I am wondering what meds for bipolar people are taking. I am bipolar and ADD. Currently I am on 900mg of Effexor xr, 20mg of Abilify, 400mg of Lamictal, and 90mg of Mirtazapine, for the bipolar. A close friend of mine who suffers from depression and ADD takes Lexapro and Ritalin. She says I should get off the Effexor, that it's "really bad stuff". Is it? What have other people found?

I was on Lithium from the age of 12 to about 20. I was taken off of that by a doc who said it was an old drug and there were newer, better drugs. I think that's when I was put on Effexor.

I have made some progress over the past 2 years on these dosages but don't feel I am my happy, old self. Years ago, a lifetime it seems, I used to have a sense of humor and was considered the funniest person my friends and family knew. The past 2 years I have become incapable of carrying on an interesting conversation with anyone, I have nothing to say about anything, I'm boring and uninterested in things. I've lost all passion for my teaching job, my creativity no longer exists. My life has become so routine, it varies very little from day to day. I've developed a bad dependence on Focalin because I think it used to give me a little of my personality back when I was on it but even that has faded and is rare now.

I sort of had a question and sort of just needed to share and get some feedback from others.

How long have you been seeing this doctor?....

Maybe it's time for a change.

Mary,
Why do you think it may be time for a change? The doc I'm seeing now has only been my doc for 2 years. Is it just a general suggestion or was there something specific about what I wrote that made you suggest a change in docs?

Mary,
Why do you think it may be time for a change? The doc I'm seeing now has only been my doc for 2 years. Is it just a general suggestion or was there something specific about what I wrote that made you suggest a change in docs?

Because sometimes.. even though they're good doctors, it's possible that he might be over medicating you. Just reading everything you're taking, made me cringe.

I was on 9 different meds at one time..and the longer I stayed on them, the worse my health became. The worse my life became and I didn't want to go anywhere or do anything. I couldn't even write like I used to, while on those meds.

See if he'll try another route of treatment. If not, maybe it's time to get a second opinion. If it were me.. I'd want that person who could laugh back ... and not the person you described yourself as being now.

That's just my opinion.

Thanks Mary. I appreciate you sharing your thoughts. I will talk to my doctor about my course of treatment.

It would still really help to know what other people were taking/doing to treat their bipolar illness. The other side effect I forgot to mention is weight gain. I know most of them cause this, but are there some that don't? My friend seems to think Lexapro does not cause weight gain. Anyone else feel this way about Lexapro or any other drug?

I am just starting lamictal for my bipolar last night was my first 50mg dose, I should be up to 100mg soon then I will be back to the doctor to see how its working. I also have abilify for anxiety but I am weary of the way it effects me and how often I think about it.

I have heard that lexapro works wonders for anxiety.

So for the lamictal seems to be working. I guess. Really all that has happened so far is the chatter in my head has quited significantly. As for my mood... I think I am cycling downward so its hard to tell. I have heard it can take a while before lamictal starts working at its full potential. So it may take time for my mood to be stable.

I wish you luck in finding the medication or combo of medications that work for you. Maybe talk with your doctor about your concerns, find out what your options are or see if you can cut back on some of the medication. I would hate to see you over medicated. (I have known two people who were, it was a difficult thing for them) A second opinion might not be a bad idea as Mary suggested. However with some insurance, I know thats not easy.

Thanks Zoie, it's always nice to hear from you! Good luck with the lamictal. Let me know how that works out for you. Yes, I'm thinking, based on all the responses I've gotten about my meds, that it is time to pursue a second opinion about all this. It's just so hard to find a reliable doctor with whom you can entrust your well being. What a vulnerable position we are all in in that regard. How many people can say their sanity is in someone else's hands to some extent (I know not completely in someone else's hands, we have cotrol over our own happiness).

Hi!

I had been on Lamictal for a very long time (5 years) but then my bipolar shifted from being mostly depression to very manic and I had to get off of it because the lamictal changed from saving my life to triggering panic attacks.

