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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by cybercafe on November 15, 2002, at 12:03:09
is there a particular medication combo which works well for people suffering from both attention deficit and bipolar? are some stimulants more likely to precipitate a manic episode?
Posted by Ritch on November 15, 2002, at 13:38:45
In reply to med combination for ADD + BP ][, posted by cybercafe on November 15, 2002, at 12:03:09
>
> is there a particular medication combo which works well for people suffering from both attention deficit and bipolar? are some stimulants more likely to precipitate a manic episode?
I never got any hypomania from dexedrine, Adderall, or methylphenidate. They all tended to make my personality kind of quiet and cold (which I don't like and partly why I am not on a stimulant now). Amps had a *slight* mood elevating effect, but mph had a complete zero effect on mood (if anything I felt slightly depressed at higher doses). SSRI's are what kick in the hypomania if I don't watch it.
Posted by cybercafe on November 15, 2002, at 19:03:25
In reply to Re: med combination for ADD + BP ][ » cybercafe, posted by Ritch on November 15, 2002, at 13:38:45
>
> I never got any hypomania from dexedrine, Adderall, or methylphenidate. They all tended to make my personality kind of quiet and cold (which I don't like and partly why I am not on a stimulant now). Amps had a *slight* mood elevating effect, but mph had a complete zero effect on mood (if anything I felt slightly depressed at higher doses). SSRI's are what kick in the hypomania if I don't watch it.
>what do you take now for mood stability and attention deficit mitch? ....
are you able to work without an ADD med? quiet and cold seems a price i'd be willing to pay to leave these poverty and get a real job, but who can say?
i find zyprexa makes me quieter, perhaps colder, but i always thought that was a sign i was becoming more normal :)
i thought dopamine agonists (stims) had the opposite effect.. i guess they make you interested and enthusiastic about boring things (work) but therefore less interested in interesting things (people)...
... i think some people here used to suggest stims for SSRI apathyany info appreciated, oh grand master mitch :)
Posted by Ritch on November 15, 2002, at 22:25:05
In reply to Re: med combination for ADD + BP ][, posted by cybercafe on November 15, 2002, at 19:03:25
> >
> > I never got any hypomania from dexedrine, Adderall, or methylphenidate. They all tended to make my personality kind of quiet and cold (which I don't like and partly why I am not on a stimulant now). Amps had a *slight* mood elevating effect, but mph had a complete zero effect on mood (if anything I felt slightly depressed at higher doses). SSRI's are what kick in the hypomania if I don't watch it.
> >
>
> what do you take now for mood stability and attention deficit mitch? ....I am now on 125-500mg/day of Depakote on a flexible dosing schedule that fits my seasonal and chronic 3-week cycles. I will take 125mg/day every day no matter what. I adjust upwards depending on season and depending on what part of my cycle I happen to be in. I am also on Trileptal 150mg/day to help with bipolar depression and listening skills (ADD symptoms), maybe going to 300mg/day if I become immune to the nausea it provokes. I have been taking clonazepam for a while now, but found that I don't need more than .5mg per day over the long haul. I can slam hypomania by boosting the Depakote to 500mg and taking 1mg of Klonopin for just a day or two, and then reduce the dose. It is VERY effective for that.
>
> are you able to work without an ADD med? quiet and cold seems a price i'd be willing to pay to leave these poverty and get a real job, but who can say?Yes, I can do it probably half of the year. The other half requires the "correct" AD's (in my case low-dose Effexor works the best), and *reduction* in Depakote (so that I don't sleep all day long). The Trileptal is an experiment, but thus far it seems to have a MILD 'energizing' effect, and I don't get the DUHS from it that I do from gaba meds.
>
> i find zyprexa makes me quieter, perhaps colder, but i always thought that was a sign i was becoming more normal :)I had a good response in the past to atypicals (Risperdal/Seroquel), but I am SO sensitive to EPS problems (even liquid PAXIL caused mild EPS at 4mg/day). I just don't even want to go there...
>
> i thought dopamine agonists (stims) had the opposite effect.. i guess they make you interested and enthusiastic about boring things (work) but therefore less interested in interesting things (people)...Psychostimulants *release* dopamine and block reuptake of NE and DA, not necessarily effect the DA receptors. I have tried Mirapex and Permax previously (DA receptor agonists) and they tended to make me very drowsy and nauseous, but I slept well on them.
