Any Comorbid ADD/Aspies take Vyvanse?

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Kyle_Kalideos
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20 Jun 2009, 1:21 pm

I'm trying to understand what I should expect vyvanse to do but I'm a little confused. I started on 40mg but that made me way to cheerful and social for my tastes. I also seem to be more impulsive about saying stupid things like "thats what she said" and repeating out loud what I read. I also about kick my teacher in the groan, I cross my legs, when he walked past me, I tend to fake kicks to the groans of my friends. Then we went to 30mg which worked pretty good... sort of. I tried to kill myself while on 30s and prozac so maybe not. When I got out of Two Rivers I was put on 20mg which seems to do nothing... so now I using the rest of my 30mgs which seem to make me irritable and impulsive. Im also on Lexapro by the way.

Anyone know what I should do or say to my psychiatrist?



nightbender
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20 Jun 2009, 3:30 pm

get me the hell of of it slowly



Kyle_Kalideos
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20 Jun 2009, 3:54 pm

Could you give me a reason why? I know now that I'm agitated and irritable again today i mean I blocked my door so no one can disturb me... very disturbing.



nightbender
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20 Jun 2009, 5:48 pm

the stuff causes developemental delay heart and liver problems brain shrinkage agitation anxiety depession mania psychosis cognitive dulling.
it a drug that that was responsible for 5 hospitalizations



Michjo
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20 Jun 2009, 5:58 pm

nightbender wrote:
the stuff causes developemental delay heart and liver problems brain shrinkage agitation anxiety depession mania psychosis cognitive dulling.
it a drug that that was responsible for 5 hospitalizations

Scare-mongering, some people need to take drugs to function. Warning people from drugs they need to function is ill-thought and shallow.



Michjo
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20 Jun 2009, 6:07 pm

As for the original question, vyvanse out of all the ADHD drugs has the least amount of side-effects. Dry-Mouth, Insomnia and Decreased Appetite are it's main ones.

I think the effects you are feeling now are because of the cocktail of drugs you are being given. Vyvanse causes a release of dopamine, serotonin and norepinephrine.

Lexapro and prozac cause more serotonin to be avaiable to serotonin receptors.

I find it hard to believe a psychiatrist would actually prescribe you all three drugs or even just two of these together, considering their effects stack (even vyvanse and lexapro together, doesn't appear to be a smart combination).

You should only be taking one of these drugs at a time, and if you have ADHD, i would suggest you talk to your psychiatrist about being placed solely on vyvanse. If vyvanse isn't strong enough he can give you desoxyn, which has the same effect but is stronger.



Kyle_Kalideos
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20 Jun 2009, 8:22 pm

They blamed prozac for my attempted of suicide so they switched me to lexapro. Ill take the sole med idea in consideration. To me the less med I have to take the better. Also I feel like I function enough without vyvanse which seems to bad for me. So Ill just have to be patient with my doctor.

Thank you both :D



Michjo
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20 Jun 2009, 8:36 pm

If you function well enough without the vyvanse and you feel fine on lexapro on it's own, then that's what you should be on. Anyway, i hope it works out for you.



IanB
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21 Jun 2009, 1:24 am

Here's my input on your situation.. Amphetamines, like Vyvanse, and SSRIs, like Lexapro, are both metabolized in the liver. The main enzyme responsible for their metabolism is CYP2D6. In addition to both being metabolized by CYP2D6, SSRIs, like Lexapro, can actually inhibit CYP2D6. This means that if you are taking them both, they may not be getting metabolized as quickly/efficiently which could lead to more than normal amounts in your bloodstream [which leads to more than normal amounts in your brain which can lead to more than normal amounts of side effects, get it? :) ]. With that said (if you're still following me, Lexapro actually inhibits CYP2D6 more than the other SSRIs. Basically what that means is if you are taking both Lexapro and an Amphetamine, it may work great or you, or it may not work well at all for you.

If you're still following me, taking an SSRI with an amphetamine can often dull the stimulating effects of the amphetamine. In my own experience, I'll tell you what has worked best for me (and others I know). First off, I started taking my SSRI every night instead of every morning. This helped so the two meds weren't "competing" against each other quite as much (so the amphetamine didn't lose as much of its stimulating effect. In addition to that, I use the SSRI as more of a "supplementary" dose to the amphetamine. Instead of taking 100mg of my SSRI, I take 75mg. This way, it still works efficiently, but does not dull as much of the stimulating effects of the amphetamine.

Back to CYP2D6 inhibition and SSRIs, like I said above, some inhibit the enzyme more than others. I am prescribed Adderall XR and Zoloft (an SSRI). Zoloft inhibits the enzyme less than other SSRIs like Lexapro do. For me, taking Adderall XR in the morning as well as Zoloft every night at the same time, works great. Of course everyone is different, but for you, I don't think it would hurt to change to another SSRI such as Zoloft and take it every night. IMO, I think if 30mg of Vyvanse was working well for you (or whatever dose you said, I can't remember), I would leave that dose where it is and try another SSRI.

Note: I am not a doctor (although hopefully will be in a few years, ha) but I do my research. With that said, I am trying to help you because I know how serious the problems you're having can be, BUT.. please please before you do anything, check with your clinician. He should know what's best for you. He also should value your opinion, so you could try letting him know the 30mg Vyvanse worked great and you would like to stick to that while also suggesting about changing SSRIs.

