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ADHD Insights: Prozac, Paxil and Amphetamines

Bill Russell acts like Prozac and PaxilADHD Challenges: Depression Medications Block The Amphetamine Trajectory

Prozac and Paxil significantly, similar to Bill Russell in this picture, block the metabolism, the breakdown, the effective use of amphetamine products like Vyvanse, Adderall, and Dexedrine. If you don’t know that simple fact you can either:

  1. remain irritable and nasty for years
  2. give up ADHD or depression treatment altogether
  3. add more inappropriate meds on top
  4. find yourself “diagnosed” with bipolar illness
  5. become even more depressed

…. to name but a few.

Specific details are discussed in this sister video on the relevance of CYP 450/2D6 for those who really want to know exactly how… at this CorePsych Blog from yesterday.

Remember This: Understanding liver function explains ADHD Treatment HOW, while label/diagnosis chasing is simply pursuing ADHD WHAT.

See this 3:34m video for more ADHD medications with Prozac and Paxil details:

 

To see the connection between brain science and common sense: evidence matters.

See the link below on “Drugs hurt my kids” to see the absolute relevance of this video. Then drop a note below to weigh in on these important oversights.

cp

Ref: This link to the first drug interaction reference [at Drugs.com] on a simple Google search for Paxil and Adderall. Also see the links just below in Related articles

 

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67 Comments
  1. Dr Parker,

    I enjoy learning from site and I have one of your books. I’m a 40 y/o woman who is a new grad RN starting my first nursing position. I am currently being treated by a psychiatrist for inattentive ADHD and depression/anxiety. I’m on prozac 40 mg daily and 5mg of Adderall BID. My problem is that even that small amount of adderall ramps my anxiety up at times to an unmanageable level. I have long felt that the Prozac and the adderall are not “playing well in the sandbox” together or that the prozac is no longer controlling my anxiety as well as in the past. During my last visit, I asked my Dr to consider a different SSRI but her solution was to add PRN Xanax for times of increased anxiety. I refuse to take Xanax when working, for a host of reasons. I’m in the dilemma of being a new nurse with ADHD on a busy hospital floor where the stimulant gives much needed focus but also increases my anxiety too much. I’m passionate about patient care and want to be a safe & effective nurse. Do you think a different SSRI would be more beneficial with the stimulant?

    • Jenn in TX:
      I do significantly disagree w your doc and will be posting another article on this interaction. My best guess: Xanax won’t be necessary after changing the SSRI. If it is, then you’re wearing a metabolic problem that creates accumulation anyway. Could be 2D6, could be immunity issues. See this playlist for your medical consideration: ADHD Meds Problems – Mind and Gut: http://bit.ly/mindgut – and – On Learning from the PM drop: http://www.corepsych.com/stimulantdropinfo
      cp

  2. Hi Dr. Parker. My son is 11 and has a dx of PDD-NOS. He presents as severe ADHD – swinging from zoned out/foggy to periods of hyperactivity (almost manic). He’s been on Prozac for a few years, because there has been some research about Prozac reducing perseverations in kids on the spectrum, and it helped tremendously with that.

    We had tried stimulant meds 4 years ago (Vyvanse) to try to help with focus and impulsivity, and it was a train wreck. He was really anxious, teary, and it didn’t help at all. So we stopped.

    Then this spring, his attention/focus was such a struggle for him, we went back to the Psychiatrist and she recommended we try Vyvanse again. She was thinking that since he was older, and also on a mood rx, that it might help this time, and it was a GREAT med for him. His impulsivity went way down, he was less teary/emotional, he was much more engaged in the world around him, and he was much more able to focus and participate in school.

    Now he’s been on it for a few months, and it seems to have stopped working. He’s more irritable, has periods of almost manic behavior, he’s much more impulsive again, and it seems to not be helping his attention/focus at all – when he does his summer workbooks each morning. Hmmm.

    So I started Googling, and came across your site and this info, and I’m wondering if his issues are from the drug interaction/buildup from Prozac/Vyvanse.

    As background, I have a history of depression and the med that’s worked best for me is Wellbutrin. Right now I’m on a low dose. I was dx years ago with ADHD-Inattentive type, so I took Adderall XR for years, but am not on it now.

    I would love to know your suggestions. I’ve contacted the doctor to discuss and am just waiting for their opinion/suggestions. My son had a hard evening last night with my in-laws where his “engine” was just really running high and they had a hard time managing him – like he wasn’t in control of himself – and that’s very old behavior that’s recently come back. The Vyvanse was SUCH a huge help – I’m disappointed it’s not working now the way it did before. I’d love to get this figured out before school starts back in late August.

    Thanks!

    • K,
      First: Any PDD-NOS child/person, in my medical opinion, should receive testing for biomedical contributions. See this pdf for suggestions and links: http://corepsych.com/tests14 – See also this video series to further amplify on the need for bringing immunity into the discussion: http://corepsych.com/immunity-playlist. I’m opinionated not because I’ve read an esteemed author and agree, but am opinionated because of the many times in my life I overlooked these issues based on my own innocence and the years we had no technology to measure imbalances.

      In future years such testing will become standard of care. Now because of the pervasive innocence and denial regarding these advances in neurobiology many still await confirmation from academicians who refuse to look at those measures – bias rules. Your question drives directly to the point of why I spend time communicating with others at CorePsych.

