View Full Version : Stimulants don't last long enough for me-- can someone solve this?


toujours99
08-29-16, 10:32 PM
Hey guys-- long time lurker here.

I've posted this question a few times on reddit trying to get some answers, and at this point I'm completely stumped.

I have GAD, MDD, and ADHD. My current meds are:

Prozac (60mg)
Wellbutrin XL (300mg)
Buspar (45mg)


My problem was that when I would take Vyvanse (50mg) for my ADHD, it would work great...but only for like 3-4 hours. I talked about it with my doc, and she suggested switching to Adderall IR. She gave me a pretty decent dose to take each day (20mg x2), and I literally felt nothing from the Adderall.

I tried watching what I ate, looking at stomach acidity, stuff like that. Nothing helped.

I know people are on Wellbutrin + Vyvanse and doing great (they say it potentiates the Vyvanse even), and I know people on Prozac + stims and are doing great. So I couldn't figure out why I was so....special >_>

The responses I got on the internet were that it was most likely Wellbutrin not allowing for the amphetamines to take effect. So, last week I started titrating down the Wellbutrin, and now I'm completely off it. I took Dexedrine today (20mg) and it lasted about 1 1/2 hours...

The reason I've turned to the Internet for some input is that I have no access to a psychiatrist at the moment (long story), so I've been working with my PCP on this issue. And as you can tell, even for a trained psychiatrist, this is a tough one to tackle I guess. (I won't make any changes on my own, I'll just discuss suggestions with my doc!)

So I was wondering if ANYONE here had ideas for what the heck is causing the issues I'm having.

I've also tried Focalin, which worked, but again, just for a very very short period. So in total I've tried Vyvanse (50mg, even trying this twice a day, which works but makes me feel...weird), Adderall (20mg 2x/day), Dexedrine (10-20mg as needed for a booster), and Focalin (10mg).

Now, I'm weaning off the Buspar and Wellbutrin, and am just taking the Prozac. My best guess (and hope...) is that the Wellbutrin hasn't had enough time to exit my system...but as the days progress and I don't see improvement, I'm starting to doubt this :\

tl;dr Tons of different stimulants barely last on me even at high-ish doses, and I shouldn't have a tolerance. I quit the Wellbutrin recently and still haven't seen improvement. ANY ideas??

Thanks SO MUCH everyone.

sarahsweets
08-30-16, 04:12 AM
Hey guys-- long time lurker here.

I've posted this question a few times on reddit trying to get some answers, and at this point I'm completely stumped.

I have GAD, MDD, and ADHD. My current meds are:

Prozac (60mg)
Wellbutrin XL (300mg)
Buspar (45mg)


My problem was that when I would take Vyvanse (50mg) for my ADHD, it would work great...but only for like 3-4 hours. I talked about it with my doc, and she suggested switching to Adderall IR. She gave me a pretty decent dose to take each day (20mg x2), and I literally felt nothing from the Adderall.

I tried watching what I ate, looking at stomach acidity, stuff like that. Nothing helped.

I know people are on Wellbutrin + Vyvanse and doing great (they say it potentiates the Vyvanse even), and I know people on Prozac + stims and are doing great. So I couldn't figure out why I was so....special >_>

The responses I got on the internet were that it was most likely Wellbutrin not allowing for the amphetamines to take effect. So, last week I started titrating down the Wellbutrin, and now I'm completely off it. I took Dexedrine today (20mg) and it lasted about 1 1/2 hours...

The reason I've turned to the Internet for some input is that I have no access to a psychiatrist at the moment (long story), so I've been working with my PCP on this issue. And as you can tell, even for a trained psychiatrist, this is a tough one to tackle I guess. (I won't make any changes on my own, I'll just discuss suggestions with my doc!)

So I was wondering if ANYONE here had ideas for what the heck is causing the issues I'm having.

I've also tried Focalin, which worked, but again, just for a very very short period. So in total I've tried Vyvanse (50mg, even trying this twice a day, which works but makes me feel...weird), Adderall (20mg 2x/day), Dexedrine (10-20mg as needed for a booster), and Focalin (10mg).

