ADD Forums - Attention Deficit Hyperactivity Disorder Support and Information Resources Community  

Go Back   ADD Forums - Attention Deficit Hyperactivity Disorder Support and Information Resources Community > TREATMENT & MANAGEMENT > Medications > Vyvanse
Register Blogs FAQ Chat Members List Calendar Donate Gallery Arcade Mark Forums Read

Vyvanse (lisdexamfetamine dimesylate)

Reply
 
Thread Tools Display Modes
  #1  
Old 12-27-11, 04:29 PM
mnmat0 mnmat0 is offline
Newbie
 

Join Date: Dec 2011
Location: Minnesota
Posts: 8
Thanks: 0
Thanked 2 Times in 2 Posts
mnmat0 is on a distinguished road
Question After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or advice?

I've been on Vyvanse for the past year and a half and am trying to decide whether to discontinue it, continue taking it at the same dosage or continue taking it at either a lower or higher dosage. My doctor does not have a strong opinion on this at all (and as a result I'm currently on a 5 - 7 month waiting list to get in to see a new pdoc instead) so I was hoping to get some input from other people who are either on this med now or have been on it in the past and hear some opinions based on shared experiences.

I'll try to briefly sum up my situation. I'd been struggling with multiple disorders for years; namely depression, social anxiety disorder, chronic fatigue syndrome, delayed sleep phase syndrome, ADD and seasonal affective disorder. I'd been medicated with a ton of different meds over the years that either did nothing or only made the issues worse and then I was put on Wellbutrin and Vyvanse. This combo worked wonders for my depression, totally eliminated the chronic fatigue, reversed the DSPS and got me onto a steady normal sleep cycle for probably the first time ever and I also made it through last winter with absolutely no signs or symptoms of the seasonal affective disorder that I'd always suffered from in the past. On the other hand, my anxiety got much, much worse and I developed many OCD-type tendencies which in many cases would distract from what I was trying to do, thus making my ADD worse as well...instead of not having enough focus it felt like I now had too much and I didn't have the will power to target that focus on the things that mattered.

So that was the first year of Vyvanse/Wellbutrin for me. Huge improvements in some areas of my life and significant steps backward in others. This summer, after a year of the combo, I made the decision that the detractors (specifically the anxiety) were just too great and something had to be done so I stopped taking the Wellbutrin in hopes that would lessen or eliminate the cons of the combo while maintaining the pros. At that point I was on 60mg of Vyvanse and nothing else. At first I found there to be little difference without the WB in the mix -- there was a very small improvement in anxiety and maybe also a tiny improvement in the OCD/distraction as well but nothing drastic. After a month or so, at the end of summer/beginning of fall, I began noticing a drop in my energy in the evenings. At first it wasn't anything major, but after another month it became significant...enough so that I started arranging my schedule around it since I knew I wouldn't be able to get anything done after 8 or 9PM. Then around early November as the days started getting noticeably shorter and colder I began to notice the return of some of the symptoms of the disorders I'd struggled with in the past, prior to the WB/Vyvanse combo...losing energy, becoming more depressed, gaining weight, sleeping later and later and so on. Also, the "crash" at night went from being around 8 or 9PM to around 6 or 7PM. I became ineffective at pretty much everything after that point, so every day I felt like I was fighting against a ticking time bomb that would render me useless once it hit.

During all this, I still had not seen nearly the kind of improvement I had hoped for in terms of anxiety and OCD so a month ago I had the Vyvanse dosage lowered from 60mg to 50mg. I've been on that dose for a month now and the returning symptoms of my past disorders have gotten considerably worse and I can't see that my anxiety has improved at all. The "time bomb" now goes off at 4 or 5PM and I feel like I'm stuck in quick sand for the rest of the day, helpless to do anything; the distraction is just too great and my energy level drops to zero. Also, my depression has returned and it's much more noticeable at night. Even though Vyvanse isn't marketed as an antidepressant, I've noticed many occasions where I've woken up in the morning hopelessly depressed and then, like clockwork, about 1.5 hours after taking the Vyvanse the depression will mostly disappear. Even when there are major and specific factors causing the depression which don't disappear, and even if I still think about those things, all the intense negative emotions that come along with them are no longer so overwhelming and constant once the Vyvanse kicks in.

