Adhd meds, am I getting manic?

[Whatayear2020]

Was diagnosed with adhd in sept, the pyschiatrist said I have adhd and possible bipolar with hypomanic episodes, so he started me on a non stimulant drug first, which made me feel depressed, then cautiously has started me on stimulant medication (elvanse 40 mg) 3 weeks ago. All good apart from the last few days, I feel happy during the day, but possibly a bit too happy, bordering on euphoric, then in the evening a proper crash into anxiety, obsessive thoughts and depression, what's concerning me most is that I suddenly have a complete decrease in need for sleep, at all, think I've had about 6 hours for the last few days. My pysch told me I need to report straight away any increased anxiety, mood fluctuations or sleep disturbances but I'm just terrified to do so! I'm so scared to be taken of this medication, it's honestly like putting glasses on for the first time, like my brain just switches on as the elvanse kicks in. I feel depressed at the thought of it being stopped. I don't know what to do! Oh he warned me that any of those side effects I mentioned I should mention could be early signs of hypomania.

Also, this may not be relevant, but I also have a tic disorder that seemed to be in remission, but there has been a big increase of tics this last week which seems to coincide with the time the medication wears off

Sorry, its actually 4 weeks I've been on elvanse now

My pysch told me I need to report straight away any increased anxiety, mood fluctuations or sleep disturbances

You have to. They might be able to find another drug that helps.

Thankyou for the reply, I'm just terrified of him taking away any stimulant based medication. I honestly feel like I'd rather not be here, it helps so much, or it did till the last few days anyway. I know I need to speak to him, and report it, I just wonder if it might be a normal mood fluctuation that would have happened without meds, like a chicken and egg situation

Also tell the psych that you feel you won't cope without the stimulants. But 6 hours of sleep sounds serious. Please talk to them.

I will, I just don't know what to say. On Xmas eve I was building my sons gaming chair for him and saw that the screws had moved across the floor, when I looked again I could see they hadn't moved at all, was a trick of the mind, but I hadn't slept for 48 hours at that point so not sure if that's something that's would happen to anyone with sleep deprivation! So annoying trying to figure out what's normal and what's not!

6 hours sleep a night? That's actually decent. Or do you mean over the few days so a couple a night? Sorry if I misread . Def tell the doc about the lows tho

I meant 6 hours in total spread over a few days. Slept for 3 hours last night.

Can you talk to them today?

I'm bipolar and totally get you. You 100% need to talk to them about this. You could always ask if you can reduce the stimulants to the dose you were at where you were still sleeping and slowly rechallenge.

The best lesson I ever learned is that I don't have to go along with everything the Dr suggests. It's good to be proactive and find solutions that you are both happy with.

I had this problem with bupropion. Gave me so much clarity, got so much done, but couldn't settle at a safe pace.

Have you tried mood stabilisers? It might be possible to take them alongside the elvanse, I'm not sure. I can't tolerate mood stabilisers, they kill any joy or clarity, but they do work for others.

You could ask for a lower dose or try another one? That doesn't sound like a normal reaction to those meds (an adult and teen in the family on slightly lower doses than that) - I would say you really need to speak with the psychiatrist if you are bipolar - sounds like you might be entering a manic period - do you always recognise when this starts? From outside those symptoms sound like it.

ADHD meds are slow release mostly and timed to last 8-12 house depending on brand. If my DS hasn't taken his by mid morning I don't let him have them as it impacts alter in the day. What time are you taking them. Make sure you eat before as you might not eat once you've had them and this can make the impact heightened.

I've emailed the clinic and got an automated reply saying they're on holiday till 4th Jan, which is frustrating. I could text or ring his secretary I suppose. I just think they'll hear mood swings and take me off the meds when it may not be the meds causing it or may be a reaction anyone could have off the meds? I just cant seem to figure out the best course of action. All I know is I feel not right but think it might be because if the medication wear off! I just don't know! I'm diagnosed adhd but the pysch thinks possibly bipolar type 2 also , but that's not diagnosed, that's his impression, in my notes it says his impression adhd with bipolar type 2 but the bipolar needs longitudinal observation to rule it out (I played it down in the assesment as was worried he'd not let me try adhd meds if he believed I was bipolar) I have had one definite hypomanic episode, well 2 maybe 3 actually but the second was in response to stress which included paranoia and the police ended up telling me I was wasting police time (I thought someone was out to get me basically, but wasn't actually happening) , and also another after being put on citalopram, but don't know if that counts as was medication induced, on citalopram within a week I was bordering on psychotic and very very high, was taken off it and it went away. I think I have mild periods of mania/hypomania every few months too, characterised by increased productivity, no sleep, feeling of wellbeing etc but that quickly changes to massive anxiety, obsessions, fixations, restlessness racing thoughts etc, but I find it hard to figure out of they're not just adhd symptoms!
All i know is right now I can't sleep, like at all, Im not eating, I'm highly anxious, with little periods of quite a euphoric feeling, but the euphoria only lasts a while. I'm getting very obsessive with Google etc, cheek biting, tics increase, pacing. I wish I just knew what was going on! It's not a very comfortable feeling. It feels frantic and a bit sinister as the evening comes in.
He said if I get feeling of high anxiety, mood fluctuations and sleep problems etc on the meds then we would need to go back and re look at the bipolar and then go from there.

