Struggling with so much conflicting information about meds.

[RizzKalifa]

Hey guys

I will try to keep it concise (not my forte, but we have ADHD and don't want to overwhelm y'all with reams of text). 30mg Vyvanse/Elvanse), 5mg Lexapro and melatonin is my current combo. ADHD meds are working well, but all my research says that there are major interaction risks with stimulants and Lexapro. I have read studies, journals and anecdotes which state the risks outweigh the benefits. The risk of cardiovascular health is real--such as developing QT prolongation and other scary effects. I am on a low dose of SSRI, so I am not worried about serotonin syndrome. I had it before, but that's another story.

However, here is the kicker. Doctors seem unphased and say that unless I have heart problems, there should be no issue. Yet the interactions with the medications can CAUSE and CREATE these issues. I am at a loss about what to do as I need to be medicated for my anxiety. Raw-dogging life doesn't work for me.

I don't mean to sound hyperbolic, but any time I approach such subjects with PCP they pm gaslight me, and I am exhausted with it. I wanted to go off Lexapro and go on another type of medication group like an SNRI because, although great at managing my anxiety, it creates depression and apathy. However, I am passed around healthcare. My psychiatrist told me to ask the GP about it because they prescribed the SSRI, and the GP told me to ask the specialist!?!!

Is there anyone else out there that doesn't deal with clinical depression but severe anxiety?

Is anyone else on this combo?

I have bouts of feeling down and bored, but it isn't the same.

[STEM_Dad]

While the risk of cardiovascular issues from ADHD stimulants is real, my own research is that it elevates real risk by only about 1%. (It's *relative risk* which is elevated by a shocking amount.)

I recently watched two YouTube videos, one by a researcher who was translating the statistics into layman's terms, the other by a doctor who has been an expert in treating Adult ADHD for over 20 years. They both essentially said the same things:

• Actual risk of cardiovascular side effects are about 4% without stimulants, and about 5% with stimulants. (My memory isn't the best...the actual numbers went into the tenths of a percentage... I'm rounding off.) The *relative risk* is based on the difference between those numbers.

• They also basically said that treating ADHD with an effective medication can help a person have a greater quality of life overall, including making them more capable of better self care.

Due to interaction between the medications you are taking, and your known cardiovascular condition, I would also be concerned if I were in your shoes.

That doesn't mean that I would insist on stopping my ADHD meds, because my overall quality of life is so much better on them than off them.

Are there any lifestyle changes that you can make to improve your cardiovascular health? Diet, exercise, stress management and meditation all can have significant positive effects on cardiovascular health and overall wellness. Having good social contact with friends and family can also be beneficial for health.

• A combination of these positive influences might more than offset the potential risk caused by ADHD stimulant meds, and it's probably a lot easier to do them if you are treating your ADHD.

-----

As for the back and forth between the two practitioners, if your GP will put into their notes for you to check with the psychiatrist for anxiety treatment options, and the psychiatrist can access those notes, then that should settle the issue more clearly. A psychiatrist is more qualified to assess treatment options for anxiety than a GP, so I don't understand why the psychiatrist doesn't simply make the change and inform the GP.

[RizzKalifa in reply to STEM_Dad]

It is frustrating as heck!! I have an app in two weeks so I am praying I can finally get some clarity, and hopefully another combo.

I don’t think I will come off Vyvanse because my quality of life is important and the positive change is much needed! I feel you on that. I am just struggling with what to take for my anx, if anything at all. Ahhh, the quest for peace of mind continues.

[STEM_Dad in reply to RizzKalifa]

