiers appears to have been a major source of psychological trauma. Moreover, the chance of death from injuries, which can nowadays be surgically treated, must have been much greater in those days. All these factors contributed to post-traumatic or other psychiatric stress disorders resulting from the experience on the ancient battlefield.”[17]So perhaps it’s not surprising that an advanced civilization with medical care would have some documents concerning the harsh psychological effects of war. Mesopotamians attributed disorders in sick soldiers to “roving” or “roaming” ghosts who were blamed for an alteration of mental state causing what they described as being a “wandering mind”.[18] Of significance to post-traumatic psychological disorders is the recording of “ghost-induced mut-ism with vivid nightmares.” [19] The reference in these cases to “slurring of speech and loss of cognitive functions” might indicate the presence of drug abuse co-morbidity, which is now known to be prevalently associated with post-traumatic psychological disorders.The Assyrians relied upon two types of healers to treat PTSD. The asipu was a spiritual healer, while the asu was a medical healer.[20] The two worked together to form a holistic model of healing. In one Assyrian ritual, the asipu would invoke the name of dead Warriors and say:“You [the Warrior who is suffering with grief] are made to swear, You lift up the reed torch and say as follows: ‘From this day on, [the dead Warrior will] head for somewhere else.’”[21]“If in the evening, he sees either a living person or a dead person or someone known to him or someone not known to him or anybody or anything and becomes afraid; he turns around but, like one who has [been hexed with?] rancid oil, his mouth is seized so that he is unable to cry out to one who sleeps next to him, ‘hand’ of ghost (var. hand of [...]).”“[If ] his mentation is altered so that he is not in full possession of his faculties, ‘hand’ of a roving ghost; he will die.”“If his mentation is altered, [...] (and) forgetfulness(?) (and) his words hinder each other in his mouth, a roaming ghost afflicts him. (If ) [...], he will get well.”[22]Weapons and tactics change, but PTSD goes back millenniaPreviously, the first documented instance of PTSD was thought to be Herodotus’ account of the Athenian spear carrier Epizelus’ psychogenic mutism and blindness following the Marathon Wars in 490 BC.[23] There was no physical cause for his blindness — no blow had been landed upon him – but Epizelus himself would later relate that he had encountered on the field a man of immense stature with beard overflowing his shield; this phasma, or phantom as Epizelus termed it, passed him by, and slew instead the man at his side.[24] Selective mutism is a severe anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often. It usually starts during childhood and, if left untreated, can persist into adulthood. A child or adult with selective mutism does not refuse or choose not to speak at certain times, they're literally unable to speak. The expectation to talk to certain people triggers a freeze response with feelings of panic, like a bad case of stage fright, and talking is physically prohibited.[25] People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.[26] Selective mutism usually co-exists with social anxiety disorder.[27]Achilles, hero of the Trojan war, is commonly held to be an ancient sufferer of PTSD.[28] Sophocles plays are filled with characters, who behaviors are nearly identical to those who served in the two Gulf Wars ( In Britain, psychologists expose veterans experiencing PTSD to Sophocles works as a way to open up a dialogue).[29] And in one potential account of PTSD, one chronicler described the crusaders coming home from the Third Crusade (1189-92), writing that though these men “survived unharmed … their hearts were pierced by swords of sorrows from different sorts of suffering”.[30]Battle of Til-Tuba (Battle of the River Ulai), Ashurpanibal's Southwest Palace Nineveh, Iraq, 660BC-650BC (wall panel; relief | British Museum)Despite the passage of several thousand years, the fundamentals of humanity have changed little, if at all. This includes being highly reliant on creating filters with which we perceive our surrounding environment. Although PTSD is no longer considered the actions of vengeful and angry ghosts, its effects would still be recognisable to an ancient physician or shaman, and it is still as damaging to the individual.[31] Many ancient cultures sought to deal with and create specific rituals to heal the unseeable and drive off the ghosts who caused them. The central purpose of these often culturally unique rituals was to welcome the returning soldier back into society and allow for the release of trauma. The Romans directed the Vestal Virgins to bathe returning soldiers, purging them of the corruption of war.[32] Native Americans performed sweat lodge purification rituals, in which the returning warriors would share their stories and sweat out their perceived ‘inner pollution’.[33] While it is unlikely that a vengeful spirit explanation is correct, it does contain the insight that the sickness originated from an inward or unseeable wounding, and these invisible wounds could be just as deadly as any outward wound.Diagnosing diseases from ancient texts, however, is not without its difficulties—not only because our understanding and ability to describe disease is so culturally dependent, but also because it is difficult to exclude other explanations such as neuro-psychological signs of head injury, which itself can be related to but is distinct from PTSD.[34] Although PTSD is challenging (and sometimes impossible) to diagnose from text alone, these accounts show that trauma and distress haunted veterans likely since humans first waged war on one another.Footnotes[1] How did Ancient warriors deal with Post Traumatic Stress Disorder?[2] Veterans of PTSD[3] Conceptualization of PTSD from the Vietnam War to Current Conflicts and Beyond[4] Is Shell Shock the Same as PTSD?[5] Symptoms of PTSD[6] Post-traumatic stress disorder (PTSD) - Causes [7] Weapons and tactics change, but PTSD goes back millennia[8] Nothing new under the sun: post-traumatic stress disorders in the ancient world - PubMed[9] The Iron Army: Assyria – Terrifying Military of the Ancient World – Part I[10] Ancient Assyrians And Their Army: 10 Things You Should Know[11] Assyria and its Army – Sargon II’s Reign I[12] Ancient Assyrians And Their Army: 10 Things You Should Know[13] The Assyrian army[14] The Hidden Evidence Of PTSD In The Ancient World[15] Post-Traumatic Stress Disorder in Assyrian soldiers | Archaeology News from Past Horizons[16] The Madness of King Rusa: the psychology of despair in eighth century Assyria[17] (PDF) Nothing New under the Sun: Post-Traumatic Stress Disorders in the Ancient World[18] Nothing new under the sun: post-traumatic stress disorders in the ancient world - PubMed[19] The Hidden Evidence Of PTSD In The Ancient World[20] Health Care in Ancient Mesopotamia[21] New Evidence of PTSD in 1300 BC: What we can learn from history — Save A Warrior™[22] Nothing new under the sun: post-traumatic stress disorders in the ancient world - PubMed[23] We need to talk about Epizelus: ‘PTSD’ and the ancient world[24] Encountering Gods: The Curious Case of Epizelus at Marathon[25] Selective mutism [26] http://Dummit; et al. (1997). "Systematic assessment of fifty children with Selective Mutism". Journal of the American Academy of Child and Adolescent Psychiatry. 36 (5): 653–660.[27] http://Johnson, Maggie and Wintgens, Alison, (2016). "The Selective Mutism Resource Manual: 2nd Edition (A Speechmark Practical Sourcebook)".[28] Was Achilles Suffering from Post Traumatic Stress Disorder?[29] Opinion | U.S. Veterans Use Greek Tragedy to Tell Us About War (Published 2017)[30] Before trauma: the crusades, medieval memory and violence[31] How did Ancient warriors deal with Post Traumatic Stress Disorder?[32] https://www.google.com/url?sa=t&source=web&rct=j&url=https://cedar.wwu.edu/cgi/viewcontent.cgi%3Farticle%3D1187%26context%3Dwwuet&ved=2ahUKEwixmqeLsYXtAhUKCc0KHeb9BoEQFjANegQIGRAB&usg=AOvVaw35yFrUYerJBcG9URRRASAk[33] Veterans Tackle PTSD with Traditional Indian Healing[34] Ancient philosophers on mental illness - Marke Ahonen, 2019

