Is this normal for Elvanse?

[nidhi99]

Has anyone else had this experience when starting Elvanse?

First dose is 30mg. Taken yesterday and today. Don't feel anything for four hours or so. Then it suddenly kicks in. Feel wired, like my eyes are wide (they aren't), jaw clenching, jitteriness, super chatty, energetic, nauseous, and like I want to go out dancing and have just taken a load of mdma (without the hallucinogenic effects!) - disclaimer, I haven't done any sort of illicit drugs for many many years, and don't even drink alcohol or caffeine these days. Then, crash around 8 hours later. Not awful but just a bit drained. Sleep has improved ten fold (though appreciate it's only been one night). I think I was naive and thought it would be a little less.... Intense?

Has anyone else had a similar experience? God knows what it's going to be like when I start taking 50mg in two weeks!

Would it be daft to stop before I've given it a chance? It's actually a really quite nice feeling despite the nausea, but I'm a bit concerned about how rollercoastery it is!

If anyone can recommend any good foods to eat with it that'd be great, even if it is just things like smoothies. Yesterday I couldn't even bring myself to have anything other than water.

Smoothies are a good shout, made with whole milk. I wouldn’t bother with protein powder or anything. Likely to put you off. If you can have nuts, ground almonds can be added. When I can’t eat due to meds side effects (happened a few times), I just have a Nesquik with whole milk. At least it gets calories in and tastes nice.

Yes if you're not eating with it, you're likely to feel v strange.

Do you have a way to contact your provider between appointments? It might be worth telling them that this dose feels too high to start on, that you're having a very intense experience and that makes it impossible to eat which is then exacerbating the result of the medication. Since it's preventing you eating, I'd probably skip taking it until you can talk to them.

I'm not a doctor but it sounds to me like your starting dose is too high. And just because other people find 30mg a low dose doesn't mean you don't have ADHD or that stimulant medication will be bad for you always. The dosing of ADHD medication is weird because what works for one person won't work for another and it doesn't seem to be correlated to things like body weight or severity of symptoms. But it also sounds to me like you're on this titration schedule where they start you on 30 and then go very quickly to 50 and then 70. I find this irresponsible and there was even an article about someone who died following this protocol recently. I also have read many accounts especially on the Reddit forum ADHDUK of people getting on well with this protocol, so don't think I'm suggesting this could be dangerous to you, I'm just saying that the provider following this plan does seem a bit lacking in communication and you might need to be more forthright in asking them for support. The Reddit forum is helpful as well.

This is the report that was made after the man died. I shared this rather than the news articles, which all made it sound like the medication itself is what's dangerous. I think that the lack of supervision and communication from the provider combined with sudden increases of the medication is what is potentially dangerous. It's a pattern common with the online RTC providers and that is a problem because the NHS services are so overloaded and causing people to need to use these services instead.

The approach where you start very low and increase slowly seems much safer to me.

Yea, I started on 20, am on 60 now. It isn't a miracle cure, but has made a big difference to my life.

So I had a day off yesterday, and started again today. Totally different to the first two days. Nausea nowhere near as bad. No wired feeling, got more work done than I've ever got done in my life, but felt completely hyper focussed and forgot to eat. Didn't even really notice it working that much, until it wore off after about 6 hours which was gutting. I took it at 6, started work at 8, got what would usually be a whole days work done then couldn't function. I could physically feel it wearing off, like it was leaving my body and my erratic thoughts were coming back. The constant song in my head again. I think the difference is that whilst I forgot to have lunch, I had a bowl of nuts, a banana, a smoothie and a packet of crisps throughout the working day, then a meal this evening. I have no idea what happened the first two days but I'm guessing it was due to essentially not eating for 48 hrs.

I also found it really hard to deviate from the task I was doing. Not sure this is normal. Does anyone else mind sharing their experience when they first started taking it?

Sounds like you might be titrating too quickly. They like to get it over quickly and then prescribe but sometimes it takes more time. I also have severe ADHD and felt really wired when I first started titrating, but it mellowed out - the aim is to feel calm and focused.

Also, have you tried methylphenidate? It can be better tolerated and not as hard on the body as Elvanse.

