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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Phil on March 19, 2002, at 8:45:28
My current cocktail is Celexa 60mg
Wellbutrin 400mg
Adderall 60mg
Clonazepam 2-2.5mgAdderall is the newest addition to my combo. Was on Ritalin for 6-7 years. I know WB can cause agitation. I've also just gotten out of an addictive relationship which can only be compared to living hell.
Any suggestions on tweaking or changing this combo? See my pdoc in a few hours & will discuss reducing Wellbutrin. My temper can be pretty explosive right now. I can't tell if Adderall made it worse.
Any suggestions, theories greatly appreciated goddamn it. whoops
Phil
Posted by Ron Hill on March 19, 2002, at 10:29:42
In reply to Anger mood swings, posted by Phil on March 19, 2002, at 8:45:28
Phil,
You didn't state your dx, but based on the list of meds you take it looks like an ADHD dx. Is this correct? Based on you mood swings, I wonder if you might also be slightly bipolar in addition to ADHD. What do you think? If so, perhaps the addition of a mood stabilizer would help.
I'm Bipolar II, but I was initially misdiagnosised as ADHD. Initially, Ritalin made me feel great, but after a while I became very irritable. How sure are you that you have the correct dx?
-- Ron
------------------------------------------> My current cocktail is Celexa 60mg
> Wellbutrin 400mg
> Adderall 60mg
> Clonazepam 2-2.5mg
>
> Adderall is the newest addition to my combo. Was on Ritalin for 6-7 years. I know WB can cause agitation. I've also just gotten out of an addictive relationship which can only be compared to living hell.
>
> Any suggestions on tweaking or changing this combo? See my pdoc in a few hours & will discuss reducing Wellbutrin. My temper can be pretty explosive right now. I can't tell if Adderall made it worse.
>
> Any suggestions, theories greatly appreciated goddamn it. whoops
>
> Phil
Posted by Ritch on March 19, 2002, at 10:49:49
In reply to Anger mood swings, posted by Phil on March 19, 2002, at 8:45:28
> My current cocktail is Celexa 60mg
> Wellbutrin 400mg
> Adderall 60mg
> Clonazepam 2-2.5mg
>
> Adderall is the newest addition to my combo. Was on Ritalin for 6-7 years. I know WB can cause agitation. I've also just gotten out of an addictive relationship which can only be compared to living hell.
>
> Any suggestions on tweaking or changing this combo? See my pdoc in a few hours & will discuss reducing Wellbutrin. My temper can be pretty explosive right now. I can't tell if Adderall made it worse.
>
> Any suggestions, theories greatly appreciated goddamn it. whoops
>
> Phil
Hi Phil,I must say out of the med list you got there the Wellbutrin set me off worse than nearly anything. I think you are on the right track about reducing it. Maybe you could cut it in half-100mgSR twice a day? Adderall could do it as well, but I would *think* all of those temperamental thoughts. With Wellbutrin I didn't have much impulse control.
Mitch
Posted by Phil on March 19, 2002, at 11:09:25
In reply to Re: Anger mood swings » Phil, posted by Ritch on March 19, 2002, at 10:49:49
Ritch, I tend to agree and will see what pdoc says. Doubt she'll have a problem with it.
Ron, I've had some pretty sharp docs but have heard BPII being missed for years as a dx. I think I asked her last appt if she thought there was any BP indications for me. If I remember right, no memory either, she said no without much hesitation. I am going to ask her about a mood stabilizer, though. She may have other ideas. I think she would like me to try Nardil but personally, I'm afraid of it.
You know, I start feeling under-medicated if I'm not on at least 5 drugs. :-D
Thanks for y'alls input. Much appreciated.
Posted by colin wallace on March 19, 2002, at 11:59:03
In reply to Re: Anger mood swings » Phil, posted by Ron Hill on March 19, 2002, at 10:29:42
Just wanna pick your brains here Ron- as you know, I get pretty awful mood swings, but they only return to baseline depressed- no highs.Just troughs, lasting hours or persisting for a day.