Adderall DescriptionA single-entity amphetamine product combining the neutral sulfate salts of dextroamphetamine and amphetamine, with the dextro isomer of amphetamine saccharate and d, l-amphetamine aspartate. kindly email juicetrip at Protonmail dot com to purchase Adderall with and without prescription, not out of context reliable sources and legit.EACH TABLET CONTAINS5 mg7.5 mg10 mg12.5 mg15 mg20 mg30 mgDextroamphetamineSaccharate1.25 mg1.875 mg2.5 mg3.125 mg3.75 mg5 mg7.5 mgAmphetamine Aspartate Monohydrate Equivalent1.25 mg*1.875 mg†2.5 mg‡3.125 mg§3.75 mg¶5 mg#7.5 mgÞDextroamphetamineSulfate, USP1.25 mg1.875 mg2.5 mg3.125 mg3.75 mg5 mg7.5 mgAmphetamineSulfate, USP1.25 mg1.875 mg2.5 mg3.125 mg3.75 mg5 mg7.5 mgTotal Amphetamine Base Equivalence3.13 mg4.7 mg6.3 mg7.8 mg9.4 mg12.6 mg18.8 mgInactive Ingredients: colloidal silicon dioxide, compressible sugar, corn starch, magnesium stearate, microcrystalline cellulose and saccharin sodium.Colors: Adderall ® 5 mg is a white to off-white tablet, which contains no color additives.Adderall ® 7.5 mg and 10 mg contain FD&C Blue #1 Aluminum Lake as a color additive.Adderall ® 12.5 mg, 15 mg, 20 mg and 30 mg contain FD&C Yellow #6 Aluminum Lake as a color additive.Adderall - Clinical PharmacologyPharmacodynamicsAmphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. The mode of therapeutic action in Attention Deficit Hyperactivity Disorder (ADHD) is not known. Amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.PharmacokineticsAdderall® tablets contain d-amphetamine and l-amphetamine salts in the ratio of 3:1. Following administration of a single dose 10 or 30 mg of Adderall® to healthy volunteers under fasted conditions, peak plasma concentrations occurred approximately 3 hours post-dose for both d-amphetamine and l-amphetamine. The mean elimination half-life (t1/2) for d-amphetamine was shorter than the t1/2 of the l-isomer (9.77 to 11 hours vs. 11.5 to 13.8 hours). The PK parameters (Cmax, AUC0-inf) of d-and l-amphetamine increased approximately three-fold from 10 mg to 30 mg indicating dose-proportional pharmacokinetics.The effect of food on the bioavailability of Adderall® has not been studied.Metabolism and ExcretionAmphetamine is reported to be oxidized at the 4 position of the benzene ring to form 4-hydroxyamphetamine, or on the side chain α or β carbons to form alpha-hydroxy-amphetamine or norephedrine, respectively. Norephedrine and 4-hydroxy-amphetamine are both active and each is subsequently oxidized to form 4-hydroxy-norephedrine. Alpha-hydroxy-amphetamine undergoes deamination to form phenylacetone, which ultimately forms benzoic acid and its glucuronide and the glycine conjugate hippuric acid. Although the enzymes involved in amphetamine metabolism have not been clearly defined, CYP2D6 is known to be involved with formation of 4-hydroxy-amphetamine. Since CYP2D6 is genetically polymorphic, population variations in amphetamine metabolism are a possibility.Amphetamine is known to inhibit monoamine oxidase, whereas the ability of amphetamine and its metabolites to inhibit various P450 isozymes and other enzymes has not been adequately elucidated. In vitro experiments with human microsomes indicate minor inhibition of CYP2D6 by amphetamine and minor inhibition of CYP1A2, 2D6, and 3A4 by one or more metabolites. However, due to the probability of auto-inhibition and the lack of information on the concentration of these metabolites relative to in vivoconcentrations, no predications regarding the potential for amphetamine or its metabolites to inhibit the metabolism of other drugs by CYP isozymes in vivo can be made.With normal urine pHs approximately half of an administered dose of amphetamine is recoverable in urine as derivatives of alpha-hydroxy-amphetamine and approximately another 30% to 40% of the dose is recoverable in urine as amphetamine itself. Since amphetamine has a pKa of 9.9, urinary recovery of amphetamine is highly dependent on pH and urine flow rates. Alkaline urine pHs result in less ionization and reduced renal elimination, and acidic pHs and high flow rates result in increased renal elimination with clearances greater than glomerular filtration rates, indicating the involvement of active secretion. Urinary recovery of amphetamine has been reported to range from 1% to 75%, depending on urinary pH, with the remaining fraction of the dose hepatically metabolized. Consequently, both hepatic and renal dysfunction have the potential to inhibit the elimination of amphetamine and result in prolonged exposures. In addition, drugs that affect urinary pH are known to alter the elimination of amphetamine, and any decrease in amphetamine’s metabolism that might occur due to drug interactions or genetic polymorphisms is more likely to be clinically significant when renal elimination is decreasedIndications and Usage for AdderallAdderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and Narcolepsy.Attention Deficit Hyperactivity Disorder (ADHD)A diagnosis of Attention Deficit Hyperactivity Disorder (ADHD; DSM-IV®) implies the presence of hyperactive-impulsive or inattentive symptoms that caused impairment and were present before age 7 years. The symptoms must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and be present in two or more settings, e.g., school (or work) and at home. The symptoms must not be better accounted for by another mental disorder. For the Inattentive Type, at least six of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes; lack of sustained attention; poor listener; failure to follow through on tasks; poor organization; avoids tasks requiring sustained mental effort; loses things; easily distracted; forgetful. For the Hyperactive-Impulsive Type, at least six of the following symptoms must have persisted for at least 6 months: fidgeting/squirming; leaving seat; inappropriate running/climbing; difficulty with quiet activities; “on the go;” excessive talking; blurting answers; can't wait turn; intrusive. The Combined Type requires both inattentive and hyperactive-impulsive criteria to be met.Special Diagnostic ConsiderationsSpecific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but of special psychological, educational, and social resources. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of the required number of DSM-IV® characteristics.Need for Comprehensive Treatment ProgramAdderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) is indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome. Drug treatment may not be indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors and/or other primary psychiatric disorders, including psychosis. Appropriate educational placement is essential and psychosocial intervention is often helpful. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment of the chronicity and severity of the child's symptoms.Long-Term UseThe effectiveness of Adderall®(Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) for long-term use has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use Adderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.ContraindicationsAdvanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma.Agitated states.Patients with a history of drug abuse.During or within 14 days following the administration of monoamine oxidase inhibitors (hypertensive crises may result).WarningsSerious Cardiovascular EventsSudden Death and Preexisting Structural Cardiac Abnormalities or Other Serious Heart ProblemsChildren and AdolescentsSudden death has been reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems.Although some structural heart problems alone may carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drugAdultsSudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD. Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugsHypertension and Other Cardiovascular ConditionsStimulant medications cause a modest increase in average blood pressure (about 2 to 4 mmHg) and average heart rate (about 3 to 6 bpm) and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with preexisting hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmiaAssessing Cardiovascular Status in Patients Being Treated With Stimulant MedicationsChildren, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e.g., electrocardiogram and echocardiogram). Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation.Psychiatric Adverse EventsPreexisting PsychosisAdministration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with preexisting psychotic disorder.Bipolar IllnessParticular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.Emergence of New Psychotic or Manic SymptomsTreatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple short-term, placebo-controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.AggressionAggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility.Long-Term Suppression of GrowthCareful follow-up of weight and height in children ages 7 to 10 years who were randomized to either methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication treated children over 36 months (to the ages of 10 to 13 years), suggests that consistently medicated children (i.e., treatment for 7 days per week throughout the year) have a temporary slowing in growth rate (on average, a total of about 2 cm less growth in height and 2.7 kg less growth in weight over 3 years), without evidence of growth rebound during this period of development. Published data are inadequate to determine whether chronic use of amphetamines may cause a similar suppression of growth, however, it is anticipated that they will likely have this effect as well. Therefore, growth should be monitored during treatment with stimulants, and patients who are not growing or gaining weight as expected may need to have their treatment interrupted.SeizuresThere is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizure, in patients with prior EEG abnormalities in absence of seizures, and very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, the drug should be discontinued.Peripheral Vasculopathy, Including Raynaud’s PhenomenonStimulants, including Adderall®, used to treat ADHD are associated with peripheral vasculopathy, including Raynaud’s phenomenon. Signs and symptoms are usually intermittent and mild; however, very rare sequelae include digital ulceration and/or soft tissue breakdown. Effects of peripheral vasculopathy, including Raynaud’s phenomenon, were observed in postmarketing reports at different times and at therapeutic doses in all age groups throughout the course of treatment. Signs and symptoms generally improve after reduction in dose or discontinuation of drug. Careful observation for digital changes is necessary during treatment with ADHD stimulants. Further clinical evaluation (e.g., rheumatology referral) may be appropriate for certain patients.Serotonin SyndromeSerotonin syndrome, a potentially life-threatening reaction, may occur when amphetamines are used in combination with other drugs that affect the serotonergic neurotransmitter systems such as monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s Wort .Amphetamines and amphetamine derivatives are known to be metabolized, to some degree, by cytochrome P450 2D6 (CYP2D6) and display minor inhibition of CYP2D6 metabolism . The potential for a pharmacokinetic interaction exists with the coadministration of CYP2D6 inhibitors which may increase the risk with increased exposure to Adderall®. In these situations, consider an alternative non-serotonergic drug or an alternative drug that does not inhibit CYP2D6Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).Concomitant use of Adderall® with MAOI drugs is contraindicatedDiscontinue treatment with Adderall® and any concomitant serotonergic agents immediately if the above symptoms occur, and initiate supportive symptomatic treatment. If concomitant use of Adderall® with other serotonergic drugs or CYP2D6 inhibitors is clinically warranted, initiate Adderall® with lower doses, monitor patients for the emergence of serotonin syndrome during drug initiation or titration, and inform patients of the increased risk for serotonin syndrome.Visual DisturbanceDifficulties with accommodation and blurring of vision have been reported with stimulant treatment.PrecautionsGeneralThe least amount of amphetamine feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. Adderall® should be used with caution in patients who use other sympathomimetic drugs.TicsAmphetamines have been reported to exacerbate motor and phonic tics and Tourette’s syndrome. Therefore, clinical evaluation for tics and Tourette’s syndrome in children and their families should precede use of stimulant medications.Information for PatientsAmphetamines may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or vehicles; the patient should therefore be cautioned accordingly.Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with amphetamine or dextroamphetamine and should counsel them in its appropriate use. A patient Medication Guide is available for Adderall®.The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.Circulation Problems in Fingers and Toes [Peripheral Vasculopathy, Including Raynaud’s Phenomenon]Instruct patients beginning treatment with Adderall® about the risk of peripheral vasculopathy, including Raynaud’s phenomenon, and associated signs and symptoms: fingers or toes may feel numb, cool, painful, and/or may change color from pale, to blue, to red.Instruct patients to report to their physician any new numbness, pain, skin color change, or sensitivity to temperature in fingers or toes.Instruct patients to call their physician immediately with any signs of unexplained wounds appearing on fingers or toes while taking Adderall®.Further clinical evaluation (e.g., rheumatology referral) may be appropriate for certain patients.Drug InteractionsAcidifying AgentsGastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines.Urinary Acidifying Agents(ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion. Both groups of agents lower blood levels and efficacy of amphetamines.Adrenergic BlockersAdrenergic blockers are inhibited by amphetamines.Alkalinizing AgentsGastrointestinal alkalinizing agents (sodium bicarbonate, etc.) increase absorption of amphetamines. Coadministration of Adderall® and gastrointestinal alkalizing agents, such as antacids, should be avoided. Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion. Both groups of agents increase blood levels and therefore potentiate the actions of amphetamines.Antidepressants, TricyclicAmphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause striking and sustained increases in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated.CYP2D6 InhibitorsThe concomitant use of Adderall® and CYP2D6 inhibitors may increase the exposure of Adderall®compared to the use of the drug alone and increase the risk of serotonin syndrome. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome particularly during Adderall® initiation and after a dosage increase. If serotonin syndrome occurs, discontinue Adderall® and the CYP2D6 inhibitor . Examples of CYP2D6 Inhibitors include paroxetine and fluoxetine (also serotonergic drugs), quinidine, ritonavir.Serotonergic DrugsThe concomitant use of Adderall® and serotonergic drugs increases the risk of serotonin syndrome. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during Adderall® initiation or dosage increase. If serotonin syndrome occurs, discontinue Adderall® and the concomitant serotonergic drug(s) . Examples of serotonergic drugs include selective serotonin reuptake inhibitors (SSRI), serotonin norepinephrine reuptake inhibitors (SNRI), triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John’s Wort.MAO InhibitorsMAOI antidepressants, as well as a metabolite of furazolidone, slow amphetamine metabolism. This slowing potentiates amphetamines, increasing their effect on the release of norepinephrine and other monoamines from adrenergic nerve endings; this can cause headaches and other signs of hypertensive crisis. A variety of neurological toxic effects and malignant hyperpyrexia can occur, sometimes with fatal results.AntihistaminesAmphetamines may counteract the sedative effect of antihistamines.AntihypertensivesAmphetamines may antagonize the hypotensive effects of antihypertensives.ChlorpromazineChlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amphetamines, and can be used to treat amphetamine poisoning.EthosuximideAmphetamines may delay intestinal absorption of ethosuximide.HaloperidolHaloperidol blocks dopamine receptors, thus inhibiting the central stimulant effects of amphetamines.Lithium CarbonateThe anorectic and stimulatory effects of amphetamines may be inhibited by lithium carbonate.MeperidineAmphetamines potentiate the analgesic effect of meperidine.Methenamine TherapyUrinary excretion of amphetamines is increased, and efficacy is reduced, by acidifying agents used in methenamine therapy.NorepinephrineAmphetamines enhance the adrenergic effect of norepinephrine.PhenobarbitalAmphetamines may delay intestinal absorption of phenobarbital; coadministration of phenobarbital may produce a synergistic anticonvulsant action.PhenytoinAmphetamines may delay intestinal absorption of phenytoin; coadministration of phenytoin may produce a synergistic anticonvulsant action.PropoxypheneIn cases of propoxyphene overdosage, amphetamine CNS stimulation is potentiated and fatal convulsions can occur.Proton Pump InhibitorsPPIs act on proton pumps by blocking acid production, thereby reducing gastric acidity. When Adderall XR® (20 mg single-dose) was administered concomitantly with the proton pump inhibitor, omeprazole (40 mg once daily for 14 days), the median Tmax of d-amphetamine was decreased by 1.25 hours (from 4 to 2.75 hours), and the median Tmax of l-amphetamine was decreased by 2.5 hours (from 5.5 to 3 hours), compared to Adderall XR® administered alone. The AUC and Cmax of each moiety were unaffected. Therefore, coadministration of Adderall® and proton pump inhibitors should be monitored for changes in clinical effect.Veratrum AlkaloidsAmphetamines inhibit the hypotensive effect of veratrum alkaloids.Drug/Laboratory Test InteractionsAmphetamines can cause a significant elevation in plasma corticosteroid levels. This increase is greatest in the evening. Amphetamines may interfere with urinary steroid determinationsCarcinogenesis/Mutagenesis and Impairment of FertilityNo evidence of carcinogenicity was found in studies in which d,l-amphetamine (enantiomer ratio of 1:1) was administered to mice and rats in the diet for 2 years at doses of up to 30 mg/kg/day in male mice, 19 mg/kg/day in female mice, and 5 mg/kg/day in male and female rats. These doses are approximately 2.4, 1.5, and 0.8 times, respectively, the maximum recommended human dose of 30 mg/day [child] on a mg/m2body surface area basis.Amphetamine, in the enantiomer ratio present in Adderall® (immediate-release)(d- to l- ratio of 3:1), was not clastogenic in the mouse bone marrow micronucleus test in vivo and was negative when tested in the E. coli component of the Ames test in vitro. d, l-Amphetamine (1:1 enantiomer ratio) has been reported to produce a positive response in the mouse bone marrow micronucleus test, an equivocal response in the Ames test, and negative responses in the in vitrosister chromatid exchange and chromosomal aberration assays.Amphetamine, in the enantiomer ratio present in Adderall® (immediate-release)(d- to l- ratio of 3:1), did not adversely affect fertility or early embryonic development in the rat at doses of up to 20 mg/kg/day (approximately 5 times the maximum recommended human dose of 30 mg/day on a mg/m2 body surface area basis).PregnancyTeratogenic EffectsPregnancy Category CAmphetamine, in the enantiomer ratio present in Adderall® (d- to l- ratio of 3:1), had no apparent effects on embryofetal morphological development or survival when orally administered to pregnant rats and rabbits throughout the period of organogenesis at doses of up to 6 and 16 mg/kg/day, respectively. These doses are approximately 1.5 and 8 times, respectively, the maximum recommended human dose of 30 mg/day [child] on a mg/m2 body surface area basis. Fetal malformations and death have been reported in mice following parenteral administration of d-amphetamine doses of 50 mg/kg/day (approximately 6 times that of a human dose of 30 mg/day [child] on a mg/m2basis) or greater to pregnant animals. Administration of these doses was also associated with severe maternal toxicity.A number of studies in rodents indicate that prenatal or early postnatal exposure to amphetamine (d- or d,l-), at doses similar to those used clinically, can result in long-term neurochemical and behavioral alterations. Reported behavioral effects include learning and memory deficits, altered locomotor activity, and changes in sexual function.There are no adequate and well-controlled studies in pregnant women. There has been one report of severe congenital bony deformity, tracheo-esophageal fistula, and anal atresia (vater association) in a baby born to a woman who took dextroamphetamine sulfate with lovastatin during the first trimester of pregnancy. Amphetamines should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.Nonteratogenic EffectsInfants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight. Also, these infants may experience symptoms of withdrawal as demonstrated by dysphoria, including agitation, and significant lassitude.Usage in Nursing MothersAmphetamines are excreted in human milk. Mothers taking amphetamines should be advised to refrain from nursing.Pediatric UseLong-term effects of amphetamines in children have not been well established. Amphetamines are not recommended for use in children under 3 years of age with Attention Deficit Hyperactivity Disorder described under INDICATION AND USAGEGeriatric UseAdderall® has not been studied in the geriatric population.Adverse ReactionsCardiovascularPalpitations, tachycardia, elevation of blood pressure, sudden death, myocardial infarction. There have been isolated reports of cardiomyopathy associated with chronic amphetamine use.Central Nervous SystemPsychotic episodes at recommended doses, overstimulation, restlessness, irritability, euphoria, dyskinesia, dysphoria, depression, tremor, tics, aggression, anger, logorrhea, dermatillomania.Eye DisordersVision blurred, mydriasis.GastrointestinalDryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects.AllergicUrticaria, rash, hypersensitivity reactions including angioedema and anaphylaxis. Serious skin rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported.EndocrineImpotence, changes in libido, frequent or prolonged erections.SkinAlopecia.MusculoskeletaDrug Abuse and DependenceAdderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) is a Schedule II controlled