I have found things are usually not simple. Read my book and you will get some idea of how complicated a web of chronic unwellness can be. Well taking Vyvanse was that way too. The goal is to find the right dose. One that lasted about 12 hours. 30mgs lasted about 5 hours in me. When I talked to my doc about this after my first dose he said to take 60 and then increase it more till it lasted 12 hours. He even said I could take a dose early and one later. So over the next 6 days I kept increasing the dose till I was taking 90mgs. And I crashed. Totally crashed.
I felt totally depressed. I wept for no reason at all twice. I was a mess in less than a week! I immediately stopped the med and felt better. But I was so disappointed. It was so promising the first two days, but then went straight downhill from there. I was perplexed. So I researched. I read and read. I found a few blogs by psych docs who used Vyvanse extensively and mostly specialized in treating ADD.
What I read made me mad. I learned it was important to very slowly raise the dose over several weeks until the right dose was found both for effectiveness and duration. One website was particularly helpful. www.corepsych.com . Dr. Charles Parker, in Reston VA, wrote a blog that resonated with so many things for me. First off, he had run the Amen Clinic in Washington DC for 5 years and then went back into practice treating patients. (Amen Clinic is basically a diagnostic service to other docs.) One of the services he offered was giving 2nd opinions on SPECT scans. So I set up a teleconference. I sent him all my scans, reports and filled a host of new forms for his office. I then had a 2 hour conference with him by phone. It was VERY interesting.
First he agreed that I had been under-treated for very obvious issues and he was kind of upset about it. He said they basically took the approach of trying to simply stabilize me from the ups and downs I had experienced for the past 35 years. But they had ignored major findings and did not treat me. He also said he felt that Amen had missed a significant finding that would explain why I responded so well to Vyvanse at first and then crashed. He said he sees it all the time in his practice.
Rarely does only one condition exist but rather there are usually “co-morbid” conditions. Typically, if all the issues are not dealt with, then one med can often either not work or cause other problems. This is why it is not unusual for people on psych meds to struggle to find the right med or combination of meds that will actually work and help them to function at a higher level.
He said the condition that Amen did not mention was the fact my whiplash accident caused injury to both the front AND back of my brain. The front was related to my ADD symptoms but the back was tied more to depression because the injury damaged the area where serotonin has more of an effect. Dopamine effects the front and serotonin the back primarily (admittedly simplistic). Truth is both are working throughout the brain but these are primary areas where they work.
He explained that dopamine and serotonin were sort of on a teeter totter with each other. When one goes up, the other goes down. In my case, my teeter totter was broken in that BOTH dopamine and serotonin were both starting out low. Raising dopamine drove serotonin even lower. That is why I crashed into a weepy depression. Vyvanse dramatically increased dopamine in my PFC. But as it did so it lowered my serotonin even lower. He said my initial response to Vyvanse told him that it was likely a good med for me, but we had to raise serotonin and noradrenalin as well. For this he recommended Pristiq.
Pristiq is another very new med. It is the son of Effexor. Pristiq is a SNRI. It raises both serotonin and noradrenalin. Pristiq is an isolated metabolite of Effexor that appeared to be the most effective and active metabolite. It was believed from studies that it was a much “cleaner” med than Effexor with a lower side effect profile than Effexor and other SNRIs and SSRI’s.
One major problem that working with Dr. Parker caused was the fact that he was in VA and I was AZ. The rules would not allow him to be my official doctor unless I actually saw him in person. Since it was quite an inconvenience for me to do this I took a different course. I went back and visited an doc, an MD who I had worked with often in the past 12 years or so as he tried to help me unravel all my mysterious symptoms. He was a good guy, a friend and often had been helpful to me. I told him all the new stuff I had learned from Amen Clinic and Dr. Parker. He was excited to learn I had uncovered a huge underlying cause of many of the issues we had struggled with over the years. I asked him if he would work with me and Dr. Parker by prescribing the meds that Dr. Parker recommended. He said that as long as he understood what we were trying to accomplish with each med he would be happy to do this.
Now this is a bit unusual because most docs would never do this. THEY are the experts and don’t need any other doc telling them what to do! His involvement will become an important piece of this update as you will see later.
So within a few days I was on Pristiq and Vyvanse. And I began to feel much better. We very gradually worked the dose of Vyvanse up to where I could feel it’s effects for about 12 hours. The effects quickly became much more subtle than my original reaction. I simply could tell that I was far more focused and calm. My thoughts did not go racing through my head. I found out what it was like to have a working Executive Center. I felt I could consider business options much more effectively. I did not have my usual tendency to impulsively make a decision. If something bothered me, I could simply think about it for awhile until settling on a direction. And Vyvanse did not push me into depression because Pristiq was doing a great job raising the levels of other neurotransmitters. I felt like my brain was hitting on most if not all cylinders again. It felt great! But there were still problems to solve. More in the next post.