So, now I"m on 900 mg of Lithium and 100 mg of topamax (but that's really to thrwart appetite issues) I also just started vyance.

I take 2mg of Ativan but only at night, to sleep (I have bad insomnia-- for as long as I remember)- not for my BP.

I know this thread could easily become information overload but for those of you on SSRIs be REALLY careful. If you are BP you should not be on an SSRI as it could make your mood swings MUCH MUCH WORSE. You should only be on a psychotropic class of drug/mood stabilizer.

:-)

I've had a 3 year long road on the med-go-round. I've been going from medication to medication to medication. I've finally stabilized thanks to Zyprexa Zydis. It currently is my primary mood stabilizer. I take it every night @ 9pm. With Zyprexa I don't get the ups and downs at least not as of yet. The only problem I've had with Zyprexa is weight gain. Zyprexa can interfere with blood sugar levels, such as hyperglicemia or diabetes. I currently am on 5mg of Zyprexa Zydis and have stabized there for 5 months now. I wish you luck on your medication journey.

Hi Jackers,

Being bipolar, ADD, and having Tourettes, I too am on a lot of different meds. But I have to agree with Mary, it may be time for you to change docs or at least get a second opinion. I don't say that because I think the meds you are on or the doses you are taking sound strange. I say that because from this thread and some of your other posts, it doesn't sound to me as though you have a very healthy relationship with your doc. You are not willing to talk to her about your focalin dependence and about your feeling that you have developed a tolerance for focalin. You have to have a doc you feel comfortable divulging this information to. Someone who will help you. After all, that is what you are paying them to do! Your question is about medication but maybe you should be thinking more about the therapy. Do you see your doc on a regular basis for therapy? If so, what is that like?

Franny

I am wondering what meds for bipolar people are taking. I am bipolar and ADD. Currently I am on 900mg of Effexor xr

I'll just comment on the effexor because I'm not an expert on bipolar.

900mg?!? That's a massive, massive dose. Make sure you never skip a dose - you'd feel horrible coming off that amount of effexor + all those other meds.

Do a search in google about 'effexor withdrawl' or 'effexor discontinuation syndrome' It's utter hell for many people when they try and get off this med. I was on 150mg and reduced my dose very slowly and still missed a month of work in the worst of it. It really, really sucks.

Time for a new doctor me thinks. Are the meds working ok? Do you feel stable? Maybe you should start getting off some of these meds with help from your doctor. You might feel better without all those meds or might only need 1 or 2 medications if you find the right ones.

Not trying to scare you :) I just think its important people know what they're in for when they start effexor.

I will jump on the new doc bandwagon as well.

The bottom line here is you need to get well. It's not about the doc or other people, it's about your health. It does not sound like this guy is helping you. I have a docs office that is doing the same and I intend to change as soon as I find a good replacement.

Do you see your doc on a regular basis for therapy? If so, what is that like?
Franny

Yes, I see my doc once a week for therapy. I have been seeing her for 2 years now. I feel unsure about what I want to do. I don't think getting a second opinion is a bad idea. The thing is, I really have thought this is the best doc I've ever had as far as therapy goes. I'm sure that seems strange to those of you who think I am over medicated. I know how defensive this is going to sound but, I really am a lot better now than I was 2 years ago when I first arrived at her doorstep. Maybe my doses are high but isn't it possible that the doses I'm on are just what I need to be well? Two years ago I didn't have a job, couldn't get out of bed until noon, never left the house, had no friends (I had moved to WA from VA as year earlier). I was barely functioning. Now I'm almost a totally normal person to the untrained eye. I'm not my bubbly self but then I haven't been that person in almost 10 years! Maybe I've mellowed with age. Or maybe that's the price for sanity. You hear all the time about bipolars going off their meds because the meds strip them of their creativity and what not. They'd rather be ill than be dull.

I'm happy for you that you've found the right med. combo that works for you. If you've made such a dramatic improvement like you said I guess stick with them.

