A little update on my “medication of ADHD:”
I’d been going along swimmingly with the Adderall XR. I hung out at 15 mg for a few weeks, which is a pretty low dose for adults. (And I’ve continued taking every single day, not taking “days off,” which I detail here.) I’ve always been pretty sensitive to medications/”substances”, either needing lower doses or having paradoxical reactions. By substances, I mean things like coffee and alcohol—if I drink coffee too quickly, it makes me tired. The tiniest bit of alcohol makes me hyper and makes me lose control of my motor mouth. Benadryl, which people sometimes take to help them sleep, gets me wired. When I had surgery around six years ago, they warned me that I’d be groggy and probably nap all day after; instead, I woke up feeling better and more rested than I ever have. I was wide awake and frustrated that I had to sit still all day—I wanted to clean the entire house and run a marathon.
So I tend to stick to low doses with most things.
After a couple weeks on 15 mg of Adderall, I was really pleased with what was happening. I was seeing regular, steady change in my life, and the emotional regulation was AMAZING. If I’d be “stuck” at 15 mg forever, I could live with it. I still felt a little “squirrel-y” at times, which could just be because I’m at the point where I need to start learning how to manage my time and make decisions without “chaos” or pressure. But because I still had 5 mg capsules leftover from the “titration” process (finding the “right dose” for me), I asked my nurse practitioner if I could take a 5 mg capsule with my daily 15 mg to see if 20 mg would give me just a little extra help in focusing. She said sure, go ahead.
20 mg was too much. (In hindsight, I maybe could have given myself more time to “acclimate,” but it wasn’t that important to me to take more.) The reason I felt it might be too much is that I did actually feel a little “amped up.” It wasn’t to an insane, unmanageable degree, but I want the ability to “learn” productivity, not to feel driven to do all the things all at once. But important to note (for what I’m going to tell you a little further down) is that I felt fine, emotionally. I emailed my nurse, and she agreed that it sounded like that extra 5 mg was too much, so stick to 15 mg.
When I had the next checkup appointment, she suggested I try Vyvanse. Because Vyvanse doesn’t have a 1:1 ratio with Adderall XR, she prescribed 50 mg, which is equivalent to just slightly over 15 mg Adderall. Vyvanse is ultimately the same as Adderall, but it’s formulated differently. For Vyvanse to “become” Adderall, it needs to be processed and broken down by the liver. The idea is that this formulation is less likely to be taken by people who shouldn’t be taking stimulant medications. It’s said to be a gentler, slower release and lasts longer. (How long medications last is dependent on individual metabolism, but generally, Vyvanse lasts twelve to fourteen hours.) However, unlike Adderall which contains a mix of immediate release with extended release beads, Vyvanse metabolizes slowly, releases all at once, and is “active” for as long as it takes for your body to process it. The nurse suggested it as a way for me to take a slightly higher dose, thinking it would be gentler and better than a higher dose of Adderall.
Long story short, the 50 mg of Vyvanse was too high. And a too-high dose of Vyvanse was WAY more extreme, and harder on me, than a too-high dose of Adderall. I experienced a couple nights of severe insomnia, for starters. I felt more emotional and was easily overwhelmed by sensory information (which was only exacerbated by a lack of sleep). My anxiety was increasing, as were my OCD behaviors. My emotional regulation took more effort, and I was less tolerant of the little sounds my son made while sitting at the table next to me doing his school work. At one point, I told my husband, “I don’t know why people want to take high doses of this shit on purpose, because it’s not fun.” (Note to those of you worried about the potential for abuse. HELL, NO.)
Anyway—score one for Adderall XR because, as I pointed out, a too-high (for me) dose of Adderall XR was significantly “less bad” than a too-high dose of Vyvanse.
