Tipping the Ever-So-Sensitive Dopamine Scales

Well, even 5 mg of Vyvanse was too much for Luke. His teacher said he was “climbing up the walls.” Stimulants are just not the thing for him. I suppose we could try a 2.5 mg dose, but I’m not sure how that would work. To give him 5 mg, we have to open a capsule and rather unscientifically knife the powder into two little piles. Could we divide up the one capsule into 4 piles—give him a few grains of powder a day? Not sure.

The amazing news is that Isabelle’s teacher said Isabelle was able to focus, participate, and complete all her work. She said the difference between Izzy with and without the Vyvanse was night and day.  I was really excited to hear that, and I must admit, a little bewildered. It had not seemed like Izzy had done well on the Vyvanse before. But as I thought about it, I wondered if Luke’s horrible days on Vyvanse had affected Izzy negatively so that we thought she wasn’t doing well either. Maybe since Luke was so aggressive, hitting, yelling, and teasing on those days, Izzy was just reacting to him. I was glad I had asked the teacher’s for their input because I’m not sure I would have ever realized that Izzy was benefiting from Vyvanse. Things get complicated when you are trying to figure out the best meds for two kids at the same time.

So we gave Izzy 5 mg of Vyvanse for a couple of days, and I started to notice that at about 3:30 in the afternoon, she was getting wild—I would say wilder than without any meds at all. It seemed that her medication was running out in the early pm. So the next day I gave her a 10 mg dose to see if it would last longer. It wore off at about 3:30 just as the 5 mg dose had. My pediatrician told me that although Vyvanse is supposed to last 12 hours, some kids need another small dose of stimulant after school. So at 3:30 I gave her another half dose (5 mg) of Vyvanse. That was bad. She was a tyrant. She was completely irrational and emotional. I felt awful for her. The things I am putting this little girl through. I immediately realized that was too much medication for her but what can you do? I wanted to magically remove it from her little body, but that was probably impossible short of having her stomach pumped. So Izzy had a rough day and on into the night. She did not fall asleep until about 3 am.

The next day, I went back to the half dose, 5 mg. I thought she better have some meds. I didn’t want her to go from having lots of meds in her body to having none and having withdrawal symptoms. But she must have still had a lot in her body, and she was exhausted. This was her worst day yet, and we were spending it on the lake with all our cousins. She screamed at everyone and everything. When she was being towed on a tube behind the boat, she screamed at her dad for going too fast. She climbed back into the boat calling him a “stegosaurus with a walnut brain, a six-headed monster, a freak, and the worst boat driver ever.” I hope we can laugh at that one day, but everyone was just trying to be patient with her. By late afternoon, the meds seemed to have balanced out, and she was having “an awesome day” and said my sister was “amazing.” Lucky dad was good and unflappable. At the end of the day, she did proceed to climb to the top of a 30-foot tree by the side of the lake where she waved in the flimsy topmost branches. I was cleaning out the boat and my niece said, “Do you see where Izzy is?” My husband went to get her, and of course, like a cat, she could get up but not down and cried as she climbed down, half-terrified, to my husband’s coaxing. I took a deep breath and reminded myself, “The meds can help her, not magically change all her difficult behaviors.”

Important lessons: 1) When you are working out meds with two kids, remember that one child can influence the other. Try to separate them for a while or ask for help from teachers or others.

2) After talking about all this with my pediatrician, I now understand that giving your child a half dose of Vyvanse in the afternoon is not the same as giving your child a 4-hour tablet of Adderall in the afternoon. Vyvanse is a long-acting med, so it will last a long time no matter what amount you take. A small dose just means a smaller amount will be in your system for a long time. On the other hand, a 4-hour tablet is just what it says, a med designed to last only four hours, no matter what the dose.

Oh my poor children are guinea pigs, and I am a medical reject. I hope we get through this in one piece. I love them though--I hope that makes up for a lot.

I Can Live with Hyper, It's Better Than Explosive

Hiking in Bryce Canyon.

Both Luke and Izzy are less emotional, less explosive, less trantrum-y. We are completely off Intuniv now and have been on Zoloft (sertraline) for a couple of weeks. I’m glad the atmosphere is more positive, but it is also more hyper, for lack of a better word (without the negative connotation). But Luke and Izzy have said it themselves. They are either more hyper or their hyperness is easier to see now that the explosive episodes have waned. But I have to say, I can take hyper. It is a gift that things are more buoyant around here. Please, do 10 somersaults. Just don’t yell and hit your brother.

Luke has not slept well for the last few nights, and I’m wondering if that is because he is off the Intuniv. Maybe a drawback from stopping that, but maybe the high emotions were related to taking it. I’m hoping bad behavior doesn’t result from this lack of sleep. If it’s not one thing, it’s the other isn’t it?

We started school yesterday, and I was dreading the “dreaded first day of school phone call”--that Luke had hit someone or Izzy was screaming. No call. So that was good. I talked to all the kids’ teachers and asked them how things went the first day. They had all been made aware of Luke and Izzy’s needs in general, so that was good. Both of their teachers said Luke and Izzy had a hard time sitting still and becoming engaged and Luke had some line-up scuffles. That is actually a good day for us. BUT I was still worried about their difficulty in sitting still and doing their work and “scuffles.” I want so badly for this year to be better than last and for them to be able to keep some friends. So I lay awake last night thinking about them and if we should try a stimulant. We were planning on adding a stimulant to the anti-anxiety med in a couple of weeks. And I decided, Why wait? If it’s going to help, let’s get it going. If it’s not going to help, let’s get this over with and on to our next drug trial or therapy or whatever is going to work!!! I started with a verrrrrry low dose (10 mg) of Vyvanse. It was like crack cocaine for Luke last time so I’m really hoping it works differently in a lower dose, without Intuniv, and with the anti-anxiety med. So far, no phone call today.

On to SSRI's

I'm trying to be on vacation, but also trying to record what's going on. Since Tuesday we have been titrating the Intuniv and starting on a low dose of Sertraline (Zoloft). Since our attempts with Focalin and Vyvanse did not work, we thought we'd hit the anxiety instead of the ADHD. Something is working now. I don't know whether it's the Sertraline or going off the Intuniv (or hanging out at the beach and running around all day) but the emotional outbursts are definitely decreasing. Luke is not sleeping as well, so that's a problem. But the days are going far better.