Thank you. That's how I felt today. But so focussed that I struggled to do anything else other than the task I was doing. Usually I struggle to do anything at all. Then I just felt really lost and stressed when it wore off.

No this is the first thing I'm trying. My main request was that I started on something that would last the whole day. I'm a lone parent and work full time from 8-4, then pick up my son and have to do housework, hobbies, bedtime etc. Which is just exhausting and my house is always a mess. I basically don't function. It was like I would've needed a whole other pill to get through the second part of the day. But I fell back into my usual ways that made me seek help in the first place.

I'm also a lone parent and I get it - I take extended release methylphenidate in a split dose, morning and afternoon. I haven't tried anything else so I can't speak from experience, but from what I've heard, it is a bit smoother and easier in terms of the side effects. For example I've never had any issue eating and sleeping with it.

That's good. I will give the elvanse some time and see what happens. I just don't know that I can cope with crashing at midday every day!

I don’t remember the starting dose being as high as 30mg so maybe you need a lower dose.

I couldn’t cope with the jaw clenching and gave up on Elvanse after a few weeks. Concerta had the same effect.

Whether or not you start on Elvanse/Methylphenidate is pretty much swings and roundabouts, you start on one or the other and then if you don't get on with it you try the other one, basically. It's a bit like contraceptive pills, the one that one person gets loads of side effects will be perfect for someone else whereas the second person could be the opposite way around.

There are versions of methylphenidate (shortened to MPH) which last 8 hours or 12 hours depending on how long you need. Elvanse should be about 10 hours' duration. Everyone will metabolise it slightly differently, though.

I got the overly focused on the one thing experience from MPH (and was really irritable with it) whereas Elvanse is more subtle for me. But it seems much more likely to me that you're experiencing it as a too-high dose mainly due to not being used to it. It's positive that it's settled down from that first overwhelming day. If you keep going you'll probably find out whether it settles further - this would have been more gentle if weaning up from a lower starting point, but anyway. Or it might be that 30mg genuinely is too high of a dose so when you have your next appointment, feed back what you're experiencing at that point and they might suggest to drop down to 20mg.

IIRC the issue may be related to licensing because Elvanse comes in two packaging formats: Elvanse and Elvanse Adult. The one without the "Adult" suffix comes in 20mg whereas 30mg is the lowest dose of the "Adult" one. Chemically they are exactly the same medication. I live outside the UK and I take a generic version of the same medication but I understand this is not yet available in the UK. The company (Teva) which produces it does distribute in the UK so maybe it will come over there soon.

I suffered quite badly from the afternoon crash the first few weeks on Elvanse but that did wear off. I’m aware of the effects lessening over the course of the afternoon but it’s not unpleasant and uncomfortable now, it’s much smoother than those first weeks. You could ask your provider for a top up for the afternoon if this doesn’t settle down for you but do give it some time first.

It sounds to me as if it isn’t the right medication. What are your symptoms? Brain fog and inattention have many causes besides ADHD. My SIL, for example, has cognitive symptoms as a result of bipolar disorder that aren’t very different from mine, but Elvanse would be a disastrous medication for her on its own — and is not one of the many medications that she takes. A friend had similar symptoms in perimenopause, got an ADHD diagnosis, but found that the right dose of HRT was much more effective. Anemia can cause severe brain fog and even confusion. (When I was severely anemic, the Elvanse was much less effective than usual; but when I recovered from the anemia I still had ADHD.) Elvanse also interacts badly IMO with SSRIs: whenever I’ve tried them alongside it I have a mild version of serotonin syndrome, including flushing and very severe nausea. I was able to take sertraline at a low dose alongside IR methylphenidate (at a higher dose) fairly happily for years.

You might give methylphenidate a try fairly soon as other posters have said. I prefer the instant release formulations to Concerta. In many ways, it was also the more effective drug (at 40-50mg a day IR, divided into two doses) for my ADHD, but the physical side effects were too debilitating. The worst problem was a perpetually dry mouth. When I was younger I could tolerate this, but after having children I was left basically unable to speak during the working day. Given that my job involves lots of speaking and presentations, this was hopeless.

If that also isn’t working well for you, I would look into other causes of your symptoms. ADHD is getting a lot of air time at the moment, but it isn’t the most common cause of brain fog in adult women. In addition, it’s by definition a lifelong condition. If you didn’t have (probably more severe) ADHD as a child, you don’t have it now.

