For two years, Molly’s ADHD medication, a generic form of Vyvanse called lisdexamfetamine dimesylate, had come in the form of a teal pill that was so large it sometimes got stuck in her throat. But when Molly, 35 (who is only being referred to by her first name to protect her medical privacy), picked up her prescription in May of this year, she immediately noticed the pills were smaller than they’d been before. She didn’t think much of it, aside from, “Oh, maybe these will be easier to swallow.” But over the next two weeks, things took a downhill turn.
“I had these huge depression swings, my executive function was zero,” she explains. “My house, which hadn’t been a mess in a long time, had just built up all this stuff, and I just felt this overwhelming fatigue, like I slept a lot during that time, and there wasn’t anything different in my normal life.”
Before her ADHD diagnosis in 2020, Molly says she was misdiagnosed with depression and experienced symptoms strikingly similar to those that appeared after picking up that fateful prescription in May. Deciding to test out a growing theory, Molly said she took a leftover pill from a previous prescription of the larger pills and felt “a night and day difference.”
She reached out to her pharmacist and asked if the new medication could be the reason her old symptoms were returning. As it turned out, the larger teal pills that Molly had been taking were manufactured in New York for a company called Camber, but the pharmacy wasn’t able to get Camber’s pills in the 60mg dose that Molly needed. So, her pharmacist had filled her latest prescription with a 60mg lisdexamfetamine dimesylate tablet made by SpecGX, a company that manufactures its drug in both Missouri and New York.
On August 25, 2023, the FDA authorized 14 manufacturers to produce generic lisdexamfetamine dimesylate. Since then, an ongoing shortage of ADHD medications — including lisdexamfetamine — has caused widespread disruptions. Amid increasing demand, limited production capacity, and tighter oversight from the Drug Enforcement Administration (DEA), patients are now being switched not only from brand-name to generic but also cycled between generics from different manufacturers, often without warning.
As a result, growing numbers of patients and physicians have raised concerns that certain generics are less effective than their brand-name counterparts, pointing to cases like Molly’s, where symptoms seemed to return after a pharmacy switch.
Ryan Sultan, M.D., a child and adult psychiatrist in New York City who specializes in treating ADHD, says about 70 percent of his patients who take lisdexamfetamine dimesylate have reported lower efficacy since being switched from name-brand Vyvanse to a generic. For most, he says a slight dose increase helped alleviate their problems, but it’s not a great long-term solution.
What Is Vyvanse?
Vyvanse was approved by the FDA in 2007. It’s a pro-drug, meaning it stays inactive until it’s metabolized by specific enzymes in your body. This built-in delay helps the medication release more gradually over time. Early versions of ADHD drugs “had a hard start and a hard stop,” says Gina Pera, an author and ADHD educator. Newer drugs, including Vyvanse and Concerta, were designed to last longer and gradually taper their effects.
Dr. Sultan explains that, in general, it’s best for most drugs to enter and leave the body gradually. When levels rise and fall too quickly, he says, it’s much more likely to cause side effects.
How is Generic Vyvanse Different from Brand Name?
After the FDA approves a drug, the company that brought it to market is granted market exclusivity for a specified period, which can range from a few months to seven years (and may be extended), allowing the drug manufacturer to recoup its investment in development and generate a profit. Once that period of time is over, other companies can make their own formulations of the same drug and sell them at lower prices.
While a generic drug must use the same active pharmaceutical ingredient (the ingredient that has the therapeutic effect on your body) as the brand-name drug, there are some differences that the FDA allows. First, a generic drug can use different binders, which are fillers or chemicals that help the pill keep its shape. Second, the concentration of the drug in your blood, or in the part of your body it’s supposed to treat, has to be similar to that of the brand-name drug, but not exactly the same. The FDA allows a small amount of variability, although differences in manufacturing quality control between labs can mean that many drugs may fall outside of this permissible window without regulators being aware.
According to Dr. Sultan, it’s possible that even within the FDA’s guidelines, those slight differences could affect how well the drug works for certain individuals. “Are we upset because we’re being given a drug that’s not as useful, or because the FDA has allowed us to be given a drug that is not as useful?” he asks.
Over the years, experts have debated about the best way to compare generic drugs like lisdexamfetamine to a brand-name Vyvanse. Current guidelines suggest that generic drugs can be tested on a minimum of 12 people, and researchers focus on measuring how much active ingredient enters the bloodstream over time, comparing both the peak levels and overall exposure between the generic and the brand-name versions.
