ADD/ADHD Treatments: Tips for Vyvanse

I guess I wonder: do you see any indications of which types of meds might be best, given our history? Wellbutrin and Straterra (both used at least 2 months) resulted in minimal benefits to focus (compared to ritalin or adderal), and definite negative mood issues. Of the stimulants he took before developing tics, Adderal worked best on focus, but was very negative for his mood. Ritalin/metadate cd seemed the best of the remaining alternatives, causing no mood problems, and improving concentration fairly well. After several years, though, we stopped stims, due to tics (which went away completely after the stimulants were out of his system.)We did try focalin in small doses, hoping its “cleaner” profile would be better, but no. We are hoping that Vyvance, which I understand is similar to adderal will not cause his tics to resume and will not cause the mood problems we saw with adderal. I am an optimist!

Shannon-
Your report does sound interesting to me – and I have been watching to see if any of this abuse material began to surface. I would love to do some investigative journalism on this report, and would welcome an anonymous call to my office,- will call back on my nickel if that person would be willing to talk to me about it. Please do ask the user to call my office with the name Anonymous for a more in depth phone review. Office number over at Contact JR under the picture.

Thanks for the input will be watching.
cp

Thank you so much. It is encouraging to hear that the mood issues seem less pervasive with Vyvance. We have known all along that the TCAs are a very imperfect solution, but tics made the stims unsuitable for our son (and he tried all, including focalin, that were available four years ago), so we had to look elsewhere. We have him on a low dose of desipramine, per Dr. Hallowell’s interesting article titled Pharmacotherapy for ADHD in Adults, by Jonathan Ratey, Edward Hallowell, and Catherine Leveroni, in which they say, “… Research and clinical experience have shown that the antidepressants Norpramin (desipramine) and Tofranil (imipranine) effectively increase attentiveness and reduce distractibility in children and adults. Tricyclic antidepressants exert their effect by acting upon norepinephrine and dopamine, the two major neurotransmitters in the attention system. They block the re-uptake of norepinephrine and dopamine into the presynaptic neuron and indirectly modify the rate of release, thus increase the activity of these two chemicals in the brain (McCracken, 1991).

In our clinical experience, 40% or more of ADHD adults respond to between 5 mg/day and 40 mg/day of Norpramin. This dose range is considerably lower than that reported in current research reports (Biederman et al, 1985; Biederman, 1988). We see the return to the use of low doses as a significant contribution to the practice of pharmacotherapy for ADHD because we have found the most dramatic responses at low dose levels. Furthermore, most of our patients report that the positive effect experienced at a very low dose range is often lost as the dose is increased. In the mid 1960′s, Rapoport reported that the majority of children with “behavior problems” he studied showed marked improvement on 10 mg/day of Tofranil; in fact, a number responded most dramatically to 5 mg/day, and were maintained at that dose without a waning of response (Rapoport, 1965)….”

However, we are planning to try Vyvance soon, once his desipramine dose is lowered to a better level (we think we may have increased it too much.) We do work with a wonderful neurologist, who has helped us since 1999. He is open to new treatments, and multiple meds, when necessary. I very much appreciate your interest, and your willingness to share your knowledge.

I’m wondering: my now 13 year old son tried Adderal years ago, and the attention benefits were huge, but it made him terribly moody , weepy, and irritable. After years on various stims, tics became a problem, and he has been on TCAs combined with guanfacine for the past three years. TCAs have been good for the behavioral aspects of ADHD, but have not helped adequately with the cognitive issues. Focus and motivation are very poor. I wonder of Vyvance is likely to cause the same mood problems as Adderal? FWIW, he also had mood issues with Straterra and Wellbutrin, which were not as effective on cognitive issues as ritalin/adderal. I very much appreciate any insight you might have. Thank you.

Jason,
First a simple point: You can’t get it right with whatever was in the hookah on board – highly unlikely the fall was due to Vyvanse alone, highly likely secondary to meds + hookah, or hookah alone.

If you are in the US you are most often talking *weed/marijuana* with “hookah” use, – and weed, as other addictive substances, should be avoided if you want the true fix.

Often unappreciated is the fact that weed may appear at first to temporarily help with ADD, but is not indicated:
1. It’s against the law,
2. It has a very short half life,
3. The incidence of cancer in many reports is 5X CA in the general population,
4. It has not been studied for the ADD application but anecdotally we often note memory diminishes and dementia-like symptoms are increased… so if you want to do well, forget it.
5. And one final emphatic point: Weed makes you *more ADD.* SPECT scans show clear PFC deterioration with weed use. Stimulants are working to correct, weed is working to deteriorate.