Now, I'm weaning off the Buspar and Wellbutrin, and am just taking the Prozac. My best guess (and hope...) is that the Wellbutrin hasn't had enough time to exit my system...but as the days progress and I don't see improvement, I'm starting to doubt this :\

tl;dr Tons of different stimulants barely last on me even at high-ish doses, and I shouldn't have a tolerance. I quit the Wellbutrin recently and still haven't seen improvement. ANY ideas??

Thanks SO MUCH everyone.

Sometimes its not worth the effort to figure out why a meds doesnt last the right amount of time, and it makes more sense to take it multiple times a day.
I take adderall xr which is purported to last 6-8 hours, I get about 4, so I take it three times a day. I also have absorption issues, so I am one of those people where time release meds are needed more than once a day. I dont know. Maybe you metabolize meds super fast- or maybe you havent found the right med or dose, but you can end the worry about it if you take it multiple times a day right?

toujours99
08-30-16, 03:36 PM
Sometimes its not worth the effort to figure out why a meds doesnt last the right amount of time, and it makes more sense to take it multiple times a day.
I take adderall xr which is purported to last 6-8 hours, I get about 4, so I take it three times a day. I also have absorption issues, so I am one of those people where time release meds are needed more than once a day. I dont know. Maybe you metabolize meds super fast- or maybe you havent found the right med or dose, but you can end the worry about it if you take it multiple times a day right?


Hi there, thanks so much for the response!

Yeah, I'm thinking it could be something with my metabolism-- I wish those genome tests were cheaper >_> really would like a definitive answer to that!

I feel weird taking such a higher dose of this stuff than what most people take, given the fact that I really shouldn't have a tolerance at all. In addition, my insurance wont cover more than 30 pills of Vyvanse a month, and when the concentration, energy, etc wears off from the meds, I still have very high blood pressure, so I get bad side effects without the good effects :( I'm not sure doubling or tripling would be safe for me

sarahsweets
08-31-16, 04:39 AM
Hi there, thanks so much for the response!

Yeah, I'm thinking it could be something with my metabolism-- I wish those genome tests were cheaper >_> really would like a definitive answer to that!

I feel weird taking such a higher dose of this stuff than what most people take, given the fact that I really shouldn't have a tolerance at all. In addition, my insurance wont cover more than 30 pills of Vyvanse a month, and when the concentration, energy, etc wears off from the meds, I still have very high blood pressure, so I get bad side effects without the good effects :( I'm not sure doubling or tripling would be safe for me
Most insurances wont cover more than two doses of vyvanse because its the only med marketed as lasting 12 hours, however I have yet to meet anyone that it lasts this long for.
I take adderall xr three times a day at 20mg and twice a day at 10mg. Its supposed to be a med that lasts 6-8 hours but for me, it lasts about 4. I have a resentment against vyvanse for a variety of reasons so maybe I am biased.

toujours99
08-31-16, 02:19 PM
Most insurances wont cover more than two doses of vyvanse because its the only med marketed as lasting 12 hours, however I have yet to meet anyone that it lasts this long for.
I take adderall xr three times a day at 20mg and twice a day at 10mg. Its supposed to be a med that lasts 6-8 hours but for me, it lasts about 4. I have a resentment against vyvanse for a variety of reasons so maybe I am biased.

Ooo tell me your resentment towards it! :)

and my insurance will cover 60/Adderall XR a month, so I may talk to my doctor about trying that next. Have you tried IR? If so, was it less effective for you?

sarahsweets
09-01-16, 04:52 AM
Ooo tell me your resentment towards it! :)

and my insurance will cover 60/Adderall XR a month, so I may talk to my doctor about trying that next. Have you tried IR? If so, was it less effective for you?

