Taking Vyvanse – and Losing Your Memory?
There are several likely explanations, so let’s review. Most importantly, remember these small Vyvanse challenges do teach us – they point the way to the next logical intervention for the most effective medication dosage strategies.
Vyvanse and Time
Vyvanse Question from Lara
I am in my late 30’s and have been on Vyvanse 50mg for over 6 months. Like some previous posters I experience some unsettling memory problems even though I have great focus. I can’t remember simple things like my children’s teachers names, or the name of a store. My word retrieval skills are terrible, or I will reverse words thought, example: “I am going to the bananas to get the store.”
This is quite common and it is only after I utter this nonsense that I notice the error. My children even pick up on it sometimes. Also, for several months I experienced a shortness of breath that seemed similar to my asthma symptoms as a child. This seems to come and go now, but is bizarre. Do you think these could be related to the Vyvanse?
Vyvanse, the Window and other Neurotransmitters: My Reply
Do look very carefully at your duration, your DOE as discussed in this post on Vyvanse dosing, and assess if it has crept up to the 14 hr range. While not always the accurate barometer [having only misrepresented Vyvanse dosage efficacy with careful questioning only 2x in my experience], it will often tell the tale.
The phenomenon of decreased memory can be related to several different issues, the most frequent, and the reason for measuring the DOE, is simply adhd-medication-management-series-measuring-the-top-of-the-window/”>too much Vyvanse, leading to an excessively long DOE [somewhere over 12 hr with some folks]. Said another way, sounds like you are coming out of the Top of the Therapeutic Window. These findings in the office are less common, as many adults have done well in specific work simulated studies with 14 hr DOE.
Shortness of breath can also be associated if the dose is slightly too high.
Another possibility, also quite likely, is that your ADHD is simply caused by a dysregulation with one of several different neurotransmitters, for example PEA. Phenylethylamine, PEA, is not commonly appreciated by the current ADHD psychopharmacology practitioners simply because we haven’t had a medication to address levels. Low PEA can create ADHD issues, and an abundance of PEA can drive the stimulant consequences [side effects] out the top of that window.
Measuring PEA, as I do now in every challenging presentation, saves big time – months of speculation and trial and error, and real dollars as the evidence will tell the practitioner exactly what to do. As you may know from these pages I am a strong advocate of science and measurement, and disparage the Missouri Turkey Shoot method of dosing – such as taking a blurb like this one from the Internet and running out to find the amino acid precursor for PEA, phenylalanine.
However, if you are interested in PEA do take a look at this article [PEA noted on pg 269] from Psychiatry and Clinical Neurosciences, for verification of this possible targeted amino acid neurotransmitter precursor for intervention, should that be the correction needed.
Neurotransmitter measurement possibilities discussed in detail on the Neuroscience page here.
Interesting Vyvanse/neurotransmitter question, thanks,
cp
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Dr. Parker and a comment for Joey,
I take 50mg of Vyvanse and 250mg Magnesium, if taken at the same time, there is little if no affect from the Vyvanse, so I have to space them at least 2 hours apart. However I have found that with Folic Acid, it has a tendency to make me feel on the toxic side if taken at the same time as the Vyvanse. So now with all my supplements I do not chance it anymore and automatically take those at seperate times of the day than my Vyvanse and Pristiq. I found that the Magnesium also decreased the affectiveness of my Pristiq, so I had to change that around as well.
Dr. Parker my concern now however is that my doctor increased my Pristiq from 50 to 100mg, because of some depression symptoms. I was previously on Prozac and vyvanse and experienced a very toxic interaction so I changed to the Pristiq. I really feel the Vyvanse 50mg works for me, and I feel the Pristiq 100mg works for me, but since going up on the Pristiq, I feel some of that toxic feeling again. When I had the toxic interaction with the Prozac and Vyvanse, I had horrible upper back muscle pain, and it has taken forever to get it to go away, that was when I started taking the Magnesium, which was a life saver. That muscle pain in my upper back is back again.
My guess from all my research to understand how the neurotransmitters work is that the Vyvanse controls Dopamine, and the Pristiq controls the Nor-epinephrine/serotonin. Is it possible that since the increase in the Pristiq that now my Dopamine levels are a little to high and that I just need to lower the Vyvanse to say 40mg? The depression symptoms are aleviated but now I feel this rigid feeling in my back and tense. I am able to focus and function except for i almost feel too driven and too focused and feeling pain between my shoulder blades and that’s when the magnesium helps. It is crazy that even ibuprophen doesn’t work but the magesium is a life saver most times.
I also think that when I had the toxic interaction between the Prozac and Vyvanse it depleted my Magnesium levels, therefore brought on the severe muscle pain in my back. I could be wrong, but with in 30 minutes of taking the Mg, the pain is alleviated.