      Second: To the point of your comment/question. The possibility that an interaction occurs between Prozac and Vyvanse is over 90%. Prozac may reduce perseverations, but so can other SSRIs. Until you see his neurobiology, the data your team will continue to speculate. Not a problem – just inefficient. My mission is to increase medical awareness on these important matters and help my colleagues become first become aware of basic biomedical issues like drug interactions, then move, as I have, to measurements and precise intervention strategies. The strong possibility that your son would improve simply discontinuing Prozac and replacing with another SSRI is over 80% in my experience.

      We can provide those tests for you long distance if you wish to contact Desiree at http://corepsych.com/services – as the pdf indicates: all FDA approved, just not in common practice. – Whoever you consult: data matters.
      cp

  3. If you are taking Vyvanse, and need to take an SSRI for depression/anxiety, which ones would you recommend? (obviously not Paxil or Prozac)
    For example, what about Zoloft, Luvox, Celexa, and Lexapro? Will any one of these work fine with Vyvanse or would you recommend one over another?

    • Ann,
      All of those are relatively clean.
      cp

      • I been taking 60mgs of IR Adderall for 2yrs now, plus 20mgs of Prozac. I ask my doctor about the combo and he simply put it ‘how do you feel” I told never better I run 6 day’s a week my BPa is strangely low for a person consuming 60mgs of Adderall everyday. My Doc said its due to my running vigorous 6 day’s a week, Which he is a little against me running at that pace (10 minute mile)in the Florida heat to boot. He just told me try to run after 4 to 5hrs from your first dose.. But I feel like superman, 1 hour after my morning dose. My resting pulse is 48 beats a minute along with a BP OF 108/56 right when I wake up. After 1 hour of taking a 30mg in the morning, my BP goes to 115/62, pulse 65 max..So in terms of Adderall effecting your heart its not accurate. If you have a history of heart and B problems, Hereditary that’s different.. I’m 50yrs old also and if was not for ADDERALL I WOULD BE DEAD OR IN PRISON NO QUESTIONS ABOUT IT..People who dog Adderall are hurting people with a real ADD Problem.. My mother had me on Ritalin at 7 yrs. old. If I stayed on it I would of been a CEO OF A COMPANY. When I focus I’m literally a Genius. I’m not bragging just letting people know that the drug for someone like me is a Miracle. I went from being a bellman in hotels to a successful stock broker. Its funny my father was reading in the wall street journal one day a article about stock brokers. IT said: Kids WHO HAVE ADD Become excellent Stock brokers. This article was after I got my series seven license which by the way I could never pass in a million years if was not for Adderall, not because it makes you smarter but I could sit down and focus and study for once in my life. I just wish it started when I was in my 20s rather than 48yrs of age…

        • Joe,
          Glad that combo is working for you. Do watch for agitation and irritation. If you don’t take it on the weekends you are intuitively solving the problem of accumulation of AMP. Your success is what we see in spite of inane media negatives who don’t interview folks like you, but interview and report on problems that do occur with uninformed medication strategies – far too common and underappreciated.
          cp

          • Thank you Dr.Parker for the quick response.. Also myself and family are concerned on your findings concerning the Prozac Adderall combo that I have been taking for 2yrs now. I’m 50yrs old now but I really don’t see me coming off Adderall.. I think for someone like me it would be CA strophic at this point in my life. My question is: Will this great effect continue 10yrs from now as long as I continue to follow my psychiatrist directions? Or will the combo of Prozac and Adderall catch up with me eventually and start to down slide and god knows what else? Like you were saying its not Lethal but there is a good chance I could go sour. AS in Paranoia, afraid to talk to people etc? Actually my only complaint up to now is I feel a bit paranoid when I’m out, not like my life is threatened but more like I feel people are staring at me for some reason. My wife has notice this in last few months. I do not want to tell my Doctor for the reason he might take me off Adderall.. I will admit if I did not know that my pills will be there when I wake up in the morning I would go into a deep depression. A bit scary. I do not abuse the drug at all. My doctor told me right out if he finds out your abusing Adderall he will drop as a patient. There signs in his office when you go into the waiting room.. He has dropped people on account on abusing Adderall.

          • Joe,
            Again, can’t be sure, but the culprit in this combo, with hundreds of folks observed over about 17 years: the Prozac can make you paranoid because it blows a person out the top on the drug interaction, and looks like too much Adderall but the Prozac is most often the problem. Why not ask to change to Effexor XR and keep the Adderall – My wager: all will be well.
            cp

          • Dr Parker, I will be going to my doctor soon. I have been with him 15yrs so basically if I want to try something new so I can see the results he has no problem swapping one antidepressant to another.. Do you feel that discontinuing Prozac and trying Lexapro would be a good switch? Or is there another SSRI OR ANY other Antidep.you would favor? I’m currently on 60mgs of IR Adderall and 20mgs of Prozac.. Lately I have been a bit more paranoid out and about for the last 3-4 months.