Ok here goes...
Vyvanse as no generic and as far as I can tell, SHIRE will fight any chance at letting anyone make a generic so its extremely expensive. I am resentful because its advertised as abuse-proof when it totally can be abused. I am resentful that is advertised as lasting 12 hours, so you would only need one dose all day, because thats rarely the case as far as who Ive met.
I dont like the fact that it takes so long to work,and that it begins to work a lot of times in the gut-because of its mechanism of action-and that people need to spend so much time worrying about whether they eat or not.
I am irritated that doctors promote it so much and it makes me wonder if they are getting anything in return. I think that doctors who take things at face value are scared to prescribe meds like adderall and go right to vyvanse.
My experience with vyvanse was that it affected my and my daughter's mood terribly- and it seemed to affect the appetite more than other meds as well.

I have taken adderall xr and ir. I take the xr about 5 times a day in split up doses. SHIRE makes brand adderall xr and all of the generics (global, teva/barr).The only generic they dont make is the one by ACTAVIS. (dont get me started on that one).
I also had taken a combo of adderall xr/ir but because I have absorption issues, the ir was only lasting 2 hours.
Adderall xr is supposed to last between 6-8 hours but I take mine every 4 because of absorption issues.

Hope this helps!

toujours99
09-01-16, 11:45 AM
Ok here goes...
Vyvanse as no generic and as far as I can tell, SHIRE will fight any chance at letting anyone make a generic so its extremely expensive. I am resentful because its advertised as abuse-proof when it totally can be abused. I am resentful that is advertised as lasting 12 hours, so you would only need one dose all day, because thats rarely the case as far as who Ive met.
I dont like the fact that it takes so long to work,and that it begins to work a lot of times in the gut-because of its mechanism of action-and that people need to spend so much time worrying about whether they eat or not.
I am irritated that doctors promote it so much and it makes me wonder if they are getting anything in return. I think that doctors who take things at face value are scared to prescribe meds like adderall and go right to vyvanse.
My experience with vyvanse was that it affected my and my daughter's mood terribly- and it seemed to affect the appetite more than other meds as well.

I have taken adderall xr and ir. I take the xr about 5 times a day in split up doses. SHIRE makes brand adderall xr and all of the generics (global, teva/barr).The only generic they dont make is the one by ACTAVIS. (dont get me started on that one).
I also had taken a combo of adderall xr/ir but because I have absorption issues, the ir was only lasting 2 hours.
Adderall xr is supposed to last between 6-8 hours but I take mine every 4 because of absorption issues.

Hope this helps!

Super helpful, thanks so much for the response. I'm very interested in giving Adderall XR a go now.

I agree completely on the Vyvanse patent. From what I've read online, they've been crazily trying to extend it, and it's going to be years and years before it might finally be generic >_> And the lies about the 12 hour duration just hurt patients. Totally agree!

aeon
09-01-16, 12:06 PM
The approved dosages for Vyvanse also make no sense given the working dosages of the other drugs in its class.

Vyvanse is weak sauce for those who need strong sauce.


Cheers,
Ian

toujours99
09-01-16, 03:20 PM
The approved dosages for Vyvanse also make no sense given the working dosages of the other drugs in its class.

Vyvanse is weak sauce for those who need strong sauce.


Cheers,
Ian

Hey thanks for the response! Can you do a comparison for me? Because I've always seen people compare dosages pretty easily, so I'm probably misunderstanding!

And what would you recommend that isn't weak sauce? :)

C15H25N3O
09-01-16, 04:08 PM
Vyvanse is weak sauce for those who need strong sauce.

I love this phrase.

@toujours:

I got Vyvanse working absolutely perfect.
I invested 2-3 month into adjustment and it absolutely works 13 hours.
I also know how to handle it to get 16 hours from it.
Sounds like not being worth the time for some.
But its heavy adjustments process teached me more and deeper into self-reflection than any therapy could have done.

Some days I absolutely dont feel it but it works.
This state makes me functioning friendly guy but attention and focus is better when I feel it.

So I can use it for live quality but also for working on different dosages.

Best thing I learned: Everything works from power of will.

(Mind meds work different on each others mind.)

Lunacie
09-01-16, 04:17 PM
Not a large percentage, but SOME of us find Omega 3 fish oil is helpful.

I started taking it when I didn't have health insurance to pay for a diagnosis or meds.

