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.
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