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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by rainbowlight on June 17, 2002, at 23:23:23
I have been diagnosed with ADD and I am going to try to convince my pdoc to let me give stimulants a try (she is hesitant - I have Bipolar II). Can you guys give me any advice? Is there a good one to start with first? Do they make anxiety worse? and do they always cause insomnia? Thanks.
Posted by fachad on June 18, 2002, at 0:21:56
In reply to Want to try stimulants, I need advice, posted by rainbowlight on June 17, 2002, at 23:23:23
I don't know if stimulants have a negative effect on BPII. It could be that they could cause mania.
For the first one, I'd say try methylphenedate (Ritalin) as the long acting form, Concerta. It's very smooth acting, and has the least harsh physical side effects.
As far as casuing insominia, no, they do not always casue insomnia.
Re anxiey, I think they frequently cause anxiety in anxiety prone people, but hardly ever in people who are not prone to anxiey. That came out a little trite sounding, but really that's how it is.
Stimulants, like everthing else, are subject to the "your mileage may vary" caveat.
> I have been diagnosed with ADD and I am going to try to convince my pdoc to let me give stimulants a try (she is hesitant - I have Bipolar II). Can you guys give me any advice? Is there a good one to start with first? Do they make anxiety worse? and do they always cause insomnia? Thanks.
Posted by jay on June 18, 2002, at 0:47:35
In reply to Want to try stimulants, I need advice, posted by rainbowlight on June 17, 2002, at 23:23:23
I would echo what fachad has said...and I would also be VERY careful with mixing stimulants and a BPII condition. Don't focus so much on your diagnosis..focus on your symptoms. Make sure you let your doc know of each and every one, and talk *very* carefully about stimulant use.Best wishes...
Jay> I have been diagnosed with ADD and I am going to try to convince my pdoc to let me give stimulants a try (she is hesitant - I have Bipolar II). Can you guys give me any advice? Is there a good one to start with first? Do they make anxiety worse? and do they always cause insomnia? Thanks.
Posted by Schuyler on June 18, 2002, at 6:00:40
In reply to Want to try stimulants, I need advice, posted by rainbowlight on June 17, 2002, at 23:23:23
> I have been diagnosed with ADD and I am going to try to convince my pdoc to let me give stimulants a try (she is hesitant - I have Bipolar II). Can you guys give me any advice? Is there a good one to start with first? Do they make anxiety worse? and do they always cause insomnia? Thanks.
I would start with Methylphenidate (Ritalin), but I would not start with Concerta, which is timed-release methylphenidate, because it is *very* expensive, and because it does not give you very many options with your dosage. I would start with generic methylphenidate myself, in small doses to begin with. Good luck!
Posted by Hattree on June 18, 2002, at 8:45:41
In reply to Want to try stimulants, I need advice, posted by rainbowlight on June 17, 2002, at 23:23:23
How are you affected by caffeine, or stimulating cold meds like sudafed? That may give you at least some clue how you'll respond to prescription stimulants.
> I have been diagnosed with ADD and I am going to try to convince my pdoc to let me give stimulants a try (she is hesitant - I have Bipolar II). Can you guys give me any advice? Is there a good one to start with first? Do they make anxiety worse? and do they always cause insomnia? Thanks.
Posted by Krazy Kat on June 18, 2002, at 9:43:18
In reply to Want to try stimulants, I need advice, posted by rainbowlight on June 17, 2002, at 23:23:23
heh rainbowlight. i'm replying to this before reading the other posts so forgive me if i'm repetitive.
i'm bipolar and take depakote. i get manic if i take ad's according to past experiences.
my pdoc prescribed provigil to offset the side effects of depakote which are similar to those of add for me - inability to focus, etc.
provigil made me very anxious and irritable. he chose that one first because he'd seen good results with others, but we all vary, eh?
