View Full Version : BP II stable on Depakote & Wellbutrin.. Now comorbidity of ADHD.. Question

01-02-13, 12:04 AM
I'm 41 years old. I was finally diagnosed with Bipolar II in my 6th year or so of college by a psychiatrist. I fell apart back then, withdrew, sought eval after eval just needing some kind of immediate relief for my feelings of desperation. I was depressed for several months, and hypomanic for months prior to that. I had always been high strung, super "hyper" as a child, an over-achiever in many classes, but did not care about others. I just didn't do my work in some classes because I wasn't interested in it. I went from making all As in one term to Fs in the next. I would always feel like I would get behind and then was just too desperate to catch up. When I finally did, though, I still excelled.

Back to 2 years ago-- I had many failed trials of SSRIs. My PCP thought I had anxiety and depression. SSRIs were terrible. They made me anywhere from very lethargic, gave me hypersomnia to insomnia, to nearly manic, and even confused for a few days, where i didn't even realize what day it was or what I was supposed to be doing. Once finally diagnosed with BP II 1.5 years ago, I began Depakote ER and Wellbutrin SR (and sometimes XL instead, depending upon which one the doc ordered at the time). I did immediately improve and my mood has been fairly stable since that time. Mood is no longer a problem, really. I do have anxiety issues and continued insomnia more than I don't, but it's not from racing thoughts like it used to be. It's just from worry about not getting my tasks done. Worry now incapacitates me and I am again at a complete standstill in graduate school, about to fail, with grades just 1 month ago no less than 99 in any class. I owe about $150,000 in debt, and I'm just sitting here looking at assignments.... overwhelmed.. numb... they are too big.

I sought help again. I have had two psychologists tell me in the past that they felt like I had ADHD and BP II both, so I figured it was time to seek help acutely again. MY PCP gave me focalin IR 5 mg 2 x day (I can't even tell I took it, honestly). I still take Wellbutrin XL 150 mg daily, Depakote ER 500 mg daily, alprazolam 0.25 mg 2x day as needed (I average about 1 a day), Ambien 10 mg at bedtime when I have my episodes of insomnia, which is nearly every night, 3 blood pressure pills (one is a beta blocker), Synthroid, Bentyl for IBS, and Vitamin D for severe vit D deficiency the past couple of months. The IR Focalin (dexmethylphenidate) would peak at about 1 hour and was gone by 2 hours at the most. I have 10-12 hours or more of work to do, sometimes 16 hours a day of work to do. I took those within a week. I then tried Concerta 36 mg daily, then 72 mg daily, and now if I have a long day of work, 72 mg every 12 hours helps me just a little bit. I work in medicine, and I'm in college to be a PCP. I do understand basic medicine, but have no experience yet with ADHD except myself and kids so far. Why in the world can I not tell that I am taking such a massive dosage of stimulant? I have looked everything I take up and there does not seem to be any significant P450 interactions in metabolism. I am ready to have genetic testing done, seriously. I have never taken stimulants until last month, and I can't even tell I take 144 mg of Concerta in a day? I mean my HR doesn't increase and my BP barely increases. No jittery feelings. Nothing. My focus may be 10% better. She has increased my Wellbutrin now to XL 300 mg daily, but that has just increased my anxiety when I take it.

Help? Opinions? I have to find something that works and fast before I waste 7 years and $150,000 in grad school. I just can't get it together!

(Mods, I'm not sure which would be the best forum for this. I'm wondering if the Depakote is so calming that it's making the stimulants not work?)

01-02-13, 01:01 AM
I would have posted this in "ADHD and Bipolar in Adults" in the Bipolar subforum.

I am by no means a medication expert but what is starting me in the face is you are taking a form of methylphenidate. From what I understand people either respond to methylphenidate or dexamphetamine. I'm sure someone else can explain it better than me.

I was tried on Ritalin and I think it worked some but I don't recall any major change. I started Dexedrine and it was a WOW big difference.

01-02-13, 01:09 AM
ok, Thanks Crystal :) This was my first post and I was trying to figure out where to put it. I was thinking it might have something to do with being on Depakote, but I knew theoretically it shouldn't because there are supposedly no interactions. I go back to my NP in 2 days. I know that the dexmethylphenidate and methylphenidate do not work. It's like I am completely immune, even though the only stimulants I've ever used are caffeine and rarely Adipex in in the past to lose weight. Thank you for your insight. I do appreciate it.

05-10-13, 03:16 PM
When I took Depakote and Ritalin I also noticed my Ritalin didn't quite as good how it should work. Don't know maybe it is because Depakote doesn't allow stimulants to work.

05-10-13, 03:32 PM
Small point: You will never ever get 16 hours of coverage from any ADHD medication, and it would be crazy to try. 8 to 10 is the outside maximum. Keep it sane. You need sleep, and you need some stability to your schedule - even though we all wish we could have an occasional unlimited work day.

05-10-13, 03:35 PM
Too high a stimulant dose starts to have paradoxical effects. ("Zombie", tired all the time,...). Maybe you need to back off to where it works. There is a right level for you, and more than that makes you worse instead of better.

It's also possible that this one just isn't working and needs to be changed.