So I'm not sure what to do now. I'm currently experiencing the worst of both worlds to some extent; I still have much of the same anxiety/OCD that I believe these meds have brought about and now also have returning symptoms of the things these meds used to keep at bay. I experienced literally zero crash in the evenings at this time last year, and I'm not sure how much of that is due to the added presence of the Wellbutrin back then and how much is due to the tolerance that's been built from another 12 months of taking this medication every day. I could raise the dosage or go back on the Wellbutrin to see if that helped, but I'm concerned about making my anxiety/OCD even worse. Best case scenario, it would take me back to exactly where I was a year ago, with the crash gone and the symptoms of my old disorders gone but still with unmanageable anxiety. I could lower the dosage further or stop the medication entirely but I'm almost positive that would bring about the full return of all my old symptoms rather than just the partial return I'm experiencing now...the big reasons to lower or stop it at this point would be a potential decrease in anxiety and OCD as well as knowing what I'd be like without the influence of any medication, but the cost doesn't seem worth it. Sorry this post is so long, but if anyone out there could offer some advice about what I should do at this point or share some experiences of what has or hasn't worked for them I'd really appreciate it. Thanks.
Reply With Quote
The Following User Says Thank You to mnmat0 For This Useful Post:
Lizzie80 (09-28-14)
  #2  
Old 12-27-11, 07:13 PM
thoughtful1 thoughtful1 is offline
Jr Member
 

Join Date: Dec 2011
Location: TN
Posts: 16
Thanks: 3
Thanked 3 Times in 3 Posts
thoughtful1 is on a distinguished road
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

For me the Wellbutrin made me anxious and angry. That being said, makes sense your getting it in combo with the stimulant. Might want to discuss with your Doc about that med being
a switched to something like cymbalta?
Reply With Quote
  #3  
Old 12-28-11, 03:03 PM
Dr RI Tuesday Dr RI Tuesday is offline
Newbie
 

Join Date: Dec 2011
Location: The End of the World
Posts: 3
Thanks: 0
Thanked 0 Times in 0 Posts
Dr RI Tuesday is on a distinguished road
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

I too am made of most of the similar disorders you are with the exception of CFS. My concern is that you are taking vyvanse every day. Which is not safe as I discovered after two years of constant existence on the substance. If the vyvanse works, then keep taking it. Plain and simple. But learn how to manage it. Take it 4 days a week and take breaks over vacations and the summer if you can.
As far as your other meds, ask your doc.

Dr. Tuesday
Reply With Quote
Sponsored Links
  #4  
Old 12-30-11, 02:45 AM
gatorADDe's Avatar
gatorADDe gatorADDe is offline
Contributor
 

Join Date: Nov 2011
Location: USA
Posts: 410
Thanks: 241
Thanked 247 Times in 141 Posts
gatorADDe has a spectacular aura aboutgatorADDe has a spectacular aura about
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

here's what I recommend:

ask yourself...

what are the side effects of taking the medication?

AND

what are the side effects of "NOT" taking the medication?

Most ADHD sufferers find that the side effects of not taking a medication are far more detrimental than dealing with side effects of taking them.

As far as how often you should take them, that's up for you to determine. Try out various ways to see what works best.
Reply With Quote
The Following User Says Thank You to gatorADDe For This Useful Post:
Lizzie80 (09-28-14)
  #5  
Old 12-30-11, 04:30 AM
Keep0nkeepn0n Keep0nkeepn0n is offline
Member
 

Join Date: Jun 2007
Location: New England
Posts: 42
Thanks: 33
Thanked 18 Times in 11 Posts
Keep0nkeepn0n is on a distinguished road
Smile Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

Hi Op,
I too struggle with nearly identical symptoms that you do. Organically I have ocd, general anxiety, what is thought to be either CFS or Lyme Disease add-pi.

I will just tell you what has worked for me.

Dexedrine - Gets me out of bed, thinking clearly, focused, functional, with a touch of Social anxiety and increased levels of OCD rituals.
Klonopin - Mixing Klonopin with the dexedrine honestly is a marvelous combination all the clarity and motivation with the ocd nearly tuned out.
5-Htp - Take this about an hour after initially feeling the effects of the dexedrine. It's really smooths out the adrenaline rushy/compulsory feelings and behavior. It does so by in theory aiding in the production of Serotonin in the brain.

With all of this in me I can often feel great it's not fool proof but it essentially boosts all of main stream "neurotransmitters"

Dexedrine - Dopamine, Norepinephrine, Slight action on serotonin.

Klonopin - Makes the gaba in your brain work more effectively and seems to have some noortropic effects even though common sense would say not.


Anyway I know how you feel. Just started on the stimulants again myself after a year or two off of them and living in utter dysfunction.

I think your goal should be to get to that higher level of functioning which you are doing by pumping out dopamine/norepinephrine. Given both Wellbutrin and Vyvanse are pro DA/NE.

When one transmitter goes up the others around it fall as is seen in the relationship between Serotonin/Dopamine/Nor.

Essentially all my rambling is saying is talk with your doctor about getting all your neurotransmitters in check. Something that is key in those with comborbid/add/ocd/depression/lethargy/anxiety.