So Ritalin was next. Ritalin lasts only about 4-5 hours for most, and for me it was only about 2. so that roller coaster ride did not work.
next was concerta, an extend-release form of ritalin. this has been pretty good for me, though it also seems to go through my system more quickly than other folks. and, it causes anxiety and "jumpiness" and irritability after about 6 hours, though not nearly as bad as Provigil.
So, here is what I am trying now - morning 1000 mg Depakote, 18 mg. Concerta. Afternoon 1000 depakote and 18 mg. concerta.
i'm re-adding some neurontin to help with the anxiety.
why is your pdoc worried? the whole stim-addiction thing? i haven't felt any need for an increase in the med. sometimes i get tired in the evening, but that's been from the beginning and could be remedied with 5 mg. of ritalin as an adjunct. it's just a question of how long do i need to be active during the day.
i AM tired w/o the concerta, but Depakote does that to me. I have no idea how I would feel if I stopped all meds.
hope that helped.
- kk
Posted by Krazy Kat on June 18, 2002, at 9:46:41
In reply to Want to try stimulants, I need advice, posted by rainbowlight on June 17, 2002, at 23:23:23
just to add after reading the others:
- no insomnia in me either unless i take my second dose of concerta after 2:00.
- my pdoc was fine with splitting the doses, but then he goes pretty much by how i feel, and not other experiences.
- it's interesting that jay was cautious about this. the first two days i was pretty chipper, but that evened out quickly and it wasn't mania. maybe it is better to start with the short-form release of ritalin to see if mania is a possibility.
take care.
- kk
Posted by 3 Beer Effect on June 18, 2002, at 11:08:28
In reply to Want to try stimulants, I need advice, posted by rainbowlight on June 17, 2002, at 23:23:23
"Bipolar disorder misdiagnosed as ADD & treated with stimulants can produce the same chaos & rapid cycling state as antidepressants can in bipolar disorder." (Stahl, Essential Psychopharmacology of Depression & Bipolar Disorder).
Obviously, ADD stimulants could push you into overt mania as they are much more powerful than Caffeine. Insomnia, anxiety, & weight loss are common side effects of stimulants & are often the reason for their discontinuation, but the anxiety & insomnia side effects can be treated with Klonopin (a 2nd line anti-manic agent benzodiazepine) in the day & Ambien at bedtime, or perhaps even with the non-addictive anticonvulsant Neurontin. They are not sure if Neurontin is a mood-stabilizer or not yet. As far as mood-stablilizers go, I believe that among the newer ones Lamictal & then Neurontin cause the least mental impairment while Topomax can cause quite a significant amount of mental impairment.
Usually, if someone had Bipolar II & ADD they would try Wellbutrin SR first before they started a psychostimulant since Wellbutrin SR, Paxil CR, & Remeron are the antidepressants with less tendency to cause mania.
Wellbutrin SR can be effective for ADD, more so in Adult ADD than in children but still is only effective in about 1/3 of ADD patients. The tricyclic Desipramine (NORPRAMIN) especially, & sometimes Nortriptyline (PAMELOR) are often effective for Adult ADD (they are not used in children for safety reasons).
Provigil (Modafinil) was rejected by the FDA for the indication of ADD because of lack of efficacy in clinical trials.
Ritalin & its refined/improved version Focalin are probably less likely to induce mania than Adderall or Dexedrine since Ritalin/Focalin only last about 3.5 hours at the most, are mostly a mental & not as much a general/appetite suppressing/physically "activating" stimulant, & seem to cause more inhibition of spontaneous behavior than Adderall or Dexedrine. Ritalin definitely causes anxiety in many & in rats causes behavioral inhibition and decreased social interaction. Generic versions of Ritalin such as methylphenidate have shown to be inferior (1/2 hour less in duration) & are best avoided.
Concerta may work since it is a long acting, smoother version of Ritalin, but it is probably more likely to cause insomnia & stomach upset & does not work for some people (I responded well to 20 mg Ritalin 2x per day but had little response to a trial of Concerta 56 mg qd.)
