Comments on: ADD/ADHD Treatments: Tips for Vyvanse http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/ Dr. Charles Parker Reports on Core Brain and Body Evidence: Psychiatry and the Mind Evolve Sat, 20 Mar 2010 16:58:33 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-7950 Dr Charles Parker Sat, 20 Mar 2010 16:58:33 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-7950 Bobby, Without reservation I strongly recommend <a href="http://www.corepsychblog.com/neuroscience">Neurotransmitter testing.</a> You do need more information - and I can tell you, from considerable experience with similar presentations, that you are quite likely high on norepinephrine in the first place. Dopamine is a precursor of norepinephrine and very likely your whole adrenal medullary picture is out of balance. Just firing more drugs without knowing those details will set you up for further unbalanced outcomes. Without examining you it is inappropriate to tell you exactly what to do - some have done fairly well with lower doses, but I don't really think that is the answer. You are too young, and have too many good years ahead to pass on the testing that will provide more informed decisions. cp Bobby,
Without reservation I strongly recommend Neurotransmitter testing. You do need more information – and I can tell you, from considerable experience with similar presentations, that you are quite likely high on norepinephrine in the first place. Dopamine is a precursor of norepinephrine and very likely your whole adrenal medullary picture is out of balance. Just firing more drugs without knowing those details will set you up for further unbalanced outcomes.

Without examining you it is inappropriate to tell you exactly what to do – some have done fairly well with lower doses, but I don’t really think that is the answer. You are too young, and have too many good years ahead to pass on the testing that will provide more informed decisions.
cp

]]> By: Bobby http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-7894 Bobby Fri, 19 Mar 2010 15:51:03 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-7894 Hi Dr. Parker, I have bipolar disorder and ADHD. I take Lamictal and Lithium for the bipolar and I was recently put on Vyvanse a few weeks ago after going through a trial of meds. Meds in the Ritalin family made me very irritable and only lasted an hour if at all, adderall and dexedrine made my blood pressure really high so I couldnt handle it. The Vyvanse worked great at first and I'm up to 70mg, but recently I can't take it because it makes my blood pressure way too high. I'm 27 years old and athletic and it's really effecting my workouts. I had gone to the Dr. about an injury sustained in the gym and when they took my blood pressure at 6:30pm it was really, really high and I had taken the Vyvanse at 8am that day. I take 70mg and recently it's just become too much. I'm also on Intuniv but they're just samples and I went to pick up the prescription yesterday and found out it's not covered by my insurance so I have to switch to an alternative. Also, yesterday is the first day I didn't take vyvanse because of the bad side effects and I couldn't focus at work at all. I met with my psychiatrist yesterday and request that I be taken off amphetamines, but now I'm realizing I really need them to do my job. For people like me who are very sensitive to these drugs, do you think it's possible to find a low enough dose that will at least be somewhat effective without shooting up my blood pressure or can some people just not safely take these types of medications? I haven't had a really, really good workout in the last 2 months since all these ADHD med trials and it's really driving me crazy because exercise is part of my way of balancing my life and managing my bipolar. Any suggestions? Hi Dr. Parker,

I have bipolar disorder and ADHD. I take Lamictal and Lithium for the bipolar and I was recently put on Vyvanse a few weeks ago after going through a trial of meds. Meds in the Ritalin family made me very irritable and only lasted an hour if at all, adderall and dexedrine made my blood pressure really high so I couldnt handle it. The Vyvanse worked great at first and I’m up to 70mg, but recently I can’t take it because it makes my blood pressure way too high. I’m 27 years old and athletic and it’s really effecting my workouts. I had gone to the Dr. about an injury sustained in the gym and when they took my blood pressure at 6:30pm it was really, really high and I had taken the Vyvanse at 8am that day. I take 70mg and recently it’s just become too much. I’m also on Intuniv but they’re just samples and I went to pick up the prescription yesterday and found out it’s not covered by my insurance so I have to switch to an alternative. Also, yesterday is the first day I didn’t take vyvanse because of the bad side effects and I couldn’t focus at work at all. I met with my psychiatrist yesterday and request that I be taken off amphetamines, but now I’m realizing I really need them to do my job. For people like me who are very sensitive to these drugs, do you think it’s possible to find a low enough dose that will at least be somewhat effective without shooting up my blood pressure or can some people just not safely take these types of medications? I haven’t had a really, really good workout in the last 2 months since all these ADHD med trials and it’s really driving me crazy because exercise is part of my way of balancing my life and managing my bipolar. Any suggestions?

