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7 hours ago, sming said:

Thanks so much again man! I've been gently pushing for dexedrine without much luck. As per my post just now though, I'm not sure my brain is respecting stims any more, devastatingly. I bumped my Abilify from 5 to 7.5mg yesterday so I just have to pray (to no God - I'm atheist) that does something positive

I've found that Abilify increases the effect of my stimulant.

7 hours ago, sming said:

I might see if I can chuck in Lexapro to get some stability since right now I'm an aggressive, despondent mess :/

SSRIs or any serotonergic medication theoretically can decrease the effect of stimulants since there's in inverse relationship between serotonin and dopamine in the brain. But, if you are having increased negative affect, you need what you need!

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7 hours ago, sming said:

Hi guys, 

thanks so much for all the input on Vyvanse and its brethren and apologies for not keeping up - I've been in a bad way. Unfortunately this topic is moot now since Vyvanse seems to have completely pooped out on me. Since Saturday, these changes have happened:

  • Emotional balance -> erratic, negative emotions. Anger, depression, aggression, despondency.
  • Generally OK mood -> deep, dark depression. That horrible empty feeling in your gut.
  • Interested in things, hobbies etc. -> deep anhedonia & staring at the wall for hours.
  • Energy and feeling alert -> spontaneously falling asleep.
  • Positive outlook -> can't see anything but doom & suicide.

This is my MO when I find a med/combo that helps it would seem. I get 2-6 weeks of benefit, then an abrupt crash back to the pits of depression. I've tried adding on 10mg or 20mg of Ritalin but that just makes me fall asleep faster and for longer. I may try the magnesium taurate & the Inositol at some point but it looks like the very mechanism of Vyvanse (and Concerta) has flipped on my brain. Increasing via supplements just feels the wrong direction.

Now, I have to admit that I've had very, very bad pain since Saturday (I have chronic back & abdominal pain) however I don't know if that's contributing to the crash or because of it.

Either way I'm seeing my PDoc sooner rather than later if this continues once my pain has let up (hopefully soon) since I'll be out of a job at this rate. Looking through mood spreadsheets, I did quite well on Lexapro (weirdly, for someone with TRD) and Bupropion years back. I might add Lexapro for some stability, take a break from stims and have another go with them.

Thanks again and good luck to all,

Pete

Sorry to hear this! I hate when this happens.

Adding the Ritalin would actually counteract the efficacy of the Vyvanse, but I think that's a moot point because, as you said, the Vyvasne isn't working anyway.

Have you tried Adderall XR, since your pdoc doesn't seem to want to try Dexedrine? Or have you tried just the Concerta, and increasing the dose to 54 mg or even 72 mg?

You could try that in addition to the Lexapro, but I wouldn't try a stimulant with bupropion. Some people take stims with bupropion and do well, but personally I felt like the bupropion "undid" the effects of the stims rather than potentiating them. But I would implore you, however, to try what you want to try!

I wish you all the best, and I hope you find something that works!

Also, there are always the MAOIs, including Emsam (selegiline, which metabolizes to L-amphetamine and L-methamphetamine), and Parnate (tranylcypromine, which is a substituted amphetamine), both of which are very stimulating. Before you start an SSRI and would have to do a washout, you could try an MAOI. (Stims are safe with MAOIs contrary to classical contraindications... stims are used somewhat frequently concomitantly with MAOIs to potentiate each other.)

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I'm now on the best combo I have ever been, and that spans decades. I tried several extended release formulations plus a PM IR booster. My doc suggested we switch to an IR based 3 times a day method. I get 3 30 mg pills a day taken in any way I would like to. 2 in the morning and then whenever I want. Or not. Or divide the three pills evenly. I find myself going back and forth from doing 2 pills or 3 pills a day. My needs vary so my dosage needs to, too. 

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