I've added some mindfulness and CBT techniques to my anxiety management tools.

~~~~~

I'm often anxious about going to work for two reasons:

1. the drive on the winding road I have to take there (I had a spinout crash on that road just over a year ago);

2. the job itself is stressful, and sometimes outright triggering for my anxiety (not a good long-term job for someone as prone to anxiety as I am).

• I have had only two jobs that were worse in terms of stress...one was at a correctional facility, ...the other one was somehow even more anxiety inducing than the corrections job.

[RizzKalifa in reply to STEM_Dad]

I am sorry to hear about your crash. I can totally empathize with those feelings. I must admit driving is extremely anxiety-inducing, I absolutely hate it. Dang, I can't believe you worked in a correctional facility, the stress would be unreal. I had a friend work as a nurse in one and I just could not imagine it, while she loved it. I find working with people difficult, although I like to help others. It's a weird paradox. Working under bright lights overstimulates me to death, thankfully ADHD meds help with a li'l.

[STEM_Dad]

Here is one of those videos I mentioned. This is the guy who goes over the research information about the cardiovascular risk associated with ADHD stimulant medications. (I don't think there was anything mentioned in it about interaction with other medications, though.)

youtu.be/A989cmSdyCE?si=t3N...(Not working as expected?)

Feel free to watch it and judge for yourself. But make sure to discuss your concerns with your doctor.

[RizzKalifa in reply to STEM_Dad]

Thanks so much Stem_Dad!

[Jalapenochips]

i’m sorry my daughter is on the Vyvanse and we just started so I don’t have any experience to share. Maybe you can help us? Good luck with everything.

[Mamamichl]

I have never had depression as a diagnosis. I have had severe anxiety for 20years now (diagnosed adhd 2 years ago). Most anxiety meds didn’t work for me. I was on Citalopram for 10 years. Now I have been on trintellix for several years, and it’s 2 part sSri and 1 part snri. I also have an emergency med (was propranolol but now is hydroxyzine). I’m not on adhd meds at this time, but I’m in the process of getting a gene site test. I think my two meds helped with both anxiety and depression, even though I only needed it for anxiety.

[RizzKalifa in reply to Mamamichl]

I have been researching and found TCAs may be the safest to take with stimulants, so I will bring up desipramine for discussion. Thanks for your input. ☺️

[Mamamichl in reply to RizzKalifa]

My partner is taking vibrid/vilazodone with his stimulants (vyvanse)…

[RizzKalifa in reply to Mamamichl]

I am super wary of possible interactions, my health anxiety is really bad. I know all drugs come with warnings, but I want one with the least risk and side effects, esp weight gain/metabolic and lipid changes. I loathe SSRIs and wish I had never started on them. I think I am going to mention proprananol or buspirone now.

[Mamamichl in reply to RizzKalifa]

My trintellix is 2 part ssri and one part snri. It works better for me than straight ssri.

[Blue_186281_red]

My understanding is that the entire theory behind SSRIs has been debunked and that any effects are just placebo. Regardless of efficacy, s/e, or conspiracy, I don't think it's controversial to claim the the effects of aerobic exercise is is comparable to any benefits claimed by drug manufacturers. Plus, there's obviously a host of other benefits for exercise.

My personal experience with (social) anxiety: In college, I didn't talk to anyone my freshman year. My natural tendency would have been to isolate and play WOW, but instead, I took a book to a coffee shop and became a fixture there for 10+ years. I found community, connection, confidence and sex. Since then, the shop was shut down by a real estate company who raised rent and snuck into city hall to pass a smoking ban. For 2 years before my daughter was born I failed to find any replacement. Now family life and society-wide social media induced social anxiety finds me in a similar social predicament to where I was at 19 and the anxiety, while tempered by age, has returned.

Without completely dismissing biological causes, my personal experience is that anxiety is a spiritual malady. We evolved to survive by contributing to the survival of a small group of people and an individual can only flourish by duplicating this dynamic. Being an atheist, I would say that this actually IS a wholly biological problem - just not one of pathological chemical imbalance. Anxiety is a form of pain and pain exists to tell you something needs to change. To treat anything but the most severe anxiety with drugs is like taking narcotics for your sore arm, when you really need a cast for a broken bone.

[RizzKalifa in reply to Blue_186281_red]

I totally get wanting to isolate. I have socially withdrew a lot of times. I would say my personality is very outgoing and bubbly by appearances, I mask my struggles pretty well. It is exhausting though, so I withdraw.

I am sorry you feel you are thrown back to where you were at 19. I hope you can find your way again, no doubt you can! I don’t use social media haha, I only use one that isn’t image-based. I find it the plague of society tbh.

Hmm being hypersensitive and experiencing side effects and withdrawal I would have to argue in my case it is not placebo with SSRI. Although, I understand placebo and testing. I am also autistic (like others the in family) so anxiety is likely a huge genetic factor. I have had therapy which aids a little, but it is my natural disposition triggered by sensory issues. Medication helps ease my pain. Raw-dogging it isn’t a life I want to lead. I am a very active person and dedicated to fitness, I eat well too so those variables don’t exasperate my anxiety.