I've not tried mood stabilisers yet no, I've tried citalopram which made me high, then mirtazipine which eventually sent me a little possibly manic, but mild (period of obsessive focused happy sense of wellbeing, that crashed into anxiety and depression, got taken if that med too!) forgot to mention that one! That was in July. Also tried chlorpromazine which I absolutely hated as felt completely flat and so unmotivated it was depressing, that's the only medications I've ever been on. Im not sure if I may he autistic, I'm waiting for an assesment, my pysch who is an adhd specialist said he doesn't get that impression, but I do struggle with social interactions and all my children are high functioning autistic and one has a different dad so must come from me so I do wonder what the odds are that I am not! Not that that would make a difference I suppose! But maybe it does, I don't know! Oh I don't know anything these days!

We've got ADHD and autism in my family. I don't know but they seem genetically close to me.

You do need to both be honest, and advocate for yourself. A tough one, I know.

Ds takes Elvanse and intuniv together for adhd. So stimulant and non stimulant. He also takes 2mg circadan for sleep. A combined drug regime has been really effective for him.

For the few hours in the day while the meds are effective I feel extremely calm and happy and motivated , so maybe the feelings I am having in the evening is due to the med wear off, maybe a top up would help or a higer dose I wish I knew what to do! Lol its such a peaceful feeling in the daytime at the time the medication would be at peak effectiveness, from like 2 hours after taking it, then that feeling lasts about 2 to 3 hours.

Cafgotyourbrain at the beginning I was taking them at about 8 am, recently due to not sleeping till about 6 am and then waking later I've been taking them later at about 10 ish, maybe thats the problem? Maybe there's some left in my system stopping me from sleeping. I do wonder if my feelings might all be solved with a good night's sleep!

FraggleShingleBellRock do you ever have episodes of hypomania that aren't euphoric, or are they always euphoric, my closest friend is bipolar and shes only experienced euphoric mania (she's been stable for 7 years with no episodes) she thinks you can't be manic with anxious energy, she might be right, I'm not sure, I've read conflicting things about it. Because I personally seem to experience anxious energetic racing thoughts a lot when I have episodes of whatever the hell it is that I experience! Lol

To clarify, my friend says mania is chatacterised by a complete loss of all anxious thought, where as I experience episodes that after a few days lead to a complete massive increase of anxious and paranoid thoughts.

You sound hypomanic to me from these few posts but try not to worry they will probably just give you a mood stabilizer in addition to your adhd meds as both illnesses really need to be treated.

Euphoria can be a side effect of adhd meds and defo should be reported.

I really struggled with bounce back from adhd meds. I was on quick release to start which I liked as could control it then moved to long acting as got an office job and thought be easier then we went into lockdown and oh my god I kept forgetting to eat and the anxiety was horrific so I stopped. What I would say is, I know you can't speak to a psych until 4th but if the meds are stopping you sleeping and you are feeling manic for you then stop taking them. I am no doctor but I imagine that is one might say. The adhd meds do not keep you alive, but sleep does. I dont know if Elvanse builds up or can be stopped? If you cannot sleep still get a GP appt and see about some relief.

Get some decent protein based meals and set an alarm to remind yourself to eat.

There are different combinations and doses/top ups that can be tried to help.

I could not sleep if I took my adhd meds after 9am. 7/7.30am was better to be honest. Do you have caffeine? That can also keep you up combined with meds,more than it would not on meds iyswim.

I find my hormones can affect Elvanse quite significantly. I'm more likely to feel more manic during the oestrogen dominant part of the cycle (so just after my period and until ovulation) then everything is more likely to go flat/anxious in the second half when progesterone is dominant, and the Elvanse doesn't seem to work as well then in general. It's actually well-documented that hormones affect ADHD medication, though not every doctor (and certainly not every patient!) is aware of that.

Sometimes I'll have a slightly more manic phase just triggered by life in general, but my hormones definitely exacerbate things in one direction or another. I'm pretty sure the Elvanse does make the phases more intense in each direction (though I'm also peri so it could be that too), but it's tolerable by my standards.

I've been on Elvanse for nearly three years, I couldn't get by without it now; I bitterly resent the decades I had before I realised I had ADHD and the years it took to get a diagnosis. Your manic episodes do sound more intense than mine, and mine do sort themselves out on their own pretty quick so I've never raised it with anyone.

Whether you see somebody or not (and it sounds like you should), have a think about whether hormones might be an influence for you as it's all useful information to assess what's happening and working out the best way forward.

BTW if I don't need to be totally with it, I usually take a break with mine (or a reduced dose/instant release - I have 40 for work days, and 30 or an instant release 5 (equivalent to a 20) for weekends/holidays). This was all prescribed by my psychiatrist. I probably feel a bit more groggy than I would have done before I was put on the medication on the days off, but I see it as giving my brain a much-needed rest. And I'll often catch up on missing sleep too. I'm usually less productive the week after weekends where I haven't taken a break from it for whatever reason.

It's totally okay to take a break; my psychiatrist was fine with it, and it probably also helps reduce tolerance though that's a controversial theory!!

Good luck with it :-)

@Shattered04 I had exactly that experience with my monthly cycle. So good to hear someone else had it too. I almost felt like I didn't need meds in the second half of my cycle.

I also found it was important to look at my lifestyle. I came to the conclusion that it needed to change. Got a job to be around people more, then went into lockdown .

I very much agree with you about lifestyle as well. I changed jobs a little while before lockdown to a job working from home. That made a massive difference to my life and productivity for the positive, as I was no longer distracted by an open plan office (and having my confidence destroyed by a gaslighting manager..!)

Downside being that working from home meant it was a lot easier to let hyperfocus, which in combination with Elvanse, at certain times of the month, completely take over. I suspect that's partly what triggers my more manic episodes as I didn't really have them as noticeable before.

I do massively miss people though. In an ideal world I'd go into an office once or twice a week but my team is global, so it's never going to happen regardless of pandemics. Still, I was expecting to meet them more than once so far! And regardless, overall I am happier.