If you have any specific questions feel free to pm or ask in the thread. It's late.
Reply With Quote
The Following 2 Users Say Thank You to Keep0nkeepn0n For This Useful Post:
425runner (01-20-12), Lizzie80 (09-28-14)
  #6  
Old 01-19-12, 04:11 PM
mnmat0 mnmat0 is offline
Newbie
 

Join Date: Dec 2011
Location: Minnesota
Posts: 8
Thanks: 0
Thanked 2 Times in 2 Posts
mnmat0 is on a distinguished road
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

OP here; sorry to respond so late.
First off I should mention that I'm still on the lower dosage of 50mg and now, after 7 weeks at this dose, the major crash I was experiencing in the evenings seems to have improved. This may be due in part to the gradual adjustment to the lower dosage, but I've also started taking a B-50 supplement at 5:00PM every day and have been using a light box for about 90 minutes every evening around that same time, and between the two my energy and focus levels aren't as depleted as they have been at night.

Quote:
Originally Posted by thoughtful1 View Post
For me the Wellbutrin made me anxious and angry. That being said, makes sense your getting it in combo with the stimulant. Might want to discuss with your Doc about that med being
a switched to something like cymbalta?
I'm already off of the Wellbutrin, I stopped taking it last summer and have been on nothing but Vyvanse (and supplements) since then. I was hoping that by eliminating the Wellbutrin from the mix that my anxiety levels would go down and I'd experience a decrease in stress/OCD as well but it hasn't made a huge difference. I think the anxiety and OCD are both slightly more manageable now than they were when I was on the Vyvanse/Wellbutrin combo but not by much and I think the improvement may be mostly due to things like CBT and other methods of treatment not involving medication.

As for Cymbalta, I haven't tried that particular medication before but I've been on similar meds in the past with decidedly negative results. However, while I've never reacted well to anti-depressants (SSRIs and SNRIs) on their own, I've also never tried them while on Vyvanse so I'm wondering if maybe their effects would balance each other out if taken together...i.e. the Vyvanse would eliminate all the mental sluggishness, fatigue and apathy that the anti-depressant brings about and the anti-depressant would eliminate all the anxiety, OCD, over-thinking, stress etc that the Vyvanse brings about. Does anyone have any experience with this? Also, just putting Cymbalta or other SNRIs or SSRIs into the "Interaction Checker" on drugs.com along with Vyvanse brings up a "Major Interaction" saying they should not be taken together due to the potentially fatal risk of serotonin syndrome, but I'm not sure how much of a risk there really is of that.

Quote:
Originally Posted by Dr RI Tuesday View Post
I too am made of most of the similar disorders you are with the exception of CFS. My concern is that you are taking vyvanse every day. Which is not safe as I discovered after two years of constant existence on the substance. If the vyvanse works, then keep taking it. Plain and simple. But learn how to manage it. Take it 4 days a week and take breaks over vacations and the summer if you can.
I'd never heard that you're not supposed to take it every day; how is it not safe?
Reply With Quote
  #7  
Old 01-19-12, 04:16 PM
mnmat0 mnmat0 is offline
Newbie
 

Join Date: Dec 2011
Location: Minnesota
Posts: 8
Thanks: 0
Thanked 2 Times in 2 Posts
mnmat0 is on a distinguished road
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

Quote:
Originally Posted by Keep0nkeepn0n View Post
Hi Op,
I too struggle with nearly identical symptoms that you do. Organically I have ocd, general anxiety, what is thought to be either CFS or Lyme Disease add-pi.

I will just tell you what has worked for me.

Dexedrine - Gets me out of bed, thinking clearly, focused, functional, with a touch of Social anxiety and increased levels of OCD rituals.
Klonopin - Mixing Klonopin with the dexedrine honestly is a marvelous combination all the clarity and motivation with the ocd nearly tuned out.
5-Htp - Take this about an hour after initially feeling the effects of the dexedrine. It's really smooths out the adrenaline rushy/compulsory feelings and behavior. It does so by in theory aiding in the production of Serotonin in the brain.

With all of this in me I can often feel great it's not fool proof but it essentially boosts all of main stream "neurotransmitters"

Dexedrine - Dopamine, Norepinephrine, Slight action on serotonin.

Klonopin - Makes the gaba in your brain work more effectively and seems to have some noortropic effects even though common sense would say not.


Anyway I know how you feel. Just started on the stimulants again myself after a year or two off of them and living in utter dysfunction.

I think your goal should be to get to that higher level of functioning which you are doing by pumping out dopamine/norepinephrine. Given both Wellbutrin and Vyvanse are pro DA/NE.

When one transmitter goes up the others around it fall as is seen in the relationship between Serotonin/Dopamine/Nor.

Essentially all my rambling is saying is talk with your doctor about getting all your neurotransmitters in check. Something that is key in those with comborbid/add/ocd/depression/lethargy/anxiety.

If you have any specific questions feel free to pm or ask in the thread. It's late.
Thanks for your detailed response; I'm actually already prescribed both Dexedrine and Klonopin, both PRN. I only take the Dexedrine when I really need an extra boost (typically in the evenings) and only take the Klonopin when my anxiety becomes unmanageable or when I'm going into a situation that I know will be very anxiety-provoking. I try to take both meds as infrequently as possible and only save them for occasions when they're really needed since the Dexedrine on top of the Vyvanse tends to agitate my anxiety a great deal and I've heard a lot about how quickly tolerance develops to Klonopin and other benzos. I've never tried taking the Dexedrine *instead* of the Vyvanse though; would there be any advantage to one over the other?

