Vyvanse was helping depression . . . now . . . aggravating mania?
James writes in to say . . .
I started having panic attacks and was very unsociable and kept to myself,all this started about 10 years ago. The doctors diagnosed me as bipolor,i’ve been on every med available for bipolar with no positive results. Last december my doc decided to try me on 20 mg 1 a day generic adderral. It turned my life around i was talking to people i had avoided for years and started back doing normal activities instead of cutting myself off from the rest of the world i also was not as angry as before. To start with one a day is all i could handle, it gave me more than enough energy. Now in august i am taking 4 a day and i feel almost like i did before i started taking them. I have severe headaches and mood swings,i also become very angry easily. My doc switched me to vyvanse, i am scared i will fall back in the rut i was in for all those years. Will vyvanse be as good as adderral, and how long should i take it before i notice a change? I wonder if i quit adderral for a couple of months and then start it again , will it give me the affect it originally did? My behavior is affecting my whole life. Is there any advice or anything encouraging?
James, I’m going to start with the assumption that your diagnosis of Bipolar disorder is accurate. With that assumption in place, the medication used for Bipolar are quite varied so that it is a leap to say that you have tried “every med available” but I will even accept that as fact. A question that is not answered is if you tried COMBINATIONS of medications. For example, combinations of antidepressants, or antidepressants with Lamictal can be quite powerful. It is also not unusual for patients to benefit from combinations when use of single agents is not helpful. But let’s assume that combinations were tried but were not successful. Use of a stimulant medication is a bit unorthodox . . . and brilliant! Hats off to your shrink!
In cases of Unipolar Depression that is unresponsive to medication, there are a variety of augmenting strategies that can be used. One of them is to use stimulant medication such as Ritalin or Dexedrine. Adderall, of course, is a dexedrine-based medication. Using stimulant medication in Bipolar patients can be tricky. The risk of precipitating mood instability, irritability, or frank mania is uncomfortably high. I can suppose that, at first, it was able to bump you out of your depression for a while . . . and then you became tolerant to it . . . and it was increased . . . and you became tolerant . . . etc until now you are on 80 mg daily (a whopping dose) and not getting benefit. Is switching to Vyvanse any better? Hhhhhhmmmmm . . . hard to say. It is not a big difference. Adderall is a combination of two amphetamine salts and two dexedrine salts. Vyvanse is also a dextroamphetameine product. Not a lot of difference. Might make a difference . . . but . . . maybe not. Won’t know till you try.
My preference would be to put a mood stabilizer on board (whichever one you tolerated best) and then challenge you with a stimulant. This could be either with a dexedrine product like Vyvanse, or with a ritalin product (such as Ritalin LA or Concerta). The hope is that the stimulant medication would provide the same mood boost with the mood stabilizer providing for stability and act as a buffer for the irritability. One of the tricks we use with ADHD kids who develop tolerance is to switch between a Ritalin product and a Dexedrine product. For some reason, this can work with some kids. Will it help with you??? Maybe. Certainly seems worth a shot.
Good luck and keep plugging away. If your doc gets stumped, arrange for a second opinion. There are always new options and combinations to consider as well as life-style changes and therapies that can be helpful.
–Dan Hartman, MD
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