Neither Pera nor Dr. Sultan is surprised to hear that people taking generic forms of Vyvanse are reporting mood problems. For some people — like Molly — depression and anxiety can be symptoms of ADHD, and if the drug made by one manufacturer is wearing off too quickly or isn’t delivering the appropriate dose, those symptoms could return. But, Dr. Sultan does note that lisdexamfetamine is more potent than other ADHD medications, which makes it “more prone to some of this emotional dysregulation.”
Does Generic Vyvanse Work?
Many patients say “no,” although the FDA currently lists all lisdexamfetamine dimesylate products as therapeutically equivalent to the brand-name drug in its Orange Book database, a publicly available database of FDA-approved medications that contains information about the drug’s patents and bioequivalence status.
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Noticing a return of ADHD symptoms on generic Vyvanse? You’re not alone. Write to us at Jessica@MedShadow.org and tell us your story
After Gina Pera and many of her readers reported problems with extended-release methylphenidate (generic Conerta) to the FDA’s adverse events database MedWatch in 2014, the FDA downgraded the rating of two drugs in the Orange Book database to BX, which means they were not interchangeable with the brand-name drug.
These generics remain available, although pharmacies should not use them as substitutes for the brand-name drug or other generics.
Issues with generic Vyvanse are not purely anecdotal. Since the FDA approved lisdexamfetamine in 2023, two companies have issued recalls. The first, from Lannett, was initiated on December 5, 2024, and concluded on June 27, 2025. The company did not release a public statement, but the FDA’s database attributes the recall to failed content uniformity, meaning some of the company’s 10mg pills may have contained inconsistent doses.
The second recall, by Sun Pharmaceuticals, began on June 16, 2025, and remains active. While the company also did not issue a press release, FDA records indicate its 60mg lisdexamfetamine failed a long-term stability test. After nine months in storage, it no longer dissolved at the required rate.
Recalls are typically temporary and do not permanently remove a drug from the market.
Dr. Sultan emphasizes the need for accountability: “We have to push the FDA and ask, ‘Are you monitoring this?’ Is this just scouts’ honor, or is there real oversight?”
When contacted for comment, neither company responded and the FDA provided no additional context for the recalls.
What You Can Do if Your Generic Vyvanse Doesn’t Seem to Be Working
If you think your generic Vyvanse isn’t working like it should, the first thing you should do is collect some data, says Pera. “If you’re going to ask for a medication change, you need to have data,” she says. “Doctors are more likely to respond to that.”
She suggests keeping a log of how the medication is working hour by hour. Keep track of tasks you’re able to complete shortly after taking the medication that you’re no longer able to do hours later.
Then, report your experience to MedWatch, as Pera and her readers did. The FDA monitors these reports, and if a large number of reports suggest that generic lisdexamfetamine dimesylate isn’t working, they may initiate testing and potentially downgrade the therapeutic equivalence codes or even remove certain drugs from the market if they aren’t found to be working as intended.
Once you or your doctor has filed a report, you can try to see if you can convince your insurance company to cover the brand-name drug for you. Dr. Sultan says, “you can plead with the insurance company for why you need a brand medication, … but the insurance company, of course, makes it an administrative chore for the patient and us [doctors].”
Molly’s insurance company had her jump through a number of hoops — having her doctor file a MedWatch report then making a copy and submitting it to the insurance company — but even then, the company only lowered the out of pocket price for Molly to get the brand-name drug from about $450 per month to $150 per month, a price she says was still too high for her budget. The generic only cost her about $20 per month.
Rather than fighting with insurance companies, Dr. Sultan says that he usually increases the dose his patients are taking, which seems to help. It’s not ideal, he says, because they may need to switch manufacturers again in the future, but it’s an option.
Lastly, Pera adds that the inconsistencies in medication quality highlight the need for people with ADHD to stay on top of any non-drug management strategies they can, such as organizational strategies that support executive function and doing everything they can to get good enough sleep. “Sleep is huge with ADHD,” Pera notes.
When Molly realized that paying for the brand-name drug was not a viable option for her, she, her pharmacist, and her doctor came up with another plan. The reason she’d been switched initially from Camber to SpecGX was because Camber had stopped making 60mg tablets, but the company still made 30mg tablets. Her doctor and pharmacist agreed she could try taking two of the 30mg pills to make a 60mg dose.
Again, she says, she experienced a night and day difference. Within the first week of switching back to the Camber medication, she says, she stopped feeling the crushing fatigue and waves of depression she’d been having. And, she adds, “I’ve got all my house stuff done.”