Second opinion is a great idea though. Gotta be real careful when you're using lots of different meds as you know. Your doctor sounds like he's experienced and worth sticking with but it wouldn't hurt to get another doctor's opinion

Now I'm almost a totally normal person to the untrained eye. I'm not my bubbly self but then I haven't been that person in almost 10 years! Maybe I've mellowed with age. Or maybe that's the price for sanity. You hear all the time about bipolars going off their meds because the meds strip them of their creativity and what not. They'd rather be ill than be dull.

Only you know if the meds/doses you are on are effective in relieving your depression and ADD. It sounds like you have made some significant gains over the past couple of years which is great, way to go! Just take the time to reasses your mood and productivity every now and then and talk to your doctor about whether you still need the same medications at the same doses you are currently on. I know how hard it can be to find a really good therapist, someone you feel really comfortable with. Just remember, she is your doctor, you pay her to counsel you so let her. Tell her about what you are going through. It probably won't be as bad as you think.

Take care
Franny

Hi Franny,
Thanks for your post. I didn't see my doctor last week, but this week when I see her I will talk to her about my meds. I just don't really know how to start the conversation because I'm basically questioning her treatment, which is kinda like questioning her ability to do her job, ya know? Anyway, I was wondering if you might share with me what you are prescribed to treat your bipolar. You can pm me if you prefer, or if you'd rather not share that's ok too.
Thanks Franny
Jackers

This is the non extended version but it's basically the same:

Dosage

Adults:
The recommended treatment dose is 75 mg per day, administered in two or three divided doses, taken with food. If the expected clinical improvement does not occur after a few weeks, a gradual dose increase to 150 mg/day may be considered. If needed, the dose may be further increased up to 225 mg/day. Increments of up to 75 mg/day should be made at intervals of no less than 4 days. In outpatient settings there was no evidence of the usefulness of doses greater than 225 mg/day for moderately depressed patients. More severely depressed inpatients have responded to higher doses, between 350 and 375 mg/day, given in 3 divided doses.
Maximum:
The maximum dose recommended is 375 mg per day (in an inpatient setting).
I know it's only the recommended max dose but you should check with another doctor about the dose of effexor you're on.

If you have a good doctor like you say there should be no problem questioning her treatment methods.

Pretty sure high doses of effexor are neurotoxic.

I PMed you with this question but figured I'd post a reply as well in case you don't get alerts for PMs while logged in...What is your source for your info here?

I just spent the last hour searching the net for info. I did find the same info about maximum dosages along with tons of examples of the horrible withdrawl that goes along with coming off of Effexor. What I didn't find was info about the neurotoxicity of high doses of Effexor. Anyone else know more about this or a site that may have info about this?

I'm checking where I found the info now jackers. Chances are you'll be fine - I usually post my source but didn't this time (stupid of me)

Please don't panic chances are you'll be fine.

Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose(this is not on the XR version)

http://qjmed.oxfordjournals.org/cgi/content/abstract/96/5/369

http://www.ncbi.nlm.nih.gov/pubmed/12702786


Ok. My understanding is that this toxicity only occurs at doses greater than 900mg and to people that are having an 'overdose', I think this means these people weren't increasing their dose slowly like you should, they just took one huge dose of 900mg+ one time. Usually much more than 900mg


http://en.wikipedia.org/wiki/Effexor#cite_note-QJM2003-Whyte-33

wikipedia is great as long as it has sources for the information.

900mg of Effexor would still be considered very high and we can't be sure about the effect it will have. You need to go talk to another doctor or preferably a psychiatrist. I've never heard of anyone taking that much but maybe studies have been done?

Just don't stop taking your effexor. As I said above you should check with a psychiatrist that the dose your on is ok.

Odd as it is I am going to have to agree with ozchris on the

900mg of effexor !!!!!!! Holy **** that is alot



Checked drug on drug interactions but will have to switch browsers to find the one I normally use be right back

Checked drug on drug interactions but will have to switch browsers to find the one I normally use be right back

Okay, I know you guys mean well but you are going to have to STOP FREAKIN ME OUT like this! I'm going to have a coronary from logging in and checking this thread. I promise I will call my doc and have a chat first thing tomorrow but in the mean time, any links to info you have is greatly appreciated.

