ADHD+ Depression med interactions

[Soror]

We have a ped and has a counselor that practices CBT. 

We like the counselor because she does practice CBT but she cannot prescribe meds. 

The ped gave a scrip for vyvanse and lexapro. 

However, when I went to pick it up they told me vyvanse was $300+ per 30 days. So, I decided to hold off and research some more, school is on spring break as it is and depression is the biggest factor right now. Adderall and Ritalin have been tried previously.

Reading the info about vyvanse I'm not 100% certain that it is good with the lexapro anyway.

Is there a typical med combo for adhd+ depression? I'm coming up with mixed info. 

I've read some about how there are different types of meds and some work better for some but I've no clue what would be the best. I've read I can do genetic analysis but I know there isn't anything local and am not sure how well accepted this is. Do I need to hunt down a dr in a city to get this done?

FWIW I am looking to help my child- please keep rude, judgy comments to yourself. If you don't have anything helpful please don't comment. I have enough judgment of myself without anyone else piling on more.

 

[klmama]

If you are concerned about the combination of drugs, ask a pharmacist.  Better, ask several.  They often know more about med interactions than doctors do.  You might get better answers if you call pharmacies in a city, as they'll see a larger number of prescriptions coming through and may have more experience with both drugs.

[maize]

I don't have specific advice about med combinations, but have you looked into discount programs for vyvanse? There should be one.

[maize]

https://www.vyvanse.com/coupon

[Katy]

Call your pharmacist. They have a doctorate in drugs. They know this stuff better than anyone. 

[Ottakee]

I agree with calling the pharmacist and checking on a discount coupon.

That said, it is generally better when there is a mood component to stabilize that first and then treat adhd.   

Also, starting 2 meds at the same time is not always the wisest course (except in crisis situations) as then you don't know which med is helping what....or which one is causing the side effects.

[fairfarmhand]

40 minutes ago, Soror said:

We have a ped and has a counselor that practices CBT. 

We like the counselor because she does practice CBT but she cannot prescribe meds. 

The ped gave a scrip for vyvanse and lexapro. 

However, when I went to pick it up they told me vyvanse was $300+ per 30 days. So, I decided to hold off and research some more, school is on spring break as it is and depression is the biggest factor right now. Adderall and Ritalin have been tried previously.

Reading the info about vyvanse I'm not 100% certain that it is good with the lexapro anyway.

Is there a typical med combo for adhd+ depression? I'm coming up with mixed info. 

I've read some about how there are different types of meds and some work better for some but I've no clue what would be the best. I've read I can do genetic analysis but I know there isn't anything local and am not sure how well accepted this is. Do I need to hunt down a dr in a city to get this done?

FWIW I am looking to help my child- please keep rude, judgy comments to yourself. If you don't have anything helpful please don't comment. I have enough judgment of myself without anyone else piling on more.

 

I'm sorry you've experienced this, because I have experienced it too.

I have no adivce, but did want to say, I'm sorry you and your child are going through this. It's so very hard.

[Soror]

23 minutes ago, Ottakee said:

I agree with calling the pharmacist and checking on a discount coupon.

That said, it is generally better when there is a mood component to stabilize that first and then treat adhd.   

Also, starting 2 meds at the same time is not always the wisest course (except in crisis situations) as then you don't know which med is helping what....or which one is causing the side effects.

This was another reason I wanted to wait on the ADHD med as well. Although, once we (hopefully) get the depression stabilized the ADHD will still be an issue to address.

53 minutes ago, maize said:

https://www.vyvanse.com/coupon

Yes, I should have mentioned that there is a coupon, it is only up to $90 if I'm reading it correctly. So, yes, it helps but still really expensive. I thought maybe others would have thoughts on whether it was worth it to try and the best to use when also treating depression.

[Soror]

20 minutes ago, fairfarmhand said:

I'm sorry you've experienced this, because I have experienced it too.

I have no adivce, but did want to say, I'm sorry you and your child are going through this. It's so very hard.

thank you. (hug)

[PeterPan]

There is something with some SSRIs undercutting by Vyvanse absorption and I don’t remember the med. dd handled it herself.

Ironiccally sometimes the ADHD meds will improve depression slightly by improving function. 
 

Goid luck sorting it out. Even if you did 5HTP, methylation, etc you still might need a med.

[Storygirl]

We had ADHD meds prescribed for years by our pediatrician, but when we needed to add something else on for mood, the pediatrician wanted us to see a pediatric psychiatrist. There was a wait of several months, and then we were paired with a psychiatric nurse practitioner (instead of the psychiatrist). And working with her is awesome -- she explains how the drugs function in the body (sometimes drawing a diagram on a white board), talks through options, explains possible side effects, let us try new things at a pace that was comfortable for us, discusses ideas that we bring to her from our research, and so on. The combo that is working here is Concerta plus Lexapro (in our case for anxiety).

If you don't feel that your pediatrician can perform those kind of helpful, detailed conversations with you, maybe look for a pediatric psychiatrist's office in your area. We do still see another therapist for counseling; the nurse practitioner does not take over that role, though she does ask lots of questions during the appointments about how things are going in general.

One other idea -- check the app Good R/X to see if you can get a better price through them. It will show you the prices at pharmacies in your area. Even if you don't use Good R/X, you may find drastic differences in price from one pharmacy to another, if you call and ask how much they charge for Vyvance. When we moved from one town to another nearby place, changing pharmacies saved us $100 a month on the Concerta; if I had known that, I would have done pharmacy shopping long before that. So you may find that you can reduce that price, if you shop around. However, since Vyvance is a name brand, it will be on the pricier side. You should feel free to tell your doctor that you need to consider cheaper options, as well.