Again, please don't do or change anything without his advise and approval, but if you have any other questions, I would be happy to help as best I can.

-Ian



Michjo
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21 Jun 2009, 12:59 pm

IanB wrote:
Here's my input on your situation.. Amphetamines, like Vyvanse, and SSRIs, like Lexapro, are both metabolized in the liver. The main enzyme responsible for their metabolism is CYP2D6. In addition to both being metabolized by CYP2D6, SSRIs, like Lexapro, can actually inhibit CYP2D6. This means that if you are taking them both, they may not be getting metabolized as quickly/efficiently which could lead to more than normal amounts in your bloodstream [which leads to more than normal amounts in your brain which can lead to more than normal amounts of side effects, get it? :) ]. With that said (if you're still following me, Lexapro actually inhibits CYP2D6 more than the other SSRIs. Basically what that means is if you are taking both Lexapro and an Amphetamine, it may work great or you, or it may not work well at all for you.

If you're still following me, taking an SSRI with an amphetamine can often dull the stimulating effects of the amphetamine. In my own experience, I'll tell you what has worked best for me (and others I know). First off, I started taking my SSRI every night instead of every morning. This helped so the two meds weren't "competing" against each other quite as much (so the amphetamine didn't lose as much of its stimulating effect. In addition to that, I use the SSRI as more of a "supplementary" dose to the amphetamine. Instead of taking 100mg of my SSRI, I take 75mg. This way, it still works efficiently, but does not dull as much of the stimulating effects of the amphetamine.

Back to CYP2D6 inhibition and SSRIs, like I said above, some inhibit the enzyme more than others. I am prescribed Adderall XR and Zoloft (an SSRI). Zoloft inhibits the enzyme less than other SSRIs like Lexapro do. For me, taking Adderall XR in the morning as well as Zoloft every night at the same time, works great. Of course everyone is different, but for you, I don't think it would hurt to change to another SSRI such as Zoloft and take it every night. IMO, I think if 30mg of Vyvanse was working well for you (or whatever dose you said, I can't remember), I would leave that dose where it is and try another SSRI.

Note: I am not a doctor (although hopefully will be in a few years, ha) but I do my research. With that said, I am trying to help you because I know how serious the problems you're having can be, BUT.. please please before you do anything, check with your clinician. He should know what's best for you. He also should value your opinion, so you could try letting him know the 30mg Vyvanse worked great and you would like to stick to that while also suggesting about changing SSRIs.

Again, please don't do or change anything without his advise and approval, but if you have any other questions, I would be happy to help as best I can.

-Ian

I didn't think about the enzyme system changing the effect of drugs and it applies in this situation considering he has been prescribed vyvanse.

However, the effect you describe is not true of ampethamines in general, it only applies to extended release formulations of ampethamine. Adderall XR and vyvanse are both extended release.

Taking normal adderall together with an SSRI, will actually boost the effect of adderall. This is because whereas extended release amphetamines (which are usually salts of ampethamine) need to be metabolised before being "active", whereas ampethamine itself does not need to be metabolised.



IanB
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21 Jun 2009, 2:15 pm

Michjo wrote:
I didn't think about the enzyme system changing the effect of drugs and it applies in this situation considering he has been prescribed vyvanse.

However, the effect you describe is not true of ampethamines in general, it only applies to extended release formulations of ampethamine. Adderall XR and vyvanse are both extended release.

Taking normal adderall together with an SSRI, will actually boost the effect of adderall. This is because whereas extended release amphetamines (which are usually salts of ampethamine) need to be metabolised before being "active", whereas ampethamine itself does not need to be metabolised.


IR Adderall is composed of amphetamine salts as well (two dextro salts, two racemic). And Vyvanse is the only ADHD stimulant that needs to be metabolized before becoming active (forgot about that, good point). Adderal XR and all forms of methylphenidate are already in their active form. But you are correct on Vyvanse...it's lisdexamfetamine which is metabolized in the liver into it's active form, dextroamphetamine. And with the effects I described...they are actually a result of the SSRI boosting the effectiveness of the amphetamine to some degree. Combining the two together seem to "kill" a lot of the stimulating effect, but not in the sense that the AMPH isn't working. From my own experience, it was like the concentration was still there, but I just wasn't "stimulated" to do anything. For the week until my SSRI dose was lowered, I could concentrate on things, but I wouldn't feel like getting out of bed in the first place. So by having the stimulating effects dulled because of the SSRI, I don't mean the amphetamine isn't working as well. I couldn't tell you the exact reason, but I've always guessed combining the two wouldn't have any unusual effects on dopamine levels which would explain why the concentration was still there.. but together, they might actually raise serotonin levels a bit too much, which would explain the "not wanting to do anything" feeling. That would also be supported by the fact that lowering the SSRI doseage to a "supplementary" amount worked a lot better for me and others I have spoken to. With all that said, I am not sure of the effect the interactions would have on Vyvanse since it is a pro drug. I have heard friends and others I've talked to describe similar effects to what I just described. Some of them were helped by lowering their Lexapro dose while others changed to a different SSRI. Either way, I know none of them changed their Vyvanse dose, so I would run that by your clinician.