          • Joe,
            Discuss w your doc: Prozac has almost no discontinuation… have seen only one case w it, so they could switch to Lexapro 10 if they are ok w it. Should not have a dip, if you do, give it a few days to settle, and do 20. Anticipate that it might take 7-10 to get more symptom free past the Prozac.
            Best,
            cp

  4. I take 20mg paxil and have every day for 11 years now. I feel fine with no depression anxiety or anything for past 10 years. I’ve tried to get off it many times even though I don’t have any side effects from it that I’m aware of. Even cutting a quarter off a pill every other day after 2 weeks I still get dizzy, brain zapping feeling, sadness which I never have ordinarily.

    I have had add since a child and still lack attention. So I am taking 30mg vyvanse only 2 days a week as a trial. Does your theory still apply if vyvanse is used only 2 days. Does it still build up issues you were reffering to. So far I have mixed opinions on it. It helps my focus quite a bit. But when it wears off I become slightly anxious sleepless and uptite.

    • Pablo,
      Sorry to sound defensive, it’s not a theory, it works that way! ;-)

      Your best bet: talk to your doc and absolutely get another antidepressant. Try Venlafaxine ER 75mg? w his approval. It will have the same discontinuation symptoms but won’t make you feel stoned if you add Vyvanse – as no drug interaction. See this video on serotonin and dopamine to help get it: http://youtu.be/Wsj219F9M2Q

      Then watch this video playlist to answer your questions about taking meds together: http://www.corepsych.com/stimulantdropinfo
      It is likely that you need both meds,
      cp

      • Thank you for your insight. Also for donating your time and thought into all of the great info you provide.

        I did watch the videos you linked in the comments. It seems that my paxil can make ADD worse. Or vyvanse could make depression anxiety worse.

        Could it be as simple as I successfully get off the paxil and my attention span increases and I have no need for vyvanse either.

        I am somewhat hesitant to change depressants due to having no depression anxiety what so ever any more. Plus I don’t know if I will have withdrawals from paxil while starting the other depression med. I Honestly I have been on paxil 20mg so long I don’t know what it feels like to not be on it. My life, work, family, is great. But… I have always felt a sort of cheesecloth drapped over me and hindering my focus on external stimuli. Could this be the paxil? I will say that caffeine helps me alot. If that tells you anything at all.

        ” If your only tool is a hammer. Everything looks like a nail”

        • I will add that for me I have always had ADD Even in grade school. It eventually led to the anxiety and depression. Whether it was the paxil or time itself I’m healed of all but the cheesecloth feeling.

          My math wasn’t right either. I started paxil,at age 16. I am now 31. 20mg every day religiously. 15 years its been. Wow.

          Anyways this will be my last comment/question so thank you in advance.

          • P,
            Well this note seals the deal, – your history makes a serious difference, and makes my suggestion about the meds close to exact. Now you have to see if metabolic challenges create probs when you do the meds as I suggested w your doc.
            cp

        • Pablo,
          The more details without clear back and forth in the office or in consult, the closer I get to pure speculation. I’m sticking to my guns… add a clean [2D6] antidepressant with your docs orders on top of the paxil, taper the paxil while on the other med, after off the paxil, then go w the vyvanse and you should be good to go. Paxil is down-regulating for sure based on your symptoms. Yes to both observations in that first sentence.
          Your clarity on Vyvanse is all I have to go on, and that is not sufficient to say anything.
          cp

      • Dr.Parker, I saw my psychiatrist and he ask me why do want to switch antidepressants if your doing fine on the Prozac, Adderall combo that you been taking for the last 2yrs? I did not go into the medical underline issue of Why’ but he said to me like he always does “quit reading what’s on the internet” you will drive yourself nuts..I told him to go to the website “Core psych” and go to ADHD Insights: Prozac, Paxil and amphetamines. He obliged and I was on my way. The good thing is if I want to try Lexapro or just something different my Doctor has problem with that. He considerers my age (50) and the dose of Adderall I’m taking,60mgs a day of IR. He keeps me on that max, dose because of my history of Ekgs, my Bp cholesterols all in Tip Top. I run 6 day’s a week is another reason. He has actually said to me in his 30yrs of practice, not many people on 60mgs of Adderall everyday have a Bp of 110/63 and pulse at 62 beats a minute (In the morning my pulse is 48 beats a min.) in the height of the drug effectiveness. He told me you have “Runner’s Heart” I told him my father’s, father is still alive at 99yrs old and my mother’s father is alive at 97yrs old. My great grandpa died at 102yrs old on my father’s side.There is no one in my entire family with heart or BP problems..Hereditary play’s a big part in the cardio system according to my family physician and heart specialists.

        • Joe,
          Completely understand your doc, have heard his response many times, but stay with the literature and my own personal experience. BP is not the marker on toxic, cognitive abundance and emotional volatility are ubiquitous, commonplace – but often subtle. You have to look for it, and when you do, it teaches how to ask about that Top of the Therapeutic Window.

