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Re: ADD/Bipolar II Meds (stimulants!) » The Undercracker

Posted by Ritch on August 15, 2002, at 13:27:36

In reply to ADD/Bipolar II Meds (stimulants!), posted by The Undercracker on August 15, 2002, at 4:13:48

> Hey All,
>
> I'm trying to get info and suggestions on what might work for my situation, as I feel my psych. tries to treat me with a "cookie cutter" treatment for BP II.
>
> First off, my symptoms (off meds):
>
> No attention span, no energy to do the things I love, general depression, hot temper, mood swings, insomnia from hell, and the occasional sleep paralysis. (basically I'm a walking corpse with a short fuse)
>
> Symptoms w/ meds:
>
> Same as above, but more weak and tired, maybe less temper although I think anger management is to be credited for that.
>
> Now for a little history:
>
> While struggling through college, I stumbled upon a music magazine article on how a large percentage of creative types have ADD. After seeing how well I fit the description, I quickly made a trip to a psychologist and had tests done. He concluded that I did in fact have ADD and sent me to an MD who stuck me on Ritalin.
>
> The crap hurt my stomach, but it seemed to help a little. The doc. kept upping the dosage until I was at around 40mg a dose x2 doses a day. By that time I was feeling a little jittery, but the positive effects wore off in time. My psychologist swore it must've been working because any normal person on 80mg of Ritalin a day would be bouncing off the walls. They later switched me to Adderall, which wasn't quite as bad on the stomach, but still the same basic situation.
>
> Enter a new town and new doctors:
>
> After being analyzed simultaneously by a psychologist and psychiatrist, they decided I was type 2 bipolar. They put me on Depakote for mood stability, Ambien for sleep, and Concerta for attention. The first two days on the stuff were great!! Within a week though, it was like I wasn't on anything.
>
> We've toyed around with the basic mix a bit. My psychiatrist took out the Concerta and then threw in Trileptal to compliment the Depakote, but then took me off. He changed the Depakote over to extended release (1000-1500mg a night). I've been prescribed as high as 150mg of Doxepin per night. Still I felt like crap.
>
> I explained the situation to my psychologist (who actually listens to me) and he mentioned some rare patients he had who required constantly varying dosages in order to notice any positive effects.
>
> So when I visited my psych a month ago, he lowered my Depakote levels to 1000mg a night, and the Doxepin to 100mg a night. He also added 100mg of Wellbutrin SR in the morning. The first two nights I was out cold from the Doxepin...and couldn't get myself out of bed! The third and fourth days were tolerable. By the time a week had passed, it was like I wasn't taking anything, so I took my psychologist's suggestion and toyed with the levels of Doxepin (only lowering the levels, never raising). Every time I made a change, I was out cold again all night and day.
>
> I told my psychiatrist what was going on today, so he's changed yet again on me. Now I'm on 500mg of non-extended release Depakote at night and 250mg in the morning, 100mg Wellbutrin in the morning, and 15-30mg of Restoril at night. I'll give it a week or so to work, but considering I took the full 30mg dose at 8:00pm and I'm writing this at 3:00 in the morning, it's not looking too good. Plus I seem to be in more of a pissy mood the past few days. Maybe it's the Wellbutrin, but I'm not really sure.
>
> Possible Solutions?:
>
> After a year long hiatus from school to sort this all out, I'm getting ready to go back. Unfortunately I don't seem to be in much better shape than I was a year ago. About the only time I've felt decent was when I was on the Concerta, which oddly didn't kill my stomach like Ritalin and Adderall. I think we may have given up on it too quickly. Ya it quit being effective after a few days, but does any sleep medication. Now that I know the secret of slightly varying dosages, I feel it might be a good time to try some of the stimulants again.
>
> Right now I'm mainly worried about drug interactions. I'm already taking three medications, one of which (Depakote) requires constant blood monitoring. Then again, I've taken them together before, but not with the Wellbutrin and Restoril in the mix. I also don't want to be taking stimulants just to get "high", although my current lows are so low that it seems nothing could get me any higher than normal.
>
> Any ideas or suggestions on what might be going wrong? Is adding a stimulant like Concerta a good idea? Are the medications I'm on making things worse instead of better?
>
> I'd really like to get this all sorted out before school starts next month. I need this "brain cloud" along with my constant exhaustion to go away so I can have a chance of achieving what I'm truly capable of.
>
> Thanks,
> -UC


Whew! Sounds like my symptoms (without anxiety). Well, to answer your questions.. Wellbutrin has the propensity to cause more hostility for me than any stimulants that I have tried. You mentioned that Concerta seemed to work really well. I noticed that your docs keep lowering the Depaktoe dosage :) Depakote does make you slow down a lot and become more tired. I wouldn't be surprised if they lowered the Depaktoe even more (say down to 500mg at bedtime), and swapped out the Wellbutrin for the Concerta, you just might have the right meds. Maybe. You might find Neurontin+Concerta to work better for you, or less Depakote+ a little Neurontin+Concerta.

just some possibilities,

Mitch


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Psycho-Babble Medication | Framed

poster:Ritch thread:116493
URL: http://www.dr-bob.org/babble/20020814/msgs/116539.html