Posted by Ritch on May 22, 2002, at 10:12:39
In reply to mood stabilizers first - ron and mom, posted by Krazy Kat on May 21, 2002, at 18:23:54
> Do you think there is any reason Not to out a mood stabilizer in place first? I ask because I felt that should have been my first treatment - it was not. I was placed on AD's, then atypical AP's, then Neurontin + AD... on and on. Only when I really pushed it was I given Topamax to try. And eventually have ended up on Depakote, with a trial for a stim to offset the ADD-like side effects.
> I can't imagine why a pdoc wouldn't try a stabilizer first, whether they're certain of the BP or the ADD diagnosis. Would there be an ill-effect?
> Just curious.
> - kk
Hi KK, Ron, et al,
I just got through looking in my mood chart for the last four months and highlighting all of the "unremarkable" mood days and the longest strings of "unremarkable" mood days were when I was on Dexedrine+Neurontin+Depakote (all low dose). Every time I see a lot of "kinks" (cycling) were when I was taking SSRI (and no dex). The stimulant seemed to "displace" the need for the SSRI, without triggering any cycling. I am convinced of my ADHD dx, however I have bipolar traits for sure as well. I have had two "technical" hypomanic episodes (4 days each) in the last four months (but *not* associated with dexedrine). I know there is a lot of dispute about comorbidity. I think in my case antimanic/anxiolytic agents such as Depakote/Neurontin combined with a stimulant (like dexedrine) seem to work the best for me anyhow. The Depakote seems to work the best for impulsiveness and hostility, the Neurontin the best for anxiety, and the dexedrine as an *anticycling* agent-in my case anyhow. I suppose one could start an antimanic agent and see if their symptoms improve, and then add on a stimulant if a large cluster of ADHD-like symptoms are still unresolved. ??