View Full Version : Need Advice -- Have appointment with Psyc doc after New Years


NickL30
12-20-07, 10:28 PM
I am going to see the original psyc doc who prescribed Ritalin, then Adderall & increased the daily dose of Prozac to 80MG a day. I got an appointment Jan 3 and driving close to 100miles to North Central CT to see him. A month after starting treatment, I got fired from that job that I relocated from NYC for.

The Adderall seems to have worsened the cycling between depression & hypomanic behavior. I seem to have every symptom except for hallucinations, delusions, thoughts of suicide.

But on days I don't take any Adderall, the depression seems deeper and seems to immediately go away after I take 2 or 3 Adderall capsules. I feel like I cannot function without it.

I can tell that when I do take it during the day it feels like this surreal buzz. But things get bad when it wears off. I now do an hour of boxing or kickboxing at night to try to raise back serotonin levels.

There is other stuff I have added as well -- Creatine Estyl Esther tablets & something called Ultimate Animal Pak Pump before working out.

When I originally saw this doctor back in September, Bipolar was never even discussed. I just wanted to get a script for Prozac since I was going thru withdrawl - not taking any for two weeks.

So, I thought of asking for Strattera which is supposed to be a non stimulant and maybe trying Lamictal as a mood stabilizer.

PraizeHim
12-21-07, 10:58 PM
I have been diagnosed with BP II and ADD and have been on and off meds for yrs...recently I was prescribed Adderall - when I was cycling it made my symptoms so much worst also, I am usually in a up,good mood before I go down and the depression comes...this time I was agitated and depressed.. I stopped the Adderall - it didnt really do anything for me in the first place but the Dr. just upped the dosage. I was taking 40 - but my doc said max dose was 30 - but it didnt make me feel calm or focused. She told me she was trying Provigil next month, so your post got my attention.

I can't work because my moods are just to unpredictable. I forgot your question- sorry:confused: I am so tired of feeling like this and nothing seems to help so I understand what u are feeling!

Crazy~Feet
12-24-07, 12:38 AM
I am going to see the original psyc doc who prescribed Ritalin, then Adderall & increased the daily dose of Prozac to 80MG a day. I got an appointment Jan 3 and driving close to 100miles to North Central CT to see him. A month after starting treatment, I got fired from that job that I relocated from NYC for. So, I thought of asking for Strattera which is supposed to be a non stimulant and maybe trying Lamictal as a mood stabilizer.
Nick, I am so psyched that you are seeing the doc. I hope he is openminded and knowledgable about Bipolar. You have some very good ideas there.


The Adderall seems to have worsened the cycling between depression & hypomanic behavior. I seem to have every symptom except for hallucinations, delusions, thoughts of suicide.

I did say it sounded like BPII to me, so that's not unusual. Standard procedure is to stabilize the mood disorder, THEN address the AD/HD. Stimulants are known to provoke hypo/mania in BPs who are not being treated for it.

Incidentally, this is EXACTLY what happened to me when I first began stimulants, and I had NO idea that I had "probable" bipolar. None at all, but man! Was I jazzed! My new meds had transformed me! My mind had been set free! I was a totally new person! Man, did I feel different! My creativity was never so high!

:eyebrow: Yea right. I was as hypomanic as anybody can possibly be. I even made posts that now no longer make much sense after treatment for my BPII.


But on days I don't take any Adderall, the depression seems deeper and seems to immediately go away after I take 2 or 3 Adderall capsules. I feel like I cannot function without it.
I think I can explain a possible reason for this:

Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Many bipolars chase mania/hypomania and once medicated, they will feel a loss. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Men tend to manifest manias younger than women do. I don't know your age...but Bipolar is progressive. Those wonderful "white" euphoric hypomanias gradually become less frequent, and are replaced with "black" hypomanias or mixed states.


The Cycling Team tends to remind each other..."This illness lies." White hypomania feels great, but compared to BP depression it's easy to mistake it for "happy". You may not be more depressed, you may be missing that glorious euphoria.

From "Shadow Syndromes":

A white mania is a difficult state to relinquish:


I simply did not want to believe that I needed to take medication. I had become addicted to my high moods; I had become dependent upon their intensity, euphoria, assuredness, and their infectious ability to induce high moods and enthusiasms in other people ... I found my milder manic states powerfully inebriating and very conducive to productivity. I couldn't give them up. (Kay Jamison)

I can tell that when I do take it during the day it feels like this surreal buzz. But things get bad when it wears off. I now do an hour of boxing or kickboxing at night to try to raise back serotonin levels.
It IS surreal.... Euphoria is madness, in it's own way. It's not justified by external reality and may even be totally inappropriate. Generally, euphoria is caused by ingesting a substance.



