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Old 08-06-11, 12:16 PM
Castiel Castiel is offline
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Arrow Please Help! Vyvanse, Doses, Docs, & Lamotraginie?

Hello out there, everyone!
I took some time to read over all the Vyvanse thread and thus far this seems like the best group of people to ask, as you guys don't mess around on fact-hunting and seem to have a reliable wealth of knowledge and experience. I'm just not sure who else to turn to and have little to no support amongst friends as I am a pretty private person when it comes to these sorts of issues.

A Bit O' History about Me and my Diagnosis
Well to start off I'm a 25 year old, 125lb female. I was diagnosed with ADD at a fairly young age and took Ritalin until the beginning of 6th grade before I was switched to Adderall in 8th. I only know this due to memories of going to the nurse and hearing the names on occasion. As a child my parents never actually took the time to explain my condition to me, what I was taking, or involving me in any of my dosing information so I have no idea about all that.

In my first year of high school I relocated to a new state and no longer had my normal doctor. Long story short, I ended up dropping my medication and never getting back onto it.

Like a lot of skeptics I bought into the lie of "ADD being over-diagnosed! Not real! Etc."; and would even proudly brag about how I'd "completely gotten over it in high school". Of course that was very easy to say when you're an outgoing 18-20 year old and are on top of the world emotionally with energy coming out of your ears. I also had the benefit of having a plethora of things to do constantly so I never got too bored.

However, when I turned 23 things started to take a severe downturn for me. It took me all the way until March of this past year to finally put my foot down, admitted to myself I wasn't over ADD, and go see my a psychiatrist. I was severely ADD and depressed at this point that I was no longer even functioning properly or attempting to take care of myself due to how behind I'd gotten in every aspect of my life.

Beginning Treatment in March of 2011

In March of this year (2011) I met my doctor via a great few recommendations online through another friend. He tested me and overwhelmingly agreed that I had ADD and seemed to have a "Well of course you're depressed; life sucks right now." attitude about my depression, as I really can't see how I'm manic in the way most permanent mood-disorders describe... I just would more have a problem pulling myself back up once I got to that point during times of emotional strife or harship.

So I have ADD. Hurray. Now as I mentioned, besides typical lack of focus, organization, not being able to find anything and losing my belonging constantly...I was also experiencing severe depression/anxiety and was having these little rage-spots where I just could not calm down.

At my first visit in early March 2011 I was started on:
30 mg Vyvanse (1x per day; Mornings)
100 mg Lamotrigine (1x per day; Mornings)
I have no diagnosed mental disorders other than ADD and -very mild- depression that only came up in these past years. Not certain it's clinical but more conditional; but I could be wrong. When I came to the office; the most I had been on -ever- was Zoloft and only for about 8 months before I came to the psychiatrist. I told him that I wasn't a depressed person and in general think pretty highly of myself and my life; I just wanted a way of getting a bit of a push to be in a better mood without being a zombie or feeling "warped" or "not myself". I don't like being less cognitive and the inability to be -too- happy about anything really messed with me.

Everything went great during March and April. As far as Vyvanse went; it was a bloody miracle drug, as many would say. After the first month trial I felt -great- and he bumped me up to 60mg of Vyvanse that I strongly agreed with as I felt that it was perfect; just weak and wore off ridiculously fast at such a low dose. I am fairly small and assume that is due to my metabolism. After that I was the productive zen mater. I reorganized my company, reconnected with friends, got my life on track. The lamortrigine seemed to work alright save for making me have some stomach problems; but in general my mood did seem elevated. Then again I was kicking *** and taking names and everything was wonderful; so I'm not sure if that was really the lamortrigine or not.

May and June? All phenomenal. Perfect; in fact.
In late June 2011, he bumps me up to:

200mg Lamortrigine and keeps my Vyvanse at 60mg.

