So, I have been on 30mg Vyvanse for a whole (checks diary) four days. I was diagnosed with ADHD on Wednesday, and today is Saturday. Probably I should wait a bit longer before I deliver the truth bombs, since my brain’s response will adapt, but everyone is keen to know the deal, and I do have stuff to say already, so here goes (I can update as this changes).
Vyvanse is a slow-release version of dexedrine. It has a lysine molecule attached to it which apparently slows metabolism and delays the overall release and processing of the drug. Instead of getting a four hour effect and having to take three doses a day (which is what I would have to do on dexies), it’s supposed to last for 12 hours.
The actual studies report that it kicks in two hours after taking it and lasts for 12 hours, so there is a reported consistent effect from 2 to 14 hours after ingestion.
The downside (because I like to finish on a high note)
I metabolise things quickly. I always have. Painkillers and other drugs with a noticeable effect kick in sooner and taper off more quickly than expected. I get about two hours relief, max, from painkillers that are supposed to last for four hours. Alcohol hits me hard, but on the upside, I sober up very quickly (to the point that it confuses people who are expecting me to still be drunk). I wouldn’t test this by, say, trying to drive, but my impulse control and ability to make decisions after I’ve done this rapid sobering up trick are… pretty solid (as long as I haven’t completely destroyed myself, which I haven’t done in a very long time, since I decided it actually wasn’t fun; and last time I did, it was by accident! Long story involving my neighbour making me Long Island Iced Teas and having trouble with the measuring…).
So, what does this mean for Vyvanse?
It means it kicks in at about 90 minutes and it seems to drop off at about 9-10 hours after I take it. Which means I’m getting 7-8 hours of effect. Seems good, right? I mean, why complain?
Except that when it wears off, I drop into an anxious jittery mess. I get anxiety that lasts for about half an hour, and then after that I’m all twitchy and ADHD and can’t focus and Twitter all the time and what were you saying and brain fog and fuuuuuck…
So one of the things that I want from treatment is the ability to actually relax in my downtime: that is, to sit down, to read, to watch TV, to be present in the moment with friends, husband and self. I’m unable to relax when I’m being ADHD and it’s been a problem for a long time. The other problem is that most of the writing I do is done in the evening. That’s my writing time, my sit-in-the-snuggery-with-the-cats time. So I really, really want those extra four hours of Vyvanse effect.
What’s the solution? Well, it turns out this isn’t an uncommon problem, and some people only get four hours out of Vyvanse and crash MUCH harder than I do (so far; like I said it’s early days). I suspect (for reasons mentioned below) that my starting dose is too low, which would be quite common as well; but increasing the dose won’t increase the duration. I could split my dose throughout the day (they’re capsules, so it would involve dissolving them in water and leaving them in the fridge, which is hard if I’m at work and get home late). Or, if my dose went up, I could take two of these a day, which would be easier (although would require phone reminders – that’s okay, that’s already my life). Or there’s the possibility if an instant release (IR) booster, like an actual dex pill, to take in the afternoon. Apparently there are things I can do which might increase duration: eat high fat meals for example (HELLO KETO except I’m not keto at the moment because I ran out of spoons due to insane life, long story, and can’t get back on it until mid-May due to travel).
Obviously, I can’t really do any of these things without consulting my specialist, and the appointment isn’t for six weeks. I’m considering emailing her office with a short list of questions about what I might do in the meantime, but otherwise, I just have to tough it out and deal with the fact that life is going to be unpleasant at about 5-7pm (depending on when I take my meds).
The other downside there is that the Vyvanse wears off at roughly the same time that my body is about to call it quits. I have (suspected, probable) Ehlers Danlos Syndrome which includes (definite, absolute) hypermobility, which means that my muscles work twice as hard as everyone else’s do just to hold me up, so after a day of being me, I’m wrecked (not also: autonomic dysfunction, low blood pressure). Even with good sleep. Even with eating right. Those things help, but my body just… is done. My joints just can’t even. So around that time, having the Vyvanse wears off is kind of like being knocked over with a brick. I would prefer to have those things occur at different times.
The upside: this stuff is so fucking good
Here’s the positive stuff: the meds definitely work. I’m able to make decisions without panicking that I’m not making the absolute best decision and going over and over my choices (we’re talking “what to have at a café for lunch”). I’m able to be on time for things (well, I’ve done it once, but I’ve only tried once so far, so watch this space). I’m able to plan my tasks more effectively and accept that I can’t do everything because I’m more aware of time. I do still get stuck in loops with Twitter and so on due to indecision and executive dysfunction – which is why I think my dose is too low – but part of my brain is aware of it and it’s easier to break out of it.
