Antidepressant + ADHD meds are messing me up. Help!

[botehboz96]

I was diagnosed with ADHD after getting a very high score on quotient testing. I also have been diagnosed with a unspecified mood disorder.

With regards to ADHD: My thoughts are always going at a thousand miles an hour, and most of the time I don't realize it. I obsessively ruminate ALOT and I have serious issues with getting distracted and procrastinating. Even reading is really difficult for me, since I will lose track of where I am in the middle of a sentence and end up having to reread numerous times before I understand what I just read. I don't even try to study at the library or in public anymore because the slightest whisper or footstep completely pulls my attention away from whatever I'm trying to work on. I'm always cramming for exams (because the only time I can actually focus is when I'm stressed as hell, pulling an all nighter,) and I am always turning in assignments at the last minute or late. (Surprisingly though, I have a pretty good GPA (3.5+) (and I'm a neurobiology major)) I don't know how I have kept myself going, I have a good memory, so trying to memorize an OChem/BioChem reaction or pathway the night before a test takes very little effort for me.

With regard to my mood disorder (Pre-Treatment): I seemed to have depression with some mixed features or rapid cycling, but neither the depressive nor the manic symptoms met all of the DSM criteria. For example, I would have really low energy and couldn't get out of bed, but at the same time I would have a crazy sex drive.  I would be irritable but I could only think about how much I hate myself. I had no motivation for anything ever. The weird thing for me is that when I feel sad, even just for a little bit, my sex drive goes through the roof. It's like I act out to make myself feel better.

So currently I'm diagnosed with an unspecified mood disorder. Wellbutrin keeps me from having negative thoughts about myself, but also prevents me from acting out in seemingly-manic ways. Pre-treatment, I had no structure in my life, I couldn't get out of bed in the morning, my sleep schedule was all screwed up, I hated myself, I was constantly ruminating about negative stuff, and I would start acting out uncontrollably with no regard for any consequences (usually after a day of feeling sorry for myself). While on Wellbutrin, I still ruminate and my thoughts still go a thousand miles an hour, but I have a good structure going, I get 8 hours of sleep every night, I am motivated to do well and pursue my goals, my self image is a lot better than it used to be (not really in a grandiose kind of way) and I am content with my life. My self control is amazing and I stay away from all of the unholy activities I used to partake in. They're not even on my mind. (Weird: Wellbutrin kills my sex drive, thank God) On the Wellbutrin, I was still having ADHD symptoms like lack of focus and racing thoughts, but my life was much more structured and I felt a million times better. I don't think this is a hypomania, because I feel normal and less crappy. Personally, I think I have some form of atypical depression, with ADHD, or ADHD and some OCD tendencies (since I have a lot of obsessive thoughts).

I started taking Vyvanse at 30mg 6 weeks ago. At the time, I was also taking Wellbutrin and Lamictal (I have definitely had issues with depressive mood swings.) The first two weeks of the medication were amazing. Not only was I in a wonderful (almost euphoric) mood, but more importantly, I was also getting all of my homework and studies taken care. For the first time in my life, I was able to cross everything off my to-do list. However, during the afternoon the medication would wear off and I would lose focus and feel kinda crappy.

After two weeks I told my doctor that I didn't think I needed the Wellbutrin anymore (since Vyvanse was already increasing Dopamine levels), so he took me off of it. I also told him about the crash in the middle of the day, and he prescribed Adderall at 10mg IR, to be taken in the afternoons. He also increased the Vyvanse dosage to 40mg. During the next week, I started exhibiting the behaviors that I associate with my depressive symptoms. However, since the Vyvanse makes me lose touch with reality, to some extent, and slows my thoughts significantly, I wasn't really aware of it. My doctor told me I could play around with the doses and see what works for me, since he would be seeing me in two weeks. I started to try different doses of Vyvanse and Adderall, starting at 10mg Vyvanse and going up to 50mg, and starting at 5mg Adderall (IR) and increasing to 10, at most, 4x a day. All of these medications seemed to increase my depressive symptoms, and since I wasn't really retaining much or cognizant of how I was doing, I ended up going three weeks without touching my homework, going to class or talking to my friends. I created a spreadsheet to track my symptoms, and I became so absorbed in it that I had no regard for anything else that I needed to do. It's like I knew that I needed to do it, but I was so determined to finish whatever I wanted to work on, that I didn't really care to do my homework. I was losing sleep, not eating, not leaving my apartment, missing classes, appointments for days at a time. I kept thinking to myself that maybe the dose wasn't high enough so I tried (systematically) to increase my doses (see above). After two weeks, I asked my doctor to prescribe Concerta instead. It made my thoughts race even more, and also made me super emotional/irritable, with pretty severe mood swings. I only took it twice because of that.

