@vixanic said in The ADD/ADHD Thread (cont'd from Peeves):
So, I guess this is the thread to say that as of last week, I have a formal diagnosis for ADHD. I'm starting new medication tomorrow - Elvanse, the active ingredient of which is lisdexamfetamine dimesylate, an amfetamine. (Edit: I am told it is called Vyvanse in the US)
Does anyone else have experience with this drug or a similar one, for ADHD treatment? Any advice, anectodal evidence of how it helps, etc?
Congrats on your diagnosis. I'm in the same boat as you and know how powerful that can be. It's also a lot to process, especially starting out on the medication ... good luck.
When you first start out on Elvanse (or any ADHD medication), you're going to be given a relatively low dosage, typically 20mg or 30mg, and it'll then be gradually increased by your psychiatrist depending on what you report back to them. With this in mind, here are my tips:
- Report back to your psychiatrist as instructed and be completely honest with them. Unlike many other types of psychiatric medication (e.g. antidepressants), the effects of stimulants like Elvanse should be apparent the day you take them. If a few hours after taking it you still don't feel anything, or if the difference is only subtle, it isn't working and you probably need a higher dose.
- Don't increase your dose without first discussing it with your psychiatrist. There's a reason they take you up a little at a time; there's a sweet spot for how much you need for it to be optimally effective, and taking too much, resulting in excess dopamine, actually has the opposite effect of what you're probably trying to achieve.
- Don't give up hope and don't despair if it doesn't seem to be working as expected. (I speak both from experience of feeling this way and from talking to other friends who've recently gone through the same journey.) Just trust your psychiatrist and communicate. It takes time to find the right dose and they'll adjust until you get there, but you will get there.
- The max dose for Elvanse is 70mg. Your doctor will probably take you up/down around 10mg at a time as needed. Typically what will happen is that every time you go up a dose, you'll feel better, and then your brain will gradually adjust to that dose until it no longer works. Then your doc will take you up again, until you reach a stable dose where the effects no longer seem to be decreasing over time.
- If the dose is too high, you'll feel high. And honestly this is an amazing feeling, I thoroughly enjoyed it until it wore off. (And it will wear off so don't get too attached to it.) When the dose is just right, you won't feel high but you'll just feel like a normal adult who can do normal adult things without it being difficult. Other than that no one in your life should be able to tell you're "on drugs" because you'll just seem like a normal person, more normal than you have been previously. I know people who take a very negative view of amphetamines (because it's commonly abused by normies as a "study drug") and they're surprised when I inform them that I take them, since I don't act like the people they've encountered who were using it without a legitimate diagnosis.
For me, 30mg did nothing. Two days later my doc boosted me to 45mg (instructing me to split the capsules and take 1.5 instead of just 1). On 45mg I felt high for 2 days which was cool and fun, then it wore off and stopped working again. I got boosted to 50mg which worked pretty well. I told my psychiatrist it was working but that the effects were subtle (though still good) at which point he took me up to 60mg. This is currently my stable dose, with a few other caveats:
- Elvanse decreases your appetite and you're going to want to eat less. This is exciting if you're trying to lose weight, especially since ADHD is often comorbid with obesity and binge-eating disorder; if you're anything like me, food is one of the few things that gives you a dopamine boost normally, which makes you think about and crave it all the time, and that goes away when you're on stimulants. That said: don't get carried away, 'cause I did, and it was not a good time. If you aren't getting enough calories, all the ADHD meds in the world aren't going to help you focus. It's OK to use Elvanse to help you lose weight and reduce calorie intake, but make sure you're making time for breakfast and dinner before/after the effects are felt. Maintain your physical health; your mental health absolutely depends on it.
- No idea what your biological sex is, but female sex hormones have a profound effect on dopamine levels, and therefore also the efficacy of ADHD medication. It's very common for the effects to fluctuate depending on which point of your cycle you're on. If female, I recommend using a fertility tracking app if you don't have one already and trying to schedule your productivity around that. Additionally I'd recommend insisting on either a female psychiatrist or at least one whose online profile lists "ADHD in women" as part of their specialisation. You will also want to do your own research on the topic because the institutional bias against women & female bodies in medicine means many doctors simply aren't informed/educated about these nuances. I've had to take a very active role in understanding my own healthcare needs to ensure that they're met. If you're AFAB and suspect you may have an endocrine/fertility condition in addition (such as PCOS, endometriosis, menopause, perimenopause, a history of hysterectomy, or are on hormonal birth control) I highly recommend seeking out a female endocrinologist in addition to seeing a psychiatrist for ADHD. Controlling/tracking your sex hormones is absolutely key to managing & treating ADHD for AFAB individuals.