In July 2011, things take a downward turn.
At the beginning of July, it suddenly began to lose it's effectiveness. I took a week break from it and tried to simply allow myself a break from it or "Vyvnanse Holiday" as I had read on the forums; and after a full week returned to the medication. When I started back on the medication of course the first time taking it again actually worked a bit better, but it was right back to tricks as usual the next day. I am back to feeling scatter-brained, lazy, and unmotivated after only 5 hours or so or less. Even the initial taking of my meds and "peak of the effects" don't feel the same. Which is quite odd as I've felt perfect for nearly 6 months.

I'm finding myself getting pretty uneasy and a bit ****ed off; and the depression is starting to creep back. I had not even had that bad of side effects save for being a bit ****ed off and cranky from time to time; and some weird ear popping/pressure drop symptoms in my head for a bit. I think for one thing, the Lamoriginine never was doing anything to begin with; or what.
I am now going to see him again in 4 days.
I really need some advice on how to approach this and have a few questions for you guys.

First , please don't try to give me some lecture about "seeking highs", "abuse". I am pretty damned self-aware and know full-well what that behavior is. I am already militantly angry enough at these stupid things that make it even harder for people who actually need this medication to function.

Let me say right off the bat that when I talk about a lack of effectiveness; I'm not trying to get high. I'm trying to function. I have never even done any hard drug in my life save for marijuana and salvia once (Hooo boy, never again.) I am no fan of feeling reduced intellectually or feeling tweaked the hell out. How I was before treatment and how I am beginning to feel once again is -no way for any person to live-; and I don't want to go back to that life at all.

1. Lamortrigine for mild to severe depression?
Has anyone else heard of this? Is it safe to take with Vyvanse?

Are there better alternatives that you've experienced that don't "zombie" you or make you feel uncomfortable?

It seemed to me that just trying a new anti-depressant and maybe something for my episodes would've done the trick; but after reading up on Lamortrigine I am nervous.

Please let me know if any of you would happen to know anything
.
2. Vyvanse dosing? Legal restrictions? What if 70mg isn't enough?
I am going to be asking my doctor next week if I can possibly kick my dosage up to the FDA maximum of 70; but I have a question.

With my doctor; I am only allowed to get "30 pills 1 time a month." Are there other alternatives to this? Are they actually allowed to write a prescription for more than 30 pills of Vyvanse at a time? Is my doctor just playing it safe?
What laws are true regarding prescription or are these restrictions just created by this office?

Also; I constantly -constantly- see people on these boards talking about doses of Vyvanse over 70mg. I mean like 140mg and above.

For me that would mean taking double-pills of varying doses or 2 of a smaller dose. By current office policy that would mean I'd be going to the damned office 2 times a month as I assume there's no way that they just write 60x quantities of any dose of Vyvanse to someone a month without the FDA having a *****-fit. Is there just some magic number; or is my doctor actually just being overly cautious?

Can someone help me out here? Any experiences or data would be beyond helpful.

2. Boosters. What the hell?
I had never actually heard of this until I started to really sit down and read all of the postings in this Vyvanse boards. Again; I am really tackling this whole thing by myself and have no guidance or anyone to turn to on the matter.

What are the types of medications that you can have as a "booster"? How long does one usually stay on these "booster" doses? Can anyone recommend something based on personal experiences?
3. How do I go about approaching my doctor about higher doses and feeling a need to begin a booster? If I want to try a different medication down the road, like Adderall or Dexedrine; how would I approach that?
Is there a specific way that I should approach my doctor about these higher doses? I will take any advice I can get. I am very nervous about interjecting my opinion too heavily since I don't want to come off like a damned drug addict by saying

"Hey. I don't see how 10 mg more is going to be enough but I'll try it that way for now. ". I'm more than willing to try 70mg; but I'm realizing that there are going to be some problems in the long run if I feel I need more.

"Doc, screw the FDA. Sack up and give me my meds" or "Hey; I seriously need a booster because this **** isn't working. ". Doesn't seem like it's going to come out right.