substance.Amphetamines have been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred. There are reports of patients who have increased the dosage to levels many times higher than recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with amphetamines include severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia.OverdosageIndividual patient response to amphetamines varies widely. Toxic symptoms may occur idiosyncratically at low doses.SymptomsManifestations of acute overdosage with amphetamines include restlessness, tremor, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations, panic states, hyperpyrexia and rhabdomyolysis.Fatigue and depression usually follow the central stimulation.Cardiovascular effects include arrhythmias, hypertension or hypotension and circulatory collapse.Gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Fatal poisoning is usually preceded by convulsions and coma.TreatmentConsult with a Certified Poison Control Center for up to date guidance and advice. Management of acute amphetamine intoxication is largely symptomatic and includes gastric lavage, administration of activated charcoal, administration of a cathartic and sedation. Experience with hemodialysis or peritoneal dialysis is inadequate to permit recommendation in this regard. Acidification of the urine increases amphetamine excretion, but is believed to increase risk of acute renal failure if myoglobinuria is present. If acute, severe hypertension complicates amphetamine overdosage, administration of intravenous phentolamine has been suggested. However, a gradual drop in blood pressure will usually result when sufficient sedation has been achieved. Chlorpromazine antagonizes the central stimulant effects of amphetamines and can be used to treat amphetamine intoxication.Adderall Dosage and AdministrationRegardless of indication, amphetamines should be administered at the lowest effective dosage, and dosage should be individually adjusted according to the therapeutic needs and response of the patient. Late evening doses should be avoided because of the resulting insomnia.Attention Deficit Hyperactivity DisorderNot recommended for children under 3 years of age. In children from 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained.In children 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.NarcolepsyUsual dose 5 mg to 60 mg per day in divided doses, depending on the individual patient response.Narcolepsy seldom occurs in children under 12 years of age; however, when it does, dextroamphetamine sulfate may be used. The suggested initial dose for patients aged 6 to 12 is 5 mg daily; daily dose may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. In patients 12 years of age and older, start with 10 mg daily; daily dosage may be raised in increments of 10 mg at weekly intervals until optimal response is obtained. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.How is Adderall SuppliedAdderall® (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product)) is supplied as follows:5 mg: White to off-white, round, flat-faced beveled edge tablet with four partial bisects debossed with 5 on one side and debossed with dp on the other side. They are available in bottles of 100 tablets (NDC 57844-105-01).7.5 mg: Blue, oval, biconvex tablet with two partial bisects debossed with 7.5 on one side and one full bisect and two partial bisects debossed with d | p on the other side. They are available in bottles of 100 tablets (NDC 57844-117-01).10 mg: Blue, round, biconvex tablet with one full bisect and two partial bisects debossed with 1 | 0 on one side and debossed with dp on the other side. They are available in bottles of 100 tablets (NDC 57844-110-01).12.5 mg: Peach, round, flat-faced beveled edge tablet debossed with 12.5 on one side and one full bisect and two partial bisects debossed with d | p on the other side. They are available in bottles of 100 tablets (NDC 57844-112-01).15 mg: Peach, oval, biconvex tablet with two partial bisects debossed with 15 on one side and one full bisect and two partial bisects debossed with d | p on the other side. They are available in bottles of 100 tablets (NDC 57844-115-01).20 mg: Peach, round, biconvex tablet with one full bisect and two partial bisects debossed with 2 | 0 on one side and debossed with dp on the other side. They are available in bottles of 100 tablets (NDC 57844-120-01).30 mg: Peach, round, flat-faced beveled edge tablet with one full bisect and 2 partial bisects debossed with 3 | 0 on one side and dp on the other side. They are available in bottles of 100 tablets (NDC 57844-130-01).Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as required).KEEP THIS AND ALL MEDICATIONS OUT OF THE REACH OF CHILDREN.All brand names listed are the registered trademarks of their respective owners and are not trademarks of Teva Pharmaceuticals USA.Distributed by:Teva Pharmaceuticals USA, Inc.Parsippany, NJ 07054Rev. I 3/2020MEDICATION GUIDEAdderall® (ADD-ur-all) (CII)(Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets (Mixed Salts of a Single Entity Amphetamine Product))Read the Medication Guide that comes with Adderall® before you or your child starts taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking to your doctor about you or your child’s treatment with Adderall®.What is the most important information I should know about Adderall®?The following have been reported with use of Adderall® and other stimulant medicines.1. Heart-Related Problems:• sudden death in patients who have heart problems or heart defects• stroke and heart attack in adults• increased blood pressure and heart rateTell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems.Your doctor should check you or your child carefully for heart problems before starting Adderall®.Your doctor should check your or your child’s blood pressure and heart rate regularly during treatment with Adderall®.Call your doctor right away if you or your child have any signs of heart problems such as chest pain, shortness of breath, or fainting while taking Adderall®.2. Mental (Psychiatric) Problems:All Patients• new or worse behavior and thought problems• new or worse bipolar illness• new or worse aggressive behavior or hostilityChildren and Teenagers• new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptomsTell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression.Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking Adderall®, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.3. Circulation Problems in Fingers and Toes [Peripheral Vasculopathy, Including Raynaud’s Phenomenon]:Fingers or toes may feel numb, cool, painfulFingers or toes may change color from pale, to blue, to redTell your doctor if you have or your child has numbness, pain, skin color change, or sensitivity to temperature in your fingers or toes.Call your doctor right away if you have or your child has any signs of unexplained wounds appearing on fingers or toes while taking Adderall®.What is Adderall®?Adderall® is a central nervous system stimulant prescription medicine. It is used for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD). Adderall® may help increase attention and decrease impulsiveness and hyperactivity in patients with ADHD.Adderall® should be used as a part of a total treatment program for ADHD that may include counseling or other therapies.Adderall® is also used in the treatment of a sleep disorder called narcolepsy.Adderall® is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep Adderall® in a safe place to prevent misuse and abuse. Selling or giving away Adderall® may harm others, and is against the law.Tell your doctor if you or your child have (or have a family history of) ever abused or been dependent on alcohol, prescription medicines or street drugs.Who should