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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by jay on December 28, 2004, at 12:17:37
I was just wondering, if I take a mood stabalizer with Ritalin (Concerta), is that ok for BP II? Also, which mood stablizer?
Thanx,
Jay
Posted by Ritch on December 28, 2004, at 14:56:31
In reply to Ritalin with Bipolar?, posted by jay on December 28, 2004, at 12:17:37
> I was just wondering, if I take a mood stabalizer with Ritalin (Concerta), is that ok for BP II? Also, which mood stablizer?
>
> Thanx,
> JayJay, I took Ritalin-LA 20mg with Depakote 500mg for several weeks with no mania or destabilization. You might get some weird reactions taking Ritalin with lithium (I think the lithium will defeat the activity of the stimulant rather directly in some way-can't remember how right now). Stims tend to make me feel just generally icky after several weeks (no cycling, just kind of a blah icky jittery feeling)-- so that's why I don't bug my doctor about them any more. I was offered desoxyn with Depakote a few months ago. No thanks!
Posted by smith562 on December 28, 2004, at 18:39:33
In reply to Re: Ritalin with Bipolar? » jay, posted by Ritch on December 28, 2004, at 14:56:31
Mitch,
Do you get the same "icky" feeling with wellbutrin too?
Is wellbutrin more like a TCA or a stimulant?
Thanks,
Smith
> Jay, I took Ritalin-LA 20mg with Depakote 500mg for several weeks with no mania or destabilization. You might get some weird reactions taking Ritalin with lithium (I think the lithium will defeat the activity of the stimulant rather directly in some way-can't remember how right now). Stims tend to make me feel just generally icky after several weeks (no cycling, just kind of a blah icky jittery feeling)-- so that's why I don't bug my doctor about them any more. I was offered desoxyn with Depakote a few months ago. No thanks!
Posted by HappyGirl on December 29, 2004, at 12:28:41
In reply to Ritalin with Bipolar?, posted by jay on December 28, 2004, at 12:17:37
Hi:
If you have Bp II, then Wellbutrin sr(generic form is now available) is SAFE to take along with Lithium or other mood-stabilizers.Ritain is a 'PURE' stimulant that is said to make 'cycling' getting worse.
Talk to your pdoc. before getting any 'stimulants' due to 'unpredicable' side-effects, particularly 'mania' to concern.
H.G.
Posted by Ritch on December 29, 2004, at 13:10:54
In reply to Re: Ritalin vs Wellbutrin » Ritch, posted by smith562 on December 28, 2004, at 18:39:33
> Mitch,
>
> Do you get the same "icky" feeling with wellbutrin too?
>
> Is wellbutrin more like a TCA or a stimulant?
>
> Thanks,
>
> Smith
Wellbutrin is more like a stimulant than any other AD I've taken. It is also "icky" for me in the sense that it provoked a lot of nausea and caused worsening anxiety over time. My panic symptoms are closely related to how calm my GI tract is. Propantheline was the first medication that I was prescribed as a teenager to treat IBS symptoms. The GP told me I was having some kind of "vagus nerve instability". Interestingly, the propantheline seemed to have an anxiolytic effect that seemed to go beyond treating the acute GI symptoms. That's may be part of the reason why I found nortriptyline anxiolytic.
Posted by Ron Hill on December 30, 2004, at 1:06:50
In reply to Re: Ritalin with Bipolar? » jay, posted by Ritch on December 28, 2004, at 14:56:31
> Stims tend to make me feel just generally icky after several weeks (no cycling, just kind of a blah icky jittery feeling)-- so that's why I don't bug my doctor about them any more. I was offered desoxyn with Depakote a few months ago. No thanks!
--------------------------------------
Mitch,How have you been? I'm committed to a self-imposed one-year block from posting (ends in Feb '05), but I need to interrupt my block to ask you a couple quick questions.
Please correct me if I'm wrong, but as I recall, your dx is Bipolar II with comorbid ADHD (or do I have your dx confused with that of cybercafe?). Also, wedged in the deep recesses of my cranial crevices is the remembrance that last year your cocktail included a low dosage (like 10 mg) of Adderall XR as an add-on to your moodstabilizer for the purpose of treating your comorbid ADHD.
Is my memory anywhere close, or am I off in left field? Here are my questions:
1) What was your dosage of Adderall, and how long were you on it?
2) What are your comments, opinions, and recommendations regarding the use of a low dosage of Adderall XR as an add-on to a moodstabilizer in a BP II patient for the purpose of treating atypical depression (via the dopamine and norepinephrine reuptake inhibitor actions of Adderall)?
3) What are your observations and/or opinions regarding the likelihood of eventual pstim poop-out if Adderall were to be used on a long-term basis in the manner described directly above in question #2?
4) Finally, what prompted you to discontinue the add-on Adderall tx?
Thanks much Mitch!