Scrap that drug as a treatment plan.

The Adderall dose likely did not reflect the correct titration in the first place because of the “hookah,” as titration accuracy is difficult to predict categorically [without that variable], -so will pass on that one.

Tics and such are downstream problems of all stim meds, especially stim meds with comorbid challenges such as one finds when one regularly smokes or uses weed. We always look for a variety of other contributory metabolic issues if tics persist.

Several comorbid issues are present here, and more should be investigated.

Hope this helps,
cp

Hello,

I have a friend who is 27 yrs old and has just been put on Vyvanase after taking 80mg of Adderall for 6 years. The Adderall was effective and she liekd it but it caused intense fidgeting and her family thinks it was affecting her personality (argumentative, insecure, agitated).

I’m not sure the dose of Vyvanase she is taking but I know that she is now taking it twice a day b/c it was wearing off — is this ok or should the mornign dose just be higher?

Also, she is still fidgeting a lot (although less than the adderall) and has developed a recurring tic with the side of her mouth (new with vyvanase). Is this a normal and acceptable side-effect? I can’t find anyone posting about it.

Lastly, the other day she got up from sitting and smoking hookah (same position for awhile) and fainted and had a small seizure. Thought it was just from standing up too fast after smoking hookah but could it be related to the vyvanase?

She is also taking effexor daily.

Thanks for your info.

I’ve noticed a decrease in appatite since starting Vyvanse (prev on Focaline XR). It also makes me nauseated when I do try to eat sometimes. Not so much a prob for me since I’m in my late 20′s ( and could always stand to loose 5-10 pounds) but I could see how this would pose a problem for children. Since this is a medication for children wouldn’t malnutrition be of concern for most parents (among other things)? I myself would never give a stimulant to a child but then my kids and I aren’t hyper-active or out of control either.

It seems to me that if a child develops an uncommom reaction to meds, such as the one noted prev, I would assume she was misdiagnosed and would take her for a second opinion to a neurologist. I think all natural methods of controlling ADD in children should be exhausted before being put on any kind of unnatural medication- especially a stimulant. In a lot of cases, it’s the parent’s frustration with trying to deal that’s causing most of the problems. Patiance isn’t something we’re born with!

My therapist also says a lot of times Bi-Polar Disorder is misdiagnosed for ADD … it can even be a combonation of both. Besides .. I just read an article on CyberPsych that scientists aren’t even sure what these drugs they are prescribing for ADD do or how they work. What gives?

I can say that i am a 42 year old woman and i was put on Vyvanse 30mg at first and then bumped up to 50mg then 70mg. I started getting a severe backache and noticed it was only when i took the Vyvanse. I also lost 45 pounds while taking this medicene over a period of 6 months. Needless to say it was somehow and my doctor still does not understand it caused my Potassium to become extremly low and I had to be put on Potassium pills. My Thyroid is also not boderline overactive. I am not on it anymore and am trying something that is stimulant free. But for those that may be new to trying this medicene i would like to make sure that people are educated to what happened to myself.

Thank you.

Dr. P,

I know this is an old thread but am hoping you still monitor responses here. An update on my “Vyvanse” kid:

We titrated up to 80mg (saw no change from 70-80) and the pDoc is unwilling to go up any further. Though I did see a longer coverage of symptom control, I don’t think it was as effective as the Adderall XR-40mg.

So we’re back to that.

Another question-
She must be medicated in order to fall asleep, yet though everything we try sedates her, her body/mind fights it and she ends up staying up way too late. She walks around with eyes half shut and looks intoxicated, yet she can’t stop her body from moving. That means repeated runs (she does not walk and she’s 19 yo) up and down the stairs, grabbing food, items, cat, etc.

I’ve just consulted with a neuropsychiatrist here at Wayne State U and his thought is to try and get a consult with Dr. Joe Biederman. Her picture is so unique and reactions to meds unusual.
I know John Ratey, who suggested intense exercise, but she is unable to follow formal routine exercise. I do have her skating and bowling once a week via special ed groups but know that’s not enough. This is a young lady who can’t read her body; who never tires; can’t tell hunger from full, etc. Extrememly hyper/impulsive due to her brain injury as a tot.

The only time she is able to sit is when she perseverates on the computer.

Any tips?