Since it works well for me, I haven't bothered to get an official diagnosis or meds.

My granddaughter's therapist several years ago snuck a Connor's evaluation through for me which showed I do have ADHD, and GAD and Depression and PTSD.

aeon
09-01-16, 05:23 PM
Hey thanks for the response! Can you do a comparison for me? Because I've always seen people compare dosages pretty easily, so I'm probably misunderstanding!

And what would you recommend that isn't weak sauce? :)

Conversion Factors for Common ADHD Medications (http://addforums.com/forums/showthread.php?t=173221)

For the same milligram dose, Dexedrine is 2.47x as strong as Vyvanse.

Vyvanse = weak sauce, expensive sauce
Dexedrine = strong sauce, much less expensive sauce


Cheers,
Ian

toujours99
12-07-16, 06:22 PM
Just in case anyone finds this thread in the future and is in my situation:

I got genetic testing done through GeneSight--and I'm not sure how relevant / accurate the results are--but I have "reduced activity" for the COMT genotype, which is claimed to be associated with a reduced therapeutic response to pretty much all the main stimulants. I'm not sure how profound of an effect it has, I've tried researching and couldn't get much information. So if anyone knows more about this, I'd be very happy to hear it.

The last thing I'm going to try is Pro/Nuvigil, because those weren't on the medication list as being affected by this genotype (only because they aren't FDA approved for ADHD). I'm hoping that maybe that different mechanism of action will be what's best for me :umm1:

It'll be at least 4 months before I can try the Provigil (long story) :( but at least that's 4 months of positive thinking that I might have found a solution :D

C15H25N3O
12-07-16, 06:43 PM
Vyvanse needs liver enzyme trypsin to split the dextroamphetmine demisilate from lysin.
Enzyme p450 CYP2D6 job is to regulate amphetamines half life.

when the concentration, energy, etc wears off from the meds, I still have very high blood pressure, so I get bad side effects without the good effects :( I'm not sure doubling or tripling would be safe for me

This effect is caused by P450 CYP2D6 and you experience bad side effects while Vyvanse was still
working - only bad. P450 CYP2D6 is followed by catechol-O-methyltransferase (COMT)-catalyzed
methylation (HMMA) and/or glucuronide/sulfate conjugation

Do not add provigil / nuvigil to wellbutrin or check interactions with your doc. I had crazy
interactions with 1/8=12.5mg of nuvigil added to 150mg wellbutrin. I am happy to be still alife.

salleh
12-07-16, 09:33 PM
....What you must realize, is that everyone had different reactions to the various meds that we of the ADHD clan take.....what some people say is a high dose ....is correct ...for them ....if your body processes your meds quickly .....that doesn't make you wrong, or a drug fiend ....It upsets me when people act all shocked at the amount of medication anyone takes ......I would venture to say that all, or close to all of us would far rather not have to take the damned stuff at all .....

...and you cannot go by the so called recommended dosage, as, for example, the adderall dosage is set at 60 mg a day tops ....only that's for children, not for adults, as far as I know, there is no recommended dosage for adults ....

.....I would talk to your person about adderall, dex used to be cheaper, but not since the "Great Adderall Shortage" of about 6 years ago or so ....dex skyrocketed in price after that .....

....As for cost, go to Good Rx online and you will find prices that even a starving artist can afford .....just figure out which pharmacy is the cheapest and print out a coupon for that one ...( or do it for a few, you never know) .....


....Good luck ...I don't know about the other diagnoses, no experience there ....

....ADHD is a hard one to get the meds correct for ....titrating up and down ....and trying the different meds, and then there's the different manufactors, and which works best for you ....

.....My pdoc and I have a lovely relationship, and he lets me set the pace.....I can take 3 or 4 tabs a day depending on how long my day will be ....I don't work a regular schedule, but amd self employed and some days are about 16 hours ....some I recover from those days ! ....many are at least 10 hours ....I take 30mm IR .....and have been taking either Dex or adderall for more than 20 years now ....( just ot give you an idea of the place I am speaking from )