As for the Klonopin, do you take it every day? I know that when I take it I get much closer to the "balance" that I'm seeking, where I'm not riddled with anxiety but also not braindead and comatose with no focus whatsoever. However, I've heard pretty much nothing but bad things about taking it on a daily basis due to how much of an issue tolerance and dependence are after taking it regularly over a period of time.

Whenever I get in to see a new doctor I'll definitely ask about 5-HTP; that seems like it could be a safer and more affordable alternative than trying to add in a prescription SSRI or SNRI med. What you said about neurotransmitters definitely makes sense as well. This article does a very good job of describing dopamine, serotonin, norepinephrine and GABA and the symptoms that having too much or too little of one or more of them (aka a 'chemical imbalance') can produce. Based on that article and everything else I've read, it would seem that my dopamine and norepinephrine levels are too high whereas my serotonin and GABA levels are too low. This is almost the exact opposite of how I was before the Wellbutrin and Vyvanse. Comparing my situation now versus my situation then, I'd say overall my current status is preferable to how I was beforehand but certainly neither one is ideal. My concern is that by trying to even things out I'll end up tipping the scales back in the other direction and will fall back into the same state I was in beforehand, and since it took me years to get out of that state the first time I hate to risk being stuck there again. Hope that made sense.
Reply With Quote
  #8  
Old 01-25-12, 05:26 PM
thoughtful1 thoughtful1 is offline
Jr Member
 

Join Date: Dec 2011
Location: TN
Posts: 16
Thanks: 3
Thanked 3 Times in 3 Posts
thoughtful1 is on a distinguished road
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

Keep in mind I am not a doctor, so my two cents are just my opinion and not to be taken as medical advice.

I notice when the stimulants are taken away I go back into a horrible circle of low energy, unfocused, unmotivated, depression, etc. For me, even when the vyvanse is not working as affective as I would like, I know that without it I would in the afformentioned state. Vyvanse is like my daily coffee. Problems is the effects have tapered off and so now I take an IR boost of adderall in the afternoon, and sometimes the AM too.

The last time I decided to come off my depression med I went into anxiety and rage very quickly. If I wasn't down and depressed, I was flipping out over everything that iI had put off and in an OCD mode that usually spiraled into anger and outbursts.

Wellbutrin is from what my doc says, more activating than other mess like cymbalta. Neurons transmitter whise, I cannot remember quick ones are in which, but I feel that if you look into it more your answer will be easy to find.

SSRIs are too much of a bring down for me. Doesn't make sense to take stimulants only to sedate with all that seritonin. At the same time, chances are more serotinin than you have naturally is needed, though less than SSRIs.

So, stimulant for energy and mild seritonin/other transmitter for mood stabilization.

If you get the mood stabilizer right you will prob be in a much better place. I would give that a chance before benzos.

Cymbalta type meds vs wellbutrin and you will see what for me was a happy medium.

Once again, this is not medical advice and I make no claims to be someone worth giving advice. Consult with your doctor. All statements are reflections of what has worked for me and my opinion.
Reply With Quote
The Following User Says Thank You to thoughtful1 For This Useful Post:
Lizzie80 (09-28-14)
  #9  
Old 02-21-12, 05:20 PM
mnmat0 mnmat0 is offline
Newbie
 

Join Date: Dec 2011
Location: Minnesota
Posts: 8
Thanks: 0
Thanked 2 Times in 2 Posts
mnmat0 is on a distinguished road
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

OP here again;
I finally managed to get in to see a new pdoc, although I've had rather mixed results so far. First of all, she didn't know what Vyvanse was...she'd never heard of it. So this is already a bad start. Then she went on to tell me how unbelievable it was that another doctor had diagnosed me with ADD ~4 years ago when I was still a teen, and how "almost all" ADD diagnoses were made prior to the age of 7, which made her skeptical of the diagnosis and "unsure" whether or not she wanted to continue the Vyvanse at all. Again, not a good way to start. Also, I tried to explain some of the things I was experiencing to her and she'd interrupt me and talk about something else, which is the last thing I expect of a doctor supposedly there to listen to me and help treat my issues.

So I'm not sure what to do about all that exactly, since I was on a very long waiting list to get in to see this doc and my insurance is very rarely accepted and would require another months-long waiting list if I wanted to find a new pdoc.

But even with all that aside, I want to address a few things here. To reiterate, my problem is that the Vyvanse *is* working very well for SOME aspects of my life but is either leaving other aspects completely untreated or may even potentially be making them worse. I'd like to find a way to continue to treat the things the Vyvanse is helping with while simultaneously treating the things that it's not helping with. In this case, those things are anxiety (#1 issue), OCD-type tendencies, general unease, tension, racing thoughts and similar things.