          Sounds like your heart is cooking well. The next issue: how’s your head, your cognitive and emotional state? ;-)
          cp

  5. Hello Dr. Charles Parker,
    I cannot tell you how excited I was to watch your video! It gives me so much hope. My doctor prescribed me 40 mg of prozac, 2 to 3 mg of Ativan for depression and anxiety. He then added dextrostat for add. I had never felt less depressed and more focused then when I first started the dextrostat. I was finally going to be myself. About a week into the dextrostat I noticed it did not seem to be working, as a matter of fact, I felt the opposite. So my dose was upped to 1/2 mg a day from 1/4. Again, it helped for a couple of days and on it went. I was devastated. I knew that whatever the dextrostat was doing was what my body needed. It was like turning on a lightbulb. I as more focused, felt feelings again, motivation etc… I feel like your diagnosis of the interactions could be the answer for me. I am going to ask my doctor if I can switch back to the Celexa I was previously on and take that with dextrostat or vyvanse.
    Thank you so much,
    Tina McCall

    • Tina,
      It’s very likely Celexa will correct the problem, it’s clean on 2D6. Then if you can take Vyvanse that is the very best because you don’t have to mess w compliance and dosing thru the day every darn day!

      Great! Do keep me posted, and a long distance high five to your doc if they can work w you.
      cp

  6. Dr.Parker, you are truly a life saver.

    I live in Paraguay, and I was thinking of suicide because I couldn’t deal with this anymore. I’ve been on fluoxetine 20mg forever, I’ve been dealing with depression since I was 16, I’m 41 now, my first diagnose was Atypical Depression (hypersomnia, over-eating, low energy,rejection-sensitivity), then ADD and depression so I had fluoxetine and metilfenidate 20mg xr once a day(worked for a couple of hours the horrible comedowns, I would become extremely irritable, moody, I would cry for no reason..), then fluoxetine and modafinil 200mg once a day, again worked for a couple of hours and then the comedowns, fatigue, even fever..

    The thing is, in Paraguay the only meds for ADD/ADHD are metilfenidate and modafinil. We don’t have anything else. I’ve lived in NY for a while and Adderall was far better than any of the other meds.. but came back here and there’s just to meds like that.. (Adderall, Vyvanse, nothing)

    So looking for something like that, I realized that we had Fenproporex (Perphoxene) available here, so I asked my doc to try that. I started with 30mg then 60mg once a day, along with my usual 20mg of fluoxetine. The first months I felt great, I could get things done, great focus, some insomnia though.. then I started feeling ALL the things you mention in this article: I felt irritable and nasty, became even more depressed and dmy doc diagnosed me with bipolar illness!!

    So I stopped the fenproporex and continued with fluoxetine, plus lithium and alprazolam. The results? Sleeping all day, still horribly depressed, even quit my job (I’m a lawyer).. I have a son and I need to get a job back.. don’t know what to do..

    I’ve been researching and other nootropic meds available here are pemoline, citicoline, acetyl-L-carnitine, GABOB, GABA, citicoline, memantive and piracetam…

    I would love to move back to NY and get the right meds but it’s hard to get a green card (LOL!) So what are my options? Should I quit these meds and start again with fenproporex and escitalopram instead of fluoxetine?

    Thanks a lot in advance and sorry for my english!

    • Lissy,
      As a lawyer w an understanding of these matters there are two avenues:
      1. The big picture: Call the international team at Shire and become involved, they may have a job for you!
      2. Do get rid of the Prozac as it interacts w just about everything relevant to psych and medicine thru both 2D6 and 3A4, including female hormones and birth control coming up thru 3A4. Yes, the switch to escitalopram would be far better. I took a few min to look up the fenproporex and just as you suspected it is metabolized through both 2D6 and 3A4 – so Prozac blocks it even more completely: http://www.ncbi.nlm.nih.gov/pubmed/15294457

      You could also evaluate dopamine [DA] precursors and other possible impediments to efficient DA activity in your PFC thru urine. We could tailor make those recommendations thru CorePsych if you sent her an email thru corepsych.com/services. If you have any other metabolic issues we could do a Brief Chat also outlined on that same page to consider further review.

      Hope this helps! Your Engilsh is absolutely not a problem!
      cp

  7. So ive been reading on here and I saw that you said that prozac can lengthen the time it takes to metabolize amphetamines. Is this why I have to keep upping my doses of vyvanse to have similar effects? Does it cause the brain to down regulate to dopamine? If so I was thinking about stopping the vyvanse for a month or two to kind of help my body reset and also I would switch back to lexapro because the combo of lexapro and vyvanse seemed to be much more effective. Any thoughts would be great!

    • Bennett,
      Your body isn’t undergoing a “reset” – it is, quite simply detoxing from AMP. When you accumulate AMP you go out the top of the Therapeutic Window, you get worse and look more ADHD. Executive Function diminishes and you can emotionally deteriorate as well w depression, sleep, irritation, and look bipolar. Lexapro is one of my top choices for an appropriate alternative antidepressant that’s clean on 2D6. See this video series to get the dose and Window right: http://bit.ly/dosevids

      That simple change should solve your probs for years,
      Best,
      cp

      • Thank you for the quick reply! I was just wondering if taking a break would help lowering the tolerance in a sense or would just switching to lexapro be enough of a change? The main benefit from vyvanse is the increase in motivation which oddly enough I would get from lower doses like 30mg where if I took 70mg it would actually do the opposite and cause me to be extremely unmotivated and just kind of zombie like

        • Bennett,
          Usually a person is clear in 1-2 days unless toxic. Far better to dial it in correctly in the first place, then leave it. If that Therapeutic Window moves around it simply indicates that the underlying metabolic problems remain active and contributory to treatment failure. Yes, zombie is too much.
          cp

          • Thank you for the replies! Much appreciated, and ive read that grapefruit juice can interact with amphetamines. Is this because it also affects 2D6?

