Patient's Query
Hello doctor,
I am a 33-year-old female. I started taking Zoloft four months back and started taking ADHD medication three months back while still on Zoloft. I started with a 36 milligram Concerta, then 54 milligrams, and it did not work. I started Vyvanse at 40 milligrams, then 60 milligrams. The 60 felt too strong, and I went to the ER because I was having chest spasms, tingly sensations down my left arm to my fingers, and down my legs to my toes.
I saw Zoloft and Vyvanse should not mix because of the possibility of them clashing and, though rare, getting serotonin syndrome. I have been feeling off since I started Vyvanse and Zoloft together with chest and leg spasms, tingling sensations, irritability, confusion, and issues with sleep. Even with my untreated ADHD, I did not have issues like that with sleep, especially when I am using my CPAP. I went to a nurse practitioner yesterday, and she is going to prescribe me Qelbree and up my Zoloft to 75.
I spoke to her and told her I wanted to wean myself off the Zoloft and get back on Vyvanse to see if Vyvanse can actually work, but she prefers me to stay on Qelbree.
I want to know if I should seek different advice? The pharmacist and PCP did not catch the clash that Zoloft and Vyvanse can have, and I am tired of starting new medications. I was thinking of getting off Zoloft anyway because I believe my anxiety and depression are mostly tied to untreated ADHD for over 30 years.
Please give me some advice.
Hello,
Welcome to icliniq.com.
I understand your concern.
If you did not find any improvement, then no need to increase the dosage and stop Zoloft (Sertraline).
Yes, Vyvanse (Lisdexamfetamine) and Zoloft, if started together then it will lead to some serotonin increase but not serotonin syndrome.
If you find any improvement with Vyvanse, then you can increase the dosage gradually and stop Zoloft gradually. But if you did not find any improvement, then it is better to continue Zoloft.
Even though anxiety and depression are secondary to ADHD (attention deficit hyperactivity disorder), one needs to start treatment for both.
The best way you can go for psychological tests, particularly TAT (turnaround time), and tests for ADHD, and start treatment accordingly.
I hope this has helped you.
Please feel free to reach out to me again if you have further queries.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
My primary care doctor took me from 60 milligrams back down to 50 milligrams. 50 milligrams is fine, but I was told by my nurse practitioner, the Zoloft and Vyvanse together are causing me to have adverse symptoms. She wants to start me on Qelbree and up Zoloft to 75 milligrams. But I am thinking of weaning off Zoloft so I will be able to take Vyvanse since Zoloft and Vyvanse clash together. My nurse practitioner prefers me to be on Gelbree and for me to stay on Zoloft.
I think the main reason why I was having anxiety and depression was because I had untreated ADHD and autism for over 30 years, and I did not know what was wrong with me. Should I go the route of weaning off Zoloft and sticking to Vyvanse to see if any anxiety and depression symptoms go away, because I would be treating my ADHD?
Please give me some advice.
Hello,
Welcome back to icliniq.com.
I understand your concern.
Yes, you can stop Zoloft only if you find any improvement with Vyvanse.
So my question is, even though you face adverse reactions to the combination of Zoloft and Vyvanse, do you find any improvement? No need to start any new medicine.
Yes, it is possible in certain cases that the underlying condition will improve then other secondary conditions will improve automatically. So, you can give it a try to continue Vyvanase and stop Zoloft 50 milligrams.
You can stop Zoloft by making it half for a week to 10 days and then stop. As I said, you can go for a psychological test for ADHD and anxiety.
I hope this has helped you.
Please feel free to reach out to me again if you have further queries.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
When I take Vyvanse in the morning, I feel more focused. I take Vyvanse at 9 am and zoloft later at 10 am. Two and a half to three and a half hours later, I feel the effects of Zoloft, but then later towards the end of the day, I feel off, and then it becomes hard for me to sleep. I stopped Vyvanse 60 milligrams for 11 days because I had chest spasms from taking Vyvanse, Zoloft, and coffee all in the same day. That was my first time drinking coffee on the same day as taking both medications. When I stopped Vyvanse 60 milligrams for 11 days (I was still taking the Zoloft during that time), the symptoms went away, and my primary care doctor prescribed me from Vyvanse 60 milligrams to Vyvanse 50 milligrams.
I do not know if Vyvanse 50 milligrams works well with me on its own because I am taking both Vyvanse and Zoloft together.
So I am not sure if Vyvanse works for me as the only medication.
Please help.
Hello,
Welcome back to icliniq.com.
I understand your concern.
As you mentioned, you had both medicines with coffee for the first time, so you might get side effects. So better to start Vyvanse and Zoloft in low dosage.
Even after that, if you find adverse effects, then stop taking both medicines together.
Start with Vyvanse and gradually increase the dosage. If you find some improvement, you will get results with Vyvanse and then gradually increase the dosage up to 100 milligrams. If not getting the desired results with 100 milligrams, then you need to add anti-anxiety medicines like Zoloft or any other anti-anxiety SSRI (selective serotonin reuptake inhibitors).
I hope this has helped you.
Please feel free to reach out to me again if you have further queries.
Thank you.
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Answered byDr. Vipul Chelabhai Prajapati
Medically reviewed byiCliniq medical review team
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