Posted by comorbid? on May 22, 2003, at 22:03:18
In reply to Re: Mirapex » PuraVida, posted by Magpie on April 8, 2003, at 2:48:59
Hi PV and Magpie
I was surfing along, looking for info about Strattera - atomoxetine - and ran across your thread. My doctor mentioned Stattera to me today and suggested I look into it, give it some consideration, to see what I thought. I have attention issues and he thought it possible that it might help. Yes, he and I have a pretty trusting relationship. I tell him what I do, and he lays out the info.
In my case, the current diagnosis is childhood-onset bipolar, type 2, seasonal, with rapid (ultra-ultra-rapid) cycling. I'm a 42-year old male, and have had the symptoms since early childhood (or as far back as I can remember; hard to say when exactly). I originally sought treatment for depression, about 10 years ago, and was on SSRIs (zoloft and prozac) for almost eight years, and two doctors.
I went back to school three years ago, to finish the BA I'd never completed. During the time I was in school, I had terrible problems with my mood, and a range of ADHD symptoms. I had hoped that my bad study habits would be a thing of the past, but the problem was still there.
I finally sought psychiatric help. Psychometric testing revealed ADHD, Inattention subtype, with hyperactive features; I met all nine criteria for attention deficit, and four out of nine for hyperactivity.
But, referring back to the above, my new psychiatrist refused to prescribe stimulants, because he felt they might induce mania. This despite the fact that I have only experienced hypomania, never full-blown mania, and never psychosis. Needless to say, I found this frustrating.
For the past year, I've been prescribed Lamictal - lamotrigine - an anti-convulsant that anecdotal evidence suggests may be useful in mood stabilization. At the time that he prescribed this drug, my doc also took me off Prozac, which he said might exacerbate my rapid mood-cycling (I appear to have a very unstable serotonin level, affected strongly by light exposure, alcohol, marijuana, you name it).
The Lamictal has been very helpful in relieving my physical symptoms - akathisia - chronic stress-induced back spasm, restlessness, and an internal situation that's hard to describe but feels like my guts are clenched. Very helpful; these problems are mostly gone.
However, it has not had any great influence on my mood swings; last autumn, which season is usually my worst due to falling light levels, was absolutely horrible, my worst in a decade. I was at wits' end with the mood swings and did some crazy things that I regret. In previous years the Prozac had somewhat helped with this, by keeping my mood from going too low, and without it I was going from hypomania to severe depression daily, sometimes twice and three times a day. Profoundly disruptive, hugely anxiety-generating. I don't want to go through that again.
So, to address my daily (and longer, light-induced mood swings), my doctor has prescribed Zyprexa - olanzapine. I'm at only 5mg/day, and although it REALLY sandbagged me at first, it now seems to have smoothed out my mood on a 24-hour scale.
I still have light-variablity induced mood swings, such that a few sunny days in a row will leave me feeling quite confident, expansive, handsome, whatever, and a few cludy days will cause me to feel low, ugly, etc, with the intervening periods characterized by anxiety. This may perhaps be moderated by an increased dosage of Zyprexa, which is the next thing we're going to try. If that doesn't do it, tapering off the Lamictal and starting on Depakote - divalproate - may be the autumn option, though with all the tests this is very expensive and I can't afford it until I'm in grad school and fully insured.
Finally, and to get back to my original point, it's not at all clear whether my ADHD symptoms are simply part of my bipolar symptom cluster, or if the ADHD and bipolar disorder are separate and comorbid. For this reason, the use of stimulants, even something as "safe" as Strattera, may be contraindicated, but on the other hand may be perfectly alright... it's a crap shoot!
What I hope you can get from this is, 1) It's hella difficult for your doctor to sort these things out, they're very complicated, and self-diagnosis, although you may "know" how you feel, is NOT a good idea, 2) there are alot of different medication strategies to work through, and patience is a MUST, 3) self-medication is ALWAYS a no-no, despite any short-term positive effects you may perceive (If you're in a bad way emotionally, just about ANYTHING may seem to give you relief, because it distracts you from your suffering. Airplane glue, alcohol, hard drugs, sex, food, coffee, cigs, exercise, you name it: They all have effects on your brain, and will change the chemistry, for better or worse....and sometimes you're so desperate for change, any change, that these things seem like possibilities), 4) TALK TO YOUR DOCTOR and be honest! And if your doctor isn't helping you, find another one. You have to participate in your treatment to make it work!I hope all this information helps you, and is not just an exercise in self-indulgence on my part.
And by the way, I asked my doc about Abilify – apipiprazole – and he said it has yet to be approved for bipolar disorder, although he did have free samples that a sales rep had left. Ah, the temptation! When I read about it, it sounded very good: A serotonin agonist and anti-agonist, meaning it would tend to stabilize the effect of serotonin on receptors in the brain, and also anecdotal evidence that suggests it may work for ADHD. Sigh. Who knows? Maybe I’ll end up trying it someday, or maybe not, if something else does a good enough job to satisfy me….
I wish you all the best, relief from your troubles and happy outcomes!
comorbid?
poster:comorbid?
thread:133458
URL: http://www.dr-bob.org/babble/20030520/msgs/228462.html