Yeah, they're tough. I get all used to not working, and then it is hard to get back into the grind. Gotta keep working on these good habits.
Still on 30mg Vyvanse + some amount of Dexedrine. 5mg hasn't worked out super well for me the last couple of days. That could just be because I spent more that 5 days on just the Vyvanse while taking a break from work. I guess we'll have to see.
Friday, December 31, 2010
Tuesday, December 21, 2010
30mg Vyvanse + 5mg Dexedrine
7.5mg Dexedrine messes with my sleep. At least, it does if I take three 2.5mg doses around 9, 11:15, and 2:30. The result felt very similar to 50mg Vyvanse; I could get to sleep without too much difficulty, but I would wake up several times from 1am to 5am and never really feel like I got solidly back to sleep.
7.5mg Dexedrine is ~17.5mg Vyvanse, so from a total dosage point of view this is not so surprising. The Dexedrine is only supposed to last ~4 hours per dose, though, unlike the Vyvanse. The point of using them together was to have the Vyvanse provide a smooth base dose over the entire day, while using Dexedrine for a short-term boost just during work hours. Emphasis on short-term. There is absolutely no reason why the extra Dex should still be hanging around at 1am. Thanks, crazy metabolism.
Still, I didn't really feel like the extra Dex was giving me a big boost during the day. If anything, I felt a little jittery. Combine that with the sleep problems and it was time to drop back down a little.
What I am trying now is actually to do the first two doses in the 7.5mg schedule, and just leave off the third. If the amphetamines really are sticking around for longer than they should, then dosing early should be the way to go. I've tried this for a couple of days now, and it feels good.
As always, the highly variable nature of my work (particularly the fact that is is often quite challenging) makes it difficult to assess how much help the meds are giving me. One thing is very clear though: I do not need caffeine anymore.
I used to really need to use caffeine to stop getting drowsy at my desk, even when I had plenty of sleep. It wasn't a caffeine withdrawal problem just mistaken for drowsiness either; I have plenty of experience with caffeine and I always used it very, well, technically. I know how much to take, when to take it, and I know when I'm getting withdrawal symptoms. I didn't take that much (1 Starbucks "grande" brewed coffee sipped over the entire day), since the research shows that chronic high caffeine use will quickly cause significant tolerance and dependence. I even cut my dose back on weekends by enough to kill any built-up dependence while avoiding significant withdrawal symptoms. I was a caffeine boss.
Regardless, I could be clean of caffeine for well over a week, have gotten 8+ hours of sleep a night for several nights, and I'd still have trouble keeping my eyes open at more that just a couple of points during the day. I know now that this was likely an ADHD symptom. My brain was getting worn out from focusing and couldn't keep up the effort. I used caffeine as an over-the-espresso-bar-counter medication for it. I don't have to do that now, at all, so the meds are helping, and they are helping in a more consistent way. Heck, I've been grumpy and/or jittery many, many more times due to bad caffeine dose choices than I've experienced during all this messing around stimulant medication.
Maybe part of the reason I didn't notice as much of a huge change as I'd expected on the meds is I was doing a good job self-medicating with caffeine? I don't know.
What I am sure of, though, is that 30mg of Vyvanse alone is more than sufficient for my weekends. That's one thing I really like about using Vyvanse and Dexedrine tabs together. On the weekends I don't have to worry about carrying around the Dex and dosing at the right time. There are no worries about feeling grumpy or losing sleep. 30mg of Vyvanse is absolutely fabulous from that point of view. I've never felt even a twinge of extra grumpiness when using it, and most of the time I feel calmer, more relaxed, and more patient.
So hats off to Vyvanse for that, I guess, even if it does crazily stick around in my system for 12 hours longer than it is supposed to. Silly Vyvanse, I can't stay mad at you.
7.5mg Dexedrine is ~17.5mg Vyvanse, so from a total dosage point of view this is not so surprising. The Dexedrine is only supposed to last ~4 hours per dose, though, unlike the Vyvanse. The point of using them together was to have the Vyvanse provide a smooth base dose over the entire day, while using Dexedrine for a short-term boost just during work hours. Emphasis on short-term. There is absolutely no reason why the extra Dex should still be hanging around at 1am. Thanks, crazy metabolism.
Still, I didn't really feel like the extra Dex was giving me a big boost during the day. If anything, I felt a little jittery. Combine that with the sleep problems and it was time to drop back down a little.
What I am trying now is actually to do the first two doses in the 7.5mg schedule, and just leave off the third. If the amphetamines really are sticking around for longer than they should, then dosing early should be the way to go. I've tried this for a couple of days now, and it feels good.
As always, the highly variable nature of my work (particularly the fact that is is often quite challenging) makes it difficult to assess how much help the meds are giving me. One thing is very clear though: I do not need caffeine anymore.
