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BPD with ADD
Heliopause posted:
Hi, I'm diagnosed with, and medicated for, BPD and ADD. I've been taking Depakote and Vyvanse for a few years now. My wife said I was displaying facial tics (tardive dyskinesia) from the Vyvanse. I didn't detect it but she insisted. My doctor doesn't think it's likely. Anyway, I stopped taking Vyvanse and my wife hasn't hasn't mentioned a tic since. But I can't focus like I did when medicated and it's clear to me that my work performance is negatively impacted - and that's a problem. I recently heard of Provigil and am wondering if that medicine might be a good alternative to Vyvanse in addressing ADD and whether it meshes well with Depakote for BPD. Any thoughts or experience with this? or alternatives?

Joseph F Goldberg, MD responded:
Dear Heliopause,

Vyvanse, and other stimulants, wouldn't cause tardive dyskinesia -- a movement disorder that results from long-term use of antipsychotic drugs -- but, Vyvanse and all other stimulants can cause tics, especially (but not exclusively) in people who have a pre-existing tic disorder. Progivil and its "enantiomer" Nuvigil are btoh wakefulness-promoting drugs (not technically stimulants) that have some research to support their value for ADHD, though they are not FDA-approved for that "off label" use and so insurance often will not agree to pay for those medicines when used "off label."
There are a number of other medication treatments for ADHD, including alpha agonists (e.g., Intuniv, clonidine), Strattera, and Wellbutrin, among others -- all options worth discussing with your doctor if the impression is that your attention problems are due to the persistence of ADHD into adulthood from childhood, and not other causes (e.g., bipolar disorder itself can cause attention problems, as can depression, certain medicines, etc.).

- Dr. G.

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