What are the criteria for BP 11 ? Are mood crashes at all symptomatic? (haven't shelled out for that online test yet, cos' Prozac and Sammy are killing my wallet!!)Col.
Posted by Ron Hill on March 19, 2002, at 12:49:28
In reply to Re: Anger mood swings- Ron Hill, posted by colin wallace on March 19, 2002, at 11:59:03
Colin,
Ask and ye shall receive. But don't expect me to do your homework on an on-going basis :)
What Are the Symptoms of Bipolar Disorder?A clear outline of the different symptoms that make up a diagnosis of bipolar disorder, plus a short description of who gets this disease.
The usual pattern of bipolar disorder is one of increasing intensity and duration of symptoms that progress slowly over many years. Patients with the disease, however, may experience symptoms in very different ways.Symptoms of Depression
The symptoms of depression experienced in bipolar disorder are almost identical to those of major clinical depression, which include:
1. sad mood
2. fatigue or loss of energy
3. insomnia, excessive sleeping, or shallow, inefficient sleep patterns with frequent awakenings
4. weight gain or loss
5. diminished ability to concentrate or make decisions
6. physical agitation or markedly sedentary behavior
7. feelings of guilt, pessimism, helplessness and low self-esteem
8. loss of interest or pleasure in life
9. thoughts of or attempts at suicideDepressive episodes associated with bipolar disorder are less likely to have a specific trigger, are not as long, and develop more gradually than those caused by major depression. One interesting study reported that bipolar patients often experienced dreams of death at the low point of their depression, and these dreams were soon followed by an upward mood change.
Symptoms of Mania
A manic episode usually comes on suddenly, and it often, but not always, follows a period of severe depression. An episode lasts for at least a week and can continue for months. Friends and family members of a person with bipolar disorder who is entering a manic phase for the first time may be relieved at first by the patient's increased energy level, gaiety, and sociability. It soon becomes apparent, however, that the person's mood is too "hyper" and that the behavior is strange. Symptoms of a manic episode include rapid speech, disconnected thoughts, grandiose ideas, hallucinations (hearing voices or seeing visions), and extreme irritability. Irritability is most often the first noticeable change in behavior at the onset of a manic phase. The patient often requires little sleep; some experts suggest that sleep loss may actually trigger or intensify mania. Close to 60% of all manic patients experience feelings of omnipotence, sometimes believing that they are godlike or have celebrity status. Some patients experience intense sexual energy or a marked increase in strength. Hypomania is a less severe variant of mania; it is of shorter duration, although it lasts at least four days. Patients with hypomania do not have severely impaired functioning and generally do not require hospitalization.
Who Gets Bipolar Disorder?
Gender
Between one and two million Americans are thought to suffer from bipolar disorder. Estimates of the lifetime risk for the disorder run between 1% and 1.5%. There is some indication that the incidence of bipolar disorder may be increasing, but more research is needed to confirm this. Bipolar disorder affects both sexes equally, but women are about three times more likely to experience rapid cycling. (Women have a higher incidence of depressive cycles than men do, and some experts suggest that antidepressant medications may trigger the rapid cycling.) In any case, rapid cycling occurs in between 10% and 15% of all bipolar patients.
Age
In one survey, 59% of bipolar patients had their first symptoms when they were children or adolescents, and, typically, there was a very long delay until the condition was diagnosed and treated. One center reported that bipolar disorder in children may be more common than previously believed. It may be underdiagnosed in this age group because it can be often confused with attention-deficit hyperactivity disorder. In addition, symptoms of bipolar disorder may be different in children than in adults When the onset of the condition occurs at these younger ages, the initial episodes may be primarily depressive. Irritability is common. Young patients tend to experience frequent episodes and increasing social problems, even if their family situations are positive. Manic phases usually begin in adolescence or young adulthood, with average age of onset being 18. Bipolar disorder, however, can also appear for the first time in people over forty years of age; in fact, age 40 is another peak onset period for women. Bipolar disorder that develops in elderly people is less likely to be associated with a family history of the disorder and more likely to accompany medical and neurologic problems than earlier-onset bipolar disorder.