I read a paper yesterday, in the car (we’re on a road trip right now). I cheated a bit. I picked a paper on a topic that I’m very interested in, and that I don’t have any imposter syndrome or anxiety about (crinoid taxonomy. I’m very comfortable with crinoid taxonomy, it’s my jam). But even though there was a podcast playing in the background, and I occasionally got distracted, I was able to get through it (and as a bonus, found one of my papers cited at the end! Which was very nice and gave me quite a thrill). And I did have to reread some bits, and I did skip the species descriptions (although that’s my personal bugbear: I don’t feel there’s a point reading species descriptions unless I have specimens right in front of me for comparison. They are necessary but very boring). But I finished. And it made sense.
I even downloaded another paper that was referenced out of interest and I’m not terrified of trying to read it.
Now, I’ll be honest – and this is another reason I think my dose is too low – it was exhausting, and afterwards I did feel like my brain had been through a shredder, and I needed to close my eyes and not focus for a while.
But I did it.
All the FEELINGS
Emotional dysregulation is a very common part of ADHD (and ASD, incidentally). It means we basically don’t have the same brakes and filters that everyone else does when it comes to feelings. I can be crushed by really very minor setbacks and my whole day is ruined. Now, I’ve been aware of this problem since at least high school (although “Katie, you’re so sensitive” was the song of childhood so… hm), and I’ve been developing coping strategies – conscious, decisive strategies – since early uni. I have a lot of “calm down, it’s okay” in my head, a lot of “take a break, think of something else, remind yourself this isn’t a big deal” voices. There’s a lot of effort, actual tiring effort, that goes into presenting myself as a calm person who’s not upset by every tiny little thing.
Part of this was because I’d never get through a day if I kept thinking “I can’t believe I missed the tram, that’s so fucked up, I’m such a loser” before I even got to my chemistry prac (literally the day that I started consciously practicing this “mental redirection” stuff).
Another part is that if I actually lost my temper the way my brain wants me to? I’d have no friends. So there’s a lot of “[x] means well and is my friend and loves me and doesn’t mean to hurt me and doesn’t know that behaviour sets me off” and “[x] will see things that way because their life has been different to mine and their feelings are valid, it makes sense, don’t get angry”.
Now, these strategies don’t work for genuine panic attacks and flashbacks due to trauma and abuse, which I have, and it’s important to separate those things I can’t control from things I can mediate. But they’re super effective strategies for normal, day-to-day life.
Here’s the thing: they’re hard. They’re so deeply ingrained in me now that they’re almost instinctive. But they’re hard, and they’re tiring. I’m constantly talking myself down from an emotional cliff.
…which by the way is also exhausting because of my (suspected) autism situation, where emotions are difficult to access and you feel them before you even are aware of them and you can’t articulate them (and cards on the table, I’m fucking articulate). So I have to play this weird double bluff game where I have to manage feelings I’m not always aware of but I know something’s up.
And on Vyvanse, I don’t need them. I mean, I still do, but nowhere near as much. Nowhere near. And it is… so good, and so relaxing, to not be constantly calming myself from a state of intensity. I can just experience a setback or a disappointment and think “Ah well, bummer,” and move on without getting obsessive about it, or artificially forcing myself to move on by (sometimes) completely suppressing that feeling.
So. That’s a win.
Fine motor control
Something I learned from combing the primary research literature (I am what I am, dammit) is that ADHDers often have quite poor fine motor control. Dopamine is useful for motor control and we don’t have enough of it. I spend a lot of time getting very frustrated because I drop things and can’t do minor stuff like get things out of my bag without consciously thinking about how my fingers and arms should move, or stuff goes everywhere. It’s really frustrating. Confounding factor: ASD people often also have this problem, and Ehlers-Danlos makes proprioception (body awareness) really hard as well.
On Vyvanse, so far, my fine motor control is improved. I make a lot less typos when it’s in effect. That would be a measurable test. I can manipulate objects with greater ease. And, thanks to the emotional effect, when I do mess up, I don’t get nearly so frustrated.
Maybe I should take up knitting.
So: as my specialist explained to me, anxiety makes ADHD worse, and ADHD makes anxiety worse, and the whole thing is a horrible feedback loop. One of the long term goals with the medication is to break that feedback loop and to ease some of that long term anxiety (the aspects of it that aren’t hard-wired or due to other causes, that is).
I have a lot of anxiety about getting things done, forgetting things, being on time, letting people down, etc. And on Vyvanse, I’m a lot calmer. I can focus. I’m clear-headed. That much-anticipated quiet in my head is really there. It’s not 100%. As I said, I think my dose is too low. I still get a lot of soap bubbles, and some of them pop before I can get to them, but I don’t feel the same urgency to get to all of them as quickly as possible.
I can manage my life and not freak out about how I’m failing to manage my life.
In conclusion: the meds are great. They help. They don’t make me high. They make me a lot more functional. But there are some problems: the crash is unpleasant, they don’t last long enough, and I think the dose is too low. Still, those problems can be resolved or mediated without too much trouble, and I’m optimistic.
Watch this space.