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Adult w/ ADD: Severe panic attacks or worse in a.m.

I take 1.5 mg Klonopin + 50 mgs of Vyvanse. I have ADD but the Vyvanse is also prescribed for depression as I cannot take absolutely any antidepressant without incredible agitation. That started several years ago.

Here's the problem at hand, as it starts: Every time I sleep, whether day (as in nap, a rare occasion) or night, I have disturbing dreams I can't put a finger on. I'm often very sad anxious and in some type of bad situation.

THEN comes the REAL PROBLEM: I awake in absolute terror. It feels somewhat like the world and myself are coming apart at the seams. I'm frantic and feel slightly less than rational.  I am pretty much completely dysfunctional for at least half an hour to two hours. The Vyvanse I take generally relieves it when it kicks in. It's as if my mind falls apart when off it. It's very drastic; like nightmare, these experiences may dissipate or, in severe cases, they essentially "bleed over into" the whole day.

I never wake up happy to face the day, excited, etc., but instead face this same terror each and every morning. If I nap in the day, I will awake with the same reaction AGAIN and, even though Vyvanse is still active, or should be, it's as if it wore off. This lessens if I sleep longer but I'm prone to very much less than normal hours of sleep. I may even sleep less the more exhausted I am.

I suspect some of this is psychological, a lot on my conscience from my alcoholic days (in recovery), plus I have never been single this long and it is not by choice...so I try to get out but am pretty isolated and often extremely lonely. All these problems don't make me feel too hopeful about meeting someone for a serious relationship, as I'd like to.

This is nothing like waking up in a bad mood. It's a full-throttle sensory attack accompanied by self-attacking thoughts and feelings, as if I'm being destroyed, losing my mind. Once it passes, aside from fearing recurrence on the worst days, I am "normal" except for my usual anxiety, mostly social. Can you tell me some possible causes and solutions? Perhaps what plagues me most is the question: Is Vyvanse relieving a false sense of going crazy, or is it creating a false sense of being "normal" while on it...which does not mean euphorically high, just keeping things in enough perspective to handle? Thank you.
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189897 tn?1441126518
COMMUNITY LEADER
Ok, now this is beginning to make sense.   Your inability to work with anti depressants is possibility due to the combination you were taking.  As I said both Prozac and Paxil when combined with a stim med can cause some very bad side effects.  "Here is more on that .... We will cover more details later, but for now just remember this: Prozac and Paxil both significantly block the pathway for the metabolism of Adderall and all the amphetamine products. [Wellbutrin and Cymbalta are moderate inhibitors, and can block 2D6 at higher doses.] If you take either of these two antidepressants together with an amphetamine, beware. You can significantly become overdosed on the amphetamine and suffer significant arousal side effects. Often this interaction can unpredictably occur several months later. The patient becomes toxic to the amphetamine, angry, irrational, can’t sleep, can’t eat, and can become dangerously destructive. The Adderall or Vyvanse often gets blamed. The Prozac and the Paxil are the problem. More about Adderall in a later post."
    This is from http://www.corepsych.com/2006/11/adderall-prozac-and-paxil-problem-not-solution/

I mention this because perhaps your problems with the anti-anxiety meds was due to the above.  And thus you might be able to deal with something in "the venlafaxine series including the generic, Effexor XR and Pristiq, then Lexapro and Celexa."
  
   I can certainly understand you reluctance to stop the klonopin.  But, you might talk with your doc and see about reducing slightly your dose and see if that makes a difference with how you wake up.