Family History
Bipolar disorder often occurs within families. Studies of identical twins raised apart found that about two-thirds of the pairs shared the disorder when one twin had it. Among fraternal twins, the risk for the second twin is only 20%. Often, families of patients with bipolar disorder include members with other psychiatric problems, including schizoaffective disorder and major depression, which many experts believe are variants along a single disease spectrum. Studies indicate that a combination of bipolar and panic disorder may be a specific inherited type. It has long been observed that children of bipolar disorder parents often have a more severe form of the disorder than do their parents. A recent study indicated that a daughter with bipolar disorder is at particularly high risk for developing a more severe form if her mother has the disorder. The study also suggested that having parents or other family members with major depression (particularly if it developed at an early age) is associated with a higher risk for bipolar disorder.
Attention Deficit Hyperactivity Disorder
In one study, 65% of adolescents with bipolar disorder met criteria for attention deficit hyperactivity disorder (ADHD); another study determined that close to 25% of children diagnosed with ADHD either already have bipolar disorder or go on to develop it. The risk for both diagnoses was highest in white males. Symptoms were also more severe in people with both conditions.
Miscellaneous Risk Factors
The time of the year appears to play a role in increasing the risk for episodes. In one study, men appeared to have more episodes during the spring and women were at higher risk during the spring and fall. In both genders, aggressive behavior peaked in the spring. The rate of the disorder is estimated to be 10 to 20 times higher among people in the creative arts than in the general population. People who are alcoholic may also be at higher risk for bipolar disorder.
Personality Traits
One interesting study defined personality traits associated with bipolar disorder. Patients tended to lack persistence, avoid harmful situations, and be dependent on rewards.
Well-Connected Board of Editors
Harvey Simon, M.D., Editor-in-Chief
Massachusetts Institute of Technology; Physician, Massachusetts General HospitalMasha J. Etkin, M.D., Gynecology
Harvard Medical School; Physician, Massachusetts General HospitalJohn E. Godine, M.D., Ph.D., Metabolism
Harvard Medical School; Associate Physician, Massachusetts General HospitalDaniel Heller, M.D., Pediatrics
Harvard Medical School; Associate Pediatrician, Massachusetts General Hospital; Active Staff, Children's HospitalIrene Kuter, M.D., D. Phil., Oncology
Harvard Medical School; Assistant Physician, Massachusetts General HospitalPaul C. Shellito, M.D., Surgery
Harvard Medical School; Associate Visiting Surgeon, Massachusetts General HospitalTheodore A. Stern, M.D., Psychiatry
Harvard Medical School; Psychiatrist and Chief, Psychiatric Consultation Service, Massachusetts General HospitalCarol Peckham, Editorial Director
Cynthia Chevins, Publisher
http://content.health.msn.com/content/article/1680.50546
--------------------------------------> Just wanna pick your brains here Ron- as you know, I get pretty awful mood swings, but they only return to baseline depressed- no highs.Just troughs, lasting hours or persisting for a day.
> What are the criteria for BP 11 ? Are mood crashes at all symptomatic? (haven't shelled out for that online test yet, cos' Prozac and Sammy are killing my wallet!!)
>
> Col.
Posted by colin wallace on March 19, 2002, at 13:26:10
In reply to Re: Anger mood swings » colin wallace, posted by Ron Hill on March 19, 2002, at 12:49:28
Cheers for that insight Ron- I owe you a homework assignment!!!!
Posted by Libby Bonine on March 19, 2002, at 15:15:56
In reply to Anger mood swings, posted by Phil on March 19, 2002, at 8:45:28
My diagnosis: ADD & chronic major depression
I was taking Wellbutrin SR 300 mg/day & Ritalin 40-60 mg/day. My biggest complaint was mood swings and fits of anger. I was initially treated for Bipolar II, Rapid Cycling and was prescribed Depakote. That made me as close to a zombie as I've ever been. I felt dead.