          • No Bennett, it the acid juice that interferes w passage thru the gastric mucosa. Same w orange juice. Not a prob for Vyvanse which is cleft from it’s prodrug form in red blood cells of all things.
            cp

  8. Dear Dr.Parker,

    I have read your book and it was really a revelation. Thank you so much for everything you are putting out to this world!

    I have a question about my ADHD. I am a picky eater, underweight and weigh only 116 pounds at the age of 24 with a height of 5’7. I always had ADHD but I also suffer from depression. I am also called the biggest procrastinator in the world by my friends and family. About 3 years ago, I was at the peak of my depression where I was sleeping 16 hours a day. The doctor had me on 100 mg of Zoloft after trying me on Prozac (which I later found was way too much for me), 300 mg of Wellbutrin and 36 mg of Concerta. I felt bad on them so I went off all medications and allowed myself to heal naturally with time. I felt better without the medications as well.

    In the beginning of this year however, I have been much better on depression and was sleeping about 10 hours a day. I thought it may be because of inattentive ADHD and after reading your book, I decided to talk to my doctor about getting Vyvanse because I was absolutely certain that I had Thinking ADHD. He prescribed me 30mg and it was too much because I started having heart palpitations shortly along with being extremely overwhelmed and overfocused. My sleeping improved and I was sleeping 7 hours a day though. However my social skills decreased dramatically and I was anxious in meeting anyone. I also felt like I was feeling depressed again.

    The doctor decided to reduce it to 20mg and I still felt it was too much for me as I was overwhelmed so I titrated it to 10mg and while it gives me focus, I still felt depressed and my sleeping increased to 10 hours a day. So he added Zoloft 25mg with it and it made me sleep even longer where I was sleeping like 14 hours a day and felt tired through out the day. He stopped that after a month and now he added Wellbutrin SR 150 mg along with my 10mg of Vyvanse.

    This has been the best combo so far (even though I feel like my working memory hasn’t been the best since I started Wellbutrin) but even with that, I feel overwhelmed when I take Vyvanse but unfocused when I don’t take it at all and only have the Wellbutrin working at the background.

    My doctor says that I have an avoidant personality, told me to stop Vyvanse and do therapy and even though I have been doing therapy for 3 months, it really isn’t fully helping me be effective as I could be in terms of focus, organization and productivity. I can never keep to a schedule! On the other hand, it’s got me back my social confidence and my dating skills skyrocketed to the roof by being just on Wellbutrin SR and I feel less depressed. I am very confused on what I should do right now and wanted to see how you would deal with a situation like this.

    • Sepand,

      1. The First Rule of psych meds for ADHD: no cookie cutter solutions – so I have no pat answers.
      2. The very close Second Rule: When you’re chasing your tail in the woods and stim meds never work predictably, and you have the overall significant negative reaction to even low dose stimulants, both MPH and AMP, you absolutely should look more deeply into metabolic causality. Your body is messing with your meds.

      I don’t know about your gut, your skin, your respiratory system, but those are the next questions with gut always first, the easiest, most obvious marker. See these Two playlists at http://youtube.com/drcharlesparkerADHD Mind and Gut, and ADHD Milk and Wheat Immunity. They are # 3 & 4 on the list from the top when you go to ‘Playlists.’ Those videos explain details I can’t cover in this comment.

      And BTW, picky eaters always have metabolic problems… the only logical step according to Galileo in ~ 1600:

      Measure what is measurable, and make measurable what is not so.

      If you wish to consult we can tell you much more if you schedule a detailed hour at http://corepsych.com/services

      Best to you and yours for a relaxing Holiday!
      cp

  9. My 10yo son has been treated for ADHD for years with various stimulants. Although his symptoms improved remarkably when he took Vyvanse, it had to be discontinued because it gave him headaches. Adderall and Ritalin did not helped him but, his teachers say that he is attentive,… on Concerta. However, I have yet to observe any improvement in his distractiblility/hyperactivity on weekends, etc.. when on Concerta. Can you recommend another alternative medication that will help reduce his symptoms. Thank you for your help

    • Michael,
      Some have success w Adderall XR even when Vyvanse proves a challenge. Always look for metabolic imbalances with headaches and a big drop in the PM when the Vyvanse, or any stim, wears off.
      cp

  10. Hi Dr. Charles Parker,

    Thank you so much for the wealth of information that you are bringing to us patients about this confusing world of stimulant medication, both online and in your book (which I bought this past summer).

    I burn through Vyvanse at an alarming rate! 50mg doesn’t reach full effect for two hours, then it only lasts for two hours,if that!(Two hours of symptom coverage). To maintain coverage,I need to dose with 25mg (after the initial 50mg) every TWO HOURS! And that doesn’t always work.
    During the comedown I get horrible migraines almost everytime if I’m not careful with hydration,sleep and blood sugar levels.

    I’m currently taking escitalopram (10mg at night) as well.
    Do you think that changing to Prozac might slow up the metabolizing of the Vyvanse a bit or would you advise completely staying away from it?

    My doctor in the past had me on an extremely high dose of amphetamine products: 250mg of Vyvanse plus an additional 90mg of Adderall (3x30mg spread over the day). I still burn through it but the headaches are worse.