I used to really need to use caffeine to stop getting drowsy at my desk, even when I had plenty of sleep. It wasn't a caffeine withdrawal problem just mistaken for drowsiness either; I have plenty of experience with caffeine and I always used it very, well, technically. I know how much to take, when to take it, and I know when I'm getting withdrawal symptoms. I didn't take that much (1 Starbucks "grande" brewed coffee sipped over the entire day), since the research shows that chronic high caffeine use will quickly cause significant tolerance and dependence. I even cut my dose back on weekends by enough to kill any built-up dependence while avoiding significant withdrawal symptoms. I was a caffeine boss.
Regardless, I could be clean of caffeine for well over a week, have gotten 8+ hours of sleep a night for several nights, and I'd still have trouble keeping my eyes open at more that just a couple of points during the day. I know now that this was likely an ADHD symptom. My brain was getting worn out from focusing and couldn't keep up the effort. I used caffeine as an over-the-espresso-bar-counter medication for it. I don't have to do that now, at all, so the meds are helping, and they are helping in a more consistent way. Heck, I've been grumpy and/or jittery many, many more times due to bad caffeine dose choices than I've experienced during all this messing around stimulant medication.
Maybe part of the reason I didn't notice as much of a huge change as I'd expected on the meds is I was doing a good job self-medicating with caffeine? I don't know.
What I am sure of, though, is that 30mg of Vyvanse alone is more than sufficient for my weekends. That's one thing I really like about using Vyvanse and Dexedrine tabs together. On the weekends I don't have to worry about carrying around the Dex and dosing at the right time. There are no worries about feeling grumpy or losing sleep. 30mg of Vyvanse is absolutely fabulous from that point of view. I've never felt even a twinge of extra grumpiness when using it, and most of the time I feel calmer, more relaxed, and more patient.
So hats off to Vyvanse for that, I guess, even if it does crazily stick around in my system for 12 hours longer than it is supposed to. Silly Vyvanse, I can't stay mad at you.
Monday, December 13, 2010
30mg Vyvanse + 7.5mg Dexedrine Sulphate
It's not going great, but it's not going badly. It's a little hard to tell because I've been very busy lately and had more and more strident stressors than usual. I've also been at one of those difficult points where I'm between tasks and have to do a bunch of assessment, organization, and record-keeping so I and the people I work with know what to do next.
One of the most difficult things about being at that sort of point, I now realize, is that I end up having to face up to what I have not accomplished or done well. I appear to have a very unfortunate self-image still stuck in my head that does not allow me to make certain kinds of mistakes and remain a competent and worthwhile person. It turns a straightforward, useful assessment process into a walk through the forest of why-I-suck. I hope that this insight into myself will help me do better at this kind of thing!
The Vyvanse alone isn't doing enough for me, but that is not really a surprise. The problem is taking the right amount of dex tabs at the right time so I get positive effects without a "down" later on. Still working on that.
I am concerned that I am developing a tolerance to the dexamphetamine in general, but there is no way to tell in the short term. I'll just have to track it. One of the ways I would be able to tell is decreased positive effects during the day and increased negative effects when coming off in the evening. The busyness and stress are making it hard to assess both.
One of the most difficult things about being at that sort of point, I now realize, is that I end up having to face up to what I have not accomplished or done well. I appear to have a very unfortunate self-image still stuck in my head that does not allow me to make certain kinds of mistakes and remain a competent and worthwhile person. It turns a straightforward, useful assessment process into a walk through the forest of why-I-suck. I hope that this insight into myself will help me do better at this kind of thing!
The Vyvanse alone isn't doing enough for me, but that is not really a surprise. The problem is taking the right amount of dex tabs at the right time so I get positive effects without a "down" later on. Still working on that.
I am concerned that I am developing a tolerance to the dexamphetamine in general, but there is no way to tell in the short term. I'll just have to track it. One of the ways I would be able to tell is decreased positive effects during the day and increased negative effects when coming off in the evening. The busyness and stress are making it hard to assess both.
Wednesday, December 8, 2010
30mg Vyvanse, again
Ugh. What a difference a few days makes. A few hours, actually, since things kind of fell apart on Sunday night, less than 12 hours after the last post.
I'd noticed a bit of irritability in the evenings on the Spansules during the week. I didn't take it too seriously, as short-term side effects are not unusual after changing doses or medications. I'd also noticed, with a little more alarm, some difficulty maintaining an erection around the same time. Again, I was willing to wait it out and see if there was really a long-term pattern.
Well, those things came together to make one big unacceptable problem on Sunday. Suffice it to say that my grumpy, anxious self made a nice wreck out of the end of the day. I had a horrible night, and I spent the morning lying in bed contemplating my own worthlessness until I couldn't delay getting up any longer.
