View Full Version : New diagnosis - Bipolar II alongside ADHD-PI


kathrynsmathryn
11-05-15, 12:43 AM
Hello all! Everytime I see my PDoc, it seems that I come back to these forums for a little more insight into what's ahead for me and how people are dealing.

I'm a long time lurker, and I haven't posted in a while. My original thread is in the ADHD section, but I feel like this one should be here, seeing as i'll be trying out medications for BP Disorder.

Some background info: I was diagnosed with ADD when I was 11, along with being a depressed kid. I've suffered through severe depression for most of my life. I also have had severe anxiety issues since I was a kid. But my parents never sought out treatment.

I got clinically diagnosed with Major Depression in my early twenties, along with Social Anxiety Disorder. I've been on Citalopram, Fluoxetine, and Sertraline (which i'm currently on). I've also tried Buspirone, Clonazepam (worked wonders before I developed a tolerance) and am currently on Alprazolam to take as needed (which i'm fortunate to report that I went from three times a day to once every few weeks). I also have tried Methylin ER (didn't increase focus, just jitters), Adderal XR (not as effective), Vyvanse (similar to Adderall with an added price!) and Focalin XR (currently on) to treat my ADD.

I went to a new PDoc today, after taking a long hiatus from any mental health professional. She seems nice enough, I hope she's a good fit. Anyway, I do have BPD that runs in the family, so i've always been aware of that possible diagnosis. I've never had any manic episodes (no psychosis), but I don't know if i've ever been hypomanic. I've been reading through a lot of forum threads and blogs online, but I don't click with any one description.

I don't know if I am BPII or if it's just a combination of the Depression/ADHD-PI/Anxiety. I've never been able to differentiate where the overlaps are and which one stems from which one. I know that there are so many points of overlap between all four - and all of which are comorbid with each other. Either way, my medications need an overhauling (my internist has been prescribing my meds while I didn't have a PDoc). I never feel any different on the SSRI's (though people close to me have reported changes), the xanax barely works anymore even when I double dose (.25mg, small dose). The stimulants work wonders for my lack of motivation and focus, but also make me abundant with rampant ideas (it's like I can't shut my mind off at all, ever). Also prescribed Zolipidem (helps with jaw clenching and helps to knock me out from the insomnia associated with the Focalin).

From what I can tell, my hypomania is extremely short-lived. I'm vastly depressed most of the time, and the happy feelings never really feel all that good. When i'm hypomanic I am extremely hypersexual (poor SO can't keep up with my libido), I am extremely organized, start new projects/hobbies, easily excitable, obsessive about completing things, smiley, charming, efficient. I wake up and am excited to do things throughout the day. I am more impulsive, I'll go for drives with no destination, go shopping for things I don't need with ideas that will probably never happen. I spend money and do things for people that are completely out of my way. In my head, I feel very "clear".This happens more often when i'm on stimulants, and last for no longer than 5 days at a time. But are these things necessarily hypomanic? Or is this the happy baseline I should be striving for?

When the depression hits, it hits hard. This is not new. I've been struggling for a long while with feeling sad for no real reason (or at least small triggers that lead to an episode). The depression lasts for a long time, waxing and waning from day to day, until I tell myself that i'm going to get my life together and sometimes force a hypomanic phase. Sometimes it just comes out randomly.

It seems like I lean more towards mood-reliant versus focus issue. Perhaps the initial diagnosis of ADD-PI was wrong (many were misdiagnosed in the 1990's) and this is BPII...? I guess time and meds will tell.

Any thoughts? Or anyone feel similarly?

sarahsweets
11-05-15, 02:36 AM
I am also BPII and have similar issues. I take a really good med regimen that has literally saved my life. The last in patient stay I had was in 2003. As far as whether your adhd diagnosis is legit or not...for right now dont think about it. Wait and see how stable you get on the meds. Once things become regular and stable then you can think about it. Some people will probably tell you that stimulants are bad for BP and they can be without proper monitoring. I have never had an issue with them but my doc has always been on top of things like that.
Welcome to the dark side!`

kathrynsmathryn
11-05-15, 03:10 PM
Yeah, i've been on the stimulants for years now. I like them a lot - minus some side effects. We're going to try Lamictal as a mood stabilizer and see how that goes. I have yet to find the right med combo to even things out, which is why I switched to a PDoc instead of staying with my regular doctor to prescribe my meds.

Fairshare
11-06-15, 04:13 PM
Hey Kathryn!

For the past three years I've been treated for depression and anxiety with major insomnia.

After a years and years of not seeking treatment (I've had my first major depressive episode in 2006) my brain was fried (just couldn't conjure up a proper sentence anymore), my nerves shattered to the point I've slept for 3-4 hours a night due to anxiety and my attention span was that of a golden retriever given a choice between a ball and a fly in the room.
I've finished law school in 2011, then a postgrad on commercial companies law in 2012 - god only knows how - since I've devoted only the slightest bit of attention to learning, always the "underachiever" as my high school teachers used to call me, saying I could have a brilliant career if only I tried.