]]> By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-7884 Dr Charles Parker Fri, 19 Mar 2010 09:24:03 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-7884 Robin, Sounds like you may be quite sensitive to the Vyvanse, and that the dose is slightly too high, even tho it is a low dose. Specific dosing strategies are on this post and on several other posts here - and all titrations should be managed with your doctor's review. My suggestion, independent of the MVP, is to go lower and slower. They have a 20 mg size for your convenience, and you just might feel that the lower dose works better for you at the outset. Another good attribute of the Vyvanse is that you rarely need to adjust it after the first month on it. Watch the DOE, and that will help. For more info on the MVP take a look at this <a href="http://www.webmd.com/heart-disease/tc/mitral-valve-prolapse-overview">WebMD link</a>. There are no specific contraindications for use of Vyvanse with MVP, but that call is up to your doc, and may be best reviewed by your cardiologist just to be on the safe side with any side effects. cp Robin,
Sounds like you may be quite sensitive to the Vyvanse, and that the dose is slightly too high, even tho it is a low dose. Specific dosing strategies are on this post and on several other posts here – and all titrations should be managed with your doctor’s review. My suggestion, independent of the MVP, is to go lower and slower. They have a 20 mg size for your convenience, and you just might feel that the lower dose works better for you at the outset. Another good attribute of the Vyvanse is that you rarely need to adjust it after the first month on it. Watch the DOE, and that will help.

For more info on the MVP take a look at this WebMD link. There are no specific contraindications for use of Vyvanse with MVP, but that call is up to your doc, and may be best reviewed by your cardiologist just to be on the safe side with any side effects.
cp

]]> By: Robin Yates http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-7868 Robin Yates Wed, 17 Mar 2010 18:04:33 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-7868 Dr Parker, I am a 39 year old female with mitral valve prolapse and am on 30 mg of Vyvanse as of a week ago. I have never been treated for my ADD and feel Vyvanse has changed my life. My concerns are the underlying MVP, and I felt like I was on a drug that was hard on my body....maybe just so many side effects. I Felt like if I had half of the effect that things would be great. Don't know if I am just too sensitive to the drug or if I didn't give it enough time. Do you think the Vyvanse would work if I cut in half? Could you also shed some insight into the mitral valve prolapse. I was told that it wasn't a cardiovascular disease, but I sure would rather be too safe than sorry. Thanks for any thoughts you may have. Robin Dr Parker,

I am a 39 year old female with mitral valve prolapse and am on 30 mg of Vyvanse as of a week ago. I have never been treated for my ADD and feel Vyvanse has changed my life. My concerns are the underlying MVP, and I felt like I was on a drug that was hard on my body….maybe just so many side effects. I Felt like if I had half of the effect that things would be great. Don’t know if I am just too sensitive to the drug or if I didn’t give it enough time. Do you think the Vyvanse would work if I cut in half? Could you also shed some insight into the mitral valve prolapse. I was told that it wasn’t a cardiovascular disease, but I sure would rather be too safe than sorry. Thanks for any thoughts you may have.

Robin

]]> By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-6888 Dr Charles Parker Thu, 11 Mar 2010 12:32:32 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-6888 Kim, If you have no cardiac problems, none previously identified, you are clear according to the standard of care. No one recommends that every adult have cardiac screening. If you have high BP, do watch your numbers, but even then it is not contraindicated, and I have seen BP problems improve with carefully adjusted doses of Vyvanse. cp Kim,
If you have no cardiac problems, none previously identified, you are clear according to the standard of care. No one recommends that every adult have cardiac screening. If you have high BP, do watch your numbers, but even then it is not contraindicated, and I have seen BP problems improve with carefully adjusted doses of Vyvanse.
cp

]]> By: KIm P http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-6594 KIm P Wed, 10 Mar 2010 03:36:25 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-6594 I am 42 years old and was recently diagnosed I was actually dx'd with hyperactivity when I was 4 years old), with ADHD and my Psychiatrist is wanting to try me on Vyvanse; however, he is wanting me to get cardiac clearance from my PCP because I have MVP. My PCP is not wanting to give me the clearance because he doesn't know anything about Vyvanse and so I basically cannot go on it because I can't get the clearance. What I am wanting to know is...is there need to be concerned? I am a nurse, but this is not my area of expertise, so I am just curious. Thank you I am 42 years old and was recently diagnosed I was actually dx’d with hyperactivity when I was 4 years old), with ADHD and my Psychiatrist is wanting to try me on Vyvanse; however, he is wanting me to get cardiac clearance from my PCP because I have MVP. My PCP is not wanting to give me the clearance because he doesn’t know anything about Vyvanse and so I basically cannot go on it because I can’t get the clearance. What I am wanting to know is…is there need to be concerned? I am a nurse, but this is not my area of expertise, so I am just curious.