Sometimes people are misdiagnosed with as Bipolar II when they really have ADD or vice versa since the symptoms for both disorders are very similar (ADHD resembles the symptoms of Bipolar mania). I guess the only way to tell is by the patients reaction to a trial of a few mood stablilizers & if that is not successful then a trial of an ADD psychostimulant.
They thought I was Bipolar II since I couldn't tolerate the insomnia from the SSRIs (eventually became manic from Zoloft 100 mg) & could not tolerate Effexor XR or Remeron. But after negative responses to Neurontin & Lamictal but with positive responses to Ritalin & Dexedrine (with no stimulant induced mania) they decided that I have ADD-inattentive type with severe depression & social phobia.
3 Beers......................
Posted by Krazy Kat on June 18, 2002, at 11:49:22
In reply to Wellbutrin SR, Ritalin, Bipolar II vs. ADD etc., posted by 3 Beer Effect on June 18, 2002, at 11:08:28
again, i am bipolar (the add symptoms were not there prior to the addition of stabilizers, though I suppose the progression of the disease could have been a part of that - I don't think we know yet...), so i may be coming from a different angle.
rainbow, perhaps some more info on your symptoms would help.
just fyi, Wellbutrin was Awful for me. No immediate mania, but I was so anxious, and so irritable, and so angry. I'm lucky my family was able to handle it.
Posted by DiscoPuppy on June 18, 2002, at 14:24:14
In reply to Re: Want to try stimulants, I need advice » rainbowlight, posted by fachad on June 18, 2002, at 0:21:56
I'm taking Adderall (7.5mg x 4) times a day. I think one of the worst side effects (or most annoying) is the fact that I have *CONSTANT* cotton mouth. I drink 128 ounces of water every day and doesn't make a bit of difference.
For me, there is a very narrow window between a dose that works for my ADD and the overwhelming anxiety that I feel on it. In other words, determining a therapeutic dose has been incredibly difficult. I feel NOTHING on 5mgs but at 10mgs, I am very anxious and grouchy (similar to what I felt on Wellbutrin).
I have no problems sleeping, as I take the last of my four doses around 3-4pm.
If you're worried about anxiety with regard to stimulants, consider Dexedrine as your first-line choice. The d-isomer is supposed to be less of an anxiety problem than the l-isomer, which is contained in the medication I take.
Also, these meds (unless you get a sustained release kind) enter and leave your body pretty quickly, which is why I'm having to take my meds 4 times a day.
I'm hoping that during my next appointment, I can see if I can try the Dexedrine Spansules.
Posted by rainbowlight on June 18, 2002, at 18:06:07
In reply to a little more... » rainbowlight, posted by Krazy Kat on June 18, 2002, at 9:46:41
Thanks for all your input. Here are my symptoms that you asked for, thought you guys might be able to make heads or tails of them. I have been diagnosed as Bipolar II. I have never had full blown mania (except when I quit Celexa cold turkey - BAD move!)I have had 2 horrible long lasting depressions (over a year) where I needed AD's to pull me out. My moods change very quickly when unmedicated. Without meds I am very impatient, agitated, nervous, hyper and anxious for the majority of the time. I now take Lamictal, Remeron and Risperdal. My moods still swing quite a bit. The depression is less. The anxiety/hyperness/unable to sit still are still there, in full force. I have been trying every AD possible to address the anxiety/agitation, the only thing that helps a little is small doses of Zoloft. I just went through trials of Wellbutrin (horrible, it was like a BAD case of the stomach flu, only lasted a week on it) and Effexor (HORRIBLE agitation, couldn't sit still at all, horrible anxiety, again only lasted a week on it). I can barely ever sit still, you practically have to chain me down to watch a movie. It seems I am going at full speed, yet getting nothing done at all. Does any of this make sense? I am reading "Driven to Distraction" and I fit all 20 symptoms for ADD. I can relate to so many things in the book.