Quote:
Originally Posted by thoughtful1 View Post
SSRIs are too much of a bring down for me. Doesn't make sense to take stimulants only to sedate with all that seritonin. At the same time, chances are more serotinin than you have naturally is needed, though less than SSRIs.

So, stimulant for energy and mild seritonin/other transmitter for mood stabilization.
I fear that SSRIs would be too much of a bring down for me as well, especially considering my awful past with them (although I was not on stimulants at the same time back then). Of course, the only medication this new pdoc recommended was yet another SSRI. I do agree that I am in need of more serotonin, though...many of my symptoms seem to line up with a lack of serotonin (refer to the article I linked to in my last post). You mentioned a "mild serotonin/other transmitter for mood stabilization." Do you have any recommendations for what medication might best fit that description?

I asked the new pdoc about Cymbalta but she largely dismissed it, saying it was a "heavy-duty" drug and that maybe I could try it after 8 - 16 weeks of giving another SSRI a go. Are all SSRIs equal in the amount of serotonin they provide? Is there one that's "milder" than others? Or possibly more geared towards anxiety/OCD type symptoms?

Lastly, I'm thinking of splitting my 50mg dose in half and going down to 25mg a day of Vyvanse. What's the likelihood that a lower dose of Vyvanse will make the anxiety/OCD more manageable? Would it have all the same results (positive and negative) of the full dose, just at half the potency? I'm thinking this might be worth trying before adding another med into the mix in any case, but I figured I'd ask here first.

Thanks again for all the help!

Last edited by mnmat0; 02-21-12 at 05:30 PM..
Reply With Quote
  #10  
Old 02-22-12, 12:39 PM
thoughtful1 thoughtful1 is offline
Jr Member
 

Join Date: Dec 2011
Location: TN
Posts: 16
Thanks: 3
Thanked 3 Times in 3 Posts
thoughtful1 is on a distinguished road
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

I would say that the question to be asked is whether the problems would be there without any mess at all. For me, I tried to taper off my SSRI(my only med at the time) and the anxiety and aggression came back full force.

So backing off the vyvanse may lower your issues, but keep in mind it may still be something that is needing rectified with another med. My understanding is that SSRIs are just that one class of drug, whereas the others are a mix of SSRI and whatever else is in the formulation, so depending on the med and the strength there is a lower ratio of the combination.

From what your doc has stated I can only assume she is old school in her thoughts and treatments. Many docs think of one med or brand med as the cure all. Maybe bringing in some literature about vyvanse to educate her would be a good idea as well.

For the time being though, an SSRI would be an option if the problems are bad enough. Lexapro is said to have the least side affects, but for me after a couple years started to slowly stop working. Once you feel stable enough to make the jump, finding a doctor more in your line of thought might be a good idea.
Reply With Quote
  #11  
Old 09-28-14, 10:53 PM
Lizzie80's Avatar
Lizzie80 Lizzie80 is offline
ADDvanced Contributor
 

Join Date: Dec 2013
Location: Planet Earth...usually
Posts: 525
Thanks: 1,299
Thanked 790 Times in 363 Posts
Lizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant future
Post Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

Quote:
Originally Posted by mnmat0 View Post
OP here again;
I finally managed to get in to see a new pdoc, although I've had rather mixed results so far. First of all, she didn't know what Vyvanse was...she'd never heard of it. So this is already a bad start. Then she went on to tell me how unbelievable it was that another doctor had diagnosed me with ADD ~4 years ago when I was still a teen, and how "almost all" ADD diagnoses were made prior to the age of 7, which made her skeptical of the diagnosis and "unsure" whether or not she wanted to continue the Vyvanse at all. Again, not a good way to start. Also, I tried to explain some of the things I was experiencing to her and she'd interrupt me and talk about something else, which is the last thing I expect of a doctor supposedly there to listen to me and help treat my issues.

So I'm not sure what to do about all that exactly, since I was on a very long waiting list to get in to see this doc and my insurance is very rarely accepted and would require another months-long waiting list if I wanted to find a new pdoc.

But even with all that aside, I want to address a few things here. To reiterate, my problem is that the Vyvanse *is* working very well for SOME aspects of my life but is either leaving other aspects completely untreated or may even potentially be making them worse. I'd like to find a way to continue to treat the things the Vyvanse is helping with while simultaneously treating the things that it's not helping with. In this case, those things are anxiety (#1 issue), OCD-type tendencies, general unease, tension, racing thoughts and similar things.



I fear that SSRIs would be too much of a bring down for me as well, especially considering my awful past with them (although I was not on stimulants at the same time back then). Of course, the only medication this new pdoc recommended was yet another SSRI. I do agree that I am in need of more serotonin, though...many of my symptoms seem to line up with a lack of serotonin (refer to the article I linked to in my last post). You mentioned a "mild serotonin/other transmitter for mood stabilization." Do you have any recommendations for what medication might best fit that description?