Then it all came to a screeching halt. I just couldn't take in any information, do any work without screwing things up let alone take part in a conversation without forgetting what it was about.

For a moment from 2011 to 2012 thanks to my loving partner and fiancé whom I cherish very much I've been so flushed with endorphins that my brain chemistry came to a relatively balanced state and I could hold a job and finally be happy, but that state of mind didn't last forever.
I still had tremendous anxiety and insomnia and my cognitive function was way below what IQ tests administered at various points in my life said.


The basic meds I got and have been on since 2012 - mianserin (my pdoc prefers it to mirtazapine), trazodone, quetiapine and lamotrigine - helped a lot, but that just wasn't it. Still couldn't get a good night's sleep, woke up groggy in the morning, lacked motivation and concentration etc.

We went the SSRI way and tried escitalopram, which didn't help at all, no effect, nada.

I complained about my attention deficit for so long my doctor finally prescribed stimulant meds (first 40mgs of Concerta, then just plain old IR Ritalin which works as it's supposed to without the anxiety Concerta gave me).

Europe is the a-hole of ADD meds, especially where I live (Poland), where adult ADD isn't even considered a diagnosis and health insurance doesn't cover any form of treatment for people over 18 as the regulators seem to think it's a disease exclusive to school children.
I'm sure I'd be better off on Dexedrine, Adderall, Vyvanse but these aren't even approved for use. I think Adderall was for a brief moment, but "due to abuse potential" it received the boot and isn't available since 2011...
Stimulant meds helped tremendously with my attention and gave me some more energy to get things done, but that still wasn't enough - sleep architecture all wrong and a stable but never really good mood.

But to the point. I've been taking Lamotrigine in a dose between a 100-200mg in the evening for years now, but neither me nor my psych though about trying it as a "daytime" med.
Somewhere in July I felt off in the depressive department and picked up some escitalopram I had laying around for a year or so. This was a real eyeopener - it somehow triggered a hypomanic episode that made me realise I've had them all my life without even realising it, just not that strong - I did a year's worth of Russian classes on my computer in a week and I can honestly say I know the language at a communicative level ;)

I didn't have a psych appointment until September but I came with this epiphany to him and we tried going with a 100mgs in the evening and another 100mgs in the morning.

This really turned things around for me - now I have a good baseline mood throughout the day although after two months I think the effect is just not that obvious but still lingering in a good way.

As for my insomnia - after brain scans, blood work etc. all came back a-OK and I haven't felt rested even though I sometimes spent in excess of 10 hours in bed. After all the "safe" Z-drugs (zolpidem, zaleplon etc.) that didn't work I finally got a shot at "normal" sleep with bromazepam, which seeing as it's a benzodiazepine, both me and my psychiatrist were reluctant to try, but all the attempts to put me to sleep until now proved futile.
My friends even joked about me being date-rape drug proof.

So now I'm still on my previous regimen of mianserin (60mg), trazodone (250mg), quetiapine (25 mg) and lamotrigine (but now 2x100mg in the am and evening) and a new addition - bromazepam, which has successfully been knocking me out for two months and giving me a chance at a good night's sleep. Additionally armed with 30-40 mgs of IR Ritalin in the day I can honestly say I'm back to my pre-university, quite happy self but without the ups and downs I had my entire life and an ability to focus "like an adult".

So now we're working up to a bi-polar II diagnosis instead of just plain MDD. My next psych appointment is in two weeks and I'm pretty sure this will be the case given the successful treatment. I'll try to push some considerations towards titrating the doses on my other meds or even removing them. The ADD-PI definitely stands.

Is lamotrigine a good consideration for BPII mono-therapy?

What combo are you currently on Sarah, if I may ask?
From what I've read our life and psychiatric experiences are very different, but I'm curious how big a dose of Lamictal you take.
I've read, that going past 200mgs for BPII doesn't yield any better results, is that true?

sarahsweets
11-09-15, 05:33 AM
Fairshare:
I take cymbalta,lamictal,buspar and Geodon. I have some absorption issues so I take all of those meds in seperate pills twice a day. The buspar is recent as in the last 6 months and it was frusterating at first because I was expecting to have the anxiety blasted away like benzo do, but I can no longer take benzos. The buspar took awhile to build up but then one day its like my anxiety was more in the backround rather than being front and center.

Nathanael
01-15-16, 11:29 PM
I have Bipolar II, and that does sound like it, although you'll need a pdoc to make a diagnosis of course. I'd say it's definitely worth looking into though. The only reason I got diagnosed is because I read about it and went in to ask if it was what I had. It wouldn't have gotten caught otherwise.
There's a high commorbidity with ADHD and BP as you probably know, so it's very possible you have both. You NEED to treat the bipolar though before the ADHD, because the ADHD meds will really mess with your episodes...