I find that when I take lower doses of Vyvanse (10mg), overall it seems to work better than the higher doses. I definitely don't focus as well as with the higher doses, and I don't retain as much information as baseline/wellbutrin-stabilized. The lower doses also don't seem to last as long as the higher doses. I maybe get 4 to 5 hours of benefit from taking the medication, and after that period, I have really bad rebound symptoms and become very anxious, even slightly dysphoric. The Adderall 10mg IR lasts for max 2 hours (after dosing).

I'm back on the Wellbutrin again, so I'm going to class and doing my homework, but I still don't know what to do. It seems, also, that I respond well to Adderall, however, the crash from adderall is sometimes a little more difficult to deal with than the vyvanse crash. Adderall, at lower doses, doesn't seem to make me lose track of time as much or become so focused that I lose track of everything around me, at least not to the extent that vyvanse does. I was thinking that maybe the mixture of D and L enantiomers in Adderall works better in my body than the 100% D enantiomer in vyvanse. (neuropharmacology was my favorite class ever so I know a little bit about this stuff.)

The first two weeks of Vyvanse let me take care of my priorities efficiently and without any procrastination. Additionally, it shut up my racing thoughts, which was such a relief. The crash was kind of rough, and sometimes I would feel like I wasn't really retaining much of the information presented in my lectures, but overall it was a blessing.


TLDR: Vyvanse + Wellbutrin was the best combination of medications; however, Vyvanse without an antidepressant kills my motivation and makes me so focused I don't care about anything else/lose track of time. Do you think this medication is right for me?

I'm back on Wellbutrin again, and my current plan is to go off of the ADHD meds all together, and wait for my body to stabilize on the Wellbutrin. I then hope to titrate my doses using Adderall, Evekeo, and vyvanse, to see if a wellbutrin-stabilized version of myself responds to those medications. I'm hesitant to try methylphenidate because of the bad experience, but I'm open to suggestions.

All ideas are welcome! Thanks so much. :)

[Paxiled]

There are no experts here, but here's my two cents worth.   ADHD is one of the most over-diagnosed disorders out there.  So are mood disorders such as bipolar 2 that are really just the way a particular person manifests depression.  So I would make sure your psychiatrist or neurologist is a really good one and not just a general doc who doesn't specialize in either these conditions or in these meds.  The second thing I notice is everything you've been put on is extremely stimulating.  Wellbutrin is the most stimulating antidepressant out there and you've added speed to it.  A lot of people suffering from depression do well on this kind of thing, but anxiety sufferers don't and it can cause anxiety and racing thoughts, so if you don't have ADHD but have this as a symptom of depression then you may be reinforcing the racing thoughts part of your disorder.  I have no idea if this is happening, but your description sounds like it is something to look into.  It's also odd that you got a lowered sex drive by taking wellbutrin -- it's known for the opposite effect, as it's often used for people who get sexual disinterest from taking an ssri or snri.  It's very possible as well that the wellbutrin, which seems to have worked pretty well for you in general with some hitches, might be stimulating enough all by itself so you don't need the speed, which is causing you the downturns when it wears off as speed does.  The snri class of antidepressants might also be worth considering for the same reason -- they target serotonin but also target norepinephrine, which is essentially part of adrenaline, so you might get a good kick out of that as well.  Those drugs are much harder to stop taking than wellbutrin, however.  So is speed.  But the first thing I'd want to do, as I said, is see an appropriate specialist if you haven't already done so to make sure the diagnosis is accurate.  I'd also get into therapy if you've never done so and see if there isn't a way you can work your way out of this or help the drugs work better if you still need them.  And again, no experts on here, just folks who have problems and most of us probably don't have what you're describing but hopefully some do.  Peace.

[Paxiled]

Oh, and procrastinating to create a high-stress environment isn't unusual -- doing things at the last minute seldom produces the best work but it often produces work that looks really good to those who judge us, which pretty much describes school.  The adrenaline kicks in, which gives us a natural boost, and when there's no time to think about things, humans focus better.  Again, in the practical world this often produces shoddy work in the long run but humans aren't great long-term thinkers.  That's why stuff fails so often.