Adderall vs. Vyvanse and Dealing With a Difficult Doc

I have a question for you pertaining to Vyvanse and ADHD in general. I’m 23 years old and currently living in Fresno, CA, and have been diagnosed by a couple psychiatrists here and elsewhere with ADHD. One prescribed me Provigil, which seems to work alright, but also gives me bad anxiety at the doses I need. Also, I had to change insurance companies and the only way the provigil would be covered required the psyche’s office to write a letter to my new insurance which they refused to do on “policy”. Thinking about things now, I really don’t like the anxiety I got from provigil and am actively searching for a new psychiatrist. I have tried adderall, though never been formally prescribed it, and have had great results, but I’m very cautious about the side effects and taboo of asking a doctor for a prescription. Recently, however, a good friend of mine told me about Vyvanse and I was able to try one and it seemed to fix all of my focus problems and jitters without the forced feeling one gets from adderall. And so all this to ask, would it be taboo or inappropriate for me to talk to a psychiatrist in my area about Vyvanse, and is it too much for me to ask a willing prescriber to write the letter my insurance needs? Would you have any advice as to who and what to talk to a doc about? Thank you very much.

Sorry about including the long question here, but there are so many issues involved with this scenario that I included it all.  Let me knock them off one by one:

Provigil for ADHD: For those of you out there who have not heard of it, Provigil is a medicine used for narcolepsy and excessive daytime sleepiness.  It has an interesting mechanism of action . . . increasing release of norepinephrine and dopamine like the stimulants, but also increasing hypothalamic histamine levels.  Remember, anti-histamines in cold agents often cause sleepiness.  Provigil increases histamine availability . . . and that helps to improve alertness.  The manufacturer TRIED to get it approved for ADHD and reportedly had good data for adults.  It’s data for children was complicated by a reported case of Stephens-Johnson syndrome (a terrible skin reaction to medicine) so it failed.  . It is therefore used as an off-label agent by some docs to treat ADHD.  The biggest problem I have with using it is that it is NEVER covered for treated ADHD and it is hugely expensive (as you now know).  It is sometimes used as an adjunctive agent to treat medicine-resistant depression.  Anxiety, by the way, is a common side effect from Provigil.

The doc won’t write a letter: Policy . . . schmolicy . . . they won’t write it because it takes time to write a letter and time is money.  Plus, it is, quite frankly, a pain in the ass to write letters all the time.  We have a “policy” in my office that if you want a letter, you gotta pay for it.  Pay for it . . . you got it!  If it is a quick letter, I will often just knock it out and be done with it.  If it takes brain power, I usually charge.  This letter would NOT take brain power.  My guess, however, is that if you had not tried some of the more conventional agents (such as Adderall or Vyvanse or Concerta) they will end up denying it in the end anyway.  Provigil is very expensive and not approved for the ailment in question.  The insurance company has every right to have you use one of the standard approved treatments.  (BTW my objection with insurance companies is them trying to steer me toward a specific medicine . . . I am the doc working with a patient . . . I want to make the determination which of the approved treatments I wish to prescribe . . . more on that another day!!!!!).

Adderall vs. Vyvanse: Really, the choice here deals more with preference and individual tolerance since the active ingredient(s) is/are very similar.  As previously mentioned, Adderall is a combination of dexedrine and amphetamine salts, and Vyvanse in only dexedrine.  Historically, Adderall has been my favorite, but as Vyvanse becomes more accepted by insurance payers, I will likely start with Vyvanse first.  Simple reason here . . . same benefits . . . fewer side effects.  If you came to me and gave me your history, I would use Vyvanse if the insurance would cover it.

Gee, doc . . . I’ve been doing my own experimenting and I REALLY LIKE THIS ONE DRUG BEST!!!!!: Ok, this is where things get dicey.  My personal approach to a person your age is to up front ASK which ones they have tried and which one worked the best.  Ain’t a 23 year old out there who has been through college with ADHD and hasn’t tried one or more of the stimulants.  Doesn’t mean your a junkie . . . just that you have been searching for answers.  Some docs will get very upset and/or nervous about working with you on this.  If they can’t be reassured by your promise not to use the medicine as prescribed, then that is likely not the doc for you.  The doc may wish or expect some testing in order to be sure of the diagnosis.  I have recently included the Quotient-ADHD testing system into my practice and it has been great . . . I repeat GREAT . . . for aiding in diagnosis and in pin pointing the dose of medicine most effective for treating my patients with ADHD.  The closest practitioner to you with a Quotient system is up in the San Jose/San Francisco area . . . a bit of a drive, but I hear they have good restaurants up there.  You could go get a test and come armed with the information to your new doc.  Go to the Quotient site on my web-site or the company website for more information (  If I were treating you, I’d take a history, do a Quotient test, and, if clinically indicated and supported by the testing, begin treating you with Vyvanse.

–Dan Hartman, MD

2 comments to Adderall vs. Vyvanse and Dealing With a Difficult Doc

  • J Lo

    I have been diagnosed since childhood with add/adhd. I have been prescribed both aderall and vyvanse up to and including other stimulant medications and nothing worked better than vyvanse. It made my life much easier to cope with day to day task and even simple household organization. It is sad that most family doctors are not willing to listen to patient history when changing resident in a new city. I have struggled my whole life trying to change my approach to which behavioral actions would combat add without medication. Hands down my life was much easier with the aide of Vyvanse. Now without medication for now going on almost two years, I dream of a doctor I can see in my currenct city who just understands my diagnosis and trials without sending me to one specialist after another to prove my case. Most make you feel you are not sure of what your body responds to or needs most. I am far more challenged without the adie of this one drug that made me feel more apt to learning new things grasping new tasks and orginization in general. More docs should listen to the patient and realize that when people tell you what works for them is honest and helpinf thier quality of life. It is a struggle for adults who suffer what so many young adults abuse. Disheartinig for those of us who suffer the procrastination effect that detours us from actually doing our body good and resting our stress in order to perform daily functions at the best level possible. Bottom line it improves quality of life by providing a way to combat the many challenges we face due to no medication. Human is human we can;t change who we are or how our brains are wired. why do so many family practioners disbeleive in providing these adults with so many challenges to be and function in the best possible way which in turn makes us more successfull.

    • doctordan

      JLo–an educated consumer is more likely to get what they need. Good for you for reaching out for help. It used to be quite hard to prove your point to a doc. Adult ADHD is difficult to diagnose at times, because it is such an internal process. We do have the availability of using the Quotient ADHD testing system that can, for a very reasonable fee, give objective information about the core symptoms of ADHD. That information can be used to educate your family doc . . . and sooth the worries about you being a stimulant junkie (the worry at the core of all physician refusal to prescribe this class of medicine). Look up on the internet where you might be able to get the test and use that information to bolster your case!
      –DH MD