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Suggestions for meds augmentation? (BP2, GAD, MDD)

Posted by LouisianaSportsman on May 11, 2012, at 23:03:16

Hey, everyone!

My primary interest for around two years now has been pharmacology. First, it began when I started substance abusing my senior year of high school. I am rather intelligent and wanted to be informed about what I was putting in my body; thus, I joined, a website which is dedicated to harm reduction, and I must say that I learned quite a bit about pharmacology albeit focused on recreational drugs. I have also lurked on this forum for awhile and it is hands down the best.

I went to one college for engineering, but I dropped out and switched to a different college where I attempted Pre-Pharmacy. My unsuccessful attempts are correlated with my opiate addiction problem.

Now, I am studying Agribusiness. I am embarking on my junior year of college, and Im set to graduate on time. I have been sober for around a year, and my grades have drastically improved. My interests have switched towards legitimate pharmacology; essentially, things my PDOC would prescribe. I have quit using non-prescribed medications and take medication as prescribed. I decided to grow up.

In the past, before growing up, I had a previous PDOC during the time of my illegal drug use and mania who did not diagnose me with Bipolar II (which I believe is absolutely correct). She prescribed me Zoloft, Strattera, and Concerta. I was not pleased with her, so I went to my GP; basically, I told her that I wanted 50mg. Vyvanse, 150mg. Lyrica BID, and to continue 50mg. Zoloft. Easy scripts. After my DUI and other personal problems, my parents forced me off these medications. They were good for ADHD and GAD but made me manic. I did not notice any change in depression with the sertraline, before and after, and no side effects which seem weird. My parents made me switch to a new PDOC.

I really like my current PDOC. I believe he was very good in diagnosing me and has been fair with medication. Ive only had four visits in four months. I believe that he would listen to my proposals about psychotropic therapy. He had me discontinue the sertraline. We also had a failed attempt with bupropion and after I was stabilized on lamotrigine, the visit after he prescribed the clonazepam.

My diagnoses are as follows:

314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type, 296.89 Bipolar II Disorder, 296.31 Major Depressive Disorder, Recurrent, Mild, 300.02 Generalized Anxiety Disorder

I am prescribed the following:

#90 amphetamine salts 10mg. PO, two tablets QAM, 1 tablet QPM for 314.01
#30 lamotrigine 200mg. PO QD for 296.89
#60 lamotrigine 25mg. PO QD for 296.89
#60 clonazepam 0.5mg. PO PRN QD for 300.02

The clonazepam has made me feel more normal than any other drug except, perhaps, the previously prescribed pregabalin. With the 250mg. daily dosage of lamotrigine, I do not notice many chaotic mood swings, and it has been very effective. I want to switch my current Adderall to Dexedrine, but for the most part it manages my ADHD symptoms well.

The major depression is not being treated. Let me explain. I get periods of what I call The Sadness, which I suppose is endogenous. Its a feeling like I want to cry. It ruminates around and takes up a large portion of the day. I get bored of my life and lack motivation. While it has always been present in some form, it has actually gotten worse since I discontinued substance abuse, especially opiates, but trust me, everything else is better. Im not sure if it is PAWS or not.

Also, circumstances have contributed to make The Sadness worse. I suffered from cannabis psychosis during the time in which I engaged in fraternity parties, road trips, and frequent sex; somehow, the world was more magical during this (manic) time. I began to believe in Solipsism and I believed that everything around me existed for me. I was amazed by just the mere existence of life, I would say The Sadness was eradicated during this time. While stoned and opiated, I would suffer some depersonalization and exist in a dream-world. It is ineffable, and I have almost forgotten what it was like. Admittedly, in terms of happiness, this would be a good part of my life, but I was too manic and not going anywhere.

Lets cut to the chase: a medication for my MDD.

My PDOC suggested augmentation of a Seroquel XR 300mg. target dose. I dont like the idea of a weight-gaining neuroleptic with lots of side effects, however.

Im not sure if Zoloft caused the prior mania or not, but I think conventional approaches to depression would be suitable since I have clonazepam to calm potential manic episodes (haven't had any in a long, long time), and I also now live with my parents.

While I have GAD (perhaps associated with my depression), I have no social anxiety and I am President of a campus organization and, also, I promote the campus to prospective students.

Still, here comes the The Sadness; its almost as if I can feel it creeping up on me; I just want it to go way!I feel as if though The Sadness is somewhat related to elements of Borderline Personality Disorder (undiagnosed).

Using criteria, The Sadness has these elements of BPD:

#Frantic efforts to avoid real or imagined abandonment and a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. (My girlfriend)

#Identity disturbance: markedly and persistently unstable self-image or sense of self. (My emotions and transition to being sober from mania.)

#Impulsiveness in at least two areas that are potentially self-damaging (e.g.,excessive spending, reckless driving)


This best describes The Sadness:

***Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness ***

Does anyone have suggestions of a medication augmentation that could possibly reduce elements of my dysphoria?

Thank you,





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