Vyvanse and propranolol

[JSizzles]

Have you observed these in clinic:

I haven’t used vyvanse too much for binge eating. Have you noticed that vyvanse exacerbates anxiety in those who do not have a primary ADHD based disorder? For instance, the patients with primarily somatic complaints. The drug reps suck but bring really good food.

Propranolol some psychiatrists use ER and others do not. I have inherited patients on XR 60 and others on just the regular 10mg. I go to the regular 10mg for social/performance anxiety patients when it seems like a good clinical fit and it works pretty decently. Anyone really like XR instead?

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[birchswing]

I'm asking this as a question and not stating a fact: What is the potential for unopposed alpha stimulation with a beta blocker and ADHD stimulant?

 

[Liquid8]

Have you observed these in clinic:

I haven’t used vyvanse too much for binge eating. Have you noticed that vyvanse exacerbates anxiety in those who do not have a primary ADHD based disorder? For instance, the patients with primarily somatic complaints. The drug reps suck but bring really good food.

Propranolol some psychiatrists use ER and others do not. I have inherited patients on XR 60 and others on just the regular 10mg. I go to the regular 10mg for social/performance anxiety patients when it seems like a good clinical fit and it works pretty decently. Anyone really like XR instead?

Personally don't think too much of the whole Vyvanse for Binge Eating Disorder marketing campaign. For one, I've never seen BED in isolation without some other disorder - usually BPD or Bulimia Nervosa that hasn't been properly explored. Secondly, my understanding is that the mechanism of binges in BED patients is that they receive a dopamine high from impulsive binge eating, and replacing that with lisdex may simply be a case of replacing one thing with another and risk predisposing them to substance misuse. Also, the BED patient who doesn't actually purge would often end up being overweight or obese. That carries it's own physical risks including hypertension, which can be worsened by stimulants.

Stimulants can increase anxiety even in patients with ADHD, often much more severe if they are drinking lots of coffee or other caffeinated beverages. It doesn't come as any real surprise that you'd also see this in patients without that diagnosis. I don't mind propranolol for performance anxiety, but if a patient's anxiety is a side effect secondary to a stimulant, I'd typically push for them to reduce the dose or stop it completely rather than add on another medication.

 

[whopper]

I don't like the idea of using a stimulant for an eating disorder. Why? Cause in most cases the eating disorder's root cause is due to deep-rooted psychological issues that need to be addressed. Almost everyone I've seen with an eating disorder has significant cluster B personality traits if not an outright personality disorder. Further it's a controlled substance, and someone with bad psychological issues being prescribed a controlled substance is generally not a good idea.

Now if the person really has ADHD and Binge Eating that's different. If the person truly has ADHD then the treating of it would likely if anything help to stabilize the person. Many people with ADHD, once stabilized, are less impulsive, more productive, and now able to better succeed at things that are pro-social like a career and their family life. Even in this type of case, however, I'd prescribe the medication in a very guarded manner at first.

 

[hamstergang]

I don't like the idea of using a stimulant for an eating disorder. Why? Cause in most cases the eating disorder's root cause is due to deep-rooted psychological issues that need to be addressed.

How different is this from most psychiatric disorders and treatment?

 

[whopper]

Some problems are more physiological vs psychological (I mean that in a learned/behavioral sense). E.g. personality disorders usually don't respond well to meds.

Same with eating disorders. Usually the main treatment should psychotherapy and not medication.

 

[JSizzles]

I don't like the idea of using a stimulant for an eating disorder. Why? Cause in most cases the eating disorder's root cause is due to deep-rooted psychological issues that need to be addressed. Almost everyone I've seen with an eating disorder has significant cluster B personality traits if not an outright personality disorder. Further it's a controlled substance, and someone with bad psychological issues being prescribed a controlled substance is generally not a good idea.

Now if the person really has ADHD and Binge Eating that's different. If the person truly has ADHD then the treating of it would likely if anything help to stabilize the person. Many people with ADHD, once stabilized, are less impulsive, more productive, and now able to better succeed at things that are pro-social like a career and their family life. Even in this type of case, however, I'd prescribe the medication in a very guarded manner at first.

Unfortunately, that is almost always the case. Borderlines, dependent, histrionic galore