I hope some of my experience helps others, I just really appreciate your site. It has really helped me to help my doctor to help me! I really wish you had your practice here in Georgia. Since finding your site, I have made more progress in the past 8-12 months than I have in the past 6 years, in leading a more productive and happier life because I am more educated by you and other people who visit this site.
Thank you so much, and please don’t ever stop what you do Dr. Parker.
Tonya –
The fact that you appear to be having a reaction to Pristiq could come from several directions:
1. It’s more than you need and you are slightly toxic simply by taking too high a dose.
2. You very likely have a metabolic underlying issue with the Mg edge you are reporting. It’s like you are way to sensitive to changes in small dosages of Mg, encouraging an underlying concern for deficiency, secondary to chronic GI issues for example.
3. Drug interaction is unlikely.
4. Unlikely that Prozac and Vyvanse created the Mg issues, but highly likely that reaction aggravated an underlying issue.
5. You are one of those folks who will very likely benefit from more comprehensive metabolic testing – and because of the likely collateral nutritional and metabolic issues I would recommend Metametrix – the Triad testing.
More information, more evidence is needed to specifically address your issues – and the good news: you would very likely improve once tested as customized in your treatment for the underlying challenges.
Thanks so much for your kind remarks, hope these notes help you and your doc.
cp
Very helpful question with an insightful & thorough reply. Kudos!
Apologies for taking so long to chime in, as I have experienced forgetfulness, inability to find the word, mixing up words, heart palpitations & the asthma-like breathing, with the breathing usually occurring as/after the Vyvanse wears off (and I’m on a MUCH higher dose) or when I took a medication break – almost like a withdrawal.
As to the forgetfulness, inability to come up with words, and switching words in a sentence, I attributed it to my ADD & brain injury. [I' have even left my self a Post-it, only to come back later and it was blank! - top that those of you who "forget" things!]
That being said, your response about PEA is spot on. My NeuroScience PEA level in 2004 was 984 v. the then “optimal range”of 175-350, while Dopamine was nearly 400, well over 2x the high end of range, and histamine was nearly double the high end as well.
By that time, I had already discovered that phenylalanine (even a small stick of sugar-free gum) spun me into major migraines, but the ‘04 test and a brief explanation of it’s relationship to PEA & and it made sense. My thoughts: [experience, not education speaking] if you have or think you have high PEA levels, watch for phenylalanine in diet sodas & nearly everything sugar-free… Beware the 5 hour energy shots!!!
It’s no wonder I have anxiety, it’s a wonder I can function!
As always, many thanks Dr. Parker!
Rich,
Interesting findings, and PEA remains, even now, so much under the radar, both increased and decreased PEA can create significant problems – with the outcome that those with these issues feel simply crazy! BTW, decreased PEA looks very ADHD, and can be corrected with supplements directed to that precursor set.
cp
Great blog! I’m new to stimulants (specifically, Vyvanse), and your blog has helped me a lot in terms of learning about the “therapeutic window.” I’m a 33 year old male who was about to give up on Vyvanse b/c of inability to get a decent duration (50 mg) without really toxic side effects (significantly increased pulse, blood pressure, forgetfullness, terrible rebound etc…). At lower doses i would have a short duration, terrible rebound, and still feel toxic at hours 4-6. All of the side effects, however, vanished, when I discontinued a supplement containing 125 mg of magnesium, as well as malic acid and folic acid. I used to take 1 in the morning and 2 at night. I also take cymbalta 60 mg, though oddly, once I stopped the supplement, the cymbalta 2d6 issue doesn’t appear to be a problem. However, this seems very odd to me as magnesium was working well before I started stimulants and upon discontinuing, everything seems much better. Could it actually be possible for magensium to interact with stimulants?
p.s., I also recently discontinued Celebrex I was taking for a broken arm that had healed a while back. Celebrex, however, doesn’t seem to inhibit 2d6 anywhere near as much as cymbalta.
Joey,
Only suggestion that comes to mind is the remote possibility of the Mg causing a more basic medium and thereby encouraging faster metabolism/entry through mucosa [in spite of the fact that cleavage of the lysine bond occurs in RBCs]. I know from experience with Adderall that an acidic medium delayed, even prevented the med from working [e.g. orange juice in the AM - reduced effectiveness in the AM], and that, conversely basic medium reportedly helped move it over faster. But bear in mind that all occurred as a mechanical release, not a prodrug action, in the stomach.
Seems like you have honed it down fairly clearly – and while I honestly haven’t heard that one before, and while the prodrug release appears to have significantly reduced that previous AMP acid/base reaction, this is a plausible explanation based on past experience with an AMP product.
