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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by qbsbrown on October 1, 2008, at 22:03:55
I know the newer stigma about ssris inducing mania and instability.
I have BPII and ADHD. I've begun Lexapro+Depakote+Dexedrine.
The ssri helps me with socialability (like my normal self), but seems to add or cause more mood instability.
Plus I can only sleep regularly on an SSSRI.
But I have also noticed that I need about twice as much of the stimulant if using an ssri.
Lamictal is an exhausted option for me (insomnia, anxeity, naseau/headaches)
If it's just depakote/dexedrine, i don't feel depressed, but im not social. I'll hyperfocus and just do my own thing, plus sleep is crap.
So there's my dilema and crossroads.
I'd appreciate some help/advice/suggestions.
You guys are the best.
Depakote+Provigil I was very social on, but I still couldn't concentrate on the job (plus depakote makes me stupid)
It it too much to have Provigil+Dexedrine+Depakote?
I'll stop now
Posted by azalea on October 2, 2008, at 21:04:13
In reply to SSRIs and BPII, posted by qbsbrown on October 1, 2008, at 22:03:55
You're absolutely correct about SSRIs causing mood instability in BPII. For sleep, what about Ambien (zolpidem) or Lunesta (eszopiclone)? Alternatively, Remeron (mirtazapine) or Trazodone . . . although they are antidepressants and may slightly increase the risk of cycling, though not as much as SSRIs.
With regard to Lamictal (lamotrigine), is it possible you had a bad reaction because of a combination with another medication? Quoting Dr. Phelps from www.psycheducation.org "about one in 20-30 people will actually get worse on it (in my experience, and that of numerous other psychiatrists who have used a lot of lamotrigine; the worsening is an increase in anxiety, irritability, or sleep problems, as though a lamotrigine was acting too much like an antidepressant. This reaction is one of the reasons why I try not to use lamotrigine when an antidepressant is already in use: lamotrigine is such a fantastic option, especially compared to the rest, I don't want to take any risk at all that it will be poorly tolerated. if things seem to be getting worse, is that lamotrigine, or might it be the antidepressant causing that? I try to avoid that situation)."
Or perhaps your doctor started at too high of dose or titrated too quickly. Some pdocs recommend starting Lamictal at 12.5mg daily and adding 12.5mg weekly. It takes a while to reach a therapeutic dose, but can be quite beneficial if you're sensitive to side effects.
For more information, here's the URL
http://www.psycheducation.org/depression/meds/moodstabilizers.htm#symptoms> I know the newer stigma about ssris inducing mania and instability.
>
> I have BPII and ADHD. I've begun Lexapro+Depakote+Dexedrine.
>
> The ssri helps me with socialability (like my normal self), but seems to add or cause more mood instability.
>
> Plus I can only sleep regularly on an SSSRI.
>
> But I have also noticed that I need about twice as much of the stimulant if using an ssri.
>
> Lamictal is an exhausted option for me (insomnia, anxeity, naseau/headaches)
>
> If it's just depakote/dexedrine, i don't feel depressed, but im not social. I'll hyperfocus and just do my own thing, plus sleep is crap.
>
> So there's my dilema and crossroads.
>
> I'd appreciate some help/advice/suggestions.
>
> You guys are the best.
>
> Depakote+Provigil I was very social on, but I still couldn't concentrate on the job (plus depakote makes me stupid)
>
> It it too much to have Provigil+Dexedrine+Depakote?
>
> I'll stop now
Posted by qbsbrown on October 2, 2008, at 21:10:16
In reply to Re: SSRIs and BPII » qbsbrown, posted by azalea on October 2, 2008, at 21:04:13
Unfortunately, I'm one of the ones that gets worse on Lamictal. It actually INCREASED my mixed moods, almost seemingly inducing.
I tried the Remeron (made me terrible depressed) and trazadone was terrible.
I seem to respond terribly to anything Serotonin like or based. Even takng L Tryptophan for sleep makes me depressed the next day.
I wonder if that's part of the BPII. I know about antidepressants making mania worse, but inducing depression w/ in one or two doses?
I guess I'll be quitting the lexapro before i give it a chance to make things work, and i'll hope that my provigil comes in soon.
regards,
Brian
Posted by azalea on October 2, 2008, at 21:17:31
In reply to Re: SSRIs and BPII, posted by qbsbrown on October 2, 2008, at 21:10:16
Have you tried Lithium?
> Unfortunately, I'm one of the ones that gets worse on Lamictal. It actually INCREASED my mixed moods, almost seemingly inducing.
>
> I tried the Remeron (made me terrible depressed) and trazadone was terrible.
>
> I seem to respond terribly to anything Serotonin like or based. Even takng L Tryptophan for sleep makes me depressed the next day.
>
> I wonder if that's part of the BPII. I know about antidepressants making mania worse, but inducing depression w/ in one or two doses?
>
> I guess I'll be quitting the lexapro before i give it a chance to make things work, and i'll hope that my provigil comes in soon.
>
> regards,
>
> Brian
Posted by qbsbrown on October 2, 2008, at 21:20:00
In reply to Re: SSRIs and BPII » qbsbrown, posted by azalea on October 2, 2008, at 21:17:31
Yes, I've tried lithium. I couldn't get above 600mgs w/o feeling stoned and derealized/depersonalized. Did help with sleep, but not sure about racing thoughts, perhaps it did.
