"Vyvanse Makes Me Tired" - What To Do About This Rare Vyvanse Side Effect

Published 2016-11-25 01:00:00 by Michael | vyvanse side-effects adhd

Vyvanse makes me tired

Is Vyvanse making you feel tired? This side effect is relatively uncommon compared with other side effects like headache and insomnia. But feeling tired on Vyvanse might surprise you given that Vyvanse is a stimulant and thus wakes most people up.

Why does Vyvanse make some people feel more alert and others feel sleepy?

In this article we’ll address these questions and more:

  • Why does Vyvanse make me feel tired?
  • What can I do about Vyvanse-induced fatigue?
  • What does this Vyvanse side effect indicate?
  • What are other common side effects of Vyvanse?

Vyvanse and Fatigue Quick Summary

  • Vyvanse (lisdexamfetamine) is a stimulant used to treat ADHD. The drug gradually releases d-amphetamine, which is a potent dopamine releasing agent.
  • Vyvanse makes most people feel more awake, but a subset of people will feel tired on the drug.
  • Feeling sleepy on Vyvanse actually supports a diagnosis of ADHD. In other words, if Vyvanse makes you feel sleepy it’s more likely that you have ADHD.

Paradoxical Reactions to Stimulants

When the effect of a drug runs opposite to what you might expect, this is called a paradoxical reaction. Feeling sleepy after taking Vyvanse is considered a paradoxical reaction because Vyvanse wakes most people up.

Individuals with ADHD are often calmed down by psychostimulants like Vyvanse. On the other hand, individuals without ADHD are more prone to experience anxiety and insomnia from stimulants.

What Does It Mean If Vyvanse Makes You Tired?

ADHD is surprisingly difficult to diagnose. No objective test exists that definitively points to an ADHD diagnosis. Instead, a psychiatrist takes into account behavior, psychometric tests, self-report from the patient, and other factors to arrive at an ADHD diagnosis.

I once spoke to a psychiatrist who said that if he’s not absolutely confident a patient with suspected ADHD has the disorder, he’ll give them a 10-day prescription for Ritalin (methylphenidate). Next, he'll check in with the patient a week later.

Often if a patient is slightly sedated by the Ritalin this can be a positive indication that the patient has ADHD. So in this case the patient’s response to the medication is used to vindicate the diagnosis.

Why Vyvanse Makes You Sleepy

Hyperactivity In ADHD

The acronym ADHD stands for attention deficit hyperactivity disorder. The hyperactivity in ADHD refers to the following cluster of symptoms:

  • inability to sit still
  • agitation
  • wandering thoughts that don't adhere to a linear chain of logic

Psychostimulants like Vyvanse effetively treat hyperactivity. Resolving the hyperactivity can make you feel sleepy.

If your baseline state isn’t hyperactive then you’re less likely to feel tired on Vyvanse. For example, a patient with Narcolepsy (the irresistible urge to sleep at inappropriate times) might take Vyvanse to stay awake!

Vyvanse (lisdexamfetamine) releases d-amphetamine which is a potent stimulant and dopamine releasing agent. Enhancing dopamine in the prefrontal cortex increases attention and working memory. Individuals with ADHD have a "reward deficiency syndrome"1 - they don't experience the same level as other people after completing a task. Vyvanse corrects this hypofunction of the reward system by increasing dopamine.

If you have ADHD and you're prefrontal cortex is "starved" of dopamine, increasing dopamine can make you sleepy. The dopamine boost decreases hyperactivity. On Vyvanse - your brain can finally "rest" and actually focus on something - but it may feel tired in comparison to the hyperactive state that it's used to. Vyvanse's calming effect in ADHD patients can make them feel tired.

The prefrontal cortex (pfc) is very sensitive to catecholamines like dopamine and norepinephrine. Moderate catecholamine levels engage D1 (dopamine receptor subtype 1) and alpha2A receptors which improves attention.

Sleep and ADHD

Individuals with ADHD also suffer from poor sleep quality and decreased sleep efficiency. Treatment with Ritalin (methylphenidate) or Vyvanse (lisdexamfetamine) results in increased sleep efficiency and increases the restorative value of sleep.

Summary: ADHD goes hand-and-hand with bad sleep. Stimulants like Vyvanse can actually improve sleep quality.

Not The Whole Story

But this is not the whole story. Low doses of stimulants actually decrease locomotor activity even in normal subjects. So there is a dose-dependent effect of stimulants on arousal and sleepiness that is independent of whether or not you have ADHD. In animal studies, researchers use locomotor activity as a proxy for arousal.

One review by Arnsten AF emphasizes that low doses of psychostimulants globally enhance working memory whether or not you have ADHD. At high doses stimulants "..impair prefrontal function via alpha1-adrenoceptors and excessive D1 receptor stimulation." Here's the abstract for this paper2:

For years, it was assumed that stimulants had paradoxical calming effects in ADHD patients, whereas stimulating 'normal' individuals and producing locomotor activation in rats. It is now known that low doses of stimulants focus attention and improve executive function in both normal and ADHD subjects. Furthermore, the seminal work of Kuczenski and Segal showed that low, oral doses of methylphenidate reduce locomotor activity in rats as well. Berridge et al have now shown that these low doses produce marked increases in norepinephrine and dopamine release in the prefrontal cortex, whereas having only subtle effects on subcortical catecholamine release. ihe prefrontal cortex regulates behavior and attention using representational knowledge, and imaging and neuropsychological studies have shown that the prefrontal cortex is weaker in subjects with ADHD. This cortical area is very sensitive to levels of catecholamines: moderate levels engage postsynaptic alpha2A-adrenoceptors and D1 receptors and improve prefrontal regulation of behavior and attention, while high levels impair prefrontal function via alpha1-adrenoceptors and excessive D1 receptor stimulation. Administering low doses of methylphenidate to rats improves the working memory and attentional functions of the prefrontal cortex, while high doses impair working memory and produce a perseverative pattern of errors similar to that seen in patients. The low dose improvement is hiocked by either an alpha2-adrenoceptor or Dl receptor antagonist, suggesting that both norepinephrine and dopamine contribute to the beneficial actions of stimulant medications.

Vyvanse Side Effect Frequency in Children

The three most common side effects are (1) decreased appetite, (2) trouble sleeping, and (3) stomach pain.

Note that most children experienced insomnia (not tiredness) on Vyvanse.

Chart source3.

What You Can Do About Feeling Tired on Vyvanse

We've dissected some of the issues related to feeling tired on Vyvanse. But what can you do about this uncommon Vyvanse side effect?

Rule Out Other Causes of Fatigue

Sometimes there's another thing causing fatigue that you might not have considered. Ask your doctor to rule out these potential causes of fatigue or tiredness.

  • Hypothyroidism - rule this out

Adjust Your Vyvanse Dosage

Sometimes raising or lowering your Vyvanse dosage

Switch To A Different Stimulant

References

  1. Comings DE, Blum K. Reward deficiency syndrome: genetic aspects of behavioral disorders. Prog Brain Res. 2000;126:325-41.

  2. Arnsten AF. Stimulants: Therapeutic actions in ADHD. Neuropsychopharmacology. 2006;31(11):2376-83.

  3. Wigal SB, Wong AA, Jun A, Stehli A, Steinberg-epstein R, Lerner MA. Adverse events in medication treatment-naïve children with attention-deficit/hyperactivity disorder: results from a small, controlled trial of lisdexamfetamine dimesylate. J Child Adolesc Psychopharmacol. 2012;22(2):149-56.

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