Anyone else out there have similar reactions?
cp
Thanks so much Dr. Parker. I feel like my appts with my doctor are so much more productive because I come in with a firm understanding of important principles (titration, etc…) that I get from your site.
Once the magnesium mystery was resolved, I asked my doctor if we could halve the dose and retitrate back up. It looks like Vyvanse’s metabolism based release mechanism just doesn’t work well for me as far as once-per-day dosing goes. I get pretty bad rebound in the evening hours from all doses, except when the dose was raised to the point that the daytime side effects are too much. On the internet, I’ve heard of this happening with some patients — something to do with Vyvane’s peak occurring fairly early and high compared to other meds (and the accompanying concept of something like “acute tachyphylaxis” (no idea if that’s the right word).
For those for whom Vyvanse doesn’t work as a once-a-day-medicine, have you seen other medications work on a once-per-day basis? Dextro-amphetamine itself is perfect, which leads me to discuss Dexedrine Spansules with my doc, though he hasn’t used them in years. Actually, I’ve heard some say that adderall xr can give 12 hours, though I’m wary of that l-amphetamine.
Joey,
Glad these posts are working for you – bottom line, sounds like you have an atypical metabolic pattern, and would predict that you will find problems with almost any stimulant – if not on the very front end, down the line. But having said that, some simply do better with the MPH products, and some react very poorly to MPH and respond so much better to AMP products. Time will tell.
Straight Dextroamphetamine simply will not last as long [circa 5-6hr], Adderall XR can be dialed in for ~ 12 hr DOE, have done so many times myself. But, and this is a big but, the only rule is to watch for the metabolic irregularities, and seek to correct the underlying metabolic issues if they do indeed exist. Even if they aren’t obvious it will often prove helpful to do the Neurotransmitter testing as so much simply cannot be ferreted out, even with the best questions.
Acute tachyphylaxis is quite common in metabolic challenges: they have a narrow therapeutic window, and the doc just can’t get it right, and the burn through dosing strategies way too easily. The solution, again: measurement. The labs are showing us many options – so best to look more carefully if problems arise.
Best,
cp
PS That magnesium issue affirms that the problem is clearly metabolic, and very likely downstream of gut issues – with the inevitable result as I suggested here: frustration with outcomes down the line. Rest reassured: the answers are there if you need to chase them down.
First, to ADD_fairy and Josh-it sounds corny and obvious, but don’t give up! You really must start at a very low dose with Vyvanse, it made all the difference for me. I forget or put off making make appt.s too, but I’m always glad when I do.
And Dr. Parker, THANK YOU yet again for your earlier comment to me about Trileptal. I cut down on the Trileptal and Vyvanse and I feel SO MUCH better! What a wonderful service you are giving us.
Jan,
Thanks much for weighing in on this tough problem of getting started. Many issues involved like trust, patient education, awareness of what to expect… it is difficult, and am glad you worked out the Trileptal with your doc.
Have a great day!
cp
First, can I point out that it’s spelled “losing” your memory, not “loosing” your memory. Sorry for being a grammer fiend.
I was prescribed Vyvanse as my first ADD drug, 30 mg. I don’t see much effect, and it gives me heart palpitations. I am despairing that I will ever find a cure for my ADD. As disorganized as I am, I haven’t even scheduled a return visit to my doctor for an alternative.
Tina,
Oops and thanks!
Will run over and correct that immediately. In the meantime, don’t despair. Cut down your dose to 1/2 cap of Vyvanse by the water titration recipe – and since you are a fiend on getting things right I will also run over and get a proper picture up asap! [It's a rerun from my old TypePad blogging platform, and didn't carry the pictures forward when I switched to WordPress.]
Take that new smaller dose with a protein breakfast, get the heart palps under control, and with your doc titrate up to a proper 12 hr duration, and if that doesn’t work, switch meds, period. Some take methylphenidate [MPH} meds if the AMP class doesn’t work out.
Some can’t take stimulant meds at all – no prob, jump over to the Neurotransmitter page here, and learn how those options can be applied.
Hang tough, I have never met anyone who isn’t fixable who wants fixing.
cp
Dr. Parker,
Are there any ways to obtain dosings of Vyvanse in smaller-than-30mg sizes? A compound pharmacist, maybe? I’m sure they’d be a little spooked to handle scheduled drugs but perhaps you have connections or ideas on this?
Thanks.
Josh,
Oh yeah – they do make 20 mg [doses are 20, 30, 40, 50, 60, 70mg] – I have a number of kids and a few adults on smaller than 20mg doses, do click over on this Vyvanse micro dose link using water to break down the dosing. Compounding pharmacists are fully licensed to divide doses, and would not be spooked about that kind of request – you’re right on, that’s what they do, thanks for that suggestion as well.