Isn't it more for BP I?
Plus I've researched that Lithium will/can cancel out Dexedrine.
Brian
Posted by azalea on October 2, 2008, at 21:35:17
In reply to Re: SSRIs and BPII, posted by qbsbrown on October 2, 2008, at 21:20:00
Lithium is used for both bipolar I, II, and unipolar depression. Long history, proven efficacy. But not for everyone.
SSRIs are not completely contraindicated for bipolar II; just make sure you have a mood stabilizer on board 1st. It's SSRI monotherapy that you definitely want to avoid.
> Yes, I've tried lithium. I couldn't get above 600mgs w/o feeling stoned and derealized/depersonalized. Did help with sleep, but not sure about racing thoughts, perhaps it did.
>
> Isn't it more for BP I?
>
> Plus I've researched that Lithium will/can cancel out Dexedrine.
>
> Brian
Posted by qbsbrown on October 2, 2008, at 21:39:35
In reply to Re: SSRIs and BPII » qbsbrown, posted by azalea on October 2, 2008, at 21:35:17
I'm not sure what I'm going to do with the Lexapro (maybe wait til there's a negative effect). I am feeling some antidepressant effects, and some instability.
I'm going to hold my depakote er at 1000mgs, because it is all i can tolerate and function. But even at 1500mgs my blood levels weren't up the therapeutic level. But i do know that 1000mgs will hold some of the racing thoughts and mixed moods for the most part, and be able to function.
Regards,
Brian
Posted by desolationrower on October 3, 2008, at 0:55:37
In reply to Re: SSRIs and BPII, posted by qbsbrown on October 2, 2008, at 21:39:35
Perhaps you should consider keeping a low level of lithium use, along with whatever else you take. A bit of benefit with low level of side effects from 3 meds could add up to a strong response.
-d/r
Posted by Racer on October 4, 2008, at 9:14:28
In reply to SSRIs and BPII, posted by qbsbrown on October 1, 2008, at 22:03:55
Although the mechanism of action is the same, the SSRIs are not necessarily all that similar. For me, Paxil and Lexapro -- *especially* Lexapro -- are miserable, while Prozac and Zoloft are far more tolerable. (Zoloft is the more tolerable for me.) It could be that a different SSRI would help more.
I think you have OCD, too? That's what I remember, at least, so tell me if my brain is skipping tracks here. If so, I'd say an SSRI might still be helpful.
Hi, Brian -- always nice to see you here...
Posted by qbsbrown on October 4, 2008, at 9:18:38
In reply to Maybe a different SSRI? » qbsbrown, posted by Racer on October 4, 2008, at 9:14:28
I know that Zoloft would be better for my sleep and migraines, lexapro proves to be the best for my socialability and being personalable. So it's a toss up.
Oddly enough, SSRIs make my OCD tendancies worse. Must mean that the underlying cause BPII/ADHD are at the root of that.
Regards,
Brian
Posted by azalea on October 4, 2008, at 22:50:16
In reply to SSRIs and BPII, posted by qbsbrown on October 1, 2008, at 22:03:55
Came across an excerpt that may be of interest . . .
The audience is psychiatrists, but it is useful from a patient perspective as well.From Current Psychiatry, June 2007:
Very little evidence exists on treating adult ADHD/BD; bupropion is the only medication studied in this population. For adult ADHD alone, clinical trials have showed varying effiacy with bupropion, atomoxetine, venlafaxine, desipramine, methylphenidate, mixed amphetamine salts, and guanfacine. Whether these treatments can be generalized as safe and efficacious for comorbid adult ADHD/BD is unclear. Nonetheless, we suggest using bupropion first, followed by atomoxetine or guanfacine before you consider amphetamine stimulants.> I know the newer stigma about ssris inducing mania and instability.
>
> I have BPII and ADHD. I've begun Lexapro+Depakote+Dexedrine.
>
> The ssri helps me with socialability (like my normal self), but seems to add or cause more mood instability.
>
> Plus I can only sleep regularly on an SSSRI.
>
> But I have also noticed that I need about twice as much of the stimulant if using an ssri.
>
> Lamictal is an exhausted option for me (insomnia, anxeity, naseau/headaches)
>
> If it's just depakote/dexedrine, i don't feel depressed, but im not social. I'll hyperfocus and just do my own thing, plus sleep is crap.
>
> So there's my dilema and crossroads.
>
> I'd appreciate some help/advice/suggestions.
>
> You guys are the best.
>
> Depakote+Provigil I was very social on, but I still couldn't concentrate on the job (plus depakote makes me stupid)
>
> It it too much to have Provigil+Dexedrine+Depakote?
>
> I'll stop now
Posted by william puga on October 8, 2008, at 23:42:37
In reply to treating ADHD/BD » qbsbrown, posted by azalea on October 4, 2008, at 22:50:16
Yeah, Wellbutrin is helpful for ADHD and can cause less mania than an ssri, in fact, some reports indicate that it can actually help mania (though i have seen it activate mania).
If you can't get to therapeutic levels of depakote or lithium, perhaps trileptal may be more tolerable? or topamax? On a good dose of a mood stabilizer, antidepressants may be more tolerable.
This is the end of the thread.
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