How can I determine if I am responding to my stimulant med dosage correctly - or if the dosage needs to be changed? Right now, I have a depressed morning mood on most days (but especially if I skipped the stimulant the day or days before), which then lifts very rapidly within a couple hours of taking the stimulant. However, at midday I can feel either (1) very "amped up" and excitable, especially if I am been doing the part of my job I enjoy (teaching) or (2) on days when I am doing other things or being unproductive, I feel a persistent anxiety for the afternoon.
What to make of this reaction? Clearly, the Vyvanse is partly treating my underlying depression, not just the ADHD. But the midday symptoms (which are uncomfortable) confuse me. Is the stimulant too high? too low? Should I ask my doctor to think about switching up something with the antidepressant instead?
Could anyone help me understand how to present this to my MD to get the proper titration?
(I need to post this question here since my access to a psychiatrist is currently limited by being underemployed and underinsured and not being able to find any psychiatric MDs who will take my crappy insurance. Currently, my primary care physician is handling my psychiatric medications.)
I am also on Vyvanse 50 mg. You'll probably get a different answer from each person that responds, but don't let that discourage you. I've been on Vyvanse for many years and only recently, after I moved across the country to another state, did I have the "opportunity" to try out other ADD meds again. I call it an "opportunity" because it makes me feel better about. When I moved, I had to change doctors, of course, and the psychiatric care where I am at now is very limited and they only really treat acute situations. I found it very difficult to find a doctor or nurse practitioner that would take the time to listen to me and understand me. They didn't believe that I was ADD and they tried putting me back on the mood stabilizers and anti-depressants. They flat out told me that they didn't believe me and that they wouldn't prescribe me anything for the ADD, even though I had been on Vyvanse for many years prior and it has been a "miracle" cure for me. At least, compared to all of the various meds that I had been trying for the 20+ years prior.
When I started on Vyvanse, it was like a fog had cleared away and I could finally "think" without all of the "clutter" in my head that was causing me to get distracted. Without the Vyvanse, I would have constant conversations in my head, with myself, basically arguing all sides of a particular topic that I was thinking about at the time. I was never able to get things done, which cause me to always be anxious. I mean heart racing, constant pressure on my chest sort of anxiety. When I take the Vyvanse, my anxiety is reduced to something that is much more manageable. Then I just have to deal with all of the typical stuff that causes me anxiety, but at least all the "clutter" is out of my head and that alone relieves so much of the anxiety. You mentioned that you notice an enhanced mood a couple hours after taking it. From my own personal experience, I can say that I too have a more elevated mood when I am on the medication, but I don't believe necessarily that it is masking an underlying depressive disorder. It might be, it might not be. What I do know is that I tend to get depressed, and I mean majorly depressed, when I am overwhelmed. It doesn't really even have to be overwhelmed with bad stressors, it could be overwhelmed with good stressors and I will still get depressed. The ADD meds will clear away the clutter so that I can think straight and when I am thinking straight, then I can work through the things that are getting me overwhelmed. I can focus on the high priority things, or the simple things, and then take care of them one at a time or even simultaneously, a little on each one. The thing is, I never noticed this trigger for the depression prior to getting on the Vyvanse, and to be honest it wasn't until that "opportunity" arose in which I had to be off of the Vyvanse for a while and I got really depressed again.
I've been at this for a number of years. I was diagnosed as having Bipolar II, when I was in college. It manifested after my dad's twin brother died unexpectedly. I was also dealing with some internal struggles at the time as well as trying to maintain my courses in college, while working to pay for college, trying to find my way in life, etc. Sound like a possible situation in which I might have been overwhelmed with several stressors? Yeah, I was. They were all pretty big life-changing events happening at the same time and I didn't have the "tools" to deal with them, nor the space in my head to sort out everything so that I could deal with them. I was treated for this diagnosis for roughly about 20 years. It wasn't until I had to find a new therapist because I was getting overwhelmed again and the anti-depressants/mood stabilizer/anxiety medical cocktails weren't doing it for me anymore and I needed to get therapy again. As I got to know this therapist and he got to know me better, he asked me if I had ever been tested for ADHD. I didn't think that an adult could have ADHD and I was biased with the "name" of the condition, because I wasn't "hyperactive" and never really had been, so I told him I hadn't been tested and that no one had ever considered that for me in the past. As he explained the reasons why he thought we should go down that road and see where I might be in the spectrum, I began to feel a bit of hope. He described so many traits that he had observed in me during our sessions that he felt that I could benefit from a different type of treatment, both medically and therapy-wise, as well. I had two sessions with him in which he gave me some tests that he had been trained to administer and then either he analyzed the results or sent them in somewhere to get them analyzed, either way, we found out that I did rank very high in very specific areas of ADD. Hyperactivity wasn't one of them, but I was well within the range to be considered for this diagnosis. He couldn't prescribe medication, but he sent off a recommendation to my psychiatrist to consider adjusting my medication based on this diagnosis. My psychiatrist tried me on a couple of meds but we settled on the Vyvanse as the one that worked best for me and we then eased me off of the other meds I was on. I was very hesitant to get off of the mood stabilizers because being previously diagnosed as Bipolar II, the doctor thought that I could easily slip into a manic state due to the stimulant. That never has happened. I haven't experienced a manic or hypomanic state since really being on the Vyvanse. An "elevated" mood, sure, but that is a far cry from being manic.
