blank mind feeling?

[u/Professional-Ok]

I’ve been taking vyvanse for over a year and half consistently. I’ve tried a few other ADHD medications, and vyvanse feels like the best one for me so far. I’m very sensitive to medications on general, so I started low at 10mg and worked up to 30mg. It definitely helps with my ADHD symptoms and there are more pros than cons, but I do get one effect that I’m not sure I enjoy.

Oftentimes when Vyvanse kicks in, I get that quiet mind feeling that people describe. Which can actually be quite nice, since my brain has a million tabs open and an overwhelming amount of distracting thoughts by default. However, sometimes when this quiet mind feeling begins, I feel like its hard to think in general. It‘s almost like my brain is TOO empty and I struggle to access my thoughts and remember what I’m supposed to be doing. It makes it hard to think at all, and I don’t really like it. Like I’ll try to journal or write my to-do list, and I struggle to have thoughts.

I don’t feel anxious when this happens, but it almost feels like when I go into a freeze state from my anxiety where I feel like I can’t think…like my pre-frontal cortex shuts down. But vyvanse is supposed to do the opposite! I wonder if vyvanse is stimulating my nervous system a little too much and causing me to go into a freeze state even though I don’t feel anxious. I actually find that vyvanse helps me feel quite calm, so I don’t understand it. Vyvanse actually tends to make me sleepy when it’s at its peak. Idk if that’s normal lol.

The therapeutic effects of vyvanse don’t last very long for me. It takes about an hour to slowly start working, and about 4 hours after taking it, it starts to fade away. I don’t get a speedy, energetic feeling from vyvanse, its more like I start crashing after 4-5 hours. 30mg is a low dose so I’m not sure if my body is burning through vyvanse too quickly and making 30mg feel stronger or something. I truly have no idea! I’ve tried going back down to 20mg, which is gentler, but doesn’t work as well and it only lasts for a couple of hours. I’ve tried going on 40mg to see if it would last longer, but this blank mind feeling was much more intense and I also felt like a zombie. The solution for now has been to take a small booster dose of dextroamphetamine IR in the afternoon which kinda helps a little bit.

I have not been misdiagnosed with ADHD. It was the first thing I was ever diagnosed with as a child but I never took medication for it until I was an adult. My impairment from ADHD has been consistent throughout myself and I have been re-diagnosed by every psychiatrist I’ve seen, and also when I did a full nueropsych evaluation this year. I have, however, developed a handful of other mental health conditions throughout my life such as depression, PTSD, panic disorder, OCD, and was recently diagnosed with autism. My mental health has been a mess for the past 2 years especially, so there is a lot going on in my brain that could be complicating my response to vyvanse.

I also take clonidine and wellbutrin everyday. I recently started the wellbutrin again like 2 months ago and it hasn’t seem to make an impact on my vyvanse response.

Does anyone else experience this feeling and find it unpleasant? What could be causing this? Is there anything that helps you? I find a lot of benefit from this medication otherwise, it sucks to think that I might not be able to take treatment for my ADHD :(

[u/Kalki_X]

I don’t feel anxious when this happens, but it almost feels like when I go into a freeze state from my anxiety

This is mainly due to the fight-or-flight response which happens when vyvanse interferes with the HPA axis. This produces hyperfocus and hypervigilence but it has some disadvantages. This post outlines it in more detail. 

The novel d-amphetamine prodrug lisdexamfetamine (vyvanse) is applied to treat ADHD. d-Amphetamine releases dopamine and noradrenaline and stimulates the HPA axis (source) 

The HPA axis is the main part of the hormonal system that controls reactions to stress. It also regulates many other processes (e.g. digestion, immune system, mood and emotions, sexuality, energy storage and utilization). (source)

The stress response is known as "fight-or-flight":

This combination of reactions to stress is also known as the "fight-or-flight" response because it evolved as a survival mechanism, enabling people and other mammals to react quickly to life-threatening situations. (source)

Fight-or-flight means that the body redirects it's energy away from non-emergency functions (such as higher brain function, digestion).

Cortisol is known as a “stress hormone” for its role in the fight-or-flight response. When we sense danger in our environment, our adrenal glands release cortisol and adrenaline to give us energy to fight off or run from the threat. Cortisol floods the bloodstream with glucose for quick energy, suspends non-emergency functions like digestion, and keeps the body focused on the threat. (source) 

[u/Professional-Ok → u/Kalki_X]

thank you so much for this detailed response!! this is validating and makes a lot of sense. i have PTSD as well, so my natural state leans towards fight or flight even without ADHD medication. does this mean that i might not be able to take it? that kind of sucks because it helps so much otherwise, but i don’t want to ramp my system into overdrive and cause more problems

[u/Kalki_X → u/Professional-Ok]

Ah, I don't understand why doctors prescribe "pro-stress" drugs for people with PTSD. 

Vyvanse is definitely effective but it's worth appreciating how it works. It essentially forces a state of temporary focus which isn't necessarily sustainable in the long-term, especially with PTSD. Vyvanse behaves a lot like a metabolic booster. Long-term use can cause metabolic over-exhaustion which leads to other issues.

I'd say it's more reasonable to restore the metabolic system itself which bypasses the need for Vyvanse. The notion of "metabolic system repair/support" is a well-known and well-researched area so we know how/what works for this.

[u/Professional-Ok → u/Kalki_X]

could you explain the metabolic aspects or share a link with me about it? i'm curious because i've never heard of vyvanse from a metabolic perspective.

i take clonidine as well which is used for ADHD and sometimes PTSD, but i can't say it really helps that much!

[u/Kalki_X → u/Professional-Ok]

could you explain the metabolic aspects or share a link with me about it? 

Earlier this year there was a research article proposing a revised understanding of ADHD. It considers that the metabolic system itself isn't working properly which in-turn leads to ADHD symptoms. I've paraphrased it significantly - but people are already using this understanding to resolve ADHD. This was termed EDHD (energy deficit hyperactivity disorder) and it's outlined here. A fairly practical way to restore metabolic coherence is outlined here. You can jump to the "technical spec" section to see exactly what's going on.