I asked the new pdoc about Cymbalta but she largely dismissed it, saying it was a "heavy-duty" drug and that maybe I could try it after 8 - 16 weeks of giving another SSRI a go. Are all SSRIs equal in the amount of serotonin they provide? Is there one that's "milder" than others? Or possibly more geared towards anxiety/OCD type symptoms?

Lastly, I'm thinking of splitting my 50mg dose in half and going down to 25mg a day of Vyvanse. What's the likelihood that a lower dose of Vyvanse will make the anxiety/OCD more manageable? Would it have all the same results (positive and negative) of the full dose, just at half the potency? I'm thinking this might be worth trying before adding another med into the mix in any case, but I figured I'd ask here first.

Thanks again for all the help!
I know that this is an older post. But I wanted to speak up, as people like me still read older threads on occasion. I took Cymbalta and it was initially "sunshine in a bottle". There are many Internet posts about the med, how it feels that way at first...and then turns on the person taking it. That was my experience. I have had depression, anxiety, Literally since birth I've had Delayed Sleep Phase Syndrome. (If one chooses to believe in that as a "disturbance", rather than simply being wired differently than society as a whole believes is the right way to function. I'm on the fence about that to this day.) Cymbalta made me into a totally different human being. I thought about death constantly. I had thoughts of suicide, violent ends to my life, that were utterly unheard of prior to that med being in my system. I am a vain female- I can assure you that shooting myself is NOT a way out I'd take. On that drug, it seemed not only possible, but a perfectly logical decision. I thank God that I ceased that drug before I did any harm to myself, and also miraculously experienced none of the withdrawal Cymbalta is known to have. Not every human being who's been on this stuff was so fortunate. PLEASE DO NOT REGARD THIS DRUG LIGHTLY. Granted, I was not on Vyvanse or any other ADD med when this occurred, as I hadn't been diagnosed yet. I do not know what such an interaction would be like. But somehow I doubt that would have changed the effects of Cymbalta for the better. That stuff does have a black-box warning, but my doctor gave it to me like it was a bottle of aspirin, and I was too young and stupid to pay much mind to the box.

The newer drugs run by the FDA (approved around 1985 or later in the U.S.) generally have far shorter testing periods, there's offshore drug testing that is not as stringently regulated or monitored as it once was, and of course less long-term documentation one way or the other about their effects exists. The write-up below summarizes some points that would give most Americans pause about prescription drug approval by that agency upon reading. Particularly haunting to me is this: "Since the FDA doesn't routinely perform comprehensive reviews of drugs once they are on the market, when uncommon but deadly side effects tend to be picked up, independent researchers are often the only hope of catching such flaws. But the trade-secrets rule can leave researchers in the dark about the most worrisome dataŚnegative results that support a failed application to market a drug."

http://www.slate.com/articles/health...g_secrets.html

The following article from the FDA website documents some of the changes within the FDA since 1985. Believe me, from personal knowledge I KNOW that the guidelines have been altered far more than this article acknowledges. This article somewhat downplays the very rapid change in drug approval compared with pre-1985 times. I am not saying this is all good or all bad; these choices have had both positive and negative consequences.

"In 1985 regulations recognized what had already become a central tenet of modern drug evaluation by formalizing the requirement that approvals be based on an 'integrated summary of all available information about the safety of a drug product.' Congress itself mandated in 1988 that each AIDS drug IND must be publicly disclosed in a computer-accessible data base to facilitate access by patients with AIDS, and formally recognized the importance of FDA's Treatment IND program in support of AIDS patients. 72 Although some AIDS organizations requested agency support of 'open clinicals' in which a drug sponsor could allow any patient access to ongoing trials with the support of their physicians, FDA refused to allow such easy access. 'The more open-ended the design of a clinical trial,' noted agency officials, 'the less likely the chance the trial will provide answers.' Between 1990 and 1992 guidelines were proposed and negotiated, and regulations finally approved by FDA establishing a 'parallel track approval' process in which special categories of drugs would be expedited during the review process and a wider group of patients would have access to the drug than under normal procedures.

