Vyvanse titration and career thoughts/tangent

[S0NIC]

This started as a question about medication titration but spun off on a little tangent about my work and career that felt relevant...

A little background...

After reading an article a (ADHD diagnosed) friend sent me (6 months ago) about ADHD in relationships (relating to this all too much), staring down the second potential job resignation in 1.5 years; after it no longer feels challenging and the novelty has worn off, and just endlessly feeling impatient, forgetful, inattentive, overwhelmed and unable to plan life... I started to look into the possibility that I might have it myself, and had my suspicions confirmed after diagnosis with a psychiatrist.

I am 3 months into my titration experience with some mixed feeling about it and just generally wanting to get some feedback from others.

My family doctor has been conservative with his approach (which I respect); wanting to review dosage monthly, but i'm not sure if it's made it more confusing for me. I have queried adding a short acting stimulant (as in my treatment plan by the psychiatrist) at each step but he has been insistent we get the longer acting dose right first (I don't think this is a terrible idea). I have consumed my dose the same way every day every day at 7am, on an empty stomach, with a coffee ~0.5-1hr after dosage, generally not eating until lunchtime, and with another coffee after lunch.

- 20mg - Felt more alert/productive/paying attention in conversations/emails up until lunchtime (12-1pm), after that my symptoms came back with an added level of frustration/irritability that made me insist on seeing my doctor sooner to review this.

- 30mg - Felt similar to 20mg (less "intense") more of a gradual increase and decrease, lasting maybe 2-3hours longer (fizzling out by 2-3pm), but notably with less of the aforementioned "come down" effects after it fizzled out. I persevered with this for 2-3 weeks before wanting to review it as my work day usually hadn't finished by the time I still needed the meds to work.

- 40mg (2 x 20mg) - The best yet. Great energy and motivation through the work day and home. Praised at work by colleagues who noticed my positive approach to tasks and generally improved demeanour. Helpful on higher pressure days at work, with motivation to do the boring admin jobs that otherwise never get done. I only had enough 20's to do 10 days like this.

"Great, let's get you onto 40mg for 3 months and we'll review in 2!"

- 40mg (1 x 40mg) From day 1 of going to a single 40mg capsule my experience wasn't the same as the 2 x 20's. I have spent the last month and a half on this dose, persevering and trialling different things. On the higher pressure work days that I have really need it, I can feel "something" but it doesn't get me over that overwhelming task paralysis without a fight and makes getting through those days laborious. I notice notice less of the positives than I did with the first 2 dosages (despite the shorter durations). It feels like it does less for longer, and leaves me feeling frustrated. My first theory, I convinced myself maybe it might be a bad batch and would see if it is the same when I re-filled the prescription, this was not the case.

I had a medication holiday when going on holiday for a week recently and was surprised at how little negative effects I experienced . Holidaying is generally less stressful (duh) and concentration demanding than work but I thought i'd be a little foggy or have some "come down" symptoms - this was not the case, I felt mostly great (just generally more distracted by my phone during car rides, and losing track of conversations at times). It also allowed me the time to test the next theory that I might've been building up a tolerance to it.

After the holiday I went straight back into a few intense problems to solve at work, and as before the 40mg hasn't felt like it has enough "intensity". It has left me feeling more disappointed and deflated in my personal life. Writing/reflecting on this I realise maybe I am just burning-out.

After this few long & intense days at work last week I haven't been able to bounce back emotionally. I know during the last 3 months on meds I have definitely had 1 or 2 intense work days where I have come home, and still had something in the tank (emotionally/mood-wise) and been able to pay attention to my partner, I could without a doubt put this down to the Vyvanse still doing something. What I've read is the feelings of irritability and "loss of spark" can be associated with too high a dose but I don't feel like this is the case. I am also aware that over time the Vyvanse will become less obvious and just continue working in the background. I also haven't felt any negative symptoms thus far. I feel like throwing a short acting stimulant might help me on those more demanding days to "jump" start me.

TANGENT

Does my work just suck if it's making me feel like this?

I have always worked in fairly technical engineering roles that have demanded a high level of autonomy with little direction, and at times working under pressure (but this has been good as I thrive under pressure - until it's too much and I burn out). I have only once had a "good" manager early in my career, that was able to keep me engaged and challenge me when I showing signs of losing interest. I'm often managing upwards and setting my own direction, but in this current workplace I know I could be doing a better job than some of the people working above me (and at times have to guide their teams due to their lack of leadership and communication that I can see is not happening).