Is there certain keywords I should avoid? In general I'm pretty open with my doctor; but I feel like there is a superb amount of bureaucracy going on in the office. I specifically liked him for not using insurance for the office visit due to "the companies being crooks" and felt his level of experience in the field really made him stand out but I am just not sure.

Is the FDA holding my doctor at gunpoint? Does he face real danger with dosing over the FDA recommendation of 70mg? Is there any way to approach this if he begins to give me trouble about it?


I never really realized just how hard it is for someone proactively trying o treat their ADD and heal their lives of the damage the illness ends up doing to your life. I also never have experienced actually -needing- something that the rest of America seems to treat like heroine. It's made me endlessly angry that people have chose to abuse this to the point that they have put enormous pressure on the ADD community.

I wish that there were some actual reform to help people get what the hell they need without having to waste effort on this dizzying cycle. I just feel like I'm tip-toeing around all of this due to how scared I am about getting off track again and being miserable.

Really, any advice or tips you guys have for me would just be phenomenal and beyond appreciated. I am fairly ignorant to the treatment and handling of ADD thanks to my parents inability to clue me in on my own health and they seem to not be too bright in general about these things so it isn't as if I'd fully trust them anyway. There's a lot of this misinformation / clever wording to create pressure by the FDA, not sure if these are office-specific rules or actual law and have no idea what the qualities of a good psychiatrist are.

I've done a ton of research, mind you, but I feel -the only way- to find these things out -for sure- are through years of experience; to why I defer to you guys.

I separated the questions into numbers. I realize this was very long so if you just want to respond to one point please feel free. I'll take any advice I can get.

Thank you guys for taking the time to read this! Stay strong!
P.S. Watson Pharmasuticals vs Shire! Very soon we may be getting a GENERIC VYVANSE! They are contesting the right to create a Vyvanse generic and with any luck we'll actually be seeing more options as far as vyvanse-based stuff. Still not sure if the dosing is going to work out for me but I know how expensive it is and thought it may provide a little hope of financial relief to those of you that depend on it. <3.
(Also just in case you don't know; you can also sign up for the Vyvanse discount card. My Doctor gave me mine.)
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Old 08-06-11, 03:46 PM
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Re: Please Help! Vyvanse, Doses, Docs, & Lamotraginie?

I think I can relate to alot of what u said. While I am not on Lamo and can only assume it is some sort of anti depressant I would guess that is part of the reason the Vyvanse is less effective. I take a large dose of trileptal as a mood stabilizer, Cymbalta for depression, a large dose of Metotoplol and calcium channel blocker for high blood pressure, so I take 2 20 mg adderall xr a day. I have no doubt my med combo makes the ADD med less effective for me.

I was diagnosed ADD 3 years ago and tried every stim out there and would quit taking them because I did not believe the diagnosis. I received the diagnosis after I trip to the hospital for psychosis, I was believing untrue things that may have been cause by steroid use to traet gout.

Long story short since I would not take the ADD meds my dr could not rule out ADD but thought it could be Bi polar because many of the symptoms overlap by the way I took the "test" and it indicated bi polar or ADD. So after many many meds I found trileptal and cymbalta worked well with Xanax as needed.

I felt my moods were more stable but never had motivation, could not follow through on obligations was always late and had no patients and could not concentrate to read more that a few sentences so I never felt normal. It was only after my high blood pressure was treated did I ask to go back to a stim to try to get some energy and motivation because all I could do is drink coffee and sit around. I was always tired.

Anyways I took my Adderall and was incredibly surprised to see motivation, energy, patients, mental focus, impaulse control and ability to start long tasks and complete them.

Sorry to get so far off your questions but I am new to this to and feel that I don't know how to communicate dose adjustments with my dr because I do not want to seem like a drug seeker. Unlike yourself I did smoke weed when I was younger and did tell It to my dr and now that I have been online investigating ADD I see these Stims are abused by people. So I really feel better medicated And don't ever use weed or anything else and don't even think about it. I just want to be normal.