My doc concluded I was not Bipolar, but was experiencing "atypical major depression, with agitation." My problem went away COMPLETELY
when he added 20 mg/Prozac to the mix.Now I take:
Wellbutrin SR 300 mg/day
Ritalin 40-60 mg/day
Prozac 20 mg/dayBy the way, my doc insisted on treating for Bipolar first, since the drugs he had prescribed
for ADD can make Bipolar worse.Good luck...
Posted by Alii on March 19, 2002, at 15:58:01
In reply to Anger mood swings, posted by Phil on March 19, 2002, at 8:45:28
Phil-
WB SR has caused extreme agitation for me. I've been on the SR for three yrs now. Through much trial and error the current combo works:
A.M. 100 mg WB SR and 25 mg Buspar
P.M. 100 mg WB SR p.m. plus 75 mg WB regular and 25 mg BusparWhen I was at 400 mg WB SR I became angry very quickly. Not a pleasant sight for myself and others. Now that the WB SR has been halved to 200 mg and the addition of the 75 mg non-SR WB the anger mood swings I occasionally experience are more directly related to processing past traumas in therapy than to the medication. The addition of the Buspar and constant med. tweaking seems to have mellowed the WB to a tolerable agitation level. Limiting caffeine to a paltry morning cup o' joe helped too. I'm also dependent upon twice weekly acupuncture to help balance the meds.
But I digress. Lowering the WB SR and adding Buspar made a distinct change in my 'sudden anger for no reason' reactions as opposed to the 'anger from therapy issues.'
And finally--sleep? When I don't get enough I become angry much more easily.
--Alii
7 yrs treatment for a few moments of relief
... and still I rise
Posted by Phil on March 19, 2002, at 20:52:03
In reply to Re: Anger mood swings, posted by Libby Bonine on March 19, 2002, at 15:15:56
ADD & chronic severe major depression
You got the diagnosis right. It's the relationship that brought on intense anger.
I'll get thru this..am over the toughest part.
Posted by Phil on March 19, 2002, at 20:59:29
In reply to Re: Anger mood swings » Phil, posted by Alii on March 19, 2002, at 15:58:01
--Alii
7 yrs treatment for a few moments of relief
... and still I riseThat's cool. Mine's unfortunately 25 years of treatment. We're a tough bunch of people that deal with mental illness.
I need to stop caffeine. It's worse than most drugs I've taken, anger wise.
Saw my doc today. She didn't want to lower the Wellbutrin because this combo is keeping me treading water. I've had a lot of failed med trials in the last 2-3 years. OOOOOooooooommmmmmmm
Posted by chiaratara on March 20, 2002, at 1:45:17
In reply to Re: Anger mood swings....Alii, posted by Phil on March 19, 2002, at 20:59:29
hi there phil.
wellbutrin did the same thing for me. it turned me into an agressive b*tch. i added paxil to the wellbutrin and have found a happy medium. paxil takes the edge of the wellbutrin, and wellbutrin takes the edge off the sitting on the couch with the munchies feeling that i get with paxil. i think the combo wellbutrin and adderall (sp?) would put me into orbit. i can imagine how you may be feeling. good luck. see if you can add a warm and fuzzy sedating ssri? take care.
Posted by Phil on March 20, 2002, at 6:53:19
In reply to Re: Anger mood swings....Alii, posted by chiaratara on March 20, 2002, at 1:45:17
Paxil was the only other SSRI that worked for me. Was on it and Ritalin combo for 4 years or so.
I really think, in my case, the caffeine is the catalyst. I'm not real good at breaking addictions and I love coffee. But screaming at traffic is a good indicator I need to make changes.
I don't chase anybody past my exit anymore!!
Hey, hey, getting better.
This is the end of the thread.
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