This has made me think about trading in the technical role (which has me analysing things to the n'th degree sometimes) for a people managing role, and I feel my ADHD super-power of empathy would make me a good manager. I also feel like the way I work (intuitively) with little/lack of direction currently, I could effectively direct a team under me to achieve a common goal.

I haven't felt this job progress as quickly as i'd like, but I have also been buying my time the last 6 months while i've been figuring out what's "wrong" with me and I sort my s*** out, seeking treatment. Anyway, I'm not even sure if there will be an opportunity for me in this organisation (or in the time frame I wish to progress), but welcome any thoughts if anyone relates to the professional stresses in their work, or how meds help, or their journey to career progression, or comments from other professionals with ADHD.

and we're back...

When my current dosage "frustration" symptoms are there, I have the same task paralysis that I did pre-meds, but with the addition of feeling much less social. I'm basically back to square 1 as to why I set out to seek treatment originally. I cannot afford to see a psychologist at the moment but this is one of the next things I wish to do if it isn't addressed by meds, or how to manage my emotions during the times the meds don't help like I expect.

- Wondering if anyone has had a similar experience with Vyvanse and where they landed with their titration was like? Are my expectations too high?

- Have you felt the deflation/frustration when a dose that was too low?

- Have you had a similar experience with titrating 2 smaller doses to mimic a bigger one and then found the single bigger dose wasn't the same, if so where did you go from there?

- For those that are adding short acting stimulants to the Vyvanse, Ritalin or Adderall, did you find these made the Vyvanse less effective? and do you now take them every day or just when you need them?

Appreciate your thoughts!

[STEM_Dad]

Welcome to the forum!

I haven't taken Vyvanse, but have read about it out of interest.

I wonder if the 2x20mg dosage worked better for you than the 1x40mg because of a difference in the delivery of the medication.

Are you being prescribed name brand Vyvanse, or one of the new generics? The formulation can make a difference.

Experience can change over time, from what I've read of others' experience with stimulant medications. (I was only on Adderall XR for 6 months, but it didn't seem like the best option for me. I've been on a generic of non-stimulant Strattera ever since.)