> ... i think some people here used to suggest stims for SSRI apathy
I found that stims seem to make it easier to *ditch* SSRI's. You seem to forget that you are withdrawing from them and don't experience much withdrawal. Most notably was taking dexedrine and finding that I could nearly stop taking Celexa...
Posted by cybercafe on November 15, 2002, at 23:07:29
In reply to Re: med combination for ADD + BP ][ » cybercafe, posted by Ritch on November 15, 2002, at 22:25:05
oh... i don't know if you get the same symptoms as me, .. but i just can't sit still i get too bored .... and start getting negative thoughts, why am i wasting my time doing this same thing, whatever it may be, for 8 hours a day .... it would be so nice to get up and do something else .... etci thought this was depression but my doc tells me by my eye movements i am no longer depressed or cycling, therefore it's probably ADD (???)
Posted by Ritch on November 16, 2002, at 9:19:12
In reply to Re: med combination for ADD + BP ][ » Ritch, posted by cybercafe on November 15, 2002, at 23:07:29
>
> oh... i don't know if you get the same symptoms as me, .. but i just can't sit still i get too bored .... and start getting negative thoughts, why am i wasting my time doing this same thing, whatever it may be, for 8 hours a day .... it would be so nice to get up and do something else .... etc
>
> i thought this was depression but my doc tells me by my eye movements i am no longer depressed or cycling, therefore it's probably ADD (???)That sounds highly probable. I have been formally diagnosed with ADHD as well as BPII, and have similar symptoms. I will get super-focused on something if it is new and challenging, but quickly get very bored with something routine and my mind will wander. Does your pdoc want to try a 1st line stimulant? It's worth a trial to see how you react to it. Make sure to try both an amp and then a mph product because people can react very differently to them. Watch for any signs of aggravated bipolar. Stims tend to have an anti-cycling effect on me, I just don't care for the residual hyper-vigilance that goes with them.
Posted by SLS on November 16, 2002, at 14:06:53
In reply to Re: med combination for ADD + BP ][ » cybercafe, posted by Ritch on November 15, 2002, at 22:25:05
Hi Mitch.
> I am also on Trileptal 150mg/day to help with bipolar depression...
My depression seems to be an atypical presentation of bipolar disorder.
How can you be sure that Trileptal is exerting an antidepressant effect?
What cognitive side-effects did you have, and how long did it take for them to disappear?
Thanks.
Sincerely,
Scott
Posted by Ritch on November 16, 2002, at 17:49:15
In reply to Re: med combination for ADD + BP ][ » Ritch, posted by SLS on November 16, 2002, at 14:06:53
> Hi Mitch.
>
> > I am also on Trileptal 150mg/day to help with bipolar depression...
>
> My depression seems to be an atypical presentation of bipolar disorder.
>
> How can you be sure that Trileptal is exerting an antidepressant effect?
>
> What cognitive side-effects did you have, and how long did it take for them to disappear?
>
> Thanks.
>
>
> Sincerely,
> ScottHi Scott, I was on a brief Trileptal trial a couple of years ago. I definitely felt an increase in energy and mental alertness. However, I got really nauseated from it and stopped it (at 300mg/day with some Zoloft which aggravated the nausea). This time around I had been through several stimulant trials with mixed success. They worked great for one or two things, but made several other things worse. It was like they made me feel the *same* mood-wise day to day (anticycling), but the sameness was an *icky* sameness (a mild, but chilly antisocial anxiety and a tendency towards increased and sometimes unnecessary obsessiveness with detail). That is *great* for *some* things, but not all day long, day after day. Anyhow, I am facing another seasonal bipolar depressive episode which typically worsens very rapidly through January, and I want to do this without stimulants AND Depakote always tends to worsen my depressions because of oversleeping. SO, that is when the Trileptal got brought back up (this time at just 150mg) along with *reducing* the Depakote to a minimal 125mg/day to reduce sleepiness. Thus far it seems to be helping. I've really got my fingers crossed I can handle Depakote 125mg + Trileptal 150mg + Klonopin .5mg + Effexor 12.5mg PLUS fish oil.
Whew!, I hope this clarifies things, I never had any cognitive sfx from the Trileptal, but *always* had cognitive sfx from Depakote/Klonopin. I can get some of the mental functioning back from a Depakote increase with time (but not fully).
Mitch
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