-- Ron
Posted by Maxime on December 30, 2004, at 2:02:41
In reply to Re: Ritalin with Bipolar?, posted by HappyGirl on December 29, 2004, at 12:28:41
I had the worse experience with Ritalin (I'm bipolar). I would crash so hard at the end of the day I thought I was going to go crazy. Then I tried Adderall XR. Big difference! It wears off slowly and I don't crash. It hasn't cause a manic episode to date.
Maxime
Posted by Ritch on December 30, 2004, at 11:11:23
In reply to Re: pstim for Bipolar II with comorbid ADHD? » Ritch, posted by Ron Hill on December 30, 2004, at 1:06:50
> Mitch,
>
> How have you been? I'm committed to a self-imposed one-year block from posting (ends in Feb '05), but I need to interrupt my block to ask you a couple quick questions.
>Hi Ron, haven't talked to you in quite some time!
> Please correct me if I'm wrong, but as I recall, your dx is Bipolar II with comorbid ADHD (or do I have your dx confused with that of cybercafe?). Also, wedged in the deep recesses of my cranial crevices is the remembrance that last year your cocktail included a low dosage (like 10 mg) of Adderall XR as an add-on to your moodstabilizer for the purpose of treating your comorbid ADHD.
>
> Is my memory anywhere close, or am I off in left field? Here are my questions:
I was first diagnosed simply as manic-depressive (before it was called bipolar disorder). Later on when they split it up it was changed to bipolar II. Never argued with that. Latest pdoc looks at symptoms and doesn't fuss with dx much, and it would be more accurate to say that I have a lot of classic ADHD symptoms and some experimentation has happened to attempt to treat the ADHD as well as the bipolar symptoms. But, I've also got for real case of panic disorder and stimulants/WB aggravated the heck out of that and those meds have proven to be unusable for me. Bipolar+ADHD+panic disorder, what a mess, huh?
>
> 1) What was your dosage of Adderall, and how long were you on it?
The first time I tried Adderall was with Neurontin (only), and I had stopped taking an SSRI. I was on just 5mg with 600mg of Neurontin for about a couple of months. Starting getting panic big time. I attribute stopping the SSRI for that more than the Adderall, but it certainly didn't help the anxiety!>
> 2) What are your comments, opinions, and recommendations regarding the use of a low dosage of Adderall XR as an add-on to a moodstabilizer in a BP II patient for the purpose of treating atypical depression (via the dopamine and norepinephrine reuptake inhibitor actions of Adderall)?
IF you don't have a clear-cut anxiety disorder I would give it a try. When I'm taking a stimulant it does seem to exert an anticyclic effect. Look for an anticyclic effect. If things start getting worse-get off the stuff. None of the usual depressive symptoms happened while I was on it. Whether that's treating my bipolar or treating "ADHD", I'm not sure. I would watch the dosage and watch for tolerance (needing to increase the dose), and also watch for reverse tolerance (which is what I think happened in my case). I did try Depakote+Effexor (lowdose)+Adderall 5mg with much better success at a later time. Should I try a stimulant again.. I would need a serotonergic med to counter the anxiety. But, I would prefer not to have the anxiety to counter in the first place :) It is also possible that the stimulant simply removed the depressive phases, and changed the expression of mania from euphoria/dysphoria to panic anxiety. It also could have changed the expression of depression to simple boredom!
>
> 3) What are your observations and/or opinions regarding the likelihood of eventual pstim poop-out if Adderall were to be used on a long-term basis in the manner described directly above in question #2?
I would be definitely be concerned about it. However, other meds poopout as well, so perhaps it is just an individual thing? I've heard about some people with ADHD who take a steady moderate dose over time and it continues to help with attentiveness, but they can sometimes get depressed..... Maybe the stimulant would best be used for a seasonal bout of bipolar depression only (something that is predictable), and get off after it would normally subside (a few weeks)?
>
> 4) Finally, what prompted you to discontinue the add-on Adderall tx?ANXIETY! Yuck. Just hate being jittery, nauseous, and overfocused. Great for work though.
>
> Thanks much Mitch!
>
> -- Ron
>
>
You're welcome!
Posted by linkadge on December 31, 2004, at 14:54:56
In reply to Re: pstim for Bipolar II with comorbid ADHD? » Ron Hill, posted by Ritch on December 30, 2004, at 11:11:23
Sometimes there is a great blur between bipolar and ADD. Both involve profound underactivation of the frontal cortex (part of the brain that is involved in exectutive function and behavioral controll)
Seemingly paradoxical is are certain cases of mania being *relieved* through high doses of stimulants. This supports the cholinergic theory of bipolar (in which cholinergic hypofunction is involved in mania, and hyperfunction is involved in depression)
There have been times where my mood felt very out of controll, and a single dose of a stimulant (coffee, dexedrine, ritalin) has provided some controll.
If you feel that your symptoms lean more towards lack of attention, then oftentimes a stimulant can be grounding.
I would tend to think that a stimulant would work better with a gabaergic mood stabalizer than with lithium. On the other hand, lithium and ritalin is a combination that has often been employed for childhood ADD/Bipolar.
Linkadge
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