View Full Version : Medication Suggestions: Bipolar II (3-4 day cycles), ADHD, Substance Abuse

01-30-09, 12:29 PM
History of opioid substance abuse, nothing IV...ever. So far I'm taking 9mg of Invega everyday, getting ready to be titrated down to 6mg from 8mg of suboxone. So far for ADHD I've tried strattera and was allergic, broke out in a rash and was very, VERY itchy, and now I'm currently on wellbutrin xl 150mg with absolutely no improvement, except for I think it's cured some mild depression, and perhaps given me a small amount of motivation to do things. I still have large difficulty concentrating and that's my biggest problem, lethargy from the Invega, anxiety, anhedonia, and irritability usually about mid-morning through until about 7-8pm at night that I blame on the untreated ADHD are my others. Any suggestions where to go to from here? I don't think the doc is going to go for stimulants with my past history of substance abuse, however, stimulants are probably going to be my best bet. I've now been clean 34 days. Any and all suggestions are appreciated.

My new research makes me wonder if a stim+clonicel are an option for me, or perhaps vyvanse or vyvanse+wellbutrin. I don't know.

02-20-09, 02:46 PM
Opioid abusers unite! Haha, giggle.
Naw, I don't anymore but I definitely used to... a lot.
I used to consider myself as having an abusive personality, but I'm starting to think I did that to run from the depression crashes (I'm bipolar II as well). I never really had mania by itself, I typically had mixed states (Mania and Depression at the same time -- the product is rage) and then extreme depression phases.

I take Adderall IR and Lamictal (Lamotrigine.).
Lamictal's kind of new. It's actually an epilepsy medicate -- apparently research suggests that bipolar is somewhat like an emotional seizure.
I like it a lot, but obviously everyone is different. I think Bipolar people shouldn't be put on antidepressants... kinda counterproductive to the mania half of it. Nevertheless, there's a suggestion.

Also, I don't feel tempted to abuse Adderall. No idea why not. In fact, I have 50 pills left... and I haven't even filled my new prescription... which I got like two weeks ago. Haha. So I don't even take the prescribed dose most of the time, most of the time I end up taking 2/3 or 1/2 of it. Even less sometimes.

02-20-09, 04:43 PM
Since you mention of some possible depression and you are currently on Wellbutrin XL 150mg, it's still possible to increase the dosage from 150 to 300mg and see if that will help both the depression + adhd symptoms. One pdoc I saw says to work with what you have before adding other medications and you could always go back down if you get side effects.

Kunga Dorji
02-20-09, 05:20 PM
Stimulants should not be used in the presence of active mania. Bipolar II is not "active mania"- it is much milder.
It is still a risk- and stimulants should not be tried without mood stabilisers in Bipolar 2. Mood stabilisers provide good cover- witha few rare but potentially severe reactions.
Prescribing to a known drug abuser is a little harder- however if you and your specialist could arrange a system whereby your supply is limited and controlled - you might ba able to get past that. Plenty of pharmacists in ASustralia wouild happily work with an arrangement in wyich you collected a couple of days supply at attime from the pharmacy. Work with your doctor,and find ways to accomodate any concerns he may have. Remember that drug abuse in ADHD is really a desparate attempt at self medication.

02-20-09, 05:45 PM
I have a diagnosis of BPII, ADD, and I used to abuse painkillers.

I have been very stable on Lamictal, Zoloft, and Adderall. Plus its completely killed any urges for opioids - I think the best thing about them was they SHUT MY BRAIN UP for a little while.

03-02-09, 02:34 PM
Great to hear of your good many mg of Lamictal are you on? Any side effects like hair loss? thanks

Carpe Dium

03-02-09, 03:49 PM
Stimulants should not be used in the presence of active mania. Bipolar II is not "active mania"- it is much milder.
Just a point of clarification. Bipolar II is a diagnosis, it is not a state of mind. Also, hypomania is not necessarily much milder than mania. There is gray territory between mania and hypomania. How one pdoc classifies may not be the same as another. Most pdoc's do not go by a strict reading of DSM on this. Many draw the line somewhere slightly less than psychosis, but not necessarily much. My only point is that be careful making the assumption that because someone says they have BPII, that they only experience slight elevation in mood and energy. Sometimes that elevation is a mind racing so fast that a couple months of disability time off work and close supervision by family are necessary.

Stims should not be prescribed to anyone who is experiencing hypomania or mania. It can exacerbate that problem and push one into mania, worse mania, or psychosis.

First move is to stabilize bipolar. With that alone comes increased attention, cognition, and memory. Rapid cycling is not stable! Stims would most likely would worsen sx by worsening the cycling either in duration or magnitude, which clearly would wipe out any ADHD sx benefit.

The two meds that helped my rapid cycling (weekly) were Depakote and later Tegretol. I'd focus on that aspect of treatment before worrying about ADHD since any tx which involves stims is apt to only make matters worse. Sorry I can't paint a rosier picture. After three years, my cycling did stop. When you find the right cocktail, yours will, too. Hang in there.

03-19-09, 04:26 PM
Just an update. Apparently the pdoc I was seeing had no idea what he was doing. I went and saw an ARNP who really seems like she knows what she's doing. The pdoc diagnosed me without any tests which I thought was rather strange. After talking with the ARNP she has changed my diagnosis after much testing and several appointments to PTSD (a trauma from childhood) BiPolar II, and inattentive ADD.

I'm getting ready to possibly try some stimulant meds. The wellbutrin at 300mg caused suicidal thoughts and the Invega I was taking apparently was causing my severe muscle stiffness, joint pain, and increased depression. Since having a two weeks of a drug holiday taking only xanax prn for anxiety I'm starting to feel great. I just started adding abilify slowly from one week of 2mg to my current week at 5mg with a goal of 10mg daily. I don't know which stimulant they're going to prescribe but I was wondering how other people are doing with a rather similar diagnosis on their meds and what their meds are. I'm a little hesitant to go on a stimulant at this time with the anxiety I've been having however, I read that untreated ADD/ADHD can CAUSE anxiety so I guess it's worth a try to experiment in order to achieve a better state of health.

What I found very interesting is that my college gpa stands at a 3.63 with a pre-medicine major. I already have an associates degree and am about 2 semesters away from my bachelors and have done relatively well in school. In other areas of my life however, there leaves a lot to be desired.

Any input is welcome at this point and thanks for the info so far.