Luckily, I did manage to get up and take my dose. An hour later, back in my right mind, I called my doctor and said I had to back off to 30mg of Vyvanse. That's the last problem-free dose I was on, and I have to get back to problem-free before I can seriously consider another experiment. I accept that this is a fundamentally experimental process, I really do. I just refuse to jump from problem to problem. I have to make sure I have a stable baseline of experience to compare with.
My doctor suggested that amphetamine may just not be my drug (his turn of phrase), and that we should consider trying methylphenidate (Ritalin) or atomoxetine (Strattera). I'm not ruling that out, but I don't think I should jump there from a crisis if I can avoid it.
In any case, it is clear that Spansules were definitely not my thing. Not only did I have negative side-effects, I didn't feel like I was getting the level of positive effects that I experienced on 30mg or 40mg of Vyvanse. This is surprising, since 20mg of Spansules is pharmacologically equivalent to 50mg of Vyvanse. I guess more amphetamine is not what I need.
So, back to 30mg Vyvanse for me. In addition to the 30mg of Vyvanse, though, I also have a bunch of 5mg dexamphetamine sulphate tablets. My deal with my doctor is that I'm going to try splitting those into 2.5mg halves and spreading 2 and then maybe 3 of them over my work day. My hope is that the smooth base of medication from the Vyvanse will prevent an evening "crash" without causing insomnia, and the tablets will let me play around with a bit of a higher dose during the day.
The best I've felt this whole time was when I was on 40mg of Vyvanse with a 5mg dexadrine tab at noon, but even on 40mg I remember feeling like I was sleeping a little too lightly and wasn't tired enough in the mornings. I think it is worth trying 30mg of Vyvanse as the base and seeing if I can't get back to the same level of positive effects by augmenting with the 5mg tabs.
I have to keep remembering that my goal is to get just enough help to be happy. I can't shoot for feeling awesomely focused all the time, or I'm likely to end up chasing that goal into riskier meds and doses than I'm really comfortable with. I'm getting a sense now, though, for how this process can take you in that direction. It is so tempting to just try a little more medication. Then when you get the negative symptoms, you get the offer to fix it with another medication, or a different medication. Going back to less seems like a step backwards, a concession, a defeat.
Well, I don't see it that way. Going back to a known good state is the only way to recover the stability necessary to make a good decision on your next steps. Maybe I'm just lucky that my unmedicated state was already not too shabby. If I was coming to meds with my life falling apart, I can see how it would be a much harder decision to back off in that direction again.
I'd noticed a bit of irritability in the evenings on the Spansules during the week. I didn't take it too seriously, as short-term side effects are not unusual after changing doses or medications. I'd also noticed, with a little more alarm, some difficulty maintaining an erection around the same time. Again, I was willing to wait it out and see if there was really a long-term pattern.
Well, those things came together to make one big unacceptable problem on Sunday. Suffice it to say that my grumpy, anxious self made a nice wreck out of the end of the day. I had a horrible night, and I spent the morning lying in bed contemplating my own worthlessness until I couldn't delay getting up any longer.
Luckily, I did manage to get up and take my dose. An hour later, back in my right mind, I called my doctor and said I had to back off to 30mg of Vyvanse. That's the last problem-free dose I was on, and I have to get back to problem-free before I can seriously consider another experiment. I accept that this is a fundamentally experimental process, I really do. I just refuse to jump from problem to problem. I have to make sure I have a stable baseline of experience to compare with.
My doctor suggested that amphetamine may just not be my drug (his turn of phrase), and that we should consider trying methylphenidate (Ritalin) or atomoxetine (Strattera). I'm not ruling that out, but I don't think I should jump there from a crisis if I can avoid it.
In any case, it is clear that Spansules were definitely not my thing. Not only did I have negative side-effects, I didn't feel like I was getting the level of positive effects that I experienced on 30mg or 40mg of Vyvanse. This is surprising, since 20mg of Spansules is pharmacologically equivalent to 50mg of Vyvanse. I guess more amphetamine is not what I need.
So, back to 30mg Vyvanse for me. In addition to the 30mg of Vyvanse, though, I also have a bunch of 5mg dexamphetamine sulphate tablets. My deal with my doctor is that I'm going to try splitting those into 2.5mg halves and spreading 2 and then maybe 3 of them over my work day. My hope is that the smooth base of medication from the Vyvanse will prevent an evening "crash" without causing insomnia, and the tablets will let me play around with a bit of a higher dose during the day.
The best I've felt this whole time was when I was on 40mg of Vyvanse with a 5mg dexadrine tab at noon, but even on 40mg I remember feeling like I was sleeping a little too lightly and wasn't tired enough in the mornings. I think it is worth trying 30mg of Vyvanse as the base and seeing if I can't get back to the same level of positive effects by augmenting with the 5mg tabs.