Thank you

]]> By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-5785 Dr Charles Parker Fri, 05 Mar 2010 11:43:51 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-5785 Philip, Sounds like you have something else going on medically, and I would have to go over you in detail to even guess what it is. Those two meds have no interaction, <a href="http://www.youtube.com/watch?v=fu0mN68rkEs">do take a look at this video </a>and see if it rings any bells, especially the last few mins. cp Philip,
Sounds like you have something else going on medically, and I would have to go over you in detail to even guess what it is. Those two meds have no interaction, do take a look at this video and see if it rings any bells, especially the last few mins.
cp

]]> By: Philip http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-5704 Philip Thu, 04 Mar 2010 00:29:44 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-5704 I'm 22 years old and was diagnosed with depression at age 15. I've tried zoloft, effexor, wellbutrin, wellbutrin with rhisperdal, cymbalta, and pristiq at varying doses. Although they all seemed to temper my emotions for short periods of time, I still had problems with my energy level that was non existant and focus. My dosage of Pristiq was increased from 50mg. to 100mg. but i was quickly brought down to 50mg. again after the change in dose made me extremely depressed and I noticed symptoms like rapid energy loss and anxiety around large groups of people which i never suffered before. I was diagnosed with ADHD Predominantly inattentive and prescribed 70mg of Vyvanse in addition to the 50mg. of Pristiq and Ambien CR 12.4 mg.. This was done during my semester winter break, for two weeks I felt cracked out but I continued taking my medication and every couple of days the uncomfortable side effects began to diminish and i noticed extremely positive results, for the first time I felt like myself and I hadn't really in over three years. As school started up again and life continued I noticed the motivation and energy I had to complete tasks was diminishing and lasted for about two weeks. When i spoke to my doctor about it he opted to increase the dosage of Pristiq to 100mg and told me I should take it for three weeks after I asked him how long i should deal with side effects. It's only been 6 days, but I've only really been out of bed for 2 out of 6 days, I wake up feeling extremely drowsy and disoriented, following that period i'm extremely exhausted and frustrated with how unproductive I am at the moment, have even less focus than before, and pretty much only have a two hour window in the evening where I feel ok enough to really walk out of my room and eat and interact with my family. Is this a normal reaction? Should I continue taking this dosage in hopes the side effects diminish? Would changing the time I take Pristiq in the morning with my Vyvanse to the evening with Ambien CR make a difference? Thanks. I’m 22 years old and was diagnosed with depression at age 15. I’ve tried zoloft, effexor, wellbutrin, wellbutrin with rhisperdal, cymbalta, and pristiq at varying doses. Although they all seemed to temper my emotions for short periods of time, I still had problems with my energy level that was non existant and focus. My dosage of Pristiq was increased from 50mg. to 100mg. but i was quickly brought down to 50mg. again after the change in dose made me extremely depressed and I noticed symptoms like rapid energy loss and anxiety around large groups of people which i never suffered before. I was diagnosed with ADHD Predominantly inattentive and prescribed 70mg of Vyvanse in addition to the 50mg. of Pristiq and Ambien CR 12.4 mg.. This was done during my semester winter break, for two weeks I felt cracked out but I continued taking my medication and every couple of days the uncomfortable side effects began to diminish and i noticed extremely positive results, for the first time I felt like myself and I hadn’t really in over three years. As school started up again and life continued I noticed the motivation and energy I had to complete tasks was diminishing and lasted for about two weeks. When i spoke to my doctor about it he opted to increase the dosage of Pristiq to 100mg and told me I should take it for three weeks after I asked him how long i should deal with side effects. It’s only been 6 days, but I’ve only really been out of bed for 2 out of 6 days, I wake up feeling extremely drowsy and disoriented, following that period i’m extremely exhausted and frustrated with how unproductive I am at the moment, have even less focus than before, and pretty much only have a two hour window in the evening where I feel ok enough to really walk out of my room and eat and interact with my family. Is this a normal reaction? Should I continue taking this dosage in hopes the side effects diminish? Would changing the time I take Pristiq in the morning with my Vyvanse to the evening with Ambien CR make a difference? Thanks.

]]> By: Dr Charles Parker http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-4910 Dr Charles Parker Sat, 27 Feb 2010 18:04:07 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-4910 Kim, None to my knowledge, - interesting question! cp Kim,
None to my knowledge, – interesting question!
cp

]]> By: Kim http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/comment-page-3/#comment-4744 Kim Fri, 26 Feb 2010 20:55:04 +0000 http://www.corepsychblog.com/2007/08/addadhd-treatments-tips-for-vyvanse/#comment-4744 I'm curious if there are other medications that require the same enzyme as Vyvanse that should perhaps not be taken along with Vyvanse... maybe later in the day instead, and if there are substances that may inhibit this enzyme (flavonoids?). I’m curious if there are other medications that require the same enzyme as Vyvanse that should perhaps not be taken along with Vyvanse… maybe later in the day instead, and if there are substances that may inhibit this enzyme (flavonoids?).

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