I don't know why so many people are questioning my ADHD. I've just spoken to a friend of mine who doesn't specialise in ADHD but is a psychiatrist and knows a lot about elvanse, which he prescribes for binge eating disorder. He has just told me that everything I'm experiencing is completely normal for a lot of people, and he works with a lot of people with ADHD as that and binge eating disorder go hand in hand. He said people have different metabolisms and some people need to be on it a couple of weeks before the wired symptoms wear off and they see the benefits. He also said that nothing that I've described points even slightly to the fact that I might not have ADHD. He also said he would be incredibly surprised, having known me for many years, if anyone who actually knew me from childhood until now didn't at least suspect it! So thanks for those who have been helpful, but no thanks to those who are having me question myself. I've appreciated reading about different people's experiences.

I remember the first day I took 30mg elvanse. After an hour/90 mins a warm happy calm came over me and my brain went quiet. I’ve been taking it for about 9 months now at the same dose and I definitely feel a big focus but never that wired feeling. It’s more of a calm that allows me to be productive.

I’d speak to your provider because maybe 30mg is too high, or you need a different medication.

I find that taking mine mid morning instead of first thing helps it last more through until bedtime. Once you have got used to the lower dose and maybe moved up more you may feel it last longer.

I have found that I am now more able to 'casually focus', if that makes sense. I feel more like most people probably do, as against extreme focus.

A reduction in the insane RSD, I'm more able to rationalise that the slight change in tone of my husband's voice does not necessarily mean that he's blaming me for something.

I've been able to carry out large DIY projects, previously I would have got myself so bogged down in too many details prior to starting I'd have completely thrown myself and declared I couldn't do it, have wasted the day reading about the perfect tool etc. or started and not been able to have the patience with myself to continue if it went wrong, or get the details right.

I've lost 2 stone without trying just through not dopamine eating.

It's not a miracle cure, I'm still not 'neurotypical', but I feel much more able to function like a real grown up.

Titration can be a funny thing. I didn't sleep for two days when I took my first dose - not hyper or really wired, just absolutely wide awake and not remotely tired. The sleep disruption settled after a week or so.

I take 30mg but only M-F as they are my working days - it helps with my focus, and curbs the impulsivity where I multi-task myself into a non-productive stress mess. It helps with the nagging thoughts which can be so distracting - I feel calmer and like my brain is clearer and not constantly whirring about, so I'm much more able to be organised.

@Barrenfieldoffucks yes on the RSD. It still feels awful, but my brain is calm enough now for my sensible voice to kick in and remind me that this is not a complete disaster, and the emotional reaction will pass - just sit, breathe, let it work through, don't give in to the emotional rollercoaster as it's not real. It's been life changing.

If you didn’t have (probably more severe) ADHD as a child, you don’t have it now.

The opposite is generally true for the inattentive presentation, which is more common in women. The difficulties in the inattentive subtype tend to be related to organisation and self motivation. Children generally have much much more environmental support with these things, whereas adults and older teenagers need to manage them for themselves. Nobody is reminding an adult to brush their teeth, go to bed at a reasonable time or prepare things for the following day and that's the kind of thing where adults with ADHD often fall down.

Granted it's not as dramatic a presentation as a hyperactive one with severe struggles around impulse control leading to e.g. drug addiction, crime, aggressive behaviour etc, that doesn't mean it's not impactful on people's lives.

Also there is a large group of posters on MN who don't believe in ADHD, or say that it exists but the threshold for treatment/diagnosis ought to be much higher (never sure in which direction they go either, because often if someone is displaying the very antisocial and destructive behaviours associated with certain hyperactive presentations, the same posters will claim that ADHD is "trotted out as an excuse for bad behaviour") so you are probably attracting a lot of those.

Ds takes 60mg a day with no side effects and it doesn't effect his appetite, however you should take your meds with breakfast porridge with jam in it is a good breakfast with them the jam gives you an instant sugar hit whilst the oats are slow realise carbs which kick in when the sugar wares off so not crash, trail mix is a good snack aswell

This is what DH found. Crazy hyper focus and forgetting to eat and go to the loo!