Along with BP II, I have Social Anxiety Disorder and ADHD-PI...I'm currently on Lamotrigine, Gabapentin, Seroquel, and Adderall (just started the past few days).

kathrynsmathryn
02-06-16, 05:11 AM
The last time I went to the pdoc we refocused on possible Borderline Personality Disorder. Unfortunately there is no med regiment for it. I'm on 100 mg of sertraline now and I've been even more depressed. Not sure where anything is going anymore because my compass seems to just be spinning all willy nilly. Not sure what to do, and I've been skipping med doses because it feels pointless and I'm losing hope for balance. I know it's a long process, but I get more and more tired of no relief every day. ��

daveddd
02-06-16, 06:05 AM
The last time I went to the pdoc we refocused on possible Borderline Personality Disorder. Unfortunately there is no med regiment for it. I'm on 100 mg of sertraline now and I've been even more depressed. Not sure where anything is going anymore because my compass seems to just be spinning all willy nilly. Not sure what to do, and I've been skipping med doses because it feels pointless and I'm losing hope for balance. I know it's a long process, but I get more and more tired of no relief every day. ��

thats tough to hear, I'm sorry

do you have a good relationship with your doctor ? could you suggest things to him?

if so here is a pretty recent study on almost all the medication out there and results on borderline and different aspects of the illness

while the conclusion states nothing is good for treating BPD perfectly , there are some promising ones for the tough depression of it and symptoms i think a lot of people may put under depression


SSRIs show of little use in BPD or any of its depressive features except aggression in men

one decent one is ability, a pretty common and mild Atypical, plus others


my sister has been out deep depression and social avoidance for years on a combination of abilify and time released adderall

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811092/


good luck

daveddd
02-06-16, 06:30 AM
I've know also seen this several times

omega fish oil for borderline depression , I've must of seen this replicated 10-15 times already, so it could be legit

and think you just go to the store and buy them

For supplementary omega-3 fatty acids, significant effects were found in one study (n = 49) for the reduction of suicidality (RR = 0.52, 95% CI 0.28 to 0.95) and depressive symptoms (RR = 0.48, 95% CI 0.28 to 0.81).24 There was also an effect estimate of a second study (n = 27) for depressive symptoms,45 but because of different formats of reporting it could not be pooled with the first one. However, these findings also tended towards better results in participants given omega-3 fatty acids (SMD = –0.34, 95% CI –1.15 to 0.46).

sarahsweets
02-06-16, 07:20 AM
I've know also seen this several times

omega fish oil for borderline depression , I've must of seen this replicated 10-15 times already, so it could be legit

and think you just go to the store and buy them

For supplementary omega-3 fatty acids, significant effects were found in one study (n = 49) for the reduction of suicidality (RR = 0.52, 95% CI 0.28 to 0.95) and depressive symptoms (RR = 0.48, 95% CI 0.28 to 0.81).24 There was also an effect estimate of a second study (n = 27) for depressive symptoms,45 but because of different formats of reporting it could not be pooled with the first one. However, these findings also tended towards better results in participants given omega-3 fatty acids (SMD = –0.34, 95% CI –1.15 to 0.46).

Do you think the benefits of the fish oil for borderline depression are similar to the way fish oil can help people with adhd? I was just interested in the similarities.

daveddd
02-06-16, 07:27 AM
Do you think the benefits of the fish oil for borderline depression are similar to the way fish oil can help people with adhd? I was just interested in the similarities.

its seems to be that while borderline and ADHD do have slight differences in presentation (which is mainly severity and possible an ADHD type illness early plus trauma ) they seem to share a lot of features, physical ones too

so a good possibility


Borderline personality traits and adult attention-deficit hyperactivity disorder symptoms: a genetic analysis of comorbidity.
Distel MA1, Carlier A, Middeldorp CM, Derom CA, Lubke GH, Boomsma DI.
Author information
Abstract
Previous research has established the comorbidity of adult Attention-Deficit Hyperactivity Disorder (ADHD) with different personality disorders including Borderline Personality Disorder (BPD). The association between adult ADHD and BPD has primarily been investigated at the phenotypic level and not yet at the genetic level. The present study investigates the genetic and environmental contributions to the association between borderline personality traits (BPT) and ADHD symptoms in a sample of 7,233 twins and siblings (aged 18-90 years) registered with the Netherlands Twin Register and the East Flanders Prospective Twin Survey (EFPTS) . Participants completed the Conners' Adult ADHD Rating Scales (CAARS-S:SV) and the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR). A bivariate genetic analysis was performed to determine the extent to which genetic and environmental factors influence variation in BPT and ADHD symptoms and the covariance between them. The heritability of BPT and ADHD symptoms was estimated at 45 and 36%, respectively. The remaining variance in BPT and ADHD symptoms was explained by unique environmental influences. The phenotypic correlation between BPT and ADHD symptoms was estimated at r = 0.59, and could be explained for 49% by genetic factors and 51% by environmental factors. The genetic and environmental correlations between BPT and ADHD symptoms were 0.72 and 0.51, respectively. The shared etiology between BPT and ADHD symptoms is thus a likely cause for the comorbidity of the two disorders.
Copyright © 2011 Wiley-Liss, Inc.

jkimbo
12-13-16, 01:58 PM
Good luck with your bipolar treatment and meds, I have not found one that worked for me since 1987. I realize most do better then I have. Holidays are the worse for me.