Beginning in the mid 1980s, FDA has focused on improving the analysis of data from clinical trials. One lesson learned from the AIDS epidemic and the concomitant development of clinical trials necessary to test drug products for its treatment is the scientific utility of surrogate endpoints in certain circumstances. Some of this data analysis has been motivated by sponsors' interest in presenting evidence of clinical effectiveness through measurements of biomarkers and evaluation of 'surrogate endpoints.' Surrogate endpoints measure outcomes that are not clinically valuable by themselves (lowered cholesterol, blood pressure, elevated t-cell counts) but are thought to correspond with improved clinical outcomes (decreased heart disease or stroke, fewer opportunistic infections for AIDS patients). FDA approved the first statin drug, for example, in 1987, based on the surrogate of lowering blood cholesterol. FDA is cautious, however, in accepting surrogates and usually requires continued post-market study to verify and describe continued clinical benefits. In 1992, new regulations for the accelerated approval of new drugs gave the agency explicit authority to rely on a surrogate marker."[-

http://www.fda.gov/AboutFDA/WhatWeDo.../ucm304485.htm

It is worth noting that the FDA has been chastised for a lack of oversight in offshore testing of drugs within recent years:

http://www.medpagetoday.com/PublicHe...alTrials/20854

Yes, I might sound like a worrywart or even a zealot. However, I'm not anti-prescription or anti-FDA; quite the opposite. But for anyone reading this, please be careful with SSRIs and other medications approved after 1985. Benzodiazepine drugs certainly have their issues (Klonopin, Diazepam [Valium], Xanax, etc.) but many of them have been around for decades and were/are studied more in-depth. The older stimulant medications share that set of similarities, at least. The long-term effects are documented better, helping us to make informed decisions more clearly about taking them.

The drugs Vyvanse, Cymbalta, Lyrica (a neuropathy and fibromyalgia med that's sometimes prescribed off-label for depression and/or anxiety), and most other newer drugs share no such long-term onshore testing and history. The amino acid added to Vyvanse in order to change its method of action (and theoretically, to lessen stimulant abuse potential) is said to be harmless, but no one is absolutely certain of that. SSRIs are widely-prescribed, but as most people have pointed out here, they are not to be regarded (or ingested) mildly.

I don't want to discourage anyone from taking medication that they need. I'm not trying to say Cymbalta will definitely do to others what it did to me, or even judge whether it is a good or bad medication for the general populace. What was awful for me might be another person's saving grace. In the spirit of harm reduction, though, I felt that I had to advise others to be extremely cautious with antidepressants in general. I post this simply in the hope that anyone reading it perhaps has more info for their own knowledge, and so that they can talk with their doctor about treatment with an understanding of modern drug approval firmly in mind.
__________________
"Don't be afraid of change, because it is leading you towards a new beginning."- Joyce Meyer
Reply With Quote
  #12  
Old 09-29-14, 04:31 AM
sarahsweets's Avatar
sarahsweets sarahsweets is online now
Mod-A-holic
 

Join Date: Mar 2011
Location: nj, usa
Posts: 26,693
Thanks: 5,650
Thanked 31,053 Times in 14,232 Posts
sarahsweets has a reputation beyond reputesarahsweets has a reputation beyond reputesarahsweets has a reputation beyond reputesarahsweets has a reputation beyond reputesarahsweets has a reputation beyond reputesarahsweets has a reputation beyond reputesarahsweets has a reputation beyond reputesarahsweets has a reputation beyond reputesarahsweets has a reputation beyond reputesarahsweets has a reputation beyond reputesarahsweets has a reputation beyond repute
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

Cymbalta is not super new. It was patent approved in 1991. In 2001 a new drug patent was applied for in 2001 but was not approved because of manufacturing violations and potential live toxicity and blood pressure issues. In essence the FDA wanted more clinical trials. After those trials the FDA determined that cymbalta did not cause those issues it was approved for depression and neuropathy in 2004. It was approved for urinary incontinence in 2005 and for GAD in 2007. It went generic about a year and a half ago. My point is that it does screw up some people but the length of time and testing is significant. It saved my life for sure.
__________________
President of the No F's given society.

I carried a watermelon?
Reply With Quote
  #13  
Old 09-29-14, 07:55 AM
Lizzie80's Avatar
Lizzie80 Lizzie80 is offline
ADDvanced Contributor
 

Join Date: Dec 2013
Location: Planet Earth...usually
Posts: 525
Thanks: 1,299
Thanked 790 Times in 363 Posts
Lizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant futureLizzie80 has a brilliant future
Re: After 1.5 years of Vyvanse I'm unsure how or whether to continue, any help or adv

Quote:
Originally Posted by sarahsweets View Post
Cymbalta is not super new. It was patent approved in 1991. In 2001 a new drug patent was applied for in 2001 but was not approved because of manufacturing violations and potential live toxicity and blood pressure issues. In essence the FDA wanted more clinical trials. After those trials the FDA determined that cymbalta did not cause those issues it was approved for depression and neuropathy in 2004. It was approved for urinary incontinence in 2005 and for GAD in 2007. It went generic about a year and a half ago. My point is that it does screw up some people but the length of time and testing is significant. It saved my life for sure.
I'm honestly glad that it helped you, SarahSweets. My warning was put out there just to help anyone who might be taking it like I did, without anyone really spelling out that "black box" thing (as my doctor really should have done). I was in my late twenties or so when I took it, not in the greatest place in my life, and really wasn't in the mood to analyze what I took- which was a foolish attitude on my part, pure and simple. The brain is so mysterious, one man's poison is another's restoration to life. The same could be said about many medications, I suppose. I do know that a lot of testing is sadly quite (how do I put it without getting in trouble)..."reviewed" in a manner where the original results are not even what FDA scientists or others in similar capacities end up seeing. Which we don't find out until long after the fact, and often after irreversible damage has been done. And the financial ties between govt. and pharma are complex and full of grey area, to say the very least.