Main issue with Tina, she need to decide if that is the med for here, then the division process becomes quite simple with my water instructions, also here at: http://www.squidoo.com/vyvanse
Thanks for weighing in, hope all is well with you,
cp
Thanks for the tips, Dr. Parker. You give me hope.
Interesting post! Glad to see practitioners like yourself diving deep into the science of things and exploring such depths as PEA.
I’m curious as to your plan of action with high PEA patients? Also, would you be willing to touch on the other symptoms you see in these patients, a little more?
I, personally, have the problem of having a high incidence of side effects on even the lowest dose of Vyvanse (22 y/o male, 130 lbs). It puts me at an unfortunate disadvantage with stimulant therapy because, to a certain extent, I can benefit from the therapeutics that a lowest dose could provide but I struggle with sides even at that. Short of cutting open a Vyvanse and adjusting dose manually, I’m left in the nether-region of ‘could benefit from ADD medicine but has too many side effects even at the lowest dose’.
I’m sure polypharmacy could address this, somewhat, but I’m not fond of the ‘turkey shoot’ aspect of that and, currently, lack the luxury of time and flexibility to get a regimen like that tuned up.
Thanks for the great post and feedback! Will be adding this to the hopper of neuroscience subjects to research.
Josh,
Yeah this stuff is so interesting!
-And the best part is seeing folks like yourself get better even tho they feel hopeless having tried everything else. I just don’t remember if you tried the MPH products. 5-7% of Caucasians and 3% African Americans just can’t take AMP products – so a try of the less effective, but differently metabolized MPH line might help. There, I like the Daytrana Patch for duration, esp in a young adult as yourself without a lot of time for messing with pill taking. Cut it up for starters if you are having these problems.
Other than that you would do well, if PEA is the culprit, to use an inhibitory neurotransmitter, like L-theonine, as it can slow down the PEA excitation. Also look at your bowel habits. Need to get that transit time down to 18-24 hr, #2 every day, lots of fluids and my favorite, flaxseed meal 1-2 tbsp in the AM with that power protein breakfast.
Could be time for neurotransmitter testing?
Thanks again for your comments!
cp
Somehow I hit post before I tweeked a last sentence or two there-grrrr…I meant to say that your discussions of the therapuetic window have helped me so much, and yet I think I was forgetting them lately. This article came at just the right time for me. Thank you so much for your Blog- you don’t know the service you do for us.
A big thanks back to you Jan for your kind remarks –
No, Effexor doesn’t create a problem with Vyvanse, it’s one of my favorites and repeatedly clean on 2D6. The dose of Vyvanse: sounds like you have that one ironed out – but the Trileptal, another favorite [watch out if you are on BC pills, pregnancy can happen as it facilitates metabolism thru CytoP450 3A4, and will burn up the BC effectiveness] does need it’s own titration.
Dosing too much can be very easy with that one, so talk to your doc about the memory and consider with her dosing strategies with Trileptal… it’s more likely, from my own experience, to create a memory problem at the top of the window.
Thanks again,
cp
I have been taking Vyvanse for nearly a year, I think (I’d be more specific if I could REMEMBER how long!). My family and I have had a very tough year-I tore a rotator cuff in January, my husband lost his job in February, and after months of fruitless job search, we started a small remodeling business two months ago. I’m taking care of the office side of things. My neuropsychiastrist recently increased my Effexor because I have had a marked increase in anxiety, which I’ve suffered from in varying degrees for many years. Oh, and I’ve take Trileptal for a year and a half, which has been wonderful for stopping mood swings for me, apparently caused by tiny seizures in a part of my brain-she says it’s not manic depression (I can’t remember what the newer term is!), as she uses EEGs with and without Ritalin to determine diagnoses. The Trileptal has caused “loss off words’ for me, a bad thing for an ADDer, but worth it when I have felt so much better the past year or so. Recently though, my memory loss has gotten much worse, which of course ups my anxiety, especially when I feel I’m not doing my part for our business. I had wondered if the increase in Effexor had made my Vyvanse less effective, but now I think, with your help, I’m taking too much Vyvanse! Any thought on how Effexor might affect my Vyvanse dosage? I did start low and slow, and I take 60 mg now-at one point I went up to 70 and was aware in a month or so that I felt “high” on that amount. I have read so much about the different theories and meds since I and my almost 12 year old son have ADD, and have usually had an intuitive sense when a drug isn’t working before. Your discussions of the therapeutic window havethis article came just at the right time for me. Thank you so much for this blog!