    My doctor doesn’t know what to do. Now he is just following my suggestions.
    I’m trying Modafinil right now (400mg)but it doesn’t do much.

    What do you think I should do at this point?

    • Mike,
      To add Prozac at this point will likely continue the symptom chase rather than seek the underlying causality – a far more important adventure. Yes, some would recommend your suggestion for the obvious reason that it does inhibit metabolism and cause accumulation, but your metabolic rate [a key indicator of underlying problems] is already far out of sorts, so why add problems to an already corrupted metabolic system?

      Yours is a clear, frequently found challenge, and deserves several data inquiries:
      1. You could look at CYP 450 2D6 polymorphisms to see if your is an uncommon ultra-rapid metabolizer genetically. Genova Labs, Genomind, for example.
      2. More to the point, less costly, and far more informative would be immune testing w Cyrex, specifically Array 3 to start for all the subsets of gluten challenge – see the several recent posts here on Cyrex, and the video training on my YouTube Playlist page that addresses this testing:
      http://bit.ly/mawimmun
      3. Before that you may wish to consider this playlist to understand your further self exploration: http://bit.ly/mindgut

      Hope this helps,

      PS: If I can help call Desiree at Services here: We consult on these matters anywhere.
      cp

      • Hi Dr. Charles Parker,

        Wow! Thank you for the quick reply! And thank you so much for your suggestions! Now I have some direction.
        I’ve been playing around with Vyvanse, Adderall xr, Dexedrine Spansules and Concerta for about three years. All I seem to get is side effects.
        Vyvanse by far has been the most consistent but still, it only seems to work for a couple of hours, then I start to feel lousy.
        My symptoms (without any stimulants) is basically fatigue and boredom. Absolutely no stimulation from anything, except maybe Megan Fox (LOL!).Trouble following conversations and constantly daydreaming, mostly about my symptoms.This is with 10mg of escitalopram as well. I know a lot of the fatigue is from the SSRI.
        When I take a low dose of Vyvanse, say 30mg in the AM (with a high protein breakfast,of course), I start to feel really lazy, worse than without the stimulant. Then after a few hours, I will start to feel irritable and headachey.
        If I bring the dose higher, say around 70mg, then I will feel some motivation and energy from it after about 1.5 hrs. I am also in a pretty decent mood.(I’ve had depression for so long that I don’t know if this decent mood is “feeling normal” or if this is the “high”).This effect will last for about 1.5hrs, then I start dropping off quite rapidly, feeling really irritable, don’t want to talk to anyone and feeling headachey.
        At this point I have to eat a decent meal, drink a bunch of water, and take another smaller Vyvanse (say 30mg) and take it mellow or a wicked migraine will pounce! Sometimes I will get one even when I do everything above.
        Anyway, thanks again for your suggestions!I think it is great that you are spending the time to help us people that feel like treatment failures. You have a good heart!

        Mike

        • Thanks Mike,
          Sounds like you’re right on it!
          Best for the Holidays!
          cp

          • Hi Dr. Charles Parker

            So I visited my ADHD specialist today here in Vancouver, B.C.
            He asked “so how are you doing? ..better or worse?”
            I said that I’m having the same problem with Modafinil as I had with Vyvanse; worked for the first few days then became less and less effective. I’m at the max dose of 400mg and it works a little bit for a few hours then I’m back to feeling fatigued and bored.
            I brought your book along and suggested that I may have a sensitivity of some kind, either gluten, milk or something else and that it may be messing with my metabolism and that I should get an IgG test done.
            He flipped through the book a bit, handed it back to me and said “No, no I don’t buy it. There is no gluten sensitivity issue.”
            I thought “Huh?”. He is usually quite open minded. I think you have to be open minded when you run into a road block and don’t know what to do.
            At that point I said “well, okay.” (I didn’t want to irritate him. After all, it was 4:15 PM on a Friday and I could tell he wasn’t in the best mood.)
            I then suggested that maybe we raise the Modafinil if it is safe to do so since I was already at 400mg.
            He took out his reference book and checked; “800mg a day for narcolepsy…ok. He then looked at me suspiciously and said firmly, “I’m not prescribing this for you to get HIGH! I’m prescribing it for you to FUNCTION!”
            Another “huh?”. “Of course not!” I said. “I want to function! How can I expect to do that if I’m getting high?”
            “Just checking” he said.
            I was shocked that he would think that I’m getting high since he has been my doctor for several years and he knows that I take this illness seriously. I’ve never abused it in the past and don’t intend to. He knows that I have spent countless hours on the internet researching this illness.
            I think he just had a bad day. Or maybe he has ADHD himself and HIS Vyvanse was wearing off!(LOL!)
            In the end, I check my prescription before walking up to the counter at the pharmacy.”Vyvanse and Intuniv”. What?! We talked about taking Intuniv IF the Modafinil increase fails to work! He also forgot to write down the Cipralex!(Lexapro in US)
            It’s not the first time that he has made a mistake on my prescription, but that’s okay. After all, he is human too.

            Anyway Dr.Parker, this was an “interesting” appointment I thought I would share with you (lol!)If you have time, let me know your thoughts.