- Elvanse is a slow-release stimulant. I recommend tracking the times you take it, the times you start to feel an effect, and the times when you start to feel it leaving your system. For me, it takes about 2 hours to kick in and lasts for 8 hours after that, but I've noticed my metabolism of the medication differs throughout my menstrual cycle and has slightly increased over time. Therefore I notice a sort of "bell curve" effect throughout the day, giving me about 2 hours of peak productivity and a slight decrease before/after that. I communicated this to my psychiatrist and was prescribed a quick-release stimulant (dexamfetamine) in addition to the Elvanse to help ensure I'm still functional in the morning and evening when the effects of Elvanse are greatly lessened. I take up to 2 doses (sometimes 0) of this throughout the day depending on whether I actually need it. (E.g., Do I have important tasks to accomplish? Am I liable to forget my keys when I leave the house if I don't take it this morning?) Typically that would mean one in the morning with the Elvanse, and one in the afternoon without.
- It's OK and even good to take breaks from the medication now and then. I find having a rest day or two per week helps ensure I'm able to relax and unwind more since the medication increases my productivity to such an extent that I will genuinely forget to goof off and have hobbies, which are still necessary for optimal mental health. On those rest days I'll also increase my normal calorie intake to ensure I'm not overdoing the weight loss or compromising my body's basic functioning.
- Taking Elvanse with or without food will modify its effects to some extent. In particular fat intake can dull the bell-curve effect mentioned, and ensure you experience a slower, more sustained release of the medication. Too much fat can dull the effects to the point where you won't feel it at all, too little will cause it to be absorbed too quickly and create a sharp/abrupt productivity peak followed by a crash straight after. Once you're on a stable dosage you should experiment a little with the optimal amount of food to take with the medication. Elvanse will be fully absorbed into your system 20 minutes after you've taken it, so you'll want to eat any food intended to aid absorption either right before or during that window. My doctor recommended a light breakfast; I found a heavy one worked better, since being vegan my diet's lower in fat/calories than most people's is regardless.
- If you wake up really late, don't take the medication that day. It'll keep you up and you won't be able to sleep. If it interferes with your sleep regardless you may want to talk to your doc about some sort of nightly sleep aid in addition, e.g. I take Trazodone and have done so historically for insomnia, even prior to being prescribed Elvanse. (Though I needed it that much more after.)
- Because amphetamines are a Class II controlled substance in the UK, and because many people do abuse amphetamines without a diagnosis/prescription, doctors are often reluctant with how much they prescribe, to whom and when. You may need to prove to your psychiatrist through consistent communication and adherence to their instructions that you can be trusted. Elvanse is considered a medication with a low abuse potential due to its gradual release mechanism; this is why it tends to be the first line of treatment offered for new patients in the UK and why you're unlikely to be offered a quick-release version upfront. If you feel like you need a quick-release medication like dexamfetamine, just be patient and give it a few months of trial/error/discussion with your psychiatrist. It's unlikely to be offered until you seem to be on a relatively stable dosage of Elvanse and have enough experiences to draw on.
I realise that was a lot but I hope it helps. It all would've certainly helped me when I first started taking the medication, and a few friends of mine on a similar journey have reported the same.
I'm UK-based. (London specifically.) If the above helps and you want someone to chat to about specific doctor recommendations in that area or just experiences with Elvanse that your psychiatrist doesn't have the time for, feel free to drop me a private message.
Unfortunately, getting seen on the NHS is difficult to the point of feeling practically impossible (especially for adults, especially for women ...) and private psychiatrists are overbooked, overcharging, and provide too little time. There's a gap in this country right now between the available knowledge/expertise on ADHD and the amount of people currently realising they need help for it.
Good luck.