Another member pointed out that many of us have a difficult time getting to the point. This post is probably a prime example, but to be honest, I joined this group for my own benefit, and sharing my story benefits me and hopefully others will take a nugget or two away and my sharing will benefit them as well. It is a win-win, as long as you're able to get something out of this that you can move forward with.
Out of all of this, what I would hope that you can get from this is that medication alone may not be the answer, and although you may find a dose that is working for you at a particular time of your life, it may not remain that way because I believe we need to factor in our life experiences, sleeping habits, eating habits and social/psychological support network, because it all plays a significant part in our overall well-being.
Personally, I found that anything stronger than 50 mg and I am likely not going to be able to sleep more than 4-5 hours a night, I also found that I tend to curl and stretch out my toes, obsessively when I am on a higher dose, so I try to stick to the 50 mg. I noticed that anything less and it is not really effective at all. I don't get the "clear" head, my mood tends to drift downwards as more and more stress piles up, I would always be tired and yet still can't sleep because my mind is always racing, so 50 mg seems to be the sweet spot for me. Now, that doesn't take care of it all, as I mentioned. Depending on the stressors I've got going on in my life at the time, I may still have to take some anxiety meds from time to time to take the edge off and to help me relax enough to sleep. You mentioned that on days that you are "unproductive", that you feel anxious. Yup, if I don't take the meds, like on a weekend, if I sleep in and forget to take it, then I'll skip a dose and I will notice that on that day, I won't really have a whole lot of "ambition" to do much, and I'll be really anxious all day. I have noticed that it is better to try my best to not skip doses and I tend to notice that I'll stay on a more even track with my mood and emotional stability. I've heard of some people taking a lower dose in the morning and then taking a "booster" of a different stimulant in the around mid day to stave off the afternoon anxiety. My nurse practitioner has suggested something like this to me in the past, but I am hoping to get over my current situation with therapy instead. I just have to find a therapist, now. If you have the means and opportunity, I would suggest seeking out a therapist that can help with "mindfulness" practices. If you don't have the means or opportunity, search for this on the web and try practicing some of the techniques of mindfulness. I have found that therapy to have worked the best for me for managing my ADD behaviors, reactions, emotions, etc.
You mentioned "midday symptoms" that are uncomfortable and confusing. Are you able to determine if the symptoms are due to the underlying depression, ADHD, something else, or are they due to the medication? Something else I have noticed about Vyvanse is that it is a med that has to actually get "processed" by your body in order for you to gain the benefits from it, whereas some of the other stimulants such as Ritalin or Adderall, they give you that "clear" head almost immediately, but those are short-lived and from what I've experienced, I was more on a rollercoaster when I was trying those. Not a high/low rollercoaster, but one for my feelings of anger and frustration, instead. When I was trying out those meds, I would easily get frustrated and wasn't able to handle my feelings of anger very well when I would get frustrated. I tended to lash out at people and overreact to things that were really not all that big of a deal, in the grand scheme of things. So, I would suggest trying to identify if the midday symptoms are due to the medication or lack of medication. If you aren't able to determine this because maybe some days you get the same results with no change in meds, look at the environmental or situational stressors at the time and see if there is a difference there. I've also noticed that my sleeping habits play a major role in my overall well-being and how well the medication can help me on a daily basis. I've always had difficulty getting to sleep. Even as early as my teen years, I can remember always being tired in the afternoon, but never being able to get to sleep at night. Looking back, now I think that was due to mental exhaustion in the afternoon because I was trying so hard to just get through daily tasks and life in general, that by the afternoon, I was exhausted. Then I would not be able to get to sleep that night because my mind was racing about all the things I either forgot that day or what I knew I needed to do the next day. BTW, I still do this, every night. Xanax is about the only thing that clears my mind at night, enough so that I can sleep.
So, writing a novel for a response to a question about how to talk to your doctor about getting the right dose for a medication to help you with ADHD, is probably not the best way to help out, but you can make that decision. Hopefully you got what you need or can now ask more questions about things you may not have realized played a part in all of this. Either way, if you made it all the way to the end of my response, then you certainly have the determination to get better and I'm sure you will work this all out. Good luck and feel free to reach out again. I know this site has helped me to gain perspective, for the little time that I have been on here. I'm sure you'll get what you need, just practice patients and realize that everyone has their own experience. Take what you need, leave what you don't and help when you can. That motto works in so many situations.
I appreciate your willingness to share your story. I don't mind that it is a lot to read and process.
I think i need to be willing to consider the possibility that the intermittent anxiety is not necessarily "unhealthy" anxiety and possibly situational. Perhaps therapy is the way to go instead of concentrating on changing the meds.
It's very hard to say though. I will find a way of presenting it to my MD for advice, one way or another.
Hi there. I had a similar mood reaction to Vyvanse. It made me feel good, less anxious, a nicer calmer person. That is, when I was in the 6 to 8 hour window that it worked. Coming off it was unpleasant with heightened anxiety or feeling down. And, if I didn't take it the next day I felt worse. Vyvanse helped me focus on reading, writing, and other learning type activities. But my home could still be a mess. Concerta gives me organizational skills, better motivation and lasts longer. But I'm more serious and intense. ( with a bump in heart rate) . If I was working on a paper for example, I would switch to vyvanse. For day to day living, I choose Concerta , for now. I'd love to hear from others too.
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