            Mike

          • Mike,
            His remarks clearly mark him as uninformed, opinionated based on group-think, and wrong on the gluten. On the Modaf: I agree w him in principle, he simply doesn’t know what to do with the Roving Therapeutic Window process – explained in this Tutorial on ADHD Med Dosing: http://bit.ly/dosevids

            He needs help on issues of metabolism, immunity and dosing strategies. No need to be shocked, he sounds like a slightly irritated guy w his back to the wall who hates being wrong and wants to get it right – an unhappy sample of stasis in the slowly evolving standard of care for ADHD.

            The larger question: how do we bring frustrated and well meaning docs into the next plateau of informed Executive Function Diagnosis and Treatment? For some quotes on that evolution that bear consideration: See this ADHD Quotes post.
            cp

  11. In the past I have been treated for anxiety with Zoloft Paxil lexapro Wellbutrin Xanax and now I am on Prozac. My doc says I am depressed and don’t know it, and that I have OCD and anxiety disorder. I have made a 3 page list on the symptoms that make everyday simple tasks seem like mountains. My 6 year old daughter has adhd and has been tested. How do I go about getting tested as an adult. I have struggled for years convinced the doctors may not be taking the correct route and I feel like I’m out of control of my own mental health. I want to fix the things that cause the anxiety attacks not just mask them with a smile.

    • Carla,
      As you know from reading this post Prozac is the very least favorite of antidepressants for those troubled by ADHD. Why? Because many experienced, peer reviewed authors have repeatedly recognized prefrontal cortical slowing is aggravated by Prozac far more than any other antidepressant – because it’s stored in brain fat – it accumulates to create ADHD even if you don’t have it. If you do, go figure.

      Get on the phone wherever you are and get a medical evaluation. Look at my ADHD Med Rules book, see the videos in this ADHD Tutorial playlist, or take tests anywhere on the Internet. Anxiety and OCD are the most frequently overlooked subsets of ADHD.
      cp
      PS: Looks from your email you might be a hair dresser… the group most responsible for changing the world through informed conversations!;-)

  12. What about mixing adderal, welbutrin and xanax. I was initially diagnosed with GAD and then ADD. Are there any interactions between these medications that I should be concerned with? I seem to be in a bit of a cognitive shut down. I was very creative and a problem solver……now I just can’t do any of that.

  13. I was diagnosed w/ adhd at young age but as I got older the symptoms were not bad enough for medication. I also suffer from severe anxiety/stress that can turn into full-blown panic attacks, for this I have been taking Xanax (1-2mg as needed only) for several years. To the point, I have lately been having severe problems focusing, concentrating, following through with things I need to get done, etc… it’s been almost three years since I have had these adhd/add issues now that I am an adult so my Dr. is convinced I am depressed and started me on a daily dose of 20mg Paxil. I have never taken SSRI’s before and the side effects started a few days after starting the Paxil and now I really do feel depressed. I am tired all of the time and my focusing and attention span are even worse than before. This Dr is new to me and I do not have health insurance so she was one of the only Dr’s in my area that accepts cash/self-pay patients so I may be stuck with her and she comes off as if it is “her way or the highway”. My next apt with her is wed 10.30.13 so I am trying to come up with a game plan. I feel my initial symptoms are synonymous with Adult ADHD/ADD and I am not depressed, plus my anxiety is well controlled with my current Xanax med. I feel she is going to try to give me another SSRI or anti-depressant when what I really need is an Adderall Rx. What would be the best way to approach her with these issues as not to tell her point blank that I think her diagnosis is wrong but…? Any advice will help & sorry for the long post. Thanks

  14. Dr. My daughter is 15 has ADHD/ADD and has been on Adderall RX 35 mg for several years. She began to have a lot of anxiety and her Dr. added Paroxetine 10mg for her daily. She is very petite for her age skin and bones.
    Recently she does not care about the way she looks when she goes to school. She used to dress up and ware some make-up she says her friends see a change in her. I am so worried the mom and I are divorced and the mom wants her on these meds I don’t. My daughter is not doing well at school and is depressed. In her own words she says she is “Out of it” and is struggling. Is there date to show these two drugs should not be used together?
    Thank you very much.

    • Arped,
      Paxil simply should not be used w Adderall ever. That’s the reason for this post. The standard of care currently does not publicize/report this interaction – but it’s prevalent nevertheless. Ask your doc to Google Paxil and Adderall or Paxil and Vyvanse and he/she can become informed. Best bet: ask for a change to Zoloft or Celexa if wanting to stay generic.
      cp

  15. Hello , Thank you so much for looking into my case in advance.
    Are there any issues ( as small as they can be) with combing Paxil (10mg) at night, and Amphetamine in the AM (10 mg). My doctor wants to me to increase Paxil to 20 mg after a week.
    here is some history!
    I have had anxieties mostly from taking exams, and also have had trouble focusing on studying specially in public areas. So for the anxiety last year i was put on Zoloft last year, that i couldn’t finish taking for more than 10 days, They say all the SSRI takes 4 weeks for it work. So I stopped. 6 months after ( now) the problem of both anxiety and difficulty in focusing still persist. I just feel that i have been very emotional person easily distracted by any sound or voice. So Just last 10 days i was put on Paxil for the anxiety part and Amphetamine 10mg for focusing. The doctor wanted me to start Paxil 1st week with 10 mg , then increase to 20. So i did the 1st week with 10 mg, it was already so powerful that messes with everything, the 1st week i experimented to see weather i should take at night or in the AM. Taking it in the AM was the worst choice so i started to take at bedtime last night was my 1st trial. Still was so hard to get out of bed feeling very drowsy, but once I tool the amphetamine i became more stabilized , awake and functioning. So my question is do u see any short or long term health problems with this combination? or do you suggest a better combination to treat both anxiety and focusing. Many thanks for your time and support.