Every time I see my dr I just be honest and say what I am feeling but I am always tense and uncomfortable when discussing my add meds. So many people judge even when they are taking the same med as you and I. I find that very hypocritical.

Again sorry to not really answer anything and thread jack, but I felt I could relate to you and wanted to share.
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Old 08-06-11, 11:27 PM
sciencer sciencer is offline
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Re: Please Help! Vyvanse, Doses, Docs, & Lamotraginie?

Lamotraginie

This drug doesn't seem to be an antidepressant however off label use it was found effective for depression related disorders. To me it's more of a epilepsy drug/bipolar. Since I'm assuming you have non-of these disorders, I think your doctor believes You have a disorder for example: symptoms indicates depression, but not truly depression. it's kind of like This drug lithium. So in my opinion he is trying to stabilize your mood.
it's really hard to tell if these Type of drugs do anything after being years/months on it.

Vyvanse is pretty effective in treating ADHD. However you seem to be already taking a high dose. 60 MG is pretty much 20 MG of Adderall. Vyvanse as a last rebound effect and longer lasting than any ADHD drug. .

I know the FDA has a lot of restrictions but They do this for the safety of individuals. These drugs over time can create more ADHD symptoms in my opinion,just like a Drug addict. your building tolerance at an alarming rate I would suggest Memantine because it seems to help people with stimulants tolerance.

strattera I think you should give it a shot. maybe he can remove Lamotraginie supplement this instead.

I think you're going on a dangerous road with adderall and will only make treating your disorder harder because you're building tolerance. Ritalin usually takes a pounding for ADHD drugs however adderall is neurotoxic while Ritalin is not and adderall is the drug that most people abuse.

90% of ADHDers respond to stimulants, however you are not respondingWhich would indicate to a psychiatrist you may not have ADHD but a disordered at causes ADHD like symptoms. This was in my case. If you're not responding to 60 mg weight being 125lb it's unlikely you will respond to 70mg. OR it could be your brain has already adjusted to the high feeling which is normal. Adhd drugs are not mood enhances rather than it give a person the capacity to carry out what needs to be done.

The difference between adderall/dex is that Vyvanse is pure dex while adderall is a mix of both. Adderall gives more of a high but will fade very quickly and has more rebound effects.

Living situation:

I mean if you living at home and doing nothing all day its unlikely you will see a difference. if you going to college and ADHD affects your ability to read and study or your ability to keep focus in class and the meds are not helping then adhd drugs are quite useless in my opinion, only in rare cases in people who still experience hyperactivity/constant restlessness.

what i LEARN ABOUT ADD DRUGS.
These drugs don't make you do anything they give you the capacity to what other people can normally do. so if your a lazy person, you will do lazy things. if your unmotivated person you will remain. so for these people who truly got adhd, if they try doing something they are suppose to do the attention the attention stays constant rather than all over the place.

Vyvanse AND STATTERIA ARE PRETTY MUCH MY LAST HOPE...and if it doesn't help me I will have to live my life constantly dealing with my attention problem and learning/process problems.

GOOD LUCK



Medicatedme
Newbie


you might be right with the Lamotraginie, it did cross my mind however I though maybe it was unlikely I would think docs would know better.

Medicatedme
Newbie "I am always tense and uncomfortable when discussing my add meds. So many people judge even when they are taking the same med as you and I. I find that very hypocritical. "


Response: That is so strange lol
but true
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Old 08-07-11, 03:44 AM
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Re: Please Help! Vyvanse, Doses, Docs, & Lamotraginie?

I know nothing about the other medication. It sounds like Vyvanse isn't working well for you. Even if it is, if it's only giving you 5 hours of relief from your symptoms, a booster seems like a strange route to take. It seems like it would make more sense to simply take 2-3 doses of a short-acting med.
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Old 08-08-11, 02:30 PM
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Re: Please Help! Vyvanse, Doses, Docs, & Lamotraginie?

