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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Drof on June 17, 2010, at 17:38:58
I have been reading this site for years and this is my first post. I really need some help. I have been diagnosed as bipolar and feel like I have tried everything there is to try. Some things work for a while but the lack of motivation and depression keep coming back. (The mania seems to be under control which was the fun part of the condition.) I am currently on Lamictal 300mg/day, Lexapro 40mg/day, Abilify 60mg/day and Adderall XR 30 mg/day. The only thing that seems to lift the depression is the adderall. I'm ok in the morning but when it wears off I'm back to depressed again. Seems like I am living for my next adderall fix. I've been on two many drugs in the past to list and starting to lose hope. Does anyone have any idea what I should try next? My doctor is pretty open and will let me dictate what I take (within reason). Is there anything I should add to this cocktail? I have an appointment tomorrow and just wondering where I should go from here. Thanks in advance for your help.
Posted by Christ_empowered on June 17, 2010, at 18:35:35
In reply to Been there done that...need advice, posted by Drof on June 17, 2010, at 17:38:58
Hey. Sorry about your struggle. I don't really know what to say...why is your Abilify dose so crazy high? The FDA only approved Abilify up to 30mgs/day. They do have a blood test now that shows levels of abilify (or whatever those pills break down into). Have you had your levels done? If your levels get too high, I think there's a risk not only of EPS, TD, and other normal antipsychotic-related side effects, but there's also a cancer risk (I think...I seem to recall reading that high-dose abilify caused cancer in lab rats). Does your doc have a reason for going so high with your Abilify? Do you have EPS? Could you lower it (that *might* help with the low-mood you're experiencing; high-dose Abilify gave me a terrible mood).
The easiest thing I can think of would be an additional afternoon "pick-me-up" with the Adderall. That's how I had my Adderall dosed out when I took it. Add, say, 10mgs in the form of the generic tablets (I believe they're called "immediate release). You could add more, but I'd think that 10mgs would be sufficient to perk you up a little w/o interfering with sleep. The tablets, like the XR capsules, come in strengths up to 30mgs.
Good luck to you and...do check on your Abilify dose. 60mgs/day of a med that's only approved for up to 30mgs/day seems a little bit risky to me.
Posted by Phillipa on June 17, 2010, at 19:32:25
In reply to Re: Been there done that...need advice, posted by Christ_empowered on June 17, 2010, at 18:35:35
What about vyvanase? And welcome to babble Phillipa
Posted by bleauberry on June 20, 2010, at 11:07:13
In reply to Been there done that...need advice, posted by Drof on June 17, 2010, at 17:38:58
I don't know, it's all so hard. I have no idea why that abilify dose is so high. It's usually better as an antidepressant in the 2.5mg-10mg range. Higher than that it turns into more of an full-fledged antipsychotic with the predictable dulling effects. Not what you need. Zyprexa in my opinion is a far better mood stabilizer/antidepressant. But mileage varies, so no way to know. You've probably already tried it anyway.
Lamictal 300mg also seems too high to me.
I think with bipolar symptoms we face the difficulty of squashing down the highs, but not doing it so heavily as to push us into apathy or depression. Did it ever occur to you that the meds themselves could be the culprits causing the depression? And that the adderall is countering the dulling/depressing side of those meds?
Lexapro 40mg. Geez, I would be depressed too. Talk about too much serotonin. I would be a lifeless blob with that much serotonin reuptake inhibition. Again, the adderall does a good job of overcoming that, temporarily.
I see two problems here. First, too much inhibitory stuff going on...lamictal, abilify, lexapro...due to the dose sizes and the actual med choices. Second, nothing on the other side to balance it out. Except for adderall. It balances things out somewhat, you feel better, right? And then it wears off, back to the over-inhibitory state.
If you were not on any meds, I probably would favor something like this:
Prozac 20mg-60mg
Zyprexa 5mg-10mg
Ritalin extended release 20mg-80mg.
And if highs still not under control, 300mg-600mg lithium.I have not clue of your history though. As you said, been there done that. It's hard. I just basically wanted to say I do not see your current cocktail as being favorable to you. I mean, with all those meds, and you still get depressed? What does that say for lexapro's performance. Nothing good. No idea what benefit you perceive in stability from lamictal or abilify, but what good are they for your depression? Zero. Maybe even making it worse or causing it.
I definitely would not add anything to this cocktail. I witness that mistake far too often at this board. Someone is already on 3 or 4 meds that are not working. Logic would say, dump those crappy meds. But no, let's pile another one on top of them, as if the new med can somehow have the power to overcome all the bad ones. It can't. Next thing you know, someone is here with a laundry list of 4 to 8 meds and they are feeling so crappy they can barely survive. Makes no sense to me. It is, I admit, an easy and deceptive trap to fall into.
I would say if you are going to get another med, one of the current meds has to go bye-bye. A direct replacement, one for one. No more add ons. Even in the Star*D program with their high number of remissions, the highest amount of meds in any given situation was 3, most either 1 or 2. Don't pile more on top of ones not working.
Just thinking out loud.
Posted by Drof on June 20, 2010, at 11:34:54
In reply to Re: Been there done that...need advice, posted by bleauberry on June 20, 2010, at 11:07:13
Thanks for your advice. My doctor and I decided to dump the Lexapro, lower the Abilify to 30mg, and add Mirapex. Maybe I should cut the Abilify even more? What do you think?
Posted by DocRon on June 22, 2010, at 17:28:24
In reply to Re: Been there done that...need advice » bleauberry, posted by Drof on June 20, 2010, at 11:34:54
Hey,
At least for me, Adderall was crap. So was Lexapro. And Abilify!
For SWIM with your disorder these seem to work:
Cymbalta 60mg
Deplin 7.5mg (VERY IMPORTANT. Its folic acid that actually enters your brain--not like supplements where only micrograms enter--with Deplin 7.5mg methylfolate enters your brain. It makes the Cymbalta work like a wonder drug)
Id' try Provigil 2-3x per day for the "pep." FAR less schitzy than the Adderall!!! Provigil works miracles. So does a low dose of Desoxyn (d-methamphetamine) but I mean a LOW dose! It is about 10,000x cleaner than Adderall. Don't know if its still available in the US...I think it is though.
Plus your Lithium.I think that SWIM is VERY happy with this combo...he could not believe how well, how "super-turbocharged" the Deplin made the Cymbalta! IMHO it should be scripted with EVERY script of Cymbalta! It's cheap and it works insanely wonderfully!!!!!
DocRon
This is the end of the thread.
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