Question: Hi, I'm an adult with ADHD (Inattentive Type). I've been prescribed 50mg of Vyvanse. The effect of the medication on my ADHD symptoms is wonderful, but the medication causes anxiety that I've never before experienced. The physical symptoms of the anxiety are particularly unpleasant, especially the rapid heartbeat. I have been opening the Vyvanse capsule in order to titrate the dosage -- I dissolve slightly more than half of the medication in water and take it in the morning. That helps the anxiety but only a little. My father, a retired physician, gave me a beta blocker the other day and I found the combination of both the Vyvanse and the beta to be perfect. I still had the benefits of the Vyvanse for my inattention but none of the anxiety. I've made an appointment with my primary care doctor to discuss the possibility of adding a beta bocker to my arsenal of medication, but I'm reading a lot about how beta blockers interact with stimulant medication. How would you recommend broaching the topic? Is my situation a common one? Do people often combine beta blockers with stimulant medication?

One last question -- I've always had trouble sleeping, which has gotten worse in my 30s. Though Vyvanse certainly exacerbates my insomnia, it's not the cause of it. I try to take occasional breaks from Vyvanse and the effect on my sleep is not very different--I have trouble sleeping regardless. My trouble is falling asleep. Once I fall asleep, I tend to stay asleep. I'm thinking of asking my doctor if I can try Rozerem, which doesn't seem habit-forming.

For the record, I DO try to exercise most days (yoga or cardio) and try not to take a computer to bed with me.

If it helps, I'm 5' tall and weigh about 105 pounds. I don't smoke and rarely drink alcohol (I might drink a single beer once a month or so).

I take fish oil supplements and Vitamin D3 every day.

Before my adhd diagnosis, I did not take any prescription drugs and I am a little concerned that stimulant medication has opened the door to the need for other prescription drugs. I'm also aware of just how much Vyvanse has helped me too, so I'm reluctant to go off of it.

Dear Dr. Sheppe,

Thank you so much for your response. I will definitely talk to my doctor about getting a prescription of carvediol and perhaps a lower dose of Vyvanse.

In regards to sleep medication, I should have mentioned this before. I have tried Melatonin to no effect. I tried taking two 3mg pills and it really did nothing for me. At various times, I have tried Advil PM and Benadryl. Both usually work, but both make it very difficult to wake up in the morning and I feel fuzzy and dizzy for much of the following day. That's when they work. Advil PM works most of the time but not always and after one or two nights on Benadryl it appears my body habituates to it and it ceases to help me sleep.

One last piece of information: Last December, I was so desperate for sleep that I took one of my fiance's Klonopin tablets (he takes .5mg of Klonopin for his RLS). It worked so well that I took it two more times. Last week I found myself desperate for sleep again and I swiped his Tylenol with Codeine (leftover from a back surgery earlier last year). I took it five nights in a row. With both those medications, I fell asleep gently, slept more deeply than I have in years, and awoke 7-8 hours later feeling refreshed and alert. I can't tell you how much I enjoyed the effects of a restorative sleep!

The problem is that I'm VERY hesitant to take either one of those medications regularly for my sleep issues. Everything I read suggests that they're high-powered and habit-forming. However, I'm wondering if their positive effect on my sleep lends some clue as to what the right sleep aid might be for me? For most of my life, I've considered myself sensitive to medication and I was raised by a physician father who preferred sleepless nights to the dangers of narcotic sleep medications. Why is it that something presumably gentle, like Melatonin, has no effect on me and that OTC drugs, like Advil PM and Benadryl, either have no effect or an unhelpful effect (it's hardly worth the sleep if I'm too dizzy to be functional the next day) while narcotics, like Klonopin and Tylenol with Codeine, seem to have the most helpful and most gentle effect on my sleep?

Is there something out there that can help me fall asleep and wake up refreshed that's NOT a narcotic?

Thank you again for your very helpful and considered response to my previous questions, Dr. Sheppe. I look forward to your reply.

Best,
XXXX


Lastly, please understand that I'm well aware of the dangers of taking medication that was not prescribed to me and don't intend to do it again. I'm sure you have to tell your patients that all the time and I just wanted to get that out of the way!