Hi Castiel,

This is a bit long, so bear with me

I am on both Vyvanse (70 mgs) and lamotrigine (75 mgs), tritating up to 100 mgs, then we'll see where we are. So yes, they're safe to take together.

Lamotrigine was originally approved as an anticonvulsant, then as a mood stabilizer. It's used off-label for "treatment-resistant" depression. It's unusual to see it used as a first-line anti-depressant. Your doc may have prescribed it thinking you have bipolar/mood spectrum symptoms, in which case he damn well should have told you so, or he may be part of a small minority of docs who think it's more effective and safer than SSRI's and go to it first (see the site psycheducation.org for more info on this).

I actually get great results with Vyvanse, and have for over two years. I take it in the morning, it works all day. The only time it wasn't working for me was when I was on Lexapro, which turned me into a bit of a vegetable.

One possible issue you may be having issue jumps out at me: Lamitrogine can vary dramatically depending on the manufacturer. Pharmacies sometimes switch generics if they get a better deal or whatever. My pdoc says that the Teva pills are the only ones with the same bioavailability as the brand name (Lamictal), and that if the generics got switched up, I should tell him right away. If your pharmacy switched generics on you, or if you went to a different pharmacy, it might account for some of your problems.

The first time I filled my lamotrigine (at my local Walgreens) I was given Teva pills. The second time I went to Costco, who carries lamotrigine made by Northstar. This weekend I went from 50 to 75 mgs, and noticed that I felt a bit calmer than I had been feeling, and that my mood was lower. At first I thought it was the "mood stabilizing" effects of the med. Then I realized, duh, different manufacturer -- at 75 mgs of Northstar lamotrigine, I could well be getting less of the medication than at 50 mgs of Teva.

So I would check that out first, as it could explain a lot.

As for taking more than 70 mgs of Vyvanse, I'm not sure how people accomplish this. I know that my insurance has a quantity limit, and wouldn't pay for more than 30 pills a month. Other people might have different insurance rules.

Plenty of people take Adderall "boosters" without ill effects. I did this for awhile this Spring, and it was pretty painless. I told my pdoc that the Vyvanse seemed to be wearing off a few hours after taking it (thank you, Lexapro!), and he was the one who brought up Adderall boosters (I was going to suggest it if he didn't). He expressed concern over me taking too many stimulants, but when I explained that I can feel when I'm overmedicated, and that I find this unpleasant, he felt better. That being said, we've worked together for two years and have built up a pretty trusting relationship.

A few more things about Vyvanse: it's most effective when taken with food, especially a high-protein breakfast (I take my meds, then have 20 grams of protein in the form of yogurt). It might be less effective if you drink lots of caffeine or eat a lot of sugar (this is true for me, not true for other people). It will be less effective if you don't get enough sleep, of don't get enough exercise (adequate sleep and exercise make everything better).

As for what the qualities of a good psychiatrist are: A good pdoc will explain what your diagnoses are, and her/his reason for making them. If you ask questions or have concerns over the accuracies of the dx, a good pdoc will take your concerns seriously, and will discuss the issue thoroughly with you. A good pdoc will explain any prescriptions s/he gives you, along with any potential side effects, and why s/he thinks, for instance, that lamotrigine is a better bet for you than Zoloft. If you experience adverse side effects, a good pdoc will work on minimizing them. Furthermore, if you feel that your dosage is too low or high, a good pdoc will take your concerns seriously, and work with you finding the right dosage -- or will have a damn good reason for keeping you on the dosage you're on, and will tell you this reason. In my opinion, a good pdoc sees her or himself as an advisor or collaborator in making sure you get the beest care you need, not someone who dictates to you,

Did your pdoc warn you about the "lamictal rash"? Did he titrate you up by 25 mgs over the course of several weeks? If not, I'd be concerned -- lamotrigine is a great drug, it helps a lot of people, and it has a low side effect profile. For most people, that is. Some people can have an allergic reaction to the med that results in a potentially fatal skin reaction. The risk of this can be minimized by titrating up very slowly.

