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Re: Expert Opinions Please on My ADD/BPII Med Cocktail

Posted by PsychoSage on March 13, 2004, at 16:54:34

In reply to Expert Opinions Please on My ADD/BPII Med Cocktail, posted by AzureBay on March 12, 2004, at 21:26:28

> Hi All,
>
> I'm fairly new here. It's obvious that most of you really know your stuff, so I would appreciate some of your excellent advice on my med cocktail.
>
> MY BACKGROUND - I was initially diagnosed with ADD of the inattentive type about 5 years ago. The neurostimulants worked well. After several months I began to notice sub-layer symptoms that I believe were there all along, probably since childhood. These included depression and severe anxiety. Interestingly, the neurostims made improvements on both. But, what I'm getting at is that I essentially became more "AWARE" of them as my ADD symptoms got under control.
>
> I was then treated with the typical gambit of AD's - tried every damn one of them, and never really got good results except with Celexa in low doses. At this point, Xanax was added into the mix, along with Atenolol for some essential tremors from the ADD med.
>
> About a year ago I arrived at point where I felt I was getting no better. I honestly felt disabled most of the time, despite the fact that the neurostim meds allowed me more focus. It was through researching online that a light went on, and I came to the conclusion that I was likely BIPOLAR II. I fit the criteria to a tee on every test.
>
> So, back to the pdoc I went, and he hesitantly agreed with me at first. We started trials of several drugs over the course of the next months, including Lithobid, Zyprexa, Geodon, Gabatril and several others whose names I forget at the moment. I had the best results with Zyprexa and Lithobid, but the side-effects were simply NASTY - weight gain and all that. Hell, I'll bet I gained 30 lbs just from picking up the prescription of Zyprexa lol.
>
> This brings us to the present.
>
> MY MED COCKTAIL NOW IS AS FOLLOWS:
>
> Ritalin 20mg tid
> Aricept 10mg
> Abilify 10mg
> Celexa 20mg
> Atenolol 50mg
> Klonopin 1mg tid/prn
> and some experimentation with Picamilon
>
> Now I'll tell you what's wrong with this picture. Something is just a little bit off in this mix. My hunch is that it's the Celexa because there is an all-to-common apathy that's been going on way before I started Abilify or Klonopin. My libido is also pretty much limp, pardon the expression, and my creativity is dampened. I'm unmotivated and unproductive. I'm not really severely depressed at the moment, but I do have highs and lows. Anxiety is a definite issue.
>
> Guys, believe me I've tried discontining them one at a time, all but the Celexa, and it's the only one constant that seems to be a likely culprit. Besides, I feel as if it interferes with the Abilify for some reason. I've also experimented with adding Lithium to this combo with very mediocre results.
>
> So... what are you honest thoughts on this medication combo? Do any of you see any interactions that throw up a red flag? Do you believe I'm correct about the Celexa being part of the big problem or is it something else? How does the Abilify fit in with my ADD med?
>
> I have had mild manic episodes while on the Celexa in this mix, and I tend to do outrageous things off and on, like spending too much or gambling - just stupid things that I later regret.
>
> If I had to keep 2 drugs and toss the others they would be the Ritalin and the Klonopin. Both seem very effective. But something else in the mix is just not working right. And I don't get the bipolar problem addressed with those two meds alone, so I'm back to square one.
>
> Have any of you with Bipolar II had good results with Abilify? Are any of you both ADD and Bipolar II?
>
> Your thoughts and help with this are deeply appreciated.
>
> Be well and thanks,
>
> Azure

Check this out:
http://www.jrn.columbia.edu/studentwork/cns/2002-03-04/126.asp

Consider the least number of meds as possible to be able to truly observe what is going on.

Consider dropping Klonipin if possible and finding alternative ways to deal with anxiety. Any benzo even taken before bed will affect more than GABA even after the theraputic effect wears off. This means it dulls other systems. There will be newer and more selective sleeping/anxiety aids because this is a huge and hot market.

Consider a mood stabilizer instead of the antipsychotics which can suck the life out of you. I personally am on Trileptal, and the side effect profile is excellent except you need bloodwork for sodium done. Lithium and depakote can be heavy duty as far as being sedating for some people, but I wouldn't know and I hope I never find out. Trileptal is my first mood stabilizer.

Consider wellbutrin, strattera or provigil for stimulant poop out and tolerance build-up.

Consider asking your pdoc to go as low as possible or when he gives a dosage ask him for less of the figure he gives you. Going low on serotonergic and antipsychotic drugs if using them is necessary can be a way to get benefits with the least trouble. I personally don't like them, and they are on the bottom of my list. I have been on two antipsychotics, and I am not interested unless I have some wild episode.

I seldom see anxiety as something that should be treated with benzos unless it is the predominant problem as if it were PTSD or Panic. benzos and SSRIs will just dull your anxiety, and they won't help you attack the issues anxiety are entangled with.


some mood stabilizers are also considered antianxiety agents sometimes.

work things out based on your feelings and observations of your mood and symptoms instead of what they claim the drug does on paper. Drugs are just claims. Substances in the body are different things. Don't be biased by what the drug is supposed to do according to the manufacturer.

To me, antianxiety, mood stabilizers{except keppra?}, antipsychotics {except abilify?}, and SSRIs are at the end of the day not good for thinking, energy and getting things done. You have to tinker to get the benefit while leaving something human left.


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poster:PsychoSage thread:323789
URL: http://www.dr-bob.org/babble/20040313/msgs/324017.html