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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I am a mental health professional and I have a client who is

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I am a mental health professional and I have a client who is currently taking Fetzima 80mg, Saphris 2.5mg, Vyvanse 50mg, Quanfacine 10mg (HS), Baclofen and Tramadol. She has Major Depressive Disorder, anxiety, ADD, Fibromyalgia. The above medications were prescribed all within the last 6-12 months. She reports suicidal thoughts (denies plan or intent), irritability, cannot concentrate, sleep disturbances . She is a working mother of three and it has greatly interfered with her work and home life. She spends all of her time in her room and has no desire to get things done at home.
She is a 39 year old married woman. History of depression, anxiety, ADD. She reports that the viibryd is pooping out at lunchtime and reports that an extended release stimulant was effective in the past. I was wondering about d/c Fetzima and Baclofen and trying Viibryd. Maybe d/c Vyvanse and Saphris and trying an extended release stimulant. ?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

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Hello and thank you for using JustAnswer. Actually Vyvanse is an extended release stimulant already, so the other option would be try Adderall extended release as that is a stronger form of amphetamine based stimulation. I am not sure if she knows this, but the Vyanse increases Dopamine, but the Saphris lowers Dopamine, so that may be why your client is not feeling focused and having difficulty concentrating because the Saphris lowers the effectiveness of the Vyvanse. She should consider discontinuing the Saphris completely before considering a change in her psychostimulant. Fetzima may be contributing to her suicidal thoughts as that is a medication that has some numerous side effects, so possibly tapering off that and switching to Lexapro, Remeron, or Lamictal could be helpful for her. The Baclofen is a muscle relaxer, so I would imagine that is not causing many of the symptoms you described here, so that probably does not need to be changed at this time.

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