When I originally saw this doctor back in September, Bipolar was never even discussed. I just wanted to get a script for Prozac since I was going thru withdrawl - not taking any for two weeks.
I looked up withdrawal and found this:

http://www.healthyplace.com/Communities/depression/treatment/antidepressants/discontinuation_events_2.asp

Researchers found that withdrawal from Prozac caused no negative events. They think this is due to the fact that Prozac stays in the body for a long time in comparison to the other SSRIs. If that is the case, withdrawal effects would not have been experienced after only 5 days of taking the inactive tablet.


I did some more Googling and the concensus seems to be that Prozac withdrawal is fairly mild...so I am going to remind you of this once again:


http://www.nyu.edu/classes/keefer/therapy/manic.html


They not only can take a person from a depressed state to a normal state, but they could cause a person who is in the mania state to go into a hypermania state. This could be very dangerous because this drug helps a person go from a depressed state to a normal state, and now the patient has to be concerned with going into a hypermania state. This is just one of the difficulties. It is a very hard illness to treat. If a bipolar person is already in hypomania or mania, an antidepressant can induce their condition. To avoid this a doctor will prescribe an antidepressant plus a mood stabilizer. Antidepressants medications are the following: Prozac, Paxil, Zoloft, Luvox, Effexor, Norpramin, Sinequan, Elavil, Anafranil, Doxepin, Nardil, Parnate.


http://faqs.org/faqs/support/depression/bipolar-faq/part3/



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WARNING: USING ANTIDEPRESSANTS ALONE TO TREAT BIPOLAR DISORDER CAN INVOLVE
SUBSTANTIAL RISK OF INDUCING HYPOMANIA OR MANIA.
--------------------------------------------------------------------------

Antidepressants (ADs) are part of most people's treatment if their disease includes severe depression. However, they must be used cautiously by bipolars. Although ADs normally do not cause folks to get high even when taken in larger doses than needed, for a significant number of bipolars ADs can cause mania or hypomania and/or may trigger rapid cycling.

Any bipolar starting on an antidepressant should monitor their moods carefully and stay in close contact with their physician until it is clear that these effects do not appear or appear only to a degree that is acceptable.

http://www.nyu.edu/classes/keefer/therapy/manic.html

The thing to remember is that bipolar disorders are life long, chronic medical conditions. They are not curable but are treatable and can be managed. According to Barry Campbell, "Bipolar Disorder is a lifelong, chronic medical condition. It cannot be cured, but it can in almost all cases be managed to at least some extent" (On-Line Services FAQ). The biggest problem with the disorder is that manic patients are in denial that they are ill and refuse to get professional help. They are afraid. They must accept their illness before they can help themselves. They are too concerned about how they will be perceived by our society since there is a "stigma" attached to psychological illnesses.

NonSequitor
12-24-07, 02:20 AM
Everything just said is so so so sooooooo true. And this is coming from the inside of the storm. I am 26, female, ADHD & BP2, and was totally stoked and so functional when last spring I was given wellbutrin 150 & dexedrine 20 (x3).

So, now I have no health insurance. This forced me in September to completely go off meds and in hindsight, regress into such a state of dysfunction that I am still to this day the albatross plaguing every person close to me. In my head, I could make no logical connection between my screwing up and how bad everything was getting. Eviction. Quit job.

I found a prescription for dex that I never filled a few weeks ago, and proceeded to take it with nothing for my moods. Bad, bad idea. I was on cloud nine, geeking out creatively for hours on end, finally taking care of the **** that had been piling up around me. It wasn't until I seemed to cross over from "happily stimulated" to "mechanical zombie" that I realized I probably was acting no more sane than Hunter S. Thompson.

Anyhoo. Really needed to get that out. BP is tricky because there are so many times that I truly believe that there is nothing wrong with my moods. And the ugliness really only became disabling when I was about 24.

I miss health insurance!!!!! :faint:

meriellyn
12-24-07, 11:48 AM
Definitely talk to your doc about the BP and try to get regulated on a stabilizer *then* worry about treating the ADHD.

I'd say it's probably best to get off the Adderall and Prozac entirely, lay off the suppliments, find a stabilizer (I love Lamictal and it does wonders for depression), then try a non-stimulant ADHD med like Straterra once you've titrated up to an appropriate dose of stabilizer. Of course your doc will help you decide the best course of action for you.

That Adderall withdrawal depression should go away once you've been off the Adderall for a bit. Lamictal should help to aleviate any remaining non-med related depression.

What sort of withdrawals were you having from the Prozac? From my experience, Prozac withdrawal is relatively brief (if it occurs at all) and you'll benefit from being off that med anyway if you're BP.

There is undoubtably an adjustment period when going on Straterra so make sure your BP is regulated first and be prepared to go through a few weeks of transitional time before you're able to decide if it's the right med for you ADHD.

Good luck! :)