Thanks for caring (I think)!
Jackers

Well - according to my interaction checker the drugs get along well I also included focalin - naturally this is not to be taken as medical advise nor is it a substitute for talking with your medical provider.


I just don't really know how to start the conversation because I'm basically questioning her treatment, which is kinda like questioning her ability to do her job, ya know?

jackers - it is your body it is your life we are talking about here - you have a right to understand your treatment regime and your health care provider is obligated to explain your treatments to you - as well as her rational behind her choices under US laws - I believe legally it is part of informed consent -


Also part of informed consent is your right to know risk factors for said treatments - she should also include what could happen if treatment is not continued.

jackers - she is working for you - it is your body and you have a right to know the risk you re taking - you have a right to get this straight from the professional who is treating you - she is legally obligated for the advice she gives and part of her obligation is ensuring you fully understand all risk involved with your treatment plans - which includes medications

I hope this helps you open a productive dialog with your doctor - I believe her to be the best source of information - in all honesty I would ask her about that effexor dose especially considering it is of concern according to your post - I am not saying you do not need it - I will be honest I have never seen any one on that much effexor . . . however according to literature you are within appropriate dosing parameters.

Source documentation (http://www.drugs.com/pro/effexor.html#section-14.4)

Initial Treatment

The recommended starting dose for Effexor is 75 mg/day, administered in two or three divided doses, taken with food. Depending on tolerability and the need for further clinical effect, the dose may be increased to 150 mg/day. If needed, the dose should be further increased up to 225 mg/day. When increasing the dose, increments of up to 75 mg/day should be made at intervals of no less than 4 days. In outpatient settings there was no evidence of usefulness of doses greater than 225 mg/day for moderately depressed patients, but more severely depressed inpatients responded to a mean dose of 350 mg/day. Certain patients, including more severely depressed patients, may therefore respond more to higher doses, up to a maximum of 375 mg/day, generally in three divided doses (see PRECAUTIONS, General, Use in Patients with Concomitant Illness).
{End Quote}

~underlining mine~

With this being said you are aware of signs and symptoms of Serotonin Syndrome??? (http://www.medscape.com/viewarticle/547426) and other adverse events requiring immediate treatment - in the US they give out a patent education sheet which normally out lines adverse events worthy of medical attention.

However any concerns or questions regarding your treatment - should be shared with your treating physician. Listening to your concerns and addressing them as well as answering any questions you have regarding treatment is part of her job.

In all honest jackers a good doc will be happy you are asking questions it is a demonstration of your interest in your own care plan = this is a good sign to any one treating psychiatric conditions - treatment noncompliance is a huge issue in bipolar patents and any experienced doctor knows this .. . . an educated patent is more likely to be a treatment complaint one. Being actively participating in your own care and well being is a sign of improved mental health.

you being actively involved in your own treatment is a desired out come to most treating physicians - I would question any doctor who discouraged patent education or rebuffed genuine questions

Thanks mead, I REALLY appreciate your words of advice. And yes, I kinda knew a little about Serotonin Syndrome...but thanks to you I'm all firmed up on the topic. Thank you for that!

Jackers

jackers - it is your body it is your life we are talking about here - you have a right to understand your treatment regime and your health care provider is obligated to explain your treatments to you - as well as her rational behind her choices under US laws - I believe legally it is part of informed consent -


Also part of informed consent is your right to know risk factors for said treatments - she should also include what could happen if treatment is not continued.

jackers - she is working for you - it is your body and you have a right to know the risk you re taking - you have a right to get this straight from the professional who is treating you - she is legally obligated for the advice she gives and part of her obligation is ensuring you fully understand all risk involved with your treatment plans - which includes medications

Yes I totally agree with what mead823 says here. Very well put. Take it to heart Jackers and follow this advice. IT's your life and well being at stake here.