You're doing the right thing by asking questions here and beginning to educate yourself. It's been demonstrated repeatedly that patients who inform themselves ans ask their doctors a lot of questions get better care than patients who are passive.

Best of luck with your situation -- let me know if I can offer any more anecdotal advice
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Current Meds: Vyvanse 70 mgs; Lamictal 150 mgs; Ativan 0.5 -1.0 mgs

Past Meds: Adderall, Lexapro, Abilify, Dexedrine Spansules, Dexedrine IR, Ritalin, Nortriptyline, Amitriptyline, Wellbutrin


The Lamictal Diaries: Medicating My Mood Disorder

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Old 10-10-11, 10:10 AM
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Re: Please Help! Vyvanse, Doses, Docs, & Lamotraginie?

With regards to the boosters, I have adderall 10mg IR. I only need them sparingly. For example, if I work until 7:30-8pm. But I honestly only break them down to 5mg. The adderall is like a jolt. And I don't like that. But it's effective in the short term and out of my system (if taken at 4pm) by 10pm when I get home. But I prefer the vyvanse. The way that my body metabolizes it the delivery system is much smoother. I'm also a fairly rapid metabolizer of everything (food, alcohol, medications...I'm a walking furnace lol) so the vyvanse only works until around 4:30-5pm, which is just fine. Most days I'm home by 6:30 and ready to unwind with a book, or cooking a new recipe, and having a good beer (really good bear! Why waste your palate on Bud light? Lol). I hope things have been going well since you started!
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Old 10-10-11, 10:53 AM
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Re: Please Help! Vyvanse, Doses, Docs, & Lamotraginie?

The lamotrigine is generally used as a mood stabilizer in conjunction with an antidepressant so if your not bipolar I'm not sure what your doc is getting at. I know very little about Vyvanse but plenty of people are on doses higher than you. Tolerance is a fact of life but it doesn't make you an addict. I would be straight with the doc and if it wears off to quickly then ask about a booster.
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Old 10-10-11, 02:14 PM
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Re: Please Help! Vyvanse, Doses, Docs, & Lamotraginie?

Quote:
Originally Posted by sarahsweets View Post
The lamotrigine is generally used as a mood stabilizer in conjunction with an antidepressant so if your not bipolar I'm not sure what your doc is getting at.
At the moment, there seems to be some debate about whether major depressive disorder is "really" a form of bipolar disorder. The grounds for this is that MDD is an illness that "cycles", as bipolar does, just without mania or hypomania. It's also the case that many people with MDD get worse on some meds, or become hypomanic on some meds, or experience "Prozac poop-out", where their SSRI's simply stop working. Lamotrigine seems to work in these cases.

I was prescribed lamotrigine after trying several antidepressants (including tricyclics as well as SSRI's). They either didn't work or made my depression worse. My pdoc put me on lamotrigine because, as he put it, "we need a different antidepressant", and we were out of options.

My pdoc thinks it's a better antidepressant than a true "mood stabilizer" (I guess in his experience it doesn't treat hypomania or mania all that well). Other clinicians and researchers think it's actually a safer choice than SSRI's for most patients who present as depressed, because it's less likely to make symptoms worse. Psycheducation.org is great resource for more information.

Apparently it works by inhibiting glutamate, an excitatory chemical that causes cell death. Cell death = low mood. If you can stop cell death, says my pdoc, you improve mood. However, since you can't open up the brain and take a look inside it (well, I suppose you CAN, but that might make things worse than they already are), nobody knows for sure.

Isn't it fun to have brain problems?
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Current Meds: Vyvanse 70 mgs; Lamictal 150 mgs; Ativan 0.5 -1.0 mgs

Past Meds: Adderall, Lexapro, Abilify, Dexedrine Spansules, Dexedrine IR, Ritalin, Nortriptyline, Amitriptyline, Wellbutrin


The Lamictal Diaries: Medicating My Mood Disorder
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