   By the way, a high protein breakfast will really help any stim med work better.   Try one of the high protein mixes (with water) or a high protein bar for a day of two and see how you feel.
   And exercise will really help!!   You are in Florida - get out and move!!!  
   Hope some of this helps.  If you need any more info - or just want to explain more - please post!  Happy New Year!!!
Helpful - 0
189897 tn?1441126518
COMMUNITY LEADER
    I am pretty sure this is psychological.  V is good for about 12 hours and then its gone - you revert back to your unmedicated self.   Also this happens in your dream state, and is probably your mind dealing with things that you have not been able to deal with.
   I think that this is something that a good psychologist could help you with with.
   I also think that, if it is possible, that you need to get out.  Go volunteer somewhere.  The need is all over the place.  You need to change what you are doing.  If it is even nothing more then helping to clean up a local park (as long as it is with people) will help.
   The other thing you really need to do is to research Klonopin.  It may be why you are having your problems.  First, "Doses higher than 0.5–1 mg per day are associated with significant sedation."  and part of your problem is that you seem to sleep very deeply.  I have also seen where you should not be on it for more then 4 weeks. and it can be very habit forming (and even deadly).    
   I would like to know what antidepressents you were on that gave you problems.  There are some like Prozac which when used with stim medications will have really bad interactions.   There are some anti anxiety meds, like the  "venlafaxine series including the generic, Effexor XR and Pristiq, then Lexapro and Celexa."  which you might want to try.
  Hope this helps.
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1 Comments
You are correct about the dreams. I have some strange sense of dream content when I awake. I only know the theme seems to be regrets and mistakes on my part, and occasionally a sense of abandonment (that being a lifelong issue).

There is a pause as I open my eyes. For a moment, I don't exactly welcome the morning. I'm more half--okay, half-dazed. But as I return to consciousness, I can all but begin to feel the ground crack beneath me and it soon feels like the sky is literally falling. The stresses and worries mount to such a pitch I can barely stand it. I am extremely disoriented and uncoordinated during these episodes.

I do sleep straight through the night but often only five hours or less. It's rare day I come close to eight. This no doubt plays a big role in the morning attacks. I have been on Klonopin since my thirties. I was on doses as high as 6 mg./day (yes, prescribed). The inability to withstand antidepressants (including those you  mention) began during an ill-advised rapid detox/rehab for Klonopin, alcohol, Ritalin (not Vyvanse at the time), and, believe it or not, I was taken off Paxil at the same time. If you know about Paxil w/d, what kind of genius would add that trauma to an already bad idea (rapid Klonopin withdrawal is not suggested by anyone who knows what they're doing, which does NOT include the rebab industry. It's the biggest scam going I've ever seen with guaranteed repeat business. They claim that's the nature of addiction. Then what's the point of the "treatment"? At best, people get so sick of spending $10K or more for anywhere else free AA/NA meetings, second-rate at best "doctors" (read: psychiatrists), minimal therapy, etc., until they they quit. This is their idea of success. Sorry for the rant.

The detox lasted five days, after which I as dropped off as in all but parachuted into an at least 150+ rehab facility. You can imagine what happened next. Freaked out does not begin to describe it and Klonopin withdrawal did not begin in earnest until a day later. I lived through a year of completely unbearable anxiety -- that suggest I ***could*** bear it if one considers lying in bed for nearly a year and actually forgetting how to drive bearable. I felt like I was on bad acid the entire time. I take 1.5 mgs now. I do not feel much effect from it. I simply cannot take that withdrawal again; that's the sole reason I take it.

Ridiculous? I sensed it would have been two full years before I would be anywhere near normal. At my age, no thanks wasting that time on agony for perhaps the same result. However, after Klonopin was reinstated, I felt somewhat better but nowhere near normal. Only when Ritalin (which was too euphoric for me, and Vyvanse took its place) was re-added did I feel normal. Better than normal? Perhaps. However, the way I felt even after reinstating Klonopin could in no way be called normal.

I have undergone a lot of trauma in the past few years. My son died a little over a year ago. My mother is in late stage Alzheimer's. I am single by "mistake" after a poor decision to go along with my ex'd decision to move back to Florida, where I now live alone. I have few friends except in relation to AA (yes, that's heavily involved in my life and regrets).

I have asked this question every way possible. I am currently working on getting back into therapy. I see my current regimen as the best of all not so hot current solutions. I tried to convince my doctor to put me on Provogil to see if that might replace the Vyvanse (I am not sure but believe it either is already or close to being an approved off-label ADD treatment). From what I've heard personally, it probably would not have worked.

So you may be right: This may be something I can only minimize with therapy. I've looked into the more extreme treatments for depression and am not willing to play with those odds, no matter how "humane" (a word which in the mouths of psychiatrists sounds like "Results? Who cares? How much do I get to charge for THAT?"

This is really quite frustrating. However, I have to say, at least it's only a couple of hours a day. The rest of the day is far from normal, but I have periods after the a.m. attacks I would call more than satisfactory, with others satisfactory, and some mightily tough.
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