not take Adderall®?Adderall® should not be taken if you or your child:have heart disease or hardening of the arterieshave moderate to severe high blood pressurehave hyperthyroidismhave an eye problem called glaucomaare very anxious, tense, or agitatedhave a history of drug abuseare taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI.are sensitive to, allergic to, or had a reaction to other stimulant medicinesAdderall® is not recommended for use in children less than 3 years old.Adderall® may not be right for you or your child. Before starting Adderall® tell your or your child’s doctor about all health conditions (or a family history of) including:heart problems, heart defects, high blood pressuremental problems including psychosis, mania, bipolar illness, or depressiontics or Tourette’s syndromeliver or kidney problemscirculation problems in fingers and toesthyroid problemsseizures or have had an abnormal brain wave test (EEG)Tell your doctor if you or your child are pregnant, planning to become pregnant, or breastfeeding.Can Adderall® be taken with other medicines?Tell your doctor about all of the medicines that you or your child take including prescription and nonprescription medicines, vitamins, and herbal supplements. Adderall® and some medicines may interact with each other and cause serious side effects. Sometimes the doses of other medicines will need to be adjusted while taking Adderall®.Your doctor will decide whether Adderall® can be taken with other medicines.Especially tell your doctor if you or your child take:anti-depression medicines including MAOIsblood pressure medicinesseizure medicinesblood thinner medicinescold or allergy medicines that contain decongestantsstomach acid medicinesKnow the medicines that you or your child take. Keep a list of your medicines with you to show your doctor and pharmacist.Do not start any new medicine while taking Adderall® without talking to your doctor first.How should Adderall® be taken?Take Adderall® exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.Adderall® tablets are usually taken two to three times a day. The first dose is usually taken when you first wake in the morning. One or two more doses may be taken during the day, 4 to 6 hours apart.Adderall® can be taken with or without food.From time to time, your doctor may stop Adderall® treatment for a while to check ADHD symptoms.Your doctor may do regular checks of the blood, heart, and blood pressure while taking Adderall®. Children should have their height and weight checked often while taking Adderall®. Adderall® treatment may be stopped if a problem is found during these check-ups.If you or your child take too much Adderall®or overdose, call your doctor or poison control center right away, or get emergency treatment.What are possible side effects of Adderall®?See “What is the most important information I should know about Adderall®?” for information on reported heart and mental problems.Other serious side effects include:slowing of growth (height and weight) in childrenseizures, mainly in patients with a history of seizureseyesight changes or blurred visionserotonin syndrome. A potentially life-threatening problem called serotonin syndrome can happen when medicines such as Adderall® are taken with certain other medicines. Symptoms of serotonin syndrome may include:agitation, hallucinations, coma or other changes in mental statusproblems controlling your movements or muscle twitchingfast heartbeathigh or low blood pressuresweating or fevernausea or vomitingdiarrheamuscle stiffness or tightnessCommon side effects include:stomach achedecreased appetitenervousnessAdderall® may affect your or your child’s ability to drive or do other dangerous activities.Talk to your doctor if you or your child have side effects that are bothersome or do not go away.This is not a complete list of possible side effects. Ask your doctor or pharmacist for more information.How should I store Adderall®?Store Adderall® in a safe place at room temperature, 20° to 25°C (68° to 77°F).Keep Adderall® and all medicines out of the reach of children.General information about Adderall®Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Adderall® for a condition for which it was not prescribed. Do not give Adderall®to other people, even if they have the same condition. It may harm them and it is against the law. This Medication Guide summarizes the most important information about Adderall®. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about Adderall® that was written for healthcare professionals.What are the ingredients in Adderall®?Active Ingredient: dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate.Inactive Ingredients: colloidal silicon dioxide, compressible sugar, corn starch, magnesium stearate, microcrystalline cellulose and saccharin sodium. The 5 mg is a white to off-white tablet, which contains no color additives. The 7.5 mg and 10 mg also contain FD&C Blue #1 Aluminum Lake as a color additive. The 12.5 mg, 15 mg, 20 mg and 30 mg also contain FD&C Yellow #6 Aluminum Lake as a color additive.This Medication Guide has been approved by the U.S. Food and Drug Administration.Distributed by:Teva Pharmaceuticals USA, Inc.Parsippany, NJ 07054Rev. H 3/2020Package/Label Display PanelAdderall® 5 mg CII 100s Label TextNDC 57844-105-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)5 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 7.5 mg CII 100s Label TextNDC 57844-117-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)7.5 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 10 mg CII 100s Label TextNDC 57844-110-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)10 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 12.5 mg CII 100s Label TextNDC 57844-112-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)12.5 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 15 mg CII 100s Label TextNDC 57844-115-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)15 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 20 mg CII 100s Label TextNDC 57844-120-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)20 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAPackage/Label Display PanelAdderall® 30 mg CII 100s Label TextNDC 57844-130-01CIIAdderall®(Dextroamphetamine Saccharate,Amphetamine Aspartate,Dextroamphetamine Sulfate andAmphetamine Sulfate Tablets)(Mixed Salts of a Single EntityAmphetamine Product)30 mgPHARMACIST: DISPENSE THEACCOMPANYING MEDICATIONGUIDE TO EACH PATIENT.Rx only100 TABLETSTEVAAdderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-105Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE1.25 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE1.25 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE1.25 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE1.25 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMProduct CharacteristicsColorWHITE (white to off-white)Score4 piecesShapeROUNDSize7mmFlavorImprint Code5;dpContainsPackaging#Item CodePackage Description1NDC:57844-105-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042211/13/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-117Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE1.875 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE1.875 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE1.875 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE1.875 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C BLUE NO. 1 ALUMINUM LAKEProduct CharacteristicsColorBLUEScore4 piecesShapeOVALSize10mmFlavorImprint Code7;5;d;pContainsPackaging#Item CodePackage Description1NDC:57844-117-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042203/03/2015Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-110Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE2.5 