Thanks,
Terry Matlen, ACSW

http://www.addconsults.com

Dr. Chuck,
My eight year old son just started vyvanse this weekend. He developed symptoms of ADHD after many treatments for brain cancer. His cancer is in remission. He is on 30 mg and felt better within forty-eight hours of beginning the medication. However, he talked and talked and talked. He did go to bed well tonight and at his normal time. Should we wait a week to see how his body stabilizes on 30mg or should we talk to the doc about halving the dose? Thank you for your website!

My son who turned five in October was diagnosed with ADHD in November. His peditrician put him on vyvanse since he is in day care all day and he can’t swallow pills. We quickly discovered that the 30mg was too high of a dose; he talked non-stop for nine hours (scary!). I found your website and cut his dose in half (thank you!). His teacher was amazed how well his focus improved, but he was still talking a lot. We cut the dose into thirds which his peditrician said was OK. His focus is still good, however his teacher has noticed that controlling his hyper activity has gotten harder for him compared to when he was on the higher dose of meds. Is increased talking a common side effect? If I raise his dose will the talking eventually get better or should I just try another medication?

My 7.5 yo son was diagnosed with ADHD this summer (although, I always “knew it.”) We started him on Adderall 5mg and climbed to 15- then cut back to 10mg in the AM and 2.5 after school. After two months of playing with it, and him losing 11 pounds and rebounding in the afternoon horribly, not sleeping, etc. our doctor put him on Vynase 30 mg.

It has been 4 days– the first was miraculous (as was the Adderall in the beginning.) But the last 2 days he was pretty nuts– very low frustration tolerance, lashing out his sibs (hard for me to tell if this is worse behavior than before we ever started medication, but I almost feel like his behavior wasn’t as outrageous before we started medication.)

Today is okay so far…but I have noticed the meds are wearing off at about 4pm– and not working all that well to begin with.

How long should we wait to increase the dosage? We got our free 30 day script and our dr said to wait until it runs out before increasing, but after yesterday I am thinking that I will be institutionalized before then )

Will increasing the dosage even help if he isn’t showing much of a change (or even worse off with it,) when taking the vyanse?

Any advice will be most appreciated.

Thank you

Sir,

I have been taking 30 mg of vyvanse for a little more then a week. Should I be able to feel a difference taking this medication?

I am naive to stimulants with the exception that up until 2 years ago I drank about a six pack of caffeinated soda a day. Now I avoid caffeinated drinks of all kinds.

I thought that since the drug was a stimulant I might feel more alert or energetic, but my wife tells me that with ADD it would be the opposite.

I am a 30 something white male, 5’6″ and about 190 pounds – fairly muscular. New diagnosis of ADD. I’ve never taken any ADD meds or any other Rx stimulants before with the exception being some of the nasal decongestants which I seldom use.

Thank you sir,

Irving

Betsy-
Yours is also a very interesting post – and thanks for sharing your super daughter with us. You are clearly affirming the not-so-parenthetical-point that we must always listen to the patient, and if we do, they will tell us how to get it right.

I completely agree with your psych about her start dose, and his observation with you that she is a fast burner at a previous Adderall dose of 80mg. You do already know she is fine with the AMP molecule, so she is not [as they say in research], a *virgin [innocent from previous stimulant, -and, in this case, not innocent from AMP stimulant] patient.*

So, with that foundation, 50mg Vyvanse would be expected to have a positive effect on prefrontal cortical brain function [to coin a phrase!]. At the previous DOE [duration of effectiveness] on the IR Adderall @ 3.5 hr, she was slightly under-dosed. I have come to expect a solid 5-6 hr on the DOE with the IR.

So, knowing that, and doing the math: 2x50mg=100mg Vyvanse = *roughly* 60 of Adderall XR she would likely, with your doc’s approval, be able to squeak up to 120mg because the DOE objective for me on Vyvanse, tho difficult to measure as precisely, is in the 14 hr range.

But, having said all of that, my next question you will have some fun with [and I won't ask for an on line reply]: How many times a day does she go #2?

Bowel irregularity [and subsequent liver dysfunction] very often confound the metabolic picture. She could be going either way: excess on the too frequent side, or, most often, on the Q2-3day side. Constipation in our entire adolescent/adult society is rampant.

I would look for metabolic and nutritional components vigorously – and even though she is smart and motivated, I am an anti-carb hound. Carbs mess up the bowel, diminish effective metabolism, mess with the estrogen system [listen to my podcast on PCOS and the other on estrogen dominance] and then can create sleep problems, appetite and breakfast problems.

All systems go into rusty shut down. We just can’t get it right with main drain working inefficiently. Scum is building in the bathtub.

This is a big deal and must be chased down to get the metabolic question effectively answered. Once those questions are completely resolved we regularly find we don’t have the problem of chasing dosage.

