Posted by Ron Hill on January 19, 2005, at 10:55:55
In reply to Re: Colin Wallace » Ron Hill, posted by Ritch on January 19, 2005, at 0:08:33
Mitch,
> You're welcome. Stims DO have good utility with bipolar for the ADD/depressive dimensions, but watch out for panic.. that was my case. If you don't have comorbid panic troubles and you can respond to low dosages for limited periods....
10 mg/day of Adderall completely resolved my atypical depression within hours of taking the first dose. I believe it is the dopamine reuptake inhibitor action, but the norapinphrine reuptake inhibitor action of Adderall might play a role as well.
Unfortunately, the Adderall caused severe insomnia (2 hr sleep per night)immediately, and within four days I was in a full-blown mania. The cause of the mania was two fold: 1) the Adderall induced insomnia and; 2) The amphetamine directly.
When the insomnia started I immediately knew that I was at great risk of going manic, but I felt sure that I could control it my increasing my Trileptal dosage. My pdoc has been ragging on me for "self-medicating" by adjusting the dosages of my meds on my own. So I called the good doc's office (which I never do) and left a v-mail on the nurse's phone to ask the doc for his permission to increase my dosage of Trileptal to reel in the Adderall induced hypomania and insomnia because I was at risk of becoming manic.
Based solely on the brief v-mail that I left for the nurse, he instructed the nurse to call me and tell me not to change the dosage of
my meds at least until the following Monday (four days later). He made this edict without even calling me to fully hear my rationale.Well sure enough, I went manic the next day (which was New Year's Eve) while the good doc was enjoying a well deserved long weekend. Initailly my wife encourged me to strictly follow the doctor's orders, but when I woke up, after my usual two hours of sleep, at 1 am on Sunday morning (1/2/05) in a full-blown manic state, my wife changed her tune and was pleading with me to take some extra Trileptal to reduce the severity of the mania. But I responded that I had told my pdoc in my last appointment that I would strictly adhere to his instructions and, by golly, I fully intend to keep my word.
Needless to say, I was on the phone Monday morning letting the nurse know my displeasure and instructing her to convey to the good doc the consequences of his poor decision. He responded by telling the nurse to call me back and grant my request to increase my Trileptal, and to grant my new added request to reduce the Adderall to 5 mg/day (which required a new script).
Don't get me wrong, I have a very good pdoc. He just made a couple bad calls. The other bad call was to start me out on 10 mg/day when we should have started with 5 mg/day. We all make mistakes, and I can forgive. I just wish that these pdoc's would listen to us patients a little better.
To bring you up to date with regard to my Adderall trial, two weeks into the trial the pstim caused burnout. My symptoms of burnout are physically drained, increasing amounts of sleep required to recover physically, aches and pains (flue-like without the runny nose and/or cough), etc.
These symptoms are distinctly different from the atypical depression symptoms of increased sleep, low energy, etc. I'm not able to articulate the symptoms of burnout very well, but trust me it's very different from the simillar words that I use to describe atypical depression.
I recognized the burnout symptoms right away because I experienced a very simillar effect with Ritalin when in 1996 a bad pdoc (my first) misdiagnosed my bipolar hypomania as ADHD and fed me Ritalin without having a moodstabilizer on-board. But that's a whole 'nother pdoc from hell story, and I'll not bore you with it here (besides, you've probably already read some of my previous rants on this topic that I've posted on PB in years past).
So back to the story at hand. One week ago I discontinued the 5 mg/day of Adderall and I left a v-mail for the nurse asking her to tell (not ask) the pdoc that I had to discontinue the Adderall trial due to burnout. I didn't hear back from his office, but I'll talk to him at my next appointment next week.
I was deeply regreting that I had to discontinue the Adderall because it had helped me so much initially and because I expected a huge rebound depression from the discontinuation. But to my suprise, the antidepressive effects are continuing even still, one week later. No hint of depression. Some hypomania, but I can chase it down with extra Trileptal.
From a pyschopharmacological standpoint, it makes no sense at all to me that the antidepressant effect continues for me after discontinuation. The half-life of Adderall is 13 hours, so it's gone by now! So my plan at this point is to use Adderall on a prn basis and to take it as infrequently as possible and for short durations. Time will tell.
> Yes, there is something weird about Depakote that I don't like regards sleep. It seems to *aggravate* sleep maintenance troubles I have. If I take a dose at bedtime it seems that it activates me and wakes me up just a few hours later and then I can't go back to sleep.. and then I DO go back to sleep right before I need to wake up- really irritating! This leaves me all foggy headed and tired all next day. SOOO I have tried taking it earlier in the evening and it has helped some but not enough. It is like a triphasic response... first I get sedated and might nap or nod off.. then there is an *activation* that happens 4-6 hrs in (while I am trying to sleep), then several hours of somnolence after that (the next morning-midday). I liked Trileptal or lithium because I could take a dose at bedtime and it would put me out right.
Mitch, do you take magnesium at bedtime? I take 750 mg of magnesium malate every night at bedtime. It really helps my sleep (going to sleep, staying asleep, and sleeping sound. Along with it, I also take 10 mg of P-5-P (co-enzyme B6) to help the magnesium do its thing, and I take 1/2 tablet of a B-100 (B-complex) so that the Bee's don't get out of balance by taking the P-5-P. The Bee's can get angry if they get outta balance. :-)
> I get clearly depressed on Depakote if I take it during a depressive episode in doses exceeding 250mg/day. You know, here's something I've been wondering about a little: Effective antimanics are associated with effective PKC inhibition, but I think brain norepinephrine levels are reduced as some downstream consequence of this...and if they aren't corrected during a BP depression an antimanic might actually worsen it.. SO I've found that a low dose of a stim or a little Strattera or nortript. whatever seems to be the right thing to counteract the antimanic's depressogenic tendencies.. just thinking out loud a little.... Mitch
Exactly!! I don't know about the mechanism, but that's why I like to decrease my Lithobid and Trileptal dosages when I cycle into a depressed phase because I'm convinced that these moodstabilizers make the depression worse. Of course, when the depression abates, I have to increase these dosages to keep my hypomania in check. But this dosage adjustment is what my pdoc is complaining about. Go figure.
poster:Ron Hill
thread:441138
URL: http://www.dr-bob.org/babble/20050119/msgs/444179.html