I emailed my nurse who said that yes, 50 mg of Vyvanse definitely sounded too high. She called in a prescription for 40 mg, and told me to give that a try. I’ve been on the Vyvanse 40 mg for… about two weeks now? When I picked up the 40 mg, I was feeling a little biased and anxious about Vyvanse, in general. The lower dose was much better, but I was still noticing some things that I wasn’t thrilled about. But I also recognized that I may still have some anxiety about Vyvanse after the bad experience with 50 mg. I recognized this and knew that the anxiety would take time to subside. I work very closely with both the nurse practitioner and my own therapist; the latter agreed that I should give the Vyvanse some time, and it absolutely sounded like I was having some panicky feelings about the Vyvanse, in general. (I had, for example, started rambling about how the Vyvanse lasted for around twelve hours, and I was obsessing over the fact that my days were now comprised of being on Vyvanse or asleep.)
Many people love Vyvanse; it works really well for them. The fact that it lasts longer and is supposed to be “gentler,” made me feel somewhat pressured to like and choose it. But after a couple of weeks, the conclusion I’ve come to is that Vyvanse makes me really appreciate Adderall XR and how well things were going for me on Adderall. It’s not “so bad” that I want to switch ASAP, but when I have my next in-office appointment with the nurse practitioner, I’m going to tell her I want to go back to (and stay with) Adderall.
The Vyvanse isn’t giving me the ease of emotional regulation that Adderall does. Overall, I feel “lighter” and more relaxed on the Adderall, but with Vyvanse I just feel…more productive and aware of my struggle to regulate. Though it isn’t frequent, Vyvanse seems to trigger more insomnia. On Adderall, I had absolutely no idea when it was wearing off. I was so regulated and at ease throughout the day that my mood stayed fairly light and level in the evening. (I seem to be in the minority with this one.) Though it’s not as bad as I’ve heard some people have it, with Vyvanse, I seem to have the infamous “crash”—I’m more irritable in the evening and have occasional headaches. The first few days, I had short bouts of dizziness while Vyvanse was wearing off. The dizziness was blessedly brief (vertigo and dizziness are issues for me) and it stopped happening entirely, but I wasn’t happy about it.
I like that Adderall seems to let me rise above my own moods. When I’m overtired, the Adderall allows me to function with clarity and lightness. Being overtired has always affected me badly, but Vyvanse exacerbates the mood swings, the anxiety, the “foggy-head.” Originally, I thought I wanted something that lasted longer, but now I prefer the shorter time of Adderall. I find myself still going back to the idea that my days are now split into “being on Vyvanse” or sleeping. I liked that Adderall made me feel like I had some breathing room and some “just me” time. I also like that I have a large window to take Adderall in the morning. During the week, I can take it at 7, 8, or 9 a.m. And on weekends, if I stay in bed longer or am just moving slowly, taking it at 10 or even 11 a.m would be fine. I don’t have that option with Vyvanse.
I’m glad that I got a chance to try Vyvanse because, having hit the “jackpot” immediately with my first med (Adderall XR), I wondered about all the other options. As I said in the beginning, this experience has made me REALLY appreciate the Adderall XR and to think more critically about what I want from medication for my ADHD. I know now what really matters (the emotional regulation and feeling “lighter”) and what I’m willing to negotiate or work on myself (developing more organizational and time management skills versus getting more of a “boost” from medication).
And again, I got lucky. I know many people struggle to find the right medication. I’m in a very privileged position where I’m not dependent on medication to survive my days; my husband’s career has given me a LOT of freedom and wiggle room. Would Adderall be the perfect medication for me if I had to function in a typical 9-5 job? Possibly not. I work from home, set my own schedule, and have been finally able to figure out and pursue work that I love. In my early twenties through early thirties (and back in my late teen years), I was a mess with work. I had a hard time focusing, keeping with jobs, being accountable, and working on a strict schedule. I’d say that the past ten years, having stayed home with my son for a bit and then working from home, has largely masked my ADHD. So Adderall XR is what works for me now, in my current situation. Had I discovered this two decades ago, Vyvanse might have been the thing I needed to survive. (There were genuinely times that my ability to support and take care of myself were questionable.)