If I were in your shoes, I'd ask the doctor to try out the 2x20mg dosage for a full month, to see if your experience is like it was initially. If it's not, you might need to try a different dosage, or perhaps a different medication.

~~~~~

On the career front, like most people looking to advance to management, you will probably have to move on to a different employer.

I'd say go for it! As you prepare to make the leap, maybe see if you can formalize the cross-team leadership that you're already doing, to be able to represent it well on your resumé.

.....

I work in Information Technology, and previously worked mostly in retail. I've only had low level supervisory roles, but felt like I did really well with putting together a good team, and with coaching and training team members. I was decently good at delegating. I wasn't so good at organizing the duties or at project management.

After I did very well in my first IT role as a lead tech support representative, I was moved into a more advanced tech support role, but was no longer in a supervisor role.

I haven't had a supervisory or trainer role ever since, and I miss it. Now that I've been diagnosed with ADHD and am on an effective medication, I think I'd do very well at it. (So, I am thinking ahead to what I want my next career move to be. I'd like to do like I did before, I love helping employees to develop their skills...but I still suck at project management, and I'm not comfortable with managing a budget. ... I'm also considering the possibility of becoming a part time ADHD coach...but can't afford the certification training yet.)

[S0NIC in reply to STEM_Dad]

Thanks for the response. After a chat with one of my managers it seems like they aren't sure of very much themselves right now, hoping I can make it work in my favour and pitch a role to them. With regard to your project management and budgetting woes, there are lots of new/good web tools out there that make these a lot easier (especially once you get your own workflow of tools working for you).

I am on a non-generic Vyvanse (not sure the generics have hit my country yet), but this week I am booked in to see my doctor so I'll wait and see what he says!

[motherofdragons62]

Hello! I am a 61 yr old female diagnosed about a year ago with ADHD after my 2 adult daughters were diagnosed. I am currently on generic Vyvanse extended release 40 mg dose along with Guanfacine HCL ER 3 mg . The one thing that stands out in your situation is the short acting dose that you have been prescribed. Have you tried the extended release option? My dose lasts 10-12 hours, and I don't get the big spikes/dips throughout the day. You definitely have to experiement with the best time to take in the morning to coincide with your peak focus demand window. Good luck!

[S0NIC in reply to motherofdragons62]

Wow good on you. I swear one (or both) of my parents have it but I doubt they'd ever seek a diagnosis or treatment despite obvious (to me) negative impacts to others in their lives.

I haven't been prescribed the short dose yet, only Vyvanse which is an ER by design. Were you prescribed Guanfacine from the start of your treament or was that a later addition by your doctor?

[Ampersand1]

I've been titrating Vyvanse for a year and a half and only recently do I feel like I've got the dosage just right for me.

Here is the bad news. I'm in a similar work situation from what it sounds like. Burnout is something I've already been suffering from and even though I feel like all my meds are just right currently, I really don't think it's a task that Vyvanse is ever going to completely address.

Which leads me to a scary word: comorbidities. I was diagnosed with anxiety and depression and the sad thing is there is not just a single pill that has "fixed things" for me. I, too, have asked my psych about a short term add-on to the Vyvanse, but she has said the reason they'd rather look to work on getting the dosage right is because going up on dosage can affect BOTH the duration and impact of the medication.

I'm a tall guy just over 200lbs and early 30s in corporate america. Take good care of your mental, give time to reset at night, and if you can afford, search and see if there is some time draining thing you don't like doing that you could pay someone money to solve for you. I'm not struggling but also not rich by any means, so I'm always used to doing all my own chores and being told by parents, teachers, etc that I'm lazy. Instead of believing that, I have found tremendous returns on investment for my mental health by doing simple stuff like paying a laundry service once a month to clean, fold, and hang up everything for me for like $40-50 using an app. Turns out there are tons of cool stuff out there like this, but between weekly therapy/coaching (crucial to go hand in hand with medicine like Vyvanse for ADHD) and a few small investments to give myself extra free time in the week, I've felt loads better in just the recent 6 months, even though work has been insane with me managing 4 projects and then being sent on a temp 3 month assignment out of nowhere, being in a car accident, doctor visits, etc etc. So I'm here to tell you to pick one thing you've been thinking about maybe doing for yourself to have more time to chill and DO IT NOW

[S0NIC in reply to Ampersand1]

A year and a half!? It sounds like I shouldn't complain, it just sucks when I don't feel like my usual bubbly self, but no doubt this incorrect dosage has been magnified by the work stress i'm experiencing. The thought I had this week was that having meds help motivate me to do tasks that normally burn me out, leads me to burnout sooner as I might've otherwise selectively chosen days to "give it my all". I'm being more conscious of this, this week.

I've dealt with Depression and Anxiety on and off for the last 10 years also (pre ADHD diagnosis), and the best medicine I found to keep these in check was good eating and most importantly regular exercise (twice week at the gym for me, or a 20 minute run if I can't make it); these are my non-negotiables. Being diagnosed with ADHD however has made a lot of my anxieties and unrealistic expectations make a lot more sense now.

The idea about doing something for myself to save some time does sound pretty deserving, my "to-do list" is not exactly the shortest and it would at the very least knock something off it. 😊 I will see what I can do for myself this month. Thanks for sharing your thoughts!

[Ampersand1 in reply to S0NIC]

Yeah, a year and a half.. long unfun story. Hahaha but I forgot to mention where I landed. I'm at 50mg, so this was a point I meant to share in my first reply.

I really need to add exercise to my routine. I know it would help but I don't prioritize it ever. Maybe I'll change that this week though and see how I feel after starting a new routine

[El-Eektrified]

Titration is a difficult process, not knowing if it will miraculously solve all your problems… guess that didn’t happen to me. I was on 50 mg of vyvanse. I took 30 + 20 separated by 5 hours, to make it last longer. Before that I was on short acting stims, but maxed out… and it simply didn’t help anymore.

My new psychiatrist then explained its mechanism to me, he drew a reversed U and explained that you’ll benefit from stimulant medication till a certain point, but if you cross it, you’ll lose the positive effect. Sounded plausible to me, so now I know that increasing a dose, doesn’t mean that it automatically will improve symptoms.

Comorbidities, like mentioned in the other reply, are common amongst ADHD. Because my treatment didn’t help, my psychiatrist discovered that Autism was obviously my main issue, and added meds that really improved things for me.

[S0NIC in reply to El-Eektrified]

I definitely didn't think it would be this hard 😅, but I suppose the benefits continue to outweigh the negatives so far for me so I persevere. That's interesting about the stimulant "reversed U" your psych mentioned, perhaps that's what i'm experiencing.

Did your stimulant treatment not help before you treated your ASD?

[El-Eektrified in reply to S0NIC]

At first I thought it did, but I wasn’t able to tell if it had any positive aspects. But then I was treated solely for my ADHD. Now I’m treated for my ASD as well, with all kinds of additional meds, guess I’m kinda“complicated” 😅