More in another post soon.

Thanks for adding to this interesting discussion, hope this helps with your girl.
Chuck

My daughter has recently begun Vyvanse (~2 months ago). She had been taking Adderall immediate release for the last 7-plus years. There were occasional forays to try XR (but she can’t swallow capsules, tablets, etc. and the taste was very bad), Methylin (which she declared needed to come in orange flavor, and refused), Daytrana which she never actually tried (would have needed at least 3 patches at a time),

Her Adderall dose was 20 mgs. 4 times a day. It used to last longer, but at present only 3.5 hours, and still that had became somewhat uneven in result.

Her psychiatrist started her right off at 50 mgs. Vyvanse and at first she seemed about the same (school was starting and who could tell what was what between that, her already severe anxiety disorder, and the new medication? She said the Vyvanse was “better,” and ventured that might have to do with not being married to her alarm watch. She has since observed (she is 15 and quite able to specify what the effect of medication is) that the Vyvanse is smoother, less “herky-jerky,” that she remembers where things are and what she has to do. I notice better planning and executing, and more initiative for chores and other things, too. She seems more relaxed, which is not a cognitive symptom, but certainly a secondary effect of cognitive problems. And, she hasn’t lost her sense of humor.

I wholeheartedly agree that it is cognitive function that is the impairment to treat, and to monitor closely and in detail what is and is not affected at given doses. In my daughter’s case,it might have been all right to start lower, but her requirements have always been high and she’s sufficiently committed to medication and the help it gives her that she would not have agreed to a very low dose. I guess that’s a case of doing things in a highly individual way.

For her, the Vyvanse is effective for about 8.5 hours and she notices a drop-off in concentration/orientation if she lets it go much longer. What are practitioners doing to handle the “after it’s done its job for the day” problem? Many people I work with need some stimulant on board in order to get to sleep, and my daughter is one of them. So many sleepless childhood nights — she averaged 4-6 hours all during her middle childhood — and we finally figured out what made the difference.

She has been taking two equal doses of Vyvanse (50 mgs.) and this sees her through past go-to-sleep time. Covering a 16-hour day would be important for lots of people.

I’m interested to hear more about this, and whether people think Vyvanse is going to take its place among the more-used medications for AD/HD.

Betsy Davenport, PhD

Terry,
Your daughter presents one of the typical/atypical problems we so often see that make this practice so interesting. On the one hand she apparently has some concommitant organic challenge with the cog impairment – which would likely make her *more sensitive* to changes and therefore *likely* would need less.

The dose correlation with Adderall 40mgXR could be anywhere from a low 50mg [=20XR], to a higher 90/100mg Vyvanse.

Here are the correlations from the *forced dose* research:
10XR=30 Vyvanse
20XR=50 Vyvanse
30XR=70 Vyvanse
But anyone working with Shire [the pharma company] including Frank Lopez MD one of the lead investigators, would tell you, just don’t think on those terms. Research is research, practice is practice. These are very vague guidelines only. Every med is different, even if it is the same AMP molecule at the *core…* -notice how I slipped in that word?

From your brief report sounds like, as you noted, it was simply too little, and the odd/strange behaviors probably were a result of simply not being on enough Vyvanse.

I have one patient at this moment on 120mg Vyvanse [roughly = 50-60mgXR?] This is unusual for me, and I confess that I see many second opinions with XR dosed much higher than I ultimately find they usually need to go. Vyvanse is most often more efficacious.

Haven’t had enough time to see it with Vyvanse, but just looking at this post looks like *too much* is already underway.

Biggest mistake with most folks is big guys – I have a post on this subject a while back – seems like folks are trying to medicate them into submission.

Would continue slowly up with your daughter, looking for full coverage thruout the day [not a drop in the PM from 2-4], all, of course, with the full authorization of your medical team there. This note is not enough information to cover all of the multiple angles in this situation.

Hope this helps a bit however,
Chuck

Dr. Parker,
Thanks for these helpful tips. Have a 19 yo daughter w/ mild cog impairment following childhood vaccine reaction (MMR), with severe AD/HD, etc etc. Trying to switch from 40 mg Adderall XR to Vyvanse. Would 70 mg Vyvanse correlate with 40mg Adderall XR? She had one dose of 50/Vyvanse and was ineffective and strange behaviors were noted. She’s in the middle of projective testing to r/o thought disorder, so I d/c’d Vyvanse till testing is complete. Just wondering if there is a chart showing dosage comparisons.

Thanks!
Terry Matlen, MSW
http://www.addconsults.com