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE2.5 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE2.5 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE2.5 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C BLUE NO. 1 ALUMINUM LAKEProduct CharacteristicsColorBLUEScore4 piecesShapeROUNDSize9mmFlavorImprint Code1;0;dpContainsPackaging#Item CodePackage Description1NDC:57844-110-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042202/03/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-112Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE3.125 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE3.125 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE3.125 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE3.125 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C YELLOW NO. 6Product CharacteristicsColorORANGE (peach)Score4 piecesShapeROUNDSize7mmFlavorImprint Code12;5;d;pContainsPackaging#Item CodePackage Description1NDC:57844-112-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042206/18/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-115Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE3.75 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE3.75 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE3.75 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE3.75 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C YELLOW NO. 6Product CharacteristicsColorORANGE (peach)Score4 piecesShapeOVALSize10mmFlavorImprint Code15;d;pContainsPackaging#Item CodePackage Description1NDC:57844-115-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042206/30/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-120Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE5 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE5 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE5 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE5 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C YELLOW NO. 6Product CharacteristicsColorORANGE (peach)Score4 piecesShapeROUNDSize9mmFlavorImprint Code2;0;dpContainsPackaging#Item CodePackage Description1NDC:57844-120-01100 TABLET in 1 BOTTLEMarketing InformationMarketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End DateANDAANDA04042202/11/2014Adderalldextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tabletProduct InformationProduct TypeHUMAN PRESCRIPTION DRUG LABELItem Code (Source)NDC:57844-130Route of AdministrationORALDEA ScheduleCIIActive Ingredient/Active MoietyIngredient NameBasis of StrengthStrengthDEXTROAMPHETAMINE SACCHARATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SACCHARATE7.5 mgAMPHETAMINE ASPARTATE MONOHYDRATE(AMPHETAMINE)AMPHETAMINE ASPARTATE MONOHYDRATE7.5 mgDEXTROAMPHETAMINE SULFATE(DEXTROAMPHETAMINE)DEXTROAMPHETAMINE SULFATE7.5 mgAMPHETAMINE SULFATE(AMPHETAMINE)AMPHETAMINE SULFATE7.5 mgInactive IngredientsIngredient NameStrengthSILICON DIOXIDESUCROSEMALTODEXTRINSTARCH, CORNMAGNESIUM STEARATECELLULOSE, MICROCRYSTALLINESACCHARIN SODIUMFD&C YELLOW NO. 6Product CharacteristicsColorORANGE (peach)Score4 piecesShapeROUNDSize10mmFlavorImprint Code3;0;dpContainsPackaging#Item CodePackage Description1NDC:57844-130-01100 TABLET in 1 BOTTLE

Looking back I can see INTJ behaviors and traits back into my young childhood. Traits that were precocious and in hindsight humorous. Like insisting on a brief case vs back pack in first grade. I had a doll at about age 4 that I named with an adult professional name, something like “Mrs. Carol J Stafford”. When Mrs. Stafford got lost during a move (Intentionally, I believe, contrary to what I was told) I never wanted and never owned another doll again. Not even a barbie. I was done investing in things that brought me no value that would break my heart(or so I thought). Had I not lost Mrs. Stafford, I may have been a different person today. lolI was a super responsible adult-like child who spent most of my childhood raising my younger brothers and sisters while my parent’s were out bar hopping nearly every night. They were functional alcoholics (not the stay-at-home type, the never-at -home type). They both worked for the government as civilians and also served as reservists in the Air Force. I don’t know how they did it and made it to work everyday. I guess when you have a mini over-achieving personal assistant and live in nanny, it’s not that hard.I left home at a very young age. By 16 I lived on my own, in another state, worked full time and made up all the high school credits I lost in the nearly 2 years I was a runaway (unable to attend school because they would have found me). Which eventually they did (find me), and made me return home about 6 months before my 18th birthday. 3 weeks after my return I bought my first mobile home with cash and moved out again. At this point they got the message, and let me do my thing.I graduated a couple months late( because of missing Utah State’s required courses, like “Utah History” (which obviously would not be available in another state, ridiculous unfair expectations for a late-year senior transfer student))However, they let me walk across the stage with my peers. But I graduated with a 3.68 ?? GPA and scholarships. That was the first time I have a memory of my parents hugging me. I’m sure there were others along the line somewhere, but I can’t remember any.The rest of my life has been spent navigating the rocky seas of my uniquely complex personality mixed with my lack of personal skills required to form successful relationships or the stick-to-it-ness to fully grow into a successful career. I spent a lot of years blaming my parents for this, but now that I am aware of the INTJ traits, I could easily debate the nature vs nurture question. Was I born this way or is this how I was “sculpted”? Either way I am an underachieving over-achiever that never fully acclimates to success and eventually self implodes.I spent 10 years as an addict, which I turned into a business. I saw a way to make money and support my habit and that’s what I did, and I was pretty good at it. It’s not like the movies ( at least not in Utah, lol). Believe me, having a 10 year tenure in that field without a couple of 2–3 year “prison respites” is quite an accomplishment. I ran a tight ship. It was for all means and purposes a business.When I finally did go to jail, It was like God answered my prayers, I had wanted out for so long. I just didn’t know how to do it. I had worked myself into a hole I couldn’t dig myself out of. Jail was the best thing that ever happened to me. Even in jail I was a dynamic leader and influencer. I got a job doing laundry as soon as I could and I just decided. I decided I was done with that old life, and I was not returning to it, EVER. I was originally arrested with two class A felonies. I did a total of 67 days before I was released(lucky). I got out the day before Christmas and the day after Christmas my house burnt down. No joke. The upstairs people had rewired their own fuse box and it blew up leaving us running for our lives.Life or fate or whatever “it” is has a way of making things happen the way they are “supposed” to. My phone with all my connections burnt up in that fire. My boyfriend and I split up that next week and so was the beginning of my “new life”.I’ve been clean for almost 10 years now. I got my teeth fixed (embarrassing truth) and got a job, re-enrolled in college and I was back. Ready to kick ass.I successfully paid off all of my court fines and completed my probation, without a hitch, within 18 months and about 3–4 years later I petitioned the court for a reduction in charges. I had a fantastic support system. I had probably 20 letters of reference that were written by my friends, family and colleagues to the judge. On the court date, The WHOLE Court room was packed with “my people”. There