Many of you know that I am a practitioner with MavenClinic, an app designed to provide healthcare services to women. Part of the MavenClinic app is the ability to ask a specific practitioner questions. Recently I received a question from a maven client which asked the following:
“Does Vyvanse make anxiety worse? If so, what are some ways you would suggest for combating the anxiety?”
This is an excellent question and I wanted to share my response here as well.
ADHD & Anxiety
There tends to be a large overlap between anxiety and ADHD. Many times patients will present with symptoms of both disorders. It takes a thorough psychiatric evaluation by a clinician familiar with both diagnoses to determine whether severe anxiety is causing difficulties with focus and attention or if difficulties with focus and attention are causing anxiety. If a patient has significant ADHD and is treated for the ADHD than many times the anxiety subsides with treatment.
Stimulant Medications for ADHD & Subsequent Anxiety
Occasionally, patients may develop anxiety or suffer from worsening anxiety when treating their ADHD with a stimulant medication. Stimulant medications include Vyvanse as well as Adderall Ritalin Concerta and Focalin. The mechanism behind anxiety from these medications is best understood in the context of the fight or flight mechanism.
If you imagine anxiety as an important tool for survival when humans were cavemen and needed to survive attacks by large predators. 
When threatened and the flight or flight response is activated your heart rate and blood pressure are elevated so that you will quickly flee from the predator or increase your ability to fight off the predator. We have found that, that the interplay between the physical symptoms of anxiety like the increased heart rate and blood pressure and the psychological symptoms of anxiety are highly related. Therefore, if someone is highly anxious and is given a short acting anti-anxiety medication which decreases their psychological anxiety, the physical symptoms of anxiety decrease as well. The same is true for the opposite, if someone is highly anxious and given a medication to reduce the physical symptoms of anxiety, there the psychological symptoms of anxiety decreased as well. This is a very interesting topic I plan to explore further in another blog post.
Stimulant medications can cause an increased heart rate and blood pressure which as we just discussed our physical symptoms of anxiety. Because physical symptoms of anxiety are present the mind will occasionally interpret this as an increase in psychological anxiety as well.
Type of Stimulant Medication & Dosage
A stimulant medication that is being used at too high of a dose or is not the ideal stimulant medication for you is more likely to cause these physical symptoms and psychological symptoms of anxiety. One option would be for the person to decrease their dose of Vyvanse and assess their anxiety with this change.
Another option would be to try a different type of stimulant medication. Vyvanse is similar to Adderall which is a amphetamine. Other stimulant medications are methylphenidates and include Ritalin and Concerta.
Non-Stimulant Medications
While stimulant medications have shown the most efficacy for treating ADHD, there are also non-stimulant medications FDA approved for treating ADHD. These non-stimulant medications include Strattera (atomoxetine), Kaypvay (clonidine and Intuniv (guanfacine). A third option is to stop the Vyvanse and switch to a non-stimulant medication for ADHD.
Current estimates show that approximately 30% of people diagnosed with ADHD also have an anxiety disorder.
Treating Anxiety Unrelated to ADHD Medication
The final option would be the addition of treatments specific to anxiety. There are a number of medication options available to treat anxiety specifically. This option makes the most sense if you experienced anxiety before starting on the Vyvanse. There are many available treatment options for anxiety including:
- Psychiatric medications such as an SSRI
- Cognitive Behavioral Therapy
- Mindfulness and Meditation
- Relaxation techniques
- Proper nutrition and sleep hygiene
I will discuss options for treating anxiety further in a future blog post.
MentalCalm 