Posted by Chloe on June 19, 2002, at 21:00:18
In reply to Kat and 3 Beers - here are my symptoms, posted by rainbowlight on June 18, 2002, at 18:06:07
> Thanks for all your input. Here are my symptoms that you asked for, thought you guys might be able to make heads or tails of them. I have been diagnosed as Bipolar II. I have never had full blown mania (except when I quit Celexa cold turkey - BAD move!)I have had 2 horrible long lasting depressions (over a year) where I needed AD's to pull me out. My moods change very quickly when unmedicated. Without meds I am very impatient, agitated, nervous, hyper and anxious for the majority of the time. I now take Lamictal, Remeron and Risperdal. My moods still swing quite a bit. The depression is less. The anxiety/hyperness/unable to sit still are still there, in full force. I have been trying every AD possible to address the anxiety/agitation, the only thing that helps a little is small doses of Zoloft. I just went through trials of Wellbutrin (horrible, it was like a BAD case of the stomach flu, only lasted a week on it) and Effexor (HORRIBLE agitation, couldn't sit still at all, horrible anxiety, again only lasted a week on it). I can barely ever sit still, you practically have to chain me down to watch a movie. It seems I am going at full speed, yet getting nothing done at all. Does any of this make sense? I am reading "Driven to Distraction" and I fit all 20 symptoms for ADD. I can relate to so many things in the book.
Rainbow,
Sorry to intrude. I just wonder if some of your "barely ever being able to sit still," could be a med side effect. Rispiradol, an atypical AP can sometimes cause akathesia, the inability to sit still...
Just a thought, you might want to mention this uncomfortable feeling to your pdoc
Chloe
Posted by 3 Beer Effect on June 22, 2002, at 1:47:03
In reply to Kat and 3 Beers - here are my symptoms, posted by rainbowlight on June 18, 2002, at 18:06:07
I'm not a doctor, but I if I had to take a guess from hearing about your symptoms, I'd guess that you'd probably end up in the hospital or worse (jail/psychiatric ward) from mania induced by stimulants.
It sounds more like you need a STRONG mood stabilizer to calm you down. Usually in ADHD children, when they become adults the physical hyperactivity tends to subside, and they tend to be left with attention deficit disorder of a more inattentive type. From the symptoms you describe you sound more like a manic-depressive/bipolar patient to me.
Have you tried any of the stronger mood stablilizers such as Lithium, Valproate, Topomax?
Since Zoloft seems to work for you, if you take one of these proven, strong, mood-stabilizers you might be able to tolerate a full therapeautic dose of Zoloft.I don't know a whole lot about mood-stablilizers but what I read about Lithium the other day was quite fascinating. It tends to alleviate or cure depression OR mania, making the patient "normal". No other compound has the same effects/activity. Most cannot cure depression or mania, just one or the other.
Another interesting thing (& an example of the worst of US pharmacuetical greed) is that since Lithium is a natural & therefore unpatentable compound, the US drug companies saw no money in it & it took almost 25 years after its discovery for U.S. drug companies to put it on the U.S. market.
3 beers.........
Posted by Francesco on July 5, 2003, at 7:53:10
In reply to Wellbutrin SR, Ritalin, Bipolar II vs. ADD etc., posted by 3 Beer Effect on June 18, 2002, at 11:08:28
I have discovered recently to have ADHD. I have been treated with Anafranil 75mg for years (for OCD which I did't have). my personal experience is that Anafranil helped a lot with focus and impulsiviness (if you can tolerate the side-effects). On the other side when I'm on Anafranil I usually start to experience OCD symptoms which normally I don't have. I found that even small doses (like 25mg) can help,I suppose for its sedative (side)effects (rather than for the antidepressant ones) and the effect is almost immediate, you don't have to wait for weeks. hope this can help.
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