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.