I have to keep remembering that my goal is to get just enough help to be happy. I can't shoot for feeling awesomely focused all the time, or I'm likely to end up chasing that goal into riskier meds and doses than I'm really comfortable with. I'm getting a sense now, though, for how this process can take you in that direction. It is so tempting to just try a little more medication. Then when you get the negative symptoms, you get the offer to fix it with another medication, or a different medication. Going back to less seems like a step backwards, a concession, a defeat.
Well, I don't see it that way. Going back to a known good state is the only way to recover the stability necessary to make a good decision on your next steps. Maybe I'm just lucky that my unmedicated state was already not too shabby. If I was coming to meds with my life falling apart, I can see how it would be a much harder decision to back off in that direction again.
Sunday, December 5, 2010
20mg Dexedrine Spansules...
Wow, the last couple of weeks have been a blur. 50mg Vyvanse worked fine without the 5mg Dexedrine, except for one thing: I couldn't sleep through the night. I could get to sleep well enough, but I would wake up several times during the night. Each time it would take a long time to get back to sleep.
Most telling of all, for me, was that I couldn't even manage to get a half-hour of sleep at the end of the night, around the time I usually get up. This is also the time I usually take my dose. I was too alert to sleep even 24 hours after taking the Vyvanse, even after barely sleeping that night. It was clear to me then that the Vyvanse must be sticking around in my system for way too long. In retrospect, this fit with my experience on Vyvanse from the very beginning. When I started on 30mg, exactly the same thing happened. I'd sleep for maybe 4 hours, and then pop out of bed effortlessly.
My doctor doesn't have any particular explanation for this. It is possible he thinks I'm just imagining the whole thing. I couldn't find much information on why it might be happening, other than some stuff about acidic diets speeding up the metabolism/elimination process, and basic or acid-neutralizing diets doing the opposite. My diet happens to not include many acidic items, so maybe that is it.
I got fed up with not sleeping on a Friday when I would not have an opportunity to talk to my doctor, so I just dropped down to a left-over 40mg Vyvanse for that day, and then went to 30mg for the weekend. No problems sleeping at all on the 30mg. Felt a little blurry around the edges dropping down to 30 that quickly, but nothing serious.
On Monday my doctor recommended trying Dexedrine Spansules as they are not supposed to last as long as Vyvanse. The mechanism for releasing the drug over time is also less complicated than Vyvanse, so it is less likely that something odd about my metabolism would cause it to last longer than usual. So far this has worked out well. I am not having difficulty sleeping, and I wake up in the morning feeling more like my usual non-medicated self; that is, I don't want to get out of bed.
I think I've been on the meds long enough to say that they are having a positive effect for sure. I think that the Spansules are not quite as potent as the Vyvanse was yet, so I may have to go up to 30mg. We'll see. My experience on Vyvanse indicates that I may have been receiving a higher, longer dose of medicine than most people would on the same intake, so it may take a larger-than-expected dose of Spansules to produce an equivalent positive effect.
Most telling of all, for me, was that I couldn't even manage to get a half-hour of sleep at the end of the night, around the time I usually get up. This is also the time I usually take my dose. I was too alert to sleep even 24 hours after taking the Vyvanse, even after barely sleeping that night. It was clear to me then that the Vyvanse must be sticking around in my system for way too long. In retrospect, this fit with my experience on Vyvanse from the very beginning. When I started on 30mg, exactly the same thing happened. I'd sleep for maybe 4 hours, and then pop out of bed effortlessly.
My doctor doesn't have any particular explanation for this. It is possible he thinks I'm just imagining the whole thing. I couldn't find much information on why it might be happening, other than some stuff about acidic diets speeding up the metabolism/elimination process, and basic or acid-neutralizing diets doing the opposite. My diet happens to not include many acidic items, so maybe that is it.
I got fed up with not sleeping on a Friday when I would not have an opportunity to talk to my doctor, so I just dropped down to a left-over 40mg Vyvanse for that day, and then went to 30mg for the weekend. No problems sleeping at all on the 30mg. Felt a little blurry around the edges dropping down to 30 that quickly, but nothing serious.
On Monday my doctor recommended trying Dexedrine Spansules as they are not supposed to last as long as Vyvanse. The mechanism for releasing the drug over time is also less complicated than Vyvanse, so it is less likely that something odd about my metabolism would cause it to last longer than usual. So far this has worked out well. I am not having difficulty sleeping, and I wake up in the morning feeling more like my usual non-medicated self; that is, I don't want to get out of bed.
I think I've been on the meds long enough to say that they are having a positive effect for sure. I think that the Spansules are not quite as potent as the Vyvanse was yet, so I may have to go up to 30mg. We'll see. My experience on Vyvanse indicates that I may have been receiving a higher, longer dose of medicine than most people would on the same intake, so it may take a larger-than-expected dose of Spansules to produce an equivalent positive effect.
Subscribe to:
Posts (Atom)