was standing room only for everyone else. It was amazing and cathartic and I will never forget it. When the judge granted me the reduction, they were both dropped to misdemeanors, the court room erupted in applause and the judge had to instruct everybody to stop. It sounds like a cheesy movie but it’s true. People stared, probably wondering who the hell I was, as I hugged probably 20–25 people on my way out. I felt like a celebrity, in a weird place for a weird reason. I am happy to say that I am now eligible for expungement, (once I can afford it.)I held my job for the better part of a decade and when we (my significant other and I) decided to move out of state, my employer, the owner of the company I worked for asked me if I would be interested in opening a new business for them in our new state. Hell ya I would! It was a fabulous experience. I was flattered by the offer. I worked hard and although the project ended before it ever fully culminated, (for financial reasons out of my control) it was life changing experience. Both good and bad. I moved to a state where I knew no one. I worked in an office by myself. No personal social interaction with anyone except my SO, for nearly a year and a half. Never had my INTJ-ness been so obvious and so painful. So this is where I cut to the chase and answer your question…As an adult female INTJ, the past 2.5 years have been, believe it or not, the hardest in my life. Never have I had so much time to turn inward without all of life’s usual chaos to keep me distracted enough to not turn on myself. I am lonely but unable to form friendships. My heart hurts a lot. I need someone to relate to. Contrary to popular belief, or at least for me, INTJ’s do need people in their lives. As superficial as our relationships with others may appear to outsiders, the truth is that they are anything but superficial. Although the outward expressions of attachment and appreciation are hard to see we know, inherently, how crucial our relationships both platonic and romantic are to our well being. We are actually ALL about people. We long to be loved and appreciated and understood and accepted. We wish we could make people feel more like they make us feel. We just miss the cues, or it’s just too much for us. We actually have to TRY to do the things that come naturally for other people, and we are so busy dissecting everything into a million little nano chunks of information, we are often too introspected to even notice that the people we feel closest to are drifting away. Even if we see it, we don’t know how to stop it. How do you “BE” more than you “ARE”? How do you express in words what someone is trying to physically see in you and expect it to be enough. How can you expect someone to settle for less than they need to feel fulfilled. How do you continue to love and invest in relationships knowing that you’ll likely never be the person they wish you were? How do you hold on without feeling guilty for holding on at the same time?Relying on any 1 person too heavily is terrifying for us. We are acutely aware of the tenuous state of our fragility. I am in love with the most tender, soft-hearted, kind, emotionally deep man I have ever known, and he is in love with the person he thinks I could be with “just a little more time...” It’s heartbreaking. It’s like holding your breath, watching the clock tick away, always wondering if this is the day he’ll finally give up. Knowing he deserves more, sensing his loneliness, and I am drowning in it, unable to save myself or him. That is INTJ.So this is how I cope, I immerse myself in anything I can to escape myself. I over work. There is no such thing as a 9–5 job for me. I LIVE to take my work home with me. I over study - over learn - over research - over analyze - If I’m not pursuing a formal education for credit, I am busy learning 10 different things at a time.Keep my mind busy at all times, at all costs. Never give yourself enough time that you might accidentally stumble into some feelings or some shit you need to deal with but just aren’t ready to, yet… Never get caught without a thought… Never stop wondering about things like “why did people start hugging”, Why do identical twins have different fingerprints? Why are plates round instead of square, STILL, even though it serves no logical practical purpose? Why did the chicken cross the road?Also, perfectionism(AKA: veiled anxiety) has stunted my ability to move on to a new job. I half heartedly apply for positions that don’t even sound appealing to me. The pressure I feel to make the RIGHT career decision is mind numbing. I’m still reeling from my last job. — I started like a rock star ( 3 upward promotions within 3 months) and (I feel ) did too good, too fast, becoming a highly visible easy target for a manager that had a buck to pass. I was so caught up in doing a good job and patting myself on the back, I didn’t see it coming. I thought those types of office politics were just things that were greatly exaggerated for the movies. The stress coupled with or maybe even caused by, my resolute determination to fight back and if I was going to crash and burn, I was going to go down swinging, had such a negative effect on me, mentally, emotionally and on my health that I became physically ill, with symptoms that mimicked signs of heart failure (and probably a mid-life mental breakdown). I decided maybe it would be better to be a “closeted super star” lol, not drawing any attention to myself . That quiet person that sits in the corner “you know that one blonde girl”. Much safer, much less risky. Better.What do I like to do? I, by nature, just like what I do or more definitively, whatever I am actually doing . But what do I like when I am not doing anything? I have no clue. I guess I like not doing anything (We are never ever “not doing anything” but you know what I mean). What am I good at? I am good at whatever I’m doing and you get the pattern. It would be easier for me to figure out what I don’t like to do or what I’m not good at.My anxiety is a constant reminder that “I’m running out of time” which just keeps me with one foot on the brake and one on the gas. Are other INTJs go- getters or do they just master whatever falls in their laps? Well let me look that up, there’s another thing to keep me busy for awhile, and I'll take a few more career assessments and watch a few more “find your purpose” videos and well there you have it. The needle is stuck and my record is skipping. The only way I know how to fix myself is by doing more of the thing that is wrecking me. UGGHHH. It can be exhausting. SO my POINT is we can be “all that” when were on the right track, but if we get derailed oh man, you’re going to have a mess an your hands. Taking things from the realm of thoughts, planning and good intention to bonafide action - No Bueno. Maybe I need a tow-truck or a tug-boat to pull me out of this mess, a life coach, a mentor , medication and therapy or maybe I need a falling star or someone to hand deliver the “perfect” opportunity, What I actually need is the algorithm that turns the code into an actual action that makes the program work… I am the perfect robot, with the right programming, top of the line, just ask my boyfriend or my previous employers.UPDATE:You won’t believe this, I received and accepted a job offer as I was writing this. I start tomorrow. That’s the second time I’ve received a job offer within minutes of (or prior to) posting something about needing a job online. Weird. Put it out to the world… I think I’ll post about winning the lottery or the yet to be known angel investor that wants to invest in “me” or the overwhelming amount of debt that needs my attention and see what this lovely gracious world drops in my lap next time… (probably a debt collector lol).