That said, I know next-to-nothing about the extent of Cymbalta's drug testing history. I did learn (after my experience, unfortunately) that Cymbalta was most definitely pushed on the FDA and marketed to fibromyalgia patients without enough substantial evidence to back it up as a wonder drug for that condition. And the severe side effects for certain patients was downplayed or outright omitted. I believe (although I'd have to double-check) that the FDA either didn't get the full report or really didn't observe it as they should have before Cymbalta was marketed aggressively in that way. The drug marketing alone is vastly different, even from when I was a kid back in the 80's. And when one has fibromyalgia, honestly you're in such misery you'll take anything to ease the pain and fatigue. You're in an incredibly vulnerable place at those times, and marketers know that. I think Cymbalta was pushed for that diagnosis in a marketing standpoint before Lyrica, the other FDA-approved drug (at the time) for fibro. And I think that both got into trouble for that same issue. My point is basically, "Look before you leap", especially to any young people reading the forum who might not know this history.

My warning comes from anecdotal experience, because what it did to me was SO out in left field from ANYTHING I'd ever felt before or since. There have been enough similar reports to worry me about others who take this and SSRIs or similar drugs, that I simply felt a moral and ethical obligation to speak up. Again, I'm not discounting anyone's experience that has been positive about the medication, and I make no accusations about this particular drug's testing, because I don't know much about it. All I care about, really, is that people are as informed as possible beforehand, when they put something in their body. And I don't mean to imply that drugs approved pre-1985 were all sunshine and roses, either. It's just that the drug guidelines changes with the AIDS crisis were so massive, the changes to the FDA structure so far-reaching, and the accepted times were eventually shortened for ALL drugs, not just AIDS-related ones. I think it was originally seven years, which is far longer than current standards, last time I looked at the stats. The offshore drug testing is also off-putting on a number of levels, and the FDA has been approving drugs with certain side effects that simply wouldn't have been acceptable a couple of generations ago. As my mom says, "'It may cause cancer of the...' is not an acceptable f-ing 'side effect'! WTF?!" I have to agree with that statement, at least!

I had awful night terrors on Cymbalta, too. My mom called them, "the Linda Blair episodes"- I woke her up constantly with my swearing and yelling out in my sleep. I'd sound like the demonic version of Linda Blair's character of The Exorcist in the middle of every night, calling out to and cussing out imaginary people out to harm me! Very violent dreams of being fought and even murdered by others. This is TOTALLY out-of-character for me, as I normally sleep like the dead, and I think others had the same problem on some of the newer antidepressants- those that aren't the older tricyclic ones. (But those could have side effects, too. I've not studied them at length.) Cymbalta's not the only one with the possible night terror thing. Chantix, a smoking cessation drug, has the same side effect. But I know that dosing, neurotransmitters, other meds, lifestyle, age, DNA, etc.- all come into play. Not everyone will have the problems I did with it.

I hope this didn't sound argumentative- not my intention at all, because I agree with you that different drugs affect different people in various ways. I appreciate how much factual information you personally have brought to the forums here, including adding to my post. Trying to do the same- presenting any stats or other relevant info for good decision making- is my way of giving back to this community which has helped me so much, with so many questions and concerns I've had since I joined. I honestly care about people, and sincerely hope that nothing I'd say would discourage anyone from seeking help and taking a medication that they need to get well.
__________________
"Don't be afraid of change, because it is leading you towards a new beginning."- Joyce Meyer
Reply With Quote
The Following User Says Thank You to Lizzie80 For This Useful Post:
sarahsweets (09-29-14)
Reply

Bookmarks


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is On
Forum Jump

Similar Threads
Thread Thread Starter Forum Replies Last Post
First Week on Vyvanse - Advice Needed (Bad crash?) ninj4junpei Vyvanse 2 02-20-11 12:34 AM
Just started Vyvanse - Advice Needed goodforu Vyvanse 3 03-19-10 01:44 PM
Switching Vyvanse to Dexedrine Spansule - But which Brand? ADVICE PLEASE tarabeatty Vyvanse 1 09-10-09 02:14 PM
Advice on asking Dr for 2x40mg a day Vyvanse? ironcurtain Vyvanse 1 07-22-09 12:03 AM
New to Vyvanse..would like some advice :) ironcurtain Vyvanse 1 06-21-09 07:55 PM


All times are GMT -4. The time now is 09:59 AM.


Powered by vBulletin® Version 3.7.4
Copyright ©2000 - 2018, Jelsoft Enterprises Ltd.
(c) 2003 - 2015 ADD Forums