  16. We live in NJ and are in Horizon HMO , do you have any recommendations for a Dr. for my daughter. She is 11 and her pediatrician is only treating for her Pink Tie appearance. He has never asked her about the effective time of her medication. I asked her about her bowel movements this week but he never asks anything other that checking blood pressure and weight. Olivia seems to have ODD with the Adhd but I do think part of her ODD is from the medication. She was on Vyvanse and Intuniv for over 2 years. It helped tremendously to get her on track but it is not as effective lately but he doesn’t even ask . When she went to the DR. this week that is when he talked to her and decided she was depressed and took her off the intuniv and put her on the prozac . That is what blew a big whistle because I don’t see her as depressed at all. As I have stated she told him also that she’s not depressed.My daughter says the medication works from 8:15(when she gets on the bus) till 3:45 when she comes home. Obviously it’s time to change Dr.s.

    • Patricia,
      An 8 hr DOE is the best you can get from Concerta, but without comorbid diagnoses it’s too short for Vyvanse. With Vyvanse we look, most often for a 10-12 Hr DOE.
      When comorbid diagnosis becomes a possibility it’s likely you do need a second opinion – the Prozac thing is very, very common as Lilly has done a great job of selling peds on the safety of the drug while avoiding the implications of 2D6. ODD can be related, by the way, to one of the 4 kinds of serotonin touchiness issues, one of them anger, that can be treated w SSRI meds if they are clean on 2D6.
      cp

    • Do give Desiree a call and set up a brief chat w me to help w next steps. http://corepsych.com/services
      cp

  17. I talked to my daughter, she insists that she is NOT depressed and that she simply is tired. I believe she may have issues with digestive problems and that the intuniv she was on was causing the build ip of the vyvanse because it was okay for a while but recently she can’t tolerate milk and other things she eats. Her Dr. has never tested for any of these issues but I have listened to all your videos and I suspect they are the root cause of her anxiety and feeling exhausted.

    • Patricia,
      Remain selective about IgG testing. I absolutely don’t use Lab Corps as they are helpful, but less precise and predictable, and if not covered are 10X the price of other groups like Great Plains.
      cp

  18. My daughter(age 11) was just diagnosed with depression after taking vyvanse and intuniv together for several years. The doctor just prescribed prozac.. I have major concerns..

    • Patricia,
      Often not a prob in the first few days, but will become a prob down the line. Please tactfully suggest that you simply don’t want to use Prozac, that you’ve read of interactions on the Package insert with 2D6 and you simply want a different med, like Zoloft which is clean on 2D6 and approved for that age range.
      cp

  19. Is Celexa a good combination with Vyvance. I take 60 mg of Vyvance and 60 of Celexa. I’m wondering about the combination.
    Linda Beth Smith

  20. I started out taking 90mg of Vyvanse for my ADHD and my Dr. thought I was depressed so he started me on 20mg of Prozac. I have been on Vyvanse 90mg for close to 2 and a half years and added the prozac probably about a year ago. I still feel depressed and I feel like its never going to get better. I feel lost and helpless. What should I suggest to my Dr. about these two medications?

    • Mike,

      Clearly the meds will inhibit full recover as there is clearly a drug interaction, often so subtle it’s misses but clearly creating significant cognitive and often affective challenges…. This video explains and references documented there for your doc. Best alternative Effexor XR or Venlafaxine ER depending on your doc’s recommendation.

      Prozac, Paxil and AMP Video: http://youtu.be/xB5dZd1ucdE
      Specifics about that Problematic CYP2D6 Pathway: http://youtu.be/nPBWgl5jFvw

      And watch for the Vyvanse to appear overdoses when the pathway is cleared – too much may rush in to that cleared pathway.
      cp

  21. This is very interesting. I am being treated for depression and ADHD. My psychiatrist just put me on Prozac 20 mg and Vyvanse, 50mg. I took the Prozac for about 3 days prior to initiating the Vyvanse. When I took the Vyvanse, my heart pounded harder and raced faster than I have ever experienced. This prompted me to check my BP. It was 150/105 and my pulse was 120. I checked it a few more times that day concerned I was having some type of reaction and the BP got as high as 154/114 and pulse got as high as 140. This lasted most of the day. Is this likely due to the drug interaction? I have taken Concerta 36 mg in the past with only slight increases in BP and pulse. I am considering taking half the dose of Vynanse and giving it another shot but probably will wait and ask my doctor first. Thanks for any feedback you have regarding this. You have some great info. here.

    • Joanna,
      Modifying the dosage only prolongs the agony – been there done that. My recommendation, for your doc’s consideration, be mindful and switch antidepressants to one clean on 2D6.
      cp

  22. what about the other ssri’s?

    • Lucianne,
      Cymbalta is fine at lower doses, – as I indicated Effexor and Pristiq are first choices in my practice if the side effect profile permits, and work very well long term with AMPs.
      cp

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