Edited April 1, 2021 by Storygirl

[sbgrace]

2 hours ago, Ottakee said:

I agree with calling the pharmacist and checking on a discount coupon.

That said, it is generally better when there is a mood component to stabilize that first and then treat adhd.   

Also, starting 2 meds at the same time is not always the wisest course (except in crisis situations) as then you don't know which med is helping what....or which one is causing the side effects.

I agree, and it sounds like you're thinking this OP, that 2 meds at once wouldn't be my choice. My son's  psychiatrist doesn't like to do that either. It's really better to know which med is causing a side effect (if there are any--I hope there aren't). Those two meds in particular both caused severe insomnia in my son. If we had trialed both at once, it would have been harder to sort out. 

I really like using a psychiatrist for this, particularly when you find that certain medications already aren't right (the adderall and ritalin). Side note: my son can only handle short or mid acting Ritalin....long acting forms always cause side effects for him that are intolerable...mentioning in case your son was only prescribed long acting forms of the adderall/ritalin)

I hope you find what helps. I'm sorry he's struggling so much. 

Edited April 1, 2021 by sbgrace

[Soror]

14 minutes ago, Storygirl said:

We had ADHD meds prescribed for years by our pediatrician, but when we needed to add something else on for mood, the pediatrician wanted us to see a pediatric psychiatrist. There was a wait of several months, and then we were paired with a psychiatric nurse practitioner (instead of the psychiatrist). And working with her is awesome -- she explains how the drugs function in the body (sometimes drawing a diagram on a white board), talks through options, explains possible side effects, let us try new things at a pace that was comfortable for us, discusses ideas that we bring to her from our research, and so on. The combo that is working here is Concerta plus Lexapro (in our case for anxiety).

If you don't feel that your pediatrician can perform those kind of helpful, detailed conversations with you, maybe look for a pediatric psychiatrist's office in your area. We do still see another therapist for counseling; the nurse practitioner does not take over that role, though she does ask lots of questions during the appointments about how things are going in general.

One other idea -- check the app Good R/X to see if you can get a better price through them. It will show you the prices at pharmacies in your area. Even if you don't use Good R/X, you may find drastic differences in price from one pharmacy to another, if you call and ask how much they charge for Vyvance. When we moved from one town to another nearby place, changing pharmacies saved us $100 a month on the Concerta; if I had known that, I would have done pharmacy shopping long before that. So you may find that you can reduce that price, if you shop around. However, since Vyvance is a name brand, it will be on the pricier side. You should feel free to tell your doctor that you need to consider cheaper options, as well.

I can't find any ped. psychiatrists here or np ped psychiatrists. 

I did look at GoodRx and all the other pharmacies are even more expensive.

8 minutes ago, sbgrace said:

I agree, and it sounds like you're thinking this OP, that 2 meds at once wouldn't be my choice. My son's  psychiatrist doesn't like to do that either. It's really better to know which med is causing a side effect (if there are any--I hope there aren't). Those two meds in particular both caused severe insomnia in my son. If we had trialed both at once, it would have been harder to sort out. 

I really like using a psychiatrist for this, particularly when you find that certain medications already aren't right (the adderall and ritalin). Side note: my son can only handle short or mid acting Ritalin....long acting forms always cause side effects for him that are intolerable...mentioning in case your son was only prescribed long acting forms of the adderall/ritalin)

I hope you find what helps. I'm sorry he's struggling so much. 

WE've done fast acting and xr ritalin but not the adderall.

[Melissa Louise]

Kid (17) takes fluoxetine + ritalin. No problem with the combo.

[SanDiegoMom]

My daughter takes 10 mg of Lexapro and 30 mg of Vyvanse, along with 80 mg of Strattera. She went on them all separately.  She has no problems. She is 21. 

[Terabith]

Little known fact:  stimulants are a third tier level medication for depression.  I definitely, absolutely do not have ADHD, but I took ritalin for awhile for depression.  It was helpful, but not a miracle or anything, and I eventually discontinued it because taking it was a pain with regard to paper prescriptions every month.  

[Soror]

Thank you all. I think we'll wait a month and see how this first med goes before looking at adding in another. We have a follow up in 1 month and I will be able to go to talk to the ped then. This week another child had an appt at the same time so dh and I had to divide and conquer.

I'm still curious about genetic tests to determine which drug will work the best. Still looking into different types of meds.

[PeterPan]

16 minutes ago, Soror said:

I'm still curious about genetic tests to determine which drug will work the best. Still looking into different types of meds.

If you already have your genetics through 23andme, you can look at their sample reports and hack backward, no biggee. Most of the stuff they do is not very revelatory, which is why many docs don't bother anymore. They look at the rate you metabolize, which can affects dosage. They don't really look at anything more complex (who your methylation status from the interplay of several genes results in a profile that may or may not tolerate a med). You can predict that if you look at the genes, but the companies doing this are very linear (this gene is associated with x, that's it). 

So if you already have your 23andme and look at their sample reports you can see the genes, work backward, and have a sense of what they would have said for free. It's all there in the fine fine print. 

You can also do something simple like x + y medication interactions in a google search, see what comes up. 

Is this person's vitamin D up? Is their thyroid ok? Food allergies (if they have any) under control? 

I get the medication thing is hard.